House Trades Freedom for Health Coverage, Senate’s Move
The House passed a trillion dollar bill that will force Americans to buy health insurance, force even small businesses to provide health coverage, and require insurance companies to cover pre-existing conditions. (The last, as I have previously argued, makes it something other than “insurance.”)
Lori Montgomery and Shailagh Murray for WaPo:
Hours after President Obama exhorted Democratic lawmakers to “answer the call of history,” the House hit an unprecedented milestone on the path to health-care reform, approving a trillion-dollar package late Saturday that seeks to overhaul private insurance practices and guarantee comprehensive and affordable coverage to almost every American.
After months of acrimonious partisanship, Democrats closed ranks on a 220-215 vote that included 39 defections, mostly from the party’s conservative ranks. But the bill attracted a surprise Republican convert: Rep. Anh “Joseph” Cao of Louisiana, who represents the Democratic-leaning district of New Orleans and had been the target of a last-minute White House lobbying campaign. GOP House leaders had predicted their members would unanimously oppose the bill.
Democrats have sought for decades to provide universal health care, but not since the 1965 passage of Medicare and Medicaid has a chamber of Congress approved such a vast expansion of coverage. Action now shifts to the Senate, which could spend the rest of the year debating its version of the health-care overhaul. Majority Leader Harry M. Reid (D-Nev.) hopes to bring a measure to the floor before Thanksgiving, but legislation may not reach Obama’s desk before the new year.
[…]
The House legislation would for the first time require every individual to obtain insurance, and would require all but the smallest employers to provide coverage to their workers. It would vastly expand Medicaid and create a new marketplace where people could obtain federal subsidies to buy insurance from private companies or from a new government-run insurance plan.
Though some people would receive no benefits — including about 6 million illegal immigrants, according to congressional estimates — the bill would virtually close the coverage gap for people who do not have access to health-care coverage through their jobs.
Carl Hulse and Robert Pear for NYT:
Handing President Obama a hard-fought victory, the House narrowly approved a sweeping overhaul of the nation’s health care system on Saturday night, advancing legislation that Democrats said could stand as their defining social policy achievement.
[…]
Democrats were forced to make major concessions on insurance coverage for abortions to attract the final votes to secure passage, a wrenching compromise for the numerous abortion-rights advocates in their ranks.
Many of them hope to make changes to the amendment during negotiations with the Senate, which will now become the main battleground in the health care fight as Democrats there ready their own bill for what is likely to be extensive floor debate.
Democrats say the House measure — paid for through new fees and taxes, along with cuts in Medicare — would extend coverage to 36 million people now without insurance while creating a government health insurance program. It would end insurance company practices like not covering pre-existing conditions or dropping people when they become ill.
[…]
Some Democrats said they voted for the legislation so they could seek improvements in it. “This bill will get better in the Senate,” said Representative Jim Cooper, a Tennessee Democrat who has been outspoken in his criticism of some provisions of the bill but decided to support it. “If we kill it here, it won’t have a chance to get better.”
[…]
The House legislation, running almost 2,000 pages, would require most Americans to obtain health insurance or face penalties — an approach Republicans compared to government oppression. Most employers would have to provide coverage or pay a tax penalty of up to 8 percent of their payroll. The bill would significantly expand Medicaid and would offer subsidies to help moderate-income people buy insurance from private companies or from a government insurance plan. It would also set up a national insurance exchange where people could shop for coverage.
This measure barely passed the House, where Democrats enjoy a solid majority in which most Members are Gerrymandered into uncompetitive seats. And there are many Jim Coopers among the Yeas: People who would have voted Nay if they were not so confident the Senate would produce a much less radical bill, ensuring any measure that reaches the president’s desk will be less mild. I’m pretty sure they’re right.
Still, this is a rather staggering measure passed by the House. If this became law, the poor would be significantly poorer and small businesses would be even less competitive with the big box stores. During a very weak economy with an unemployment at ten percent, no less. Oh, and insurance rates will go up for the rest of us, too, as companies amortize the cost of absorbing people who have costly illnesses — who will by definition be a net drain on the pool from Day 1 — by passing it on to the rest of us.
Presumably, the rationale behind these moves is to wreck the current system entirely, making a government system the only alternative. Certainly, it’s not a good faith measure to improve the current system.
I get that the status quo is far from perfect. Young, healthy people often can’t afford health insurance. (I went without during my graduate school days, for example, unable to justify spending $250 a month out of a $750 stipend to cover the incredibly unlikely event of getting seriously sick.) The poor clog up our emergency rooms. People are stuck at their job because they’d lose coverage at an otherwise preferable job. Dealing with insurance companies can be a nightmare.
This bill helps address some of those problems, at least at the margins. But it exacerbates others.
Moreover, this plan does nothing to address the fundamental problem with the status quo: The unsustainable skyrocketing in health care costs. If the Senate were to somehow pass the identical bill, we’d cover more people — a good thing in and of itself — but at a higher per unit cost. That means an even greater share of GDP would go to health care from the beginning with no additional constraints on the escalation of costs.
If they’d just voted my plan, a voucher for basic health insurance, we would have still had the freedom (both to decline the voucher, and where to take it if you accepted it).
This seems one of those sad conditions where congress will do the thing “reachable” in a path dependent way, rather than anything remotely best.
If this abomination is passed in the Senate, here is the bureaucracy we will be faced with:
The Nancycare version of Obamacare
The House Republican Conference has gone to the Herculean effort of tabulating the new federal boards, bureaucracies, commissions, and programs that would be established by the House bill–all in the name of cutting costs, of course! They add up to 111:
1. Retiree Reserve Trust Fund (Section 111(d), p. 61)
2. Grant program for wellness programs to small employers (Section 112, p. 62)
3. Grant program for State health access programs (Section 114, p. 72)
4. Program of administrative simplification (Section 115, p. 76)
5. Health Benefits Advisory Committee (Section 223, p. 111)
6. Health Choices Administration (Section 241, p. 131)
7. Qualified Health Benefits Plan Ombudsman (Section 244, p. 138)
8. Health Insurance Exchange (Section 201, p. 155)
9. Program for technical assistance to employees of small businesses buying Exchange coverage (Section 305(h), p. 191)
10. Mechanism for insurance risk pooling to be established by Health Choices Commissioner (Section 306(b), p. 194)
11. Health Insurance Exchange Trust Fund (Section 307, p. 195)
12. State-based Health Insurance Exchanges (Section 308, p. 197)
13. Grant program for health insurance cooperatives (Section 310, p. 206)
14. “Public Health Insurance Option” (Section 321, p. 211)
15. Ombudsman for “Public Health Insurance Option” (Section 321(d), p. 213)
16. Account for receipts and disbursements for “Public Health Insurance Option” (Section 322(b), p. 215)
17. Telehealth Advisory Committee (Section 1191 (b), p. 589)
18. Demonstration program providing reimbursement for “culturally and linguistically appropriate services” (Section 1222, p. 617)
19. Demonstration program for shared decision making using patient decision aids (Section 1236, p. 648)
20. Accountable Care Organization pilot program under Medicare (Section 1301, p. 653)
21. Independent patient-centered medical home pilot program under Medicare (Section 1302, p. 672)
22. Community-based medical home pilot program under Medicare (Section 1302(d), p. 681)
23. Independence at home demonstration program (Section 1312, p. 718)
24. Center for Comparative Effectiveness Research (Section 1401(a), p. 734)
25. Comparative Effectiveness Research Commission (Section 1401(a), p. 738)
26. Patient ombudsman for comparative effectiveness research (Section 1401(a), p. 753)
27. Quality assurance and performance improvement program for skilled nursing facilities (Section 1412(b)(1), p. 784)
28. Quality assurance and performance improvement program for nursing facilities (Section 1412 (b)(2), p. 786)
29. Special focus facility program for skilled nursing facilities (Section 1413(a)(3), p. 796)
30. Special focus facility program for nursing facilities (Section 1413(b)(3), p. 804)
31. National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 1422, p. 859)
32. Demonstration program for approved teaching health centers with respect to Medicare GME (Section 1502(d), p. 933)
33. Pilot program to develop anti-fraud compliance systems for Medicare providers (Section 1635, p. 978)
34. Special Inspector General for the Health Insurance Exchange (Section 1647, p. 1000)
35. Medical home pilot program under Medicaid (Section 1722, p. 1058)
36. Accountable Care Organization pilot program under Medicaid (Section 1730A, p. 1073)
37. Nursing facility supplemental payment program (Section 1745, p. 1106)
38. Demonstration program for Medicaid coverage to stabilize emergency medical conditions in institutions for mental diseases (Section 1787, p. 1149)
39. Comparative Effectiveness Research Trust Fund (Section 1802, p. 1162)
40. “Identifiable office or program” within CMS to “provide for improved coordination between Medicare and Medicaid in the case of dual eligibles” (Section 1905, p. 1191)
41. Center for Medicare and Medicaid Innovation (Section 1907, p. 1198)
42. Public Health Investment Fund (Section 2002, p. 1214)
43. Scholarships for service in health professional needs areas (Section 2211, p. 1224)
44. Program for training medical residents in community-based settings (Section 2214, p. 1236)
45. Grant program for training in dentistry programs (Section 2215, p. 1240)
46. Public Health Workforce Corps (Section 2231, p. 1253)
47. Public health workforce scholarship program (Section 2231, p. 1254)
48. Public health workforce loan forgiveness program (Section 2231, p. 1258)
49. Grant program for innovations in interdisciplinary care (Section 2252, p. 1272)
50. Advisory Committee on Health Workforce Evaluation and Assessment (Section 2261, p. 1275)
51. Prevention and Wellness Trust (Section 2301, p. 1286)
52. Clinical Prevention Stakeholders Board (Section 2301, p. 1295)
53. Community Prevention Stakeholders Board (Section 2301, p. 1301)
54. Grant program for community prevention and wellness research (Section 2301, p. 1305)
55. Grant program for research and demonstration projects related to wellness incentives (Section 2301, p. 1305)
56. Grant program for community prevention and wellness services (Section 2301, p. 1308)
57. Grant program for public health infrastructure (Section 2301, p. 1313)
58. Center for Quality Improvement (Section 2401, p. 1322)
59. Assistant Secretary for Health Information (Section 2402, p. 1330)
60. Grant program to support the operation of school-based health clinics (Section 2511, p. 1352)
61. Grant program for nurse-managed health centers (Section 2512, p. 1361)
62. Grants for labor-management programs for nursing training (Section 2521, p. 1372)
63. Grant program for interdisciplinary mental and behavioral health training (Section 2522, p. 1382)
64. “No Child Left Unimmunized Against Influenza” demonstration grant program (Section 2524, p. 1391)
65. Healthy Teen Initiative grant program regarding teen pregnancy (Section 2526, p. 1398)
66. Grant program for interdisciplinary training, education, and services for individuals with autism (Section 2527(a), p. 1402)
67. University centers for excellence in developmental disabilities education (Section 2527(b), p. 1410)
68. Grant program to implement medication therapy management services (Section 2528, p. 1412)
69. Grant program to promote positive health behaviors in underserved communities (Section 2530, p. 1422)
70. Grant program for State alternative medical liability laws (Section 2531, p. 1431)
71. Grant program to develop infant mortality programs (Section 2532, p. 1433)
72. Grant program to prepare secondary school students for careers in health professions (Section 2533, p. 1437)
73. Grant program for community-based collaborative care (Section 2534, p. 1440)
74. Grant program for community-based overweight and obesity prevention (Section 2535, p. 1457)
75. Grant program for reducing the student-to-school nurse ratio in primary and secondary schools (Section 2536, p. 1462)
76. Demonstration project of grants to medical-legal partnerships (Section 2537, p. 1464)
77. Center for Emergency Care under the Assistant Secretary for Preparedness and Response (Section 2552, p. 1478)
78. Council for Emergency Care (Section 2552, p 1479)
79. Grant program to support demonstration programs that design and implement regionalized emergency care systems (Section 2553, p. 1480)
80. Grant program to assist veterans who wish to become emergency medical technicians upon discharge (Section 2554, p. 1487)
81. Interagency Pain Research Coordinating Committee (Section 2562, p. 1494)
82. National Medical Device Registry (Section 2571, p. 1501)
83. CLASS Independence Fund (Section 2581, p. 1597)
84. CLASS Independence Fund Board of Trustees (Section 2581, p. 1598)
85. CLASS Independence Advisory Council (Section 2581, p. 1602)
86. Health and Human Services Coordinating Committee on Women’s Health (Section 2588, p. 1610)
87. National Women’s Health Information Center (Section 2588, p. 1611)
88. Centers for Disease Control Office of Women’s Health (Section 2588, p. 1614)
89. Agency for Healthcare Research and Quality Office of Women’s Health and Gender-Based Research (Section 2588, p. 1617)
90. Health Resources and Services Administration Office of Women’s Health (Section 2588, p. 1618)
91. Food and Drug Administration Office of Women’s Health (Section 2588, p. 1621)
92. Personal Care Attendant Workforce Advisory Panel (Section 2589(a)(2), p. 1624)
93. Grant program for national health workforce online training (Section 2591, p. 1629)
94. Grant program to disseminate best practices on implementing health workforce investment programs (Section 2591, p. 1632)
95. Demonstration program for chronic shortages of health professionals (Section 3101, p. 1717)
96. Demonstration program for substance abuse counselor educational curricula (Section 3101, p. 1719)49. Grant program for innovations in interdisciplinary care (Section 2252, p. 1272)
50. Advisory Committee on Health Workforce Evaluation and Assessment (Section 2261, p. 1275)
51. Prevention and Wellness Trust (Section 2301, p. 1286)
52. Clinical Prevention Stakeholders Board (Section 2301, p. 1295)
53. Community Prevention Stakeholders Board (Section 2301, p. 1301)
54. Grant program for community prevention and wellness research (Section 2301, p. 1305)
55. Grant program for research and demonstration projects related to wellness incentives (Section 2301, p. 1305)
56. Grant program for community prevention and wellness services (Section 2301, p. 1308)
57. Grant program for public health infrastructure (Section 2301, p. 1313)
58. Center for Quality Improvement (Section 2401, p. 1322)
59. Assistant Secretary for Health Information (Section 2402, p. 1330)
60. Grant program to support the operation of school-based health clinics (Section 2511, p. 1352)
61. Grant program for nurse-managed health centers (Section 2512, p. 1361)
62. Grants for labor-management programs for nursing training (Section 2521, p. 1372)
63. Grant program for interdisciplinary mental and behavioral health training (Section 2522, p. 1382)
64. “No Child Left Unimmunized Against Influenza” demonstration grant program (Section 2524, p. 1391)
65. Healthy Teen Initiative grant program regarding teen pregnancy (Section 2526, p. 1398)
66. Grant program for interdisciplinary training, education, and services for individuals with autism (Section 2527(a), p. 1402)
67. University centers for excellence in developmental disabilities education (Section 2527(b), p. 1410)
68. Grant program to implement medication therapy management services (Section 2528, p. 1412)
69. Grant program to promote positive health behaviors in underserved communities (Section 2530, p. 1422)
70. Grant program for State alternative medical liability laws (Section 2531, p. 1431)
71. Grant program to develop infant mortality programs (Section 2532, p. 1433)
72. Grant program to prepare secondary school students for careers in health professions (Section 2533, p. 1437)
73. Grant program for community-based collaborative care (Section 2534, p. 1440)
74. Grant program for community-based overweight and obesity prevention (Section 2535, p. 1457)
75. Grant program for reducing the student-to-school nurse ratio in primary and secondary schools (Section 2536, p. 1462)
76. Demonstration project of grants to medical-legal partnerships (Section 2537, p. 1464)
77. Center for Emergency Care under the Assistant Secretary for Preparedness and Response (Section 2552, p. 1478)
78. Council for Emergency Care (Section 2552, p 1479)
79. Grant program to support demonstration programs that design and implement regionalized emergency care systems (Section 2553, p. 1480)
80. Grant program to assist veterans who wish to become emergency medical technicians upon discharge (Section 2554, p. 1487)
81. Interagency Pain Research Coordinating Committee (Section 2562, p. 1494)
82. National Medical Device Registry (Section 2571, p. 1501)
83. CLASS Independence Fund (Section 2581, p. 1597)
84. CLASS Independence Fund Board of Trustees (Section 2581, p. 1598)
85. CLASS Independence Advisory Council (Section 2581, p. 1602)
86. Health and Human Services Coordinating Committee on Women’s Health (Section 2588, p. 1610)
87. National Women’s Health Information Center (Section 2588, p. 1611)
88. Centers for Disease Control Office of Women’s Health (Section 2588, p. 1614)
89. Agency for Healthcare Research and Quality Office of Women’s Health and Gender-Based Research (Section 2588, p. 1617)
90. Health Resources and Services Administration Office of Women’s Health (Section 2588, p. 1618)
91. Food and Drug Administration Office of Women’s Health (Section 2588, p. 1621)
92. Personal Care Attendant Workforce Advisory Panel (Section 2589(a)(2), p. 1624)
93. Grant program for national health workforce online training (Section 2591, p. 1629)
94. Grant program to disseminate best practices on implementing health workforce investment programs (Section 2591, p. 1632)
95. Demonstration program for chronic shortages of health professionals (Section 3101, p. 1717)
96. Demonstration program for substance abuse counselor educational curricula (Section 3101, p. 1719)
97. Program of Indian community education on mental illness (Section 3101, p. 1722)
98. Intergovernmental Task Force on Indian environmental and nuclear hazards (Section 3101, p. 1754)
99. Office of Indian Men’s Health (Section 3101, p. 1765)
100. Indian Health facilities appropriation advisory board (Section 3101, p. 1774)
101. Indian Health facilities needs assessment workgroup (Section 3101, p. 1775)
102. Indian Health Service tribal facilities joint venture demonstration projects (Section 3101, p. 1809)
103. Urban youth treatment center demonstration project (Section 3101, p. 1873)
104. Grants to Urban Indian Organizations for diabetes prevention (Section 3101, p. 1874)
105. Grants to Urban Indian Organizations for health IT adoption (Section 3101, p. 1877)
106. Mental health technician training program (Section 3101, p. 1898)
107. Indian youth telemental health demonstration project (Section 3101, p. 1909)
108. Program for treatment of child sexual abuse victims and perpetrators (Section 3101, p. 1925)
109. Program for treatment of domestic violence and sexual abuse (Section 3101, p. 1927)
110. Native American Health and Wellness Foundation (Section 3103, p. 1966)
111. Committee for the Establishment of Native American Health
I just looked for one of those mannning, the “Interagency Pain Research Coordinating Committee”, to see if it was new or continuing.
Continuing:
http://thomas.loc.gov/home/gpoxmlc111/s660_is.xml
Hmm. Introduced my a Mr. Orrin Hatch, which party is he?
It is a striking list, but I’d bet there is more continuing spending there than “the bureaucracy we will be faced with” implies.
(Basically it’s a cheater’s list – a list of previous legislation that this bill refers to.)
I get that the status quo is far from perfect.
Actually, James, Republicans have acted as if the status quo is perfect.
In all the years Republicans were in the White House and the numerous years they controlled one or both houses of the legislature, they did nothing to address the problems you cited, rising costs and uninsured sick people.
They did, of course, pass a prescription drug benefit for seniors with no funding. It worked, as McCain’s best demographic was old folks.
Republicans might be able to help solve some problems in a way they find less objectionable if they would stop screaming “death panels” and “socialism” and propose something decent. They won’t.
Manning is cutting and pasting wing nut e-mails into the comments now?
Unfortunately, it probably doesn’t even solve anything. To do that more fundamental reform is needed. What’s more likely is that the various players will just learn to game this system as they game the current one.
That’s the basic problem with approaches of this sort. They’re doomed to failure from the start because they don’t recognize that the other parties are also intelligent actors who will respond with tactical and strategic moves of their own.
I might have a similar frustration to Pug’s. If this is plan is bad in a typically Democratic way (despite the odd Republican component), what was there to move it to the middle? I don’t think Death Panel BS was all that useful.
I like the post title: Trading “freedom for health coverage”. Yes, the freedom to be uninsured, reminding me of that Anatole France quote:
The freedom to spend one’s money as one sees fit is rather fundamental. As is the freedom to offer to employ people at rates and conditions they’re willing to trade their time and labor for.
This bill will make young, poor people poorer, forcing them to buy something they likely don’t need at the expense of things they certainly need and want. And it’ll make small businesses go under or force them to stay small rather than adding that one incremental employee that will force them to offer health insurance to all at great expense.
This is bull. I have been refused health insurance. I moved from NC where I had a policy to CA where I had to get a new policy and was refused. Why? Because I take Zocor for very well-controlled cholesterol.
Really. That’s the reason they gave.
I have no problem paying, but I am not allowed to buy health insurance. A decision made solely in the interests of health insurers’ profits.
So for God’s sake stop regurgitating the usual tired Republican crap about our freedom. Mithras is right.
If you are getting a employer-provided health plan then you don’t know what the hell you are talking about on this issue. Go out in the market, James, try to get a policy on your own. (Which is where more and more people will end up) and then come lecture me about my freedom.
Every government has a laundry list of things we can’t spend our money on, but most take it away from us (by tax) then they want to say what we must spend it on.
I’d say that the breakage here is in method of control, by mandate rather than by tax. How did we get here? We got here because the traditional method of tax and spend was “socialist.” So we got something worse.
This path-dependent politics is deeply dysfunctional but it certainly isn’t just one side’s fault.
Incidentally, on this freedom to spend one’s money as one sees fit, can I stop paying for social security? How about Medicare? The VA? Where are all you principled Republicans on these issues?
How about the taxes I pay for defense? I mean, just think how wrong it is to force me to pay for the defense of liberty. You’re denying me my liberty in the guise of defending it.
You want to know why the GOP is reduced to fear-mongering, gay-bashing and race-baiting to attract voters? Because your core ideology is empty. If you people ever had to go to the voters and lay out your actual positions on issues you’d get 3% of the vote.
Screw grandma, it’s my money. To hell with sick kids, it’s my money. Are there no prisons, no workhouses? Except when it comes to paying for the next KBR contract, then suddenly it’s the government’s money.
FICA is a tax that falls on all wage earners as is Medicare. That is doesn’t fall on all wages equally is a different subject.
I would have less objection to the individual mandate, as it’s called, if it were a tax levied on all wage earners (like FICA or Medicare).
But it’s not. It’s a requirement to buy something. That’s a lot different than anything the federal government has done to date. The analogy to the states’ requirements that drivers carry auto insurance isn’t even that close.
Isn’t modern liberalism all about wrecking the current system and burning any bridges so we have no way to go back? Rather than making smaller changes and judging their effectiveness Dems have decided to bet everything on one roll of the dice. That is a poor way to govern.
For me this has gone too far. No more civility is required when they take away my freedom and doom my business. This has become a battle for America and it’s future.
James, I would take issue with just about every characterization and every prediction you’ve made here. Nor do I share your concerns regarding the supposed loss of freedom in being forced to provide for one’s future (much like Social Security or Medicare, as noted in the above comments, except that the forced contribution goes to the private sector in the overwhelming majority of cases).
But that’s cool; this is obviously a bitter pill for conservatives of a libertarian bent to swallow, and unlike most conservatives your opposition to this proposal is rooted in a deeper principle than Barry Soetero Must Be Stopped. You’ve managed to articulate your values and concerns genuinely and forcefully, without pulling punches, yet also without lying or name-calling. That’s why I keep coming back here.
The irony of this bill passing the House on December 7th will not go unnoticed, adding infamy to a date that will live forever in the minds of the betrayed, and their progeny.
In fact, it makes that part worse. The government’s involvement flat out guarantees prices will go up, not down.. A look at the healthcare costs vs governmental involvement over the last 50 years shows the more governmental mandates on healthcare, the more the cost of healthcare goes up, in an almost exponential fashion. Of course, the effect isn’t limited to healthcare, but is the same for anything the government tries to do, to the exoact degree of government involvement.
That’s because the real solution is to get the government out of healthcare. As in OUT, Period. Now what chance do you suppose that would have of passage among power hungry congress critters, I wonder?
I want to snark, but I realize it was just a foolish mistake. Check your calendar ;). It’s November 7th. A date which hasn’t been proclaimed as one that will live in infamy. Although I’m sure conservatives will disagree now.
I have not seen a good summation on how the House plan will be harmful for small business. Anyone have a source? Did they eliminate the subsidies the Senate plan had?
That aside, conservatives predicted Armageddon when Clinton raised taxes, when Reagan raised taxes and when Bush I raised taxes. They predicted that deregulating the financial sector, decreasing taxes on the rich and lowering capital gains taxes would give us all an economic boom. Any government expenditure can be seen as a loss of freedom, but we do not get to pick and choose on things like , say, needless foreign invasions. Better to debate this on its merits rather than the issue of freedom. I will take these predictions with a grain of salt.
Steve
I’m sure that if you put that up for a straight up vote before the people, no more medicare etc., you’d get less that 10%
This is what makes the whole thing path-dependent. You don’t have enough votes in a democracy for your “plan” but you have enough to divert from what the majority really do support.
Republicans probably do have cause to be angry about this bill, but I think independents have greater right. Stupid partisan politics have deadlocked us into a bad solution.
Dave has at least tried to find a solution. My memory of James’ posts, as honest as they may be, is that they have been more about blocking paths in this chess game than opening them up.
I am just going to pretend I am a wingnut for a moment… Is that in the constitution?
This is an excellent point. A few years ago, I gave up an employee position with good benefits to take a contracting gig with a promising upside. Health insurance? No problem I figured, I would just carry myself for a while. At the time i was a 47 year old, non-drinker, non-smoker, not overweight, never had a serious health problem. Cholesterol & blood control issues being managed with medication.
Well, guess what, I got turned down. Repeatedly. Sorry Charlie “pre-existing conditions”. Luckily, my wife was able to get an exemption to add me to her coverage.
There are not that many people my age who are healthier than I am. A lot of good that did. The experience was a real eye opener, and it made it very clear why the GOP wants to “de-couple” health insurance from employment.
ulyssesunbound;
Thank you,there has never been a time when a snark would be more appropriate, I certainly had a brain glitch, and with more than one calender in my face. I apologize for the error and appreciate your kindness.
On the bright side I have four more weeks to get my Christmas shopping done![lol]
No argument there. The question is, why aren’t you pissed at the GOP for their complete and utter refusal to even try to work the problem in a bipartisan manner? Simply saying “NO NO NO” is not governing.
It was not that long ago that a reform minded GOP Congress worked with a Democratic President (for a while, at least) and we had a period of pretty good governance in this country.
“The question is, why aren’t you pissed at the GOP for their complete and utter refusal to even try to work the problem in a bipartisan manner? Simply saying “NO NO NO” is not governing.”
These twin arguments are canards. The GOP over and over this year tried to rein in the Democrats and craft a common-sense approach. Pelosi would not hear of it. Every opposing good idea was shot down. When you are a minority party, you can be completely shut out of the process and then simply smeared as “not cooperating.” That’s the Pelosi way.
“NO NO NO” is also a canard. Did you truly examine the Republican substitute measure? Of course not. You would have seen affirmative solutions to every one of our main concerns, such as a provision to deal with the pre-existing conditions issue (which absolutely needs solving), interstate competition, and limitations on lawyers dictating the way medicine is practiced with their constant threat of devastating lawsuits hanging over the heads of even excellent doctors.
Reasonable people are trying to solve American health care’s problems directly and efficiently — but no, Queen Nancy must have her vast bureaucratic expansion and her demonization of American business (pitting it as the federal government’s ultimate opponent) built into her metastatic tumor of a plan.
“‘The freedom to spend one’s money as one sees fit is rather fundamental.'”
I am just going to pretend I am a wingnut for a moment… Is that in the constitution?”
It’s called “Life, liberty, and the pursuit of happiness.” Your liberty and your pursuit of happiness are harmed if government is confiscating your assets and essentially giving them to me or to someone else to spend.
The only way to truly preserve liberty is for me to defend your right to live freely (and by extension, spend what you earn) as you see fit, at the same time that you defend my right to do the same — and as long as we do not harm each other, and do not swipe each other’s property or assets to give to other people to consume — then liberty and the opportunity to pursue happiness are preserved for us both.
“No argument there. The question is, why aren’t you pissed at the GOP for their complete and utter refusal to even try to work the problem in a bipartisan manner?”
Ed beat me to this. I think you are falling for the Democratic rhetoric where in every breath they talk about the bipartisan approach.
They refused all efforts.
I just heard Obama on the TV say its all paid for. More Bullshit.
As a matter of fact, yes. It’s the total sum of the Constitution, in fact, because of the dictates of a limited government that the Constitution calls for. Those limits on government have of course been ignored for far too long.
Proof? Let’s consider Representative James Clyburn.
It’s your age, no doubt. The same thing happened to my mother when she was in a period without employer-provided health insurance, and she was in her early fifties.
Pray tell, which party was it that was stirring up the tea-baggers and spouting slander about the whole thing being an effort to turn the health-care system into “government-run health care like in the UK”? Which party was it in the Senate who sent in representatives to negotiate with Baucus, who then spent the whole time obstructing negotiations while sabotaging then with their base (Senator Gr-asshat, please stand up)?
Don’t give me that “Republicans tried” crap. By and large, they didn’t. Their leadership in Congress certainly didn’t – they’re much more concerned with repeating 1994 in 2010.
“Pray tell, which party was it that was stirring up the tea-baggers and spouting slander about the whole thing being an effort to turn the health-care system into “government-run health care like in the UK”? Which party was it in the Senate who sent in representatives to negotiate with Baucus, who then spent the whole time obstructing negotiations while sabotaging then with their base (Senator Gr-asshat, please stand up)?
Don’t give me that “Republicans tried” crap. By and large, they didn’t. Their leadership in Congress certainly didn’t – they’re much more concerned with repeating 1994 in 2010.”
You’re being profoundly disingenuous.
First of all, “Teabaggers” is itself the nastiest of slanders and you know it. Be more civil in your discussion, please, if you require civility in return.
For Republicans, a new all-encompassing, massive (I would say crushingly massive) federal medical bureaucracy is a non-starter. You bet Republicans are trying to obstruct that aspect, because it would fundamentally transform America’s character as a free state.
As for solving problems within the health insurance industry, Republicans have all kinds of ideas. All kinds. But these ridiculous 100+ new bureaucratic entites with their absurd leftist-euphemistic names are off the table — we say to Democrats, try again.
Read the Republican substitute bill and seriously think about it. It’s 1/10 the size of PelosiCare and full of truly great ideas. Pre-existing conditions, covering the uninsured who want coverage, allowing people improved access to health practitioners (including Medicare/Medicaid patients who often do want to pay for elective extra care that under the current system and under PelosiCare they wouldn’t be allowed) — it’s all in there, without the massive, outrageous crush of new bureaucratic lard.
Anjin, the stupidity of your first question is beyond the pale. Have you ever read the consitution? Do you know what it is for? Goverment does not have the power, according the the Consitition to mandate the purchase of anything. Interstate commerce was never meant to infer the power to mandate individual purchases. Yes I get to decide how I spend my money, not the government. That is why the bill of rights exists. Looks like Congress has dismissed our 1st amendment rights, maybe it is time to exercise our 2nd amendment rights.
Yes indeed it is. How many of our countrymen & women will die because they are largely shut out of the health care system?
It is worth noting that the right has been whining almost endlessly about being forced to pay for the health care of strangers. Well, now those strangers are going to have to buy some insurance. Do you want to address the problem, or do you just enjoy whining?
“For Republicans, a new all-encompassing, massive (I would say crushingly massive) federal medical bureaucracy is a non-starter”
Could we amend that to say it is a non starter unless it will get them votes? Please Google Bush, G.W.-Medicare, Drugs.
I have started looking over the Republican bill. Under the rescission part, it still lists fraud which I believe is what is used now. It also shifts costs to the states, even more than the Dems plan I would think, though I have not seen an official estimate.
I also have experience with high risk pools. Wife and I are both physicians. My brother-in-law lost his job so he lost his health insurance. He had a prior pulmonary embolus. No one would insure him. The would not even offer a price. He applied, with our help, to the high risk pool in our state. There was not enough funding for all of the applicants so he went on a wait list. He died after 2 years waiting on that list.
My initial thought glancing through the Republican plan, is that it is a wet dream for the insurance industry. They can dump all of their high risk people, who will go to the high risk pools, which the states will not be able to fund. Insuring nothing but healthy people, nice work.
Steve
And yet you dare to suggest that you understand the problem better than Sarah Palin & Rush Limbaugh…
Your analysis is pretty much dead bang on. The GOP has no interest in changing the status quo. The insurance companies are making billions, the important people (IE, ones who have money) have access to good health care. Everyone else, TFB.
I know plenty worse, and to be blunt, they brought it on themselves in part by calling them “tea parties”.
I don’t.
That same medical bureaucracy they were only too happy to create with the massive prescription drug plan? Or the one they’re defending now when they attack the Democrats for potential cuts?
“…as companies amortize the cost of absorbing people who have costly illnesses — who will by definition be a net drain on the pool from Day 1 — by passing it on to the rest of us.”
Since we as a nation do not allow people to die in the streets, please pray tell James, who is paying for these costly illnesses amongst the uninsured today?
Actually they called for mailing tea bags to Washington in protest. It was just unfortunate that the dirty liberals knew a name to match that. (Not being dirty or liberal I don’t recall what the name means right now … but I’m not going to look it up.)
http://www.snopes.com/politics/taxes/teaparty.asp
So to avoid being dirty liberals we should say “tea bag protesters” … or maybe that’s still too close.
I have drawn this comparison before , but it is perhaps useful to draw the comparison again; consider the railroads. Over regulated, over unionized, the railroad’s simply could not compete. So the solution for all of the over involvement of the Federal government in the affairs of the railroad’s was to take over the railroad’s entirely.
Is there any doubt that’s the pattern here?
Actually Eric the solution for railroads was to build a mind-numbingly expensive interstate highway system.
Odo, more mind numbing that $870 billion stimulus that has yet to stop the loss of jobs or a $1.8 tillion dollar health care plan that will not lower the cost of heath care? These wonderful ideas brought lovingly to you by the progressives have not worked as stated. Social security will go bankrupt because the democrats spent the money and Medical has unfunded obligations which will cost in the trillions. There is no right to health care and the government does not have the authority, in a free country to force you to buy into the system. James is right. You cannot insure a pre existing condition. That is just sharing the cost. Wealth redistribution. If not than I should not have to buy car insurance until I have an accident. Deal with the logic of that A**hole Anjin.
Why don’t we consider the military? The best in the world at what they do by so far it is not even worth discussing.
And they all work for the government…
Do you honestly think you can go without health insurance, then go to an insurance company when you need 150k worth of treatment and offer them a few hundred bucks a month in payment? That is indeed an interesting form of logic…
That did work out quite well for the oil companies…
Interesting question Zelsdorf. This page says the initial costs, for the initial system was $500B in 2008 dollars. According to this page though the per-year costs had ramped up to $120B/year by 1991. I suspect that cumulative numbers, with ongoing maintenance commitments would be higher.
(One of the things about “crumbling infrastructure” and “unsafe bridges” is that building them isn’t enough. Building them implies future budget.)
My bad, the $120B was cumulative, but not in inflation adjusted terms.
Having read the entire thread I vote Michael Reynolds’ the most hysterical and poorly thought out rant.
It appears that America’s health care system is going to be dragged, kicking and screaming, into the modern age.
I honestly cannot comprehend those who fight and fight to continue a system that is demonstrably terrible for an OECD country (by far the highest costs, middle results) just to protect insurance company profit margins.
Drew:
I apologize for introducing actual, first-person experience into a debate. I realize that was a terrible thing to do.
But just to nail the lid on my sad little coffin, maybe you could explain for me why a mandate is an infringement on liberty and a tax isn’t? Or why taking my money for defense is fine but taking it for health care is not? And could you clarify for me why Republicans think universal health care is tyranny but Medicare isn’t? Because — lacking as I am in intellectual heft — I don’t quite get it.
I’ll sit here very quiet while you explain.
Most of Europe, Japan, Taiwan and Singapore all have health care systems that cost much less than ours, yet deliver care about the same in quality. They all have heavy government involvement. How do they make it work so well with so much government involvement? Do their governments work bett or are they just smarter than we are?
Steve
James, I think harping on the escalation of health care costs is really kind of a red herring. People will keep paying more for better treatment as long as they can afford it. If you want 1970 health care prices, then go back to health care practices, pharmaceuticals, and availability fo the 1970s. Otherwise, the only way way to stop growth in the cost of healthcare is to stop developing new capabilities and drugs. Why is the fact that people choose to spend more of their money on their own well being a bad thing that requires a government solution?
Of course, I predicate all of this on the idea that I am free to choose how I spend my time and money. Apparently, that may be a bad assumption moving forward.
Oh, you mean like this stinking pile of manure?
That also worked for Twinkle Toes Tom…I assume you were also mortified when the GOP did this?
Perhaps if the GOP had actually tried to do something to reform health care/health insurance in this country when they held all the levers of power, we might have avoided this latest development which seems to be driving a lot of conservatives/Republicans crazy…alas…
Interested Party:
Don’t you think it deserves a direct quote? From your link:
My bolds.
Of course, Michael, but even that will not convince the true believers around here that the Democrats don’t want to “take over” health care as well as everything else in their lives…but while they moan and groan about that, they don’t realize that the opposition party is offering nothing of value…
Is the freedom to bake chocolate chip cookies in the constitution?
The freedom of a person to buy something naturally includes the freedom not to buy; the opposite side of that is the freedom to sell or not to sell. But freedom is bull to you.
I’m not a Republican, but I have heard them talk about things like reforming Social Security before. It doesn’t last long (third rail and all). I also recall lots of screaming about Bush expanding Medicare a few years back. I’m not really a Libertarian either, but the “party of principle” does have a stance on all the things you mentioned.
That’s a very Tea Party-ish headline there, James. “House Trades Freedom for Health Coverage.” To make matters worse, I read through the post looking for which freedoms exactly were traded, and well…I didn’t really see any.
You mean we lost our freedom NOT to have health insurance? Or small businesses lost their freedom NOT to give their employees health insurance.
You make some good points in the body of the post, mostly about some of the unintended consequences (which, let’s be honest, happen with every bill that comes through Congress and in this case, are mostly economic rather than freedom-related), but then you cap it off with a near-hysterical “Them liberals are taking my freedoms!” headline. Not impressed.
I actually agree with you on most of this stuff. But it led my philosophy in the opposite direction it led you, apparently.
I don’t suppose that “Yes” was the answer you were expecting, but it’s one that I’ll give.
Michael,
Both a mandate and a tax are an infringement on liberty. That one is wrong does not make the other right or less wrong. Guess you parents never told you that one. You know, two wrongs don’t make a right.
And yeah, you are hysterical. And its still shitty legislation.
Well, I’m sure with, as reported, the overwhelming majority of people WANT reform, it will be fine. And remember, the government has been running programs for decades that are as financially sound as any bank they are currently watching closely for signs of illness so they can prop it up with tax payer money. I think once people just stop and reflect on all the success the government has had in running things like Medicaid, Medicare, and Social Security, they’ll see there is no reason for all this concern.
Wasn’t that lost as soon as the first taxes were raised (including sales tax)? Not to mention various banned substances (drugs, weapons such as grenades or small thermonuclear devices), bans on imports from certain countries etc.
Every government puts restrictions on its citizens, including the restriction of how they spend their money.
Do you think you’ll ever grow up, Steve? Many of us were libertarians in our youth. But most of us outgrew it. Like we outgrew acne and chronic masturbation.
Government = Violence! Taxation = Theft! Me, Me, Me, Mine, Mine, Mine! Why should I have to contribute anything to the country I live in? Waaaah!
Child.
I suppose to any liberal, the House Republican Conference is composed of wingnuts, but the list I posted was their creation from reading the bill. It is bound to have residuals from current practice, and even some past Republican contributions.
Whoever said that all Republican contributions in the past were good? They are still, however, a contribution to the total bureaucracy we will possibly be saddled with, included in yet another liberal incursion into non-Constitutional legislation (the Nanny State).
The bill is DOA in the Senate, I hear.
One American dies prematurely due to lack of health insurance every 12 minutes. How many since this post went up?
Who cares? Those people were still free to die!
I have been thinking more about the “life, liberty and the pursuit of happiness” issue that the right keeps bringing up. And they are correct.
The founding fathers did, after all, name these as inalienable rights of man. Life, liberty and the pursuit of happiness.
It kind of implies that the government has a fiduciary duty to do everything possible to keep its citizens alive. You know, making sure everyone can see a doctor from time to time is a great way to do that.
Ummmmm, Ed, that phrase occurs in the Deceleration of Independence, not the Constitution. Don’t they teach you the difference between the two in teabagger school? This is one of the real flaws in the “Everything I know I learned from Glenn Beck” approach to life…
Great News, everyone! Anjin going to be making anti-Abortion arguments form now on!
Anjin, a little logic here…. recognizing it’s a bit of a strain for you, I’m going to allow you a few days to come up with an answer. At what point does someone’s right to something mean the government has to provide it?
Clue: The founders were talking about limiting government so that it couldn’t be taken AWAY, as George had a habit of taking away all three at his whim to ‘provide for his subjects’.
Anjin, that is the politically correct version….
Life, liberty, property, was the original… it meant if you own your own life , liberty and property you won’t become a slave to some one who owns your life, liberty and property.
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This one perhaps?
provide for the common defense, promote the general welfare
After all, does the government have to provide defense?
Bit, you have to keep something in mind when you are talking about the intention of the founders. They were giants, and you are a small-minded twerp. That makes it pretty darned difficult for you to understand their thinking. Simply reading
The American Thinker” and then regurgitating their positions will not get the job done.
Oh? So you’re saying there’s an implied right here? Do you feel the same way about Roe v Wade, where the SC determined an implied right to privacy? Oh, yes, that’s right… you righties have been arguing ad nauseum since then that such a right doesn’t exist. Y’know–judicial activism.
Typical Verdon: complain about some economic policy, offer only an Econ 095 solution (if any), then become rude when others point out the glaring faults and lack of imagination.
Michael: Steve’s “philosophy” summed up nicely by John Cole:
God, I hate to feed the troll:
from Wikipedia, G.A.:
Correct me if I’m wrong, G.A., but wouldn’t the words that wind up in the Constitution be “the original” words, and the words that don’t be the “politically correct” words? (Well, at least politically correct if you’re a rightwing nutty.) Just sayin’!
Not at all.
You may want to consult the tenth amendment.
Oh, yes, the vaunted “10th Amendment” defense. The one under which there is virtually no case law, because it’s meaning is so obscure that it’s merely considered a “truism,” apparently.
Maybe I’m quibbling, but, the meaning of the 10th amendment isn’t exactly explicit–or rather, explicit in the way we mean when we say “explicit” concerning amendments. Whether you like it or not, Eric, your still suggesting an implied right only here.
If your gonna cherry pick stuff don’t leave a link to the site that has this in the middle of the stuff you cherry picked.
and then start straw donkeying what the truth of matter is from you limited sources….
Just braying……
And I don’t know if you realize it or why, but the feeding the troll part, nice:)
Right… Well, ya see, G.A., if you’d been paying attention, those words are from the Virginia Declaration of Rights, not the Declaration of Independence. And that wording isn’t what wound up in the Declaration.
This is what you said in response to Anjin:
So, I’m not cherry picking at all; I’m actually quoting in context. Based on your own words to Anjin, you’re arguing that the Framers–Madison, Jefferson, Franklin, et al–were being “politically correct” when they put “Life, Liberty, and the Pursuit of Happiness” in the Declaration. Think I’m wrong? Well, geez, right there in my citation it says:
So I’m not exactly sure how you know what the Framers “meant” in this context when the text of what you cite doesn’t support your assertion.
Eric the pc thing was a joke.
Life, liberty, property mostly came from the sermons that our founding fathers listened to, as did our declaration a lot of it came from the writings of one man, try “The two treatises of government” by John Locke.
Ummm… nice try, but no… that still does not require the government to pay for such. Try again.
Well, I’m quite sure that like most big government types you’d rather ignore the 10th.
Oh, I’d not call it ‘quibbling’.
Let’s look closely:
Nothing ambiguous about it. If it’s not in the constitution, the federal government should not be doing it because those are the exclusive provice of the states and the people.
I’d bet that GA has never read anything by Locke, Any Thing.
Those would be the people who elect representative to congress, no?
Wish you had cared about the constitution as much when Bush was pissing on it on a daily basis…
Well, what does “promote the general welfare” mean? It means something, after all, even if the founding fathers did no spell it out for the dullards (yes bitsy, this means you).
I am reading this to mean you oppose a woman’s right to an abortion.
So we need to preserve freedom, and keep the government out of people lives and peoples business.
Except that it is necessary for the government to tell a woman what she can and can’t do with her own body. (well, I guess its not really her own now then, is it?)
I keep thinking of something my mother always says. “If men got pregnant, abortion would be a sacrament”.
So that would mean I’m wrong, lol….
So is this your new lib strategy,remember back when how I must be wrong cause I’m not a good speller and non grammatical, lol
That is some Ideology you guys have.
hahahahaha……..