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For those of you who don't know who Paul Starr is, here's a thumbnail biography:

He is a professor of sociology and public affairs at Princeton University.

He and Robert Kuttner are the co-editors and co-founders(with Robert Reich) of The American Prospect.

In 1984, Paul Starr won a Pulitzer Prize and Bancroft Prize for his book The Social Transformation of American Medicine

In 1993,he was the senior advisor for President Bill Clinton's proposed health care reform plan.

Basically, nobody knows the ins and outs of healthcare policy and the politics of healthcare policy better than Prof. Starr, whose biography and associations should, give him a lot of credibility with the progressive community.

Here's what Prof. Starr has to say recently about the Senate Healthcare Reform Bill:

If Congress can complete work on health-care legislation and send it to the president (as of mid-January, the final bill is still under negotiation), it will be a stunning historical achievement and the most important liberal reform since the 1960s. It may also be the most underappreciated social legislation in recent history. Never in my experience has such a big reform been treated as so small. Never have Democratic members of Congress who are putting their careers on the line for something they believe in been so vilified as sellouts by influential progressives. And never have those progressives been so grudging in their endorsement of landmark legislation or so willing to see it defeated.

How this happened is clear. Facing united Republican opposition, Democratic leaders made a series of concessions to win over centrists in their own caucus and to neutralize key interest groups. One point of contention -- the public option -- came to symbolize hopes on the left, and when that provision was unable to pass the 60-vote hurdle in the Senate, some progressives such as Howard Dean concluded that the entire bill had been gutted.

But that conclusion is wrong. The legislation would be a major advance in two important respects. After a long period of rising inequality, it would boost the living standards of low-wage workers and their families and improve economic security for the middle class as well. And it would be the most ambitious effort in recent history to reorganize a major institution on a basis that agrees more closely with principles of justice and efficiency.

Please read the entire article and if you still don't think the Senate bill as is represents major beneficial change, snap out of it!

Paul Starr's not a lone voice in the wilderness on this either.  Here is what Dr. Atul Gawande has to say:

For many decades, the great flaw in the American health-care system was its unconscionable gaps in coverage. Those gaps have widened to become graves—resulting in an estimated forty-five thousand premature deaths each year—and have forced more than a million people into bankruptcy. The emerging health-reform package has a master plan for this problem. By establishing insurance exchanges, mandates, and tax credits, it would guarantee that at least ninety-four per cent of Americans had decent medical coverage. This is historic, and it is necessary.

In deference to my friends at firedoglake, I'll leave out what Jonathan Gruber of MIT has to say about the bill.

Ezra Klein and Jonathan Cohn are the two liberal bloggers/journalists I've trusted the most to provide even-handed and extremely well-informed reportage and analysis of healthcare reform over the past several years.  Here's what they had to say about the Senate bill right after it passed:

Jonathan:

The U.S. Senate has voted to pass the most ambitious piece of domestic legislation in a generation--a bill that will extend insurance coverage to tens of million Americans, strengthen insurance for many more, and start refashioning American medicine so that it is more efficient.

Ezra:

It is, without doubt or competition, the single largest social policy advance since the Great Society.

Paul Krugman isn't necessarily a healthcare expert, but, as a Nobel Prize winning economist, he's certainly better equipped than average to determine the validity of claims about the effectiveness of the Senate bill and nobody ever accused him of carrying water for the Senate or White House.  This was his admonition to liberals regarding the Senate bill:

[L]et's all take a deep breath, and consider just how much good this bill would do, if passed — and how much better it would be than anything that seemed possible just a few years ago. With all its flaws, the Senate health bill would be the biggest expansion of the social safety net since Medicare, greatly improving the lives of millions. Getting this bill would be much, much better than watching health care reform fail.

...

Look, I understand the anger here: supporting this weakened bill feels like giving in to blackmail — because it is. Or to use an even more accurate metaphor suggested by Ezra Klein of The Washington Post, we’re paying a ransom to hostage-takers. Some of us, including a majority of senators, really, really want to cover the uninsured; but to make that happen we need the votes of a handful of senators who see failure of reform as an acceptable outcome, and demand a steep price for their support.

The question, then, is whether to pay the ransom by giving in to the demands of those senators, accepting a flawed bill, or hang tough and let the hostage — that is, health reform — die.

Here's a handy chart prepared by Jonathan Gruber (sorry FDL, I guess I couldn't leave Prof. Gruber out completely)and Jonathan Cohn regarding what the bill is expected to do for average working to middle class people:

Healthcare Cost Projections

You can see from the chart that many of the families who need help the most will save a lot of money under the Senate plan.  You might say that health insurance is still too expensive for families and I would agree with you, especially if this chart told the whole story, but it doesn't.

The whole story is even better for the uninsured than the chart would lead you to believe.  It starts with the fact that the insurance you buy under the Senate bill is much better than the insurance you can buy on the open market now and the insurance exchanges will provide a better mechanism for purchasing the insurance.

Prof. Starr again:

Here is our current reality: In most states, insurers can deny coverage to people they deem too great a risk, exclude pre-existing conditions for others, and charge however much they want based on health, age, or other characteristics. Routinely, subscribers whose health deteriorates have their coverage cancelled. Under existing law, insurers have an incentive to design every aspect of their business so as to avoid individuals with high health costs. People who obtain coverage individually or through small employers get an especially bad deal because they lack the purchasing leverage of large employee groups.

...

And here is how the legislation would change that reality: It would expand coverage, first, by extending eligibility for Medicaid to people with incomes under or near the federal poverty line and, second, by subsidizing private insurance for people earning up to four times the poverty level. More than 30 million people would gain coverage as a result (the more generous the subsidies, the higher that number). The basic rules of the insurance market would change. Insurers could no longer exclude pre-existing conditions or charge according to an individual's health; they would be required to issue a policy and renew it for any legal applicant; and while they could vary premiums by age, they could do so only within limits, unlike current practice.

The law's central organizational innovation would be to create insurance exchanges offering multiple insurance plans, initially for those in the individual and small-group market, to give them the buying leverage and benefits of choice enjoyed by workers at larger firms. (An earlier name for the exchanges, "health insurance purchasing cooperatives," better conveys their function as a group purchaser.) The exchanges would play a critical role in restructuring and policing the market. To discourage insurers from cherry-picking the healthy, the law would require them to pay into a risk-adjustment fund if they enrolled a healthy, low-cost population; conversely, the fund would compensate insurers if they signed up a more costly group of subscribers.

Now, a lot of progressives have objected to the Senate bill as a giveaway to the insurance companies based on: 1. the presence of an individual mandate; and 2. the absence of a public option.

Professor Starr's got an answer for that too:

But, critics ask, isn't the entire program a gift to the insurance industry because of the mandate -- the requirement that individuals purchase coverage? The mandate or its equivalent would be necessary in a reformed system regardless of whether health insurance were public or private. If there were no mandate, but people could, whenever they wanted, get coverage with no pre-existing-condition exclusions, the rational choice for the healthy would be not to buy insurance until they got sick. But because insurance works only if the healthy as well as the sick pay for it, the system would break down. It would be like saying people needed to pay for the protection of the local fire department or for fire insurance only when a fire broke out in their home. As a practical matter, without a mandate, health-insurance premiums would have to be significantly higher -- and government subsidies would rise along with them, making the program more costly.

The insurers, I am confident, would be happy to keep the present system, which has been highly profitable for them. From their standpoint, reform presents both economic and political risks. Although the mandate would bring them new customers, many of those customers are people whom no insurer has been willing to cover in the past because of their poor health. Moreover, if the federal government is on the hook for subsidies for private insurance, it will develop a direct interest in keeping down insurance rates. Under the reform plan proposed by Bill Clinton in 1993, the government would have imposed a cap on increases in the average premium in the insurance exchanges. The current legislation does not include such a budget cap, but the insurers must be concerned that it could be enacted after the exchanges are established.

As the debate began in 2009, the public option took the place of the budget cap as a way to limit the industry's control over premiums. In its original "robust" form, the public option would have paid doctors and hospitals at Medicare rates, which are now 20 percent to 30 percent below what private insurers pay. If such a plan had been offered to everyone below age 65, it would have had a significant price advantage over private insurers, who predictably opposed it for fear of being driven out of business. But a Medicare-like plan would have also reduced the revenue of hospitals and other providers so sharply as to plunge them into a crisis, so they opposed it too. There was never any chance that Congress would approve that version of the public option, even within the exchanges. After all, the proposal threatened to reduce providers' revenues below their existing levels, which not even the Clinton plan's budget cap would have done.

By the time the public option died, however, the version under discussion was no longer much of a threat to insurers or providers, who would have been paid negotiated rates, just as they are under private plans. And because the public plan would likely have attracted more of the chronically ill (and the risk-adjustment system would not have corrected 100 percent for their costs), the Congressional Budget Office estimated that the public option would have had higher premiums than those of private insurers and would have enrolled only about 2 percent of the population.

Still, the public option might have provided some protection against exorbitant premiums in states where there is little competition among insurers. And it polled well in public-opinion surveys, though if things had worked out as the CBO projected, the public option would have been a big letdown -- and a conservative talking point against future government action.

Last year I suggested that the public option would likely serve as a sacrificial lamb in the effort to pass a bill, and that is what happened. Democrats sacrificed it to propitiate the lords of the Senate -- Ben Nelson and Joe Lieberman. But that may not be the end of the story. If costs prove to be higher than projected, the public option will have been spared any of the responsibility and may, like the budget cap, yet have its day. The current legislation includes a variety of provisions to control costs, but it has no hammer to ensure that they are controlled, and we may ultimately need one.

A claim that I've seen made over and over again is that the Senate bill forces you to buy insurance from a private insurance company.  It does not.  What it does is force you to buy insurance or pay a $750 annual penalty starting in 2014.

To get a little bit personal, this portion of the bill interests me very much. I currently do not have health insurance.  I am an unmarried, childless, self-employed professional with a modest income that is probably too high for any subsidies.  

I think that you would agree, based upon the foregoing information that I have more than a sporting or purely altruistic interest in what the Senate bill does for and requires from the uninsured.  And I am convinced that this is a great deal for me!

Why?  Because, as Ezra Klein once pointed out on his blog: the option of going without insurance and paying a $750 annual penalty is probably the best deal in the bill.

Ezra:

[I]t's simply not true ... that the people paying the $750 individual mandate penalty get nothing in return. Far from it, in fact. For one thing, they get access to emergency care, as happens now. For another, they get the chance to come back into the system when they actually need insurance. Someone who puts off purchasing coverage and then tries to buy Aetna's plan the first time they collapse unexpectedly will not be sold a plan. Having chosen not to buy insurance when they didn't need care, they can't buy it now that they do need care. They become the priced out or, in some cases, locked out.

Under reform, these people get the chance to come back into the system when they need coverage. They can't be discriminated against. Indeed, you can argue that these folks, the ones willing to game the system, are the most advantaged of all the groups. It's why the individual mandate should be stronger, not weaker, than it is now. This isn't the biggest deal at the outset of the plan, as there's fair evidence showing that people overvalue insurance and will buy it even though paying the penalty is a better deal. If that turns out to be wrong, you can strengthen the mandate down the road. But the economics of the situation favor the people who decide to pay the penalty rather than purchase insurance, not the other way around.

So, if, once the new insurance exchanges have opened and I go on and can't find a policy that is affordable and to my liking, I can opt to pay $62.50 per month for the security of knowing that if I ever become seriously injured or ill, I can go back to the exchange and purchase (a suddenly more affordable looking!) insurance policy that suits my needs and cannot be denied or charged anymore for a policy than any other person in my age group.  Have I died and gone to heaven?!

So, if you've ever seen me getting testy with someone who wants to hold up the bill to try to squeeze a weak public option back in or to make sure that no insurance company has to pay an excise tax on high-end health insurance plans.

Before I conclude, I just want to rattle off a few more of the benefits conferred upon the public by the Senate bill that weren't really mentioned elsewhere in this diary:  

Expands  Medicaid to cover an additional 14 million low-income people.

Reduces projected budget deficits by $132 billion.

Provides $10 billion for community health centers.

Creates pilot programs that experiment with ways to bend the long term cost curve.

Here's my bottom line: even without a fix, the Senate Healthcare reform bill would represent a historic victory for progressives and for American families.  When progressive activists who should be celebrating this triumph, instead accuse the Senate of having sold the American people out, they are being grossly unjust to our Democratic senators.  

I'm not just upset by this because of my general aversion to injustice, but also because by unjustly criticizing our Democratic Senators and the Senate Healthcare reform bill, progressives are helping to ensure that bold action on progressive priorities is never taken again.

That is what is known as shooting yourself in the foot or cutting off your nose to spite your face.  Whichever metaphor you choose, I beg progressives to stop injuring our own body parts!  Now!

So, I urge you to call your Senators and Representatives and ask them to finish the job now and do whatever they can to make the Senate bill even better.  And, while you're at it, thank them for all the hard work they've done to bring us right to the verge of a historic progressive victory! (Unless, of course, your representative and/or Senator voted against healthcare reform or is named Joe Lieberman or Ben Nelson, in which case I urge you to call them and give them holy hell!)

Originally posted to seanwright on Sat Feb 13, 2010 at 05:00 AM PST.

Poll

The Senate Healthcare Bill, if passed, would represent

64%65 votes
35%36 votes

| 101 votes | Vote | Results

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Comment Preferences

    •  Neither (6+ / 0-)

      Your poll is nonsense.

      Stop Rob "The Job Outsourcer" Portman. Jennifer Brunner for Senate http://www.jenniferbrunner.com/

      by anastasia p on Sat Feb 13, 2010 at 05:46:48 AM PST

      [ Parent ]

      •  Just choose. It's not like you've got anything (5+ / 0-)
        Recommended by:
        Cedwyn, Norbrook, jsfox, indubitably, Onomastic

        to lose.  Sheesh!

        "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

        by seanwright on Sat Feb 13, 2010 at 05:51:06 AM PST

        [ Parent ]

        •  Misleading lies on mandate ignoring rest of world (0+ / 0-)

          You quote:

          "The mandate or its equivalent would be necessary in a reformed system regardless of whether health insurance were public or private. If there were no mandate, but people could, whenever they wanted, get coverage with no pre-existing-condition exclusions, the rational choice for the healthy would be not to buy insurance until they got sick. But because insurance works only if the healthy as well as the sick pay for it, the system would break down. It would be like saying people needed to pay for the protection of the local fire department or for fire insurance only when a fire broke out in their home. As a practical matter, without a mandate, health-insurance premiums would have to be significantly higher -- and government subsidies would rise along with them, making the program more costly."

          BULLSHIT!

          You sneakily ignore that progressive nations always pay for those premiums by means of taxes. That saves millions from being dumped BECAUSE THEY GOT SICK AND WERE OVERWHELMED BY BILLS. Also, Obama took all the ways progressive nations control costs off the table. That doubles to quadruples our prices of drugs, among other things.  HOW DARE HE DO THAT?

          For that reason alone, we need to go back and start over without Obama's Malthusian betrayals.

          Just a little omission, huh?

          WHAT exactly do insurers give us? (besides denying care) What value do they add BESIDES raising prices SO high that THEY exist? Please, WHAT?

          by Andiamo on Tue Feb 16, 2010 at 09:26:04 AM PST

          [ Parent ]

          •  How dare you come into my diary after the lights (0+ / 0-)

            have been turned off and everybody's gone home and accuse me with your bolded, capitalized, italicized and underlined statements and parenthetical innuendoes and accuse me of lying!?  How dare you!?

            Now as to the substance. Yes, obviously, this country could, in theory, accomplish universality through higher taxation & greater government control. But has it ever occurred to you that suddenly changing a system like ours to a system like they have in England or Canada would cause a huge amount of economic dislocation and that ther isn't anything close to the political will necessary for such a massive change in congress?

            So why the fuck do you insist on blaming Obama?

            "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

            by seanwright on Tue Feb 16, 2010 at 06:37:19 PM PST

            [ Parent ]

    •  Geez Seanwright.... (16+ / 0-)

      This is why I love the "other" kind of HCR post versus yours:

      I'm sick of wading through all of your facts. How boring.

      I'm OUTRAGED. I'm not sure WHY most of the time - this Democratic Congress busted their butts to deliver us the first true progressive health reform bill in a lifetime, but I'm SURE it's not good.

      This bill is a pure "turd sandwich". I've been told so, and EVERY diary written that says so gets recc'd to the top of the list. It HAS to be true, no?

      I should be against it. No, wait, maybe for it. No, now DEFINITELY against it. No, no, wait, now ABSOLUTELY FOR IT. Well, on odd number days, the Senate bill must pass because it's better than nothing. But on even numbered days, I'm standing firm on public option or nothing. Overload - please advise. Tell me what to think seanwright.

      Finally, you leave me no guidance as to which Democratic Senator I should despise and primary. I see a "D", any old "D", NOT supporting single payer, I WANT BLOOD. GIVE ME BLOOD. And pitchforks. And torches. Let's get 'em. And don't give me any of that nonsense about how you get elected as a "D" in Arkansas or Nebraska or Louisiana. I said BLOOD, not details. You give me none.

      Oh, and I want my ponies. And unicorns. Yeah, unicorns. I love the unicorns.

      Good diary. Bravo.

  •  All This To 'Sell' NOT Getting The Reconciliation (5+ / 0-)

    Sidecar Fix?

    Why?

    ~Ruff

    •  I'm for a sidecar fix. (20+ / 0-)

      My point is that badmouthing the bill and badmouthing senators, like Harry Reid for instance, who worked their butts off to get us this bill, is totally counterproductive.  Why would anyone ever want to take on a big progressive cause again if their reward for handing progressives a huge victory is a bunch of progressives shrieking sell out?

      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

      by seanwright on Sat Feb 13, 2010 at 05:19:53 AM PST

      [ Parent ]

      •  Funny, I Don't Feel The 'Huge Victory' (6+ / 0-)

        you claim for progressives.

        Progressives actually have very little in this bill in the way of 'Medicare For All', a 'Robust Public Option', and advocates for single payer still have arrest records.

        Please don't tell progressives that this lobbyist-written bill is some great victory for progressives.

        We don't believe you, and the customer is the final judge of quality.

        I'm going to laugh when Harry Reid goes down, that's how much I appreciate all that 'Weak Reid' has done for progressives.

        ~Ruff

        •  The customer has neither seen nor (6+ / 0-)

          felt nor, in most cases, understood the product. How can he objectively judge?

          Iuris praecepta sunt haec: Honeste vivere, alterum non laedere, suum cuique tribuere. - Ulpian, Digestae 1, 3

          by Dauphin on Sat Feb 13, 2010 at 05:44:19 AM PST

          [ Parent ]

          •  Consumers Don't 'Objectively Judge' (3+ / 0-)

            Otherwise the only cars ever sold would be tops in Consumer Reports magazine.

            As I said, the 'Cave-In To Senate Whores' Bill could use some 'Change We Can Believe In' from a sidecar reconcilation fix bill passed by the Senate BEFORE the House votes for the corporatist deal corrupted Senate bill.

            ~Ruff

            •  Well, (5+ / 0-)

              I don't care whethe something is popular or not. If HCR controls costs and improves public health, I'll support it, even if it's unpopular. I'm interested in what works.

              If consumers are so irrational that they won't judge the merits at all, then, well, they deserve what they get.

              Iuris praecepta sunt haec: Honeste vivere, alterum non laedere, suum cuique tribuere. - Ulpian, Digestae 1, 3

              by Dauphin on Sat Feb 13, 2010 at 06:04:20 AM PST

              [ Parent ]

              •  What We're Going To Get Is (3+ / 0-)
                Recommended by:
                buckhorn okie, cybrestrike, lcarr23

                A lot of Dems? losing their seats.

                The Teabaggers are energized and the Dems? have pointedly and repeatedly betrayed their base.

                You can support the Senate Sellout if you want, but your words are falling on thousands of deaf ears when you try to peddle not doing the sidecar reconciliation bill FIRST.

                Let's face it, the Senate Dems? don't want to face a reconciliation sidecar fix bill because they'd have to actually have to take a stand against their base that they absolutely can not defend.

                ~Ruff

                •  Oh, absolutely. (3+ / 0-)
                  Recommended by:
                  seanwright, lcarr23, Onomastic

                  They do not want to change the bill, which is why we're left with this or nothing.

                  Iuris praecepta sunt haec: Honeste vivere, alterum non laedere, suum cuique tribuere. - Ulpian, Digestae 1, 3

                  by Dauphin on Sat Feb 13, 2010 at 07:31:57 AM PST

                  [ Parent ]

                •  What base? (5+ / 0-)

                  Define please. Are you refering to the people who actually elect their Senators and Representatives?

                  Or are your refering to those whose speciality seems to be drapping their egos all over the internet and on TV?

                  Because Dems can stand up and defend the bill quite nicely and do. Senator Franken and Sanders come to mind immediately. And they all should do so far more often. There's too much misinformation out there coming from both sides of the political sphere.

                  The Kaiser Foundation conducted a tracking survey that clearly illustrates the divide between "opinion" and "facts."

                  http://www.kff.org/...

                  Most of the respondents to the survey did NOT know what was in the Senate Bill. Their beliefs about it, were "objectively wrong." No doubt due to having gotten their information from MSM, and so called activists on both sides of the political divide.

                  But wait!

                  When the same respondents were asked about specific components of the bill, for example, banning limits on lifetime coverage or setting up the Exchanges, why lo and behold - they were overwhelming in favor.  

                  As Nate Silver said in his analysis of the KF survey -

                  it's much harder to read the opinion polls as a "mandate" against the health care bill when much of that opinion is based on demonstrably false beliefs, some of which have been perpetuated deliberately by opponents. And it's much harder to know how the Democrats ever expect to pass a health care bill or similarly complicated policies like cap-and-trade if they wither in the face of polls that reflect less a disparity of opinion and more a poverty of accurate information.

                  http://www.fivethirtyeight.com/...

                  Who knew facts would make such a difference!

                  Well, folks like Prof. Starr, Klugman, The Kaiser Foundation, Cole and others obviously do.

                  So Dems can, should, and must get the facts out to people.

                  But if you say facts don't matter, that only the so called "base" matters, that Dem's haven't accomplished anything, then that must trump reality!

                  Whew, I love a little clarity on a Saturday.

                  We must accept finite disappointment but never lose infinite hope. - Dr. Martin Luther King

                  by Onomastic on Sat Feb 13, 2010 at 09:16:06 AM PST

                  [ Parent ]

          •  Nobody without rose colored glasses seemingly (2+ / 0-)
            Recommended by:
            seanwright, Onomastic

            "understands" the bill or the miracle of Lourdes.

            "Fascism should more properly be called corporatism because it is the merger of state and corporate power." -- Benito Mussolini

            by enhydra lutris on Sat Feb 13, 2010 at 08:40:48 AM PST

            [ Parent ]

        •  I also laugh at (8+ / 0-)

          the contention that the public option was our holy grail. The public option was a comprimise. Singer payer was the holy grail.

          I am also disturbed that anyone would frame this bill as a "huge victory," and doing so, if it passes, could be our real electoral downfall. Its tweaks are nice, but if people conitnue to get premium increases of 39%, they're going to ask what the "huge victory" is. Once they start getting taxes on insurance that is costly through no fault of theirs or being forced to buy what they can't remotely afford, they're going to be really unhappy. Of course, I'm so confused I don't even know if the mandates and the excise tax are still in there, but I hope not for the sake of this "huge victory."

          Stop Rob "The Job Outsourcer" Portman. Jennifer Brunner for Senate http://www.jenniferbrunner.com/

          by anastasia p on Sat Feb 13, 2010 at 05:50:37 AM PST

          [ Parent ]

          •  You don't get to "compromise" before legislative (5+ / 0-)

            negotiations even start.  The public option was progressive's compromise on what we thought an acheivable opening negotiation stance would be.

            "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

            by seanwright on Sat Feb 13, 2010 at 05:52:58 AM PST

            [ Parent ]

          •  Ezra on TRMS last night - horors! (5+ / 0-)

            I am scouring the liberal blogs/diaries for anyone else who is a little miffed at our gal Rachel for letting Ezra Klein streamrole her last night on this very question.

            She opened by saying that she trusts him more than anyone else to give the lowdown on health care reform. She asked him outright about reconciliation. He says that it is the second most boring word in politics --a riff on her riff about filibuster.

            She asks him how long it will take the Congress to pass HCR with reconciliation (at least that is how I remember it, there aren't any transcripts out yet). He ignores that line and goes right for the jugular --starting with blaming Coakley for the entire fucking mess-- by saying that it will take 24 hours for Congress to pass HCR.

            Rachel is mightily impressed. How is this so? she asks.

            So Klein lets it rip. House passes the Senate Bill as is and it lands on Obama's desk and he signs it. Nuff said. 24 hours.

            So Rachel, why didn't you call him on his bait and switch and refusal to engage in a meaningful rap on why the House wants a sidecar and a reconciliation? Rachel just let it all go.........

            McJoan quoted Pelosi yesterday on at least one reason:
            mcjoan notes ~
            Pelosi also said she is open to Republicans presenting new ideas at the Feb. 25 bipartisan health care summit called for by Obama, but she said she’s already seen the Republican health care alternative offered on the House floor and said it only provided insurance for an additional 3 million people instead of the more than 30 million in the Democratic bill.

            So, Rachel, I love ya but come on already with the Ezra worship. Get another point of view next time if all you can deliver is shoving the Senate Bill down our throats End Of Story-like.

            •  Ezra is absolutely right. (14+ / 0-)

              The House needs to be pressured to just Pass. The. Damn. Bill.  If we get a fix that's icing on the cake.  But the Senate bill, as is, is well worth passing and passing it does nothing to prevent a fix later.

              "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

              by seanwright on Sat Feb 13, 2010 at 06:38:15 AM PST

              [ Parent ]

              •  You inspired me to print the above (3+ / 0-)
                Recommended by:
                buckhorn okie, cybrestrike, Onomastic

                as my first diary.

                And I frankly don't think we should not pass the Senate Bill and get this done...but let's not kick the rest of the stuff out of the picture.

                The Senate Bill is basically from the same crew who just cooked up the Jobs Bill that Harry Reid knocked back with a wallop.

                If you haven't read the Ryan Grim piece in HuffPo about the Baucus - Grassley boondoggle K Street WTF!!!! then do it! There is a good reason why progressives need to keep the conversation lively about the crap that is coming out of the Senate Finance Committee.

                And Ezra should be ashamed of himself for continuing to kick at Coakley so completely for the failure of that that election. She shares the blame with Harry Reid and the weeks of imappropriate wrangling and angling to shuffle enough goo into the 60 vote cloture trap.

                The truth is that every decent American was thoroughly disgusted with the Senate and our independent voters peeled off of Coakley in MA toward the only alternative vote: one lucky stiff named Brown.

                •  Always happy to inspire a first time diarist! :) (4+ / 0-)
                  Recommended by:
                  bumblebums, sherijr, Norbrook, Onomastic

                  I don't know who or what is to blame for Coakley's loss exactly.  But I don't blame Harry Reid. The man is the most charism devoid human being I've ever seen in elective office, but I think he's been doing yeomen's work in an utterly thankless job.

                  "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                  by seanwright on Sat Feb 13, 2010 at 07:08:19 AM PST

                  [ Parent ]

              •  kill. the. damn. bill. (0+ / 0-)

                and start over when Obama is out of office; something will have to be done with 5-10 years regardless. The damn thing wouldn't kick in until 2013 anyway.

                The chart above shows SUBSIDSIZED families still paying a whooping 17-22% of their income towards medical expenses!! Unsubsidized families of moderate income could be expected much, much more. To a private, criminal cartel no less! WHOOP-DEE-DO!!

                Don't let the awful be the enemy of the horrifically bad.

                by virtual0 on Sat Feb 13, 2010 at 07:55:24 AM PST

                [ Parent ]

                •  Ha! Ha! Exactly! (7+ / 0-)

                  Oh, wait, your not kidding?  Oh God.

                  "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                  by seanwright on Sat Feb 13, 2010 at 08:17:41 AM PST

                  [ Parent ]

                  •  sorry, but I'm more interested in the big picture (2+ / 0-)
                    Recommended by:
                    wsexson, lcarr23

                    ..the trend this government is going down the privatization road to appease their corporate benefactors is dangerous and is eroding the foundations of our democracy and working and middle classes. This bill epitomizes this trend. We need to start over on the right foot; one that honors the role of government, our working and middle classes, and the democratic processes with our representatives listening to us instead of the lobbyists.

                    Don't let the awful be the enemy of the horrifically bad.

                    by virtual0 on Sat Feb 13, 2010 at 08:32:58 AM PST

                    [ Parent ]

                    •  This bill slaps a whole bunch of new regulations (2+ / 0-)
                      Recommended by:
                      Whimsical, Onomastic

                      on Corporations all to the benefit of consumers.  It also puts about 14 million new people on Medicaid.

                      So what's your problem with that.  You want lasseiz faire?  Leave the poor corporations alone?

                      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                      by seanwright on Sat Feb 13, 2010 at 08:37:58 AM PST

                      [ Parent ]

                      •  We need a plan that has a government-run (0+ / 0-)

                        component; we need to be headed toward the direction of a non-profit system. This bill locks in a privatized, for-profit system. It will leave America as the only industrialized nation with a for-profit healthcare system. It's unsustainable and furthers the trend of this country heading in the wrong direction.

                        Don't let the awful be the enemy of the horrifically bad.

                        by virtual0 on Sat Feb 13, 2010 at 08:56:09 AM PST

                        [ Parent ]

                        •  We don't "need" any such thing right now. (3+ / 0-)

                          What we need is to keep moving the ball down the field.  If you can't replace a corporate function, regulate it.  You are in favor of passing up on a great opportunity out of sheer obstinancy.  You are turning your back on tens of millions of people who will benefit from this legislation for no reason that I can see beyond willful, stubborn pride.

                          "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                          by seanwright on Sat Feb 13, 2010 at 09:27:06 AM PST

                          [ Parent ]

                        •  Wrong. France and the Netherlands, to use just (5+ / 0-)

                          two examples, have Universal Coverage that are a mix of public/private components.

                          The Dutch and the French organize their healthcare differently. In the Netherlands, people buy health insurance from competing private carriers; in France, people get basic insurance from nonprofit sickness funds that effectively operate as extensions of the state, then have the option to purchase supplemental insurance on their own. (It’s as if everybody is enrolled in Medicare.) But in both countries virtually all people have insurance that covers virtually all legitimate medical services. In both countries, the government is heavily involved in regulating prices and setting national budgets. And, in both countries, people pay for health insurance through a combination of private payments and what are, by American standards, substantial taxes.

                          This article examine both systems, how the people within view them, and how they compare to our HC system, or lack there of.

                          http://www.boston.com/...

                          If you read the artical you'll also discover that France and the Netherlands are also facing challenges with their HC systems. Both countries are taking steps to address those issues, including those that introduce more market competition and reward healthcare providers - that is, doctors and hospitals - who get good results.

                          The Senate Bill incorporates lessons learned from European countries like Germany, France and the Netherlands, while moving us towards Universal Coverage.

                          Senator Sanders' expansion of CHC's are non-profit and establish the infastructure of a non-profit system.

                          His Waivers for State Innovation also lead in the very direction you claim to want.

                          There has also been little news coverage of Sanders' fight to allow states waivers so they can move forward with their own "health insurance concepts, including single-payer." Such language is now in the Senate bill and Sanders is still working with Senator Ron Wyden to strengthen it. That is exactly how Canada developed its healthcare system, with a successful program incubated in Saskatchewan. This provision is actually stronger in the Senate bill--it didn't make it into the House version.

                          http://crooksandliars.com/...

                          Sanders' CHC's and State Waivers are but two examples.
                          Medicare expansion is another and so are the Mandates.

                          We must accept finite disappointment but never lose infinite hope. - Dr. Martin Luther King

                          by Onomastic on Sat Feb 13, 2010 at 09:49:24 AM PST

                          [ Parent ]

                        •  And where are you going to find the votes (3+ / 0-)

                          at this late for anything like what you want?

              •  Why not press the senate to pass the house bill? (1+ / 0-)
                Recommended by:
                lcarr23

                Because the likelihood of either is the same, which is basically nil.

                Only, one (will flawed) would be better than the other (while flawed) if it did.

                More and Better Democrats

                by SJerseyIndy on Sat Feb 13, 2010 at 08:20:39 AM PST

                [ Parent ]

                •  Why don't we just start from scratch and insist (1+ / 0-)
                  Recommended by:
                  Onomastic

                  on single payer or government run healthcare or nothing?  We can't pass the House bill in the Senate right now.  We couldn't pass it before when we had 60 votes, we can pass it now when we have 59.  I'm not interested in playing chicken with the conservatives.  They really are crazy and will drive this country off of a cliff before they swerve.  It's incumbent on progressives to keep working for progress and taking what they can get when they can get it.  Even if it isn't as emotionally satisfying as they'd imagined it.

                  "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                  by seanwright on Sat Feb 13, 2010 at 09:57:44 AM PST

                  [ Parent ]

                  •  Exactly, but inverse. (0+ / 0-)

                    We can't pass the Senate bill in the House right now.

                    And 'round and 'round we go... accepting those realities while working to change them.

                    More and Better Democrats

                    by SJerseyIndy on Sat Feb 13, 2010 at 10:10:38 AM PST

                    [ Parent ]

                    •  I don't think you get what I'm saying (1+ / 0-)
                      Recommended by:
                      Onomastic

                      We there are three items on the healthcare menu right now. One, the hous passes the Senate bill and then their is some kind of reconciliation fix. Two the senate passes some kind of reconciliation fix and then the house passes both bills. Three, we get nothing.

                      I'm fine with one or two but prefer one becausevit brings us more clarity more quickly. But I've said many time that we should simultaneously pressure the House to pass the senate bill and the senate to pass the fix.

                      What I'm urging progressives to do is 1. Recognize that the senate bill, as is, is a big advance for social/economic justice and modify your rhetoric accordingly and 2. Pressure both the House and the Senate to pass the Senate bill and fix in whatever order as quickly as possible.

                      I don't see a downside to that approach. I do see a downside to encouraging the house to sit on their thumbs until the senate takes action, which is that the strategy could lead to deadlock, delay & more ugly infighting.

                      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                      by seanwright on Sat Feb 13, 2010 at 12:02:52 PM PST

                      [ Parent ]

                      •  Thank you for stating what so many are thinking. (1+ / 0-)
                        Recommended by:
                        seanwright

                        And by the way, I greatly appreciate your work on this diary and sharing it with the community.

                        Having a discussion based on policy and tactics, not agendas, has been a welcome relief.

                        We must accept finite disappointment but never lose infinite hope. - Dr. Martin Luther King

                        by Onomastic on Sat Feb 13, 2010 at 12:15:36 PM PST

                        [ Parent ]

                        •  They set this whole thing up TO KEEP PRICES HIGH (0+ / 0-)

                          and that's why its a betrayal of Americans.

                          We have to stop wasting 50% of all nongovernmental dollars spent on INSURANCE COMPANIES and billing them.

                          That's it. Deal with it.

                          You people lied and tried to cram a bill down our throats to preserve your obscenely high prices that are killing millions, and you failed.

                          WHAT exactly do insurers give us? (besides denying care) What value do they add BESIDES raising prices SO high that THEY exist? Please, WHAT?

                          by Andiamo on Tue Feb 16, 2010 at 09:31:32 AM PST

                          [ Parent ]

                      •  Who is encouraging the House... (0+ / 0-)

                        to sit on their thumbs?

                        So many strawmen, so little time.

                        The House has decided for itself to sit on their thumbs. The Senate can easily get them off of their thumbs by passing fixes to make their bill better.

                        More and Better Democrats

                        by SJerseyIndy on Sat Feb 13, 2010 at 06:12:30 PM PST

                        [ Parent ]

                      •  You've almost convinced me (0+ / 0-)

                        But I still don't understand how anything at all in the Senate bill addresses the cost of outrageously high premiums, copays, and out of pocket expenses for those of us who don't qualify for the subsidies.  And frankly, the chart you gave doesn't exactly inspire hope for the poor either.  

                        I work with poor children who go without dental care, medicine, and food and their families are not going to be able to afford the premiums or out of pocket expenses any more than they can now.  If they can't afford to feed their children how will these limited subsidies help them acquire decent health care for them?

                        I'm still deeply concerned that this bill relies on voodoo economics and hope that the health care industry and competition will bring the magical cost controls into being and historically that has not happened at all.  I'm thinking of the credit card "reforms" that another Kossack used as proof of what good Obama has accomplished so far.  

                        I don't have such strong objections to passing an HCR bill that gets the "foot in the door" but I also am greatly concerned that the benefits of the senate bill are being trumpeted as the best thing since sliced bread and the average voter will not see or feel that in ways that will positively affect their votes next November.

                        Hope I'm wrong about that.

          •  I agree, the excise tax is ludicrous and that (0+ / 0-)

            alone would result in a "huge victory" for the Republican Party.

            •  The excise tax is a relatively small issue and is (7+ / 0-)

              on the whole good policy.

              Check out Paul Krugman:

              The health insurance excise tax
              OK, clearly I have to weigh in on this. Should there be a limit to the tax deductibility of employer-provided health insurance, which is what the excise tax in the Senate bill is supposed to fix?

              My answer is yes, but the final bill should address the criticisms.

              The argument for limiting the tax exclusion is that the tax break on health insurance encourages over-spending, so limiting it could help in the process of "bending the curve". More generally, since we think the United States spends too much on health for not-so-good results, it makes sense where possible to pay for expanding coverage from the health sector itself. Both arguments are reasonable.

              The counter-arguments seem to run along three lines.

              First, there’s the argument that many "Cadillac" plans aren’t really luxurious — they reflect genuinely high costs. That’s surely true. A flat dollar limit to tax deductibility has real problems. At the very least, the limit should reflect the same factors insurers will be allowed to take into account in setting premiums: age and region.

              Second, there’s the argument that any reductions in premiums won’t be passed through into wages. I just don’t buy that. It’s true that the importance of changing premiums in past wage changes has been exaggerated by many people. But I’m enough of a card-carrying economist to believe that there’s a real tradeoff between benefits and wages.

              Maybe it will help the plausibility of this case to notice that we’re not actually asking whether a fall in premiums would be passed on to workers. Even with the excise tax, premiums are likely to rise over time — just more slowly than they would have otherwise. So what we’re really asking is whether slowing the growth of premiums would reduce the squeeze rising health costs would otherwise have placed on wages. Surely the answer is yes.

              The last argument is that this hurts unions which have traded off lower wages for better benefits. This would be a bigger issue than I think it is if the excise tax were going to kick in instantly. But it won’t, giving time to renegotiate those bargains. And bear in mind that this kind of renegotiation is exactly what the tax is supposed to accomplish.

              A last general point: we really don’t know what it will take to rein in health costs, but that’s a reason to try every plausible idea that experts have proposed. Limiting tax deductibility is definitely one of those ideas.

              Bottom line: the details of the excise tax should be fixed, but it’s on balance a good idea.

              "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

              by seanwright on Sat Feb 13, 2010 at 07:17:19 AM PST

              [ Parent ]

              •  The overspend argument does not make sense. (3+ / 0-)
                Recommended by:
                Kitsap River, wsexson, cybrestrike

                There is little an individual can do to lower the cost of medical treatment.  The only choice most people have is to get seek treatment or not.  Do you think people seek medical treatment for fun and enjoyment?  The effect of this tax will certainly reduce medical expenditures, not price, because fewer will be able to afford the out of pocket and won't seek needed treatment and suffer the consequences, which undoubtedly in some cases will be an early death.  Others will get treatment and then have to declare bankruptcy because of greater out of pocket expenses.  

                Politically, it doesn't even matter if it's good policy or not.  Hurt, or just look like you are hurting, the middle class economically and they will vote for Republicans (aka Brown) and then you can kiss any kind of positive health care changes goodbye.

                Now, as to neutralizing the burden of the tax by passing the savings on to employees with higher pay is laugh out loud funny.  Most people, including the thousands in my company, are not getting raises and are just happy to still have a job.

                •  Of course individuals have little choice on cost (3+ / 0-)

                  That's why you need systemic changes in incentive through regulation and changes to the tax code.

                  Employers sometimes overspend on healthcare because a dollar of money spent on insurance is much cheaper than a dollar spent on wages because its not taxed. How many times have you heard somebody say, I hate my job, the pays lousy, but I can't leave because the benefits are amazing! So people stay on jobs for the gold-plated insurance that never says no.  Meanwhile their doctors are charging fees and providing services that they never could've gotten away with on a more cost-conscious plan.  Thereby artificially increasing demand for services and thereby increasing cost.

                  Frankly, it would be better if the link between work and healthcare was completely severed, but it would be too disruptive.

                  There's always cost and benefits to actions.  Certainly, the excise tax will cause some people with amazing insurance to have slightly less amazing insurance.  Meanwhile, it will start bending the cost curve down, which will benefit everyone and 30 some odd million people who don't have insurance at all will get insurance.

                  I thought the Republicans were the ones who wanted to ensure that the poor stay poor and the rich get richer.

                  "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                  by seanwright on Sat Feb 13, 2010 at 09:39:50 AM PST

                  [ Parent ]

                  •  No one knows if the excise tax will bend the cost (0+ / 0-)

                    curve, as Krugman admits.  We do know that the excise tax is the poison pill of health care.  Pass HCR with the excise tax and you will have Republican rule and that will translate very quickly into health care for the very wealthy only.

                    •  I want to hear the Danish peoples or for that (1+ / 0-)
                      Recommended by:
                      seanwright

                      matter our friends to the North, reactions to the excise tax fixation.

                      They must be torn between laughging their asses off and shaking their heads in complete bafflement at our immaturity and selfishness.

                      We must accept finite disappointment but never lose infinite hope. - Dr. Martin Luther King

                      by Onomastic on Sat Feb 13, 2010 at 10:22:47 AM PST

                      [ Parent ]

                    •  Worst case scenario (1+ / 0-)
                      Recommended by:
                      Onomastic

                      The excise tax doesn't bend the cost curve, it's paid by the insurance companies, thereby helping to provide the revenue stream necessary to provide all of the subsidies that allow 14 million new people to get medicaid and millions more uninsured to get subsidies to buy insurance and yes, people with the most expensive plans, under that scenario, would probably see their premiums increased a little or maybe slight additional co-pays or something.

                      And that's the worst case scenario.

                      Best case scenario, it does help to bend the cost curve and leads to higher wages and taxes on the higher wages people earn pays for all the good things in the bill.  There's really a lot more win in the plan than lose for everybody but the insurance companies and healthcare providers who actually benefit from ever-rising costs.

                      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                      by seanwright on Sat Feb 13, 2010 at 10:41:13 AM PST

                      [ Parent ]

                      •  Wrong, the worst case and most likely scenario is (1+ / 0-)
                        Recommended by:
                        Onomastic

                        that they will cut benefits by raising deductables and co-pays, and increasing premiums, especially for smokers and older employees.

                        These employees will then vote Republican and I think you can take it from there.  

                        •  I think your pretty much wrong on this. (1+ / 0-)
                          Recommended by:
                          Onomastic

                          These Cadillac plans are obtained through large employers who purchase insurance in a risk pool where everyone pays the same basi rate for the same plan. The excise tax will have a marginal impact on a marginal group. It's not going to lead to mass voter revolt. The only reason it's become such a bugaboo on the left is that some of the peopl on whom there is a marginal impact are members of unions. That's why there's been talk of a fix involving exemptions based on income level or union status.  

                          "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                          by seanwright on Sat Feb 13, 2010 at 11:40:10 AM PST

                          [ Parent ]

                          •  Most large employers are self insured and hire a (0+ / 0-)

                            real insurance company to administer their plans and to take advantage of negotiated rates with health providers.  They will bear the tax directly or cut benefits. What do you think they will do?

                          •  I never said costs wouldn't (1+ / 0-)
                            Recommended by:
                            Onomastic

                            be shifted to employees. I jus said that the employees within a given company would not be affected unequally and I don't think it would be a huge effect.  More likely, I think, is that employers opt for plans below the threshold.

                            "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                            by seanwright on Sat Feb 13, 2010 at 12:55:27 PM PST

                            [ Parent ]

                        •  or the elderly could realize that instead of (1+ / 0-)
                          Recommended by:
                          seanwright

                          having to pay ten times higher rates, they'd only be paying 3 times more than a younger person.

                          I smoke. I should pay more, that is if I had insurance in the first place.

                          Frankly I'm not worried about the excise tax.

                          But then, like the majority of Americans, I don't make $200,000 dollars a year.

                          If I did, I still wouldn't be worried about it.
                          If I couldn't take care of my family and afford good insurance while making that kind of money, there's a problem.

                          And it isn't the Senate Bill.

                          It seems at times that those who complain the most are those with the least to lose, while those who have already lost so much or are in danger of doing so are dismissed or marginalized.

                          Anyone who thinks that most American have not or will not figure that out, are saddly mistaken.

                          We must accept finite disappointment but never lose infinite hope. - Dr. Martin Luther King

                          by Onomastic on Sat Feb 13, 2010 at 11:57:43 AM PST

                          [ Parent ]

        •  The point of my diary was to try to melt your (9+ / 0-)

          ice cold heart so you could feel the love, Ruff.

          "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

          by seanwright on Sat Feb 13, 2010 at 05:54:06 AM PST

          [ Parent ]

        •  Well (5+ / 0-)

          We don't believe you. Perhaps if your team would bring credible evidence to the table instead of rhetorical flourishes, you'd make a more convincing case. :)

          Much of the Emanuel Derangement Syndrome on this site can be traced to the convergence of two old and ugly stereotypes, of the black man and the Jew. *blueness*

          by indubitably on Sat Feb 13, 2010 at 07:21:21 AM PST

          [ Parent ]

      •  So is using language (6+ / 0-)

        like "centrists" (a meaningless term) to refer to those on our side blocking the bill because they are agents of special interests. There is nothing remotely "centrist" about these people and "centrism" is not their motivation.

        Stop Rob "The Job Outsourcer" Portman. Jennifer Brunner for Senate http://www.jenniferbrunner.com/

        by anastasia p on Sat Feb 13, 2010 at 05:47:52 AM PST

        [ Parent ]

      •  Poor, poor babies. (1+ / 0-)
        Recommended by:
        lcarr23

        Why would anyone ever want to take on a big progressive cause again if their reward for handing progressives a huge victory is a bunch of progressives shrieking sell out?

        Those Senators and WH worked their darned butts off to serve us little guys! They heard the voices of 85% of us and went on the airwaves day and night to argue passionately for their case for single payer and the public opion! They stood up to Republicans and made them bow to  majority rule! They dethroned Olympia Snowe. They twisted Blue Dogs arms. They sent Insurance and Hospital lobbyists packing and said "no backroom deals for you!" They told Pharma drug re-importation was on the table to make drug prices affordable for the average America.

        They worked late into the night and over the weekends to get the bill passed to save the lives of 1000s uninsured dying each day and many more going bankupt from medical costs. They made sure that the little guy pays 20%+ of their income to a private, for-profit criminal cartel that is forever raising its rates far beyond the rate of inflation and shifting it policies to make them more onerous and unreliable by the day. They made sure America remains the only modern nation with a for-profit, privatized healthcare system.

        Yes, the WH and Congress - always looking out for the corporate interests little guy, and still the little guy isn't grovelling at their feet in perpetual adoration! Those ungrateful whiners!

        Don't let the awful be the enemy of the horrifically bad.

        by virtual0 on Sat Feb 13, 2010 at 08:15:57 AM PST

        [ Parent ]

        •  I'm sorry you're so blinded by terminal (3+ / 0-)

          resentment that you can't help but bit the hand that reaches out to assist you.  Not really sure what to say other than that to your particular brand of fact free paranoiac rant.

          "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

          by seanwright on Sat Feb 13, 2010 at 08:20:51 AM PST

          [ Parent ]

          •  what is fact-free about my 'rant' (1+ / 0-)
            Recommended by:
            lcarr23

            and in what way is it paranoid? Facts please.

            Don't let the awful be the enemy of the horrifically bad.

            by virtual0 on Sat Feb 13, 2010 at 08:27:14 AM PST

            [ Parent ]

            •  Pehaps he's referring to the diary. (4+ / 0-)

              You know, up there ^^^^^^^^^^?

              It had all these charts and research done by scholars, Pulitzer Prize winners, policy wonks and stuff.

              We must accept finite disappointment but never lose infinite hope. - Dr. Martin Luther King

              by Onomastic on Sat Feb 13, 2010 at 10:04:55 AM PST

              [ Parent ]

            •  I'm not sure how to respond. (2+ / 0-)
              Recommended by:
              mem from somerville, Onomastic

              By exhaustively listing all of the known facts in the world and observing that none of them are present in your comment?

              It's the sort of generalized unsubstantiated suspicions about underhanded dealings that led me to call it paranoid.

              Yes, there were a lot of negotiations that went on in a lot of rooms that had doors and a lot of times those doors may well have been closed rather than open.

              Yes, representatives from various effected industries were consulted.

              And yes, accomodations were made to lots of powerful special interests.

              That is inevitable and if you can't handle it and would rather get no change, then that's on you.

              But what emerged was a bill that overwhelmingly is for the benefit of ordinary citizens, particularly those who need help the most.

              But you don't want legislation to go forward because your paralyzed by the fear that somewhere, someone in some corporate boardroom in some undisclosed location is making a profit off of this whole thing.

              "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

              by seanwright on Sat Feb 13, 2010 at 10:09:08 AM PST

              [ Parent ]

  •  I eagerly await (5+ / 0-)

    to see what these experts say once the bill is fixed and passed!

  •  Just for clarity (6+ / 0-)

    You should probably point out in your diary the fine print at the bottom of Gruber's chart.

    Also:

    So, I urge you to call your Senators and Representatives and ask them to finish the job now and do whatever they can to make the Senate bill even better.

    I think that in order to urge them to do whatever they can to make the bill better, one has to first point out what needs fixing.

    All together now. :)

    Move Your Money The truth is too big to fail. Justice is too big to fail. Peace is too big to fail.

    by Burned on Sat Feb 13, 2010 at 05:18:40 AM PST

    •  There's so many diaries on what's wrong with the (14+ / 0-)

      bill, I didn't think we needed one more.  I just wanted to point out what was right with the bill.  Which in my opinion is  a lot.  I figured the thing was long enough anyway without adding a bunch of stuff about increasing subsidies, expanding medicaid, etc.

      My point was also that passing the Senate bill, as is, without any fix would, in and of itself be a huge victory.

      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

      by seanwright on Sat Feb 13, 2010 at 05:23:20 AM PST

      [ Parent ]

      •  Your point is to silence those (2+ / 0-)
        Recommended by:
        mint julep, buckhorn okie

        that want to fix it and then pass it.
        Not going to happen.

        Move Your Money The truth is too big to fail. Justice is too big to fail. Peace is too big to fail.

        by Burned on Sat Feb 13, 2010 at 05:28:21 AM PST

        [ Parent ]

      •  Frankly, I have been hammered to death (4+ / 0-)

        with a list of what's right about the ill. Mostly it's nice little tweaks that won't directly affect most of us. What I want to know is how it's going to prevent my premium from going up 90% NEXT year too so that I have to drop to an even MORE worthless tier of coverage. I had to drop this year to one that prevents me from seeing a doctor for anything short of life-threatening because co-pays are now two weeks grocery money.

        Stop Rob "The Job Outsourcer" Portman. Jennifer Brunner for Senate http://www.jenniferbrunner.com/

        by anastasia p on Sat Feb 13, 2010 at 05:52:17 AM PST

        [ Parent ]

        •  Cost containment is one of the bills weaknesses (3+ / 0-)
          Recommended by:
          yella dawg, sherijr, Onomastic

          There is no sure fix for containing cost growth.  But read Gawande's articl linked in the diary.  He says that the pilot programs created by the bill are a smart way to start dealing with the issue.

          "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

          by seanwright on Sat Feb 13, 2010 at 06:03:43 AM PST

          [ Parent ]

          •  When insurance companies (1+ / 0-)
            Recommended by:
            Onomastic

            show record profits and still go for double digit premium increases, it isn't about cost containment. It is about abuse of the system and customer fraud.

            One major problem with the Senate bill is there no central regulatory system with the power to police insurance companies. That isn't cost containment that is just sensible public protection when you are demanding they become customers of a private company by law.

            Nor is there a real bottom line basic insurance plan that is a non profit baseline (96% Medical loss ratio) that all insurance companies must offer which is also another common sense requirement to mandate insurance purchase.

            For the Senate bill to have real teeth and not be a disaster both politically and as policy both those factors should have been addressed and included. Without doing that what little the bill gets right, will be wiped out by what it gets wrong.

            When the cheerleaders have an adequate answer for those problems and a means to correct them IMMEDIATELY, then there is ground for discussion. Until then it is nothing more then ignoring the gaping holes in the foundation while looking at the one brand new two by four under the front door.

            •  Actually there are things in the Senate bill to (1+ / 0-)
              Recommended by:
              Onomastic

              address precisely the issues you raise.  

              From the New York Times:

              Insurers competing in the new exchanges would be required to justify rate increases and those who raise prices excessively could be barred from the exchanges.

              Insurers would be required to spend more of their premium revenues — between 80 to 85 cents of every dollar — on medical claims. According to a recent Senate Commerce Committee analysis, the largest for-profit insurance companies spends about 74 cents out of every dollar on medical care in the individual market.

              Plus the much despised excise tax puts downward pressure on rising premiums.

              Plus there's a whole host of pilot programs designed to try to find ways to begin controlling costs better.

              I appreciate the substantive nature of your point.  This is precisely the sort of exchange I was hoping to have when I wrote the diary.

              "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

              by seanwright on Sat Feb 13, 2010 at 08:51:46 AM PST

              [ Parent ]

              •  Actually (1+ / 0-)
                Recommended by:
                seanwright

                all that is smoke and mirrors as the Senate doesn't provide any real authority to oversee Insurance companies throwing most of that to the states. So make that "could" into "maybe, perhaps, if we can" about the exchanges, especially since most state agencies do not have that authority. As for the little they have kept on a national level, they provide little to no power to enforce any decision.

                Also look at excise tax logically. It doesn't really put any pressure on the insurance company setting premium increases as it will just become part of the premium, it puts pressure on the party purchasing the insurance - that is who really faces the excise tax. The insurance companies will just sell cheaper policies with less responsibility as most companies will purchase policies with less coverage and higher co-pays and deductibles - meaning the companies will still be spending the same amount or less  but still getting their 20 percent for Medical Loss Ratio.  

                Certainly if the insurance companies raise their prices to a certain point all policies will be considered cadillac and most if not all employer health insurance will be dropped. And as everyone becomes individuals in the insurance market the excise tax becomes pretty much an individual surcharge if it doesn't disappear at all.  But in the process of that happening more and more people will have less and less coverage - and more will face medical bankruptcy. What A WIN for health care reform!

                I do realize that is the goal of the excise tax, but part of the way it was sugar coated was that the money companies use for insurance would convert to higher wages for employees. Something that is with few exceptions a pipe dream. So the taxes (increased income taxes or the excise tax)  that were expected to help pay for the HCR subsidies will not exist - leading to cutting said subsidies OR an increase in tax rates or other excise taxes to cover the subsidies.

                Why not at least be realistic and demand that all savings from reduction or elimination of employer based plans be turned into increased wages for individual insurance purchase hence making the increase in income tax collection at least accurate (and protecting the people who have fought long and hard and forgone wage increases for those benefits.) I won't get into why that isn't on the agenda or in the bill, but suffice it to say that the same corporate owned senators who designed this bill wouldn't want to piss off their real constituents by doing that - even if it is a more honest representation of cost and savings.

                As to the medical loss ratio, frankly that is too high even for the profit section. The fact that people look at and post that as reasonable doesn't make it so. That is pretty much the Medical Loss Ratio now, and we all know there are record profits. It shouldn't be less then 90 percent.  As for the base/bare bones insurance for the mandate, once again if you are going to require by law purchase of a product from a private entity you should require said product be NON profit - meaning no extra money for advertising or big bonuses or lobbying congress only money for administration and cost and reasonable salaries which would easily put the Medical Loss Ratio in the low to mid nineties. Adding to the basic policy would have to be the profit center.

                •  I'll rec for getting in and wrestling with the (1+ / 0-)
                  Recommended by:
                  Onomastic

                  facts.  Some of your views on what will happen seem like reasonable enough guesses, but, to paraphrase the President at the Q & A, I haven't seen a credible economist who would back what you say up.

                  The excise tax, by design will change the way the employment based health insurance market works to some extent.  I haven't seen anyone making the apocalyptic claims your making.

                  There's three ways this can go:

                  1. Best case scenario: the excise tax kicks in, the highest cost plans go the way of the dinosaur, employees get slightly less costly plans that still provide good coverage, employers pass savings on to employees as higher wages, employees pay income and payroll tax on increased wages, that increase in tax revenue goes to help pay for the 14 million new low income medicaid recipients and subsidies for millions more self-insured middle and lower income families.
                  1. Middle case scenario: the excise tax kicks in, the highest cost plans go the way of the dinosaur, employees get slightly less costly plans that still provide good coverage, employers pocket the savings as profits, employers pay tax on increased profits, that increase in tax revenue goes to help pay for the 14 million new low income medicaid recipients and subsidies for millions more self-insured middle and lower income families.
                  1. Worst case scenario: the excise tax kicks in, employers keep buying plans expensive enough to be subject to the excise tax, the premiums become a little higher or the benefits become a little less good or both, the insurers pay the excise tax, that increase in tax revenue goes to help pay for the 14 million new low income medicaid recipients and subsidies for millions more self-insured middle and lower income families.

                  I don't think even the worst case scenario is all that bad.  Yes, it does put the lie to the fact that everybody gets to keep their plan if they like it.  But if we do nothing and premiums keep rising lots of people are going to lose their insurance or have their benefits reduced.  There's no way around it.

                  I don't see anything in your post that would lead anybody to reasonably conclude that we are somehow better off with the status quo than we would be if the Senate bill were passed as is.

                  "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                  by seanwright on Sat Feb 13, 2010 at 01:58:50 PM PST

                  [ Parent ]

                  •  Where in your scenarios (0+ / 0-)

                    is the employers stop providing health care insurance, pocket the savings and put their employees into the exchanges as individuals having lost both coverage and now having an increased expense of 8 percent (or more) of their income?

                    Because that is a very real possibility. In fact it is the most likely scenario for smaller and non union businesses in higher cost regions. Just because the backers of this plan don't want to discuss it doesn't make it any less real. That is a real worst case scenario.

                    As to your worse case scenario, most people who have the so-called cadillac plans would consider that the BEST case scenario. As they get to keep their coverage with the least amount of change. You know people like miners and factory workers and truck drivers, who have some real reasons why their plans cost so much which have little to do with things that really affect their health if they have less coverage and have little to do with excess health care. And who will remember who did this to achieve little or nothing to make their lives better and as in Massachusetts just won't show up to vote.  Which only proves that you aren't looking at this in any realistic manner.

                    For instance in your middle case scenario you still have the excise tax paying for 14 million who have no coverage. WRONG. That has little or no chance of that happening, as business tax rates on the profit won't begin to be the same as either the excise tax or the personal income tax rate on increased wages. This is part of the reason that most economists backing the Senate plan waffle about the figures presented for the excise tax - the model is flawed. Business pocketing the savings doesn't provide the numbers the others do and that wasn't scored by the CBO.

                    Sorry, but you keep ignoring the lack of a designated basic plan, and the lack or real regulatory authority in the Senate plan. If you are going to model your system off the Swiss and Netherlands you really have to follow through on what makes it work. Add to that a very real lack of understanding that using a tax plans that lessens people's coverage for health care reform is going to piss them off, especially since even liberals aren't going to go for it when it doesn't really fund the totally inadequate numbers of uninsured that the Senate plan covers. There are very real reasons thinking people would reasonably conclude we are better off with the status quo then we would be if the Senate bill were passed as is.

                    If the Dems want to save this disaster at all, the only answer is reconciliation,  cleaning up the Senate bill along the way and attempting to do it right, with real regulatory oversight and real funding choices.  Especially since there aren't the votes in the House to pass the Senate bill as is anyway.

                    •  Sorry I didn't deal with all of your questions (1+ / 0-)
                      Recommended by:
                      Onomastic

                      and contentions last time.  I'm afraid I'm not going to be able to do so now, either. And, frankly, I'd hate to use all of the energy necessary to thoroughly address your points this late in a pretty much extinct thread.

                      What I'd like to do, with your permission, is use your comment in another healthcare diary where I can adequately address it point by point.

                      If you'd like, I could email my draft to you before I publish and I would include any rebuttal you wanted to give in the text of the diary.  I would publish it on Monday as I'm going to have my hands full with Valentine's day tomorrow.

                      Having said that I'll just give you the bare outline of how I'd respond.

                      First, I'd note that you seem to be mostly concerned with how the bill will affect people who are currently doing well under our present system.  I think it is hard to argue that people who are uninsured right now are somehow better off at present than they would be under the Senate bill.

                      I would also note that "status quo" doesn't mean everybody just gets to keep what they have.  For one thing people who are doing well today could turn into people who are in dire need as a result of a prolonged illness or job loss.  Furthermore, the present situation is that healthcare costs are skyrocketing and the quality of peoples' insurance is deteriorating at ever increasing rates and larger and larger numbers are joining the ranks of the uninsured.

                      With respect to the rest of your contentions: I think the Senate bill does a pretty decent job of preventing employers from dumping employees into the exchange through its employer mandate and other regulations.

                      With respect to your contentions about regulations and the designated plan, I agree that those could use strengthening, but don't think the bill is as weak in that area as you seem to think.

                      And I think the excise tax is generally expected by economists to work better than you seem to think it will.

                      Okay, let me know what you think of my proposal.

                      Thanks,

                      Sean

                      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                      by seanwright on Sat Feb 13, 2010 at 05:47:53 PM PST

                      [ Parent ]

                      •  Mmmm. (0+ / 0-)

                        We'll have to disagree about the efficiency of the excise tax. And about the strength of the employer mandates, which I think you vastly overestimate.

                        As to coverage, if we had a real blue print, I might be persuaded. What is considered the minimum access to health care that people should have? What is considered adequate? What is considered good? What is considered excellent? What is considered gold plated over the top? The big problem with the excise tax is it is based on cost not on what the policy offers. For instance just on region alone the same policy in one region might be one cost, and in another might be double that cost. So why would that policy be 'cadillac' if you got it in say New York and not Nebraska? Now consider the fact that double digit premium increases are the norm and there is a time lag before most of the things that are supposed to bring down costs check in. How many plans become 'Cadillac' during that time.  Think about it when you are asking people to accept less coverage and less access to health care in a health care reform bill because they live in one region and not another or because there has been no real containment of actual health care costs.  But then I don't think anyone should be trying to make the case that some people should be ending up with less access to health care in order to pay for health care reform. Especially since there are more effective ways, as in the house bill, to pay for the subsidies and coverage of the uninsured which do not do that.

                        Good luck with your diary, I hope you can change my mind. I'm glad you are going to try to address my concerns. While I think that this is a case where intelligent people of good will can honestly and deeply disagree, I do believe that the more things can be discussed the better. As in the better everyone's understanding of what the various health care reform options offer and don't offer, the difficulties in getting them to law and what problems people see in the bills both for policy and politics.

                        Unfortunately I would prefer you keep quotes to a minimum or  just paraphrase anything of mine you choose to use.  Mostly because I probably will not have the time to respond to another diary depending on when you publish. I'm pretty much awol during the week and I hate to say that trying to get more then 6 hours of sleep will continue to be my priority during that time. Feel free to do what you need to keeping that in mind.

        •  With all due respect (11+ / 0-)

          there's unanimity from credible left-of-center health care policy wonks (including the guy who came up with the public option in the first place) that the Senate bill is a decent (not great) bill that would help millions of Americans. The CHCs would have affected more people than the House public option would.

          It's a portion of the activist community who has for whatever reason been repeating enough talking points about how the Senate bill is a crap bill that has talked itself into believing a lot of things about this bill that are completely false.

      •  This like declaring victory in 1943 (3+ / 0-)
        Recommended by:
        Hiroprotag, buckhorn okie, 2laneIA

        and packing up and leaving World War Two.  We liberated Sicily and Tarawa!  An historic victory!

        Pathetic failure, that would have been.

        •  I'm not asking anyone to declare victory (6+ / 0-)

          Just stop accusing our generals and troops of treason.  And maybe even give them a little pat on the back before you urge them on to other battles.

          "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

          by seanwright on Sat Feb 13, 2010 at 06:05:40 AM PST

          [ Parent ]

          •  Low expectations of Congress (0+ / 0-)

            will get you the third-rate results you deserve.

            Just how much is too much to pay for health care?

            Should average Americans give up college educations for their children so they can have price-rigged health care and a roof over their head?

            We all need to raise our expectations if we are ever going to get out of this mess our Congress has gotten us into on so many fronts.

            Why on earth should the American people accept representatives further extending to insurance companies an anti-American, anti-competitive, anti-trust license to steal?

            Why should we accept representatives who aren't competent enough to resolve this problem when they have overwhelming support from the people they represent (name just ONE republican or democrat you know who wants to be overcharged by twice the going rate or who would object to paying lower prices)

            Why on earth should Americans accept that they pay twice as much for health care and die sooner?
            (with rates are expected to DOUBLE in ten years)

            Why should insurance, drug and other health care interests be able to name whatever random amount they'd like to remove from each American wallet so a few can take unearned profits home and milk average Americans? (and especially for products and services that mean life or death) That's extortion.

            Why shouldn't health interests have to compete for a living like the rest of Americans who have to pay them?

            WHO says we shouldn't either convince members of this Congress to take their oaths and responsibilities more seriously or else replace them with others who will?

      •  Plenty is right. (2+ / 0-)
        Recommended by:
        2laneIA, Anglo

        And plenty of peole already accept that.

        What we, (or I, personally, anyway) refuse to accept is a concerted effort by those who would demand we rush the Senate bill through the House before we make it more right.

        Because having the best bill possible is something worth working for, not something worth sacrificing through capitulation.

        More and Better Democrats

        by SJerseyIndy on Sat Feb 13, 2010 at 06:10:03 AM PST

        [ Parent ]

        •  is it worth sacrificing the bill altogether? (5+ / 0-)
          Recommended by:
          Sylv, Whimsical, seanwright, sherijr, Onomastic

          if this game of purity chicken kills the bill, then what?

          People are upset Obama hasn't solved all the problems yet. C'mon, he's only been in office one year...the man went to Harvard, not Hogwarts. - Wanda Sykes

          by Cedwyn on Sat Feb 13, 2010 at 07:33:56 AM PST

          [ Parent ]

          •  Who suggests sacrificing the bill altogether? (0+ / 0-)

            I'm not seeing that.

            What I see, and maybe you see something different, is a concerted effort to push the Senate to make their version of the bill better in fixes through reconciliation before the House passes the original version of the Senate bill. Likewise, I also see a concerted effort to push the House to pass the original Senate bill as is.

            I'm not seeing any concerted effort to sacrifice the bill altogether (except by Republicans, of course).

            However, if the two above concerted efforts conspire to cause the sacrifice of the bill altogether, then what? I suspect then there will be more finger-pointing and hand-wringing than there was after The Debacle of MA.

            And like The Debacle of MA, many on all sides will be right.

            More and Better Democrats

            by SJerseyIndy on Sat Feb 13, 2010 at 09:01:31 AM PST

            [ Parent ]

            •  the thing is, though (1+ / 0-)
              Recommended by:
              seanwright

              is that the fixes are a cudgel that can kill the bill.  opposing them kills the bill.  it's a weapon for conservadems and GOoPers, who don't want any reform, to wield.  pass the bill and get to fixing it and the entire dynamic is different.

              People are upset Obama hasn't solved all the problems yet. C'mon, he's only been in office one year...the man went to Harvard, not Hogwarts. - Wanda Sykes

              by Cedwyn on Sat Feb 13, 2010 at 11:42:47 AM PST

              [ Parent ]

              •  You might not have noticed... (0+ / 0-)

                but the bill is dead without the fixes.

                Hence, the round and round...

                More and Better Democrats

                by SJerseyIndy on Sat Feb 13, 2010 at 06:09:31 PM PST

                [ Parent ]

                •  I don't agree (0+ / 0-)

                  The progressive caucus is constantly drawing lines in the sand and then getting pushed back across them.  If Obama cracks the whip hard enough, they'll jump.  As they should.

                  "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                  by seanwright on Sat Feb 13, 2010 at 07:41:38 PM PST

                  [ Parent ]

                  •  Time will tell, I suppose. (0+ / 0-)

                    Personally, I find myself tending to agree with you. But I'll not find myself encouraging them to jump again, and further compromise their own Party platform to those demanding they do.

                    Because I'm of the opinion that:

                    the problem is not House Progressives standing up not only for the policy pledges contained in the Democratic Party Platform, but also for policies supported by a majority of the American public...

                    BUT...

                    the problem is Senate ConservaDems standing in the way of not only policy pledges contained in the Democratic Party platform, but also policies supported by a majority of the American public... and Senate Dems who refuse to work around them.

                    More and Better Democrats

                    by SJerseyIndy on Sat Feb 13, 2010 at 07:59:25 PM PST

                    [ Parent ]

                    •  I agree with you about the Senate Conservadems (0+ / 0-)

                      I think Lieberman and Nelson are awful and I think Landrieu and Lincoln aren't far behind.  But when you are no longer dealing with a 60 vote threshold and only need 50 votes (with Biden as tiebreaker), I actually think the Senate is at least as liberal as the House.

                      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                      by seanwright on Sat Feb 13, 2010 at 08:14:06 PM PST

                      [ Parent ]

        •  The point (9+ / 0-)

          I see seanwright making is that we'll get NOTHING if we continue to trash this bill alongside the wingers. The "fixes" that are being discussed would be good, but they are mostly incidental to the overall impact of the current Senate bill. Our voices could help the American people realize the major reform this bill would bring - but right now, they're not hearing that from us because so many are hell-bent on what they see as the bill's weaknesses.

          Almost everything you do will seem insignificant, but it is important that you do it. - Mahatma Gandhi

          by NLinStPaul on Sat Feb 13, 2010 at 07:59:46 AM PST

          [ Parent ]

          •  No "trashing alongside the wingers"... (0+ / 0-)

            as you call it, is needed to get nothing.

            As a result of a standstill resulting in policy differences, we're getting nothing as it is, with not one more word needed.

            I'm pretty sure criticism of the Senate bill isn't what's keeping it from being passed in the House.

            What's keeping it from being passed is it.

            So, it clearly needs to be changed.

            More and Better Democrats

            by SJerseyIndy on Sat Feb 13, 2010 at 09:05:30 AM PST

            [ Parent ]

      •  If you'll notice... (0+ / 0-)

        some ("many"? surely not "all", but surely not "a couple") of those diaries that point out what's wrong with the bill ALSO take time to point out what's right with the bill. It's just that the focus is on what's wrong with the bill, so as to get it fixed to make it better. Which would be an even huger huge hugistic victorious victory.

        So, why not?

        More and Better Democrats

        by SJerseyIndy on Sat Feb 13, 2010 at 08:26:20 AM PST

        [ Parent ]

  •  I Am A Liberal But I Am Not An Idiot (13+ / 0-)

    The house should pass the damn senate bill.  The house could pass the bill tomorrow and it could be on the President's desk on Monday. PASS THE DAMN BILL!

  •  If you think that families of four (3+ / 0-)
    Recommended by:
    buckhorn okie, wsexson, Burned

    with those income levels will be able to afford those premiums, never mind the total risk, you do not appreciate what it costs a family of four to live. In fact, many people who do not have children would have a hard time suddenly losing ten or twenty percent of their income. And the kicker is, that money goes to insurance companies like Anthem Blue Cross, not to health care providers.

    "We have met the enemy, and he is not us."

    by 2laneIA on Sat Feb 13, 2010 at 05:28:11 AM PST

  •  You obamamots = teh suck. :) (6+ / 0-)

    Between birthers, deathers and mouth-breathers, the gop has got 'teh crazy' and 'teh stoopid' covered.

    by amk for obama on Sat Feb 13, 2010 at 05:30:00 AM PST

  •  Thanks for this and the chart (6+ / 0-)

    especially.  Real numbers have been mostly missing from the debate here.

  •  Your blithe assumption (2+ / 0-)
    Recommended by:
    Sylv, buckhorn okie

    that you can purchase insurance after you get sick or injured, and have it cover your hospitalization or treatment that occurs prior to buying it is probably wrong.  Plus, you have to be well enough to be able to conduct the transaction to get covered going forward. And I suspect that the premium will be quite high, which the Senate bill allows.

    "We have met the enemy, and he is not us."

    by 2laneIA on Sat Feb 13, 2010 at 05:34:11 AM PST

  •  Awww, those poor wibble Democratic Senators (6+ / 0-)

    "Progressives" weren't the ones who went off in the back room to cut a deal with Billy Tauzin that took hundreds of billions of dollars in potential cost savings off the table.

    "Progressives" weren't the ones who put in a Cadillac tax on people who actually have good health care plans at present, and progressives weren't the ones who went into another back room to give certain unions an exemption from said tax for no good reason whatsoever other than pure politics.

    "Progressives" weren't the ones who went into another back room and weakened the Public Option, taking more cost savings off the table, and progressives weren't the ones who went into another back room and removed it entirely to make Joe Lieberman happy, even though it was a popular feature.

    "Progressives" weren't the ones who right in front of everyone put in an amendment in the House bill that would probably reduce the access to reproductive services that women with private insurance enjoy now.

    There are things that weakened public support for the bill, not progressives complaining about them. The Cadillac tax alone was probably responsible for Scott Brown in Massachusetts and without his victory, health care would be law right now.

    •  Here's another great quote from Starr's article (7+ / 0-)

      that I didn't include in my diary:

      If immaculate conception is a requirement for good public policy, few great legislative achievements will meet the test. The concessions on health-care reform are not nearly as egregious as the concessions made to pass Social Security in 1935, when Democratic leaders placated Southern lawmakers by excluding agricultural workers and domestics, who happened to be heavily African American. To pass Medicare in 1965, Congress bought off the hospitals and doctors by agreeing to pay the former according to their costs and the latter according to their "customary" and "prevailing" rates. Those policies did long-term fiscal damage. By comparison, while making financial concessions to health-care interests, the current legislation claws back some of the revenue through taxes on those industries and ends excessive payments to private health insurers under Medicare.

      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

      by seanwright on Sat Feb 13, 2010 at 05:59:58 AM PST

      [ Parent ]

      •  The taxes on those industries (4+ / 0-)

        are going to be paid by us, in the form of higher premiums.  The excise tax doesn't save money.  It just shifts costs to make the bill look better.

        The concessions would probably be seen differently if they were given to secure another great government entitlement program like Social Security, rather than requiring individuals to buy private insurance insurance with no meaningful cost controls and the IRS collecting a penalty if you don't hand over the money.

        "We have met the enemy, and he is not us."

        by 2laneIA on Sat Feb 13, 2010 at 06:07:53 AM PST

        [ Parent ]

        •  Weird (10+ / 0-)

          The taxes on those industries are going to be paid by us, in the form of higher premiums.  The excise tax doesn't save money.  It just shifts costs to make the bill look better.

          This looks like a classic GOP argument against taxation of corporations and businesses - that the tax will just be passed on to consumers and workers.

          Is this now the liberal Democratic position on taxing corporations?  Watching this argument being made by those on the left has been one of the weirdest things I've witnessed in the HCR debate.  

          "You must be the change you wish to see in the world." -Gandhi

          by Triscula on Sat Feb 13, 2010 at 06:14:44 AM PST

          [ Parent ]

          •  Here's what one of those GOP unions had to say (2+ / 0-)
            Recommended by:
            buckhorn okie, pragprogress

            about the excise tax.

            This tax would have a dramatic effect on those plans forcing steep reductions in benefits, shifting of costs to workers and a significant increase in taxes on millions of middle-class families.

            The excise tax was a significant factor in why Martha Coakley lost, and what happened in Massachusetts could happen in a lot of other places later this year.

            "We have met the enemy, and he is not us."

            by 2laneIA on Sat Feb 13, 2010 at 06:50:42 AM PST

            [ Parent ]

            •  Was it? (3+ / 0-)

              The excise tax was a significant factor in why Martha Coakley lost, and what happened in Massachusetts could happen in a lot of other places later this year.

              Is there polling to support that?  Everything that I have read suggests otherwise.  

              "You must be the change you wish to see in the world." -Gandhi

              by Triscula on Sat Feb 13, 2010 at 07:02:06 AM PST

              [ Parent ]

              •  Yes. (2+ / 0-)
                Recommended by:
                buckhorn okie, Onomastic

                Wall Street Journal:

                Republican Scott Brown's victory in the Massachusetts Senate race was lifted by strong support from union households, in a sign of trouble for President Barack Obama and Democrats who are counting on union support in the 2010 midterm elections.

                A poll conducted on behalf of the AFL-CIO found that 49% of Massachusetts union households supported Mr. Brown in Tuesday's voting, while 46% supported Democrat Martha Coakley. The poll conducted by Hart Research Associates surveyed 810 voters.
                ...
                Guy Molyneux, a pollster with Hart Research Associates, said the poll showed "pretty strong evidence" of voters who worried the health-care overhaul moving through Congress would tax their employer-provided benefits, even though Mr. Obama had agreed to a deal that exempted workers in collective bargaining agreements until 2018.

                "We have met the enemy, and he is not us."

                by 2laneIA on Sat Feb 13, 2010 at 07:11:05 AM PST

                [ Parent ]

                •  I don't see mention of the excise tax there (4+ / 0-)

                  Did the polling directly address that issue?  I'm going to assume that it didn't since I think you would have cited it if it did.  Concerns about the health care overhaul doesn't = "the excise tax cost Coakley the election".  I will grant that a complete lack of vocal support and explanation of the proposed overhaul has definitely contributed to confusion,ambivalence, and worry about what reform will mean and how it will benefit people.  Could that have played a role?  Sure.  However, I think most of the responsibility for that loss lies with Coakley herself, the state party, and the DNC.  From what I understand, the analysis and polling following the election supports this.

                  "You must be the change you wish to see in the world." -Gandhi

                  by Triscula on Sat Feb 13, 2010 at 08:38:04 AM PST

                  [ Parent ]

                  •  Yeah but some conservative pollster said that it (3+ / 0-)

                    was "pretty strong evidence."  Case closed.

                    "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

                    by seanwright on Sat Feb 13, 2010 at 08:57:01 AM PST

                    [ Parent ]

                    •  There's this great tool called Google (1+ / 0-)
                      Recommended by:
                      pragprogress

                      which is handy for keeping you from making an absolute fool of yourself.

                      The Garin-Hart-Yang Research Group, the political division of Peter D. Hart Research Associates, is one of the most respected and successful political polling firms in the country for Democratic candidates. The firm has assisted in more than 400 political campaigns and counts among its current clients 10 members of the U.S. Senate, 16 members of the U.S. House of Representatives, and five sitting governors. Garin-Hart-Yang also has been the lead pollster on the influential Women's Monitor national polling projects for EMILY's List over the past four election cycles.

                      "We have met the enemy, and he is not us."

                      by 2laneIA on Sat Feb 13, 2010 at 09:44:35 AM PST

                      [ Parent ]

                  •  You have to be able to put together a few facts. (1+ / 0-)
                    Recommended by:
                    pragprogress

                    First, what the pollster says the voters said.  Two, the way that GOP has framed the excise tax from the get-go and what Brown campaigned on.  Three, there is no other "tax on benefits" on the table.

                    If you have a different understanding about election  polling, then link to it.  There were no exit polls.

                    "We have met the enemy, and he is not us."

                    by 2laneIA on Sat Feb 13, 2010 at 09:57:17 AM PST

                    [ Parent ]

                  •  It does mention the excise tax . . . (1+ / 0-)
                    Recommended by:
                    2laneIA

                    the poll showed "pretty strong evidence" of voters who worried the health-care overhaul moving through Congress would tax their employer-provided benefits

                    That's a specific reference to the excise tax, which is a tax on employer-provided benefits.

          •  Excise tax tool to unwind employer-based subsidy (3+ / 0-)
            Recommended by:
            buckhorn okie, 2laneIA, Onomastic

            I was surprised to see Klein liking this Bush-McCain drum-beat in reading TRMS transcript this morning:
            'The Rachel Maddow Show' for Tuesday, February 9th, 2010'

            Ezra Klein:
            "What John McCain and George W. Bush proposed, which were, again, bigger changes, was to begin unwinding the employer-based subsidy or the subsidy from employer-based insurance.  The Democrats actually agreed, and above House member objections, the president and the White House were pushing for the excise tax which would begin to do that."

            http://www.msnbc.msn.com/...

            •  I think the employer based subsidy should be (4+ / 0-)
              Recommended by:
              Sylv, otto, Cedwyn, Onomastic

              unwound too.  I don't think healthcare should be tied to employment at all. Plus ending the tax break to employers for purchasing health insurance would help to beging getting healthcare costs under control.

              "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

              by seanwright on Sat Feb 13, 2010 at 07:23:03 AM PST

              [ Parent ]

        •  Bingo. (2+ / 0-)
          Recommended by:
          buckhorn okie, 2laneIA

          It's one thing to make concessions for a new, wide-ranging public program like Social Security and Medicare.

          It's quite another when those types of concessions are made to the exclusion of the creation of a new public program (single payer or public option, for example) and the inclusion of mandates to purchase private products from a price-gouging industry.

          More and Better Democrats

          by SJerseyIndy on Sat Feb 13, 2010 at 06:16:11 AM PST

          [ Parent ]

    •  Brown ran because Coakely ran (2+ / 0-)
      Recommended by:
      seanwright, Onomastic

      the worst campaign that I've seen in years, finally taking that title away from Kathleen Kennedy Townshend, whose ineptitude resulted in Bob Ehrlich being MD's first GOP Governor in 36 years.

  •  If I'm reading the chart correctly... (2+ / 0-)
    Recommended by:
    Dauphin, Onomastic

    150% of PL = $1966/52/4 = $ 9.45 per person/week premium cost.

    200% of PL = $3629/52/4 = $17.45 per person/week premium cost.

    250% of PL = $5797/52/4 = $27.87 per person/week premium cost.

    300% of PL = $8468/42/4 = $40.71 per person/week
    premium costs.

    This is based on a 40 yr old head of household.  

    Nobody held a wake for America's manufacturing industry, and now we are supposed to give a fuck about these assholes in the insurance business? - Playon

    by blueocean on Sat Feb 13, 2010 at 05:59:55 AM PST

    •  Taken a bit farther... (5+ / 0-)

      at 150% of PL after tax bring home per month for a family of 4 would be around $2,300.00

      $ 2,300.00

            900.00  Rent/House payment 2/3 bedroom
            200.00  Gas/Elec  YMMV
             60.00  Phone
            300.00  Car & Insurance
            600.00  Groceries
            100.00  Gas for the car
            160.00  Health Insurance Premiums

      Total 2,320.00 Nothing left for
                    Co-payments/Deductibles or clothing,
                    car repairs, home repairs, etc.

      I don't see this being an ideal solution even though I also don't see how it would be possible to get premiums lower than $9.45 per person/month.

      I've tried to be fair with my estimates.  

      We need better wages.  Raising a family of 4 on $17.50 per hour is just about impossible.  Many wage earners don't even come close to that.

      Nobody held a wake for America's manufacturing industry, and now we are supposed to give a fuck about these assholes in the insurance business? - Playon

      by blueocean on Sat Feb 13, 2010 at 06:18:00 AM PST

      [ Parent ]

  •  Jonathan Cohn Fixxy (1+ / 0-)
    Recommended by:
    buckhorn okie

    Someone would appear to have a sever case of short-term memory loss. Did he simply just FORGET about the bill passed in the House. He must've, because it's more ambitious than the Senate bill, extends coverage to more Americans than the Senate bill, strengthens it for that many more, etc:

    The U.S. House of Representatives has voted to pass the most ambitious piece of domestic legislation in a generation--a bill that will extend insurance coverage to tens of million Americans, strengthen insurance for many more, and start refashioning American medicine so that it is more efficient

    Accuracy fixxy to reflect reality!

    More and Better Democrats

    by SJerseyIndy on Sat Feb 13, 2010 at 06:05:25 AM PST

    •  Not sure you get the point (3+ / 0-)
      Recommended by:
      Sylv, yella dawg, Onomastic

      The point is that it the senate bill would be the most ambitious law if enacted.  The House bill would be even more ambitious if enacted.  No fixxy required as far as I'm concerned.

      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

      by seanwright on Sat Feb 13, 2010 at 06:25:42 AM PST

      [ Parent ]

      •  So, your over-arching point is: (2+ / 0-)
        Recommended by:
        buckhorn okie, 2laneIA

        the senate bill is better than nothing?

        In many respects I agree. In other respects, I don't.

        But what we can probably both agree on equally is that:
        the House bill is better in more respects than the Senate bill, and would be more ambitious if enacted.

        So all the better to try and push the final product (assuming there will be one, which looks increasingly less likely with each passing day) more towards the House version, by pushing for fixes to the Senate bill through reconciliation first before final passage.

        More and Better Democrats

        by SJerseyIndy on Sat Feb 13, 2010 at 06:28:58 AM PST

        [ Parent ]

        •  The Senate bill does a lot to improve a lot of (3+ / 0-)
          Recommended by:
          Sylv, Whimsical, Onomastic

          people's situations and virtually nothing to make anyone's situation worse.  It's a huge improvement over the status quo.  I want to see improvements to. What I don't what to see is this bill getting killed if we can't get the improvements.

          "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

          by seanwright on Sat Feb 13, 2010 at 06:55:00 AM PST

          [ Parent ]

          •  Virtually nothing? (0+ / 0-)

            I suppose that would depend on viewing the new requirement to purchase a private product or else suffer a money penalty for making a personal choice not to purchase a private product as not making anyone's situation worse.

            Those being forced into that decision would probably see it as at least $750 worse. And that's $750 that means plenty to them.

            But all that aside, you won't see me pushing for killing the bill.

            You'll see me pushing to make the bill better, and, in the event of failure in that regard, crossing the next bridge if/when we come to it.

            More and Better Democrats

            by SJerseyIndy on Sat Feb 13, 2010 at 07:04:57 AM PST

            [ Parent ]

            •  Did you read my entire diary? (3+ / 0-)
              Recommended by:
              Cedwyn, Whimsical, Onomastic

              Did you see this part:

              A claim that I've seen made over and over again is that the Senate bill forces you to buy insurance from a private insurance company.  It does not.  What it does is force you to buy insurance or pay a $750 annual penalty starting in 2014.

              To get a little bit personal, this portion of the bill interests me very much. I currently do not have health insurance.  I am an unmarried, childless, self-employed professional with a modest income that is probably too high for any subsidies.  

              I think that you would agree, based upon the foregoing information that I have more than a sporting or purely altruistic interest in what the Senate bill does for and requires from the uninsured.  And I am convinced that this is a great deal for me!

              Why?  Because, as Ezra Klein once pointed out on his blog: the option of going without insurance and paying a $750 annual penalty is probably the best deal in the bill.

              Ezra:

              [I]t's simply not true ... that the people paying the $750 individual mandate penalty get nothing in return. Far from it, in fact. For one thing, they get access to emergency care, as happens now. For another, they get the chance to come back into the system when they actually need insurance. Someone who puts off purchasing coverage and then tries to buy Aetna's plan the first time they collapse unexpectedly will not be sold a plan. Having chosen not to buy insurance when they didn't need care, they can't buy it now that they do need care. They become the priced out or, in some cases, locked out.

              Under reform, these people get the chance to come back into the system when they need coverage. They can't be discriminated against. Indeed, you can argue that these folks, the ones willing to game the system, are the most advantaged of all the groups. It's why the individual mandate should be stronger, not weaker, than it is now. This isn't the biggest deal at the outset of the plan, as there's fair evidence showing that people overvalue insurance and will buy it even though paying the penalty is a better deal. If that turns out to be wrong, you can strengthen the mandate down the road. But the economics of the situation favor the people who decide to pay the penalty rather than purchase insurance, not the other way around.

              So, if, once the new insurance exchanges have opened and I go on and can't find a policy that is affordable and to my liking, I can opt to pay $62.50 per month for the security of knowing that if I ever become seriously injured or ill, I can go back to the exchange and purchase (a suddenly more affordable looking!) insurance policy that suits my needs and cannot be denied or charged anymore for a policy than any other person in my age group.  Have I died and gone to heaven?!

              "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

              by seanwright on Sat Feb 13, 2010 at 07:11:57 AM PST

              [ Parent ]

              •  Okay, so... (0+ / 0-)

                the access to emergency care aside, as Ezra points out that is as it is at present (except, of course, people aren't getting fined $750 at present), that leaves the option to buy back in.

                Basically, you're paying $750 to be able to get back into the private insurance market.

                Wanna know another way some of those opting out of the private insurance market at present can get back into the private insurance market?

                By providing them with the jobs they lost that offer private health care coverage they lost, and now opt not to purchase because they can't afford.

                And they wouldn't even have to be fined $750.

                But why not try to get that fine dropped to $500? Wouldn't that be an even better deal for those folks?

                More and Better Democrats

                by SJerseyIndy on Sat Feb 13, 2010 at 08:07:09 AM PST

                [ Parent ]

              •  just as a heads up (1+ / 0-)
                Recommended by:
                seanwright

                on my tag fix, in case you are wondering and didn't catch it. removing the double "ii" from "individual mandate" for proper search find.

                More and Better Democrats

                by SJerseyIndy on Sat Feb 13, 2010 at 08:17:32 AM PST

                [ Parent ]

    •  Cohn also assumed there would be a fix (5+ / 0-)

      Not quoted by the diarist, but in the same piece:

      First, though, there is more legislating to do. The Senate has a bill, but so does the House. The two chambers must work out their differences--over how to pay for the plan, what level of financial protection to provide, how to design the regulatory infrastructure for making insurance coverage available. With Congress out of session, negotiations are likely to stretch out over a few weeks; both White House and Capitol Hill sources now say it's likely passage will wait until late January or even February.

      "We have met the enemy, and he is not us."

      by 2laneIA on Sat Feb 13, 2010 at 06:30:11 AM PST

      [ Parent ]

      •  Everyone would like to see a fix. (5+ / 0-)
        Recommended by:
        Sylv, Cedwyn, NLinStPaul, Whimsical, Onomastic

        My point is that even if we don't get a fix This. Bill. Must. Pass.

        "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

        by seanwright on Sat Feb 13, 2010 at 06:41:11 AM PST

        [ Parent ]

        •  This. Bill. Won't. Pass. Without a fix. (1+ / 0-)
          Recommended by:
          buckhorn okie

          The House Bill passed 220 to 215.  Of the 215 who voted no, only Massa and Kucinich said they did so because it wasn't progressive enough.  Stupak and Cao voted yes, but said they would not vote for the Senate bill because it isn't sufficiently punitive to reproductive choice, and Stupak claims he has 10 more Dems who will follow suit.  Two other yes votes: Wexler retired.  Jack Murtha passed away.

          The Speaker says she does not have the votes to pass the Senate bill because it is not progressive enough, which means that there is some number of progressives who won't vote for it.  So if you are minus those people, and the 14 likely no or absent who voted yes last time, or even some of them, the Senate bill can't pass in its current form.

          Pelosi keeps saying this.  It isn't rocket science to understand it.

          "We have met the enemy, and he is not us."

          by 2laneIA on Sat Feb 13, 2010 at 07:04:16 AM PST

          [ Parent ]

  •  Thank you for the diary (8+ / 0-)

    But I think your efforts are wasted.

    It took Howard Dean 2 days to realize he was wrong and reverse his stance 180 degrees regarding the senate bill.

    Anyone who can't take an objective look at the entire bill after 2 months isn't the type to change thier mind in response to reason and facts.

    Selling on intrade at around 30 last night.

    "Don't fall or we both go" Derek Hersey

    by ban nock on Sat Feb 13, 2010 at 06:16:17 AM PST

  •  HCR is Dead (0+ / 0-)

    and the Democrats have no one to blame but themselves..Repugs didn't kill it..WE DID..

    All Dems..Progressives..Blue Dogs..moderates and the president..Plenty of blame to go around..

  •  regardless of what progressives think (1+ / 0-)
    Recommended by:
    buckhorn okie

    or what they say on blogs like this, the bill will not pass with or without a sidecar until its poll numbers go up.  As long as the excise tax and medicare "cuts" keep its poll numbers down with "likely voters", it will stay where it is: in limbo.

    •  Part of what keps the numbers down (9+ / 0-)

      ...is that politicians and progressive activists are MIA as far as talking up the bill's many advantages.  The only voices that are being heard are Republicans, teabaggers, and "kill the bill" folks on the left.  Is it any wonder that the public has become ambivalent?  

      "You must be the change you wish to see in the world." -Gandhi

      by Triscula on Sat Feb 13, 2010 at 06:43:18 AM PST

      [ Parent ]

    •  Wrong. The only reason the bill may not (1+ / 0-)
      Recommended by:
      seanwright

      pass is because people aren't getting information about what's actually in it.

      The Kaiser Family Foundation's tracking survey has information you may find interesting. They actually did some checking on how plain folks view the Senate Bill and why.

      That's something worth checking out when you've got progressive activists and Republican Congresscritters all screaming - "kill the bill! The people hate it! And so do we!"

      http://www.kff.org/...

      Nate Silver's done a nice job of looking at the very interesting reality the survey reveals.

      Most of the respondents to the survey did NOT know what was in the Senate Bill. Their beliefs about it, were "objectively wrong." No doubt due to having gotten their information from MSM, and so called activists on both sides of the political divide.

      When the same respondents were asked about specific components of the bill, for example, banning limits on lifetime coverage or setting up the Exchanges, why lo and behold - they were overwhelming in favor.  

      As Nate said -

      it's much harder to read the opinion polls as a "mandate" against the health care bill when much of that opinion is based on demonstrably false beliefs, some of which have been perpetuated deliberately by opponents. And it's much harder to know how the Democrats ever expect to pass a health care bill or similarly complicated policies like cap-and-trade if they wither in the face of polls that reflect less a disparity of opinion and more a poverty of accurate information.

      http://www.fivethirtyeight.com/...

      If dems and progressives don't come together to help get that info out then it's a self-fulling prophecy -one we will have helped create.

      We must accept finite disappointment but never lose infinite hope. - Dr. Martin Luther King

      by Onomastic on Sat Feb 13, 2010 at 11:35:45 AM PST

      [ Parent ]

  •  The only false choice propagated here (6+ / 0-)

    is the one which gives us a choice between a supposed POS bill which will help no-one but big insurance, and deep sixing HCR in favor of....what?  almost certainly nothing whatsoever but continued suffering and misery for all those working poor and less than upscale middle class workers and professionals not covered by their employers.

    Somehow trading some HCR for "nothing whatsoever" sounds quite sensible to some of us here.

    NOT TO ME

    It's absolutely insane and will deprive hundreds of thousands of needed medical treatment, force them into medically-related bankruptcies and cause millions of others to live in constant fear.

    Who says that 20% of a family's income in the most extreme possible medical crisis is unaffordable. These same families RIGHT NOW face 100s of Thousands of dollars in out of pocket costs if the same crises occur. The 20% max amount set forth in the chart means that a family making say..45k will have to finance or find some other way to borrow perhaps 3 or 4k in the worst case instead of going into debt for 300k or, more likely, bankruptcy. In most cases these families will pay less than 10% of their income. Families making 35k or so will pay far less than 10%...perhaps 6-7% on average. This sucks, perhaps, but still, it makes coverage possible for those who otherwise would have absolutely no hope.  

    I am part of a 2 person firm. My salary and distribution income is about 40k right now in the current economy. My premium, paid by my firm, is going to about 7k in April (total benefits package is under 50k). Thus I am paying about 14% of my income for insurance converage, (including premium & benefits)...assuming I stay perfectly healthy and require no care or Rx medicine, that is. This is bearable (though profoundly unpleasant). Most families making less will pay a far lower average premium with the subsidies than I do now. I should add that I live in NY; my living expenses are higher than those of most other people in this country.

  •  Isn't it a bit telling? (14+ / 0-)

    This diary offers a significant amount of commentary, insights, facts, and perspectives on what is actually in the bill, and experts' opinions on the social and economic impact of its passage, yet it won't get a sniff of the reclist.

    Yesterday, we had a nonfactual, opinionated, inconclusive rant about another line in the sand we should demand, one that is politically tenuous at best and does not necessarily promise to deliver one ounce of substantive change from the bill already on the table, and it zooms to the top of the rec list in minutes.

    I read through the comments here, and it's the same cast of characters, with the same nonsense, refusing to acknowledge or accept that there could be any other means or avenue to achieving what we ALL want. That this may very well be the very best starting point available in this political climate to bring about the most sweeping social change in nearly 3/4 of a century to this country, and yet we'd be willing to scuttle it if we don't get everything in one blow.

    It's very scary that this site has begun to systematically lose all sense of process, compromise, history, and reason in favor of heavy rhetoric, personal attack, myopia, and black and white idealism. Much like our "friends" at RedState and on the Limbaugh show. Scary because we have a LARGE NUMBER of critically important issues to tackle and problems to begin solving, and we've bogged our own leaders down in some battle of ideals with no strategy, no sense of realism and something that resembles a chicken with its head cut off. In short, we've acted as clueless and as hysterical as GOP'ers have always accused Dems. of being. They count on it.

    PASS THE SENATE BILL. AS IS. THEN PASS A JOBS BILL. AND PASS A LOBBYING REFORM BILL. MAKE PROGRESS. GET TO WORK. FREE THE VOTERS OF MAINE, AND NEW HAMPSHIRE, AND CONNECTICUT, AND OHIO OF THE GOP/LIEBERMANN SHACKLES THAT ROB THEM OF A VOICE.

    It's that simple. THAT is what the people want.

    •  Spot on, AI. (6+ / 0-)

      You are exactly right. This is an excellent piece.  

      He had me at this:

      Never have Democratic members of Congress who are putting their careers on the line for something they believe in been so vilified as sellouts by influential progressives.

      But it was great all over.

      Earns no money here for blogging, commenting, or driving traffic to any web site.

      by mem from somerville on Sat Feb 13, 2010 at 07:23:18 AM PST

      [ Parent ]

      •  Couldn't agree more mem. (4+ / 0-)

        Remember when the original "We are the World" was being recorded?

        Quincy Jones put a sign over the door to the studio saying "Check Your Ego at the Door."

        These so called "leaders" need to do the same.

        When what they're doing hurts more than helps, it's time to step back and reevaluate.

        If, of course, the people they're supposedly fighting for actually do matter.

        We must accept finite disappointment but never lose infinite hope. - Dr. Martin Luther King

        by Onomastic on Sat Feb 13, 2010 at 08:27:10 AM PST

        [ Parent ]

    •  Sums up my feelings. (3+ / 0-)

      It's very scary that this site has begun to systematically lose all sense of process, compromise, history, and reason in favor of heavy rhetoric, personal attack, myopia, and black and white idealism.

      Sad, as well.

      Hair On Fire is the new black!

      by arielle on Sat Feb 13, 2010 at 09:36:14 AM PST

      [ Parent ]

    •  You are 100% correct (3+ / 0-)

      Unfortunately, for those other posters, this is more about saving face and trying to shield themselves from the blame when/if (though most likely when) HCR dies. For months on end they screamed to "kill the bill" and teamed up with Jane Hamser. With Scott Brown winning, sensing the debacle that is still most likely to come, this is their way of trying to shield themselves from the blame when/if HCR (again most likely when) HCR finally dies. That's why they are, in their self-serving way, trying to "save healthcare reform". That they remain unrepentant in their position says it all.

      I've asked them how they realistically expect the public option to come. I've asked them how they plan on magically convincing four to seven of the problem Senate Democrats to change their minds. And, just as you say, you're right that you haven't been able to get coherent answers because they don't have any. All of their "answers" have ignored the uncomfortable political realities at hand.

  •  No one is saying that the (1+ / 0-)
    Recommended by:
    buckhorn okie

    Senate bill does not have positive and beneficial aspects.  They're saying that in toto, it's shitty and we deserve and should be getting better.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White

    by zenbassoon on Sat Feb 13, 2010 at 07:19:13 AM PST

    •  My argument is that, in toto, the Senate bill is (4+ / 0-)
      Recommended by:
      Sylv, NLinStPaul, a night owl, Onomastic

      a massive improvement over the status quo and that, even as we push for more, we should acknowledge that and that our baseline position should be, whatever else happens, the bill must pass with or without a fix.

      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

      by seanwright on Sat Feb 13, 2010 at 07:26:21 AM PST

      [ Parent ]

  •  Pass the House bill! (1+ / 0-)
    Recommended by:
    buckhorn okie

    As is!
    Better yet, let's fix that one before it passes too..

    Move Your Money The truth is too big to fail. Justice is too big to fail. Peace is too big to fail.

    by Burned on Sat Feb 13, 2010 at 07:39:11 AM PST

    •  Yes. Let's insist on something we can't have. (5+ / 0-)
      Recommended by:
      Sylv, Cedwyn, Whimsical, yella dawg, Onomastic

      That'll show them.

      Maybe I'll get a disease and be forced into bankruptcy or die. Then they'll be sorry!

      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

      by seanwright on Sat Feb 13, 2010 at 07:43:25 AM PST

      [ Parent ]

      •  I'll be sorry if that happens to you. (0+ / 0-)

        :(

        House says they won't pass the senate bill as is.
        Maybe they're lying? Maybe we should force them to concede?

        Long range...I don't want to do that. I like the little bit of courage they show for the American people and would like to encourage much stronger courage and much more of it.

        Move Your Money The truth is too big to fail. Justice is too big to fail. Peace is too big to fail.

        by Burned on Sat Feb 13, 2010 at 07:54:09 AM PST

        [ Parent ]

        •  So I wonder (1+ / 0-)
          Recommended by:
          seanwright

          if "showing courage" is what this is about for you?

          That would make some sense since the "fixes" that are being proposed are really pretty incidental in the overall scheme of this bill.

          Or would you make a case that those fixes are the heart of your objections to the bill?

          Almost everything you do will seem insignificant, but it is important that you do it. - Mahatma Gandhi

          by NLinStPaul on Sat Feb 13, 2010 at 08:07:23 AM PST

          [ Parent ]

        •  I think if progressive were unified in a message (3+ / 0-)
          Recommended by:
          Sylv, Whimsical, Onomastic

          of "Pass. The. Damn. Bill." that at least the progressive caucus would sit up, take notice and maybe actually go ahead and vote for the bill.  I think the main thing holding back the progressive caucus is fear of ill-informed progressive activists.

          "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

          by seanwright on Sat Feb 13, 2010 at 08:30:14 AM PST

          [ Parent ]

          •  Heh, well there you are for reals. (1+ / 0-)
            Recommended by:
            Onomastic

            I'll just take my ill informed, scary, progressive caucus kidnapping self off to another conversation.

            Have a great day seanwright.

            Move Your Money The truth is too big to fail. Justice is too big to fail. Peace is too big to fail.

            by Burned on Sat Feb 13, 2010 at 08:46:21 AM PST

            [ Parent ]

            •  I'm sorry if I offended you. (2+ / 0-)
              Recommended by:
              Triscula, Onomastic

              But I wrote a substantive diary on what I know is a controversial issue because I've gotten the clear impression that a lot of people are basing their opinions on a faulty understanding of what the bill accomplishes.

              I don't take a backseat to anybody on being a progressive.  My views are much more liberal than centrist.  But I will always take progress over nothing, no matter how compelling the reasons for accepting nothing are.

              And I thought that whole "I'm gonna get huffy now cuz you just called me ignorant" thing was a rightwing trope.  We lefties are supposed to be effete intellectual snobs.

              "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

              by seanwright on Sat Feb 13, 2010 at 09:07:10 AM PST

              [ Parent ]

        •  "Courage" (5+ / 0-)

          Yes.  I'd like to see them concede.  There's nothing courageous about "noble" failure.  Leaving 45,000 people per year to die from lack of coverage is an abominable act.

          Why is it "courage" when House members are afraid of the political ramifications of voting on this bill but when Democratic senators balked at the House version for the same damn reasons it's "cowardice"?

          What amazes me is that so few of our elected officials and many members of this community aren't more afraid of the political ramifications of failing to pass any reform at all.  Talk about myopic.

          "You must be the change you wish to see in the world." -Gandhi

          by Triscula on Sat Feb 13, 2010 at 08:51:19 AM PST

          [ Parent ]

          •  "Courage" is being more frightened of the voters (1+ / 0-)
            Recommended by:
            Onomastic

            than of the special interests I guess.  My view is that courage is keeping your head when those about you are losing theirs and blaming it on you.  And trusting yourself when others doubt you, but making allowance for their doubting too.  But that's just one man's opinion.

            "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

            by seanwright on Sat Feb 13, 2010 at 09:09:50 AM PST

            [ Parent ]

        •  It could be that the House is just trying to show (3+ / 0-)
          Recommended by:
          a night owl, seanwright, Onomastic

          bravado before passing it. Or it could be that these last few weeks they have been privately working to fix it. I don't know.

          •  I'll be mightily pissed if the reason we don't (2+ / 0-)
            Recommended by:
            seanwright, Onomastic

            get this done is because of House resentment of the Senate.

            •  Oh, are we allowed to talk about that? (2+ / 0-)
              Recommended by:
              a night owl, seanwright

              It's just like the typical kid excuse of -

              He hit me first! or
              He took my toy! or
              She got her ears pierced why can't I! or
              Why can't I do a sleep over? or
              Why can't I ride shotgun? or

              At some point you have to grow up and part of that is rarely, if ever, do you get everything you want when you want it.

              And if someone's life is riding on it, then you better deal.

              There's far too many lives riding on getting this done for anymore juvenile posturing.

              We must accept finite disappointment but never lose infinite hope. - Dr. Martin Luther King

              by Onomastic on Sat Feb 13, 2010 at 11:10:07 AM PST

              [ Parent ]

              •  Agreed (3+ / 0-)
                Recommended by:
                a night owl, seanwright, Onomastic

                Lately, when it comes to this issue, I feel like I am increasingly dealing with children in a toy store who are throwing temper tantrums because the toy they want isn't in stock any more; and there isn't any prospective of a better toy coming in anytime soon.

                •  There's far too much of it. (2+ / 0-)
                  Recommended by:
                  a night owl, seanwright

                  There should be phrase like spoiled bratitis or something.

                  I get disappointment.

                  I know full well what's like when a very important dream feels snatched away.

                  At some point the emotional reaction just gets in the way.

                  Reality still needs to be delt with.

                  We must accept finite disappointment but never lose infinite hope. - Dr. Martin Luther King

                  by Onomastic on Sat Feb 13, 2010 at 11:40:54 AM PST

                  [ Parent ]

      •  Yep (2+ / 0-)
        Recommended by:
        seanwright, Onomastic

        And some people get angry for mentioning this, but I would venture to guess that most of the "kill the bill crowd" probably has decent coverage. They can afford the luxury of that position because, no matter what happens, they'll still have access to care. Can't say the same for people like you.

  •  This is one of the best diaries (10+ / 0-)

    I've seen on explaining the Senate bill. Thank you seanwright - and PASS.THE.DAMN.BILL!!!!!

    Almost everything you do will seem insignificant, but it is important that you do it. - Mahatma Gandhi

    by NLinStPaul on Sat Feb 13, 2010 at 07:51:49 AM PST

    •  I think if Progressives could be convinced to get (0+ / 0-)

      behind that mantra: PASS. THE. DAMN. BILL!!!  And forget about trying to come up with some way to adjudicate the intercameral power struggle between the House and Senate, the fate of healthcare reform would not be in doubt at all right now.

      Also, thank you and I'm glad you enjoyed the diary. :)

      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

      by seanwright on Sat Feb 13, 2010 at 02:10:49 PM PST

      [ Parent ]

  •  You clearly put a lot of work into this (4+ / 0-)
    Recommended by:
    arielle, Whimsical, seanwright, Onomastic

    And that should be commended, whether a person agrees with you or not.  I do agree with you, by the way.  I'm really anoyed by House members who insist this bill isn't good enough, while people like myself who would be covered in the Medicaid expansion suffer.  They have their coverage.  When do we get ours?

    •  Exactly. (1+ / 0-)
      Recommended by:
      arielle

      The fact that 14 million more people get Medicaid coverage is reason enough all on its own for celebration.  Add to that that people with pre-existing conditions that require special treatment can now get subsidized insurance from an exchange when they couldn't get ANY insurance before and progressives should be absolutely ecstatic.  I just can't believe that progressives are this indifferent to the needs of our most economically vulnerable citizens.

      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

      by seanwright on Sat Feb 13, 2010 at 09:15:30 AM PST

      [ Parent ]

  •  Great post (5+ / 0-)

    But look for it to be lost upon certain individuals here. I agree with you about the "kill the bill crowd" but you're just not going to reason with them. Some posters here who teamed up with Jane Hamsher and her colleagues are either completely stupid (which I doubt) or just downright dishonest. I have gotten flack for saying it before, but Hamsher and her supporters have turned into the Cindy Sheehans of healthcare reform. Just like Sheehan started off as a positive influence, as time has moved on, they have become hindrances. They're no longer positive influences in my opinion.

    I find it disingenuous that they were inflaming the community here against the Senate bill for the final months of 2009, only to turn around start "trying to save reform", when their actions have all but left any bill on life support (no pun intended). In my opinion this is their attempt, sensing the bill's likely death, to shield themselves from blame when the post-mortems on "who lost healthcare reform) start. That they remain unrepentant in their positions and are unwilling to admit that they possibly could have been wrong says it all to me.

    At some point the perfect became the enemy of the good. Some people started assuming that the public option had a chance; it never did--at least not in the Senate. The votes were never there. And now with Brown winning in MA, besides the House approving the Senate bill and doing reconciliation fixes later, I don't see how anything passes. That's the reality here. It's not pretty.

    I'll also get flack for saying it, but it wouldn't surprise me if the majority of the "kill the bill" crowd had great health coverage--or at least access to halfway decent coverage. The same applies to the heads of NOW, NARAL, and Planned Parenthood who were angry over the abortion provisions. No matter what happens, at the end of the day, they'll still have their six figure salaried job with great benefits. It doesn't matter if women have access to abortion if they can't even have health coverage at all. At some point that fact, however unpleasant, went over their heads. Whatever happens, should nothing pass, they will be okay. They can afford the luxury of screaming to "kill the bill"; the 47 million without care aren't as fortunate.

    The other point is that the opposition out-organized the pro-reform side. I was sounding alarms as early as last spring that the bill was in trouble. When ads from Conservatives for Patients Rights and Patients United Now went unchallenged for months I knew the bill was in trouble. The pro-reform side allowed the lies to unchallenged for months. They shaped the narrative and framed the debate.

    Overall I do agree with you. Unfortunately too many people here are just not going to listen to you.

    •  Thanks, At the risk of being offensive (1+ / 0-)
      Recommended by:
      Triscula

      It seems like a lot of people have made the transition from straight up ignorance, which is easily correctible to willful ignorance which is very difficult to do anything about.

      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

      by seanwright on Sat Feb 13, 2010 at 09:18:02 AM PST

      [ Parent ]

      •  A lot of it is probably willful ignorance, (1+ / 0-)
        Recommended by:
        seanwright

        downright dishonesty, and stupidity. It's probably a combination of all three unfortunately. After months of screaming "kill the bill" some people are now stuck or have dug into their positions. As I said in my first post here it is my opinion that they are just no longer positive influences in the debate any more.

    •  Disheartening but true (4+ / 0-)

      When I saw this diary earlier today I felt sure it would make the rec list.  I mean, it's a well researched, substantive diary on a very hot issue, right?  And after being thoroughly befuddled to see a pointless diary by a well-known diarist about what she is (not) "sorry" for sit on the rec list for many hours yesterday(and attract hundreds and hundreds of comments),I was still hopeful that substance would rise to the top. Disappointing.

      "You must be the change you wish to see in the world." -Gandhi

      by Triscula on Sat Feb 13, 2010 at 09:21:21 AM PST

      [ Parent ]

      •  I feel the same way (3+ / 0-)
        Recommended by:
        Newsie8200, Triscula, seanwright

        Again I feel that that other diarist and her supporters have become the Cindy Sheehans of healthcare reform. I got flack for saying it but I just don't think that they are positive influences in the debate any more. They've turned into the healthcare version of Code Pink.

      •  Obviously, (1+ / 0-)
        Recommended by:
        seanwright

        you are not yet cynical enough.

        I had no belief it would hit the wreck list.  lol

        It is the true believer's ability to "shut his eyes and stop his ears" to facts that do not deserve to be either seen or heard which is the source of his unequaled fortitude and constancy. He cannot be frightened by danger nor disheartened by obstacle not baffled by contradictions because he denies their existence. - Eric Hoffer

        Hair On Fire is the new black!

        by arielle on Sat Feb 13, 2010 at 09:50:33 AM PST

        [ Parent ]

  •  Not everyone can take advantage of this deal. (2+ / 0-)
    Recommended by:
    cybrestrike, seanwright

    Not everyone can take advantage of your "good deal". They - We - are the ones who cannot go without health insurance for any reason.

    We are two diabetics. Both of us are now in our 50s, which means that we will be permitted to pay as much as three times the amount a younger diabetic could be charged for the same or lesser coverage. We live in an area with fairly high insurance and medical costs, the Pacific Northwest. That annual premium for a family of four of $12,042? The one that will shrink down with the Senate bill? If you earn over 400% FPL, which we do as a family of 2 though we still have a modest five-figure income even with my disability check, there is no limit on what we can be charged. I have been told "well, if it is too much, you have the option to just pay the fine!" That's all well and good for someone who doesn't need ongoing health care to stay alive. But as a dialysis patient and someone who will hopefully soon get a kidney transplant, I'm not in that category of people. I do need ongoing health care to stay alive. I need to be able to get prescription medications that will cost probably over $20,000 annually and I need to know that my insurance company will pay for them. I need to be able to afford the co-pays and co-insurance for my specialist office visits and I need to know that seeing my GP once every month to, at most, three months will be covered under 'preventive care', that I won't be restricted to an annual checkup only. I cannot afford a lesser level of care than what I currently receive, because I would like to stay alive and healthy. We in the USA have the lowest rate of survival and the highest death rate for dialysis patients of any industrialized nation. And dialysis patients almost all have single payer health care - we get Medicare automatically.

    Thing is, though, if the reason you have Medicare is that you have ESRD and you're under 65, then if you get a transplant, you get removed from Medicare eligibility once you've had your transplant for 3 years, until you are 65. You are considered "cured" of a disease for which there is no cure, only treatment modalities. Transplantation is another treatment modality, that's all, not a cure. But there goes your Medicare, and all of a sudden you're in your 50s and thrown onto the private market to get whatever meager health insurance policy you can buy with your disability check. Let's say you're my friend Juanita, who is 55 and up for transplant from her daughter if she's a match. So she gets her transplant, but when she's 58, there goes her Medicare, just at the time when her insurance (purchased on the exchange) is at its most expensive. She gets a policy she can afford on disability, because she has other disabling conditions, not just ESRD, and tries to live with it. But the policy that covers what she needs is more expensive than the top allowed for premiums for someone in her income bracket; she makes too much to get Medicaid, but too little to afford the policy she really needs (one with a lower co-insurance than 40%, given all her medical needs), even with subsidies. The one she can afford has prescription coverage but leaves her with ruinous co-pays for prescription drugs to keep from rejecting her transplant. She starts taking less of her medication than is prescribed for her: she splits pills, skips others, takes less per day of most of them than she should. It starts to show when she experiences rejection episodes, yet knowing what is causing them and wanting to avoid them is not enough to increase the amount of income she has. Sooner or later, but in any case probably sooner than it should have been, she rejects her daughter's kidney and goes back on dialysis. Where, guess what, she has Medicare!

    If this damn bill just had Medicare for ESRD patients instead of Medicare for dialysis patients (all of whom have ESRD unless they're in acute kidney failure, which is different), and said that we could keep Medicare no matter how old we are in order to see our specialists, have our tests, and afford our drugs, that would be different, but it doesn't. This bill won't help Juanita, and it most likely won't help me.

    I am in the "fix the damn bill, then pass it" camp. I am not in the kill the bill camp. Absolutely I am not. But I do think that it can and should be improved at least incrementally before passage. I don't have a lot of skin invested in whether there's a public option or not, since I want single payer for everybody. But it still won't help me, and is likely to cost my family a lot more for insurance than we already pay, since it means that group rating for employers will go away, instead ensuring that insurers can hike premiums for individual employees as they age or as members of their family age. It won't help disability recipients whose checks, while small, are still enough to put them out of Medicaid eligibility. It won't help dialysis patients and the new cuts to Medicare are already hurting them: dialysis patients are on the hook for new co-pays of hundreds of dollars a month, more than 1/4 of their disability checks after taxes, because of bundling and other cuts. (The shortfall has to come from someplace, and apparently it's supposed to come out of dialysis patients' pockets.)

    I would like to see, not just an annual cap on medical expenses, but a five-year combined cap on medical expenses, because I don't think the one-year limit is sustainable for most families if they have to pay out that amount year after year. There needs to be a recognition that paying out over $50,000 over five years is a lot and that many families won't be able to do that and be kept whole. The one-year cap seems to be thought of as catastrophic one-time worst case scenario money, but for some people, that is not a one-time expenditure they're looking at but an ongoing one. If you become catastrophically chronically ill - the kind of illness that is expensive to treat, doesn't have a cure, and requires ongoing care to live - you're looking at paying out that amount each and every year. And if one member of a family becomes sick but everyone else is healthy, you'll still have to pay out that amount for the one person. You won't be on the hook for the single person amount, you'll be on the hook for the family amount, because you're covered as a family by one person's policy through their employer, or by the policy you purchased on an exchange. You're on the hook for an amount that's supposed to represent the maximum out of pocket for multiple people, yet you'll pay it for one person because you're a family. That is not right and is something that should be addressed and fixed. There needs to be a five-year cap as well as a one-year cap, and the five-year cap needs to be lower than five one-year caps combined, in order to be sure that this is sustainable for families.

    This has got quite long and I will shut up now. Thank you for an informative diary; I already had seen most of what was there in other places, but from other comments, it is apparent that not everyone had. Good job, even if I do disagree.

    Living kidney donor needed; type B, O, or incompatible (with paired donation). Drop me a note (see profile).

    by Kitsap River on Sat Feb 13, 2010 at 10:06:30 AM PST

    •  I am very sorry for you and your family and (1+ / 0-)
      Recommended by:
      Kitsap River

      friends troubles.  How do you get coverage now?  Are you certain that the legislation wouldn't improve your situation at all?  I would think at the very least, if you aren't getting coverage from an employer, you would benefit from the creation of the exchanges and the subsidies and the removal of the discrimination based upon pre-existing conditions.

      I don't dispute that the current legislation doesn't do nearly enough to help people in your situaton, but my opinion is that swift, decisive action by the House in passing the bill INCREASES rather than decreases the likelihood of a good fix.

      And thank you for your kind words about my diary and taking the time to give such a long thoughtful response.

      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

      by seanwright on Sat Feb 13, 2010 at 10:28:52 AM PST

      [ Parent ]

      •  Two ways (2+ / 0-)
        1.  My partner is covered by his employer, and I am covered under that as his spouse. Right now, that insurance is primary. This changes in June.
        1.  I have Medicare for now, even though I'm 50, because I'm on dialysis. My sister may be able to donate a kidney to me as early as this spring, and after that, I will have up to three more years of Medicare, then I get kicked off it until I'm 65 or lose my transplant, whichever comes first. Hopefully age 65 comes first.

        Concerns:
        Right now, Washington state says that one employer is treated as a group, and given a group rating by an insurance company. This means that everyone in the group is treated as equivalent, regardless of actual age or health status (although both of those things are taken into consideration by the insurer in setting the group's rate). Everyone in the group pays the same amount for the same coverage by the same insurer. If the employer offers a choice of plans, then everyone who selects Plan A pays the same as everyone else in Plan A who works for or is covered under that employer's Plan A policy, and the same for Plan B, etc. In other words, if Microsoft makes a deal with Regence Blue Shield to offer a policy to Microsoft employees and family members, the cost is the same to all employees for employee coverage, to all employees for spouse or domestic partner coverage, to all employees for coverage of their natural-born or adopted children. Joe Smith, who is 62, will be charged exactly the same for himself and his 60 year old wife as 24 year old Jaime Mendoza will be charged for himself and his 23 year old partner Nguyen Tranh. What the Senate bill apparently does is allow Regence to hike up the rates on Joe and Mrs. Joe to three times the rate that Jaime and Nguyen pay, despite the fact that they're in the same pool, at the same company, and have heretofore been paying the same rate. That worries us a good deal, with both of us in our 50s.

        And no matter what they raise it to, whether it's twice what a younger person pays or three times what a younger person pays, we'll have the same coverage that we have now, only we'll pay two or three times as much for it. No matter what they raise it to, we'll have to keep paying it, because I won't be able to live without it, and I do mean that quite literally. I am concerned that if it gets to be too much, my partner will approach his employer and see if he can arrange to have me covered instead of himself and just stop paying for his own coverage. I have a good basis for believing that he might try this, because it is exactly what he did when we were faced with a situation where insurance premiums for me were breaking our backs financially and we were slipping farther and farther into the hole. He did it several years ago and I thus have reason to believe he would do it again if he felt the need. That is dangerous, and it was dangerous then; he had just been diagnosed with Type 2 diabetes, just like his father was at a similar age. I had diabetes and other conditions which were disabling me, though, like things that made my hands quit working for a while from time to time, so he decided my care was more crucial than his own and saw to it that I could continue to get that care. In retrospect, it may have been what saved me; I had continuous coverage for over 2 years when our insurance company tried to tell me I had to wait a year before starting dialysis, and they had to eat those words and cover me from the first day because I had had that continuous earlier coverage.

        But knowing we can get coverage no matter what our age (as long as it's below 65), and no matter what our medical conditions, is fine - it's somewhat reassuring. Less reassuring and more worrisome is knowing that availability of coverage does not mean the availability of the funds with which to buy it, and even the cap on premiums as a percentage of our income does not guarantee that those funds are available to buy it. It's not that we throw money around, but between a house, insurance, animals, a car payment for my car, repairing his car, ferry tickets (a big one! $147 for ten round trips and another $150 or so for his monthly passenger and bus pass), utilities (especially heat in the winter), etc., etc., not to mention the $500 or so in prescription co-pays monthly and the co-pays for doctor's office visits and deductibles for medical care, we don't have a lot TO throw around. We're stretched pretty thin, by and large, though there are undoubtedly some areas where expenses can be trimmed a little. It's not enough to make up the difference. I fear we will slip back into the hole gradually and never climb out.

        I don't see this bill as preventing as many medical bankruptcies as everyone thinks it will because there are people like us. Because people will still slip downwards into a hole and scream for a way to get out of it. Because for people who don't have a huge annual income or a trust fund from which to draw, the annual cap is not sustainable if it is what gets paid out by the family in medical costs year after year.

        I have to say that a huge savings in personal cost, a huge preservation of quality of life, and a huge savings in financial terms would be realized by opening up Medicare to everybody who is or ever has been on dialysis for chronic kidney failure. (Acute kidney failure can be cured and often is; it occurs for very different reasons than CKD. Chronic cannot be and is not.) Or better yet, open it up to everyone in Stage 4-5 CKD and ESRD (sometimes called Stage 6) so that the people who are seriously ill but aren't on dialysis yet get the benefits of Medicare specialist visits at Medicare rates, enabling them to see the professionals that will keep them off costly dialysis, and so that people who qualify for transplantation can get a transplant as soon as possible (preferably before they start dialysis) and then keep the ability (via Medicare Part D) to buy prescription drugs at affordable costs and thus make sure they take the proper care of their new grafts. Make sure that this is good not just while they're on dialysis and up to three years afterward, but for life, so there's no worry about losing the gift of a kidney due to money. Over the course of several years, funding the patient keeping the transplant in this way will prove to be a savings to Medicare over the cost of dialysis, which is ghastly expensive. Over the course of a patient's life, quite a bit can be saved this way by the Medicare system, and the patient will enjoy a far better quality of life to boot.

        I want to see Medicare around when I turn 65 and see it still viable, paying benefits that are as good as today's, when I'm something like 85. I want to see it available to my nieces and their children and their children when they are old enough. I want to see us taking our place with the other industrialized nations of the world and removing health care costs from the backs of our country's employers. I want to see HR departments figuring out ways to compensate employees with things like merit pay increases and productivity profit sharing, not with things like arcane health care policies that don't cover what it seemed like they should. I want to see both the House and the Senate recognize that just because one person in a family spends a week in the hospital, it doesn't mean that the entire family is sick and that this should be taken into account when figuring out the cap amount. One sick person equals one person's worth of cap, not two or four or more. Sue and Roberta should not pay more for their cap just because Roberta is covered under her wife's policy than they would if Sue got a policy from her employer and Roberta got one from hers.

        Above all, I don't want to hear politicians and activists breathing a weary sigh and saying "Damn, I'm glad that is over. Let's not talk about it again for several years, please." I want to see them fix the Senate bill via a reconciliation sidecar, pass the Senate bill and the reconciliation bill, get those both to the President's desk, and see President Obama sign them before midsummer at the latest. And the very next day, I want to see them back at work, making calls to legislators, talking about the need for reform of health reform, about ways to make it better for the American middle class and working class. I want to see legislators talking about the need for more reform, more work, more changes, more focus on this, every single day. No let up. No resting on the laurels. No "victory moment" beyond a photo on a wall in their offices and a thank-you from the President and the people. I want to see everyone breathe, and then get the heck back to work to change it and make it better.

        Living kidney donor needed; type B, O, or incompatible (with paired donation). Drop me a note (see profile).

        by Kitsap River on Sun Feb 14, 2010 at 03:53:04 AM PST

        [ Parent ]

        •  Thank you for sharing so much about your personal (1+ / 0-)
          Recommended by:
          Charles CurtisStanley

          situation.  This is the part of the discussion I don't think we're getting enough -- the impact of the legislation on the lives of people who need help the most in dealing with medical expenses.

          You seem so well informed on the topic that you've likely already heard of it, but are you familiar with the state innovation waiver in section 1332 of the bill?  This could be a real godsend for people living in places like Washington, Vermont and Massachussets where State legislatures have already taken the lead on serious healthcare reform.

          It basically allows individual States to opt out if they present a plan that meets or exceeds the standards of the national plan and take all of the federal dollars that would have gone to their State and use it as funding for their own plan.

          Also, I don't think there is anything in the bill that overrides or undermines State consumer protection laws.  The legislation claims that all insurance plans offered will be subject to Federal and State consumer protection laws, but I want to research that issue some more.

          My understanding was that there was some concern that State consumer protection laws could be undermined by a provision allowing insurers to sell across sate lines, but that was addressed by limiting the selling of policies across state lines to regional compacts entered into and negotiated between states.

          I absolutely agree about the no resting on our laurels part of what you have to say. But I think improvements will be much easier once the bill is passed than the will be if the current legislaion is abandoned. I don't think the Senate bill gets us all the way to good, comprehensive healthcare, but I do genuinely believe that it gets us out of the ditch and on the road to such healthcare.

          I don't really have time to research and address all of issues you've raised in your post right now.  But I'm planning to write another diary very soon addressing some of the issues raised in comments on this diary and the issues you've raised will definitely be front and center.

          "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

          by seanwright on Sun Feb 14, 2010 at 12:51:43 PM PST

          [ Parent ]

  •  This article seems timely (2+ / 0-)
    Recommended by:
    mem from somerville, seanwright

    Let us realize the arc of the moral universe is long but it bends toward justice. - MLK

    by mahakali overdrive on Sat Feb 13, 2010 at 10:11:06 AM PST

  •  Hey seanwright, (1+ / 0-)
    Recommended by:
    seanwright

    thanks for this and all of the work you put into it.  Initially when the Senate bill passed I was underwhelmed, but after hearing "this is a shit sandwich" one too many times I decided to take a look at it myself. I will confess to not having read each and every page, however I did spend several hours looking it over.  It is my opinion that it is a step forward, and that the positive aspects of the bill(the expansion of Medicaid and the CHCs being just two examples) far outweigh any negatives. I support it's passage without any further ado.

    "As nightfall does not come at once, neither does oppression..." William O. Douglas

    by Patricia Bruner on Sat Feb 13, 2010 at 11:10:52 AM PST

    •  Maybe my expectations were unduly low (1+ / 0-)
      Recommended by:
      Patricia Bruner

      But I was actually surprised at how good the bill was when it was all said and done. I feel like they really built a sturdy framework here that can be built upon and improved until we actually have a decent healthcare system.  It certainly doesn't get us all the way there in one step, but it's a strong start.

      "Thou thoughtest that I was altogether such a one as thyself." Psalms 50:21 h/t R. Browning

      by seanwright on Sat Feb 13, 2010 at 02:07:03 PM PST

      [ Parent ]

      •  I was surprised too, (1+ / 0-)
        Recommended by:
        seanwright

        if one takes the time to read it, it's actually a fairly decent piece of legislation with a great deal of foresight.  I will be pushing back against the s. sandwich meme it is time that kind of overblown, overly simplistic rhetoric is laid to rest.

        "As nightfall does not come at once, neither does oppression..." William O. Douglas

        by Patricia Bruner on Sat Feb 13, 2010 at 02:17:11 PM PST

        [ Parent ]

  •  Here's the real truth about the bill: (0+ / 0-)

    It sucks.  It further intrenches the current health care for profit system.  It forces millions into that system and taxes the middle class to pay for them, rather than the upper class.  It is a reactionary bill.

    "Trust me, after taxes, a million dollars is not a lot of money." Michael Steele.

    by Paleo on Sat Feb 13, 2010 at 03:40:57 PM PST

  •  Cohn and Klein are liberals? (0+ / 0-)

    Maybe so. But they're not progressives.

    "Trust me, after taxes, a million dollars is not a lot of money." Michael Steele.

    by Paleo on Sat Feb 13, 2010 at 03:41:37 PM PST

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