Centuries ago, there were people who would have claimed royal-blood as a reason why they should rightly live at the top of the heap and exploit everyone else.

Now we call those people CEOs, executives, senators, doctors, brokers, bankers, etc.

They’re still on top.  And they still think God not only gave them the right to exploit the rest of us, but the duty.

And so a country founded on a lot of high-minded talk about promoting “liberty” and “freedom” and stopping tyranny turns out to be just another in a long line of political vehicles intended to make sure the people on top stay on top, and the people on the bottom stay on the bottom, and the people in the middle careening between those polar opposites.

Meet the new boss.

Same as the old boss.

And we did get fooled again. 

Same as it ever was,
same as it ever was,
same as it ever was…

This whole issue is so very simple and yet they don’t understand it.  Everything except a public option can be undone within one Republican adminstration.  Some through rewriting laws other through just shoddy regulation enforcement.  You can talk about ratios and banning recissions and forcing the accept pre-existing conditions but unless these are enforced it doesn’t matter.  You can say insurers must write policies for those with pre-existing conditions but if they can make premiums $5,000 a month for said policy does it matter?  You can say patients can’t be dropped but if you don’t enforce it in a timely matter the patients will be dead or broke soon anyway.  The public option forces the government to repsond no matter the party in charge.

Robert makes good points.

And while half the world seems to be bashing government-funded healthcare, it’s worth taking a look at this new study from economists at the University of California. It was summarized in the Stanford Social Innovation Review as follows:

Research: Medicare Saves Lives

For decades, Americans have squabbled over whether the government should expand Medicare, maintain its current scope, or cut it altogether. But their debates have suffered for lack of an answer to one vital question: Does Medicare make a difference?

A new study shows that Medicare indeed makes a diff erence for seriously ill patients—and that difference is the one between life and death. Following the fates of more than 400,000 people admitted to California hospitals through their emergency departments, a team of economists finds that patients who are just over 65 years old—and thus eligible for Medicare—are [less likely to die compared to those who are just under 65 years old, and being admitted through the ER with the exact same type of medical conditions].
*****

We’ve got a public option, and the over-65-year-olds seem to like it quite well. What’s everyone else so afraid of?

I support the public option, but as someone who currently lacks health insurance—and couldn’t get it in the private market at anything less than usurious rates due to pre-existing conditions—I can state flatly that requirements on insurance companies to write politices, subsidies for up to 800% of the poverty line, and fair and equal pricing would be huge for me. Tremendously huge. Like, the difference between being insured and not being insured huge.

Don’t get me wrong—I think the public option is swell, and were I God-Emperor of America, it would be the law. But I’m going to be seriously pissed if health care reform dies because my fellow lefties were trying to prove a point about ideological purity. Because if the left kills health care reform this go-round, we are killing it for another generation. And I don’t want my daughter facing what I’m facing right now.

What’s even more hilarious is that the same conservatives who say that a public option is unfair are usually the same ones who want the “guvmint” to give 5,000 $ school vouchers for every school kid, to be spent at the public or private school of their parents’ choosing.  Because hey, the competition would be great for the public schools (never mind that the public schools have to educate everyone, while the private schools are free to pick and choose the brightest and best behaved). 

I’m not sure why giving “guvmint” money to private schools to compete with public schools is a terrific idea, but creating a public option to compete with private insurers is a Communist plot.  Maybe there would be less wild shrieking if we were handing out 5000$ vouchers to everyone in order to buy public and private insurance as they chose, but the results would be the same as for school vouchers; more money would end up with the profiteers, and the government would be left holding the bag.

We want the public option because anything else is a giveaway to the insurance agencies, which are already leeching billions of dollars out of the system and from people in the most desperate of circumstances.

If it’s just an insurance mandate, that’s corporate welfare.  It gives 47 million new customers to the insurance companies without any means of controlling costs b/c the taxpayers will subsidize the difference.  More customers + tax money for higher premiums!  No wonder health insurance stocks are still going up.

The public option is the only acceptable compromise.  If we give that up, none of the other reforms are worth it, b/c the entire system is so broken that these “reforms” will not fix it, but only delay the total breakdown while lining those bloodsuckers pockets.

I’ll fucking vote Nader next time.  (Well, not Nader, but I’ll write in Kucinich or Dean or Feingold or Schakowsky)

Our Congress is afflicted with Stockholm Syndrome. It’s a survival tactic.

Our elected officials cannot imagine standing up to corporations because they can’t survive without them… maybe quite literally. How do you stop playing nice with the hand that feeds you, that gives you social support and a paycheck? How do you fix a system that makes standing up for yourself a suicidal act?

Here’s a bit from a good link about Jaycee Lee Dugard and Stockholm Syndrome:

The relationship that can develop between hostages and kidnap victims and their captors is now known as “the Stockholm Syndrome,” a type of emotional bonding that is in reality a survival strategy for victims of emotional and physical abuse.

... The bond that exists between the captor/abuser and his or her victim is strong and can compel the victim to stay with (or otherwise support the actions of the abuser) when the need to run is blatantly obvious to everyone but the victim. The investment that one has made in the relationship directly impacts the ability to recognize the negative or threatening aspects of the association.

... The bottom line is that staying alive can allow us to adapt to the worst of situations, something, perhaps, similar to abused children or women who are victims of domestic violence but do not try to leave or “escape” their abuser.

Our elected officials are too dependent on corporations for their livelihoods and support systems. If they fail to play ball, they could lose everything.
Over time, why wouldn’t this survival strategy turn into an emotional bond, in which they feel more empathy and allegiance for the corporations than for the real live people they were elected to represent? Plus, they’re around those lobbyists every day… they’re not interacting with us day by day. They have deeper, closer relationships with lobbyists than they have with us.

Voting for Nader, etc. is not going to be as effective as fixing these social-animal features gone wrong.

Sometimes I feel a great deal of despair about the fact we’re social animals. Because, as such, we will do anything to protect our support systems; including destroy our consciences and sell our own mothers down the river.

I believe it’s pretty safe to kill legislation, unlike Jeff Fecke orEzra Klein.  The health care situation is so grave right now that even if it loses now, we will still revisit the issue in a few years.  Most probably when Medicare becomes untenable—which is not so far from now.  Health care costs must come down.  As in, it absolutely must come down because there isn’t any more give to go.  It’s already expensive.  It’s already recognizably barbarous to most citizens.  Between the delegitimization of the political system and declines in economic activity that result from continued political passivity, there will be no choice but to revisit health care.  If you don’t believe me, check out the political pathway of California’s budget system from Grey Davis’s tax increases to his recall, to Governator’s intitial big bond play, to the progressive collapse of California’s ability to pay for needed services.  Yes, it was slow when California’s decline started in the 70’s.  You had decades passed between movements.  But crisis happens more and more often and closer together.  You can do the same with the history of American slavery, or just about any other inflective point issue. 

We will see health care revisited.  A failure here, I think is most likely not going to affect the chances of some kind of institutional change to allow more government participation.  So what we are fighting for at this time and place is to choose what kind of government participation we will get.  So, in an odd way, I’m pretty unsentimental about whether we get a public option.  We’re not likely to get a *good* public option, and one that does just enough is an enemy to not just perfection, but good enough for long term stability as well.  The health insurance industry is dead in the long term, I think, and everything that happens right now is about gracefully transitioning.

The industry is dead in the long term because there is no way to capture profits from an honest use of talents.  Health care costs are rising too quickly.  Thus stocks or bonds will not perform well enough to cover even not-quite-so-predatory behavior, let alone professional insurance co behavior.  The only way to stop health care cost growth is essentially for the government to insist in some form to stop it.  Health is a natural rent, much like breathing.  People will have to pay whatever or consider hemlock.  Intrusive government is unavoidable.  When Medicare finally, and for sure, blows up—and most certainly before about 2014, then the shit storm really begins.

Also, as this has been going around the blogosphere recently…

It’s just getting more important to not give in the face of sociopathic oppositional behavior.  There’s alot of power in not giving a shit about anyone or anything.  Sometimes you do have to figure out how make them care without actually cutting off your nose.

IIRC, one of the cornerstones of free market and capitalism is consumer agency to keep prices low, generally taking the form of competition for the lowest price or best value of goods and services, and some level of ability to modulate demand based on price.

But here the consumer has none of the standard options.  Hospitals don’t compete with each other; they don’t advertise prices or even quote them before the treatment has been provided, and the demand is based solidly on need, with immensely high stakes if it’s not met.  I.e. we have a system where providers can charge anything and have people scramble to pay it because the need is externally applied, narrow in scope (one can’t really opt for different quality or options to get it at a cheaper price the way one can with a car, house, or food) and requires immediate action.  This is why health care costs are through the roof.

Now into this mess step the insurance companies, and rather than spread the costs out among people for least amount of burden to all involved, they jumped on the captive-market bandwagon themselves, gorging along with the healthcare industry on the profits to be had from people who have no choice but to pay or risk dying—-and that isn’t enough for them, they want to also refuse to pay for health care when people actually need the services they paid to have covered.  They want to drop policies when people have expensive diseases, or to not cover people who have been diagnosed with anything.  They want to make people pay for big chunks of their own care first (deductibles) so that they’re free of having to cover the most common, everyday health care costs AND the catastrophic illnesses and injuries that are the whole reason people get insurance in the first place.

And they get to do it all because there’s no legitimate consumer choice.  No options.  Lives on the line to keep people buying, to artificially create demand for and acceptance of this excessively exploitative system, its high prices and its catastrophically negligent provisions.  And they trumpet “free market,” “capitalism,” and “fair competition” to the heavens in their arguements for their rights to keep shitting on the actuality of all three.

This is about power. If we have the power to get a public option, we have the power to get single payer. There’s no point in compromise. Insurance companies and their whores in Congress do not want to build an agreement, they want to destroy the political power of their opponents. This compromise talk is bullshit because, in compromise, the opposing side gives up something they want, and the ONLY thing the insurance companies and their allies want nothing except the deempowerment of their opponents. You may as well pursue single payer because the resistance against it will be identical in degree and tone to what is occuring now AND you’ll have the added bonuses of being intellectually, consistent, ethically sound, and politically brave which will help rally the base. Half-measures will result in a whole loss.*

*( . . . and if a single-payer plan would lose then so would a public option. As I said, the resistance would be identical. The advantage is that the allies brought together for a single-payer plan are greater in number and scope than seen when public option is pursued, making for increasing political strengnth, even in failure.

Here’s something that must be said…

Why is one of the original Pandagonians selling his soul to the devil?  I’m talking about none other than Ezra Klein.

The sweet gig at the Washington Post seems to have changed him.  And not in a good way.

Here he is pissing all over the absolute necessity for a public option just like a good Villager should:

If the public option needs to be dropped to secure passage of the final bill, then that may be the unfortunate reality of the situation. But that’s the context in which you drop something like the public option: A context in which you get something significant for the concession, like passage of everything else, or much more money in subsidies and much stronger exchanges. You don’t drop it in the hopes that the compromise will be seen by opponents as reasonableness rather than weakness. The public option is good policy and, if it comes down to it, the largest bargaining chip. You don’t give it away lightly. But you do have to keep it in perspective.

The public option is a bargaining chip?

Seriously?  WTF, man?

You’re helping the Blue Dogs show us the bottom of the bus.  I certainly hope those D.C. insider cocktail parties are worth it.  And Ed fucking Schultz is now officially more progressive than you are on this issue.

I support the public option, but as someone who currently lacks health insurance—and couldn’t get it in the private market at anything less than usurious rates due to pre-existing conditions—I can state flatly that requirements on insurance companies to write politices, subsidies for up to 800% of the poverty line, and fair and equal pricing would be huge for me. Tremendously huge. Like, the difference between being insured and not being insured huge.

Decent points, except subsidies up to 800% of the poverty level aren’t being discussed anywhere.  They are haggling between 300-400% as far as I know, which is substantially different than 800%:

The Finance Committee has already indicated that they plan to scale back the subsidies to help low-income individuals to buy insurance, providing help to those earning up to 300% above the poverty line, as opposed to the 400% that’s in the HELP/House bills. Snowe argues that most of the uninsured fall below the 300% mark, though-according to multiple sources-she believes there are some “unique problems” that those in the 300-400% range face. She is going to continue deliberating ways to help these individuals in negotiations.

For me, the reasons the public option matters are quite different:

1) living in MA, the non-public option ideas don’t appear to be any different than Romneycare, which still has costs growing much faster than inflation.

2) Related to #1, lower-middle class (or middle class, depending on the subsidy schemes) will be worse off financially.

3) Does anyone really believe that without a serious alternative to private insurance (or even with one) that the insurance company lobbyists won’t build in loopholes to screw people?  Because they’re really good at that.  To me, a strong public option means security.

4) The only thing that repeatedly garners massive support is the idea of Medicare-for-all:  the polling numbers haven’t budged.  Yet the Democrats (aka the stupidest political party in recorded history) are running away from a strong public option, either because of political miscalculation or because of financial considerations.

5) Any plan that doesn’t lower costs for most, increase security (i.e., no recission), and limits healthcare options will be politically deadly.  There is a legitimate argument made by middle class households (there’s also a illegitimate, racist one) that, while the rich have been receiving all the benefits and perks, they’ve been getting the shaft (e.g., protecting executive bonuses in essentially nationalized companies, tax breaks, etc.).  If many people don’t see a gain in something, this ‘reform’ will be seen as another Democratic program that helps the poor and the rich (or doesn’t really cost the rich anything) and that screws the middle class.  This would be a political catastrophe, particularly since Democrats will be perceived as playing true to form.

6) A strong, Medicare-for-all, public option is defensible and easily explained:  if a working 65 year-old can buy into Medicare, why can’t a 35 year-old?

That’s why watching the PO die is so frustrating for me, anyway.

If it’s just an insurance mandate, that’s corporate welfare.  It gives 47 million new customers to the insurance companies without any means of controlling costs b/c the taxpayers will subsidize the difference.  More customers + tax money for higher premiums!  No wonder health insurance stocks are still going up.

It’s worse than that.  No public option coupled with a mandate is simply a tax - the most regressive tax ever imposed on Americans.

That’s why the public option is a necessity, because while Obama and Congressional Dems are publicly considering getting rid of it, they are holding the line on an individual mandate.  Unsurprising, I guess, since irredeemable whores like Max Baucus know that a mandate is free money for his masters.

So Amanda’s arguments make sense, but they’re completely beside the point.  Mandate + no PO = worst tax increase imaginable, something hugely destructive to America’s poorest citizens. 

If they drop the mandate, then they can drop the public option and pass some meaningless “reform” bill that nibbles around the edges.  They can declare a Village Victory and hopefully keep Congress out of the GOP’s hands next year.  Then in a few years they’ll have to work on this again, and perhaps that time the public outcry for public option - or single payer - will be loud and strong enough.

I also think it’s important to note that a lot of liberals are committed to single payer, and see the public option as a compromise measure towards moving in that direction. They’re quite suspicious of the entire private health insurance market. Eliminating the public option - which they see as a means of giving single payer a fair test - removes the only incentive they have to back reform. I’m not in that camp myself, but I can certainly see their point, and it would be a mistake to under-rate their intensity or commitment.

Here’s why.

Back in the eighties California passed compulsory car insurance.  It required a minimum of car insurance (a real bare minimum) to legally drive a car.  At the time it was sold to the citizens as being one way to bring down insurance costs once everyone was insured.  At the same time, California established a state office of insurance to watch over the industry.

So what’s happened since then?  Nothing really.  Car insurance have increased in California right along with other states and the state insurance czar is basically a lapdog for the industry.

In other words, “mandating” health insurance will do nothing except mandate insurance company profits by law.  It won’t lower the costs because insurance companies have no desire to lower the cost of insurance, they only care about lowering their costs, which means paying out less.  It’s that fucking simple.  There’s no mystery here.

That’s why a single-payer, government is so vital.  The profit motive has to be taken out of health insurance because it’s killing people.  I guess we can tolerate for profit insurance for our cars, our homes and our businesses because, well, we have to.  But when it comes lives, can’t we, for once, just do the right fucking thing?

What Robert and Mike and some others said, but more so. Big companies are really really good at getting around regulations. And regulations with teeth, plus the staff to enforce them thoroughly, are really expensive and intrusive. Imagine, say, a regulatory regime where health auditors looked at a random 5% of claim decisions and could reverse those decisions with a stroke of the pen, requiring the company to go to federal court to get relief. Insurance companies would be on their knees begging for a public option.

Dan wrote:

You’ve missed the most brazen piece of bullshit underlying the argument that we can’t have a public option because private entities won’t be able to compete: public options don’t even drive competing private entities out of business

I’d point out here that it was President Obama himself, not just one of his minions, who tried to make this point, and then use the Post Office as an example!  Not exactly a good move.

You have four problems:

1 - When you say that there are 47 million people not covered by insurance, you are concomitantly saying that there are roughly 250 million Americans who do have health insurance.  If a lot of people who have private insurance aren’t wholly satisfied with it, they are even less trustful of the government to be able to make things better.

2 - Of the 47 million uninsured, many are already eligible for Medicaid, but simply aren’t on the rolls, because they haven’t bothered to apply or some paperwork snafu; if they have to go to the hospitap, the paperwork will get filled out, as the hospital will try to recober its costs.  About ten million of the 47 million aren’t American citizens, half of those being here illegally.  This creates a substantial block of the uninsured who either cannot vote, or are among those least likely to vote.

3 - There is a substantial segment of the population who just doesn’t believe that it is the proper role for government to provide health care, period.

4 - The plan to sell the public option insurance is seen by many—including me—as something drummed up to be a palatable alternative, since single-payer is probably unsaleable in the US, but one that is destined to fail so miserably that it will be used as the road to single-payer./

6) A strong, Medicare-for-all, public option is defensible and easily explained:  if a working 65 year-old can buy into Medicare, why can’t a 35 year-old?

Mike, that’s what’s so fucking frustrating and disheartening to me about this whole clusterfuck. The entrenched interests were always going to fight tooth and nail against ANY proposal that doesn’t simply hand over money and captive customers to the insurance bloodsuckers. So why pick that fight over some complicated yet half-assed proposal that nobody even seems to know quite what it is, instead of fighting that very same fight on behalf of expanding an immensely popular program? Just fucking brain-dead. I really don’t know how much longer I can hold my nose and support the Dumbocratic Party.

“A strong, Medicare-for-all, public option is defensible and easily explained:  if a working 65 year-old can buy into Medicare, why can’t a 35 year-old?”

That right there is the single most frightening idea in American healthcare — but only to the entrenched powers of Big Medicine, Big Pharma, and Big Insurance!

Regardless of how it starts out, eventually it would lead to the Holy Grail of universal healthcare: Single Payer.

It makes so much sense, would be relatively easy to implement, would save huge amounts of money, and would represent an immense victory for the American People.

...now if only we lived in a democracy where actual human citizens are represented, and not just obscenely wealthy corporate interests…

The public option serves as a distraction: the real swindle is the removal of single-payer from the discussion entirely. Imagine if you sat down to negotiate with someone and everyone in the room, from your lawyers to the arbitrator, all said to you off the bat, “Look, you’re not getting a fucking thing you want here, so what’s discussed today will be, and only be, how much you lose.” That’s not a negotiation that’s a shakedown. That’s what’s happening here.

Again, there is NO political difference between pushing for single payer and pushing for public option bullshit. The resistance will be the same, but the rhetorical effect and political fallout will be far different.

Ezra always tended towards the center more than me or Jesse.  I’m not so sure that the WaPo has influenced him.  His values are very much to the left, with the people, etc.  His strategies are more centrist.  He sees it as pragmatism, which is a legitimate argument, I think.  I just differ with it.

well, contrasting his and your take on the racism used against health reform was interesting—starting from that post where he sez that commenting on Gates was a mistake.  The evolution of that theme as people grew ever more crazy in Ezra’s writing was fascinating to me.

The public option serves as a distraction: the real swindle is the removal of single-payer from the discussion entirely. Imagine if you sat down to negotiate with someone and everyone in the room, from your lawyers to the arbitrator, all said to you off the bat, “Look, you’re not getting a fucking thing you want here, so what’s discussed today will be, and only be, how much you lose.” That’s not a negotiation that’s a shakedown. That’s what’s happening here.

Again, there is NO political difference between pushing for single payer and pushing for public option bullshit. The resistance will be the same, but the rhetorical effect and political fallout will be far different.

I disagree.

Yes, I agree that single-payer really is what we should be shooting for, but I disagree with the level of resistance that it would face compared to the public option.

Wingnuts citizens aren’t really driving the opposition on this.  It isn’t even Fox News.  Sure, they are both handy tools being used to demagogue the hell out of the whole thing, but they aren’t the real force at work here.

It’s the insurance industry itself.  More specifically, it’s the money that the insurance industry is dangling over the heads of the players involved, particularly in the U.S. Senate.

And while they have a virtual deathgrip on the Republican Senate Caucus, they’ve figured out that the safest bet is to pay off BOTH sides, which they largely have - and so their money lines quite a few Democratic Senators’ pockets as well.

And while you can say that the resistance would be no worse if the Democrats were pushing single-payer instead of a public option, I disagree.  I think it would be a lot worse.  If they are spending $100 Million to fight a public option, they would spend $500 Million to fight universal single-payer healthcare.

And ultimately, that’s money that’s either gonna be dangled before a Senator who is willing to play along, or used as a threat to finance an opponent for a Senator who won’t play along.

But they are all affected by it.  These folks in Congress know the score.  They look at the same polls as you and I.  They know that the public will exits to pass some pretty damn progressive reform, probably even single-payer.

But money talks.  And our campaign finance laws are worthless.  Aetna, Wellpoint, Cigna, and the rest have a hell of a lot more easy money for these folks than us average proles.  And the senators know that.  And they are gonna vote in accordance with the wishes of their biggest financial benefactors… which would be the insurance industry, not us.

Yes, the political will to get single-payer done exists.  Among us lowly proles.  Not so much with that 100 person club in the upper chamber of Congress, who ultimately makes the call.

Dan:It’s unsellable because of sociopaths who get their jollies in the suffering of others, and think that suffering is a great marketing strategy for their particular ideology.

In any case, lets play some policy chess, shall we?

-Under the proposed reforms, if properly enforced, private insurance can’t operate as it does now. The profit margins will be trimmed to all hell, or negated completely. All that waste will be eliminated. However, please note that waste actually is people’s livelihoods…both of evil people who perpetuated the system as well as the good people who fought against it. (As a side note, it’ll also hurt people’s retirement funds, so keep that in mind as well)
-So it’ll probably result in single payer, which is the most economically efficient system.
-But again, a lot of that waste is actually good paying jobs. Bye bye those jobs, dropping the employment levels lower, lowering wages even more.
-The endgame IMO of the current economic malaise, and that includes health reform is that the entire economy from the ground up needs to be rethought. Worked hours and renumeration for those hours need to be brought in check, to make sure that each and every person who wants a economically rewarding job can have one.

THAT’S the tough part. Do I think there are many politicians who are aware of this? No. But I know of at least one who does know this, at least up to the last point, and that seems like a no-brainer. That politician?

Barack Obama.

When it comes down to it, the big block to health care reform is that people just can’t stand the idea that the person sweeping their floors or flipping their burgers is working 30 hours a week, has just as good heath care, owns their own house and is saving for their kids college just like they do.

Ezra Klein works for the Washington Post after they fired Dan Froomkin.  He has bread, and it is buttered, and he’s aware of how it gets buttered.

Dan wrote:

About ten million of the 47 million aren’t American citizens, half of those being here illegally. This creates a substantial block of the uninsured who either cannot vote, or are among those least likely to vote. (me)

The argument underlying this statement is, of course, “dirty Mexicans don’t deserve to live.”

People who think that corporate profits ought to trump basic human rights are FUCKING SOCIOPATHS.

The only one who said anything about “dirty Mexicans” would be you.  How difficult is it to understand that politicians are primarily interested in voters?  If the uninsured are only about 1/6th of the population, and perhaps a quarter of them cannot vote, poliicians are going to be less concerned about them.

3 - There is a substantial segment of the population who just doesn’t believe that it is the proper role for government to provide health care, period. Me

25% != “a substantial segment of the population”

Statistics fail.

Yeah, 25% is a substantial segment.  If that is the percentage of people who don’t believe that providing health care is the proper role of government, that would still make them a larger segment than the number of people without health insurance now.

And while 25% isn’t a majority, electoral majorities are composed of an aggregation of smaller interest groups, philosophies, etc.

4 - The plan to sell the public option insurance is seen by many—including me—as something drummed up to be a palatable alternative, since single-payer is probably unsaleable in the US, but one that is destined to fail so miserably that it will be used as the road to single-payer.

Single-payer is unsalable in the US because of people like you, who clearly don’t have the first fucking clue what you’re talking about but insist on telling us all about it anyway, and people like the ones you listen to, who know even better than we do that you don’t have the first fucking clue what you’re talking about and think lying to stupid people for short-term political gain is the single most fun thing in the world.

Well, Dan, “people like (me), who clearly don’t have the first fucking clue what (I’m) talking about but insist on telling us all about it anyway,” are still voters.  Yeah, I know: you don’t think that people who disagree with you are intelligent, and you think that “stupid people shouldn’t be allowed to vote,” but you know what, a whole lot of people you think shouldn’t be allowed to vote are allowed to vote.  Sorry if that bothers you.

DTG wrote:

Yes, the political will to get single-payer done exists.  Among us lowly proles.

OK, so why isn’t it getting done?

Our politicians are smart people, and they know that giving the public what we want is the best way to get re-elected.  You’d think that, if the political will to get single-payer passed really existed, our politicians would be falling all over themselves to make it happen.

Even in the Demoratic primaries, where all of the candidates agreed that something major had to be done about health care, only the most marginal candidates (Mike Gravel and Dennis Kucinich) supported single-payer; the major candidates (Hillary Clinton, Barack Obama, John Edwards, Bill Richardson) were all supportng something along the lines of what’s on the table right now.

Ezra Klein works for the Washington Post after they fired Dan Froomkin.  He has bread, and it is buttered, and he’s aware of how it gets buttered.

True… but Eugene Robinson also works for WaPo, and he seems to be staunchly progresssive on just about everything, including healthcare.  The Pulitzer Foundation likes his work, as they gave him one of their spiffy awards a few months ago.  And he’s been willing to take Obama to task on the healthcare issue.  I think a lot of the liberal-leaning MSM villagers are still so infatuated by candidate Barack Obama that they are scared to challenge President Barack Obama.

“OK, so why isn’t it getting done?”

...with millions in Insurance Co. money being poured in politician’s pockets, it truly is a wonder as to why they do the Insurance Co.‘s bidding and ignore the rest of us…

“Our politicians are smart people…”

...that is obviously true of some of them, but not as a blanket statement…

”...and they know that giving the public what we want is the best way to get re-elected.”

“We”?  Who is “we”?

This is the stuff that makes it difficult to take you seriously sometimes, Mr. Pico.  You say something like that and it sounds like you just graduated from high school and are still stuffed full of unwarranted idealism. 

There are (at least) two constituencies in this country:  You and me and the people like us (the word “prole” is a nice label), and the People Who Count.

I have one vote, you have one vote, every prole has one vote.  But the People Who Count have one vote plus a whole lot of influence.  So while the election system grants them one physical vote just like everyone else, their influence is worth hundreds, thousands, millions of votes.

I can write a letter every day to my senator and one of her minions will toss them in the trash as soon as they are opened and it’s discovered I’m just another citizen.  I can’t donate mega bucks.  I can’t pay for one of those $10,000/plate fund raisers.  If I stand up and shout in a townhall, I’ll be removed by security.

But if Walmart, Exxon, or Blue Cross Blue Shield says something (via people or money or both), it will be listened to very carefully, and it will probably be taken very seriously.

Can you not see the truth of this?

“You’d think that, if the political will to get single-payer passed really existed, our politicians would be falling all over themselves to make it happen.”

The proles can want, and wish, and pray, and vote all we want and the politicians won’t have the “political will” to do what we want.  If we want/wish/pray/vote and give them a large check, then we would be heard…

Ok, I gotta protest this aspect.

The problem IS NOT the insurance company.  They are part of the problem, and the most visible and consensually agreeable villians.  However, they are just another face of the general issues relating to health care, and they exist because they were a bad compromise and a bandaid on that original situation.

This focus on insurance company omnipotence and villany obscures the ultimate goal of increasing access to health care to much more people.  In part, I agree with Klein about the relative worth of the public option, and I really don’t want to end up with a bad program that is mostly done to be seen to do something.

In any event, even if you can wave away political opposition to single payer/provider, you would still not address the central issue that there is not enough health care to go around.  Then the fight inevitably goes toward more telegenic groups such as doctors and local governments, and this will be a nastier fight.  In the end, this is about drastically cutting doctor’s livelyhoods as well as pharm company profits.  It’s also about directly contesting the attitudes of a wide swath of the populace that health care isn’t a basic need/right, but a sumptuary good that deliniates who the deserving are.

This is going to be a long fight and we simply can’t afford to take our eyes off the real ball of making health care available to many more people.  Focusing on insurance companies and their perverse incentives without understand who or what sets these perverse incentives is not in our interests.

Yes, the political will to get single-payer done exists.  Among us lowly proles.

OK, so why isn’t it getting done?

As I stated previously, it isn’t getting done because the majority of U.S. Senators are effectively being paid off by the insurance industry not to do anything.

They know that a solid majority of Americans want a public option.  But they also know that some filthy rich donors who work for UnitedHealth and Cigna DON’T want a public option.

It’s a hell of a lot easier to raise money when you can make a few phone calls and solicit a bunch of $5,000 checks from people who don’t even blink about that kind of money than having to go out and beg 500 average people to cut you $10 checks each.

Money talks, baby.  And the insurance lobby has a much larger, faster, and more efficient money pipeline to these folks than us proles do.

this is actually the single best reason for having a public option:

“The main argument against the public option is that the insurance companies don’t want to have to compete against it. “

any healthcare delivery reform lacking a public option is a complete waste of time. it will merely facilitate the increased flow of public and private dollars into the coffers of the health insurance industry.

In any event, even if you can wave away political opposition to single payer/provider, you would still not address the central issue that there is not enough health care to go around.  Then the fight inevitably goes toward more telegenic groups such as doctors and local governments, and this will be a nastier fight.  In the end, this is about drastically cutting doctor’s livelyhoods as well as pharm company profits.  It’s also about directly contesting the attitudes of a wide swath of the populace that health care isn’t a basic need/right, but a sumptuary good that deliniates who the deserving are.

I’m not gonna dispute that this isn’t part of the problem, but the reality is that for every multi-millionaire doctor you see on television, there are tons who aren’t multi-millionaires.  The vast majority of doctors in the U.S. aren’t wealthy.  Yes, they are in the top 5%, but they are on the low end of that top 5%.  There’s a pretty massive income chasm between someone in the top 0.1% margin and someone just inside the 5% margin.

The vast majority of doctors make six figure income by middle-age.  But this is after racking up $200,000 of student loans, and working 60 hour work weeks as residents/fellows for 4-6 years out of school for $40,000/year.  They may start to enjoy a bit of the higher-earner lifestyle by their mid-30s, but most of them are still paying off student debt into their 40s.

True, you can get rich becoming a doctor, and surely some go into the practice for this specific reason.  But not the vast majority, at least not as a primary motivator.  If it’s really only about money, they could just get an MBA (at a lower cost) and go into the financial sector, where they would get rich a hell of a lot quicker.

Yes, doctors here will probably have to take a pay cut in the long run if we are to get to a sustainable healthcare system.  But if they are gonna have to settle for a salary comparable to what one would make working in a call center, there won’t be a ton of people going to med school.  Why run up $200,000 in student loans if you are gonna hit an income ceiling of $50,000/year in your profession, when you could hit that same ceiling without taking on such massive debt and giving up 10 years of your life to non-stop work in the process?

In good, strong single-payer nations, doctors still make a fairly high wage, though not as large as here.  So some expectation of physician wage reduction is fair, but they will still want enough earning incentive to deem med school and residency to be worth the cost.

I agree on big pharma being a major culprit as well.  I place most of the blame on those who have commoditized healthcare, the folks making money hand over fist without delivering any actual healthcare goals themselves.

“We must win this fight to prove to the American public that elections do mean something”

hear, hear

DTG wrote:

As I stated previously, it isn’t getting done because the majority of U.S. Senators are effectively being paid off by the insurance industry not to do anything.

They know that a solid majority of Americans want a public option.  But they also know that some filthy rich donors who work for UnitedHealth and Cigna DON’T want a public option.

The underlying assumption is that the people really, really want health care coverage reform, and it’s just the evil insurance companies and their money, persuading/bribing/whatevering our poor, stupid politicians to do nothing.

But I think back to 1994.  Bill Clinton ran on health care reform, among other things, and a lot of people liked the idea of health care reform.  Yet, when the actual proposal was fleshed out, it didn’t look so pretty, and in 1994 the voters took it out on the Democrats in office.  I’m guessing that congressmen today can remember what happened in 1994. 

It’s really pretty simple: once elected, congressmen and senators can pretty much get re-elected reasonably easily, unless there’s a real reason not to do so; the last thing these guys want to do is piss off the voters.  If a lot of congressmen are hesitating on this, it’s because that’s how they are reading their constituents.

Special interest money is nice, but it isn’t worth losing your next election.

DTG, this is understood, and this is where I wanted to direct people’s attention towards.

The system is corrupt.  It’s far too expensive to make new doctors, and we’re making too many of the wrong kind.  It’s expensive to build hospitals, and most hospitals are being built in already overserved areas.  It’s expensive to discover new drugs, and most research is focused on me-too drugs.  There are huge sunk costs laid all around our health care system, with armies of determined partisans out to preserve livelyhoods, debt service, and sense of privilege. 

Stopping the insurance companies does very little to actually solve underlying problem, because at least in part, it is there to mask these systemic underlying issues by pretending that there is some sort of capitalist basis for denying access to health care when it is more truly an arm of the government (Fannie Mae, only with more realistic financial firewalls) that rations out an insufficient supply of health care. 

About the only thing that can fix our system is by forcing people to absorb losses.  We can do it neatly with carefully crafted jubilees or we can do it via implosion.  Any way we do it, we essentially do have to cap doctor’s salaries in some fashion.  We have to cap national GDP % on health care in some fashion—which means lower profits and zero profit growth for many industries.  Which would incite banshee cries from hell and all sorts of anxious violence by established parties.  Insurance companies are only the first step, and we should not focus on them.  As evil as they can be, this is more about an evil spread out into many areas of our society.

In the beginning (the late 1920’s) the US created a health care system that was based on two incompatible ethical systems—
Medicine, which is based on the ethic of providing care to patients—and—
Private health insurance. which is based on the ethic of generating profits for shareholders.

All institutions based on the ethic of providing care (education, police/fire protection, religious bodies, families) are inherently socialistic. Services go from those who have the wherewithal (financial resources, skills, power) to those who have the need (students, crime victims, hospitalized parishioners, dependent children, etc.)

All institutions based on the generation of profits charge the maximum freight to their customers in exchange for providing goods or services so that their investors may be rewarded.

And we wonder why we’re in this unholy mess?

On a more personal note, a year ago I watched my uninsured son endure hours of agony with a kidney stone, because he knew that whatever relief a hospital visit might provide, it could leave him with years of debt. It ripped my heart out seeing his face contort and turn purple.

I sent the White House an email telling them they would be insane to drop the public option, because any private poilcy my son could afford wouldn’t do jack squat with helping get the care he needs.

While I’m usually really interested in the politics and procedures in these debates, this one really strikes close to home.  I’m terrified. 

I love the idea of single payer, and don’t understand why Democrats didn’t start negotiations at a single payer system and “settle” for the public option.  But, if their idea of compromise is dropping the public option and keeping the individual mandate, I’m fucked.  Quit my job and go on Medicaid fucked. 

I do not have health insurance now.  I would like it, but I only work part time while I finish school.  I make enough to live.  I don’t have money left over at the end of the month.

I have no pre-existing conditions, but I am “childbearing age.”  Because I seem to have a functional uterus, insurance costs over $400/month.  That’s almost as much as my rent.  If we pass legislation with a mandate and no public option (or, as was mentioned above, subsidies up to 800% of the poverty line) a whole hell of a lot of people are going to be in a much worse situation than they are now. 

The Democrats won’t just lose the Congress in 2010.  We won’t get it back for a generation.

DTG in STL: We’ll have to agree to disagree, then.

You fail to address the fact that fighting for a powerful policy that will not win is still politically wise because it rallies the base and pushes the country towards that policy, making a future fight easier. Public option isn’t anywhere near the rallying cry of single-payer; one helps, the other completely fixes the damn problem. That’s why it’s so important that the goalposts be moved from jump to make sure it’s not on the table in the first place. Public option can be finessed into worthlessness, but single payer utterly destroys the regressive elements in our healthcare system.

This is why the level of resistance will be the same. Sure, the insurance companies may spend more money, but they will have to spend more money just to keep up with the the increased popularity of the idea. Bigger bribes for Senators is basically a wash—you’re “haggling over the price” as Shaw put it. So the only real use of that increased insurance money would be to manipulate the public, the very same public that would be more energized to resist their message because the policy they oppose is so very sound. I assume the absolute worse abuses of campaign finance laws and come to the conclusion that the differences between insurance copany behavior in either case is nil. Instead, the only real differences between pushing public option and single payer are a) the side effects of the struggle itself (disappointing the base as opposed to rallying the base) and b) the actual outcome (feeding a parasite less as opposed to its complete destruction).

I see no reason why the public option will magically be more likely to pass than single payer. Hell, the public option exists for rightwingers—and I include “moderates” in this formulation since their value system is not liberal in this issue—as I was saying, exists for rightwingers to have something to take off the table in the first place. It’s a surreal bit of extortion; in order to make it look like there’s a “compromise,” a weaksauce policy we don’t really want is cast aside as part of the “negotiation.”

And if you think I’m wrong about pursuing the policy your base actually wants, please explain to me the rise of the rabid right since the late Sixties and their amazing success in achieving ideological control of the Republican party despite an overall culture that considered them failures. IIRC, liberal used to be a good word. . .

Yes, the political will to get single-payer done exists.  Among us lowly proles.

Not uniformly, no. Many so-called “progressives” kissed Obama’s ass as soon it was fashionable, despite the fact that it was obvious his health care plan was worse than pathetic—the insurance companies were backing him during the primary and Krugman criticized his plan as being the absolute worst of the frontrunners (Edwards being the best) in the NYT. There are people up and down our little caste system who like single payer, but what’s interesting is that it’s the pseudoprogressives who are bringing obsequiousness to an art form and throwing out even the public option (thus creating the biggest tax hike in U.S. history as a side effect of their divine-level brownnosing). Quislings are more powerful when the measures being discussed are half-assed.

Comment #37: shah8  on  09/04  at  01:36 PM
The problem IS NOT the insurance company.

Yes it is. Health Insurance is an industry where one gains a profit by not providing a service. It is an inherently Bad Thing. It should not exist. Insurance is built around possibilities, but health care is an inevitability. It’s simply amazingly stupid and irresponsible not to go to a doctor regularly (given that it’s affordable), if only for check-ups. These companies are parasites so their continued existance is bad.

there is not enough health care to go around.

Yes there is. If there’s enough money in the budget to murder children at weddings in Pakistan, there’s enough money for health care. Elimination of insurance companies gives us ready-made clerical staff for the opening of thousands of new community clinics and hospitals. Construction of new health care agencies will, of course, require huge amounts of labor. It’s too bad we don’t have a huge unemployment problem to soak up that labor demand and aren’t in one of the worst economic slumps in history such that this process would justify huge amounts of stimulus spending—

Oh wait.

In the end, this is about drastically cutting doctor’s livelyhoods as well as pharm company profits.

No it’s not. Doctors live very, very well in other parts of the western world. It’s child’s play to maintain that standard when the government runs health care. Y’know, we could even go all out and make nurse lifestyles nice as well. More public funding for medical education could help here as well.

If you’re thinking “that’s politically difficult,” well, that’s fucking irrelevant, isn’t it? Everything worth doing here—everything worth doing—is politically difficult. The point is none of it is impossible and creating false limitations is exactly what rightwingers do to their political opponents. Why would you help them in this?

Yet, when the actual proposal was fleshed out, it didn’t look so pretty, and in 1994 the voters took it out on the Democrats in office.

Voters threw the Democrats out because Clinton’s triangluation efforts moved the party rightwards and dems stayed home for the poles and/or went ahead and voted for the “real” conservative. Dana is attempting to rewrite history here. No discussion of Clinton’s fuckover of the Democratic party is complete without mentioning NAFTA.

My last post:

dems stayed home for the poles

. . . and dems stayed home from the polls. . .

Blogposting, talking, eating, and taking phone calls all at the same time results in gibberish. Who knew.