And the Rest Is Just Noise

[TampaYankee]

Why the health care bill is the greatest social achievement of our time.

Food for thought.

http://www.tnr.com/article/politics/just-noise

[TampaYankee]

It is time to take our profits and plan to reinvest in further health improvements in 2011. The present bills are so flawed, and practically speaking there is so little flexibility in the Senate Bill if passage of any bill is to be gained, that I favor bypassing the Conference Process and urge the House to accept the Senate Bill as written. My reasons are given below.

I'm very disappointed with the Senate bill, less disappointed with the House bill but disappointed nevertheless. I believe that single-payer is the best way to achieve universal coverage and cost restraint, although I am leery of bureaucrats and politicians running anything. However, the insurance industry has shown that they too are unable to meet the health care needs of the nation -- the reason being that really is not their mission only the vehicle to their mission: profits.

Health Care was my second priority in securing a Democratic victory in the last election, Supreme Court appointments being the first. I am bitterly disappointed with the political process that has achieved the results to date although not suprised. Also I am bitterly disappointed with the results achieved. I was willing to compromise away single-payer in favor of a robust public option, recognzing the political realities. I was disappointed when that option was weakened to make it limited to only the few who fit the narrow constraint for participation. I was demoralized when it became clear that this could not gain 60 votes. I was elated when Medicare Buy-In was offered as an alternative -- a much better option than the anemic public option IMO. I was futher elated with the ascension of the drug reimportation ammendment. Both crashed and burned at the alters of special-interest politics and senatorial ego.

I was bitter at the final result and wondered why bother to proceed. Sure, there still are some very important advances gained -- extended coverage with subsidies for those who need them, end of recission and pre-existing conditions exlcusion, both very important reforms. Will this fatten the insurance companies? Undoubtedly, and that burns me. Maybe the Medical Loss Ratio will curb the insurance companies unabashed milking of the premium payers. One can hope. Surely they will work to game the system to their advantage.

Yet, taking the long view of what has been gained and the fact that social improvements in the fabric of our nation have been few and far between, and in recognition that such advancements are seldom made in the absence of convulsive events, I'm prepared to settle for what we can get while we can get it and then work to improve what is a deeply flawed bill. In the Wall St vernacular, if we don't take our profits now in the hope that the market will go higher we stand to loose what has been gained. Loss of the extended coverage with subsidies, end of preconditions and recissions, imposition of premium allocation to medical care constraints and real curb in cost growth are too important to lose. Better to cement the gains and incrementally build more than to always hope to hit the jackpot or bust.

If we fail now I believe we won't revisit this again until we are driven to by a convulsive event, likely the widespread failure of the national insurance/medical system or failure to gain control of our budget with attendant rampant inflation and demands for massive reduction in spending with deep cuts in medicare, medicaid, and social security -- which plays right into the GOP/Conservative Right Wing playbook.

Make no mistake, notwithstanding what some progressives think, failure to act will not increase Democrats in Congress in the midterm election. There will be no tidal wave of public rage to unseat those against single-payer or public option. Just because polls indicate that so many people are unhappy with the present bills does not mean that they aagree on the same alternative -- both extremes hate the bills. The Red States will still be Red, Purple may turn more reddish too. The Dems in Congress are at their high water mark right now. They will lose seats in both houses. There will be no moderate Republican tidal wave sweeping into office to change the complexion of the opposition. It is very unclear that all losses will be restored in the next presidential election, nor is it clear that Obama will be reelected in 2012. If the Dems recover and thrive in 2012 it will be time to revisit a public option or extending Medicare below 55 in addition and to instituting better ways to pay for Health Care.

Thus it is time to take our profits and plan to reinvest in further health improvements in 2011. I suspect the lowest hanging fruit at that time will be drug reimportation. That might even be achievable next year. Some in the GOP seem ready and willing to embrace that. I would like to see medicare buy-in revisited too.

As the benefits of the new health care are embraced and fear of change subsides, the next round of advancements will come easier hopefully. There is something to be said for evolution over revolution, escpecially when one-step revolution is demonstrated to have little chance of success without a convulsive event as catalyst. Even in those cases change was limited and evolved over time to the programs we have today.

Finally, IMO the present bills are so flawed, and practically speaking there is so little flexibility in the Senate Bill if passage of any bill is to be gained, that I favor bypassing the Conference Process and urge the House to accept the Senate Bill as written. What little in the way of improvements to be gained realistically from the House Bill does not warrant putting the important Health Care advances at risk of another tap dance in the Senate. The GOP knives are still out, the intransigent Dems are not going to be shamed into 'doing the right thing' or have a change of heart or be bullied into compliance at the threat of being accused of killing Health Reform. That would have already happened if it were a possibility.

This has already become a painful and bloody process spilling over into an election year. Why put everything at risk AGAIN for what few minor improvements might be achievable. The Risk/Reward ratio just isn't there. We should take the profits we have and come back in 2011.

I hope the progressives are smart enough to see the glass half-full so that we can cement progress and move to the next level. Progressives have a demonstrated history of shooting themselves in the foot going back to Ted Kennedy shooting down Nixon's health care reform, which Ted came to dearly regret, for decades. I came across the article referenced in the top level post which describes some of the more recent history of prgressives failing to take the glass-half-full view. Maybe they won't make the same mistake again. I'm not convinced they won't. Their way or the highway has usually led to the highway.

Finally, the Progressives ought to be more than willing to lend at least half-hearted support of this advancement if for no other reason that GOP belief that such an advancement will fundamentally change the GOP's ability to influence the government as they desire, going forward. The GOP Holy Grail is to pare back our government to a Treasury Department, Secretary of State, and War Department, with a presiding executive who oversees day-to-day governmental operations and acts as Commander-in-Chief when necessary. They see a popular national Health Care program as the death knell to any future influence to achieve their aims. With popular national health care, Social Security and Defense taking up to 90% of the budget, it doesn't leave them much to take a meat ax to. They would be consigned to tikering at the edges of government, denying the quest for the Holy Grail. History shows that it is very difficult if not impossible to take away from the people those programs that enjoy widespread popularity. Even deep-pocket lobbyists have a hard time swimming against a populary supported stream.

This could have been a lot shorter. Sadly, I dont have enough time to devote to that refinement.

[TampaYankee]

Why the health care bill is the greatest social achievement of our time.

Food for thought.

http://www.tnr.com/article/politics/just-noise

Another article in a similar vein...

http://www.nationaljournal.com/njmagazine/nj_20091224_5120.php

The Left's Fatal Abstraction

Critics Of Health Reform On Obama's Left Have Largely Focused On Symbolic Issues

by Ronald Brownstein

Thursday, Dec. 24, 2009

With the Senate's passage Thursday morning of sweeping health care reform, President Obama took another giant step toward the biggest legislative achievement for any Democratic president since Lyndon Johnson muscled Medicare into law in 1965.

Comprehensive health care reform has defeated every president who has pursued it, from Franklin Roosevelt to Bill Clinton. But, even with some hurdles remaining, Obama is now on track to sign legislation early next year moving the U.S. toward universal coverage. Though the bill bears all the scars and imperfections of its arduous advance, it's likely to stand as the signal domestic accomplishment of his presidency, even if he serves two terms.

And so, naturally, the reaction of the most visible component of the Democratic base has been to link arms with congressional Republicans and the conservative grassroots to insist that the bill be killed. Even as conservatives denounce the bill as an ominous extension of government's reach, leading lights of the Internet-based digital left like Howard Dean, MoveOn.org, Markos Moulitsas and Arianna Huffington are portraying it as a Christmas gift to special interests. One side sees a socialist taking America on a sleigh ride toward Sweden; the other a sell-out surrendering to big business and reactionary "ConservaDems." Who says no good deed goes unpunished?

The new Internet-based left, because it is so heavily reliant on college-educated whites generally less exposed to the economy's storms, has a blind spot on kitchen table issues.

The right's fury is easy to understand. It has opposed universal coverage for generations both on policy (excessive federal intrusion into the marketplace) and political grounds. Though conservatives are now confidently predicting a short-term backlash against the legislation, the right's shrewdest strategists have long worried that if government-guaranteed health care ever takes root, Americans would become more inclined to look to Washington for economic security, which would weaken conservative anti-government arguments.

The left's outrage is more puzzling. The bill has been wrenched by many compromises. But it imposes on the insurance industry tough rules long sought by liberals, including a ban on the denial of coverage for pre-existing conditions. Once fully phased in, it would spend nearly $200 billion annually to help more than 30 million uninsured Americans obtain coverage. Yet it squeezes enough savings from inefficiencies in current health spending that the Congressional Budget Office projects it will reduce the federal deficit in the near- and long-term, and the independent Medicare Actuary calculates that it will vastly extend coverage while increasing total national health care spending (by business, government and individuals) by less than a penny on the dollar through 2019. And it advances almost all the ideas that cutting-edge reformers consider essential to slowing long-term cost growth by nudging the medical system away from fee-for-service medicine toward approaches that more closely tie provider compensation to results for patients.

Against all that, the aggrieved left has mostly focused on two concessions made to centrist Senate Democrats: restrictions on abortion coverage and the abandonment of a public competitor to private insurers. But each is a largely symbolic dispute: There's little evidence the legislation would seriously constrain access to abortion, and the CBO has estimated that only about 6 million people would choose a public option. (It was equally irresponsible for the Senate centrists to threaten to sink the bill over such tangential provisions.) Even political scientist Jacob Hacker, widely considered the father of the public option, wrote this week that it "would be wrong" to derail the bill because it still contains "vital reforms."

In some respects, the left's discontent may be unavoidable. Perpetual dissatisfaction is the nature, and arguably the role, of activists. It's easy to forget that not only did liberals issue similar complaints about Clinton, but conservatives like Newt Gingrich groused that Ronald Reagan cut too many deals with Democrats.

The new Internet-based left, because it is so heavily reliant on college-educated whites generally less exposed to the economy's storms, also has a blind spot on kitchen table issues. According to the Census Bureau, just 6 percent of college-educated whites lack health insurance, for instance, compared to 19 percent of African-Americans and 31 percent of Hispanics. But the idea that Democrats should just press restart after the grueling struggle to reach this point carries an air of fatal abstraction: If health reform fails now, the next chance for big change probably wouldn't come for years, if not decades. "The universal rule of health care -- there are no exceptions -- is you get what you can," says Brown University political scientist James Morone, co-author of The Heart of Power, a recent history of health care politics.

Still, the left is raising one legitimate concern: the risk that Republicans will seize on the deals the White House cut to secure support from individual senators or key constituencies like drug manufacturers "to rebrand Obama and the Democrats as the party beholden to special interests," as Huffington wrote. The left's prescription for that problem -- junk the health care bill -- is batty, but that doesn't mean its diagnosis is wrong. With a populist wave building against all large institutions, Obama could find himself deluged if he doesn't learn to surf.

The president's strategy of enveloping potential opponents has brought him to the brink of an historic health care victory. But if Obama is to keep his head above water next year as he moves to issues like financial regulation and climate change, he may need to tilt his dial from conciliation toward greater confrontation with the powerful interests blocking his way.

[Guest Conway]

The reality is starting to set in for governors and state legislators now. The reason that the administration can claim the program is budget neutral is that the plan is designed to dump its additional operating and medicaid costs on states. I'm in Atlanta this week where the AJC is reporting that, as written, Obamacare will cost the state of Georgia up to $500 million annually. Just think what it will cost for already cash strapped states like New York and California.

Mark my words. This legislation will end up being an albatross around the necks of states for years to come.

[MsGuy]

"Just think what it will cost for already cash strapped states like New York and California."

3 to 4 billion for California, according to the Governor. Not clear which iteration of the bill that might be based on.

[TampaYankee]

The reality is starting to set in for governors and state legislators now. The reason that the administration can claim the program is budget neutral is that the plan is designed to dump its additional operating and medicaid costs on states. I'm in Atlanta this week where the AJC is reporting that, as written, Obamacare will cost the state of Georgia up to $500 million annually. Just think what it will cost for already cash strapped states like New York and California.

Mark my words. This legislation will end up being an albatross around the necks of states for years to come.

If this Health Care legislation passes then it will have to be revisited sooner better than later. At the risk of being accused of understatement, the present legislation is suboptimal. In fact some parts of it are just plain crazy. Unfortunately, this happens when there is lack of broad congressional support for the basic legislation purpose. That concentrates unusual power in the hands of a few critical politicians or in troublesome special interests. That is the nature of American politics.

[TotallyOz]

I am so disappointed with the Senate, I keep getting their Senate ReElection campaign money requests and I have asked to be taken off the list. I won't give any of them one dollar! They have royally screwed this up. IMHO

This was a once in a lifetime chance for real change and it goes to show that it will be politics as usual in DC.

[TampaYankee]

I am so disappointed with the Senate, I keep getting their Senate ReElection campaign money requests and I have asked to be taken off the list. I won't give any of them one dollar! They have royally screwed this up. IMHO

This was a once in a lifetime chance for real change and it goes to show that it will be politics as usual in DC.

True "They have royally screwed this up." and true "that it will be politics as usual in DC."

But I wouldn't write 'them Senate Dems' all off. Senators are like cats, impossible to herd. It's a fact, sometimes a very undesirable one. The Senate Leader cannot impose strict discipline. Only the Senate party caucuses can. Neither can the President. Seems odd but it is a fact. These guys are elected by the States. There are not that many of them and they need each other's help to get things done. Alienate one or ten and a senator screws himself with regard to his pet projects. Payback is a bitch that bites the payer too.

Some Senators are worth supporting, some are worthy of being cut loose. Target your contrubtions to the good guys up for re-election. I won't miss Blanche. All the others seem preferable to the alternatives. So maybe a contribution to the Senate Electoral Campaign Committee is not out of line in 2010.

Blanche Lincoln of Arkansas

Barbara Boxer of California

Michael Bennet of Colorado

Christopher Dodd of Connecticut

Daniel Inouye of Hawaii

Roland Burris of Illinois

Evan Bayh of Indiana

Barbara Mikulski of Maryland

Harry Reid of Nevada

Kirsten Gillibrand of New York

Chuck Schumer of New York

Byron Dorgan of North Dakota

Ron Wyden of Oregon

Arlen Specter of Pennsylvania

Patrick Leahy of Vermont

Patty Murray of Washington

Russ Feingold of Wisconsin

Some of the above are retiring. My presumption is that their party replacement is better than the alterantive as I wouldn't vote even for Abe Lincoln if he ran again as a Republican. No disrespect to him but anyone that lends organizational strength to the POG and the wingnut crazies is automatically disqualified IMO. Not too worried though as I'm confident he couldnt meet the new ten point wingnut litmus test for GOP support.

I wouldn't mind Sestak replacing Spectre even if he is a bit of a staff--driving-maniac. The same would be true for replacing Bayh if I thought there was a winning Dem replacement. IN the best of all possible worlds I would dump a handful of others but I must await that circumstance.