People may criticize Obama and I hear a lot of rhetoric from opposition, but every time I hear Obama speak for himself, He sounds like he totally and completely has his finger on the pulse of the people.

I'm not blind to the fact that he is a politician and politicking does happen, but he is one of the most down to earth politicians I've heard in a long time... I only wish more of them would consider the average Joe instead of just the high income earners like John Barasso who lives in his own bubble...

In many ways, I agree...he clearly -does- understand. Now, if he could just translate that understanding into -doing- what he says he'll do. So far, on every single issue I cared about, he's failed to move in the direction he said he would.

No single payer.
He voted for amnesty for telecoms who illegally wiretapped.
Nobody is going to be held responsible for the use of torture.
Guantanamo is still open.
We're still involved in two hopeless wars.
We still don't have -any- financial reform, much less something meaningful.
We still have don't ask, don't tell.
We still have the Defense of Marriage Act.
The Justice Department has -expanded- the state secrets defense even farther than the claims made by the Bush administration.

I'm not really willing to give him much more benefit of the doubt, until and unless he starts living up to at least -some- of his promises.

I agree with Stormy. Doesn't matter what he says it matters what he does, it also matters what he can do and apparently having the House and the Senate isn't enough. The point here is we might get something, but it won't be what the public has wanted for decades it'll be for the corporations to either be supported by it, or make money off of it. We have a welfare state, it's for the richest among us.

While, I agree, he is a very down to earth person I think one of his major flaws is his willingness to 'reach across the isle' as they say. You cant argue rationally with irrational people, it's a trap I myself fall into frequently when I bicker with people about religion.

I think that Obama made a VERY valid point that blew the senator's argument out of the water; but is that going to change the senator's opinion? Hell no. THAT is largely why Stormsinger's list, in my humble opinion, is now a bunch of unfulfilled promises.

Still I sympathize with him a bit. It has to be hard to bicker with people that are genuinely good at debating (politicians) but are so caught up in ideology and the idea of appeasing their idiot constituents that they become unreasonable people. For the aformentioned reasons I say he just needs to grow some (bigger) balls (he obviously has some ca hones already) and stop trying to win over Republican support.

Barasso is making a fundamentally bad argument.

"Cost should be the first question"

Like hell it should. Cost should not even be considered. The doctor should decide if you need an MRI, and he/she shouldn't consider cost either. Health care should not be a business, it should be a basic right.

In any individual case, that is clearly the ideal. However, when looking at the overall picture, cost -is- important. Even if it's not a for-profit business, health care does have costs...and those costs do have to be paid somehow. Clearly, if the total costs of health care surpassed the total productivity of the country, that is not a supportable situation, and other things are also necessities.

In short, I agree that he's making his argument badly, but I'm not sure the argument is fundamentally wrong. I suspect though, that it's not even his -real- objection, if you could prove him utterly wrong here, he'd just switch to another argument. It's just a political ploy.

>> ^gwiz665:
Barasso is making a fundamentally bad argument.
"Cost should be the first question"
Like hell it should. Cost should not even be considered. The doctor should decide if you need an MRI, and he/she shouldn't consider cost either. Health care should not be a business, it should be a basic right.

>> ^Stormsinger:
In any individual case, that is clearly the ideal. However, when looking at the overall picture, cost -is- important. Even if it's not a for-profit business, health care does have costs...and those costs do have to be paid somehow. Clearly, if the total costs of health care surpassed the total productivity of the country, that is not a supportable situation, and other things are also necessities.
In short, I agree that he's making his argument badly, but I'm not sure the argument is fundamentally wrong. I suspect though, that it's not even his -real- objection, if you could prove him utterly wrong here, he'd just switch to another argument. It's just a political ploy.
>> ^gwiz665:
Barasso is making a fundamentally bad argument.
"Cost should be the first question"
Like hell it should. Cost should not even be considered. The doctor should decide if you need an MRI, and he/she shouldn't consider cost either. Health care should not be a business, it should be a basic right.




None of that is true. It is merely a cultural and ideological system that has been ingrained into our psyche. Schooling does it, your parents do it, and eventually you do it to others and reaffirm it against yourself. I doubt beavers care what the cost of their dams are, for a small example.

Religion does the same thing. Or any system that creates a "institutionalized" type of behavior, were those actions sanctioned have always been status quo, and there is of course no other way to live. So sayeth the documents of yonder and old. There are few people that are selfless to the point of helping their fellow human beings whenever they can. There are seldom fewer that do the same, but see through the ruse and lead people to a truly revolutionary new age.

What the fuck are you saying? You think "cost" is a meaningless word?

"Cost" is nothing more than a way of measuring the resources required to produce a product or service. If 100% of our time and effort is spent on health care, who produces the food we -also- need? Or is that also just indoctrination? Maybe we don't really need food, shelter or drinkable water.

"Cost should not even be considered" is a nice soundbite, but give it any thought and it's clear that it can't possibly work in the larger picture. As a simple example, let's assume that a new treatment is discovered that would completely cure heart disease. It only requires the complete output of one million people for several years to treat someone. The soundbite would say that such a treatment should be given to everyone...totally ignoring the fact that it's simply not physically possible.

A lay person should never be in the position to decide his health based on the money in his pocket. That's barbaric. Regular joes have no clue if they really need an MRI or CAT scan or whatever, which is why a medical professional should make that call (while consulting the person of course). This doctor should ideally not consider the cost of the MRI, but whether it would actually help. In reality, some form of cost is evaluated as well of course - a CAT scan never really hurts, so if there's no evaluation then everyone would just get it for no real reason - but when it comes down to "This could really help you, but you can't afford it" it's just wrong.

Everything I've ever seen on the Cost side is that Medicare and Medicaid is much much more efficient than the insurance system. In fact where Medicare and Medicaid struggle is when they have to deal or use the insurance system in some way, it all gets bogged down in paperwork and bureaucracy.

For decades a lot of the public have wanted a health care for everyone single payer system. The only time this began to get traction was when GM endorsed a change in health care because it costs them $2000 more to make a car in Detroit than it does in Windsor Canada, because they have to pay for Health Care. That is a sign of a broken democracy but it's also a sign that this is cost effective and should be done the way the public wants.

As I said, in the individual case, the ideal -would- be that cost doesn't matter. It's only in the large picture that it should, simply because it must. Just because the Republicans are unwilling to admit the complexities of the issues are real, doesn't mean we should refuse to consider them (the complexities, that is...I'm pretty much sure we -have- to ignore the Republicans now).

I'm really not arguing with you, you know... I'm all for ensuring that everyone has good health care, and not just the emergency-only bankruptcy-inducing form we sort-of-kind-of have now. My preference would be for a single-payer system, preferably one that removes the fee-for-service incentives completely. But no matter what system is used, cost is still going to be an issue. Don't try to kid yourself, rationing, in some form, -always- exists. Currently, that form is by insurance coverage. In a single-payer system, it'll likely be something more along the lines of certain services won't be covered, or will only be covered in separate add-ons to the basic coverage.

[edited a typo]

>> ^gwiz665:
A lay person should never be in the position to decide his health based on the money in his pocket. That's barbaric. Regular joes have no clue if they really need an MRI or CAT scan or whatever, which is why a medical professional should make that call (while consulting the person of course). This doctor should ideally not consider the cost of the MRI, but whether it would actually help. In reality, some form of cost is evaluated as well of course - a CAT scan never really hurts, so if there's no evaluation then everyone would just get it for no real reason - but when it comes down to "This could really help you, but you can't afford it" it's just wrong.

I view healthcare the same as I view police and fire departments.

I'm sorry, sir, but your police insurance doesn't cover being the victim of a hit-and-run, we can't investigate that. We have the best police system in the world, and can't afford to protect those who don't want to pay for it.

The conversation about cost is interesting, and frankly if anything was made clear at the summit it is the central issue of contention. To those that say it is meaningless, that's ridiculous. Of course it matters, you just want there to be "uniform standards of care." It's not that you don't think costs matter, it's that you don't think "ability to pay" should. Personally I don't mind that, but there are obvious gray areas. Plastic surgery is a medical procedure, for instance. Some people need it (burn victims, say). Others, maybe not? Where exactly you put those sorts of lines, and who decides, is the crux of the question.

Currently, the health insurance agencies make the call. I think there is broad agreement that their power to do so should be removed (get rid of pre-existing conditions, etc). The issue then becomes, who does? How do you control costs? The proponents of single-payer generally want the government to make that call. They should, according to democrats, at least make broad outlines to the scope of doctors' discretion.

Conservatives frequently prefer health savings accounts (similar to Singapore's system). They feel this puts the consumer in the position to weigh various options, and thus promotes competition. One of the arguments is that skyrocketing healthcare expenses are the direct result of end consumers not directly feeling the costs, and making shrewder choices. Especially with a pay-per-procedure system, it's created perverse incentives (needless tests, up-coding, etc).

Well @bmacs27 I'm not really arguing that costs don't matter at all, they do, but the main issue should be if the procedure could help the patient. The consumer should not be the one making the decision (at least not alone) he is not a medical expert, he has no idea if a cat-scan would help or not, and the reason we have doctors is so that we don't all have to be. The doctor should be the final judge of what should be done, maybe while consulting the consumer, since it's obviously his/her body - optimally, the consumer will always choose what the doctor recommends, because he/she is the expert.

Now we just have to remove the incentives for the doctor to use more expensive treatments than what is needed. It's a corrupting system. THAT is what needs fixing. Once the cost concerns are marginalized and health concerns are prioritized much higher, the system will be far better.

In Denmark (yes yes, we are great) the doctor has to approve of any greater stuff. Plastic surgery too, but you can get it done anyway if you want to pay for it yourself. For instance, I had a "talgknop" (sort of a big pimple, like an ingrown hair thing) in my forehead removed (plastic surgery) which my public health care just took care of it, because my doctor deemed it so. I have no idea how much it would have cost me to have it done myself, likely I wouldn't have had the money for it.

Back @gwiz665 : I know you aren't. Like I said, you are arguing for uniform standards of care. We agree that what needs fixing are the perverse incentives in the current system. The question is about how to do it. Correct me if I'm wrong, but under most European systems doctors receive a fixed salary right? That seems fine, as it removes the incentives I'm talking about, but here in 'Merica, we call that pinko hogwash. People should be able to earn more by working harder. The government shouldn't be able to take away that option.

All I'm saying is that another way to prioritize treatment quality, while not having skyrocketing costs is to create HSAs. The idea is that if we took the amount spent on healthcare over the course of the average citizen's life we could just hand everybody half a million dollars in "health care stamps," or whatever you want to call them. That would be what you get to spend, and you get to decide how to spend it (on health related expenses). If you spend it all like an idiot, tough luck, that's how we roll. But it would put you in a position to say, you know, this pimple isn't really bothering me, I'd rather wait and see if I want that hip transplant when I'm older. This puts control of the transaction back in the consumer's hands so we aren't all at the mercy of some fixed income doctor, or government bureaucrat. Doctors obviously still recommend the treatments, but it makes the consumer better able to hold doctors accountable.

@bmacs27, sounds like you want DeLong-care.

It sounds like a viable enough alternative to me too, though I'm not sure what would prevent doctors from trying to sell you on tests & procedures you don't need. Presumably patient sticker shock, but that seems like you're pushing the decision point onto the patient, who's going to make the call on largely economic grounds.

It seems better to me if we have doctors be the ones who have strong positive incentives for quality of care, and weak incentives to control costs. IMO, patients shouldn't have to factor costs into their medical decisions, since they aren't really trained to understand where they can and cannot cut corners on their health, and doctors with bad incentives can't be relied upon to provide unbiased counsel.

It seems like most countries solve this by having fixed, national prices for procedures that are negotiated at regular intervals by the government and the providers/insurance companies.

We're ideologically fixated though, and refuse to engage in something like this. Well, unless you're 65 and older, then we do it all the time.

@NetRunner : Yea, something like that. I'd rather just pick some fixed amount everybody gets for life however, and just hand them the money when they are 18. It doesn't even have to be money right away (to defer the inflation). It could just be stamps that are converted to cash by the doctors when they are reimbursed for services. It's got most of the qualities of the progressive plans. It's egalitarian. It puts money in the pocket of people that need it. Unlike those plans however, it would get the votes from both sides.

Like I said, it isn't that radical. It isn't like the European style systems, but there are models. Like I mentioned, a similar system is quite popular in Singapore (which I wouldn't describe as an entirely backwards society, I could do without the caning, but you know, quit yer litterin'). For whatever reason, however, this debate always gets bogged down in this quagmire of European system or status quo, which I find bunk. I think there are legitimate concerns with the European way of providing health that don't fit neatly with our cultural identity. There would be broad Republican support for a bill that puts consumers in charge of cost control (this video could be cited as evidence). So why not consider that sort of plan? Because it doesn't inch us along the path to single-payer? Political points? What is it? Why isn't it even on the table?

Also, @NetRunner : re: cost control.

What prevents doctors from selling unnecessary tests is partially the sticker shock, but mostly the second opinion it prompts you to seek.

@bmacs27: it's an easy fix. The doctor gets payed a fixed salary and bonuses for the number of patients treated successfully. There you go. The more you work, the more you make.

Or a simple hourly rate instead - again, the more you work, the more you make.

When doctors get extra cash for recommending a certain drug over another, there's a big damn problem. The only consideration should be if it will help or not.

@gwiz665 : yea, but you still have problems. For instance, if reimbursement rates aren't in perfect agreement with operating costs for various tests than private practices still have distorted monetary incentives.

The bottom line is that many of us on this side of the pond still feel that self-organizing systems often yield more efficient solutions than puppet-strings.

And many of us also look at the results of the last 70 years and say...this could be markedly better, but it's hard to see how any other approach could be a lot worse. The so-called "free-market" really has proven itself to be notably less than successful in the health care field, for any but the wealthy (and my doctor, among others, would say even the wealthy are not served well).
>> ^bmacs27:
The bottom line is that many of us on this side of the pond still feel that self-organizing systems often yield more efficient solutions than puppet-strings.

@Stormsinger : When it comes to healthcare what free-market exactly were you referring to? Was it Medicare, or the ones that can't compete across state lines?

Like I said, it's worked well for Singapore. Is there something I don't know about Singapore? Does it have more cooties than Europe or something?

Also, for the record, I'm not exactly Blankfist. In fact, I referred to myself when talking with Blankfist as "statist swine." I get paid by the government to do public funded research in human vision. I supported the stimulus, and thought the bailouts necessary. I don't support Ron Paul. I hate tea-baggers. I just happen to think maybe the European system isn't the be-all and end-all of efficient healthcare.

>> ^bmacs27:
I'd rather just pick some fixed amount everybody gets for life however, and just hand them the money when they are 18. It doesn't even have to be money right away (to defer the inflation). It could just be stamps that are converted to cash by the doctors when they are reimbursed for services. It's got most of the qualities of the progressive plans. It's egalitarian. It puts money in the pocket of people that need it. Unlike those plans however, it would get the votes from both sides.
Like I said, it isn't that radical. It isn't like the European style systems, but there are models. Like I mentioned, a similar system is quite popular in Singapore (which I wouldn't describe as an entirely backwards society, I could do without the caning, but you know, quit yer litterin'). For whatever reason, however, this debate always gets bogged down in this quagmire of European system or status quo, which I find bunk. I think there are legitimate concerns with the European way of providing health that don't fit neatly with our cultural identity. There would be broad Republican support for a bill that puts consumers in charge of cost control (this video could be cited as evidence). So why not consider that sort of plan? Because it doesn't inch us along the path to single-payer? Political points? What is it? Why isn't it even on the table?


Let me unpack this a bit, and respond separately to policy substance and the politics of the bill.

I'm not sure how a "lump sum" grant would work. Is there a hidden assumption in there that this is to replace their Medicare benefits later in life? Are there new taxes to offset it? Do people get to keep what they don't spend as cash? What happens if you get a serious illness and deplete it before you're 30?

Part of the advantage of the plan DeLong proposes is that most of the cost is borne by the individual themselves. They also have strong incentives to keep themselves healthy, since any money they don't use gets rolled over into their IRA, or if they so choose, returned to them immediately. If they're young and healthy, this means they have a pretty strong push towards saving 15% of their income at all times. If they do get sick, they have an incentive to try to deal with their illness as cheaply as possible, since every dime is out of pocket. If they get seriously ill, and blow through their HSA, they know what they pay is capped at 15% of their yearly income, and everything past that is paid for by the government, so they know they won't go broke.

A lump sum plan seems to lose most of those advantages.

As for politics, what Democrats are proposing now is actually to the right of the bill Republicans offered to Bill Clinton in the 90's. It's more conservative than the Massachusetts Romneycare reforms.

Republican opposition isn't ideological. There isn't a single god damned thing Democrats could do with this bill that would make Republicans vote for it. They win by handing Obama a defeat, period. Any reform that dramatically improves the system that's signed into law by Obama means historically huge credit will be heaped on Democrats in general, and Obama in particular. They will do anything to stop that from happening.

That said, I would have loved to have seen Democrats propose something like what DeLong suggested, just to hear what the Republican anti-reform talking points would've been. Probably they'd just demagogue the mandated 15% contribution to HSA's and call that a "government takeover" of health care. They'd probably still say that all we need to do is tort reform and to "let companies sell insurance across state lines" which would in effect eliminate the states' ability to regulate insurance.

The only bill that would ever get broad Republican support is one introduced by a Republican majority in congress.

@NetRunner : Yay! An actual conversation.

Yes, the assumption is that medicare is gone, in fact, all other "health insurancey" middlemen are gone. The whole point is that health insurance, aside from catastrophic care, isn't really insurance at all. We aren't transferring risk to anyone (the traditional definition of "insurance"). We are just taking expenses we know we'll encounter, and paying someone to book keep for us. Why not cut out the middleman and pay directly? It's not like we file claims with our car insurance to pay for oil changes. Why should I file a claim to pay for regular service on my body?

To be honest, I don't really care how you pay for it. Republicans probably prefer the underhanded flat tax of the printing presses. If you want to use a progressive tax, whatever, that's fine. In any event, the bills only come due when the "stamps" are converted, so it isn't like you need the government to have the money up front. I mentioned the lump sum just because it gets around the problem of catastrophic situations where the person hasn't paid in enough yet, and the government has to bridge the gap. It removes uncertainty about how much everyone is getting. When it's out, we throw you under a bus (that's smartass for you pay out of pocket). Thus, you still have the incentive to minimize costs. Whereas with the Delong solution you have questions like, when do you roll it over, how do we predict government liability, etc...

Politically speaking I can sympathize quite a bit. However, this IS what conservatives are suggesting we do. You saw it yourself in the video, the guy was calling for HSAs. Obama was the "demagogue," calling it a rich man's solution. If Obama would allow himself some humility here, and pitch a new proposal partially drafted by Republicans, I think he'd win the support he needs. The Republicans are looking for a gracious out to this whole "party of no" nonsense. They know that nobody likes pure obstructionists, they just can't appear to be entirely caving either. They need it to look like they at least contributed something to language of the bill. They need it to look like they have some real ownership, that's all.

@bmacs27 just, for the record, I'm not claiming that the Scandinavian Model is the end-all solution, but it's certainly far better than what you have now. I would like to see the free market work on this, but the incentives of the "free market" isn't in the best interest of the patients, but rather of a lot of other interests (doctors, pharmacies, drug companies). It makes me feel poorly when patient's health is prioritized lower than money interests.

@gwiz665 : It's funny, because I just got through talking with my lab mate about why this wouldn't work. He just said it wouldn't fly politically. All the vested interests (i.e. insurers, pharma, AMA, etc) all want the Dem's bill. In other words, nothing to do with patients.

@bmacs27, I've got a few concerns about this lump sum idea. One is that you'd replace medicare with it, which seems like a bad idea right off the bat. Second, you push the problems with predictability of cost from government and insurance companies which must only worry about large pools of people and statistical averages, onto individuals who have literally no way of predicting their individual lifetime health costs. Third, any potential savings people make by limiting their spending benefits the US Treasury not themselves. Fourth, you're still leaving people without a safety net, both in the case of severe illness, or simple poor planning.

Those seem like huge issues to me, and the bit about savings benefiting the Treasury seems like a political poison pill to boot.

As for Barasso calling for HSA's, he wasn't actually presenting a policy prescription. He just said he liked HSA+Catastrophic insurance because it makes patients control their own costs. Obama was right to call that a rich man's solution, because you need to have enough disposable income to be able to save enough to cover out-of-pocket medical costs, and currently those are still largely driven by the bad incentive structure of our existing insurance system (in other words, they're ridiculously high).

You said, "If Obama would allow himself some humility here, and pitch a new proposal partially drafted by Republicans, I think he'd win the support he needs." I think this is a deeply misguided statement. The assumption here is that Obama's plan is some radical, left-wing proposal that's antithetical to Republicans, when in truth, Obama basically took previous Republican reform bills as his inspiration.

Since Obama pre-compromised in this way, Republicans just moved the goalposts, and said that Obama's plan is Stalinist health care, and if he wants to be reasonable, he has to drop the public option. So they dropped the public option. Republicans said instead of the House's surtax, they wanted to the tax exemption on employer benefits reduced or eliminated. So the Democrats did that too. The Republicans said they didn't want an employer mandate, so Democrats dropped that too. The Republicans said that they didn't want health insurance subsidies to pay for insurance that covers abortion, so the Democrats added language that did that too. Republicans said that they didn't want insurance companies to be required to cover end of life counseling (DEATH PANELS!!!), so Democrats dropped that too. Republicans said that they didn't want illegal immigrants covered, so Democrats put in strong language forbidding it, and setting up a system for enforcing it.

I could go on like that for quite a while longer. Republicans have been involved in this process from the beginning, and have extracted a ton of concessions from Democrats, in return for absolutely zero votes. The whole time, their rhetoric hasn't softened one iota -- it's still Stalinist, Nazi-ist, Socialist, Fascist Health care that's going to bankrupt our government, bankrupt our citizens, and get everyone killed, grandmas first.

That kind of thing makes it politically impossible for Republicans to turn around and say "well, now it's not so bad".

Obama started with a very moderate, bipartisan bill, especially considering the sizable majorities he still enjoys in both chambers of Congress. The idea that he needs to compromise more with Republicans is ludicrous.

>> ^bmacs27:
@gwiz665 : It's funny, because I just got through talking with my lab mate about why this wouldn't work. He just said it wouldn't fly politically. All the vested interests (i.e. insurers, pharma, AMA, etc) all want the Dem's bill. In other words, nothing to do with patients.


Yeah, this is why things like single-payer and replacing traditional insurance with HSA's is a fantasy in today's world. The Democratic bill is pretty much the only special-interest-friendly way to reform health care in a positive way -- big, sweeping changes that put insurance companies out of business just weren't in the cards.

It's why the Republican bill is essentially just tort reform (which limits liability of providers), allowing insurance companies to sell across state lines (which allows them to all relocate to the state with the most lax regulation), and changing the tax incentives so that people are likely to move from the employer/group market to the individual one (which is more profitable for the insurance industries, since you lose collective bargaining power).

In other words, the Democratic bill tries to be win-win for both people and the special interests, while the Republican bill basically just helps the big business interests squeeze more money out of people.

Here in America, it seems that it's contrary to our cultural identity to pass legislation that hurts the bottom line of big business in any way.

I -did- make sure to put free-market in quotes, and add "so-called" to the description, just to make sure nobody mistook my comment for a claim that there's anything like a free market in this country. Sheesh...should I have used caps lock too?

All I was trying to do was represent that there are also plenty of folks who believe that we've waited long enough for "self-organizing systems [that can] often yield more efficient solutions than puppet-strings" to show that they actually will. It's time to try something else...way past time, IMO.

And just for the sake of accuracy, there isn't really any such thing as "THE" European system...there's a bunch of different systems used in Europe, from fully socialized to private non-profit highly-regulated insurance. Virtually all of which are demonstrably more effective than ours.

All that said, I don't expect much...I expect that our government-by-lobbyists will continue to keep any real reform of the inherently fucked-up fee-for-service approach from being considered. Even though I hope I'm wrong, I no longer believe we're going to see any real change until after the apparently inevitable violence, and even then it's questionable.

And why does the preview look fine, but the quote gets messed up when actually saved?

>> ^bmacs27:
@<a rel="nofollow" href="http://www.videosift.com/member/Stormsinger" title="member since May 19th, 2007" class="profilelink">Stormsinger : When it comes to healthcare what free-market exactly were you referring to? Was it Medicare, or the ones that can't compete across state lines?
Like I said, it's worked well for Singapore. Is there something I don't know about Singapore? Does it have more cooties than Europe or something?
Also, for the record, I'm not exactly Blankfist. In fact, I referred to myself when talking with Blankfist as "statist swine." I get paid by the government to do public funded research in human vision. I supported the stimulus, and thought the bailouts necessary. I don't support Ron Paul. I hate tea-baggers. I just happen to think maybe the European system isn't the be-all and end-all of efficient healthcare.

>> ^NetRunner:
Here in America, it seems that it's contrary to our cultural identity to pass legislation that hurts the bottom line of big business in any way.


That's not fair captain demagogue. The proposal I made is as unfavorable to big business as single-payer. It just appeals more to voluntarists/proponents of free-markets. It jives better with our cultural identity because it trusts the people to make their own decisions. Yes, the safety net isn't perfect, but I happen to be okay with letting evolution plod along albeit at a glacial pace.

We're the descendants of the people that thought they could do better without the King, remember?

p.s. the Democrats' legislation HELPS the bottom line of big business in a BIG way. The only people hurt are regular folks that are just fine with the way it is (presently, most of the country). You just happen to dig the scum-sucking lawyers over the scum-sucking executives. Suit yourself.

>> ^Stormsinger:
And just for the sake of accuracy, there isn't really any such thing as "THE" European system...there's a bunch of different systems used in Europe, from fully socialized to private non-profit highly-regulated insurance.

Alright... here's a new proposal we'll call the "Greek system". It's beauty is in the simplicity. Everybody gets a cadillac plan, retires at 58, and we mail the bill to Germany. How does that sound?

>> ^bmacs27:
Alright... here's a new proposal we'll call the "Greek system". It's beauty is in the simplicity. Everybody gets a cadillac plan, retires at 58, and we mail the bill to Germany. How does that sound?


That only works if you get the banks that issue your debt to hide the fact that they expect you to default, while they bust their butts selling it to others. But once you get the Ponzi schemers involved, you're golden.

Wait... [Ackbar]It's a TRAP![/Ackbar] Germany just forwarded the bill to AIG which the US implicitly guarantees. Oh well...

I guess those sorts of brilliant plans only work in Greece. I preferred it when they just asked us to run up the beach with machine guns.

@Stormsinger...

@bmacs27, my chief point in that comment was that the vast, overwhelming majority of congress is too indebted to big business to pass anything that won't help the existing big businesses either make scads of money short term, or give them a stable business model long term. So, of course the bill helps the bottom line of big business -- the question is, is it simply a gift, or do the American people get something out of it too? I think that this one is a win-win. I would've preferred a win-lose situation (people win, company profits lose), but as long as it seems like there's a fair mutual benefit, I don't begrudge letting the insurance companies make a little more money.

As far as ideology, it only enters into this because one party sees political gain in making it out to be an ideological issue. For proof of that, revisit what republicans proposed in the 90's, and look at what Mitt Romney implemented in Massachusetts. They're arguably less free market than the plan making its way through Congress now. For a real shocker, go back and look at what Nixon wanted to do.

As far as the public at large, I guess what I'm really saying is that I refuse to condone the mistaken idea that free market absolutism is some core tenet of our country's cultural value system. Even amongst conservatives and libertarians, there's certainly no reason to think that government mandated HSA's that abolish a sector of the existing economy should be more acceptable than government mandated insurance, with a new regulatory regime that will improve competition and consumer protection, unless of course people go on TV every day to say the latter is socialism and/or fascism.

I would suggest that existence and popularity of Social Security and Medicare undercuts the idea that Americans are largely conservative ideologues. If Americans really were even remotely the kind of ideologues that you suggest, those programs would already have been dismantled and dismissed as mistakes. Instead, you can't get support for repealing them, even if you call it "privatizing".

The above is my long-winded way of saying that all the talk of ideological resistance is propaganda. When you ask people about the individual provisions of the Democratic plan, everything but the individual mandate is popular, and even the individual mandate has a better net favorability than the bill that contains all of those elements.

The problem isn't that the bill is fundamentally unpalatable to the American people, it's that the American people don't know what's in the bill, and Republicans have filled that void with fear and lies (and Democrats have done little if anything to combat that).

As far as getting Republican voes, Republicans don't actually have an ideological objection to what Democrats are trying to do. They have a political imperative to object to what Democrats are trying to do, no matter what they actually try to do. Republicans aren't suggesting more dramatic, free market reforms, they're proposing minor tweaks that would disproportionately benefit insurance companies rather than people, and wouldn't address any of the shortcomings of the existing system.

>> ^NetRunner:
So, of course the bill helps the bottom line of big business -- the question is, is it simply a gift, or do the American people get something out of it too? I think that this one is a win-win. I would've preferred a win-lose situation (people win, company profits lose), but as long as it seems like there's a fair mutual benefit, I don't begrudge letting the insurance companies make a little more money.


Myself, I'd be -far- happier if there was anything in that bill to limit the insurance companies to a -little- more money. From what I see, there are no such limits, and they're going to be free to gouge us as much as they like. Indeed, as they've already started doing. There -were- attempts at such limits in some of the bills, but I don't believe the idea made it into the final Senate version, did it?

@Stormsinger, IIRC, the Senate bills still had a mandated medical loss ratio of 80-85%, which means that insurance companies must spend 80-85% of their revenue on claim payouts.

I guess I also think if things go south, we'll come back and do stuff like a public option, medicare buy-in, or something more radical like the DeLong setup or single payer.

I doubt we'd go back to the existing status quo.

>> ^NetRunner:
@<a rel="nofollow" href="http://www.videosift.com/member/Stormsinger" title="member since May 19th, 2007" class="profilelink">Stormsinger, IIRC, the Senate bills still had a mandated medical loss ratio of 80-85%, which means that insurance companies must spend 80-85% of their revenue on claim payouts.
I guess I also think if things go south, we'll come back and do stuff like a public option, medicare buy-in, or something more radical like the DeLong setup or single payer.
I doubt we'd go back to the existing status quo.


I'll have to go look then. I thought I remembered it being dropped. If that requirement is still in there, the bill is better than I feared. Mind you, I worked for those folks for a long time, and I don't really trust them not to cook the books. But that simply means we need the Insurance Commissioners (or something similar) to be supported in their duty to monitor the industry. Once a few companies get slapped down, the rest might get the point.