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We Need the Stinking Mandate
by tmccarthy0 6/24/2012 - 10:15 am
We need the mandate. The Supreme Court will rule on Monday, probably and it seems to me they've either struck the mandate down or the entire law down. Striking the mandate alone is going to have a number of negative effects on the insured and uninsured, the first of course being that 45 - 50 million people will continue to be without health care. But it is much more complex than that, and we have an example of what will happen without the insurance mandate.
Washington State Health Services Act of 1993
In 1993 when I first began working on the issue of health care as a professional, was the year we passed the most extensive insurance reform law in the nation. As a state we were seeking near universal coverage for the citizens of Washington State. What passed the legislature that year was this:
Waiting periods for pre-existing conditions were effectively abolished and insurers were required to sell policies to anyone who could pay. To attempt to control costs, the law provided for premium caps to be phased in only if competition among insurers failed to moderate increases. It also included mandates that uninsured individuals buy their own policies and that employers pay at least 50 percent of the cost of insuring their workers, and that uninsured individuals buy their own policies.
It sounds really good doesn't it? But there you see it, the dreaded mandate, one that requires employers (like Wal-Mart) to pay at least 50% of the cost of insuring their workers and that the uninsured buy their own policies.
But as luck would have it by 1995 a new legislature was seated and the individual mandate was repealed and the employer mandate was repealed and what happened afterward should be a lesson to every American.
Within 18 months of the adoption of the law, key features of the Health Services Act of 1993 were repealed. Most notably, the mandate that all citizens of Washington purchase insurance, and employers not only offer insurance to their employees but they pay at minimum of 50% of premiums, was repealed. Legislators left in place new consumer protection provisions, a.) eliminating waiting periods for pre-existing conditions; b.) guaranteeing that an insurance policy would be issued to anyone who could pay. (does any of this sound familiar??, it out to republicans are planning the same thing, even extending the "keep your kids on until they are 26 provision") It is a great intention, to keep the populace happy, and so not particularly motivated to change congressfolks.
The Cost: The number of insurers writing policies for individuals began to shrink immediately. Higher-risk individuals bought policies that were previously unavailable to them causing premiums to rise, and some healthy people took their chances and dropped their coverage.
Washington's new health care policy was much like the national bill today, the Health Services Commission, appointed by the governor, was instructed to produce a menu of the types of services that would be required for a basic insurance policy.
Unintended Consequences:
There were many;
As I stated above, by 2000 there were more uninsured Washingtonians than when the law was enacted in 1993. In 1993, 11% of Washingtonians were uninsured by 2000 15% were uninsured.
By 2000 only 2 insurers selling individual policies were left.
A onetime open-enrollment period (3 months) was enacted; no waiting period for pre-existing conditions was guaranteed, encouraging consumers who most needed insurance to sign up. (Does this sound familiar to anyone, anyone at all?)
Premiums rose drastically, the high was around 35%.
The two individual insurers left had ceased to write new policies, leaving those who could afford to purchase the policy out of the system.
This also affected small business because premium increases had become too expensive for a small business to afford.
It's a lesson for the nation, pay attention folks, this is important.
But I fully expect the Supreme Court to strike down the mandate. They have insurance. I wonder though, will those members of the Supreme Court take the blame for the catastrophe that is waiting in the wings if or when the mandate is struck down?
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Medicare for all, take off the caps on all income.
Medicare for all ......I also won't a pony.
You have to convince the voting public that they agree with you.
Bill Mahrer made a comment that Bill Clinton would have sold Obamacare as a way to get freeloaders to pay for their health care. This suggests that Obama faced an easy task. Mahrer forgets that Clinton failed in his effort for major health care Reform.
Soundbites are easy. Getting reform passed is hard.
Should read "I also want a pony."
The mechanism for collecting the Medicare and Social Security taxes was already in place.
All we needed to do was tweak the system, to make it better.
Medical care IS a Social Security.
Collect from all, including the Super rich, to support the SOCIAL SAFETY NET ………..Take off the CAPS
Why do we need a maximum taxable earnings cap?
Tell Congress to stop weakening Social Security as they attempt to privatize it. They need to Strengthen Social Security make it better.
Force the rich to help support the safety net, we don't need spectatators.
A reasonable and rationale resolution that should be enacted in our quest to achieve a positive solution!
A truly, working mans candidate, would push for it.
FDR signed the Social Security act in August 1935
It is imperative that each generation strengthens it and doesn't allow it to be weakened, by those opposed to the very ideal.
To the self-serving capitalists; Social Security is Socialism and the idea of taxing them, to support the American peoples safety net, makes them cringe at the thought.
Don't ask them to support American families, they only want American families to send their kids to fight wars, to protect THEM, your well being is of no concern.
It would be interesting to know how many of the 1% actually file for and collect their ss benefits, even tho' to them I'm sure it's regarded as a pittance.
How can we find out?
Shame the 1%,
That is; if they have the conscience to feel shame.
I remember reading an article about this, will do some research when have chance.
I think the article said Warren Buffett didn't collect his and there was a small listing of those who did and didn't.
http://www.dailykos.com/story/2011/04/19/968549/-Entitlement-hating-Paul...
very interesting. From this article, it is apparent his family needed the healthcare public option too. Hmmm, how quickly they forget.
I notice that no commenter to this blog has attempted to address the case study in this blog which outlines the possible consequences of the Supreme Court striking down the individual mandate in the legislation.
The Medicare for All answer is an inadequate answer to the problem, if it is this difficult to get universal coverage through legislation that keeps private insurers in the loop, there is almost no chance of expanding Medicare to all citizens which would limit the services private insurers could cover.
This was our experience in Washington State with insurance mandates that were repealed and the consequences that came with that decision of the legislature. More people became uninsured, private insurance became all but impossible to obtain for individuals, and costs rose, in some cases astronomically. It has implications about what the nation could be in store for, if the mandate part of ACA is struck from the legislation. The consequences I've referred to are worth discussing, because of the severe impact they could have on the economic future of the country. We are already being consumed by high costs in health care, this suggests those costs could skyrocket to an even greater degree. It is another financial catastrophe in the making. The discussion of the size of any person's balls is straw man FDL issue, but won't give us a greater understanding of what could happen in the future because of a decision that will most likely take place on Monday.
But friend, they don't and won't just leave.
This is a multi-billion dollar, maybe trillion-dollar, industry that employs many hundreds of thousands, maybe millions, of people. Regular people.
They won't go gently into that good night because some state insurance commissioner puts up insuperable barriers.
Try that, and you won't just have CEOs, the Chamber, Harry and Louise, and Sheldon Adelson down your throat, you will also have all them "little people" these companies employ down your throat.
Can you imagine the headline: Progressives kill off sixth largest industry in country!
Good news is, all these out of work people have insurance coverage. Now, if they can only find a way to put food on their families...
Have you perchance conflated health care (18% of GDP) with health insurance , whose vig, while an unconscionable 20% or so, all ends up in Conn?
No, I don't think so.
Well, how about we put some real numbers with dollar signs in front of them to help crystallize the consequences?
About five years ago I started shopping around for health insurance after the work in these parts started thinning out and Mr. flower got an inkling he was soon to be out of a job. I have a pretty serious pre-existing condition and I didn't want either one of us to be without insurance.
Here is the dollar amount I was quoted five years ago: $1859/mo.
That was for me only.Well, me and my pre-existing condition. That amount was what I had to pay every month...on top of an annual $5000 deduction. On top of the condition that the insurance company would not cover any costs associated with my pre-existing condition for the first two years of the policy. This was BC/BS of Michigan...the only company that would issue me a policy because they were required by law to cover everyone regardless of their health. There was no rule in place that said they must charge the same price as a policy issued to the average individual, which was around $350/mo. This was for an average policy...no fancy stuff.
The layoff came, COBRA ended and needless to say I could not afford the BC/BS policy so I went without coverage.
After the ACA passed, they did away with those ridiculous conditions and premiums which made it much easier to be covered. Like many states, Michigan set up an exchange especially for people with pre-existing conditions to buy policies that filled in the gap between now and when the ACA goes into full effect in 2014. Through this exchange the cost to me would be roughly $358/mo.
The above really has nothing to do with the mandate. But it does show how spreading the burden of cost over all shoulders eases the load on those who have a persistent need. It shows that there is a need for a public option.
Now, if this were all to disappear, the $358 premium would disappear as well, returning to the $1859 or probably worse. The insurance companies are gonna get their goddam money one way or another.
The mandate is needed if a public option is not an option.
The basis for the fear of many...NO public option was advanced.
This mandate may be, the proverbial "camels nose under the tent".
An attempt to grab more power and the people clamored for it.
But if the public option had been available, we would have clamored for it instead; of accepting a government run amok and its laws of unintended consequences, coming back to bite us in the
This is a great example flower thanks for this.
It's interesting that the temporary high risk pools which were expected to cover 5 million people and are only covering 68000 nationally. Only 1,250 in Michigan. Amazing,you would think that people with preexisting conditions would be rushing to get coverage, and the response has been so underwhelming.
http://www.healthcare.gov/news/factsheets/2012/06/pcip06152012a.html
Perhaps it's that the people who have preexisting conditions and are most at risk would avoid lack of coverage and can't meet the 6 months uninsured requirement to participate. If they are already covered and paying 1800 a month, they would have to be drop that coverage for 6 months before being eligible for the high risk plans, which is a risk most people with serious preexisting conditions would not take.
I am not insensitive to those with preconditions that might make them expensive or difficult to insure. Hell, I am one of them! When I was unemployed, I spent 3 unemployment checks on rent and the last unemployment check covered only about half of my COBRA payments ($700/mo). I ran a serious deficit of almost $900/mo after student loans, car insurance, food, utilities, transportation, smokey-care, and I was lucky because I had some savings to tide me over. can I appreciate that someone without my medical circumstances might choose to remain uninsured? Absolutely. Should they be penalized for not being able to afford insurance and then still not have any coverage if they get sick? Hell no.
Because you need a mandate for universal healthcare (which you do in order for it to work) does not mean that the individual mandate in ACA is constitutional. Two very different things. If you want to install an individual mandate you need 1.real cost controls and 2. a public option that forces the private market to compete for consumers. Otherwise there is no incentive for the insurers to do anything except continue to fleece the consumers.
If you want to half-ass health reform and force people to pay penalties for not buying a private product so that your friends in the insurance and pharma industries support all these new captive customers - excuse me reform, there is zero constitutional basis for that. So the fault for losing the pre existing protections goes on the people who crafted the shitty law, not the Court for recognizing rightly that it is fatally flawed.
It's unclear (to me at least) why inserting a "public option" would convince these justices to rule the plan constitutional. For one thing, the big "argument" seems to be the questionable constitutionality of forcing someone to engage in "commerce."
People still have to buy into a public option. It isn't free-free. And the libertarians amongst us don't want to be told they have to buy anything, including public options.
If we'd gone for a single payer plain and simple and coverage was simply there the way SS checks simply start showing up at age XX, THEN this argument might have merit.
As far as I can tell, cost controls and forcing private insurers to compete for consumers has nothing to do with the constitutional argument. Private insurers will have to compete for customers in the private exchanges--against each other.
If only we could actually vote on a viable public option with all the viable facts put forth in a format that was easy for most to comprehend. Put that on the same ballot with presidential and congressional candidates and betcha' that would break all voting records. What a concept!
I'd have to go digging around, but...
As I recall, the "public option" that was on the table was a very weak one in terms of who could qualify for it.
Of course! My 'fantasy' encompasses a much better, stronger and more 'user friendly' public option package to be on the referenced ballot.
'(We) Actually voting for' is a very dangerous proposal, as it would cut out the lobbyists, the political patronage, and the political donations politicians need to run billion dollar campaigns. How are the for-profits supposed to buy off a hundred million voters?
You also mention 'viable facts' which is an equally dangerous concept. A lot of rich Republicans are right now planning and spending tens of millions to ensure no one knows the facts, and to be equally certain that no one on corporate TeeVee news talks about 'viable facts'.
The GOP solution to the post-mandate health care dilemma is the same as their solution to everything else, ignore it, or cut a small insufficient miserly Medicare/Medicaid coupon for those who can't afford a regular policy. Redeemable only at Republican connected corporations. At the same time cut taxes on the rich raising the deficit even faster.
Then, let the (health) marketplace work it's magic until the whole thing collapses. Final phase: then let the Democrats try to clean it all up in 4 years.
Again we return to how dumb are voters and the truth that too many choose to remain ignorant of truths. Anyone who bases their vote on partisan issues and/or candidate campaign based ads provides the basis for 'stupid is as stupid does'.
The federal government constitutionally has the power to provide for the general welfare; it does not have the power to demand that you purchase services from a private company. So when they want to insure that people have some retirement insurance, the federal government can force you to pay FICA/Old Age taxes. They cannot force you to invest in the private stock market or pay a penalty to the federal government to achieve the same noble goal.
So if, as part of the healthcare mandate, there was a public option run and maintained by the federal government that people were forced to buy into if they did not have employer or private coverage and if such coverage was affordable that would be acceptable because it provides a public benefit. Penalizing people who can't afford private health insurance (and still leaving them with zero health coverage and massive debt if they do get sick) has zero basis in the constitution. It's nothing but a poor tax.
But there are mandates in place with penalties if you do not have auto insurance, workman's comp insurance and various other 'insurances'.
Mandates from the federal government for workers comp and auto insurance? Well I'll be. Learn something new every day.
Who cares where the mandate comes from...the state or the feds? It's still a mandate and there are still tax penalties if you don't follow it.
State mandated penalties, etc. But, these have been allowed to stand by the feds.
Worker's comp protects third parties, like auto.liability coverage, and like auto coverage it is a mandate attendant upon another regulated activity, employment of workers. Also, it embraces a "bargain," pursuant to which workers cannot recover tort damages from negligent employers.
It's no bargain, considering the lost wages you will incur, over your lifetime, when you are disabled.
The legislature, who establishes scheduled injuries, do so at the advise of insurance carrier lobbyists.
I guess it's not a poor tax because, under ACA if fully implemented, the government will subsidize the costs of insurance for people who can't afford to buy it without help. But, to me there's still a huge difference between:
We will tax you to pay for this system, which will give you benefits.
And
We will tax you and then help you by a beneficial insurance policy from AIG.
The subsidies are only up to 300% of poverty, so if you are singleton making 40,000 in NYC, you are SOL for any subsidies. factor in rent and living expenses. Individual group insurance rates of about 600/month. And that's just for insurance premiums, doesn't actually cover the actual cost of care (deductibles, copays, prescriptions, etc). There are plenty of people that will pay a penalty of $800 annually to go uninsured because it is still economically not viable for them to buy private insurance. So we punish them and they still have no access to health care. RomneyCare is actually superior to Obama care because they have a panel that looks at the affordability of coverage and has the ability to waive the penalty if coverage was unaffordable.
Then you change the bill.
There are panels in ACA, too.
No, there are not panels in ACA empowered to waive the penalty if someone cannot afford coverage.
Then you put them in.
Well, you've certainly accepted the Republican argument hook line and sinker.
You have a bunch of "ifs" in here which could just as easily apply to ACA. For example, "if such coverage was affordable..." Well, who decides that and what is affordable? The feds do.
So, likewise, the feds can decide how much of a subsidy they are going to give to make plans affordable, and they can adjust it if it's unworkable. I see no difference here. In fact, it's the feds who decide what and how much Medicare and Medicaid pay for. There is no magic here.
But you also overlook a key point. Assuming the public option on the table wasn't limited (which it was), what would happen if the public option were, in fact, much, much better than all the private offerings?
A flood of people would leave the private offerings and pile into the public option--destroying the illusion that this approach was anything but a single payer approach in disguise.
(That would be fine by me, but...)
Do you honestly think anyone in Congress would simply destroy one of the largest industries in the country with a flick of their legislative pen...or that said companies would go quietly...or, even that there wouldn't be a populist outcry as all those folks employed by the industry were fired?
Yes, Dijamo seems to keep falling back on that right wing conspiracy document, the Constitution.
"Affordable" - well, the courts will likely hear a case over a tax levee that leaves a typical citizen $20/month to live on. I think there are various clauses in the Constitution proper and the Bill of Rights that say government can't just abscond with property and leave people in the gutter, but maybe I've been listening to too much Rush (the band or the goofball announcer). "provide for the general welfare" might not fit if a tax or obligation likely puts them in poverty with no parallel benefit.
And yes, Congress would destroy a US industry if it was left-wing or union-run. The auto industry only asked for loans - a measly $22 billion or so altogether - while Wall Street asked for freebies 100x that. Which one did we put into bankruptcy?
Well, in fact, most constitutional scholars still agree that the mandate is constitutional. And a good number of judges have ruled that way. Even though a bunch of them now think it may get overturned.
So we're left with constitutional scholars saying that a constitutional provision may be deemed unconstitutional by essentially a right-wing bench. Dijamo agrees. And I guess so do you.
Of course, the Constitution is, effectively, whatever SCOTUS says it is. So maybe they will rule that it is unconstitutional. But when it was proposed, the idea that the mandate was unconstitutional was a right wing fringe idea.
The right wing worked overtime to make it acceptable. And now "even" Dijamo (et tu?) has bought into the theme.
My larger point, however, was that the question of affordability is one that has to be decided--and can be decided--by the government, regardless of which plan one goes with. Does the public option cost too much? The government can lower it. Are the subsidies too little? The government can raise them.
Your last paragraph doesn't make any sense. The government didn't allow either industry to fail, did it?
I said you cannot have a mandate without a public option/benefit from the very beginning because the government does not have the power to force someone to buy from a private provider or penalize them for it. Your brilliant constitutional scholars who knew this was constitutional can think of not one single relevant precedent for this. Under the Commerce Act, simply for the fact that I am alive, the Obama admin is arguing I must buy from a private provider or pay a penalty to the federal government that leaves me with no benefit whatsoever. If people took the policy blinders off, no way they would be defending this as constitutional.
Yes, but...
If you have someone who doesn't qualify for the public option because of his income and doesn't want to buy insurance because he's healthy...will still be forced to buy a product from a private company.
You can't square this circle without single payer, I'm afraid.
In the meantime, this plan does good and, in fact, where implemented in MA, has dramatically increased the level of coverage there. Maybe there are no poor people in MA, I don't know. As I understand it, it has also lowered premiums for individual policies that state.
If you're worried about waivers for people who can't or won't, it seems to me that the administration has already issued all kinds of waivers. I don't see why it wouldn't issue waivers for people who simply can't afford the premiums.
Do. Not. Listen. To. Rush.
If you need a fix, try Klaatu. That should hold you.
Otherwise, your arguments have all been correct so far. Keep it up, and I'll send you a copy of Emerson Lake and Palmer's Greatest Hit.
Pressure's on.
Jon & Vangelis? Bleep bleep goorgle thrax?
Making the progressive argument that the government should not be in the business of mandating that people be captive consumers for an out of control industry that makes up 1/5 of our economy is now a Republican argument. Just because the Republicans say the sky is blue does not mean as a Democrat, I have to argue the sky is actually magenta if it is in fact blue. We can agree on very basic things (like the individual mandate in ACA is unconstitutional and wrong) for very different reasons and have very different solutions.
Earth to Peter Schwartz. The ACA has already determined what subsidies will be given. Up to 400% of poverty (which is less than 11,500 for a single person). So if you make about 45K as a single person living in NY, no subsidies for you. The feds will NOT be determining rates for the exchanges, don't know where you are getting that info from. And the subsidy will only be for a percent of the premiums, which no doubt will continue to rise. You make $1 over that and you are SOL for any subsidies, and premium protections or out of pocket cost protections. Your argument that the feds have the power over any cost controls is not in the ACA bill. And individual states rather than the federal government will have the right to review premium increases which means the Washington state insurers leaving for greener pastures will still be allowed to occur. Yes, yet another Obama give away to his friends at AHIP.
I don't assume that single payer will happen overnight, although I think it will happen eventually. But how could a flood of people enter the public option (or the exchanges) if the only way you can get offered it is if you don't have employer based insurance? The poor insurance companies are already showing they compete with public plans since people are already signing up for private Medicare Choice plans and supplemental Medicare plans. And many of the private Medicare Choice programs are very competitive HMO style operations without the 20% Medicare copay requirement and built in prescription drug requirements.
On the other hand, if the insurance companies can't compete, why the fuck is the federal government not only using our tax dollars to subsidize them and overpaying for health care in the process, but also forcing every single citizen to be a captive consumer or pay a penalty to the federal government that still leaves them entirely uninsured? The fiscal and health stability of this country should be more important than the profits of Aetna and United Healthcare. YMMV.
Earth to Dij: No level of subsidy is written into stone. No criterion is written into stone, either. Guess what? Entire government programs that have lasted for decades can be changed and even done away with by Congress. That's why we have to keep defending SS and why changes to eligibility are constantly discussed.
I fail to see what's hard about this concept. If something we've created doesn't work, we fix it. In the meantime, however, we get the benefits it does provide.
You, it would seem, would prefer to do away with ALL the benefits for the hope that somewhere down the line we'll get even more benefits. This is akin to your double bank shot through the fog strategy of how to achieve progressive policies at the national level. Squelch anything that falls short and bank on hope that we can get something better de novo.
Who knows? Maybe you're right, but I wouldn't get real certain about it.
Your second paragraph is okay, except that the constitutional attack is based on the unconstitutionality of forcing anyone to buy from a private company, not on whether they can afford to buy.
This means that if you don't have insurance and aren't poor enough to qualify for the public option (whose bar will be set pretty low to avoid flooding, as you rightly point out), you are still forced to buy a product or face penalty.
From a moral standpoint, it matters that a poor person who can't afford insurance is being forced to buy insurance, but not from a constitutional perspective. You don't honestly think that all them GOPers are arguing that the mandate is unfair to poor people--except where it shakes a judicial tear loose--do you?
Candidate Obama's original plan would have fallen short of universal coverage but expanded coverage but making insurance more affordable bringing down insurance premiums by $2500. That would have been a decent first step that we could build from. Make it affordable, and then make it universal. Once in office, President Obama allowed AHIP and PHRMA to write the bill putting the mandate first while stripping out the cost savings protections (public option, negotiation of prescription drug plans)
http://www.forbes.com/sites/brucejapsen/2012/06/17/mandate-to-buy-coverage-health-insurance-industrys-idea-not-obamas/
Of course there are laws and programs that can be started out imperfectly and improve gradually. Social Security is a good example of that taking a public benefit and expanding it gradually. If FDR had forced everyone to buy stocks/use private insurers or pay a tax to the federal government and still receive no benefit upon retirement, I'm guessing the expansion would not have gone as smoothly. You can't build real healthcare reform on the foundation of ACA. It is flawed beyond repair.
Obama's original thought was a good one.
I agree with it in principle, but there's a huge devil in the word "affordable."
Just to elide the argument a bit: What's "affordable" to you isn't to me.
And some people, it seems, don't want coverage even when they can afford it. The young and health, for example.
So the concept of affordability often quarrels with the specific dollar amounts that are meant to represent "affordability."
As I recall--perhaps I'm wrong--his plan to achieve affordability was competition within the context of controlled state exchanges. If he intended to exert a heavier governmental hand in ensuring affordability, then I say, "He still can with ACA and I bet he will when the complains start arriving."
He can also use waivers so that people aren't penalized for not being able to afford something and not getting it. Why not? It isn't hard to imagine him doing something like that. Upping subsidies and/or offering waivers are two easy fixes so that people don't end up getting penalized for protection they never get.
So I have to disagree that the plan is "flawed beyond repair." These two fixes fix the problem you cite and are easy.
It's interesting to read that Obama thought the mandate was a "minor difference" between his plan and Hillary's.
But I think he came around to her way of thinking that if you envision most people taking private insurance and you want to get rid of pre-existing condition exclusions, then you have to have everyone in the pool. You just won't get private insurers to take on that kind of risk otherwise.
Or, you go single payer and change the equation entirely.
But beyond ALL this, everyone is ALREADY in the pool. People who "aren't buying" insurance for one reason or another actually have coverage, but of a very inefficient and costly type, and we all pay for it.
The question is, how do we configure the pool and how do we make it accessible and affordable?
Looking back on it, I think Medicare For All would have made the most sense from virtually every perspective. It would have been easier sell politically to the average person who loves Medicare and "understands" it. It would have been easier to implement. It would have covered everyone at a lower cost.
It would have faced two big obstacles: 1) the insurance industry and the people they employ, and 2) the deficit hawks who've proven themselves able to sell snow to the Eskimos. (Actually, the Eskimos could probably use more snow, but you get what I mean.) Hard to know how significant these challenges would've been. Right now, it's hard to imagine they would've been tougher than what we're seeing now.
regarding the obstacles, you may have included the Senators who were beholden to the insurance industry as part of the insurance industry, but I think they need to be added a separate obstacle. Specifically: Democrat Senator Ben Nelson of Nebraska.
It never ceases to amaze me how little Obama supporters knew or cared about his specific policy proposals. I guess that's why it's easy to applaud his position no matter what it becomes, and no matter how contrary to his previous positions you supported. State based exchanges were proposed in the health insurance subsidy act negotiations, not as a candidate. A refresher of candidate Obama's plan:
http://www.nytimes.com/2007/05/30/us/politics/30obama.html?_r=1
Of course ACA cannot be repaired because
the Gang of Six, Obama, PhRMA and AHIPsomehow, no one knows how, Congress forget to put a standard severability clause in the law meaning if one provision is struck, the whole law is likely to be struck. The Solicitor General has already argued that if you strike the mandate, pre-existing protections have to be struck too. Plus, you'd think this Congress would be less accommodating to positive changes than the Congress Obama had for the first two years I would think. Which is why if he wanted to pass bold real lasting reform, there was no better time to do it than those first two years and he wasted the opportunity in favor of snuggling up to PhRMA and AHIP for a crappy health insurance company subsidy law seriously flawed from a constitutional and policy perspective.Severability has nothing to do with whether Congress can improve a program.
That said, you, of all people, should be applauding the non-severability of the law because if they strike down one part, they will have to strike down all of it.
IOW, you'll get what you want from this law--its elimination. Also, its defeat will make it a tidge more likely that your man, Romney, will win.
That said, in all the recent commentary, I haven't heard about anything that forces the justices to kill the whole bill if they kill the mandate.
And all the talk seems to be that, even if the bill is struck down, the Republicans will try to keep all the popular parts, which seem to include EVERYTHING except the mandate and the part that says, "Obama was here." They poll VERY well.
Um, nothing in your quote comes to me as a surprise...
• Competition within a regulated exchange seem to be the primary way costs would have, and will be, kept down. They will be set up at the state level instead of at the federal level. Not sure how much difference this will make to the final outcome.
• States that don't set up an exchange will have one set up for them by the feds.
• As far as a proposal changing when it becomes law...you can't really be that young. AFAIK, ALL proposals change when they become law. You have 435 heavily lobbied people picking at them. So what?
As far as what he shoulda coulda done and foreseen, etc., I can agree with you if I stand on my tippy toes and squint--or not--but really, I don't care. Everyone has weaknesses and makes mistakes. The point is, we are here. I think we should face forward and move in that direction.
It is not about knowing or caring about what was originally put forth by Obama, it is that those proposals are basically irrelevant for discussions as to what we do right now in the year 2012 with what we as a country actually have. And this is a different discussion than whether one wants to look back historically and debate whether should have or could have done more. Problem is, people are always mixing in the debate about the past (which can't be undone) and the debate about what to do now.
Where we are now is that we have an individual mandate for private health insurance that is likely to be struck down, and rightfully so. The debate for what we do now begins once the Court strikes it down. My solution, obviously, would be a real public option which requires people to buy at a minimum government basic coverage if they are uninsured. The Obama admin wants to drop the pre-existing conditions exclusions and guaranteed issue because being friends with AHIP is more important than universal health care reform.
And it doesn't change the fact this debacle could have all been avoided had the President allowed any progressive input on the health care bill rather than allowing it to be crafted by AHIP, PhRMA, and the Gang of Six. But no, it's shut up progressives. Everything can be fixed in time despite the serious flaws with the bill, including an unconstitutional mandate. Vote for shitty health care reform or you'll embarrass the president. Who is embarrassed now?
How do you now get to a public option if the mandate is struck down? What makes you think the politics, which were and are now very difficult, suddenly become much easier than they were before?
How do you get an exclusion for pre-existing conditions if you don't have a mandate (and you're not allowing everyone into the public option)?
And how do you get universal health care unless you allow everyone to join the public option, IOW, single payer?
And how does one keep it budget neutral?
Why did not one Republican in the Senate back then break ranks? Because not a single one of them was afraid it would hurt them with their constituency. Just because someone tells a pollster he or she is in favor of universal health care doesn't mean they also think it is a huge issue to them and is willing to make any personal sacrifices to make it happen.
It would be nice, but I'm not sure it's possible, to keep it budget neutral.
Personally, I don't think it's important. Adding 30 million people to the rolls, many of whom won't be able to pay or pay the full freight, means that more money will have to be paid.
Exactly - and unless there is a massive shift in Congress with the next election, a non-budget neutral plan is DOA.
I'm sorry, but this is just laughable.
President allows "progressive input" and the opposition and obstacles just melt away.
Obviously you didn't follow health reform at all or all you wait for is matching orders to see what you should support. Obama took the public option of the table, let phRMa ahip and the gang of six write the bill. Got no bipartisan consensus out of it, had to use reconciliation anyway and the only pressure he applied was to progressives like kucinich to support the shitty bill even though they had zero input on it. What's laughable is you are so blind you don't see that a democratic president should be using his pressure on the moderates Dems rather than only pressuring progressives.
But you know, Bauchus is the most powerful guy in Washington. What could Obama do but pay his fealty, who could expect Obama to show some fucking leadership. The presidency has no power so he might as well return to where the real power is, the senate where he can officially join the gang of six. Laughable indeed.
You are misrepresenting the facts: June 3rd, 2009 in a letter to Sens. Kennedy and Baucus the President restates his support of the inclusion of a publicly run health insurance policy. Paragraph 6.
And we all know the reason there is no public option is because Senator Kennedy died and Senator Baucus killed it. These are facts. But it becomes insanity to have to discuss this over and over again, as this blog isn't about that particular subject.
Continually rehashing things that have already taken place is a dead end street. We can discuss the potential direction to take to attain said goal, but we can't change the past.
What I wrote about is a specific example, what happened in Washington State, not just to the cost of health insurance but to the availability of health insurance, when our own mandate was repealed. It has implications to what the events that might take place regarding the cost and availability of health insurance for the general public. Republicans want to keep all the goodies in the law for the middle class, cause they love that stuff, but want to make sure that insurance companies don't have the necessary numbers to keep premiums low and to continue to underwrite individual policies. The effect here was more people became uninsured.
All rested on Teddy, eh? No one could have fought back?
We are a bunch of elitist aristocrats, stuck to 1 Cape Cod bootlegger family.
Though some remember the situation a bit different, say as a done deal in a back room in July 2009:
http://www.beyondchron.org/news/index.php?itemid=7923/
http://www.huffingtonpost.com/miles-mogulescu/ny-times-reporter-confirm_b_500999.html
But kudos for the "he wanted to, but people & events got in his way" buff up.
If you can find a 3rd besides Kennedy & Baucus, we can give him his own trifecta.
Good find
Are they forgetful or deliberately obtuse?
;-)
LOL! Tmac writes the best Obama fan fiction.
I think you left out that Obama selected Tom Daschle (D-AHIP) for HHS Secretary until he was forced to pull the nomination. You think if he wanted someone more along the lines of Teddy Kennedy, he might have made a different choice than someone already deeply immersed in the health interests lobby.
And even after he was pulled, Daschle was still vitally involved in the
health reformhealth insurance subsidy act and was actively involved in the behind the scenes dealings on behalf of the administration.And of course Daschle wants to take credit for his efforts on behalf of his friends in the industry so they continue throwing more money his way while he avoids paying taxes, he revealed that in July while the administration was still publicly giving minimal lip service to the public option (because words are what matters in tmac-land, not actions) the deal they made with the insurance cos. and the White House was that there would be no public option.
And in the final coup de grace, Obama creates his own Obama fan fiction denying that he ever campaigned on a public option.
I'm sure someone somewhere is stupid enough to swallow the tmac propaganda (Nancy Pelosi wrote the bill! It only went wrong because Teddy died!) that goes counter to everything that happened. But I am not that someone and I resent blatant dishonesty and knowingly misrepresenting facts to support your candidate.
Response below...
I'll take my shitty bill--which, despite all of your idiotic ravings, can easily be fixed if need be--to your "no bill." Which, frankly, is all you have.
Actually the Supreme Court is going to take the shitty law and dismantle it because it's unconstitutional. You thinking that's an easy fix is idiotic. :)
Sorry, but you still have no bill.
And, in fact, even if SCOTUS strikes the mandate, it seems quite likely that virtually all of its constituent parts, which poll VERY well, will be kept.
Meanwhile, you still have no bill. You have no way forward to a bill even. And that isn't an easy fix--I agree.
It never ceases to amaze me how little Obama supporters knew or cared about his specific policy proposals.
Nod nod from me on that one! Especially depressing: not the promises he went back on, but the approaches and opinions he was very clear about and continues to this day, when you see people who were strong Obama supporters at TPMCafe, who you know are smart people, all in an outrage about those things now. When you know you posted stuff at the time saying: hey, everyone, didya notice he's for this and this and against this and this? Willful blindness in voting, by smart educated people, this I find very scary. Did then, do now. Is more than a pet peeve with me. Is not about "I told you so." Is very much about "how can people get so self-deluded by campaign fever that they shut off their brains?"
Oh come on - we have to explain Beatlemania now?
It was an event, like the launch of Angry Birds and seeing The Dark Knight and getting your first tattoo whacked out on PCP and Coors Lite at the county fair. All just seminal happenings that seemed important at the time but fade with the years.
You're making her point for her, PP.
The other point that's rarely mentioned is this...
If we do away with ACA, what happens to all those poor people who can't afford insurance even with a subsidy? They are still without insurance.
What happens to all those poor people who could afford insurance with a subsidy? They are still without insurance.
What happens to all those out of control insurance companies? Still out of control.
What happens to those premiums that are going up and up. Still going up and up.
What happens to underlying health care costs that ACA took a shot at controlling? Still going up and up.
Going backwards is still going backwards...
Of course, what might happen if we do away with the mandate is end up keeping many of the individual pieces of the ACA which have very high approval ratings even among Republicans. Almost all of them.
In fact, the one piece of ACA that really depends on the mandate--no exclusion of pre-existing conditions--is overwhelmingly popular. Sans mandate, though, we might not be able to keep that.
Once Obamacare is dismantled into its constituent parts, the only part that's really objectionable and unpopular, I'm afraid, is the one labeled "Obama."
This is actually not the Republican argument. The Republican argument is "We hate everything Obama. Period." That's it.
The people are already captive and will remain captive even if the mandate goes away.
Unless we get single payer, this fact won't go away. And all you have to offer is "I don't assume that single payer will happen overnight, although I think it will happen eventually."
Sounds like Obama to me, but without any actual strategy or accomplishment.
I knew when I wrote my post last night that TmacC was going to come kick my ass over it. This is a good argument.
But, I say, it's a good argument about state regulation (the Romney position in 2012) over what really is a national issue. Meaning that, sure, if Washington State makes it expensive for private insurance carriers to do business while doing business in Kentucky is largely high margin, insurers will dump Washington State unless Washington's population is high enough to make it worth their while at lower margins.
Federal regulation isn't the same thing. It's one thing (and no small thing) for a company to decide to do business in Kentucky but not Washington. But it's a far larger thing for a company to decide to do business not in the U.S. but in Brazil. It also makes very little sense, once you are operating on a global scale, to try to ignore the largest consumer market in the world. This is actually at the heart of most of my economic arguments, which is that, for the most part, businesses will pay any price for access to US consumers and that, in the end, we ask for too little. We could, for example, easily end offshoring just by telling U.S. businesses that if they outsource labor abroad, they cannot sell domestically. Those companies that decide not to sell in the U.S. can also be stripped of domestic status, including the protections of the bankruptcy code. Companies could then do the math and choose between the U.S. and Russia as a place to do business.
The same is true with health care. National legislation tells Cigna or Aetna or UHC to either conform or try their luck in some other country. That's a very different proposition than leaving Washington.
It is a complicated issue.
If other countries that we have trade agreements with, have socialized medicine, are these costs incorporated into the price of the traded goods?
Do our manufacturers/producers have a disadvantage, if we tack on the added costs of employer provided healthcare to every widget made?
When NAFTA was agreed to and it was suggested we would lose our sovereignty, our control. Did that spell the end of employer provided Healthcare in America?
Did we have to go with private insurers, because manufacturers and producers wanted to trade goods, without being burdened with social issues?
Manufacturers and producers want no part of protecting the cause of safety nets. They even hate OSHA
Keep out these cheap foreign goods, it leaves American workers unprotected and unable to wrest control from the capitalists.
OSHA can be a pain in the hind parts. But the system provides a way to pass on the cost of protecting workers to clients that cannot be avoided by most providers of a product or service and thus becomes simply a part of the cost of buying the product.
It would be within the logic of NAFTA to insist that all manufacturers who enter the market play by those rules in order to level prices without resort to currency speculation. In that sense, the loss of sovereignty you refer to is less about what happens in the U.S. and more about how other countries operate. The disputes with China about working conditions is often presented as a purely humanitarian concern but is also a dispute about real costs and how their ledgers should be measured against ours. (they are carrying a significant portion of our debt, etc.)
I think arguments for tariffs (keeping cheaply made goods out of the market) should be separated from arguments about how to make the market more humane for everybody involved. I understand how tariffs would help us as a nation to provide more openings to do work here. But I object strongly to the idea that choosing that path is free.
Like you said, it is complicated.
Bingo. Not to mention even in Washington State where the insurers have been chased away by such unfriendly practices, their NON-PROFIT Insurers are sitting on mega surpluses. Http://wainsurance.blogspot.com/2012/01/non-profit-health-insurer-surplus.html. Can't imagine the for-profit ones. Billions in reserves and profit are not enough, they want to leave the state to find more accommodating pastures. Not so easy if the health care reform is national.
The case study is evidence of what the consequences will look like if the mandate is struck from the bill. I think that is pretty simple and straight forward, it seems congress is going to make the same mistakes that Washington State legislators made by keeping all the goodies, including barring insurers from discriminating against those folks with pre-existing conditions, which is going to be one very expensive proposition for insurers. It would be a travesty if fewer people were insured as a result of the Supreme Court severing the mandate from the bill, (if that can even be done). But will I be shocked when it happens, no I will not.
I've heard it said that Clinton failed because the Insurance companies fought so hard against his plan. This time Obama tried to co-opt the Insurance Companies reaction by giving them what most industries would consider a sweetheart deal; a lot more business by way of the mandate. But getting in bed with the Insurance companies didn't work either, they still fought against the ACA.
So, the only option left, it seems to me, is to get rid of the Health Insurance Companies as we know them and offer Universal Health Care using their already established infrastructure. In other words, Nationalize the Health Care Industry. (How do you think that would sell in an election year?)
I can hear the screams of socialismmmmmm echoing from freeperville right now! It is interesting to think about though.
Some more socialism would be a good thing.
"SEE FOLKS we were right, LOOK Obama is a socialist"
"It came out of Kenya"
Shrieking "ahhhhhhhhhhnoooooooooo"; the seed is planted
Find the Birth certificate, before were consumed
He's one of THEM
Yeah, that's kind of what I thought would happen ... but they're doing that anyway.
So why not have it be FOR something ... and perhaps, if we pushed back hard enough, we could destroy the power of that message once and for all.
Imagine interviewing some grandparents who lived during the Great Depression, telling us how FDR saved the country.
How fearful they are that their grandchildren may not be so fortunate.
We have been brought low by the same group that brought us the Great Depression; it doesn't mean we have to remain low.
Get more stimulus money working for America, and Americans can do the rest.
America can do better if we're given the resources. Been there done that.
Unless you want to return to the days of Bush; we've been there and done that too.
That grandparent you mention is actually, my mother, who was born in 1918, and has spoken to me often through the years about the Depression and her admiration of FDR.
Doing that would be fulfilling a dire prophecy by a god of those on the right side of the aisle , see
http://www.youtube.com/watch?v=fRdLpem-AAs
or the wikipedia entry on same here
Listening to Reagan, it's hard to disagree.
Except; I didn't hear any solutions to the problems we face, other than; the need to block Socialism.
He mentions how a doctor might be told, he cant practice in a particular jurisdiction, because there are to many now.
The free market would dictate that too, unless the doctor or graduate wanted to give away their services for free.
Maybe healthcare would be cheaper?
Reagan's first point is that in 1927, a Socialist party candidate said Liberalism is Socialism in disguise. Gee, and some record company guy said the Beatles would never amount to much ... (I was going to say Hitler predicted the Third Reich would last 1000 years, but why drag Hitler into this discussion?)
I hate that b*llsh*t domino theory of snowballing Socialism. "If we have socialized medicine, eventually your son will have to wait to be told by the government what job he will do ... " No such thing has ever happened, has it? And yet, no one ever laughs in the faces of these cretins or challenges the theory as complete crap.
NO !!! please dont bring up the unspeakable name.
I placed this over on Destor's post, so, risking accusations of spamming, here it is again. Saw this on UP with Chris Hayes this AM. This discusses the human side of the health care mandate issue. FWIW, I think it would be terrible if this loses and it all goes away.
Quotes from PP's first article:
PS: It's "mere existence," eh? Not enough a lot of people couldn't ditch their for-profit plans and move to the public option. If the for-profiteers need that kind of pressure, then folks need to be able to switch, and they couldn't. So this is nonsense. Beyond, I fail to see why we need a public option to ensure that for-profit plans have a waiver for pre-existing conditions. Guaranteed issue is guaranteed. So if you're turned down, you have a case.
PS: "If the Democrats had at least fought for single-payer, I could be okay with not having a public option in the final bill." Huh? First of all, NO ONE has any right to complain that single payer was "dropped." It was never on the table. No candidate ran on it, except maybe those who also decided it was okay to get .00001% of the vote in their own district.
But somehow, Chron would be pacified if we had fought and lost on something that was never on the table AND ALSO didn't get the thing that he's now complaining about not having. Really? Progressives seem enamored of the fight, but utterly indifferent to the actual result. They shit on the result, but mourn the absence of a losing fight. I guess that makes for good movies, but...
PS: I like transparency. It is a good goal. Important to democracy. But it seems to me that Obama made a calculation that he needed AHIP, etc., on the side of the bill instead of against it. That was a calculation and maybe it was wrong. Maybe it was right. But the lack of "progressive input," as Dij goes on about, doesn't change whether that decision was correct or wise in terms of getting a bill. Again, Obama and everyone else was looking back at the failure of Clinton health care. So they decided to go a different way.
Progressives would have us believe that there was a dark, sinister, corporatist motive here on Obama's part. I don't see it. They also seem to think if only Obama had "fought," things would have turned out differently. Or even if they had turned out badly, at least we would have fought. I prefer moving forward however imperfectly to fighting and losing.
And here's why: When you get something, real people get real benefits. When progressives "fight the good fight and lose," they get nice memories and maybe a book deal in their sixties, but no one but them is helped.
You don't see the dark sinister corporatist motive because you are willfully blind, which is quite frankly worse than just being stupid.
Now you've cut me to the quick...
Give me a few seconds and I'll recover...
One thing everyone should agree about is that neither Hillary Clinton nor Obama campaigned to overturn the current economic system in America - and the American economic system is corporate in nature. Both Clinton and Obama believe in providing stability for corporate America. Now this can be seen from some progressive viewpoints as an inherently dark and sinister motive. Other progressive viewpoints can see this is merely status quo moderate politics, and that such an approach is necessary in order for incremental reforms to occur. Which is not to say that one can't have dark and sinister motives when crafting policies regarding corporate America. But simply acting in a way which sustains the system and props it up is not itself evidence of such motives.
In fact, FDR's New Deal--the whole grail of progressivism--was an attempt to prop up capitalism in the face of its failure.
capitalism with a smiley face
This is an add on at the bottom of your second link. I found it interesting in light of our discussion, previously, about Clinton v Obama relative to progressive ideals.
Not to re-argue the point, but Clinton's overall thrust was a move to the right and an adoption of a corporatist approach to solving social problems. New Democrat. DLC. Third Way.
Part of Obama rejected this approach--which gave progressives "hope"--though another part was always centrist. The only thing about Clinton centrism, and you pointed this out when we were going back and forth, it does get things done.
*Sigh* I respected Clinton because he was a triangulator who invited all parties to the table, progressives conservatives and centrists. He'd take a little from the left, a little form the right and come up with a decent compromise - as in welfare reform. Health care reform, not so much but then he didn't let the industry write the bill.
Obama starts dead center and bargains away the farm to the conservatives and Republicans. And the result is that we get legislation that is more Moderate Republican than centrist. He's at home with the Bachus, the Conrads, the Senators Collins and Snowe. It is who he is.
This actually wasn't directed to you, but to PP, but okay...
My point was back then and was remade here, when you look at the whole picture, Clinton moved the frame to the right.
"Not so much" on health care? He got nothing. I know in your special political lexicon that's equivalent to a win, or the next best thing to a win, but that's you.
AFAIK, the failure of HillaryCare did not move anything forward. And the second time around, she argued heatedly for a mandate, which she had opposed before.
I know you think the presence of her government option changes the constitutionality of the mandate, but the only person I've heard say that is you.
Unless you're going to let everyone into the government option--and she was not because that would be single payer -- then some folks who don't have or don't want insurance are going to be forced to buy it. As far as I can see, THAT is the so-called constitutional issue at hand.
The problem is, everyone already has coverage, in effect, because they can't turn you away at the ER. And we are all paying for all this coverage. So we already have universal health care, a very poor and expensive form of it.
In short, everyone is already in the health care "market" and is paying for it and that's why the Commerce Clause applies. And the precedent you've been asking for are all the expansions of the Commerce Clause in the past.
Your ramblings have no foundation in reality. S-CHIP to give universal health care to children was the next pivot on the health insurance front and was pretty successful I think.
We'll see tomorrow re: the commerce clause allowing the federal government to force every single citizen to purchase a product from an private company or pay a penalty that offers them zero benefit whatsoever. If an uninsured person goes to an emergency room, they still will get stuck with the bills. It's not like they receive any benefit from paying the penalty.
It was successful, but it still left a LOT of problems and uninsured people in place.
And thus far, ACA has been pretty successful. And a lot of people LIKE what's in the bill. They just don't like that it's Obama's bill.
Those ER hospital bills will be a lot higher than paying for insurance. So if you can pay those bills, you might as well get covered.
And you won't be saddled with bill collectors if you don't pay your ER bills (many of which get written down anyway).
Plus, you'll get to see a primary care physician. You get free preventive care. You'll get covered for Rx.
And if you decide not to buy insurance, nothing is going to happen to you. Even if they go after your refund...even if you don't get a waiver for financial hardship... even if you don't qualify for expanded Medicaid...then set your withholding so that you get your "refund" in your regular check.
At best, you'll be even at the end, so no penalty "deducted." At worst, you'll owe the IRS back taxes, and they still can't levy the penalty.
But the notion that a bill can't be adjusted when problems like this crop up is ridiculous. ALL bills are adjusted. For you to maintain the opposite is just silly.
Of course, the justices may, like you, accept the "broccoli" argument. And then we'll have to see.
The talk seems to be that, in the face of "victory," Republicans will be inclined to keep many of the VERY popular constituent pieces of the bill, which I guess is another way to win.
Maybe the lack of a waiver for pre-existing conditions will be the straw that ushers in single-payer or a public option, which will also be a win.
Or you can call it the "next pivot."
Oh don't worry. Obama and his DOJ have already argued if the mandate goes, the pre-existing exclusions must go despite the fact his primary campaign proposed precisely the opposite. You can tell because tmac is right there picking up the talking points. And so the GOP will be (by appearances at least) pulling for populist provisions and the Democrats will be standing in the way to protect their friends at AHIP and PhRMA rather than using this opportunity to fix the problem with a real public option.
You just can't make this shit up.
They would have to go dijamo, because there would be no way to keep the cost of insurance low enough for anyone to purchase if there is no mandate. The mandate keeps the pool large enough to sustain the cost of care for those who are already ill in one way or another and require long term care.
So this blog, (weird to have to explain it over and over again) is about an example of what happened when our mandate was repealed. It is a case study, a real thing, it really happened. It continues to be a blog about the consequences of repealing a mandate without dealing with all the stuff people want their insurance to cover. Republicans have promised to keep everything that people love as law. Well then there are issues that must be dealt with, because it is another financial disaster for the nation, in the making. You are going to keep trying to drag us back to the epic bot/bagger argument, but that isn't the topic of this blog, how hard is that to grasp?
I know, you are so genuinely CONCERNED about this issue. Which is why you wrote this blog about you can't have an guaranteed issue/no pre-existing exclusions to criticize Candidate Obama's proposal in 2008 as doomed to fail.
No?
Okay, you wrote it back when ACA was being debated to justify that the individual mandate was needed.
Not then either?
Ah, I see. You wrote it when everybody and their mama wrote the same blog with their same concerns about Washington State's experience with the individual mandate.
What a co-inky-dink. Seems like a industry PR push for Democrats to respond to the mandate by eliminating all the consumer friendly provisions rather than go for a real public option that would be able to withstand constitutional scrutiny.
Dijamo, you continue to think that a mandate + public option would eliminate the constitutional issues being put forth. It would not.
Since the public option, including Obama's and Hillary's, would not allow everyone in, some people would still be FORCED to buy health insurance even if they didn't want to.
Being forced by the government to buy broccoli is the issue...as the Republicans see it.
You do a little side step by saying, "forcing poor people to buy broccoli," but the Supremes and Cuccinelli and Florida aren't talking about poor people. They are talking about people. THAT is why they brought the suit. They don't care whether poor people can buy anything.
(In fact, all they're REALLY trying to do is wreck Obama's bill and get him out of office. But that's a different matter.)
Full single payer would eliminate the constitutional problems--but no one proposed it. That is, no one in a position to make it happen.
If the government created a public option that people who did not have insurance elsewhere were required to pay the government for and receive benefits from a government administered plan, I think that would withstand constitutional scrutiny. The difference is it is a welfare plan rather than a financial penalty. See the Social Security Act for a federal welfare benefit that people were required to pay into, but did not affect everyone. It doesn't have to be single-payer or nothing.
Now, if you have doubts about the constitutionality of that proposal, but still argue that forcing people to pay a penalty to the federal government for not buying a private product where they still obtain zero benefit after paying that penalty is A-ok per the Constitution... you might be a Republican or an industry-hack.
Okay, so maybe I misunderstood you...
• Anyone who wanted to have insurance, but couldn't afford it could buy into this public option if they met the financial criteria.
• Anyone who wanted to have insurance and couldn't afford it, but didn't meet the income threshold for the public option, would be out of luck...unless they got subsidies so they could buy private insurance.
• Anyone who could afford insurance, but didn't want to buy it, could simply not buy insurance and wouldn't suffer any penalties.
Is that close?
Two points about this. Once these various thresholds are set, they still have to be adjusted in order to conform to reality, complaints, people who slip through the cracks. So we still have an imperfect bill that has to be adjusted.
(In principle, as I've tried to point out, this is no different than adjusting the penalties, allowing waivers and all the other adjustments I've suggested, assuming they aren't already in the plan. Some people seem to think financial waivers are available, but adding them is certainly as easy a fix as adjusting thresholds or adding or increasing subsidies.)
Generally speaking, you need as many healthy people (my third bullet) in the pool as possible, so that costs stay within the solar system. So I think you really need to get those young, healthy folks in the pool--and that's what the mandate tries to do. Although those people would probably be more than willing and able to pay the penalty that can't be enforced just to do as they pleased.
Okay, a third point...pre-existing conditions.
If you say that anyone with a pre-existing condition could join the public option, regardless of their income, then you will be weighing down the public option with a lot of sick people who need very expensive care. Everyone with a pre-existing condition will flock to this option.
If you want private plans to waive this condition, then you need to get many healthy people into the private pool to offset the sick people. This not being a dictatorship yet, they won't agree to take these people otherwise. This is what the mandate is supposed to do--get broad participation.
Candidate Obama said that if we just "make" insurance cheap enough, everyone will buy it. This sounds promising, but I'm not sure it's true, and Hillary didn't think it was true, and eventually, Obama didn't think it was true.
For one thing, how do you make insurance cheap enough to draw in this many people? I think this problem leads you inexorably to single-payer. This also has problems unless government also takes over the provision of health care. And ultimately, we have to deal with the cost of the underlying medical services.
BTW, taking all the poorest people and those with pre-existing conditions off the private market is probably the nicest thing you could do for private insurers.
They get the cream of the crop, while the rest of us get the crust of the crap.
And since the people who are sickest aren't also those most able to pay--in fact, they are generally the least able to pay--you are digging a nice financial black hole where, more than likely, the sickest and poorest get the worst care (ultimately).
As far as the constitutional issue goes, my summary of it is this: bullshit. It was and is a bullshit argument from beginning to end. This won't stop the righties on the bench from going with it, but it's still bullshit.
The whole point of insurance is to spread the risk as widely as possible to cancel out the cost of those who are sickest. The only way to spread this risk out as widely as possible--unless you're going to buffer against the risk by the cherry picking of the healthy that profit insurers do--is to get the biggest pool as possible. Ideally, everyone.
Get private insurers, out of the business of making a profit, off of peoples misfortunes.
Who said the government of the people and for the people, can't have a larger risk pool?
A risk pool, made up of ALL citizens. Helping to defray the cost of preexisting medical problems.
Private insurers cant do it, thats why they cherry pick.
Risk management isnt rocket science.
For profit hospitals; seems contrary to a more perfect union.
Imagine the biblical good Samaritan, asking the victim; you got any money or I'll leave you here to die.
Every citizen pays into the system and everyone benefits from the system and there may be some savings at times.
Savings that can go into the General fund; instead of some United Health's, CEO's pocket.
http://ctwatchdog.com/health/102-million-payout-to-united-healthcare-ceo-draws-outrage
UnitedHealth CEO paid 1737 times average worker - Minneapolis ...
He profits; WHY?
Why not the citizens of the United States?
Dont stop at medical care, expand it to cover all insurance needs.
Pay at the pump for auto. A rider policy necessary to defray the cost of enforcement for bad drivers.
Pay for disaster relief to cover FEMA.
If All State in Florida, suffers to great a loss, do they get government assistance? The people of the United States gets to pay the cost for disaster relief. While the insurers get to cherry pick?
Who needs the Private insurance companies, if the government took care of the general welfare; seeing as how WE THE PEOPLE are saddled with the more than general, when disaster strikes.
Anyone who does not opt for employer or private insurance would be required to be enrolled in the public plan. No income restrictions for participation.
That sounds okay. Of course, it then becomes a magnet for anyone who wants to save a bunch of money. Even if they could afford a private plan.
You might make some headway in persuading some folks if actually explained in what way there really an opportunity to get a real public option. That is, when one sees "opportunity" as an advantageous circumstance or combination of circumstances or favorable or suitable occasion or time, to make a public option a reality. Thanks to the results of the 2010 elections, Congress is even less hospitable to a public option than it was in 2009. With the approaching elections, most politicians won't want to start talking about something complex like new health care reform legislation, especially when people are clamoring for direct action on the jobs front.
You've always got an excuse...sometimes many altogether...don't you?
You're always for incremental change...as long as you don't have to admit that it is incremental change.
It's tough being principled when you aren't really.
Incremental change is fine. "Incremental change" that's a hope and a prayer waiting to get voided by SCOTUS or retracted by the next Congress? Well my, that's progress to believe in.
As someone said above, "Thus far ACA has been pretty successful". Uh, yeah, right. What's the buy-in rate of the different provisions? How many implemented over the roadmap? How many successfully? Is this a neutral observation, or a hope and a prayer for how it actually goes?
Weird comment. Are you the Dagblog "principles" scold? Incremental change is fine, especially when it has a roadmap to something better, or is better all by its lonesome.
Incremental change that impedes real progress can be problematic. Incremental change that causes massive problems can be problematic.
There's a Gartner 4-quadrant in there somewhere.
Don't know where I acquired the "nothing but the whole tamale" moniker. Perhaps I should get a mask & cape.
Really what is the difference between moderate Republican policies / legislation and centrist policies / legislation. And whether one gets there through triangulation or through some other means doesn't make any difference.
And even if Clinton brought progressives to the table - the Welfare Reform act was not a thing of beauty it can be argued, and was something that would make a moderate Republican smile:
Obama Derangement Syndrome requires that Clinton be painted in the rosiest of hues.
Though five seconds ago he was accused of giving in to everything the Republicans ever wanted--and his DLC, Third Way, New Democrat movement packed with corporatist, faux progressive Quislings--now, with Obama in office, he is a paragon of progressive virtue.
The reason the welfare rolls dropped--remember the SOTU address that was so loudly praised here a few threads ago?--was because people were pushed off. And the only reason poverty didn't go through the roof was because the economy was inflated on a bubble of dot.com helium.
Everything looks a lot rosier when the green is flowing...
now waaiiit just a minute. I stand proudly second to no one. vis-a-vis ODS...but my loathing for Fat Bill is a point of pride. Of course I am chairman of Trotskyites for Paul, and how crazy is that??!
With "that," I have to part company with you.
My point wasn't to argue the worth of the reform, merely that there were plenty of progressives who were upset about it at the time, not because of some numbers on a spread sheet but because of the structural changes it made that undermined the efforts of those working to get people the assistance they need. That is what the wonderful triangulation got us. The point being - the welfare reform under Clinton is something very similar to what Obama would probably have achieved. Except somehow Clinton is all wonderful because somewhere a progressive or two was listened and then triangulated, whereas Obama was operating with dark, sinister corporate intentions - such as hoping for privatizing the food stamp system at the state level like here in Indiana under Gov Mitch.
Your point like everyones was to bitch and moan about possible negative effects that never happened until we threw our temper tantrum against Gore, so Bush got elected and he really screwed the poor by making welfare reform super-punitive, but we still like blaming Clinton because "triangulation" sounds like tough math we had in grade school.
Tell me how the fuck "reaching across the aisle" differs in principle from "triangulation", except as Dija notes, Clinton included progressives in those cozy reach-around moments.
I'm saying that they aren't different (which goes along with the point being made in the Obama is a major force in progressive politics thread a little while ago, which was making the case that Obama was bringing us back to the days of Clinton - without the tech and housing bubbles)
The progressives want option A, the moderates option B, the conservatives option D. The only thing that will actually fly is option C. So Obama goes directly to Option C and he is called weak and caving into the repubs. Clinton triangulates, makes the progressives feel all warm and fuzzy inside because they were "listened to" and the end result is Option C.
And don't include me in that temper tantrum against Gore. The point is being able to point out the weakness of legislation and policy without throwing the baby out with the bath water - which is what it seems some want to do when it comes to Obama. Clinton was "great," but Obama is destroying the movement.
As Mr Schwartz has very well stated over and over, there are flaws in ACA that can be corrected. Making Obama out to be some sinister corporate lackey is facilitating the same kind of tantrum that gave us Bush.
Which Obama?
Imagine that YOU are one of those union members or factory workers whose jobs have gone overseas. Imagine that you’re hanging on to Barack Obama’s “rhetoric” about NAFTA. Imagine how you’ll feel when you find out that — wink, wink — it was just campaign talk.
WINK WINK; "I really had no intentions, of keeping any perceived promises, I made to get elected; including the handling of the ACA. Whatever private insurance wants, they’ll get. ?????????
Which Obama are you talking about AT.... the one that wink winks?
http://www.noquarterusa.net/blog/1651/shocker-obama-campaign-reveals-fake-stand-on-nafta/
Clever. The housing bubble that didn't pop until 7 years after Clinton left office? The tech bubble that had a 1-year burst before regrouping? (Cisco was in the dirt then - where are they today?) Yeah, I'll take those tough problems over financial meltdown and mass illegal mortgage foreclosure. [nothing we could do to limit over-exposure and predator mortgage practice in those 7 years I guess - damn Clinton]
But then you pretend Clinton did nothing for progressives - just a sham show - while Obama is honest? It's not like Clinton triangulated every issue. And he ran on what he delivered - NAFTA was part of his campaign plank - if progressives wanted to vote against it, they could damage Clinton at the polls - and they did.
Whereas, Obama told progressives in advance there would be no public option? Hardly. As noted by NY Times & others, it was a backroom deal Jul 2009 to get insurance companies on board. TMac still blames it on Ted Kennedy dying & Baucus playing too hard ball. That's our "honest" head-direct-to-Option-C-do-not-pass-Go president.
But on health care, and S-CHIP, progressives were at the table helping write the legislation. For the 1993 tax hike and Earned Income Tax Credit, the result was brazenly progressive. There was no 'leading from behind' - Clinton put stakes in the ground and fought for those.
As I noted before, with reconciliation Hillarycare would be law. Without reconciliation Obamacare would be stillborn. Even with, it's an ugly baby that with plastic surgery & physical therapy & special education might be made to walk & appear in public one day, but it will likely be dissected & thrown in the trash by SCOTUS in the process, so don't put too much love into the little beastie. Perhaps time to think of a planned birth this time, rather than a bastard consummated in disrepute in a dark alley somewhere.
Rog, the reason you run into someone who's "tainted" every time you turn around is this: No one "untainted" is willing to get "tainted" to un-taint the tainted.
And every time they try, they get tainted and have to move over to the other side with their fellow tainted. Taint, or be tainted.
This is the Groucho Marx paradox. Karl was all for getting tainted, believing that, since everyone was tainted, no one was tainted. But that was a long time ago.
Christians put it this way: Blessed be the tainted, for they shall inherit the earth (and not pay inheritance tax)--a very tainted place, as I understand it.
I am serendipitously reminded of a good friend who worked at the Mustang Ranch. She was complaining about the need to pluck out occasional greying pubic hairs, and my third wife, the hooker, admonished, referencing hair dye "If you paint your pubes avoid the taint" (now back to family hour.. )
I could a memory to that one...but I won't-:)
Or: If you're not part of the problem, you're not part of the solution.
I don't know about that - since us tropes are just a singular tangent space of a quartic surface, they don't give us that kind of information.
Jolly, actually I do mention Max Baucus up there in a response to dijamo,
This blog was not meant to elicit yet another discussion about the Great Disappointments & Predictions of Progressives and how the rest of us are plain dumb Obamabots. It just wasn't and it isn't, I think we have had that discussion far too many times, it gets us no where. In fact it is as lame as reading anything more about the Orly Taitz obsession with our Kenyan President.
Tthis blog, as I keep reiterating, describes an important example of the possible consequences of the mandate being struck from the law. Leaving all of the goodies in, just like the Washington State Legislature did way back when. It was a complete disaster. It left more people uninsured, created an insurance market with wildly rising unpredictable costs, and instead of expanding the pool of insurance providers in the state it actually chased providers away. It is a very important issue, one that we might have to grapple with as a nation as soon as tomorrow.
Everyone knows what Baucus did when Sen. Kennedy died, but it is irrelevant to this blog. I don't know why we have to keep fighting the same lame shit over and over again, it is what it is, right? Now we are going to have to deal with whatever the consequences will be as a result of the decision tomorrow. What happened in Washington gives us a view into the future, I think that is worth discussing. I also thought it was worth people knowing. Knowledge could help us avert some of the possible consequences.
In general these fights break out over and over again because it the haggling over the nuances of history. Bring up the Civil War and see what kind of brewhaha breaks out in the thread. Some people are more entertained by this kind of wrangling than others.
In particular, people I think are just in a holding pattern because the decision hasn't come down yet. Once it does, then people can start bickering about next steps (with all the finger pointing and flame wars about who is to blame, etc).
"I have but one lamp by which my feet are guided, and that is the lamp of experience. I know no way of judging of the future but by the past." http://en.wikiquote.org/wiki/Patrick_Henry
You got that right TMC .....The Obama experience could have been averted ?
http://dagblog.com/reader-blogs/we-need-stinking-mandate-14070#comment-158126
Had candidate Obama kept his promise; the Battle for Wisconsin, may never have happened?
Detroit may not have needed a bailout?
MANDATE SURVIVES IS CONSTITUTIONAL! WOOT!
Yay for poor taxes!
Didn't you say you would say, "Obama is smart," if the bill were upheld?
Being a fan of Obamacare, of course, I won't hold you to the "penalty."
Obama is smart by being able to pass a health insurance company subsidy act by taxing the middle class, and still fool democrats into thinking this is a victory.
I don't think that was the promised statement.
But, as with Obamacare, I'll say this: "It's a start."
Every single one of your over-the-top angry Nostradamus style predictions were wrong dijamo, every single one. So your "poor tax BS", is just another piece of misinformation in your repertoire of inaccuracies.
From now on, every single time you make a predication I'll be sure to expect the opposite to happen.
And for the record, I've written about the mandate since the Clinton Administration. These policies weren't created in 2008, Democrats who have been in this game for a long time, were always fully prepared with a bill that included a mandate. (We prepared for it in the mid to late 1990's) As I've written about here on DAG more than once, all universal systems that evolved into a single payer style program began with an insurance mandate. The English mandate was enacted in 1911, but Germany had a mandate in the late 1800's.
The winner in this, the working poor, who almost never have access to primary preventive care, it is too bad your anger clouds your ability to see it, this is a giant leap for a progressive America.
Well, I've enjoyed our discussion, tmac. While I do think that the insurance companies got an undeserved subsidy here, I'm very happy to keep the other benefits of ACA and it is a big step towards something better. Also, on a crass horse race note, happy to see Obama head to November with a victory under his belt, rather than a loss. Because that's what a lot of people are going to remember -- that his opponents took him all the way to the highest court and then lost. That really counts in election politics.
I am still shaking and recovering from this, elated doesn't begin to describe how I feel. A lot of my life was spent working on this issue. I can't even get on my bike yet, the tears are still streaming down my face, tears of relief, thrill, I am stunned. And this:
I couldn't agree more.
Well, I did say it was indefensible by the Commerce Clause and it was. Apparently the Supreme Court thinks poor taxes to promote private services are a-ok per the Constitution, and the government to basically tax anything anytime it wants. teller argument for Novemeber. in the battle of public opinion, well I guess we'll see. the GOP is going to use this as a rallying tool, and the Democrats are still not going to be able sell a shitty poor tax as a political victory. Also states are not going to be forced to expand Medicaid or lose Medicaid funding. that I did not expect, but may impact how many poor people actually get the subsidies part I do support.
For today, you Obama and AHIP/PhRMA can celebrate the passage of the /health insurance subsidy Act. Congrats!
Tell ya what, though: If we had single-payer, we'd have a big ole tax issue, too. Which would be a "teller argument for November."
Now comes the work to get the people elected who are going to improve it rather than undermine it.
Or at least to filibuster a repeal.
Hey, that's not how we do things on our side, Flav. We'll filibuster, lecture people about civility, and then allow half of the bill to be repealed, with the other half repealed last minute, as a rider.