Krugman: If you don’t like the mandate, why not support single payer?
Bill Gardner at The Incidental Economist offers a rather decorous, mild reply to the people making [the argument that guaranteed health insurance is an assault on America’s freedom]. I’d put it more forcefully: the pre-ACA system drastically restricted many people’s freedom, because given the extreme dysfunctionality of the individual insurance market, they didn’t dare leave jobs (or in some cases marriages) that came with health insurance. Now that affordable insurance is available even if you don’t have a good job at a big company, many Americans will feel liberated — and this hugely outweighs the minor infringement on freedom caused by the requirement that people buy insurance. (Also, if you don’t like the mandate, why not support single payer?)
— Paul Krugman, Insurance and Freedom, NYTimes.com, today
I’ve said now here at AB too many times to count, but most recently five days ago, that the highlighting of Obamacare horror stories–real or fabricated–is really an argument for single payer. Every single horror-story problem–real, fabricated, or predicted down the road–would be cured by single payer. But, to my knowledge, no one else was writing this in print for public consumption. Now, Paul Krugman has done that.
But why aren’t the Dems pointing out that what the Repubs appear to actually be complaining about is the absence of a public option, or that the ACA didn’t establish single payer? Maybe sometime before the election, they will–if others who have a wide readership make the point, as Krugman did there.
Why aren’t the Democrats doing that indeed!
Why haven’t they been educating the country all along instead of assuming that “facts on the ground” would do the communications job — even though 80% of Americans, and probably even a higher percentage of those who vote — would not be directly affected by the new ways to get insurance and thus would not have the strong vested interest in understanding the law and resisting the Republicans lies about it? All along, they should have had a sizable publicity campaign on the simple premise that if you are going to cast a vote based on what you think you know about the new law, you should at least make sure you know what’s in it — and her’s what’s in it for you..
Now, the way to connect to all adult Americans, including especially those who have been getting and will continue to get their insurance through their employer, is that they now have the assurance that they will be able to get insurance even if they lose their job. Krugman’s “freedom” insight is a good tack on this: the law gives you more freedom than you ever had before — freedom to make decisions without worrying so much about keeping benefits, freedom from fear of losing your job.
Will the Democratic organizations do something like this to help out all their candidates? Will they do national (and local) campaigns that sell the advantage of voting for Democrats who will put into law policies that will help ordinary people instead of Republicans who are tearing down the country in the service of billionaires? No. The Democrats’ communications experts are the epitome of incompetent. They will leave each candidate to his or her own devices — except, of course, that they will dictate the content of their campaigns from their DC perspective, disregarding shifting local needs, as a condition for receiving the money support.
When missing-in-political-action blame is assigned I have to give to Obama what is Obama’s: isn’t the program named after him?
At the time Obama was pushing national health insurance — and typically backing off single payer at the first sign of Repub resistance — 76% of Americans polled in favor of single payer. As usual with president useless he seemed to have a grand opportunity to take it all away from the opposition — imagine what FDR or Truman or LBJ or maybe even domestic deck-chair-rearranger JFK would have made of that political opening — and Obama never tried to simply communicate simply with the American people.
Obama is a political bureaucrat or something — his high tech machine can sift out the last quarter of a vote from a back county in Ohio (a quarter is one-quarter of a chance to win a vote in “expected value” poker terms) but seems not to have the simplest eighth-grade math comprehension of so many real world economic issues. ???
Dennis, Obama had a problem you are not acknowledging: blue dog Democrats like Lieberman, Landrieu, Baucus et al. They joined with Republicans to force us into the insurance friendly plan that emerged. Public opinion polls were unlikely to and did not change this.
I love the total lack of knowledge of how a bill is made law shown by “and typically backing off single payer at the first sign of Repub resistance”.
The entire scenario was well covered, and people still do not know what(and why) it happened.
Course my favorite is people considering Lieberman a Democrat “because caucus”. Have never heard of a Dem(actually an independent) going to the RNC and endorsing the GOP candidate for President.
oops
forgot to end with “and be considered a Democrat.”
Sure, single-payer could take care of the absurd complexity of access amidst duplicative programs – why, oh why do we need, say, separate Medicare, Medicaid, and Obamacare, why not fold it all together?
The flip side is that as it stands, many doctors for example do not accept Medicare. The solution to that elsewhere in the world is to more-or-less nationalize the whole mess – to forbid private practice to some degree, or, as in Canada, to a very high degree.
And that’s where the fun begins.
Consider how “single-payer” deals with even something trivial and nineteenth-century, road construction. Endless delays, repeated do-overs, brand-new drains that don’t drain, everything falling apart – and yet one can’t drive anywhere during the warmer months without enduring extensive orange-barrel delays. That is, utter incompetence and total corruption.
Or public transit. Endless delays and off-hours closures for “construction” that’s never really completed. Drivers mystified out of their minds by the concept of getting the noon bus or train underway when the big hand and little hand are both on the twelve. That is, utter incompetence and total corruption.
Then look at Medicare, the closest to “single payer” that we have. Endlessly repeating doctor “visits” signifying nothing. We’ll write you a prescription, that’ll be another “visit” for each word, you can have it next March. Well, I exaggerate slightly. But utter corruption all the same. And complex “donut holes” that leave the coverage worse than that provided by a hospital gown.
Then look at, oh, England or Canada. It’s easy to get trivial stuff that you don’t need, like doctor visits for common colds, or for which the need is very modest, like flu shots. So tourists who happen to catch cold come back gushing foolishly with praise. But God help you if you need anything serious. If you can afford it, you leave the country and pay for it yourself (for example the US clinics that install all-but-unavailable artificial joints into Canadians.) Otherwise, you may well die before you ever get to the head of the queue.
So how do you get “single payer”, monopoly/monopsony, ever to do anything in any field anywhere in a timely and competent manner? The “economics” answer has been “you don’t, set things up to force competition so the incompetents will be driven out.” That’s hard to apply to medicine, of course, but is there any other answer?
This was ll covered in real time in Summer/Fall 2009 at AB.
Four of five Committees with jurisdiction passed out compatible bills in July 2009: the House Tri-Committee Bill which was complete in scope and Senate HELP which wasn’t, because Senate Finance had jurisdiction over Taxes and Medicare. All Senate Finance had to do was to pass their own portion of PPACA under Regular Order of Committee Hearings, Markups and Amendments and then passage out of a Committee that at that point had a two vote D majority.
That did’nt happen. Instead Baucus simply chucked Regular Order and sidelined his own SubCommittee on Heatlh Chairman Rockefeller while trashing both the House Tri-Committee Bill language AND Senate HELP and instead went to n Ad-Hoc Gang of Seven that originally had 4 Rs to 3 Ds before one R dropped. That is PPACA was handed over IN ITS ENTIRETY to a Rump Group of three Rs two Conservadems and relativele non-entity Bingaman.
This didn’t have to happen. Reid let Baucus hijack the entire process and Obama voiced no objection. Reid and Obama had other options. They could have insisted that Baucus confine himself to those portions actually under jurisdiction of Finance and/or required that the process go through Regular Order rather than let Baucus go right to end stage negotiations over the whole bill with three Republican Senators. Or Reid could have simply brought the House Tri-Committee to the Senate Floor and allow the amendment and compromise process to work out there. And in fact in the end that is close to what happened after Senate Finance’s Gang of Six pissed away five months then deadlocked.
That is the whole CF could have been avoided and PPACA powered through via the Senate Supermajority Obama enjoyed in Summer (but lost by Fall after Kennedy was replaced by Brown) IF REID OBAMA AND PELOSI had stomped on self-appointed Czar Baucus. The worst possible outcome would have been end stage negotiations with Obama, a united House Dem Caucus and 57-58 Dem Senators on one side and maybe Ben Nelson and Landrieu on the other. Which could have led to an August 2009 Rose Garden signing with Kennedy looking on.
There is a myth that Obama was simply blocked by the normal process of Congress when nothing about this process was normal at all. And the PO was among the first but by no means the only victim of what can only be explained as an Obama belief that he (with Baucus) could deliver a Post-Partisan product. We’ll look how well THAT worked out.
You could look all this up. It is as close as the Angry Bear archives.
I am talking about the dog that did not bark. Obama had the golden opportunity (like he does with a world changing, poverty ending $15 minimum wage) to go out and rouse the electorate — to goad them into insisting their elected reps support what THEY WANT, single payer. When you have a great issue and an agreeing public you can ride rough house over any Congress.
Harry Truman said, “The power of the presidency is the power to tell people what they damn well should have known in the first place.” Obama keeps passing up golden opportunities to rouse massive support in favor of what people damn well already want in the first place. Madly frustrating. (Maybe being some kind of academic progressive he just doesn’t care in any deep, visceral way.)
Denis:
I agree with Jack and Bruce. There is no way this could have been forced through Congress and the Repubs would have taken a great delight to hand Obama a major defeat of this magnitude. I would also suggest single payer is not what you may want in the end. There are pitfalls to this many people are not recognizing.
As far as having a backbone and taking a stance on other issues, I would have liked to see him do it more. When you know the outcome, why not draw the proverbial line, admit to the potential loss, and claim a moral issue?
Bruce.
What super majority?
You counting Lieberman, the Senator From The Insurance Industry?
I can hardly follow all that info in your post (can’t :-]) — but — what would President Elizabeth Warren have done under the same circumstances?
Answer: she would have taken the fight to the public — and not quit until she had gotten everything they wanted. She would have cut the too-complex-to-unwind legislative knot.
Michael yes I am.
Do you really think Joe L would have joined the Rs in a filibuster of a Bill that DELIVERED TENS OF MILLIONS OF CUSTOMERS TO BIG INSURANCE?
Or would he have simply demanded concessions that were way smaller than those Baucus gave up on Day 1?
Look AHIP went hot and cold on PPACA largely in calibration to presence or absence and magnitudes of the MLR provisions (BTW highlighted by ME in late July as THE KEY provision). And in point of fact MLR went missing over the course of the Summer and only got replaced in cursory form in either the Pelosi Speaker’s Mark or Reid’s Leader’s Mark and totally re-implemented in a last minute amendment (at which point AHIP pivoted from support to opposition). So it wasn’t a simple narrative, not if you were paying attention in real time.
But none of it reduced to Cartoonish “But Lieberman was a Doo-Doo Do-Do”. Former State Insurance Commissioner Ben Nelson was more an obstacle than Lieberman. But neither of them individually or in combination was as much a problem as that faced by Obama and Reid when they needed BOTH plus a R to get to 60.
I just think Reid and Obama had infinitely more pressure points on a 60 member Dem caucus in August than a 59 member caucus in Dec. because by the latter date no SINGLE Dem caucuser could be blamed. While in August Lieberman or Nelson would have been faced with being THE Senator who killed ACA. Which to repeat delivered 10s of millions of customers to their Insurance Industry patrons.
Denis
Candidate Obama made three initial hires to his Economic team back in 2007:
Austan Goolsbee as lead Macro guy
David Cutler as Health Care wonk
Jeff Liebman as Retirement Security wonk
Later adding Jason Furman and then as Chief Capo Larry Summers over the course of 2008
If you wanted to understand where Obama was going to lean on Macro you might well have looked at Goolsbee’s record (hint he got raves from George Will in real time). Ditto on Cutler for Health Care/Single Payer and Liebman on Social Security. If you had (and Prof B Rosser and I did back then) you would have 1) Squealed to High Heaven and 2) understood that when it came to economic policy that Obama and Clinton were drawing from exactly the same Bob Rubin Wall Street/Larry Summers Harvard KSG pool. For example both Cutler and Liebman worked in the Clinton WH and then were picked up by Harvard.
I was agnostic on the whole Obot/PUMA debate because I knew FROM INSPECTION OF THEIR ECON HIRES that neither would satisfy the yernings of either a Progressives or Die Hard New Dealers like me. None of that was ever in the Org Charts. Now I would have enthusiastically backed either, because hiring a combo of WarMonger McSame and Caribou Loon Barbie meant war on Iran within a year.
But everything about Obamas cautious response to the meltdown with its Wall Street and non-Single Payer or even Public Option bias was predictable by examining the people he CHOSE to give him economic advice. Something readers of AB were warned of as those hires were happening.
Look nobody likes assholes that say “I told you so”. Which may explain why I have so few friends.
Bev:
Single payor will not work. (period) You are speaking nonsense.
Especially assholes who say “I told you so” who are and were wrong. Obama simply did not have the leverage to muscle the blue dogs. The bully pulpit is just noise without the votes and he didn’t have them nor the ability to get them. The insurance industry owned the votes he needed and I think that Bruce and others making the same arguments know that.
Jack D,
Pardon me for differing — but! — Obama had 76% of the votes of the American public going in, without even beginning to explain why THEY were right. That’s what kills me — didn’t even have to stir people up; they were already on, er, uh, not his side I guess, but on the single payer side. Still are — piece of cake any time for any truly progressive president (Warren?).
Very informative, Bruce — as usual. Wonder what other world this guy lives in? ???
Bruce
actually I am grateful to you for telling us, even when you have to tell us “I told you so.”
PaulS
maybe in the state where you live.
but i have watched road construction pretty closely in the state where i live. and there is no corruption and not much incompetence. sometimes its a little hard to build a new road or fix an old one “under traffic.” but we get it done in spite of the assholes who think it should be done overnight by fairies.
Given the complete and chronic incompetence of the Obama administration during this transition, and the bad design of ACA , by 2017 there may be a stronger case for single payer, perhaps as an emergency measure.
I just hope we can minimize the damage until then.
JackD he had to muscle those same Blue Dogs to get the bill passed in December. And exactly which Blue Dogs were on record as being against the number one campaign priority of the newly elected President anyway?
Remember that the Tri-Committee Bill in the House passed out of all three committees with relative ease, even House Commerce which had the highest percentage of Blue Dogs among the 3. This was done in the usual way, by accomodating their concerns through the Amendment process in the process of marking up the bill in Committee. To the extent that Blue Dogs (much more a House phenomenon then than in the Senate) were an obstacle their objections had already been overcome.
Can you point to anything in the actual historical or legislative record that would show that anything in the post August 2009 legislative environment around PPACA was being driven by ANY Blue Dog as such? Did Obama and Pelosi have much identifiable opposition from the Blues on final passage of the Bill? If not then you are just coming up with a convenient excuse. PPACA had strong House support in July 2009, certainly strong enough that the bill could have been passed even with a number of Blue Dog defections. The problem was always going to be in the Senate.
The problem was that Obama and Reid decided to allow Baucus to just sideline progressive Dem’s, including EVERY SINGLE such in his OWN COMMITTEE to set up his Gang of Seven Turned Six. You sir are talking through your hat because when I say “I told you so” I mean that quite literally:
http://angrybearblog.strategydemo.com/2009/09/gang-of-six-regular-order-johnson.html
http://en.wikipedia.org/wiki/Gang_of_Six
During 2009, the Gang of Six consisted of six members of the Senate Finance Committee of the 111th United States Congress who attempted to negotiate a compromise to pass a health care reform bill.[1] Among the bills under consideration at the time were the United States National Health Care Act, the America’s Affordable Health Choices Act of 2009, the Healthy Americans Act (Wyden–Bennett), and the America’s Healthy Future Act (Baucus plan).
The six states the legislators represented – Iowa, Maine, Montana, New Mexico, North Dakota, and Wyoming – had a combined population of 8.4 million, about the same as New York City, or 2.74 percent of the United States as a whole.[2][3]
Democrats
Max Baucus (Montana)
Jeff Bingaman (New Mexico)
Kent Conrad (North Dakota)
Republicans
Mike Enzi (Wyoming)
Chuck Grassley (Iowa)
Olympia Snowe (Maine)
(end)
Do you see any Progressives there? Any sign that Reid or Obama leaned on Baucus to maybe have something less than 2/3rds of their own Party represented by Conservadems Conrad and Baucus from North Dakota and Montana? Ya think maybe Bingaman was the designee to carry water for Obama here? If you are going to overrepresent smallish rural States why not include Rockefeller from W. Virginia? Who was your freaking Health Sub-Committee Chair? For that matter why go to a ‘Gang’ that allowed equal voting to the Republiocan minority when you had a two vote majority in your own Committee?
These are unanswered questions. But not unasked. Because I was asking them at the time. The facts are perfectly clear: Obama willingly gave the keys to the Health Care car to Baucus. And there is nothing in the record that can explain this away by some appeal to the new to appease House Blue Dogs of Traitor Joe Lieberman. The only plausible explanation is that Obama, in retrospect foolishly, thought there was some possibility that Congressional Republicans might in some way cooperate in passing ACA. And that it was worth allowing Baucus to sideline ALL big state and/or progressive Dems in doing so. Which frankly is right in line with the basic ‘Hippy Punching’ agenda of his major domestic and economic advisors from Rahm and Larry down.
http://angrybearblog.strategydemo.com/2009/07/house-tri-committee-health-care-bill.html
My post from July 14th 2009 with graphs and bill language and everything.
And this from July 3rd:
http://angrybearblog.strategydemo.com/2009/07/kennedy-dodd-help-bill-with-cbo-scoring.html
And I see that I am not perfect. Contrary to my recollection Kennedy-Dodd came out BEFORE the House Tri-Commitee Bill.
Which brings up another point. Almost all the controversial parts of ACA were under the purview of Senate HELP, that is Exchanges and Public Option and Minimum Covered Benefits and Medical Loss Ratio. What was left out was the precise language of the tax on existing health care plans and the provisions directly targeting Medicare, which as noted were under the Jurisdication of Senate Finance. That is between the House Tri-Committee Bill and Senate HELP most of the problematic constituencies had already had their main concerns met, in particular Big Insurance didn’t really have a lot of dogs in the Medicare fight. All that had more or less been addressed already, all that remained was for Senate Finance to pass out their own piece. And I defy anyone to find any reason beyond Baucus’s need to have him be the face of Health Care Reform that the whole process should start over from scratch with totally new language and then pivot straight to end game negotiations with a handful of Senate Finance Republicans. It is not like Enzi, Grassley and Snowe were even the power brokers among the Senate Republicans, there was exactly nothing in this dynamic that would guarantee that “One Term President” OConnell or Conryn or any of the other R Grandees would go along with some deal cut by Olympia Snowe.
Look this whole debacle was a total Own Goal by the Obama Administration. Maybe there would have been ultimate problems muscling through ACA in August of 2009. But what would those problems have been compared to the horribly drawn up and ultimately failed process in Senate Finance? The most charitable read is that the Obama team never thought they would lose that 60th vote by having Massachusetts flip its Senate seat to an R. And truly the race to succeed Kennedy was Coakley’s to lose. But then again Kennedy, though clearly dying in Summer 2009 was not dead yet.
But alright concede that nothing here was a slam dunk. But the argument that Obama was just backed into a corner by business as usual in the Senate and just ended up with the best deal possible under the circumstances was and is bullshit of the highest order.
Oops a correction.
Big Insurance DID have a dog in the Medicare fight. Because one of the biggest pieces of funding for ACA was the savings in eliminating the premium differential between regular Medicare and Big Insurance Medicare Advantage plans, which were a cash cow. But I don’t think that was a deal breaker and in point of fact I don’t recall that Baucus even tried to back out those savings, it just not seem to be the case that ACA rose or fell on the issue of Medicare Advantage.
Still It was a big pot of money and the source of all that “Obama is cutting $600 billion out of Medicare” crap the R’s ran at him in 2010. With remarkable success. BTW another argument for getting the deal done in 2009 rather than let it drag into the mid-terms.
Bruce, your apparent belief that the desires of the public represented by polling will overcome the influence of money is charming if naive. Yes, Lieberman controlled matters. He was the 60th vote as I know you recall. What was Obama supposed to do to turn him around, water board him? All of the maneuvering in the legislative world that you describe did not change that fact. As far as Obama somehow controlling Baucus role in all of this, Obama was the president, not the senate majority leader.
Were “they” trying to get Republican support so the bill could be called bipartisan? Of course “they” (President Obama and the senate Democrats generally) were. And no, it didn’t work and it also didn’t change who Joe Lieberman was or how he behaved.
PaulS: “Consider how “single-payer” deals with even something trivial and nineteenth-century, road construction…”
Yeah, right. Geez, Paul, I know you’re probably not old enough to remember the PWA, CCC and the other busy projects that built the US highway system, parks, Mount Rushmore, the Hoover Dam and on and on, but there are such things as history books.
Up to the present day, sure — corruption tries to get in everywhere, like mold or mice. But you think that private business is LESS prone to corruption and overcharging than state-run enterprises? Heck no. Generally, their costs balloon past the original bids, a kind of blackmail once they have their shovels in the public purse.
Noni
“I can’t see a way in which I could vote for cloture on any bill that contained a creation of a government-operated-run insurance company,” Lieberman added. “It’s just asking for trouble – in the end, the taxpayers are going to pay and probably all people who have health insurance are going to see their premiums go up because there’s going to be cost shifting as there has been for Medicare and Medicaid.”
http://www.politico.com/news/stories/1009/28788.html
“The day before, Mr. Lieberman threatened on national television to join the Republicans in blocking the health care bill, President Obama’s chief domestic initiative. Within hours, he was in a meeting at the Capitol with top White House officials.
And on Monday night, Democratic senators emerged from a tense 90-minute closed-door session and suggested that they were on the verge of bowing to Mr. Lieberman’s main demands: that they scrap a plan to let people buy into Medicare beginning at age 55, and scotch even a fallback version of a new government-run health insurance plan, or public option.
Mr. Lieberman said he believed that the Medicare expansion was off the table, though he did not get any guarantee. “Not an explicit assurance, no,” he said. “But put me down tonight as encouraged at the direction in which these discussions are going.”
Mr. Lieberman could not be happier. He is right where he wants to be — at the center of the political aisle, the center of the Democrats’ efforts to win 60 votes for their sweeping health care legislation. For the moment, he is at the center of everything — and he loves it.
“My wife said to me, ‘Why do you always end up being the point person here?’ ” he said, flashing a broad grin in an interview on Monday. ”
http://www.nytimes.com/2009/12/15/health/policy/15lieberman.html?_r=0
The first question that needs to be answered is “Must everyone have health insurance?”
If the answer is yes, then a mandate is required and single payer is but one way to satisfy that mandate.
At the current time it seems pretty clear to me that the majority in Congress do not believe that everyone deserves health care.
PaulS: And then look at, oh, France, Australia, Taiwan, Japan, Sweden, Norway, Holland, Austria, Germany. Funny, how rightwingers always mention England and Canada, but not the ones I’ve mentioned. And that’s not to mention that while healthcare in England and, especially, Canada are not even close to the what the American rightwing cliche claims, and that in both countries, the government runs not simply the insurance system but also the medical system itself; it owns the hospitals and employs the doctors. That’s true as well in France and some of the other countries I’ve mentioned, which don’t have doctor and hospital shortages. But Medicare, which is a single-payer insurance system but uses the same private doctors and hospitals that private insurance companies do, hasn’t created a doctor and hospital shortage here, and Medicaid is what, to a large degree, funds physician residency programs and emergency rooms.
I am sort of curious, though, about this idea that we should privatize road construction and maintenance. If only the Eisenhower administration had thought of that!
Do you folks ever, ever think for yourselves, rather than spouting canned cliches? Best as I can tell, the answer is, no.
Bev:
If you are inferring these countries have single payer, you are wrong.
From my own experience in Germany, I can tell you Germany does not have single payer. They have a hybrid system. The gov. pays a large portion of the bill and private insurance picks up the rest. The same exists in France. I suspect if we were to examine other countries with the exception of England and Canada, you would find similar versions.
Medicare is not single payer. It is like I explained to you one time before. Medicare picks up 80% of the bill. We pay a premium for Part B. There is a gap of 20% which we buy supplemental insurance to cover. We also buy prescription coverage dependent upon what Tier drugs we take. There is no coverage for vision or dental. Don’t confuse Medicare with single payer.
EMichael fair points.
I would say that Joe had a lot more leverage in October (your Politico cite) and in December (your NYT) than he had in August when he would have been filibustering a dying Teddy Kennedy’s life work.
But if Lieberman was the real obstacle all along the gambit of allowing Baucus to take things to end stage negotiations with R’s backed only by a fellow Conservadem, I guess in hopes of getting a R to actually break from her/his caucus and vote for cloture, seems dubious. As opposed to just putting Joe (and perhaps Ben Nelson) in the position of simply blocking ACA via filibuster on the Senate Floor.
Because filibuster was all they had, it being very very hard to count to as many as 11 Dem defectors that Summer that would have blocked passage after the filibuster died. Why not take three days and then let Joe and pals mount a speaking filibuster for the whole of Fall?
So I’ll concede a point to you. But that doesn’t add up to “Obama had no choice but to give the keys to the car to Baucus and Senate Finance” Because it is hard to see how that path would have ultimately gotten by Lieberman. At best Obama made what turned out to be a bad gamble by going that roundabout route rather than making the issue a One on One between him and Joe.
The ACA was the opening gambit. It got a healthcare law in place. The next move is to start carving it into something that provides healthcare to people rather than excessive profits to corporations. Those profits are better spent on helping people.
In September and October, proposals surfaced that would have allowed states to make their own decisions whether to allow a public option into their exchanges. Of course, probably 30 or more states would have wanted it as an option for their consumers. Proposals differed on whether it should be an opt-in or opt-out, but since it was so fair on the surface — why should you have the right to prevent New York or California from offering a public option if they want it, Senator Lieberman? — it had the chance of gaining considerable public support.
That might not have won the day at the time, but such a debate, which would have become very intense and nearly excruciating for Lieberman and the Blue Dogs, would have greatly enhanced the long-term prospects for a public option. Indeed, it might have made the narrower version, the 55-plus Medicare buy-in, with a state exchange opt-out or opt-in choice, the acceptable compromise. Moreover, the states deciding to keep the public option out of their exchanges initially would have had energetic in-state debates that could only help Democrats locally.
On one Sunday in October, however, when the Sunday shows all asked about the proposal, Rahm Emanuel, David Axelrod and Valerie Jarrett combined to kill it. Not something like, “We’re not sure, but it’s an interesting proposal and we’re looking at it,” mind you, but a debate-stifling response that signaled the Democrats who seemed energized by the proposal to STFU: “That’s not something we would be interested in.”
We learned later how Obama had already agreed to kill the public option even as he continued to pretend a bill without it was not an option. This was a threat that public pressure would resurrect it, and it had to be shut down before that pressure could gain critical mass. The fact that all the networks were asking about it showed that critical mass was not very far away.
One upshot of Obama’s abandonment of the public option, with only insults for the base and no attempt to win their grudging support for the basic structure — Emanuel’s “retards,” for example — was the worst mid-term disaster in modern U.S. history. We have been paying the price for the ineptitude with which the matter was handled ever since, and their is no light on the horizon at least until 2017.
Amazing.
When the ARRA passed it set a record as the most changed(dollar amount) piece of legislation in the history of the US. Snowe, Collins and Spector had immense power to actually decide what the legislation was.
Didn’t matter who ran what committee or what they wanted or what Obama wanted. You gotta count to 60. And people somehow think these committees work in a vacuum and the results are then considered by the full body. That is not true. There is ongoing vote taking behind the scenes on each and every part of a piece of legislation.
Same thing happened with the ACA. It wasn’t about who ran what committees or what Obama wanted or anything like that. It was about getting to 60. And the choice the WH and the Dems had was whether they wanted some reform that catered too much to insurance companies or whether they wanted to just to make ” life very intense and nearly excruciating for Lieberman and the Blue Dogs” (Urban Legend) and gain some worthless PR from a filibuster of a Senate bill with the public option.
They chose to get what they could and attempt to claw back what they could from the insurance companies. Trust me, if the insurance companies and Lieberman knew that MLR was going to be in the final bill, even the watered down ACA we have would never have hit the floor.
And if the blue dogs thought there was a chance in the world that Pelosi could get the Senate bill approved in the House and then take out their pet projects through reconciliation(in one of the best piece of politics I have ever seen), Lieberman might not have even mattered as the blue dogs would have stopped it.
Course Obama could have made all of the progressives(real and so called) who constantly complain about the ACA not going far enough really happy by refusing to sign it and sending it back demanding a public option or lowering Medicare to 55 or maybe even Medicare for All. Course then we would be in the same place as we were in 2008.
And the blocking of health reform would join a long list of blocked programs that would shows how little the GOP cares:
Bills Blocked by Republican Filibusters
Friday, November 22, 2013
Here is a list of bills that would have passed the Senate if it weren’t for Republcians requiring a 60-vote threshold.
113th Congress:
Manchin-Toomey Background Checks
Vote: 54-46
Keep Student Loans Affordable Act of 2013
Vote: 51-49
Would keep the interest rate of subsidized federal student loans at 3.4% for another year
Student Loan Affordability Act
Vote: 51-46
Would keep the interest rate of subsidized federal student loans at 3.4% for two years.
Sequestration replacement
Vote: 51-49
Would postpone the sequester until Jan 2, 2014
Required millionaires to pay at least a 30% tax rate
112th Congress
Bring Jobs Home Act
Vote: 56-42
Would grant businesses a tax credit for eliminating a business outside the US and relocating it in the US
Would deny businesses a tax deduction for outsourcing expenses related to outsourcing a business
Small Business Jobs and Tax Relief Act
Vote: 53-44
Gives small businesses a tax credit if their 2012 payrolls were higher than their 2011 payrolls
Paycheck Fairness Act
Vote: 52-47
Requires employers to prove differences in pay are not gender-related
Would allow employees to discuss salaries without retaliation, and allows government to collect data on women workers to better evaluate the wage gap
DISCLOSE Act
Vote: 51-44; reconsidered 53-45
Requires corporations, super PACs, labor unions, and other groups to disclose donors who give in excess of $10,000 for political contributions
Paying a Fair Share Act of 2012
Vote: 51-45
Requires millionaires to pay a 30% minimum tax rate
Expresses the Sense of the Senate that tax reform should repeal unfair loopholes and expenditures and make sure the wealthiest taxpayers pay a fair share of taxes
Repeal Big Oil Tax Subsidies Act
Vote: 51-47
Extends tax credits for energy efficient residences, electric vehicles, and other alternative forms of energy including wind facilities
Teachers and First Responders Back to Work Act of 2011
Vote: 50-50
Allocates grants to states to help them rehire teachers and others working in educational support
110th Congress
DREAM Act of 2010
Vote: 55-43
Emergency Senior Citizens Relief Act
Vote: 53-45
Provide senior citizens with a tax credit in lieu of a Social Security COLA
Paycheck Fairness Act (again)
Vote: 58-41
Creating American Jobs and Ending Offshoring Act
Vote: 53-45
Giving employers tax breaks for bringing overseas jobs back to America
http://www.sanders.senate.gov/newsroom/recent-business/bills-blocked-by-republican-filibusters
Add in the American Jobs Act; another couple hundred real bills; and countless others that weren’t even brought to a vote because the results were known beforehand, and then consider the effect of any PR bs the WH or the Dems might have gotten by demanding the ACA be more progressive.
In my consideration that effect would be exactly zero.
Run, THAT–the German, French, and Medicare-type system–is what I and, I’m pretty sure, most people (including Krugman, most likely) are talking about when we say “single payer.” We mean single-payer insurance for everyone, which could pay for all expenses, or most expenses, or some major part of expenses, and which, if it doesn’t pay all expenses, would be supplemented with private insurance or as out-of-pocket expenses.
The hospitals would not be government-owned and the medical staff would not be government employees (as, I believe, they are in Canada and England)–notwithstanding PaulS’s and other wingers’ suppositions.
Bev:
Paying expenses does not resolve the issue of higher cost. You, Krugman, and the others have it incorrect when you call out for single payer as that is all single payer does is pay expenses. Advocating for single payer is advocating for a bill paying system of health care with better outcomes at a better cost.
“There are few truly single-payer systems in the developed world. Canada has one, as does Taiwan. Most countries rely on many, many insurers. Germany, for instance, has more than 150 ‘sickness funds.’ The Swiss and Dutch health systems look a lot like Obamacare’s health-insurance exchanges. In France, about 90 percent of citizens have supplementary health insurance. Sweden has moved from a single-payer system to one with private insurers. Yet all these countries pay vastly less for drugs, surgeries or doctor visits than Americans do.”
These countries do not have the medical staff on salary nor do they own the clinics or the hospitals. What the Swiss, Dutch, Germans, French, etc. do is legislate drug, procedural, etc. pricing. Companies then decide if they wish to do business in that country. Guess what, the costs of healthcare in those countries are far less than in the US.
Prices are set by the market today. Insurance companies have little bargaining power and typically use Medicare plus a percentage in setting pricing. This is why it is so necessary to allow Medicare to negotiate pricing. STR alluded to hospital and doctor consolidation which will make it even worst then what it is today as I wrote here: On the Horizon “After Obamacare”” The free market leaves a fragmented system of payers which in the aggregate has not power against the healthcare industry. In the end, while insurers have difficulty negotiating with the industry, they are better at designing systems.
“’Single payer isn’t a panacea,’ said Uwe Reinhardt, a health economist at Princeton University. ‘The magic they have is setting rates. But neither Medicare nor Canada has done anything innovative on the delivery side. Taiwan is trying a little bit but not a whole lot. By and large they just pay bills.’ The limitations of single-payer systems became clear during the health-care debate, when the Congressional Budget Office projected that premiums for a public option would be higher than premiums for private insurance — unless a public option could avail itself of Medicare’s pricing power.” “What liberals get wrong about single payer”
Obama is supposed to turn Medicare lose eventually to negotiate; but, the problem will still remain if prices are not set. Countries which have this type of price setting power are the ones you mentioned; however, calling it single payer leaves out critical parts which are necessary to make the system work. If you just installed single payer, what would happen to ESI? It would be abandoned and all costs picked up by employers would then fall on the government. “The limitations of single-payer systems became clear during the health-care debate, when the Congressional Budget Office projected that premiums for a public option would be higher than premiums for private insurance — unless a public option could avail itself of Medicare’s pricing power.” And in the end having that same power as Medicare is not enough if consolidation continues.
Damn! Taiwan! I knew I was forgetting an important example! You’ve got it exactly, run, when you say that what matters most is bargaining power. I wrote about that, citing to Klein’s post, earlier this year. But that’s the point; that’s why we do need single payer of some sort. It would have the needed bargaining power, because everyone would be a policyholder. That’s what I, Krugman, and others who advocate for it, mean when we say that it would solve the problems that the real, imagined, or predicted-down-the-road Obamacare horror stories are about.
And really, THAT’S what the Dems should point out.
Bev:
BS. You threw something up there without having the facts on the PPACA which is readily available. I know I had it right.
Waaait. I wasn’t being sarcastic about Taiwan. France and Taiwan have the best healthcare insurance systems in the world, from what I’ve read. I usually include Taiwan in my pro-single-payer posts and comments, but this time I forgot.
EMichael
“Didn’t matter who ran what committee or what they wanted or what Obama wanted. You gotta count to 60. And people somehow think these committees work in a vacuum and the results are then considered by the full body. That is not true. There is ongoing vote taking behind the scenes on each and every part of a piece of legislation.
Same thing happened with the ACA. It wasn’t about who ran what committees or what Obama wanted or anything like that. It was about getting to 60”
Okay fine. But where is the argument that Obama couldn’t have gotten to 60 in August 2009 by putting the burden right on Nelson and Lieberman? After all at that point Republicans hadn’t yet established the principle that you needed 60 votes on EVERYTHING there was still a window that said that you only needed 60 to proceed to debate.
In fact you could make the argument that all of your 2013 and 2014 examples were REASONS why Obama and Reid should have gone to the “Johnson Treatment” (the subject of the previously cited post from August 2009)
http://angrybearblog.strategydemo.com/2009/09/gang-of-six-regular-order-johnson.html#sthash.3oZTsan7.dpuf
against Baucus.
Obama blinked and allowed 60 to become the new 50 plus 1. By letting his prime campaign issue be captured by Presidents Baucus, Nelson and Snowe. I am still waiting for the argument that showed that putting the last two or three Dems on the spot and actually making them run a real honest to God talking filibuster in August 2009 in the face of a dying Kennedy wouldn’t at LEAST have gotten them to allow the bill to go to DEBATE. Which is all it would have taken. Now maybe once the Bill went to the floor Obama, Reid et al would have had to made many of the same concessions as they ended up making five months later. But instead they allowed a piss-poor precedent that ANY piece of significant legislation has to have 60 votes just to open discussion.
Hindsight is 20/20. But exactly what did I get wrong in this twice cited Sept 1 2009 post called “Gang of Six, Regular Order & the Johnson Treatment”? And you really need to click through to see the photo that illustrated it to show what I meant.
My post-mortem on how Obama screwed the pooch on ACA. This from Sept 2010: “The Spitting/Splitting Moment: When Obama lost the New Dealers”
http://angrybearblog.strategydemo.com/2010/09/spittingsplitting-moment-when-obama.html
And I still stand by this conclusion:
“It was a straight out power grab by Baucus. And out of some bizarre desire for Senate Comity above all things (Reid) or an equally bizarre belief in accomplishing some mythical, mystical Post-Partisanship (Obama) the Majority Leader of the Senate and the President of the U.S. simply turned over the keys to the HCR car to a guy representing less than 1/3rd of 1% of the American population. Which if it had worked would have been okay, although you can bet the final product would have been a lot crappier from a liberal perspective than either HR3200 or Senate HELP, but it didn’t, instead the Committee deadlocked for almost half a year forcing first Baucus and then Reid to produce their own versions just in time to get bogged down by the Christmas Holidays. What had been at the introduction of the Tri-Committee Bill and Senate HELP a one month process to be finished prior to the August 2009 recess instead dragged into the next year and with it sucked all of the enthusiasm out of the New Deal faction of the Democratic Party. A group who had spent much of that late Summer and Fall defending the Obama Administration against the Purity Party Progressives, surely in the end he wouldn’t just sell us out!
But Obama did. And along the way showed additional contempt for Liberals by agreeing to a Catfood Commission almost as loaded to the center-right and right as the Gang of Six, and seemingly devoted to tearing away the centerpiece of the New Deal in the name of Social Security ‘Reform’ and ‘Fiscal Responsibility’. The only thing lacking was a ‘No Dogs, Irishmen or New Dealers’ sign on the South Lawn.
“
Bruce,
The ARRA was signed into law on February 17, 2009.
And we all know what happened to Spector and Snowe.