Stop Me Before I Vote Again

Balancing this safe and predictable act of Leiberman is the unpredicted, possibly unimportant, but still making me feel better this morning, action of Howard Dean in saying "kill it now!"

to the press
it's just another dean scream

he's marginalized
like the kos brigade he created

"safe and predictable act of Leiberman "
you miss all the fun hce

u party pooper u

"they attacked my wife "

http://www.jewishrockland.org/display_image.aspx?ID=158129

imagine that !!!!

here is where one sees me
as a never the worse the better guy
i agree with krugmuffins here:

" the truth is that health care reform was probably doomed to be deeply imperfect..... we’re basically in a hostage situation...
Now, in a hostage situation there are times when you have to just say no — when giving in, by encouraging future hostage-takers, would be worse than letting the hostages perish. So the question has to be, is this one of those times? I don’t think so,... highly imperfect insurance reforms, like Social Security and Medicare in their initial incarnations, have gotten more comprehensive over time. This suggests that the priority is to get something passed."

he goes on

".. what’s happening, I think, goes beyond health care; what we’re seeing is disillusionment with Obama among some of the people who were his most enthusiastic supporters. A lot of people seem shocked to find that he’s not the transformative figure of their imaginations.... there’s a lot of bitterness out there. But please, keep your priorities straight.

By all means denounce Obama for his failed bipartisan gestures. By all means criticize the administration. But don’t take it out on the tens of millions of Americans who will have health insurance if this bill passes, but will be out of luck — and, in some cases, dead — if it doesn’t"

Owen, Krugman's comparison to Social Security and Medicare looks pretty cynical to me. Why go for those as an analogy when we have an accurate model? The correct comparison is to RomneyCare. In addition, he uses the same rhetorical sleight of hand as the RomneyCare advocates. Access to insurance is not the same as access to health care. Access to insurance can be rigged in way that robs the funding that goes directly into the provision of health care. The most vulnerable people stand to get hurt much more than they were before, and the individual mandates are nothing but a direct subsidy to the most parasitic part of the health care system.

"correct comparison is to RomneyCare"
i agree completely

and yet to me that fact is no more cynical then Clio Herself
being clever in her agency

since we got
not even a public option
or an extension of medicare
let alone single payer
clearly this strikes off
the ssi /medicare analogy

uncle here merely regulates
and taxes and subsidies
the existing private provisioning systtem

but certain euro-state health care provisioning paths
suggest those roads also lead to rome sugar Al

the whole massive debate has from day one struck me as a diversion of prog focus(obviously welcome if unintended by the PTB )

we have a welfare state we have state mediated transfer systems
we are sweden's ugly giant step sister
headed to the same ball

what we aren't
--at least with out some great unmobilized force putting up a real scrap --

is a system prepared to open
the corporate job site
to free unrestricted jobbler self organizing

to me
not health pay or climate remediation
but the limp lame loosey goosey
employee free choice act
seems a fit battle ground for todays agenda
in the real class frontier war

medi struggles are pale home front stuff nightingale pitter patter
as is the cap vs tax frog mice war

and yet as such one oughta take both
as given
for what they are
forced injections of funds public and private into an already bloated medi-sec/energy sector
macro value positive
micro value ambivalent as hell

yes social welfare value mixed
and easily improved in the collective mind of pwogie hollow
but by unstoppable mommentum
headed toward mecca
by positive mission creep
as inevitably as the negative processes that power them onward

radical chest beating in goo goo areas is counter productive in my estimation

if 30 million folks get covered and it leads to placebo effects only
for now i'll take that over dean's coriolanus act

if i'm wrong and no souls get lifted outside of places like board rooms and faculty lounges
then i'll have been dead wrong

i'm familiar with that condition

so lets score romney care up to now
maybe i'm already dead wrong
maybe the micro welfare here is all rip off

rewards only
higher prices
margins and other corporate gin fizzery

and on balance
no healthcare increases
at the margin

Agreed, by and large, especially on the workplace organizing. There's nothing good coming if folks are not in a position to make kleptocrat obduracy a losing proposition.

op, so mandated private insurance isn't a terrible terrible idea?

I find that hard to believe.

Mandated private insurance is a FANTASTIC idea if you are in finance, insurance, health care as your line of work.

Unemployed? Come on you lazy bugger. Go find a damned job already. It's not Uncle Sam's fault you're too un-motivated to find a minimum-wage job for which you compete with over 1,000 people each time you apply.

We Congresscritters know what it's like for you unemployed people. We have to try to get re-elected periodically, and let me tell you that's no picnic Charlie!

--Joey "Liebfraumilch" Lieberman

Solving the health insurance problem by forcing people who can't afford health insurance to buy it makes as much sense as solving the homeless problem by forcing homeless people to buy houses.

Obama/Romneycare is just another corporate giveaway. Even people with insurance go bankrupt every day,or are cynically and fraudulently denied coverage under the insurance they pay so dearly for. Privatized health insurance and health delivery is the problem, not the solution.

The "baby steps" argument is the ideological essence of pwoggiedom.

"Solving the health insurance problem by forcing people who can't afford health insurance to buy it makes as much sense as solving the homeless problem by forcing homeless people to buy houses"

what ya say gang
lets keep the analogies reasonable here

i'm gratified to see
this site draws genuine friends
of the lowly young and waqed (lyw)

and yes i suspect there will be a nice net out of this mandate for the insurance crowd

and yes i'd have prefered a pub op with no mandate...now

and only a mandate after regs bite
and uncle subsidies are so enticing
most lyw's have voluntarily signed up

and of course as the SP gang say
only after adverse selection games
by the pri-sec players
requires a mandate to capture free riders in exchange
for a crack down on policy terms

but it came the opposite way
the way favorible to corporate interests

right it's aweful
we live under a corporate dictatorship
and what's more
today
it's the dembot hemi
that plays star corporate agent role
on this
as on empire

NEXT !!!!!!!

"The "baby steps" argument is the ideological essence of pwoggiedom."
exactly correct

my friend and comrade
health carre reform
IS a pwogie issue

the lesson we pinkos can draw ??

we live under a corporate dictatorship

reforms will be framed by them
and diluted by them
till they fit smoothly with trans nat agendas

recall one fact:

the whole fuckin health sector can't continue to expand twice as fast as the economy
forever
and the us economy can't get so lopsided
compared to its oecd "partners"
especially given its global gendarme role

the cadillac health sector is headed for
the cost compactor ..till it arrives there
the oinkers may indeed slop up some bounty
but its a mess of pottage folks

to attack the corporate system you gotta see the system's dynamics for what they are
long term and what they aren't

example of aren't

they aen't about one sector hogfests
at the expense of the other sectors
at least not in perpetuity
sector the arms sector the energy sector the drug sector not even the FIRE sector

keep your shirt on until the battle is acroos the board stuff
like job site liberation

op, I'm not sure why you are so wedded to compromise on healthcare. If I didn't know any better, I would say that you are coming down with a serious case of crackpot realism.

i'm a cracked pot all right
in fact some might say

a cracked pol pot

but like that man-demon i try to seperate
the system's adjust-ers
from the system's stress-ers

and note i say system not people
i see this adjustment to the system
as a stress reducer to it's people
i may well be wrong
this bill may turn pure predator
on its way to becoming an act of congress

hell if sugar Al is right
and i wouldn't bet odds agin him

even as it stands now putting together the best of both chamber's bills
we already face
a penal colony quality
sado-cannibalist blood feast

if mittcare appeals to ya

pax vobiscum my children

There's something tangential to chew on in what you've been saying in this thread: the lion's share of harvesting the people is not getting divvied up in a roughly equitable manner amongst the oligarchs. The other sectors are not getting their "fair" share. So there's more tension and mistrust than usual at the top of the food chain. Spite and payback at the top might very well come in the form of a benefit at the bottom.

I hear ya, Al.

Might. Or as my Georgia friends say, "might could."

There's a musical sound to colloquialism. And depending on how it's said, it can mean "not a fucking chance" or "kindly disposed to do so".

In this context, I think it's going to wind being the former. The oligarchs who're being shorted on the loot would have to be very anxious about retaining control of their own fiefdoms to risk loosening the screws.

http://www.counterpunch.org/lindorff12172009.html

the link is to what i suspect to be a typical pinko rant call for defeat of the pending health bills

"What could have been a transformational moment in American politics--an end to decades of corporate health care ... has been squandered....Doctors will get richer under this "reform." Insurance companies will get vastly richer under this "reform". Pharmaceutical companies will get richer under this "reform". But there will still be millions of people left with no access to health care. There will still be tens of millions of people who will get substandard or even pathetically trashy health care. And the cost of medical care, both for individuals and for society as a whole, already the highest in the world, will continue to soar. To make matters worse, taxes will also go up dramatically, by at least $100 billion a year. For extra laughs, while these costs would start hitting the public right away, the "benefits" of the bill wouldn't go into effect until 2013, meaning that a likely resurgent Republican Party, ousting Obama from the White House, and the Democrats from the majority in Congress in 2012, would simply undo the whole thing anyhow "

To be honest Op, I really can't tell where you're coming from here. You seem to me to be contradicting yourself. You obviously recognize what a dog this so-called reform is, yet you support it on the basis that it might lead to something better down the road. A lot of those poor people forced to buy crap insurance at exorbitant rates may indeed see some health benefit from it, but they will also likely see themselves having to choose between food, education and keeping a roof over their heads and paying for this monstrosity. Food and shelter being more important to the maintenance of human health than our dysfunctional medical system, I scarcely see the benefit of this.

We need to do more than just reform health insurance. We have to completely scrap the medical system itself and start from scratch. What good is throwing more money at a system where a yearly body count that would put Pol Pot to shame is tolerated because malpractice is profitable and fixing stuff costs money? Are we doing the uninsured a favor tossing them into this meat grinder?

There is no comparison between this bill and SS or Medicare. Healthcare is not a pwoggie issue. Single-payer healthcare is the pwoggie issue. It is already a massive compromise and surrender to kleptocratic capitalism. It would definitely be an improvement in that it removes at least one layer of kleptocracy while providing full coverage for everyone at about the same cost as we pay for medical care now, but it would leave the other layers intact.

Baby stepping is about setting our sights low right at the starting gate, then accepting a kleptocrat's wet-dream over our already compromised and shortsighted goals. There is nothing wrong with incrementalism when it can reasonably be expected to improve current conditions and perhaps lead to future improvements, but we should have been going for a fully nationalized system from the word go and maybe, just maybe, accepted single-payer as the bottom line of how far down we'd go to accommodate capitalism. I don't see how this bill can do anything but hurt working people who are uninsured.

"Are we doing the uninsured a favor tossing them into this meat grinder?"

sean
if by that you mean the young low waged and healthy......

NO

from them
the system is extracting additional tribute

that is the meaning of a mandate for them

extraction from well in excess of benefit back

but universal health
--by means of corporate vehicles --
as we all know
requires just such a mandate
at some point to function sustainably

above i suggested the path of reform
one ought to prefer as a card carrying humanitarian

we don't get that
under a corporate
two party
de facto dictatorship eh ??

--------
" We need to do more than just reform health insurance. We have to completely scrap the medical system itself and start from scratch."

if we have the political power
to pull that off my man
why restrict it to socialization of just one sector ???

if we don't have the power
then this wish joins the flying horse department

if you want power then go for it
attack the base of the PTB
attack their rent flow pipelines
and their wells pumping surplus
out
of the producing classes

don't get a hair shirt on
over a safety net reform
or like health reform
over a coverage/cost tussle

if i'm contradicting myself
maybe i'm for once
getting into the thick of it eh ????

"if you want power then go for it
attack the base of the PTB
attack their rent flow pipelines
and their wells pumping surplus
out
of the producing classes"

I think the argument here is that the current healthcare bill vastly expands the rentflow pipelines and empowers the PTB.

If I understand you correctly, you want the mandates to increase the rents flowing to the healthcare industry, in order provoke demands for cost-control measures?

sounds like quite the game of 11-dimensional chess. I highly doubt that it would turn out the way that you are expecting. I don't really get your whole "make things even more horrible for the working class and reward the elites, so that eventually the masses will demand a solution"

things already are horrible, and the majority are already demanding a solution

Bob
Not sure the reformed system
Would be worse then the unreformed system

More expensive. Yes but who pays what here

insure 30 million folks
And reg out priors
As. a screen

Uncle gets into. The subsidy game
Uncle borrows billions

Macro here looks all to the good
Better nurse hat
Keynesianism then
Helmet keynesianism
At the margin

Every bill obviously can summon forth
The pinko wrath
At the system that produces such arbitoir reforms
Primarily because after the reform it's still an arbitoir

In particular I want to be clear
The worse the better apropos the lower strata of the job class
is anathema to my sense of class struggle

If I' m wrong it will be because this reform kills and imiserates more souls then the status quo ante

op, I'm sure I'm missing the point of sarcasm here, but your arguments sound like they are in favor of eternal corporate power retention merely because something good might trickle down. I guess there's a Swiftian sense of humor in it, what with you supporting the Houhynyms and Brobdingnagians all that....

I guess adopting Brand Obama's arguments has some comic value. I guess.

"Bob
Not sure the reformed system
Would be worse then the unreformed system

More expensive. Yes but who pays what here

insure 30 million folks
And reg out priors
As. a screen

Uncle gets into. The subsidy game
Uncle borrows billions"

No, see that's where you are wrong. You're not paying attention to act two of this whole sorry spectacle. It's bi-partisan defecit hawk time!

Get ready for the Obama debt commission:
http://www.cnn.com/2009/POLITICS/12/15/obama.debt.commission/index.html

ooh what a treat

It looks like he's getting ready to wreck Social Security and Medicare, in addition to turning health insurance into a social welfare catastrophe - one that's worse than the impact of Bush's prescription drug benefit. Put another way, he's worse than Bush.

if by wreck u mean gut super Al
i guess we'l see if he really is the better
corporate cola
both regan and gwb foundered when they directly assaulted the core legacy of the new deal :SSI
for what its worth
i suggest this gas shop he's commissioning
is an intentional press diverting
cul de sac

like the 9/11 con-mittee
and the baker hamilton con-mittee
a running of the bulls
only a danger to damn fool journalists and big feet

but posts on this will throw more light then comments

http://www.newyorker.com/reporting/2009/12/14/091214fa_fact_gawande

on the cost cutting "mirage "
tucked inside
our dembot health reform bills
evaluate during free swim

op, that article is terrible

Turn of the century agriculture is a terrible analogy for healthcare reform

- food and healthcare are fundamentally different types of goods
- insurance market failures are not analogous to ag development issues
-everyone at that time was struggling to increase ag production, while right now it is only America that is lagging behind, while clear solutions have been developed in other countries

It's basically the same type of bullshit that you hear from any AMA type or petty healthcare rent-seeker... it's save-the-rustbelt-ism

op, that article is terrible

Turn of the century agriculture is a terrible analogy for healthcare reform

- food and healthcare are fundamentally different types of goods
- insurance market failures are not analogous to ag development issues
-everyone at that time was struggling to increase ag production, while right now it is only America that is lagging behind, while clear solutions have been developed in other countries

It's basically the same type of bullshit that you hear from any AMA type or petty healthcare rent-seeker... it's save-the-rustbelt-ism

maybe jrossism is a better description, if you know who I mean

Owen, Gawande's analogy is even worse than Krugman's. Bob hit all the high points on that. He's got it dead to rights.

Every last diehard, deadender, professional liberal is pulling out the stops to pass this miserable piece of shit. What's common to all of them, outside a pathological inability to make honest comparisons, is a job that appears safe from the effects of it. The premise of the piece of shit is increased participation in risk pools, sold with the usual corporate "trust me on this, no really" non-promises from the only beneficiaries. The self-employed and under-employed are going to get hammered. The labor force that lives in the legal shadows will get hammered. Medical practitioners who play it straight and compassionate are going to be even more at the mercy of insurance companies. The putative protections are all the usual consumer-driven opportunities to raise a beef - if you can afford it, know how to do it and can spare the time to pursue it. This is worse than the status quo. Any mooted fix is going to follow the same pattern as the prescription drug benefit "doughnut hole", which remains a disaster.

http://www.boston.com/news/health/articles/2009/09/28/support_for_mass_health_insurance_overhaul_drops_but_is_still_strong/

poll on mitt care

" 59 percent of those surveyed said they favored the state’s multimillion-dollar insurance initiative, down from 69 percent a year ago. The poll, by the Harvard School of Public Health and The Boston Globe, found that opposition to the law stands at 28 percent, up slightly from 22 percent in a June 2008 survey
....79 percent of those surveyed wanted the law to continue...Only 11 percent of state residents favored repealing the law...Roughly 90 percent of Massachusetts residents had health coverage before the law went into effect and now state data show that about 97 percent do"

so 7 % got coverage and ~25% think coverage conditions improved for them

if the 7 % all feel improved that leaves
18 % placebo ??

support still there
but confidence is "eroding "
in mittcare's cost control capacity
as rates continue 10% compounded annual rise

globe :

"Percolating throughout the poll findings is a gnawing concern over rising health care costs, suggesting that support could erode further if the state fails to slow the growth of medical spending...when asked whether the law was having an impact on the cost of their own care, only about one-quarter of those surveyed said the law
was “hurting’’ their own costs....
a quarter thought it had improved the quality of their health care and their ability to pay medical bills if they get sick...residents who said the Massachusetts law should be continued were asked to name the most important change needed, and 30 percent of that group volunteered some cost-reduction measure"

" 59 percent of those surveyed said they favored the state’s multimillion-dollar insurance initiative, down from 69 percent a year ago. The poll, by the Harvard School of Public Health and The Boston Globe, found that opposition to the law stands at 28 percent, up slightly from 22 percent in a June 2008 survey
....79 percent of those surveyed wanted the law to continue...Only 11 percent of state residents favored repealing the law...Roughly 90 percent of Massachusetts residents had health coverage before the law went into effect and now state data show that about 97 percent do"

So we have 10 percent of the population uninsured prior to this legislation who are now being forced to pay for this dog and presumably pissed about it, but it is opposed by over 28 percent of the population, including those who have insurance from work or some other means.

A high rate of support from the middle class and those with secure jobs? No surprise there.

it's not clear sean

11% want repeal
are they the 7% forced to buy insurance coverage plus 4 %
made up of the stil un-insured
plus 1 % of the already insured ??

that's your best case here

i can think of a scrooge count
-- subsidies for these lazy bones ??--
well above 1 %
in fact i could easily figure there were
11-3= 8 ...8 % scroogery types in the commonwealth

we need more survey numbers lots more

maybe you're in spirit quite correct
but sean don't scramble and over play your hand here
why pre determine this

just to further enflame your anti corporate johnson ???

believe me such tactics convince
few beyond
your fellow
hard johnson
anti coorporate
chorus line members

The survey doesn't tell all that much, Owen, as far as health care itself goes. Prior to the enactment of Romneycare, the poorest of the uninsured got medical care paid through the free care pool. Those with limited means got scaled assistance. The RomneyCare "safety net" does cover the people who can't get insurance, for whatever reason, but it does so much less generously. I keep saying: the expansion of insurance coverage does not necessarily mean greater access to health care.

The survey tells us a few things, however, as far as insurance goes. RomneyCare has hurt people who were doing okay before, and the lack of a cost containment mechanism is increasingly worrisome to them.

cost containment/productivity enhancement

the family doctor vs the family farm

this suggests the medibiz folks like the sgri biz folks are planning to direct cost containment processes to their advantage
ie personel in group pracs
clinics and hospitals
will take the big squeeze

trim the job blubber
and earned producer rents

not the corporate product rents

"the lack of a cost containment mechanism is increasingly worrisome to them."
exactly what has been "defered"
in all these "bribe first" schemes

costs that must be contained will be contained
at least relative to other oecd players

the distribution of the cuts is the struggle as yet unengaged
one has to assume entrenched
medi sec corporate interests will
foist as much as possible on health care recipients thru plan coverage cuts
and the human "productive factors"
from housekeeping thru techs and aides to registered nurses hey maybe even ...doctor -specialists
the ama once the zionpac
of professional lobby outfits
may today suffer from goo goo humanist counter currents among the specialist class

doc welby of course could rally the nation if need be

quite a hedgerow system to blast
yer cost cutters thru but what must be done will
only be sure
what ever must be done
can be done seceral ways
and we'll get the way that fits closest
to tower troll specifications

OP, this survey isn't likely to be convincing to anyone but the math impaired. This survey tells us nothing about how the people most effected by Romneycare feel about it. At most, only 10/59 or17 percent of the people claiming to be satisfied with the plan are directly effected by it. That's your best case here. That's if we assume 100 percent satisfaction among the 10 percent of the population that was previously uninsured, which is highly unlikely. It could be as little as zero percent, if none of the previously uninsured are satisfied. The other 83 percent of those claiming to be satisfied could be satisfied for reasons that have nothing to do with the plan itself, such as the fact they don't have to pay for a government-financed plan that primarily benefits others or they buy into the propaganda that single payer is socialism and threatens the best medical system in the whole wide world. We don't know. People are often satisfied when they don't realize there are better alternatives. It is a little disingenuous to do a survey of the entire population of Massachussetts without also focusing just on the people most effected by Romneycare.

Contrast the findings of this survey with the one here:

"One-third of Americans told pollsters that the U.S. health care system should be completely rebuilt, far more than residents of Australia, Canada, New Zealand, or the U.K. Just 16 percent of Americans said that the U.S. health care system needs only minor changes, the lowest number expressing approval among the countries surveyed."

http://www.foxnews.com/story/0,2933,136990,00.html

http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2004/Oct/Primary-Care-and-Health-System-Performance--Adults-Experiences-in-Five-Countries.aspx

sean

we are trying to understand here not
convince eh ??

you are over playing your cards likke conversion is on the line

everyone here is for single payer now
we need no convincing

the scrap is over the increment or decrement this reform will entail over more status quo
not whether the reform
is way way way below single payer

math impaired ???
what math i see no math
i see numbers
but
beyond the stat sample confidence interval
no math

the contrast is between non mitt care states and the mitt care state

recall the proposition on the table

kill national mitt care it's worse then the status quo
sez doc dean

now if this bribe to the special interests
only strengthens their hand to block cost control down the road

let's talk about that

i rely on the social necessity to curb the sectors growth to put that notion to rest

we will have cost containment and as of now we have no notion of how the cuts will be absorbed and by who

details:
obviously the 3 % still without coverage aren't likely to favor it
as to the 7% now covered
as i understand it
the state projected higher use
of it's exchange
---more former uninsureds
chose to sign on to their company plan then expected ---
are they happy ?? unhappy ??
is the state premium subsidy
as Al suggests inadequate ???
lot's of questions

but whatever you're doing with the numbers
i can't see the outcome of all your
shuffles changing the simple result

how many want repeal..... 11%
ie going back to what amounts to the status quo
elsewhere today

if i were a pol and thought that number might hold up
i'd vote this in

yes "People are often satisfied when they don't realize there are better alternatives"
but you're talking alternatives to an alternative no one outside mass has experienced

-------

the thrust of this seems a bit off:

"they don't have to pay for a government-financed plan that primarily benefits others "

the commonwealth pays for the subsidy plan sean
so as tax payers funding "hand outs"
one has dis satisfaction potential
even if only from scrooge types
isn't their medicaid enough for the real down and out
why should we pay from middle class spendthrifts

---a profile of the target sub population
is really young free riders taking a small risk eh ?? is that what the dragnet caught ???

--------------------
of course you are absolutely correct
we need a survey that is "focusing just on the people most effected by Romneycare"

if we are into this reform
to improve the lot of the uninsured

i'm not

--in fact i don't buy the health gains from universalization include 20-40 k
pre mature deaths per annum ---

the universal mandate is really about ending adverse selection/free rider problems
which as a society wide problem
is no doubt much over played

as i understand it
the state projected higher use of it's exchange
more former uns chose to sign on to their company plan then expected
are they happy ?? unhappy ??
is the state premium subsidy
as Al suggests inadequate ?

You're seriously misreading what I wrote here, Op. I am not comparing Romneycare to single payer, and I trust that everyone here has the good sense to know our current system sucks and that single payer would be a massive improvement, although still a concession to capitalism. I am arguing against Romneycare on its own merits, and the idea, implied by that survey, that Romneycare must be working as so many people appear to be satisfied with it. Based on what little data that survey gave us, it is clear the majority of the people claiming satisfaction are not the same ones being forced to buy health insurance. At most, only 17 percent are. Everything else is basically speculation. I am also arguing that single payer should be the rock bottom minimum of what any leftist should get behind barring some very tangible evidence that the more kleptocratic alternatives offer some kind of major improvement over the current system. I see not a shred of such evidence for Romneycare.

the commonwealth pays for the subsidy plan sean
so as tax payers funding "hand outs"
one has dis satisfaction potential
even if only from scrooge types

Sure, but have they gotten an increase in taxes to cover it yet? These things tend not to sink in until the bill comes due. Such people may well be covered by the "unsatisfied" category. Who knows?

profile of the target sub population
is really young free riders taking a small risk eh ?? is that what the dragnet caught

I have no idea of knowing, but if so, why does it matter? Young people are utterly desperate nowadays and can't find decent employment or affordable housing. Now we are going to hammer them with mandatory craptastic insurance and scold them for being free riders? C'mon. Young people who cannot afford both health insurance and rent have already decided what their priorities are. Now the government is going to make that decision for them for no other reason than to enrich insurance companies. If you don't buy into the idea that 20 to 40 k people will be saved by universal coverage, (and I also see no reason to believe it so) then what reason can you have for supporting this?

We can only speculate as to the potential benefits of Romneycare: fewer deaths, greater health...what else? But the harms are clear and obvious.

"we will have cost containment and as of now we have no notion of how the cuts will be absorbed and by who"

Well, we already know that they are cutting 500 billion out of the Medicare budget for starters. I wonder how much you will like obamacare once it has strangled medicare and medicaid to death.

I find your idea that cost containment will come out of the insurance industry's pocket quite absurd. There's nothing in this bill that would force that. And isn't NOW supposed to be the once-in-20-years opportunity to cut costs? I thought that's why every was supposed to accept this POS. The rationalizations are shifting so fast these days that I find it hard to keep up.

also, there seems to be some sort of strange cognitive capture going on in the United States where universal (high deductible, gamed) health insurance is thought to be the goal, rather than universal healthcare. The two are not the same.

The problem isn't that there are people lacking health insurance, the problem is that people are "insured" in the first place. There is a world of difference between private insurance and public risk-pooling. You can't get effective universal healthcare when the costs are so high. Do you plan on spending 20% of GDP on healthcare?

The main difference is that in private insurance, the insurer has to guesstimate each risk in advance, then strategically overcharge to earn a profit. In order to keep loss ratios under control, they spend a whole bunch of money screening risks, paying lawyers to deny claims, etc, etc. In a public system on the other hand, the government just pays for illnesses as they occur, and the cost is tallied up after the fact and smoothed out over the long run. There's an important difference there.

Public option, or even the medicare expansion I could live with. Even though they were thin gruel, they were at least a step in the right direction. The current bill just doesn't seem to do anything to address the key problem of everyone under 65 being bent over the barrel by insurance companies. Whether they pay them through premiums or taxes, they are still going to be getting screwed by the insurance companies.

I find the whole "it will save X lives" morality play unconvincing. If that's the logic, then I've got a solution for the banking crisis. Instead of any financial reform, how about we just force goldman sachs & co. to feed 10,000 starving Africans. How can you say that we should force the bankers to reform, when being such an "idealist" would mean the death of 10,000 people?

It's a false dichotomy, and a gambit served up to avert reform where it is really needed.

"people are utterly desperate nowadays and can't find decent employment or affordable housing. Now we are going to hammer them with mandatory craptastic insurance and scold them for being free riders"

yes

sean you are comparing this to single payer

your words
"single payer should be the rock bottom minimum of what any leftist should get behind"
folowed by this serious off set
" barring some very tangible evidence that the more kleptocratic alternatives offer some kind of major improvement over the current system."

in other words if a corporate induced self reform is a benefit to the helot citizenry ??
i'm no humanist sean
private charity is possibly okay by u then too eh ???
if it helps some folks ??

i'd rather an onerous intra job class
tax and transfer system
to wealthy folks voluntary charity payments
of the exact same size !!!!

of course single payer is the reform standard
and of course the present system reform is being "over sold"
by krugman-reich type humanist realists
because to them
4 more years of the status quo is worse
and starting from scratch again next session
is hazardous
both those propositions bare scrutiny
i'm far from confident the first is proven or the second even admits of a proveable case
but such are reasons and rationalizations

at bottom the humanist realists will take anything that drips something more
"net" down to the lower middle wrungs here

and yet despite my ignoraant reflexive doubt about the immediate "up side"
i believe with deep conviction based on system wide dynamics
there WILL be a sector shake up of serious proportions which won't over time and thru reformulation
produce "only"
greater "klepto corporate "
rent rake ins
no it will lead to sector wide containment and comprehensive inclusion payment participation and coverage
ie de facto socialized health insurance

i expect the "reform "to pass and lead to further reforms as krugman suggests

i have no doubt
"only" greater surplus is the short run likely hood
but universal health insurance is coming and from a humanist perspective that is to the good in any form that includes greater shares of the populace covered and receiving
public premium subsidies thru income qualification

though no humanist
i find it politically stupid to obstruct humanism or oppose it
even when "gulled"
if they can't be unguilled
by brats like dean then i won't oppose em
in their vile notions
of distributions to the poor

and of course system wide cost control
is as i repeat ad infinitum
inevitable and unpostponable

despite the corporate form it will take here

--again " experts " contend
switzerland and the netherlands
give useable guidance
for us stuck inside the american mobile
to a better system

okay we're 20-30 years behind
but the distance will be more or less made up
in i suspect 10 years time
its an oecd competition induced necessity

"Young people who cannot afford both health insurance and rent have already decided what their priorities are. "
and correctly so
my common law hitched daughter makes for a ready example close to my eyes

and that is precisely the reason
particpation must be
by law
it's not like car insurance
ie a pure free rider problem
someday every one gets real sick and fucked up
and will wish they had insurance
so it's moral hazard but the same solution
is required

you correctly don't like
who's gonna end up paying
and to whom

--but even here
it's both
generational and life time income class
one looks at here --

fine the rip will be awesome

but this is wrong:
"Now the government is going to make that decision for them for no other reason than to enrich insurance companies"
no other reason or no other result ??

i agree there is the very distinct possiblity
there will be
no other signifigant immediate consequences
beyond a nasty shift
in the burden of pay ins
and equally nasty increase
in the total pay ins
by both the state and private sectors

yes and enrich not just insurance corporations but
also health provider corporations too
drug companies other medical product companies etc
that's the bribe part right ??
bribe ..bribe
as in privateer tribute
flowing into corporate coffers
extracted from humble young mcjob geefs
why??
to accomplish by worse means possible
the foundation of any
humane health payment system
which must include:
universality of coverage
and yes some what more nastily
compulsory participation in payment

example of a why:

the no priors screening law
begs for adverse selection abuse
if participation is voluntary
if we are to have universal health coverage
and have it seem fair by average american notions of fairness
then
like social security
the benefit must be "earned"
by contributions
ie
requires universal participation in pay in

i bet we could discover many folks
in the system ie paying into the system
without getting anything more back then the young and restless outsider
the point is many pay
while few receive

that's socialization of risk
ie insurance
the rest is merely a compulsory payment account
for doc visits and other routine screenings
and of course they are complusory payments
because these are supposed to capture unknown problems
and treat em earlier and blah blah blah
we get 20-40k lives extended each year chatter out of goo goos on this process

the notion being
they've paid for it can't get the money back so they'll go to the doc

btw
that reason for whatever it's worth
is driving goo goo support well beyond reality
of that i'm sure
and this medical blood bath of neglect
is why goo goos go along with the corporate bribes

"cost of the system mate "

of course they may or may not think they personally will bare a sizeable new burden in tax pay ins themselves
so yes only experience over time
as with mittcare
will tell us about popular support
and i agree welfare systems come under attack as they expand and folks get bombarded
by
agitprop .....corporate and otherwise

this analysis is not approbation sean

--- i submit
you still aren't keeping analysis fully seperate from advocacy

example :

"single payer should be the rock bottom minimum of what any leftist should get behind"
that is advocacy eh ??
and here's
where the need for analysis gets acknowleged :
" barring some very tangible evidence that the more kleptocratic alternatives offer some kind of major improvement over the current system."

that process of analysis and evaluation is on going and best approached not with a mind to quick refutation
like finding a rent bug in a program
and going
"yup i thought so corporarte piffle
off with its head" like the red queen

simply holding the fort against "reforms"
till relieved by the revolution
at least without examination
won't contribute much to your movements expansion

act too much the red cavalier
and we surely earn the label

dogmatic
brat pack nihilistic
zero think
infinite knee jerk

raw romantic rebel

mere self agrandizing gesturer

------
lots of mindane worker types
as u know
lack the luxury to indulge
their "personal" notions of justice
implied by total rejection of corporatism

and our goo goo front mates are turned off too

they want to save souls from drowning
not exult in the worse the better cause it brings the end that much nearer

true or untrue
it's like man boy love
we got a bad "social context" here in amerika
to push that line
unless you like splendid isolation

or confinement

"I find the whole "it will save X lives" morality play unconvincing. If that's the logic, then I've got a solution for the banking crisis. Instead of any financial reform, how about we just force goldman sachs & co. to feed 10,000 starving Africans. How can you say that we should force the bankers to reform, when being such an "idealist" would mean the death of 10,000 people?"

lovely bob

if not entirely analogous
in deed you capture the hostage citizenry of a corporate dictatorship here

they say
do it our way
or more of you will suffer and die

lovely

-----------------
literary florish aside
now for the skunk works

"I find your idea that cost containment will come out of the insurance industry's pocket quite absurd"
where in heavens name did i say those words
find em and i'll wack my pee pee with a window sash
i certainly don't believe that for an instant
they hardly represent enough of the health sector's system wide cost to begin with

the project of cost containment will have many fronts many will be squo0zen but mostly expendable personnel not corporate profits

"The rationalizations are shifting so fast these days that I find it hard to keep up."

why bother
look at the bills instead
in fact look at mitt care in practice

"The problem isn't that there are people lacking health insurance, the problem is that people are "insured" in the first place. "

gibberish bob

"There is a world of difference between private insurance and public risk-pooling."

true

then you mean to say
"the problem is that people are.."privately insured eh ??

"You can't get effective universal healthcare when the costs are so high. Do you plan on spending 20% of GDP on healthcare?"

again not a completed thought process

---bob do you have battle fatigue ???--

are you saying perhaps a health system paid for by a national vat
would end up slashing itself to death
if the sector swelled over 20% of gdp ??

that's conjecture based on what ??

what if folks want that much health servicing
food once was 30% of gdp eh ??
a vat tav to provide free food
isn't too far from free drugs eh ??

lot's to ponder here
but not using sky hooks

needed cost controls are for the health providers mostly not the health payment system

as to whether there are any tangible cost containments in here for health insurers themselves
i doubt that as much as you do

they got a bribe

let us be clear there is what we pay for services and products that can be cut
and we can also cut services and products themselves
i'm only talking about price rise suppression

"The main difference is that in private insurance, the insurer has to guesstimate each risk in advance, then strategically overcharge to earn a profit. In order to keep loss ratios under control, they spend a whole bunch of money screening risks, paying lawyers to deny claims, etc, etc. In a public system on the other hand, the government just pays for illnesses as they occur, and the cost is tallied up after the fact and smoothed out over the long run. There's an important difference there."
by regulation of private insurers
this has been accomplished in switzerland bob
is it optimal ??
no

but mother nature's designs aren't often optimal either

"The current bill just doesn't seem to do anything to address the key problem of everyone under 65 being bent over the barrel by insurance companies. Whether they pay them through premiums or taxes, they are still going to be getting screwed by the insurance companies. "

hey we exist in a system not of our choosing
the point is to battle it

effectively and given the lefts limited strength it needs to be applied quite specifically and only where it can make a decisive difference
all else is sunday paper wrestling
like this site

i received this mass e mail today

Dear owen,

The White House and the Senate leadership will jettison any public insurance option in order to pass a health care bill. They will also increase restrictions on women’s reproductive health choices. And tax workers’ health benefits. And allow insurance companies to choose which state will regulate their corporate practices.

All in the service of enacting tax-subsidized mandatory purchase of for-profit health insurance.

Will the House go along? Will healthcare reform pass if they don’t?

There are many ways to stop this health insurance reform bill by fighting over abortion, immigrants, the excise tax or the public option, but apparently only one way to pass it—bow to the pro-corporate Democratic “moderates” and count on progressives to fold.

So it will likely pass.

And then the fight begins.

We have learned through the historic alliance between the California Nurses Association—now part of the largest registered nurses union in the country, National Nurses United—and Progressive Democrats of America that each time the end is declared, we open a new path for struggle.

Like when the Democratic National Committee wouldn’t take a stand for guaranteed healthcare with everybody in, nobody out. But PDA and CNA organized, and the language was inserted in the Democratic platform. And again, when the state option for single-payer couldn’t pass the committee, or was stripped from the House bill. But thanks to the grassroots outrage at the House leadership betrayal, the fight moved to the Senate where Bernie Sanders is still fighting for it.

Or when conventional wisdom said Eric Massa couldn’t win running on single payer in a GOP district. But he did. And then he was one of two principled progressive votes against the compromised House bill.

Yes, we need to steel ourselves if we cannot defeat this insurance industry bailout bill. Progressives who want single payer but believed that the public option was politically viable may learn a hard lesson: We need to win the debate on Medicare for All, not try to avoid it.

Thanks to the hard work of activists in every corner of the US, PDA and CNA have been fighting to do just that.

We’re doing a sustained campaign against the corrupt corporate power that strangles democratic progress in the Senate, reduces change to the lowest common denominator, and blames government for the failings of the for-profit system.

Hope isn’t about a candidate or a piece of legislation. We build hope through action—walking inside the halls of Congress and agitating outside.

Carry on!

Michael Lighty
Director of Public Policy, CNA/NNU

it's double talk like that
which creates seans and maybe bobs too

Well op, it's good to know that everyone who disagrees with you can safely be categorized as a "sean" and maybe a "bob" as well. It is also good to know that my opinions fall neatly into the category of romantic advocacy, based on nothing but my cock, while yours represent penetrating analysis, based on a survey from the Boston Globe and your remarkable ability to predict the future. I have already stated my reasons for avoiding a more complex analysis, and that is that I trust everyone here is already familiar with the facts, and doesn't require a lecture on how insurance works or the free rider problem. I thought I was writing a comment on a blog post, not a dissertation. Aside from the cheap and gratuitous ad hominems, is there a point you are trying to make here?

Unlike you and Krugman, I have no way of telling the future, so I will just stick to the simple fact that Obamacare sucks in the here and now. It is, in and of itself, an anti-reform. I see we will be gutting Medicare to pay for it. Judging by the past, I see no reason to assume that this bogus "reform" will lead to real reforms in the future. Medicare was a step in the right direction, but it has been 50 years since it passed, and the only "reforms" it has led to is a doughnut hole and Obamacare, which is no reform at all. I see no reason to predict a different result for Obamacare. When you support a dog, don't be surprised when a dog is all you get.

It goes without staying that any universal health care system will have to be financed with compulsory payments. There also is no conceivable system that doesn't involve someone getting more out of it than they put in, so there will always be free riders. The question is, how much, for what, and to whom? The biggest free rider in the system is the insurance industry, which extracts trillions of dollars from the system while adding absolutely nothing of value. I am a humanist, so I have no problem with a system that covers those who do not pay into it, but I see no reason to piss money away on the insurance industry based on the unlikely probability it will lead to reforms in the future.

sean why blow a fuse mate ???

your soul is too restless

you are among comrades here

no belt bombing please
and no intentional cartooning of views
shades of mum-go

obviously u know my view
is not based on the survey
that is only evidence
and hardly in itself convincing

btw
why avoid " a more complex analysis" ???
i stand ready to learn

ad hominem ???

its your questions and points
i'm addressing here not you sean
if i'm intervening its to
set sean back on his feet
not scorn him

arrogant of me ???

prolly but so what who cares
who am I to u sean

if you read my comments
i usually just
suggest u consider xyz
harmless enough eh ?

surely you don't think
educating an old wrangler like me
will be easy ??

even if i like to be proven wrong

-------
points:

" I see no reason to piss money away on the insurance industry based on the unlikely probability it will lead to reforms in the future."

obviously i expect reforms by necessity
if nothing less will do

the sector can not indefinitely
continue as it has these past 30 years

do u agree ??

"Obamacare sucks in the here and now."
not helpful but true

"It is, in and of itself, an anti-reform"
heer's the meat line

anti reform
as in a road block to reform
the abolition of reform
or somply a delay of reform ???

give me some idea how the status quo
leaves reform doors open
in a wat the pending bills will not ???

is more years of the status quo
better for low income households ???
worse for the insurance companies ???

you refuse to have any expectation of further reform if this passes
but by implication you either see no possibility of reform anyway
or you figure by sticking to the status quo
we have a higher probability of "real" reform
which is it ??

the way all this interconnects
in your head is crucial sean

i sense ad hoc piecemealing here
value driven
teleological pot shots

points just get cherry picked
without coherent thinking
in an attempt to dismiss but
not to comprehend

"The biggest free rider in the system is the insurance industry, which extracts trillions of dollars from the system while adding absolutely nothing of value."

"extracts trillions ??? "
as in profits and bonus pay to top execs ???
trillions ??
it passes on most of what it extracts right ??
what are health insurance profits as a percent of the extractions
if it spends money wastefully and it certainly does
on staff and marketing wipe it out in your mind and see if the problem of health sector growth is much reduced over time

yes single payer would slash these costs
but
how much in dollars per annum ??

where we all i think share the conclusion
the state is corporate dominated
to get in a rage when the state performs according to specifications seems silly
unless you are in agit prop mode
which clearly i'm not

the point that motivates me is very simple

rads can't handle reform they want it to fail
either because its a delusion which seems to be seans view
or it co opts job class strata
the greater class struggle needs
on the side of the future

the hatred of the corporate trolls
is often so wild
rads freak out
they chortle they dance by the light of the moon
but they won't be gulled into noticing reforms
they must be anti reforms or at least anti revolution

it reminds me of the old left in form
right in essence casuistry

a not uncommon axiom:

nothing positive under uncle
no real reforms are possible
"within" the system

just as there are no left errors
that aren't really right errors at their core

if you can imagine
by act of congress
a "how much, for what, and to whom? "
that marks at least a meliorative advance
for certain job class strata

is this a reform process ???

if yes it
adds little here
to churp about
how
we are still on the far side of eden
obviously

Everyone knows where I stand on RomneyObamaCare. No need for me to belabor previous points.

I do have a digression to add to this, however, and it's one that's been gnawing at me. Owen mentioned that insurance, and the whole medical industrial complex, has been aggrandizing at a rate that's started to hurt other vested interests. Needless to say, I very much doubt this will redound to the benefit of people who need relief. What I wonder is there speculations or insights regarding how long those other interests will tolerate being nudged away from the trough?

Al -

Big Insurance has been reformatting itself for the past 30 years, man. Anyone who has played on their astroturf pitches knows, the world of Insurance in 2010 will be nothing like the world that we saw in 1990 or 1980.

My former corporate slavery was devoted about 60% to insurance company insolvency / rehabilitation and related corporate finnageling. Insurance companies always are working at ways to pinch more profit-dollars out of every policy buyer's premium dollar paid and every claimant's injury-value dollar claimed.

Most big insurance companies are affiliated either formally or in close informal proximity with other financial business interests. They are ready to be flexible if Uncle Sam or the Great Consumer Pumpkin should give them a frosty Heisman Trophy stiffarm. Their primary means for getting what they want have been, traditionally, what we are seeing now with "health care reform" -- dictating the terms of business to the government entities and personnel who supposedly regulate the insurance carriers' operation. I expect that primary vector will carry forward as long as we allow this charade of "republican government" to hold sway.

Thanks, CF. That's bleak and precise in a way I find perversely reassuring. There's nothing to lose from being "unreasonable".

"where in heavens name did i say those words
find em and i'll wack my pee pee with a window sash"

I don't think you did, as much as I would like to see that

"---bob do you have battle fatigue ???--"

no, just fatigue.. was half awake when I wrote that

anyways,

"then you mean to say
"the problem is that people are.."privately insured eh ??"

Yes, my point was just a basic semantic one, gibberish I guess you could say. It's just that the difference between public and private insurance is so large that it really warrants using a different word to describe it. My preferred distinction would be public risk-pooling vs. private insurance. The principle of risk pooling is the same in both, but in the private market you have a whole system of writing put options on a risk by risk basis that basically defeats the whole purpose. Insurance originated as a non-profit cooperative system for mariners, and it wasn't until later that what we call private insurance emerged. IMO there is an important difference between the two, and it should have stayed cooperative.

It is odd that despite all the hoopla about derivatives, few people seem to realize that private insurance is just an OTC derivatives market. Actually it is significantly worse than the OTC derivatives markets that you hear about in the news: private consumer insurance is characterized by extreme information assymetries, with regular people being forced to buy complex derivatives on their own health and belongings with no access to actuarial studies, and from vastly more sophisticated firms. Besides that, from the perspective of insurers, it's a "market for lemons", which leads to excess premiums and cartel pricing. Buying your healthcare in the form of an OTC derivative contract on your future healthcare costs is just a fundamentally terrible system. IMO that is the root of all evil in the US healthcare system (the cause of high provider costs), and the reason that I am so wedded to the insurance part of reform in particular. the overpricing originally occurred in the insurance market, while the rest of the sector simply inflated its prices to to capture a chunk of the rents that were there for the taking. Even if the provider costs make up more of total bill for healthcare, 5% out of the 7% of the insurance part of healthcare costs is pure waste, and can be eliminated with no reduction in services. I think it is a much easier cut to make than to start cutting at the provider level. It is also the root cause of high costs at the provider level.

Fixing this is obviously what they had in mind with the exchanges and standardization in the new bill (which I generally support as means of fixing out of control derivatives markets), but I doubt that the exchanges will put any dent in the cartel, and their stock prices seem to imply that this is the case. It's still just a derivatives market, and I doubt that they will be able to standardize individual health risks the same way that you would a bushel of soybeans. It will continue to be a market for lemons, characterized by rampant overpricing and cartel collusion.

The Swiss plan is a public plan that is privately administered on a NON-PROFIT basis, in exchange for the opportunity to market add-ons to the public. If the US health insurance industry is willing to do all the paperwork of a public plan in exchange for being able to sell some travel insurance, then I guess I wouldn't mind, but I don't see anything in this bill that points towards a Swiss system.

I guess the main point I'm trying to make here is this: why start with the painful cuts to services and personnel that may be overpaid but are at least somewhat productive, when it is the insurance system that is driving up costs across the sector and could be eliminated, removing both a systemic problem and a significant chunk of waste, with no reduction in services?

I don't buy that the public-option was never actually on the table.. everyone including the healthcare industry thought that it was going to pass, but they managed to thwart it in a last minute coup. Sure, single payer wasn't going to happen (and if you remember, I don't think I was a particularly vocal single-payer, anti-public option supporter at the time), but public option could have happened and was going to happen. I don't see the point in making an after-the-fact Panglossian assessment that the public option was politically impossible, and then reasoning from there that it was either the current bill or nothing.

Bob, that is one of the clearest looks at the systemic guts of the insurance industry I have ever seen. I don't want to get fulsome about it, so suffice to say it makes things much easier to explain to people who are curious, but know very little.

Solid analysis, Bob.

The origin of insurance in the risk-pooling cooperatives is something most insurance buyers today know nothing about. They don't realize the origins of insurance are in a communitarian perspective, not a profiteering perspective. The whole point was to guard against the losses inherent in maritime transport of items.

Modern-day insurance laws and regulations will allow such risk pooling and self-insurance (captive insurer; self-insured retention; risk-pooling agreements), but the majority of insurance companies doing business aren't following that model. Their model is instead a system of arcane math-based gambling, where the insurer assumes part of the risk and then hopes the risk never materializes. The game for most insurers is to find insureds who aren't ever likely to submit a claim. This means pure gravy for each premium dollar taken in.

The extent of reliance on the arcane math of actuaries depends on the line of insurance under consideration. For property/casualty lines, actuaries aren't too busy. For life/health lines, it's all about the actuary's justification for policy pricing, and the bulk of "regulation" of the core of health insurance and life insurance has to do with actuarial standards used in policy pricing. There are claims-handling restrictions and sales-based restrictions, but the requirements for actuarial machinations are where the real arcana lie.

Another thing most insurance buyers don't realize is that insurance carriers really leverage their risk. They reinsure their portfolio of risk so that most of what they underwrite is not really risked, financially speaking -- it's risked by the reinsurer(s).

Also -- let's not forget the contributions insurance companies make toward the ever-spiraling-upward costs of medical care.

Medical care is priced on the assumption that a third party (an employer, a health insurer, an HMO, or the like) is paying the bills with much deeper pockets than the average American personally possesses.

This means both the buyer of health care and the provider of health care have no personal stake in the buyer's ability to pay for the health care at issue -- they've both punted on that question, turned the responsibility over to the third party payer for the buyer's needs.

Auto Makers learned this a long time ago - they can sell more cars if they can finance the cars beyond what any individual buyer can pay today.

Bob

I agree about pub op it really was on the table

The victory by the insure corporations
over pub op
Was not a done deal

The swiss
System
Evolved from prof
Allowed
To the no prof regulation. By way of

National referendum

Why that system is instructive
To american pwogs ?

The swiss passed thru by means of a corporate non SPH paradigm
To a de facto
Equivalent

I think you are on target
About the distinction between a social insurance system and a corporate insurance system

To call the present system social insurance
Is to miss this distinction

Society as a whole must be the pool
To capture the greatest risk spread eh ?

Mandates
for universal
pay in achieve this

The pay in rates
Can be laid down
With pseudo independent sub pools of course
if the principal is only to reward risk reducing actions

hmm.. I guess I can sort of see the logic with the mandates

The goal is (A) universal risk-pooling (B) under a non-profit system
Public option gave us B: the non-profit system without universal risk pooling
Mandates provide A: universal (although still balkanized) risk pooling, but no non-profit system.
I take it your idea is that either one eventually leads to A & B (single payer, or de facto single payer)?

Public option still seems like a significantly shorter and surer route towards achieving A + B.

Al & C F, thanks. I wish that more people paid a little more attention to how insurance works, and how they are being systematically fleeced on basically every type of insurance that they buy. The topic is so painfully dull though, that I can't really blame the average person for not bothering. It's a real leech of an industry, and my hope is that the sooner people understand the advantages of public health insurance, the sooner they start demanding the socialization of other standard risks, like auto insurance.

"Public option still seems like a significantly shorter and surer route "
absolutely
but we get the flat out for profit corporate way
not even a mediated non prof corporate way like germany

as gracefull sardonic uwe reinhardt
has repeatedly pointed out
amerika won't get there if any where
the most efficient way
not even the average way
we have the most balled up health system
in the oecd
basically because we can "afford" it
both our system's absurd costs
in multi use resources and labor wasted
and it's brutal human consequences
in misery and exclusion

bob
simple insight
insurance leads to pool max
pool max means socialism

it's as true of credit risk as of health risk
and fire quake and weather risk

obviously the cost /benefit analysis
in each area is both intricate and on going

flood plain insurance is my favorite example
of bad cost /benefit analysis

obviously i expect reforms by necessity
if nothing less will do

do u agree ??

I agree that change is inevitable, but I don't agree that change has to be positive. The current "reform" sees us gutting Medicare by $400 billion over the next 10 years. As the good ship SS Healthcare continues to sink under its own weight, it will be the 3rd class passengers who get dumped overboard first.

anti reform
as in a road block to reform
the abolition of reform
or somply a delay of reform ???

It's an anti-reform in that it in that it makes things worse for the working class and people with moderate incomes but no insurance in the here and now. Its only tangible benefit is that is might achieve universal coverage, but even that is not certain. Only the costs are certain, the benefits are purely speculative. The $400 billion in cuts to Medicare will hurt the elderly and disabled to pay for crap insurance for the young and vigorous who need it less than they do. Among other things it is a wealth transfer from an efficient single-payer system to a dsyfunctional private sector one. I expect to see a dramatic rise in bankruptices among people forced to pay as much as $10,000 for a family of 4 earning $60,000 a year. There is simply no magical way by which families and individuals who cannot afford to pay for insurance will now suddenly be able to afford it. I am talking about real world inability to pay, not the government's ludicrous poverty line.

It is a dangerous bill in that it strengthens the hand of the insurance industry, and will drive up the cost of insurance, drugs and medical care, as there are no cost controls included as with Medicare. There is no provision to refuse payment for medical errors, "never events," or other medical mishaps, so our medical system may become even more reckless and dangerous as doctors and hospitals pursue all that new cash coming in. It is speculative to imagine that this thing will somehow open a back door to single payer, particularly as it includes a powerful assault on the only single-payer insurance we currently have.

I believe the status quo, as bad as it is, is better than this plan.

you refuse to have any expectation of further reform if this passes
but by implication you either see no possibility of reform anyway
or you figure by sticking to the status quo
we have a higher probability of "real" reform
which is it ??

None of the above. Like I said I can't tell the future. I don't refuse to see any expectation of reform, I just see no reason to imagine it is a given. If we look back through history, none of the medical industrial complex's previous attempts at protecting its rice bowl have resulted in serious reform, why expect any different now? I have yet to see shit magically transform itself into sugar. If there is going to be reform, we are going to have to work for it so why not start working for it right now rather than accept a backward plan like this in the hope it will lead to the change we want?

i sense ad hoc piecemealing here
value driven
teleological pot shots

That may be so, but I suspect it is due to the fact I don't express my opinions well, rather than that those opinions are wrong. Don't shoot the messenger.

points just get cherry picked
without coherent thinking
in an attempt to dismiss but
not to comprehend

I have the feeling you have an economist's tendency to view humans in the aggregate, rather than on the individual level. You have done the math, and in your head, the cost benefit analysis shows us coming out ahead by a slight margin, so you say, "let's go for it." But even if you're correct, the individuals effected by this plan may not share your view of what is cost and what is benefit...on the whole, their expectations and feelings about what is desirable may be entirely different from yours. You might imagine a few bankruptcies and evictions here and there are a fair price to pay for universal coverage, the people being evicted might not agree. With single payer, the savings will pay for the uninsured so there is no added hardship to lower income people. That is why I feel it is the minimum we should accept.

yes single payer would slash these costs
but
how much in dollars per annum ??

I have seen estimates of $350 billion a year for overhead and God knows how much for profit. the industry claims a mere 3.5 percent for its profit margin, which seems unlikely given the money that passes through its hands. The Obama plan is projected to cost $1 trillion over the next 10 years, whereas single payer would save us at least $3.5 trillion over 10 years just on overhead alone, so we could do the equivalent of Obamacare and still come out $2.5 trillion ahead. Add savings from the government's ability to negotiate for drug prices like Canada does, and cost containment measures, and we are looking at trillions of dollars that would otherwise get pissed away with the current system plus Obamacare. I agree that in the long run single payer will fail to curtail costs, but it should decrease them significantly over the alternative. In the end a fully nationalized, non-profit system is arguably the best option for keeping costs under control.

http://www.pnhp.org/facts/single-payer-resources

nothing positive under uncle
no real reforms are possible
"within" the system

I certainly think real reforms are possible within the system if we fight for them. My father and grandfather were union organizers. If they believed no reform was possible within the system they would have proven themselves right. You seem to think reform is impossible unless we take what's handed to us without complaint. Does rejection of this bill mean we will not see another chance like it for 40 years? I see no reason to think so, unless we choose to make it a self-fulfilling prophecy.

if you can imagine
by act of congress
a "how much, for what, and to whom? "
that marks at least a meliorative advance
for certain job class strata

is this a reform process ???

Absolutely. I don't see this alleged reform as meeting those criteria, though.

if yes it
adds little here
to churp about
how
we are still on the far side of eden
obviously

It makes all the sense in the world, op. We don't have to accept table scraps if we fight for better.

"bob
simple insight
insurance leads to pool max
pool max means socialism

it's as true of credit risk as of health risk
and fire quake and weather risk

obviously the cost /benefit analysis
in each area is both intricate and on going

flood plain insurance is my favorite example
of bad cost /benefit analysis"

not sure I follow entirely..

do you mean that private insurance is a sort of private risk-pool accumulation stage that eventually gives rise to demands for socialism, in a Marxist sort of narrative?

perhaps you could elaborate that comment a bit

also, one thing about the Canadian system that a lot of people forget is that the American healthcare market exerts a significant upward pressure on our costs. The factors of production (doctors, nurses, equipment) are mobile, and the presence of a system to the South where doctors get higher wages and diagnostic equipment demands a higher price forces the Canadian system to match the prices to a fair degree.

If the US adopted the Canadian system, and a few other problems were fixed (restrictions on med school enrollment, recognition of foreign credentials), I think that it would be possible that both systems could be run for 8% of GDP or less. Pure speculation, I know, but I'm pretty sure that the US's contribution as a driver of global healthcare costs is not insignificant, particularly in the case of Canada.

"basically because we can "afford" it
both our system's absurd costs
in multi use resources and labor wasted
and it's brutal human consequences
in misery and exclusion"

That reminds me of one other factor that gives America the potential to actually achieve significantly lower healthcare costs than Canada, and I suppose a defense of the efficiency of the Canadian system vs. the European and Asian that appear to be more efficient on a % of GDP basis.

A huge drag on the Canadian system is our large territory and sparse population, coupled with the rights-based health guarantee to deliver a standard of care to all Canadians, regardless of where they live. In the Arctic this leads to absolutely absurd cost levels. Food and medical supplies have to be flown in on ultra expensive bush planes, patients have to be flown long distances in order to receive specialized surgeries, and doctors and medical personnel have to be paid triple the normal wage in order to go live in a small trailer on a frozen tundra where the sun doesn't rise for half the year.

It's probably this inefficiency that spurred Canada to establish public healthcare, which came out of rural prairie provinces, rather than the cities. When compared to extremely high density european states, few people seem to factor in the natural inefficiency of the Canadian situation, vs. the natural efficiency of a european country or small asian country like Singapore in delivering social services. To give a rough idea, Canada's population density is 9 people per square mile, U.S. is 32, Germany is 594 and Singapore is 18,189 (Obviously this doesn't take into account internal distribution (urbanization etc.) which has been improving in Canada).

"I agree that change is inevitable, but I don't agree that change has to be positive"

absolutely correct !!!! change to recruit our pwog allies has only to appear possibly positive
this reform has that possibility
regardless of the class distribution of the cost reductions
in secot employment consitions and wages
and in coverage quality and quantity

"Its only tangible benefit is that it might achieve universal coverage, but even that is not certain."
universal coverage follows universal pay ins
as the vote follows direct taxes
and the military draft

" The $400 billion in cuts to Medicare will hurt the elderly and disabled to pay for crap insurance for the young and vigorous who need it less than they do"
gibberish
the young are being drafted into the pay in legions precisely because even with subsidy they will be net contributors

besides lets talk annual cuts here versus annual prtojected expenditures by category
and let's look at the cost cuts as two dimensional both service cuts and cost for service cuts
nothing as you say is totally pre determined here
and
" If there is going to be reform, we are going to have to work for it so why not start working for it right now rather than accept a backward plan like this in the hope it will lead to the change we want?"
exactly

is defeat of the bills pending
ie rejectionism
the better part of the progressive struggle here comrade ??
maybe so if a better reform requires a rejection of this one
but i don't think so
fighting to maxiimize the reform elements
in this process means as with all reform processes
work thru the system as it evolves
ie thru extension and modification
of this abettoir's reform frame work

the bills are a manifestation of a systemic necessity to reform itself
and i believe the path forward made possible by enacting not rejecting
the bills now pending is the better path

pay to free the hostages
in this case progress itself

and precisely here on the cost cut edge between coverage reductions and real pcost reductions is where the protracted struggle will occur
my guess crunching the lowly staff elements
within the health and insurance sectors will come first
because they might look politically better then chrunching the universal coverage ...err at the margin
both will be shaved undoubtly

"I have the feeling you have an economist's tendency to view humans in the aggregate, rather than on the individual level"

no on the class level as you do
byut your identified maximand
is the bottom elements the crushed elements the undocs the wildly unfortunate
the job-less property-less
systemic outsiders
fine
but they need partner classes mate
formed out of elements of the mcjob class plus both the kulack workers and the pwogie burger professionals

"the individuals effected by this plan "
to me that includes those wage class elements that will be contributing to the subsidy program as well as benefiting from it
and even they require the mobilizing effect
of this mandate to stand up and fight for their class interests

as to individuals

" You might imagine a few bankruptcies and evictions here and there are a fair price to pay for universal coverage"
are you suggesting the status quo going forward
will yield lower totals of these miseries
then the reforms ???

on another dimension :

i submit
we all know single payer is giganticallt better more progress etc etc
stop convincing the convinced
however one might add
among other advantages to the job class
SP individualizes the relationship between insured and insurer
ie escapes the baneful mediation
of privateer corporate plans
made by privateer corporations and sold too privateer corporations
not uncle plans made by uncle directly for indivduals

choice ? as in switzerland germany holland etc
if the now for profits get their basic coverage plan deprofitized
that begins to simulate SP
one can look at medicare plus to see the horse play ahead on this
btw
they bills allegedely close off the uncle subidy to the health insurance corps in medicare plus...we'll see
interestingly as u know
these cuts are lumped in to the scare stampede on medicare cuts

since the pub op was the kernel of SP
it still needs to be fought for
i suspect only further insurance scandals can propell that however
yes more blood pain humiliation and tears

"I have seen estimates of $350 billion a year for overhead and God knows how much for profit"
15 % admin costs for the payment system
on all sides of these transactions
seems fair
and let's say SP reduces that to zero
just to be maximizing
that amounts to at best two years worth of sector growth at present growth rates

the profits on the insurance company portion of that payment system is less
then 35 billion
a huge margin 10% but drugs are 20%

hey cut that out and you don't notice it
thats 1.5% reduction in sector social cost

single payer is about provider cost reduction not payer cost reduction

the insurance corporations do an aweful job
of cost control
they work to grab market share
by costly blandishments that obscure
changes in coverage and co pay
and improve their screening and filtering
not clamping down on sector costs
it's as if they were on a cost plus system
with rigged bids
like public sector builders

"You seem to think reform is impossible unless we take what's handed to us without complaint"

i can only laugh
this discussion is not about agitprop sean
it;s analysis
and now you've helped me with the process
and i thank you for that

to put too fine a point on it

i'm trying to teach you how and when to "complain "my friend
how to "fight" for the class you seem to champion
out of altruism one suspects
i contend
to win is all
even disgracefully if necessary
but to win

not to lose with honor
and a saved soul

unions are a perfect school btw
both positive and negastive
to learn
effective reform under corporate capitalism get a job working for a union
it's in the family eh ??

" The $400 billion in cuts to Medicare will hurt the elderly and disabled to pay for crap insurance for the young and vigorous who need it less than they do"
gibberish
the young are being drafted into the pay in legions precisely because even with subsidy they will be net contributors

It's not gibberish, op. The young are indeed net contributors...to the insurance companies' bottom line. But people who qualify for Medicare are barred from participating in Obamacare, so there is no benefit to them whatsoever. Yeah, you can say Medicare is funded as a pay-as-you-go program and the burden is largely on the young, but that is just a technicality. Most people on medicare have paid into the system for decades and have earned their benefits, which are now being cut to finance the subsidies for Obamacare. This is taking the $.95 per dollar of Medicare money that usually goes directly into medical care for high risk patients and funneling into insurance for low risk patients, where a greater portion of that money will translate into "profit" and "waste" than with Medicare.

is defeat of the bills pending
ie rejectionism
the better part of the progressive struggle here comrade ??
maybe so if a better reform requires a rejection of this one
but i don't think so
fighting to maxiimize the reform elements
in this process means as with all reform processes
work thru the system as it evolves
ie thru extension and modification
of this abettoir's reform frame work

What you are saying makes sense but only if this supposed reform is truly beneficial. Therein lies our disagreement and we can go around and around for days on this. I don't fail to grasp your logic, op, but see no reason to accept its premises.

the bills are a manifestation of a systemic necessity to reform itself
and i believe the path forward made possible by enacting not rejecting
the bills now pending is the better path

Call me cynical, but I think the bill is a manifestation of our congress's propensity to whore itself out to the highest bidder.

are you suggesting the status quo going forward
will yield lower totals of these miseries
then the reforms ???

Yes, I do. The primary risk we are looking to socialize with health insurance is the risk of bankruptcy due to catastrophic medical illness or just being swamped by more medical bills than you can afford to pay. Considering that medical expenses are the number one cause of bankruptcy in our country, and 80 percent of people bankrupted by medical expenses have insurance, it is abundantly clear that private health insurance fails miserably at eliminating the risk of bankruptcy due to medical bills. Meanwhile, medical bankruptcy is relatively rare in the Euro systems. So I don't expect universal privatized coverage will necessarily result in less bankruptcies due to medical expenses. I do think the cost of insurance itself will lead to a lot of bankruptcies, as bankruptcies often result from trivial medical expenses:

The medical debt causing these bankruptcies isn't overwhelming in many circumstances. Statistics available in 2003 are as follows: about 20% of bankruptcy filings involve a medical debt of less than $1,000; about 40% involve a medical debt of less than $5,000; and 13% of bankruptcy filings involve a medical debt of over $10,000. One would think these people could make some sort of payment arrangements to pay off the debt rather than file bankruptcy.

http://voices.washingtonpost.com/health-care-reform/2009/06/new_study_shows_medical_bills.html

http://www.bcsalliance.com/y_debt_medical.html

So if that's all it takes to drive many families over the edge into bankruptcy, what do you imagine Obama's $10,000-a-year grand slam is going to do to a lot of families out there?

"I have seen estimates of $350 billion a year for overhead and God knows how much for profit"
15 % admin costs for the payment system
on all sides of these transactions
seems fair
and let's say SP reduces that to zero
just to be maximizing
that amounts to at best two years worth of sector growth at present growth rates

That's true but largely irrelevant to the point., Regardless of what the growth rate of costs in the system, overheads costs have been pretty stable as a percentage of premiums and will still be there pending some serious improvements in efficiency.

single payer is about provider cost reduction not payer cost reduction

Ultimately, the people who pay, namely us, will pay less with single payer than the status quo. IMO, it will take full nationalization to really reduce or even cuts costs altogether. So long as there is a profit to be made and somebody willing to foot the bill, costs will soar. The right wing says get rid of the government bill payer, I say get rid of the profit.

i'm trying to teach you how and when to "complain "my friend
how to "fight" for the class you seem to champion
out of altruism one suspects
i contend
to win is all
even disgracefully if necessary
but to win

not to lose with honor
and a saved soul

With respect op we are not "fighting" anything, and as far as the left in America is concerned, there is no "we." We are just haggling on a blog is all. Congress is going to do what the fuck it likes without any input from the rest of us. But if by some miracle a resurgent left arises to actually fight the good fight and all that, then I hope we will have the good sense to fight for what we want rather than what the man is willing to scrape off his table for us. Obamacare isn't a Phyrric victory, it's a Phyrric defeat. It ain't worth fighting for.

sean i'd reply but the tread has been
back filed by the blog systems
filing clock

i suspect you won't see this

but

yes we do fight
we fight thru the independent
SP movement mate

and no one is satisfied with boss slops
but they need dissecting for poisons and nutrients

and that is on going
the rest of your points we'll address in future posts i'm sure