Stop Me Before I Vote Again

House defies Bush, OK's drug plan

The US House of Representatives, in repudiation of President George W. Bush's Medicare prescription drug plan, yesterday passed a bill requiring the government to negotiate drug prices with pharmaceutical companies.

....Several government officials.... said enabling Medicare -- through the secretary of health and human services -- to negotiate with drug companies would not drastically cut drug prices.

The bill "would have a negligible effect on federal spending because we anticipate that the secretary would be unable to negotiate prices across the broad range of covered Part D drugs that are more favorable than those obtained by the prescription drug plans," wrote the Congressional Budget Office, a nonpartisan research arm of Congress....

Senator Max Baucus , Democrat of Montana who helped negotiate the 2003 law, said he supports giving Medicare the ability to negotiate with drug makers.

http://www.nytimes.com/2007/01/12/washington/12drug.html?ref=politics

Bush Threatens Veto of Medicare Drug Bill, but a Senator Is Seeking a Middle Ground

WASHINGTON, Jan. 11 — President Bush threatened on Thursday to veto legislation that would require the government to negotiate with pharmaceutical companies to obtain lower drug prices for Medicare beneficiaries.

But chances for passage of some version of the legislation increased when a pivotal figure, the chairman of the Senate Finance Committee, said Congress should repeal a provision of the 2003 Medicare law that prohibits such negotiations. The chairman, Senator Max Baucus, Democrat of Montana, said he did not favor price controls, but did believe that Medicare should be able to negotiate prices in “discrete areas where seniors need our help the most.”

Drug Bill Demonstrates Lobby's Pull
Democrats Feared Industry Would Stall Bigger Changes

Before taking control of the House last week, Democratic leaders briefly considered proposing a new government-run prescription drug program as a way to reduce seniors' drug costs, according to Democratic aides and lawmakers involved in the deliberations.

But House Speaker Nancy Pelosi (D-Calif.) and her allies chose a far less ambitious plan -- to require the government to negotiate for lower Medicare drug prices.... They stepped back largely out of concern that the pharmaceutical industry would stall a complex change, denying them a quick victory on a top consumer-oriented priority....

To strengthen their position, drug firms and their trade groups have been transforming their Washington operations by hiring top Democratic lobbyists to gain access to new committee chairmen, bolstering Democratic political donations....

Even longtime industry nemeses like Rep. Fortney "Pete" Stark (D-Calif.), chairman of a House health panel, are impressed. "They're pretty potent," he said this week. "They're not bush-leaguers when it comes to spending money and lobbying."

Democrats... now that they have a chance to rewrite the law... are pressing for what party leaders concede is only a minor alteration. "This is a first step," said Rep. Charles B. Rangel (D-N.Y.), chairman of the House Ways and Means Committee.

I'll humbly add: yes we can begin the task ... right now... potentially; but mostly we don't and won't want to. It's like an epic return: our fine hero gets almost home straight off in chapter one, but by hook crook or hubris she misses the chance, and soon finds herself on the long arduous outward leg of a much longer circling back. Seems Clio likes to frustrate those with the clearest social vision.

Consider a pal of mine, anonymous at his own request, whom I'll call Mr. S. He sees as if from the mountaintop -- and what do he see? Where as-by-right single-payer for-all health care should come, there's instead the Democrap, Mommy Dearest universal "dummy up bub" mandate.

I must quote S's generalization: it goes a long way toward revealing just what new-deal pale-deal of a Godot we pwogs are waiting for:

"The liberal petit bourgeois, who owns the means to get himself to the means of production owned by the capitalist, cannot for the life of him comprehend the risk aversion of people who have lived in close proximity to the realities of power disparities. It is intuitive to the liberal that pooled risk equates to a shared benefit. And so it does, provided the people in the pool have a means of enforcing the contract to obtain the benefit. Where that power can be taken away or ignored, all risk pooling means is that those most able to deal with being bilked will wind up in a relatively more endurable misery than those with lesser means.

Being unable to recognize this reality, the liberal will be thoughtless in admonitions to join the risk pool, will suffer hurt feelings when the invitation is rejected and will blame the refuseniks for the failure of the scheme, however crackpot it maybe. If the process of obtaining the benefit is sufficiently galling and demeaning... a certain percentage will reject a real benefit, and not just the eternally dangled carrot of neoliberalism.

When the liberal is caught in circumstances where enough people reject the opportunity to join the risk pool, enough so that those who have joined stand to suffer alone, regardless of the existence or absence of a potential benefit, he will become passive aggressive in the same style as a shoplifting schoolboy who is blatantly careless in order to make sure his comrades are dirty. And later justify this by pointing out that after all, he did risk the same punishment he brought on them.

Beveridge's plan has so many obvious, easily detectable flaws,especially when compared to redistributive plans that limit outcomes as a means of correcting power disparities, but it was easily accepted and put in place.

Because it neglected, by design, the most important part of social justice — addressing power disparities directly — it was easy to undermine, stint and finally be turned into a means of punitive control.

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I don't know whether to be infuriated or laugh out loud. All three -- oh, alright, two now -- "frontrunners" have totally, obviously ignored the demand for nationalized healthcare and have simply twisted the meaning of "Universal Coverage" to mean "forced to become a 'customer' of for-profit healthcare corporations". Oh, don't forget: "coverage" just means you've bought corporate health insurance; it doesn't mean you're actually going to get any care when you need it. So, Hillary wants to garnish the wages of even the lowliest burger-flipper or freelancer who goes without health insurance so he can pay his rent, so that she can brag about "universal coverage".

God damn, I hope they nominate Hillary. Perhaps everyone who's fed up with the Donkeycrats living in the pockets of Big Pharma and dodging the healthcare issue might actually grow a pair and vote for Nader, even if he's going to "lose".

Man, I'm sure glad he's running. Too bad that, living in DC, our vote has as much influence over the "election" as pissing into the wind; otherwise I'd actually risk being called for jury duty later by going out and voting for Nader (it'd be my first vote in any election in this city since '04, the last time I voted for Nader). I remember posting at Stop Me some time back, discussing how people need to get some balls and approach this freak show the way the Palestinan and Iraqi resistance fighters do -- like people with nothing to lose -- they'd be amazed at how liberating it can be to realize that "elections" in this country don't mean anything and go into it with some other ideas besides whether or not somebody they like is going to "win", or is "electable". Just get totally banzai about it, y'know? At the risk of repeating myself, I think it's time for some "political suicide bombers" to "seize the plane"(*). Banzai, Ralph! Crash that sonofabitch.

Here's the item:

http://news.yahoo.com/s/ap/20080203/ap_on_el_pr/campaign_rdp_31

WASHINGTON - Democrat Hillary Rodham Clinton said Sunday she might be willing to garnish the wages of workers who refuse to buy health insurance to achieve coverage for all Americans. The New York senator has criticized presidential rival Barack Obama for pushing a health plan that would not require universal coverage. Clinton has not always specified the enforcement measures she would embrace, but when pressed on ABC's "This Week," she said: "I think there are a number of mechanisms" that are possible, including "going after people's wages, automatic enrollment."

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(*) Dear Department of Homeland Security:

Mike is being metaphorical here. No need to send the SWAT team.

Sincerely,

The Editor

Sunstein, working for and with right-wing deregulatory think tanks, published a piece called "The Arithmetic of Arsenic", arguing that everyone needs to stop being so emotional about these things. We can't decide whether arsenic should be in our water based on fuzzy-wuzzy arguments about not killing people. No, we need to be hard-headed realists and decide exactly how much a human life is worth and whether filtering arsenic is worth the cost. In short, we have to do cost-benefit analysis.

Open Left diary

If you're a bit sleepy, Sunstein can seem quite reasonable when he's advocating the gentle nudge of a benevolent government. No one wants to be pushed around. Everyone wants good governance. They want to see it pursued with cost effectiveness, a light touch and soothing bromides. Mmm, most people could live without the bromides. In practice the ethic he espouses amounts to selective minimalism and malign neglect, both of which are weighted to shake out beneficially for concentrations of protected, privileged private power. Both of which he supports through narrowly focused jurisprudence. He labels his philosophy "libertarian paternalism". Love and oxymoronic nonsense will find a way. It's all about Benevolence and Pragmatism. Private power won't seek to regulate your snack breaks, within reason, and certainly not at the federal court level, except as needed to defend productivity, workplace harmony and possibly employee insurance costs; you won't thwart liberty through hysterical regulation of toxic dumps.

The diarist notes that it would be easy to dismiss Sunstein as an ingenuous, blinkered ivory tower type -- if he weren't about to take charge of regulatory oversight in the Obama administration. What can I say? He's right.

Who can lick these brutes -- Conyers or Stark? One big slice, straight through the neck -- Conyers' uncle payer plan (HR 676); or the slow bleed to death -- Stark's free-to-choose Medicare bill?

That looks like our pair of prog options -- if we have any options to the fudgepot of corporate rent sumps the health payment and financing system has formed itself into over the past 60 years.

Is there a serious difference here? I doubt there is, in the long run -- given a choice, a la Stark, the citizenry will gradually opt for uncle's medicare system, obviously.

So why, besides the art of the impossibly superior, prefer Conyers' plan? I submit mobilizing for flat-out single-payer now is the only way to pass the Stark slow bleed sooner rather than later.

I find this whole topic tedious beyond measure -- except that the present stymie manifests beautifully and in many dimensions just how corporate control works here in the US ofA.

A solid majority of voters want single payer now -- but they ain't gettin it.

There's a nice purp line up at Alex's place:

http://www.counterpunch.org/mokhiber04162009.html

"The will of the American people is being held up by a handful of organizations and individuals who profit off the suffering of the masses. And the will of the American people will not be done until this criminal elite is confronted and defeated."

... and the Menshevik Stark:

Here's a single-payer-now advocate posting up at Alex's bloc house:

"...Democrats, with the exception of John Conyers and a few others -- don’t want to abolish the private insurance industry.

They are capitalists and believe in the capitalist system that makes health care a commodity to be bought and sold.

For them, [either] health care is not a human right [or] they don’t want to take on President Obama... Like the true cowards they are, they will not oppose Obama on health care reform even though they disagree with him."

1. It doesn’t make health care a human right that can never be taken away.
2. It continues to divide, devalue, and define people by their health status.
3. It can’t address the endemic racial and gender disparities in the system, including the 12 million undocumented.
4. It leaves the employer based system of health care provision intact.
5. The link has to be broken so workers are free to change jobs, go on strike and not fear loss of coverage.
6. The system would continue to have multiple payers [with] the complexity and gaps in coverage that are inevitable when there are numerous bureaucracies to navigate.
7. Where will the money come from to finance the plan? In a time of economic recession.... A public plan [option] is not fiscally sustainable because it’s rooted in a multiple payer system that foregoes at least 84% of administrative savings.

"Single-payer.... would immediately inject 400 billion into the system by eliminating bureaucracy, billing apparatus, administrative waste, advertising, corporate profits, and CEO compensation. That’s enough money to bring everyone into the system with no co-pays or deductibles."

"It’s a proven fact that a single-payer system can cover everyone and control costs. Period, end of discussion."

Enter Health Care for America Now (HCAN). Here's Helen's characterization:

"HCAN thinks it’s impossible to get rid of the insurance companies, they’re too powerful, and they have too much money and influence. They don’t believe a large social movement can be built to take on and win against the insurers and the government.. "The leadership of HCAN are the ones who would have said under slavery, “We can’t win abolition, so let’s settle for a few reforms that make the lives of slaves more bearable.”"

Above, the face of squalid compromise, Rep Sacagaweakowski. A shrewd posssibility artist or a simple coward, or a con-artist sell-out?

Here's the wonderful Ms Redmond taking on the congresslady:

"In a heated exchange with Schakowsky before the rally, [Schakowsky] argued HR 676 (she is a cosponsor of the bill, yes that’s right) has no chance of passing and something has to be passed this year. She lied and said there isn’t enough support for single-payer, but there is for a public option -- We said the insurance industry is going to fight just as hard against a public option as it will single-payer so let’s have a smackdown for single-payer."

Then comes this -- and I feel compelled to ask -- does it swallow its own tail?

"Their solution: the creation of a public plan to compete against the private insurance industry they despise. Speaker after speaker projected a wish list of health care reforms onto the nonexistent public option plan: benefits must be comprehensive, coverage must be affordable, no denial of care, and equal access to quality care. Who could disagree if a plan like that could actually be enacted? The problem is the United States will never, ever get a plan like that while the private insurance industry is still breathing. "

Her thesis:

"Only a single-payer system, one that drives a stake through the heart of the insatiably greedy insurance corporations once and for all, can deliver on those promises."

Then again -- to continue her heroic parallel -- it was half-measure Abe and an army imbued with Unionist horsefeathers that finally "engineered " emancipation. Clio plays bank shots on occasion.

But really, I think Helen needs to be answered in detail. The question becomes a two-parter, both an 'if' and a 'can': if it can pass, where a single payer can't -- then can pub option lead to single-payerlike consequences down the road, or only back to the present profit-cancer hodgepodge?

In order to pre-empt known and possibly unknown sources of hysteria: I owen T S Paine support single payer 100%. Other options are presumed guilty here till proven innocent. Single payer wears the title belt.

In an earlier post I foolishly -- as is my wont, alas -- threw out a lifeline to the pub-option boys led by Peter Starkweather I should have then, and do now, reframe this issue:

Let us examine the pub-op for its potential economic and political dynamic with an open mind and a keen analytic pair of eyes. As I understand it, Father Smiff even as I type this, is hard at work on his portion of this joint project

While you wait, here's a poser by Ms Redmond:

"... why don’t the Democrats and HCAN fight to get rid of the parasitic private health insurance industry once and for all, instead of constantly and unsuccessfully, decade after decade, trying to rein in, regulate, and do an end run around them?"

Owen provocatively passed along an interesting link recently, from one of those "progressive" outfits that likes to drape itself in the flag (their logo is shown above). Old SMBIVA hands will know that this is like catnip to me.

Owen's teasing lead takes us to the Campaign For America's Future, and in particular to the blog of one Bernie Horn.

Bernie reports ecstatically that a secret poll, taken by the infamous Dr Frank Luntz on behalf of the convalescent Republican Party, has now become public. Bernie seems to feel that this is like stealing the other team's game plan. Now we've got 'em, by God!

In fact Luntz's report -- all 28 pages of it -- contains few surprises. It's rather gratifying to read, even so. Lantz finds that people aren't interested in economic theory, for example. Notions like "competition" and "the market" leave them cold. What scares them is the idea that a "government bureaucrat" might interfere with their health care. Based on my own experience with government bureaucrats, this seems like a well-founded worry.

It's an interesting example of the complementarity and (perhaps unconscious) collusiveness of liberalism and so-called conservatism. Nobody, or almost nobody, trusts a high-minded liberal soul-engineer. And with good reason. Anybody who's ever had a long-faced meeting with his kids' teachers, or had a "social worker" visit his house, is likely to feel inclined to join the NRA and perhaps provision a bunker somewhere in Idaho. The so-called "conservatives" -- actually, of course, corporate millennarians -- can then come along and pick up these chips of justified resentment.

The Gummint Bureaucrat, Luntz concludes, is the only bogeyman available. Nobody wants that sinister clown in his life.

It's worked before, and it might work again. If it does, liberalism has only itself to blame.

Interestingly, the progressive Bernie Horn cedes some ground that the reactionary Dr Luntz didn't claim. Bernie cites a market-researcher named Celinda Lake, shown below:

Celinda has impeccable "progressive" credentials, which is to say that she only works for Democrats. Bernie attributes to her this insight:

Lake has made it clear that Americans strongly support progressive legislation to guarantee quality, affordable health care for all, as long as they can choose their doctor, their healthcare package, and their insurance provider.

It's noteworthy that Luntz's report mentions "providers" only once (and "packages" not at all). Luntz's reference to "providers" occurs in a negative context. He's telling his clients what NOT to say. Don't say this, Luntz advises:

[Health care reform] will put private healthcare providers out of business so that everybody will eventually be in a lower quality gov’t program.

It would be fun, in a modest way, to have Lake's and Luntz's wise and pricey lucubrations displayed in parallel columns. Perhaps somebody will leak (if not drain completely) the Lake, so the hapless public can see in the round what advice its adscripti-patres are getting from their respective resident gnomes.

From AFP:

"President Barack Obama is Monday to outline plans to cut US healthcare costs by two trillion dollars over the next 10 years, part of a bid to slash spending while making treatment more affordable.

Obama is expected to detail what he will describe as an "unprecedented commitment" by six major healthcare lobby groups to limit spending increases over the next decade, senior administration officials said on Sunday.

The White House hopes the voluntary plan -- drawn up by groups representing insurance firms, hospitals, doctors, pharmaceutical makers and a labor union -- could eventually save US families as much as 2,500 dollars a year."

List of sponsors:

"America's Health Insurance Plans, the American Medical Association, the American Hospital Association, the Service Employees International Union and the Pharmaceutical Research and Manufacturers of America."

For connoisseurs of intellectual comedy, here are the Schumer provisos:

• The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.
• The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.
• The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.
• To prevent the government from serving as both “player and umpire,” the officials who manage a public plan should be different from those who regulate the insurance market.

"In addition, Mr. Schumer said, the public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims, [and] the public plan should be required to provide the same minimum benefits as private insurers."

Addendum, from MJS:

Doug Henwood passed along a press release he got from SEIU about this come-to-Jesus movement by some obviously frightened sinners:

SEIU Announces Unprecedented Coalition to Save $2 Trillion in Healthcare Costs, Pass Obama Healthcare Plan

‘Game-Changing’ Moment Marks Success of Union’s Long-Term Investment and Leadership in Healthcare Reform Efforts

WASHINGTON, DC— "Today, four years of unrelenting efforts by SEIU members to create a new American healthcare system that lowers cost, improves quality and is affordable for every American took a giant step forward.... From the start, SEIU has worked with the belief that this is not a Democratic problem or a Republican problem – it’s an American problem....” said SEIU President Andy Stern.

Service Employees International Union, AdvaMed, American Hospital Association, PhRMA, America’s Health Insurance Plans and the American Medical Association have met with President Obama and committed to the President’s vision of meaningful healthcare reform that guarantees every American access to affordable, high quality healthcare. In a moment being charactetrized as a “game changer” by the Administration, the organizations pledged to take aggressive steps to cut healthcare costs that could save the country $2 trillion over ten years and save each American family roughly $2,500 a year.

“If we are going to get our economy back on track, we must tackle the growing healthcare crisis. Everyone – physicians, hospitals, healthcare workers, payers, suppliers, manufacturers – shares responsibility in making sure healthcare reform happens this year,” said SEIU Healthcare Chairman Dennis Rivera. “We all understand that guaranteeing meaningful reform is too important to be left to politics. It’s a moral imperative, an economic imperative, and essential to the well being of every family in our country.”

From the Divided We Fail, Better Health Care Together and Partnership for Quality Care coalitions, which include disparate groups like NFIB, Business Roundtable, Wal-Mart and AT&T, to the progressive coalition Health Care for America Now, SEIU has worked to bring key healthcare stakeholders to the table to ensure reform could happen. As the nation’s largest union of healthcare workers – doctors, nurses, pharmacists, technicians and others – our workers understand that reducing costs is critical to promoting health and preventing illness.

“It’s a sign of how committed industry leaders are to reforming our healthcare system that these groups were able to come together and offer proactive proposals on cutting healthcare costs. Cutting healthcare costs means improving the quality of care patients receive, putting money back into families’ pockets and keeping businesses open on Main Street. We may not always agree, and haven’t in the past, but we know that this is the moment and now is the time to fundamentally change the way we take care of American families and workers,” added Rivera.

“SEIU is firmly committed to bringing about real change to our healthcare system that includes a public health insurance option that provides people with a choice of a public health insurance plan, gives them greater control over their healthcare and creates much needed competition,” said Andy Stern. “As providers and consumers, SEIU has played a leading role in the efforts to reform our national healthcare system for years because we know our members, their families and their communities cannot wait any longer for change that works.”

- ### -

MEDIA NOTE:

Background on SEIU’s efforts to reform the national healthcare system, which include:

• Challenging Fortune 500 companies to contact us about the nation’s failing healthcare system to discuss possible solutions; convening coalitions of business, provider, academic and labor representatives to create a climate and impetus to make healthcare reform a top priority;
• Co-hosting the first presidential forum focused on healthcare reform; and
• demanding that every candidate running for president produce a comprehensive healthcare plan in order to be eligible for our endorsement;

... can be found at www.seiu.org.

SEIU would no doubt respond that this is a case of stealing the enemy's clothes. But if the point of this clothes-theft is to act like the enemy, then why should the rest of us prefer the robbers over the robbed?

My darling imp, Harvard Yard's own Greg Mankiw, recently weighed in on the pending pub-op plan. Here's Greg, lasering to the nub right up top:

"Most discussions of the issue leave out the answer to the key question: Would the public plan have access to taxpayer funds unavailable to private plans? If the answer is yes, then the public plan would not offer honest competition to private plans."

Now I know that not a soul reading this gets swayed by such a caveat. We pwogs of the saber-toothed variety couldn't give a Dutch fuck if "taxpayer subsidies would tilt the playing field in favor of the public plan," because for us heroic crypto-socializers the pub-plan-op is at best "a disingenuous route toward a single-payer system."

I think Greg is wrong even on his own terms, and I think he knows it. The imp hasn't counted all his potential tilts. Some are costless and sufficient.

But let me back up first. Let's look at a GSE like Fanny and Freddie. Are those taxpayer funds at work? Well, not so anyone regular should care. Yes, Uncle's implicit guarantee reduces their borrowing costs; but hey, that doesn't come out of the hides of taxpayers like you and me, does it?

Maybe Greg intentionally leaves something out here -- I doubt he misses much of anything in these waters -- but he's clever, he has an escape hatch in his use of the fuzzy phrase "taxpayers' funds". And if one takes the bait -- and surely we're meant to (note the slip into the use of the word 'subsidy') -- then we assume Greg means some sort of overt taxpayer cost, which indeed raises hackles.

You could so twist these words around to make a pub-plan option "standing on its own financially" look like "a private nonprofit plan," but "in essence" it would hardly be so.

Any civic "foundation" has to pre-build an adequate endowment before launching itself. On the other hand, an uncle-backed outfit simply issues bonds that in the event won't require any out of pocket taxpayer subsidy.

Uncle's guys could quickly be up and running and over the initial hump to the point where they're servicing their fixed costs and starting to retire their sunk costs out of operating margins like any viable privateering corporation does.

No operating subsidy needed, especially if the new outfit is just an add-on to medicare with its already existing facilities and staff.

Obviously if the criterion is Greg's "fundamental viability of the enterprise", then any startup hump is irrelevant, right?

Greg tries closing his argument with this: "But then what's the point [of a public plan option]? ...If advocates of a public plan want to start a nonprofit company offering health insurance on better terms than existing insurance companies, nothing is stopping them from doing so right now."

See, Greg wants us to conclude the reason these non-profit options don't already exist is because there aren't any worthwhile savings there to capture. Indeed the non-profit, with its eunuch's driveless nonprofit constitution will prolly higher-cost themselves out of existence.

T'ain't so, and Greg knows it, or he wouldn't be blowin' his casuist's sax like this.

Yes, a pub-plan option could be a competitor to be feared, Greg -- but not because it might have availible to it some taxpayer subsidy. Yes, Greg, you're right: unlike sleeping under bridges, "There is free entry into the market for health insurance."

But no, it does not follow that if a public plan without a taxpayer subsidy "would succeed, so would a nonprofit insurance company."

The real reason there are no viable non-profits today is simpler: what if a nonprofit on the scale necessary to capture these known economies is, as a practical matter, unconstructible by civic action alone?

If so, then Greg's "bottom line... honest competition in the provision of health insurance" does not lead to his conclusion that "a public option cannot do much good," since if it could some private goo-goo outfit would already be doing it.

Nope, Greg, you can't exorcise the spectre with that facile florish. Stay tuned, and see what, if anything, can fell PPO.

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PS: Greg gives his overanxious tilt away right at the end by adding this bit, quite gratuitously and without further support: a public option "can potentially do much harm."

Well yes it can -- to the private profiteering insurance ghouls; but not to the pocketbooks of us little schmucked-up tax- and premium-payers.

Tom Daschle, of course. From The Note:

"While I feel very strongly that consumers should have the choice of a national, Medicare-like plan, my colleagues do not... But we were concerned that the ongoing health reform debate is beginning to show signs of fracture on the public plan issue, so in order to advance the process of developing bipartisan legislation and to move it forward, it's time to find consensus here."

Let's cut the shit here, with some serious surgical precision: when it comes to health insurance it's either 676(*) or 666. There is no goo-goo in-between.

That about gets to the nuts of the pink-rad smackdown on public-option, eh?

I for one recall all too vividly your humble happy commentman here forced into a dung-beetle crawl through comment cage after comment cage, pursued by a 676er of self-described highest pink pedigree.

But it seems I'm not alone on the flabby left. In fact my defanged stalinoid friends over at People's Weakly are into dive-bombing these 676-or-bust stalwarts. Here's a fusillade fired there recently by one John Rummel:

Narrow thinking on health care

The single-payer bill introduced by Michigan Rep. John Conyers, is a fine piece of legislation and it is understandable that those who have worked hard for its enactment are passionate about this cause.

What is not understandable is the drawing of a “line in the sand” that divides those fighting for health care reform between supporters of 676 and those supporting a strong public option....

Would people who haven’t had health care for years and have no present hope of having it dismiss the public option saying “No, let’s wait for something better”?

But the meliorites argue on, as in this by impatient temporizer Kount Krugula:

The solution to climate change must rely to an important extent on market mechanisms — it’s too complex an issue to deal with using command-and-control. That means accepting that some people will make money out of trading — and that yes, sometimes trading will go bad. So? We’ve got a planet at stake; it’s crazy to cut off our future to spite Goldman Sachs’s face.

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(*) HR 676, that is, the single-payer bill.

It appears that all our scholastic disputations here about single-payer and public-option were moot: we're not going to get either one:

AP: Public Option Nixed from Health Bill
Senate Committee Said to Jettison Gov't Plan and Employer Mandate, Both Top Democratic Priorities

(AP) After weeks of secretive talks, a bipartisan group in the Senate edged closer Monday to a health care compromise that omits two key Democratic priorities but incorporates provisions to slow the explosive rise in medical costs, officials said.

These officials said participants were on track to exclude a requirement many congressional Democrats seek for businesses to offer coverage to their workers. Nor would there be a provision for a government insurance option, despite President Barack Obama's support for such a plan.

It's really a perfect, textbook example of the way the Democratic Party scam works. The party consists of two components: shills -- otherwise known as "progressives" -- and aisle-crossers. The shills -- people like Barney Frank, say -- get the suckers into the tent by denouncing imperial war and advocating reasonable things like card check and a sensible health care system. Once in the tent, the suckers get mugged by the aisle-crossers -- people like Lieberman and Baucus -- who make sure that none of these reasonable things actually happen.

Most liberals are able to see this pattern, and their indignant response is that "we" -- meaning the Democratic Party(*) -- should get rid of the aisle-crossers, since they are obstructing "our" agenda.

This is like telling a lobster that he ought to get rid of his right claw.

The passionate tango of shill and aisle-crosser is the Democratic Party's summation of the law, its institutional life process, its raison d'etre. A lobster wouldn't last long without his right claw, and the Democratic Party, in anything like its present form, wouldn't last long without the aisle-crossers. They're a vital organ. If you live by seducing and then mugging people -- which is what the Democratic Party does -- the mugger is as indispensable as the seducer.

And both are equally contemptible.

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(*) This construction always puzzles me. Sports fans do the same thing. I know plenty of people who refer to the Yankees as "we", and none of them is named Steinbrenner.

If the embed doesn't work: http://www.youtube.com/watch?v=xOB1zOBr7IM

YouTube URL, if the embed doesn't work:

http://www.youtube.com/watch?v=FFK9XuXCeno

As Salon describes it:

Grayson digs in deeper

House Republicans wanted Rep. Alan Grayson, D-Fla., to apologize for saying the GOP healthcare reform plan is "don't get sick," and if you do get sick, "die quickly." And Grayson did head back to the House floor on Wednesday to discuss his remarks -- but the apology the congressman made is probably not what his Republican colleagues had in mind.

"I would like to apologize -- I would like to apologize to the dead," Grayson said, citing a recent study that showed almost 45,000 Americans die each year in part because of a lack of health insurance.

After, a Rob Reiner among progs:

The squalid compost heap labeled "healthcare reform" by a peacock-proud Nanikins, the popeyed dominatrix of the House, has provoked a lot of harsh stuff -- but an especially beautiful piece of pink hysteria is over there at Counterpunch, written by one Jay Fred Murphy. Tidbits:

"The Democrat Congress gave us a corporate driven healthcare bill which amounts to nothing more than a de facto bailout of the healthcare insurance companies.... Imagine promising the poor and desperate people of this country healthcare reform and passing legislation which will not only hurt the working class but strengthen the very forces which oppose real reform – the healthcare insurance companies... spread misery on national level [and] destroy any possibility for meaningful healthcare reform for the next 40 years."

And the man can wander off topic pretty fair, too. He gives us a marvelous detour back in time through the Clinton wallow -- it's quite a Mr Toad's wild ride -- before we get down to an account of some of the highlights of this house bill of abominations, which

"... will not only drive up insurance costs but will not even permit the government to negotiate with pharmaceutical companies, thereby driving up pharmaceutical costs as well! ... Americans will now be forced to buy health care plans from private insurance corporations. Forced! ... What a choice: buy insurance coverage or pay a penalty of hundreds or even thousands of dollars per family if they decide to forgo insurance"

"A little arithmetic... Imagine a family at roughly 300% of poverty -- around $55,000 a year. It will cost them in the neighborhood of $15,000 in taxes, $14,000 in mortgage or rent; close to $20,000 on childcare and they'll need around $7,000 for food. That puts them in debt already! Now they will be forced to buy health care... forced! Under penalty of law! Even with government subsidies they will still be in debt!"

"The Senate version of health care reform is even more draconian than the House version."

But enough of this self-indulgent delighting. The reason I posted this lies elsewhere. See, ah -- well -- the piece actually stars none other than Father Smith's wrestling partner, and the nation's prima ballerina of the center aisle, nutmeg senator Joe Joementum Liebfraumilch.

"The real hero of this tragedy [is] Joe Lieberman [who] promises to join a Republican filibuster!"

"While it is never morally acceptable to do something wrong even for a good reason (the ends never justify the means), it is always morally acceptable to do something right even for the wrong reasons!"

"Lincoln -- did not free the slaves because it was the morally correct thing to do. He did it for political reasons but nevertheless he did do it and it was the right thing to do."

The highly moral moral:

"We may not like Joe Lieberman and Max Baucus but ironically we may be in their debt if they are successful in preventing this very dangerous piece of legislation."

Even Dennis K gets a look and a pause to consider, well, the very topos of this blog:

"Perhaps Kucinich does more harm than good by remaining in such a party. By remaining a Democrat he legitimizes the actions he opposes and keeps millions of well intended people from forming a truly progressive opposition party believing the myth that the Democrat Party can be changed from within."

The Senate's Christmas gift to us all was a massive giveaway to the insurance companies, with some nice stocking-stuffers for the pharmaceutical vultures. Surprise, surprise.

I happened, during the festivities of the season, to encounter an old friend of mine, a clever and decent chap whom I like and admire. He has a staff position of some consequence on the Democrats' side of the Senate, and he was was over the moon with joy about having passed this abomination of a bill, though the last time I remember talking to him about it, he was expecting, or at least hoping for, a good deal more from health care "reform".

We didn't really get a chance to get into it, but if I understood him right, he was happy that they had been able to pass something, no matter how awful. This was an achievement, it seems -- even a win. Our Team put some kind of a ball through some kind of a hoop, or between some kind of poles, or over some kind of wall, or something. The Other Team didn't want us to do anything, but we did something. And even though it was kind of an awful something, that means we put a point on the board! We can hit the campaign trail next year and say, hey, we gave you... well, never mind exactly what. We scored, that's what matters.

My friend, of course, is a career Democrat -- though in his private life he is a conscientious and exemplary human being, a doting father, and excellent company over the dinner table. He is an excellent example of how participation in the Democratic Party teaches otherwise intelligent and decent people to lower their expectations so far that what any ordinary uninitiated person would consider defeat smells a lot like victory.

Harvard has spoken:

Lack of health insurance is associated with as many as 44,789 deaths per year in the United States.

Of course observational science and its attendant measurements have limits, both by design and by ungovernable desires. this study was by a batch of single-payer enrages.

A "finding" like this unfortunately sounds hysterical to the untutored imp-mind of a person like... well, me. are undetected and or untreated morbid processes really killing off that many of us each year? Unlike seat belts, the life-extending benefits of wearing health insurance can't be quite so simply and directly counted.

The grail number here in this study is 1.4 -- i.e. the uninsured are 40% more likely to die this year then their corresponding insured fellow citizens. Now no one can sanely deny that folks cruising through their daily routines with undetected hypertension, diabetes, or testicle tumors are in the same potential category of quart-a-day bourbon drinkers and sky divers; but how would one go about measuring this added mortality risk?

You'd have to check out death rates among the uninsured and a corresponding cohort of insured -- in effect compare each uninsured person to his covered twin -- "covered" here meaning insured for the prior three to five years, and twin meaning -- ideally -- "identical" in age, sex, income, ethnicity, education, blah blah blah... you know, corrected for the basic dimensions such sociostats usually include.

I guess the scarcity of these studies in ready public supply prolly proves "we got a problem, Houston", since one can probably conclude that the information shortage occurs because any interested party with bucks enough to fund such work prolly would find any death claims are death claims too many, to paraphrase tail gunner Joe.

But be they what they may, these numbers -- do they increase the collective urgency of the 85% of us McJob smurfs already covered? Do we hear these numbers... if we hear these numbers... and go "Oh my God, stop this insanity! Uncle! Plese cover the other Americans out there uncovered! Where do i send my check?"

Or is it like earthly climate change, to people living on another, climate-controlled planet?

Okay, confession time. I've always had a sneaking fondness for Dennis Kucinich, ever since his madcap days as the boy mayor of Cleveland, when he made the "business community" so hot under the collar that they started to exhibit random quantum effects, winking in and out of existence and leaving half-dead cats strewn in the streets.

Oh, I always knew better. I mean, the guy's a Democrat. Doesn't even try to hide it. But I couldn't help myself. It was my dirty secret.

So it's a relief to see the "maverick" neatly lasso'd by Rahm Emanuel & Co., and meekly proclaiming his support for the Great Insurance Company Pig Trough, aka "health reform":

Mr. Kucinich said he would keep working for a government-financed single-payer health care system. But after coming under intense pressure, which included a visit to his district on Monday by Mr. Obama, Mr. Kucinich said he did not want his objections to stand in the way of the legislation.

“If my vote is to be counted, let it count now for passage of the bill, hopefully in the direction of comprehensive health care reform,” Mr. Kucinich said.... “We have to be very careful that the potential of President Obama’s presidency not be destroyed by this debate.”

I was so cheered by this gratifying news, so glad to have this discreditable little monkey off my back, that I felt up to a quick tour through the pwoggo blovosphere. Here's a representative take from Kos -- literally the first post on this subject that my eyes lit upon in the orange bog:

Kucinich and ... Michael Moore have, by their own words, taken one for the president.... both plainly say it should be passed because of their desire to see President Obama's presidency succeed....

Try to let that sink in. They want the right-wing attempts to delegitimize [Obie] to fail. They do not think this bill is real reform (the word "detest" comes into play), but will support it anyways. I respect both men and absolutely take them at their own words.

Kucinich conceded that he decided to swallow the bill because failure would be a threat to Obama’s overall agenda. Moore said, "Pass it because, if President Obama takes a fall on this one, I don't know if he'll be able to get back up. And then NOTHING will get done. We can't have that."

A gloomy picture. But there are some grace notes of low comedy that you can always rely on; like the preposterous macho rhetoric these Dembo weenies love so much, which becomes ever more more purple in direct proportion to the hapless abjection and cringing slavishness of their politics. "Take one for the president," forsooth!

Here's Paul "bellwether" Krugman, liberal conscience terrier, summing up Obomneycare (hopefully for the last time):

".. withdrawing coverage... is [now] widespread... for a simple reason: it pays.... Employment-based health insurance... is unraveling.

Americans overwhelmingly favor guaranteeing coverage to those with pre-existing conditions...To make insurance affordable, you have to keep currently healthy people in the risk pool, which means requiring that everyone or almost everyone buy coverage... You can’t do that without financial aid to lower-income Americans so that they can pay the premiums...

You end up with a tripartite policy: elimination of medical discrimination, mandated coverage, and premium subsidies."

Here's the cost arch versus the status quo arch, according to Krug -- per CBO 'findings':

"the proposed legislation would reduce the deficit by $138 billion in its first decade... [$14 billion on average per year -- peanuts, anyone?] ...and half of 1 percent of G.D.P., amounting to around $1.2 trillion, in its second decade."

To put this in perspective one needs a few more embedded number assumptions. The health sector is currently gaining GDP share. The numbers look something like this: the difference between general inflation and health sector inflation per annum revolves around 5% -- 8% health-sector vs. 3% over all. So the rest of the economy is inflating at a little over 2%.

Watch Mr Fright Graph climb!

The health sector share is now 15% of GDP. But if the health sector is inflating at 7-8% a year -- doubling every 10 years or so -- then as the sector grows as a share of GDP it would "pull" the overall inflation rate up towards itself. For example, if the health sector share gets to be 1/3, then the inflation rate of rest of the economy would only "out weigh" it by two to one, instead of today's six to one. At that point, with an 8% health sector inflation rate, to keep the overall rate down to 3%, the rest of the econmy would have to inflate at less then 1%. Yikes, that's the verge of the infamous deflationary trap!

Where does that put this bill's cost control measures?

If we stick to the bill's projected outcome -- twenty years or so to close the rate gap -- is that really bending the cost curve fast enough? Of course not.

Obviously, despite the patent cost crisis, price controls are far from "job one" here. In fact, despite all the circle-dancing and arm-waving, it looks to me like cost control ain't a serious part of this bill at all. It's behind numero uno: insurance profits; numero dos: health sector profits and fees; and numero last but not least in the hearts of googoos everywhere, the humane crusade to cover the uncovered.

A nice lapidary exchange today between Doug Henwood and another participant -- let's call him Aquifer -- on lbo-talk:

Henwood : Forcing people to buy shitty insurance from private vendors is outrageous. Subsidizing that is also outrageous. Nice if you're an insco, though.

Aquifer: Then why do they oppose it now?

Henwood: They do? I thought they'd been pretty quiet. They wrote the draft of the Senate bill, which is pretty much what they're voting on now. Wall Street seems happy with events: over the last year, Aetna stock is up 40%; United Health, almost 60%; Wellpoint, almost 80%; and Cigna, 100%. All but Aetna are outperforming the S&P, which is up just 50%.

We have a passed health bill before us!

Viewing this hideously huge and mutilated brute of a thing I'm reminded of the great William Lloyd Garrison, shown above looking a little like Noam Chomsky around the mouth, and his support for Lincoln and his war.

Recall that Garrison disdained all electoral politics and politicians for 30 years or more -- "I will be as harsh as truth, and as uncompromising as justice". So far as he and his abolition crusade were concerned, the federal system he faced was the slavers' system, plain and simple: a system cursed from its star-chamber conception, from its very genetic code. Indeed, every July 4th -- from some time in the mid-1850's -- ole Bill publicly and conspicuously burned the US constitution in front of a large picnic gathering of righteously reveling "African slavery abolitors".

Garrison even advocated "non-violent secession" as the solution. not electoral circle dancing -- secession of the free states, of course, or any compact grouping of free states (New England, say).

Then after that long and steadfast record of total rejectionism comes his Lincoln moment. Many of his followers and friends quite naturally found it nothing better than a squalid betrayal of his burningly pure ideals, and yet he never wavered, so far as I know, when Clio allowed glorious reform to enter stage right in the person of a giant ape of a railroad lawyer.

This craggy-looking quondam "rep" from the western outlands, this second-rank Illinois pol, probably from the shallowest of opportunist waters... But apparently Garrison knew his man when he saw him; knew him for what he was, and in spite of that, for what he would become. He knew this man, by waging a disgraceful, corrupt and bloody war for "union", would at the same time by steps inevitable liberate the enslaved of the South.

Yes, he favored just letting the South go, at first, but when war came Garrison discarded that stance and plunged willingly, publicly and controversially into the fight, sending a son to join the scrap with a black regiment.

A lesson there somewhere, I think, and one worth much pondering, brothers and sisters.

Owen and I obviously have a very different take on the "health reform" with which Obie & Co. have just presented us. Among his other reasons for seeing the glass half-full, Owen cites the likelihood that at least some people, under the new regime, will get some health care that they wouldn't have gotten otherwise.

Personally, I wonder if this is even true -- whether premiums and copays and caps won't go so high that the net effect on people's health will be negative. But let's say, arguendo, that Owen is right. I still hate it.

Now I don't like to think of myself as a hard-hearted person. But alarm bells go off in my head when I hear arguments like this -- we need to buy, mentally if in no other way, into some corporate-aggrandizement pile-o'-crap like the health "reform" because otherwise, People Will Die. And their deaths, in some obscure way, will be our fault.

It seems a lot like the lesser-evil argument, in fact. Vote for the Democrats -- and ratify their stampede toward war, immiseration, and the police state -- or Even More People Will Die under the other gang's rule.

I used to view this kind of thinking as taking short-term gain even if it means long-term loss. Now that's not an entirely unreasonable thing to do. After all, the loss is tomorrow and therefore conjectural, whereas the gain is today -- or at least, later this afternoon -- and at least somewhat more nearly certain. And who knows, maybe, by tomorrow, the horse will learn to talk. There's a case to be made -- as long as there's a real choice to be made.

But maybe this model -- choosing short-term versus long-term -- doesn't quite fit our case: those of us, I mean, who don't have any actual choices to make, except about what we think, and what we say.

Dennis Kucinich -- recently pilloried here for his cave-in on the "health" bill -- might be able to make this argument. His vote, presumably, made a difference. If he had voted No, and the bill had failed, and if those People Had Died -- if they could really be known to have died on account of his vote -- then maybe he could plausibly tell us that his conscience would be uneasy.

But for those of us in the peanut gallery, it's just empty grandiosity to think that our wonkish twitterings make any difference to the near-term outcome. They don't; and so I'd say we have not only the luxury but the duty to say, "the hell with the near term, if it means further aggrandizement for those thieves in the insurance companies." Nobody will die on account of us telling the truth; so don't we have a duty to tell it? And maybe, just maybe, something one of us says somewhere will open somebody else's eyes a little bit.

But we're certainly not serving enlightenment by spreading yet more gray-vampire "realism": more hopeless, resigned, take-what-crumbs-you-can-get defeatism. That just amounts to apologetics for the Dembo Judas goats who lead us every day a little farther into the abattoir. Its only effect is to drain away people's indignation and whatever impulse they might have to resist.

And that -- our steady progress deeper into the slaughterhouse -- brings me back to the short-term/long-term argument. It's too kind to the Kuciniches, even, I now think -- too kind even to the people who do have some responsibility for outcomes. They ought to be able to see where all this is going. They're not simply in the position of people who have to weigh a conjectural near-term good against a conjectural long-term harm, in a world characterized by stationary probabilistic processes. Rather, they are in the position of people who can see a blatantly obvious project being carried out before their eyes, step by step, and who must choose whether to facilitate it or monkeywrench it, to the best of their ability.

Dennis chose to facilitate it, as far as I can see. So if MInos drops me an email asking for advice about Dennis, I'll tell him, Send the little fuck straight to the hottest patch of burning brimstone you've got.

http://hcfan.3cdn.net/415b606e9dc7b1655c_w2m6ibgwg.pdf

Industry Trying to Undercut Congress,
Weaken Provision Worth $1.9 Billion to Customers

Say we spread that $2 billion savings over 100 million premium payers. That's 20 bucks a year each. And what was your annual premium, last time you checked?

Oh my God! If the elephant boys retake the Hill -- no $20 rebate for you!

Kevin Zeese wants to stop corporate masked political messaging by lawsuit, because "big business interests are using non-profit front groups to hide their donations in an effort to dominate the elections anonymously."

Seems the corporations don't want to insight us, eh?

He then goes on to make this point: "concentrated corporate power is the central issue creating dysfunction in government."

Example: "Concentrated corporate power prevented a real solution to the health care crisis in America because the insurance, pharmaceutical and for-profit hospitals would not allow real reform."

I note "for profit" used here as if nonprofit hospitals aren't part of the problem, or AMA doctors, or or or....

If you over-focus on the for-profit corporate form you miss the full thrust of these interested parties, whether it's hospitals or universities or churches or professional associations. These huge nonprofit formations are as surely enemies of the interests of us common people as any Wall Street private equity fund.

Even if we someday get single-payer, even if we purge "for-profit corporates" out of the health services industry entirely, the remaining interested parties will fight like hell to retain their advantages, whether they form up as for-profit corporations or remain as pristine, as free of private profit motives, as, well... the Roman Catholic hierarchy!

In local news... the famed three-headed dog, formerly set to guard the entrance to Hades and now in the private equity business, just got the OK to buy the Boston archdiosece hospital "chain" Caritas.

And it's not just the pope that's cashing in chips here; lots of public hospitals are on the auction block too. In the words of our reliable chronicle the WSJ: "Many governments are selling or forging partnerships with for-profit entities to offload their public hospitals". Counting all sales, public, sacred, profane but private: "53 hospitals, totaling $3.1 billion".

Should honest altruistic hearts fibrillate over this revoltin' development? I say no. As far as I'm concerned, bring on the for-profit wrecking crews.

And why? Because there's real investing to do here in new technology? No: because Soviet enterprise methods have led to absurd cost sumping. Hospitals need to be destroyed to save our childrens' childrens' childrens' health and welfare.

I know, I know, we SMBIVA types are supposed to figure the gouger profiteering corporate maxi/min boys will reduce quality, reduce wages, and raise prices anyway. Maybe so.

But they sure as hell will knock the Holy Joe act out of the operating room and the convalescent ward once and for all. Hospitals like colleges need to shed their fraudulent sheep's clothing. Non-profit? My ass! Doing well by doing good has turned health care into rampant petty all-against-all sharking worthy of Volpone, and openly going Wolf, Incorporated opens the door to socialization and a national health system.

Okay, okay, so that's only the first of N doors we gotta open to get to a comprehensive national publically owned and operated health system. But you gotta trust in Clio here. The gal knows how to use these corporate octopi to do Her dirty work for her.

Cool off, it isn't the SS taking over here. Maybe you don't need a Himmler after all, for every single world-historical purpose? Maybe just Hacksaw Duggan in a Savile Row suit, two-by-four in hand, a taste of Old Testament house cleaning... an updated Hebrew judge.

... is right twice a day.

SMBIVA is not exactly a fan site for the judiciary branch, but let the record show that Bush-appointed judge Henry E. Hudson has done a truly marvelous thing, and I am not being one bit ironical:

A federal district judge in Virginia ruled on Monday that the keystone provision in the Obama health care law is unconstitutional....

In a 42-page opinion issued in Richmond, Va., Judge Hudson wrote that the law’s central requirement that most Americans obtain health insurance exceeds the regulatory authority granted to Congress under the Commerce Clause of the Constitution.

The judge wrote that his survey of case law “yielded no reported decisions from any federal appellate courts extending the Commerce Clause or General Welfare Clause to encompass regulation of a person’s decision not to purchase a product, not withstanding its effect on interstate commerce or role in a global regulatory scheme.”

The insurance mandate is central to the law’s mission of covering more than 30 million uninsured because insurers argue that only by requiring healthy people to have policies can they afford to treat those with expensive chronic conditions....

The administration has said that if that [insurance mandate] eventually falls, related insurance reforms would necessarily collapse with it, most notably the ban on insurer exclusions of applicants with pre-existing health conditions.