More Vitriol Toward my Fellow Lefties

I am in the process of working on a broader piece regarding the split between the so-called activists versus the more incrementalist wonks on the health care bill (focusing particularly on the ludicrous notion of a possible netroots and tea party convergence -- holy fucking dimestore Marxism, Batman!). In this narrative, it's the true-blue lefties as embodied by Jane Hamsher and others at Firedoglake, the kosacks, Glenn Greenwald, the Huffpost, and (maybe) Atrios versus the more tepid and technocratic -- Ezra Klein, Matt Yglesias, Josh Marshall, and Nate Silver, among others.  

Now although I read and enjoy to varying degrees each of the above, I have always identified a bit more with the activists group -- largely because of my own propensity for hot rhetoric and a certain visceral pleasure in the brotherhood (and sisterhood) of outrage.  But I have to say, my frustration with large aspects of the activists group continues to grow, not simply because we have come down on a different side on the merits of the current health care bill, but because I have found their arguments to be fanciful, evasive, and extraordinarily badly reasoned on both practical and policy grounds.  (And let me repeat -- I am in favor of single payer and think it would be the best outcome -- but it is not going to happen now or in the foreseeable future -- there are not even close to 50 votes for it in the Senate.)

Recently, both Nate Silver and Ezra Klein have posted pieces in which they pretty much eviscerate the arguments of the activists.  Read them both -- I can't add much.  I was ready to move on to the broader issue above, when I read this piece by Marcy Wheeler at Firedoglake and it made me cringe anew.  It's just filled with disinformation and demagoguery and completely disconnected from reality. 

Wheeler (whose work during the Scooter Libby case I quite liked) rips the Senate Health Care Bill for requiring the American peasantry to pay feudal tribute to our insurance company overlords.  The offense -- a hypothetical family of four with a total income of $66,150 would be expected to pay $540 a month for insurance.  Now, I am not minimizing the burden of this, but what the fuck does Wheeler think said family is paying now for insurance?  I was just bargaining a contract today where the health care provided to union members on a composite basis (under a self-insured non-profit plan) is $12,500 a year, which is oddly enough, a good deal.  As an employer, I can tell you that my law firm is shelling out closer to $1,500 a month to cover our employees through private insurance.  In other words, being able to get insurance for a family of four at approximately $6,500 a year is a substantial improvement over the status quo. And it's the status quo to which the bill needs to be compared.  Because if the "kill-billers" have their way, that's where we will be -- not in some future health insurance utopia, but the ugly reality of now, with 45 million or so uninsured and costs pressuring our employer based system to its limits.

Similarly, Wheeler's fulminating about out of pocket expenses and copays is also misplaced.  Right now, there are simply no legal limits on these items -- under the Senate bill there will be such limits, even if they are not as low as one ideally would like. Once again, the comparison needs to be to the actually existing world if no health care bill is adopted. 

Wheeler also claims that insurers would make profits of up to 15 to 25% on the premium dollars of our hypothetical family.  She does not show her work.  Her assumption seems to be that every dollar not spent on reimbursing health care providers is "profit" to the insurer.  I hope that isn't the case, because it would be tragically stupid.  All insurers, including not for profits, have certain overhead costs that are associated with paying claims.  For instance, the salaries of the people who pay the claims, the people who audit the claims payments, the people who open the mail, sweep the floors, sign up doctors and hospitals, negotiate discounts with same, process appeals, process premium payments, keep the highly sophisticated claims payment computers and software up and running, insure compliance with privacy regulations, process COBRA notices and premiums -- well, you get the idea.  Ah, you say, well with "Medicare for all" we could avoid these costs.  Um no -- who do you think pays Medicare claims?  Well, the same private insurers who act as government contractors to process Medicare claims.  (No, government employees do not do this.)

I have worked with self-insured, union health plans for 25 years.  They do not make profits, they do not pay exorbitant CEO salaries, they don't advertise -- nonetheless they typically have administrative costs that are at least 10 - 15% of the premium payments.  It's just that labor and information intensive an endeavor. 

Now I am opposed to for-profit health care insurance.  I consider it a waste.  But it is not an industry in which 25% profit margins are being made.

Wheeler also conflates out-of-pocket expenses to payments to the insurance companies.  But such payments go to providers, not insurers.  They may be part of the overall health care burden an individual faces, but they are not profit to the insurers.

Lastly, Wheeler objects to the fact that health insurance payments for these subsidized families will exceed what they are paying in federal income taxes -- up to 9.8% of their gross income -- what she describes as a "tithe" to private insurers.  Again, what percentage of income does Wheeler think such families are paying now?  The workers with whom I net today are paying roughly 25% of their income for health insurance.  (Well, their employers are paying it, but to most employers this money is fungible -- if they have to pay it for health costs, they don't pay it in wages.)  To allow the uninsured to obtain coverage for between 2% and 9.8% of income is a huge net plus to these people.  Similarly, the massive expansion of Medicaid (government run health care) and community health care facilities (government provided health care) under the bill should be viewed as a major victory for progressives.  

It's depressing to see so many good people react to their understandable frustration with the Senate and the power of industry by resorting to magical thinking and inaccurate arguments.  The ability to count to 60 and to think in a linear fashion should not be deemed the qualities of a sell-out, but rather essential components of anyone who wants to fight in this arena. 

Killing this bill would be an enormous disservice to tens of millions of our fellow Americans who desperately need relief.  We will regret it for decades to come if it happens.   

Comments

[dmf]

amen, brother.

[Delicious Pundit]

Well, their employers are paying it, but to most employers this money is fungible -- if they have to pay it for health costs, they don't pay it in wages

Too true. I pay for my nanny/housekeeper's health care, and the premiums have gone up so much that I haven't been able to give her a raise in years -- partly because the writers' strike bookended a couple of terrible years and I almost lost my own healthcare). I'm eager to see whether the exchanges amount to anything.

[Steve Balboni]

Well said.

[Mandos]

Amen! Preach it!

It's a bizarre bizarre world when Markos and Corrente and Ian Welsh and Jane Hamsher and Howard Dean are all on the same page as each other, and I am on the same page as Brad DeLong. It's like there's now a grand PUMObamabot Coalition, a chimera of political ineptitude that's magically coalescing. One ring to rule them all...

I for one can't pretend that anyone who thinks that by killing the bill they'll get a better one anytime soon isn't a moron. Newsflash: a bill failure has a ready scapegoat attached, Obama will pin the tail on the scapegoat, take the hit, and move onto something else.

It's like, all these Johnnies-come-lately have woken up shocked! SHOCKED! that a government dominated for decades by corporate interests behaves like...a government dominated for decades by corporate interests. That the majorities acquired on Nov 4, 2008, where like a license for us to get our Emma Goldman on or something.

I think it's a seriously problematic bill that does not adequately control costs and so much worse than what really needs to be done, it was created by capitulating to the worst parts of the American political establishment, etc, etc, etc.

But for something that was crafted inside a broken system, it's still movement on something that the health insurance industry would rather no movement happen at all...

[minstrel hussain boy]

having done some research myself i gotta say your numbers add up boyo.

i am all for non-profit insurance. that's the foundation of the business. it started with concerned presbyterian ministers in scotland who were worried about the welfare of a minister's family should he die. same same with the commercial insurance that grew out of lloyd's coffee house in london during the "golden age" of piracy.

when folks decided that there was plenty of cream in that milk jug for them to siphon off, things started going all south on us. the first ripples i saw that there might be trouble in the hills was right after katrina and rita hit the gulf coast in such rapid succession. a lot of the insurance companies down there had violated one of the basic tenets of the biz. they had more potential liabilities than they had assets to cover.

i've operated that way myself a few times. i've gone light in poker hands when i didn't have the money to lose. i've made some pretty decent golf shots when i didn't have my nassau covered. the potential for absoltue disaster (especially if you're playing poker with guys whose last names end in vowels and their middle name is always "the") can raise the excitement level of the wager but it's really no way to live.

the biggest lesson i took home with me from the netroots is that in politics a lot of time you have to grab for what is gettable. most politcal progress is hard slog incremental.

even this bill is an improvement. it ain't what we would want, but we might find we get what we need... (cue the nasty telecaster tuned to "g" for some very snotty stone's licks)

[Mandos]

But, you know, the bigger problem is that neither the Obama administration has delivered any piece of progressive red meat of significant size to make it look like even the *Kossacks* are getting enough ROI for 2008. As much as I think this bill should pass, that's a problem. What right-wing interest is Obama willing to throw up against a wall? Will he be able to do this in 2010? Or is the party willing to risk a completely demotivated base?

[Mandos]

Er, "neither the Obama administration nor Congress".

[Sir Charles]

DP,

This is a big issue in my line of work. Most building trades unions negotiate a direct hourly contribution to their medical and pension plans. When all you can negotiate is $1.00 an hour raise and $.70 needs to go to the medical plan and $.30 to keep the pension plan solvent, the members get nothing in their pockets and lose ground to inflation. But that's been a part of our reality for the last twenty years.

Mandos,

Welcome again. Anyone who writes "chimera of political ineptitude coalescing" and "getting our Emma Goldman on" is always welcome here.

It is interesting to see that both Howard Dean and Markos seem to be backtracking a bit. I was surprised at Markos on this, because he has always had a strongly pragmatic streak in him. Dean, to be honest, strikes me as a guy who doesn't always think through what he is saying. And no, the fact that he is a doctor doesn't impress me -- so is Tom Coburn and that rat bastard from Alabama who just defected to the Republicans (good riddance to bad rubbish there). I have a lot of respect for what doctors do professionally, but they don't strike me as any more insightful on this debate than anyone else would be.

I do think Obama should try to throw a little red meat to the troops, but in the end, he needs to catch a break on unemployment. That more than anything else will decide the mid-terms.

mhb,

I think eventually we will probably end up with heavily regulated private insurers and non-profits dominating this market. It works well in parts of Europe.

[arbitrista]

I think the answer one could to give to the question "what are they paying now" is, in many cases, nothing. They don't have insurance and don't consume medical care because they can't afford it. So for those people this mandate would constitute a finances-breaking tax.

I think the other fear is that as employers drop employees, forcing them to enter the exchange (and doubtfully rebating the old health insurance costs the companies were paying in the form of wages) at prices they really can't afford.

I also believe there is a reasonable objection based on principle to requiring people to purchase a private good without a viable public alternative, or with further engrossing the already substantial influence of private corporations on our public life.

All of these objections are of course entirely distinct from the strictly political objections to the health care bill - that a mandate is going to be unpopular, particularly with young voters; that the benefits are too slow in being deployed; the insurance companies will use their expanded market base to enhance their campaign & lobbying capacity; that liberals will have lost all credibility with having failed to follow through on a threat, etc., etc.

[big bad wolf]

hot rhetoric? really? you?

i tend toward the activist side too. that is, i think, how one ends up in a job in which you throw yourself against the wall for a living. still, in my job, as in politics, sometimes that hurling of self looks silly becuase you are doing it next to an open door. in those instances, no matter how principled it is to break down the wall with your body, it is better for the client to use the door.

nice piece at edge of the american west on yet another roosevelt.

http://edgeofthewest.wordpress.com/2009/12/22/some-notes-on-tr/#more-12454

[Ken]

This is my first post here. I really can't take sides on this issue, because I really don't know what the right answer is. I'm not a policy wonk, or a political activist; I'm just an ordinary working schmuck who reads blogs. What I do know is this: When a bunch of people who have been working together toward a common goal for years find themselves looking at the same set of facts and drawing very different conclusions, it does NOT mean that half of them have suddenly switched sides. It means that there are different ways to interpret those facts. And at that point BOTH sides need to stop flinging vitriol, take a deep breath, and start listening to each other.

Here's my fear about this bill -- I'm just afraid that we are setting ourselves up for a win the battle/lose the war situation. There is no doubt that everything everyone says about the good things it does are true. These are important, supremely worthwhile gains. But the critical question is how will it be perceived by the average voter? I'm not talking about the small percentage of blog readers and activists, I'm talking about the average, low-information working class voter who gets everything he knows from TV news (including Fox). Which way is this person likely to be pushed to vote in 2010? 2012? Because if these people THINK they are being screwed, whether it's true or not, they are going to vote Republican. And if enough D seats flip, then the whole thing will end up being repealed, and we lose EVERYTHING.

Again, I'm not taking a side here. If anyone has a good answer to this, I'll be ecstatic to hear it. But the people I'm describing here are the people I work with, and I'm afraid that this is exactly how they are already feeling.

[Sir Charles]

arbitrista,

People really can't afford to be uninsured. The subsidies on this bill are actually half decent and most people should be able to afford coverage. If they can't there are provisions to allow them to opt out. Finally, even the penalty is pretty much a token. It's not terribly onerous.

As far as the requirement for people to buy a private good -- it seems to me that we do this routinely for car insurance. I don't see anyone suggesting that it means we are making the GEICO salamander the leader of a new foruth branch of government -- although I, for one, welcome our adorable, English accented, lizardy overlords.

I would like to see an acceleration of benefits under the law so that people can see its upside.

ken,

Welcome. I think that one of my biggest concerns is that the bill as drafted is actually a pretty substantial achievement for progressives, even if it's not everything we want, but many on our side are making it seem like the worst thing in the world. This is not exactly the best way to sell either the bill or our effectiveness.

The bill cannot be repealed. Obama will veto any repeal attempt and there is no way that the GOP is going to be in a position to override the veto. Indeed, I think claims that the Republicans are going to take back either house of Congress are nonsense.

It would be nice to see a concerted effort to explain to people what the benefits of this legislation are, instead of feeding them disinformation and outrage like many of our brethren are doing.

Finally, I keep hitting on this topic with some vehemence because I hate to see our side engage in disinformation. It's one thing to disagree with aspects of the bill, but some of these posts are just disingenuous or affirmatively ignorant.

[oddjob]

I am not a lefty, although I would be described that way on this matter since I prefer a single payer regime to anything else. Having said that, speaking simply from a pragmatist's viewpoint, I don't see how throwing this bill (mess that it is in some ways) overboard and starting over is better.

When you would still have the very same cast of characters as before, with the very same agendas (personal & otherwise), and the very same levels of political leverage (or lack thereof, as the individual cases would be), I fail to see how assuming a substantially different outcome the second time around is anything but the most foolishly fanciful thinking.

[Davis X. Machina]

One problem with the blogosphere -- not all of it, but like Lincoln, all of it some of the time, and some of it all of the time, is that it's fundamentally engaged in taking the American fondness for social signaling via choice of consumer goods and applying the same idea to politics.

By the time hit the Senate floor "Public option" was every bit as much a brand name as "9 West", and as full of, and empty of, meaning,

No one on the internet knows if you're a dog, but everyone gets to see what you type.

[Prup (aka Jim Benton)]

This should make Sir C delighted. Today, to quote Steve Benen:

As part of a Republican attack on health care reform today, Sen. Orrin Hatch (R-Utah) read a post from FireDogLake on the Senate floor today.

[Mandos]

Actually, Hamsher and Norquist are jointly calling for an investigation of Rahm Emanuel. Not saying that Emanuel doesn't necessarily deserve it, but...

[Ian Welsh]

Well, my record on economic prediction is far far better than Matt Yglesias, Ezra Klein's, Nate Silver's or Brad DeLong's. Perhaps I don't qualify as the "thoughtful" side of the blogosphere because I'm not mealy mouthed enough?

And I think this bill will be a disaster. It will not contain costs, they will continue to rise faster than either wages or inflation. The excise tax is not inflation indexed, so it will erode high end insurance, which is the only insurance which means people actually get coverage. Annual and lifetime caps are back into the bill, the actuarial values are low, and so on. In many cases people will be forced to buy insurance they won't be able to afford to use, especially if they get really sick.

Forcing people to buy bad insurance whose cost will increase faster than wages or inflation doesn't seem like a good bet to me.

But hey, no doubt I'm not "thoughtful".

Not that I give a damn about the public option, the House plan's public option was so weak it was close to meaningless. My dispute with FDL etc... is not that they're in opposition now, it's that they weren't in opposition months ago.

But I wouldn't worry, your lords and masters don't care what progressives think, whether progressives agree, or disagree. All that matters is that pharma and insurance companies are onside because they know that this deal will be good for them.

And when it comes to understanding 2,000 page bills, I may not trust Ezra or DeLong or Yglesias, but I do trust that the medical industries know exactly what they're getting and that if they like it, they'll be doing well out of it.

And since I understand basic economic facts, that means I know that they think they'll make more money than they would have without the bill. Since the bill does not increase the deficit, where do you think the money's going to come from? Or rather, who?

[Krubozumo Nyankoye]

First some trivial corrections on a cogent point, that is the Geiko Gecko, not a salamander (reptile/amphibian) and oddly they have chosen to give him a Aussie accent. I happen to adore geckos because they can walk on walls and ceilings and ravenously eat all kinds of arthropods that can be dangerous besides just unpleasant. Be that as it may I think the car insurance analogy is false. There is no mandate to own and operate a car, it is just that if you do you have a responsibility for the mayhem you can cause. In terms of health insurance, there is a significant difference, chosing not to live as opposed to chosing not to drive is rather more inconvenient.

Once again I have to emphasize that I am far removed from the tone of this discussion in any 'man on the street' sense. Be that as it may I think that this backlash against the legislation in question is understandable to a certain extent, albeit very unrealistic.

When I refer to the past administration I always speak of it in terms of a decade of mis-administration because, let us face facts, it isn't over yet. It will probably never be "over" in any tangible sense.

The question that I am trying to answer only for myself is will this make any difference in the long term or is it doomed to fail in a way that is so spectacular that the rip roaring tide comes back in 3 years and the plutocracy enjoys further unfettered ascendency?

What is clear from SC's original post is that this legislation is too complex for the average person to comprehend in their 'spare' time. So they have to rely to one extent or another on what other people say who at least appear to have the time to fathom it. What strikes me as truly bizzare is that anyone on the left can see this as a failure. True it is not the ideal, but then what is ideal and when did it last become law? It seems to me that if the same amount of attention had been paid to what began happening in 2000 by those on the left, a lot of the mess we are in now could have been avoided or at the very least blunted. So why are they attacking each other? Is it out of petulance or just unrealistic expectations? I don't think so, I think it is out of confusion.

The quote is only attributed to Einstein, but it still rings true... "What we have here is a perfection of means and a confusion of aims."

What is the most outstanding difference between the hoi poloi and the titular members of the plutocracy? Security.

The stuggle will continue. The outcome to this stage is still a foregone conclusion, to simply tip the balance such that the outcome is in doubt, is a major victory for the forces of social justice.

[Mandos]

*OR* it's possible that they like it because the alternatives not-quite-on-the-table involved transitions away from their model of doing business and therefore ultimately extinction. Compared to that, anything looks good.

[ari]

Ian, show your work, okay? Otherwise, you're arguing by assertion, which isn't very convincing.

[Sir Charles]

Ian,

I don't believe that I called you out by name as unthoughtful or anything else in this post.

As for not caring what progressives think, I'll stack my progressive bona fides up against anybody. I'm not a fucking poseur and a know-nothing (as I think some of these folks are) or a rich dilettante like Jane Hamsher. I've slugged it out in the trenches for working people for my entire adult life. And I'm definitely not mealy-mouthed.

You may well have the superior grasp of economics that you credit yourself with. However, I think there are two things that as a Canadian you don't understand well --the difficulties of getting progressive legislation through the American political process and the difficulties of not being insured. People do not have the time for the holy grail of health bills to somehow miraculously win the support of the 60th most liberal senator in the U.S. The lack of access to health care is a killer.

You haven't once suggested a realistic path to get to where you want to go in this debate. It's all well and good to fulminate on the sidelines, but if we can get 30 million people insured, even if it's not ideal, I'll take it.

You are ignoring the increase in Medicaid access, the increase in community health centers, and the sizeable subsidies being given to working class Americans to be able to purchase insurance.

You are incorrect to suggest that only high dollar policies give good health coverage. My coverage is still $6,000 a year shy of the $21,000 tax threshhold and it fully covered a hospital stay this year for me that was in excess of $80,000. Virtually all of my union clients provide good health care to their members for less than this threshhold. Could this become a problem down the road -- absolutely, but probably not for several years. Making these kinds of small adjustments to such legislation is much easier than putting through a comprehensive bill.

Ultimately, you are willing to basically watch the whole edifice that we've begun to construct crash and burn, in the hopes that from the ashes something better will arise. Maybe if this wasn't my country I'd be willing to take that bet, but it is, and I've lived through enough right wing nightmares to last a lifetime.

KN,

I agree with you in principle -- both this bill and the Clinton plan in 1993 were too complex for people to really grasp. Unfortunately, thre is an awful lot of negative reaction among the public to a pure single payer system, which would certainly be the easiest thing to explain. So we are forced to take our existing system and graft something on to it-- not ideal, but probably the best that can be done for now. If it fails, then maybe a robust public option will be a much easier sale down the road.

[Mandos]

Yep. I've not yet seen a realistic description of what happens when this bill is defeated. Not from any of the people who want it to die. One thing is for certain: the Democratic congresscritter who blocks this bill will, rightly or wrongly, suffer the full weight of the public blame, and Obama will merely wash his hands of it, and take what's left over of the failure hit--and Congress will not be picking it up until well after the next Presidential election.

And the insurance companies are happy to proceed under this extant regime for the time being.

Is this actually better than passing the bill? I'm really, really doubtful of that.

[Prup (aka Jim Benton)]

I will have a lot more to say on this, particularly to Mr. Welsh, but I have to add one thing to Mandos' comment. If this were blocked, those who reluctantly supported it, at what they saw as particular risk to themselves, and who are already feeling the lies that are being leveled against them -- for example, the most execrable, excrental of human beings, Tony Perkins said, just Tuesday, "Senators Ben Nelson and Robert Casey gave mere lip service to protecting the most innocent among us by placing their stamp of approval on government funding for abortion coverage in direct conflict with longstanding policy." -- are, if left out to dry, going to be much harder to be convinced to go along the next time. We might get the Stupak Amendment -- or even worse.

As for the benefits of this bill, besides the ending of the 'pre-existing condition' and 'recission' problems, there is a 'requirement that insurance policies sold through the exchanges have medical loss ratios of at least 80%.' (Thanks to Mark Kleiman for spotting this.)

What this means is that "The “medical loss ratio” of a health insurance policy is the percentage of premium dollars going out to providers, as opposed to marketing, administrative overhead, and profit. So the provision is the decisive answer to the charge that the individual mandate in the bill gives the insurers a license to steal by offering junk insurance that people would be required to buy. The enforcement mechanism is staightforward: any firm that pays out less than 80% must rebate the difference to its policyholders."

Those three things, by themselves mark an improvement worth celebrating, as far as the bill is from what any of us want.

[Prup (aka Jim Benton)]

excrental shd be 'excremental' a mild description of how I feel about the elegant Mr. Perkins.

[ikl]

Ian, aren't you trying to have it both ways? You complain that the Senate bill doesn't contain costs, but then go on to denounce the excise tax. If the excise tax is really as big a deal as you seem to think (for better or for worse, it is not so clear that it will make such a big difference), then this will certainly put downward pressure on health care costs. Right now we have a very big tax subsidy for health care paid through employer provided health care. If the excise tax ends up hitting a lot of plans, this will provide a big incentive to keep costs down (or, if people get bad coverage instead, their having to pay out of pocket for more will also tend to lower overall costs). This might be, all things considered, a bad thing as you claim. But I don't think that the parts of your argument above fit together at all: either the excise tax will be ineffective in reducing costs but won't hurt very many people or it will change behavior (in which this could be a good or bad thing depending on how things play out).

[Prup (aka Jim Benton)]

Mr. Welsh: I will, I hope have several long comments building on this one tomorrow, but I don't believe you fully realize how different a President is from a Prime Minister -- who has been a legislator for many years and knows the real as well as the formal powers in the legislature -- how little control a President has even over members of his own party -- who are elected independently and with no 'delisting' by the National party -- or the rivalries between the executive and legislature. (You may know each of these formally, but I doubt if you understand them as they work in action.)

I am sure you have little feel for how politics has changed, unprecedentedly, over the past year, and how the expectations of both the President and commentators no longer match the way politics is practiced, or the full effect of the parade of lies that have been sent out unchallenged -- to where 50% of the uninsured prefer the current system to any wholesale reorganization.

And I am absolutely sure you can never feel what it is like to have to beg co-workers to look and see if they have antibiotics in their medecine chest, because you can't afford the time off to get an ear infection treated, and when you go to the hospital you know it is another you will be unable to pay because you have higher priorities like rent -- that you are alreqady behind on -- and food. Or how it feels to doit in an emergency room for six hours knowing that one factor in 'triage' is whether you have insurance.

And you can't imagine needing a foot operation -- an emergency that has to be done now or you'll lose your foot -- knowing that it will cost more than you have ever earned -- gross -- in a year. Or how 'lucky' you feel when the hospital care -- not the operatiopn -- is so mishandled that you have enough to complain about -- including a clinic follow-up where an unsecured bench almost breaks your leg -- it was a glancing blow, lord knows how -- that the bill can be settled on an informal 'you don't sue us, we won't sue you' basis. (If it hadn't been, you know you would be an 'undischarged bankrupt' the rest of your life.)

Those didn't happen to friends, or relatives, or 'clients' of mine. Each one happened to me. And maybe I may now have Medicaid -- and, soon, Medicare as well, and my wife has both. But I don't want anyone else to have to feel these things.

No, this bill isn't great, maybe it's pretty bad. But I know what the current system is like -- and because my sister-in-law has lived in Canada for decades, and was treated for her ovarian cancer there, without a charge -- I know what a good system would be like. But I'll take even these improvements, as something to build on.

[Corvus9]

Hmm, well this has been a really neat discussion that I regret not being a part of, as I'm getting ready to go out of town for the holidays. I just want jto say that I think the overall problem with the politics of the bill right now are that since the debate has been so focused on the public option that most people (except the Ezraian wonks) have a clear understanding of what's actually in the bill. Once Obama gets a chance to explain what the bill is all about, say, at the State of the Union, I think a lot of this animosity will go away when people realize just how much of a boon this bill really is. Maybe it doesn't tackle long-term costs, as if the percetage of GDP, but it does lower the out-of-pocket costs for the average family by several thousand dollars a year, and sets up the framework that all future reforms towards universal healthcare can be built upon.

Happy Christmas!

[Sir Charles]

Corvus,

Well said.

Merry Christmas to you too buddy. And safe travels.

Time to leave the office and go clean, fold clothes, and wrap gifts. Perhaps while enjoying a hot fortifying beverage.

[Mandos]

Here's another way of thinking about what has happened. There are essentially two classes of reforms:

1. Reforms that begin the process of phasing out private health insurance.

2. Reforms that do not.

I for one consider (1) to be infinitely more desirable than (2). What we're getting is (2). A lot of the people who want to kill the Senate bill really believe that anything other than (1) is a failure.

Under (1), however, an entire industry faces (eventual, likely) abolition, and in a country where capitalism is an official dogma the way that communism is in China, how likely is it that the political system is going be able to jump straight to that?

[oddjob]

Totally OT, but much too good not to share:

OH

MY

GOD!!!!!!!!!

:)

Hat tip, Sully.

[Prup (aka Jim Benton)]

Oddjob: This has been big news around the Right Wing Watchers -- usually combining the acceptance of JBS support with Christian Complaints -- and threats to pull out -- because CPAC lists GOProud -- a 'gay (crazy)-conservative' spin-off of the Log Cabin Republicans -- as a sponsor.

[Sir Charles]

Mandos,

Yeah, the insurance industry is incredibly well connected politically. I interned for a very liberal member of Congress back in 1980 and even he was cozy with the industry. (They had a big presence in Massachusetts -- MassMutual, Prudential, and John Hancock were all big players there.) They employ a ton of people, build a lot of big buildings, have a related web of agents with whom they deal (sort of like the auto industry), and have a shitload of money. So essentially killing the private insurers would be going after some very big scalps -- it certainly wasn't going to happen in the first go round.

But we can live with a properly regulated insurance industry -- they do in places like Germany quite nicely. You will have to change the character of the business over time without actually getting rid of them.

I would nonetheless like to move to no private insurers so as to save on adminsitrative costs, but I don't think its essential to good health care reform or delivery.

oddjob and Jim,

Rachel Maddow has actually been giving this big play.

But once again, it would be nice if the David Broders of the world took note.

[oddjob]

it would be nice if the David Broders of the world took note

What? and be rude????????????

HORRORS!!!!!!!!

[minstrel hussain boy]

Oh, we're meetin' at the courthouse at eight o'clock tonight
You just walk in the door and take the first turn to the right
Be careful when you get there, we hate to be bereft
But we're taking down the names of everybody turning left

Oh, we're the John Birch Society, the John Birch Society
Here to save our country from a communistic plot
Join the John Birch Society, help us fill the ranks
To get this movement started we need lots of tools and cranks

Now there's no one that we're certain the Kremlin doesn't touch
We think that Westbrook Pegler doth protest a bit too much
We only hail the hero from whom we got our name
We're not sure what he did but he's our hero just the same

Oh, we're the John Birch Society, the John Birch Society
Socialism is the ism dismalest of all
Join the John Birch Society, there's so much to do
Have you heard they're serving vodka at the WCTU?

Well you've heard about the agents that we've already named
Well MPA has agents that are flauntedly unashamed
We're after Rosie Clooney, we've gotten Pinkie Lee
And the day we get Red Skelton won't that be a victory

Oh we're the John Birch Society, the John Birch Society
Norman Vincent Peale may think he's kidding us along
But the John Birch Society knows he spilled the beans
He keeps on preaching brotherhood, but we know what he means

We'll teach you how to spot 'em in the cities or the sticks
For even Jasper Junction is just full of Bolsheviks
The CIA's subversive and so's the FCC
There's no one left but thee and we, and we're not sure of thee

Oh, we're the John Birch Society, the John Birch Society
Here to save our country from a communistic plot
Join the John Birch Society holding off the Reds
We'll use our hand and hearts and if we must we'll use our heads

Do you want Justice Warren for your Commissar?
Do you want Mrs. Krushchev in there with the DAR?
You cannot trust your neighbor or even next of kin
If mommie is a commie then you gotta turn her in

Oh, we're the John Birch Society, the John Birch Society
Fighting for the right to fight the right fight for the Right
Join the John Birch Society as we're marching on
And we'll all be glad to see you when we're meeting in the John
The John, the John Birch So- ci- i- teee

by micheal brown, recorded by the chad mitchell trio...

[Sir Charles]

oddjob,

Well, he could balance it out by pointing to our propensity to say fuck. And to joke about Michael Kelly's demise. And by "our" I mean me.

mhb,

So old that they're new again, eh? I feel like I'll soon be dusting off my Tom Lehrer record.

[big bad wolf]

heading out to the east coast
don't want to pay no dues getting through
merry christmas to you.

and happy whatever you celebrate at home. we do a couple at my house and i say the more celelbration, the more candles the better. this is a great site, with great hosts and a wonderful group of interesting and smart people from whom i learn much

[Prup (aka Jim Benton)]

The sound of one mouth laughing
Kills the laugh, and shouts of
Simple joy are smothered by
Indulgent faces waiting for
Return to Earth

Even beauty loses color when
It is not seen through
Someone else's eyes.

There is no way I've found
To celebrate alone

So gather your friends together and have a great night, day, week, and year

Prup

[Krubozumo Nyankoye]

SC - in reply to earlier reply. I am probably naive in the extreme but it always seemed to me that if it was explained properly single payer would be an easy sell.

#1 everyone is insured. cradle to grave, no strings attached.
#2 government pays the providers at nationally negotiated rates, rates could vary somewhat by region allowing for COL.
#3 employers are required to pay what they would otherwise pay for insurance to employees.
#4 probably no tax increase on anyone, better pay means higher tax revenues.

I know that is too simplistic but it is at least an approach. It has always struck me as just plain weird that the great socialism bogeyman is so effective a meme when most people have been educated in public schools and universities. The health insurance 'industry' can go away, there are plenty of other things to insure that fit the model better.

As to celebration, it is worthwhile to point out that I always have feelings of goodwill and good fortune for those I interact with and those I do not. Adversary or ally. This particular time of the year is significant in the Northern hemisphere, I gather from glimpses at weather reports that there is a lot of snow falling. Here the days are slightly longer now because we are a few degrees south of the equator but not so much that you would notice. It is just about midnight. All the workers who normally live here with me are away with their families, I gave the cooks the weekend off because there is no one to cook for. Surprisingly the satellite uplink is strong and consistent, must not be many people on line. The watchmen are still here, they have no where else to go and are absorbed in the football on the TV.

I want to pick through a few more sediment samples tonight before sleeping. The lab has to be air conditioned because the equipment cannot tolerate the temperature fluctuations and the humidity. You'd think that it would be a refuge but it is actually better to just adapt to the actual conditions so I can only stand it for two or three hours at a stretch. Out of force of habit I write everything down into notebooks which are then transcribed into computer files. Twice a week all the files are transferred to servers in the US. That takes most of the night usually. There is an almost invariant routine about things here, peppered with untoward events. But I am so accustomed to the routine that I only break it once or twice a year.

Still I have a child-like expectation of surprise and wonder on an almost daily basis. I never know what is to be found in those small aluminum dishes filled with multitudes of tiny rock particles and individual minerals. Until I search through them.

So all my good wishes go out to the community who will read this, now or eventually, but most of all I wish all can at some point experience the fullfillment and completeness of following a bit of nature's muse. Every day is an education.

Best wishes to all,

[low-tech cyclist]

I feel like I'll soon be dusting off my Tom Lehrer record.

I'll save you the trouble, SC:

Christmastime is here, by golly
Disapprovfal would be folly
Deck the halls with hunks of holly
Brother, here we go again!
...
Angels we have heard on high
Tell us to go out and BUY.

Merry fucking Christmas to all, and to all a good night!

[Sir Charles]

KN,

I think single payer (or as people wisely put it, Medicare for all) should be an easy sell. It isn't. I suspect much of this has to do with the constant presence of racism and tribalism in the U.S. It's kind of a variant of the defintion of a puritan -- a conservative is someone who lives in deepest fear that somewhere an undeserving black or brown person is getting the same benefits which he also receives. If you think this isn't true check some comment links sometime about how health care reform is all about giving benefits to "illegal" Mexicans. It's pathetic.

But I don't want to end on that sour note. I want to again thank you for showing up and joining in here. It seems like you have a pretty unique vantage point and I very much enjoy your thoughts on things. Have a lovely holiday such as it is and keep enjoying your work. There are few things in life better.

l-t c,

Enjoy your Christmas with your family, especially your little boy. It's great to have you here on board. Here's hoping that in 2010 we get a chance to say hi in person.

[Sir Charles]

bbw,

Don't get tangled up in blue or TSA lines.

Jim,

Have a great Christmas.

[oddjob]

Well, he could balance it out by pointing to our propensity to say fuck. And to joke about Michael Kelly's demise.

No, you don't understand! You're recommending that the Godfather of Bipartisanship Concern Trolling actually dare to say the truth, namely that the Emperor does not wear clothes!

MON DIEU!!

[Prup (aka Jim Benton)]

To Sir Charles and KN:
First to you, Sir Charles. I hate to disagree so strongly, but I always start with an initial and testable hypothesis, that, when talking politics, religion, or the like, people (not necessarily their leaders, but people in general) really believe what they are saying.

What they believe may be totally irrational, may contradict what they said -- equally sincerely -- two days or two paragraphs ago, may have only the slightest and most tenuous connection with facts, may in fact be the height of stupidity, but the 'real reason' they say it is because they think it is true.

(An argument such as yours, Sir Charles, may explain why certain people are 'susceptible' to certain types of irrationality -- because it plays into certain pre-existing prejudices and beliefs -- which may in fact be unconsciously held. (The person who argues "But some of my best friends are..." really believes this disproves a prejudice he thinks he doesn't have -- instead of proving he does have it.)

[From here on, I'm going to generalize the term 'quackery' to refer to the type of thinking I am referring to, using it for political quackery, religious (and atheist) quackery, sexual quackery (including not only most homophobia, but a belief in 'abstinence-only'), etc.]

The problems with your explanation, though, are

first, that it requires a different explanation for each form and example of quackery, and hides the similarity in the type of thinking I am trying to highlight;
second, that it makes it harder to see examples of quackery on 'our side' because we don't like to accuse our friends of being insincere;
third, that it makes it almost impossible to see quackery when we look in the mirror, because, of course we know we are totally unprejudiced;
and, finally, that it makes it much harder to combt and change the quackery we come up against, causing us either to dismiss the quack-spouters as 'hopelessly stupid' or to convince them using arguments that they don't think are relevant to themselves

Also we have a tendency to overlook 'quackery on our side,' accepting a Chomsky and rejecting a DeMint. Not only is this dangerous because we can follow 'our' quacks down wrong paths -- see Nader, Ralph and "Tweedleism" -- but we can totally misunderstand what we are being told. Look at the number of 'liberals/progressives' who flirted with the campaign of the "Texas doctor" -- whose name I never use for fear of causing a flood of his supporters here -- simply because he opposed the Iraq War and the 'War on Drugs.' His other positions came out soon enough to destrpy that movement, but we still find an unhealthy dose of 'right libertarianism' floating around.

(On the other hand, 'our quacks' can divide us from people who should be our allies. A lot of solid, sanely skeptical thinkers avoid linking with us because of the HuffPo's WND-like support of various medical quackeries, particulaly anti-vaxxers. (The same for Robert Kennedy, Jr.) Going farther back, how much support did we lose from the science-minded community when we accepted Proxmirism?

Much more on this -- if you can stand it -- including a reply to KN on why 'educated people' fall for this nonsense. But I have house straightening to do.

[Sir Charles]

Jim,

You really don't think that opposition to single payer is largely along the racial tribal lines I suggest? (I think that's the argument to which you were responding.) Oh, that and the paranoid tendency to believe that health care will be rationed in such a way as to deny you needed care -- as opposed to the present system where we know no rationing ever occurs.

I don't think Chomsky is really the same as DeMint. I don't agree with much of what Chomsky says, but it is not really in the "know-nothing" style of DeMint.

The Texas congressman of whom you speak is a lunatic. Anyone who thinks otherwise just isn't really paying attention.

Finally, I find the anti-vaccine campaign deeply distressing. It is craziness that is eventually going to cost lives.

[Dave]

Jim,
Not surprised that you're a lawyer and can pay any price for health insurance for yourself and your buddies in the firm. The insult to struggling families in this bill (and your response) is that they care a whole lot less about their family than you do.
They can buy health insurance with no bill passed and certainly would if they could afford it. You don't know them and see the choices they make every day to buy food(forget about healthy food), clothing, education, heat, transportation etc. etc. They will give up other essentials for their families if forced to pay thousands a year to a health insurance company. Your reasoning that progressives should shut up now that the Senate has spoken is evidence of both elitism and fatalism. We don't need a bad bill which we will be stuck with for my lifetime, at least. A crisis is a terrible thing to waste (Rahm?) and this one will be wasted if we accept the Senate Bill. Pound a stake in the heart of this lobbyist product and there will be another bill before the next election and a much better one at that. Keep the crisis alive until it bears fruit that is worth eating.

[Sir Charles]

Dave,

You mean me and not Jim. I may be a lawyer, my friend, but you don't seem to understand who I represent. My clients are building trades members, printers, teamsters, and other people who get their hands dirty every day. The union that represent these people struggle every day to assure that they maintain decent health coverage for their members.

The bill that you scorn would make insurance affordable to millions of people either through expanded Medicaid coverage or by means of subsidies.

Your diatribe indicates a not very careful reading of my post or much knowledge of the content of the bill. What's the bill look like that you're going to get passed? Oh shit, I forgot, there isn't one -- because you don't know fuck all about what you're talking about.

By the way, my buddies in the law firm in this case would be the secretaries, paralegals and other clerical staff, along with associate attorneys. Partners in the firm, like me, pay the full freight of our actual age weighted premiums -- a pretty stiff sum that we are fortunate to be able to handle.

[Mandos]

There won't be another bill, and if there is it won't be a better one. What will happen is that it is either killed by nefarious forces. First of all, whomsoever kills it will face the opprobrium of the entire Washington establishment and media. Obama will wash his hands of it right over the head of whoever succeeds in killing it.

More so if it is a progressive politician who does so.

If it is killed by conservatives of one form or another (by abortion-mongering or something), it stands a *slightly* better chance of coming back, in a worse form.

[Mandos]

Oh, well, I for one happen to agree with a lot/most of what Chomsky says both in politics and linguistics. I guess we can't have everything :)

[Mandos]

Er, I'm typoing a lot these days: "What will happen is that it is either killed by nefarious forces or by progressive ones." But actually I meant to delete that sentence entirely *facepalm*.

[Mark T]

This is viciously funny - Republicans never could have passed a crap bill like this. Coming from Democrats, you latch on to it -

If this bill is killed, the impetus for reform is still there. If this bill is passed, reform is dead.

If this bill is killed, many Democrats may lose office. And that makes a difference because ..... ?