Robert Reich thinks the healthcare bill would be an improvement, but just barely

In the interest of fairness, I thought that I should include a link to this new piece by Robert Reich. Reich, unlike Dean, and some of the other people I’ve been quoting here lately, thinks that the current version of the healthcare bill being considered in the Senate would be worth passing. Here’s a clip:

“Don’t make the perfect the enemy of the better,” says the President and congressional insiders when confronted with the sorry spectacle of a health-care bill whose scope and ambition continue to shrink, and whose long-term costs to typical Americans continue to grow. They’re right, of course. But by the same logic, neither the White House nor congressional Democrats will be able to celebrate the emerging legislation as a “major overhaul” or “fundamental reform.” At best, it’s likely to be a small overhaul containing incremental reforms.

Real reform has moved from a Medicare-like public option open to all, to a public option open to 6 million without employer coverage (still in the House bill), to a public option open only to those same people in states that opt for it, or about 4 million (the original Harry Reid version of the Senate bill), to no public option but expanded Medicare (the Senate compromise) to no expanded Medicare at all (the deal with Joe “I love all the attention” Lieberman).

In other words, the private insurers are winning and the public is losing.

…Is the effort worth still worth it? Yes, but just. Private insurers will have to take anyone, regardless of preconditions. And some 30 million people who don’t now have health insurance will get it. But because Big Insurance, Big Pharma, and the AMA will come out way ahead, the legislation will cost taxpayers and premium-payers far more than it would otherwise. Cost controls are inadequate; in fact, they barely exist. If Wall Street’s top brass are “fat cats,” as the President described them last weekend, the top brass of Big Insurance, Big Pharma, and the AMA are even fatter. While they don’t earn as much, they’re squeezing the public for even more.

We are slouching toward health-care reform that’s better than nothing but far worse than we had imagined it would be. Even those of us who have seen legislative sausage-making up close, even those of us who never make the perfect the enemy of the better, are concerned. That two or three senators are able to extort as much as they have is appalling. Why hasn’t Reid forced much of the bill into reconciliation, requiring only 51 votes? Why has the President been so cowed? In all likelihood, the White House and the Dems eventually will get a bill they can call “reform,” but they will not be able to say with straight faces that the reform is a significant improvement over the terrible system we already have.

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23 Comments

  1. Oliva
    Posted December 18, 2009 at 12:05 am | Permalink

    Worth a look, though too much to read and do:
    “Does Obama Hate Liberals?” by Marc Ambinder, Dec. 17 2009, http://politics.theatlantic.com/2009/12/howard_dean_has_become_the.php.

    There’s another good article at the Atlantic about so-called dandelion and orchid genes, about humans and rhesus monkeys having this orchid part in common, http://www.theatlantic.com/doc/200912/dobbs-orchid-gene:

    Most of us have genes that make us as hardy as dandelions: able to take root and survive almost anywhere. A few of us, however, are more like the orchid: fragile and fickle, but capable of blooming spectacularly if given greenhouse care. So holds a provocative new theory of genetics . . .

  2. Kim
    Posted December 18, 2009 at 8:41 am | Permalink

    I’d like to think that this is true, and that that there’s some marginal improvement in this new bill. I like that people with preexisting conditions, for instance, can’t be turned away. I cannot, however, get beyond the fact that this current plan mandates that all Americans must buy insurance from a private company. That corporatocracy plain and simple.

  3. EOS
    Posted December 18, 2009 at 10:17 am | Permalink

    “Kill the Bill!”

    Please call your senators now and urge them to “kill the bill!” The Senate switchboard is (202) 224-3121.

    The bill(s) do not provide universal coverage. They increase the costs of health care,and decrease both competition and medical treatment options in the long run. The proposed bill(s) under consideration include:

    – A mandate for employers to offer insurance or pay a fine, which will spur many to pay the fine and end employee insurance plans resulting in significant cost increases for currently covered individuals

    – $500 billion in Medicare cuts for older Americans, thus introducing rationing

    – The ability of profit oriented insurance providers to charge up to 4 times more for individuals with existing medical conditions, essentially ending coverage for many of the currently insured who have chronic illnesses who although they will have access, won’t be able to afford coverage

    – Mandated taxpayer subsidies for abortion on demand

    Nobody ran on this platform – nobody voted for these results.

  4. Kelty
    Posted December 18, 2009 at 12:33 pm | Permalink

    “This is what I meant a year ago when I said the next year will determine whether Barack Obama will be an Uncle Tom groveling before the demands of the corporations.” -Ralph Nader

    http://www.thedailybeast.com/blogs-and-stories/2009-12-18/the-man-cheering-obamas-health-care-woes/full/

  5. MoveOn
    Posted December 18, 2009 at 3:50 pm | Permalink

    Dear MoveOn member,

    The latest Senate health care bill has no public option. No expansion of Medicare. And it does too little to guarantee that uninsured Americans will actually be able to afford the coverage they’ll be required to purchase.

    Former insurance executive Wendell Potter put it best: the bill is “a big bailout to the [health insurance] industry.”

    But it’s not too late to fix the bill. And as Joe Lieberman has shown, just one senator willing to stand in the way can force legislation to be changed dramatically.

    Senator Bernie Sanders, a strong proponent of the public option, has already made clear that he’s opposed to the legislation in its current form—and he could decide to block it until it’s fixed.

    But there’s enormous pressure from all sides to pass a bill quickly, no matter how weak it is. Let’s show Bernie and other progressives that we’re counting on them to block this version of the bill—and we’ll get their backs if they do.

    Can you sign our petition opposing the current Senate health care bill? Clicking here will add your name:

    http://pol.moveon.org/block/

    The petition reads: “America needs real health care reform—not a massive giveaway to the insurance companies. Senator Bernie Sanders and other progressives should block this bill until it’s fixed.”

    Despite this latest setback, we can still win the health care fight. The House has already passed a strong health care bill with a real public option. It would cover millions of uninsured Americans, offer real competition to the insurance companies, and reduce costs in the long run.

    MoveOn members overwhelmingly support the House bill. But it’s clear from member feedback and surveys that the majority of MoveOn members oppose the Senate bill as it now stands.

    And recent polls show growing opposition among grassroots progressives generally—the very folks Democrats in Washington count on to volunteer and donate to their campaigns. One found that one-third of Democratic voters will be less likely to vote next year if Congress doesn’t pass a public option.6

    So to get real reform, we need to immediately send a powerful message to Senate progressives like Bernie Sanders, Roland Burris, and Russ Feingold that we’re counting on them to block this bill until it’s fixed.

    Click here to add your name to the petition:

    http://pol.moveon.org/block/

    Thanks for all you do.

  6. Posted December 18, 2009 at 5:41 pm | Permalink

    Bernie Sanders is already saying that he may not vote for it.

    And, I think, regardless of whether or not it passes now, we’re going to have fewer Democratic seats next time. This is our only shot to get it right. We might as well try, right?

    And, can you imagine how much different things would be if corporate money wasn’t in the equation?

  7. Glen S.
    Posted December 18, 2009 at 5:59 pm | Permalink

    I agree there may be fewer Democratic seats next time … but, I think the Democrats chances will be MUCH worse in the 2010 elections if some version of the current Senate bill passes.

    Democrats, by caving into Lieberman, Nelson, etc. (and, by extension, the Health Insurance and Pharmaceutical lobbyists), are essentially “snatching failure from the jaws of victory.”

    For example, according to a Progressive 2000 poll, conducted within the last 48 hours:

    ” A health care bill with a public option has 59% support. A health care bill with a public option and Medicare expansion has 58% support. The current proposed health care bill with mandates, but no public option or Medicare expansion, has 33% support.

    A strong majority of voters say that President Obama didn’t fight Joe Lieberman hard enough for the public option: 63% to 29%.

    One popular talking point is that this bill “provides” 30 million Americans with health coverage. But only 36% said they agreed with that statement. 48% of those polled said they felt that requiring people to buy insurance isn’t the same as “providing” insurance.”

    This bill is a disaster in the making — and Democrats need to scrap it and start over. Once Obama and Reid have come to grips with the fact that Republicans are NEVER going to support this — and once they finally come up with a “real” bill that guarantees access to affordable healthcare — they need to be willing to use either the “nuclear option” to overcome a Senate fillbuster, or use so-called “reconciliation” in the House to push it through.

  8. Peter Larson
    Posted December 18, 2009 at 7:20 pm | Permalink

    All states require people to buy some level of auto insurance to drive a car and people do it or they pay a huge fine.

    Banks require people to buy collision insurance on their vehicles when they borrow money to buy the car.

    Banks require people to buy insurance on their homes as a condition of lending money and people do it or they can’t get a loan.

    I really don’t understand why it is a problem that people would be required to buy insurance. Japan requires it. People buy it. Germany requires it. People buy it.

  9. Posted December 18, 2009 at 9:25 pm | Permalink

    Damn you, worldly Pete Larson… coming here with all your facts.

    Yeah, it hadn’t occurred to me to equate it with auto insurance. And, never having been to Japan or Germany, I didn’t know that they required it. I just assumed they had systems where healthcare was provided.

    I’m still of the opinion, though, that we need a public option, in order to force competitiveness.

    And thanks for the polling data, Glen.

  10. Jules
    Posted December 18, 2009 at 10:02 pm | Permalink

    If there were strong regulations of the insurance industry, the mandate wouldn’t be as much of a problem. But with no public option or Medicare buy-in, this just ropes in millions of more customers for the insurance companies, forcing them to buy shitty insurance. It makes no sense whatsoever. Kill the bill.

  11. Ale Roka
    Posted December 18, 2009 at 10:26 pm | Permalink

    Peter Larson,

    And if I don’t want to buy auto insurance, I have the choice not to drive.

    If I don’t want to buy health insurance, what would you suggest I do?

    Neither autos or banks make insurance a requirement of everyone who is alive.

    There is a huge, huge difference.

  12. Peter Larson
    Posted December 19, 2009 at 12:09 am | Permalink

    No, the German and Japanese health systems are almost completely private.

    In the Japanese system, medical costs are controlled and fixed by a government body so that you pay the same price for a procedure at any clinic or hospital. Individuals are required by law to have health insurance and insurance plans are generally in house, cooperative medical savings plans run by your employer. If not, then there are private insurers you can buy insurance from. For the homeless and those unable to work, there is a public system, but very few people have to take advantage of this. So no, Japan is not socialized medicine, the system is nearly completely private but tightly regulated. The same is true of the German system, where people are required to have insurance and costs and insurance companies are tightly regulated.

    In the end, the American system, with Medicare and Medicaid is actually closer to true socialized medicine than the Japanese and German systems, which can boast universal coverage, 99 percent of which is completely private.

    The clincher in the Japanese and German systems is that insurance companies are barred from making profits off health insurance plans, something that would never work here. In Japan, since most of the plans are run in house, this isn’t much of an issue, but in Germany, often companies will get in the health insurance business as a way of selling other products such as home/life/auto plans. Obviously, this would never work here and there would be large opposition from the profit makers.

    And, for the record, Ale’s argument is just silly.

  13. Me
    Posted December 19, 2009 at 5:24 am | Permalink

    “I really don’t understand why it is a problem that people would be required to buy insurance. Japan requires it. People buy it. Germany requires it. People buy it.”
    The health insurance for a healthy person is better compared to liability insurance for motorcycles. You can really completely total a motorcycle and do no damage to another vehicle, and if you damage your motorcycle that much, you are dead anyway. So what good is insurance to a healthy person? Better to play Lotto where the profits and losses are already certain and even printed on the backs of the little cards. Would insurance companies print on the backs of their cards how much they make on healthy people who don’t need insurance? No, they prefer to hide their profits and sneak you out of your money. There are mountains of accountants running the numbers in insurance companies to be absolutely sure that they will make money on you when you buy insurance, even if you get hurt. Why force people into that racket?
    Still, no proof that the price of health care will come down. What does “tightly regulated” costs by the government mean? Like the bidding sytem they use for the Pentagon? I don’t trust that in the least.
    But here is the problem for me. When the insurance companies lobbied the governments to pass laws against people driving without seat belts, my insurance did not get cheaper. Those statistics that the seat belts save lives show that that money goes into the insurance companies’ pockets. Now the insurance companies are back doing what they do best. Using our government to screw us and make money for themsleves.
    I would be for almost any system that would allow a person to put away a few dollars in case of illness, and be sure he would be okay. No reason for insurance if health care is affordable anyway. Insurance just keeps reasonable prices for health care out of reach of the normal person. Not good.

  14. Peter Larson
    Posted December 19, 2009 at 8:15 am | Permalink

    Well, no you’re insurance rates did not go down, but they didn’t go up as much as they would have either. If a coffee shop gets coffee for cheaper than what it pays now, they don’t usually lower the price of a cup, but when it comes time to raise prices, they may not be forced to raise it as much as they would otherwise.

    “Tightly regulated” means just that. A board in Japan get together every 4 years and revise a giant book with standardized prices for every medical procedure, supply and pharmaceutical used in Japan. The results is that a medical visit that would cost me more than $500 in the US, only costs me $30 in Japan. You can be cynical if you’d like, but the end outcome is that health is affordable for everyone, just as you’d like, which I assume you’d be into, like most Americans. Without regulation and cost containment, medical costs will continue to rise in the US and the rolls of the uninsured will continue to grow.

    I’m not suggesting the the US copycat the German or Japanese systems. It would be nice, but difficult here for a number of reasons. But I think we have much to learn from countries that are able to claim nearly universal coverage through the private sector.

    In addition, I’m tired of all the left and right wing rhetoric about “socialized medicine”, “public options” and “single payer systems”, assuming that are no other alternatives. The level of misinformation is incredible on both sides.

  15. kjc
    Posted December 19, 2009 at 10:01 am | Permalink

    ha. my friend just said to me the other day, “if someone makes that auto insurance analogy again i’m gonna…”

    not praise jesus.

    i’m not sure what you mean putting rhetoric about “socialized medicine” into the same category as “single payer system”. one’s an actual system. the other is bullshit propaganda.

  16. Peter Larson
    Posted December 19, 2009 at 12:02 pm | Permalink

    Both are bullshit propaganda if people just use them as catch words, but that’s just my opinion.

    I grew up in a place that did not require auto insurance. When it came time to require that all auto owners have it, people fought it tooth and nail saying that for government to require insurance was an infringement on individual rights and unAmerican. But now, it’s required, and people pay.

    For the record, I consider health coops and medical savings plans to be equivalent to having some form of insurance. My opinion is that everyone should be required to have some minimal option, just as we do with liability insurance for auto owners. To not have insurance is not only a risk to individual health but also a risk to society as a whole, who often will have to foot the bill in one form or another.

    But, why would anyone care what I think? I’ll shut up now.

  17. Brackinald Achery
    Posted December 19, 2009 at 1:59 pm | Permalink

    Just because people suffer evils while they’re still sufferable doesn’t make the evils good, nor does it justify further evils.

  18. Ale Roka
    Posted December 19, 2009 at 11:03 pm | Permalink

    Silly, Peter? Care to expand?

    You compared banks requiring people, who purchased something on a loan from the banks, to insure the loan, to:

    people being required to purchase something to cover them-actual-selves.

    If the bank loans me money for a house or car, the bank actually owns the car/house. So, the bank requires me to insure the cost to protect the bank from potential loss.

    I’m still operating under the, perhaps naive, assumption that I, for better or worse, still own myself. (Correct me if I’m wrong. I’d like to meet my owner.)

    If I own my home, outright, I don’t have to buy insurance, do I?

    If I don’t drive my car on streets where I could do harm to someone else’s property, I don’t have to insure it, do I Peter? (That 63 Buick I do donuts in on my cornfield is legally uninsured.)

    Said again, more slowly.

    The bank owns the house. The bank owns the car.

    I own me.

    Huge difference.

    Your remarks are simply, um, “cuckoo.”

  19. Peter Larson
    Posted December 20, 2009 at 12:22 am | Permalink

    Liability insurance on a car is not about ownership, it’s about taking responsibility when you hit someone so that the person injured or the state doesn’t have to.

    The same can be said of your health. If you don’t have the means to pay when you get ill and use health services, then either the hospital has to take the loss, effectively paying for it themselves, or the state has to foot the bill against money that you never paid in, essentially shifting responsibility to the taxpayer. So no, it’s not really about ownership at all, but about who, in the end, has to take financial responsibility in the event of a major health issue, or, in the case of automobiles, an unforeseen accident.

    The other option is to stop requiring emergency rooms and public hospitals to provide treatment regardless of insurance status, but that would just be wrong.

    I really don’t understand why it is unacceptable to require someone to have the means to pay for health care, even if it only covers the most serious and infrequent of health events as in the case of high deductible policies.

  20. Me
    Posted December 20, 2009 at 2:17 am | Permalink

    Peter wrote, “I really don’t understand why it is unacceptable to require someone to have the means to pay for health care, even if it only covers the most serious and infrequent of health events as in the case of high deductible policies.”

    I don’t understand. If it only covers the most infrequent health events, then, the government or the hospital, as you admit, will have to “foot the bill” every time one of the frequent illnesses occurs. People who can’t afford the services using the services just doesn’t make sense, and cannot be sustained.

    Peter wrote, “But, why would anyone care what I think? I’ll shut up now.”

    I don’t think anybody in this thread has said they don’t care what you think. People wouldn’t bother typing at you if they didn’t care what you think.

    Peter wrote, “If a coffee shop gets coffee for cheaper than what it pays now, they don’t usually lower the price of a cup, but when it comes time to raise prices, they may not be forced to raise it as much as they would otherwise.”

    Not a big deal to me, but when I was in business, I passed on to my customers whatever savings I found. It’s good business.

    Well, it boils down to a few things. Doctors are expensive, hospitals are expensive, drugs are expensive. Insurance is also expensive, but that seems like an issue that would take care of itself if the real problem could be fixed.

  21. Peter Larson
    Posted December 20, 2009 at 9:03 am | Permalink

    Well, obviously, I would support full coverage for everyone. However, there are inexpensive fee for service clinics and even federally funded clinics which provide services at a price based on one’s ability to pay. These clinics can take care of basic primary care, children’s health, maternity health and everyday, normal health events such as colds and flus, small injuries and are generally accessible to everyone. The services are affordable and available to everyone right now.

    I believe that, rather than provide a comprehensive public option for health care, the feds would do well to expand ferderally funded clinics to provide more services to a wider number of people. Hence, the reason that I would suggest requiring everyone to have a policy which will cover major accidents and major health events. We already have this to some extent.

    In the end, I agree; the problem is costs. Until we work to control costs, it will be difficult to change anything.

  22. Glen S.
    Posted December 20, 2009 at 12:53 pm | Permalink

    Peter: I think the idea of federal funding for free or low-cost clinics is great — they can certainly be a great benefit to people living in inner-city and rural locations which lack adequate health care resources, and can provide a safety-net for people with routine health issues, i.e. common illnesses, minor injuries, etc., and everyday needs such as prenatal care, vaccinations, etc.

    However, what happens when seemingly “routine” health care issues become more complicated — when a trip to the doctor for a cough turns out to be lung cancer or heart disease? Or, when regular prenatal care identifies a complicated pregnancy? “Community” clinics can do a great job with everyday care — but rarely have the kinds of sophisticated labs or equipment (MRI’s, etc.), or access to the kinds of medical specialists that are frequently necessary to provide advanced diagnosis or more complex follow-up care.

    Likewise, people who end up being diagnosed with severe or chronic conditions frequently need numerous (and often very expensive) prescriptions to treat their illness. How beneficial can these clinics ultimately be if people still can’t afford the prescriptions they need?

    My point is that low- or no-cost clinics are can be a PART of the solution, but they are hardly the total answer. Again, I think the major, fatal flaw in the whole health care debate so far has been to treat the individual pieces of our health care “system” as just that — individual pieces: Medicare (parts A, B, C, and D), Medicaid, S-CHIP, private insurance, employer-provided insurance, the “public option,” name-brand drugs, generic drugs, drug re-importation …

    The “system,” as it currently exists is too diffuse and too complicated for anyone to understand … and that is what makes it so easy for health insurance and pharmaceutical companies to continually find ways to game the system to their advantage — and to the detriment of the general public.

    That is why, as I’ve watched this whole health care “reform” debacle develop, I’ve only become more convinced that a taxpayer-supported, single-payer insurance plan is the ONLY option that is truly capable simplifying the system, dramatically reducing costs, and providing high-quality affordable health care for all Americans.

  23. Peter Larson
    Posted December 20, 2009 at 2:56 pm | Permalink

    I agree that low cost and free clinics are not a total solution nor was I making any suggestions to that end.

    I don’t agree that a taxpayer supported single payer system is wise, nor feasible and have personally lived and been covered under plans in countries that do not have such systems, yet can claim universal coverage. Both of the countries in question do much to keep costs low, just as we should have been doing all along and could do in the future. I’m not confident that this will happen, though.

    Still, no one has ever been able to offer me a convincing argument against requiring every resident of the US to maintain a minimal level of coverage.

    I am less that confident that anything will change in the US system (or lack thereof). The political will simply is not there. It is truly unfortunate. or

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