286 Comments on “Health Care Passage Thoughts”

1. As a pre-emptive note:

   The Mallet of Loving Correction is in play as of NOW. Please be polite to each other even if you disagree with each other vehemently as to the benefit of the health care bill. Also, just as a general tip, comments that are rhetorically indistinguishable from what they would be if the GOP and the Democrats were merely football teams in the Super Bowl are likely to be mocked by me, if in fact I don’t just delete them for inanity. What I’m saying is be as smart in your comments as I know you can be. Thank you.

2. Really, Obama got something done? His inaction and inability to do anything is the stuff of late night humor and parody. Obama is just a bozo that fooled everyone, enough about him.
   As for the healthcare passage. I like the idea but I am still not sure anyone really knows what will come out of what is passed. I think the GOP is wrong in so strongly opposing this particular bill because they just make themselves out to be heartless to the average joe.
   While I like the idea, I still am greatly concerned how this administration and congress is so quickly digging us deeper in debt. $12.5 trillion and getting deeper, now to the point where we might lose our AAA rating…. Yeah, something still needs to change.

3. Mostly I’m relieved it’s over and talk radio (which my girlfriend listen to a lot) can move on to other topics now.

   However, I do think this is one of the best things to happen to the US in a long time even with all the political damage Obama suffered from it. It will be interesting to see what it means for the mid terms…

4. Although I support the bill on the whole, I agree with some of the fiscal objections, particularly the notion that taxes which don’t take effect for eight years are unlikely to actually occur. It then occurred to me that maybe this is the first step in the Democrat’s version of Starve the Beast, applied to the military budget. A large portion of the Democratic base would be happy to see our worldwide military presence withdrawn, which would save hundreds of billions a year. But since that seems unlikely on its own, an alternative strategy is to increase domestic spending in advance, and then when the inevitable debt crisis hits military spending is the only thing which can be cut quickly with acceptable domestic impact.

   Of course, Starve the Beast didn’t actually work in the 80s and 90s…

5. I’m really glad the bill made it through, and I think Obama will benefit more from this in the long run than the short.

   Being a former Republican, I still have little voices in the back of my head that are worried about the whole thing, but I think for those worries, at the very least, this is a grand experiment. Now we get to see what the bill really does, and if it is as good as I believe it to be.

   I’m optimistic.

   On a lesser note: Alas! You have already said everything I wanted to say in my own blog!
   Well… Maybe I’ll just link to here….

6. I think the idea that the GOP is going to retake either the House or Senate (or both) is optimistic at best, and the idea that they would be able to retake both with the majorities needed to overcome a presidential veto is the sort of magical thinking that usually indicates either profound chemical imbalances in the brain or really excellent hashish.

   *snort* Hey, you could warn a girl before coffee goes thru her nose and all over a perfectly good keyboard!

   Overall, I agree with you, so — Nicely said, sir. Nicely said.

7. I don’t have anything particularly wise to add to this, so I’ll just say that I’m pleased. Sure, it’s imperfect, but it’s the first step to something much better than what we have now.

8. I, too, am grateful to see this happen. Rumors are already floating about lawsuits aiming to block the law’s use, once signed. That sends chills down my spine. “Hey, I’m going to sue you to keep these people from having a shot at being healthy.” How much do you have to hate someone to want them to not have access to healthcare? So, what’s the next big crap-storm the “pundits” will use as an excuse to hate Pres. Obama?

9. It’s refreshing to hear a reasoned assessment of an issue that, from an outsider’s perspective, quickly became a rhetorical nightmare.

   From the Canadian point of view, the whole conflict was baffling. I will never understand how someone can willfully, and successfully depict universal health care as a bad thing.

10. Except for possible challenges on First, Fourth, Fifth, Sixth, Ninth and Tenth Amendment grounds, as well as violating the McCarran-Ferguson Supreme Court decision, and having Attorneys General of 35 states contemplating legal action, it was good (In the sense of “other than that, Mrs. Lincoln, how was the play?” good)

    Social Security and Medicare were passed by bipartisan votes, meaning that each side gave a bit. That manifestly didn’t happen here. I’m sad that it didn’t.

11. As an outsider to the whole process (hello from Scotland) Obama’s big mistake (as in a tactical mistake that made everything take forever) was that he kept trying to bring the Republicans onboard, he gave them chance, after chance, after chance, when no matter what he did they were just going to say no.

    I think it is great he tried, it shows he is the type of president he said he was going to be, he wanted to build consensus like he promised, he wanted and end to the monkey poo flinging politics, but sadly his opponents did not. I don’t know how this plays in the US, but the fact he tried makes him look fantastic to us (and probably will in future history books), but in tactical terms it was a mistake.

    I think it is a good strategic play though. In years to come when the people say the current system doesn’t go far enough, that people still fall through the gaps, Obama can now throw up his hands and say I tried to do more, but they wouldn’t let me. The next round of reformers will be able to further because the naysayers have already shown themselves to be disingenuous and their cries will fall on deaf ears.

12. I’m pleased. Is it a great bill? Uh, I’m not really sure our current parties are capable of it. Is it a start that is long overdue? Yeah.

    Do I think the democrats will lose votes at mid-term? Yes. But my corollary to that is, I think both the democrats and republicans may lose a lot of people at mid-term elections. It wouldn’t surprise me much if the electorate has a “throw-out-ALL-da-bums” attitude and everybody’s surprised. We’ll see.

    I, too, am frustrated at an overall lack of competence on the part of democrats. Although their 60 vote supermajority was really only a technicality–hell, Lieberman was one of those 60–it seems to me if you can’t get something done with that kind of a majority, then you’re just screwing around. On the other hand, the GOP has made it clear (to me, at least) that they’re really AGAINST many things like, oh, health insurance coverage for everyone, AGAINST closing the Medicare donut hole, AGAINST insurance reform, AGAINST, etc…. it’s a little hard to figure out what they’re FOR.

    Of course, McCain said, “There will be no cooperation for the rest of the year” which strikes me as a perfect opportunity for Democratic leadership to say, “Why should that be any different?”

13. Good post, but a quibble. In politics as in running away from an angry bear, you don’t have to be the fastest or best, just faster or better than the other guy.

    Also, what the Republicans forget is that, in 1994, people had something to vote for, the “Contract for America.” Trying to get people to vote against something is an uphill battle – see the Democrats in 2004.

14. I’m glad it’s passed, I’d have liked other things in it (public option mostly), but this is a good start to covering the majority of people who weren’t covered and gets rid of the ‘oh sorry you’re sick now, we’re cancelling your coverage’ inanity. WE’ll see what this does to the cost of care which is too high compared to other developed countries for similar coverage, but this is a good start.

    I’m not actually that concerned about the fiscal impact even if the projected savings don’t come about. Yes, it’s a trillion dollars… over 10 years. People who get all foamy in the mouth over that haven’t had a problem spending a similar amount on Iraq and Afghanistan over a similar time period. In fact, they’ve called people who don’t support that expense unpatriotic. Odd, how people are fine with some kinds of spending but others are a waste of money.

15. Your post encapsulates 100% of my thinking.

16. John Sandwich Guy:

    “Except for possible challenges on First, Fourth, Fifth, Sixth, Ninth and Tenth Amendment grounds, as well as violating the McCarran-Ferguson Supreme Court decision, and having Attorneys General of 35 states contemplating legal action, it was good”

    Well, you know. George Wallace stood in the schoolhouse door. It’s not entirely surprising that others opposed to a similarly sweeping change might do the same. I suspect over the long run the result of the opposition will be the same.

17. So now that ‘the’ health care bill is about to be signed into law, will the Dems have what it takes to push the rest of the ‘real’ health care reform needed – actual stuff to control costs, and a single-payer option? You know, the HARD part of the battle that they just dropped.

    I’d also like to see some action of preventing another economic meltdown, and some action in bringing the troops home. If we keep spending money on Iraq and Afghanistan, no amount of cost savings by a new health care bill will be enough.

18. *APPLAUSE*
    Not a whole lot more to add, other than I hope we can improve this thing further in the years to come. Great post.

19. “Really, Obama got something done? His inaction and inability to do anything is the stuff of late night humor and parody.”

    Which, as last night made perfectly clear–to say nothing of his other pushes–was more a media caricature and buffoonery than actual representation. He just did something that no president since Johnson has done.

    “Obama is just a bozo that fooled everyone, enough about him.”

    Would you like some cheese with that?

20. If the GOP really wants to make hay out of this legislation without being stupid about repealing it they need to position themselves carefully. Take the attitude of “well, we didn’t want this particular legislation because of some points we don’t like. Now that it’s here, our job is to fix it.” It gives them the ability to “like” the parts that are popular (many of which they supported anyway) and to present themselves as the party to “fix” the parts that aren’t.

21. I am excited for the passage of bill, and glad to see congress actually get something done. I have grown increasingly tired of people of who label themselves as fiscally conservative rail against the bill as expensive, when it in fact lowers the cost of healthcare to our government.
    It is politcally convenient to pretend that our current system would incur zero cost in the future, but in truth what has been passed is vastly superior from a fiscal sense than the status quo.

22. Mmmmm, “really excellent hashish.”

    Wait, what were we talking about?

23. Apparently, when it’s a major piece of legislation like this, it’s always a long, nasty battle and the vote is always close, to allow some in the pioneering party to take an opposition stand. In other words, there was no way that Obama could have rammed the bill down anyone’s throat, not and have it work. Now the Republicans can run on that they opposed it, whether or not they do anything further, but unfortunately for them, that will still not make the Tea Partiers love them. It’s going to be interesting to see what happens in the Republican primary elections. Although the Republicans are bound to pick up some seats, we’ll also see some situations like we had in New York, I expect, where the Republican is besieged and the vote goes to the Democrat.

    For me, this bill is going to be of a great deal of help to my sister and my mother, and so I am very grateful. Even more, it clears the way for so many other important fixes finally. They attached the student loan bill to the healthcare vote and got that passed too.

    What I hope is that eventually we’ll have smarter, less “magical thinking” capitalism, where business executives don’t put their personal fortunes above shareholders, customers, employees and infrastructure because they simply can’t do it anymore. And that’s going to make U.S. and world business a whole lot healthier. And with healthcare reform, which is not perfect but can be adjusted, we’ll have a healthier workforce as well. Sadly, the racism and bigotry issues that were so evident these last few days are probably going to take much longer to improve.

24. Guess I’ll just have to link to this post from my blog since I couldn’t have said it any better. Excellent analysis, as always.

    Being a former conservative Southern Baptist and former Republican, I have a lot of friends and acquaintances that are not happy, to put it mildly. I’ve heard a lot of apocalyptic doom saying this morning. “I went to bed free and woke up a serf,” “This is how liberty dies,” and my favorite, “This is another sign that the end times are here and Obama is the anti-Christ.” Thank God, literally, that I got out of that Manichean mind-set.

25. John Sandwich Guy@10 Social Security and Medicare were passed by bipartisan votes, meaning that each side gave a bit. That manifestly didn’t happen here.

    Since many Democrats’ default position was single payer (Medicare for everyone), with a compromise position of a public option to provide actual, you know, competition to the private insurance companies — neither of which is in the final bill — I’m not sure how to respond to your comment. Republicans refused to vote for even this watered down bill, a bill that included many of their ideas. If there was no bipartisan support for this bill, IMO the fault lies with Republicans more interested in bringing about “Obama’s Waterloo” than in bringing about changes in health care delivery.

26. I guess that answers part of one of my reader’s requests from last week.

27. Except for possible challenges on First, Fourth, Fifth, Sixth, Ninth and Tenth Amendment grounds, as well as violating the McCarran-Ferguson Supreme Court decision, and having Attorneys General of 35 states contemplating legal action, it was good (In the sense of “other than that, Mrs. Lincoln, how was the play?” good)

    Ok, I understand at least the idea behind the 9th and 10th amendment, and 1st you’re probably talking about freedom of association, but Fourth, Fifth, and Sixth? Also McCarran-Ferguson Supreme Court decision? Do you mean the McCarran-Ferguson Act?

    Social Security and Medicare were passed by bipartisan votes, meaning that each side gave a bit. That manifestly didn’t happen here. I’m sad that it didn’t.

    Yes, there are at least six republican ideas in the health care bill, but the Republicans wouldn’t budge. Also, the composition of Congress is considerably more ideologically rigid than it used to be – remember Southern Democrats and Northeastern Republicans? They don’t exist in numbers anymore, since the Civil Rights Act proceeded to break that up. The sort of Republican who voted for Medicare likely wouldn’t make it out of a primary today.

    Bipartisanship requires the other party to be willing to vote for the bill. Even Cao voted against the Senate bill, and he represents New Orleans, and only won because his Democratic opponent got caught with bribe money wrapped in tinfoil and stuck in his freezer.

28. Speaking as a person from a country with socialized medicine, I spent the first decade of my adult life whining because I had to pay out a paltry sum each year for health care (around $240) and eventually moved on to realize it was a pretty damn good investment when my son was born (free). It all now makes sense, even though the tax burden remains high, that I should be able to afford to live without fear of tragedy becoming economic as well as human.

    Now I grew up with the system, so I don’t really know the ins and outs or the U.S. realities but whencitzens are losing their insurance on a whim and a doctor friend of mine (a chiropractor) continually complains he is at the mercy of your HMOs, you got to wonder where the upside of Americans keeping the status quo is/was?

29. I’m certainly relieved that fewer people will get into paralyzing debt because of medical bills, but this bill doesn’t do nearly enough to address the real sources of strain on the health care system itself. That’s a big problem because with this bill passed, the political class will declare mission accomplished and we’ll run right into the real health care crisis at 60 mph with our eyes closed.

    How is this going to help deal with overconsumption of “free” treatments? How is it going to help end the culture of defensive medicine? How is it going to reduce the administrative burden of a million different byzantine claims systems?

30. My major concern about this bill is what it will (or won’t) do for health insurance costs. I like some of the big plusses, although I have to say that banning recission does seem like one of those things that’s so obvious you wonder why it was ever legal in the first place.

31. Social Security and Medicare were passed by bipartisan votes, meaning that each side gave a bit. That manifestly didn’t happen here. I’m sad that it didn’t.

    Yes, I wish for more bipartisianship but you can’t say they didn’t try. I saw a meeting hosted by the President, inclusion of numerous amendments and ideas, a year of debate (I’ll count the shouting matches at town halls as debate), and so forth. Everything was met with “Nope. No. No way. Nope. Socialism. Nada.”

    When the other side doesn’t want to budge, what are you going to do?

    As I said to a friend on Twitter: Eventually you stop looking for the gate and just climb over the damn fence.

32. Mr. Scalzi I have to say, in addition to being a good writer, you have a high aptitude for situational analysis – in this case the political fight surrounding health care. I wonder if this doesn’t come in part from your pragmatic position with regard to our political parties, and I know that this is why I ultimately agree with your analysis. I can’t steadfastly associate myself with either party, but often find myself repulsed by the dangerous tactics of the right. The media, which I like to consider another large, inept political player in our politics, tried its best to derail the public debate on this issue, with its focus on red-herrings, sensationalism, nerfarious mischaracterizations and what not, but was ultimately defeated by . . . I don’t know what. Maybe after a few months of American citizens bemoaning the lack of cajones by the Democrats, they decided they wanted to actually earn their living. Or maybe, just maybe, for once, reason – percolated by non-traditional MSM outlets – managed to overcome the lies thrown against it.
    -John the sandwich guy: I’m sorry but your post makes absolutely no sense. If you’re referring to the McCarran-Ferguson Act, that was passed in response to the c. 1940s flat-earth philosophy that “insurance” companies were not engaging in commerce, and was a direct response to the Supreme Court ruling in U.S. v. Southeastern Underwriter’s Association (322 U.S. 533), which confirmed congressional authority to regulate the insurance industry based on the interstate commerce clause of the constitution. As for the other amendments you rattled off, it would take some creative (mis)-characterization to create any viable or legitimate legal challenge on those grounds.

33. While there are some good points to the bill, the cost will be…. staggering.

    If the Senate bill goes forward, it will lead to an expansion of the deficit in the out years, since the tax increases are front-loaded and don’t cover the late year costs. The upcoming “doctor fix” for Medicare rates will wipe out the surplus the bill creates, and add 500+ billion in deficit. If the fix is not applied, expect most physicians to refuse new Medicare patients, as there will be many more procedures that cost more to perform than they net. My wife will be between a rock and a hard place in her practice if it goes forward.

    Also, Social Security taxes are expected to go up from wage increases as employers push employees onto exchanges and give them raises instead of insurance. All that money is allocated to offsetting the bill’s costs, yet the increase in SS wages will drive up Social Security payments later on, increasing the SS deficit.

    Some the the supposed “Republican ideas” cited above as being in the bill are just not true. Two examples: insurance purchases across state lines are only allowed if the states in question allow it. Not what was wanted by the (R)s. The malpractice reform is a few million to allow states to experiment with ideas, not serious reform such as a system based on worker’s comp.

    I also expect that the “cost curve” won’t bend (Baumol’s cost disease still applies to medicine), the pace of drug innovation will slow, and we will be left holding the bill for a large bureaucratic structure erected by this.

34. I really don’t think the GOP will have any problems with this, and in fact will see this as an absolute victory shortly. Soon they will be able to cherry-pick problems that surface and point out how “if Obama had not rammed his bill through without some thought, these kinds of things would not have happened” and “with our candidate we will fix all the problems that Obama created with his bill” – I predict this will not even cause a blip for the GOP.

35. @Steve Buchheiton
    “Mmmmm, “really excellent hashish.”

    Wait, what were we talking about?”

    Makes me wonder about the future of medical marijuanah.

36. While there are some good points to the bill, the cost will be…. staggering.

    And yet the CBO thinks that it will reduce the deficit by $130 billion. Staggering, indeed.

37. Well he did manage to encourage bi-partisanship; Against his Health Care bill.

    So we’ll see how this goes. Generally speaking, I shouldn’t complain since this is a huge transfer of wealth from the uninsured to, well, people like me.

    I’ll likely be able to retire sooner, while those unfortunate to be younger than me likely won’t have much of a chance of retiring at all.

    But just think, soon science may conquer death in which case Social Security and Medicare will have to go away: Problem solved.

    Of course, given that the taxes come well before the benefits, it’s also quite likely that people will be upset enough to throw the bums out and repeal the whole thing.

    But I do agree repeal is unlikely before 2013, OTOH, there is a good chance that Republican’s will win majorities in at least one chamber, because the whole Health Care debate will be on the front pages for many months yet to come. If that prediction comes true and unemployment has not abated by August, Democrats will suffer greatly.

    And it’s possible that the Senate will not pass “reconciliation” which will allow the President to sign the Senate Bill in it’s entirety. If that happens, it will seriously piss off the House members. They will feel snookered and uncooperative.

    But they’ll have good company.

    We’ll see how this plays out.

    But I’m guessing it won’t play out well.

38. Excellent post, John. Such a relief from the histrionics in certain internet forum populated primarily by tea party types. *cough*bar*cough*

39. The democrats are in real trouble in November. The economy will not improve enough to help them (it really has to improve by the summer since the numbers don’t come out until months later). They are going to lose alot of seats.

    It is worse in 2012. Democrats have to defend 20+ seats and republicans have to defend less than 10 in the senate.

    As far as this making Obama a two termer. Losing this vote, would have killed his presidency. This does not make him a two termer. Benefits do not come in for the most part until 2014. It can still hurt him.

    The 3 big factors in Obama being a 2 termer are

    1. will unemployment drop enough by 2012. If it is still at 7%, he is in trouble.
    2. will the deficit drop at all? If it not, he is in trouble.
    3. Who will the Republicans nominate? If it is Sarah Palin, we could have 20% unemployment and Obama would win. I don’t think she is running though.
    4. If there is a terrorist attack in the US, he can’t win. Fair or not. That alone would cost him an election. No terrorist attack does not really help him.

    My big concern about this is the cost. The $138 billion surplus does NOT include the doctor fix and it involves taking money from medicare. This whole thing assumes that over 10 years we can save $500 billion in waste, fraud, and abuse in medicare. I have trouble believing a number that big. It is almost silly. If we actually do save that much… wow.

    I am pretty moderate. I feel bad for people who do not have medical insurance, but this is really expensive and we already have a huge debt.

40. I don’t think the constitutional challenge will stand. The argument is that if the congress does not have the explicit right to do something in the constitution it can’t.

    However, the supreme court has ruled that the interstate commerce clause is so broad that this should fall under it. I don’t think the Supreme Court will over turn this. It will go to the supreme court though.

    John: Comparing this to John Wallace standing in the school house door (note he was a liberal democrat btw and it was a Republican president who sent in the national guard) is not a fair comparison.

41. George R.R. Martin on HCR

    Also,

    Lay Lake on HCR

    I really can’t overstate how much a shift like this means to freelancers, especially full time writers. Everyone, and I mean EVERYONE I know who’s a full time writer who doesn’t have health insurance through some finagling is thrilled about this. An I know a heck of a lot of writers, freelance journalists and independent contractors.

    This bill will allow a new generation of freelance workers to actually afford to stay freelance if they can’t afford insurance through an individual provider.

42. I’ll point out that there are at least 10 state attorneys general who are going to file suit on constitutional grounds, and that should keep things tied up for a while.

43. America can not afford this. Also, how on earth would you need over 2500 pages for a Bill that is supposed to help us?
    It will destroy Small Business.

44. Do you mean the McCarran-Fergusson Act, passed after the United States v. South-Eastern Underwriters Association Supreme Court case? Where Congress decided to exempt the insurance industry from most regulation, after the Supreme Court ruled that insurance was commerce, and could be regulated by the Federal gov’t?

45. oops. Jay’s post is here

46. Welcome to the rest of the developed world, USians.

    Hopefully this sort of thing never happens again:
    http://www.reuters.com/article/idUSTRE62G2DO20100317

47. @ @43 – It will destroy Small Business.

    Small businesses with less than 50 employees aren’t even touched by the bill. Try again.

48. Small businesses with less than 50 employees aren’t even touched by the bill. Try again.

    Of course their employees are, which is why the Insurance Companies are seeing a rise in their stock prices today.

    Strangely, all weekend I heard that the Republicans were against this bill because they were in the pocket of Insurance Companies who were against it.

    But didn’t insurance companies just get a whole bunch of Government mandated customers?

    I’m still scratching my head about that.

49. Mark @34: Soon they will be able to cherry-pick problems that surface and point out how “if Obama had not rammed his bill through without some thought, these kinds of things would not have happened”

    Only in Bizarro world would a bill which took nearly a year to pass, and saw extensive and even nationally-televised debate, be considered “rammed through Congress”. The only thing it was rammed through was the GOP’s blockading tactics. Sadly that Bizarro world seems to be where most Republicans are living these days.

    Now, I have to say that I for one will rejoice when I hear a member of the GOP say

    “with our candidate we will fix all the problems that Obama created with his bill”

    because that means we’ve WON.

    Josh Jasper @41:

    Software is another field that has a lot of freelancers and small start-ups and will benefit hugely from this bill. Entrepreneurship should not be a privilege reserved only to the rich and the healthy (and the lucky).

50. David Frum, of all people, posted an excellent piece from a Republican point of view.

    I suspect that the first GOP head to roll over this will be Sen. McConnell’s — he who devised the “Zero Republican votes” strategy. I don’t think he can be effective after this without doubling down and filibustering everything.

51. Excellent post.

    Health care reform was not my primary reason for voting for Obama, though I agree it’s extremely important. My main reason was the hope that he would roll back many of the excesses of the Patriot Act.

    I’m still waiting on that one. Hopefully once the dust settles from this fight, he’ll look into limiting our government’s power to spy on and harass its citizens.

52. Guess: Wallace was a “Democrat” during an era in which southern Democrats would make current-era moderate Republicans look like hippies.

    As for your comment on the deficit: it’s a red herring for Republicans. The moment you press them on either the years 2001-09 or the fact that countercyclical fiscal policy shows that it’s a good thing when dealing with a recession, you get a lot of stuttering or variations on “These Go To 11”. People only care about the deficit when someone’s telling them to care about the deficit.

    When I hear the old Chicago school folks jumping up and down applying microeconomic thinking to a macroeconomic environment, well, it’s just so darned adorable!

53. Aside from saying “amen, Scalzi”, I want to signal-boost this comment from elsewhere:

    One reason the Republicans are shitting themselves over this is this is the first real aid to a crucial segment of their base, the self-employed. None of the tax cuts really helped them because they pay far more in SS and Medicare taxes due to having to pay both halves and there have been no cuts in either of those. Subsidies, insurance regulation and an internet based exchange to shop for policies are going to be very popular. There will be those griping about the mandate until their wives tell them to shut it now that the kids are covered.

54. Many years ago I heard communism described as being “when we share YOUR stuff”. Always liked that definition. The last year or so has led me to the conclusion that an accurate description of socialism might be “when the government helps you”. When it helps me, it is of course completely warrented and correct.

55. Robert Murphy: that Frum piece is, indeed, excellent. I think Frum nails the fact that, as long as the “leaders” of the Republican Party are entertainers rather than politicians, they’re going to keep spinning their wheels until either the angry meter hits red or burns out.

56. Frank – What insurance companies took a hit in is the inability to arbitrarily raise prices, drop people for having the wrong sort of diseases, and cap payments for expensive life saving procedures. They took a hit, trust me. There’s more in the Washington Post article I link to after my reply to you.

    In six months, all new plans will have to cover the full cost of preventive care, including annual physicals and children’s immunizations. Insurers won’t be able to require prior approval for patients who need to see gynecologists or go to the emergency room.

    This will cost them money. No doubt about that.

    —–

    Everyone else who’s yamemring about how this will hurt small businesses Look here– small businesses with fewer than 25 employees and average annual wages of up to $50,000 will receive tax credits to offset the cost of buying insurance for their workers.

57. First off, in the case of Obama’s behavior, I think he was doing the same rope-a-dope strategy as before. The Republicans peaked too soon and wore themselves out. Obama saved his time and energy and did a strong push at the very end and with key progressives in his own party that he needed to tide over.

    There are some excellent articles on the web pointing out that Obama’s key strength is patience and he doesn’t feel the need to win every news cycle 24/7. The Republicans wore themselves out trying to sustain all this anger for so long and he just let them burn themselves out.

    And the Democrats are handicapped by something the Republicans lack: diversity. Yes, they have a range of attitudes and ideas in the Democratic Party and that makes it harder for them to get everyone on board than the Republicans who have been tossing their diversity of thought overboard.

    Yes, HIR has flaws, but I take the long view on this matter. Every time health care reform tried to get passed and failed, the harder it got the next time around. Repeated failures makes success harder. The fact is that we now have a success and against really bad odds and this is going to bolster Democratic confidence and make it easier to pass future correcting bills in the next Presidential term.

58. I don’t have anything against the benefits of the the bills that were passed, if I fact I think most were long overdue. No one’s arguing that health-care in the US was(is) broken. As several others have pointed put previously, though, I am concerned how this will be paid for and what it will do to the national deficit. I (and I’m sure many others in various in the allied health educational systems) do worry that it suddenly may become significantly harder to repay my $100,000 pharmacy student loans if my earning power is cut out from underneath me after I graduate in two years.

59. I will only add one thing to supplement your analysis as to why Republicans will not be able to repeal this. Here it is.

    For better or for worse, the insurance industry and possibly the hospital industry will now have 35 MILLION new customers. That’s good for business, right? At least, today’s financial markets, and especially the health care sector seems to think so.

    If you’re a bona-fide pro-business pro-repealing Republican, try explaining to your healthcare lobbyists that you’ll be shrinking their customer base. Yeah, good luck with that.

60. Guess:

    “John: Comparing this to John Wallace standing in the school house door (note he was a liberal democrat btw and it was a Republican president who sent in the national guard) is not a fair comparison.”

    Who’s John Wallace? I was referring to George Wallace, and calling him a “liberal Democrat” is simply and flatly incorrect. Likewise, it not being a “fair” comparison is also incorrect; you’re apparently wrapped up in who’s a Democrat and who’s a Republican and missing the “who’s an obstructionist and who’s not” issue.

61. Guess: I know it may be hard to remember, but not every Democrat is/was a liberal. And Dixiecrats were a breed unto themselves.

    I’m a liberal, and this is not the measure I would have wanted to see. I wanted single payer universal care for a lot of reasons, including to free up the movement of labor from places where industry is dying to places where innovation is happening, rather than having to ride the factory in its death-throes because you have diabetes or your kid has asthma. Yeah, I’m a child of the Rustbelt, why do you ask?

    But this law does real good in the lives of many people, more than the 32 million uninsured when you start to count in the young adults who can extend their parents’ coverage, women who will no longer suffer price discrimination, freelancers with pre-existing conditions and on and on. And real good for real people is my progmatic marker for the common good.

    And on a side note, Scalzi, why aren’t you the next James Carville?

62. As someone who lives in a country with socialized medicine, I’ve had to pay no more than $500 per year on health care – including dental – for my family (excepting my daughter’s glasses).

    Where is this magical land? It is here in the United States. I’m in the military and get free or very low cost medical coverage. And it is all subsidized by the taxpayer. If I can get this great service, why can’t we expand it to the rest of the country?

63. Mr. Scalzi, I must say that I love you, in the most platonic, socially healthy, and non-stalkerish of ways. Brilliant post.

64. John – mostly agree, but, except for the photo, you have completely omitted the critical role that Speaker Pelosi played.

    By some accounts I’ve read, she’s the one who managed to get the Democrats, including Obama, to man up after the Massachusetts election and finish what they started rather than wallowing. She deserves a lot of credit for this – it was not at all an entirely-Obama-led victory for the Democrats.

    In fact, in my view, he didn’t *lead* nearly as much as he should have from day 1 – but that’s a rathole many internet discussions have gone down…

65. Josh

    What insurance companies took a hit in is the inability to arbitrarily raise prices, drop people for having the wrong sort of diseases, and cap payments for expensive life saving procedures. They took a hit, trust me. There’s more in the Washington Post article I link to after my reply to you.

    They didn’t lose anything. They made the deal in exchange for a huge pool of people (the young) who have to pay and are unlikely to have to receive. It’s called expanding the risk pool. Insurance companies could not get this customer base on their own because the young often didn’t feel like they needed the expense, especially when they were just starting out in a career. Up until now, Insurance companies only had customers who were more likely to get payouts. This is one reason Democrats claim that their bill will drive down health insurance costs. And they would have been right about that, if it wasn’t for all the other stuff…

    And preventative care is not as big a cost driver as people actually getting sick; and I mean hospital sick. My employer has been stressing preventative care (which is paid for) and exercise for years because they know it cuts health care costs.

    The fact is, this bill does in no way “punish” health insurers.

    Martin

    First off, in the case of Obama’s behavior, I think he was doing the same rope-a-dope strategy as before.

    I find these assessments of the President’s extraordinary political acumen extremely amusing. Especially since for over a year now I have been impressed with how politically inept his administration has been. In fact, I was astonished at how poor a politico he is given his brilliant campaign.

    I laugh everytime I hear some nut-case say that Obama is the anti-Christ because the anti-Christ would be a great politician, unlike our President.

    Of course, he could always get better….

66. Rumors are already floating about lawsuits aiming to block the law’s use, once signed. That sends chills down my spine. “Hey, I’m going to sue you to keep these people from having a shot at being healthy.”

    I’m still not certain what standing some of these people claim to have to file such lawsuits. What’s their injury? Is it of such direct effect on them that they’re legally aggrieved?

67. The Republican Attorney General in Washington State has filed suit on Constitutional grounds along with Republican AG’s in 11 other states.
    The state attorneys general say the reforms infringe on state powers under the Constitution’s Bill of Rights.

    I expected this, let’s ty it up in the courts and help influence the election this fall.

    My question is this: If this is unconstitutional in 12 states with Republican AG’s why isn’t it a problem in the other 38 states?

    Is it only unconstitutional if your a Republican?
    Hmmm, I see a pattern here and it ain’t pretty.

    For the record, I’m an ex-republican who got tired of “NO” to everything that they didn’t think of first.

68. This is really going to hurt the Democrats come election time. I agree that it’s probably not enough to take back the Senate, but taking back the house is a strong possibility.

    I also agree that the kind of supermajority required to overcome a presidential veto (or senate filibuster) is just a crack addled pipe dream.

    On the other hand, the Democrats just put the IRS in charge of forcing people to buy insurance they don’t want. That’s how the Republicans are going to spin it. It’s even true (if grossly oversimplified). That’s a pretty big stick to use come campaign season.

69. Well, first off, hurray!

    During the last year, President Obama has been catching a lot of flak that runs along the lines of, “Well, he’s good at making speeches, but when it comes to governing…” I think that his last-minute press for health care passage reveals that, when it comes to governing, making speeches isn’t just fru-fru; it’s a crucial part of the job.

    If you haven’t seen it already, please watch Obama’s speech to the House Democrats on Saturday. I don’t know if John approves of YouTube links here, so instead of providing one I’ll just point you to YouTube and give you the search string “Obama speech to house Democrats”. It’s an amazing piece of work. In 30 minutes he not only makes a powerful case for the bill, but also movingly describes the nature of a representative’s duty to his or her constituents.

    I don’t often say, “I’m proud to be an American,” because that phrase is all too often used by mindless boosters as a deflection of criticism and a replacement for thought. But I’m certainly proud today.

70. Beautifully said, John. As well it should be :)

    I’d spent the last few months calling my congresspersons and Senators every week, exhorting them to support HCR. I’ve spent the last few weeks calling them to beg them to support this particular bill (“Yeah, it’s not enough; but it’s a start and we have to start somewhere”). I know the ignorant savages were calling multiple times per day to scream at and threaten them; I’ve heard stories of staffers reduced to tears by the abuse.

    So now I’m been calling my congresspersons’ offices to thank them. It’s amazing – kind of touching, in fact – how thankful *they* are to hear a constituent appreciates what they did.

71. When did we in the US start using Socialism as a curse word on par with the Seven Words You Can Never Say on Television? What good is a government that cannot take care of it’s citizens?
    I don’t hear this manic hatred of public education, public sewage treatment, public water treatment, or any of the many other socialist endeavors in the US. Yet keeping people healthy is somehow evil? I don’t get it.
    I REALLY don’t get it when conservative Christians oppose public health care. I don’t recall Christ asking for payment up front prior to healing the sick and lame. Yet they see no disconnect between the views of Christ, “Whatever you do to the least of these…” and the anti-health care camps who use lies and misinformation to try to win over all opposition?

72. I am a family practice doctor who sees a lot of patients on Medicaid and some patients with no insurance. I keep wanting some details that are not showing up in the summaries of the bill that I am seeing on the web. Maybe you or someone else who is reading this knows?

    I have heard that poor people are going to be eligible for Medicaid. My experience is that only kids or adults with kids under age 18 get put on Medicaid. That will presumably be expanded so Medicaid covers the working and non-working poor who don’t have children or whose children are grown. Do you know what percentage of the poverty line you would have to be at to qualify for that?

    Also, who is paying for the increased number of people on Medicaid? Traditionally the states pay for Medicaid. I live in Ohio, and as you know, it has been financially strapped the last couple years. I worry about adding more financial obligations to the state budget. I have been trusting that when congress says that they are reducing the deficit, it does not mean that they are just shifting the cost burden on the states, but I have not heard anything one way or the other.

    The other concern is that Medicaid generally pays physicians less well than regular insurance. If I charge a $70 office visit, most regular insurances will actually pay me about $57. Medicaid will pay me $37 or $38. Most doctors that I know limit the amount of Medicaid that they will see for this reason. If we get a sudden influx of people on Medicaid, are they going to be able to find physicians to see them? I know our local health department, which is the care-provider of last resort in this county, is already bursting at the gills, even without more people needing to be seen. The health dept does see people without insurance now, but they charge $30 a visit, which prevents lots of people from coming in. I would expect an increase in business if all those people got insurance. Back several months ago, I had heard that the federal government was going to subsidize Medicaid so that physicians would get higher re-imbursements. Have you heard if that is still true?

73. If “aloofness” is now Beltway-speak for “acting like a sober, mentally-stable adult who is not one bong hit away from a total psychotic break”, MORE PLEASE.

74. Thievery.

    Just plain thievery…

    but as many people can rationalize stealing a loaf to feeding a starving child, they can rationalize this.

75. You know, living in countries that have had ‘socialized health care all my life, I’ve never been all that dismayed by it, but then again, I don’t pay taxes, (in fact last year the government paid me!) so maybe I don’t have a natural aversion to giving money away for some intagible benefit.
    And maybe the next time I visit the states, I won’t have to spend ages worrying about getting travel insurance just so I don’t have to worry about injury by bison charge.
    In any event, congratulations to all you Americans, you can now claim that the end of the world is nigh.

76. I’m pleased with the outcome of this legislation, mainly because it should help people that have been left behind in the current way health care is ran in this country.

    I do think that people who are worried about costs are right to be worried, not because the bill itself will raise costs all that much (it may even lower the deficit), but because by itself I don’t think it will fix all of the things that are driving up the costs of health care in this country. I do believe there’s a good chance it will at least reduce the administrative headaches of the current system (requiring the implementation of a standardized claims/billing system in order to be in the health-care exchange is pretty much a no-brainer).

77. To stfg@72 and others who’ve asked, fundamentally –What’s in the bill?– let me suggest a recent Reuters Fact Box article which details the big bullet points and makes clear when they take effect; beginning with those aspects that will start immediately, and those which will be phased in over time (through 2018).

78. >but as many people can rationalize stealing a loaf to feeding a starving child, they can rationalize this

    Actually, I think that’s one of the few cases where ethically speaking theft is probably not going to be considered to be a big deal, unless they’re stealing a loaf from *your* starving child in order to feed *their* starving child. On the other hand, I don’t see how this failed analogy has anything to do with HCR.

79. to deCadmus @ 77 –

    Yes, I saw that. It says almost nothing about the specific questions I have, though. There is a mention of a plan through Medicaid to prevent nursing home admissions, but the article does not address Medicaid otherwise.

80. This bill is a big steaming pile o’ cr*p that has stunk up the hallways of COngress and is now set to destroy what remained good in our healthcare system. Want facts on it? GO here:
    http://fdl.me/dqSkHF

    The Democrats will be held responsible for their act of arrogant hubris and their horrible destructive meddling, and their attack on American freedom, American jobs, and American prosperity. The taxes will kill jobs, the mandates will kill freedom, the entitlement expansion will bankrupts the US and make us a 3rd world-level debtor nation. The only winners are a few corporate folks who now get a captive audience for their wares … the very strawman-bad-guy in the phony Democrat sales pitch! Oh the irony!

    It’s a sad day for America and the only silver lining is that the miscreants who did this evil deed will get theirs come November. How DARE the Democrats do such a narrow partisan bill when the PEOPLE were saying clearly “NO!!”

    “My question is this: If this is unconstitutional in 12 states with Republican AG’s why isn’t it a problem in the other 38 states?”

    Democrats are willing to shred the Constitution, that’s why.

81. “There is a mention of a plan through Medicaid to prevent nursing home admissions, but the article does not address Medicaid otherwise.”

    Medicaid is being expanded by a large amount. This will bankrupt many state treasuries and force your state taxes higher. The second-order effect will be to ruin your educational system and other state-level programs as costs get squeezed.

    Bad news all around.

82. “Everyone else who’s yamemring about how this will hurt small businesses Look here- small businesses with fewer than 25 employees and average annual wages of up to $50,000 will receive tax credits to offset the cost of buying insurance for their workers. ”

    Who PAYS for those subsidies? oh yeah, they increased incomes taxes, ALOT. Especially on subchapter-S corps making $250,000 a year or more … oh wait, THAT’S SMALL BUSINESS.

    The Govt is ripping off small business, FORCING them to sign up for health insurance or pay an additional 8% payrolls tax, AND force all individuals (including self-employeds) to sign up … and they throw them a bone of a few tax credits that will NOT make up for those added costs.

83. IIRC eligibility for Medicaid is going to expand, but the benefit for households in the “not rich but not desparately poor either” demographic is in the form of subsidized access to private insurance plans (on the “exchanges” that will be set up), not through Medicaid.

84. “As far as this making Obama a two termer. Losing this vote, would have killed his presidency. This does not make him a two termer.”

    This bill is an attack on American freedom, raises taxes, destroys jobs, and destroys the Federal budget.

    We have millions of fewer jobs than when Pelosi was made speaker 3 years ago, and the Pelosi ? Obama record on jobs is dreadful.

    It would be INSANE to give a man who delivered this monstrosity a second term. He needs to be impeached.

85. STFG @ 72 – See this chart for your Medicaid questions.

86. SJM:

    In the future, aggregate your posts into one big single one, please.

    Also, I wouldn’t be holding your breath for impeachment.

87. “As an outsider to the whole process (hello from Scotland) Obama’s big mistake (as in a tactical mistake that made everything take forever) was that he kept trying to bring the Republicans onboard”

    You ARE an outsider. He never did ANYTHING to incorporate ANY Republican concerns. It was all a PR stunt to even talk to them, he talked but never listened. He let Congress write the bills in backrooms. This is one of the worst-written big bills in American history, and some of them have been stinkers.

    This Senate bill is a horrible confection of special giveaways to different senators and payoffs to special interest groups. Not a single Republican idea was added and not a single Republican vote was seriously courted.

    And bully for that. The Democrats can own this monstrosity 100%. It raises healthcare costs, will balloon the deficit, increases taxes and does nothing to bring rationality into healthcare decisions. It is far worse than the status quo.

88. Very well written as usual, and I agree with just about all of it. Especially the bits about the Democrats failing to work together until their noses were rubbed in it. I’d agree with the reform bill in general, too, if I didn’t think it’s going to bankrupt the American government even more quickly than Medicare/aid was already working toward.

89. He never did ANYTHING to incorporate ANY Republican concerns.

    I must have imagined the health care summit. I must have imagined the way in which the HCR bill was an almost exact duplicate of the one Mitt Romney put in place in Mass. I must have missed the exchange that James Fallows reported:

    “GOP member: ‘I’d like this in the bill.’

    “Dem member response: ‘If we put it in, will you vote for the bill?’

    “GOP member: ‘You know I can’t vote for the bill.’

    “Dem member: ‘Then why should we put it in the bill?'”

    http://www.theatlantic.com/politics/archive/2010/03/health-care-reform-the-morning-after/37823/

90. Stfg – and to others

    No offense, but it isn’t as if you don’t know how to do research. Particulalrly when you already have your specific questions drawn.

    It seems to me it isn’t as hard as people seem to think to inform themselves in this day and age on issues that interest or concern them.

    My point is more that I feel awkward telling you facts and opinions about a bill that concerns you directly. I mean, debating a position when you have one is fine. But, telling you the facts you’ll form your opinion on may lead to some awkwardness if we then disagree and you quote me as your source.

91. SJM: re: Job losses

    The economy was losing over 750k jobs a MONTH when Obama took over, in no small measure due to the previous inept government. Blaming Pelosi is pretty disingenuous.

    That rate is now pretty close to zero. That’s pretty impressive given how bad things were.

    Oh. And this small businessman is looking forward to the changes. Especially living in an area where the largest local employer in my sector offers totally free healthcare making it very hard to recruit in this uncertain market.

92. This is a sad day for me John.
    This isn’t about budgets or benefits or parties. It’s about freedom.
    I no longer have the freedom to choose whether to be insured or pay my own bills out of pocket or buy a catastrophic policy. If I try to opt out I will be fined. If I don’t pay the fine I’ll be arrested and may go to jail. If I resist, what then?
    America is about individual liberty. Equality of opportunity.
    I support health care reform. Cross lines access, tort reform and regulations prohibiting dropping those who have paid their premiums but contract a serious illness are things we can all agree to. I cannot support this bill.
    I say this with no snarkiness or sarcasm John.
    I’ll miss you. I really will.

93. >>…If I resist, what then?…<<

    Ask Peter Watts…

94. SJM@87:

    OMFG, nice to know the whole separation of powers thing now sucks on GOP Bizarro World.

    Also, your average child learns PDQ that being “listened to” does not mean screaming and stamping your feet will get you your own way.

    There’s also only so many times you tell someone to go fuck off, before they take what you say at face value.

    I know you’re eventually going to find a way to hold Obama personally responsible for the Fall for Troy, but as others on the sane right and the left have pointed out there are serious flaws in HCR as it stands. What a shame the Congressional GOP was too busy losing its collective mind to make them.

95. SJM says, “The taxes will kill jobs, the mandates will kill freedom […]”

    What? How does health care kill freedom? I mean, if you can provide some analysis to back that one up, I’d love to hear it. Because that logic must be truly dizzying.

    And the last time I checked, most of those other socialist nations aren’t exactly a dictatorship because of their medical coverage. (Nor, indeed, are they anti-freedom at all.)

    If you want to toss out reasonable arguments that include fears of tax issues, debt levels, etc., that’s one thing, as those are fact-based arguments that can be argued and discussed logically. Hysterical nonsense about the end of freedom, though, is certainly not helpful to such a discussion.

    If you want to talk about killing freedom, then somewhere else we should discuss those PATRIOT Act laws that were supposed to expire years ago. Or those unconstitutional NSA wiretaps on US citizens without warrants.Those were instituted by a right-wing politician, so they aren’t a threat to freedom?

96. Your essay pretty much captures my sentiments exactly. I your predictions about the effects for this November and further are correct – although I largely agree with them, and given my failures as a political prognosticator and an assessor of what the American people will go for that can’t be a good thing.

97. >Thievery.

    Just plain thievery…

    but as many people can rationalize stealing a loaf to feeding a starving child, they can rationalize this.<

    Actually I'm pretty sure that the theivery happened when the Insurance Company I pay a significant amount of my paycheck to decided that since my son was born prematurely and had reached his "Lifetime Cap" within the first 100 days of his life, they wouldn't pay for his care anymore.

    Stealing any financial stability from my family's future. Forever. So, if I have to "steal" a bit back from the taxpayers to make sure that my son gets the care he needs for his medical condition (which e will fight for the rest of his life by the way) then yeah, call me the thief.

    The only people who I have met who are against this bill, even the ones who say its on fiscal grounds, are lucky enough to not know or be related to anyone seriously ill. I hope they are lucky enough to not know what this fight is like.

    I wish that I had more time in the past 15 months to do more to help this move along, such as calling and writing to more congressmen and women, is because I was spending too much time calling my insurance company to make sure that my son would have a chance at life.

    By no means perfect or nearly grand enough in its scope, this law should start helping Americans enjoy a better shot at life.

98. @SJM
    “We have millions of fewer jobs than when Pelosi was made speaker 3 years ago, and the Pelosi ? Obama record on jobs is dreadful.”

    Oh come on. Since when was Pelosi in charge of job creation and economic growth? The dip in jobs is, in case you’ve forgotten, due entirely to the spectacular recession we’re in, which, in turn, was in no small part caused by the economic policies of the Republican-controlled government in the early part of the decade.

    In fact, the Pelosi/Obama record on jobs has been characterized by a substantial reversal of trends as the country pulls itself out of the recessionary nosedive and climbs back up the other side of that parabola.

    This, coupled with your other comments (Obama never tried to reach out to Republicans?), leads me to believe that you’re not trying to be serious in this discussion.

99. @Medley #64
    you have completely omitted the critical role that Speaker Pelosi played.

    My favorite tweet last night by Ali_Davis. She wrote, “Pelosi just went down in American history. And disappeared from Texas history.”

100. One of the Republican Attorneys General who’s signed on to challenge this reform in federal court is Rob McKenna, not Douglas Adam’s beknighted rain god but rather one of two Republicans elected to statewide office in the half-rainy state of Washington. He’s persisted in the post mostly by not drawing much attention to himself. We’ll hope he doesn’t take the Secretry of State, a remnant liberal R reminiscent of the great days of Dan Evans, with him when he goes.

     In line with that look back at the long lost age when both political parties were slightly less indurately conservative than the Democratic party is now, I’ll point out that the bill passed last night is way less “socialized” than what Richard Nixon proposed.

101. “In the Carboniferous Epoch we were promised abundance for all,
     By robbing selected Peter to pay for collective Paul;
     But, though we had plenty of money, there was nothing our money could buy,
     And the Gods of the Copybook Headings said: ‘If you don’t work you die.'”
     – Rudyard Kipling, “The Gods of the Copybook Headings”

     I’m betting upon a huge entitlement crash sometime between 2020 and 2030, and am planning my savings and career path accordingly. All this bill does is move the time frame up a bit. Actually improving health care? I bet no. Repealable? Again, I bet no… at least until this country is left with the choice between keeping all of our entitlements and defaulting on the national debt. Nations, like men, only make the right choice once they’ve exhausted every alternative.

102. Thanks, Chris Gerrib, that’s what I was looking for.

103. I’m sorry the exchanges won’t be going live until 2014. I’d quit my day job today if I could afford health care on my own.

     This bill is going to be a huge boon to entrepreneurism (along with writers and other artists) in this country. You just wait.

104. @ Eric #92

     >”I support health care reform. Cross lines access, tort reform and regulations prohibiting dropping those who have paid their premiums but contract a serious illness are things we can all agree to.”<

     Sure, fine. Implement those two. Now what do you do with people with catastrophic illnesses that decided not to buy insurance or bought insurance late by lying that they were not sick?

     Say you think people who didn't have insurance should be left to their own wits with paying for it. What about those that try to sneak in? If the health insurance companies are allowed to deny these folks, then they will be able to rescind based on claimed fraud and we're back where we started with people losing their insurance when they get sick because they didn't report their acne.

     The other option is a mandate.

     Is there a third? Not really a workable one that I see. Maybe you have some ideas though. The point is that the practice of rescinding policies has a legitimate purpose, and if you take it away from the insurance companies because they've been abusing the privilege, you have to decide what to do about the legitimate problem it was there to solve.

105. John,

     George Wallace was contravening multiple Amendments to the Constitution as well as the spirit of the Constitution; the Republicans are not obstructing any part of the Constitution with their opposition to federalized health care. The Constitution is a declaration of negative rights; i.e. the government can’t do certain things to you without due process(in certain cases). It is a very sad smear on your part to compare principled opposition to the federal takeover of 1/6th of the national economy to a racist bigot. I would also point out that this isn’t quite the law of the land just yet; the Senate still has to pass the fix-itbill; I imagine many Congressional Democrat heads exploding if Obama was audacious enough to sign the original bill and say this is the final bill.

106. I think Health Care Reform is important, nowhere near as important as civil rights legislation, but significant nonetheless. However, for the long term health of our country, the important thing is to reign in health costs and this bill does nothing to do that. In fact, it punts the relative small measures to do so for 8-10 years and more or less ‘hopes’ that congress and the president then will have more courage to take on further entrenched problems at that time. It would have been far better to take on the serious issues (health care reform, insuring the uninsured, medicare and medicaid costs spiraling up) now. This could have been done many different ways. In a liberal framework it could have been done with a single-payer system that uses its monopoly/bargaining power to bring costs down. In a conservative framework Rep. Paul Ryan’s plan would have lowered costs by making health insurance something that individuals buy, rather than have market distortions from employer coverage where people are unaware of the full costs. Finally, in a moderate plan, similar to the Senate’s original version or McCain’s campaign HCR plan, there would be no more tax deductions for businesses’ health care plans (or at least from the most expensive ‘cadillac’ plans). This would lower costs by removing the incentive for companies to provide really expensive health care plans (instead of more compensation-higher wages) and if people pay for more of the costs out-of-pocket they are likely to use it less.

     Unfortunately, none of these approaches were taken. The liberal and conservative approaches to lowering costs were unacceptable to the other wings. The moderate approach advocated by the McCain Campaign was unacceptable because Obama had campaigned against it. The moderate Senate approach was unacceptable to labor unions, a core constituency group, that would have been particularly hit by it. One can only hope (as unlikely as it is) that future politicians will have more courage than current ones and that this will be solved before it becomes a calamity for our children.

107. @ John Sandwich Guy
     Regarding the Attorneys General setting up for legal action, there was an excellent interview on NPR with the AG of Virginia. I can’t find a link, but if you track down an All Things Considered podcast or transcript, it’s worth a listen.

108. JESR:

     Unless the person in the Washington Attorney General’s office was outright lying to me, Rob McKenna is NOT planning on joining a lawsuit challenging the new HCR law. I told her I was glad to hear he wasn’t, and also told her he’d be out of his mind to do so if he was contemplating it. That kind of GOP idiocy doesn’t go over well in Washington State (at least, not in the Western half where most of the people live) and he’d likely be booted out of office.

     So if you know otherwise – if you have a cite saying McKenna is joining the GOP challenge – please let me know!

109. I’m not sure “inexperience and aloofness” are quite how I would characterize Obama’s failure to fight back and insist on what needed to be done, until finally he debated the hell out of the GOP just recently and the Democrats found their nerve (or their principles, or recalculated their odds of reelection, or whatever). But I certainly hope that the lesson is learned, and we don’t have this same protracted and almost-ineffectual fight over the next major bill. The key will probably be whether the frightened tea partiers notice that there is no government death panel or internment camp or other sign of Fascism or Stalinism after all. If they do, perhaps the next wave of fearmongering lies will have a bit less impact.

110. This will bankrupt us just like the NHS has bankrupted the UK with its ridiculous per-capita costs, which are nearly 50% of what the USA pays per-capita for health care. There’s no way we could possibly afford to pay that. Socialism shall be our doom. DOOM I say.

111. martinl:
     I’m reminded of my little brother who lived for a while in the UK. He railed against “socialism” when he came back. Oh, those British people have no freedom! And then when people asked him about living in the UK he enthused about the quality public transportation, the free local fitness centers, and so forth…

112. Yes, SJM, let’s talk about the poor, long-suffering Republicans for a moment.

     Let’s talk about how their idea of reasonable debate is spitting on a member of the US House of Representatives (Emmanuel Cleaver, of MO-5).

     Let’s talk about the confederate-flag-waving, threatening-sign-toting, whiter-than-the-building crowd that decided to express their displeasure with the bill by calling Representative John Lewis a n—-r to his face.

     Let’s talk about Gingrich’s pep-talk to Republican members, before they headed into the chamber to get their butts handed to them by the will of the majority. You know, the one where he said the bill would end up being as disastrous as the Civil Rights Act.

     Gee, I just can’t imagine why no one would take their suggestions seriously.

     The reconciliation bill included more than a hundred Republican amendments, and it still got no Republican votes–because their leadership decided they were going to oppose it no matter what, and threatened anyone that even thought of breaking ranks. When that happens, it is the right and in fact the duty of the majority to move on and get it done without them. The minority doesn’t have veto power.

113. I haven’t noticed the NHS (60 years old and still going) bankrupting the UK. Must have happened in the last half hour or so.

114. Annalee Flower Horne: Thank you, that’s exactly what I wanted to say, but couldn’t find polite enough words to say it.

     I do feel sorry, though, for the people who feel that their opinions and beliefs were not taken into account. A lot of them are simply being manipulated into thinking that, often for the sake of entertainment. And all of them deserved better Congressional representation than they got.

115. Casey L.: The receptionists never know anything until there’s a press release. I went to look for the reference I’d read this morning, and just as I found it there was a news report on KUOW that McKenna is entering that suit.

     Now, I was willing to accept that I’d misunderstood something earlier: it happens, and I’m prone to believe anything negative of him after hearing him quote Wikipedia’s version of the Boldt decission and say it’s not settled law (a misconception which has cost this states millions in legal costs and billions in liability to the tribes). But he really is willing to jump into it with both feet. Dumbass, as the saying goes.

116. @180 (Casey) http://www.atg.wa.gov/pressrelease.aspx?&id=25402

     Shockingly you were lied to by a Republican. I know!!!

117. Thanks for helping me cull my RSS list, which was getting too long. Off you go…

118. Eric wrote: “I support health care reform. Cross lines access”

     Really?

     Have you actually thought about the consequences of doing this?

     The people who push that as a solution are on crack. What would really happen is similar to what happened with credit cards.

     States would engage in a race to the bottom, setting up the most permissive insurance regulation regime, in order to attract insurance companies.

     Yeah, it might be cheaper sometimes, but only because the insurance companies won’t actually have to provide any care at all.

     Just like with credit cards, Americans would end up getting reamed hard.

     Cross-border insurance buying is just yet another ill-considered facile Republican solution to a complex problem.

119. JESR – You’re right, and my apologies. I’ve called the AG office again, and they must have been hearing from people like crazy, because they’ve got a comment line set up just for this issue. I’ve commented on it there and also filled out an on-line form – saying, as loudly yet politely as possible, “Are you out of your goddamn mind?” McKenna got into office only because he was supposed to be a sane GOP’er (like Washington’s Sec of State Sam Reed) but if he’d gonna join forces with the GOP/teabagger/nutcases, he ought to get his ass thrown out of office.

120. Ech @ 33:

     **insurance purchases across state lines are only allowed if the states in question allow it. Not what was wanted by the (R)s.**

     What exactly is wrong with “as long as the states in question allow it”? Is this not a protection of State’s rights? Or do our “federalization is bad!” brethren prefer to have powers removed from the State’s hands?

     Also, as I’ve had to explain to my father who demands that he be able to buy the same policy in NY as he can in FL, we have 50 states with 50 sets of state laws. There are health care laws in NY that they don’t have in FL or TX or CA and vice versa. So you either force every state enact the same laws and policies, allow them to choose specific reciprocity – as this bill does on this issue – or you completely federalize ALL health care laws and policies.

     Well, which is it then?

121. Martini@110:

     I would be refreshing if you actually had some idea what the hell you were talking about where the NHS is concerned. Think it’s fair comment to say that nobody in England is claiming the NHS is perfect by any means, but it has “bankrupted the UK”? (Then again, I suspect in Tea Bagger Bizarro World, the British Conservative Party are a pack of God-dammed Stalinists…)

     Do you have to be functionally psychotic and/or economically illiterate to be in American politics, or is that an optional extra?

122. I am very curious about where all the people complaining about the requirement to purchase health insurance were when nearly every state in the union made auto insurance mandatory.

123. I would also point out that this isn’t quite the law of the land just yet;

     Yes, it is. Whatever the Senate passes via reconciliation will change HCR, but as soon as Obama signs it, the current bill will be the law of the land.

     I would be refreshing if you actually had some idea what the hell you were talking about where the NHS is concerned

     And they say Americans don’t understand irony. Everyone piling on martini: he/she was being *ironic.*

124. Craig:

     “Do you have to be functionally psychotic and/or economically illiterate to be in American politics.”

     Looking at the majority of the Democratic party and some of the Republicans? Yes, Yes you do.

     Andrew

125. I would venture that martinl@110 was engaging in sarcasm re: NHS bankrupting the UK.

126. Oops, silbey beat me to that observation!

127. And they say Americans don’t understand irony. Everyone piling on martini: he/she was being *ironic.*

     If that’s the case, I withdraw and apologise. Still, when Stephen Hawing had to call bullshit on the idea that the NHS would have left him to die, I think I can be forgiven for missing the “irony”.

     Still, to bring the Pollyanna, I did have the delightful spectacle of Ian McKellen ever so politely telling View harpy Elisabeth Hasselbeck she didn’t know what the fuck she was talking about regarding English healthcare:

128. Sorry about the Poe’s Law guys. Yes, I was being ironic. I thought combining “we’ll be bankrupted by cutting our costs by 50%” with complete obvious inaccuracy (the UK is not bankrupt) would be clear enough, but having seen some of the serious commentary, I see I was overly restrained.

     A more direct statement of my point:

     Dear folks claiming we will be bankrupted by socialist health care,
     ***Socialist health care favourably comparable to our own is proveably cheaper than what we are using now.***

     mll

129. >I am very curious about where all the people complaining . . . were when nearly every state in the union made auto insurance mandatory.<

     Can you imagine the money the hate radio gang could make today from such an obvious socialist thrust to kill our freedom of the road, confine us and emasculate us all?

130. Everytime I read someone say hcr is a federal takeover of 1/6th of the national economy, I know I’m reading someone who has no idea what they’re talking about.

131. Steve Burnap: I am very curious about where all the people complaining about the requirement to purchase health insurance were when nearly every state in the union made auto insurance mandatory.

     I’m glad I’m not the only person wondering this.

     However it’s not a complete red-herring, since the requirement for auto insurance is, as you said, a state mandate, within the state’s police powers. If I understand the argument correctly, what conservatives (and wingnuts) are complaining about here is that the requirement is a federal mandate, and (they claim) outside Congress’s authority to impose under the Commerce Clause.

     Given the broad reach the Supreme Court has found in the Commerce Clause in the past, I suspect this isn’t a winning argument, but I’ve been wrong in the past.

132. Charles #71: When? About the time of the communist revolution in Russia. There’s always been a gung-ho libertarian segment of the US for whom any government subsidy or tax is evil.

133. @Silbey, if Obama signs the Senate bill that the House passed and the Senate is unable or unwilling to pass the changes that the House passed after they passed the original Senate bill, then I would imagine Congressional Democratic heads exploding in outrage. Now, I don’t quite see this happening because the Senate Dems are going to use reconciliation to change their bill, so all they need is 50 warm bodies and Chuckles the VP to vote aye.

     There are a couple of things that makes this so called health care reform fiscally and politically unsustainable. One is the 500 billion dollar Medicare cuts (part of which relates to doctor reimbursement for Medicare and Medicaid patients) that pays for approximately half of the cost of the bill. The problem here is that these cuts have been legislatively mandated since the late 90’s and Congress has reneged on going through with those cuts after pressure from the AMA and hospitals. So, what are the odds that Congress will find the gonads to go through with the cuts that pay for half of this montrosity? Zip, zilch, nada, nyet. Which means that Congress, in their infinite grab for more revenue to fund their paen to bigger government, will have to raise more taxes to feed the beast.

134. @Silbey, if Obama signs the Senate bill that the House passed and the Senate is unable or unwilling to pass the changes that the House passed after they passed the original Senate bill, then I would imagine Congressional Democratic heads exploding in outrage

     Yes, but that doesn’t mean that the current bill, once Obama signs it, won’t be the law of the land. It’s been passed by both Senate and House, and (soon) signed by the President. Voila, a law!

135. @ 131 Colfax; Yes every state requires auto insurance BUT the auto insurance companies can sell across state lines and provide a variety of policies, from the bare bones minimums allowed by the states (which varies) to higher-cost and higher value policies. This competition is what allows auto insurance to be relatively inexpensive. However, the HCR bill, sets up state managed “exchanges” that only offer, from my reading of the bill, 3 policy choices that have mandated expensive programs that most policyholders will never use; i.e. mental health (drugs and shrinks) programs, substance abuse, etc. Most people that I know have health care policies that offer these policies as an additional add-on with a significant(generally patients are responsible for 40% of the cost of treatment) copay. This mandate to add these services to all health care policies will simply add to the cost of health care premimums.

136. Eric @92: Yours is probably the most rational argument against the reform bill I’ve seen presented here.

     I can only offer that sometimes giving up freedom for the good of society is the right thing to do. As examples, I offer a) curfews during disasters – violate constitutional rights of freedom of assembly but the power is granted to the government under those limited circumstances. b) State mandates to buy auto insurance are designed to ensure that people don’t put others livelihoods at risk by leaving them without compensation in the event of an accident. c) Bans on smoking in public places to prevent disease from second-hand smoke.

     Similarly to b) and c), mandated health insurance can help prevent the uninsured from transmitting their untreated diseases to the insured. I’ll admit this isn’t how the measure was presented either in congress or to the public, but there is a justifiable public health benefit beyond the economic benefit to those who were not able to afford insurance under the old system.

137. @ Christopher Shaffer (see how I spelled your name correctly?):

     There are a couple of things that makes this so called health care reform fiscally and politically unsustainable.

     That may be; but my point wasn’t that it was sustainable. I was pointing out the difference between the two types of insurance requirements. And noting that it’s unlikely to be overturned by the Supreme Court on a Commerce Clause argument.

138. @136 Bozo the Clone:

     “I can only offer that sometimes giving up freedom for the good of society is the right thing to do.”

     “…Despotism can be a development, often a late development and very often indeed the end of societies that have been highly democratic. A despotism may almost be defined as a tired democracy. As fatigue falls on a community, the citizens are less inclined for that eternal vigilance which has truly been called the price of liberty; and they prefer to arm only one single sentinel to watch the city while they sleep. It is also true that they sometimes needed him for some sudden and militant act of reform; it is equally true that he often took advantage of being the strong man armed to be a tyrant.” – G.K. Chesterton

139. Chesterton

     And he said that around a century ago, and shockingly there are still lots of democracies all over the place, including Chesterton’s home, Britain.

140. There may be some quite good things in this current HC bill — but I’m sceptical till I see a write-up that lists both good and bad things.

     For example, till now, people of all ages and incomes could order drugs from Canadian pharmacies, much cheaper than the same drug from US sources. This is now forbidden iirc.

     $500 billion cuts to Medicare.

     Forcing people to buy insurance, on penalty of fines collected by the IRS. (And if they do buy — cost of premiums, plus cost of deductible, plus co-pays — would take several thousand dollars before the family got any help from the insurer.)

141. I’m a leftist Independent, but right now I’m imagining a cartoon.

     A scultor studio, an elephant labeled “2011 GOP legislators” holding a chisel to a big ugly statue, saying “I’m chipping away everything that doesn’t look like a REAL Health Care bill.”

142. # Steve Burnapon 22 Mar 2010 at 6:58 pm
     I am very curious about where all the people complaining about the requirement to purchase health insurance were when nearly every state in the union made auto insurance mandatory.

     =================

     The cost is nowhere near comparable. The required insurance (liability only) even for a heavy old vehicle is only about $200/yr. The health insurance looks like being several thousand for a family.

143. I’m wondering why that all couldn’t have been in a single post, bemused outsider.

144. My take on how Obama played this is thus: From day one he stated he wanted to change the partisanship and dysfunction of Washington. He obviously has not been successful (yet), but he damn sure tried. At nearly every turn he offered the GOP the chance to contribute (contrary to their protests that they were never asked for their input). Every time he extended his hand he got bit by the rabid right.

     He allowed the GOP to back themselves right up to the edge of the cliff, all the while trying to talk them back away from that drop. They now have the choice of either jumping or breaking ranks. In a way, he gave them more and more rope along the way and waited to see if they would really hang themselves.

     Whether intentional or not, this was political rope-a-dope, and the GOP are George Foreman trying to get off the mat…

145. @80

     Wow.

     Just… wow.

     DEMOCRATS shred the constitution.

     Democrats.

     Two words for you.

     Dick

     Cheney

146. You know, I should have the freedom to drive without insurance. What does it matter if I don’t have it – it’s my right. So what if I destroy someone’s car and their health and have no means to compensate them for the loss I caused.

     It’s the same in health care. Me being sick doesn’t cost anyone – or society at large – anything because it’s just me. Health care only affects the sick person, right?

     Right?

     Is anyone else sick of the people who don’t get it that healthy citizens save us ALL money in the end? Is it just that one extra step into the abstract from car insurance that makes people go all stupid?

147. Joel@146: And there are real costs associated with uninsured people getting sick — costs that are paid either through higher taxes or higher premiums for those who are insured.

148. bemusedoutsider@142: I wasn’t talking about cost. I was talking about all the complaints that mandating insurance was somehow unconstitutional, or an unprecedented intrusion. I am just wondering why the people saying such never complained about auto insurance mandates.

149. This happened to a friend of mine. Assurant Health canceled her policy after she was almost killed in a car accident.

     http://www.westword.com/2010-02-11/news/health-care-hell-the-insurance-company-didn-t-give-a-damn-the-jury-decided-it-ought-to-give-37-million/1

     The healthcare bill makes this behavior illegal. If it does nothing else, I will consider it a success.

150. I am getting hit on my blog today by a few Rush lovers. Head on over and see my views of our new bill. Leaves some comments,

     http://www.csdaley.com/2010/03/enjoy-costa-rica-rush.html

151. AAaannnd… I should read all the posts BEFORE posting. But I read too darn slow and can never count on actually finishing something this long. Turns out, you guys already made my point about the tyranny of auto insurance.

152. John @147

     Precisely.

     And now, off to the land of nod.

153. John with GR@149: That’s the thing with this bill. I think it is a pretty horrible bill and looks absolutely nothing like what I’d write if I were Emperor of Congress. It is, however, an improvement over the status quo, which is completely appalling.

154. “if the GOP really wants to run on repealing health care law this year or in 2012, even the Democrats can manage to point out to millions of voters that this means letting insurers drop you or your children from their rolls and making it harder for seniors to buy the prescription drugs they need to survive. ”

     I wish I could be as optimistic as you are that the Democrats will actually think of saying something like this, when the time comes. I’m so accustomed to seeing most of them flap broken wings and make a fish-mouth “uh… uh… uh…” that I fear that expecting them to point out the obvious may be setting the bar too high.

155. BtW, here’s an op-ed piece about the vote whose concluding lines I particularly like:

     “But it is also a victory for America’s soul. In the end, a vicious, unprincipled fear offensive failed to block reform. This time, fear struck out. ”

     http://www.nytimes.com/2010/03/22/opinion/22krugman.html?hpw

     If only this defeat would convince people to abandon hysterical, lying, fear-mongering, mindless, fact-free, lunatic shrieking as the dominant form of political interaction and instead seeking intelligent, constructive, informed discussion as debate as the way to get elected and influence policy.

     And, yes, I also wish Godiva chocolate would rain down from the sky.

156. “My big concern about this is the cost. The $138 billion surplus does NOT include the doctor fix and it involves taking money from medicare. This whole thing assumes that over 10 years we can save $500 billion in waste, fraud, and abuse in medicare. I have trouble believing a number that big. It is almost silly.”

     Hmm. Well, speaking of silly big numbers, the CBO estimates we have spent $604 billion in war costs in Iraq and Afghanistan between 2001-2007. And that was while we were doubling down in Iraq and before we stayed the course in Afghanistan.

157. In related news, get a load of http://www.gop.com.

     This isn’t just the teabag nutters, this is the official party.

158. Okay, my #155 pretty already made obselete by that ad. So much for hoping the GOP might re-think its “let’s be like naked, shrieking, painted, drunken lunatics at a sports event” approach to politics after this debacle.

159. I just wrote a follow up blog to my earlier one talking about how both parties left me sour.

     http://www.csdaley.com/2010/03/our-party-politics-are-killing-us.html

160. >> Steve Burnapon 22 Mar 2010 at 10:53 pm

     I wasn’t talking about cost. I was talking about all the complaints that mandating insurance was somehow unconstitutional, or an unprecedented intrusion. I am just wondering why the people saying such never complained about auto insurance mandates..<<

     False comparison.

     You dont HAVE to buy auto insurance if you dont have/drive a car.

161. @ John Sandwich Guy:

     “Except for possible challenges on First, Fourth, Fifth, Sixth, Ninth and Tenth Amendment grounds, as well as violating the McCarran-Ferguson Supreme Court decision, and having Attorneys General of 35 states contemplating legal action, it was good”

     I’m not trying to be snarky but how does this law violate freedom of speech/religion/petition, the right to a trial, the right to avoid self incrimination, or the right to privacy(among others)?

     I can see where you’re going with the Ninth and Tenth but otherwise what you just typed would be like me challenging a tax law by citing the second amendment. I do think it’d be interesting(not *good*, but interesting) to see how SCOTUS would react seeing how sporadic they’ve been as of late on sovereignty issues.

162. I looked at my copy of the Seattle Times this evening (it’s a morning paper, but I don’t have time…) and found on the front page only two articles:

     The head above the fold was “Historic healthcare overhaul passes.”

     The head below the fold was “Get ready for beefed-up airport security checks”.

     We have lost in this country, finally, any sense that individuals count as more than cogs in the machine, that the State serves us, rather than we being servants of Leviathan.

     IMNSHO, the real road to healthcare reform is to abolish tax breaks for businesses to cover insurance premiums for employees, and end government healthcare subsidies, including abolishing Medicare and Medicaid, along with other the subsidies that have boosted the cost of healthcare in this country.

     I found those Times headlines both emblematic and symptomatic of the decline of our nation, and thought of quotes by Benjamin Franklin and Samuel Adams:

     “If you love wealth more than liberty, the tranquility of servitude better than the animating contest of freedom, depart from us in peace. We ask not your counsel nor your arms. Crouch down and lick the hand that feeds you. May your chains rest lightly upon you and may posterity forget that you were our countrymen.”
     – Samuel Adams

     “They that can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.”
     – Benjamin Franklin

163. @DGrace — And I’ll step up here and promise that you don’t HAVE to buy health insurance, if you don’t have a body. How’s that for fair?

     People with no health insurance are a *public health issue*. Being sick doesn’t just affect you; it affects everyone you come into contact with, and potentially many other people besides.

164. Mr. Scalzi: Thanks for your thoughtful analysis.

     …

     SJM / #80: You know who else complained about “meddling”? The villains on the Scooby Doo cartoons I watched as a child 25 years ago.

     I’d like to take you more seriously than that, but I can’t while your arguments sound so much like Teabagger shouting points.

     …

     I’m cautiously ecstatic about what this legislation will mean for entrepreneurship in the US, and for my family and friends in particular.

     The unavoidable uncertainty surrounding key factors in health insurance (rescission and price) was the single biggest factor in the career choices that my wife and I made over the last 10 years.

     Maybe my self-employed dad won’t have to go bankrupt when he gets sick. Maybe my brother can pursue his dream of opening a store in his small, economically struggling community. Maybe my dual-citizen wife and I won’t have to move to Canada in order to pursue career independence.

     With the reforms we are now likely to see, it seems that self-employment in the US will become a viable option for people with families and/or an unwillingness to gamble with their financial lives.

     Maybe this is just the shot in the arm the US economy needs to thrive in the modern era!

165. Stupid badgers.

166. @146 Joel:

     Those same people also don’t get it about public schools. Why pay if you don’t have children and etc.

     ***

     I’m not thrilled about being required to buy health insurance. But then, if the available plans for purchase become reasonable and can’t drop me for stupid things anymore, I’m more amenable to buying it in the first place. Also, it would work better (in my case at least) to call the fine a “tax” rather than a penalty, since I’m actually more willing to pay taxes toward the common good than to pay fines because I suck.

     Overall: Yay first step. :) Hopefully more of them will soon follow.

167. Kurt @162:so I’m guessing that the Victorian status quo where the poor had very little, if any, access to medicine fits you well?Because that’s what you are proposing, in essence- no breaks or rebates, everybody pays their way and devil take the hindmost.

168. It took losing their senate supermajority and the GOP overwhelming the public discourse on the health care process to get enough Democrats in line, with many I suspect motivated by the simple fear that what the GOP would do to them if health care passed was less painful than what would the GOP would do to them if it failed.

     I’m wondering if… maybe Obama finally pulled out the stops and made Health Care happen because of this, rather than out of a steadfast confidence that it needed to get done. I’m sure it was an important sledgehammer to whack legislators with (for example Kucinic).

     I wonder how much of what is IN this bill Obama cares about, and how much he promoted because he thought it would get it passed. I’m not saying it was “all tactics”, I’m saying I have no idea how much was tactics and how much was policy beliefs.

     On the other side of the equation is Obama learning that he can’t stand back and wait for congress to do things he wants them to do. Just being president in itself doesn’t make his platform into law… And I think he learned a lot about that this year.

169. The rest of the world, i.e. “the socialists,” do have a health care crisis: number of doctors, access, aging populations, etc. In particular, all such systems appear forced to make the choice between going bankrupt or paying doctors/hospitals so little that it becomes a profession fit only for the spiritually inclined. However, they still seem to spend less than we already do in our glorious “market-based” approach. Just because the new health care bill does not solve the underlying structural problems of modern Western society does not mean we should keep the ridiculous system of distribution/lack thereof we currently have/had? in place. Hopefully, the current bill is a stepping stone to an even more rational system.

     On the other hand, the people who think it is a solution to more intractable problems/crises in our economy and health care are also deluded. We are still driving towards that cliff as fast as ever, but now we have turned on the AC and provided fluffier pillows and iPods for more passengers.

170. “They that can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.”
     – Benjamin Franklin

     I’ve been thinking about this quote a lot today. Mostly I’ve been wondering why none of my conservative friends weren’t screaming it from the rooftops when the Bush administration decided habeus corpus was at the discretion of the president. Consider the following two scenarios: Congress passes some law outrageously limiting individual freedom, or the police get your name wrong and decide you’re one of those “others” that don’t need to be charged with anything in order to be held in jail. Which sounds more likely? Only a diehard conspiracy theorist could think it is the first.

     And for every commenter who has shot down the analogy between car insurance and health insurance, where is the rational individual who can defend Farm Subsides when government handouts are bad, bad, bad?

171. Double negative, sorry. I wonder why my conservative friends weren’t concerned about suspension of habeus corpus, not why none of them weren’t.

172. SarahK @170:
     I’ve been wondering also why so many people who are eager to spend hundreds of billions to keep Americans “safe” seem to be unwilling to pay an extra dime to keep Americans “alive”.

173. i feel the new health care reform bill will have a influental impact on the world and health industry will take a impact because of the bill but i will help our citzens tromandecly

174. Well, since I’m going to be forced to buy crappy overpriced health insurance by the government, I guess I won’t have as much disposable income to spend on luxuries.

     Luxuries like science fiction books.

175. Luxuries like science fiction books.

     You hear that, Scalzi? When you can’t beg an editor to take a book off your hands, and old copies of OMW languish in dusty piles in the remainder bin, and your starving daughter asks “Why can’t you sell books any more, Daddy?”, you’ll be SORRY that you voted for OBAMA and his COMMIE HEALTH PLAN.

     Eric @92, “tort reform” is insurance-company-ese for “keep your hands off our profits”. There are much better ways to reduce malpractice suits that don’t involve protecting incompetent doctors or making sure insurance companies don’t have to pay off claims. One of them, of course, is to stop committing malpractice for fuck’s sake. We have tens of thousands of preventable medical errors in the US every year. The other way is, when a doctor screws up, to disclose the screw-up, apologize, and try to make it right. The University of Michigan’s hospital system has slashed both malpractice suits and costs by taking the latter approach. Turns out that most people just want an apology and not to have to pay to fix the doctor’s mistake. Who knew!

176. For those who have heard all the “Canada’s health care system is horrible” rhetoric out there, here’s a post from someone who’s lived under both the US and Canadian system:
     http://network.nationalpost.com/NP/blogs/francis/archive/2010/03/08/276285.aspx

     Some good food for thought here.

177. My husband is blind and chronically ill — a transplant recipient in renal failure. Still, he and I worked full time until his health declined late 2005. Since then, I have had no health coverage, and I have had to fight with the state to get the medical care he was entitled to. We ended up paying thousands of dollars that we shouldn’t have because nearly all Medicaid employees (and I’ve had a pretty wide sampling) are incompetent.

     I would love to have medical coverage. I would love to have a mammogram. No. I would not love to have one. But I would love the security of being able to get one, and being able to get treatment if I get some catastrophic disease.

     Here are my worries about the new health care law:

     I also love having my husband around. So far, just in 2010, he’s had five hospital admissions with various problems. While Medicaid is a mess, the laws protect us — when I fight, I know that the laws are on my side, and I can get him the care he needs. When I’ve asked pro-health care reform people what this would mean for him, no one has had an answer. This law seems to be utterly changeable and undefined. No, I’m not talking about death panels. I’m talking about changing Medicare/Medicaid without putting similar provisions in place, or allowing case workers to figure it out as they go along. A week’s delay — a day’s delay — in getting my husband an expensive procedure or antibiotic will be enough to have my two children fatherless.

     According to what I’m reading, I still won’t have health coverage in 2014, because we don’t have a dime to spend on my health — we live on his Social Security and whatever I can write to sell while sitting in hospital rooms and ER’s. I won’t have health coverage, but I will get fined.

     I realize that my concerns have been obscured by the endless airtime given to the crazy people (I’m pretty sure Armageddon won’t be triggered by an act of congress). But I and many people like me have been ignored. It’s much easier to mock the shrill soundbites than to address the reasonable questions, but we deserved to be respected, heard, and informed, instead of being forced to watch helplessly while someone did an end-run around our lives.

     Health care in this country desperately needed reforming, but something this complex and critical shouldn’t have been a quilt of political and financial agendas, stitched together by elite bargainers with nothing to lose personally. Blue team or red team, this is all a game to them, and health care reform was the Superbowl. They don’t care about people like me because I have no money and no influence. If that sounds cynical, be assured that they taught me this themselves over the past five years.

     It’s passed. I hope it’s good. I hope we all get reliable health coverage out of it, and that it doesn’t bankrupt our nation. But I’d appreciate if people would understand that behind the raving lunatic camera magnets, there’s some seriously scared people out here who just want to keep their lives intact.

178. Every time I hear a siren go by I am disappointed in my neighbors for taking part in socialized fire care. How dare The Government take money out of my pocket to pay for the mistakes of those too ignorant to properly manage a fire on their own time and at their own expense?

179. http://thinkprogress.org/2009/10/16/dawn-smith-cigna/
     This is a case like Naomi’s above. This woman found she had a brain tumor in 2005. Without explanation, insurance denied coverage of treatment. Then in 2007, they found another brain tumor. Again, insurance continued, without explanation, to deny treatment. Finally, she paid out of pocket for the first to be treated. Her insurance premiums doubled – again without explanation. Last year, her co-pay went up $3,000, again, without explanation.

     Yep, our system is far superior to anyone else’s.

180. I’m glad it passed, I’m hoping there will finally be less blathering about it on the radio. Maybe I can actually listen to the talk shows I like rather than just plugging in my ipod every time I go in the car.

     I’m particularly happy about the being able to be on parent’s healthcare until 27 bit since as a 22 year old making my money from selling on eBay (which pathetically is earning me more per month than I was making while teaching and is much less stressful and tons less work. Never really appreciated just how shitty teacher’s salaries were until I was one however briefly that lasted) there’s no way I can afford insurance on my own. I’m on a fairly expensive medicine right now and I’m at the point where I’m taking it every 3 days just to make it last because I can’t afford it. So yes, very pleased.

181. Nice read. If anything, I think it summarizes some very good points.

     Will it be the best thing for America? Time will tell. I’m simply glad it passed (irregardless of the tactics). Let’s hope it truly does make a change.

182. The one fear-mongering argument that keeps coming up with my right-wing friends is that somehow health care reform laws will lead to the government controlling us all; the end of freedom; the end of democracy as we know it. The hyperbole gets old after a while, but I’ve yet to hear their “logic” if indeed there is any.

     Let’s explore it, though, seriously. The right succeeded in passing the USA PATRIOT Act and has yet to let it expire. The previous administration got the NSA to set up massive wiretap operations to monitor phone and net traffic without warrants. Then passed a law preventing anyone from suing AT&T for giving them such access without a warrant. They set up torture plans for enemy combatants, then when that didn’t go so well, they created “extraordinary rendition” plans to let others do the torture for them; despite the fact that torture is an unreliable interrogation tactic.

     And the right says all of these things are somehow less damaging to our freedom than HEALTH CARE? Seriously? That’s the stance they want me to stand for? Nope, can’t do it. The only way that makes sense is if freedom is redefined to mean, “freedom for the wealthy to let others suffer needlessly.” And that’s not the sort of governing I want to live under. That’s not government. That is bullying with governmental authority.

183. John Wallace was a very good college basketball player at Syracuse in the late 1990s who was drafted by the Knicks.

     That was a pretty bad mixup…

     Of course republicans are obstructionist. They think this bill is a bad idea. When we have a republican president against, I do not see a problem with liberals “obstructing” bills they don’t like. It is why we have more than one party.

     I am not sure I am opposed to this bill or not. I feel for people who do not have health insurance. I do not buy the silly loss of freedom argument. The constitutional challenge will not go anywhere due to the interstate commerce clause.

     That being said. This is very expensive. If you look deeper into the CBO numbers there are alot of questions. Such as $500 billion of the funding comes from medicare. They “pay” for this by assuming they can cut $500 billion is waste, fraud, and abuse. That number is not believable. It is too big. I don’t see Obama explaining exactly how he is going to save all this money. Every government program like this ends up costing more than originally planned and we have a huge budget deficit already. The deficit is a real problem going forward.

     I have mixed feelings about this bill.

184. Blue team or red team, this is all a game to them, and health care reform was the Superbowl. They don’t care about people like me because I have no money and no influence.

     Years of dealing with insurance companies – professionally, that is – have persuaded me that you are if anything not cynical enough.

185. Mythago @ 175 –

     “The other way is, when a doctor screws up, to disclose the screw-up, apologize, and try to make it right.”

     I was having a conversation with someone about malpractice and defensive medicine costs in the USand they mentioned this example.

     Did they, in the case you mention about apologies and offering to make it right, make that not a legal admission of responsibility? Meaning that if a negative outcome occurs, the hospital or doctor can apologize and retry for free without damaging their ability to defend themselves in a potential malpractice suit over that mistake?

186. Other Bill @185 – think about it for a minute. The ‘admission’ would be telling your jury, in essence, “Dr. Fell admitted he made a mistake and offered to try and make it right, which included paying for the treatment, her lost time at work and her inconvenience. But guess what? That wasn’t good enough for Ms. Plaintiff.” Boy, I just bet those jurors would be lining up to write Ms. Plaintiff a big old check!

     “Tort reform” is not really about reducing huge jury awards; it is about driving up the costs of bringing a malpractice case so that if you are hurt by malpractice, you won’t be able to persuade a lawyer to take your case in the first place. And therefore protecting insurance companies from having to pay out claims.

     Here’s an interesting link which itself points to some other interesting links on the subject: How to put medical malpractice attorneys out of business

187. Well. I think the admission I had in mind was essentially more the doctor says to the patient “this is a terrible outcome and we are sorry it happened. We think we can do something to fix it and we’d like to try.”

     Which is not the same as saying “I made an unforced error and I’m sorry. I’d like to try and fix it.”

     right? Because if patients really just want apology and the apology involves saying I’m a bad doctor, dothey really want that person to try and fix their mistake? So, there are negative outcomes that are not based on malpractice.

     The point of the example the person I was speaking was that prior to that the doctors had to keep it cold and distant because an expression of regret over a negative outcome not malpractice would lead them to an isue if the patient decided to sue later.

     I didn’t want to debate tort reform with you. The example sounded the same and I wanted to k ow if you had a source for that.

     The example she mentioned also included a clause allowing doctors to incorporate themselves so that in the event of having to pay a malpractice settlement their personal assets would be secure. This led to a decrease in defensive medicine costs (because they felt safer personally) and didn’t deny anyone the ability to Go to court over malpractice.

     I would remind you that the same studies that note malpractice settlement costs are 1-2% of all healthcare dollars ( and justifiable cases in themselves) also note that defensive medicine costs are up to 10% of all healthcare dollars, totally a result of doctors feeling personally insecure, and provide no tangible benefit to anyone. The harvard one in particular that everyone cites for the 1-2 percent notes this.

     Which is why I was interested in whether or not this was the same example. And if you had a source. Because it seemed to be a way to reduce defensive medicine incentives, not infringe on malpractice law suit access for patients and make everyone a lot happier.

188. Guess @183:

     The GOP are obstructionist because they want /everything/ to be their way, and are not open to any sort of compromise. They are willing to throw a shitfit and abuse parliamentary rules (such as the filibuster) for pretty much every bill.

     The Dems were at least willing to pick their battles when they were in the minority, and the party in general is disorganized and spineless enough that some of them could usually be found to sign on to a GOP bill.

189. Kevin @188: If what the Republicans have is spine, I’m not sure I *want* a Democratic party with spine.

     Guess @183: They “pay” for this by assuming they can cut $500 billion is waste, fraud, and abuse. That number is not believable. It is too big.

     I think I’ve heard this from a couple people now in this thread. Why do you say that? I haven’t looked at the CBO report, and I don’t have any domain expertise, so I have no way of knowing that that number is right, but I also have no way of knowing that that number is *wrong*. What ways are they talking about cutting waste, fraud, and abuse?

     (And, err, isn’t cutting waste, fraud, and abuse in Medicare and Medicaid something the Republicans should be all over?)

190. Foxnews has a graphic up with a picture of Obama on the right and a caption in all caps to the left saying STATES GO TO WAR.

     At least that’s the top story on their mobile website that I see with my iPhone. The second is that most Americans fear the economy is going to collapse. Although it doesn’t mention health insurance reform, it’s a survey conducted by fox about the apparently purvasive deep fear of big government killing the economy.

191. Mythago –

     The link you provided has two comments at the end talking about the policy in practice in Canada and one indicating they think PA also has that law. And that’s the state that I remembered from my friends example.

     Not sure about whether the incorporation is also PA.

     On apology, there’s an article that appears to be behind a paywall whose abstract appears promisingly relevant to the subject:

     Malpractice Allegations and Apology Laws: Benefits and Risks for Radiologists
     Journal of the American College of Radiology, Volume 5, Issue 12, Pages 1186-1190
     S. Baker, C. Lauro, A. Sintim-Damoa

     (not sure if you’d have access to this sort of thing through a database subscription for your job)

     Another study on apology laws:

     http://www.aeaweb.org/aea/conference/program/retrieve.php?pdfid=375

     From what I can tell at a glance it looks like some states are taking the approach of protecting the apology from being an admission of culpability in a lawsuit.

     But I still can’t find anything on private practice doctors incorporating themselves. Although, I’ll admit it wasn’t exactly a thorough search.

192. Other Bill @187, all I can do is point you to the real-world evidence where the practice of the apology has been tested, and has been found to actually reduce malpractice claims AND costs. The person you were speaking to is 100% wrong; being cold and distant is exactly what gets doctors sued. I take it you haven’t looked at the link I posted, which of course is your right, but it addresses a lot of those issues.

193. I think the more libertarian-minded opponents of this bill (of which I count) would have somewhat less of a problem if there were some sort of opt-out provision to the insurance mandate, whereby one would agree to forego access to any federally-subsidized health insurance. I’ll be curious to see if this idea is raised as time goes on, as the mandate seems to lie at the crux of most of the state-based objections.

194. @#169 PrivateIron: “The rest of the world, i.e. “the socialists,” do have a health care crisis: number of doctors, access, aging populations, etc. In particular, all such systems appear forced to make the choice between going bankrupt or paying doctors/hospitals so little that it becomes a profession fit only for the spiritually inclined. “

     As a European, Belgian citizen, I’d like to object: while we face the same problem every Western economy faces – aging populations and a gigantic hole in our budget because we had to bail out banks… thank you G.O.P. deregulation… have forced us to look into big future cuts to avoid a debt spiral – the claim that hospitals/doctors are paid so little is just false.

     Specialist doctors make between 150K and 500K euro a year over here, depending on the specialization.

     On the other hand, our “socialized” medicine system just works: we have access to great quality care, locally, at very low cost.
     One example: our baby boy was born at 30 weeks, and required six weeks in hospital, of which three in the NICU.
     Overall (real) cost: 150K EUR… Cost to us, after the single payer system kicked in: 13K EUR. And of course, after my employer’s benefits scheme: 75 EUR.

     Try matching that in the US. I wish you the best of luck (even with the new bill, I’m afraid).

195. Amitava @193 Are you willing to opt out for life? Do you give your permission for the community to let you die on the street if you can’t pay? Insurance pays for itself by having a large enough population that those who are not sick pay for those who are.

196. #160 DGRace (and anyone else curious about the mandate and attendant fines – source is Side-by-Side Comparison.. (from the Kaiser Family Foundation), and the first column is what was passed on 3/21)
     
     Require U.S. citizens and legal residents to have qualifying health coverage. Those without coverage pay a tax penalty of the greater of $695 per year up to a maximum of three times that amount ($2,085) per family or 2.5% of household income.

     The penalty will be phased in according to the following schedule: $95 in 2014, $325 in 2015, and $695 in 2016 for the flat fee or 1.0% of taxable income in 2014, 2.0% of taxable income in 2015, and 2.5% of taxable income in 2016.

     Beginning after 2016, the penalty will be increased annually by the cost-of-living adjustment. Exemptions will be granted for financial hardship,religious objections, American Indians, those without coverage for less than three months, undocumented immigrants, incarcerated individuals, those for whom the lowest cost plan option exceeds 8% of an individual’s income, and those with incomes below the tax filing threshold (in 2009 the threshold for taxpayers under age 65 was $9,350 for singles and $18,700 for couples).

     Everything I’ve been able to read on the “trigger” for this indicates that the trigger for the fine is when someone eligible and able to access coverage doesn’t, but yet still tries to access healthcare that even before this bill would require insurance of some kind — i.e. and emergency or hospital visit that is *non-elective*.

     The snark in me wants to point out that you know, if you are that averse to being forced to buy health insurance, you don’t *have* to go to the hospital for a critical illness. You could sit it out and hope for the best.

     But if you do go and you don’t have insurance, why is that any different than the people who are bitching *now* about how uninsured people are driving up the costs of health care for all of those who do pay into the system already?

     Even at their highest, the fines are laughable…they aren’t going to be fining people who have no or low income, they aren’t going to be fining the people who object to medical care on religious reasons…what they are saying is that if you plan on playing the wait and see if I get sick game, and are willing to pay for the cost of an emergency room visit out of pocket, they are going to make sure you put in something toward the costs the rest of us are already paying. And unlike the the hospitals who spend millions on trying to collect on the outstanding balances of patients who can’t or won’t pay what their insurance doesn’t cover, the Government is going to get their “fee” up front out of your taxes… just like they do if you cash in early on your 401K.

197. Gah. Well it looked like the link was there when I previewed…

     Side By Side Comparison

198. “Are you willing to opt out for life?”
     You could, I suppose. Or you could opt-out for fixed intervals, after which you’d either get health insurance or opt-out again.

     “Do you give your permission for the community to let you die on the street if you can’t pay?”
     Absolutely.

     I should like to point out that I do, in fact, have health insurance, and wouldn’t personally advise someone to take this option. However, at the end if the day I believe it should be *their* choice (so long as they accept the attendent risks), as opposed to one that’s foisted upon them.

199. Naomi: There is financial assistance built into the bill for people who can’t afford insurance, including subsidies to Medicaid that expand the coverage. They aren’t trying to ding the millions who can’t manage insurance; they’re trying to change the way that the insurance industry operates. We may even get some limited public option assistance stuff back in the bill. In the meantime, I’m very sorry you have to go through this and I hope your husband’s condition improves.

     Charles #182: You’re missing your right wing friends’ point, or rather, their preferences. For them, it is not losing “freedom” to have the government take whatever measures it deems necessary for the security of the country (a police state.) Losing freedom is instead if the government takes over the means of production from businesses. If the government helps people, it destroys the potential market to make money off of middle class people for the same services (although it doesn’t really,) which right wingers argue weakens business and thus the country. This has its roots back in the battles over labor unions, when businesses claimed that having to give decent working conditions and wages would destroy them, and thus America’s strength. Since the government is charged in the Constitution with regulating commerce, business routinely paints government as trying to overstep its bounds, in order to minimize regulation. Of course, the government isn’t trying to take over the means of production, and the economy isn’t going to make business much money if they destroy the middle class, which they are well on their way to doing, but if you can imply it, there are people who firmly believe that the U.S. will become the Soviet Union given half a chance. We’ve got a lot of people who grew up during WWII and the start of the Cold War, and we have a lot of people who firmly believe that government always helps the immigrant (non-white) newcomers over older (white) inhabitants and that this will destroy their opportunities for jobs, wealth, services, etc.

     Guess #183: “They “pay” for this by assuming they can cut $500 billion is waste, fraud, and abuse.”

     They don’t assume it; they actually have to document it and give those numbers to the CBO. Essentially, they are doing about the only thing the Republicans actually approved of but failed to do themselves — cut waste and reduce bureaucracy in Medicare. We’ve already paid billions for Iraq and Afghanistan without a peep from the concerned citizens who claim healthcare is the end — and healthcare is not that bad comparatively. The claim that we can’t pay for it has been disproved repeatedly and right wing media simply ignores it.

     Other Bill #190: “it’s a survey conducted by fox about the apparently pervasive deep fear of big government killing the economy.”

     They ought to know since they are the ones who generated the fear on Murdoch’s orders. Essentially, the government makes a nice blame target for business whenever things go wrong, as well as serving as a bailout bank. There is also this sociological factor going on:

     http://www.ottawacitizen.com/business/Doomed+wrong/2620618/story.html

200. About malpractice suits, I have a veterinary story.

     I took a young dog in for a routine spay and, for unknown reasons, she hemorrhaged and nearly died. The veterinary care required to save her life cost thousands of dollars. Furthermore, she suffered permanent damage–a spinal cord injury. She can walk, but only just barely.

     I think I could have successfully sued my vet. But there was no need. The vet never admitted fault, and in fact I have no idea whether incompetence or an accident was involved, or if it was just bad luck. But the vet paid ALL of the dog’s followup medical expenses, and kept my dog on the premises for months so that she could have rehab/therapy on a daily basis, none of which was ever charged to me. In the end, I received a bill for the cost of a routine spay and nothing else.

     It’s still a tragedy, because the injury is permanent and nothing can ever undo that. But because the vet made such an effort to put things right, I never considered filing a lawsuit.

201. Mythago –

     I think there is some cross posting there. So, I’ll ignore your rude dig about not looking at your reference.

     I went looking for others because I found the statistics in that post interesting, but not detailed enough from the portion quoted to say anne dote is supported empirically. Nevermind that I agree apologies and interactions probably do reduce lawsuits.

     I’m looking at part of the incentive for doctors not to involve themselves anyway. I think it’s fear based, even if empirical evidence ultimately proves it’s irrational.

     Which is why I was intruiged by the idea of states protecting that apology. And it would seem states found it worthwhile to go ahead and remove that fear. I think alot of states have done the same for car accidents to encourage people to help one another in the aftermath.

202. Other Bill @201 – I’m not sure why you chose to see a “rude dig” that isn’t there, instead of what was there, namely an acknowledgment that you probably hadn’t had time or inclination to drop everything!!!right now!!!! and read the link and the link’s links (which are in the original article – not in the comments).

203. I remain completely baffled by the people who view public health care as some form of socialism.

     By the time Galileo went on trial for heresy the Italian city-states had provided free at-the-point-of-use health care for several centuries.

     Galileo was a socialist; who knew?

204. Alpha Lyra@200: When I first heard about preemptive apologies for medical mistakes, that was sort of how I understood it; people are simply less likely to file a lawsuit if their injury is acknowledged and fault is admitted (and, possibly, if compensation of some kind is offered up front, though I don’t know if that’s always or even usually the case).

205. Mythago –

     Fair enough. Of course it’s your right to know if you meant offense.

     I didn’t follow to the editorial because it wasn’t quite what I was looking. But if the secondary links are more research document based in nature I’ll definitely follow them when Ive more time tonight.

     KatG –

     Yeah they manufactured it. I’ve been embarrassed as an American about what has been allowed to be incorporated as ‘legitimate’. I was even surprised by this headline from them. States go to war against the president…whose government is killing america.

     That’s just creepy.

     Or how about how you can now call someone a murderer in the floor of the house and offer a little whoops i got caught up in the moment apology? Like, when did that become common enough that nobody really considers it a serious issue? Or bow about how no one seems to think it’s a big deal that protestors actually spit on representatives? Or call a guy at Selma a racist slur? Or anyone? Or have a representative say that type of language is bad, but…

     Or like it’s okay to graphically indicate there’s a war on between the states and federal government.

     But yeah. It’s been manufactured.

206. Amitava D: Are you seriously suggesting that, upon seeing a heart attack in progress in public, good samaritans first check to see if the victim is a libertarian before calling 911? And, if so, the first-responders should not be paid for their service if they show up anyway?

     Let’s say society agrees to the additional administrative overhead and increased overall mortality rate of the following test:

     * Is the victim a libertarian?
     * If no, administer CPR and/or call 911.
     * If yes, does s/he have a large wad of cash or a large bank balance?
     * If no, let die in the street.

     Who pays to transport the body to the morgue?

     Who pays for the mortician to determine cause of death?

     Maybe you don’t think someone should be forced to become a customer of a morgue. Who pays for the reduced quality of life resulting from a dead, decomposing body in the street? Or loss of business from the corpse in the aisle at the supermarket?

     How about, instead, we face up to the fact that everyone in society benefits from having healthy neighbors?

207. Graham Freeman @206

     Indeed so; millions of people dying from the plague seems to have convinced the citizens of the Italian city states of the points you make.

     Should you need further assistance in convincing people that dead bodies are really not good to be around I can recommend Carlo M. Cipolla’s

     ‘Cristofano and the plague: a study in the history of public health in the time of Galileo’.

208. Graham Freeman: Let me give you a simple answer first: for someone who opted not to have health insurance, I imagine the system would work for them in much the same way it does today, which is another way of saying it would not, in many cases, work much at all. But that would be *their choice*, and I have absolutely no problem with that. I don’t believe the govt. has any business protecting people from themselves.

     “Are you seriously suggesting that, upon seeing a heart attack in progress in public, good samaritans first check to see if the victim is a libertarian before calling 911?”
     Of course not, the victim’s personal philosophy is immaterial. The only salient point in the argument here is whether or not they have health insurance. Good samaritanism is always something to be encouraged, and an example which I should like to think I follow.
     As stated before, however, should any passers-by choose NOT to act as Good Samaritans, I have no problem allowing the possibility that someone may die on the street if they’ve chosen to take that risk upon themselves.

     “Who pays to transport the body to the morgue?
     Who pays for the mortician to determine cause of death? Maybe you don’t think someone should be forced to become a customer of a morgue. Who pays for the reduced quality of life resulting from a dead, decomposing body in the street?”
     Most of that would, if I’m not much mistaken, be the responsibility of a coroner, which IS a job that, in my opinion, falls legitimately under the purview of the govt.(either county or municipal, can’t remember).

209. Graham Freeman –

     “How about, instead, we face up to the fact that everyone in society benefits from having healthy neighbors?”

     Uh, that’s a well known gubmint lie. How do people not know this? Don’t you get Glenn Beck? Health is a zero sum game. If you’re chronically sick or dying, that’s all the more good health for me. That’s the peoples’ truth, that is.

210. 207: Indeed. But health insurance and public waste disposal, in any event, are two separate issues.

211. John, I hope it works well, I really do. Having grown up on an Indian reservation and seen the Indian Health Service in action, and having had military and VA care (before and after TriCare) … as well as private and group insurance … I’ll pray for all of us. We’re going to need it.

     I don’t seen how this has fixed the problems of paying for health care in the United States, it’s just provided a platform for the politicians to throw mud at each other and collect millions, if not billions, into their campaign spending lockboxes.

     Yes, some will be able — eventually — to get coverage they can’t currently get. I might even be one of them. I doubt that if I were to need that care, I’d survive the process to get it. Been there, done that, ….

212. I don’t believe the govt. has any business protecting people from themselves.

     I assume you’ve managed to avoid all government regulated food, drugs, highways, workplaces, power outlets, water supplies, and all the other sundry things that government does to protect people from themselves?

213. silbey @ 212 — there’s a moral hazard when government steps in with “quality” regulation. Sell bad things, they eventually shut you down, but the customers — who didn’t look at the product as closely as they should have — die anyway. OSHA tried to fine a theatre I was working in $50,000 for not keeping gallon cans of casein paint in metal storage. It’s not flammable! It was paint in a can, was the argument ….

214. 212: Heh, one of the reasons I became a vegetarian is b/c I don’t trust federally-inspected meat. But to address your point…

     I can accept govt. regulation of things like highways and water supplies b/c by their very nature these things involve many people. An individual’s health (insurance), on the other hand, does not, *if you’re willing to remove yourself from the public system*…and that’s something I think people should have the right to do.
     So if you support the idea of an insurance mandate in order to protect a person’s neighbors from his/her potential illness, I can ideologically accept that argument, although I don’t agree with it. What I don’t accept, however, is the idea that the govt. can force you to buy health insurance because it’s *in your best interest*, even if you, for whatever reason, would rather take your chances and go without, while still accepting the possible consequences therein.

215. htom –

     moral hazard or not, there is a functional reason for this. I’m not an engineer and I have no basis for determining bridge/road/building safety. Same for fire codes and other such things. I’ve no way of determining whether meat is unsafe by any method other than consuming a particular brand until it almost kills me and then blindly trying another brand.

     I think that really isn’t a moral hazard for the governmen to engage in quality control and set and enforce standards for things that would otherwise kill you.

216. 212: One thing I intended to mention; your analogy is rather apt, as not too long ago a state legislator in Georgia (my native state) introduced a bill allowing for the sale of raw milk, which is currently prohibited. Now, if I’m a customer, and I want to buy a bottle of milk straight from the heifer’s owner, *and I make clear that I’m willing to accept the risk that I get Salmonella, etc.*, why should anyone have the right to stop this interaction?

217. Transaction, arrgh.
     Other Bill: Feel free to set those standards, fine; but if I, as an individual, want to consume/engage/whatever outside of those standards while willingly accepting the risks therein and negating any liability on the part of someone else, why should I not have that right?

218. Amitava D.@214:
     The government is not merely protecting people from their own choices here, it is protecting society from the foolish choices of individuals who think they’re immortal. Unfortunately, humans are herd animals, and certain diseases can rip through an otherwise healthy population very quickly. We basically have two lines of defenses against that: people being able and willing to go to hospitals quickly when they feel sick, and people getting timely and accurate information through the media. Guess which one I have more faith in as of this afternoon?

     Now, that’s one argument in favor of it, but I’m not saying it’s the main one. The requirement to get insurance is mainly a consequence of forcing the insurance companies to accept new people who are already injured or ill: otherwise all the healthy people could go without insurance until the day they got sick and pick it up right then at no real risk to themselves. They’d be crazy not to. But the insurance business requires as many healthy people as possible to enroll to spread out the financial risk, or they go under and nobody gets insurance. Bottom line: If the country’s insurance regime is to not fall under the weight of the sick people they’ve so far been able to avoid covering, everyone needs to join in.

     So, we had a nationwide choice between forcing people to get insurance or allowing insurance companies to continue denying coverage to sick people. Congress and Obama chose the former, and I think they were right to. So, argue all you want for the ‘right’ to not get insurance, but be aware of what else you’re arguing at the same time.

219. An individual’s health (insurance), on the other hand, does not, *if you’re willing to remove yourself from the public system*…

     Oh baloney, it does. Shall we start with vaccines and the benefits/hazards of herd immunity and the lack thereof, and then move onto contagious diseases of all kinds?

220. Amitava –

     the difference is that until this, no matter how closely you examined your health insurance, the insurance company could essentially change the service it was supplying you with at it’s discretion.

     They were allowed to say “we never knew you would cost so much, we simply won’t pay.”

     And you know what. If you don’t want it, don’t get it. You won’t have to pay a full tax penalty until 2016.

     But I’d prefer you have it, because *when* you get sick with food poisoning from your freedom meat and go to the emergency room your choice affects me because I have to subsidize your care.

     But, if you have a religious objection you can get around it and It seems like a lot of the freedom to kill myself if I want people seems to be rather faith based, founded on mythical principles that are remembered from ancient times as the majestic beauty that was the garden of freedom. Even though it probably never happened like that.

221. Kevin Williams @157:

     Well, that just straightened it all out for me. All this time I thought it was Obamacare that was going to bring down the Republic and end life as we know it, and it turns out it’s Pelosi’s fault after all. Glad to know GOP.com is so overwhelmed with demand that they’ve added 16 hours to collect money to fire Pelosi.

     It’s as if they’ll all get better at their jobs if she were to lose hers.

     In a properly privatized government, of course, the GOP leadership would all be fired for doing such lousy jobs at representing the majority of their own constituents.

222. 218: I don’t see how people who opted-out of getting health insurance would affect the risk pool since, by pursuing that option, they’d effectively be removing themselves from the pool altogether (since they wouldn’t have any guarantee of care in the event that they did get sick).

     219: “Shall we start with vaccines and the benefits/hazards of herd immunity and the lack thereof, and then move onto contagious diseases of all kinds?”
     Uh-huh. So I suppose you’d support a compulsory vaccine policy for all US citizens? If, say, you don’t get your Tdap every 10 years you’re fined? How about a mandatory annual comprehensive panel for all major communicable diseases? And a national registry for those who come up positive?

     220:”And you know what. If you don’t want it, don’t get it. You won’t have to pay a full tax penalty until 2016.”
     As I said, I actually do have insurance, and I wouldn’t advise anyone to opt out. I just think that they should have the option.

     “But I’d prefer you have it, because *when* you get sick with food poisoning from your freedom meat and go to the emergency room your choice affects me because I have to subsidize your care.”
     Not beyond the ER you don’t, not legally. That’s kinda the whole point I’m trying to make. (‘Freedom meat’ made me laugh).

     Anyway, I’m removing myself from the discussion for now, enlivening as it’s been. Ironically enough I have an exam in internal medicine tomorrow afternoon, so wish me luck!

223. One last thing, I didn’t know there was a religious exemption. Interesting. Why can’t there be a philosophical exemption too?

224. “Shall we start with vaccines and the benefits/hazards of herd immunity and the lack thereof, and then move onto contagious diseases of all kinds?”
     Uh-huh.

     Ah, excellent. So you do believe that health care is a shared responsibility. Good to know.

225. Nope, that was sarcasm. As was, I assume, your response. Okay, now I’m REALLY leaving, damn thee!

226. Amitava D. : Good luck on your exam. Thanks for debating in a substantive and cool-headed fashion. We need more of that in our public policy dialogues.

227. Amitava –

     while I very much believe what I said, I’m glad you laughed at freedom meat.

     The problem though that outside of the er isn’t relevant. ERs will treat the patients on their doorsteps.

     And that affects how hospitals bill out for their services in total. Losing areas are offset by higher prices in other areas.

     Also, I think we do have a compulsory vaccine program in The US. I mean, there are ways out, just like the insurance requirement, but if you want your kid in a public school shots are mandatory.

     The moral objection tha these people should have the freedom because it doesn’t hurt anyone else is wrong. Because it isn’t an insulated choice. Except for maybe the one percent of uninsured who are billionaires and would just rather pay the bill.

228. John, thought you might be interested in this:

     An open letter to conservatives

229. Bryan@#4
     Oooo, oooo, “starve the beast” you suggest might be the stealth strategy to pay for all the debt being rolled onto us by this health bill and other recent legislation? Sign me on. Am I the only American tired of our being a world-wide empire with military bases and troops spread around the planet. I have prayed for years for a President who would just issue the Executive Order to bring the troops home from everywhere. I voted for Obama. I like much (but not all) in the new health law. But, I also like David Ramsey and his Financial Peace University for individual citizens mired in debt. I do not want my grandkids shackled by public debts run up on our watch. So, if some smart insiders thought spend the money now, and when the bill come due we close our bases in Turkey, Germany, fill in the blank____, then I applaud those insiders. Smart thinking. Being the world empire after WWII and during the Cold War made some sense. Those times are behind now. The world no longer needs us to be their policeman and protector. What a nice “unintended” consequence of the new health law this could eventually turn out to be!

230. Amitava: “Indeed. But health insurance and public waste disposal, in any event, are two separate issues.”

     No, they’re not. Waste disposal, hazardous waste disposal, water supply and sewage, coroner and morgue services, police, firefighters, paramedics, ambulances, government funded emergency hospital services and drug research, roads, courts, public buildings in which people can also die, including schools, immunizations for kids in those public schools, basic safety for kids in the schools, including teachers and staff, power lines, street lights, traffic lights and signs, gov. telephone lines, radio broadband communications, snow removal, disaster emergency resources, etc., it’s all connected and it’s all one big system and it all effects health care issues and is effected by health care issues, certainly by dead bodies.

     Dead bodies on the street and the health hazards they would produce, out of a population of 300 million — as we are currently witnessing in Haiti — cost way more money in taxes, healthcare costs, clean-up and disposal costs than just getting some people some healthcare coverage. That’s why the millions of uninsured people are such a problem. (And we currently have to deal with the problem of too many street bodies now as we pushed all our mentally ill out on to the streets.)

     More to the point, nobody wants to die in the street. The only people claiming that health insurance is a freedom issue are the young and clueless and Randian libertarians who inevitably have health insurance, including some Congresspeople who get socialized medicine from the government and seniors on Medicare. It’s like saying, “well you can go out there and die if you like, I’ll just stay here all safe in the government fort where you aren’t allowed. It’s a matter of freedom.” Which works real well for you until your health insurer informs you that you have to leave the fort now, and don’t come back.

     The mandate portion is part of keeping health insurers from abuses and dumping people off the roles. The entire reform bill is to keep people from being bankrupted by medical expenses — because they don’t want to die in the streets. Which also helps the government stay solvent so that they can afford to have a coroner who actually comes to get the occasional dead body on the streets. If you want the coroner and the people who pick up your trash, the government has to deal with getting the populace healthcare. Otherwise, the system sinks as it has been sinking and very rapidly for the last two decades.

231. 227-And here I am again. Only for you, Other Bill!

     Have you ever worked in an ER? I have, and in my experience unless you’re there for an asthma attack or something like that, and are *actually sick*, the bulk of the treatment that takes place is done once you’re admitted, ie out of the ER.

     You’re right about school kids, but
     1)as you say, vaccination is only legally mandated if they’re attending public school, and
     2)kids are kind of a gray area, libertarian-wise, since they’re not autonomous beings. (That’s why I specified ‘all US citizens’). Kids don’t have the right to smoke cigarettes either, and I don’t have a problem with that. This is why I remember immediately warming to Obama over Clinton and Edwards in the Democratic debates b/c he supported an insurance mandate for children alone (as opposed to adults) since, as he put it, ‘they don’t have a choice’.

     Your last paragraph is well-taken, and although I would still disagree with the premise, I can accept that particular justification. The thing is, I think one’s health *can* be made more of, if one desires, an insulated/personal choice. And if it’s possible, it should certainly be an option.

     All-rightey! Closing computer now! All the best!

232. Health care reform is very personal for me. I work with a very annoying person who has been unable to leave this place and seek other employment because her preexisting conditions would prevent her from getting adequate insurance coverage.

     The bill Obama signed into law today means there’s hope she’ll move on to greener pastures and make this pasture a much more quiet place to work.

233. MasterThief @138 – I’m not blaming anyone for their vigilance against government intrusion, but by definition a government falls somewhere between despotism and anarchy. None of us wants either of those extremes. So what we’re really arguing about is what constitutes justifiable government intrusion. That’s a debate that dates back in the U.S. before the Declaration of Independence.

     For more recent examples — during the Bush administration, the libtards got their shorts in a knot over due process for suspected terrorists, especially after some obvious false arrests. Now the tea partiers/baggers have their shorts in a knot over coerced spending.

     As too many people have said over the past few years, (starting with GWB in 2004, I believe): “Elections have consequences.” One consequence right now is that a Democratic majority gets to define government intrusion the way it sees it rather than take the definitions from the previous 8 years. If the Republicans get a majority in November, that may or may not be a referendum on health care and government intrusion, but it will mean that the Democrats can’t just do whatever they want.

234. This is coming way late, but so be it.

     Just thought I’d say that I found this to be rather inspirational. I don’t think I could have said this as well as you have here and reading it gave me a boost.

     So, thanks!

235. Excellent commentary so far. Hmm, my thoughts are these:

     1) Where are the funding and incentive plans to encourage medical students to chose working as an underpaid primary care doctor in Small Town, USA? (’cause you know they are sitting there saying, “Hey! I could make millions as an ‘ologist in a cool urban center! And not be “overworked”).

     2) For those who claim that “socialized, governmental take over of health care” will lead to rationing–well, we have that now. I routinely have to tell patients, “Hey, I know you need a knee replacement in order to return to your job as a mechanic, but even if you HAVE Medicaid or Medicare, no orthopedic surgeon will see you because they don’t get reimbursed enough to take care of you.”

     3) And why does a specialist have to get “more” in reimbursement? Because they have to pay boatloads of malpractice insurance and pay out hefty amounts for medical student loans. (Too bad tort reform didn’t make it into the bill-that would have been nice). Wouldn’t it also be nice if all doctors (regardless of specialty) were paid the same–but then didn’t have to pay malpractice? (you could still have a really nice life, and maybe some money could be diverted into the education system so teachers could be paid more).

     4) And, finally, there are 333 million people projected as our US population (Census results pending). If everyone had to pay $200 into the pot, what would 66 trillion plus dollars fund for healthcare? Hmmm. And it would DEFINITELY be less than the expected taxes we will be paying for shortly. . . but OH NO, that is SOCIALIZED MEDICINE (snarl, snap, grrowl) and the end of America as we know it!

236. Amitava –

     Fair enough about what actually takes place in the ER. Let me rephrase. If you don’t have any insurance in the US and you get seriously ill or injured, your two options are hope the ER and whoever will take you or probably die.

     Considering the question was phrased in a moral way, I can’t see how any value set would approve. Either ‘you’ impact me by receiving treatment subsidized by taxpayers and/or insurance havers or you die.

     I liked Obama’s original take on health insurance about no adult mandate based on the fact that people in the US who don’t have insurance don’t do so voluntarily. And they don’t have to be unemployed. You could work three minimum wage jobs, never have more than a few hours to sleep and have no health insurance.

     So, either you die because something was taken out of your reach, or you impose on me, even if you don’t want to.

     I wouldn’t prefer a mandate, but given that I think most people who just don’t want health insurance are billionaires, I imagine they will either find the fine irrelevant or do the calculus as it affects them and decide to buy the insurance outright.

     Everyone else will probably be thrilled. But, then, I think, for the same reason, it makes no sense not to let illegals buy insurance on the exchange with their own money.

     And the conclusion I come to, even though it isn’t all unicorns and cake, in our current healthcare system health insurance is a must. And if we can help people get some, even if it in olves a requirement, it’s a good idea.

     Oh, and other mandated vaccinations: legal immigrants. If you want to become a citizen you have to get your jabs.

237. @231: Amitava D.

     Point of clarification: The requirement for immunizations depends on where you live as each state allows for certain types of waivers–either for a) religious b) philosophical (i.e. conscious objections) or c) medical reasons (allergy or contraindications to vaccines).

     Some states are VERY restrictive (see key states in the South) and only allow medical exemptions. These kids must be immunized to go to public school, or be home-schooled (and a lot do).

     In other states, you can sign your preferred waiver, and head off to school but as I tell the parents in my office, be prepared to keep your kids home for up to two weeks if measles or chickenpox or pertussis is going around! Your kid will be the first sent home.

238. Colorado FamIly Doc

     You’re right. And I should have put that mandate in quotes or something. They are state based and some are you must comply! Unless…you wish to sign this waiver.

     Which isn’t a one to one comparison to the insurance mandate.

239. I’m entertained, in a cranky sort of way, by the attitude (exemplified in @233) that habeas corpus and due process are some kind of wackaloon fringe lefty issue.

240. Random thoughts after reading a very long comment thread.

     The bill does contain an opt out provision for *states* provided they come up with an acceptable alternative (and no, I’m not going to site…too darn tired to look right now) to the individual mandate. As I recall, this kicks in later (memory says 2014, but it could be later).

     There are work force provisions acknowledging the scarcity of primary care docs as well as docs willing to work in rural areas. Also lots of funding incentives for community health centers. This was intended to address access issues in expanding the health care system.

     Medicaid doesn’t change for those already on the program. Medicaid is expanded for all Americans (legal) at or below 133% of the federal poverty level (again too tired to figure out what that is currently, but it’s low) and this includes childless adults (for the most part only children, women and ABDs qualify). Furthermore, the Medicaid expansion is paid for by the feds at 100% for I think three years and then it ratchets down in successive years ending up at a 90% federal matching rate in 2019. States will have to come up with those matching dollars, and yes, it will be a big amount. I don’t know enough about how other states fund their Medicaid programs, but it will be a huge amount for us in CA (but I think doable…well, that is if we can finally start having a rational debate about taxes in the state – we pay for these services already, but not in any way that makes sense).

     Also, the bill (and my references here to the “bill” I guess should now be the “law”) has some worthy public health/preventive health provisions (public health to shore up our deteriorating disease surveillance system and preventive health in terms of seeing what might work to drive down health care costs due to chronic disease).

     I’m cautiously optimistic, but know implementation will be extraordinarily hard.

241. Sorry, to clarify, women, children, the aged, blind and disabled (ABDs) *currently* are those eligible for Medicaid.

242. *nod*

     On the 5th of March I got an email nominally from Jen O’Malley Dillon, Executive Director of the Democratic National Committee, whining about the GOP and asking if I could send money to support the democratic resistance to the crazies, and I realized I’d pretty much had enough. I wrote back:

     “Jen, I agree that enough is enough. You should be decrying their behavior in the major media and on the floor of the house and senate, not in order to beg me for $5. The democrats control the white house and congress. Get your act together and demonstrate you can do something in a coordinated fashion. You can start by getting those idiots who say they will block the health care bill because of concerns about abortion on board with the plan.

     I’m not sure why I’m supposed to support the party when the party seems bound and determined to prove itself ineffectual at governing.”

     I’m pleased to see they have passed the bill, even if it’s not necessarily what I would have written, if it were me. Now, there’s a lot of other stuff I’d like to see coming down the pike, especially prison reform and the approval of a site for the national women’s history museum, so I hope things continue in a productive manner.

243. David@194

     You could not be bothered to read one more sentence of my post? Or your English comprehension is more academic than idiomatic? I start addressing your main point in the very next sentence and more or less agree with you, though not completely. I am not an expert on the issue, but my source on this is mostly NPR who I doubt are biased against European models of health care delivery.

244. PrivateIron@243 – I don’t see the problem with my post? I did read all of your post, but is it so wrong to respond to your first sentence, to point out that while most European countries face budget cuts in healthcare, the point where doctors will be underpaid is a *long* way off indeed?(**)

     I replied, in fact, because this is one of the things that irritated me again and again in the whole US debate: time and time again, some (many?) US news outlets paint the picture of the European system as being bankrupt, resulting in low-standard care by second-rate medical personnel. That’s just false.
     Will there be cuts in our healthcare? Possibly. Does that mean it is not at all feasible to keep up the standard of care? No!
     As in any publicly funded sector, constant oversight is needed to cut excesses, spot loopholes and otherwise make sure the system is not exploited… huge savings can be made there. Not to speak of our Belgian government apparatus in general, which is top-heavy… but that’s another discussion altogether.

     (**)Just to be clear: I don’t want to suggest doctors should not be compensated royally – they work long and hard hours, with great responsibility (even though malpractice litigation on this side of the ocean is peanuts compared to the US situation).

245. It is wrong because it mis-characterizes my post. You imply that I think the US system is working or is better than other systems. You make it sound like I don’t know that we over-pay for health care, then you finish with a rhetorical flourish challenging me to do as well or better than your system does as if we were engaged in a debate from opposing sides when really, not so much, at least for the issue you addressed. As for the specifics of the Belgian medical profession, I don’t claim to be an expert, but your claims did not impress me that much. Telling me what specialists make does not tell me much about the average doctor’s compensation. Nor does it tell me, for example, how many doctors there are, how available they are to public system patients and if the medical schools are producing enough young doctors to replace older ones and what sort of challenges they face. The Belgian system could be fine for all I know, but I think you could have made your point without a misleading reference to my post’s content.

246. Point taken. I did not mean to mischaracterize your post, nor would I assume to know what you think.

     As stated in my previous comment, I was simply responding to the statement that the European model is not financially sustainable… if I did that a little too enthousiastically, then I am sorry for that.

     No flame war intended!

     As for some of your other questions: I’m not a scholar in our healthcare system, but I can generally yet vaguely state that:

     – general practitioners do make far less than specialists, but are usually still better off than the vast majority of people (if you would look at the hours worked vs income, that might be a different story)

     – we have too many doctors (from time to time we have to cap the number of medical students) rather than too few

     – all doctors are available to all patients except for some types of care that are not covered by the public system (pure esthetic surgery and some cutting-edge or extremely rare procedures) which are very expensive indeed

     – nurses and other related staff are typically not paid as well. This is definitely a weak point.

247. This is a little late, but there is precedence for the federal government mandating purchase of insurance. The National Flood Insurance Reform Act of 1994 mandates that individuals obtaining a loan in a special flood hazard area purchase and maintain flood insurance. In fact, purchase of flood insurance by individuals is mandated in a number of circumstances by federal law.

248. It seems to me that this is nothing more than a power grab and has nothing to do with health care. It should be obvious to all that the Democrats only interest is in taking over as much as possible. Banking, auto industry, health, jobs, etc. Conceptually this all sounds great, but who will pay for it all. The government has only demonstrated incompetence in what the currently manage. When the real impact if this and other Democrat conquests come to fruition the people of this country will blame the party in power at that time. More than likely it will be the GOP. If it is such a wonderful plan why wait to begin implementing it? How well is medicare working?, Medicaid? VA care. There is your heath care future. Everyone cheers when the banking executives bonuses are dictated by the government. Will you cheer the same when they take yours away? Will you cheer when the government starts making health decisions for you?

249. Medicaid? My kids have it, because they are special needs kids adopted out of state custody. It’s a hell of a lot better than the coverage I get through my insurance at my job as a teacher. They always get seen right away and there is never a copay. I’d be thrilled to have as good a coverage as they have. I won’t, though, because this plan is *not* a single payer plan, unlike Medicaid. Pity.

250. @NoFanOfGov :

     About 50 years ago, my grandpa was seriously injured on a construction job. The company running the job treated him like a disposable good – they threw him away. And so, my grandparents’ upward mobility screeched to a halt, they lost their house, and they’ve struggled with the health and financial consequences ever since.

     As a child in the 1980s, I fell seriously ill with a fairly hard-to-diagnose life-threatening disease. I was hospitalized for almost 2 weeks, and I came –>this<– close to dying. My mom was an undergrad in college, and my dad was just starting out as a self-employed contractor in his field. Our family had no financial resources whatsoever. Without Medicaid, we would have been treated as a poverty/charity case by the hospital. Given that the extraordinary care they provided only just barely saved my life, I'm confident that a slight reduction in care (due to being a poverty/charity case) would have meant my death. So, I feel justified saying that Medicaid saved my life.

     These days, Medicare keeps my grandparents in pretty good health care. (Saved my grandpa's life just yesterday, in fact.) Social security keeps a roof over their heads. The combination of the two means my grandparents are still around, and yet they don't pose a crippling financial burden on me.

     I'm now a productive self-employed person who generates quite a bit of paid work (read: jobs) for others. So, from my perspective, I'd say that these gol durn gubmint programs have done pretty well, and I'm extremely proud of the leaders who helped make them a reality. I'm sorry that you seem so susceptible to propaganda spouted by the bed-wetters on TV.

251. There are a number of comments about how the new legislation will “destroy” the current medical system in the U.S., but both the American Medical Association (http://www.ama-assn.org/ama/pub/health-system-reform/ama-supports-reform-passage.shtml) and the Association of American Medical Colleges (http://www.aamc.org/newsroom/pressrel/2010/100321.htm) supported passage of the bill.

252. I think it makes moral, philosophical and economic sense for as many Americans as possible to have access to regular, competent health care.

     …that someone else paid for. Oh, and if you don’t want insurance, even with a subsidy, too bad. Paying your own bills is now illegal, because you see we need you healthy people to help foot the bills of the unhealthy. No, no, not through voluntary charity, we’ll take it at gunpoint, tyvm. Why, it just makes moral sense, can’t you see?

     This is the classic misunderstanding of economics behind all statism — what the state provides must be seized from the productive, and that has a terrible cost. The U.S. health system does more to keep people alive than any other system in the world (twice as many transplants, twice as many MRIs, highest cancer survival rates), because we don’t have government rationing and we do the majority of innovation as well (most drugs and devices are available here a year before they are in Europe, we do most of the medical trials of new tech, and most Nobel prizes in medicine go to Americans). The reason is that we are the last major semi-free market in health care.

     Having lied this bill into law, the Dems will now reap the whirlwind.

253. TallDave:

     “…that someone else paid for.”

     Just like Social Security! Let’s kill that too!

     Apropos to this, it’s been noted that a fair number of folks adamantly opposed to health care reform are dependent on government services in one manner or another. Of course, many of them will tell you that’s different.

254. No, people pay into Social Security and are paid back. Same with Medicare. Those programs are going bankrupt because our idiot lawmakers lacked the courage and common sense to tie them to actuarial realities, but they can at least be said to be something other than a giant transfer of wealth from the productive to the unproductive.

     If you want to destroy innovation, then by all means kill the free market in the name of fairness, and reap the sundry benefits that N Koreans and Cubans enjoy today.

255. No, people pay into Social Security and are paid back. Same with Medicare.

     Oh. So it’s OK to take my money without my consent for Social Security and Medicare – money I might otherwise wisely invest for myself, or use to secure heath care in my own old age – because maybe, if I get that old, I might get some of it back? Some free marketer you are.

256. No, it’s just less bad than taking it and giving it to someone who did nothing to earn it.

257. Would we all be richer today if not for SS and Medicare? Undoubtedly; obviously you don’t create economic efficiencies by having the gov’t seize and redistribute income. Allowing for the cumulative effect over decades, we’d probably have a PPP GDP per capita around 20% higher today (or around $10K more per person) in their absence. OTOH, I’m willing to accept the argument of an offsetting social good in taking care of the elderly, especially since it’s less of a tax and more of an incompetently administered gov’t savings program, and it distorts but doesn’t entirely destroy the free market.

     I’m much less willing to accept the idea that the government can create a net public good in an industry by seting price controls and forcing productive people to buy things for less productive people. This has rarely produced good results. You tend to get more of what you incentivize…

     “We have a system that increasingly taxes work and subsidizes nonwork.” — Milton Friedman

258. TallDave, you argued that the new health-care plan is bad because “someone else paid for” it and we’re taking, “at gunpoint”, the money required to pay for health care for laggards. That’s also true of Social Security and Medicare, and your lame argument that those are different is, well, lame. “Less bad”? So what? Car theft is “less bad” than murder, but I don’t see anybody arguing that it’s all right if car theft is legal.

     I get it: it’s politically unpopular to suggest abolishing Medicare. Admit that, instead of pretending that refusing to abolish it is consistent with free-market values because, well, it’s not too bad.

259. Very lame. By your same logic, Communism is ok, because Social Security is OK.

     Ad nauseum arguments are boring.

260. Here’s an example of the very real problem with incentives: I know someone in his 40s who has just realized something: if he limits his realized investment income to the point he will qualify for Obamacare subsidies, his work income is low enough relative to his premiums that he only improves his position slightly by working. The bill reduces the financial difference between working and not working to the point he doesn’t feel it makes sense to work anymore.

     This is the incentive system we’re creating.

261. BTW John, The God Engines was brilliant, a great read. I would recommed picking up Capitalism and Freedom by Milt, he explains it all and I promise you won’t burst into flames upon picking it up.

     I’ll leave you with de Tocqueville:

     “Subjection in minor affairs breaks out every day and is felt by the whole community indiscriminately. It does not drive men to resistance, but it crosses them at every turn, till they are led to surrender the exercise of their own will. Thus their spirit is gradually broken and their character enervated…
     That power is absolute, minute, regular, provident and mild. It would be like the authority of a parent if, like that authority, its object was to prepare men for manhood; but it seeks, on the contrary, to keep them in perpetual childhood: it is well content that the people should rejoice, provided they think of nothing but rejoicing. For their happiness such a government willingly labors, but it chooses to be the sole agent and the only arbiter of that happiness; it provides for their security, foresees and supplies their necessities, facilitates their pleasures, manages their principal concerns, directs their industry, regulates the descent of property, and subdivides their inheritances: what remains, but to spare them all the care of thinking and all the trouble of living?”

262. TallDave –

     it’s when you use terms like productive people versus unproductive or less productive people that I stop listening to your argument. In which case your application of the de Tocqueville quote comes across misguided at best.

     That people have been priced out of insurance who work more than fulltime on minimum wage and can’t afford the health care are “less” productive?

     And what sort of price controls are we talking about here? The fact that insurance companies shouldn’t be able to rip as much profit from you as they like until they elect to simply not hold up their end of the arrangement.

     Arguments which don’t really account for the facts at hand and make pejorative value judgements about the “motives” for poverty are also boring.

     Internet wrong righted.

263. Ad nauseum arguments are boring.

     Man. And I thought I was getting too old to keep the Latin names of my fallacies straight.

     OtherBill, it’s a classic example of “my benefits are earned, your benefits are stolen”.

264. Mythago –

     that’s my other problem with that argument. It’s the precursor to calling for an end to taxes. Because if I already pay my taxes for my benefits, and everyone else’s benefits are their own flavor of wrong-just-wrong then why shouldn’t I just cut the middleman out?

265. John, I’ve noticed there is a large fairness gap in writing. While a large proportion of writers are unable to garner even 1,000 book-purchasing readers, others are routinely taking hundreds of thousands or even millions — and most shockingly, many books are not published at all because Big Publishing is only interested in making profits not helping writers spread their important ideas. These awards are only making things worse.

     Now, obviously we can all agree the government must ensure universal access to readers for all writers. My question for you is, should this be accomplished by 1) seizing these unfair profits from so-called “popular” authors and their publishers and using them to print copies of disadvantaged books which book stores would then be forced to carry, or 2) simply limiting printing and sales of all books to a proportionate share of total books published, based perhaps on the prior year’s total sales of all books. I think both ideas have their merits, but I’m curious what a writer such as yourself thinks of these proposals.

     from:

     http://www.classicalvalues.com/archives/2010/03/letters_to_scal.html

266. Fiyero! How good to see you!

267. To those who favored this legislation, what I can’t understand is why you waited. In other words, given the HUGE MORAL ISSUES AT STAKE, its odd to me that you guys carped for 20 odd years (more ?) about the need for health care reform, instead of just doing something yourselves. By doing something I mean simply find someone who needs help, and help ’em. Perhaps some of you did, but with all the wealth, rich movie stars, etc. etc. its odd you guys couldn’t cobble together a private charity or something to help a measly 12 million people (thats the real #, by the way). Heck, I’m sure a bunch on the right would have chipped in, as they tend to give more to charity as a % of income. Had you done this, people could have been helped all these years…you didn’t need to ask permission, or win a majority…you could have just done it.

     Truly, the last thing this legislation is about is helping anyone. If it were, you would have done that already. What this is about is forcing your version of morality on everyone. Claims of heroism above fall rather flat…how heroic is it to force people to participate in this ? Heroic would have been doing something meaningful 20 years ago…

268. M. Simon:

     That question (originally posted to an inappropriate thread here and deleted because of it) is at best lazy satire, and not worth my responding to with any seriousness.

269. The GOP is surging:

     http://hotair.com/archives/2010/03/29/gallup-crumble-obamacare-underwater-again-gop-surges-on-generic-ballot/

     My estimate based on the current popularity of the Dems is that they win about 175 seats. i.e. about a 60 seat loss in the House.

     But it is early yet. If the Ds keep dropping the numbers will go higher. My prediction is 100 seats. My top prediction is 120. I would be satisfied with 80.

     Will it be enough to repeal the bill (the Senate is the key) – no. Will it be enough to keep the bill unfunded – very good chance.

270. John,

     Will the Government make you buy a Government Motors car?

     But I can understand your testiness. It looks like what ever the merits of the satire a LOT of folks are thinking along similar lines and will be voting accordingly in November.

     In a way I’m glad the bill passed. It will keep the Democrats down for another 20 years (See Clinton, Bill, 1994)

     Just remember – anything gotten at the point of a (government) gun can be taken away at the point of a (government) gun.

     BTW this bill is not a health care bill. It is an insurance bill. And for a while the insurance companies intend to make out like bandits. Always nice to see Chicago Politicians at work.

271. M. Simon:

     “In a way I’m glad the bill passed. It will keep the Democrats down for another 20 years (See Clinton, Bill, 1994)”

     Yes, as we all know, Bill Clinton was so hobbled by his health care failure that he lost the 1996 election!

     Otherwise, if we all recall, on January 20 lots of people were absolutely convinced health care reform was dead and Obama’s administration hamstrung. And, well, look how that turned out.

     Which is to say there’s a lot of time between now and November, M. Simon. I’d suggest holding off counting on your House majority quite yet.

272. Notice how the above comment in reply to M. Simon fails to address the question concerning whether the government can also force you to buy a car from GM. The cheerleaders for the health care “reform” bill have yet to come up with a plausible answer as to why the government has the authority to force you to buy health insurance but not a car from Gover.. I mean General Motors. I find the dodging of that question almost as hilarious as the notion that the Republican Party suffered a major defeat even though they are outnumbered by almost 80 in the House and 19 in the Senate. The Obama administration was so incompetent that it took over a year with majorities not seen in a generation to pass the bill, all to proclaim victory for a bill that has no real tangible effects for four more years (I should probably qualify that with the words “positive effects”, because the list of businesses claiming multimillion dollar losses grows by the day), didn’t produce a bounce in the presidential approval numbers and still has more opposition than support. Boy, that is a real huge defeat for the Republicans.

     But the most hilarious is the assertion, again made in the above riotous comment, that the drubbing the Dems got in 1994 didn’t hobble Bill Clinton or was not a staggering defeat for the Democratic Party.

273. “… it was opposed to it in shrill, angry, apocalyptic terms, and saw it not as legislation, or in terms of whether or not health care reform was needed or desirable for Americans…”

     Yeah, the Republicans never mentioned how it would lead to increased premiums for a large percentage of families, poorer quality medical care, longer lines at the doctor’s office, rationing of care, mountains of debt for future generations, the negative impacts on small businesses, the ceding of control from doctors to bureaucrats, the fact individuals would lose their current plans, doctor shortages etc. Oh, wait, yeah they did, which is why the above quote is so much bullsh*t.

274. Then again, I could be wrong. Maybe you consider all the obvious shortcomings, pointed out on numerous occasions by the Republicans, of this bill to be “desirable for Americans”; or perhaps you were just living in a cave when they pointed out all the substantive reasons why this bill is neither”needed” nor desirable for Americans”.

     It simply amazes me that after a year we are still hearing and seeing variations of the bogus and incredibly(almost unfathomably so)lame “Republicans are opposed to any health care reform” “Republicans didn’t have any ideas” and “opposition to this bill means you oppose reform entirely” arguments.

275. Some “genius” wrote:
     “I’m not actually that concerned about the fiscal impact even if the projected savings don’t come about. Yes, it’s a trillion dollars.”

     Wow, that kind of attitude won’t cause the United States to go bankrupt, will it? But hey, nothing strengthens a country like crushing levels of debt. It certainly has worked wonders for Greece and Portugal.

     The same genius then wrote:
     “People who get all foamy in the mouth over that haven’t had a problem spending a similar amount on Iraq and Afghanistan over a similar time period. In fact, they’ve called people who don’t support that expense unpatriotic. Odd, how people are fine with some kinds of spending but others are a waste of money.”

     Given the tenor of the above comment I am assuming you are one of those people who did get up in arms over the cost of Iraq and Afghanistan, yet you now don’t care about the costs of an entitlement that, since it will never be gotten rid of, will cost way more than those wars. And you have the nerve to imply that it is others who are hypocrites?

276. I love reading sentences like this one:
     “…but if whomever is the GOP candidate in 2012 plans on running on repealing the health care laws, well, you know. Good luck with that. I’m sure Obama would be delighted for them to try.”

     It is freakin hilarious that people think a bill that is unpopular is somehow going to boost Obama’s reelection chances. To get an idea of how f*cking dumb the above sentence is, imagine if Obama would have run on keeping the troops in Iraq for another two or three decades, because that is similar to what the “I dare the Republicans to run on repealing this unpopular bill” are proposing. Repeat after me: BILLS THAT HAVE MORE OPPOSITION THAN SUPPORT FROM THE AMERICAN PUBLIC GENERALLY DO NOT AID SOMEONE IN HIS REELECTION CHANCES. 99% of the so-called “rights and benefits” of this bill don’t kick in until after the 2012 election. Meanwhile, the list of companies that are detailing how this “reform” bill will cost them millions and billions continues to grow, as does the number of companies that have indicated they will be dropping employee health benefits as soon as possible or hiring less because of the new “reform” bill. And let us not forget the insurance companies, such as Aetna, that are already telling reporters that they will be increasing premiums significantly before the November elections (as detailed in BusinessWeek). If you think letting a kid stay on his parent’s policy until he is 26 is going to win new converts to this bill prior to the midterms, you even more of an uncritical Obamabot than I could have imagined (which would be hard given the slobbering fawning of the last several paragraphs of the above piece).

     But even more silly is the talking point which seems to have been handed out by the DNC to every Obama sycophant-blogger on the planet about how repealing this bill would necessarily mean repealing the parts about pre-existing conditions and the donut hole etc and therefore these things can never, EVER, be addressed again. Because that is exactly what the Republican want to do, even though they said for months they oppose recission and pre-existing condition denials-of-coverage.

     “Like the GOP, he went all in, but unlike the GOP, he didn’t do it just for tactical advantage or for short term advantage of power and party…”

     The above quote is another reason I generally don’t waste much time reading blogs published by hyperpartisans. They simply refuse to believe that their ideological opponents oppose bills out of principle. The notion that the GOP opposed this bill JUST for short-term political gain and not because they also thought it would be damaging to the health care system and the country as a whole and, get this, because a majority of their constituents opposed it is absolutely ludicrous and, for lack of a better word, stupid. Almost as stupid, but not nearly as nauseating, as the assertion that Obama did this because he is so pure and noble.

277. Expat. Laughing at you all. I will come back after my retirement to enjoy free health care at your expense, while also enjoying the fact that I won’t be paying anything to support anyone now, on account of being far out of reach of the IRS.

     Let’s see here: Social Security, Medicare, Medicaid – and you still haven’t grasped that creating more systems with built-in freeloader incentives is a terribly bad idea? You truly want to go down the European road? Is misery really so attractive so long as it is shared? The fact that you bicker for partisan advantage while they’re burning America in Washington makes me think the American people deserves what’s coming its way in a decade or two.

     Fair enough. Enjoy. I know I will.

278. It is, of course, utterly false to claim that the GOP was “simply opposed to health care” – because that straw man lets you resort (as you do) to the usual liberal nostrums about screaming, incoherent rage, yadda yadda.

     The fact is that the GOP presented sensible concerns about ObamaCare that deserved discussion: that it will decrease the number of healthcare providers, particularly Medicare (it’s already happening), that it will increase the deficit (it will, and if you believe the CBO, you haven’t been paying attention to how the Dems gamed them), that ObamaCare is designed to drive private insurors out of business (a feature, not a bug), and that it will increase costs to employers (already happening).

     And, of course, the GOP presented several reasoned alternatives to ObamaCare, none of which were allowed to be debated in Congress by the Democrats, which in turn allowed the media to pretend they didn’t exist. There’s more, so much more, but that alone puts the lie to your claim.

     And, hey, did you happen to notice that every major poll — every single one — shows that the majority of Americans are opposed to this legislation? Are they all shrill, angry, and apocalyptic ‘tea baggers’? Or is it just possible that they understand what ObamaCare is really about, and don’t like what it portends?

     That’s not to say that the Republicans are not inept at getting out their message and generally incompetent (the fish rots from the head, and the head is named Steele), but it’s obvious that you’ve bought into the Democrats’ narrative, and it doesn’t appear that you’re interested in looking beyond it to, you know, all of the facts.

     That’s a shame, because it decreases your credibility as an incisive writer in my (and others’) eyes.

279. BOb:

     “Notice how the above comment in reply to M. Simon fails to address the question concerning whether the government can also force you to buy a car from GM.”

     That’s because it’s a dumb question, not worth spending time on. So I skipped over it to something else. I recognize you may feel it’s an insightful question worth lots of brain cycles, but, yeah, I don’t really.

     Aside from this, BOb: there’s not much reason that your multiple sequential posts couldn’t have been a single larger post. Try that moving forward, please. Thanks.

     Screwtape:

     “It is, of course, utterly false to claim that the GOP was ‘simply opposed to health care'”

     The recorded vote tallies in the House and Senate would like to have a word with you about this. Now, I recognize that you might think uniform opposition in every recorded vote might mean something else than “opposed to heath care,” but that’s, shall we say, an interesting interpretation, and I’m not one I’m inclined to take seriously.

     Aside from this, it’s pretty clear from the context of the entry that “health care” in this case refers specifically to the then-current bills (now law) working through Congress, so any attempt to expand the discussion outside those perimeters is sloppy arguing, which can be disposed of without too much discussion; likewise any argument along the line of “it’s not health care, it’s ObamaCare,” or however you wish to dispose of actual GOP votes on the bills as being not relevant in terms of being opposed.

     “That’s a shame, because it decreases your credibility as an incisive writer in my (and others’) eyes.”

     I’m going to get right on losing sleep over that, Screwtape.

280. “That’s because it’s a dumb question, not worth spending time on.”

     Ok, so that leaves us with one of three options.

     1) The Government can’t force us to buy a GM product; for a simple reason you can easily give us. It’s too simple to worry about (but just for fun, give it to us).

     2) The Government can force citizens to buy GM products, but you’re ok with that. (Why shouldn’t the government choose all your purchases, right?)

     3) You refuse to deal with hard questions. But instead think if you say “not worth dealing with” people will drop it. (How’s that working for you so far?)

281. Well, there’s the fourth option, of “it’s a dumb question, and not worth spending time on.” Which was actually the first option, and the one I chose.

     You, of course, are welcome to spend as much time on it as you like; I wouldn’t presume to stop others from dwelling on questions I consider dumb. I’m just not going to do it myself.

282. “…it’s pretty clear from the context of the entry that “health care” in this case refers specifically to the then-current bills (now law) working through Congress, so any attempt to expand the discussion outside those perimeters is sloppy arguing…”

     Er, except that you elided the discussion inside those perimeters — where I pointed out that 1) “the GOP presented sensible concerns” about the then-current bills, and that 2) “the GOP presented several reasoned alternatives” to the then-current bills. It’s difficult to see how it could be any more contextual.

     It’s also glaringly apparent from the context of my entry that the GOP was opposed to the then-current bills being considered in Congress — and not to health care reform as a concept. But, hey, that doesn’t fit the narrative, so just feel free to, you know, ignore it.

283. Screwtape:

     “But, hey, that doesn’t fit the narrative, so just feel free to, you know, ignore it.”

     Indeed I will, because your argument doesn’t reflect reality. Leaving aside that “sensible” and “reasoned” here are matters of opinion, the GOP never had any plans ever to vote for the health care bills no matter how many GOP-originated ideas were adopted (and many were, as Mitt Romney is all too aware), because early on it was decided to obstruct passage of anything relating to health care in order to damage Obama.

     The suggestion that the GOP’s “sensible and reasoned” objections and discussion might have led to any real movement on the GOP side toward health care this time around implies you weren’t paying attention to what was actually going on and/or are delusional as regards to the GOPs strategy and tactics during the heath care debate and/or that you’re trying to revise history. You’re free to believe and/or attempt what you like, but I’m not obliged to treat your argument seriously, regardless of how you came to it.

284. 267 John in Jax — politicians always have to decide whether it’s to their advantage to “fix the problem” or “have the issue”. In this case, I suspect that both were trying to do both at once, and both failed miserably. Not that either will ever admit it.

285. [Content-less invective targeting me posted several months after entry was posted that adds nothing to the thread deleted — JS]

286. [deleted for the same reasons as above. Joel Mackey, one more of these gets you dumped into the moderation queue — JS]