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View Diary: Senate Bill is '93 Repug HCR Bill (96 comments)

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  •  Yup, it is... (3+ / 0-)
    Recommended by:
    cotterperson, LordMike, Kharafina

    But it's also worth noting just how spectacularly the Clinton effort went poof.

    Forget filibusters - the 93 'Democratic' plan couldn't even a floor vote in the Senate because Mitchell never even came close to getting a simple majority.

    DPM was saying the WH was living in a fairy tale.

    It's not like the '93 plan came close to passage - it got walloped.

    In a vacuum, it was a better plan than this one -

    But for all the grief the administration takes for its dealmaking this time out, they recognized:

    Fighting PhRMA, AHIP, and the AMA was an exercise in futility.  

    They cut a deal with PhRMA (which was basically nothing more than "OK - status quo... for now" - there were a few trade-offs in both directions around the fringes... WH support for patent extensions here, PhRMA promises for cost containment there.)

    They recognized that you cannot touch the AMA sacred cow.  Actually, about 1/3 of American physicians aren't even members of the AMA -- but if the AMA comes out in opposition to a health care bill - it's going down to defeat.  

    We haven't spent much time on the provider side of cost containment - mainly so as not to piss off the AMA - but that's going to have to be something we talk about down the road.... and boy, get ready for that fight.

    Know what's even more sad?

    The '93 plan was actually weaker than the early 70s plan that Nixon was willing to work with Kennedy on.

    This is why we need to pass this bill, warts and all, this time around.

    Every time - we end up with weaker sauce.

    In 2030, when President Malia Obama tries to get HCR done, the bill will probably be nothing more than free aspirin shipped out with your tax refund.

    I guess everyone's got their own blog now.

    by zonk on Tue Mar 09, 2010 at 02:44:29 PM PST

    •  The we should rid ourselves of the notion... (4+ / 0-)
      Recommended by:
      corvo, tnproud2b, JesseCW, eXtina

      that this bill represents a first step.  This is the best we will ever do.

      •  True. One notion we all seriously need to (5+ / 0-)
        Recommended by:
        kurt, dmoore9504, JesseCW, eXtina, tassojunior

        disabuse ourself of is that this bunch of losers in Congress -- and I'm talking about the ones on our side, dammit! -- will magically "improve" the bill at the first opportunity.  

        Much more likely is that they'll take whacks at it while similarly "reforming" Social Security and other entitlements.

        •  Ummm... (1+ / 0-)
          Recommended by:
          taylormattd

          Are you aware of the state of Social Security as it originally passed?

          If your skin had any pigmentation or you happened to have a vagina -- you weren't covered by the original Social Security Act.

          In fact - there are still little known and discussed "retired Railroad employee" provisions.  Know why?

          Because coverage for those folks was added later - and had to be added later because at the time Social Security was passed, employees of railroads were specifically excluded because -- guess what -- most of them were black.

          You've got an appalling lack of historical perspective you should really work to reconcile.

          I guess everyone's got their own blog now.

          by zonk on Tue Mar 09, 2010 at 03:09:28 PM PST

          [ Parent ]

          •  Not nearly as appalling (0+ / 0-)

            as your lack of current perspective.  The bipartisan leadership of Obama's little panel to discuss Social Security 'reform' talks only of cutting benefits, raising the retirement age, etc.

            More people are covered by Social Security now than when it was introduced?  DUHHH.  Can a war or two, or tax wages a bit less regressively, and there would be plenty of money.  But nooooOOOOOooooo.

            •  OK (2+ / 0-)
              Recommended by:
              taylormattd, tnproud2b

              Now you're lacking in perspective on the current status of Social Security.

              SS has never been 'bailed out' by funding out of the standard federal budget - it was always conceived as a simple matter of "everyone pays X percent in, everyone gets Y percent in benefits back".

              That's - in fact - how Democrats were able to get it passed... by selling it specifically as not being redistributive.

              Back in the 30s -- and even up until just recently -- we had more people paying into Social Security than drawing benefits.

              That equation is changing (in fact, I think we've already crossed over into more beneficiaries than funders).

              It's a simple result of shrinking American families and an aging population.

              When you have more people drawing benefits than paying into the program - there's no escaping a coming deficit.

              As someone who still has 30 years left to pay into the system (and whose eligibility date happens to fall right around the time the trust fund runs out) - I'm quite happy that for a change - an administration is actually thinking about what happens when I retire.

              I guess everyone's got their own blog now.

              by zonk on Tue Mar 09, 2010 at 03:36:07 PM PST

              [ Parent ]

          •  but SSA was never a mandate to buy private (2+ / 0-)
            Recommended by:
            corvo, JesseCW

            retirement plans.

            Tho that may come.

            •  We're getting pretty far afield from my point (0+ / 0-)

              which was simply that SSA as originally passed paled in comparison to SSA today in terms of who it covered.

              I'm not dodging your point - but similes have their constructive limits in a discussion.

              I guess everyone's got their own blog now.

              by zonk on Tue Mar 09, 2010 at 03:40:28 PM PST

              [ Parent ]

              •  privatization of SSA will be coming (1+ / 0-)
                Recommended by:
                JesseCW

                not too long after private health insurance is firmed up.

                •  Because? (0+ / 0-)

                  If you're referring to the conference this past weekend, satan jr (that would Summers to Rahm's satan sr) specifically said that the 2008 market crash has effectively killed any appetite for privatization.

                  He did suggest the possibility of providing a sidecar -- an elective contribution into an additional fund administered federally -- but I don't see what the problem is with that.

                  I guess everyone's got their own blog now.

                  by zonk on Tue Mar 09, 2010 at 03:59:15 PM PST

                  [ Parent ]

                  •  Ryan Bill is privatization for future generations (2+ / 0-)
                    Recommended by:
                    corvo, JesseCW

                    and lord knows what's coming under the banner of "Entitlement Reform".

                    •  And Ryan's plan (0+ / 0-)

                      can't even get a sizable minority of GOP co-sponsors.

                      As much as I disagree with his plan, I'd much prefer to work with a Ryan - who is at least an honest broker about his policy aims - than most GOPers.

                      When you get down to it - we DO need entitlement reform.

                      Perhaps I'm being selfish here - but as someone who is of the age where I could be in for the royal screwing - I'm quite happy to see it be taken on.

                      Both Medicare and Social Security were architected under a reality -- a majority younger America funding benefits for minority older America -- that simply doesn't exist anymore.

                      One way or another, that's just something we need to face.

                      I guess everyone's got their own blog now.

                      by zonk on Tue Mar 09, 2010 at 04:06:04 PM PST

                      [ Parent ]

          •  Nope. (4+ / 0-)
            Recommended by:
            corvo, tnproud2b, JesseCW, dmw97

            Social Security covered both women and African-Americans.  In fact, the first American to receive a monthly Social Security check was a woman, Ida May Fuller.  What left most women and minorities out were the types of jobs that were eligible, which were generally occupied by white men.

            You could say Social Security started as a sort of limited public plan.  It kind of makes it clear why moderates and conservatives shy away from even a limited public option.  When people find out how well it works, they want to be included in the program.

            •  Sure (0+ / 0-)

              But you don't think they pulled jobs to exclude randomly out of a hat, do you?

              Despite the fact that it wouldn't be till the 1960s that the post-Civil War amendments really took full effect -- you still couldn't write legislative language that conflicted with them...

              ...so - you got around it by taking stock of the lay of the land and crafting legislation to meet the same ends.

              I guess everyone's got their own blog now.

              by zonk on Tue Mar 09, 2010 at 03:38:20 PM PST

              [ Parent ]

            •  I'd say, too (0+ / 0-)

              If you were in a covered job - participation in Social Security wasn't optional.

              SS worked because everyone paid in.

              That's one of the problems with a public option - how do you ensure it's not just an adverse selection pool?

              I guess everyone's got their own blog now.

              by zonk on Tue Mar 09, 2010 at 03:43:51 PM PST

              [ Parent ]

              •  One can count on an adverse selection (1+ / 0-)
                Recommended by:
                corvo

                That's why the public option would be sold on an exchange where other insurers could hopefully be assessed to make up for the expected adverse selection.

                That adverse selection is highly desirable because the public option has a lower administrative percentage and would cost all exchange buyers less to make up for.

          •  Stop fucking rewriting history. (4+ / 0-)
            Recommended by:
            denise b, corvo, tnproud2b, dmw97

            Jesus - how the hell do 20 people in two weeks wind up spouting the same counterfactual bullshit in defense of this bill?

            Because coverage for those folks was added later - and had to be added later because at the time Social Security was passed, employees of railroads were specifically excluded because -- guess what -- most of them were black.

            Not even close to true.  Their Unions had already negotiated Pension Plans with the Railroads which they want to preserve.  They didn't want to pay into social security - and while nearly all porters were Black the overwhelming majority of Railroad employees - from Yard Bulls to Engineers to the maintance crews (outside the south) were white.

            If your skin had any pigmentation or you happened to have a vagina -- you weren't covered by the original Social Security Act.

            This is, simply, untrue.

            Domestics, Seasonal Labor, Government Employees, and virtually everyone who didn't work for an hourly wage, were excluded.  

            However - many women and people of color were covered.  Many white men were not.  

            It was the poor that were discriminated against (and still are as they are much more likely to be paid "under the table" or work for companies that go bankrupt and stiff SS).

            At least get some honest talking points.  

            'cause you know that you can't change shit by ridin' the fence... The Coup

            by JesseCW on Tue Mar 09, 2010 at 04:03:13 PM PST

            [ Parent ]

      •  It does represent a first step (3+ / 0-)
        Recommended by:
        taylormattd, LordMike, Loge

        Look -

        Believe it or not, though a dastardly pragmatist - I actually share the same long-term goal as single payer advocates.

        I've got no use for a private health insurance industry - at least, not on a grand scale... I mean - hey - maybe you keep 'em around to provide some degree of extended coverage for those that wish to buy it; but ultimately - there's no need for them in a basic coverage scheme.

        You get this passed because it represents the first, real federal oversight onto the health insurance industry.  

        For the first time -

        1)The feds are defining what must constitute minimum coverage

        2)The feds are defining premium-to-benefit ratios

        3)The feds are outlawing most and capping the few remaining discriminatory practices insurers use to cherrypick

        This isn't the best you're going to get.

        Are you aware of how the various other models we envy evolved?

        None of them happened in a single piece of legislation or single act... They all took years.  Canada's system started with a single province going single payer.  It took 20 years until Canada nationalized it.   England - Tories like Churchill in particular - were envious of Germany's system, which itself took nearly a century to evolve into what it is today.

        I guess everyone's got their own blog now.

        by zonk on Tue Mar 09, 2010 at 03:04:38 PM PST

        [ Parent ]

        •  & state single payer waiver must be before 2017 (4+ / 0-)
          Recommended by:
          corvo, dmoore9504, JesseCW, Losty

          that's a trick in the Senate bill that will stop states moving toward single payer now and may even imperil experiments like HealthySanFrancisco.

          •  Provision? (0+ / 0-)

            I'm not necessarily doubting you -

            But I have read the Senate bill multiple times and I'm not recalling the section or the language that does this.

            I guess everyone's got their own blog now.

            by zonk on Tue Mar 09, 2010 at 03:11:58 PM PST

            [ Parent ]

            •  here's link (2+ / 0-)
              Recommended by:
              corvo, JesseCW

              KFF comparsion chart- choose Senate plan and "State provisions"
              http://www.kff.org/...
              also a good article from VT single payer group:
              http://vermontforsinglepayer.org/...

              •  OK (0+ / 0-)

                Thanks -

                I think the Vermont group is being a bit hyper-concerned -- one of the big reasons that the bill has so many long term provisions, kick-in times, and then puts off additional waivers until 2017 is because it really IS a pretty massive job for HHS and DOL to get their act in order to administer the changes.

                The Vermont group - and I did read their entire post - seems to be using this provision to push passage of a Vermont single payer bill... bully for them.

                The Vermonters are actually saying that they need to enact their single payer plan before 2014 - or else they couldn't enact one until 2017.   There's essentially a 3 year blackout period for granting waivers.

                I went back to the specific sections both KKF and the VT group are talking about - and I do see the point - either you pass a state based single payer by 2014, or, you have to wait until 2017 when waiver requests re-open.

                I don't think that was necessarily intended as a state-based single payer poison pill -- the legislation goes out of its way to avoid interfering with good state plans -- but I think it's more a reality of not wanting to make a difficult implementation even harder.

                I guess everyone's got their own blog now.

                by zonk on Tue Mar 09, 2010 at 04:50:48 PM PST

                [ Parent ]

        •  The insurers aren't going to cherrypick (1+ / 0-)
          Recommended by:
          corvo

          They simply won't enroll anybody because the first ones to sign up will tend to be the sicker folks.

          Health insurance won't be commercially available.

          Commercial rolls will be closed.

          Companies will get dropped. They will not be able to get new policies.

          Only a public option can ensure coverage availability.

        •  "The feds are defining premium-to-benefit ratios" (1+ / 0-)
          Recommended by:
          corvo

          If big insurer is going to have a profit increase, you hospital and drug people have got to increase your pricing.

          Hospital rates up by 12%. Let's see what the drug makers are going to do. We need a 15% overall health care increase for the profit-based bonuses to kick in.

          You need to have fixed dollar maximum markups, not percentages because then all players benefit by provider price increases.

        •  Individual workers in England (1+ / 0-)
          Recommended by:
          corvo

          had to pay for health insurance starting in 1911 I believe.

          In 1948, British coverage was extended to the whole family and all Britons.

    •  I've never done hard time (2+ / 0-)
      Recommended by:
      corvo, eXtina

      but I saw enough even in juvenile detention to know that "Well, if I give up a handjob today I'll better prepared to fight back tomorrow" wasn't a winning long term strategy.

      'cause you know that you can't change shit by ridin' the fence... The Coup

      by JesseCW on Tue Mar 09, 2010 at 03:56:55 PM PST

      [ Parent ]

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