When Can We Expect Health Care Reform (Whoever Wins)?

American health care reform has been historically difficult to achieve, both for structural and political reasons. Many of you have heard of, or are advocates of, HR 676, the The United States National Health Insurance Act, a single-payer national health program. Maybe you heard about a Senate universal health care proposal, The Healthy Americans Act, cosponsored by 12 Senators. Perhaps you've been wondering what its chances are for passage. Perhaps you've been mulling over the health plans from Clinton, McCain and Obama (and Edwards), trying to do some comparison shopping. Or, perhaps you just want to know what to expect with a new President in the White House. This review of health reform data will hopefully help put the difficulties of enacting reform in perspective.

For starters, let's look at the political side via this tutorial from Kaiseredu.org. It's important to note that while health care remains an important issue that matters in the upcoming election (along with Iraq and the economy), Republicans, Independents and Democrats do not agree on the issues or the relative importance of health care as an election issue. Those with insurance are satisfied with their own health care coverage (83% to 93% depending on the question), but fear paying more for care (41%) or losing coverage altogether (29%). That >80% satisfaction is a key finding, because people satisfied with what they have a) don't want to give it up and b) are less likely to push for change. And when asked to rank health care along with other important issues facing Americans, Democrats tend to rate health care as more important than either independents or Republicans, so the push for health reform is not unanimous by any means.

Another important difference is that Republicans are more worried about cost-containment and Democrats more interested in expanding coverage. This leads to the following caveat; while much of the public agrees with the goal of  increased coverage, there is no agreement about the best solution to get there. In fact, when all solutions are considered, single payer is way down on the list of "best solution", coming in at an anemic 37% (see slide).  Needless to say, that doesn't make bills like HR 676 any easier to pass. By the way, the uninsured are substantially less likely to vote (in 2002, 30% of the uninsured under 65 voted compared to 49% of the insured under 65).

See also the ambivalence about government vs private insurance in providing medical coverage (government better - 21, private better - 60 if you are a Republican, government better than private 41 to 36 for Democrats. A fifth of the country thinks they are the same or does not know).

By the way, another reason to suggest a lack of political pressure is to  look at the habits of voters. As seen in the slide, half the voters vote on issues, the other half vote on character, values, experience, leadership etc. Given that split, it's tough to make a case that the public is driving change, or that 2008 will be the year health care reform is going to decide the election all by itself.

Well, that's public opinion and public opinion can change. So what do the academics say about the likelihood of health reform and changes in health care financing (i.e. the structural side)? Eh, maybe chances are not so high, at least right away. Echoing the theme of non-agreement of what to do, an article in Health Affairs by Victor Fuchs (the Henry J.Kaiser Jr. Professor Emeritus at Stanford University and a research associate at the National Bureau of Economic Research) writes

Enduring reform must cover the uninsured, reduce inefficiency in funding and delivery of care, improve quality, and tame but not destroy the development of new medical technologies. Obstacles to reform include "special interests," especially as they exploit the U.S. political system; Machiavelli’s Law of Reform, which favors the status quo; and the inability of reformers to agree on a common approach. Short-term prospects for enduring comprehensive reform are virtually nil. Over five to ten years, prospects are fifty-fifty unless there were a major economic, political, social, or public health crisis. In the long run, major reform is inevitable.

So what is Machiavelli's Law of Reform? From The Prince:

He who desires or attempts to reform the government of a state... must at least retain the semblance of the old forms, so that it may seem to the people that there has been no change in the institutions, even though they are in fact entirely different from the old ones.

Still, a major asset to reform hopes is the possibility of same-party control in DC. That has to improve chances of reform but as noted, also in Health Affairs, by William L Roper (dean of the University of North Carolina at Chapel Hill (UNC) School of Medicine and chief executive officer of the UNC Health Care System):

The 2008 election will focus renewed attention on fundamental health care reform. Lessons from past politically driven reform efforts show that although fundamental reforms may make for good politics, a systemic shift in how health care is financed and delivered is unlikely to occur. Calls for fundamental reform over the past twenty-five years have prompted incremental changes that have had a major impact on the U.S. health care system. Many of these changes were driven from outside the political system. The forecast based on past experience is not radical change; it is more of the same.

That resistance to change is something we've covered here. It's partly a function of the resiliency of the health care system, and partly a function of a lack of political pressure to make changes.

Nonetheless, change is in the air. Single party rule in DC is possible (more so for Democrats than Republicans, and Democrats rate health care a higher issue than Republicans do). Costs are driving business and consumers alike to consider health reform. The NY Times this month:

The American carmakers’ problems underscore the need for a government-backed system of universal health care, which would relieve some of the costs that have made competing so much harder.

Who knows? With a Democratic victory in November, and a leader in the White House, a recession in the economy and business pushing to reduce costs, we may just get the perfect storm of events that'll move the ball down the field.

Friday, Feb 29, 2008
A new poll on health care from NPR, the Kaiser Family Foundation and the Harvard School of Public Health finds that a majority of Americans are backing key elements in the health reform proposals of Democratic presidential candidates Hillary Clinton and Barack Obama.

But even if that happens, check the conclusion from the NEJM authors:

Looking forward, the ranking of health care as a top issue in the primaries and plans for serious health care reform proposed by both Democrats and Republicans are major steps toward a larger debate in the 2008 general election and beyond. However, the intensity of the debate, and whether it engages the nation the way the last great health care debate did in the early 1990s, remains to be seen. In addition, the prospects for actual health care reform are tempered by two factors: the wide differences in the two parties' views of what health care reform should look like and the current level of satisfaction that majorities of both parties have with their own health care situations.

Reform needs to happen. Just don't expect it to all happen at once (childrens' coverage has more consensus than adult), or at the expense of what people already have, or even to necessarily look radically different (see Machiavelli), whatever anyone promises.

Sources
This is a follow up on Daily Kos posts here (Medical Crisis: The Shape Of Things To Come), here (Perspective on Health Care Reform), here (What's The Effect Of Recession On The Health Care Safety Net?), and here (Health Stories: HR 5449). The posts use public opinion polling from Kaiser, here with a summary tutorial, narrative supplied by Claudia Deane (formerly of the Washington Post polling unit). Further elaboration appears here in more academic form published in the January 24 New England Journal of Medicine with co-authors from the Harvard School of Public Health and John F Kennedy School of Government). The latest poll from NPR/Kaiser/HSPH is dated 2/28/08, and available here.

•  mcjoan will be posting later this afternoon

  on the presidential candidates and their suggested solutions.

  SNL and others can make fun of the 'boring' health care debates, but it'll become a good deal more heated when the D and R debates happen.

  by DemFromCT on Sun Mar 02, 2008 at 05:37:18 AM PDT

  •  excellent review

    thanks for this post.  

    on the political side, perhaps it's worth adding into the equation that Obama is a young candidate and (I think) one we're expecting health care reform from.  I assume he'll be running again in 2012 and asking for our support.  The flip side of that is, my gut says the political pressure will be off if there's an Obama second term, so if we don't get health care reforms made in Obama's first term then they're not going to happen.

    on the mechanics and economics of how health care works now (hint: it's not just "greedy corporate profiteering"), there was an outstanding post-length comment from RickB explaining the costs of the current health insurance system that I'm indebted to him for, and that those who are interested in that sort of thing may want to read over.

    by emptypockets on Sun Mar 02, 2008 at 06:12:19 AM PDT

    •  emptypockets, Obama has promised . . .

      repeatedly on the campaign trial, healthcare reform will happen before the end of his first term.

      I hope and believe the American people will hold him fully accountable.

      by nyceve on Sun Mar 02, 2008 at 06:16:19 AM PDT

      •  holding him to it

        when you put it that way, I have to recognize the reality that if he's in office and running for re-election, most of us are going to support him with little regard for his record or whether he's held to any of his promises (which have sometimes been diluted or re-parsed by changing circumstances in the past).  Perhaps our focus should better be rested on Congress?

        But to clarify my comment, I was reacting to DemFromCT's quote from Fuchs about short-term reforms unlikely, 5-10 year reforms an even bet, and long-term reforms inevitable.  Politically it is hard for me to imagine that 5-10 year reforms (basically Obama's second term) will be more likely than short-term reforms.  But again, perhaps I am seeing the reform process too president-centrically.

        by emptypockets on Sun Mar 02, 2008 at 06:27:03 AM PDT

        •  Hell, no.

          ...if he's in office and running for re-election, most of us are going to support him with little regard for his record or whether he's held to any of his promises...

          If Barack fails to do the job, we must primary him.  It know it's painful, but (like loving parents) Progressives must be prepared to administer Tough Love.

          Since nobody here wants to vote Republican, Green, or Nader, the only weapon we have is a Primary challenge against Congressmen, Senators, and (yes, Virginia) Presidents.

          by ManhattanMan on Sun Mar 02, 2008 at 07:07:21 AM PDT

          •  Heh

            ...Progressives must be prepared to administer Tough Love.

            They have been so unwilling to do that so far, do you think they ever will?

            If they do every do it, boy will it be ugly!!

            by ripcw on Sun Mar 02, 2008 at 07:10:57 AM PDT

            •  progressives around here

              don't know HOW to administer tough love.

              by Buffalo Girl on Sun Mar 02, 2008 at 09:10:54 AM PDT

              •  We're learning. n/t

                by neroden on Sun Mar 02, 2008 at 05:43:23 PM PDT

          •  way to miss the point

            first of all, unless he's an utter disaster, any primary challenge against "President" Obama that "we' try will fail.

            Second, the point of leverage if YOU REALLY WANT CHANGE is CONGRESS and always will be.  People need to stop focusing on the Presidential race and start focusing on Congress.

            And the other point I think DemfromCt is making is that if you really want healthcare change, especially single payer, the public needs to be persuaded before any Congress or President will make it happen.

            by Buffalo Girl on Sun Mar 02, 2008 at 09:10:30 AM PDT

            •  Congress is more important...

              ...I 100% agree.

              But I am objecting to the idea that a Democtratic President becomes immune to Progressive concerns once elected.

              If we hire someone to do a job, and they don't do it, we have to be prepared to fire them.  Otherwise they will keep messing up.

              But perhaps we should table this discussion until 2009...!

              by ManhattanMan on Sun Mar 02, 2008 at 09:39:37 AM PDT

              •  regardless of what you think

                they WILL be immune because it is unlikely you will have ANY capacity to fire them.

                by Buffalo Girl on Sun Mar 02, 2008 at 09:51:16 AM PDT

        •  I agree

          I think whoever wins, it is imperative it happens in their first term.  If it doesn't happen, the obit will be waiting again and we will have to wait another 15 years.

          In that sense I agree it is much more likely we will have health care reform within 2 years, rather than 10.

          With that said, I think that Obama's plan is so unworkable it doesn't have a prayer of passage.  The only question is if Congress can pass something other than the president's health care plan.

          by ripcw on Sun Mar 02, 2008 at 07:08:15 AM PDT

      •  I'd be very pleased if much gets done

        already the lowering of expectations is beginning.  It's hard work gettin' health care, hard work.  And we gotta cut them costs first....

        by NearlyNormal on Sun Mar 02, 2008 at 07:32:42 AM PDT

      •  After they "hold him fully accountable" ...

        ... health care reform will take another 15-year siesta.

        by RonK Seattle on Sun Mar 02, 2008 at 08:53:58 AM PDT

    •  Obama

      I believe he has promised universal health care in his first term. (Not that I believe it will happen.)

      by OLinda on Sun Mar 02, 2008 at 06:17:54 AM PDT

      •  He has made that promise, but ...

        ... his proposed solution does not fulfill that promise.

        And all three leading Dem's introduced "universal" plans that offer palliative care for the existing system, while vesting that system more deeply.

        by RonK Seattle on Sun Mar 02, 2008 at 09:01:52 AM PDT

  •  DfC, even though it is a minority

    that have been touched by "healthcare" issues or have a friend/family member affected.

    They are likely to be a great deal more involved in the political process and bring more people into it.

    I have excellent health care and never have had a complaint vis-a-vis any of my kids or wife. But my mother doesn't have insurance. Seeing that has caused me to do donate spend tens of hours campaigning for politicians who will pursue health care reform.

    Many of the political activists i've talked to consider this their #1 issue.

    So if the next Dem president wants to keep his job...s/he'll have to make sure this gets done.

    by daddy4mak on Sun Mar 02, 2008 at 06:13:26 AM PDT

    •  and there are those

      who have healthcare but the premiums and deductibles are quite high. So many with insurance are finding they cannot afford insurance with the increased rates and the deductibles keep climbing higher and higher. When people have to pay so much out of pocket and more and more procedures are not being covered at all; that is also depressing people and discouraging them.

      by wishingwell on Sun Mar 02, 2008 at 08:13:29 AM PDT

      •  My Thoughts Exactly ...

        I have medical insurance. But I'm desperate for health care reform because I do not know how much longer I can continue to scrape together $11,000 per year to pay for it!!! Lately that rate has been boosted every 6 months. When will I hit that fateful day where I simply can't pay the bill and have to "go naked"? And now DemfromCT says that meaningful reform, although "inevitable", won't happen realistically for "maybe" 5 to 10 years??? CRAP.

        by Pat K California on Sun Mar 02, 2008 at 09:32:55 AM PDT

        •  states may be ahead of the national reform

          curve. All is not lost or abandoned.

          by DemFromCT on Sun Mar 02, 2008 at 09:59:17 AM PDT

          •  States tend to run ahead of the curve

            on most of the major social reforms.  I believe we'll see more states doing reform before we see it on a national level, but I'll take it any way we can get it done.

            by deliciae on Sun Mar 02, 2008 at 06:30:16 PM PDT

  •  Agree, excellent diary

    One thing you don't really draw out is the implications of these polls for single payer vs. multi-payer.

    I wouldn't be surprised if there are also some polls that indicate more than 50% support for single payer, but I think the evidence is overwhelming that there is simply no chance of passing a single payer scheme like Canada in the next 8 years.

    Single payer advocates I think really should re-conceive their role in this debate. They should think of themselves as setting the "left" position in contrast to which multi-payer universal health care is the compromise. Because if the debate is only seen to have multi-payer UHC vs. no UHC at all, then in the next eight years the compromise will be an expansion of child health care and not much else. But if a Democratic president can present a UHC scheme as non-radical in contrast to single payer, then I think the chances of getting everyone covered go up.

    By the way, as I periodically state in health care debates, my current employer is a health insurer. My full take on the difference between the two, based on an analysis of other nations, is that single-payer tends to be slightly more efficient than multi-payer UHC in terms of reduced admin costs (on the order of 1% of total costs or less). On the whole, there is no net impact on the quality of care or access to care. National decisions about how much to spend determine whether (and for what conditions) there is significant rationing of care.

    Most importantly, both types of systems can be far better than the current US system, spending around 10% of GDP on health care rather than the 16% we current spend, with quality of care as good or better than that in the US and access to care better than in the US except (usually) for elective treatments and end-of-life care (much of which in the US is of very questionable value in terms of improving QALY--quality adjusted years of life).

    by jd in nyc on Sun Mar 02, 2008 at 06:38:21 AM PDT

    •  Single Payer...

      ...is unachievable any time soon.  You are absolutely right.

      It is one of the things, maybe the main thing, that always pissed me off about Dennis Kucinich.  All the way back to 2004 he seemed to be under the very mistaken impression that all he had to do was stand up in a debate and announce that America needs single payer.  He (and many other single payers) totally miss the boat on what they need to do.

      They are so rabidly sold on why single payer is the only workable solution, they assume that if they just stand up and say this is what we need that people will be convinced.

      They are also go to meetings all the time made up of mostly single-payer advocates and so just get caught up in thinking there is a huge grassroots movement for single payer health care.

      I'm sorry, but there is not.

      Most people have heard about single payer and rejected it.  The single payer movement needs to be re-worked from the ground up.

      I agree with you that it has critical elements to add to the debate, and very well may be what we need in this country.  But the popular support is simply not there, and that realization requires a fundamental change in approach for single payer advocates.  And I say that with love.

      by ripcw on Sun Mar 02, 2008 at 07:17:30 AM PDT

      •  Wrong.

        Over the course of 2007 polling data has markedly improved for single-payer. A 2007 Field Poll (link is in a reply to DemfromCT somewhere in this thread) showed a 12% increase in support for single-payer here in CA, and another poll from August showed that among CA small business, single-payer was the preferred option, the only one that got majority support.

        I agree that the single-payer movement has a lot of work to do, and that part of it involves reworking the message. But you are wrong to say that "the popular support is simply not there." Even if it wasn't there, wouldn't that mean our job is to produce that popular support?

        Single-payer is not just the best option. It's the only option.

        by eugene on Sun Mar 02, 2008 at 08:31:15 AM PDT

        •  Thinly sourced

          Wow, you can slice and dice a couple polls from California! That proves the movement of hundreds of millions of single payer advocates is being ignored yet again!!!!!!!!

          It's exactly that attitude that is going to make single payer that much further out of reach for you, me, and everyone else.

          by ripcw on Sun Mar 02, 2008 at 09:14:31 AM PDT

        •  We can wait for single payer until the cows come

          home.  Meantime, more and more of us will fall into the ranks of the uninsured.  

          At the end of the day, I would love to see a single payer system put in place but on a practical level, it's not going to be the first plan that the politicos turn to.  When you're talking about eradicating an entire industry, particularly one that donates LOTS of cash to those who make these decisions, it's highly unlikely to happen as the first step in reform.  

          Let's take what we can get and protect as many folks as possible while we work towards single payer.  No sense in an all-or-nothing approach that ensures more and more people will continue to suffer the consequences of being uninsured.

          by deliciae on Sun Mar 02, 2008 at 06:37:19 PM PDT

      •  We gotta stop

        saying that single-payor is impossible.  Our crazy multiple-payor system is exactly why our administrative costs are 2 to 3 times larger than other wealthy countries, approaching $300 billion this year in additional paperpushing.

        Multiple payor also makes quality initiatives much harder - things like electronic medical records, disease management, and investments in prevention are harder to justify economically when the customers will switch plans every 3 years.

        The key barrier to single payor are the health insurance companies - many of them would be out of a job.  That's also why Bush's Healthcare Savings Accounts are so dangerous - creating another constituency against single payor (the financial services industry like Fidelity).

        by koutterson on Sun Mar 02, 2008 at 05:56:07 PM PDT

      •  re: single payer, Medicare, and Machievelli

        In the body of this topic there is the assertion that single payer support is "anemic" because it is the choice of only 37%. However, the same slide shows that 74% support Medicare for all. That shows how wording is all, since Medicare is universal health insurance for those over 65. (Moreover, the poll allows multiple choices - when forced to take a single choice, single payer is right in the center of the pack at 15%)

        This phenomenum precisely illustrates the topic author's citing of Machievelli's "law of reform": Single payer is new and sounds scary, so only 37 % support it; universal Medicare sounds familiar so 74% support it.

        Conclusion: stop talking about single payer and fight like hell for universal Medicare. This was basically the tack Edwards took.

        by Kit on Mon Mar 03, 2008 at 06:44:37 AM PDT

        •  single payer and universal health care

          are not the same thing. But machavelli is exactly right about the importance of how the plan looks.

          by DemFromCT on Mon Mar 03, 2008 at 09:43:05 AM PDT

          •  Yes to Machievelli, but not to non sequiter

            single payer and universal health care are not the same thing

            Well, that's another point entirely. Within the normal context of the argument over health insurance, no one argues for single payer that doesn't imply universal coverage. Nor does anyone suggest you can't get universal coverage without single payer - hence the Rube Goldbergian plans put forth in Massachusetts and by the Democratic aspirants.

            BTW, in this context, it is best not to mix "insurance" with "health care", universal or not in either case. That loose talk allows opponents to conflate single payer health insurance with the whole health care system, tarring the latter as "socialized medicine" in which the government runs the health care system and pays the doctors, thus slyly eliding that epithet back on to single payer insurance.

            You can call single payer either "socialized insurance" or Medicare for all - hence my point to start with  

            by Kit on Mon Mar 03, 2008 at 10:05:28 AM PDT

            •  socialized medicine is another 'by party' thing

              it doesn't scare, it doesn't block, it's not even an insult to democrats, and for the most part independents.

              Poll Finds Americans Split by Political Party Over Whether Socialized Medicine Better or Worse Than Current System

              BTW, in this context, it is best not to mix "insurance" with "health care", universal or not in either case.

              Not a practical suggestion. In a pure academic realm somewhere in a parallel universe, maybe. Not here, not in this election. People want to know who is covered and what will it cost? That will require discussing health finance, health access and health quality (my preferred split) though it will also require being clear what we are talking about.

              by DemFromCT on Mon Mar 03, 2008 at 10:42:09 AM PDT

              •  Clarity of thought and expression required

                On the contrary, I am suggesting hard-nosed practicality. Socialized medicine is government-run medicine, as in the UK. There is no serious discussion of such a prospect here. It is a red herring.

                When we allow Republicans to characterize single payer health  insurance as socialized medical care, we not only debase the terms of the argument we cede unncessary ground.

                All the other issues you relate are independent of the discussion of how to get universal insurance coverage, though such coverage will no doubt affect those issues, in the sense that change in any moving part of a machine affects others.

                by Kit on Mon Mar 03, 2008 at 11:28:24 AM PDT

                •  nah

                  better to say clarity of politics and human nature required. Lectures on clarity of thought and expression are misplaced.

                  We don't allow or disallow discussions of socialized medicine, e.g., they happen regardless of our intent, so it's best to understand the impact, and plan accordingly.

                  The topic is going to be health plans and health care, health care prpposals and health care reform. We don't get to define what it is called. Remarkable hubris to think we do.

                  by DemFromCT on Mon Mar 03, 2008 at 11:52:40 AM PDT

    •  I completely

      agree.  

      It would be far easier to pass a UHC model similar to Germany's than the single payer model in Canada which bans private expenditures on health care.  

      by fladem on Sun Mar 02, 2008 at 08:16:05 AM PDT

      •  But, following Machiavelli's rule of reform....

        What about single payer under another name, i.e., "Medicare for All"? as has been proposed by a political insider like Lawrence O'Donnell.

        To me, I think we need to at least look at ways to take profit out of health care -- it wasn't that long ago that Blue Cross and I think Blue Shield were both non-profit companies. I don't know how you put the genie back in the bottle on this, but that seems like an important part of the puzzle. (Part of the reason that Kaiser, which I'm a lifelong member of, has less problems than the others is that it is still a non-profit corporation.)

        by LABobsterofAnaheim on Sun Mar 02, 2008 at 08:32:07 AM PDT

        •  I think the barrier

          is banning private health care spending, which a number of UHC countries (the UK and Germany, eg) do not do.

          It is important to understand that the Canadian system has a safety valve - the US system.  If the line is too long in Canada, Canadians often will go south and pay privately.  

          I actually think banning private health care spending would be challenged on due process grouns, and very well might be unconstitutional.

          by fladem on Sun Mar 02, 2008 at 09:10:47 AM PDT

        •  Medicare for Everyone!

          But we need to get rid of Medicare (Dis)Advantage and the role of the insurance companies in Medicare Part D.

          Medicare parts A and/or B need to be the model.

          Actually, we'd make huge progress if we just expanded Medicare part A to everyone: the medical costs it covers (catastrophic hospital/surgery stuff) are by far the most fearsome to most people.

          by neroden on Sun Mar 02, 2008 at 06:35:24 PM PDT

        •  The Privatisation Trap

          So Blue Cross/Blue Shield go private, then for-profit, then stop fulfilling their mission; NY establishes a new health fund (I can't remember its initials), now it's talking about going private -- rinse and repeat.

          Each privatisation gives a one-shot boost to the public treasury, while giving even more money to the managers -- and then causes the privatized company to stop fulfilling its purpose, necessitating the creation of a new public agency.  And then the rent-seekers try to privatize that one....

          Similar sorts of things happened with Conrail.  Government bailout, privatization, merger, now its successor in northern NY (CSX) is undermaintaining the Water Level Route -- which is of statewide importance -- to the point where there are state and federal investigations, and probably eventually there will be a new infusion of government money....

          Kudos to Kucinich for refusing to privatize the Cleveland (I think?) water system.  He stood for sense when it was unpopular, and was conclusively proved right within just a couple of years.

          Not to be doctrinnaire -- I'm all for privatizing naturally competitive operations, like when the government is running sheep farms or restaurants (which has happened in some countries).

          by neroden on Sun Mar 02, 2008 at 06:44:35 PM PDT

      •  Difference between health insurance and delivery

        You buttress the insidious argument that single payer is somehow "socialized medicine". Single payer is universal, government sponsering health insurance. The way in which the health care is delivered is an entirely different animal: it can be through socialized medicine as in the UK (government runs and pays for hospitals, doctors, etc) or it can be through a system like France, a patch-works of private, public, non-profit institutions. The latter is like our current system, except that in France there is universal single-payer insurance on top of it. Obviously, this is what a single-payer system would look like in the US.

        by Kit on Mon Mar 03, 2008 at 06:54:07 AM PDT

        •  our LACK OF UNIVERSAL HEALTHCARE is KILLING US...

          with STRESS... really..

          One thing the propaganda doesn't tell US(A)

          ..Is that even with its minor failings (compared to the totally out of control dysfunctional USA of today) the people in all of the MANY other countries that have what you call "socialized medicine" (but what everyone else calls UNIVERSAL HEALTH CARE) would not trade it in a million years for the nightmare we have here which TERRIFIES them.. Absolutely terrifies them.

          Why do you think insurance companies make huge amounts of money on temporary visitors to the US so they can buy short-term health insurance for the durations of their visits here. Everyone knows someone who got injured here and they remember and shudder..

          People here are under a HUGE amount of stress because of our LACK OF UNIVERSAL HEALTHCARE.

          Chronic, life threatening stress causes brain damage, it slowly destroys the hippocampus, damaging your short term memory..

          Lack of access to healthcare and drugs kills something like 18,000 people a year..

          See this web page..

          http://en.wikipedia.org/...

          by Andiamo on Mon Mar 03, 2008 at 04:58:43 PM PDT

    •  What evidence would that be, exactly?

      Show me the evidence. I believe you are assuming the evidence is overwhelming, without actually having the facts to prove that point. I have, in another comment here, given polling data that suggests single-payer is much closer than you believe. So I am calling your evidence out. Let's see it.

      If you don't have it or can't produce it, would you be willing to reconsider your assumptions?

      by eugene on Sun Mar 02, 2008 at 08:28:41 AM PDT

      •  We are projecting human affairs into the future

        As such, there will never be "proof" of what will happen, so when I say "overwhelming evidence" it has to be a matter of judgment. DemfromCT just went through a number of really important points that have a strong cumulative impact, and I won't repeat them. Here are some other factors that are salient:

        1. The United States almost never nationalizes industries. The only recent example I can think of is airport screeners, and that's because after 9/11 Republicans decided that this was a matter of national defense. Also, it's a tiny industry. Health insurance is not national defense, and it isn't tiny.

        2. Insurers will fight far, far harder if it is a matter of their survivial, vs. merely a matter of increased regulation. You will have to overcome stronger lobbying and (more important) advertising aimed at public opinion. They would use every means available to throw into doubt the cost of the single payer proposal, the ability of Americans to trust a new govt-run institution not to be wasteful or have bad service (like the DMV), etc.

        3. Increased revenues from UHC will partly compensate for increased regulation and lower margins, decreasing resistance even more for this alternative to single payer in comparison.

        4. Hospitals are paid at a higher rate by private insurance than by Medicare (and far more than by Medicaid). Not only do private insurers pay better, but if they leave and there is only one payer, that payer will have enormous leverage over providers and they do not want this. If you can find a single head of a hospital system who is calling for single-payer, let me know.

        6. The Clintons' first attempt at UHC failed for several reasons, but one of them was that people saw it as taking away something familiar and replacing it with something untested. Single payer would do that; UHC would not necessarily do so (The Clinton and Edwards plans would not).

        7. The facts in favor of single payer are not what you think they are. It is NOT massively less costly than multi-payer, nor does tend to provide higher quality, and so there is no pressing need to go with the more radical option. Here are the statistics. Given that fact, inertia, familiarity and industry resistance to change will all strongly favor less radical reforms.

        by jd in nyc on Sun Mar 02, 2008 at 04:19:57 PM PDT

    •  Administration Costs 20-30%, not 1%

      Private insurance introduces administration costs of 20-30%, compared to public programs of 3-5%. You are specifically incorrect when you claim 1% difference between Universal Single Payer and Private Insurance companies:

      By the way, as I periodically state in health care debates, my current employer is a health insurer. My full take on the difference between the two, based on an analysis of other nations, is that single-payer tends to be slightly more efficient than multi-payer UHC in terms of reduced admin costs (on the order of 1% of total costs or less). On the whole, there is no net impact on the quality of care or access to care. National decisions about how much to spend determine whether (and for what conditions) there is significant rationing of care.

      Administration costs include: At the insurance company side: Profits, Staffing, Billing, Benefits and Denials. At the Doctor side, staffing to deal with insurance companies. At the employer side, HR departments. At the consumer side, endless hours of tracking down claims and benefits paperwork.

      by MetaData on Sun Mar 02, 2008 at 08:33:24 AM PDT

      •  Please re-read my quote

        I said that in countries with universal health care (i.e., not the US) the average is about 1% higher in total costs. I should have further specified that this total is in relation to GDP. Look at this table for specifics.

        The numbers you want are in the rightmost column.

        In other comments in this diary I say more about differences in admin costs between the US and govt-run systems.

        by jd in nyc on Sun Mar 02, 2008 at 03:26:23 PM PDT

        •  In the US, Insurance companies take 30% ADMIN COS

          In the US, Insurance companies take 30% ADMIN COSTS, and they often don't pay the benefits they promise, they try to avoid paying by denying care.

          (To get an idea of how they think, they call each payment to a healthcare provider a "medical loss")

          One way they avoid these pesky 'medical loss' problems is by taking your money UNTIL YOU GET SICK, and then they find an excuse to DUMP YOU.

          This is called "rescission".

          Here are a bunch of stories about this issue..

          Read and weep..

          http://www.latimes.com/...

          We desperately need to realize that as long as we allow the insurance companies to run this show they will do this kind of thing. This is one situation in which the government needs to get involved because otherwise it is little you against BIG THEM and you will almost always lose.

          Republicans complain constantly about our litigous society but it is THEM who have created this mess by giving the corporations SUCH a huge and obscene advantage that they do whatever they want out of greed and people's lives are OFTEN ruined so badly that they have absolutely no option but to sue.

          WHEN THEY CAN...

          WHY CANT THEY? Lawyers TIME 'is VERY valuable'.. SO

          For each person who GETS to sue there are HUNDREDS of people who suffered injuries who NEVER GET TO SUE, because they cannot find lawyers willing to take their case. Even when they have cases, good cases, they aren't big enough. Maybe they were old, or didn't suffer as they died, or were unemployed and so could not claim lost wages, or they died, and had no children, or they were renters, and didn't have a home they lost.. or a million other reasons..

          LIFE IS CHEAP.. VERY CHEAP..

          Why couldn't they get lawyers? Because often..bluntly..

          OUR LIVES ARE NOT WORTH ENOUGH MONEY TO THEM

          Literally.. Literally

          DON'T get me started..

          by Andiamo on Mon Mar 03, 2008 at 05:16:42 PM PDT

  •  'tis an excellent review ...

    ... but I have to add, from a point of view of diminished expectations, that developing consensus on how to reform the U.S. health care delivery system has been almost comically impossible for a generation.

    I appreciate Obama's disclaimer that "we need to work on controlling costs first."

    But health care in this country is a $1.5 trillion-plus monster, north of 15 percent of GDP and heading for 20 percent, with costs increasing, according to latest figures I've seen, 7 percent annually.

    I think sometimes that the only way we can reform it is in a way that will actually drive up costs in the short term -- and that is, to compete with it from the ground up.

    Free clinics, staffed by medical personnel who are paid the going rate. Free med school for doctors who give X years to the public system and continue to run "blended" practices.

    And, probably, the partial outsourcing of some unaffordable medical procedures and surgeries. And bring dental in under the new tent, too.

    I don't know that we can reform the existing system in any way that actually means much for quality of care and affordable costs. I think we might have to challenge it from the outside and let it reform itself in response.

    by jeffbot on Sun Mar 02, 2008 at 07:02:17 AM PDT

    •  Updated Spending Numbers

      Health care spending is $2.1 trillion as of 2006, expected to double by 2017--a number that will be roughly 20 percent of GDP. The projection assumes 6.8 percent spending growth--which is at the low end of recent health spending growth. By 2017, you're looking at $13,000+ annually in per capita health spending, which is an enormous amount of money--particularly given that people like me, in their 20s, tend to do nothing more than see a doctor for a routine physical (if that.)
      http://content.healthaffairs.org/...

      I don't particularly like Republican solutions to health reform, but the right wing does correctly focus on costs--high costs for treating really sick people do price a lot of people (both employers and individuals) out of being able to afford insurance.

      by absurdist on Sun Mar 02, 2008 at 10:41:14 AM PDT

      •  Thanks ...

        ... as "they" say $1.5 trillion, $2.1 trillion ... pretty soon you're talking about real money, yessir. ;-)

        I've said it before, here and elsewhere ...  I ended up outsourcing my dental work to Costa Rica and I've come to think of "medical tourism" as being part of the overall solution, rather than a byproduct of the problem.

        by jeffbot on Sun Mar 02, 2008 at 11:17:25 AM PDT

  •  CNA/NNOC

    DemFromCT, can you comment on how CNA/NNOC's healthcare campaign fits into all of this?  Or will mcjoan's piece cover that at all?

    Based on this quote, doesn't quite sound like they're using the same statistics you are:

    Rose Ann DeMoro, executive director of CNA/NNOC, noted on the call that, "Compulsory insurance purchase is not healthcare and will do nothing to solve our healthcare crisis.  Two-thirds of Americans say they’re ready to move to a single payer, ‘Medicare for All’ system and now it’s time to force the politicians to listen to them."

    And thanks for your magnificent piece.

    by Ronit on Sun Mar 02, 2008 at 07:26:01 AM PDT

    •  I love the CNA folks but

      I don't know where they got their numbers. I've sourced mine.

      by DemFromCT on Sun Mar 02, 2008 at 07:45:49 AM PDT

      •  see also from the ABC/WaPo poll

        Previous polls have asked this differently; one last year asked if people would support or oppose "a national health plan, financed by taxpayers, in which all Americans would get their insurance from a single government plan," and found 40 percent support. The wording in this ABC/Post poll weighs the proposal against the current system, and adds the Medicare model to the description. Context also can play a role; this poll asks about universal health after a long and probing series of questions on the current system.

        interestingly, Claudia Deane, who narrates the tutorial from Kaiser, was at WaPo in 2003 as asst polling director, if memory serves...

        by DemFromCT on Sun Mar 02, 2008 at 07:52:54 AM PDT

      •  Dog ate my homework.

        Didn't mean to imply you should do mine for me, btw.
        Again, thank you for this important work.

        by Ronit on Sun Mar 02, 2008 at 08:10:39 AM PDT

      •  You only have one poll

        The actual polling on this has some rather wide margins. The CNA numbers are at the higher end, and in fact yours is at the low end. I have seen numbers ranging from 35% (an August 2007 Field Poll here in CA, itself a 12% increase from December 2006) to 42% in an August 2007 poll of CA small businesses (which outpolled the individual mandate plan Arnold offered) to 52% supporting higher taxes for universal health care in an October 2007 LA Times/Bloomberg poll. And finally Harvard had a poll showing Americans are not afraid of the "socialized medicine" bogeyman.

        Most people who discuss health care reform simply assume that the public doesn't want single-payer, and never care to look at the numbers.

        The numbers are favorable. The numbers suggest we should make an all-out push for single-payer.

        by eugene on Sun Mar 02, 2008 at 08:20:38 AM PDT

        •  state polls are apples and oranges to national

          polls, and state reform apples and oranges to national reform, but thanks for posting those.

          There is as other commenters have noted, great wisdom in allowing the states to be the labs testing the different systems.

          I also agree (but didn't comment on) socialized medicine bogeymen.

          by DemFromCT on Sun Mar 02, 2008 at 08:39:46 AM PDT

          •  The last two polls

            Were national polls.

            by eugene on Sun Mar 02, 2008 at 08:57:20 AM PDT

            •  the bloomberg poll looked at universal health

              not single payer.

              The HSPH poll looked at 'socialized medicine' not single payer.

              Single payer has a solid 37% (Kaiser) - 40% (WaPo) base, and gets higher depending on how it is described.

              Still a ways to go with the public. Not unachievable, just not there yet.

              by DemFromCT on Sun Mar 02, 2008 at 09:03:00 AM PDT

              •  Point being

                If we want to understand the whole range of factors shaping the politics of this issue, those other polls DO matter. Majorities for "universal health care" mean that if we played up that frame, a specific single-payer plan would presumably do well.

                The "socialized medicine" claim is frequently used by timid Kossacks to argue against a push for single-payer - but the poll suggests this concern is overblown.

                Finally, I think we're wrong to wish and hope that the polling numbers will look really strong before we start working to make single-payer happen. You'll never see consistent majorities without us taking the initiative and building a single-payer movement that will move those numbers - and therefore move the politicians.

                What the constellation of polling data should suggest is not that single-payer is going to be enacted in January 2009 - but instead that we are very, very well positioned to begin that necessary political movement.

                The only reason we aren't doing that movement is people have convinced themselves that single-payer isn't possible - but the evidence suggests otherwise.

                by eugene on Sun Mar 02, 2008 at 09:11:44 AM PDT

                •  do it in CA

                  we'll watch.  ;-)

                  by DemFromCT on Sun Mar 02, 2008 at 09:13:03 AM PDT

                •  Thank you, Eugene ...

                  ... your comments give me hope.

                  The rest of you "pragmatists" out there ... well, geeze, don't worry about little ol' me and millions like me. We'll just be BANKRUPT and WITHOUT INSURANCE before you decide the "time is now right" to DO SOMETHING.

                  by Pat K California on Sun Mar 02, 2008 at 09:41:42 AM PDT

                  •  don't confuse pragmatism with not caring

                    or lack of activism. The polling data is to explain what we're up against, not to tell us what to do or what the outcomes are.

                    But the data is the data. and data suggests a better shot at the state level for single payer (for CA), whereas at the national level exploration of different ways to define and achieve universal care (rather than focus on single payer alone) may be in the cards.

                    by DemFromCT on Sun Mar 02, 2008 at 11:08:38 AM PDT

    •  I did find something to that effect

      from 2003.

      ABC News/WaPO poll (.pdf).

      As noted, support for this universal system is conditional. If it limited Americans’ choice of doctors, support drops sharply, from 62 percent to 35 percent. Likewise, if it meant waiting lists for some non-emergency treatments, support falls to 38 percent.

      Concerns about future costs and coverage help fuel interest in universal coverage. Support ranges from 45 percent among people who're entirely unworried about paying their future health bills to 73 percent among those who are "very" worried. It ranges from 53 percent among those who aren't worried about losing coverage through job loss to 67 percent of those who are. And it's 49 percent among who think the country is not headed toward a system of rationed care - but 68 percent among those who think it is.

      There also are political and ideological aspects to views on universal coverage. Democrats favor it by more than 3-1, and liberals by more than 5-1, while Republicans and conservatives divide evenly.

      by DemFromCT on Sun Mar 02, 2008 at 07:50:03 AM PDT

  •  A really great piece

    Public attitudes on health care are not nearly as straightforward as people think.

    In the mid 90's the State of Vermont came close to enacting Universal Health Care on its own.  The effort had significant outside funding, and was being led by a  
    popular Vermont Governor (Dean).

    And it failed. Since I was living in Vermont at the time, I followed the debate pretty closely.  I think you can draw a couple of lessons from that effort that are consistent with this article:

    1.  Most people like the care they get.  

    The failure to understand this was the single biggest mistake reform proponents made.  

    2.  Most people think they pay enough for their care.  Any proposal that increases the amount they pay for health care to cover the uninsured will be troubled.

    3.  Most of the anxiety around health care is about the fear that they may lose it.

    When they debate was over, I concluded that a single payer system would be virtually impossible to enact here. (An aside, in my experience on DKOS around this issue I have found very little understanding of what the single payer model in Canada means versus other UHC models like those in Germany or Australia).

    This is why Dean did not campaign on a Single Payer solution in 2003 - he had learned the lessons of the Vermont failure of the mid-90's.

    by fladem on Sun Mar 02, 2008 at 08:14:10 AM PDT

    •  I hope I highlighted

      those very points. Thanks for the comment and insight.

      Doesn't mean it can't be done. Does mean it won't be done right away.

      But those points need to be closely looked at when proposals hit the table.

      by DemFromCT on Sun Mar 02, 2008 at 08:23:42 AM PDT

  •  There are two fundamental flaws with this post

    One is that no acknowledgment is made - anywhere - that Kaiser is one of California's largest HMOs. Does that invalidate their numbers? Perhaps it does. I would be very, very cautious about using their numbers alone to use as a base for an analysis of the politics of American health care reform.

    The other flaw is that it really doesn't answer the question of when we can expect health care reform, as it doesn't delve deeply enough into the issue of why we don't have it already. It seems pretty clear to me that one main reason is that we progressives keep telling ourselves that single-payer just isn't possible, that Americans will never go for it.

    Is there any other issue on which we surrender before a shot has been fired? Where we talk ourselves out of pushing for our most desired goal?

    The only way we will get real health care reform - which necessarily is single-payer - is if we organize a movement to make it happen. No politician is going to drop it in our laps, not unless we have mobilized and laid the groundwork first. So if we're going to do that, don't we need to stop talking ourselves out of promoting single-payer, and instead look at the reality - yes, become a reality-based community again - and start fighting to make single-payer a reality?

    by eugene on Sun Mar 02, 2008 at 08:26:08 AM PDT

    •  that's an unwarranted assumption

      the numbers have been peer review published in the NEJM with co-authorship with Harvard School of Public Health. Please check "sources" at the end of my post.

      those kaiser data are excellent... now how you interpret them is another issue altogether ;-)

      No one is surrendering. As the post concludes, reform is inevitable (and single payer is a reasonable place to go). But if you deny the data and ignore the time scale, you are missing the boat on what the post says.

      If you raise unrealistic expectations and then wonder why you failed, you have only yourself to blame.

      by DemFromCT on Sun Mar 02, 2008 at 08:45:50 AM PDT

      •  Unrealistic expectations

        So are you saying single-payer is an unrealistic expectation? It seems to me the proper approach is to use polling data to plan out a strategy to make a winning single-payer movement, not to continue the "talk ourselves out of it" strategy that hasn't gotten us very far these last 15 years.

        I understand the point about the NEJM numbers, but as I pointed out to you elsewhere, if we're going to be talking about polling data on health care reform, we should be realistic and place those numbers into context.

        "Unrealistic expecations" cuts both ways. If we have an expectation that Americans will not or have not begun shedding their previous objections to single-payer, when in fact they have done so, are we not being unrealistic?

        Reform is inevitable. But the timeline is up for grabs. There are many reasons to believe we can make it happen within 5 years, just as there are reasons to believe we're going to have to wait 50 years. I think it's time we stopped trying to guess the future and instead started using real-world numbers - ALL of them - to plan out a movement.

        by eugene on Sun Mar 02, 2008 at 08:56:12 AM PDT

        •  exacxtly right, eugene

          Reform is inevitable. But the timeline is up for grabs

          Depending on what happens with the economy (trumps everything), the debate that takes place between McCain and [fill in blank] needs to discuss proposal, cost and timeline.

          In this post and others, I've explored some of the barriers to reform, but as I've noted, we may be in for a perfect storm that confounds expectations.

          if anyone is serious about health reform, we need more D's in the Senate, House and WH. it will not happen with divided govt.

          by DemFromCT on Sun Mar 02, 2008 at 09:09:33 AM PDT

          •  Agreed on all of it

            Personally I think we should take the SCHIP approach to producing those larger Democratic majorities - define the GOP as a party that is standing in the way of solving our health care crisis.

            As long as we're interested in giving people here the information they need to produce a successful movement I'm totally on board with what you are writing. But I think we need to argue strongly against the notion that the American people are not interested or are opposed to single-payer. The numbers are fluid but trending in our direction. We need to capitalize on that momentum, but in a smart way.

            by eugene on Sun Mar 02, 2008 at 09:13:59 AM PDT

            •  from a practical perspective

              I think it should be tried in CA, and then move east.
              Let's find out what works and what doesn't, similaer to MA and VT.

              by DemFromCT on Sun Mar 02, 2008 at 09:17:19 AM PDT

              •  I don't think that people whose lives are ruined

                by these issues are really in a position to make themselves heard. They drop off the map, they lose their homes, they become so immersed in their problems that they do not have time to participate in online forums and when they do, they don't articulate their problems well in the blogosphere. They have looked into the abyss, so to those who have not experienced it, they sound like Chicken Littles and none of the influential elite listen to them.

                Its like that saying about how first they came for the xyz.. I forget the verses..

                But - its happening - there are a lot of people who are losing their grip on what we have come to see as a normal American life right now. Our dysfunctional healthcare mess is a hue cause of this and its getting worse, quickly, as all the power blocs square off against each other with the hapless human beings in the middle, beseiged from all sides.

                There must be a limit to how much worse it can get.. but nobody knows what it is. I am sure that its much lower than we are at now. Look at history, things often get very bad before change happens, and when it happens it is often violent. That is what democracy is supposed to help us avoid, but if all of the mechanisms that would make that possible become co-opted by the machine, then the long term outlook is not good.

                We need to avoid that at all costs.. which means more than keeping people talking, that wont lead anywhere unless there is more pressure for ACTION and COMMITMENTS.

                by Andiamo on Sun Mar 02, 2008 at 12:02:59 PM PDT

              •  Is that possible though?

                Individual states may simply not have the financial power or available tax dollars to make this work. Given the national nature of the health care industry, we are likely going to need a national solution.

                by eugene on Sun Mar 02, 2008 at 12:14:49 PM PDT

                •  CA came awfully close

                  and with the proper homework, why not?

                  As you pointed out at the time, this was a flawed bill, but sets the ground rules for next time.

                  by DemFromCT on Mon Mar 03, 2008 at 06:33:27 AM PDT

    •  I believe that the

      kaiser foundation is a different entity from the HMO.

      by fladem on Sun Mar 02, 2008 at 09:12:26 AM PDT

      •  Yes, they are

        But the link should be noted.

        by eugene on Sun Mar 02, 2008 at 12:16:22 PM PDT

  •  This certainly puts the "single payer' advocates

    on notice. As a nurse educator who is quite aware of much of your information, I have despaired at much of the hubris on this site regarding the JRE and HRC plans.

    by hairspray on Sun Mar 02, 2008 at 09:03:54 AM PDT

    •  eugene has some great points

      about state level prospects in CA, but CA is not the rest of the country.

      by DemFromCT on Sun Mar 02, 2008 at 09:12:02 AM PDT

  •  oops mcjoan will not be posting today

    she was temporarily blinded by the plaid jacket (see story), but should be able to return to posting soon.

    by DemFromCT on Sun Mar 02, 2008 at 11:21:08 AM PDT

    •  no word as to whether plaid blindness

      is covered or whether it qualifies as a preexisting condition.

      by DemFromCT on Sun Mar 02, 2008 at 11:22:20 AM PDT

•  If you have healthcare out the wazoo, of course

  you don't think about it or need to. I really do think the remaining 25-30% of Bush supporters/GOP base have a total lack of empathy, pure and simple. They are not their brothers keepers and just plain don't give a damn about anything but their tax rates. It is that simple. They need to be marginalized if we are ever going to make this country "strong" again.

  by tnichlsn on Sun Mar 02, 2008 at 05:44:33 AM PDT

  •  by healthcare I meant health insurance,, sorry.

    by tnichlsn on Sun Mar 02, 2008 at 05:45:46 AM PDT

    •  Important Distinction

      by healthcare I meant health insurance,, sorry.

      Those two terms get so tangled in the health care debate it is so key to keep them separate.  When we talk about health care, most people actually mean health insurance.  But quality of health care is also a key issue that is wrapped up in this monster as well!

      by ripcw on Sun Mar 02, 2008 at 07:20:12 AM PDT

      •  You think about it if you pay for it....

        I have decent health insurance, but it costs over $10,000/year, and will probably be over $12,000 next year.

        People who get it through their jobs have no idea how much their employers are paying.

        I would be paying less net, and most employers would too (GM would go back to consistent profitability, for instance) if we switched to single-payer and funded it through increased income taxes.

        I'm not sure what the political gap is preventing single-payer from being politically 'possible'.

        It's good for people paying for insurance, good for people who are uninsured, good for businesses paying for insurance, good for doctors and doctors' offices, good for superrich people paying cash for medical care, and good for people getting insurance through their employers (because they're not tied to their jobs anymore) -- and economically efficient, and good for the public as a whole.

        And bad for who? -- health insurance companies and their CEOs and shareholders (and to a lesser extent their employees).  The definition of a special interest.

        I think the hostility to single-payer is due to reality-impaired right-wing ideology ("It's socialism!  Run and hide!  The government is always worse than private industry!") being way too embedded into people's thinking.

        by neroden on Sun Mar 02, 2008 at 05:54:01 PM PDT

  •  Listen To Yourself!

    How can someone who self-identifies as a "liberal" or "progressive" say something like that???  Your sig implies your strong support for civil liberties, and yet you wish to silence a minority that you don't agree with because you have deemed them defficient.  That's sad and disgraceful.  It is precisely this sort of hypocrisy and vitriol that allows opponents to discredit your movement and drowns out the more reasonable voices.  As a moderate non-partisan, that is disappointing to say the least.

    by Skeptical Independent on Sun Mar 02, 2008 at 06:05:51 AM PDT

    •  calm down...

      "marginalize" means "defeat them in political combat."

      We had to do that with the civil rights act too, you know.

      by daddy4mak on Sun Mar 02, 2008 at 06:15:49 AM PDT

    •  these people had unlimited/uninterrupted rule

      for 6 years and fucked everything and I do mean everything they played a role in up completely. They do need to be marginalized, a good number need to be put on trial and sent to prison. This website is not a moderate non-partisan website, it's stated purpose is to elect democrats and preferably progressive ones at that. And it is not I alone who have deemed them deficient, it is the nation's 70% who are itching for a change and beyond that history itself.
      And BTW, I am an active member of the ACLU for the precise reason you state. Because if I had my drathers, I'd rendition their leaders off to some hellhole for an extended display of waterboarding, up-close and personal. But my friends a ACLU remind me there is a more democratic way to address these issues...

      by tnichlsn on Sun Mar 02, 2008 at 06:27:56 AM PDT

      •  sorry for the rant everyone and for off-topic

        discussion. I'll shut up now. (he said sheepishly.)