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As we all know, Joe Lieberman said he would veto any bill that includes Medicare buy-in or the public option. Citing data that shows that leaving people uninsured will result in over 150,000 extra deaths over 10 years, Ezra Klein responded that Lieberman is willing to cause 150,00 deaths to satisfy his desire for revenge on liberals.

Klein was right, give or take some thousands of lives. But that's going to make your head explode, twice.

A premise of this argument is that being uninsured can kill. That's one natural reason to want universal healthcare, obviously. But it's not a reason that progressives here and elsewhere have been emphasizing at all. The reason is that it conflicts with the biggest narrative of health care reform: that health insurers don't "add value," that they sell "crap insurance" which isn't real, and that they kill people with denials by the thousands (though I've never seen a statistic on this). I've argued numerous times that it is absurd to claim insurers don't add value: if they didn't add value, no one would bother to buy health insurance or worry that they don't have it. As for crap insurance and denials of necessary care (as opposed to unwarranted care), they are real phenomena, but at the margins of the industry and not the centerpiece.

This is not at all to defend the way our health care system works now, or health insurance in particular. Massive reform is essential. But a pillar of the argument for that reform on the left flies in the face of reality, a reality that we all accept when we aren't focused on scapegoating insurers.

Now, for the second head explosion: Howard Dean says that Democrats should not pass the health care reform bill if the public option and Medicare buy-in are not included. As per the Urban Institute, the same 150,000 people will die without universal healthcare over 10 years as they would in Lieberman's case. So, by the same logic, Howard Dean is apparently willing to cause the deaths of 150,000 people to satisfy his desire for revenge. In Dean's case, the revenge would be on health insurers and conservadems instead of liberals.

My guess is that most people at this point will want to defend Dean by saying that actually Ezra Klein was wrong, and that a better reform is around the corner. But the prospects for reform aren't any higher if the current bill fails because liberals reject it, or if the bill fails because moderates reject it. The number of deaths isn't any less, and failure to pass is failure to pass, regardless of your motives. If this compromised bill can't pass, how can a more uncompromising bill that attacks the heart of powerful special interests pass, as Dean wants?

Like a lot of people, the direction of this debate on health care reform has got me angry, so this is an angry diary. I've written very detailed, carefully sourced diaries supporting my point of view in the past, for those who are interested in a debate.

Here. Here. and Here.

Final note: I do think Dean has an "out" that Lieberman didn't have. Dean is not in the Senate, so he can oppose the bill but he can't threaten to withhold his vote. I volunteered full time for Dean in 2003/04, and I have enough respect for him now to think that he may actually be doing a very clever feint: becoming the visible face of liberal disappointment and opposition to the latest compromise. Given Lieberman's determination to oppose anything liberals embrace, Dean may be the symbolic opposition to this compromise in an attempt to get Lieberman and others to accept it and not ask for other concessions. I hope that is what Dean is doing. As I wrote a few months ago:

I don't pretend to know whether the public option will be included in a final bill, or if it does whether it will pass or will mean universal health care fails to become law. I'm happy to use the public option to draw fire away from other critical aspects of reform. If it is included in a final bill and passes, and the public option hasn't been eviscerated in the process, that will be some brilliant maneuvering and a great accomplishment.

But if it passes, it almost certainly will be weakened to the point of irrelevance in the short term because, at this stage of the game, nothing that cuts deeply into the bloat in our $3 trillion health care system will pass. The entire industry, and not just insurers, will see to that. So it would be a tragedy, if it comes down to it, to refuse to compromise on the public option, leaving millions uninsured for the next 4, 8 or more years.

Coverage reform now with minor cost reforms. That will set the stage for major cost reforms in 2-4 years.

Flame away.

Originally posted to jd in nyc on Tue Dec 15, 2009 at 09:05 PM PST.

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Comment Preferences

  •  Tip Jar (8+ / 0-)

    Ein Mißverständnis ist es, und wir gehen daran zugrunde.

    by jd in nyc on Tue Dec 15, 2009 at 09:05:17 PM PST

    •  Health insurance companies add value the way the (5+ / 0-)

      casinos in Vegas add value, only Vegas pays back a bigger percentage on the dollar than insurance companies.

      •  ridiculous (1+ / 0-)
        Recommended by:
        DRo

        No one worries about going bankrupt if they don't play the slots. No one dies from not having gone to a casino.

        If what you mean is that insurance is a system to redistribute wealth on a probabilistic basis, sort of. In this case the unlucky (the sick) get "lucky" in that they hit the jackpot of other people's money to pay for their care. That's how insurance works.

        Same thing would happen if the government were providing care. Instead of premiums, other people's money would come from taxes to pay for the care of the sick.

        Ein Mißverständnis ist es, und wir gehen daran zugrunde.

        by jd in nyc on Tue Dec 15, 2009 at 09:22:30 PM PST

        [ Parent ]

  •  Lieberman will gut the bill even more (1+ / 0-)
    Recommended by:
    Yosef 52

    He has said he can't fully support it yet. And what Joe says goes. The fact that progressives aren't willing to draw a line in the sand on this issue disgusts me.

    Don't donate to the DSCC in 2010 - they'll give your money to Harry Reid. Donate to the candidates instead!

    by arcticshadow on Tue Dec 15, 2009 at 09:14:09 PM PST

    •  how? (0+ / 0-)

      reconciliation? If you do that, you lose all the reforms that affect the delivery system and attempt to improve the quality of care, as well as reforms that remove the ability of insurers to discriminate based on gender or prior conditions.

      Also, I'm not sure how reconciliation works, but it may be that Conrad is holding that up all by himself since he runs the committee it would have to go through.

      The Senate is broken. I don't think it's the Democrats being weak.

      Ein Mißverständnis ist es, und wir gehen daran zugrunde.

      by jd in nyc on Tue Dec 15, 2009 at 09:17:43 PM PST

      [ Parent ]

  •  Bogus. n/t (2+ / 0-)
    Recommended by:
    alizard, pyegar

    This health care system is a moral atrocity. Dr. Ralphdog

    by AllisonInSeattle on Tue Dec 15, 2009 at 09:29:01 PM PST

    •  groupthink n/t (0+ / 0-)

      Ein Mißverständnis ist es, und wir gehen daran zugrunde.

      by jd in nyc on Tue Dec 15, 2009 at 09:43:49 PM PST

      [ Parent ]

      •  yes, but your group (1+ / 0-)
        Recommended by:
        AllisonInSeattle

        of health insurance industry buddies are not our group. We call you people the opposition when we're being polite.

        Looking for intelligent energy policy alternatives? Try here.

        by alizard on Wed Dec 16, 2009 at 12:05:22 AM PST

        [ Parent ]

        •  based on misunderstanding (0+ / 0-)

          You don't know who I identify with, and you don't know the economics of health care. You don't know how to solve the problem in a politically feasible way, and you think that there is some evidence that single payer is the only system of universal care that works (there isn't any such evidence, if you've looked at the world beyond the Anglophone nations).

          One of my goals is to get private insurers turned into highly regulated non-profits, similar to Switzerland, Germany and the Netherlands. Administration costs for health insurance there are similar to single payer countries, and so are medical costs.

          On top of that, the strongest lobbies in health care right now are the hospitals and doctors. By far. The fact that they have escaped criticism by and large in the popular media is a measure of that strength.

          Ein Mißverständnis ist es, und wir gehen daran zugrunde.

          by jd in nyc on Fri Dec 18, 2009 at 07:18:29 PM PST

          [ Parent ]

  •  Pass the bill -- THEN go to reconciliation (4+ / 0-)
    Recommended by:
    denisedh, pgm 01, amk for obama, Amayi

    to adopt the strongest public option that can pass the house and get 50 votes + Biden in the Senate.  There is nothing in this bill that keeps us from coming back for another bite of the apple - next week, and  after the 2010 elections, and after the 2012 elections.  If progressives work hard to primary the Conservadems and defeat the Rethuglicans, we could have a Senate in 2011 that will pass an even stronger public option.  

    How about some nice television ads -- cute kid with no health insurance -- cut to the kid's parents weeping at her funeral -- Joe Lieberman voted to keep <this kid> from getting the health care that could have saved her life.  Vote against Joe Lieberman (fill in Ben Nelson, and all 40 Republicans).Lets see how well that goes over with their "pro-life" base. No mercy, no prisoners.  

    "My country, right or wrong; if right, to be kept right; and if wrong, to be set right" -- Sen. (and Major General) Carl Schurz, 1872

    by Diesel Kitty on Tue Dec 15, 2009 at 09:34:58 PM PST

    •  agree to an extent (1+ / 0-)
      Recommended by:
      amk for obama

      I just responded to a similar post of yours in another diary. I like the tactic of doing the stuff that can't go through reconciliation in this bill, and then doing the purely financial things in a stronger form in another bill.

      Ein Mißverständnis ist es, und wir gehen daran zugrunde.

      by jd in nyc on Tue Dec 15, 2009 at 09:49:03 PM PST

      [ Parent ]

    •  Execept that 2010 is an election year (0+ / 0-)

      And Congress Critters are chickenshit. They won't vote for something that Republicans will lambaste them about.

      It's all so stupid.

      --Mr. President, you have to earn my vote every day. Not take it for granted. --

      by chipoliwog on Tue Dec 15, 2009 at 10:23:07 PM PST

      [ Parent ]

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