November 24, 2009

• How come Conservatives don’t realize how much they’ve already won on Health Care?

  Recently the Democrats have been praising the Health Care Reform bills on the grounds that they save lots of money and reduce the deficit. According to the Congressional Budget Office (CBO) the bill will MAKE money every year and over ten years reduce the deficit by over $100 billion. And that’s good and it’s good for them to praise it. It’s definitely a real accomplishment.

  Republicans in contrast have been still yelling that it’s ALL LIES! It’s tricks of the numbers! It doesn’t take into account the second decade! It doesn’t include the doctors pay fix! It raises all our taxes to do it! Etc. etc. All of those things are false and the republicans were more than happy to accept CBO estimates when they were in their favor.

  So Democrats are patting themselves on their backs for creating such an awesomely fiscally conservative bill.

  Am I the only one who sees how incredibly odd this is?

  In theory the Democratic party are the liberals. In theory the Republican party are the conservatives, especially the fiscally conservative. Isn’t that supposed to be the order of things? Why are Democrats praising themselves so much for achieving a fundamentally conservative goal? And why are Republicans so outraged that they’ve succeeded in this?!?!?

  It all goes back to a point I keep having to return to again and again. The vociferous, angry, enraged Republicans and Conservatives don’t seem to comprehend at all how much they’ve already WON on Health Care.  I mean really, since when is it Liberals who are wanting to cut the deficit by holding back on money going into Health Care!?!?!?  Since NEVER. That’s when.

  I’m a liberal. And I would not have the slightest problem if the CBO came back and said the the Health Care proposals will end up costing the Federal Government like $700 billion over ten years even AFTER taking into account incoming revenue. The CBO tends to overestimate costs anyway and underestimate savings.

  Still, what if they’re right? Why would I still not care? One reason is that deficits aren’t to emergency levels by the standards of most economists. We won’t be able to borrow our way out of another economic crises not by a long shot, but we do still have plenty of credit we can use to get our economy back on track NOW if we spend it wisely. We still have a ways to go before we’re bankrupted. We’re a large, rich, and powerful country. It doesn’t work like an individual’s budget. We might as well spend money NOW to make ourselves healthier and more productive rather than wait until we really are at a point where we can’t afford to borrow any more.

  But the bigger reason is that Health Care SHOULD NOT BE THAT FAR DOWN ON OUR PRIORITIES LIST!!

  There are plenty of ways to raise money and we have things that we spend far more money on, EVERY year that we could very easily cut back on in order to gain money for Health Care. Most notably our military budget. We spend $600 Billion a YEAR without getting ANY of it back on the military. And that number has been GROWING year after year. (Yes Obama’s military budget is HIGHER with wars included than past budgets despite what you heard about on Fox News about steep military cuts) Similarly the total cost of the Iraq and Afghanistan wars as of 2008 was something like $900 Billion by ITSELF (and that’s in addition to the normal military budget). If we simply did not engage in those wars, we could have afforded ALL of Health Care Reform even if we spent TWICE as much money on it as we currently plan on spending.

  And there’s plenty of other areas we can cut back on too.

  It’s unclear whether the TARP bailout bill really needed to be as large as it was. And even if it needed to be,  we could have taken control over or otherwise exerted our influence over those companies getting bailed out so that taxpayers reap some of the benefits of these companies’ now substantial profits. Those profits could have easily gone toward Health Care. We could stop spending exorbitant prices on the futile and ridiculous Drug War and we could stop locking up so many of our fellow citizens and as a consequence cease have to pay to maintain as many massive expensive prisons.  All that money could be going to Health Care too. We could stop paying out large amounts of money to hire contractors who are basically corrupt like KBR and Blackwater to do things that our military, police, and civil servants could do just as well and probably for less money. We could be more careful in how we give out foreign aide and stop funding any regimes that utilize our money for weapons and to oppress their own or other state’s peoples. At the very least we could threaten to withhold aid to those countries until we know that they are working toward peace.

  Or we could raise taxes but we could do so in a SMART way that reflects what the PEOPLE want. For example, we could raise income taxes or estate taxes on the richest 1% or the richest 5% individuals or businesses. Or we could implement an accumulated wealth tax on those individuals. We could create a tax on financial transactions to reduce the amount of speculations. We could tax hedge funds or create some sort of tax on buying up other businesses or a tax on companies that are “too big to fail”.  Or we could create a Carbon Tax to reduce global warming. OR go with the cap and trade system but instead of giving away credits to pollute we SELL them to companies and they have to bid on them in the open market. All this could help us combat global climate change at the same time that we make money for Health Care Reform. Or there’s the age old legalize marijuana and tax it idea. Or just taxing other bad things that are detrimental to society. A modest tax on sugar or a tax on heavily fatty or high cholesterol substances, or a tax on alcohol and cigarettes or a tax on fast food or on sugary soft drinks.

  OR we could simply use a Single Payer System which all evidence seems to suggest would same ENORMOUS amounts of money. Private Insurers throw away 20 cents of every premium dollar on Administrative Costs. Nowhere else in the world is that much money gone to waste. Every more socialized system comes out better.

  These are LIBERAL solutions to the funding question. There’s no dirth of ideas on the liberal side for how to come up with the money.  It’s just that when liberals think about funding they think about rearranging our national priorities altogether so that matters of our social significance to regular people come out on top. That’s the LIBERAL Strategy for dealing with issues of funding.

  The LIBERAL strategy is not hold back as much as possible on Health Care so that we can ensure that all projections show us not increasing the Deficit. That’s something that was done to appease CONSERVATIVES.

  And it seems to have been a pointless endeavor since not a single conservative changed their mind. The mere fact that the bill conforms to what they WANT is irrelevant.

  It’s like that for issue after issue after issue on Health Care.  Let’s just go down the list shall we?

  COVERAGE:
  A liberal plan would cover any person in the United States because it’s the right thing to do and it’s a basic human RIGHT not a privilege. That’s why the initial campaign was for UNIVERSAL HEALTH CARE. The plan we get DENIES illegal immigrants coverage and FORCES people to pay. Those who can’t afford Health Care coverage even after receiving subsidies will STILL not be able to get coverage. Current estimates are that 31 million out of the 45 million uninsured will end up covered. Better than nothing to be sure but by no means can that be called “Universal”.

  ABORTION:
  A liberal plan would cover abortions and allow federal money to go toward it. They would overturn outdated rules and guidelines and put the decision back where it belongs entirely between the woman and the doctor. Adding additional prices and conditions to abortion just adds to its unnecessary stigma and chips away at a woman’s right to privacy.

  What we got in the Senate is a bill that explicitly re-enforces rules against federal funding to abortion and denies funding from this bill to go toward abortion. What we got in the House is an even more far reaching formulation of the same thing which could result in removing all incentive for insurers to even bother with offering abortions certainly in the individual and small group insurance market and partially even in employer markets. That restriction includes money from government subsidies so at the bare minimum it’s making abortion more expensive and probably less tenable for poor women.
  
  MANDATES:
  While there has been some split amongst liberals, many liberals have been very leery of the idea of an Individual Mandate. The way they see it is that such a system just ends up filling the pockets of insurance companies by gifting them with numerous new customers who otherwise would never have bought insurance. In effect, the government ends up giving the insurance companies money indirectly to provide insurance to poor individuals by giving those individuals government subsidies. This like a wasteful convoluted process when the government could instead just as easily pay directly to provide those individuals who can’t afford Health Care, actual Health Care.

  A liberal plan would not have individual mandates. Instead it would either cover people directly and/or require employers in businesses over a certain size provide their employees with insurance. The latter would cover many more people but places the burden on the employer.

  What we actually got in both Health Care plans is both the Individual Mandate and the Employer Mandate. Only the Employer Mandate is watered down by providing employers the ability to pay a tax and avoid the requirement of providing insurance for employees who don’t have it.

  BARGAINING:
  A liberal plan would never simply take the word of various industry players that they will lower cost. Rather, a liberal plan would use the government’s powerful bargaining power as a representative of so many people to force down prices on Drugs and Health Care. The companies would then be required to find ways to reduce their costs and limits the amount to which they can profit on sickness and death.

  Yet what we had was at the very beginning of the process, the President and Congress negotiated deals with all the major players in terms wherein those players promised to reduce costs and “play nice” and in return the legislation would not include anything that significantly hurts them nor would the Government use its bargaining power to force down prices.

  END OF LIFE COUNSELING:
  A liberal plan would absolutely reimburse doctors for end of life counseling. It’s actually really helpful both in terms of controlling costs AND in making people feel more comfortable and happy. It gives people that extra support that they need during difficult times and ensures that they aren’t forced to undergo painful procedures and put themselves and their family through suffering they don’t want to go through. It’s a perfectly logical reasonable thing to do. And there’s absolutely no reason to suspect Doctors would try to force people to die. If they were there are numerous laws against that not to mention ethics guidelines within every medical setting.

  But what we got of course was a huge campaign against this by conservatives calling end of life counseling “Death Panels” and insinuating the utterly false proclamation that “Government Bureacrats” would be the ones deciding whether Grandma lives or dies. As a result end of life counseling provisions were removed from the bill.

  And of course there’s:

  THE PUBLIC OPTION:

  Words almost cannot describe how far liberals have compromised on this. But let’s try to do a basic rundown of all the compromising steps.

  1. A liberal plan would be single payer where doctors and hospitals are paid directly by the State and through Taxes. The UK has a system somewhat like this. We have it too. The VA’s Health system works like this. (An even MORE liberal system would also put direct democratic control over the payment mechanism. That is the PEOPLE decide what procedures are supported and are directly involved in selecting the people in charge of making those decisions. Each Hospital and Clinic is run by its employees in a cooperative subject only to the guidelines of the National Health Department, but that kinda stuff is so crazy nobody’s talking about it.) In any case in such a system if adequate care is not provided the citizens can petition their government to change the system.

  2. A less liberal plan would be single payer where the federal government pays everyone’s insurance. IE the government foots the bill but all doctors and hospitals remain privately owned. Effectively it would be medicare but it would offer MORE services (like regular checkups, dental, vision) and EVERYONE would be automatically enrolled from birth to death. Canada has a system like this.

  3. A less liberal plan than that would be where you just take Medicare like we have it now and just give anyone and everyone the OPTION to sign up for it. Private doctors and hospitals still exist. And Private insurance companies still exist. They just compete with Medicare. Individuals just have to choose whether they want a private insurer or they can choose medicare.

  4. A less liberal plan than that would be where you start up a new Public Insurance Company (called a Publoc Option) that has to survive solely on the basis of premiums from its customers. It’s separate from Medicare but anyone can sign up for it and it gets to use the Medicare negotiated rates on drug and medical prices.

  5. A less liberal plan than that would be where you have that same Public Insurance Option with Medicare rates but only those who don’t already have insurance and can’t get insurance from any other system are allowed to sign up for it. If your employer provides you with insurance you can’t drop it in favor of the Public option even if it would be cheaper for you or would provide better coverage. This boils down to only 3-6 million people being eligible for the public option.

  6. A less liberal plan than that would be the same Public option that only people who don’t have insurance can sign up for but which has to negotiate rates on its own with the insurance companies. Obviously thanks to 5 the bargaining power of this public option would be limited.

  7. A less liberal plan than that would be exactly the same Public option as above with no negotiated rates, but also where States can choose to OPT OUT of the plan.

  8. A less liberal plan than that would be the same Public Option but rather than States able to Opt Out, States have to OPT IN.

  9. A less liberal plan than that would be the same Public Option but States OPT IN but ONLY IF certain TRIGGER Conditions are met. Namely only if insurance companies fail to drop cost by a certain amount by a certain year and Congress doesn’t at any point between come in and change the law then the States then get to have a public option.

  I’d pretty much say any of these plans above FOUR is not a LIBERAL plan at all. It’s a CONSERVATIVE Health Reform Plan. It could have just as easily been invented by a Conservative legislature.  Guess which plan one of those is in the House Health Care Reform Bill?

  Number 6. 

  Guess which one is in the Senate Health Care Reform Bill?

  Number 7!!

  And in the Senate they are saying Number 7 CAN’T PASS! It has to go to 8 or 9 or something worse as of yet in-conceived before the bill can pass.

  In addition several other limited attempts to reintroduce LIBERALISM to the bill have been shot down. For example an amendment was proposed to provides and protects States rights to set up their OWN Single Payer System if they so chose. This got little support and was rejected. Proposals were made to LOWER the age of Medicare, meaning okay so maybe not allow everyone to enter into Medicare but why not allow anyone over the age of 45 or 55 to choose it as an Option?!? Nope. No dice.

  Could you imagine that if liberals controlled either House of Congress as Conservative commentators claim to be the truth, anything close to this Bill ever coming close to passing? Of course not!

  Do you see what I mean?  The Conservatives have TOTALLY WON in so many ways on Health Care Reform. They’ve Crushed. They dominated. Liberals were PWNED in the worse way. Liberals got almost nothing that they wanted. Conservatives got virtually EVERYTHING they wanted.  And yet they WHINE as if they’re being wronged. They shout and throw a tantrum as if they HAVEN’T ever gotten their way on ANYTHING.

  And why is that?  Well because we have two parties. One is called the Democrats. They are Corporatist Fiscally Conservative Party of War Hawks.   The other is called the Republicans. They used to be even more fiscally conservative and hawkish version of the Democratic party, but today they are increasingly becoming a Crazy Corporatist Socially Conservative Party of Religious Fanatical Conspiracy Theorists. They are almost cultist in their refusal to accept anything that does not precisely align with their extreme ideals.

  There is no liberal party in our political system. There’s a Conservative Party that pretends to be liberal when they think it will get them votes and a Conservative Party that is too fanatical to even be bothered to pretend to care what anybody thinks. Instead they just focus on beating the other party and will resort to any level of despicable tactics to achieve that.

  And in spite of all that… believe it or not, I’m not THAT cynical. It could be even worse. We COULD have provision that allows insurance companies to compete across State lines. Then we’d have the Credit Card company effect on insurance and a bubble would likely result. We COULD have lost restrictions on denying coverage for pre-existing conditions. 

  Indeed here are according to Ezra Klein 12 good things the Health Care Reform bills DO do and even give us well before 2014:
  

  1) Eliminating lifetime limits, and cap annual limits, on health-care benefits. In other words, if you get an aggressive cancer and your treatment costs an extraordinary amount, your insurer can’t suddenly remind you that subparagraph 15 limited your yearly expenses to $30,000, and they’re not responsible for anything above that.

  2) No more rescissions.

  3) Some interim help for people who have preexisting conditions, though the bill does not instantly ban discrimination on preexisting conditions.

  4) Requiring insurers to cover preventive care and immunizations.

  5) Allowing young adults to stay on their parent’s insurance plan until age 26.

  6) Developing uniform coverage documents so people can compare different insurance policies in an apples-to-apples fashion.

  7) Forcing insurers to spend 80 percent of all premium dollars on medical care (75 percent in the individual market), thus capping the money that can go toward administration, profits, etc.

  8) Creating an appeals process and consumer advocate for insurance customers.

  9) Developing a temporary re-insurance program to help early retirees (folks over 55) afford coverage.

  10) Creating an internet portal to help people shop for and compare coverage.

  11) Miscellaneous administrative simplification stuff.

  12) Banning discrimination based on salary (i.e., where a company that’s not self-insured makes only some full-time workers eligible for coverage.

  Now those are some altogether good things. Pretty much all of them are agreeable to almost everyone even conservatives. And both bills include these kinds of things. That’s why Health Care Reform might still do some good even if it’s far FAR from ideal.
  
  The bill that passes is never going to be a triumph of liberalism. The best we liberals can hope for it to be NOT terrible. It will do some good for real people. Not nearly enough. Not nearly as much as COULD be done but still some real good. Just don’t buy into this idea that Conservatives have been bullied and beaten down by the great LIBERAL Majority and are having this bill pushed down their throats. The reality is exactly the opposite of that.  In spite of unending concessions on the part of liberals, there’s still no guarantee even that ANY bill will pass because four conservative supposedly Democratic Senators STILL oppose it. The continue to demand more concessions.

  The reality is conservatives have won almost every single battle in the Health Care Debate and are poised to possibly win even more.  It’s just that for some reason they either aren’t aware or PRETEND not to be aware their own victories.

  • 6:09 pm
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