The the Senate health care bill is "much, much better than nothing":

Do the Right Thing, by Paul Krugman, Commentary, NY Times: A message to House Democrats: This is your moment of truth. You can do the right thing and pass the Senate health care bill. Or you can look for an easy way out, make excuses and fail the test of history.
Tuesday’s Republican victory in the Massachusetts special election means that Democrats can’t send a modified health care bill back to the Senate. That’s a shame because the bill that would have emerged from House-Senate negotiations would have been better... But the Senate bill is much, much better than nothing. And all that has to happen to make it law is for the House to pass the same bill, and send it to President Obama’s desk.
Right now, Nancy Pelosi, the speaker of the House, says that she doesn’t have the votes to pass the Senate bill. But there is no good alternative.
Some are urging Democrats to scale back their proposals in the hope of gaining Republican support. But anyone who thinks that would work must have spent the past year living on another planet.
The fact is that the Senate bill is a centrist document, which moderate Republicans should find entirely acceptable... very similar to the plan Mitt Romney introduced in Massachusetts... Yet it has faced lock-step opposition from the G.O.P., which is determined to prevent Democrats from achieving any successes. Why would this change now that Republicans think they’re on a roll?
Alternatively, some call for breaking the health care plan into pieces so that the Senate can vote the popular pieces into law. But anyone who thinks that would work hasn’t paid attention...
Think of health care reform as ... a three-legged stool. You would, rightly, ridicule anyone who proposed saving money by leaving off one or two of the legs. Well, those who propose doing only the popular pieces of health care reform deserve the same kind of ridicule. Reform won’t work unless all the essential pieces are in place. ...

So reaching out to Republicans won’t work, and neither will trying to pass only the crowd-pleasing pieces of reform. What about the suggestion that Democrats use reconciliation — ...which bypasses the filibuster — to enact health reform?
That ... may become necessary... But reconciliation, which is basically limited to matters of taxing and spending, probably can’t be used to enact many important aspects of reform... it’s not even clear if it could be used to ban discrimination based on medical history.
Finally, some Democrats want to just give up on the whole thing.
That would be ... utter political folly. It wouldn’t protect Democrats from charges that they voted for “socialist” health care... Congress ... already passed reform. All it would do is solidify the public perception of Democrats as hapless and ineffectual. And anyway, politics is supposed to be about achieving something more than your own re-election. ...
Now, part of Democrats’ problem since Tuesday’s special election has been ... waiting in vain for leadership... Mr. Obama has conspicuously failed to rise to the occasion.
But members of Congress, who were sent to Washington to serve the public, don’t have the right to hide behind the president’s passivity.
Bear in mind that the horrors of health insurance — outrageous premiums, coverage denied to those who need it most and dropped when you actually get sick — will get only worse if reform fails, and insurance companies know that they’re off the hook. And voters will blame politicians who, when they had a chance to do something, made excuses instead.
Ladies and gentlemen, the nation is waiting. Stop whining, and do what needs to be done.

Posted by Mark Thoma on Friday, January 22, 2010 at 12:33 AM in Economics, Health Care, Politics Save to del.icio.us Tweet This Permalink Comments (76)

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lark said...
Pelosi says House won't pass Senate Health Care Reform.
Expect 44,789 deaths per year to start, and that number will increase as more and more are uninsured.

Reference: http://pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf

And if we wait 16 years (since reform was last defeated) to fix this, how many will die? A minimum of 716,624 Americans.
That is Harvard estimate.

Why is it okay to slaughter Americans like this?

Here is the affordability calculator. Before you dismiss this plan as unhelpful, see what it would do for you.

http://healthreform.kff.org/SubsidyCalculator.aspx#tableLinkDiv

If you make a low income,say 20K a year, you get full health insurance for 1153/ year. Not cheap - but this is health insurance, covering a full range of stuff you would have to pay out of pocket if you didn't have it: routine appts, serious or chronic conditions, the works. The govt subsidy is ~$1500 a year. That's the Senate plan. The House plan would have been more affordable.

Reply Jan 21, 2010 at 10:53 PM

Patricia Shannon said in reply to lark...
If you make 20K a year, you can't afford 1153 a year.

Reply Jan 22, 2010 at 11:13 AM

Bruce Wilder said...
This will be an interesting test of political intelligence and suicidal tendencies.

Reply Jan 21, 2010 at 11:41 PM

Jo said...
Translation:

'Someone, anyone, please listen to my (self-proclaimed) really, really good ideas. - I mean I'm liberal and stuff'

Reply Jan 22, 2010 at 12:51 AM

reason said in reply to Jo...
PK is employed to express opinions, and he has a VERY good record. He has mostly been proved right by events. Can you say that? Then why the silly snide.

Reply Jan 22, 2010 at 01:47 AM

Barkley Rosser said...
I am in full agreement with PK on this and posted two days ago on Econospeak to the effect (shame on Mark for not linking to ME). The only reason for dawdling is the rumbling that there might be a way to get enough Dems in the Senate to agree to do some changes through reconciliation. But, my understanding is that part of that deal will still have to involve passing the Senate bill as is, with these reconciliation amendments, if one wants to call them that, being the sweetener to get the House to do so. As the Senate bill remains validly passed until December, there may be some time on this. However, given that many other things are pressing, and most Dems in both Houses are sick of this and want it done, the sooner the better.

As it is, I am skeptical that the House will avoid getting itself tangled in making too many demands for the ConservaDems in the Senate, who are very antsy about going the reconciliation route. So, in the end I think Krugman is right: it will be the Senate bill as is or nothing (or not very much).

Reply Jan 22, 2010 at 02:01 AM

Barkley Rosser said...
Another aspect of this is the peculiarity of the Massachusetts situation. They have health care reform, the only state that does. So, there is a perception that national health care reform will only cost them money. Hence the irony of Mr. Health Care Reform (Ted Kennedy)'s state electing the crucial vote to block any further serious consideration in the Senate. But the mass media interpretation has put the fear in all the Senate (and many HOuse) Dems, who are now going all balky.

Reply Jan 22, 2010 at 02:05 AM

Holly W. said in reply to Barkley Rosser...
What mystifies me about this whole situation is that my understanding is that Massachusetts should be the state LEAST affected by the health insurance reform bill, since we already have the model in place. John Kerry has been working hard to make sure things stay the same here. So I don't quite understand the anger MA residents have been expressing about this reform. None of the Brown voters I've seen quoted has said anything about hating the MA health care system.

Reply Jan 22, 2010 at 08:13 AM

kharris said in reply to Holly W....
As I understand it, the common explanation is that since MA has universal coverage, there is nothing much to gain, while the switch to a federal program could mean that something is lost. I don't know whether anybody in the State actually thought that, but it is what pundits said to explain the focus on health care and the badness of that focus for the Democrat.

Reply Jan 22, 2010 at 10:41 AM

JeffF said in reply to Holly W....
I don't know that one can say that the election was due to overt opposition to healthcare specifically.

The vote counts I have seen appear to indicate that the election is one of motivation. The Republican got basically the same vote count as McCain, the Democrat got a lot less than Obama. So Republicans turned out and Democrats did not.

Republicans really hate democrats in general so I think are quite motivated in general right now. Surely some of them specifically voted because of health care but I suspect a lot of them voted because they had a chance to replace the hated Kennedy.

Democrats are highly de-motivated but not just by health care. The whole center-right coddling democratic senate, house, and presidency have got a lot of people shrugging their shoulders.

And then that democratic candidate appears to have run a really awful campaign.

Reply Jan 22, 2010 at 10:46 AM

ken melvin said...
We need a little 'people power'.

Reply Jan 22, 2010 at 04:22 AM

tinbox said...
What exactly is the track record...the most similar situation I recall was PK demanding Democrats support TARP (and fixing it later,hahaha....).

Reply Jan 22, 2010 at 04:24 AM

save_the_rustbelt said...
I'm really stunned at this meltdown, the Democrats had all of the stars in alignment but could not execute good old fashioned political basics.

Where's LBJ when he was needed (ya, I know, dead, but...)?

Reply Jan 22, 2010 at 04:57 AM

Holly W. said in reply to save_the_rustbelt...
And yet I hear conservatives state with confidence that Democrats could manage to run a police state. Puh-lease. Democrats can't control their own party members, much less anyone else.

Reply Jan 22, 2010 at 08:28 AM

Soccerdad said in reply to Holly W....
"And yet I hear conservatives state with confidence that Democrats could manage to run a police state."

Won't stop them from trying though.

Reply Jan 22, 2010 at 08:36 AM

Patricia Shannon said in reply to Soccerdad...
How weird. The Republicans advocate torture, reading people's e-mail w/o warrant, imprisoning people w/o trial, etc., and they say they are afraid of Democrats creating a police state. Weird.

Reply Jan 22, 2010 at 11:18 AM

New Jersey said in reply to Holly W....
An openly corrupt, incompetent, and totally politicized police state doesn't have much to recommend itself.

The average guy gets totally screwed over, the really bad actors get a pass, and/or end up working for the police state.

Its like Tony Soprano Goes to Harvard. "Nice little business you have here. Be a shame if the EPA inspectors came by. Maybe if you gave these three guys a job, and kicked in a little to the Union PAC, I could get you an exemption."

Reply Jan 22, 2010 at 09:01 AM

Holly W. said in reply to New Jersey...
And Soccerdad:

You guys seriously don't see those lockstep Republicans as being ALOT more likely to manage to carry off a police state? The fact that none of them ever dare to truly break ranks doesn't creep you out even a teensy bit?

Reply Jan 22, 2010 at 10:02 AM

Stevester said in reply to Holly W....
Ron Paul?

Reply Jan 22, 2010 at 06:06 PM

Beezer said...
Taxpayers don't like paying taxes, even if they know it gets them something worthwhile. It's a simple statement but it is complicated at the same time.

Eighty five percent of Americans have health insurance. Or so they believe. These Americans have some compassion, God bless them, and many know one or more of the remaining 15% who suffer because they cannot afford health insurance.

This duality creates a tough problem when it comes to universal health care. The majority of Americans want health care reform so that everyone, or nearly so, can afford timely medical care. But they don't want to pay for it.

Krugman is correct in pointing out that Democrats have a conundrum but the right thing to do is get the reform ball rolling, irrespective of potential negative political consequences.

It's got a Hail Mary pass type of appeal. But Washington DC is in the thrall of money, prestige and the next election. These realities don't support sacrifice for the common good.

I've said all along that Obama needs to villify the bad guys. Identify them. He's begun to do this, to a meek degree, with Wall Street. As for health care, he needs to push the legislation to the House and call for a vote. The vote is recorded and can be used in due time as more and more Americans lose the insurance they thought they had, and the bills continue to outpace the majority's ability to pay.

He'd better make the pass, if he can. Failing to do so removes any positives he might gain from all the effort spent to date. And with the money unleashed yesterday by the US Stupid court, he'd better act fast. Soon, yesterday's history will be regularly re-written today by a mass media funded by large corporations.

We really are in the soup as a nation. Our future is very shaky.

Reply Jan 22, 2010 at 05:32 AM

Beezer said...
Speaking of the US Stupid Court, their decision yesterday was a death blow to a free press.

Bought and paid for will be the press of tomorrow.

Talk about a restriction of free expression.

Reply Jan 22, 2010 at 05:38 AM

yuan said...
"I mean I'm liberal and stuff"

Even a casual observer of politics wold note that a large part of the liberal wing of the democratic party did not support this farce of a reform bill. And while PK is a self-proclaimed liberal I don't think he would have been considered liberal 20 years ago.

But everything is doubleplusgood in Oceania...erm...the USA.

Reply Jan 22, 2010 at 06:03 AM

yuan said...
part= portion

Reply Jan 22, 2010 at 06:04 AM

GregL said...
This is perhaps KK's clearest, most concise and very timely political piece. If the House does pass the Senate Bill as is, PK will deserve credit for pushing it over the line.

This is especially so if Obama continues to stay on the sidelines on this issue (as he does for almost everything).

Reply Jan 22, 2010 at 06:10 AM

Reno Dino said...
Tuesday marked the beginning of a three-year lame duck period for this administration.
President Brown is waiting in the wings. Thinking back to a year ago brings to mind the old adage: All trouble starts off being fun.

Reply Jan 22, 2010 at 06:35 AM

Eric said...
Finish reconciliation and put the modified bill back into the House and Senate. Try to pass it. If it fails solely because of a 41 vote Republican minority refusing to limit debate, make HCR the absolute centerpiece of the 2010 campaign. If the Democrats really believe the nation supports this as a critical priority, then a much better bill in 2011 is better than the Senate bill today (if that were even possible, which it probably isn't). And if it turns out that the electorate next November disagrees with that HCR is as critical as some believe it to be, that is valuable information. Proceed with confidence and just begging for the Senate bill isn't a confident move for a party that still enjoys what a review of history will show to be a significantly large majority in each house plus the Presidency.

Reply Jan 22, 2010 at 06:57 AM

roger said...
The odd and repulsive thing is that even the advocates only point to one or two things that are any good about the bill - notably, the extension of universal coverage by way of mandating insurance and funding the cost for the poor. So, if that was the small small egg that the Congress has produced, after a friggin' year - why did they waste the year? They could have passed a tiny change in what amounts to insurance regulation regarding pre-existing conditions and put aside a little money to pay for those who couldn't afford insurance and that was that. This is not healthcare reform, and the bill doesn't look to me like it is repairable in the direction of single payer or some kind of public option system. Just like Bush's pill bill, the more likely direction is to entrench the 'soft costs' - the corruption.
This is what makes me angry. The past year was an economic disaster, and it should have been addressed vigorously and experimentally - myself, I think much more attention should have been paid, for instance, to enormously expanding credit for small businesses, which disproportionately employ the young. We've already had small business credit programs, they don't have to be invented. If the Dems had any brains, they would see how they were positioned to benefit from the same generational good will that helped Reaganauts with the generation that came of age during the seventies and turned against Carter. That has been an investment that keeps on giving for the GOP. But they seem determined to piss away their advantages, and have since 2007, really, when they gave Bush a pass on foreign policy.
I'd love to know what the whole point of the healthcare strategy was. Was it to destroy healthcare 'reform' for another generation? If that was the point, congrats! Dems, you did it. As Robert Scherer said, the Dems took a vast majority position last year - which congregated around basically extending Medicare - and utterly trashed it. The figures are now reversed, and the only figures that count - of course - for the center right media are figures that show a lack of support for healthcare reform. The former figures, that vast popularity - well, unfortunately it was for a reform that wasn't 'politically viable'.

Reply Jan 22, 2010 at 07:07 AM

Patrick said...
Obama - like Clinton before him - jumped the gun.

Most Americans are not at the point where they feel the pain with health care. Sure, the unemployment rate is very high, but most people still have jobs and thus health care.

Rising costs are exactly what is needed to get a universal system. Eventually nobody will be able to afford care, insurance companies will go broke - thus breaking their power - and the political will to create a universal system will be created.

Similarly, gutting medicare and SS will create so much death and misery among the boomers that they'll finally support a universal system (probably something like the Dutch system).

So I say let the insurance companies go wild. Let costs get totally out of control. The sooner most people can't afford care the better.

Reply Jan 22, 2010 at 07:07 AM

kthomas said in reply to Patrick...
Pain being the key word.

Not enough people have suffered. I could not agree more.

Reply Jan 22, 2010 at 09:53 AM

Bruce Wilder said in reply to kthomas...
More pain, please!

Reply Jan 22, 2010 at 12:39 PM

Fred C. Dobbs said in reply to Patrick...
But the point, supposedly, is it's a Boiling Frog
situation, that costs are going to get far worse soon & we should act soon to prevent that, though it may not seem so bad now, if you're employed, etc. You know how expensive COBRA is right?

You're suggesting an Apocalypse, so I guess you're not serious.

Reply Jan 22, 2010 at 03:56 PM

Patrick said in reply to Fred C. Dobbs...
The frog boils though, doesn't it.

Well, I'm Canadian so I don't know first hand how expensive COBRA is.

From my vantage point, nothing short of an apocalypse will convince Americans to support universal health care, regardless of how it is formulated (Canadian, UK, or Dutch/Swiss). The boomers hold the balance of power, and they are transitioning from a demographic that experienced very modest unemployment levels (and hence pretty good insurance coverage) to being covered by medicare. There is no immediate gain for them in changing anything, and there is no reason to believe that, as a group, they'll have the foresight to jump out of the pot. Just look at global warming. And y'all did elect The Shrub. Twice. As far as I am concerned there is almost no limit to how stupid and short sighted people can be (and I don't just mean Americans - it's true of humanity as a whole).

Until there is sufficient economic hardship to purge the notion of economic prosperity as a proxy for moral rectitude from American culture, universal health care is always going to be perceived as equivalent to promoting sin i.e. "If you want health care, then get a job, you lazy slob."

So yeah, I am talking about an apocalypse and yes I am serious. I'd be happy to be wrong. Honestly, it's getting harder and harder to be your neighbor.

Reply Jan 22, 2010 at 09:16 PM

Alex Tolley said...
A week certainly is a long time in politics. It must be less than a month since PK was writing about the expectation that the health care bill reform would pass. Now it is up in the air again.

What is interesting to me is that the wrong message is being sent from Massachusetts. The spin is that this was a referendum on big government and health care in particular. However, yesterday I was attending a lecture by political scientist Christopher Achen, who argued that voters rationalize their arguments for voting the way they did to manage their beliefs and party affiliations. In his opinion, the health care issue was a rationalization and that the real reason for teh republican win was that voters were voting based on the poor economy and the standard "blame the incumbents". If he is correct, then the Democratic party should get a spine and really make the effort to pass health care reform, spotty as it is, just as PK suggests.

Reply Jan 22, 2010 at 07:49 AM

Barkley Rosser said in reply to Alex Tolley...
What you said. Excellent. Also, regarding the MA voters in particular, there is no evidence they are unhappy about their health care reform. It is that they got theirs, but are afraid that a national reform will raise their taxes. Stupic, but not totally irrational.

In any case, I think Alex is right that they were mostly voting on the current state of the economy. Heck, it is easy to forget that Reagan had positive poll ratings in the 30s (worse than Obama has at any point) during the recession of 1982, and the Dems made big pickups in the Congress that fall.

Reply Jan 22, 2010 at 09:06 AM

Michael Cain said in reply to Alex Tolley...
"...then the Democratic party should get a spine and really make the effort to pass health care reform..."

What then to do about states like Nebraska? Certainly in the eyes of much of the national party Ben Nelson is a DINO. But right-center is as far to the left as can get elected in Nebraska, and the Dems have said that they intend to run a big-tent party with room for the right-center. Some parts of the bill were genuinely unacceptable -- his state government officials know that the expansion of Medicaid is a future budget-buster for them. It is not an accident that the price for Ben Nelson's vote was to protect his state from that pending disaster.

The Dems really do seem to have only two choices for getting a bill passed: have the House accept the Senate Bill, or say "F*ck the Senate rules," and go the reconciliation route. I think Pelosi is right that she doesn't have the votes, and not just because liberals don't like the Senate bill; there are some right-center Dems in the House who have no doubt now heard from their state officials that they need the same kind of protection that Nebraska got. And I don't think Reid is going to be the leader who says, "We don't care about rules any more."

Personally, I think the Dems backed the wrong horse on health insurance reform. They pandered to too many special interests. They made it hideously complex. Simplicity sells. If the national Republican party wasn't being run by idiots, they could have stolen the whole reform issue from the Dems.

Reply Jan 22, 2010 at 09:38 AM

Barry said...
Patrick: "So I say let the insurance companies go wild. Let costs get totally out of control. The sooner most people can't afford care the better."

We tried that, starting after the failure in '93.

Reply Jan 22, 2010 at 07:59 AM

Patrick said in reply to Barry...
The process isn't complete. Until it's widely believed that having a job and 'playing by the rules' doesn't get you health insurance, then there will be no reform.

Reply Jan 22, 2010 at 09:39 AM

anne said...
http://krugman.blogs.nytimes.com/2010/01/22/the-choice/

January 22, 2010

The Choice
By Paul Krugman

So, House Democrats have a choice: do they pass the Senate bill, or do they go back to the drawing board and spend several months cobbling together a plan that’s worse in almost every dimension, generating thousands of stories about hapless Democrats * — and almost surely find that Senate Republicans block the new plan, too.

Guess which way they seem to be leaning. **

Maybe they’ll come to their senses over the next few days. It would be really helpful, of course, if Democrats actually had a party leader — you know, the president or someone. ***

* http://voices.washingtonpost.com/ezra-klein/2010/01/and_the_failure_stories_begin.html

** http://www.nytimes.com/2010/01/22/health/policy/22health.html

*** http://tpmdc.talkingpointsmemo.com/2010/01/cooling-off-period-white-house-takes-step-back-and-leaves-health-care-to-hill.php?ref=fpa

Reply Jan 22, 2010 at 08:09 AM

b. said...

Better Than Nothing! Newsflash: Gitmo to close some day, approved torture officially reduced to Army Field Manual "compound stress" only, infinite detention now pseudo-legal, detainee loss rate due to homicide now stable.

On the health care front, Having A Bill is better (for those in the bill-making business) than Not Having A Bill. Actual bill guarantees health insuirance - but does not guarantee actual care - to more of Not Everybody by promising insufficient subsidies for mandated purchase of for-profit near-monopoly insurance plans, barely bending the cost curve by aiming at cheaper plans and abetting continued care denial to make up for sustained profit and overhead growth.

Who does Krugman think is blocking the "Senate bill"? Try this one for size:
http://www.politicsdaily.com/2010/01/20/bart-stupak-election-a-wake-up-call/

Mass voters said: If the only choice is between a shithead running for the opposition and a fraud coasting for the dysfunctional supermajority, I'd rather have the shithead with fries to piss on the dysfunctional supermajority.

That might be "counterproductive" for the likes of Krugman that are focused on keeping the establishment gears well-oiled - Bush should have never driven stick shift, right, Paul? - but being "productive" has not exactly paid off for the working majority for three decades or four.

Krugman needs to focus on supporting Bernanke's re-appointment.

Reply Jan 22, 2010 at 08:23 AM

Peter K. said...
rustbelt:

"I'm really stunned at this meltdown, the Democrats had all of the stars in alignment but could not execute good old fashioned political basics.

Where's LBJ when he was needed (ya, I know, dead, but...)?"

I am fed up with people bitching about Obama. He's just one part of the puzzle, an important part but still.

If it wasn't for Obama (and Al Franken and Arlen Specter switching parties) the stars wouldn't have aligned where a good to so-so bill looked likely to pass.

Scott Brown got 51% of the vote and independents are mad at incumbents b/c of 10% unemployment and failed state governments.

Reply Jan 22, 2010 at 08:41 AM

save_the_rustbelt said in reply to Peter K....
Like the Steelers playoff hopes, a good roster and good intentions do not count for much.

Results count. Close does not count.

Reply Jan 22, 2010 at 09:21 AM

Reality Bites said...
Alex, sounds like the Prof. was trying to rationalize himself into believing that the special interest laden health care bill which would have increased costs for almost everyone and also added more than $1 trillion to the debt was what Americans really wanted. Thank God the people of Massachusetts succeeded in doing something that millions of Americans had been trying to do for months, kill a very bad bill.

What must be done now? Start crafting legislation that would reduce costs instead of increase them. Allow policies to be offered interstate, make it harder to sue for malpractice or cap punitive damages, and allow companies to offer policies without mandated coverage. The States can mandate the insurance companies offer a standard or group of standard plans that would have all the mandated coverage options, but allow non-mandated coverage also.

Finally, some attempt has to be made to inform the American people that health care is expensive. In order to reduce costs, someone has to act as a goalkeeper, denying care to those who aren't going to benefit enough to outweigh the cost. I still don't see any way around this, the dead health care bill never dealt with this issue and that's why it was useless as a cost reducer.

Krugman can keep on blaming Republicans, but Obama better understand that Americans do not like their leaders to be whiners. At some point, the buck has to stop and someone has to be held responsible for what occurs. Frankly, the left needs to shut up because no one is buying their whining. Americans either don't care, or understand that no Republican support was needed at all before this point and Democrats still have a bigger majority than Republicans ever had, for at least 3 decades. Those who want the power to craft legislation and determine the course of the nation must also accept responsibility, otherwise they are not fit to lead and should cede control over to those who aren't afraid to lead and are willing to accept the consequences.

Reply Jan 22, 2010 at 09:07 AM

Lee A. Arnold said...
Wrong wrong wrong! Everything just changed!

CALIFORNIA IS TRYING TO GET SINGLE-PAYER. The California Senate Appropriations Committee just approved Thursday (yesterday) a proposal to set-up a single payer system in California. It goes to the full California Senate next week.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/01/21/BAAN1BLNTP.DTL

This immediately changes everything in the healthcare debate! Think!! California is the seventh biggest economy in the world and single-payer will cut into private insurers' profits in a very big way. Private health insurers are going to have to change tactics in Washington immediately, to prevent this from happening. They are going to have to go back and try to get a deal from the U.S. House.

This changes what progressives should do next. First, support the California bill.

Next, hold it up as a states' rights model and don't let the U.S. Congress pass any provision that would prevent a single payer in California or any other state.

This is not only going to get us all single-payer, and sooner rather than later. And it not only puts the corporate moderate Dems on notice.

It is also going to drive a wedge between the teabaggers and the corporate moderates in the Republican Party. What is Scott Brown going to say -- that he supported Massachusetts' healthcare reform but is against what California is doing because it goes further than the U.S. Congress' bill?!

Reply Jan 22, 2010 at 10:24 AM

JeffF said in reply to Lee A. Arnold...
California can't do anything in its present state.

There is absolutely no chance that this plan could be passed because it requires a tax increase and tax increases require 2/3 of the legislature and the legislature is more than 1/3 republican and the republicans will never vote for any such tax.

California is far less likely to make progress on this issue than the US senate.

Want to know how health care is going in California? Last year funding for the poison control center was cut 50%.

Reply Jan 22, 2010 at 11:02 AM

JeffF said in reply to JeffF...
BTW this California plan would also have to pass the US senate as it involves completely reorganizing all the federal health care funding.

Reply Jan 22, 2010 at 11:03 AM

mark said...
"Ladies and gentlemen, the nation is waiting."

Would this be the same nation that every poll shows is opposed to the bills passed recently in each house? Or some alternate nation that exists in Paul Krugman's mirror.

Reply Jan 22, 2010 at 10:42 AM

Patricia Shannon said in reply to mark...
Do you really think the public really KNOWS what is in the bills?

Reply Jan 22, 2010 at 11:26 AM

mrrunangun said...
Why is the public majority opposed to what PK and his friends are certain is good for them? Most likely those paying attention who cannot anticipate being the beneficiaries of special treatment in exchange for a vote from Sens Nelson or Landrieu are skeptical. If they are not putatively Democratic union cardholders such folks feel, not unreasonably, that the prospective burdens and benefits will be unfairly distributed. Watching the government operate in recent years gives support for such asuspicion. Consideration of the broader public interest has taken a back seat to special interest pleading since 1968 and such pleading has prominently infected the health bill. People think that is particularly inappropriate in a bill of this type.

On the other hand, everyone understands the relatively uncomplicated medicare deal and it has been regarded as a fair deal from its inception. It affects Democratic and Republican constituencies equally. If the complex senate plan is not going to be enacted, how about expanding medicare eligibility to all or part of the under-65 population on an income and/or wealth related sliding scale purchase plan? It's not a sophisticated technocratic proposal, but it can be understood and supported by the public as the present bill cannot.

Reply Jan 22, 2010 at 12:20 PM

anne said...
I do not pretend to understand what happened in Massachusetts, but what I do understand is that Paul Krugman was right in pushing for health care legislation whether the House of Representatives or Senate versions before Massachusetts and immediately pushing for the Senate legislation following the vote. Suddenly passing any reasonable health care reform legislation became far harder, so no matter the complaints with the Senate bill take a decided step to universal care and work on the roughness from there. The politics had changed.

Failing to push through legislation immediately will seemingly only weaken subsequent reform attempts this year. While I do not understand the Massachusetts vote, I understand that state residents would stop any attempt to toss away the Massachusetts health care plan.

Reply Jan 22, 2010 at 12:47 PM

Fred C. Dobbs said in reply to anne...
Any state plan depends on an infusion of
federal assistance. If that doesn't arrive,
the plan will 'wither on the vine' so to speak.
The residents don't have too much say in the matter. I think such plans are usually established in the expectation that the 'real' Federal plan is imminent, because it's practically impossible to afford such plans otherwise.

Reply Jan 22, 2010 at 12:57 PM

Fred C. Dobbs said...
If the healthcare bills die, who gets the blame?
(Or is it credit?) If the result is that more Democrats
get elected this year (!), and only if, then perhaps there's
a chance that the NEXT Congress actually produces a decent
bill. (The Bernie Sanders bill, for example.) The Senate
bill is a turkey, the House bill not so much better. Yes,
if we don't get more Democrats elected, the chances are
nil that those bills will be better. So, the only thing
to do is get more Democrats elected a.s.a.p.

Massachusetts not withstanding. At least we've still got ours.

Reply Jan 22, 2010 at 12:49 PM

Beezer said...
mrrunangun

Expansion of Medicare? Howard Dean says that's what the Dems should have done. If the head of the Democratic Party says he doesn't like the bill, then no one should be surprised it can't pass.

Honest debate went into the can early on with this issue, thanks to the $260 million spent against it by the status quo. You could give every state exemption from Medicaid and it still wouldn't pass.

Keep it simple and sweet. The bill was written by lobbyists for health insurance corporations--that's why it is 1,000 pages of sausage. Anything representing reform that got into that bill made it simply because even a dumb mass media would spot what was happening.

Reply Jan 22, 2010 at 12:56 PM

Fred C. Dobbs said in reply to Beezer...
Practically, probably, the only way Expanded
Medicare would work is if it were 1) affordable and 2) re-imbursement rates for procedures were increased significantly. Big Healthcare does not care for Medicare reimbrsement as it is, a loss- leader. How to expand coverage, keep it affordable, and raise re-imbursement? Otherwise, a fine idea.

Reply Jan 22, 2010 at 01:03 PM

bill said in reply to Fred C. Dobbs...
Affordable to whom?

Patient at the point of service?

Patient on 15 April?

People other than the patient on 15 April?

% of GNP taken in federal, state, local taxes?

Reply Jan 22, 2010 at 03:17 PM

Fred C. Dobbs said in reply to bill...
Mostly 'affordable to patients'. My point, however, is that it just isn't all it's cracked up to be, though it would seem 'simpler' to implement.
Tax increases would ensue if costs aren't contained, and that's unlikely. We're desperate, no?

Reply Jan 22, 2010 at 03:47 PM

anne said...
The problem with health care reform in Massachusetts has been the complaint I had about the direction of national legislation, which has been to allow insurance companies to price coverage which in turn means there will be no meaningful limiting of health care cost increases in the state. As long as health care costs rise at the sort of rates they have been for several decades, care will become increasingly unaffordable. So Massachusetts will have an increasing affordability problem unless there are controls over insurance company premiums, which in turn will mean limiting drug and medical equipment costs.

Massachusetts however is a beginning plan, given the sense of Paul Krugman, and there would seem to be no remaining choice for a national model with the turn of events.

Reply Jan 22, 2010 at 01:27 PM

Fred C. Dobbs said...
Call the Republicans bluff on Tort Reform. Figure out how
to limit malpractice costs. Tie it to massive efforts to
improve quality-of-care, electronic records, whatever.
Either that or Single Payer, or nationalize Big Insurance.

Reply Jan 22, 2010 at 02:20 PM

Barkley Rosser said in reply to Fred C. Dobbs...
Fred,

Where, the House or the Senate? I posted on Econospeak when the Senate passed their bill that it would have been better if there had been a bipartisan compromise in which the GOP got tort reform and the Dems got a public option. In an earlier time such a compromise might have been possible. It might even have been possible if somehow Obama and McCain had gotten together and worked it out, although there have not been any indications that they ever had such a conversation.

As it is, my niece has been covering health care on the Hill for the AP. I asked her if there was ever at any point such a proposal or approach made by either side. She said "no." Both parties are simply too beholden to their own special interest groups and also so into simply engaging in partisan warfare, certainly in the Congress.

As it is, there is no way this is going to come up at all in any serious way at this point.

Reply Jan 22, 2010 at 02:26 PM

Fred C. Dobbs said in reply to Barkley Rosser...
Obviously, neither side wants the other to be
successful with any of this. Force the issue
by electing a whole lot of Democrats is most
likely the only way that would work. Electing
a whole lot of Republicans would not be such
a good idea, obviously. Bluff-calling is a
clever tactic, but not practical really.

Reply Jan 22, 2010 at 02:42 PM

anne said...
"Call the Republicans bluff on Tort Reform. Figure out how to limit malpractice costs."

Tort reform for medical malpractice suits was already in place in 27 states by 2005, and more since. The matter has long been of minimal importance in terms of health care costs but is of importance for conservatives who for reasons I do not quite understand find classes of attorneys threatening (possibly because these are attorneys threatening to conservative business interests). *

* http://www.nytimes.com/2005/02/22/business/22insure.html

Reply Jan 22, 2010 at 02:44 PM

Fred C. Dobbs said in reply to anne...
Seems to me that Sen Judd Gregg's lead talking point, he being 'The Thinking Man's Conservative' don't you know, was 'Got to have Tort Reform'. So obviously, there's just not enough of it around (to suit him), because he wouldn't just be trying to shoot down Universal Healthcare, would he?

'Calling their bluff' doesn't mean that they will
then cave, but politically it might help. Maybe.

Krugman is frustrated with Obama. He ought to be more frustrated with Republicans, of course.

Reply Jan 22, 2010 at 03:40 PM

paine said...
the absurd kill rate estimates
hung around the neck
of status quo-ing on health payment
adds a very odd relish
to the goo goo crowd wailing
" give us just about anything please
so long as we can believe
it will begin to stop the killing "

hence the urgency
to the krugman flying wedge strategy here

now i'm all for anything that will mean uncle spends more
money gleened from self fabricated credit
so the fact this stage one of great reform
will probably be mostly price increase
and very little medical services increase

i greatly doubt the system is killing off
us less well heeled citizens
at a 20-30 k annual clip
let alone numbers like our meadow lark
buys --45k--
i'll admit i haven't seen the obverse number
that is how many lives per year
we'd save if st max's new health covenant
passes into law next month
vs next year

do we fear the redo will come out even worse ???

85 % of america is already covered and i bet a higher percentage then that among actual voters

the only kinda system change they want enough to vote about
is one that will cut their costs
and instead all they hear about is increases in cost

rightly so

goo goos love shooting themselves in the face
so long as the cause is righteous
want

Reply Jan 22, 2010 at 03:08 PM

paine said...
in 08 2.5 million souls departed their bodies
in the US of A

25k by dint of poor coverage
is 1%
if lark's 45k
close to 2%

(1)Diseases of the heart 28.5%
(2) Malignant neoplasms cancer 22.8%
(3) Cerebrovascular disease stroke 6.7%
(4) Chronic lower respiratory disease emphysema, chronic bronchitis 5.1%
(5) Unintentional injuries accidents 4.4%
(6) Diabetes mellitus diabetes 3.0%
(7) Influenza and pneumonia flu & pneumonia 2.7%
(8) Alzheimer's Disease Alzheimer's senility 2.4%

numbers in the no coverage kill range

(9) Nephritis and Nephrosis kidney disease 1.7%
(10) Septicemia systemic infection 1.4%
(11) Intentional self-harm suicide 1.3%
(12) Chronic Liver/Cirrhosis liver disease 1.1%
(13) Essential Hypertension high blood pressure 0.8%
(14) Assault homicide 0.7%

All other causes 17.4%

now we might exclude all deaths
to those 70 or older
on the rationale
medicare kicked in five years earlier

anne what's the total deaths to those prior to age 70
or there abouts ???

Reply Jan 22, 2010 at 03:50 PM

Patricia Shannon said...
http://www.sciencedaily.com/releases/2010/01/100121092008.htm

ScienceDaily (Jan. 21, 2010) — Reducing salt in the American diet by as little as one-half teaspoon (or three grams) per day could prevent nearly 100,000 heart attacks and 92,000 deaths each year, according to a new study. Such benefits are on par with the benefits from reductions in smoking and could save the United States about $24 billion in healthcare costs, the researchers add.

Reply Jan 22, 2010 at 03:53 PM

Patricia Shannon said...
Has anybody else been the recipient of one of the e-mails filled with lies, being passed around by conservatives?

Reply Jan 22, 2010 at 03:58 PM

im1dc said in reply to Patricia Shannon...
Yes, I have seen a constant stream of the most vile awful lies and looney tunes BS from so-called Conservative Republicans continually for years.

Their stream of consciousness and alternate universe is not pretty. They truly believe in themselves and their propaganda. Facts that refute them do not change minds, only inspire more total utter stupidity from them.

The only blessing that comes from reading their stuff is it helps you know your friends from your enemies.

Reply Jan 22, 2010 at 06:39 PM

anne said...
http://www.ncpa.org/pdfs/2009_harvard_health_study.pdf

September 17, 2009

Health Insurance and Mortality in US Adults
By Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser, Danny McCormick, David H. Bor, and David U. Himmelstein - American Journal of Public Health

Abstract

Objectives. A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data.

Methods. We conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey. We analyzed participants aged 17 to 64 years to determine whether uninsurance at the time of interview predicted death.

Results. Among all participants, 3.1% (95% confidence interval [CI]=2.5%, 3.7%) died. The hazard ratio for mortality among the uninsured compared with the insured, with adjustment for age and gender only, was 1.80 (95% CI=1.44, 2.26). After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body mass index, leisure exercise, smoking, and regular alcohol use, the uninsured were more likely to die (hazard ratio=1.40; 95% CI=1.06, 1.84) than those with insurance.

Conclusions. Uninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time.

Reply Jan 22, 2010 at 04:06 PM

anne said...
http://www.ncpa.org/pdfs/2009_harvard_health_study.pdf

September 17, 2009

Health Insurance and Mortality in US Adults
By Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser, Danny McCormick, David H. Bor, and David U. Himmelstein - American Journal of Public Health

The United States stands alone among industrialized nations in not providing health coverage to all of its citizens. Currently, 46 million Americans lack health coverage. Despite repeated attempts to expand health insurance, uninsurance remains commonplace among US adults.

Health insurance facilitates access to health care services and helps protect against the high costs of catastrophic illness. Relative to the uninsured, insured Americans are more likely to obtain recommended screening and care for chronic conditions and are less likely to suffer undiagnosed chronic conditions or to receive substandard medical care.

Numerous investigators have found an association between uninsurance and death. The Institute of Medicine (IOM) estimated that 18314 Americans aged between 25 and 64 years die annually because of lack of health insurance, comparable to deaths because of diabetes, stroke, or homicide in 2001 among persons aged 25 to 64 years. The IOM estimate was largely based on a single study by Franks et al. However, these data are now more than 20 years old; both medical therapeutics and the demography of the uninsured have changed in the interim.

We analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III). NHANES III collected data on a representative sample of Americans, with vital status follow-up through 2000. Our objective was to evaluate the relationship between uninsurance and death....

Conclusions

Lack of health insurance is associated with as many as 44789 deaths per year in the United States, more than those caused by kidney disease (n=42868). The increased risk of death attributable to uninsurance suggests that alternative measures of access to medical care for the uninsured, such as community health centers, do not provide the protection of private health insurance. Despite widespread acknowledgment that enacting universal coverage would be life saving, doing so remains politically thorny. Now that health reform is again on the political agenda, health professionals have the opportunity to advocate universal coverage.

Reply Jan 22, 2010 at 04:07 PM

paine said in reply to anne...
anne
thanx for the link

i'm not in a position to evaluate this calculation
obviously

not even the mere methodology
only the vaguest of alarm bells sound
when i'm forced to confront rude empiricks
the water boardings of these poor data bases
it's been my limited eexperience
results with miraculous regularity
seem to confirm
the prefences of sponsors and /or researchers
much as in jurisprudence
the ready confessions in the era of mandatory confession seemed to nicely pop up in the end

no reason to underline these authors "stake"
in single payer
at any rate
the grail here is of course
their 1.4 ratio
i can't imagine this finding lacks foreign counterparts from the era -- gone long ago --
when universal health was seriously
still on the "to do" agenda
of just about all our more humane
fellow oecd member states

Reply Jan 22, 2010 at 06:38 PM

kilo said in reply to paine...
I spent a couple of hours reading through some of this a few weeks ago.

They aggregate a fairly large number (dozens) of studies which looked at specific issues, e.g. diabetes care. Lots of footnotes.

They claim to have accounted for the obvious factors - age, previous health, income, etc. Impossible to know without detailed analysis of the underlying studies.

Most of the impact falls in 4 or 5 areas. Diabetes is one that I recall. There is even some delta in emergency room trauma care results, which surprised me. As you might expect, they attribute a lot of the delta to delays in seeking care and less effective follow-up care. Interestingly, in some cases Medicaid is worse than no insurance at all.

Its pretty hard for the non-specialists (at least me) given any reasonable degree of effort, to evaluate whether, and to what degree, any thumbs were put on the scale here.

My overall impression is that there is an impact, although the error bars may be significant.

However, if mortality delay is the figure of merit metric for evaluating plans, one might consider whether the money might be better spent doing the equivalent of putting statins in the water supply (or at least buy out the patent), or offering a $10 billion X-prize for an effective type-2 diabetes prevention drug.

Reply Jan 22, 2010 at 10:28 PM

paine said in reply to kilo...
thanx kilo

"My overall impression is that there is an impact, although the error bars may be significant"

seems reasonable "some" impact exists
but stark kill rates and totals
need lots of convincing and ready to hand
back up
or they'll be waved off as goo goo agitprop

pseudo accurate body counts here
may only reduce persuasiveness

the number of folks
who die from smoking
eating deep fried foods
protracted couch spud drills
or any other risky behaviour
that only indirectly impacts
morbidity
obviously have a problematique
qualitatively higher
then proximate causes
like not wearing a seat belt

churning thru your daily routines
with untreated diabetes
or hyper tension
or a malignant tumor
is qualitatively
like say
drinking a quart of fine whiskey a day

no one would disagree
stuff like that will shorten a few life spans

screening and treatment obviously lengthen lives

btw
that medicaid kills result
if statistically meaningful
has a nice ghoulish suggestion
sleeping inside itself
doesn't it

Reply Jan 23, 2010 at 06:00 AM

anne said...
Looking to health care from another perspective:

http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2008/Jan/Measuring-the-Health-of-Nations--Updating-an-Earlier-Analysis.aspx

January, 2008

Measuring The Health Of Nations: Updating An Earlier Analysis
By Ellen Nolte and C. Martin McKee

The concept of amenable mortality before age 75 was developed in the 1970s to assess the quality and performance of health systems and to track changes over time. For this study, the researchers used data from the World Health Organization on deaths from conditions considered amenable to health care, such as treatable cancers, diabetes, and cardiovascular disease.

Between 1997–98 and 2002–03, amenable mortality fell by an average of 16 percent in all countries except the U.S., where the decline was only 4 percent. In 1997–98, the U.S. ranked 15th out of the 19 countries on this measure—ahead of only Finland, Portugal, the United Kingdom, and Ireland—with a rate of 114.7 deaths per 100,000 people. By 2002–03, the U.S. fell to last place, with 109.7 per 100,000.

Mortality Amenable to Health Care, 2002-2003

Deaths per 100,000 population

1. France ( 65)
2. Japan ( 71)
3. Australia ( 71)
4. Spain ( 74)
5. Italy ( 74)
6. Canada ( 77)
7. Norway ( 80)
8. Netherlands ( 82)
9. Sweden ( 82)
10. Greece ( 84)
11. Austria ( 84)
12. Germany ( 90)
13. Finland ( 93)
14. New Zealand ( 96)
15. Denmark ( 101)
16. United Kingdom ( 103)
17. Ireland ( 103)
18. Portugal ( 104)
19. United States ( 110)

Reply Jan 22, 2010 at 04:12 PM

im1dc said...
I could't say it any better:

January 22, 2010

"Obama Needs to Decide on Health Care"

William Galston: "If he still wants legislation, he should invest the full authority of his office to persuade the House to endorse the Senate bill, accompanied by a package of amendments to be considered separately under the reconciliation process. If he has concluded that he has no choice but to take the issue off the table, he should say so. If he continues to utter hopeful banalities devoid of concrete meaning, the fragile reform coalition will collapse within days, with consequences that will endure for decades."

http://politicalwire.com/archives/2010/01/22/obama_needs_to_decide_on_health_care.html

Reply Jan 22, 2010 at 06:41 PM

Soccerdad said...
Do you really think the public really KNOWS what is in the bills?

Precisely the problem...mistrust of our federal government.

Reply Jan 22, 2010 at 07:49 PM

anne said...
http://krugman.blogs.nytimes.com/2010/01/23/intimations-of-sanity/

January 23, 2010

Intimations Of Sanity
By Paul krugman

Politico reports * that Harry Reid and Nancy Pelosi are working on a strategy that just might save health care: get the House to pass the Senate bill, while the Senate uses reconciliation — a process that avoids the need for a 60-vote supermajority — to address some of the concerns of House Democrats.

That’s very good news.

Of course, if they do this, there will be howls of protest — they’re defying the will of the 41-59 Republican majority in the Senate! This violates (the spirit of the Constitution) the very strange rules the Senate has imposed on itself. But I hope Democrats have learned by now that the public doesn’t know or care about such things.

Right now, the Democrats are, like it or not, the party of health reform. They can either be the party that passed reform, and at least stands for something, or the party that tried to get health reform but proved itself incompetent and weak in the process.

They need to pull this out.

* http://www.politico.com/news/stories/0110/31886.html

Reply Jan 23, 2010 at 08:12 AM

Fred C. Dobbs said...
'Finally, some Democrats want to just give up on the whole thing.
That would be ... utter political folly. It wouldn’t protect Democrats from charges that they voted for “socialist” health care... Congress ... already passed reform. All it would do is solidify the public perception of Democrats as hapless and ineffectual. And anyway, politics is supposed to be about achieving something more than your own re-election. ...'

You've got to know when to hold 'em & when to fold 'em.

Not 'utter folly'. Maybe 'hapless & ineffectual'. If it
can be hammered home that the reason for the debacle is
primarily that there still aren't enough votes for the
'ideal' solution, then that is definitely 'taking a risk'
that more votes can be produced after this year's election.

If the votes aren't there to produce useful legislation,
then making a persuasive case as to the urgent need to
pull in more 'good' votes is the democratic way to deal
with the problem, rather than put in legislation that
benefits special interests way more than 'the people'.

Reply Jan 23, 2010 at 10:58 AM