[cannotseethe]

	Originally Posted by themuzicman To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	What would be preferable is for insurance to return to what the product is intended to be: Paying a company to assume a catastrophic financial risk. ... It is always more expensive. We are literally wasting money by insuring non-catastrophic financial events.

This part makes perfect sense to me. You've seen these medical clinics in places like CVS that offer simple medical services like flu shots without requiring a doctor visit? I'm curious about where that trend will lead and whether it will create upward pressure on the system as a whole. (of course I'm not proposing that as an alternative health care reform, just remarking on it).

An inherent tension in the system we have now in the US is that doctors are gatekeepers. Some medical conditions are just too complicated for a non-expert to understand. So you have situations in which the health care consumer cannot (will not?) be informed enough to make a rational choice about their care. You might say: well, they can at least make a rational, informed choice about their health care provider. However, doctors are part of the market dynamic too (this is key; it's not like deciding which brand of soap to buy). And they are more informed than the consumer. The consumer has limited ability to "shop" for doctors (because of the limits of health plans, but also because it's difficult to change doctors practically speaking). So there is little reason for doctors not to utilize the informational advantage they command.

Thinking that this screwball setup could function well as a market, then, is naive. To be efficient, markets require rationality on the part of the consumer as well as information balance (all actors have access to the same information) and choice (consumers can change doctors, at least). None of these conditions hold, so it's no wonder that our market-oriented health care system is a nightmare. It's not impossible that the whole thing could work well as a market, but I doubt that tweaks to the current system are going to get us there. The incentive structure is way out-of-whack.

It does make sense to get doctors out of the loop for simple things, though. Hell, I have to get a referral from my primary care physician when I want to have my eyes examined at an optometrist. I, and most people, are informed enough to make rational choices about things like having an eye exam.

[themuzicman]

	Originally Posted by Shauru To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	You did not answer the question. You side stepped it. Telling us why they are bad at it is not the same as telling us why they have no right to intervene.

I'm saying that their intervention will only make things worse. It has already been demonstrated that governments cannot effectively run health insurance or health care. Just look at government run health care around the world.

	This whole argument tires me. So let's sum it up and agree to disagree: If you think you have something to lose by the larger availability of health insurance to the poor, then you're going to piss and moan.

The poor are already covered. it's called MEDICAID.

This it the big secret in all of this: Those who aren't covered are either the young (18-25, about 40% of those without coverage) who refuse medical insurance (which congress is trying to FORCE upon them), the self-employed, who, again, choose not to have it to save expenses, and those who work for companies that aren't large enough to afford health insurance for their employees.

These folks have enough income to not qualify for MEDICAID (which means they aren't poor).

	If you can forsee that you may one day lose all your money and it might be nice to know that in world requiring health insurance for reasonable access to healthcare you might have a shot at living, then you you're going to be a little more happy.

Why does the government have the right to force someone to buy insurance, when that insurance doesn't protect anyone by themselves? (Especially given the ridiculously low rates at which those who tend refuse insurance actually have a catastrophic loss.)

	We good?

As far as the disagreement, in part. I think a proper understanding of why we are in the skyrocketing cost circumstance we are (namely government intervention), the fact that government run health care is a failure where ever it has been tried, and the fact that medicare and medicaid force providers who participate to do so at a loss are significant in the discussion, as well.


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Section 3403 of Senator Harry Reid's amendment (page 1020) states that "it shall not be in order in the Senate or the House of Representatives to consider any bill, resolution, amendment, or conference report that would repeal or otherwise change this subsection." Unfortunately, the subsection that it applies to deals with regulations imposed on doctors and patients by the Independent Medicare Advisory Boards a/k/a the Death Panels.

The Senate bill is attempting to prevent any future congress from repealing this subsection, essentially tying the hands of future legislators to fix or remove this provision.

The rest of the article makes a good point about the lack of transparency and bipartisanship, in spite of promises given by President Obama, but that's a secondary issue to me.

[phej]

Seems like it's taken out of context. The language looks like it's to limit debate by the House or Senate. It's akin to the "up-or-down" kinds of votes (like treaties, I believe).

(D) and (E) after this clause say:

Originally Posted by the bill

(D) WAIVER.—This paragraph may be 22 waived or suspended in the Senate only by the 23 affirmative vote of three-fifths of the Members, 24 duly chosen and sworn. ‘‘(E) APPEALS.—An affirmative vote of 2 three-fifths of the Members of the Senate, duly 3 chosen and sworn, shall be required in the Sen- 4 ate to sustain an appeal of the ruling of the 5 Chair on a point of order raised under this 6 paragraph.

[Shauru]

[SARCASM/]That quote wasn't loaded. And the phrase Death Panels must be in the legislation, it certainly sounds like legal mumbo jumbo.

Congress? Not acting together in harmony on the capitol hippie hill? No way man.[SARCASM]

I'm having difficulty in finding just what this refers to in the exact bill. I will continue to search, but if you would care to provide me with the actual part of the bill that this section is protecting from changes, perhaps a real discussion can be had.

[themuzicman]

	Section 3403 of Senator Harry Reid's amendment (page 1020)

.

[boldbidder]

	Originally Posted by Warrior To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	I was looking to drop insurance (at least for me and my wife, had not decided on the kids yet) and pay cash for my health care to save money anyway. If I am forced to have insurance, that will represent a considerable cost delta.

Are you serious? You realize the negotiated prices the insurance companies pay vs what an average citizen would be is often a 3X or more difference. So in effect by not leveraging the sham power of insurance companies you would instantly be paying 3X or more for any medical care, prescriptions would be be even worse. I think you should retool your calculations.

Recent personal example, a few weeks ago my wife and I went for our level 2 ultrasound. The raw cost (the bill we would have received without insurance) would have been $2700. The billable rate to our insurance provider based on their negotiated prices was ~$800. Now granted, one isn't having ultrasounds performed every month normally, but such cost variances are present across the board.

[Mullanaphy]

Boldbidder, part of that issue is due to the problems of insurance in the USA. Definitely we probably all agree that reform is in need.

Anyways back to my reply. The prices you get from hospitals are usually negotiable as well and then dependent on what you can pay. Had an ER visit that was billed at ~$1,000 down to less than half of that (~$300) after dealing with someone in the bills department.

I think the discrepancy in the bills are due to the fact that the hospital knows that they're going to get the money from the insurance company while the average joe that comes in not so lucky. So in a way to balance it out they'll charge a lot more to make up for the difference, which ends up screwing over the honest people...

[Shauru]

Originally Posted by themuzicman To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.

The poor are already covered. it's called MEDICAID. This it the big secret in all of this: Those who aren't covered are either the young (18-25, about 40% of those without coverage) who refuse medical insurance (which congress is trying to FORCE upon them), the self-employed, who, again, choose not to have it to save expenses, and those who work for companies that aren't large enough to afford health insurance for their employees. These folks have enough income to not qualify for MEDICAID (which means they aren't poor).

As I have mentioned before I'm open to some information. Can you provide the statistics on these claims? Preferably one from an independent analysis rather than your usual conservative sights?

[nacht]

	Originally Posted by Lucid To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	This version of the bill does very little except provide the health insurance companies with more customers and allows them to operate from states with the lowest regulation standards.

It does quite a bit more than that (starting with a significant amount of money to poor and sick individuals), but the exact details on what it does will depend on the final unified version.

Essentially we would raise the number of covered from 83% to 94% with government subsidies to help purchase coverage. It removes the ability to deny coverage based on pre-existing conditions or to charge at a different rate based on either pre-existing condition or gender (2701.a in the version I am looking at) . There can also be no lifetime limits on coverage (2710, though I believe yearly limits are still in there).

That, by itself, is huge. It also provides a huge amount of money to the poor and sick, which again is huge, while simultaneously reducing our deficit (according to the CBO's reports).

The health exchange is still in there as well, even if the public option is not.

	It does nothing to control costs,

Well, not
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. They have a few in there (e.g., the excise tax), albeit not as many as I would like.

	yet includes a mandate that we must all pay the health insurance companies whatever they charge and will provide subsidies to those companies in order to cover some of those who cannot afford the coverage which will be required by law.

I'll note that the mandate is part of what will keep costs down due to the way risk pools work. Meanwhile the cost for not buying into insurance starts out at a rather paltry $95 in 2014 and rising to $750, and those who can't afford it are still helped by individual subsidies. It doesn't really seem to do all that much to line insurance companies pockets in ways they aren't being lined already.

It is not ideal, admittedly, but none of this is in any way new: Most of it has been in the bill since the beginning in one form or another (some of them much worse).

I'll also note that in the scheme of incremental changes: Get this kind of thing passed, and then you can force through modifications (e.g., a strong public option) based on the reconciliation process. This is an arguably better strategy than letting the severely crippled public option pass that is likely to actual get 60 votes in the senate. If this doesn't pass, then that route is dead in the water and the political costs to actual getting health care reform passed will be tremendous (remember the last time this sort of thing was attempted was in Clinton's first term).

See also:
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.

---------- Post added 12-22-2009 at 12:55 PM ----------

	Originally Posted by Mader To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	And, of course, Congress is not at all concerned that requiring folks to buy health insurance is unconstitutional. Why would they worry about a little thing like that?

I am not at all convinced by the arguments I've seen that this is unconstitutional, at least based on existing jurisprudence.

In United States v. Kahriger (1953) it was ruled as acceptable to have an occupation tax on people who ran gambling establishments (collected wagers) and it is almost certain that such a requirement can be classed under the commerce clause.

	Originally Posted by Mader To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	What are they going to do when the Amish refuse to buy health insurance? Put them in jail, put a lean on the farm?

Neither. A little minimal fact checking is a good thing here.

First, there is a religious exemption to the mandate (In H.R. 3962, Part VIII, Sec 59B(c)(5)). Second, it is specified as a tax (the value for which I keep hearing bandied around for individuals is $95 in 2014, $750 after that).

[Shauru]

	Originally Posted by themuzicman To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	.

Yes but that only restates the quote you provided early. It only talks about the limitations on changing recommendations made by the board. It does not tell us what board it is referencing directly. That is why I asked.

As far as I'm reading it, which could be wrong. It is merely suggesting that they can't directly go in and change parts of the bill. They can only change the part of the bill that says they can't directly change the bill plus caveats. It just seems like they've added an extra step to any changing the bill.

Am I getting this right? Someone?

[boldbidder]

	Originally Posted by themuzicman To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	These folks have enough income to not qualify for MEDICAID (which means they aren't poor).

So making more money than the min threshold for Medicaid in no way affords you the opportunity or eve the resources to get health coverage. You realize there's a reason that 70% of bankruptcies in the US are the result of medical bills. That doesn't just happen to the poor and semi-poor. Boatloads of well to do families have had their assets decimated by medical bills, and thats even with coverage. This doesn't even include those who have some sort of condition that would make them uninsurable. This notion that somehow not qualifying for Medicaid makes you wealthy enough to buy your own insurance in the current market is laughable.

---------- Post added 12-22-2009 at 03:07 PM ----------

	Originally Posted by Mullanaphy To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	Boldbidder, part of that issue is due to the problems of insurance in the USA. Definitely we probably all agree that reform is in need.

I understand the intricacies of the mechanism quite well. I've spent a good portion of my career working for pharmaceutical companies and medical device manufacturers and I've seen first hand the silly crap they pull on hospitals (like reselling a $400 low end Dell PC as a "medical grade" workstation for 3K because you put a certain logo on it). The hospitals invariably pass as much of this cost onto consumers (patients) as they can, but they'll settle for volume in the form of certain insurance providers in exchange for charging lower prices. The individual who wants to just go pay cash is the one who gets really screwed. Honestly if I only had to pay the Aetna negotiated price for everything, I wouldn't have a problem with only carrying catastrophic style coverage and paying cash for everything else.

[thod]

I thought it was a general principle that no assembly could limit the decisions of those that may follow it. This would be saying that the assembly of today is senior to that of tomorrow. If you had a republican majority, they would pass bills saying that no subsequent democratic majority could overturn them. Thus they would forever lock the country into the republican mould, and vice versa. This is counter to democracy. Your great grandchildren must choose themselves the rules under which they wish to live and not be constrained by the wishes of dead men. The dead have no opinion, no voice and no power. Government is about the living.

[Ray9]

	Still not a fan of citing any sources, are you? It's not hard to do. Watch-- Most Americans do in fact want a public option, according to this and this poll. These polls indicate that Americans do not like the versions of the bills that do not have a public option.

The most egregious aspect of this healthcare bill is that it is opposed by the majority of the people who will be affected by it. It's going to be passed-if it passes, in the middle of the night when few are watching because this is how socialist beaurocracies work. As in socialism/communism the elite minority who will put the bill into effect are unaffected by it and protected from it by virtue of their elite status. It can't be stated emphatically enough that is is really not about healthcare at all but a mechanism for the expansion of government and a once-in-a-generation opportunity to transfer power from the individual citizen to the power elite. If one listens carefully to the comments made by the bill's supporters it is clear that they believe the average citizen is not capable of self-determination and so decisions must be made by a tiny nucleous of of empowered individuals against the will of the citizen for his own good. This is a wake up call for anyone who wants to remain free from the paralyzing drug of central planning that saps the vitality of many of the world's societies.

[nacht]

	Originally Posted by Ray9 To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	It's going to be passed-if it passes, in the middle of the night when few are watching because this is how socialist beaurocracies work.

Actually it's going to be passed--if it passes--at
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, not midnight. The only reason it is being passed so close to Christmas is because they are trying to get it done by the end of the year and the GOP has been throwing every tactic in the book, including
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, in order to push it off until next year.

	As in socialism/communism the elite minority who will put the bill into effect are unaffected by it and protected from it by virtue of their elite status.

That tends to be true in capitalist societies as well and has nothing to do with "socialism/communism."

	This is a wake up call for anyone who wants to remain free from the paralyzing drug of central planning that saps the vitality of many of the world's societies.

The rhetoric here keeps getting thicker and thicker but the substance is getting thinner and thinner.

Triumphant rhetoric is very dangerous when it isn't backed up by facts.

[ATCGs]

This bill is absolutely still worth passing. It will enable my fiance to get coverage (which she can't now, because of a pre-existing condition), and, once able to get coverage, to actually be able to afford that coverage. Instead of the current state of affairs - which involve us hoping beyond hope she doesn't get sick, pregnant, etc etc - we will actually have insurance. The only problem i have with the bill is that it doesn't take effect until 2014 (or even 2013, with the house conference changes being considered). We need help now.

But we'll take what we can get. F***ing republicans, (and that g-d independent. I'm moving to CT).

[reb]

	Originally Posted by Mader To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	If you get hurt by a doctor/hospital, you can sue. The attorney who represents you, generally speaking, get 50% of any damages awarded to you. So, if you fall and break your leg, sue and get $5 million dollars, your attorney gets $2.5 million of that. Nice work if you can get it- tort reform should be included in any bill.

Mader, we have 'tort reform' here. 3 years ago, when an ent messed up my sinuses, i consulted an attorney to see what i could do about it. the attorney told me 'for all practical purposes, doctors are untouchable in the state of texas. have to have several doctors to testify against the one who did wrong, and you won't find them. cost you perhaps $50k to get to the court to start with.'. so, along with my insurance company, i paid for the corrective surgery myself. there is no price that can be put on the two years of my life i've spent trying to recover from badly infected, sealed up sinus cavities, had i been able to get to court.

be careful what you wish for.

[LaoTzu]

	Originally Posted by themuzicman To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	It has already been demonstrated that governments cannot effectively run health insurance or health care. Just look at government run health care around the world.

As a Canadian, I would just like to say you don't know what you're talking about.
If you're happy to pay a middle-man, then by all means continue. But leave us out of it
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(no rebuttals needed, we can agree to disagree.... just mind your manners when trashing what amounts to the 'rest of the free world')

As for the OP: I wasn't going to respond, because ... well I have no sympathy either way, I don't care what the US does (though I have opinions).
I understand the reasoning behind your post, and why it is relevant; but if every rich person stopped giving to charity, the missing funds would eventually come out of government funding anyway; and so the cycle would continue (you would find yourself paying more). It's in your best interest to continue the lie that charity makes up for a lack of social services...

[hubcap]

Whichever bill is ultimately passed by this congress and signed into law by Obama is simply a means for the government to take over 1/6th of the economy of the United States under the guise of altruism.

It is obvious from the buyoffs that have taken place in order to get the necessary votes that what's best for the country at large has nothing to do with it. It's all about what's expedient.

There will be no cost savings to the taxpayers. Ultimately we will pay more in taxes which will slow any recovery to the economic recession we are currently facing. The unintended consequences of the passage of this bill will come to roost and all the politicians who supported the bill will run for cover and scream that it's someone else's fault.

The only positive thing that will likely result is that a bunch of the politicians who vote in favor of this monstrosity will likely be looking for new jobs after the 2010 election.

[Blum]

Is it true that they are going to force all americans to buy health insurance, even if they don't want it. If that's the case, I may be going to jail soon after this bills passes.

[RBM]

	Originally Posted by hubcap
	The only positive thing that will likely result is that a bunch of the politicians who vote in favor of this monstrosity will likely be looking for new jobs after the 2010 election.

I'd expect those politico's to find the new job's right where they have been found for several decades - in the lobbying industry.

[Mader]

Point taken Reb.

However, John Edwards paid for his house with lawsuit money. Probably paid for some of those $400 haircuts, too. We often think of lawyers as either ambulance chasers or hero's in our moment of need. Well, they are both, but they are businessmen, they need to bring in work so they can pay their own mortgage. Sometimes they are not concerned about the big picture, they want to have some extra money at Christmas time. Reasonable suits are justified, $100 million suits, with the lawyers getting 1/2 are not justified.

Currently in my family. Young married couple, both under 30, both lost their jobs in March 2009. Both currently receiving unemployment. Two young children. Mom and child qualify for TennCare (our version of Medicaid), Dad does not. Why?

so, yes, the system needs to be updated and tweaked, but to try to make massive changes, wit the internet posting all the special deals that various states are getting, voting at 1am, THIS bill is a very bad idea. Bloggers on both sides will be going nuts, and I suspect that some good people will lose their Congressional seats because of the way this bill is being handled.

And, illegal aliens are still eligible. What about the Americans who still do not qualify????????

[Lucid]

	Originally Posted by hubcap To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	Whichever bill is ultimately passed by this congress and signed into law by Obama is simply a means for the government to take over 1/6th of the economy of the United States under the guise of altruism.

Considering that what the bill in question does is actually strengthen the private health insurance industry.... how do you figure it's a "government takeover"? It seems more like a corporate takeover to me.

[themuzicman]

	Originally Posted by boldbidder To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.
	So making more money than the min threshold for Medicaid in no way affords you the opportunity or eve the resources to get health coverage. You realize there's a reason that 70% of bankruptcies in the US are the result of medical bills.

Which is a good reason to have insurance against the catastrophic loss.

That doesn't just happen to the poor and semi-poor. Boatloads of well to do families have had their assets decimated by medical bills, and thats even with coverage. This doesn't even include those who have some sort of condition that would make them uninsurable. This notion that somehow not qualifying for Medicaid makes you wealthy enough to buy your own insurance in the current market is laughable.

And, unfortunately, that's where we are with medical technology. It's expensive. But, as I stated before, the solution isn't to force everyone to have insurance because insurance is inherently more expensive than paying for it outright.

So, rather than overhauling the entire system, altering how everyone received insurance, let's create a program for those with long term, chronic and uninsurable conditions, who lack the assets to pay for them. Solve the small problem, rather than creating a huge one.

But this isn't the big problem we're trying to solve. Rising medical costs, as I've detailed before, are the result of Americans being overinsured due to huge government tax breaks offered to businesses. That solution is arrived by less government, not more.

---------- Post added 12-23-2009 at 06:41 PM ----------

Originally Posted by LaoTzu To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.

As a Canadian, I would just like to say you don't know what you're talking about. If you're happy to pay a middle-man, then by all means continue. But leave us out of it To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts. (no rebuttals needed, we can agree to disagree.... just mind your manners when trashing what amounts to the 'rest of the free world')

I would prefer to pay the doctor directly. However, $12000 is taken from me and given to an insurance company, and the only way to get at it is to use medical services.

As for the OP: I wasn't going to respond, because ... well I have no sympathy either way, I don't care what the US does (though I have opinions). I understand the reasoning behind your post, and why it is relevant; but if every rich person stopped giving to charity, the missing funds would eventually come out of government funding anyway; and so the cycle would continue (you would find yourself paying more). It's in your best interest to continue the lie that charity makes up for a lack of social services...

It's also in our best interests to get the government to stop giving businesses huge tax breaks to offer "insurance" for things that we don't need insurance for.

[reb]

Mader, i understand what you are saying, and agree. everything i have seen politicians do in my lifetime has had at least one element (and usually many) either left out, perverted or messed up. short sighted fools playing for votes, and getting reinforcement from those 'who still believe'.

i'm waiting to see what happens. i have what i would call 'decent insurance', and i can't get good healthcare. i can get 'pills and shots' and both are of dubious value. i cannot imagine how anything the fools in washington can do is going to improve anything. it's a mistake to have either of these parties in power to the extent they can do anything more than what they've already messed up.

do you know if this bill is going to give you some insurance coverage? i know of a couple people with no insurance (through no special fault of their own). if those folks do not get some kind of coverage, i will see this as 'another total failure of our leaders'....and i use the word 'leaders' very, very loosely.

[nacht]

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, where he points out that:

Firstly, I don't think you can make a credible argument that the bill will leave poor people worse off. The bill provides To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts. to working-class people, in some cases providing them with in excess of $10,000 worth of assistance per year. Perhaps more importantly, as Jonathan Cohn and Jonathan Gruber have outlined, it To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts. to lower-income families because of annual caps on out-of-pocket expenses. And -- something that hasn't gotten enough attention -- the bill increases the Medicaid threshold from 100 percent to 133 percent of poverty; about half of the assistance in the program is devoted to that Medicaid expansion. Now, you can certainly argue that the bill is not quite generous enough -- I wholeheartedly agree with that position, and hope that the subsidy levels can be improved, particularly in the 133-250 percent of poverty range. There have been To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts. , however, to conflate the maximum amount that people might have to pay under the bill with the amount they will usually pay. In a typical year, a family of four making $50,000 will have to pay about $300 per month in premiums to cover the entire family. That compares with a retail cost, before subsidies, of about $1,000 per month. They'll probably also bear some out-of-pocket expenses. But no matter how bad things get, a family's exposure is limited to about 20 percent of its annual income. That compares with the status quo, in which even an insured family can bear downside risk of as much as 68 percent of its income, and in which an uninsured family has essentially unlimited downside risk. I don't mean to suggest that 20 percent of one's income is pocket change -- especially given how little savings the typical American family has -- but it's potentially the difference between having to cut back on vacations, entertainment and meals out versus filing for bankruptcy or losing one's home. Secondly, I don't think you can make a credible argument that reconciliation is a smart strategy. You can certainly argue that reconciliation is possible -- meaning, that you might be able to pass something that you call a health care bill via reconciliation. But I've not seen a persuasive case -- or even really an unpersuasive case -- to rebut the To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts. that what reconciliation would take out of the bill (most notably the exchanges and the protection for people with pre-existing conditions) is better than what it might be able to put back in (a middling public option or Medicare buy-in). Nor have any of the structural problems I've pointed out with the more "creative" versions of reconciliation really been addressed; people have just dropped the argument when I've pointed out these problems. Although, with the Senate's passage of the bill this morning, this has probably become a moot point. Thirdly, I don't think you can credibly argue that the bill would be improved -- policywise -- by dropping the individual mandate. You can argue that dropping the mandate makes political sense. You can argue that we can add the mandate later. You can argue that the mandate should be restructured. You can even argue that it's morally unacceptable. I'd disagree with most of those arguments, but you can make them in good faith. But fundamentally, you can only get (at most) two out of the following three things: a bill without an individual mandate; affordable health insurance; coverage for people with pre-existing conditions. This is To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts. . (In the status quo, we sacrifice coverage for people with pre-existing conditions and arguably affordability, especially for those on the individual market.) you want to argue that the Senate's bill is worse than the status quo, or otherwise an unwise choice, without resorting to any of these three arguments, then more power to you; we're in disagreement, but we're having a logically coherent discussion based on different preferences and priors. And if you want to argue that the appropriate progressive reaction to the bill is a lukewarm one, and that it would be premature to celebrate while the bill can and should still be improved, I certainly don't have a problem with that. Implicitly, in fact, that's what a lot of people -- particularly Markos, Howard Dean, the unions, and Darcy Burner but also many others -- have been saying all along. The differences I have with those folks are more semantic than substantive, and I apologize to anyone to whom I've conveyed the wrong impression.

This, I think, covers the key points. It is very, very difficult to make the argument that "all" this does is help insurance companies, that this does not contain a lot of good improvements to the current situation, or that it somehow doesn't constitute "reform" at least in the context of what we could expect.

This is not to say that there isn't room for legitimate disagreement. That this contains all of what one might want, or that this is what I think is in any way best for health care reform or that this is necessarily the best approach. There is a great deal of room--outside of these arguments--to argue that it is worse than the status quo, or any number of other things, and yet I keep seeing these arguments made by progressives against the bill.

It is, however, consistent with what I expected to actually be passable and with what was being negotiated previously, and has quite a few things that were and still are goals of health care reform. It is also the best chance we have seen to reform these things in 15 years, and I do not believe we can wait another 15 years if this were to fail.