Acknowledging Obama's failures

I'd appreciate it, in light of the travesty that is this healthcare bill, if one could point me to a convenient list of doctors who will perform Essure procedures on nulliparous women in their 20s.

Well said. But add one more item about education for completeness sake. By appointing Arne Duncan, President Obama is continuing Bush's efforts to turn the Department of Education into another agency of corporate welfare. By refusing to significantly modify NCLB, he also is constructing a national education plan that gives minority children a anemic version of the rich education that his daughters get. The irony of a black President doing this is stunning.

Politics is the art of the possible. Given the circumstances we are damned lucky with Obama. At least the smart guys run the shop for once in a generation. Like sausage crafting legislation is best not directly observed. Yet this bill is the ONLY thing to come out in fifty years so it is still a hell of an accomplishment given the opposition from assorted teabaggers, birthers, and other assorted wingnuts. Like social security and medicare the point is to get the bill, in the following years we can start to take some of the bad stuff out and try to get better stuff in.

carl: Much more was possible but it wasn't wanted by the Obama team. That's the long and short of it. Shoddy goods.

The Republican Party will cease to exist before Obama leaves office. The Blue Dogs will split from the Democrats and be the new opposition party. That will be the end of wing nuts in national politics. There is no way that Obama will be a failure. You have to be patient. It's just too soon for Obama to challenge the Pentagon on Iraq and Afghanistan. It would only give the wing nuts an issue to keep them alive. Give him time. He told us some things would have to wait for a second term.

Robert: Obama was crystal clear on his Afghanistan policy during the campaign. And there are plenty of ways he can be a failure. He failed on health care (a subject he never cared much about, IMO, and again for which he had a lousy campaign position). He and his team have given away much they didn't have to give away. They did it because they wanted to give it away. Rahm Emanuel and that crew don't agree with me (and probably you) on this. They are conservative Democrats and bought and paid for. The Republicans, of course, are even worse. But we should be clear-eyed about this and not invoke the Good Czar and the Bad Minister scenario.

Your contention that Obama gave away much on health reform that he didn't have to give away is, in my opinion, simply wrong.

Witness that the current bill only passed by only a few votes in the House. Witness the difficulty in getting 60 votes in the Senate.

The reality is, the U.S. political system is set up right now so that it is very difficult to get ANYTHING done.

You favor single-payer health care. So do I. But how many votes do you thing single-payer could get in the Senate? I would be surprised if it would get more than 35. I doubt if it could get more than 150 in the House. It wouldn't make much difference if Obama gave the best speech in the world in its favor, and ran the best grassroots campaign in its favor, there simply aren't the votes to come close to passing anything close to single-payer right now.

Whatever the faults of the current health care reform, at least: (1) many more of the uninsured will get covered; (2) there are provisions to limit the ability of the private health insurers to cherry-pick risks. Both of these provisions can be strengthened over time.

Politics is the art of the possible.

Obama gave away the reproductive health of 51% of the nation. Some bargain.

rdaneel: They could have started with single payer and wound up with a better public option. They could have fought for it. They didn't do either. And the Stupak amendment? I think much more was possible than this. But not if you don't fight.

In my opinion, if they had started with single-payer and fought for it, they would have wound up with no bill at all.

The notion that "fighting hard for the ideal" leads to anymore than a glorious defeat is, in my opinion, incorrect.

This isn't only my judgment. Read Ezra Klein's blog at the Washington Post or Jonathan Cohn's blog at The New Republic. I think both Klein and Cohn know much more about what is politically feasible in health care reform than I do, or, as far as I know, than the writers of this blog do. Your expertise in public health does not give you expertise in health care politics.

Do you really favor "no bill" over the House bill or the Senate bill? If so, why? How can you possibly prefer no bill to a bill that would, according to the CBO score of the bill, extend health insurance coverage to millions of Americans?

I prefer half a loaf or even a quarter of a loaf to no loaf at all.

rdaneel, in this area I tend to agree with you. But revere(s) are right to be angry. just because this is the best we can get is no reason to be thrilled with it.

My further comments here .

Discussing the health care issue as a failure of Obama is too narrow minded for my taste.

I view the failure of healthcare reform as more of a reflection of the people of america.

We have allowed the discussion of health care reform to devolve into something that is intellectually embarrassing.

Death panels, "keep your government hands off my medicare", free markets for healthcare and so are all social placebos, distractions from the real issues.

No where in the discourse is there any suggestion of using the available evidence from other countries who have successfully implemented health care systems that are almost unanimously factually analyzed to be superior to our own.

And now, great, we're back to debating abortion, which is what like less than 0.01% of all medical procedures and expenses?

Awesome.

DemFromCt: If all that revere was saying is that he/she was angry and disappointed in the health care reform bill, I would have no quarrel with that sentiment. There are some real problems with our political system, and it is frustrating that we can't get a better health care reform bill.

But revere seems to be saying something more: (1) Obama didn't want a better health care reform bill than this, and (2) a significantly better health care reform bill than this was politically feasible. Furthermore, the post certainly implies that the current health care reform is NOT important and meaningful. I think all these propositions are wrong.

Perhaps anger has led revere to overstate the situation, but I think we need to "keep our eyes on the prize", and try to move forward as fast as we can. We need to have a clear vision despite our anger. This health care reform bill, if it passes, is not the end of health care reform, but the beginning. On the other hand, if it fails, we will not have any further effort at progressive health care reform for a long time.

Chris, abortions are more common than heart surgeries in the United States.

rdaneel: (1) I don't think he cared enough to get a better one. He didn't campaign for one and he didn't fight for one; (2) we'll never know, unfortunately; (3) Is it better than nothing? In some ways it's a step forward, although the abortion amendment -- which probably won't get fixed -- is a huge step backward, so we're balancing incommensurates. But there is also the question of opportunity costs. Will passing this crappy product (that does have some important and good features) prevent further progress? Ezra Klein does know a lot about health care politics. Jon Cohn? Not so much, IMO. But we can still differ on this, while acknowledging that we'll never know. I am not of the Candide School of politics, however. This is not the best of all possible worlds. I think there were possible worlds that were better.

He is a man of action. He is a man of mystery. He's a doctor. He is not edited but re-arranged.

AND HE'S PISSED, about to prescribe a whole can o' whoop-ass to cure your political impotence! Coming to Capitol Hill this holiday season, "Dr. RAMBLE-O, PhD."

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The worst Democrat is still better than the best Republican, but again, who isn't? No President in history was as bad as George Bush, so not being as bad as Bush is a stupendously low bar to meet. The thought of a McCain presidency makes my blood run cold.

That the Democrats would be crappy was also expected and that Obama would disappoint us is no surprise. There are a lot of terrific Democrats, but they didn't prevail, although they could have if Obama had helped, but he didn't. More to the point, the worst Democrats are also stupendously bad on their own.

No one should be surprised. On two of the most important issues -- health care and Afghanistan -- Obama's positions were the worst of any Democratic candidate and he's continued to have lousy positions. Obama and his rascal Chief of Staff Rahm Emanuel could have prevented the substandard health care "reform" bill it looks like we are going to get; but Obama and Emanuel didn't want to prevent it.

All that said, we're still glad Obama was elected. I was sentient during JFK's presidency. The sixties changed the face of this country and the desire for change unleashed by the Obama campaign can and may well do the same. Much of the change in the sixties came from a Hope that appeared to be unrealized.

If we could tell the future we'd be rich now. We're struggling like so many others. We're pissed and going to take it out on Blue Dog Democrats. The Republicans aren't even in the picture, they are so crazy.

I'm a doctor. And I'm really pissed.
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My concern is the focus in this Bill, and in the national debate, on health insurance reform, rather than health care reform. Even the most left-leaning position seems to assume that the "best" option is "single payer" health insurance, assuming that everyone needs health insurance. In fact, what everyone needs is health care. Insurance is just one means to pay for that. What's wrong with a VA-style "single provider" health care plan?

I've had both fee-for-service health insurance, and HMO-style health care. While they both have their problems, I much prefer the HMO-style "single-provider" mode. If I had a problem, I could argue with them about the care, or the doctor. Now when I have a problem, I have to argue both about the care and how to pay for it. I never spent so much time with stupid insurance paper work when I was with an HMO.

Do we really need to have, and pay for, an additional layer of bureaucracy on top of providing health care?

When this bill passed the House yesterday, my blood already ran cold. A year ago, briefly I believed the Left and leftwing Democrats had produced a working coalition; once the Emanuels and Orszag and Summers got in as advisors, it was clear the conservatives--and the big, big donors--still were calling the tune. A couple of posters here ask what's so wrong with the House and (expected) Senate bill. Ask any woman, for starters. Then ask a senior who, turning to regular Medicare after his Advantage program is eviscerated, finds his tests or specialist visits 'waste-control'led to rarity. Or a family mandated to support the insurance industry by buying the only, substandard, health coverage they can afford, then forced--even as now--to choose between getting a noncovered procedure and paying the rent. Ask someone in her late 50s whose age-based premium costs will still leave her eating dogfood. Ask. . . but you all know all this. Is it better that Obama get this bill through than that he fail and leave those--not yet down and defeated, Revere--far rightists and Republians to win big three years from now? Yes, obviously, but . . . the cost in lives is already so huge. I hope you are right, Revere, and what has been done to healthcare reform will stir another Sixties. Truly, I hope this. But for last night, I just went to bed and cried.

It's been reported that the Obama admnistration prevented a vote on an amendment that would have allowed states to implement their own single-payer systems (let alone any pressure that might have been/probably was exerted on Weiner to not put forth his federal single payer amendment.)

What more is there to say ?

Isn't amazing that the Dumbocrats always sneak things in at midnight so the people have no input? Thanks to Nancy Sneaker of the House Pelosi.

Oh, my blood wasn't cold... It was boiling. All of the money in this country is going to go resident with the government and the Dumbocrats just don't understand what its going to do. Its going to suck up all of the money... period. Very few of you read the bill I can see. 1990 pages of pure horse shit that unless removed and done away with totally ...Well Revere you might get to see a civil war in your lifetime or a breakup of the US. Who is going to pay for this crap? Can you tell me how many people can afford 15,000 a year? How many can afford 1/2 of that? Please oh left wing ideologue

15,000 for a family of four making 80,000. THEN THEY ARE GOING TO TAX YOU ON THAT TOO ! So your 15,000 is now income even though you paid it out. Same and more tax than that if your employer pays for it. How long do you think the system is going to work. The revolt will be almost instantaneous.

How nice that all of these people who signed on to this particular abortion bill failed to understand the implications. The rank and file doctors are leaving the AMA because they got it...As did most of the sentient seniors in AARP. Obama bought their country asses off in the management. What quivering little piles of goo they are. Quick send out for me to get my white coat, because I will be qualified to practice medicine too. Yep, faith healing is in there. Shit they will be running to let people go to faith healers because well it wont cost them much.

This is as bad as the goddamn stimulus bill.

Oh, I'll be laughing my ass off when the first government official shows up to arrest someone for NOT buying insurance down South. They might get one or two to go peacefully, but the result is that they are going to need a lot of body bags old friend for both civilians and the Obamastapo. After a while they will figure it out and this left wing masturbation session will end and likely permanently for a lot of people. One way or another this is going to end and soon. Either from financial ruin, GDP falls to negative, or they will spend us into 3rd world nation status.

Nope, I think this is the final straw. A Communist regime is in place. There is only one other system in the world that does this kind of stuff and Revere you are happy to point out that its a Communist one and you give glowing reports on their system. Have you ever been there? Health care is not a right, its a privilege and the privileged are going to be the ones who get the care while the rest of us drink out of flowerpots when we cant get someone to bring us water. As they do in the UK...Their answer... We're sorry, it wont happen again. Sometimes its better to do NOTHING.

When the real costs come to light there is going to be hell to pay and this will go the way of TennCare and the Dodo bird...Its already falling apart in Massachussetts, cost overuns by the tens of billions... Not millions BILLIONS and its only been in place for two years.

Yep this will go or the government will as you know it. Sovereign states laws and Soto Mayor. They might try to actually say we are not really states but that we belong to someone else... the USGovernment. Kind of like the money in someone's pockets that government says is someone else's. Redistribution..?. Fuck me but this is nothing more legalized theft.

It will tank the economy in under two years, they'll say we have to pay more and then when there is no more money to take in taxes because people will not be able to live...They will ration it. Forget it Social Security types... You are screwed and big time because they are only going to spend a certain amount of money on you after 65. Thats it...Fixed number. Need that hip fixed ...fuck you. Need that cancer treatment? Fuck you. You cost too much to maintain.

If nothing else you people and specifically you lefties need to quit pontificating and RTFB.....

READ THE FUCKING BILL !

No, I can tell you that the layoffs you are seeing now will pale in just a couple of years as this walks its way into the history books. The country will fail simply because we will take the money, spend a certain part of it on healthcare and then steal it for something else. Like Chris Dodds favorable interest rates, or Barney Franks little dacha with his boyfriend. Or my absolute favorite....Timmy Geitners Christmas Bank list. All of the great hedge funds are in it.

Remember to have a democracy you have to have a large, well educated and affluent middle class... This will finish it off. The idea is that this is going to increase your standard of living.. Not a chance. It means many people will just collapse in an ER just to get a meal. Remember it took only 7 years for Tennessee to collapse under the weight of a LIGHT system of this kind of care. It was 500 million in the hole in a state of only 6.5 million.. How many payers do you see in that mix? We are still paying it off and thats from 5 years ago.

The Marxists are in charge until November of next year and there will be absolutely no capital spending now so the economy is going to tank not later than March. Lets not forget our pandemic either, it can hasten the demise of this experiment in health care. The end result will be bankruptcy for the country times, well more like exponentiated than times. I personally think its a well orchestrated game that is being pushed by the UN. Another little group that needs to go.

Stick around. If it passes the Senate then I will put everyone on part time, provide no insurance for my people and just hasten this on out the door. Wont matter anyways. Its all based upon income and no one is going to have any except for the filthy rich who will get richer from the latest sock it to the people routine. I laugh at the idea of paying for it with taxes on everything that moves and doesnt move. Spend, spend, and then when there is for sure no more money, spend some more. I guess in high school and at UMass you dont have to take economics to get out of there.

I dont recommend anyone put a foot on my doorstep telling me that they are going to arrest me for not paying for health insurance. Going to need a few more joes than what they can show up with after the first couple of weeks. I wont be the only one either.

But the worst part is yet to come. That will start when the unemployment rises to 15%. I wouldnt give you a plug nickel for what happens then. First will be they gut the military. Oh we are already out of Afghanistan, you saw it when he didnt deploy them.. Costs too much. Next will be that everyone gets a check. Said check will be in Zimbabwe million dollar notes to buy bread because the inflation rate is at 1000 %. Then we will see the final straw when the Russians come rolling back into the EU, and China moves on SE Asia again. But this is the future... its a prediction. It still has to clear the Senate and it might not.

Sometimes its just better to do nothing as I said. Have to have a country with a strong military to have freedom folks. What they are talking about is using the military on their own citizens.

Wow MRK, I used to think you were just misguided, but now it's clear you're completely fucking batty.

There is nothing inherently wrong with the blue dogs, in my opinion: they merely represent a fiscally-conservative wing of the party. They were on the wrong side in this debate, but this debate was never going to produce what this country needs. The Republicans are focused on something that they can all readily agree on: stopping anything from happening. The dems, on the other hand, are fighting over something that is hard to agree on - doing something, and the details of what should be done. Therein lies the familiar problem regarding why the dems can never accomplish anything, even before the Repugs get warmed up.

I'm terrified that the Repugs aren't done politically. We may see the ultra-conservative, theocratic/fascist wing of the party split off. But I would go so far as to say that there is no candidate from the traditional two parties that is worth supporting right now because of out-and-out capture of our government by corporate moneyed interests. Yes, this country desperately needs a single-payer system. Yes, this bill is a train wreck. Yes, I was angry and disgusted that either the Afghanistan or Iraq war was started: I could never see how killing women and children would bring back the 9/11 dead. But none of those is going to get addressed until there is a fundamental change in how much abuse the American people are willing to take, and some concrete measures to change the entire culture of DC.

The House bill passed with 220 votes. It would be nice if critics would indicate how they think a better bill might have passed. It seems to me there's far too much easy ranting going on and it strikes me as a bit childish. You know, women who have no health insurance at all already don't have abortion covered under the status quo. The bill is far from perfect, but I understand that it does begin to achieve the goal of expanding coverage and bending the cost curve. Given that an imperfect bill has barely passed there seem to me to be two potential responses: (1) redouble our efforts to elect more and BETTER Democrats that will expand the public option, repeal Stupak, and tie reimbursement to Medicare rates, or (2) complain and undermine the Dems in 2010. I don't see how (2) helps achieve any progressive goals, but it does feel nice to indulge indignant moralizing and its a lot easier than ringing doorbells.

If you think that any of the other Dems would have passed any bill at all through the House in the first 10 months you're nuts. This is a stunning political achievement. I wish better could have been done. I just don't see how.

jrshipley: The vote was what it was. The question is whether it would have been different if the Obama team had fought for a much better bill rather than continually compromising. The idea that this as the best that could be achieved is a self-fulfilllng prophecy in the view of some of us. There will be disagreement about this and you obviously disagree. But what was given away -- and especially the abortion amendment -- makes this bill so flawed as to call its total value into question. News reports indicate that there is a lot of other business friendly crap hidden in it as well. The lobbyists got what they were after, at all of our expense. If this were a Republican bill or a Bush bill (and there isn't much in it that they will have trouble with, their don't-throw-me-in-the-briar-patch pose notwithstanding) every progressive would be screaming about it.

We believe that it is of value to be clear-eyed about these things. When Democrats or Obama serve up a steaming pile of shit, we shouldn't call it porridge. That's not our function. As a progressive I vote Democrat most of the time but I'm not a Democrat. Partisan hackery is partisan hackery.

"The sixties changed the face of this country and the desire for change unleashed by the Obama campaign can and may well do the same. Much of the change in the sixties came from a Hope that appeared to be unrealized. "

Yours is a silly generation that needs to get over itself. The accomplishments you surely like from the sixties--civil rights, civil disobedience, Medicare, broadened social welfare net, Medicaid, etc.--were NOT accomplished by pied-eyed youthful hopers like yourself, but by the remaining generation of your parents, the New Dealers. I'm speaking as a twenty-nine year old Democrat, thankful Obama supporter, and pro-health care reform activist. The simple fact is that if anything gets passed it will be a minor miracle, but it has very little to do with Obama not wanting it enough. There is one reason above all others that there is no meaningful health care reform coming our way, and that his the Senate and the prevailing Senate procedural rules. This is the same body that blocked meaningful civil rights legislation for eighty years, and has stopped health reform for half a century. But that's besides the point. What were you expecting Obama to do? Wishing for something doesn't make it so, and not because you're not wishing hard enough, or don't want it badly enough, but because the wish itself is incoherent and false. Surely you realize that if John Edwards, or Hilary Clinton, had come in pushing for their stated plans this issue would have gone down in flames before it even started. Long message short: I'm proud of Obama, I'm proud of what we may just yet accomplish, and as a younger Democrat, I don't like being scolded by aged hippies who live in some la-la land where dreams and folk songs changed the world. They didn't. The only real thing your generation has left mine is mountains of debt and a splintering political system.

Well at least Revere always sticks to his guns. Its a progressive panel in the House and about 1/3rd of the Senate thats pushing this. They are Marxists.

Take the money from someone to give it to someone else. These guys dont understand simple math. If you aint got it, you aint got it. Put you in prison for not buying a state mandated program? Patently, totally, completely fukwitted thinking thats going to get someone shot the second they try to enforce it. For me it gets down to a decision, what will I do to save my country? Thats what the tea baggers that are ridiculed by the left as batty and uneducated are thinking out loud. Obviously not progressive enough for the lefties.

What would you do? Do you just comply or do you show up at rallies and send tea bags to the White House and Congress. What do you do with a Congress that doesnt pay the slightest bit of attention to the people that elected them. I havent seen healthcare rallies. I have seen anti-takeover rallies though and thats what this is. The best healthcare system in the world about to be destroyed by Communists. .

I am serious about this. The sentiment down South is that the government intrusion into our lives is about to end...One way or another. After 150 years of Po' South the jobs that ARE in the country are mostly here. This will just add yet another tier to the cost basis of operating in the US. Why build anything here? Toyota's big plant is on hold in MS now as is the one across the river in AR. Reason? Demand and cost of doing business. So lets just pile a lot more on?

This pile of crap is deliberately mandated to create an untenable public system that destroys the ability to pay for a private one with an expensive public one. It will ensure that something gives. It means that nothing else will be funded except in dragging the concrete block across the floor jerks and only in the districts that have pull in "progressive" votes. That means the ones with the most poor. That also means that they will remain poor for the rest of their lives because even if you get an education, it doesnt mean you will have a job.

Social Security and Medicare will suffer and unless you read it you wouldnt catch it.

This will suck up 50% of the income in this country by what becomes effectively a VAT at every level. Just to maintain a 10% inflation rate... I will have to raise my charges by 35% and that will be to maintain the standards that I have now and they are pretty low. Its a given that even with that I will have to cut my 100% paid for employee insurance...Gone. Hey, I have laid off 8 in the last year... Want to see what I could really do? I am an employer and not a progressive hack that would sit back and say that all things come from government. State run jobs is what we are talking about as well.

Far end progressives are nothing but Marxists/Communists. This isnt socialism that we are talking about here... Its Communist Manifesto stuff...Look that one up too while you reading the bill. Match them up with whats happened, what they want to happen. Gee B. I can read and write and while it may piss you off, you might have to look and see what it really means just in case I might be right...Go read the damned thing !

So who gets hit first? Social Security/Medicare-two of the worst programs ever thought of in this country but its there and getting rid of it would doom the seniors. But to pay for healthcare, they will have to tax that as income as well. Simple math folks. Basic service government with healthcare becoming the single facet of our lives. We will be trying to get what we pay for, they will be trying to limit what you get. And bureaucracy? Accounting for it will cost us about 2 bucks for every 1 we take in and 2 for every 1 we pay out. I read of at least 10 maybe 15 of those springing up with it becoming management by committee rather than a direct doctor to patient relationship. They will have to go begging to these committees to get a service, a procedure, a medicine. This is INSANE.

The bottom line is the costs. Only a few will ever pay into this. B-You didnt learn how to add an subtract in school obviously. All you are doing is making obnoxious statements based on flap. I read the whole bill and I still dont understand a lot of it. Subreference this, reference that, except when so and so is over the age of x gets this. You either read it or you dont. It is a pile of shit that does NOTHING to provide healthcare. Its loaded with things that have nothing to do with healthcare. Everything is a death committee, a hip committee, a doctors certification committee. Too many doctors in an area...Force them to move. They simply will not be able to survive and the quality of the doctors will drop to 3rd world nation status.

Death panels are in there, abortion, mandatory participation, arrests and guess what if you get cut at the office you still get the bill for the whole year... 15,000. Abortion? Hey, even if I wasnt against abortion as a rule I can do that math too. There are 12 seniors in 10 years for every baby being born. They will have to support our old asses and they had better crank up and make the US amenable to having babies. Most of this is the cheap seats. The really expensive comes in about 12 years.

Lets show a few more things. It gets also to the point that it districts by implications so the bozo's in say NYC get more for their people due to population than say Tupelo Ms. Very uneven, very, very political. And when the till is empty in a district, you dont get any more until the next budgeting year. Can I get my flowerpot now?

How many doctors will participate? None that I have heard of. The idea is that by negotiating rates it will drive it down. Right ! Its a demand based system. What do you do when the doctors just say no? There will be private care right up until they do away with those people too by law. You practice as we tell you too, or you dont practice. Yep, thats in there too.

They simply want you at 65 to go and crawl into a hole and die... You count for nothing in this convoluted pile of shit. Oh Revere means well believe me, but there isnt any way to pay for Social Security, Medicare, the military and now THIS based upon current incomes. You STILL have to live in the world in which you live IN. I can see at least a 25% inflation rate in our near future because we simple spend money on people and then put it into the ground with their bodies when they die. Nothing productive comes from putting gold into the dirt. Bankruptcies will rise like rockets as will the unemployment. The outlay in EVERY country that has adopted this has ALWAYS exceeded the intake. Now B. I dare you to find me a country that has this and is solvent short of Norway which has less population than my state, and about 250 oil wells going.

It goes in and in ten the US goes out. I would put it at 5 years but I can see that government will impose yet more taxes, then the system collapses at about ten. History repeating itself. Rome fell because they lost their labor pool and everyone got rights. They didnt fund the military, they fed the poor instead. Corruption was off the scale, the land was all owned by certain families... Hey I am just putting the pieces of the puzzle out there for you to start assembling. Once they are all in place you get to look at the big picture.. You wont like what it looks like as it starts to go together.

Funny thing though... Its gotten more debate here than it did on the House Floor. Thanks to Sneaker of the House Peolosi. Government should be open and transparent. Havent seen that out of the Obamanation yet.

JAC-Just another Carter.

In order to make the comment sections worth reading, it is usually necessary to moderate them, otherwise one gets lengthy screeds by mentally ill individuals like Mr. Kruger, and normal readers will give up on the comments altogether, which would be a shame. So I hope you folks might undertake some light moderation, in order to discourage the nuts from messing it up for the rest of us.

Thank you.

Brian: Yes, it's been a problem. I have told Randy several times about the length of his comments and over the years he has complied but then inevitably relapses. I have always been reluctant to moderate comments as this site has been unusual in the breadth of political views (given my resolutely Left perspective) that have been able to converse because of a common interest in public health matters. Like a lot of things in life, it's a matter of achieving the right balance and we don't always succeed.

Randy: Please don't do it anymore, out of consideration for others. A simple request.

@Kruger:

BAHAHAHAHAHAHAHAHAHAHAHAHAAAAAA!!!!

Wait, you were *serious*? Oh, dude. I'm sorry. Do the doctors think there's any hope?

But, anyway, Obama...

Um, folks, he was always a moderate. The progressives seem to have projected their hopes onto the man instead of paying attention to who he actually was. I can't fault *him* for that. And we should have known soon as he started surrounding himself with DLC dorks that we were going to be Clintonized with modifications. Such as letting Congress take "the lead" in health care reform instead of making a proposal and fighting for it.

That is, the DLC types learned the *wrong* lessons (they're good at that) from the Clinton health care fiasco. So it's pretty much inevitable it was going to be incrementalism so fine you need a microscope to spot it.

On the other hand, things could have been much, much worse. Sarah Palin could, right now, be a pace maker failure away from the Presidency...

Looking down the road to the Senate. I keep hearing that the Senate Bill has to be written so as to get a "filibuster-proof" 60 votes. And I ask "Why?" Let the Republicans (or the Senator from The Hartford Group for that matter) filibuster. Not just threaten, mind you, but make them take the floor and talk, and talk, and talk, and talk. And then make them talk some more. That will have 2 effects: 1. their constituents (and the rest of the world) will see they have absolutely nothing of substance to offer, and 2. when they finally shut up, take your 50+1 votes and pass what you damn well please.Then, go to the conference with the House and ask them if they want to side with the people with no ideas and nothing more to say, or if they want to pass a bill that benefits the people they were elected to serve.

@MoM...

Nail. Head. Hit.

My advice to the Dems is essentially the same. Suck it up and let them filibuster. Why are they so afraid of a filibuster anyway? What a bunch of wimps...

I will also agree with revere here at least this far - any one who is surprised by what is coming through was not paying any attention. Obama delivering on his promised bill of goods. In my case it is exactly what I voted for and supported but I understand why those farther on the progressive scale than I wished for something else.

Obama is pragmatic. And moderate really. Only slightly on the progressive side. As advertised.

Single payor has no chance in this country. Wish it be otherwise all you want it aint gonna happen. OTOH we can get something that gets everyone covered with a basic set of benefits and that moves a little to undoing our current system of subsidizing the purchase of healthcare the most to those who need it the least. We can get rid of pre-exisiting conditions. The sell out on abortion services sucks but this is a lot better than our current circumstance and is I think the best that can reasonably hoped for.

And I don't get why the public option is such the be-all and end-all. Really.

Don: I have single payer health care (it's called Medicare). It will happen because anything else is not sustainable.

Re comments by Mark and MoM:

I have no objection to letting people ACTUALLY filibuster, but if 40 plus people want to filibuster, they can go on forever under Senate rules. So, the filibuster does not necessarily stop and then you can pass it by a majority. You have to get 60 votes to stop the filibuster. It is not clear to me why you think that an ongoing filibuster would put more political pressure on the 40 plus who are filibustering than on the Senators who are trying to pass the health reform bill. Maybe the public would turn against the filibusterers. Maybe they would turn against health reform. Who knows?

Regarding the problem of 60 votes, Josh Marshall at Talking Points Memo has a good post on the 6 votes that are most problematic in getting to 60 votes. Seeing those 6 problem votes, and the issues they are worried about gives some sense of the political challenge in passing health care reform in a political system that has the Senate and a de facto requirement for a 60 vote majority to pass any thing. To avoid having this comment held up, you can find this Talking Points Memo post by googling "Talking Points Memo" and "Six Senators". It is depressing to see what issues these Senators are worried about.

Brian-Lets put it into a format that your dim witted little brain can comprehend. Your constant references to mental illness are pure crap and goes right to what I said about tea baggers and those that disagree with the leftists. You must be mentally ill, unbalanced to disagree with us lefites. To be able to do anything, you MUST have a country to operate from and that doesnt mean a bankrupted one. There are so many sovereign states initiatives on the boards now that if even half of them pass, there will be no US in ten years. Your healthcare crap will go by the wayside instantly when just one state says no and that means also beyond those that are saying it now.

What are you going to do, declare war on them?

What would push a state so far as to say no? Only taxation, and then the demands of the federal government imposed upon them. You MUST do what we tell you. Uh-huh.

EVERY state in the US is in deep trouble and the contributions required of each will bankrupt them. This is in addition to all of the other taxes that will have to be added just to get by. I can see you havent read anything. Come back like a good little child when you read all 1990 pages including the abortion funding strike like I have and we can have an educated discussion of it. I read it and I still cant believe it.

That includes you Mark. You are obviously not working at anything other than at a McDonalds, and your rants mean nothing to me because it doesnt go to the root of the issue.And that is that this package has been rammed down our throats in the face of incredible fire against it. Nor was it debated. It got about four hours of play and then the midnight vote. Kind of like their pay raises and THEIR healthcare that they get for life nitwit.

Oh, it might pass the Senate, but it will be ripped out by the next one. You are right about one heartbeat away...We could have Joe "I paid off the UAW with tax money to build a car plant in Maryland while closing the ones in Michigan" Biden as president. You are a misinformed idiot Mark.

Understand I want all of the people who cant afford it to get healthcare. That would be the second that their HBO is turned off, they arent running around in Escalades having never worked by their own admission, have food stamps and after they prove that they are eligible for coverage that isnt based on color, race or sex. Lets start simple...How about ability to work? Should you get healthcare if you are able to work and do not seek employment? If you arent working, should you have to pay the minimum which is to be about 3000 a year? Should you have to pay taxes on that after you have paid for it already as income? All unanswered in this crap of a bill.

The idea that we HAVE to provide the net for everyone who doesnt have a net is going to bankrupt us even worse. It will tank the ones paying the bills already and who have been paying up until now.

Good reference to the New Dealers Michael. My family has always been conservative. I disagree about what Obama is because I think he is a kid thats getting railroaded by his own party's extremists. Your better reference is to the splintering political process.

Zosimus covered that pretty well.

It took Rome just 100 years to disintegrate, we are already in the process of beating that record.

Randy: No more name calling. I'm serious. It's true you were also flamed but your hyperbolic and hysterical comment invited it. If you use the kind of rhetoric you habitually use you shouldn't be surprised or offended when people derisively dismiss it. I don't want any more of it. I agree with Brian that it is subverting rational discussion. Enough.

Last spring I spoke with a well-placed administration person working on healthcare and other reform ("reform"?) who is a highly respected, quite remarkable, former leader in several sixties/early-seventies movements; this person believed the best to be got was a public-option healthcare reform. We wished each other the best: for, in spite of disagreement on method, ours is the same struggle for, eventually, universal quality health care. I think this recognition is important for us here, too.
Thanks, rdneel, for the lead to Josh Marshall at Talking Points Memo--sounds like something very useful to check out.
Another link--info, some useful some not, on activities re the reform ("reform"?) is the healthcareoregon listserve on yahoo.
Michael, one form taken by "divide and conquer," as you may have heard, is the pitting of young vs. old, particularly in the U.S. I am sorry you are so sure the civil rights, anti-Vietnam-War, women's rights, ethnic identities, disability rights, adoptee rights, etc. movements of the 1960s and 1970s had no effect; I strongly suspect that many Black and female legislators, among others, would disagree. You may want to read more indepth histories of the time; your proclaiming "Yours is a silly generation that needs to get over itself" really adds nothing.

As I understand it (thanks to a bit on NPR earlier today) Medicare was indeed originally planned to expand to become a true single payer system. But those were different days when the New Deal was still fresh in people's minds. The times have changed.

Today you have an entrenched insurance industry with deep pockets to influence the opinions of a public many of whom aren't so sure about this evolution stuff, believe in the literal word of the Bible, and were all too ready to accept that health care reform meant death panels. Many still believe that Iraq was connected to 9-11. I would be happy to live with single payer (although I don't see it as perfect of a choice as you do) but, at a minimum, now is not its time. You won't beat that industry's ability to manipulate public opinion. And piss off the docs? A bad group to have lobbying against you one on one en masse.

Meanwhile the list of administrations that have failed to deliver anything of any value on health care reform is long and as varied as Nixon and his CHIP http://www.kaiserhealthnews.org/Stories/2009/September/03/nixon-proposa… to Clinton's disastrous poisoning of the well. I'll take substantial improvement achieves over perfection lost and be glad.

My three reasonable pillars have been:

Universal coverage by an individual mandate.

Same price for the same product whether bought by MegaCorp, Mom and Pop Corp, or individual Joe Blow, with no pre-existing condition exclusions allowed.

Reversal of our current subsidization of health insurance purchase by tax code - from the current payroll tax deduction that subsidizes the wealthiest the most - to a tax credit that supports the poorest the most and the wealthiest not at all. Of course with a safety net of Medicaid for those whose income in nonexistent or too small to afford care even with a tax credit.

This plan gives us two and a half of those pillars and I can live with that. It is ALSO sustainable.

Hysterical... Far from it. Thats an opinion based in leftism Revere. You were the one that set it off with the first pop against Ron Paul. Its a lightning rod you set and then you wonder why it gets hit? Jeez.

I have been here for YEARS and these people have always called me delusional, mental, and a lot of other things and you did shit about it then and you are now. I am always cordial to people and you know it. When provoked though you can see just about anything. Thats the reason they still call me out for special jobs.

Most of these people are accomplished leftists that are the antithesis of what America was founded on. One of which was free speech and out of respect for you I will refrain from name calling but as you say enough is enough. The issue is so simple and that is whether we send this country down the path to destruction or to something lesser than it was even 40 years ago, or even ten under Clinton. I am pretty tired of watching everything I have worked for go out the door so some schmuck can up his living standards at the expense of mine. This is nothing more than a YAR-Yet another resolution that the leftists, progressives, communists, sociialists and Marxists can agree upon that someone else owes someone else a lifestyle. That would be everything from housing to healthcare. It would never occur to you that the reason the mortality rate is so crappy is because we have crappy parents that have been on the government dime since birth. You live in a different world up there Revere. I live in the middle of the trenches every day. Its one of the reasons that out of the finances that I plucked up and went to Afghanistan as a contractor. Do you seriously think I would do that at 54 if things were going great in this country?

Rational discussion is done rationally. Anyone and that includes me that calls someone a mental patient isnt going to get a desired result.

First one that starts the name calling gets it right square between the eyes from now on. Remember, by your own admission I have my own following that 10-10's and listens in. I say what they are thinking mostly. Rarely does the right or even the center get a voice here and thats a crying shame.

You know what bothers them the most Revere? They are scared that I might be right. Revolution is the next logical step if economics fails to bring these people back to the middle.

Randy: I'm going to let you have the last word in recognition of the years you have spent here. But that's it. From now on behave yourself on the length of your posts and their tone.

Keep it Revere....

Its what leftists do.

Hope is not a strategy.

Great Googlie-Mooglie, Obama has barely broken a year in office and y'all are picking over the bones and pontificating over his term like it has ancient history. Yup ... uh ... hu. He was always a disappointment ... only go inta office cuz he followed the biggest loser ever to hold any office over dogcatcher. An everone runnin agin im was smokin crack.

The country is coming down from 50 years of artificial economic high. We boomed after WW2 because we were the only industrialized nation to survive the war intact. And we built on and rode that wave through fair means and foul. The GI bill, investment in education, infrastructure, space exploration and basic science and research all paid off handsomely.

On the other hand military spending seemed like it might pay off but never did. Military adventures were profitable back in WW2. Back then you could literally exterminate a population and claim the land. That went out of style, but not out of feasibility or effectiveness, before WW2 was over. Even major powers doing the Monster Mash went out of style with nuclear weapons. No fun knocking down army men if the guy at the top might get exterminated or the sandbox becomes a radioactive wasteland. Sure you have 54 divisions on the border but you can't do anything with them. Takes all the fun out of it.

As weapons went from large numbers of boots, boats and troops, projects requiring large numbers of workers and large industrial plants, to a few dozen planes and a few hundred missiles a year, boosting a much smaller sector of the economy, the military stopped being even a decent way of boosting employment. MacNamara tried to run the war in Vietnam as a profit making operation, But our allies and Uncle Ho didn't cooperate. Which left simply printing money as the way to finance it. Inflation inevitably followed.

Of course the middle class American dream was all sunshine and vertical light into the mid-60. People forget that mom didn't go to work in the 70 because she got liberated. She went to work to keep the middle class family in the ever more hard pressed middle class. Of course if both parents work you need two cars. Which made the oil crisis that much tougher.

Somewhere in all this major industries figured out it was easier to make money juggling money and financing deals than making things. GM and the rest of them went into finance. A new way to sucker the middle class and make the poor feel like they can at least look middle class, long term finance and revolving debt.

By then the government and industry had long ago stopped innovating. All the nations that had been destroyed in WW2 had rebuilt. They had learned all the manufacturing technology we had developed and their workers were often as well educated as ours. So our industrial base went overseas.

Bottom line here is a lot of folks like Kruger had always assumed that the sunshine and vertical light, the expectation that they would do better than their parents, and their children better than them, were a divine right. So now, well into act three of their play, they realize that someone moved the cheese. Overlooking the fact that the rest of the world was held back by 20 years by WW2. That after WW2 they rebuilt and worked hard at developing their people and infrastructure. The US was sitting on its laurels.

There is a reason US made cars were so easy to work on from 55 to 75. They were essentially the same car with a different body. The US auto makers realized they could sell the same car repackaged with minimum improvements and we would buy it. Spending money on redesigning bodywork and marketing is cheaper than real industrial research and innovation.

Of course the baby boomers are having a hard time seeing this reality. They were sold down the river. So now they are mad as hell. But they have been told for fifty years that business and unregulated capitalism were the golden goose that lays the golden eggs of prosperity for all. 'What is good for GM is good for America', said just a few years before they started moving overseas. So when they look under the bed they only see communists and Marxists and socialists because those are the names used in their childhood for dark forces.

Yes the country is falling apart. Not the first time either. We were on the verge of our own communist uprising before the New Deal was enacted. Over 20% unemployment, over 50% in spots. And no welfare or jobs programs to keep the idle hands busy or enough money flowing to keep starvation at bay. To make matters worse the country had prohibition so you couldn't get a drink either. FDR came to power in part due to a promise to rescind prohibition.

It isn't as bad as all that. But for boomers who are accustomed to a certain standard of living the end of the 50 years of artificial economy and the evaporation of the American dream is something of a jolt. They really are seeing reality for the first time and asking where their country is. We made a deal with the devil 50 years ago and now the bill has come due. The US is having to grow up.

The secessionist play is all just a farce. Kruger isn't going to lead an army of overweight white guys who are pushing 60 and storm anything but a Rite-Aide or a Country Kitchen. Sure, if they want to be drama queens they can do something really stupid. Like the moron who attacked the Holocaust Museum. A tragic loss of a good guard's life. Needless and useless drama from an idiot who wanted attention. Most will quite sensibly retire to a nice screened perch where they can reminisce about the good old days, write rants on web sites and shake their cane at the kids on the lawn.

Of course they aren't the only ones with unreasonable expectations. Obama, y'all thought I forgot about Obama, didn't ya, isn't done yet. He has three or seven years to go. He was bound to be a transitional figure and to make incremental changes. Remember that the voting rights act was seen as not nearly enough by civil rights leaders. Or that the south went crazy over it. There were calls for secession and claims there would be a mass uprising. Notice the combination. The progressives saying it isn't enough while the conservatives predict 'the end of days'.

Of course the 'end of days ' didn't come and the voting rights act was just a shoe in the door. The healthcare changes made in the next few months are not the end of the story. A pubic plan, any public plan, will weaken the insurance industry. As they get weaker money flows away from them into actual healthcare. Which reinforces the overall plan. Fact is we have a public healthcare system. Medcare, medicaide, the ER. We just can't control our costs because insurance has a stranglehold over every part. Doctors spend a third their time with paperwork and begging for permission to do the right thing. Patients run scared to say anything because they can be cut off or rates raised.

Obama is facing a tough time. Transitioning the economy back to building things and innovating, we used to be good at that, isn't going to be simple or easy. Problem is we don't know how to get there, and what we do now seems much easier. Then there are the baby boomers who want to hold onto their illusions of what life was going to be and what they were owed. If he can take even a single step on each of those issues in his term, gaining some momentum in the right direction, then he will have accomplished quite a lot. The first step is often the hardest.

So Art, what you're saying is that you know he's doing a good job because both sides are unhappy with him? :)

Actually, I am pretty much with you: it is too soon to grade. I still see him as having the potential to be one of the great ones, not with bombast but with quietly understanding what cards are in his hand, knowing which ones are in the deck, reading the other players well enough to have a good idea of what kinds of hands they have, and playing a smart game that results in people slowly becoming aware that most of the chips are ending up in his pile by the end of the day. We'll see.

I think this is a historical moment. Say what you will, Revere, Obama made a huge step forward. Just wait 2 years, nobody will want to go back to the old system.

Don: I have single payer health care (it's called Medicare). It will happen because anything else is not sustainable.

I realize that demographics are the biggest problem with it, but in what other way is Medicare spending sustainable? The Democrats have to include large cuts in Medicare in order to maintain the illusion that this bill will not add to the deficit. This includes cuts to payments to doctors that are extremely unlikely to happen, and cuts to Medicare Advantage.

The problem as I see it, is that no one (Democrat or Republican) seems interested in addressing the source of the problem. It was funny (though not in an amusing way) that this report seemed to get so little attention. Fraud, defensive medicine, excessive or redundant paperwork, medical mistakes (that then require further treatment to fix), and lastly, American lifestyle problems account for as much as one third of all health care spending, if this report is correct. How much of what Democrats propose addresses any of this? How much of the little Republicans have proposed addresses this? (It is false to claim that Republicans aren't proposing anything, but they certainly aren't proposing anything that is proportional to the size of the problems with health care.) If we could reduce this waste by half, as a country, we could afford to pay for this entire bill without any new taxes or cuts to existing programs with a lot of money left over. I just don't see how any proposals, ranging from single payer to this bill, are going to do anything about most of that waste and bring the long-term cost curve under control.

@rdaneel...

"...but if 40 plus people want to filibuster, they can go on forever under Senate rules."

Yes. And? Oh the horror of catered gourmet foods instead of restaurants! And the thread count on the sheets of the roll away beds? Shocking I tell you!

So for what, exactly, do we give those dorks six figure incomes and a bevy of privileges and benefits (including government provided, tax payer subsidized health care)?

What the Dems are doing is disgraceful. If you never call the bluff, you spend your entire time running with your tail between your legs. A group of people (that is, Congress in toto) that actually sent our young to 120 degree summers in a desert to get shot at aren't willing to pull an "all nighter" once in a while? Oh, the *humanity*!

Seriously, consider that we're talking a potential loss of confidence in the entire system. Does voting matter? You "throw the bums out" only to watch those same bums run things because the people you gave a massive majority too in both houses are acting like whipped dogs?

The issue is actually far, far broader than losing a particular vote. It's losing millions of *voters*. Who, watching the cowardice, say, "screw voting, doesn't get you anything".

The Dems better learn *real* quick that they lost in the Virginia governor's race because of a collapse in turn out on their side. The GOP turn out was essentially the same as 08 but the Dem turn out was way down. The people that gave the Dems the White House and big majorities in both houses are souring on the party and becoming apathetic. And that will hurt in 2010. Big time. Because the tea baggers may be insane but they're committed.

Filibusters aren't "fun" on *either* side. So call the bluff. Maybe it won't work and you'll lose in the end but you would have shown backbone and your supporters might not stay home in 2010. If you weasel and cower and bow to the people who the public voted out in a big way, who's going to bother voting for you next time?

@Don S...

"Single payor has no chance in this country."

Ah yes, the inside the beltway common wisdumb. No, not snarking on *you* but you've swallowed something that is best described as "rose fertilizer".

Go seriously dig into some polls (pollingreport.com is handy). If you say "public option" or "single payer" you get tepid support to outright rejection.

If you say, "expand Medicare" you get *resounding* support.

I can't find the specific poll I have in mind and it passed by unremarked but one asked the public if they would support expanding Medicare down to the age of 50 and the support was in the 70s. Near three-quarters of the public. Including high levels in support among self-identified Republicans. Hell, even the GOP is trying to tank health care reform by claiming it will hurt Medicare. They're attacking a public option by defending a single payer system.

Go figure.

The Dems should have *started* with universal Medicare. Or "Medicare for all" or "Medicare Part E" (conveniently having that handy 'E' you can 'market' as 'everyone').

Even if you had to negotiate downward, you still would have started from a 'higher' place than where they did. Plus, you'd have cut the opposition off at the knees. They could only attack the proposal by attacking Medicare.

Look, single payer *already exists* in the US. It's just not open to everybody. And it's popular. And the people who are on it will defend it quite literally to their last breath. And I'd defend it like crazy myself even being years away from it. My *mom* needs it.

Speaking of mom, who watches Fake News and was a card carrying GOPer, these days she says, a bit confused, "Why don't they just give everybody Medicare?"

@Kruger...

Oh? You want me to take you seriously? Okay.

"You must be mentally ill, unbalanced to disagree with us lefites."

Or maybe you're just mentally ill. The fact that this never occurs to your type raises the probability that you are, well, mentally ill. Ridicule actually serves an important function, it gives feed back. Not always correct feedback but being dismissive is what the seriously mentally ill do. Try to tell a clearly mentally ill street person that they're mentally ill sometime. It will be an instructive lesson.

"What are you going to do, declare war on them? "

Yes, we did. We call it, "The Civil War". I'll leave the question of who won as an exercise for the reader.

And despite the delusions of the tiny "tea party" crowd (and, yes, you are tiny and few), the US isn't going to break up over a health care bill. Nobody's going to start Civil War II over a health care bill. Nobody loves their insurance corporation so much they're going to risk being shot for them. Nobody is going to take up arms because Glen Beck is a craven little con artist. Nobody is going to risk life and limb to defend Sarah "I can't hold a job for more than five minutes" Palin.

Most likely outcome? A few of the tea party types go the way of what we now call Al Qaeda. Having been rebuffed at the polls (see also, NY district 23), convinced that some magical majority "really supports us, not them", and whipping themselves into a bizarre frenzy of believing they're Thomas Jefferson reborn, they'll decide that violence is the only way to "shock the conscience" of the public and "awaken them" to revolt.

Then they'll be arrested, tried, and executed while the GOP runs like hell to distance itself from them and passes the Whigs as they run.

"You MUST do what we tell you. Uh-huh."

Ah yes. The "patriots" who believe in rebellion against the duly elected government. Did you know that insurrection is one of the named reasons in the Constitution that the government has the power to use the military to shoot at you?

Try reading the document some time.

"That includes you Mark. You are obviously not working at anything other than at a McDonalds..."

You amuse me.

"And that is that this package has been rammed down our throats in the face of incredible fire against it. Nor was it debated."

You lie.

Simply put, you lie. This is absolutely not true. And no amount of tea baggage ranting will change the reality that the vast bulk of us have actually experienced.

"Oh, it might pass the Senate, but it will be ripped out by the next one."

Because of the now 17% of the electorate that calls itself Republican?

Sorry to have to break this to you but the GOP is literally dying out. It's actually an exciting period for those of us who approach things more from an anthropological/historical angle. The last time a major political party collapsed in the US was in the 19th century. Watching a major political shift in the party system is quite fascinating. A real, "You were there at the making of history" moment.

Demographically speaking, the US is going through one of its periodic swings. The base of the "conservative" movement is now firmly based in the late boomer to pre-boomer whites of the population. In colloquial language: "old white people". Also know as, "dying off".

Time gets us all in the end. It's just the way of things. The tide is moving left and you're playing Canute.

Shrug.

"Understand I want all of the people who cant afford it to get healthcare."

Ah, so you're on board with single payer then!

We, as a country, can easily afford, and in fact would save thousands of dollars per person each year, going to a single payer system.

We can all afford health care. So let's.

"That would be the second that their HBO is turned off, they arent running around in Escalades having never worked by their own admission, have food stamps and after they prove that they are eligible for coverage that isnt based on color, race or sex."

Oh, I get it. I got mine, screw you! Funny how that never applies to elections. You lost. Get it? Why can't we, the majority, just tell you, "Screw you" and be done with it?

Be careful what you wish for Sparky. The wealthy can decide at any time, "We got ours, screw you!" and you won't have health care either. Oh you'll work. You just won't be able to afford health care. But so what? They got theirs.

You aren't rich so why would you matter? You should have thought of that before you were middle class you idiot! You tax payers, always *wanting* things. Go back to work! And buy more crap! You have room left on that credit card! Max it out!

It'll be your turn. I know you don't believe that but reality always wins in the end.

"The idea that we HAVE to provide the net for everyone who doesnt have a net is going to bankrupt us even worse."

Yeah. Not like we're going broke now is it? I mean, that economy the GOP and Bush left behind, it's going like a bat outta hell! We're all gonna be rich, Rich, RICH!!!

Oooo, laid off. Buh-bye. But, before you go, here's your Cobra. Only $1,200 a month! Such a bargain!

Next time, plan ahead and be a multibillion dollar corporation. Then Paulson would have cut you a check out of the US Treasury, no questions asked! Even though you took the country and much of the planet to the brink of total financial system collapse, you deserve it. Because you're just gosh darn pretty!

(Hint: Paulson was Secretary of the Treasury under George W. Bush the well know liberal, socialist Democrat right? The bank bailouts and buy outs took place under a GOP administration.)

And deficits? Don't make us laugh. The last President to turn in a balanced budget had the name "Clinton". The guy who came after him who had a GOP dominated Congress until the last couple of years of his time in office DOUBLED the national debt. The fastest increase since WWII. The biggest social welfare expansion in the 40 years since the creation of Medicare was rammed through by the GOP. And the just recently ended budget (which budgets run from Oct 1 to Sep 30) which turned in a $1 trillion plus deficit was the last Bush budget.

Of that, Obama was responsible for around about $200 billion in stimulus tax cuts and spending. Leaving easily our first $1 trillion dollar deficit courtesy of the "conservative" GOP.

"...I think he is a kid thats getting railroaded by his own party's I think he is a kid thats getting railroaded by his own party's extremists."

What color *is* the sky on your planet?

From a global perspective, there is NO LEFT in the US. A tiny fraction of the progressive Democrats might be considered "center" by the rest of, oh, Earth. Parties like the GOP either don't exist or are tiny factions of "extremists" in the rest of the democracies of, oh, Earth.

The Dems *ARE* the conservative party. What you are likely to see, to your obvious dismay, is the US shifting toward the true political "center" of, oh, Earth. This would mean the ongoing dissolution of the GOP and the Dems splitting into two parties. One center-right (from the world's perspective that is), one center with a center-left (again, by world standards) faction.

In short, we're likely moving away from being the outlier and exception to being more in the mainstream of, well, Earth.

Sorry but that's the way the chads hang. Demographic shifts happen. The world goes on. Shrug.

"It took Rome just 100 years to disintegrate, we are already in the process of beating that record."

Yeah, Bush and the GOP did their best to bring us down. They may have succeeded.

Oh you think not? Try again Spanky. The financial system protections laid down in the wake of the Depression were repealed by the GOP. We went *exactly* down the *same* path they did in the 20s. And it was Gingrich and Gramm and McCain who took us down that path.

And the reich, erm, right has enough of a grip on things that the psuedo-liberals are cowed and taking us down the path of Japan where they enabled "zombie banks" to leave them spinning their economic wheels for a decade. The big banks MUST be seized and broken up the way the FDIC does with ordinary banks (mine included) or we'll spend the next decade or two in a relentless recession.

Which, Sparky, will discredit your little "movement" even further. Not that it'll need help. It will be mostly a nursing home phenomena in a decade or two.

Eventually, *somebody* is going to point at the 10 trillion dollar elephant in the room. While all of you are yapping about the maybe $1 trillion health care "reform" will cost us over ten years, that same ten years will see ten times that go into a military that is sucking down more money than the militaries of all other nations on Earth *combined*.

Who are we arming against? The aliens on the dark side of the moon?

Learn. Some. History. Especially before invoking Rome. Because what *you* want is what led to *their* downfall. Pax Romana cost them a fortune. They neglected their own citizens (Katrina anyone?) and let their infrastructure collapse (like a bridge). But the wealthy got wealthier and that's what matters eh?

Over-extension, exhaustion, collapse.

Lather, rinse, repeat.

We maintain bases in almost every nation on Earth. And empire is expensive ennit? WWII bases are still open. And have become whole little cities, self-contained, subsidized, and costly. It took months of squabbling and resolve to cancel just *one* Cold War era jets that isn't worth squat for anything but hefty maintainence contracts for aerospace corporations. Nobody talks about cutting our bloated military budget even while we rack up massive debt and our "enemy list" has shrunk to a couple of goat herders in the hills and a kook in a rice paddy.

And trying to deal with the former by use of that bloated military has been a catastrophic failure. Remember bin Laden? Remember when we caught him and put him on trial?

Oh wait.

And speaking of history repeating itself. And speaking of history repeating itself. You know what they call Afghanistan yes? "Where empires go to die."

The USSR's last act on the world stage was invading Afghanistan.

And then they closed up shop and disappeared.

Obama's legacy may end up being our Gorbechev. After the damage has gone too far, all you can do is try to ditch in the Hudson River...

Oh and apologies to all for the length of that post. I'll take a loon serious once out of some vague sense of fairness. After that, it's all short, pithy snark. :)

"The financial system protections laid down in the wake of the Depression were repealed by the GOP."

Well not only: http://en.wikipedia.org/wiki/Glass%E2%80%93Steagall_Act#Repeal_of_the_A…

"The bills were passed by a Republican majority, basically following party lines by a 54-44 vote in the Senate[12] and by a bi-partisan 343-86 vote in the House of Representatives"

Obama is a disaster.

Art-You would be sadly mistaken son. You I can see have never kicked a door in. Nor have you ever been in a firefight or lost someone in one. But I am supposed to be nice to people like you.

And there I go again... Accusing Revere of the double standard but then again I am a mental patient on the left wing masturbation session.

Good description Jo. I am glad you kept it short. Wouldnt want Mark getting away with calling you or me a mental patient in under 5 pages.

Obama isn't a disaster. John McCain would have been a disaster. George W. was an unparalleled disaster. But Obama could have been much more helpful and gotten us a better bill. He didn't.

Mark: What I told Randy. It's enough. I want a stop to this.

Back to the point of the original post. Ezra Klein now has a post directly on this, entitled "Is a flawed health-care bill better than no bill at all?" His answer is Yes, and he goes on to explain why.

One of the key points is this: even an imperfect health care bill will lead to further reforms in the future. In contrast, a failure of the current bill will likely lead to less efforts to reform health care in the future.

Mark,

I accept little revealed truth be it wisdom or wisdumb. Let us accept a hypothetical poll found that a solid majority would endorse Medicare-for-all at this point in time. I would still say "and?" That tells us naught of what the poll results would be after the massive PR campaign against it was waged by the very deep pockets defending themselves against an existential threat. Many docs would also one-on-one campaign against it in office settings as they'd feel (and not without cause) that it gives all the power to one side of the price negotiation and would leave them at the mercy of kindness of a cash strapped Congress who could always balance a budget on their backs. It would lose. No received wisdom there, just my own analysis and acceptance of the nature of public opinion.

Actually, I rather enjoyed Mark's history trip here, and the energy in Kruger's rants would be fun if he'd edit before posting (so I could see if there's *any*thing he writes I might agree with). But can someone here clarify--really--what the House bill, *as passed*, does or doesn't do to Medicare? (I admit to not wanting to read the whole thing, not this week anyhow.)

M. Randolph Kruger @52 [quote]Art-You would be sadly mistaken son. You I can see have never kicked a door in. Nor have you ever been in a firefight or lost someone in one. But I am supposed to be nice to people like you.[/quote]

Ah, good to see I got through that thick 'door busting' skull. I was wondering when you would get around to the 'I'm the real American and y'all are just pansies' argument. Doesn't hold water. It is just pathetic.

Essentially your whining about how you 'worked for everything you got' and 'played by the rules' and 'did the bidding of the system' and now your old, washed up, and the system isn't treating you fair. Waaa. Get over it soldier.

The system was rigged from day one. You were sold a bill of goods fifty years ago. If you had stepped back and seen how the game worked you would have realized that rich folk don't send their sons to fight. Its all kids from poor families, recent immigrants (one of the reasons why the GOP will never really be against illegal immigration), kids from Podunk towns without any options that join the military.

That the vast majority of kicking doors, firefights and losing people didn't have anything to do with keeping our nation safe or secure. You got used, exploited, taken advantage of. Get over it. Your main problem is you think your special. Like wearing a uniform wasn't just a job choice. Some put on a uniform, some a tool belt, others a business suit. And every one of us that wasn't in the upper five percent of the SE strata got used.

Your also missing the irony that the military is very much like the communist paradise Marx envisioned. They tell your what to wear and when to eat. And cover all your needs. Need a tent so you can take the kids camping on the weekend? Drop by special services and pick one up. On base first-run movies were $2 and groceries were available tax-free and at a deep discount at the commissary. Of course if you, or your wife, or kids get sick they just have to visit the local on-base clinic or hospital. A marvelous place where the doctors don't fight with insurance companies to get their patients treatment. The patient needs something they get it. A little more complicated now that there is Champus and off-base providers but most Americans dream of having the sort of medical insurance that the military, and congress, have.

So really it isn't just that your pissed at being mistreated your standing pat with a good old 'I got mine argument'. Your not getting enough of some things but your worried about losing what you have. Tough posture. I guess we find out how good you are at yoga and maintaining outrageous poses.

@revere...

Never planned on continuing it.

@Don S...

I'm not talking guaranteed success. But. Medicare has broad support. Even the GOP has to pretend to be protecting it when attacking "soooshulism". It would be seriously difficult to mount an attack campaign against Medicare. No matter how deep the pockets are. It would at least have turned the tables and put the anti-reform crowd in a very, very awkward position. They had it too easy this time round.

Such as a large number of the panicked, upset people at the fake "protests" mounted by Dick Armey and United Health were seniors who'd been terrorized by lies about Medicare. If Obama had *started* with Medicare and talked about expanding and building on it, at least that part of the "protests" would have been very, very difficult to pull off.

Look, the common inside-the-beltway wisdom is that single payer can't happen. So Obama and the Dems ruled it out from the start. They capitulated. So how do we even know whether converting Medicare into single payer is possible with the public?

Nobody has tried.

And I think you've misread the doctors. Maybe because of the smoke screen of the "we're down to 19% and falling" AMA? Doctors are quitting the AMA in disgust these days. Maybe not in droves. Yet. But it's happening.

Public option/single payer in polls of doctors is over 70%.

http://www.npr.org/templates/story/story.php?storyId=112818960

Doctors are being squeezed. The situation that you describe *exists now*. Doctors are having to hire increasing numbers of staff to chase shrinking payments from insurance companies. One of my mom's doctors was at his wits end having to employ five people to do nothing but fight with the insurance corporations.

In fact, it's taking class action suits to get paid now:

http://www.newsinferno.com/archives/4562

Yeah, United Health of tea party fame, bought the once independent agencies that set the "usual and customary" rates. It's not just the consumers that are getting run over.

But how are we going to know how it would turn out when Obama threw in the towel before the fight even started? At *least* if he was going to have to negotiate "down", he couldn't have started higher?

@Roman...

Yeah, not only. And Clinton stabbed us all in the back by signing the bill. But you see who proposed it and pushed it. The Dems aren't much better but the GOP led us right over a cliff. And I think we're still falling. We'll see over the next year. I suspect the banking crisis has only just begun...

Mark, agreed--including re the banking crisis (though possibly these waves may be longer, with cream skimmed at each crest). Do keep in mind, though, that some of those "anti-Obama-care" United Health-backed tea-party rallyers were--in some cases--simply unreported single-payer backers (why unreported? guess).

Mark,

Bait and switch. A strong public option to compete with insurance companies is not single payer - despite the GOP attempts to confuse the two. A poll showing that docs like one cannot be used to inform about how they feel about the other.

I am a doc and I know many. Not a member of the AMA. Would gladly accept single payer even though I know it is against my own self interest. And I know quite a few who would be with me. But the bulk of docs would work against that which is against their self interest. This I know not because of AMA smokescreens but from many conversations. It is not a "misread."

Nothing can pass without the major players assent. The progressive hand is far from strong enough and a bluff would be called.

Don: Not according to this:
http://www.prospect.org/cs/articles?article=the_doctors_revolt

You sir or madame, need to do some research on this Democrat you may have heard of, by the name of "Joe Biden".

Mark,

An interesting poll. But before we move away from you first cite let's look at it in more detail in an article that gives us more information. http://voices.washingtonpost.com/ezra-klein/2009/09/doctors_support_the…

Look at the graphic. MD support for the public only plan in that survey was 9.5%. Why the difference? Because the actual question in the poll published in the Annals of Internal Medicine was not about support for single payer but about "support government legislation to establish national health insurance,â http://www.pnhp.org/news/2008/march/most_doctors_support.php - in other words a strong public option. Your cite misrepresents.

The fact that most of this argument in this blog is over the public option shows that you all just like everybody else don't get it. In my state, insurance companies are paying 80-100%+ of the incoming premiums in claims (the 100%+ one is a company who just left the market - bad underwriters obviously). If you think there is huge cost savings there, there are not. Having worked for the govt for many years, I'd bet their overhead will be double the insurance companies.

There is a lot of good information on inefficient medicine and the medical arms race (google that term if you don't know what it is). These are the kind of things that need to be addressed, but everybody is missing the boat arguing over the public option. It doesn't amount to a hill of beans either way. Public Option, single payer, or current system are all going bankrupt under the real problem is addressed and it is not.

George,

Your state is quite unusual and you'd lose your bet by a large margin.

Medicare runs at about a 3% overhead compared to 15-25% for private insurance companies. Now some naysayers try to handwave that away by pointing out that Medicare has a sicker population with higher medical costs that dilute administative costs ... and that may indeed play into it to some small degree. But not all of it.

And that does not explain away the fact that even the States run Medicaid programs have significantly lower overhead than the privates, about 20% lower by most estimates.

The main reason that the privates do not want to have to compete against a public option in a fair fight (self-supported by premiums) is that they know they'd end up losing. A strong public option WILL inevitably lead to "Medicare for all" because the simple fact is that over time the lower overhead of the public option will win willing customers.

Interesting discussion; possibly among the best that I have witnessed, here. At least during those periods when the comments weren't careening off into utter insanity.

Mark at 48: Very nice writing; cogent reasoning.

Nearly forty-five years ago, when I was a nineteen-year-old Marine grunt, in Vietnam, I was forced to become intimately familiar with the nature of war, and combat. And I was very quickly introduced to the irreducible metric of survival. I learned that everything in that astonishingly malevolent environment had but one single purpose...to find a way, any way, in which it might destroy me. And those around me. The sun was a monstrous creature that rose up, inexorably, out of the waters of the South China Sea, every morning, and subsequently thundered down upon anything that was unfortunate enough to be exposed to it...and you were always exposed to it. This was not "your sun," this was a sun that could -- and did -- kill.

I learned that the snipers were omnipresent, and sometimes their aim was true. I learned that a simple misstep could get one of your feet blown off. I envied the people who, during the course of an operation, would seize up, along the trail, in the throes of heatstroke (their brains would be cooking; and often, they would never come back again; they would be lifted out by helicopter, and placed in a body-size container of ice, to rapidly lower their core temperature). There were times -- many of them -- where I would have welcomed that.

I learned a valuable lesson. I learned what the true nature of combat is. It is not the Republican mantra, of do this for "God and Country;" neither is it "glory," and majestic sacrifice. It is far simpler, and immediate than that. What it is, and always has been, and always will be, until the end of war (which we will never see) can be summed up in four simple words: Get the job done. Truly mundane and drab? No? It is nothing more than that. Ever. You "get the job done," or the other guy will. And that is the nature of "politics," also. Don't ever expect that it will be any different. Obama, who has never seen war, or combat, has, in my opinion, an inherent understanding of this, where politics is concerned. This person wants to be the most unifying, greatest president that this country has ever seen. And I genuinely believe that he wants to see this for us, and not for him. That is a hard roe to hoe; he started out with the worst hand that any incoming President has ever been dealt, in our entire history. Period. This would have easily crushed most human beings. Even the very strong. He revels in it; but he will be hard pressed to continue to right the legions of wrongs in this country, well into the latter stages of his second Administration. But I fully expect that he will stand up to the challenge; in my opinion, that is just who he is. I may be wrong, here, but I do not think so.

My apologies btw. My last post should have been addressed to a revere, not Mark. The point remains however. Docs are to a large degree against single payer but FOR a national insurance that competes against the privates in a fair fight.

"the wealthy got wealthier"

They had lots of help. And we didn't merely let them... we insisted they take everything we had, and everything we will have.

So long as we turn to their television instead of our mirrors, so long as we turn to their Washington instead of our neighbours, they will graciously allow us to sweep up the crumbs under their tables and magnanimously accept the gathered crumbs to feed their dogs.

Please, Sir! More abuse.

I don't think Revere has put this in the proper historical or political perspective.

First, while we'll never know, its highly unlikely that Obama would have gotten something better had he just started with a higher opening bid. Obviously, we can't just rerun the world, but Teddy Roosevelt, Franklin Roosevelt, Truman, Nixon, and Clinton all started with bids along Revere's line, and the result wasn't a strong bill, it was failure long before where we are. Expanding health care succeeded only with the narrow JFK/LBJ plan.

Single payer might be great policy, it might be a moral necessity, but it has a ton of political opposition. Insurance opposes it, the AMA would oppose it, AARP would probably oppose it. Right now, pro-reformers have spent more than anti-reformers. That would not be the case.

And on votes? You think Lieberman's a pain now, imagine if the President's opening offer had been to off a major industry in his state.

Second, the criticism about Obama not fighting for it is problematic because it seems a bit opportunistic coming from the left in general. After all, the left blamed Clinton for not letting the Congress come up with its own bill. Now, Revere may not have joined that criticism, but with that background, I think the certitude behind Revere's point is weaker.

Third, I really don't see the huge fuss with the Stupak amendment. Yes, it would be better if that confusing language about fungible money was removed, but it doesn't have any net negative effect on the vast majority of people. Medically necessary abortions are covered, people with company insurance are not hit by the amendment, and people who previously could not afford or buy insurance are getting more than they did. Its only people who presently are insured on the individual market who make little enough to be subsidized that could potentially suffer a negative here - and how many of them, given the choice between elective abortion coverage and lower prices + outlawing limits on recission and preexisting condition denials, etc would take the former? Sure, its imperfect, but its not reasonably a net negative bill on that front.

You're dreaming if you think there's going to be a re-run of the Sixties. Putting aside that "Left", and "Right" don't mean anything anymore, the remnants of the American "Left" now dwelling in complete obscurity, are so intellectually crippled by anti-Semitism, otherwise known as anti-Zionism, that it can't think straight about very much of anything.
The other thing is, the Sixties were awful, mostly because of Marxism, in my opinion.
Sorry fella, but a progressive, working-class movement in this country anytime soon? It's not going to happen.

Ed: I don't know if you were there or not. I was. And it was indeed awful, but Marxism had nothing to do with it. You might give Perlstein's Nixonland a read if you want to know how really awful it was. Or maybe you've already made up your mind. I'm not returning to a return of the sixties, just a return of the civil engagement and optimism we could make a better world that spawned it. If that's dreaming, I guess I'm a dreamer. Meanwhile, enjoy the music we gave you.

I have devised a plan that achieves universal coverage but does not require single-payer. It also reduces medical costs by putting the consumer first.

The plan:

* Every person puts 15% of their income into a health savings account.
* All health care spending comes from this account.
* If you do not have enough money in your account to pay for a purchase, then your account balance goes negative. You can think of this as an instant health care loan from the federal government. However, unlike other loans, this loan has no interest, and you cannot be denied this loan.
* If your account balance is negative, then 20% instead of 15% is deducted from your pay check.
* When you die, any positive balance is passed on in your estate. If you die with a negative balance, any assets you own first pay off your loan. The remainder is your estate. If there are insufficient assets, then the negative balance is simply "written off" by the government and paid for out of general tax revenue.
* This program replaces all other medical programs in the United States at every level.
* It may be necessary to have a small tax on medical services to pay for indigent care (those who die with negative balances).

jeff: the same for education? No subsidies for businesss? roads? Why just health care? how are we going to control costs? What if I go into massive debt? Could I possibly save enough from my income? (remember, medical charges can easily go into millions).

I'm a southern lady getting up there in years and this bill just terrifies me. I know very well what will happen to those of us who live in rural areas. Our doctors and health care professionals will be needed to serve in high population areas. Our clinics and hospitals will close. The high cost of premiums will force many from their land. Some like myself will be going to prison for willfully refusing to participate. Some of our men will be driven to violence. You Yankees might not like to hear what someone like Mr. Kruger has to say or the manner in which he says it but I think he speaks for a lot of us in the South at least.

Kay: Since i spend a lot of time in a southern Red State I can tell you that you folks have some pretty bad health care down there. You have the worst health indices in the nation and you pay more for it than everyone else. Your choice. You have made your bed but you want the rest of the nation to lie in it. No thanks.

Ed,

There are indeed, I suspect, some anti-Semites who relish in the cover of just beating up Israel and its alleged cabal of Jewish protectors (lobby/media/etc.) as means of disparaging Jews in general and who use it as a way to spread stories of "disloyal Jews" who pull the strings, etc. They are hateful and they exist. But there are also those who come to other positions than my mostly Israeli favorable conclusions for honorable reasons, even if I disagree with them. And even among those of us who describe ourselves as Pro-Israel, Zionistic even, are those who find much to complain about in various Israeli governmental actions. To lambast all that is "anti-Zionist" as anti-Semitic is not only unfair, it is, I believe, counterproductive to reasonable discussion and rational debate. The charge of anti-Semitism must be made only when it is overwhelmingly clear that such is the case, and even then it is often better to just bite our tongues.

Don't get me wrong - some of the Left is as bad as much of the Right: reflexive posturing in lieu of true analyses of complex circumstances. There are "intellectuals" who exhibit little intelligence on some campuses, and those who take on "Leftist" positions like any other affectation, as a means of belonging to a particular in-group. But the the Left has not at least made a conscious effort to purge its ranks of all dissent and of critical thought like the current incarnation of the Right has.

The Left has an intellectual limp perhaps; the Right is actively giving itself a lobotomy.

Once we get over the name-calling let's get pragmatic and get ANY movement rolling on Health Care reform.

o. jeff:

Re. "...Every person puts 15% of their income into a health savings account..."

You've never been poor, have you?

Don S., thanks thanks and thanks for the succinct and strong discussion (#77) of the antisemitism/anti-Israel/anti-Israel's-policies/secret-Elders-of-Zion-running-Congress/etc. issue in re the U.S. left. One has the discussion so many times.
And, grace RN, re #79, having been poor---yes.
Does anyone know (re the Mexican figures on 2009h1n1 deathls among patients visiting clinics there) what the ratio of flu patients who go and do not go to those is (1) with this flu (2) with seasonal flu?

Don, Paula (Ed is too far gone to address): For the record, I do not stand with the current Israeli gov't (or the previous one, for that matter). Netanyahu, Barak and Sharon are war criminals (as are Hamas). I stand with the Israeli Peace movement and Israeli Physicians for Human Rights, with all Israelis and Palestinians (like Dr. Mustafa Barghouti, whom I know personally) pledged to non-violence. I do not stand with the neocons in AIPAC but the peacemakers at J-Street. I am a Jew last, a member of the human species first. I've had enough malignant tribalism shoved down my throat. Equating condemnation of AIPAC as tantamount to talk of the Protocols is a bit over the top, IMO. I suspect we all three are different but can at least talk to each other. Ed is a cartoon character and I have nothing to say to him.

"...Every person puts 15% of their income into a health savings account..."

Some people may have to give up their cell phones, cable television, etc and save their money for future medical care needs.

"jeff: the same for education? No subsidies for businesss? roads? Why just health care? how are we going to control costs? What if I go into massive debt? Could I possibly save enough from my income? (remember, medical charges can easily go into millions)."

We control spending by having *every* person ask how much the service costs. You can only spend money for legitimate health care expenses, such as would be covered by the Canadian health care plan or a major employer health care plan. It is fine if you die with a negative balance. Some people will be less fortunate and require greater medical care during their lives. These people will die with a negative balance, to be paid for by all of us through a tax on medical care.

You see -- my plan basically make each person a consumer who is concerned about costs. While at the same time, it achieves universal coverage like advocates of single-payer demand. It does this by making government a funding/financing agent at the backend--backstopping the spending and providing the insurance net at the backend.

It also eliminates the adversarial insurance racket that drives up costs for consumers and health care providers. All the millions of people currently employed fighting insurance companies can be re-purposed into doing productive work.

Revere, re your #82, "Equating condemnation of AIPAC as tantamount to talk of the Protocols is a bit over the top, IMO"--yes, agreed; I didn't mean those slashes as equal signs.
o.jeff, wouldn't your plan run into the same opposition as single-payer, in trying to eliminate the health insurance industry? But also, why is the de facto healthcare tax a straight 15%--wouldn't simply using the progressive income tax (or what's left of its once-progressiveness) be fairer?
Also, has anyone an answer re the Mexico clinics (#80)? Thanks.

Thank you Paula. No idea about the Mexico clinics though.

Kay, I missed your comment cross posting. Allow me to comment now.

Our current system FORCES many medical school graduates into more lucrative specialty medicine just to manage debts. (Over the past decades we have graduated more physicians but not created more who go into primary care.) That has hurt rural districts most of all as specialists MUST operate out of high population densities.

The reform package includes provisions that make primary care more attractive. The short version is that more primary docs and more people in rural districts with insurance that covers it, means more care for rural districts, not less.

"o.jeff, wouldn't your plan run into the same opposition as single-payer, in trying to eliminate the health insurance industry?"

There seems to be three key players in the health care debate: consumers, providers, and insurance companies. Of the three, insurance companies really should be the weakest political force. The only way they had influence was that the got consumers on their side -- by making consumers fear losing something they had.

My plan puts consumers in control. You spend the money. It is your money. You can spend it with whomever you want -- as long as it is a legitimate medical expense.

" But also, why is the de facto healthcare tax a straight 15%--wouldn't simply using the progressive income tax (or what's left of its once-progressiveness) be fairer?"

I support progressive income tax. However, this is not a tax. Your money stays your money. It goes right into your own bank account. In other words, this program does not transfer money from one person to another. The only time that type of transfer occurs is at death. If you die with a negative balance, then your "medical debt" is "written off" by general tax revenues.

Hello,

I didn't expect any responses at all, so it was nice to see people write something.
I still think my argument stands about the anti-Semitism on the remnants of the "Left" now and forever dwelling in complete obscurity. The routine comparison of Israel to Nazi Germany, for example, that goes on all the time among the scattered remains of the Socialist(Marxist?) "Left" is anti-Semitism. Implying that Israel is somehow responsible for the war in Iraq also occurs routinely. Both of these ideas are viciously anti-Semitic. Comparing the United States to Nazi Germany also occurs often and is another indication of peoples'(on the Left) inability to think clearly, really, it seems about anything at all. George Orwell's book The Road to Wigan Pier is very instructive in this regard.
I would love to see a working-class, pro-union, New Deal type movement get going, but as happened in the 60s it will most likely be crippled by Marxism. And how could I forget, the rest of the "Left" completely absorbed with identity politics, post-modernism, anti-science studies, etc. not really leftists at all, in my opinion.
Anyway, I just wanted to give a little more detail about what I said earlier.
And, oh yes, for the record, I stand with the Israelis and their current and previous governments. I would urge all people of good will(in the Kantian sense) to express their undying solidarity with the people of Israel in whatever way they can. I always try to defend Israel in conversation when I hear people saying foolish things, but it's not easy sometimes to do so.

Just a brief clarification:

I wrote that sometimes it's not easy to defend Israel in conversation, what I meant was that people criticizing Israel can react very badly when challenged, as in, getting screamed at by someone whose lost their self-control, for example. That's happened to me on a couple of occasions. Also, the strength of the hatred for Israel among some people(Americans) is a bit shocking and is difficult to deal with in a rational way.

Oy! read who's for whose. Ah, age...

Ed,

Making comparisons between Israel and Nazi Germany, etc., is minimally very stupid, but not necessarily anti-Semitic. The simple fact is that the farther you get along each pole, the more likely you are to find those who reduce complexities to simplistic Good versus Evil, Rebel Alliance versus the Death Star*, formulations. Hyperbole is just easier than seeing all the grey tones. Ignorance is not per se hateful. And the dreadful fusion of ignorance with arrogance (I like the neologism of ignorragance for that) always benefits from a good slapdown, but it does not always have hate as its motivator. Accusing people of hate will usually only further polarize a discussion. Including among the lurkers.

And in the spirit of the hijack, I am over all a bit of a Zionist, whose thoughts about what is best for Israel, for the region, and for American interests, are pretty much with the J Street group. Sometimes friends don't let friends drive drunk ... or build settlements that are an impediment to the peace that is in everybody's informed best interests. Israel will and should defend itself, but its OWN best interests are served by doing so with much more restraint than it often exhibits.

*You may enjoy this song - just the lyrics here. http://www.lyricsmania.com/lyrics/atom_and_his_package_lyrics_12043/att…

Don,

Thanks for the link to the lyrics, very funny! I don't know what Israel should do about the settlements, it's really up to them. But as Alan Dershowitz pointed out to Noam Chomsky who offered no rebuttal, the Arab states were offered a two-state solution in 1947 and rejected it, and then invaded Israel. So, settlements don't bother me too much.
Anyway, to unhijack things, let me say that this healthcare bill is awful, worse than I thought possible. The penalty for not having insurance is particularly bad, very unjust, unfair. Maybe it will get people to organize something.
Oh yes, since this is a science blog, what about the "Left"'s embrace of environmentalism and global warming? Yes, I'm a climate-change sceptic, based on my agreement with Wittgenstein's views on language in the Tractatus.

revere,

Do you really think you can completely escape tribalism? Or perhaps your POV is actually as you state - avoiding only "malignant tribalism".

Tribalism is, as I have argued elsewhere in your blog, unavoidably part of the human condition, be it nationalistic, religious, or otherwise. When push comes to shove, you would choose you grandchild's life over a stranger's, a member of your self-identified clan or town, over someone who is unknown to you. When it comes down to it the issue for most is just how we decide which group(s) we belong to or at least most identify with. And if somehow an individual manages to identify with no one more than any other, no matter. The rest of the world will impose an identity upon him or her any way.

I would argue that we not deny our human tribalistic nature but instead recognize it so that we can better be on guard against its consequences, so that we can at least contain it, and its, on balance, negative effects.

Yeah, yet another hijack!

Ed,

Being a global climate change skeptic is, at this point, a bit like being a Flat Earther or a Creationist. No offense.

And the past in the ME is merely preamble - the issue is how to move forward.

Hijack, embrace and extend!
Re: global warming, I would refer you to Bjorn Lomberg and also spiked-online.com. Oh yes, and Michael Crichton.
The "Left"'s environmentalism also pretty much guarantees no New Deal movement to improve people's lives. I would put "Sustainability" in the same category.
End of hijack.

Revere, you posted up just a short while back about having to take someone to the emergency room in your fair state.

I believe you stated for the record that in your blue state, that the time to be seen was unacceptable. Hours in fact.

This is in one of those states that demand you purchase insurance or else. This was and is a pretty socialist state before they put it in two years ago and now everyone is oh so healthy. Its not a snark its a fact.

The state healthcare budget is already gone to the tunes of BILLIONS of dollars... Their numbers not mine.

So lets join that wagon?

Frankly-I look at where its supposed to be working such as the UK/Canada places like that and the experiment states and brother...It aint. Didnt work at all in Tennessee and left us with a huge deficit that we are still paying off.

Now we have this goof ball plan that really only creates bureacracies for hips, cancers, what have you to decide if you are viable or not or whether you deserve the treatments. Its not going to like go to the doctor, he says you need a hip replacement schedule them in a month...That would be reasonable. Its pushing on month after month for some serious treatments. MRI's and the like.

The costs will explode like a bomb and take the country with it, or they will use those committees as effectively death committees for the elderly as they will be the big drains on the economy. The CBO given the parameters by the Sneaker of the House still came in at over 1.2 trillion bucks and thats based on a moderately good economy. It isnt.

Guess you also missed the suck out of 500 million a year from Medicare to pay for this stuff. You would get that if you guys all read whats in it. The references and sub references give you a headache. But all it does is create the B word and no H word. Sorry old friend if my tone is one of pure derision on this thing. The other part of it is that it doesnt exclude illegals. If they do this under the big plan and they dont take them out of it and send them back to Mexico when they present themselves, it will be so bankrupt and so fast it will stun even Obama. They will flood across that border like a brigade of 16 year olds in heat. Just to jump onto our wagon. Before it was jobs in the fields, now it will be for our healthcare. Healthcare and social services is what pushed Gray Davis out in California, another state which is bankrupt. New York by Xmas. Who is going to pay for this? How WILL they pay for it? Health savings accounts? I called a big BS on that one years ago. How will they fund that?

The Med here in Memphis is closing its ER it would appear permanently now... The reason? Costs of dealing with the illegals. Better to gate them to the private hospitals.... Then what? No ER's or no illegal care?

Again, this is the reason I say healthcare is a privilege and not a right. What do they do when it just falls apart. He who has the gold makes the rules.

Illegals are specifically NOT addressed in the Sneaker of the House bill. If they put it in under the present suggested bill it will simply take all the money and even Obama I think is starting to get that picture. The job losses from fines and companies falling apart because of the 8% per employee surcharge just to employ them. Not to mention the overall 15% increase in company taxes means biz is going to have to swallow it or go broke because you cant raise rates in a recession. 23% tax increase on biz and we are just supposed to sit back and take that? No, I dont think so.

Also your response to Kay wasnt very responsive.. I went to a red state? Which one? Be more specific... Did you go to all the hospitals here? This is my problem with that kind of answer to her. One off? You have to cite something better than we gotta lay in our beds here.

Ed, you do know that Crichton is a fiction writer, don't you? And really not even that good of one. He just beats the same theme in every book: scientists are always messing with things they do not understand and are not to be trusted. Fine. We get his POV. If you are interested in some responses to his work of fiction you can go here http://www.pewclimate.org/state_of_fear.cfm

I'll decline getting into a point by point. I don't debate with Flat Earthers or Creationists or Truthers either.

Being Canadian, I can't claim to understand the complexities of your political and health care systems, but as a citizen of the country to your north and as such, someone who has been saturated with all things American since birth, I do have an observation.

What is it about universality and the collective good that many Americans are simply unable to comprehend, let alone embrace? It's sad, and maddening from up here, to witness how the pervasive every-man-for-himself, dog-eat-dog, survival-of-the-fittest mentality supersedes everything, even the rare chance, the downright incredible good luck in fact, of finally having a leader who embodies integrity, intellect and vision.

Honestly, you don't deserve Obama.

Hijack or otherwise, is anyone surprised this discussion, like any other, eventually gets into Israel-Palestine? Some of us are pro-Israel (not its current/recent administration/s!) and pro-Palestinians too; we support the peace and social justice movements in Israel as in the U.S.; we have both Israeli and Arab friends in the M.E. And we do get tired of the good vs. bad guys rhetoric spewed onto, nearly as much as from, this region.
On another front, the "They will flood across that border like a brigade of 16 year olds in heat" from one commenter makes one wonder, as a non-U.S. friend once put it, what possibly makes people in the U.S. think anyone else wants to live in such a brutal nation?

Ed,
How can Wittgenstein on language, in the Tractatus or elsewhere, relate specifically to evidence (or the theories, ftm) of climate change? Though I'm not sure we want to toss this kitchen sink into this discussion too.

Don,

Yes, I know Crichton was a fiction writer, but he also wrote a well thought of book about Jasper Johns(so Crichton's no dummy), and one of his "novels" called "State of Fear" attacks environmentalism. There are some videos on Youtube where he talks about global warming. And I agree, he's not a very good fiction writer.

Paula,

Wittgenstein says in the Tractatus, that

1). It is impossible to predict the future based on the present.

2). Everything important can't be said, it can only be shown.

As regards 2), if it were properly understood, all education schools in America would immediately close. As regards 1), the use of mathematics in finance is a perfect example of the problem that Wittgenstein was talking about.
So, we can't predict the weather two months out with any accuracy at all, and we're trying to predict the climate change of the Earth? That's part of my disagreement with global warming.

Ed, your point (1) simply empties the notion "prediction" [I'm not sure how LW dealt with this in later works], and (2) would apply to any statement in science, so it would be strange if either could relate to facts of, e.g., climate change. Meanwhile, as we wait for philosophy to resolve these issues (they rather predate Wittgenstein), it would be interesting to hear if anyone knows more re the newly released CDC data on 2009H1N1.

I want all the things on your list except the open borders.

I think open borders allows the people with gumption in Mexico--the ones who would be a force for change there if they couldn't just run away from the problems by coming here--to run away instead of fixing Mexico.

There's really no reason Mexico shouldn't be as 'first world' as the US or Canada, except for the rampant corruption. As long as their best workers deal with the problem by running away to us, Mexico will never get fixed.

That said, those here should have health care. Because being an illegal in this country shouldn't be a death sentence if you happen to get seriously hurt or sick--it is at most worthy of a fine and the indignity/inconvenience of deportation.

What is it about blogs that make people so rude?
Or is defending Israel unconditionally and questioning(in a transgressive, playful post-modernist way(I'm being very sarcastic here))the orthodoxy surrounding climate change both ways to really tick people off? That is, is it just the subjects that cause people to be rude and not the discussion format itself, the anonymity for example?
What I object to in climate change doctrine most of all, is the Kyoto Protocols, which will impoverish hundreds of millions of people if fully implemented and only delay the rise of global temperature by a few years. The earth may be warming, I don't know(no one knows) but throwing many millions of people into poverty is not a solution in my opinion. Bjorn Lomborg now believes that the earth is warming because of human activity(carbon dioxide), but he thinks we would be much better off preparing for global warming rather than trying to prevent it, which most likely is impossible anyway. Lomborg believes that we(the human race) are much better off spending money to give people clean drinking water, etc. than trying to postpone the inevitable and that for only few years at a tremendous cost.
The two things I said about Ludwig Wittgenstein(hereafter LW), relate to "facts" of climate change or anything else because they are a guideline to the statements that can be made about the world. There are facts or "states of affairs" in the world with which propositions are concerned. LW's idea in the Tractatus, one of them anyway, is that any existing state of affairs that are described in a set of propositions provides no basis for predicting a new state of affairs, that is, what can be said in language is bounded by what exists in the world at the time(the present) we make those statements, whatever they are. Therefore, according to LW the attempt to model the earth's climate mathematically is absolutely hopeless.
This reminds me of Keynes argument about frequency versus probability, Keynes believed that it's foolish to use the same probability distribution in an equation because the probability distribution(s) is(are) not stable. Keynes also opposed regression analysis in economics for the same reason.
These both relate to climate change and other attempts by humans to predict the future.
These points seem incontestable to me, if someone wishes to demonstrate how, in a polite way I'm wrong then I'd be happy to read what they say.

To continue with LW.

One can object that one can predict future states of affairs based on an existing state of affairs, for example, an about to be launched space shuttle, we are able to say where it will be at some time in the future. Or take celestial mechanics as another example. LW's response, I think, would be to point out that these states of affairs are within science, or mechanics, the one area of knowledge where LW believes true propositions about the world can be made, if I'm understanding him correctly.
So to climate change. I believe that LW would say that there are facts about the earth's climate, infinitely many, and propositions constructed out of these facts will either correspond or not correspond with existing states of affairs in the earth's climate. But we have no means of accurately predicting a future state of affairs merely because we know infinitely many facts about the earth's climate today and can group these facts together into propositions that describe a current state of affairs. I think LW would say that climate science is not like mechanics, the earth's climate is simply beyond our understanding probably forever(okay, that last bit is Chomsky). We cannot go from the "facts" of the earth's climate today to mathematical models that will tell us what the "facts" of the climate will be 100 years from now. We can't even do that for one month!
This is because in the Tractatus at least, LW writes that both logic and mathematics say nothing about the world, which, with qualifications, I believe is correct.

Cheers!

Revere - I know very well our health care is poor. In the not so distant past you could get a veterinarian to sew up the gash you got tending the head gate vaccinating cattle. If you are deeply involved in one of the many ultra fundumentalist religions you might give birth attended by a midwife who insists you sit in a bathtub full of water as part of the procedure. Our clinics are staffed with rotating doctors and nurse practitioners who do the best they can with a population that is more often than not undereducated, superstitious and generally not disposed to follow through. Rural electrification and better roads are the only things that benefited country people in the past century. I don't think our problems are of our own making; afterall, the world we live in is determined by the wishes of people in the population centers.

Don - unfortunately it takes time to make more doctors and something definately will have to be done to make rural practices more attractive. Perhaps the Northern Exposure solution - the government foots the bill for the education and the doctor agrees to practice X number of years in Timbuktoo.

Kay, you make some excellent points re rural areas--and how people's lives out here tend to be determined by the metrops. I've learned rather quickly, too, since moving into the a countryside, that country persons are, indeed, not "undereducated, superstitious and generally not disposed to follow through." And they are well aware of their limited options re medical care.

Hmmm...not a peep from any of you so far, even though I've been more polite and reasonable than a couple of the people who blog here.
The words, "bien pensant", come to my mind, but maybe I'll be proven wrong.

Ed, not trying to ignore you, but the statements by Wittgenstein and others re logical statements, statements of fact, prediction, etc. take more discussion time, to do seriously, than is practical on a blog/comments site. Have you read Paul Edwards' work--I'm thinking in particular of the article "Will the future be like the past?" and Edwards' discussion (not there, especially) of contrapositives. An interesting take, from an ordinary-language viewpoint (so to speak) on future-tense statements.

Kay,

Yes it takes time. And this health reform package unfortunately isn't perfect. But this package does some good for rural districts and may help preserve some rural primary care; there is nothing in it that will make your hospitals and clinics close, drive people off their land, etc.

Ed,

I have politely engaged but there are only so many hijacks of hijacks that I can indulge myself in as playtime.

Your current points regarding global warming are that Crichton is a smart guy so if he writes a fiction book following his usual formula of bad scientists messing with the complexities of nature, then he must have a point, that you believe that LW would consider the study of climate to be one of those things beyond our understanding and ability to predict and that is good enough for you, and finally, that it is more cost-effective at this point to invest in adaptation than in mitigation.

I've already pointed to a site that addresses Crichton's fictional points one by one, which you have ignored.

As to LW, I've never held much truck with philosophers, except that subsection of philosophy that became science - and science is all about making models of the world that predict future events, testing them, falsifying them or not, and improving upon them. Which works, despite LW's apparent skepticism. Perhaps information swallowed in a black hole is unknowable, or that which is moving away from us faster than the speed of light ... other than that there is just that which is unknown and not understood, not necessarily unknowable. (And btw, THAT I recognize as a nonfalsifiable belief.)

Even that which is so massively nonlinear that it falls under the rubric of Chaos Theory, subject to immensely different results based on infinitesimal changes in starting conditions (I am sure you've heard of the "Butterfly Effect"), are able to be predicted as a set of probabilities, and that is what Chaos Theory is really about, not that things cannot be predicted ... as a simple example: we cannot predict which combination will come up on any single roll of the dice by analyzing the mechanics of the dice as they roll, but we can say with confidence that the odds are better that the two dice will add to 7 than to 12.

Climate science IS at the point of being able to say with confidence that if we roll with the dice we are currently rolling with the odds are great that we will have a climate changes of great consequences and not insignificant that the result will be catastrophic climate change and that if we change the dice by decreasing our greenhouse gas emissions we can alter those odds very significantly.

Which brings us to the last claim, that it is more cost-effective to invest in adaptation than in mitigation, essentially, that as a fire approaches our house (never mind whether or not we lit it) we should not bother turning off the gasoline pump leaking gas on the ground, clearing away underbrush for a ten foot perimeter, and hosing down our siding - better to spend the energy putting money into the account at Home Depot to rebuild after the fire. Let's just leave it at that I beg to differ.

Paula,

I don't know Paul Edward's work, I've read some Gilbert Ryle whom I liked a lot, but that's all as far as ordinary language philosophy. From what you say about Edward's it sounds interesting, but I'm not sure he had the same concerns as LW, who was more concerned about boundaries of language, what is language, that kind of thing. But thanks for the suggestion.
Funny about the contrapositive, I was told in a REal Analysis class that if the contrapositive of a statement is true, then the statement itself is true. Somehow that doesn't seem quite right.

Don D.,

You've ignored my point about the Kyoto Protocols, which according to Bjorn Lomborg, by the admission of the authors of the Protocols themselves, will only delay the expected temperature rise by about 3 years, I don't remember the exact figure. This at the cost of impoverishing hundreds of millions which is, in Lomborg's opinion again, what will happen if the Protocols are put into effect.
You don't like philosophers therefore you don't have to respond to them. There's not much I can say to that.
I wasn't thinking of Chaos theory at all in what I posted here so I'm not sure why you're mentioning it. What I was trying to say, which I got from Chomsky, is that there are things in the world which are simply beyond our cognitive reach. Chomsky indirectly got this from LW(I think), hence my mentioning the Tractatus. The climate is probably one of those things too complex to understand, meaning not that we can't say anything at all about it, but that we cannot model it mathematically the way we can things in mechanics or statics. Another example of things beyond our cognitive reach is that Godel showed there will never be an axiomatic system with the power of arithmetic that's both consistent and complete, it's simply impossible.
And LW's skepticism is not about science, I wouldn't really call him a skeptic at all. Oddly, he seems to be more of a mystic if anything.

Here's a quote from the paper on Crichton:

"The first is âa natural warming trend that began in 1850 as we emerged from a four-hundred year cold spell known as âLittle Ice Age.ââ Skeptics frequently discuss the idea of a natural warming trend or rebound, yet they never offer a mechanism to explain the rebound (e.g., what has changed in the climate system that has enabled it to recover from the Little Ice Age?); they simply state that it is natural. Climate scientists always ask the question of whether natural influences can explain climatic changes, and multiple examinations of the major natural influences on the climate (e.g., solar energy and volcanic activity) have concluded that natural factors alone cannot explain observed 20th century climate change."

Since the earth has been warning since 1850 and some climate scientists claim that carbon dioxide is the cause of that warming, then how to explain the warming that's been occurring since 1850? In particular, between 1850 and 1900? There were no cars then, so what could it have been? Also, it's amusing how the author in the last sentence leaves out the 1850-1900 period when summing up, that is they only mention the 20th century.
My problem with this response to Crichton is that it assumes we understand everything about how climate changes, when really we understand very little, compared to the kind of claims global warming people want to make. The author says we looked at everything, volcanoes, solar energy that we could think of and found nothing, therefore, they conclude it must be human activity. But if, as global warming people say, CO2 is that cause of global warming how does that work in this situation? The author is assuming greater knowledge than we really have, in my opinion.

Anyway, I'd be interested in your response to:

1). The Kyoto Protocols authors own admission that it will only delay the expected temperature rise by 3 years. I got this from Lomborg, is he a liar? He might be, I don't know.

2). If increases in CO2 explain global warming, how do you explain the rise in temperatures between say 1850 and 1920? I don't think we were putting much CO2 into the atmosphere then especially compared to now.

3). How, if we can't predict with any accuracy the weather in 3 months, can we predict weather over 100 years?

4). Oh yes, Freeman Dyson.

Don't know if Lomberg is a liar, or is mistaken. Or confused. Very confused. Or if just your understanding of him is. I don't know which. If you are really interested how and why the world's global community of climate scientists have concluded with near unanimity that rising levels of greenhouse gases are causing climate change, that risk of catastrophic change (tipping point)is real, and that decreasing the levels to a much less risky level is cost-effective and achievable, then please spend some time at this link http://www.pewclimate.org/global-warming-basics

Weather is not climate. Weather is observing the dice in motion and trying to predict which faces will be up in 1 second's time. Climate is saying what the odds are you will roll more sevens rather than twelves after a thousand rolls.

And sorry, no offense, and no desire to be rude, but I have only so much time in my life to play on line. This is my entertainment such as it is. I really don't want to spend too much of it debating that the earth isn't flat with you. I am not ignoring you but I am moving on to other activities.

Hello Don S.

Okay, you've ignored my points and then insulted me by comparing me to a Flat-Earther, with forehead villanous low. I looked at the document you referred me to on Crichton, I raised a substantial point about it, you have refused to reply to it and then, as I said, insulted me.
Sorry buddy, but you haven't acquitted yourself well in our discussion.

Fare thee well, my bien pensant friend!

And here's a link for you:
http://www.yourdictionary.com/bien-pensant

And yet one final link for Don S.:

http://books.google.com/books?id=kto37M4olh4C&pg=PR12&lpg=PR12&dq=bien+…

to give the full flavor of what bien pensant means. The paragraph beginning:

"Flaubertâs chemist is the personification of July Monarchy complacency, of a dogmatic stupidity(betise in all its forms is a key Flaubertian theme) and of bourgeois smugness. These manifest themselves above all in the constant reiteration, by Homais and others, of pretentious platitudes, in the turning and polishing of posh ideas(idée chic)â¦"

should be particularly instructive.

I would like for the original issue to take the hit and that is that they STILL havent come up with a way to pay for this. Paula you are right we are a mean assed society with all of those companies that are so bad. You know the ones that generate most of the jobs for the people that live here, and in many cases abroad. The taxation of the middle class businesses that is proposed to pay for this ensures that these people will have no jobs and tank the economy. It will be a pell mell fall too. The imposition of the taxes and fines on the smaller business for not "participating" which is a euphemism for being made a criminal by condition is just off the scale. You dont buy it? You go to jail or you get fined or both. Good, let the revolution begin.

Obama is already talking about 5% budget reductions next year because the tax imbalance is now at 1.73 trillion dollars. Add in the 4 trillion already spent on top of the existing debt limit and you got big problems. Do the math and divide that bill by 305 million Americans. I wouldnt be surprised to see them try to raise the debt limit. Do the math by hand on 5 trillion dollars per person in America. Sorry, most computers dont go that high and that included Excel. 305 million which will reduce by 2 million a year in ten years for 15 years all the while incurring bigger and bigger health care debt for the government and not the individual. You lose the drains but you dont lose the debt. You leave it for the next guy to pay. Our kids are going to be paying most of their income in as taxes.

Who are they going to tax for this? Births are and have been steadily declining in the US.

http://www.healthnews.com/recession-blamed-for-decline-in-us-birth-rate

Who is going to pay for it? It is a simple question...No rhetoric...All I hear is how we are a bunch of hard asses and that we are cruel and all of that usual stuff and that this should be a right.

Address the prime question...

Obama hasnt got a clue on how to pay for it. Honestly looking at the numbers I couldnt even begin to think it would work unless government took 65% of every dollar based upon last years income and that means at all levels. Longer term-we arent even going to be able to pay for the stimocrap that has already been done unless they cut all of the other spending out.

Decision time-Health care at all costs and lose the country and allies, or toss the whole deal?

Be careful how you answer.

Ed, I've a big press deadline Monday and also this is all a major thread hijack, but there are so many interpretations of Wittgenstein, and so much to the whole verification-meaning-(language use)-etc. thread in philosophy . . . Skip Ryle; works by Stroud, Black (on phil of science), maybe Edwards, possibly even Malcolm (maybe), eventually Cavell--well, and so many others. There's a collection, Logic and Language, fairly good. You've read LW's Philosophical Investigations, presumably. Okay, that's all for this hijack, on my part.

Randy: And I'd like to know who is going to pay for Iraq and Afghanistan, too. George W. and a cowardly Congress didn't pay for a dime of it. Not a dime.

Ah...but there is that Constitution thing and it doesnt say a word about entitlements, but it does refer to the military and war making powers. I also believe that it was the DEMOCRAT controlled Congress that authorized and authorizes the money for that.

The definition of common good and welfare is fleeting in the Constitution.

I still refer to an almost like type system in your state... You know the one... its already bankrupt and they are curtailing services. Cant be blamin' GWB for that one and thats pretty close to what this might turn into.

So what do we do? I dont have any answers except for what Jesus said, "There will be poor always, look at the good things that YOU have." Pretty good acknowledgment of a problem that has no fixes. I do know that the fix might do us and well, I dont owe anyone else a living that I am aware of under the law. But there are those that would change that.

Randy: It has nothing to do with the Constitution. If you think something is unconstitutional the Constitution has a remedy: the Courts. You raised the issue of paying. That's a separate question. Who is paying for Iraq and Afghanistan? George W. and a cowardly Congress (both parties) didn't pay a dime. Why aren't you complaining about that? Where does it say in the Constitution that's OK, in so many words? In fact, doesnt the Constitution say that only Congress can declare war? When was that done?

I an outsider - British - who reads here mainly for the flu and zoonotic disease info. My main interest, re the US, is in your foreign policy as that bit of madness is the one that spills out into, and destabilises, the rest of the world. As a US watcher all your problems seem to have the same solution - campaign finance reform. While usually defined as a Democracy your system is functionally closer to a Corporate Oligarchy. While this thread is nominally about the healthcare package it has spread to include the US's wars in Afghanistan, Iraq and its influence on preventing any meaningful chance of peace in Israel/Palestine. While all elected officials are so heavily dependent on corporate or lobby group finance I don't see how any meaningful change is possible. Even if you got a {resident who did not care about his second term and was willing to bite the cheque book that brung'im there does not seem to be any chance of getting enough senators or congressthingies to follow suite. Is it the will of the people or the will of the money that makes the US's priorities completely different to any other G8 country - or anyone else for that matter - when it comes to military or healthcare spending?

Ed,

A bit thin skinned for posting the intertubes, eh? And do keep up - I compared your Climate Change Denying to being a Flat Earther BEFORE I ever ignored anything you have said. Sheesh. But hey, it's Sunday and I a little time, so what the heck.

True, despite my love for Spinoza, my thoughts about most philosophers is best expressed in song - http://www.youtube.com/watch?v=xQycQ8DABvc In any case, no I do not think that LW's thoughts on epistemology and language have any bearing on the field of climate science. Even less so your thoughts about what his thoughts might be, what he "would say".

I also only care as much about what the physicist/mathematician Freeman Dyson thinks about Climate Science as I did about the Nobel Prize winning physicist Linus Pauling's "heretical" views on Vitamin C. Spinoza, now that was a heretic. These guys are just people who think that because they know something about one field that other people don't understand it qualifies them to be experts on everything else. Pauling thought he knew more about medicine than medical experts (who happen to work with a very complex system that they do not have a complete understanding of and that they actually cannot model mathematically the way we can things in mechanics or statics, heck a doctor can't say where a particular blood cell is going to be in a minute's time, how do we think they can make predictions about a circulatory system?!?) - that he was a heretic, daring to question medical orthodoxy. He wasn't. He just a fool, a very intelligent fool, but a fool nevertheless. No, a smart person opining about a field they have no expertise in, informs naught.

And your "point" about a milder period of warming, followed by some cooling, before the larger period overall more consistent warming trend that has occurred since about 1910 - can't say I get what point you think you are making. No one is saying that human made causes are the sole driver of all climate variation. What has been established is that human contributions are being overlaid on top of other causes of variations and swamping those other factors. The swing up and back down again from 1850 to 1880 to 1910 was up and down about 0.2 degrees from the mean. Now we are globally 1.0 degree above that same mean and in some areas 4 degrees above that mean. Oh, there are years, and decades even, since 1910 that have seen global decreases, but the overall trend is up and up and up. It's a scary graph. We now have more CO2 in our atmosphere than we have had for at least 800,000 years.

Are global scientists able to predict with precision exactly what will happen as a result? And what even more greenhouse gases will do? No. Unfortunately so far their predictions seem to be too conservative. (The Greenland Ice Sheet, for example, is melting FASTER than they have modeled it would. http://www.bristol.ac.uk/news/2009/6659.html ) But they can model quite well a set of likely ODDS of what will happen at different levels of greenhouse gases. Business as usual has a very real risks of extremely severe consequences. Mitigating those risks is cheaper than adapting to them.

And given the site that we are discussing this at, let me make this analogy: epidemiologists are unable to say exactly what any pandemic capable influenza bug will do. They have much less ability, by their own assessments, to know what this current one would do without mass vaccination, than climate change scientists have to model with confidence what the climate will do over time with particular levels of greenhouse gases. Should we then not vaccinate anyone? If all they can say is that there is a risk of catastrophe if we do not vaccinate that can be reduced if we do, should we respond that well then immunization is distracting from spending money on hunger, etc.?

Fortunately the reality is not either/or. Many interventions can achieve both.

And by the way, when did villains start to have low foreheads? Villain isn't part of my DDx anyway. http://en.diagnosispro.com/differential_diagnosis-for/low-forehead/3339…

Fare thee well as well. I think between my posts I have addressed all of your "points" such as they are. If you really want the science behind it then seriously visit that Pew link and click on the science link - this may work - Climate101-Science-Jan09.pdf

Paula - I didn't mean to imply that all rural peoples are "undereducated, superstitious and not disposed to follow through (on health care matters)" but that in very rural areas, a significant proportion of the population does fit this description. The fundumentalist religions that prevail here in the South have a lot to do with it as well.

Don - As millions are added to the numbers of people who can access health care, the need to add physicians and other health care professionals to treat them will increase immediately. What consolidation of schools, big agriculture and WalMart did to undermine the small towns and rural populations of America, this legislation (and a little malicious help from Cap and Trade)coming to pass just as we enter the era of oil depletion will finish it off. Perhaps you don't mind that but those of us who love rural life inspite of its shortcomings are sick at heart.

I honestly can't say I follow you Kay.

How does getting coverage to the currently uncovered lead to the collapse of small towns? Small town primary care docs have a better chance of making a go of it by getting more patients able to come in for preventative care and getting paid for it.

Hopefully that primary care can result in less need for specialty care, emergency room care, and hospitalizations, which the rural poor may currently get but then be unable to pay for currently. Under our current system even those with health insurance can easily go bankrupt when they get ill (http://www.consumeraffairs.com/news04/2005/bankruptcy_study.html).

There is nothing in health care reform that will lead to the WalMartization of health care or the death of small town America - if anything it does the exact opposite.

Paula,

Thanks for the suggestions, I'll keep an eye out for that book, Language and Logic.

Kay, my apologies--I didn't mean that it's you who call rural people ignorant etc. As for the ignorance that's there, some seems to come from restricted education, some from regional know-nothingisms, is my own impression.
Don and Kay, in this part of the countryside--perhaps a misleading one, since it's a tourist location too--there are lots of patients for the primary care physicians; more patients will definitely mean requiring more PCPs. I suppose nothing in the health "reform" bills being considered prevents future increased funding for medical students, so more could go into primary care--?
Ed--you're welcome. So many books in this area--enjoy!

After the Obamacrats are done printing more dollars for all this shit, I'll be happy bringing my wheelbarrow of trillions of dollars for a loaf of bread.

Paula,

So before this web page completely fades away, I just wanted to mention again that you, and others, might find Bjorn Lomborg, www.spiked-online.com and www.reason.com interesting, if you're not already familiar with them. Also, Freeman Dyson has written "skeptical" stuff about global warming. The site www.reason.com is a little nutty, free markets and all that, but on a number of things I do agree with them.

Best,
Ed

P.S. Interesting that you never really responded to what we all were talking about.

While Rome goes up in the U.S. legislatures, can we yet make one more attempt to remind the solons what they're talking about is people's lives and health? I am aware, like most of you, that it is only a pitiful parody of healthcare "reform" soon to be melded into law by Senate and Congress. And that it is being paid, in very major part, by "trimming the fat from" Medicare, while helping the health insurance industry continue to thrive, is, too literally, sickening. And what of those still to be left outside the circle of the insured? We are to cheer "Wow, there's reform!" and avert our eyes?