Something good is better than nothing

… and the health bill that gets to the President’s desk is going to have a lot of good things in it. Some activists need to take a deep breath and notice that.

Ezra Klein has about had it with activist/netroots threats to oppose health care reform if there’s no public option, and he calls the meeting to order:

The achievement of this bill is $900 billion to help people purchase health-care coverage, a new market that begins to equalize the conditions of the unemployed and the employed, and a regulatory structure in which this country can build, for the first time, a universal health-care system. Thousands and thousands of lives will be saved by this bill. Bankruptcies will be averted. Rescission letters won’t be sent. Parents won’t have to fret because they can’t take their child, or themselves, to the emergency room. This bill will, without doubt, do more good than any single piece of legislation passed during my (admittedly brief) lifetime. If it passes, the party that fought for it for decades deserves to feel a sense of accomplishment.

Yes, it’s a shame to have to give in to extortion by the likes of Ben Nelson and Joe Lieberman. But even in raw political terms the activist threat is lunacy. If we pick up three more seats next November, we won’t have to do that quite so often. If the Democrats can’t get a bill on the President’s desk, the only question is how many seats the Democrats will lose.

And that’s even before you notice that letting people die for lack of health coverage in order to express your dislike of Blue Dogs is pretty damned sick.

Footnote Here’s an especially egregious example of infantile behavior: a single-payer advocate, a member of a group that wants to scrap the whole reform effort and start from scratch, arguing that a bill that extends medical coverage, caps out-of-pocket expenses, and forbids recissions and exclusions of pre-existing conditions won’t do anything to reduce the number of medical bankruptcies. Could any sane person seriously believe that?

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

26 thoughts on “Something good is better than nothing”

  1. I dunno, I think it might be true, only because I don't think the penalties will be enough to discourage it, and will potentially be assumed as a cost of doing business. It is hard for me to imagine an influential industry — one with the kind of political pull the health insurance industry has — actually facing serious consequences for anything.

  2. The insurance companies get to keep denying coverage until 2014 for those with pre-existing conditions. They get to now increase their pool with a mandate that does not control their prices they charge. The Big Pharma guys get to keep ripping off insurers, and insureds, with their ridiculously priced medications. And the system gets more convoluted with new regulations and other mandates. I don't see this at all as anything really "good." And it was certainly not worth the Stupid (Stupak) amendment. And let's watch whether that really gets thrown out in conference…

    I'd have rather gone simple: Medicare for All. And I think you would have too. So why did we not do it? We let Ben Nelson and his corporate marinated whores (yes, I can we can say that if it's a guy at least!) control the agenda with Republicans, the AMA and insurance companies. I'd rather us turn over the tables and start over with a simple plan the CBO will clearly show cuts significant costs, covers everyone and simplifies paperwork for anyone who is under the plan: Medicare for All. If we're going to be called socialists, then by God, just go for the right solution that finally can give socialism something nice to point to. And let the opponents bray at that. What we'll find is that our leverage for a much better plan will emerge. And the Ben Nelsons, Blanche Lincolns, etc.? Run primaries against these traitors to their own constituents, who endorsed a robust public option in every poll, immediately cut off their DNC money supply, and strip them of committee chairs. It can be done. It's been done by real leaders such as FDR and LBJ before. And watch the enemies of reform come crawling back. It's a shame that Pelsoi, Reid, Obama et al have no understanding of negotiation rules and tactics.

    This is better than ripping on David Himmelstein, who knows more about this issue of health insurance than you and I combined. I''m so tired of attacks on those who are "lefties" when we keep coddling right wing jerks like Max "Hire My Girlfriend" Baucus and Ben "Republican in Democrats' clothing" Nelson.

  3. Sorry, Mark, but I'm not convinced. If the net effect of the bill is to raise costs, enrage millions who are forced to buy insurance that they cannot afford, and undermine the credibility of government in general and the Democratic Party in particular, then this bill could be the end of health insurance reform instead of the beginning.

    There is no question that a robust public option limits costs to the taxpayer and to policy holders. So, opposition to the public option is clearly not about cost or fiscal responsibility. And the Republican Party's long history of mendacity, short-sightedness, gaming the system, and disingenuous argumentation certainly should give one pause. The proposition that the bill constitutes a self-defeating give-away to the insurance industry – and possibly a poison pill – is not far-fetched and deserves to be addressed.

    Those of us who think the problem with the system is the private insurance companies should not be faulted for continuing to argue for solutions that address the real issues. Calling your opponents infantile does not advance the dialogue on this issue.

    Cures that do not address root causes are rarely effective. Sometimes they do more harm than good.

    In an era when we are increasing our involvement in Afghanistan, throwing trillions of dollars at Wall Street, and propping up home pices without helping people actually stay in their homes, it is not unreasonable to ask if the administration and Congress have their eyes clearly on root causes.

  4. Given that the medical bankruptcy stats are entirely fictional, why wouldn't single-payer advocates use them against everything but single-payer?

  5. The fact is that a bad bill, and it is not clear what will emerge except that it could have been orders of magnitude better (that's not hyperbole), will impose costs on people by requiring them to buy insurance. It is not clear that insurance will be affordable or cover the costs. At the end of the interview Himmelstein compares the current debate to arguing over aspirin or tylenol for someone with cancer. You transform that into the faux outrage of "Dr. Himmelstein argues that tylenol and aspirin are useless for people in pain." I'd say you are just as guilty of distorting the debate and any political effect that emerges from your "reasonable" advocacy is likely to be less valuable compared to Dr. Himmelstein's greater expertise and greater passion.

  6. As Michael C has said, many of us think this bill has gotten so bad that the cure could be worse than the disease. A scheme that raises the costs for me and many others with insurance by making it taxable and using the proceeds to subsidize insurance for the poor could be good or bad, depending on just how effectively it improves regulation of the insurance industry. Any loopholes they've managed to get into that regulation will be used to exploit all of us. If you doubt that, just look at Aetna's announcement that they aren't making enough money, so they're going to raise prices enough to force 650,000 people at the bottom to drop coverage. If they're going to be in a position to just raise prices to their hearts' content, the fact that they're compelled to offer coverage doesn't do much to offset the fact that everybody is now mandated to pay their prices.

    To me the public option is a way to control these costs in a way that I understand, through competition with an alternative that isn't part of the existing rapacious, colluding, monopolistic pack. If that's now so compromised that it won't do that, then there's no reason to mindlessly keep defending it. But I don't see much other reason for confidence this isn't going to turn into another Medicare Part D style boondoggle. Ezra is a smart guy who specializes in doing this kind of analysis, so maybe I should trust his judgment. But in his post he also said that passing this legislation would be evidence that liberals are running the country. At that point I started wondering whether he and I are actually living on the same planet.

  7. Why is it that when the netroots hold it hostage, it's lunacy; but when blue-dogs do, it's merely extortion? If the Public Option is so unimportant to fight for, why do various folks fight so hard against it?

    I suppose both sides by now have turned the fight into a talisman of control over the Democratic Party. Which faction wins shows future direction, or so they believe.

  8. I would oppose any health reform that only denies coverage of certain medical procedures to people named Kleiman, no matter how beneficial the results for everyone else, on the same principle that makes me oppose any bill that denies coverage of abortions to people who need them.

  9. Kleiman, you know the general sway of your comments, but so far they are running 8-0 (with one wingnut abstaining) against the idea that Himmelstein is being "infantile". I think you owe him an apology and a correction.

  10. If Congress scraps the current health care reform effort there will be no "starting over."

    So instead of "infantile," how about "destructive" or maybe "foolish" as descriptors. Better?

  11. Who says you can't start over. I'm sorry. But Larry B, YOU are the one with the infantile point of view. If Pelosi and Reid were real leaders, they'd send Anthony Weiner out there, along with Sherrod Brown, out on the circuit pushing Medicare for All. And the union leaders would be right there building the momentum. And you watch how fast the insurance companies start to come to the table with compromises. As for the Ben Nelsons, et al., again, you get the rest of the 51 Democratic Party Senators and say, "This is it." And tell Nelson, et al., "You don't come aboard, you're stripped of your power as chair of any committee, the DNC money is cut off, and we will work a primary against you. You want to become a Republican? No? Then stop acting like one."

    I have no problem with the idea of "Don't let perfect be the enemy of the good." But this bill, and the discussion in the corridors of Congress, is not good. It's bad.

    So, I would say, "Don't let the idea of getting something done lead us to enact something bad." Really, Larry B and Mark K, who needs Son of Medicare Part B? Because this is what it is shaping up to be…

  12. I'm with Digby on this one. The public option isn't a policy issue anymore, the version left in the senate bill is so weak as to be laughable (although if the Coburn amendment require congressmen to use it passes it may get better in a hurry) Anyway at this point the question remain is "do liberals have the power to force this to happen" If the answer is no then when Cap and Trade or EFCA comes up all that will matter is what Presidents Nelson, Conrad, and Lieberman say we are allowed to do. If the answer is yes then the myth of a "center-right" nation takes a body blow and reporters might start returning the calls of people like Sanders or Franken when it comes to policy questions.

    In the face of a united opposition Democrats need to show that they have the power to pull their caucus together and win on the must-pass legislation. More than that they need to show they can do so without being fully held hostage to the centrists within. Right now they are looking at a thirty point enthusiasm gap going in to 2010. Liberals and progressives came out hard a year ago and right now a lot of them feel like they were taken to the cleaners (this is partially their own fault, candidate Obama never promised to be anything other then a centrist technocrat) During the campaign they were promised a public health care option and now the time has come to deliver.

  13. Well, Mitchell J. Freedman has me convinced, through the awesome rhetorical power of repetition and name-calling, that if Pelosi and Reid just click their heels together three times it will suddenly become possible to get single-payer through Congress, despite all the evidence to the contrary.

    I guess the only question now is whether they each click their own heels together, or what. Maybe they have to click all four heels together?

  14. You know, Warren, this thread started because Mark, the proprietor, called a respected and knowledgeable advocate of Medicare for All "infantile." I think I have not even approached that level of "name-calling" when it comes to any commenter on this board.

    Your glibness cannot mask the fact that Pelosi and Reid have not shown any leadership and have let the Blue Dogs control nearly every step of their corporatist agenda–even when polls in the Blue Dogs' states, for example, showed support for a strong public option.

    If you don't try, you don't even have the chance to win. And Pelosi and Reid have not done anything to put pressure on these Blue Dogs the way an LBJ knew how to do–and which can still be done. It's why I told the DNC to screw off when they called my house to ask for money. We support those individual Democrats who actually represent people's interest, not corporate interests, and we don't support Stupid/Stupak who probably thinks the planet was made 10,000 years ago as he places a woman's life below that of a zygote.

  15. And the funny thing is that nowhere in Dr. Himmelstein's interview does he advocate not passing this legislation. He lays out clearly and articulately why it does not address the issue that the interviewer is asking him about. "Infantile" indeed. If everyone is being so pragmatist about this then consider what the practical effect of screwing the left will be in the 2010 midterm.

  16. ElliotG, re-read. What Kleiman says is that Himmelstein is a member – a founder, actually – of a group (PNHP) that wants a do-over. This is true, or at least has been of PNHP spokespeople. What he calls infantile is the claim that the current proposal won't mitigate the problem of medical bankruptcy. We might cast about for another word, but whatever else it may be, the propensity systematically to underestimate the benefits of a less-preferred course, like the propensity to overestimate the political prospects of one's preferred one, isn't really rational. And I'm afraid that's what Dr. Himmelstein & a fair number of other, I'm sure admirable, people are up to.

  17. Wow, I can't believe I disagree with you so wholeheartedly. First, the question isn't "If" but HOW many seats will we lose. People are understandably upset and it's hard for me to believe that the optimism that boosted Dem turnout is going to be around in November unless we have some miraculous turn around between now and November. Understandably, these activists realize that if it's not now, it will definitely be never.

    Second, calling their behavior "lunacy" couldn't be more off. Sure, part of their rhetoric is bluster, but most of it isn't. Backing away from a public option means that guys who are clairvoyant enough to recommend their girlfriend for a government job but similarly foresee a public option as wasteful and "big government" are actually running the Dem show; I didn't think that Dems would shy away from the ideals of Ted Kennedy so quickly after his death. I mean, if now is not the time for a gut check akin to what Pelosi pulled off in the House, then I'd like to officially resign my identification as a Dem. I don't want to think about this period of time and give my kids the Dennis Green post-game speech, "They are who we thought they were…and we let 'em off the hook!"

    And third, treating these activists like they are analogous to the Birthers/Tea Baggers/Hussein crowd is not only apples-to-oranges, public option activists at least have the good sense to get their news from a guy who doesn't boil frogs on live television.

  18. "Something good is better than nothing."

    Yes, but that's not the real argument being made. The argument is that whatever the Senate passes is better than nothing. That's a very different argument. What more, Ezra Klein – who is probably not the best person to go to on the merits of the "public option" since he was prepared to ditch it pretty much from the get-go – describes a bill which does not match the reality.

    build, for the first time, a universal health-care system

    The claim that the bill will provide a basis for building a universal health care system is utter nonsense. Have we forgotten – assuming we ever knew – that the same assurances were made about Medicare and Medicaid? And yet here we sit, nearly 45 years later, still talking about "first steps." If you want to sell the bill, sell it on what it does, not on some misty dream that by virtue of allowing Democrats to say "Health care reform? We've done that," it will do more to delay than to advance.

    thousands of lives will be saved by this bill

    Starting when? Provisions won't be in effect until 2014 and the White House has already said that it's unreasonable to expect the insurance companies to accept all comers (i.e., drop pre-existing condition limitations) until after there's a universal mandate, which shouldn't come until after the "exchange" is in operation. In other words, at least several years from now. Meanwhile, opt in? Opt out? Triggers? Ultimately, who is covered? Who is eligible for the "exchanges?" None of that is resolved yet. It's comforting to say "thousands of lives will be saved," but it's also hyperbole.

    Bankruptcies will be averted

    How many? How? When? The bill contains no rate caps. As the "infantile" Dr. Himmelstein (and many others) have noted, upwards of 2/3 of bankruptcies result from health care costs and 3/4 of those people had health insurance – that is, nearly half of all bankruptcies came from health care costs among people who had insurance. Related to that, there is the notion that the bill caps yearly out-of-pocket expenses. It does not. It only says such caps can't be "unreasonable." What's more, caps on yearly and lifetime expanses can be maintained for some types of insurance and apply only to "dollar value," a limitation insurers have evaded in the past by, for example, capping the number of visits for various types of treatments.

    Rescission letters won’t be sent

    Nonsense. The bill allows for cancellation of coverage in the event of "fraud or material misstatement of fact" – which is exactly the set of claims the companies make now! What, you think they send letters saying "we're canceling your insurance because you got sick?" There's always some claim of withheld information or some such.

    take their child, or themselves, to the emergency room

    Actually, the emergency room is the one place many without insurance can take their children or themselves now. That's what some on the right use to claim there is no unavailability of health care. (The part they leave out is that in those cases the ER is only required to provide palliative care, that is, to relieve the immediate symptoms or treat the immediate injury.)

    This bill will, without doubt, do more good

    There's actually a rather fair amount of doubt about that.

    fought for it for decades

    There's the bottom line: This is not what we fought for, for decades! This actually locks in the dominating position of the health insurance industry, actively shoves the option of single-payer (ala Canada) or a national health care system (ala the UK) into the trash, tosses the hope of universal coverage to some unseen and unseeable spot down the road, and will even by the claims of its proponents leave about 18 million uninsured ten years from now – while promising improvements which depend wholly on the degree to which the federal and state governments are prepared to vigorously enforce its every aspect in a way they have never shown any interest in doing before.

    Whether or not the Senate bill is worth passing is a judgment call based on balancing the frankly limited good it can do now with the greater good it will postpone indefinitely. People can make their own choices on that, but labeling those who say the bill just isn't good enough to deserve support as "sick" people who are for "letting people die … in order to express [their] dislike of Blue Dogs," now, that's "infantile."

  19. Whether or not the Senate bill is worth passing is a judgment call based on balancing the frankly limited good it can do now with the greater good it will postpone indefinitely.

    How do you know it will postpone it? Seems to me that what's more likely to postpone further reform is failure to accomplish anything. I'm not so sure there will be a future groundswell of support for single-payer if the starting point remains today's status quo.

  20. David Wolford,

    You don't know until you try. Paralysis by analysis is precisely the problem among too many thoughtful Democrats in Congress and with regard to those who agreed with Mark on this thread. Those of us who disagree are simply saying we ought to be pushing our position with the strength that a Stupid/Stupak or Ben Traitor Nelson or Joe F'ing Lie-berman push their position. The important thing to note is that most Americans can support Single Pay or Medicare for All as it is relatively easy to explain, unlike these other convoluted plans. And since we're already being called "socialist", we can at least say what we mean and move on from there. I am strongly convinced that a tough position for liberals will be far more successful in securing health insurance reform than the current method, which again is only empowering the Blue Dog fools who will go down in a primary challenge or to a Republican next year anyway. Look at silly Blanche Lincoln's poll numbers these days. If she stands for people, however, her constituents will be far more likely to back her. Too bad her head is up the butt of the Capitol Building or worse, K Street insurance industry lobbyists who tell her she is a "centrist" for bending to their will, not the will of her own human constituents. Simply put, "moderation" as defined by David Broder, is a loser more often than not. And it produces complicated legislation that benefits the very industry sought to be regulated.

  21. I am strongly convinced that a tough position for liberals will be far more successful in securing health insurance reform than the current method, which again is only empowering the Blue Dog fools who will go down in a primary challenge or to a Republican next year anyway.

    If they're Blue Dogs who lose, you can expect them to be Republican pick ups. The consequences of that won't be more fertile ground for reform, but a rejection of it. As for those like Blanche Lincoln and Ben Nelson, I'll bet they're well-aware of what their constituents think, which is why they aren't all-out supporters of single-payer.

  22. "Understandably, these activists realize that if it’s not now, it will definitely be never."

    You do realize that the unstated premise of this is that your health care reform isn't publicly defensible? If you could defend it, prolonged debate would increase support for the reform, not reduce it. You're tacitly admitting that, the more the public hears about your plans, the less they like them.

  23. David, why don't you read something before you make statements with assumptions like Lincoln or Nelson know what their constituents think. They don't, anymore than Snowe in Maine, who ignored polls showing majority support in Maine for a robust public option. And what these morons fail to understand is their weakness is what comes through, which hurts worse with independents than one's position. That's why Grayson has a much better opportunity to win his tighter registration seat again. The last thing I would assume is that Nelson or Lincoln know a damn thing about what their folks outside of DC know or don't know.

    And Brett, I know you were not responding to my comment, but please don't count me in as saying it's now or never. I am saying, let's get tough in negotiations now, and not be afraid of any now or never scenarios. Reid got tough with Republicans today. He needs to get tough with the Blue Dogs. And really, now that we are in flux in terms of plans again, Reid and Pelosi have an opportunity to redeem themselves, but the sad thing is they will expend much energy trying to water down Nelson's anti-abortion amendment, rather than getting us back to the larger issue.

  24. To Brett Bellmore-

    That isn't the premise at all. The premise is that we have a margin in which a public option is available, but that margin likely won't be around by November. And this isn't really about trying to cut off debate. If debate actually illuminated the issue and swayed certain Blue Dogs and Republicans one way or another, I'd be all for the debate; that's obviously not the case. No matter what health care bill comes out of the Senate, Republicans will not vote for it. The Senate debate then isn't some kind of Lincoln-Douglass exercise, but a purely political show whose reviews come in the form of 15-second clips that the evening news broadcasts.

    There's nothing more I'd like than to go coast-to-coast with a "Medicare for All" campaign, but when you are stuck with people like Baucus, Nelson, and Lincoln as your cargo, you realize there's no point in stopping every five minutes for re-fueling.

  25. It only takes fifty votes and the VP to abolish the filibuster. if the filibuster is insurance the premiums are bankrupting us. Enough.

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