President Obama Changes the Tone

Regardless of the centrality of the “town hall” to the American mythos, the continuing “debate” on health care has borne more of a resemblance to Athens, and the chaos of pure democracy, than anything in the American past. The American rhetorical tradition is more in the mold of statesmen calmly making their case, like the “Federalist Papers” or Paine’s “Common Sense.” And so yesterday, the American President took to the New York Times to explain the need for, and limited reach of, his healthcare plan.

[O]ver the past few weeks, much of the media attention has been focused on the loudest voices. What we haven’t heard are the voices of the millions upon millions of Americans who quietly struggle every day with a system that often works better for the health-insurance companies than it does for them. [. . .]

This is what reform is about. If you don’t have health insurance, you will finally have quality, affordable options once we pass reform. If you have health insurance, we will make sure that no insurance company or government bureaucrat gets between you and the care you need. If you like your doctor, you can keep your doctor. If you like your health care plan, you can keep your health care plan. You will not be waiting in any lines. This is not about putting the government in charge of your health insurance. I don’t believe anyone should be in charge of your health care decisions but you and your doctor — not government bureaucrats, not insurance companies.

This is the much-needed reboot the healthcare debate has been begging for, a refocus on the real problem of under-insurance, with more than a few subtle slaps at the more deceitful of his opponents.

But let’s make sure that we talk with one another, and not over one another. We are bound to disagree, but let’s disagree over issues that are real, and not wild misrepresentations that bear no resemblance to anything that anyone has actually proposed. This is a complicated and critical issue, and it deserves a serious debate.

The question is whether anyone will read it, or care. You have to admire a President who respects his country enough to expect citizens to put down their megaphones to read a newspaper. Sadly, the past few weeks hardly justify his optimism.

Always remember that democracy in America is, as the Founders themselves said, an experiment — the greatest experiment in human history, designed to prove that a great people can build a great nation and, together, rule it wisely, to secure “the blessings of liberty” to all. For two hundred years we’ve bucked the odds and defied history itself. But if we can no longer set aside fear, shut out dishonesty, and focus for one second on a serious problem, that experiment may be approaching its end.

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77 comments

  1. It may be too late on this. The Town Hall rabble are taking it over for themselves and actually becoming a grass roots movement. I wonder if the Republicans are going to be happy with what they started.

    Republicans Gettimg Booed, too.

  2. I agree. Too little, too late. The Saturday New York Times? The least read day of the week in a dying medium. And he didn’t give us anything other than the vague pleasantries he has been repeating ad nauseam. Asking people to simmer down and talk is nice, but how about using the power of his office and his supposed oratorical skills to actually frame the debate?

  3. I read a good article the other day that i can’t seem to find now. They were talking about how Democrats have tried to frame much of this debate by telling stories of real people who had terrible things happen to them because they didn’t have healthcare. The not-so-subtle message is that we should listen to these stories, feel shame and push for the government plan.

    On the flip side, there are an equal number of stories floating around from people who really like their current plan, are fearful of government involvement in healthcare and don’t like the plan being put forward. The not-so-subtle message coming from the Left in reply is that these stories don’t mean as much.

    1. I think you’re absolutely right, Mike. All the anecdotes don’t really tell us anything, so let’s look at some numbers instead.

      The United States
      ——————
      Total health costs, % of GDP: 16.0%
      Total health costs/capita: 7,290 USD
      Public health costs/capita: Ca. 3,500 USD
      Physicians per 1000 capita: 2.4
      Life expectancy at birth: 78.
      Uninsured Americans: over 40 million
      Underinsured Americans: Who knows?
      Complexity of system: Makes grown men weep.

      The United Kingdom
      ——————
      Total health costs, % of GDP: 8.9%
      Total health costs/capita: 2,992 USD
      Public health costs/capita: Ca. 2,500 USD
      Physicians per 1000 capita: 2.5
      Life expectancy at birth: 79.1
      Uninsured British: None
      Underinsured British: None
      Complexity of system: Go to doctor, get treatment.

      (Ok, not all numbers, but still…)

      Comparing the systems like this, looking at the costs vs. the results, I still don’t see what it is that’s so amazingly attractive about the American system. Seems to cost a lot of money in return for some not very spectacular results and a lot of entirely avoidable human suffering.

      1. I’m always surprised at how many people “defend” the current health care system, which was almost created out of accident The employer based health care is so…strange.

      2. Gotchaye · ·

        I generally agree with you lanfranc, but it is worth noting that you really ought to only compare things like life expectancies between similar ethnic and cultural groups. The British are 95+% white (or so sayeth Wikipedia). The US is only 80% white, including Hispanics, and a much larger portion of the US’ white population is going to be Hispanic (15% of the whole population, or almost 20% of the white population, compared to probably negligible numbers in the UK). There are even noticeable differences between groups of non-Hispanic whites. To really get a good comparison, I’d want to see life expectancies for people who claim “White British” on the UK census compared to life expectancies for (the technical term escapes me at the moment) whites of Anglo-Saxon descent in the US. But it does seem hard to believe that whatever deficiencies exist in the British system couldn’t be made up for with another few percent of GDP.

      3. Comparing the two countries is bunk. It’s sort of like when people point to the lack of murders in Britain as evidence as to why we should ban guns here. Apples and oranges.

        You keep coming back to a universal system lanfranc but you keep ignoring the fact that it’s been taken off the table by the White House. Furthermore, they are now sending out feelers for removing the public option all together which would lead towards the kind of co-op plans that the GOP (and a lot of Americans) support. I’m just wondering if liberals are going to be honest about how they feel about that.

        1. I strongly disagree, Mike. At least as far as cost is concerned, the OECD figures are adjusted for purchasing power parity and other economic factors, so they are comparable. Share of GDP and public budget are also comparable factors. If we deny that, doing any kind of macroeconomics at all becomes impossible.

          Also, I’d appreciate it if you’d stop trying to hide behind vague musings about “liberals”, and instead give me a clear and reasonable explanation of why you’d want to keep a system that costs twice as much as necessary, yet leaves 15% of your population uninsured. You can’t just ignore those numbers.

          1. I’m not trying to hide behind anything. I’m trying to get this conversation back on subject. The post by Ames is about the current debate in the US…and a European system isn’t even on the table. So why are we talking about how great you think the European system is?

          2. That’s because I still haven’t managed to get anyone to explain why the American system is so great, despite what seems to be pretty obvious deficiencies. I’m really trying to understand here, honest.

            By the way, there’s nothing inherently “European” about a single payer system. Canada has one, too, which works just fine.

            1. At its core, we believe that the American system fosters a lot more innovation. Government control stifles that. Almost every economist in the world will second that assesment.

              I assume your question is for the liberals AND the conservatives, since libs don’t seem to be supporting single-payer either.

              1. swconference · ·

                Ooo, what are you citing for that economist agreement?

            2. My questions are for anyone who cares to answer them. I’m a bi-partisan questioner.

              But you mention innovation – fair enough. I doubt your “almost every economist” assertion (Paul Krugman is certainly not one of them), but never mind that. I still have some further questions, however, such as:

              – How does this somewhat vague concept of “innovation” translate into measurable benefits for the average health care consumer, and how are these benefits sufficient to make up for the deficiencies in the system? Also, couldn’t you achieve the same level of innovation by introducing a more rational system that did not cost twice as much as it had to, and instead spend that money on direct health investments instead of health consumption?

              – Further, even if this innovation leads to a better health care for some, how is it defensible that over 15% of the population do not in fact have access to this health care?

              – Also, as long as we’re talking economics, how about the system’s potentially harmful effects on the economy through limiting job flexibility (employees may be less willing to change jobs if it affects their insurance), greater incidence of risky lending and eventually bankruptcy because of excessive healthcare expenses, and the spending of an unnecessarily high share of GDP on what is essentially a service rather than production?

              1. Lanfranc,

                Here’s what makes me crazy about folks that live in Europe and get on the % of GDP bandwagon: The reason that countries like Britain are able to keep their healthcare costs lower is because most of the innovation that is taking place is happening in the US. And that is happening because our for-profit system drives it. It’s INCREDIBLY smug to brag about your low healthcare costs as you all take medicines and use life-saving technologies that were invented in the US. I mean seriously, show me any source that claims that more medical breakthroughs happen in Europe than they do in the US. The Brits can’t even get their Mad Cow problem under control, but they want to brag about their healthcare system. It’s ridiculous.

                In a given year the US spends about $260 billion on pharmaceuticals. That’s R&D all the way up to production. Now I don’t know what the number is for the UK but obviously it’s going to be a LOT lower because there’s not really any incentive for drug companies because the government kills profits. So you say that because yours is a lower % of your GDP it must mean that your system is more efficient, etc. So let’s put that % of GDP in perspective. In the US we spend $88 billion per year on tobacco. We spend $90 billion on alcohol. We spend $121 billion on soft drinks. If you’re doing the math I believe that is $299 billion, or $39 billion more than we’re spending on all those drugs that eventually find their way onto shelves in British pharmacies. So when you start slinging around % of GDP figures and comparing our countries, let’s keep this in mind. Even with our high % of GDP Americans still find plenty of luxury goods they seem to want more.

                But if you and Ames want to go down that road we could also start comparing all kinds of things as a % of GDP. Housing, for example. Or food. Or banking. As of March the UK has spent almost 20% of their GDP on their banking bailout. The US has spent about 6%. This disparity must mean that our banking system is better and the UK would be crazy not to copy it, right? If a country spends a lower % of their GDP on a given commodity then that = a better system. That IS the logic we’re using, is it not?

                Here’s what it boils down to: Yes, the US has a problem with people being uninsured. But a big part of those uninsured are either illegal immigrants or they are people that aren’t accessing systems we already have in place, like Medicare and S-CHIP. When you weed out those who are essentially uninsured by choice because they aren’t using what’s available or they aren’t here legally, the problem of the uninsured is relatively small. And not to sound cold , but the number of people who will suffer from no insurance is tiny compared to the number of people who will suffer in the future if innovation is stifled by a government-run system. If you can tell me how you maintain a US-level of innovation while moving to a universal plan…I’d love to hear it. But if that was possible, why isn’t it happening in Europe?

              2. Maybe the simplest way to compare things is the US and Canada. Canada is able to spend a lot less on their military because we spend a lot more. If the US stopped using a for-profit model Europe wopuld be forced to spend more or face a plateau of medical advancement.

        2. If the public option dies, it dies because the GOP managed to fool 30% of the people 100% of the time. A shameful victory which, God willing, will shorty prove pyrrhic.

          And Mike you remain wrong on both. Unless Americans are more violent or prone to illness, both comparisons work.

          1. So then you would like to see a universal system Ames?

  4. Mike,
    Here’s what I want – a healthcare system that acknowledges that healthcare is NOT a private commodity, like Spam or Cheerios or even gasoline, but instead a public gtood, like park space, or education. I want a system where I can pay a reasonable premium each month to get that healthcare (based on my income), a system where everyone can have access to all sorts of different treatments, and a system where the people making decisions about what is the best course of treatement for me are me and my doctor.

    For those of us well paid eneough, and by large enough employere, that syatem now exists (albeit hatlingly) in a private insurance “Market.” That market, however, is not universal, nor does it want to be. Insurance companies are not in the business of providing healthcare – they are in the business of making profits for their shareholders by taking in as much as possible in remiums and paying out as little as possible in services. That is why they are private corporations, not public agencies.

    The problem is, because they want to make a profit, they will actively deny coverage to those who can’t pay, or those whose care (i.e. the part the insurance company tries to keep low) is too costly. Hence the existing condition exclusions we hear so much about – which is rationing of healthcare delivery under a market based system.

    The private company delivery model also, past a certain point, stiffles innovation, not government interaction or competition. As long as insurance companies can keep premiums received relatively high, and payouts in services relatively low, they have no incentive to innovate, because innovation costs money. Same is true in most private industires – look at America’s once world leading auto industry if you don’t believe me.

    Having said all that, I consider the current attempt at healthcare reform to be an unmitigated disaster. Once again the House wrestled with an issue, passed a bill, and the weak-leader Senate stalled. By the time they get back to DC at the end of the month, I fully expect they won’t pass anything, and since all the meaningful stuff (Like a public plan option) has now been carved away, I think they should stop wasting time and move on. Of course, I think a number of them deserve to be un-elected next time around, but we’ll see if that is allowed to happen.

    1. Phillip,

      All of the stuff you are talking about can be addressed and improved without moving to a government-run system.

      1. then it is privately run and hence for profit and we’re back to where we started.

        1. Nancy,

          A for-profit healthcare system is why you can go to the store and buy pretty amazing medications over-the-counter for next to nothing. It’s why soldiers coming back from Iraq are getting amazing technologies to help them overcome their injuries. A for-profit system in the US is what Europeans count on.

          1. mike, i can go to almost any other country and buy even more amazing, along with the usual medications, over the counter.

            1. Yeah – and where are those drugs coming from?

              1. not necessarily from here!!!

                1. So give me a %. How many drugs sold in Europe we’re developed in Europe verses the US.

                  Here are some basic numbers about American vs. European medicine:

                  * The American five-year survival rate for prostate cancer is 99 percent, the European average is 78 percent, and the Scottish and Welsh rates are close to 71 percent. (British data were incomplete.)

                  * For the 16 types of cancer examined in the study, American men have a five-year survival rate of 66 percent, compared with only 47 percent for European men. Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.

                  * American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent for European women. For women, only five European countries have an overall survival rate of more than 60 percent.

                  Much of that is attriubted to unwillingness to spend more on the part of European governments.

                  1. I assume those numbers do not include people who never make it to a hospital because they don’t have insurance?

                    1. So…yay…more Europeans make it to the hospital, only to be told that over half of them will die from a disease that claims less than 20% in the US. I’m sure that’s comforting.

                    2. You’re right – it is actually pretty comforting to be able to go to the hospital without worrying yourself sick (excuse me) over whether your insurance will pay for it, or whether you’ll need a new mortgage or go bankrupt if it doesn’t.

                      Also, do those European averages include the Central and Eastern European countries?

                    3. So their dead – but at least they aren’t in debt.

                      Keep trying to spend that one. How are so many more people dying in Europe than in the US with universal healthcare? It doesn’t matter if it’s one country. With a universal system, why is that happening?

                    4. Well, to paraphrase Lewis Black on The Daily Show a few weeks ago, the bad news is that five out of five people eventually die of something.

                      Look, God knows the Western European health care systems aren’t perfect either. There’s much room for improvement. But the bottom line is that for all their faults, they do manage to cover every single member of society regardless of means or social status. I’m sure the US system is the greatest in the world if you have the money and the patience for it and if you’re fortunate enough to avoid falling into one of the many cracks in the system. If you don’t, well, it’s an entirely different story.

                      Personally, I think that taking such an approach to a basic human right like health care is barbaric. But maybe that’s just socialist of me, I don’t know.

                    5. I find the differences in mortality rates for curable disaeses to be much more troubling…and you still haven’t managed to explain why that is the case.

                  2. http://jnci.oxfordjournals.org/cgi/reprint/jnci;88/2/78.pdf

                    many drugs are developed in europe and stonewalled here, sending people there to avail themselves of these drugs that the FDA won’t, can’t approve.

                    and you’re correct, a number of drugs sold in europe are developed here, but not approved here, thereby sending people overseas to get treatments.

                    1. Lanfranc,

                      Wouldn’t logic dictate that if American healthcare is going to fail someone it’s in the early detection stage? Preventative care is usually the first thing to go when you don’t have insurance.

                    2. Gotchaye · ·

                      You might think so, but, to the best of my knowledge, that’s not how it works with cancer. There’s something of a principal-agent problem here. Insurance companies are providing a product to consumers, and consumers really like fancy stuff like MRI machines (it’s possible that US malpractice law also encourages more screening). It’s not that the US uninsured are still getting cancer screening, but that the US insured are much more likely to get early screening than the European insured. The standard argument is that this screening is in fact very inefficient in most cases, and that having all of those MRI machines sitting around is a rather big waste. You’ll note that this was at one point one of the things that conservatives used to brag about the US system – we have many more MRI machines per capita than Europe does.

                    3. Even fans of the US system don’t really deny there’s a lot of waste (hence the greater share of GDP) but as the article I posted points out, that still leads to better care. Europeans may be frugal, but then their early detection rate is crap. It’s the same way with R&D. You have some companies that will waste millions on R&D but the American system makes them keep trying because the potential profits are so big.

                  3. Gotchaye · ·

                    First, Ames can you please go to some comment format that doesn’t endlessly shrink the width of replies. Or, can we all agree to at most reply to only top-level comments? Multiple threads could still be distinguished that way.

                    Second, comparing cancer survival rates is a lot like comparing life expectancies. You need to provide a lot more information than you have in order to support a conclusion that one system is doing a significantly better job than another.

                    Suppose that the US does much, much more early screening for cancer than Europe does (I think that this is in fact true). This will hugely increase the number of cancer diagnoses (what’s the measured incidence of these cancers in the US and Europe?). However, virtually all of these diagnoses will be of cancer without many obvious symptoms. Some of these diagnoses will be of early-stage cancers that will eventually be very dangerous, and early diagnosis in this case saves lives. However, a large number will also be of cancers which will not grow quickly enough to be life-threatening, in which case each extra diagnosis produces an extra survivor as a matter of course. It’s left unclear what the real ability of each nation’s system to deal with cancer actually is – it’s conceivable that the country with the higher survival rate is actually worse at treating cancer that is at all threatening and the rate is just artificially boosted by virtue of early diagnoses of non-threatening cancers.

                    1. In addition, it’s important to note that the cancer figures quoted here are five-year survival rates, not absolute mortality rates or ‘cure rates’ as Mike would have us think.

                      I think the higher survival rates for the US simply reflects that most cases are diagnosed its early stage, when practically all patients can expect to live at least five years anyway. It’s great to have an early diagnosis, but beyond that, it doesn’t really tell us much.

                    2. (Actually, I think I managed to say pretty much the same thing you already did – but that’s just me being socialist. :nods:)

                    3. Gotchaye · ·

                      I was aware of that, but I don’t think that it was made sufficiently clear in my post. Thanks.

                      Yeah, when I talk about an early diagnosis producing survivors as a matter of course I mean that an early diagnosis will often get people past the five year mark before the cancer would be life-threatening, not that large numbers of cancers are simply never life-threatening (though for all I know this is also the case). Obviously in such cases the resulting higher survival rate is in large part due to what is essentially a difference in book-keeping.

        2. Mike, your failure to parse the difference between pharmacology and primary care will be your undoing. Unless I’m sorely mistaken the public option would apply to healthcare, meaning the prescription but not development of drugs. The US model for medical science development, on the pharmacy front would remain unchanged.

          Also I’m glad to hear you trumpet the success of military medical care and drug development. You know, of course, that the military medical plan is a single payer system, wholly public. And you must know, too, that the pharmacological research system is mixed public private, after Bayh-Dole. Your acknowledgement that government “interference” works is appreciated!

          1. Every universal system in the world relies on price controls. It’s the default position for single-payer systems. Price controls kill innovation. That’s economics 101 Ames.

            And innovation of the kind that injured vets are benefitting from is not because they have a government-provided healthcare plan. It’s because private companies have a consumer that will pay top dollar for cutting-edge treatments. Comparing the military-provided system to universal healthcare is not even remotely accurate.

            1. I’m not sure where this price control noise comes from. Also, it’s funny how successful public programs are attributed to the private sector. Is there any reason to believe it wouldn’t be the same thing for the public option?

              1. ECON 101 Ames. If the government controls healthcare they will put price controls in place. look at any European plan and you will find that is the case.

    2. The question that comes up, is why do Americans need to pay for R&D for the rest of the world? Why are we paying nearly twice as much as everyone else.

      That’s not a requirement, and there’s no reason that the cost can’t be spread around.

      Pharmaceutical companies are not just going to quit.

      1. We pay the R&D for ourselves and the rest of the world piggybacks, just like Canada does on our military. And as i pointed out, no one is complaining about the % of GDP we spend on soda, smokes and beer. Why is it outrageous to spend so much on medicine? It only seems outrageous when compared to other countries which goes back to their piggyback system.

        How do you ‘spread the cost around’ when you are removing profit from the drug companies through price controls and lack of demand?

      2. Exactly, we don’t exclusively benefit from R&D while others suffers.

        If the pharmecutical companies know they can bargain with let’s say Great Britan at a lower price, because they know they get more money from the US to subsidize everything they will.

        But if they go into it knowing they need to bargain at a level that is equitable everywhere, that price would be higher in those negotiations with other countries.

        1. From economist Tyler Cowen:

          In real terms, spending on American biomedical research has doubled since 1994. By 2003, spending was up to $94.3 billion (there is no comparable number for Europe), with 57 percent of that coming from private industry. The National Institutes of Health’s current annual research budget is $28 billion, All European Union governments, in contrast, spent $3.7 billion in 2000, and since that time, Europe has not narrowed the research and development gap. America spends more on research and development over all and on drugs in particular, even though the United States has a smaller population than the core European Union countries. From 1989 to 2002, four times as much money was invested in private biotechnology companies in America than in Europe.

          Dr. Thomas Boehm of Jerini, a biomedical research company in Berlin, titled his article in The Journal of Medical Marketing in 2005 “How Can We Explain the American Dominance in Biomedical Research and Development?” (ostina.org/downloads/pdfs/bridgesvol7_BoehmArticle.pdf) Dr. Boehm argues that the research environment in the United States, compared with Europe, is wealthier, more competitive, more meritocratic and more tolerant of waste and chaos. He argues that these features lead to more medical discoveries. About 400,000 European researchers are living in the United States, usually for superior financial compensation and research facilities.

          This innovation-rich environment stems from the money spent on American health care and also from the richer and more competitive American universities. The American government could use its size, or use the law, to bargain down health care prices, as many European governments have done. In the short run, this would save money but in the longer run it would cost lives.

          Medical innovations improve health and life expectancy in all wealthy countries, not just in the United States. That is one reason American citizens do not live longer. Furthermore, the lucrative United States health care market enhances research and development abroad and not just at home.

          http://www.nytimes.com/2006/10/05/business/05scene.html?ex=1317700800&en=5889b4819eaf787a&ei=5090&partner=rssuserland&emc=rss

  5. Also the buzz now is that the Senate will stall until the furor dies down and just do public option then, or force the GOP to filibuster.

    1. The White House took the public option off the table yesterday. If the Senate goes forward they will be fighting a losing battle with dwindling support.

      1. The Senate is already fighting a loosing battle with dwindling support – mostly because they are in need of 100 backbone transplants.

      2. My point as I said yesterday.

        I can’t believe people thinking of a secret slipped in single payer system if we can’t even get a public option.

        The health care debate has been nothing but compromise and concessions which will leave us with a weak and nearly worthless bill.

        1. It’s pretty remarkable how quickly the administration folded. Shows you how much power the Blue Dogs have.

  6. There’s only one reason the blue dogs and White House caved (and don’t count them out yet!). It’s because the GOP managed to whip up a firestorm around a few nonissues. Demagoguery works. Notice no serious debate was had over the merits of the plan, because the GOP didn’t think they’d win it. Sad, but politics as usual for Palin’s GOP.

    1. Ames – you’re better thant that. Political efforts don’t fail because of the other side alone. The Democratic plan and the approach to rolling it out was flawed form the start. Until liberals want to be honest about their intentions, the public will always doubt their motives.

      1. And are the conservatives honest about their intentions? It does seem like a lot of this debate consists of a bunch of well-off politicians and pundits, who presumably have all the insurance they could possibly need, hoodwinking the people who’d actually benefit the most (lower middle and working class) into opposing it. Funny how that works out.

        1. (Hmm. Seems like I’m being socialist again.)

          (Dear me.)

      2. Lest anyone doubt why the GOP appears to be winning on healthcare. Hint — it’s not because of real issues.

        http://theplumline.whorunsgov.com/republican-party/exclusive-new-poll-finds-majority-of-republicans-either-believes-or-isnt-sure-about-death-panel-claim/

        1. So Ames, you believe this is a great bill being killed by an evil GOP…right?

        2. Quite simply, whether it is or not, the GOP has not once aimed or landed a true, intelligent attack on it.

          1. You’re not answering the question Ames. All you seem to want to add to this conversation is remarks about how the GOP did this terrible thing to the healthcare bill. But you refuse to say whether or not you prefer universal healthcare or what you think about the quality of this bill.

            I mean, if the bill sucks, shouldn’t the GOP be praised? So that sort of implies you think it’s a good bill or at least worthy of passage.

  7. republicans tapped into a deep seated fear, i mean seriously deep seated fear, a man of color telling the white populace what to do!!!

  8. Nancy,
    You may be right for a few people, but I think, as has been pointed out numerous times elsewhere, that the Republicans tactics worked so well here because there is a lot of pent up frustration in America, and very little of it is about healthcare reform. This is just the issue to let it all out.

    1. philip, i don’t disagree about your comment of “pent up frustration”. i was frustrated for 8 years, as i’m sure many others were as well.

      do we ever get past this frustration? i hope so. my kids are 22, 20 and 18 and boy do they have their work cut out for them. what a baptism by fire they’re having.

  9. No, Mike. America deserves quality debate. If the bill is bad, we should’ve heard why it was, not lies towards the same end. Democracy isn’t a scorched earth process, except for elements of your party, especially your vaunted ex-VP candidate. I’m increasingly tired of even the smarter elements of your party, of which you unmistakably are one, refusing to acknowledge that you’ve been hijacked by nutjobs. It’s high time you either stand up to them and fix the party, get a new one, or at least condemn the failures as failures when they happen. The country can only benefit from a real, serious, intellectually honest opposition party, but the modern GOP is certainly not it. Jettison Pawlenty, Jindal, Palin, Huckabee, DeMint, Grassley, and Romney, and rebuild with what you have left. Sadly, it’s not a lot, but there are a “few good men” left. The GOP is dying, a slow death that will take a few cycles, but its death throes are damaging as all hell.

    As to the merits of the actual bill, yes, I do think it’s a good bill. The reforms to existing private insurance are not just helpful, they’re necessary. I get dicked around by insurance companies like every two months, trying to tell me that a condition I’ve had since I was 12, and naturally covered, is somehow pre-existing. After a month of batting it’s resolved. But I’m sophisticated enough, and have enough time, that I’m able to fight that battle; many aren’t. That’s ridiculous.

    I do NOT necessarily support a single-payer system. As sure as I am that it would work, I don’t think the country’s really ready for it. I fail to see what’s so offensive about a public option as a compromise. As I’ve said, the “slippery slope” argument is bullshit, and if starts to freeze out private care, we can deal with that IF it happens, because it’s not inevitable. Since it wouldn’t impact pharmacology, etc., I fail to see the crippling blow to innovation. In fact, it might help; who’s afraid of a little competition? And the rationing line is just a flat out misrepresentation, one that ignores the very real rationing going on today under private care.

    There are reasonable arguments against those positions. But NO mainline Republican politician has made them. All we’re hearing is (1) SOCIALISM, (2) COMMUNISM, (3) FASCISM, (4) death panels!, (5) RATIONING, etc.

    1. Ames,

      I really don’t know how you can look at the bill and say it’s a good one. A lot of your fellow Democrats aren’t even doing that. (That’s also, of course, part of the reason that the one-sided criticism of the GOP is just that.)

      I’m also trying to figure out how you can claim that a public system and price controls would promote innovation within the medical industry (not insurance, medicine)?

    2. Repeat after me — Public OPTION.

      1. Repeat after me – Private industries cannot compete with government programs.

      2. That’s just not true. Think this through. The public option is a bare minimum plan, reformed enough to be equitable but with limited coverage. I for one would not take the public option. My employer’s plan isn’t that hot, but it gets the job done. I imagine most at or around my income bracket, above, and probably substantially below would still opt for their employers’ plan or private coverage. The public option is for those who can’t afford any better. Under that plan the private market still powers innovation, the benefits of which will still reflect in the public plan eventually.

        1. I don’t know about you, but if I opt out of my employer’s plan I get the money. A lot of people will take that route.

      3. That only works for the post offices! ;)

  10. isn’t innovation a bedrock of capitalism?

    i go round and round on this subject on many sites and i see NOTHING from the right. isn’t competition also a bedrock of capitalism? so how be this be socialist and marxist and fascist at the same time?

    someone explain that to me like i’m a two year old.

  11. I think this whole “innovation” angle misses the point. For one thing, we do in fact have pharmaceutical companies in Europe – actually, <a href="http://en.wikipedia.org/wiki/Pharmaceutical_industry#Market_leaders_in_terms_of_revenue&quot; six out of the ten market leaders are European – but more to the point, it’s not particularly meaningful to say that breakthroughs are either “European” or “American” or whatever. Even smaller pharmaceutical companies usually have research centres in several different countries, and academic researchers, who do most of the necessary basic research behind the drugs, have always cooperated across borders.

    1. But the profits are realized through the American market.

      1. Only partly. The US market is the largest at 43%, but Europe accounts for 31%. Besides, the huge American market would still exist with a public option or even a single-payer system. Perhaps the overall health spendings would go down somewhat, but this would be offset by greater efficiency in the system, such as avoiding the hidden expenses that hospitals incur in administration or loss of income from patients who can’t pay their bills.

  12. Just a bit of perspective on this whole thing from Clive Crook this morning:

    “The gap between the right of the Republican party, which is providing the angriest critics of the reforms, and the left of the Democratic party, which thinks the proposals too timid, is unbridgeable. These groups do not merely disagree. They despise each other. Their differences are only secondarily about policy. They hold each other’s values in contempt.

    These snarling extremes are nonetheless somewhat alike. They have an equal and opposite penchant for conspiracy theories. Almost a third of Republicans, according to a recent poll, believe the unsupported story that Mr Obama was not born in the US (in which case he would be disqualified from serving as president). But remember that more than a third of Democrats subscribe to the even more outlandish theory that the Bush administration knew about the attacks of September 2001 in advance.”

    Now please insert the usual liberal explanations on why the two different groups of crazies are different and how the GOP crazies are way more numerous.

    Also, Ames, you mentioned in an earlier post that you were geting tired of the ‘intelligent Republicans’ not cleaning out the GOP. I would contend that if we had the same level of patience for the Democrats circa 2000-2003 where would things be? Let’s remember that President Obama has been in office less than 7 months. Republicans have plenty of time and there are lots of folks out there we can hang our hat on, including perhaps, Romney. As for me personally, I’ve always been a conservative first and a Republican second. I’ve decided I don’t have the energy to watch our days in the wilderness with much interest so I’m mostly blogging about things like farming and education policy these days. I’ve had my fill of politics for awhile.

    1. Currently on iPhone so more later, but for now-

      I don’t hold with the irreconcilable differences theories. There is real disgust there but it’s bridgeable. For my side’s part, I think we get people who oppose healthcare on principle, but not those who lie to get their way on it.

      And no, I do dispute the truther/birther equivalent. There were never any birther bills on the floor; no real congressmen behind it; wasn’t pushed by the liberal equivalent of fox news; etc. I’d question, too, the “30% of democrats” number. Source? Most truthers I’ve heard, the predominant ones, are either birthers and Republicans now or just unaffiliated whackjobs. Literally no comparison.

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