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Will We Get a Health Care Bill in 2009?

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It’s decision time. The Congress will or won’t pass a major health care bill during the next few weeks.Will we get health care reform in 2009?Almost certainly not. As I have been saying for months, if we get a bill it will be more a trillion dollar entitlement expansion funded by relatively minor provider cuts and about $500 billion in tax increases.

That is not health care reform.Will we get that trillion-dollar entitlement expansion health care bill?That outcome lies in the coming convergence on Capitol Hill of three extraordinarily powerful, and contradictory, forces.


The Democrats Are Absolutely Committed to Producing a Health Care Bill

After more than 60 years of trying they have never been closer to adding a third leg to their domestic policy legacy of Social Security and Medicare. Leaders in the party are cognizant that this is their chance to do what both Roosevelt and Johnson accomplished and join them in their place in history.The leadership and the White House will do anything they can to get any bill that qualifies as a breakthrough. If they can get this to within a handful of votes in the House and one
or two Senate votes they will drag this thing across the line.Can you imagine a Senator or House member trying to deflect the pressure they will be under if they turn out to be that last vote the Democrats need? “Senator, the party has been trying to do this for 60 years. If this fails it will not be the President’s fault or the leadership’s fault. It will be on your head to explain to the Democratic Party why, after all of these years and getting so close, you alone chose to give the President and the Party what could be a crippling legislative
defeat instead of a generational victory.” Sort of like becoming the Billy Buckner of the Democratic Party!The Public Has a Great Deal of Anxiety Over the Democratic Health Care EffortThe polls are at best split about down the middle. The Rasmussen Health Care Tracking Poll has consistently showed support for the President’s
efforts on health care—really a proxy for the entire Democratic
effort—in the low 40s and opposition in the mid-50s.It is now clear that the town meetings were more than just the far right making a lot of noise.Just how do you pass something as far reaching as a health care bill with an approval rating in the 40s?The Democrats Don’t Yet Have a Health Care Bill That Can Become LawWhile a bill is highly likely to clear the Senate Finance Committee in the next few days, the real negotiations will first be in each house as both Reed and Pelosi try to draft something they can pass on their own.
If that happens, then the most critical negotiation will begin as the House and Senate reconcile their bills and the tendency of the House to move farther left and the Senate to expect something more moderate.They still don’t have a way to pay for it. Every time they have put a tax on the table it has come off that table in just a few days. The current taxes aren’t so much agreed to as just the last generation of unpopular
proposals that are serving more as placeholders than final decisions.The House has a tax on the “rich” the Senate doesn’t like while the Senate has a tax on “Cadillac” health care plans that the unions can’t wait to kill once it emerges from under Baucus’ control.While most of the special interests have been bought off with the deals they cut to limit their contributions to paying for the bill, the American Medical Association (AMA) stands out as a critical player that has not yet been
satisfied. While the House bills spend more than $200 billion to fix the Medicare fee cut issue (which is yet unpaid for), the Senate Finance Committee has ignored the problem with just a one-year patch and a “trust us.”There is also a real unease over the combination of middleclass premium support subsidies, the bare bones character of the health insurance policies people would get, and the fines they would pay if they did not comply with the individual mandate. Republicans are going to continue hammering on the new “taxes”
this would create. If Democrats increase the subsidies they have to find more money to pay for it. If they exempt the middleclass from the mandate what good have they done for what are a lot of swing voters already anxious about all of this?If millions are exempted from the mandate, the insurance industry will have a problem covering everyone and eliminating pre-existing conditions and medical underwriting provisions.Then the states are almost unanimously balking at more Medicaid unfunded mandates in the out years of the bill.Add to that the debate over an employer mandate, a MedPAC with policy powers, and growing criticism of Medicare Advantage cuts. And, that is before the thousand-page bill sees the light of day and who knows how many more “death panel” scares.On top of all of this there is the public option issue. As I have been saying since spring, there won’t be a Medicare-like public option. But just how will the Democrats
finally compromise this issue. Co-ops are fizzling and there is one big devil in the details for any kind of trigger. Recent suggestions for the states running the insurance market for the near poor and proposals to give states the flexibility to create their own public plan would add an almost byzantine complexity to what is already a complex bill.If you take the “Cadillac” tax out of the Senate Finance bill and add in
the more than $200 billion for a Medicare doc fix, you’ve created an almost $500 billion gap to fill.

……

So, there are these three powerful, and contradictory, forces about to converge on Capitol Hill. Just how will they finally sort-out?

That will make for the most fascinating domestic political battle in recent history.

Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of
his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

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  1. Health Care and the Law of Supply and Demand
    Health care costs are soaring! It is an economic law that prices rise when there is not enough supply and too much demand. Demand that is being fueled by health care insurance and Medicare, while on the other hand the supply of Doctors is being hindered by the high costs of education. A long-term solution is needed, one that would not just help the United States, but the world.
    Increasing demand by offering health care insurance is not the answer! It just will bankrupt our government. Medicare is an unchecked burden that is not working. We must increase the supply of Doctors by offering scholarships to anyone with good grades with the desire to become doctors, how can a doctor start his practice saddled with $50,000 of college debt. He naturally has a desire to pay off loans by overcharging. If we increase the supply of Doctors, competition will naturally drive prices lower. We also have to increase the supply of hospitals and force these doctors with scholarships to intern in these clinics. This will dramatically cut health care costs, and will lower insurance premiums and would help keep Medicare costs down. Think about the benefits long term, more Doctors doing research, more doctors educating more doctors and more doctors to help in disasters around the world.
    Building hospitals will create jobs and would be a great investment in America’s infrastructure and help lower healthcare costs.
    Medicare is a perfect example of how government healthcare would work. It is inefficient and unchecked, and a burden on our country. I know patients that have been charged 125$ for 1 Tylenol and Medicare paid and when brought to Medicare’s attentions they were unwilling to research the overcharge for a minute amount.
    The problem with health insurance is that the doctors have two prices, one charged to insurance companies and one to patients without insurance. A visiting relative without health insurance and my daughter both went to the same doctor for strep throat. The doctor charged $20copay and the insurance paid $65 but he insisted on charging the patient without insurance $125. Why not just $85? He discounts his prices to the insurance company but to a poor patient who can’t afford insurance he charges 50% more. Is this fair? How can he charge one patient one price and another a different price? This should be outlawed!
    Creating Doctors would not be a burden on our country but a boon for our country and our economy, cutting health care costs long-term. It would be an investment in our country’s future as opposed to a long-term nightmare.

  2. Why the big rush on this health care bill? …and all government preoccupation with it. Don’t we have more pressing issues like the economy, massive unemployment, two wars? Are they living in another world?

  3. IT’S A MAD, MAD, MAD, MAD WORLD
    No, I am not talking about the 1963 Stanley Kramer hit of the same name starring Spencer Tracy, Milton Berle, Sid Caesar, Dick Shawn and many more screwball celebrities. Do you see a pattern? The movie characters were Captain Culpepper, J. Russel Finch, Melvin Crump, D.D.S., and Sylvester Marcus, respectively. The names sound kind of kooky, too.
    The film portrays the dying words of a thief that spark a madcap cross-country rush to find some treasure buried under a “big W.” The actors were crazy, zany, greedy and selfish. Pelosi, Reid and Obama are, well similarly, wacky, silly, and zany, but also daft, chaotic and nutty with one major difference. They have substantial, considerable power. This control will likely destroy an already flawed system while enacting a grossly inferior one with even more waste, fraud, expense and peril to the American people.
    Pelosi, Reid and Obama and the liberal loons just don’t get it.
    View:www.lawdocblog.com for the details

  4. Nate,
    You think you have some kind of intellect because you shill for the insurance companies who rip this country off every day.
    Any idiot can find examples from any healthcare system in the world that shows problems, but the big picture points to a joke of a healthcare system in this country.
    Some very good dedicated healthcare professionals, but a complete F’ed up system.
    Other than a third world country can you please point to one OECD country that has basically an entirely private system please? Where the government is less involved than in the U.S.?
    Waiting??
    Robert,
    I do not think the deficit is the most important thing when talking about +40,000 people dying a year because they do not have health insurance. A disgrace.
    The deficit is a red herring. It is manageable. The $1 trillion number will only represent 4% of the healthcare expenses expected over the next 10 years. That should leave the other 96% to find cost savings. Doable.
    You want to complain about the deficit, complain about the defense budget or the trillions of unfunded tax cuts that Bush pushed through. The defense budget was approaching $300 bn before 9-11 and will likely be $650 billion in 2009. That is half the entire planet’s military spending for 5% of the world’s population. A joke. You could cut $100 bn out of the defense budget and pay for the entire healthcare bill without any cost cuts or new taxes. And you would still have $500 bn of defense spending, which would still buy a lot of defense.
    And there was also a recent poll that said the majority of Americans would pay more for better healthcare. People would pay higher taxes to get better healthcare.
    See this:
    http://www.reuters.com/article/GCA-HealthcareReform/idUSTRE58T0MY20090930
    And Robert what bureaucrats are you talking about? The insurance indutry bureaucrats who ration your care and decide what to cover and not cover and what doctors and hospitals you can go to and who can have insurance? Or are you talking about the government bureaucrats who basically run Medicare fairly well. There is a very high approval rating from people who use medicare.
    By the way I would rather have a government bureaucrat run healthcare than a insurance company bureaucrat. At least we the voters and the tax payers can control the goverment bureaucrates. We can get rid of them and we can can tell them what to do, as we can vote in the politicans to change the system as we like. We have no control over the insurance company bureaucrats.

  5. Healthcare is a disaster in the USA because of GREED on the part of insurance companies, medical profession, hospitals & employers. Its a disgrace that all elected are swayed by lobbists for employers, the medical profession, insurance companies and the well-being of the citizens of this country. The direction of reform will be a burearchy which will cut cost of health care on the backs of everyone except who the lobbyist represent. Why should tax payers stand for this? We must take action- we have the power of our votes to send a message to these useless politicans that if they don’t protect us- they are out. If the politicans didn’t have to raise so much money to run for office, then lobbyist wouldnt have influence with their donations. Large companies such as Shell have notified employees that major changes to their healthcare is coming now so when Washington finally passes the reform, they will be providing an inferior & more expensive plan to employees. I’m sure other companies will do the same in the near future.
    I have several friends in Canada in which Seniors pay NOTHING for doctor visits or prescriptions. All medical is covered & they can go to their choice of doctors. There isn’t the delays for referrals or hoops to jump through to get approvals. Theirs is a system of TRUE HEALTHCARE & the medical providers are afluent but not GREED. Hasn’t this country learn that greed only leads to the financial collapse we are experiencing in this country. WE SHOULD ALL BE ASHAMED & NOT TAKE IT ANYMORE!

  6. If my care gets a flat tire, I replace it with a new tire…not a new car. The fact that congress is legislating (steamrolling) a complete overhall of OUR health care system is a frightening. Ironically, congress is not requiring that their personal health plans match those which they are legislating. The free market (capitalist) system that grew this great nation has been canibalized by our power seeking govenment for the last 70+ years. What’s left is being shredded in a final wave of (guilt driven) ignorance. You better not learn how to catch fish…they’re preparing a nice line for your weekly government fish stipend.

  7. Phillip do me a favor and shove this guys arm down your throat.
    http://www.moonbattery.com/archives/2009/10/the_shape_of_so.html
    “Do you realize that the U.S. is the only country that has basically an entire private healthcare system?”
    Actually no idiot that isn’t any where close to true. What your where trying to say in your ignorance is industrialized, as many countries have no form of government care at all. People are responsbile for 100% of their care with no saftey net. If you want to get technical our free market system is the most predomonate in the world.
    Do you ever tire of looking the fool phillip?
    Peter you need to pay attention when I explain to you the large insurance companies you hate are not the entire market. You keeping berating the entire industry like it is monolithic. There are thousands of campanies doing the exact opposit of what you claim you refuse to admit exist.

  8. Read it and weep:
    http://www.nytimes.com/2009/10/11/health/policy/11cost.html?hp
    Though, no surprises for those who understand the forces at work.
    Peter,
    I agree there is no chance for a public option with teeth that would be universal. I was made optimistic that something less universal might pass by the recent proposal to offer states the choice to accept or reject a public option. If they accept it would use Medicare-like rates (and utilization controls Medicare does not have). I think the opt-out is a smart strategic move, but it seems that it will now probably get squeezed out and not included in a final bill. If so, ignore my comments about private payers taking the opportunity to cut rates.

  9. Forget the right and left of this argument. The majority of us vote our pocketbooks, still, in this day and age. If Congress passes anything that smacks of increased debt, we will vote them out of office at the next chance, regarless who they are or whom they represent. Remember: WE are the government. This debt is OURS. Paying it off is OUR RESPONSIBILITY.
    All the chatter about benefiting this segment and that segment of society, relieving seniors of our burdens, safety nets, and the rest is simply that: chatter. WE will have to pay the piper. We better define in our own minds what we want to experience the next time we need a round of medical tests, a disease or accident requiring hospitalization, prescriptions that will ease or cure a health situation, a choice of good medical professionals in case we need opinions, and so on. Do WE want our own choices in what we select, the chances for improving our situation, how much that will cost, and how we will pay? Or do we want bureaucrats whom we’ll never see making those decisions?
    Do your representatives in Congress really know the ins and outs of what they are about to decide?
    You better answer these questions for yourself, honestly, make your decision, and voice it to whomever you can. Quickly.
    R. Russell, Batavia, IL

  10. Nate,
    Up to your usual right-wing nutcase ideological discussion and talking points.
    “Health care is a crisis created by government, exasperated by government, and feed by stupid liberals with no clue what they are talking about when reform is discussed.”
    Do you really believe your line above? Of course you do, coming from someone who believes government is always evil.
    Do you realize that the U.S. is the only country that has basically an entire private healthcare system? Seems funny logic to blame government.
    How do governments around the world do a far better job at providing healthcare to their citizens than the U.S. private system does?
    The U.S. healthcare system: Islands of excellence in a sea of mediocracy.
    Sorry buddy you had that last 8 years and you lost the election. Time for a new direction.

  11. Dennis,
    What is with the hatred of immigrants? You a very bitter individual.
    The cost to pay for illegal immigrant healthcare in this country is less than 1/2 of 1% of the annual cost we pay of healthcare. Illegal immigrants are such an incredibly small part of the healthcare cost problem in the U.S. it is not even worth talking about. People who try and bring the illegal immigrant issue into the healthcare issue are playing politics pure and simple. There are far bigger fish to fry with regard to healthcare costs than the costs to pay for illegal immigrants. By the way illegal immigrants contribute a lot to the tax base of this country, so they are actually not entirely getting some of this stuff for free. Some studies show that 50-60% of illegals file income tax returns, so they actually pay the same amount of taxes we do, but will not benefit from social security. It amazes me how many times some idiots bring illegal immigration into the discussion on healthcare reform on this site. A BS conservative/insurance industry talking point.

  12. A couple of points about this post:
    1) There have always been three legs to healthcare reform: coverage, quality, and cost. To say that adding to the coverage is not healthcare reform is disingenuous by the author. Getting +94% of people insured in this country is reform from where I come from. And if the costs are started to be tackled that is also reform.
    I would also add that healthcare reform is not a static event. This will be the start of a process that will take years to develop. One thing we know is that the problems are not going away. The key is to get the process started. A healthcare bill will do that.
    2) I am not sure what polls the author is reading (Rasmussen has always been notoriously bias), but the overwhelming majority of polls suggest that healthcare reform is very important to the American people and they want it now. It was a very big issue in the election. Go here to read the various polls for yourself.
    http://www.pollingreport.com/health.htm
    By the way the 40% number the author quotes is now 46%.
    See: http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/september_2009/health_care_reform
    Hard to judge those types of polls when we do not even have a bill in which to judge. And we cannot push through policy in this country based only on polls.
    3) The author is right. The final details of the bill have not been worked out. But, the CBO does say the Finance committee’s version of the bill would actually cut the deficit. I think paying for it is a bit of a red herring. We are talking about less than $100 billion a year over 10 years. The less than $1 trillion cost will be less than 4% of the total healthcare costs expected over the next 10 years. That leaves the other 96% of costs to find cost savings to pay for this bill, and that is before any tax increase. This should be very doable and manageable. Christ, you could cut the nearly $600 bn defence budget by $100 billion to pay for this, and you would still have $500 billion on defence, which still pays for a lot of defence. Before 9-11 the defence budget was moving toward $300 billion.
    4) The author seems to be using every excuse in the book why not to have healthcare reform. What are you afraid of? If we listen to people like you, nothing would get done in this country. None of this is written in stone and can be changed as healthcare reform develops over the next few years. We can keep things that are working and throw out things that are not working. The important thing is to get the reform started. And if you think this country does not need healthcare reform than I am not sure what planet you are living on.
    I guess the fact that since the author represents insurance companies, it is clear that he does not want reform. He is probably is making a lot of money in the current system and what it to stay exactly the way it is, despite, it bankrupting the country, making us less competitive, being responsible for +40,000 of deaths every year (people who do not have insurance), etc. etc.

  13. “If a new public option passes, watch for private insurers to start driving their rates closer to Medicare even before the new public option can take effect.”
    jd, I don’t have much hope now that Democrats have the guts to cross their healthcare backers and pass a public plan, even one that will probably be toothless in driving down costs. My own state’s congressional delegation received $5.2 million between 2003 and 2008 from drug makers, health care professionals and the insurance industry. Our new Democratic Senator Kay Hagan received over 200K in 2008 and has been opposed to a public option. BCBS controls healthcare in this state.
    As well I haven’t seen proof that if rates are cut providers won’t find a work-around to keep their incomes in the upward trend. Insurance companies don’t care about system cost trends as they’ve been happy serving as pass through agents for higher costs. If insurers start exercising system cuts watch for renewed “death panel” accusations.
    If you view this as an initial “reform” step then where do we go from here after 2013?

  14. “Will we get health care reform in 2009?
    Almost certainly not. As I have been saying for months, if we get a bill it will be more a trillion dollar entitlement expansion funded by relatively minor provider cuts and about $500 billion in tax increases. That is not health care reform.”
    I have no problem with immigrants coming to this country and paying their way. That is the American way, or was in the ‘past’. But, today, show me a health care bill that is going to prevent someone in this country illegally from showing up in a United States emergency room and being refused treatment. It won’t happen. There are no laws in place. With that said, no matter what type of health care bill comes out, unless LAWS are changed, people who pay no taxes will continue to live in the United States receiving free health care at the emergency room. A health care bill won’t fix that since people can’t be refused critical health care at an emergency room. We can’t even keep people residing in this country illegally from attending publicly funded schools. Why would an illegal immigrant (who doesn’t pay taxes) pay for low cost health care when he can continue to go to the emergency room for nothing? I would be curious to see a comparison to the increase in health care costs against the increase in illegal immigrants to the U.S.

  15. “Even so, I don’t expect costs to actually go down in real terms.”
    No reason not to. Cost is flat and treanding down for millions of people, the problem is more people haven’t hit the point where they are willing to take action to stop the increase. I just returned from a confeence of TPAs, as much as we hate the large insurance carriers we hate providers more. There are things many TPAs are doing to acheive flat or negative cost trends.
    These solutions are not as easy taking a pill, they require work but those employers willing to do the work are not having cost issues with health insurance. This can all be quickly undone by congress though. Like they always do their are a few things in their bill that will make it harder to control cost.
    A big discussion was on Health Risk Assesments and wellness, recent government action have made these nearly impossible to do on a voluntary basis and outright iillegal on a mandatory basis. If we can’t determine the risk we are expected to manage how can we manage it?
    Next is the OOP caps being proposed. There are some terrible provider systems, Baylor in TX, from a cost perspective. The only way insurance companies can counter these is not paying their exbornate charges. That puts the hospital in the position of having to charge the patient the difference, something they prefer not to do as then they have to explain their fees being 200-400 times medicare. This also wakes the patient up to the cost aspect and hopefully gets them to use a more eficient provider next time. If their cost is capped and lifetime benefit endless they have no reson to care. A perfect example of what complete idiots liberals are.
    Union plans, government plans, etc have no motivation to reign in cost. It is not their money so why bother spending it efficently. We need to put serious teeth into pension funding laws, give them 5 years to be 100% funded or everyone gets cashed out and plan desolved. That would wake them up real quick and they would save money on their health so they could divert it to their pension plans.
    Health care is a crisis created by government, exasperated by government, and feed by stupid liberals with no clue what they are talking about when reform is discussed.

  16. jd, I don’t think people are expecting a magical, one stroke solution anymore, if they ever did. However, I really don’t like to underestimate the collective intelligence of voters. I think they will know if the so called reform bill that is passed this year turns out to be inconsequential and bot uninsured rates and costs keep growing in the next couple of years, while congress engages in the blame-the-other-guy game.
    I agree that the voters, this one included, will appreciate an incremental approach. However, there has to be something of substance in the first increment in order to get the ball rolling. Containment of insurance prices would qualify as a good increment, but I don’t see that happening without some sort of public option, and if I’m not mistaken, that’s exactly what you are saying as well.
    So all they really need to do now is add the public option to the bill, probably handcuffed and blindfolded until the next increment comes up,

  17. I don’t really care if it costs money To fix health care in America.
    We’ve spent the last 8 years, 700 billion dollars and 4000 American lives trying to bring democracy and a better life to the poeple in Iraq. For 7 years Our country has been consumed over the debate on how to solve their problems, rebuild their country and improve their lives.
    And we did it all AT OUR EXPENSE. They weren’t even asked to pay a DIME…even when oil was at 4 buck a gallon.
    Now it’s time for Americans to start fixing the problems we have here at home.
    And if it means spending money we have to borrow to pay to fix broken roads and bridges or providing affordable health care to taxpaying Americans….so be it.
    I suggest those who were so eager to borrow money from our children to fund the rebuilding if Iraq be the first in line to poney up money to rebuild our country and provide a better life for AMERICANS.

  18. I should explain this statement: “Costs will very likely go down.”
    I mean that after a lag of six months to a year, assuming a robust public option passes, watch for the medical cost trend to be lower than expected. Partly this is cyclical and partly the effect of private plans preparing to compete with the public payer and using the opportunity to regain an edge over providers they’d lost in the late 90s.
    Even so, I don’t expect costs to actually go down in real terms. If we’re lucky, they will stay flat as a share of GDP from around 2011 to 2013. In that time, the public will need to be educated about the reasons why our care costs twice as much as the rest of the world. Once the focus can shift from the relatively minor issues of private insurer admin and profit, I think it will.

  19. The health care industry in America has been a special-interest-ridden money sponge since at least the 80s, impervious to deep reforms since, well, since forever, and now all of a sudden people say that rank-and-file Democrats as well as independents will abandon their elected representatives if they don’t simultaneously provide universal health care and fix the delivery system to lower costs dramatically (and, oh, by the way, don’t interfere with how providers treat or how they get paid).
    This is a bunch of BS. It’s well-meaning, but it totally misreads the situation. It misreads what is politically possible, and it misreads what the public will think about the actual reform a year or two down the road. This is the thinking of people in the beltway and policy wonks who have fallen in love with their favorite system reforms and can’t bear to see them not included in the most historic piece of health care legislation since Medicare and Medicaid were created.
    I used to be one of you.
    1. Full reform isn’t possible now. Get used to it. The industry lobbies support universal care reform but with one voice oppose reforms that have the effect of cutting growth below growth in GDP. AHA and AMA/physician lobbies could and would thwart full reform even without AHIP, PHRMA and
    Republicans chipping in. The public can’t be an effective force on behalf of full reform because it doesn’t understand the cost drivers and is easily lead, particularly by provider lobbies.
    2. Full reform isn’t necessary now. The Sky is not falling. Sure, it’s a heavy rain, but we can and must endure it for a few more years before the pieces are in place for full reform (my guess: 2013). One of the biggest pieces that has to be in place is insurance reform to create nearly universal health care. Note that there is a phase in period, so high costs don’t hit for a couple years and this will be a time when the focus will shift from condemnations of insurers that don’t explain 80% of our cost problem to concerns about our delivery system that do explain the 80%.
    3. The average voter will appreciate the incremental reform. This is a new safety net. The exchange will make things easier for millions. Costs will very likely go down. If a new public option passes, watch for private insurers to start driving their rates closer to Medicare even before the new public option can take effect. They will have to, given the length of contracts. You heard it here first!

  20. you don’t think much for yourself Gary do you? Did you even bother to read the sampling on the survey? WOW what a shock you heavily over sample democrats and the results show a preference for Obama and the Democrats, never would have guessed that in a million years.
    Wonder what would happen if we over sampled Conservatives? Not that AP or any of the other media would ever make that mistake.
    Further the over sampling is all in the strong and moderate level.

  21. “Just how do you pass something as far reaching as a health care bill with an approval rating in the 40s?”
    Patience. This today from FiveThirtyEight.com:

    Meanwhile, two more good pieces of news for Obama. First, a new Quinnipiac poll shows voters moving toward him and away from congressional Republicans on the health care issue. Second, and perhaps relatedly, the latest AP-GfK poll shows Obama jumping from +1 net approval a month ago (50 percent approving, 49 percent disapproving) to +17 (56 percent approving, 39 percent disapproving) now. As for his specific ratings on health care, he’s net-plus again (but narrowly, 48 percent to 47 percent), after being down 10 points a month ago.

    The same Quinnipiac poll “found voters support a government-run plan to compete with private insurers 61 percent to 34 percent” and “64 percent of voters disapproving of the way Republicans in Congress are doing their jobs, with 25 percent approving.” link

  22. “Just how do you pass something as far reaching as a health care bill with an approval rating in the 40s?”
    Same way they passed Medicare, lie and claim it is something it isn’t.
    “If I remember correctly, there was an election a year ago and the people have spoken loud and clear.”
    Nice try Margalit, but they voted for someone who would close Gitmo, end the war, not raise taxes on the middle class, not stack his cabinate with lobbyist, post bills online foir review, and have the most ethical government ever. Since every last one of those promises have been broken you can’t stand there and claim a mandate for his health care reform de jour
    “We, canadian, would rather live here then move down there because we do not want to loose our medicare.”
    Ya that’s it hogay, more like we would shoot your ass if we caught you trying to sneak across the border, aye

  23. “Here I have more faith in the private health plan industry than in the government having the incentives to do this effectively.”
    Where is the proof other than the usual methods used by insurance companies to cut THEIR costs, not system costs; pre-existing, recissions, 6%-10% compounded premium increases per year, denial of payment, co-pays, high deductibles.
    The Democrats will loose much of the base that gave them and Obama the election if they can’t rid themselves of lobby influence $$ and pandering to the reich wing. Signing just any bill won’t fool their supporters into thinking this is somehow reform.

  24. No one expected that all of the ailments of the US health care system would be fixed by a single piece of legislation. Achieving progress towards universal health coverage by introducing federal subsidies and expanding Medicaid eligibility is a useful initial step.
    The real challenge will be cost containment. Here I have more faith in the private health plan industry than in the government having the incentives to do this effectively.

  25. Nothing good comes out without a cost. So spending money on health care sure is an improvement to spending on war and instead of killing people it will help them survive.
    Don’t you see that this government is trying to help you and all those pharmaceutical companies and the medical system will survive without the BIG profits.
    We, canadian, would rather live here then move down there because we do not want to loose our medicare.
    Hogay, Canada

  26. Have you noticed that the decibel level in healthcare reform discussions dropped significantly over the last few weeks? There are no more town hall confrontations to report on, so media coverage is also down. In a way, this may reflect either public fatigue, or the fact that most Americans have already made up their mind, or both. Actually, this presents a good opportunity for our legislators to clear their heads and try to develop a roadmap towards a more efficient system that works to keep us healthy. Without taking care of healthcare costs it is naïve to expect a great deal of popular support for the reform, especially from those, who do not directly benefit from expanded coverage.
    A month ago, I published a blog ”HEALTHCARE REFORM: ARE WE LOOKING IN THE RIGHT DIRECTION?” ( http://betterhc.blogspot.com/2009/09/healthcare-reform-are-we-looking-in_16.html ), in which I said that over-utilization, over-specialization of the care delivery system, and the way we see and use it were obvious reasons (to me, at least) for the runaway costs. Unfortunately, no one on Capitol Hill seems to be seriously interested in making that a priority.

  27. “The Democrats Are Absolutely Committed to Producing a Health Care Bill” You’ve got that right. They will pass and sign anything so long as they can pass and sign something.
    “The Public Has a Great Deal of Anxiety Over the Democratic Health Care Effort”
    I wouldn’t put it that way. With 60% or more of the public supporting a public option, what anxiety there is can be attributed not to the Democratic effort to do something, but to the likelihood that the Democrats will be bought off and produce nothing of value to the general public. Rasmussen is asking the wrong question. Research 2000 has asked the more relevant one: http://www.dailykos.com/statepoll/2009/9/3/US/358 .
    “The Democrats Don’t Yet Have a Health Care Bill That Can Become Law”
    Well sure they don’t, and that’s because the gap between what the public wants (real, systemic reform based upon a powerful public competitor able and authorized to use its market position to control prices and assure universal care) and what the interests that hold significant Democrats and most Republicans in their pockets want (45 million mandatory new customers, weak regulation and no new competitor, aka a license to print money) is huge.
    So, I’m pretty sure the bill is there, not fully specified in writing, but fairly well specified by the observable pattern of influence buying in the U.S. Senate.

  28. All these polls are meaningless. It depends how the questions are phrased. Add the word “choice” and you get great support for a public plan. Add the word “unfair” and all support goes down the tube. Most people don’t understand the issues involved, and this includes most folks on Capitol Hill.
    If I remember correctly, there was an election a year ago and the people have spoken loud and clear.
    Democrats were not sent to Washington to cater to Republican agendas. If we wanted that, we would have elected more Republicans.
    So how about quitting the CYA bi-partisanship games and do what the voters want done….. No excuses will be accepted in 2010 and definitely not in 2012.

  29. Who knows. since congress and the senate plus the president are unable to agree on anything at this point Doing nothing makes the most sense but who says they are sensible.

  30. If California can be crushed by runaway credit and debt, then the USA can be, too. To hell with health care reform, another version of leaching on producers by way of organized slime (government).
    Reform government now. Make it take it’s medicine for making promises that no one could afford. Cut spending now. Get it over with. Just do it.
    What arrogance to assume anyone is entitled to anything just because a bunch of elected morons vote it in. Well, you cannot redistribute wealth that will never exist. You cannot steal it faster than it is created. Keep the change.

  31. So let me get this straight. You’ve said all along that health reform has to cater to Republican interests or else it’s a waste of time because it won’t be popular. Democrats cater to those interests as you say they should, thus producing a much worse bill. And now you’re saying that people are rightfully concerned that the bill isn’t very good. And, you’re saying that you’re the smart one because you saw this coming from the beginning.
    Is this a joke?

  32. There does seem to be a palpable panic throughout Capitol Hill that this is our one and only chance to fix health reform. Indeed, it seems likely that any Democrat who doesn’t vote for the current bill will be demonized as ‘the one who let health reform get away.’ But perhaps we should take a step back and realize that there isn’t a ‘magic pill’ for our current healthcare system – and a single health reform bill isn’t going to fix everything. While the need for change is urgent and we must come together to start working now, we need to be thoughtful and open-minded in this discussion. We need to all commit to having personal responsibility for our own health and the health of others, and we need to start truly innovating and working together to drive real change.

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