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The Boston Massacre

Robert Laszewski Tuesday’s Republican victory in Massachusetts means the current Democratic health care bills will not be on the President’s desk in 2010.

Forget the crazy talk of ramming something through—including just having the House pass the pending Senate bill.

I’ve talked to lots of people in the past few months that didn’t like the Democratic effort but conceded that the Dems won the 2008 election on a platform to do health care their way. They would say, “elections matter” and could, albeit begrudgingly, understand Democratic attempts to pass their brand of health care.

But losing Ted Kennedy’s former seat in Massachusetts with the singular issue being health care?

The game has changed. Democrats just can’t any longer spin the polls that for months have been so negative on the Democratic health care efforts.

The conclusion is now crystal clear—the people don’t want this. For goodness sakes—they rejected it in Massachusetts! On the political shocker scale this rivals “Dewey Defeats Truman” and the ’94 elections.

When Bill Clinton lost the ’94 elections, he went before the press the next day and took responsibility for what happened and then spent the next two years successfully rebuilding his presidency.

Obama and the Democratic leadership really only have that course in front of them now.

Defying the American people at this point with these foolish hypotheticals about how they could still thwart the obvious will of the people and pass their bill would only result in their digging themselves into an exponentially deeper political hole.

I am not sure Reid, Pelosi, and Emanuel understand this—they have proven to be incredibly politically tone deaf all winter.

But I will tell you something you can take to the bank—a lot of their House and Senate moderate Democrats do understand what this means and you can expect them to begin moving off these bills in the next 24 to 72 hours.
A trickle will lead to a stampede and that will be it.

There will be no interest in staying aboard the kamikaze flight Reid and Pelosi are now piloting straight into the 2010 elections.

In the end, this was 1994 all over again. The Democrats thought they could unilaterally do health care their way and blew it just the way they did 15 years ago–out of pure political arrogance.

Let me repeat something I must have said on this blog a hundred times—health care is too big an issue to be done in any way other than a bipartisan fashion. One side simply can’t move something this big, complex, and controversial without lots of political cover from the other side. This bunch, to their peril, never understood the lesson that both Social Security and Medicare were passed by comfortable bipartisan margins.

There is no doubt in my mind that there were at least 10 Republican Senators that were ready to deal in good faith on this issue—the “gang of six” plus the Republicans who had signed on to the Wyden-Bennett bill, for example.

But when Max Baucus was given the opportunity to try for a bipartisan solution, his hands were tied—bipartisanship was defined as Republicans having to sign-on to the Democratic bills their leadership and the left wing of the party were overly confident they could pass on their own.

Health care is an easy issue to demagogue. The opposition will always do it. Republicans, including these ten Senators, did a lot of it the past few weeks. That is why the opposition needed to be neutralized in the first place with real bipartisan support.

As readers of this blog know, I have been pessimistic about this effort for more than a year. But, today I also believe there is a way to pass a substantial bipartisan health care bill that would cover at least 30 million people, reform the insurance markets very much like the Democratic bills would have, and begin a process of real systemic change. I also believe that can happen in the next couple of years. It could all be in place by the same 2014 date the Democrats had in their bill.

But for now, the overly confident and unwilling to compromise Democrats blew it again.

With their solid majorities and popular new President, whom else do they have to blame?

The only way for them to make this election-year mess worse would be to ram their bill through. There are lots of Republicans in this town secretly hoping they will!

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56 replies »

  1. This is one of the more thoughtful pieces I’ve seen online, though the notion of “providing healthcare for 30 million people” in some cost effective way that doesn’t destroy the current system is naive, especially when you factor in illegal immigrants who don’t pay in to the system. This video sums it up for me:
    http://www.youtube.com/watch?v=G4B4ry1pSjs

  2. The recent debate around how to best control health insurance and the cost, has pushed the issue of prevention to the front. Why is prevention so important? Everyone is complaining about the cost but the cost would not be as high if everyone took the time to properly take care of themselves. I know prevention is only a part of it but it is an important part of health. It is important because the average person is overweight and running up the medial cost. If you look at the generations before us they were in much better shape and took care of themselves. Studies has shown that a person who is in good shape and has Individual Health Insurance does not cost the government a lot of money. For those who do not cost the government more. I ask is the government our brother’s keeper.

  3. I want the government to decide not to pay for the PEG tube, blondie. I never said I want them to decide to put it in or not. Futile end of life care must be a topic of healthcare reform. Without it, there is no way any money will ever be saved. After that comes cataract surgery for nursing home patients. After that comes dialysis for demented people. Where is the point where the government no longer pays for stupid care?
    Why did the nursing home send me a resident having a minor allergic reaction at 3:00 AM? Bacause they are afraid of the regulators! This has got to stop. There is no need for an ambulance, a hospital and a doctor at 0300 for a minor reaction to hair dye!! Where do you want to cut costs?
    Deal with something real for a change.

  4. MD as HELL,
    So you want the government to decide when the PEG tubes go in, but are opposed to government structuring and subsidizing insurance plans.
    What exactly is it that you want government to keep their paws off? Money?

  5. The democrats had to compromise so much on this bill that Howard Dean wanted the Bill to be scraped. What nonsense is the author talking? THE ONLY REASON SOCIAL SECURITY AND MEDICARE PASSED IS – politicans were not as partisan back then, there was no cable TV, no blogs post like to confuse people. No way would medicare pass today! AMA opposed medicare back then, this admin tried it’s hardest to keep negative campaign kill the bill, obviously something as huge and complex as this will be impossible for anyone, they were close… Medicare has such huge opposition when passed, look how Repubs support now though they were the ones killing it when it was proposed. This health care bill would have been hugely popular down the road in 10-15 years just like medicare.

  6. Md as Hell- Which entity do you propose will solve the problems that are faced? And stop owning all the people when you make sweeping comments. Obama has undertaken to fix economy & get universal health coverage.
    What was your solution to corporations tanking during the bust?
    If you don’t have solution then let him run the way he thinks is best. You had your way with GW Bush for 8 years and you will get your chance again. Economy clearly ain’t your sweet spot. So rather leave it at that.
    As for end of life care, talk to you fellow age group pals and conservatives about need to sacrifice.
    By the way, do you have any numbers on how much end of life costs are?
    Further give us some reasons on what we can telling aged dying and in pain as reasons as to not consume some drug or surgical procedure?
    How many patients died under your watch? What were you doing when they were dying? Did your actions depend upon their age?

  7. Margalit,
    The only thing the President was elected to do is not be George W. Bush.
    He was not elected to scrap the constitution, to take over GM, to hijack healthcare, or to make the dollar worthless.
    He must have believed his own hype.
    The recent special elections are clearly saying the people do not want him or the dems to run their lives.

  8. rbar,
    With controlling majorities in both houses and the White House all Democrat, the Republicans are responsible for absolutly nothing in this situation. You might contend that they should have supported something in this process, but there was nothing to support.
    I will be responsible for my hand washing. The governemt needs to be responsible for paying for rational end of life care.
    I say again; if they cannot/will not reform end of life care, then they can never cut any costs.
    I would send them all to GA (government anonymous) but they do not believe there is a power higher than themselves.

  9. I saw that, Peter. And I thought conservative justices are supposed to be strict constructionists…. This is mind boggling.

  10. “There is a fine line between seeking consensus and plain cowardice.”
    Margalit, this bill WAS a result of cowardice, that’s why it lost my support. But you haven’t seen anything yet with the Supreme Court’s blessing to give corporations unlimited license to spend at will to give them the candidate they choose. Fox News must be salivating.

  11. Massacre??? This is as much a massacre as the original Boston Massacre was.
    Inconvenience? Yes, probably, even though Massachusetts is the last state in the Union to be qualified to express an opinion on health care reform.
    The facts are that Democrats have a President in place and a sizable majority in both houses. If they want to pass a bill, they should be able to pass a bill.
    So can we please stop making mountains out of ant hills and give in to every pressure and every veiled threat? This is not what the people voted for. We voted for universal care, for a public option and for CHANGE.
    A health care reform bill should have passed six months ago and should have included the above and excluded much of the pandering to special interests.
    There is a fine line between seeking consensus and plain cowardice.
    Abandoning this bill and attempting yet another “consensus” at this juncture would be misguided at best. If we must go back to the drawing board, go ahead and add the public option back in and remove the preposterous “compromises” and get the legislation through even if it means changing Senate rules. Republicans were willing to do that for a couple of judiciary appointments. Surely health care is more important.
    We need the Democratic Public Servants in Washington to have the courage of their convictions, to represent those who elected them, and to stand and fight for the American People. Right here. Right now.

  12. MD,
    I agree that there is an extent of overregulation, but OTOH, no propfession incl. ours functions completely self regulated … look at our collective inability to do proper hand hygiene, avoid unnecessary ABx, back sx and other procedures … we have regulate what matters in HC, that’s the difference between good and bad policy.
    Re. end of life care: there were timid attempts in early drafts (compensate advanced directives etc.). This was destroyed by calculated GOP clowning about “death panels”. The dems may be corrupt and ineffective, the GOP appears to be either idiotic or, more likely, evil.

  13. Frank RN,
    Do you really need JCAHO and CMS telling you how to be a great nurse? Do you really need all those suits walking around, simply to compoly with regulations imposed by other suits? Do hands that do not touch patients need to multiply exponentially as they have in the last ten years just for regulations like HIPAA?
    Just wheat do you mean by “we can do better”. I don’t need them at all to take care of patients.
    Unfortunately the only thing government can do is put more people watching people actually work.
    There will be no reform until the feds stop paying for putting PEG tubes in bedridden nursing home patients. That is to say, until families have to pay for futile end of life care we will never get rid of futile end of life care.
    If we cannot start reform there, then there is no political will to really reform anything.

  14. As unpopular a concept as it is, I was (and am) for universal health care, including single payer. But, the way the Dembs (my own spelling!) went about this, I went from feeling a sense of sadness to one of relief that this is not going to get the rubber stamp this year.
    Having said that, the nay-saying, knee-jerk, over my dead body anti-universal health care crowd are really hard to take. Health care for all benefits us all. Just look at our health outcomes compared to the rest of the industrial world. Can’t both sides at least acknowledge that we can do a better job with health care in this country and take it from there?

  15. Let’s see now: We’re going to pay for the medical needs of the uninsured, one way or the other, because they are simply turning up in ER’s for the treatment they require. At the same time, 40,000 Americans a year (or is it a month?) are being put to death because they don’t have insurance. And you expect to be taken seriously?

  16. Robert- You can’t be spending a trillion for nothing.
    Irony is we will pay the cost regardless of the bill when those young uninsured (your forgot old uninsurable) turn up in ER.
    Please read Maggie Mahar’s article on the topic.
    http://www.healthbeatblog.com/2009/12/glass-half-empty-glass-half-fullthe-senate-has-a-bill—-part-2-of-3.html
    Some benefits are listed below.
    Please show some moral courage and say which one are not worth it and we will understand. It’s just a matter of different priorities and choices. We can’t argue with that.
    regards,
    Vikram
    Primary care physicians will see increases in their Medicare and Medicaid reimbursements;
    Insurers will not be allowed to discriminate against customers suffering from “pre-existing conditions.”
    The legislation provides an additional $10 billion dollars over the next five years for community health centers. This funding will create centers in 10,000 communities.
    From this point forward, children cannot be denied coverage because of pre-existing conditions.
    Insurers in the large group market will have to spend 85% of the premiums they spend on medical care.
    Medicaid expands.

  17. I can’t believe most of these comments. Do all of you really think that we would be better off with the passage of this legislation. Don’t any of you understand at all how the health care system works in this country??? We have a Fee For Service payment mechanism in this country. Nothing in the current Health Care Reform bills do anything to change this. Basically, the more services performed, the more fees collected. The economic incentives are totally in the wrong direction. Tell me how leaving this system in place will lead to greater affordability???? And access to health care for the uninsured, —- don’t make me laugh. Many uninsured are uninsured because they choose to be. Young people, especially, would rather spend their money on beer or a new ipod or a new cell phone than to purchase insurance. What about the requirement that everyone has to purchase health insurance, you say? What if they don’t — they pay a fine which is less than one year’s premium for Health Insurance. The first year, it is less than $100. This legislation could pass and 3 years from now, we would still have millions of uninsured people. What about those “big bad insurance companies” who are robbing us blind? Have you checked the financial statements which are on file with your various state insurance departments to see what their profits are? We can eliminate pre ex and underwriting but who is going to pay the cost of this. I’ll tell you who — you are if you are insured. In my state, we already have a State Insurance Pool for people who cannot purchase coverage due to medical conditions. A single 45 year old will pay over $750 per month.
    All of you who think this legislation will improve access and affordability are totally wrong. Rates will increase and Health Care will continue to gobble ever larger portions of our GDP and we sill still have millions of uninsured using the ER when they get sick or hurt. Why?–The basic reimbursement system, Fee For Service, with all of its economic incentives to overspend and overtreat will be unchanged. And if all of that isn’t bad enough, someone will have to pay for the subsidies, government jobs to do all the regulation and etc. We all know who will end up paying these costs.

  18. It certainly was a Boston Massacre. However, a system of checks and balances is good. If the Democrats can’t pass a health care bill with 59 senators in their back pocket, how do they expect the American people to swallow it?

  19. You do have some very valid claims. To implement health care reform of this magnitude requires bi-partisan support and consensus. Since the beginning of this most current effort neither has occurred thus prognosticating the inevitable peril of the proposed health care bill. Having said that, I think it’s unsavory for anyone to rejoice in the failure of well intentioned efforts to incorporate more Americans in the health care system just because they deem the approach to be unlike those that their party would employ. I believe once politicians are able to move away from the “us” and “them” model, listen to one another’s ideas for addressing system deficiencies and get off of their political high horses then maybe just maybe we can actually have a bi-partisan bill with terms agreeable to all.

  20. “Scott Brown won in MA because he drives around in a pickup truck with 200,000 miles on it.”
    Looks like he (that “working man’s” guy) won’t have trouble getting health insurance though with that public option “cadillac” plan congress has reserved for themselves. I doubt he’ll emerge as the “Mr. Smith Goes To Washington” type guy he ran on – look for same old, hooray for my party politics.
    “it will be in no small measure due to the corruption of the political system that odious lobbyists like you represent.
    The result in MA was a repudiation of the corrupt system,”
    The Supreme Court just ruled that corporations can be considered just like ordinary citizens when it comes to campaign donations. If you think it’s corrupt now just wait until the floodgates of cash are unleashed. Running as an independant canidate of the people on federal funds – forget it, you’ll have to toe the corporate line or be drowned by the bully bullhorn of “free” speech.

  21. What hurt the bill most was it’s size. Had it been a $300 billion bill it could have passed without so many issues. Though it wouldnt have stopped political posturing.
    I believe the reason, the cost of bill is so high is due to it’s attempt to insure the uninsured through massive subsidies. Now if the uninsured problem isn’t tackled now it will get even worse and it will be even more difficult. With improving economy the problems might be masked for a while before we revisit the issue again in next recession.
    While there is a lot of anger, I hope the angry will realize that anger doesn’t solve problems. It just makes it worse.

  22. Scott Brown won in MA because he drives around in a pickup truck with 200,000 miles on it. I live in Massachusetts. I watch the local news and read the papers. All of the reporting was on the horse race, and none of it on the issues. Scott Brown won because his advertising campaign was effective. Period. Not so different from Obama, really. Voters aren’t interested in understanding healthcare reform, and the news media isn’t interested in explaining it. Coakley was portrayed as cranky and unlikeable, and Scott Brown was portrayed as a regular guy who drives a pickup truck, the kind of guy you’d like to have a beer with. That is the kind of nonsense that wins elections, not substantive issues.

  23. The Dems need to take their medicine and cut Medicare. They need to do it incrementally and they need to do it gradually but they (or the party in power) must cut Medicare. There is no money for anything else without this.

  24. If the Democrats fail to enact meaningful health care reform, it will be in no small measure due to the corruption of the political system that odious lobbyists like you represent.
    The result in MA was a repudiation of the corrupt system, not a referendum on any single issue. Until people like you find honest work, it will continue to be so.

  25. If something doesn’t pass on this go round, we’ll be waiting another 20 years for a solution to this problem. That’s not acceptable to me, and I suspect that’s true for a lot of people. Just establishing the norm that everyone in this country have insurance is a huge and beneficial change.
    >>HIPAA already insured access to health insurance.
    Apparently, you’ve never actually looked at what passes for a HIPAA policy in some states, WA, for example, allows insurance companies to place a limit on what they’ll cover per year in prescription drugs. Think there are any individual policies on offer there that don’t have a limit of a couple of thousand dollars? How well do you think that would work out for someone with a condition requiring expensive medication? It also allows comparitively low lifetime limits. Got a condition that can be managed, but will require treatment for the rest of your life. Gee, that’s too bad.

  26. It’s time to rethink the system. We need to end Medicare, find ways to create smaller health systems which individuals can pay for. Once the economic clout of mega hospitals and insurance companies and drug companies are gone — and it won’t take much to bankrupt them — maybe we can design a health care system that is affordable enough to insure one way or the other.
    What can you do? Get together with groups to create a medical cooperatives, like food cooperatives. Contract with a doctor to provide care at reasonable cost and eliminate by agreement extra-ordinary measures, second opinions and unneeded tests and malpractice litigation. Pay directly without insurance; it worked once when our parents paid for health care.

  27. MG that is a quasi chicken and egg argument. I would argue if it was not for Medicare and government intervention cost never would have gotten out of control like they have. A summation would point out the deflation of cosmetic and elective procedures. I would also point out the corlation, cant prove causeation, of OOP cost sharing and inflation. And there is recent data from CDHP that shows decreased spending and more importantly price shoping.
    I would also argue that the elimination of most fraud and abuse would have significant impact in restraining price inflation.
    A good catostrophic policy and decent planning 85-90% of seniors would have no problem easily affording all of their care. We would still need to help 10-15% put that wouldn’t cost anything near what we spend on Medicare and Medicaid combined today.

  28. Nate – For a change you actually did. I would bet that Medicare patients though would want more than “catastrophic care” only given how exorbitant the price of health care has become and the overwhelming majority of most seniors to afford serious healthcare expenditures.

  29. MG I see one ? total in your post and I did specifically answer it. Not only providing you my answer but plenty of supporting documentation in case you doubted me.
    No, seniors today would not push for Medicare like it is structured today. They would ask for the same thing they asked for back in 1965, catostrophic insurance in case something serious and unforseen happened but other then they stay out of their healthcare.
    People don’t like politicians all up in their daily lives. If Washington hadn’t screwed up healthcare we wouldn’t need them to pay all the little bills and day to day management. If Medicare as it exist was so great they wouldn’t have to threaten people to keep them in it.
    Did I answer the question?

  30. Nate – Do you ever actually answer a question that is posed to you or do you just ignore them/rant on a tangent subject but not directly answer the question/rant incoherently?

  31. This election was not a result of the lack of movement or poor legislation on Health Care. It was a better run campaign in conjunction with the disappointment of the the lackluster performance of the Democratic Party. We all agree (other than the insurance companies) that health care is in need of overhaul. What I believe we can also agree upon (other than the insurance companies) is that the legislation in place needs to be thrown out the door. We are mandating insurance on 3 million people. Even if the insurance companies received 1 dollar a month from these people; that is an additional 3 million dollars a month in their pockets without any restrictions on their costs of service. Sure we get a “no per-existing condition” clause; but at what cost? The insurance companies wrote the legislation which is now being forced down our throats.

  32. why is a small simple bill that accomplishes things almost everyone agrees on out of the question? Who doesn’t support fixing the fraud and abuse in Medicare? Why does that have to be wrapped in taxes and mandates? Besides pharma who opposes reimporation of drugs? Give individuals the same tax benefits as employer plans, preferrably with a cap.
    If this was truly about fixing health care they would pass small effective bills every year or every other year. The fact this is not even an option proves this is not about fixing healthcare.

  33. It’s unclear whether a “bipartisan” bill could ever be achieved, but what’s begun to show is that people are rejecting the health care bill in its current form. While electing Obama was generally a vote in favor of reform, the brand of reform being pushed through Congress was not sitting well with the American public.
    Here’s hoping that Brown’s election in Mass will slow things down a bit; a delayed bill is better than a flawed, partisan bill that pushes the administration’s agenda more than it furthers the achievement of good, affordable health care for everyone.

  34. Oh please, there are obvious areas of substantive health care reform that would garner large majorities today; including Medicare and SS. 1) Taxing cadillac benefits for ALL taxpayers 2) health care courts (med mal tort reform) 3) national public exchange 4) EMR 5) Medicare negotiating in bulk for drug prices 6) medicaid for all children 7) ability to buy into Medicare between 55-65 if not insured at work 8( ability to dedcut health insurance premiums if self employed 8) no Louisiana purchases of Nebraska deals 9) loan forgiveness/scholarships for med students to go into primary care..but this would require standing up to unons, trial lawyers, Billy Tauzin, etc. Oabam can still save this in a proncipled way and come out on top – but he will have to decide if he wants to irritate former (and future) Goldman Sacks employees in his cabinet, unions, trial lawyers….

  35. “Health care reform” is degenerating to political theater, wherein the primary objective is to make a grand, self gratifying display of one’s egalitarian principles, against the backdrop of the moral defectives who view “equal and unlimited health care for all” as the fruit of ideological dementia. There are more cost-effective ways of assuring adequate levels of care for the indigent and uninsurable, and there will come a time when “progessives” will, albeit through gritted teeth, become amenable to discussing them.

  36. Your right MG why bother actually reading a history book when you can just post ill-informed comments online. Assuming you do know how to read pick up a book or look up the congressional record and see what the public wanted and what was passed.
    “you really think Nate that the largest block of Americans (who also voted in the largest numbers) wouldn’t heavily push for these types of programs if they weren’t in place?”
    What I really think is what really was at the time Medicare was passed; an OVERWHELMING majority of American’s, young and old, wanted catastrophic coverage. 87% of seniors had no problem paying 100% of their medical bills, what scared people was Grandma losing everything with a prolonged illness. What they got was the exact opposite.
    Since you don’t appear to be very bright MG allow me to help you with your history homework;
    “By 1964 sustained efforts to legislate compulsory health insurance at the national level had continued for three decades. For 30 years since the Committee on Economic Security first endorsed the idea, Congress and the public repeatedly rejected it.”
    Does this sound familiar?
    “as shown below, the 1965 bill and the procedures employed in its passage were rife with transaction-cost augmentation, allowing government officials who supported it to impede public opposition.”
    Like today where Democrats twist the reform the people actually want into what they want to sell;
    “Moreover, a Gallup poll released on January 3, 1965, showed that efforts to sway public opinion on the national health insurance issue had been at least superficially successful: 63 percent of respondents now approved of the idea of a “compulsory medical insurance program covering hospital and nursing home care for the elderly … financed out of increased social security taxes”
    “The gulf between what the public thought and what was actually in the bill was enormous. The most pressing rationale for compulsory health insurance continually put forward by government officials and echoed by the public was the specter that responsible older people could be ruined financially by catastrophic illness.”
    Here is the money quote;
    “During the 1965 Senate Finance Committee hearings, Chairman Russell Long (D., La.) asked HEW Secretary Anthony Celebrezze, whose department had written the bill, “Why do you leave out the real catastrophes, the catastrophic illnesses?” (U.S. Senate Hearings 1965: 182). When Celebrezze replied that it was “not intended for those that are going to stay in institutions year-in and year-out,” Senator Long countered: “Well, in arguing for your plan you say let’s not strip poor old grandma of the last dress she has and of her home and what little resources she has and you bring us a plan that does exactly that unless she gets well in 60 days.”
    “Long added that “Almost everybody I know of who comes in and says we ought to have medicare picks out the very kind of cases that you and I are talking about where a person is sick for a lot longer than 60 days and needs a lot more hospitalization” (U.S. Senate Hearings 1965: 184). [14] Yet the very element that government officials continued to cite to win public support for Medicare was deliberately omitted from the administration’s bills.”
    “Despite their limited coverage, the bills came to be known as “Medicare,” a term coined by a reporter to describe a previously established comprehensive health care program for military dependents. Many people therefore assumed that the bills before Congress would cover all forms of medical care, including outpatient physician fees and extended illnesses. When Rep. Albert Ullman (D., Ore.) cited allegations that the “public is somehow being hoodwinked” and “being misled” and asked HEW’s Wilbur Cohen about the degree to which the public misunderstood the program, Cohen stated that “we do recognize this problem and I think it has been complicated by the use of the term ‘medicare’ which is an erroneous term when applied to this program” (U.S. House Hearings 1965: 104).”
    When you manage to remove your head from your backside MG I suggest you spend less time commenting on blogs and more time learning your history.

  37. Bob – I agree with you to a point but the Congressional Register voting record for the past year shows the Republicans in the Senate voting against bills put forth by the Democratic majority as any minority party in the past 100+ years of Congress.
    You have to go back to the Democrats of the Reconstruction Era to find a minority party that has voted so often and in such large numbers (as a % of their members) of the party in charge as the recent Senate Republicans have done.
    It is pretty unlikely that Obama would have found 10 Republican Senators who would have voted on any bill the Democrats put forth. Kind of why it was laughable that Brown ran as an “Independent Republican.” If Brown is really an “Indepndent Republican” and votes that way in Congress, McConnell and Republican leadership will make his life miserable by giving him the worst committees in Senate, etc.

  38. “Medicare and SS would never pass today. The media doesn’t have enough control over information diseminated to the public. Medicare and SS only passed becuase of the lies and hidden facts.”
    Completely disregarding the fact that these programs were both passed at completely different time periods, by different politicians, and due to different reasons, you really think Nate that the largest block of Americans (who also voted in the largest numbers) wouldn’t heavily push for these types of programs if they weren’t in place?
    Good for a laugh and a view of the world that is skewed to the right.

  39. What is the general public opinion about health care reform? “Affordable health care” for all. People are asking for “affordable health care” first, after you achieve it, you expand it for all. The current health care bill surely is “for all”, but “maybe affordable” unless you get zillion dollar deficit, eveually mean raising tax somewhere,current bill may not the ads that get everyone on board from the first place. If any party get this right, health care bill may have a chance to success.

  40. Usual nonsense, I am sorry to say, from Mr. Laszewski. As tcoyote notes above, the election of Mr. Brown is a protest vote against the assumption of Democratic politicians in Massachusetts that they can perpetually ignore the electorate. Much like President Obama’s election there was apparently a confluence of many serendipitous occurrences at the same time that permitted Mr. Brown’s election. As those with knowledge in Massachusetts point out, the healthcare legislation passed in Massachusetts and the system therefrom works better than the collective features of the House and Senate bills.
    If anything, one could argue that Massachusetts voters want an effective bill passed by Congress as opposed to nothing which apparently is what Mr. Brown wants. I.e. complete opposite of Mr. Laszewski’s contention.

  41. Health care has always been the third rail of American politics, as what is needed to govern the sector is both too complex and contrary to Americans’ popular political philosophy. Every time it has come up, those taking the initiative have taken a political hit. Republicans got their turn during Medicare reform legislation in the 1990s.
    Seen in historical context, getting reform bills as far as Congress has in 2009 is impressive.
    If reform doesn’t happen this year–and reform now appears unlikely–politicians will steer clear of anything substantive for at least a dozen years. So we can look forward to watching our health care disintegrate even farther and provide bad care for increasing numbers of Americans.
    Will failures in the medical system eventually reach a point that alters common political thought among Americans? Don’t count on it. The sector is too complex, the populace too easily misled, and health politics too driven by fear rather than rational thought.
    No substantive reform is likely to get adequate consensus in this country. Most agree that reform broadly speaking is needed, but there has never been agreement around a specific reform direction.

  42. What is in the healthcare bill, at this point, has now been rendered absolutely secondary to the PROCESS of how it was arrived at.
    The political process SHOULD be hotly debated; it SHOULD represent all relevant points of view; it SHOULD ensure all voices are heard. And it SHOULD serve the public as a whole.But it SHOULDN’T be so corrupted by concessions (hello-Nebraska?), questionably-legal provisions (union-based plans exempt from excise taxes that non-union-based plans must pay) and shenanigans that work to defeat the reason that two-party and bi-cameral government was created for.
    We should all be ashamed that so many things come down to a party-line vote. Including YOU, members of Congress. You are a disgrace for not putting the best interests of the American working populace first. How can they…WE…be subservient to achieving political, party-line goals? You have made the American people the pawns in the great political chess game…the ones sacrificed so that the Bigger Players can achieve their ends. How can WE have any confidence in ANYTHING that you, Members of Congress, do if we are forced to believe that it is all done to the benefit of factions…not through the working together of two parties and two Congressional Chambers, arriving at agreement through the good ole fashioned PROCESS of compromise and dedication to the result?
    I don’t think I’m alone in expressing the disappointment so many of us have in how you, Members of Congress, have dashed the hopes we had for a bright, well-intentioned administration to bring about “CHANGE”. The only thing that has changed so far are some names on the doors. And so far…nothing is for the better.

  43. I wonder if Medicare, Social Security and Massachusetts’ universal healthcare program were dismantled, if people receiving those “socialistic” benefits would approve of the dismantling. In fact, polls show those are the people that seem most opposed to healthcare reform – mainly because they got “theirs” and are not willing to let others share. I also wonder if people now receiving Medicare and Social Security benefits were opposed to creating those programs in the first place (much of the country was back then). I agree with Mr. Brown, unfortunately, that healthcare reform is dead. There will be no bipartisan compromise because the Republications have one agenda – defeat any agenda of President Obama. Sorry, Mr. Brown, but I don’t think they need, or want, your suggestions. Lies and exaggerations have led us to the defeat of healthcare reform (not to mention the lack of political will by our politicians). The future for healthcare will be messy – and expensive. I suggest investing in the stocks of insurance companies.

  44. Whoa,what passionate comments. I am from Massachusetts, and am as disappointed as anyone else that Obama could not correct the huge inherited deficit from two wars. adequately “punish” the perpetrators of our financial crisis, and get the government to accept the responsibility to offer affordable health insurance to all citizens IN ONE YEAR. Here’s hoping that Scott Brown will be now be able to help him out over the next three.

  45. Personal observation: both parties reek. Us Independents are growing by the year. First Bush lied to get us into a trillion dollar disaster in Iraq, now the Dems tried to raise taxes by a trillion dollars and had the unmitigated gall to call something without tort reform “health care reform”.
    Obama promised change (meaning get out of Iraq, no more back room deals, curtailing lobbyists, etc) and got the independent vote.
    The way this health care deal has gone has lost the dems the independent vote for 2010.

  46. “But at least it means that uninsured person has access to health insurance.”
    Never let facts get in the way of good liberal dogma and propoganda. HIPAA already insured access to health insurance. That boat sailed years ago. What you want is wealth redistribution, you want someone else to be forced to pay the bills of your chosen people. The public won’t suppor this so you wrap it in the lies of people not being abloe to get insurance. Unfortuently they invented this thing called the internet so Matt and the MSM can’t hoodwink the public like they use to.
    Medicare and SS would never pass today. The media doesn’t have enough control over information diseminated to the public. Medicare and SS only passed becuase of the lies and hidden facts. Both where poorly designed disasters waiting to happen. When the left tried this now, Cap and Trade, HC Reform, the public is to quick to learn the truth and the facts and rise up against it. The only way another pillar of liberalism will ever be passed is if it was introduced and voted on within days and the public didn’t get a chance to read it.
    “The Republican party has been hell bent on stopping Democrats from reforming health care since the early 90’s”
    Wow Tom are you clueless. DOn’t know how to read or jusgt choose not to? It was Democrats who blocked AHPs since 1990 to protect their Union overlords.
    bev M.D. if that was true then why don’t the liberals sign off on any of the R’s reform bills they produce every year? See note above about not being able to lie to the public since the internet. Anyone can look up the bills the Dems have blocked for the past 16 years and see your lieing. Old games don’t play anymore. Instead of tricking the public into buying your crap your going to hav to start actually selling it on merit, something your liberal agenda lacks.
    I rather do nothing Lynn and my cost go up 20% in the next 5 years under a private system I control then vote for what the Democrats are selling and my cost go up 50% under a mandated system funded by taxes I have no control over. Really a very simple choice and the one the majority of Americans are making.
    I would disagree with your efficient remark, I can rattle of a dozen previous pieces of legislation that made us less efficient and added no or minimal benefit. It’s simply not true that everything Congress passes is an improvement. History has shown the exact opposite, we would be further ahead without most previous legislation. Bad bills have bad results.

  47. The problem was the idea was right, but going through the process killed it. The vote in MA was against more costs, questionable outcomes, back room deals, outright bribes of Senators, and secrecy. Americans do support health reform, but this was not “it” in any good sense after the process deployed by those in control created a sour sausage. The middle of both parties must coalesce and create a viable option with simple solutions that we know work. The far right and far left will continue to fight and try to gain an advantage for the 2010 elections.

  48. Public opinion polls (the good ones) have consistently shown over the past 2 years the American public is ambivalent at best and confused at worst on healthcare and reform. I believe our “sausage” legislative process vividly reflects this ambivalence. The MA election is just one more kink in that process.
    We get the Congress we elect. But there are also consequences (higher costs and more without access) to continuing with the current perverse incentives. Failing to address 16% to 20% of our economy isn’t a rational option. Our healthcare delivery and insurance sector isn’t going to be more efficient or effective without reform to modify those incentives.
    I guess I should be excited that I’m allowed the liberty to have a pre-existing condition and to be uninsured a little longer.

  49. Although I didn’t like the monster that this bill became, I felt it was better than nothing going through, followed by no change in health care for another 16 years (1994-2010).
    I fear that I agree with pheski – the Republicans’ sole agenda is to defeat anything – anything – on Obama’s agenda. They do not care one iota about changing health care.

  50. I was previously under the impression this was an intelligent blog! This election was decided by the stupid things the loser said. Democrats should pass the bill, it’s significantly better than what we’ve got-all the smearing by right-wing talk radio can’t change that. Once it’s passed and people realize it’s better, Democrats will be OK. The Republican party has been hell bent on stopping Democrats from reforming health care since the early 90’s-you can’t trust anything they say about bipartisanship. They want health care to be rationed by insurance companies(who kick back $$$ to the Republican Party) and everyone that can’t afford it can just die. This line about going slow is ridiculous–we’ve been talking about it for over a decade; they just want to not do anything until Republicans get back in power-so they can do nothing! Oh, and costs? Medicare part D was not a problem and was rammed thru overnight without letting Democrats have a say.

  51. @Bob~>
    Bipartisan with the Republicans? LOL.
    Their approach, nicely documented in internal memos and evidenced by their behavior from day 1, is hyper-partisanship: prevent the Democrats from governing, don’t let them pass anything, don’t let any progress happen. The well being of constituents and the fate of the US are less important than returning the Republicans to power.
    Sorry. That comment puts you in the group of commentators we should ignore.

  52. What’s the message here? A Republican takes Ted Kennedy’s Senate seat??? What that tells me is that there are no safe seats, and the idea that 2008 was a “transformational” election, and that Obama and Congress were hired to completely reshape our society, damn the cost, was delusional bullshit. 2008 was a “throw the bums out” election, a repudiation of an arrogant and out of touch Republican elite that mismanaged the economy and our image and position in the world. Blaming the Republicans for this latest turn of events takes a lot of nerve. The Democratic party’s leadership is as out of touch with what’s worrying the typical voter as Bush, Cheney and Tom DeLay were.
    Obama was, in fact, a thoughtful, pragmatic moderate Democrat whose political advisors fundamentally misread the electorate. They did not have a mandate to complete the New Deal. People hired him to change to tone in Washington, and to solve our problems. One of those problems was the inequity and high cost of our health system. As the healthcare issue evolved, it became hijacked by the party’s left wing, who believed all the “transformational election” claptrap.
    To put it mildly, there isn’t a lot of patience with our political process right now. Baucus and Grassley were ridiculed for trying to find common ground among moderates of both parties as a basis for moving forward. They were right. Pelosi and Rahm Emanuel were wrong. There’s still a chance for health reform, and it’s not by passing the bloated mess embodied in the two bills which passed the respective houses. If there’s a reset button, I hope the President and Congressional leadership find it and push it. Otherwise, there will be a lot more politicians in that unemployment line come November.

  53. A further thought from Ezra Klein:
    “For now, it’s worth observing that a Democratic Party that would abandon their central initiative this quickly isn’t a Democratic Party that deserves to hold power. If they don’t believe in the importance of their policies, why should anyone who’s skeptical change their mind? If they’re not interested in actually passing their agenda, why should voters who agree with Democrats on the issues work to elect them? A commitment provisional on Ted Kennedy not dying and Martha Coakley not running a terrible campaign is not much of a commitment at all.”

  54. “Unwilling to compromise Democrats?” Incredible, just incredible that you would say that. Mendacious, actually. This was modeled on the Massachusetts solution that was clearly bipartisan. The Gang of Six met for months and came up with dozens of bipartisan compromises that made it into the final bill. Are the liberal 20% who think that this bill went a few compromises too far just imagining things, and really they’re getting Single Payer?
    The Democrats won a majority so large it comes along only once every generation or so, and you’d think if ANYTHING counts as a mandate to do things the way they had wanted, this was it. Bush claimed a mandate with 51%, and I’d bet that you were silent about that at the time. Republicans have not had majorities this large in our lifetimes, and yet they have not hesitated to push massive bills when they thought they might succeed at passing them, even if it meant exploding the deficit by hundreds of billions, even trillions of dollars. If I thought the umbrage at arrogance were spread equally, I’d cut you slack on this. But the deficit hawks always seem to slink away when Republicans come to power.
    Republicans decided to obstruct, delay and demagogue this legislation, and because of the 60 vote super-majority requirement and Democratic timidity, they might succeed.
    “There will be no interest in staying aboard the kamikaze flight Reid and Pelosi are now piloting straight into the 2010 elections.”
    Right: they are interested in cutting the engines and diving right into the sea. Failure to pass anything after all this will be massively demoralizing to Democrats, will further embolden Republicans, and worst of all: most people will have the mistaken impression that this bill would have done horrible things (forced people into health gulags, drained the treasury, etc.). If it actually passes, the giant balloon of scathing health punditry will pop, leaving mere vapors.
    The stupidest, most self-destructive thing Democrats could do right now is throw in the towel, walk away, and trash-talk this bill to present the whole party as a bunch of clueless fools for trying to pass a malformed bill. The glass is 1/3 full, but it’s better than hot air.

  55. So Bob, you’re an uninsured person with a pre-existing condition. Is it better for you that Democrats ram through what you incredibly seem to think is a radically left wing bill–even though everything approaching left wing in it has been stripped in the Senate version. But at least it means that uninsured person has access to health insurance.
    Or are you better off keeping the House Democratic, even though they do nothing?
    I suspect if I was in that situation I’d prefer the former.
    If Karl Rove was a Democrat, that’s what they’d do.

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