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The Reinvention of Social Progress

I watched C-Span through the entire voting process on Sunday night. Socialism? Tyranny? The GooznerRepublican hyperbole was unhinged from reality.

Democratic claims that the health care reform marked a major milestone in domestic policy were closer to the truth. But billing the legislation as comparable to the advent of Social Security in the 1930s or Medicare and Medicaid in the 1960s simply isn’t accurate.

Why do I say that?

  • For the 85 percent of Americans with coverage, either through their employers or government programs, not much changes except having the reassurance that one can get Medicaid or buy subsidized insurance if you lose your job.
  • Social Security and Medicare are social benefits guaranteed to everyone. They are paid for by universally-imposed taxes. This legislation’s only universal requirement is that individuals and families pay a tax if they don’t buy private insurance. Somewhere between 6 and 7 percent of the population will not have health insurance in 2019, according to the Congressional Budget Office.
  • National regulation of the insurance industry was long overdue. Banning discrimination for pre-existing medical conditions and ending denials of coverage after someone gets sick are big wins for the American people. But these regulatory reforms are aimed at abusive practices. They do not fundamentally alter the employer-based insurance system. Compare those changes to the systemic shifts in industrial practices required to comply with the Clean Air Act, the Clean Water Act or the creation of the Occupational Safety and Health Administration. We are still very much in the era of small-bore reforms.

It’s important to remember how we got here. The employer-based system is unraveling. The number of working-age adults who get private insurance through their place of employment shrank from 69 percent to 63 percent between 2000 and 2008. That was before this devastating recession.

The upward creep in the number of uninsured — now 50 million — would have been much worse without previous expansions in government programs like the Children’s Health Insurance Program and Medicaid. This reform, by expanding government programs and subsidizing the private insurance system, attempts to shore up the existing system, not fundamentally alter it.

The biggest change from the bill will be political. Unlike welfare reform during the Clinton administration or No Child Left Behind from the Bush years, this legislation’s first principles are progressive in orientation. It seeks to expand the social guarantees of U.S. citizenship, not penalize or impose requirements on people who participate in public programs.

After 30 years of conservative rule, that is a major change. It is worth celebrating.

Merrill Goozner has been writing about economics and health care for many years. The former chief economics correspondent for the Chicago Tribune, Merrill has written for a long list of publications including the New York Times, The American Prospect and The Washington Post. His most recent book, The $800 Million Dollar Pill – The Truth Behind the Cost of New Drugs ” (University of California Press, 2004) has won acclaim from critics for its treatment of the issues facing the health care system and the pharmaceutical industry in particular. You can read more pieces by Merrill at  Gooznews.com, where this post first appeared.

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Lisa LindelljdExhaustedMDLawrence J. KramerNate Recent comment authors
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Lawrence J. Kramer
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Sorry – My last post was to the wrong thread. Moderator should feel free to delete it (and this one).

Lawrence J. Kramer
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[COmment delayed by posting issues…] Ryan – I’m only addressing here the analysis that Mr. Greaney is offering – i.e., that the issue is class. I have not argued that anyone “deserves” not to have healthcare or that not having it is not a burden. I have not offered arguments against the current bill, because I don’t object to the current bill, as far as it goes. I’d just don’t share the Marxist perspective, and I think it leads down blind policy alleys. As regards your numbered points, I think you overstate the burdens on young people who cannot get… Read more »

Nate
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Nate

I like that, Matt can we make that happen? Make the right eye beadyer as homeage to my conservative brothern

Lisa Lindell
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The posts I like the best are Nate, MD as Hell, Rob Lamberts, Margalit Gur-Arie, Barry Carrol (just wish he’d post more often), and if Wendell Murray keeps coming back, I’ll likely read everything he writes.
But Nate you’re in a league of your own. Yes, you deserve a picture and a theme song. You should jazz up your name, I’m envisioning the “e” at the end of your name as a face with 2 beady eyeballs and an evil grin.

Nate
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Nate

heck in that case I want compensation Matt, the masses speak! And my picture posted, my fans deserve that. And a theme song.

Lisa Lindell
Guest

Nate, you’re not going to get kicked off. You are the Simon Cowell of THCB. You have a fan base and keep people coming back. That doesn’t mean we agree with you, it just means you got game.

louisdous
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louisdous

Actually, well less than 1 million. However, that may be enough to justify taking over the construction business and levy an additional tax on caddilac homes and force the hotels and motels to take in people with pre existing camping experience. I mean it is about time that all Americans have at least a basic amount of housing security, and don’t consider the dumpster as qualifying as government approved housing, since as we already know, that’s reserved for access to food. Thanks for listening. LD

Nate
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Nate

jd what country do you live in? There are millions of homeless people sleeping on public land. You can’t sleep in the middle of a street but you sure as heck can sleep in a park, storm drains, and all over the place

louisdous
Guest
louisdous

Ms. Arie, I appreciate your willingness to concede that your original two points are indeed, disputable, as indicated by your response which: 1) Confirms that, in fact there are not too many Americans that cannot access health care, since you are disputing the quality of access to care all American have, not whether they have access or not, and 2)Since you recognize price is not the same thing as cost, and point out that like house sale comparisons, the location (neighborhood) is an important factor, one could easily dispute whether the higher health care costs in say New York(America) are… Read more »

Lawrence J. Kramer
Guest

You borrow to buy a house, you get a tax deduction. You hire someone poor, you get a tax credit. There’s a new tax coming to fund coverage of pre-exisiting conditions and subsidized health insurance. If you buy health insurance, you get an exemption from that tax. What’s the big deal?

MD as HELL
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MD as HELL

If you cannot afford a cemetary plot, you give your worhtless body to science. It is not unconstitutional to be dead, but your body will not be voting, except in Chicago.
“Effectively” mandated is not the same as specifically mandated, jd, but it should not sway brainiacs like you.

jd
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jd

I am effectively mandated to do all kinds of things and purchase (directly or indirectly) all kinds of things. I am not at liberty to be homeless, in the sense that I cannot sleep on the street or in a park. That is outlawed. So, I have four options (but really, at most I only ever have one or two options, as you’ll see below). 1. Stay in a shelter. This is only allowed if they are not aware that I’m wealthy enough to pay for a room on my own. If they know I have a job, they’ll tell… Read more »

jd
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jd

“I have a bozo test for commentators on health insurance. Anyone who calls refusing to sell health insurance to people who are already sick “discrimination” is a bozo.”
Well, I have a bozo test for speakers of the English language. Anyone who tries to school someone in the use of a word while at the same time misusing it is a bozo. Discrimination.
The question isn’t whether it is discrimination. The question is whether this instance of discrimination is ethical or legal. That’s the debate.

Margalit Gur-Arie
Guest

louisdous,
Willingness to pay the price does not imply that the price is low or high. Comparison to other geographical markets where the same product or service is being sold is a better indication. So by comparison to Europe or Japan or Australia or any developed country, the cost of health care in the US is too high.
Regarding access, having access to a dumpster behind the grocery store does not qualify as having access to food.

ExhaustedMD
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ExhaustedMD

“You know we will have real health care reform when the majority party needs docs on their side more than lawyers.” Great statement, MD as Hell! The only problem is, what is the predominate profession in the Legislative Branch of government? It ain’t primary care physicians and nurses, folks. Wouldn’t it be great if doctors could change professional standards of lawyers? You think this bunch would just be reasonable in arguing the intrusion? I would hazard to guess if you gave the MMPI, a personality test, to both doctors and lawyers, narcissism and antisocial traits would be higher in the… Read more »