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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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31 replies »

  1. [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 healthcare outside the emergency room. I suspect that the vast majority stay healthy long enough to get jobs that provide coverage, if they touch all the other bases. Most of the people who have jobs that do not provide health insurance are in those jobs for reasons other than that the lack of health insurance keeps them from advancing. Lack of health insurance after a year of work is more likely a consequence of not advancing than a cause of it.
    I agree that fewer and fewer jobs have healthcare, but I lay the blame for that on our trade policy, which has made healthcare too expensive for employers to provide. But, remember, I am FOR universal coverage, and for whatever additional opportunity it creates (which I just think is less than you think it is), so don’t expect me to make the case against it.
    I do not see anyone “greasing” the pole to keep competition out. Well, I do, but you may not like my take on who’s doing it to whom. The only pole-greasing I see is White men’s decision in the 1970’s to give economic opportunities to their women instead of to Black men. If you want to talk about greased poles, look at the number of two-earner White households and zero-earner Black ones. (I am not unsympathetic to Marxist arguments per se, just to bogus ones.)
    I hear you when you say that efficiency can provide the resources for universal care. I would like to be able to agree, but I want to see the case made in more than a conclusory way. A weakness of the current bill is how little it does to enhance efficiency, trying instead merely to wring the profits out of administering claims, which is why I see demonizing insurance companies as counter-productive. I’d like to see incentives for PCP’s to reduce utilization. Others think we can reduce “unit cost,” but I don’t see how that affects resource utilization. (“Energy” does not appear in my posts. When I speak of “resources,” I mean mostly the human ones – man-hours and educational attention. Competing needs are for good government, industrial innovation, and infrastructure, to name a few.)
    I’m not sure why my assertion that race played a part in BHO’s election bothers so many people. We’re talking about a freshman Senator with no legislative achievements. I can see lots of good reasons why he beat McCain. But Hillary? Pundits pretend the differences were tactical, but that’s just not enough. The proof will come in the 2012 elections, when Black turn-out falls and coat-tail incumbent Democrats lose. (Elsewhere, I think the Dems will have a surprisingly good year, unless jobs, not healthcare does them in.)

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

  3. 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.

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

  5. 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.

  6. 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

  7. 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

  8. 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 too high or whether the costs of health care in say Oklahoma (Canada) are too low. I suggest it is sophomoric to use nebulous phrases like “health care costs too much” to voice your opinion and then proclaim that this opinion contains so much certitude that it is indisputable.
    I find it more productive and interesting to consider why many Canadians make the decision to pay “too much” for American health care services instead of enjoying the Canadian health care they pay less for. Can cost of healthcare in Canada be considered lower if in fact you end up paying “too high a cost” for it separately and in addition when you travel to America and basically double pay? I imagine there are Canadians that may dispute whether it is possible for the Canadian costs to be too low, when they end up paying both the “too much” cost and the “lower” cost combined.
    Thanks for listening (and conceding). LD

  9. 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?

  10. 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.

  11. 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 me to go to a hotel. The shelter is a bit like Medicaid.
    2. Stay in subsidized housing. I still pay something, but not a full market rate. This is a bit like folks who will get subsidies in the Exchange to purchase individual insurance.
    3. Rent an apartment/room. If options 1 and 2 are not open to me and I don’t have a ton of money, I’m going to rent.
    4. Buy a condo/brownstone, etc. If I have a lot of money and good credit, I could buy a place of my own instead of rent.
    As a rule, you can’t squat on public land or other people’s land (if they don’t want you). Aside from the fact that being homeless stinks and I avoid it for that reason, even if I liked it I am prevented by law from doing it. Given that I am not penniless, I am thereby forced to pay for a place to live. And of course, my payment is going to enrich a private party.
    Why is this not unconstitutional, you Constitutional scholars opining on this blog?

  12. “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.

  13. 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.

  14. “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 latter group. Not that doctors would have no narcissistic tendencies, but in raw percentages, I doubt physicians would be close to what would be seen in lawyers.
    And what does that say about the representation from the Legislative Branch of government of this country, if my hypothesis is correct?
    Think about it!

  15. Nate: No worry about being kicked off of this website. There is some entertainment value in your comments, if nothing else.
    I am still trying to figure out from your comments in what area you might have knowledge. I suspect that you have knowledge about something, but that something continues to be evasive.

  16. 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.
    I’m not saying that pre-existing conditions clauses are a good thing, only that they were a necessary evil absent a requirement that people pay into the system either through premiums or through taxes that could then be used to subsidize insurers if they have to sell insurance to people who are already sick. It makes no sense to have the taxes go to the general Treasury if the freeloaders then get insurance at the expense of the insurance company (i.e., its insureds).
    Health insurance is the classic case of “We have met the enemy and he is us.” Insurance companies – the big ones, anyway who run employer group plans – love to pay benefits. They pass the cost of claims on to the employer, who passes it on to employees and customers in some proportion. The insurance company basically makes its money by investing premiums or by charging for what amounts to “shipping and handling” in the mail-order business. The cost of the program is basically claims plus mark-up. The more claims, the more profit. That’s why the briar patch of 32 million more insureds doesn’t really scare the insurance companies.
    But insurers compete on rates, and one way to keep rates down is to reduce claims. Thus, the more competitive the insurance market becomes, the worse it becomes for insureds. That’s because employers fund the paid benefits, but employees lose the denied ones. That mismatch in interests makes for trouble. But the insurance companies are just the bookie in that bet.
    I think it’s a good thing that people be able to move from one insurer to another without worrying about pre-existing conditions. The rule should be that a new carrier cannot deny coverage you had with an old one. But two things must be true for such a rule to make sense. Unless the flow of sick people between carriers evens out in the scheme of things, carriers must share (through a reinsurance pool, say) the costs each bears as a result of portability. And everyone must be made to buy insurance while healthy so that those who do are not forced to subsidize those who don’t.
    It remains to be seen whether this bill creates those conditions. What is clear, however, is that it makes no sense (other than the political sense of trying to fool enough of the people enough of the time) to demonize insurance executives who do not commit corporate suicide by insuring the uninsurable.

  17. Merrill you are either clueless or an opportune propogandist with no morals.
    “For the 85 percent of Americans with coverage, either through their employers or government programs, not much changes”
    30-50% increase in premium in 2 years isn’t much? Being told your plan isn’t qualified and thus no longer allowed to be sold isn’t change? Being forced into 1 of 4 approved exchange plan designs? Not being allowed to buy catostrophic insurance? Having your FSA capped? Self Funding possibly being eliminated forcing employers to buy insurance from carriers with much higher overhead?
    “This legislation’s only universal requirement is that individuals and families pay a tax if they don’t buy private insurance.”
    Do you not know what guarantee issue is? Carrier must sell everyone a policy regardless of of medical condition, how much more universal can that be? DO you have any clue how much this will drive up cost? People can pay a small penalty and go without insurance then when they get sick carriers must sell them a policy. Once they have incurred their claims they can then drop off again and pay the penalty.
    “They do not fundamentally alter the employer-based insurance system.”
    BS pre-ex and cancelling polices of people that lied to get cheaper rates were a direct result of anti selection pratices. Carriers now have zero protection from those being dishonest, this will cause rates to skyrocket.
    At the expense of getting kicked of THCB this needs said, your a liar and an idiot, everything you said are lies to sell broken promises to come. Liberals are trying to kill private insurance by making it so expensive people can’t afford it. If that is your goal fine your entitled to your opinion but be enough of an American to put your cards on the table. Your post are as disgusting in their deceit as the bill congress passed.

  18. “There are no Americans with out access to health care. It’s a fact. ”
    I like this kind reinforcement in your 2nd sentence! Happy that you settled the issue.
    Re. your first point, please google terms like third party payor, medical infaltion, outcome research, evidence based medicine etc.

  19. “There are two indisputable facts: health care costs are too high and there are too many Americans unable to access care.”
    Dispute:
    1) I suggest there is nothing more important to spend money on than health care. Do you think George Washington would have said that $4 of antibiotics was too much to spend treating the stafff infection that ended up killing him? So, who gets to arbitrarily determine what the proper amount to spend is. It used to be the folks that earned the money, not those that take the money. Millions of Americans have willingly spent more than 20% of their assests on health care for themselves and loved ones. People used to spend more than 20% of their resources on food. Wonder if anyone one pronounced that we are spending too much money on food.
    2) There are no Americans with out access to health care. It’s a fact.
    So your batting 0 for 2 on indisputeable facts. Thanks for listening. LD

  20. So wrong in so many ways:
    “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”
    ****except the change of trillions of dollars in new taxes these 85% will pay and the trillions in deficits these 85% and future generations have to pay on top of their premiums that will be rising pretty near as fast as they are now, and some have argued will actually increase faster…CMS Chairman****
    “Social Security and Medicare are social benefits guaranteed to everyone”
    ***Social Security benefits are not guaranteed, but provided at the whim and direction of a capricous congress***
    “They are paid for by universally-imposed taxes”
    *** They are paid for, not universally, but only by legal Americans that work***
    “This legislation’s only universal requirement is that individuals and families pay a tax if they don’t buy private insurance.”
    ***you forgot to include the requirement of what type of private insurance people will be forced to buy; that it goverment approved private insurance****
    “Somewhere between 6 and 7 percent of the population will not have health insurance in 2019, according to the Congressional Budget Office”
    ***In Mass. where coverage is mandated, the percentage of the currently uninsured is very close to the percentage of folks driving cars with out insurance (appoximately 15%).
    ***Objective studies of the legal, uninsured, folks that are not eligible for government programs, that want insurance but can not obtain it now due to reasons other that they want to spend their money on other things is about 5% (15 million). So we spend all this money we don’t have to bring that number to 6 or 7%: brilliant!
    “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”
    ****There are plenty of national regulations of the insurance industry already (ERISA, ADEA, COBRA, HIPAA, et al). How are they working out? These geniuses in Washington have spent billions of our tax dollars concocting these regulations and forced employers and individuals (and ultimately the end consumer) to spend hundreds of billions more on hiring mind readers (Accountants/lawyers/consultant/etc.) to attempt to comply with these “national regulations” that were so poorly written by congressional jokers that never understood what they were doing. COBRA was written 25 years ago to eliminate job lock due to Pre-Existing Conditions. And now, 25 years later, there are still situations with COBRA that remain unresolved. Good luck with this next monster***
    “The upward creep in the number of uninsured — now 50 million”
    *** just plain old BS***
    “After 30 years of conservative rule, that is a major change.”
    ***This is just a childish attempt to rewrite history. There has not been 30 years of Republican rule much less conservative rule. I’ll grant you that 12 years (1994-2006) is close to the ratio of 6 years of benefits for 10 years of costs****
    I suggest two things:
    1)You do not know much about the facts, and
    2)What you do present is dishonest.
    Thanks for listening. LD

  21. MD as HELL,
    There are two indisputable facts: health care costs are too high and there are too many Americans unable to access care.
    There are two possible ways to proceed: work on reducing costs first, while the underprivileged are asked to wait outside, or bring everybody in and grapple with the costs while everybody is covered.
    No doubt, the latter choice will cost us more money, and no doubt the former is not the American way of solving problems.
    If we need to find some extra money to take care of our children, may I suggest that we curtail our Sisyphean work of turning rocks half way across the globe looking for imaginary terrorists and their equally imaginary weapons of mass destruction.

  22. You will know we have had real healthcare reform when the majority party needs docs on their side more that lawyers.

  23. Cutting Medicare is not about cutting docs; it is about cutting benefits. There is no 41% cut just out of the docs. So, bye-bye feeding tube. Bye-bye- free scooter. Bye-bye dialysis if you are a cocaine addict or too old or noncompliant with your medicines. Bye-bye doctor choice. Bye-bye new medicines. Hello Wal-Mart $4 list. And hello waiting lists. Maybe you can tip the matre’d for a seat near the care.

  24. The healthcare problem was always the cost, which is driven by 1) The cost of medical care, 2) Usage of medical services 3) Law Suits, and 4) Taxes and administration. This bill does nothing to address ANY of those costs except to cut medicare rates by 41% over 10 years. Do you think docs will continue to work for a 41% pay cut? I don’t think so!
    We don’t need change, we need solutions, and solutions can only be developed by American business, not by congress. MediBid has such solutions, you simply register for an account, post your medical request, and before you know it you’re shopping for healthcare across state lines. MediBid creates competition among medical providers which does not exist in today’s system of price fixing by Medicare and the AMA.
    Simple procedure, amazing result.

  25. I find it appalling those who walk in-step with everything that his thrown their way. Why dont you read the fine letter of the bill. There is a program that will be setup to start a non-profit health insurance. Let’s have everything non-profit, why not. we dont need tax revenue, private jobs, opportunity. The problem here is no writer or democrat understands what the American economy is. They think its a place for handouts and nothing more. Our education loan system went to govt. What’s next, where does it end? if you say here, i say i dont believe you.
    The real reason it ends here is because we cant afford anymore of this junk.
    IF you believe this reduces the debt, and really provides healthcare with outcomes and not just people holding a form saying they have healthcare, you are as dumb as those that passed this monstrosity.
    I find it it bafoonish that so many had a “belief” over what reality is.
    For the billions used up (make that trillions) the outcome will be very VERY little.

  26. One of my favorite moments watching the debate on TV happened on CNN. As I remember it, Wolf Blitzer was speaking to a Republican among the panelist, and at then Blitzer spun to the monitor and said “Let’s listen in on the debate.”
    At that moment Republican Devin Nunes took the mike and launched into a tirade about “Socialist Utopia” and “Soviet Planning.” When he was done, Blitzer turned to the Republican panelist and asked “what about that?”
    The panelist was without words. There was no way to defend Nunes’s nonsense. Yet it proved to be a microcosm of the Republican position on health care.

  27. I don’t know… I enjoyed C-SPAN. I watched on Saturday and the whole thing on Sunday, with Ezra Klein’s twitter list for color commentary.
    Somehow, the process seems right to me. Not right in the sense of “right and wrong”, but right in the sense of “working as intended”.
    If you just look at the process itself, without making judgment on who is right and who is wrong, the House looks very much in order. I bet if we were able to bring some of the founders back for a visit, they would feel comfortable in the House. People are dressed a bit differently, and dogs are not allowed in, and you can’t challenge anybody to a duel after a good shouting match or 3 hours oration, but other than that very little has changed.
    People argue that the system is wrong and we shouldn’t be bound by an almost 250 years old document. I guess it’s possible and the process could be improved. Not sure about resilience though. The one we have now may not be fancy, but it is very sturdy.

  28. I also think it’s noteworthy that this bill cements a critical difference between the parties: Democrats are fiscally responsible, and Republicans are utterly profligate deficit-spenders.
    Reagan began the major increases in deficits, though he also raised taxes a number of times to offset some (but nowhere near all) of his spending. He was a net deficit creator. When the first Bush raised taxes to decrease the deficit, his party turned on him. And his net fiscal contribution was, like Reagan, more debt. The second Bush, quite frankly, pursued the most fiscally irresponsible policies of any US President.
    Clinton’s financial performance was a key indicator that Democrats were committed to fiscal responsibility. His policies eliminated the deficit and began to lower the debt.
    Yet until Obama, a plausible argument could have been made that it was congressional Republicans who deserved the credit, or “divided government” that deserved it, or even the fact that he was from the southern, “centrist” wing of the Democratic party and not the progressive wing that explained his fiscal approach.
    But with this bill, it is extremely clear that fiscal responsibility has emerged as a CORE Democratic value. This major health bill, sponsored by a President from the progressive wing of the party, passed by a Democratically-controlled Congresswithout a single Republican vote, will decrease the deficit. And unless I’m missing something, it’ll decrease the deficit by more than any piece of legislation passed since Clinton was President.
    It stands in shocking contrast to the Bush drug bill passed just a few years ago under a Republican President in a Republican Congress. This was also a major bill that made commitments of hundreds of millions of dollars on a permanent annual basis (and unlike the Democratic bill, it wasn’t the glorious fulfillment of a promise they’d been making for more than 50 years). And it was entirely deficit financed.
    But what about the stimulus???
    Yes, there was a deficit-financed stimulus bill. But the Obama administration has been VERY clear about limiting deficit spending only to short-term measures directly intended to deal with the greatest economic recession our nation has suffered since the Great Depression. Every reputable economist agrees that since we have reached the zero bound on monetary policy, major short-term deficit spending is the only option to short-circuit the recession and prevent the economy from spiraling into a depression. Obama’s actions are entirely consistent with his pledge: to deficit spend ONLY as a short-term measure to beat the recession.
    At this point, the Republican fiscal policy is to drive up the deficit. By cutting taxes with the bulk of the cuts going to high-income earners, and by net deficit spending for all new initiatives and the ongoing operations of government.
    The Democratic fiscal policy is fiscal responsibility. To achieve it by cutting taxes ONLY for non-wealthy people, by having deficit-reducing policies for all new initiatives and for ongoing government operations, and to only deficit spend as a limited, short-term response to an extraordinary economic crisis.
    It’s kind of incredible that the Democrats are willing to take such hard political blows for almost zero political credit. It’s almost like they actually give a flying fig about future generations.

  29. I second Dennis’ comment and in general Mr. Goozner’s commentary. I listened to a few of the brief tirades from Republican members of Congress, but the vehement nonsense from them was too much to stomach, so I gave up listening and watching any of it.
    “After 30 years of conservative rule, that is a major change. It is worth celebrating.”
    I agree with this statement in its intention, but the rule has not been “conservative” at least given traditional conservatism that in fact has positive attributes.
    The rule has been from the extreme right-wing which has no principles and only represents the interests ultimately the wealthiest of the wealthy in the USA and uses the nutcase segment of the population that is not wealthy as its shock troops.

  30. “The Republican hyperbole was unhinged from reality.”
    You said it! For over a year the Grand Obstructionist Party (GOP) has been sounding like a broken record, with nary a serious policy proposal from their mouths. All the party has is an ideology that says the free market always works best. (The only thing resembling a plan from them was their House substitute amendment back in November, which only covered 3 million.) By being the party of “no,” they missed their chance to have an impact on a bill that, by all measures of how health care is paid for and delivered in this country, is long overdue. Ironically, if they had recognized that this was inevitable and at least some of them had been involved, we would have gotten a better bill.
    The universal requirement that everyone buy insurance is the key to a successful overhaul and the only way insurance reform will work. For those who claim it is unconstitutional, just focus on the financial penalty for those who do not have insurance. That penalty is, in reality, an annual emergency room access tax (which I will choose to pay through my insurance, thank you very much).
    The regulations on the insurance industry are so long overdue, that I really wonder how Republicans will try to argue for repeal of all the consumer protections. The next seven months will be interesting.
    To use a military metaphor, this is no time for a “Mission Accomplished” banner: the insurgency is about to begin.

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