Back during the Bush Administration, I created a couple of controversial posts pointing out that Bush had achieved several longstanding liberal goals, including a vast expansion of Medicare, and greater federal aid to, and control of, local education. However, he got very little credit from the liberal side for these achievements.
On the Medicare front, commenters, other bloggers, and my email correspondents insisted that the Medicare expansion was simply a “payoff” or “giveaway” to the drug industry because it expanded the industry’s customer base without creating price controls, or even allowing the federal government to negotiate drug prices directly. My interlocutors held this position with great vehemence. (Indeed, this was a major Democratic talking point and a common enough criticism to inspire an academic paper, “Was [Medicare] Part D a giveaway to the pharmaceutical industry?”)
So imagine my surprise to read the following in the Times tonight:
With a sweeping overhaul of the nation’s health care system, Congress would be giving the health care industry as many as 32 million additional paying customers in the next few years.
That would mean millions more Americans buying private health insurance and better able to pay for their hospital stays, doctors’ visits, prescription drugs and medical devices.
And some analysts said as the vote neared that the final legislation was shaping up as much kinder to the industry than many initially feared. Hospitals and drug makers, which supported the final legislation, would be clear beneficiaries, analysts say, even if the outlook for insurers was less certain….
Drug makers, meanwhile, may have the most clear reason to celebrate the legislation. Pharmaceutical companies are going to be asked to contribute $85 billion toward the cost of the bill in the form of industry fees and lower prices paid under government programs over 10 years. But they can look forward to tens of billions of dollars in additional revenue as more people with insurance visit doctors and fill prescriptions.
The legislation will also eventually close the gap in Medicare drug coverage, known as the doughnut hole, in which elderly patients must pay for prescription drugs rather than having them covered by the government. Many chose to stop taking their medicine or switched to lower-price generics.
And significantly, the legislation allowed the drug industry to “avoid any of the issues that were particularly of concern — price control or more regulation by the federal government,” said Barbara Ryan, an analyst with Deutsche Bank.
I’m looking forward to seeing all of Bush’s critics on his Medicare “giveaway” at the next tea party rally!
But seriously, I’m really wondering, if you were among my liberal interlocutors who adopted the line that Medicare Part D was a malevolent “giveaway” to the drug companies, how are you feeling about Obamacare?
UPDATE: Speaking of which, if the problem the Democrats in Congress identified with Medicare Part D was its failure to coerce a reduction in drug prices, why haven’t the Democrats used their huge Obama era majorities to reverse that?
josh bornstein says:
David, I am not sure I see your point. If you are suggesting that liberals (like me) have a lot of issues with the current bill, and do indeed see it as a huge reach-around for Big Pharma, that seems like a fair point. But what does that have to do with me showing up at (or skipping) a Tea Party event? If Tea Party = Opposition to Health Care reform based on the lack of price controls, then that makes sense.
But that’s not what the Tea Party stands for (at least, as I understand their positions). They are against a multitude of things, so I would not expect people to show up at their events unless those people supported all, or most, or even many, of the TP positions.
My immediate take on your post was that you were creating a straw man. “If you criticized Bush’s Rx bill but you don’t physically show up at a TP rally; you are a hypocrite.” Is that really what you meant? If not (and I admit to misunderstanding people all the time, so it’s certainly possible.), can you explain what you are trying to suggest in your last sentence?
(I’m not sure if this is related at all to your post. But you would have to concede that just about every liberal has been consistent in their praise and criticism of this Health Care bill. “Yeah, there are good things in this bill. But I wish there had been a Single-Payer option, or some other real competition to the current private insurance racket.” Sadly, the Republicans, with their–entirely understandable, from a political perspective–filibuster threat, prevented it.)
March 22, 2010, 1:39 amJim N says:
I think the main point would be that the right of the Democratic Party killed off things like the public option and reimportation, which would have provided competition to the insurance and pharmaceutical companies. 80% of the Democratic party and President Obama would have liked this bill to have been less of a give away, but it wasn’t going to happen. They took what they could get. Medicare Part D was passed on the terms that the Republicans and President Bush wanted such as no negotiation for bulk rates.
March 22, 2010, 1:40 amRicardo says:
I don’t see the comparison. Medicare Part D prohibited the federal government from bargaining with pharmaceutical companies for lower prices on drugs — the federal government was forced to buy retail. As complicated as this new piece of legislation is, I don’t see any provision that prohibits private insurers from continuing their current practice of bargaining with pharmaceutical companies for lower prices.
The issue is not whether or not drug companies benefit — they clearly do anytime they have more customers. It’s how they benefit (by charging retail prices to the federal government) and at whose expense (the taxpayers’) that was at issue.
March 22, 2010, 1:40 amChristopher Cooke says:
My understanding is that Pharma has to pay approximately $80 billion in future profits in exchange for new customers. That was the deal that was struck with Pharma. So, they are giving up some profits for new customers and their support against the insurance companies and US Chamber of Commerce. Probably, this support was one of the main reasons the bill passed. No, I don’t think this was as bad as Medicare D, because Pharma gave up something. In the end, Pharma was much smarter than the insurance lobbyists, because it predicted this would pass and thus it worked to help shape the final bill rather than fight the bill and wind up on the losing the side (like the Republicans).
March 22, 2010, 1:55 amLawGuy5000 says:
The answer is in part of the NY Times story you quoted but did not bold. You wrote:
Try looking at it like this:
Drug makers are going to make money because more people will be insured. Millions will be insured. Millions will be insured.
March 22, 2010, 1:57 amAllan says:
No-one is against pharmaceutical companies making a fair profit. And there is nothing that shows that they will make more than a fair profit with this legislation, unlike the Medicare Part D legislation.
Indeed, had Medicare Part D not been such a sweet deal for pharmaceutical companies (and had it not had the donut hole) it would likely had more enthusiastic support from liberals.
This is progress. Obama clearly won this battle and I cannot see how Republicans will be able to recover, except to cooperate. I just cannot see how running on repealing this legislation has a chance in Hell of succeeding.
My prediction: Obama’s approval rating will go to 60% in a week.
March 22, 2010, 1:57 amDavid Bernstein says:
If you’re a betting man, I’d love to take that bet!
That was also true of Medicare Part D–millions who weren’t ensured for prescription drugs (a huge medical expense for many elderly) became insured.
March 22, 2010, 2:04 amJames N. Gibson says:
Spoken like a true Liberal. None of these things go into effect for several years and until they do, and people see a real improvement in their lives, what does he have to show for it. To get his approval ratings up he has to do more then ram home legislation that is demanded by the far far left. Tomorrow will dawn and there will still be the recession, the bleak job market, the high deficit, the wars in Afghanistan and Iraq and any number of other issues. The healthcare debate has simply shoved everything off the TV for weeks. Now with it settled, everything else will come back to the forefront with the economy being center stage.
March 22, 2010, 2:21 amJames N. Gibson says:
As Charles Krauthammer put it, the only reason why the Dems may not get too badly hurt by this in November is that the new Taxes will not go into effect until April 2011. Then there is a period of a few years were all that happens is the taxes and the new Healthcare provisions don’t kick in until after January 2013 and Obama’s planned re-election. And just to sweeten the story the taxes on the cadillac healthcare packages some unions have now won’t be until two years after Obama’s second term. And without that tax the system will not be deficit neutral after 2018 as the CBO indicated.
In truth a house of cards that requires further future actions in order for it not to break the Federal budget. And the bigger problem will be those millions more Allan mentioned. Are they millions more who get insurance, or are they millions more that have to now buy insurance.
March 22, 2010, 2:25 amSteve says:
Liberals were generally quite unhappy about the White House deal with Big Pharma. That doesn’t preclude some of them from concluding that it was worth the tradeoff at the end of the day.
March 22, 2010, 2:35 amBrian G. says:
The Republicans lost. Obama and the Democrats won Get used to the permanent Democrat majority, as Democrats will be long-rewarded for having the guts to give health care to everyone in the face of the insurance companies and their big money, and despite the racist Tea party rallies all over the country. The real will of the people has prevailed. And the best part, the Democrats stuck it to Bush.
March 22, 2010, 2:37 amRicardo says:
That was not the critique you cited above. The critique was that the federal government was banned from negotiating with drug manufacturers the way that private insurers and even the government’s own Veterans Administration do. The VA pays 40-50% less on some brands of drugs compared to Medicare Part D because of this. It’s reminiscent of Dave Barry’s joke about his own poor bargaining skills:
“I’m the world’s worst car buyer. I come from a long line of Presbyterians, who get their name from the Greek words pre, meaning ‘people,’ and sbyterian, meaning ‘who always pay retail.’… My idea of an opening tactical salvo is to look at the car’s sticker price and say to the salesperson, ‘This looks like a good deal! Are you sure you’re making enough profit on this?’”
March 22, 2010, 2:57 amWho IS Barack Obama??? says:
The Firedoglake people were probably alone on the left in being consistent on this.
March 22, 2010, 3:03 amGreg B. says:
The fact is, Democrats now and in the past have cared overwhelmingly about two things: expanding health care to people who need it and controlling costs. For that reason, we were in favor of a prescription drug benefit where the federal government could use its power to negotiate lower prices with drug companies. We opposed Bush’s approach because while both sides were looking to increase access to health care, Bush showed no interest in cost control. Cost controls were defeated because of the Republicans.
This time around, most Democrats favored both expanding health care coverage and controlling costs, whether by means of a single payer system that would feature the superior efficiencies we see with Medicare, or a public option, or a host of cost control measures that did make it into the final bill. This time, Republicans opposed both. Because we could not get a single Republican to support any aspect of the bill, and because we had to win over more conservative democrats, we lost on some cost control measures, such as the public option. But in both cases, the vast majority of Democrats were consistently on the right side, in favor of controlling costs, and the vast majority of Republicans, if not every Republican, was in favor of keeping cost controls as weak as possible. So, in summary, while we feel pretty good about Obamacare, in one sense we feel the same about this legislation as we did about Medicare Part D: both would have been better laws without the useless and unprincipled Republican Party.
March 22, 2010, 3:11 amleo marvin says:
Where do you come up with this stuff? You apparently have no idea what the “far far left” would demand, so let me give you a clue. I’m probably around the center of the Democratic party, and if I could demand something, it would be single payer. Rest assured no one on the “far far left” (whatever you think that means) is popping Champagne tonight. This bill was only the best that could be passed after the death panel demagogues scared lots of people into thinking they opposed the bill despite supporting just about everything in it.
March 22, 2010, 3:15 amNunzio says:
I was against Medicare D because we can’t afford it, the same with Obamacare.
March 22, 2010, 3:23 ammls says:
I think that the important thing to recognize is that both sides of the political spectrum are primarily bound together by a sense of moral superiority over the other. Ideology, in the sense of having actual principles of governance that one believes are important regardless of “which team” is advancing them, is distinctly secondary.
Many people on the left (EJ Dionne, for example) have claimed that the current bill is really a “Republican bill,” full of ideas that the Republicans would have supported if it weren’t for the fact that they are being advanced by the Democrats.
I disagree that the bill, taken as a whole, consists of “Republican ideas,” at least if that is taken to mean principled free market thinking. But it is probably true that if Bush had proposed a plan identical to this, most Republicans would have supported it just as they did the prescription drug plan.
On the other side of the coin, it seems to me almost beyond a reasonable doubt that Democrats would have vigorously denounced the plan if Bush had proposed it. One can show this even without relying on the assumption that Democrats instinctively opposed anything Bush proposed. Just consider the fact that the law will cut 500 billion dollars from Medicare. It is simply unimaginable that the Democrats would not have opposed this as a Republican assault on Medicare.
The bottom line is that whichever party is in control in Washington, there is a built-in incentive to grow the size and scope of the federal government. As Tom Perriellio put it, “unless you tie our hands, we’ll keep stealing.” And he went on to prove it by voting for the bill!
March 22, 2010, 3:57 amOperationCounterstrike says:
As I recall, the reason we said Medicare part D was a give-away to the drug companies was it refused to let the government bargain with the drug companies for cheaper drugs by threatening to import drugs from Canada. That WAS a give-away.
I am not aware of Obamacare granting our drug companies monopoly status the way Medicare Part D did.
March 22, 2010, 4:21 amDesiderius says:
Leo Marvin,
“Rest assured no one on the “far far left” (whatever you think that means) is popping Champagne tonight.”
This is only true in the sense that government monopolies are, in fact, inconsistent with the stated goals of the left. The actual left that we have are very much popping them, including here in our faces, accurately recognizing this as the first step toward the government monopoly they unfortunately do seek.
Here’s hoping some new generation will recognize just how reactionary such a result is.
March 22, 2010, 5:44 amMaryG says:
As one of those healthy new consumers forced into subsidizing the industry’s failing business plan, personally I’m hoping the Supreme Court steps up to declare this whole mess unconstitutional.
You can’t force someone to buy a product from a private company that they neither want, nor will use — on penalty of federal fine.
With the abortion mess neatly packaged inside (you have to join a pool you object to, that provides morally objectional services), I’m hoping SCOTUS can frame this as clearly a violation of individual rights to force us to subsidize these procedures with our unused premium money. If a system ever needed “checks”, this is the time for the Court to deliver.
March 22, 2010, 5:49 amDesiderius says:
The central problem is that the Boomers still live in an affluent country, with all the “generous” impulses that arise from that condition, while the following generations no longer do. This bill just makes that disparity a few hundred billion worse.
Coming next: the importation of another 30 million or so Mexican serfs to keep the Boomers living in the manner to which they’ve become accustomed.
March 22, 2010, 6:08 amStephen Lathrop says:
Issue-wise, I think the Democrats got suckered on this bill. Please, please don’t throw me into that brier patch. Politically, it’s a Democratic party triumph over Republicans, for now.
The only reason Republican politicians resisted was because it was a Democratic raid on Republican territory. The Republicans’ client industries didn’t resist, just the politicians. Republican politicians have nowhere to go if Democrats are going to turn themselves into Republicans and move into the Republican townhouse. That makes Republican politicians furious. It makes the left furious too, by the way.
March 22, 2010, 6:15 amcelticdragonchick says:
I agree. Poor houses or just letting sick people die are always far more cost effective alternatives.
Better we spend what few resources we have on making sure that the worthy wealthy keep their proper place.
March 22, 2010, 6:44 amMichelle Dulak Thomson says:
celticdragonchick,
Poor houses or just letting sick people die are always far more cost effective alternatives.
Indeed. I am always reading about how wasteful it is that the vast majority of medical expenses are incurred “in the last six months of life.” Eventually someone’s going to realize that the simplest way to reduce that fraction is just not to expend much medical effort on anyone who looks likely to die.
That was your point. Right?
March 22, 2010, 6:55 ampublic_defender says:
1) Bush gives Big Pharma a benefit because he wants to payoff a contributing industry. And since the Republicans were in the driver’s seat, Democrats had to take the good (expanded Medicare) with the bad (no price controls for purchases from Big Pharma).
2) Obama has to compromise to get a bare majority, so has to compromise with Big Pharma to get his bill passed.
Big difference. It’s really stupid logic (and beneath the usual quality of postings on this blog) to equate compromises one has to make to get a bill passed and actual goals each president was pursuing.
Your argument is like saying a prosecutor who agrees to a big reduction in a sentence for one murderer in return for testimony against an even worse defendant supports low sentences for murder. Or a prosecutor who agrees to a huge charge reduction for a child rapist because he’s unsure of how the kid-victim will hold up in court supports leniency for child rape. You can do better. You usually do.
March 22, 2010, 7:43 amSteve Gleit says:
The difference is that Bush got nothing in return for his giveaway; HCR expands coverage to 31 million people. You gotta pay to play baby!
March 22, 2010, 8:01 ammls says:
I would like to introduce public defender’s post as an exhibit in support of my argument.
March 22, 2010, 8:02 amnoahp says:
As the people of MA found out, just because you have an insurance card in your pocket doesn’t necessarily mean you can call your scarce primary care provider and make an appointment. But you can still go to the. ER and wait and wait. This is the change we have been waiting for? I have Medicare which will pay for a screening colonoscopy in a population that almost surely does not benefit but first you must have a referral from the dwindling supply of primary care providers.
Oh but you say that now with all the new paying customers the market will meet the demand? Perhaps. I predict the major “fraud” activity will be centers with primary care nominal gatekeepers distributing patients to interal specialists for surgery, radiological tests and procedures, cardiology, etc. In other words exploding costs. Look out.
March 22, 2010, 8:43 amAllan says:
Mr. Gibson,
For many of us, it is not that health care reform will do anything today, or even in the next few years. It is that this is the change we voted for. This is how history will reflect that Obama got his voters back…
March 22, 2010, 8:57 amgeokstr says:
Like the 60 billion every year from Medicare alone that goes to fraud? Think about it for one second. Multiply that by 10 years and you can pay for two-thirds of the Democrats bill with this one “Republican idea” alone. And that’s just Medicare. Medicaid is just as bad, and Social Security is full of kids coached to disrupt classes to fake ADD/ADHD and phony disability cases.
Of course, you would be putting all those Democratic supporters/voters on the receiving end of the fraud out of work, so there is that to consider.
But, like all the other nasty aspects of communism, like the 100 million dead people killed because they didn’t believe, the current batch just claims the last one didn’t do it right, but they will.
March 22, 2010, 9:10 amJoe says:
Many people on the left (EJ Dionne, for example) have claimed that the current bill is really a “Republican bill,” full of ideas that the Republicans would have supported if it weren’t for the fact that they are being advanced by the Democrats.
This is a bit much — the better idea is that it has various Republican ideas in it — but then again, various top Republicans said in the beginning they supported 80% of what the Democrats were trying to do, so I can see how Dionne might have been confused. Likewise, once upon a time, yes, someone like Nixon might have supported such a bill. “Republican” means something else these days.
I disagree that the bill, taken as a whole, consists of “Republican ideas,” at least if that is taken to mean principled free market thinking.
I’m unsure if that is what “Republican ideas” consistently are these days.
On the other side of the coin, it seems to me almost beyond a reasonable doubt that Democrats would have vigorously denounced the plan if Bush had proposed it.
Not sure I’ll take those odds. I’ll add though — by similar odds btw — that every single Democrat surely wouldn’t have voted against it. This was no Medicare Part D limited deal. As I recall, btw, Kennedy supported No Child Left Behind. So, such counterfactuals are, well unclear.
March 22, 2010, 9:44 amAndrew J. Lazarus says:
Well, except for the donut hole. And of course the part requiring Uncle Sam to pay retail, that made a lot of sense too. And the fact that Medicare D Bush-style made absolutely no attempt to raise revenue to offset its costs. It was 100% credit-card financing. And now Republicans come along whining about the costs of Obamacare. Well, the cost is less than Medicare D! I suppose the take-away is that money shoveled to Big Pharma and Big Insurance is better than money spent on genuine, affordable health care for more Americans.
March 22, 2010, 10:15 amThales says:
Call me a skeptical progressive, or liberaltarian, or something like that; I support a safety net but think we should employ the visible hand sparingly. But, like the great liberal (in the original sense) UK publication The Economist, I simply think that it’s unconscionable that in a country as rich and technologically advanced as the U.S. we don’t (until the results of yesterday’s vote take effect) have that safety net include some form of universal health care or health insurance.
All that said, I agree with some thoughtful critics of the bill, left and right alike, and essentially agree that was worth passing, but only barely. It *is* a giveaway to big insurance in the sense that they have a huge new customer base; it isn’t only in the sense that the industry is being turned into payment processors and data collectors rather than insurers. What I mean by this is that by removing rescission, exclusions for preexisting conditions (i.e. “uninsurables”), lifetime claim or policy limits, and all the other fun we’ve come to associate with health insurance, along with the individual mandate (enforced by a tax) the government has really allowed them to continue to exist as needless middlemen, free to collect premiums but with very little “rational” [in the sense that bad risks can be simply dropped] pricing ability to attach to those collections. Will private insurance be put out of business as some Republican critics suggested? Yes and no. Yes in the sense that they won’t continue business as usual, no in the sense that now that they aren’t truly insurers anymore, they’re getting a pretty sweet deal.
Most traditional progressives are outraged, but think of this either as an unseemly compromise necessary to ensure passage or as a way station toward something more sensible, like Medicare for all (I don’t think we’re going to get there) or a public insurer competing with the now-neutered private ones. Many would have preferred scrapping the employer-based system for everyone, and letting not just the uninsured participate in open market operations (along the lines of Wyden-Bennett or the Wyden free choice amendment, perhaps coupled with a public option). Everyone honest or informed knows that the bill does not do nearly enough to control costs, although the significant funding for pilot programs to explore recoupling pricing of care with quality outcomes shouldn’t be ignored.
So that’s my honest “liberal” assessment of the bill. It is a giveaway, and an unseemly one, in many ways similar to Bush’s Medicare Part D. I do think this one is better financed [though that's really hard to assess], and I do think there was more of a tradeoff with some strings attached to the insurers–but yes, it is a giveaway.
March 22, 2010, 10:20 amMarcus says:
Jim N:
I think the main point would be that the right of the Democratic Party killed off things like the public option and reimportation, which would have provided competition to the insurance and pharmaceutical companies.
What?
March 22, 2010, 10:23 amCitizenCain says:
If intellectuals posting here are so smart, how do they propose paying for the program when Medicare is approaching bankruptcy and Medicaid is already there?
Before you answer, consider interest rate yields increasing dramatically because of forces outside our political system (India just raised rates). You are foolish if you think the US is too big to fail.
We were a democracy before liberals decided they know better than TAXPAYER citizens what is best for the country.
The war has begun. It will be up to history to show if liberals or TAXPAYER citizens win.
March 22, 2010, 10:28 amBecky says:
As previously stated, a peice of paper in your pocket is not medical care. A diploma does not indicate you are educated either.
I firmly believe that all third party pay arrangements are flawed in containing costs (in any segment of the economy), and was very disappointed at Medicare’s expansion under Bush.
Those with financial resources or a doctor in the family will receive better care than those without. If I were a doctor, I would take the customers willing to pay 30% more for my services. I suspect the better doctors will do better in the cash world, and the average doctors will settle into the government insured world with the rest of us lower income types. For one thing, not having to have as large a staff to deal with paperwork means doctors could focus more on medicine.
As far as I know, this bill does not prohibit doctors or pharmacies like Walgreens from refusing to accept insurance like Medicaid.
The bill forces consumers to participate, but not providers. It seems like a method of increasing demand and decreasing supply
March 22, 2010, 10:34 amDiggs says:
The answer to your question is much more simple than others are making it out to be.
March 22, 2010, 10:40 amMedicare D was evil because it was put forth by a Republican.
Obamacare is good because it was put forth by a Democrat.
There isn’t a single answer above by any of the Leftists that have written so far. that is any different than that simple fact. More words, surely. But no different in meaning.
Patrick Pierce says:
I started to wear black today to mark the death of the greatest experiment in personal freedom the world has ever known, that human history has ever known. The leftist commentors here are fooling themselves as it is well known that K-Street lobbyist wrote this 2,700 page boondoogle along with academic elites who now run our country. The very idea that top-down command and control as a working principal of running an economy and governing a populace works in the long-term is ridiculous. All the whining about medicare-d not negotiating with pharma… the government doesn’t negotiate, it dictates and generally within an intellectual vacuum because the normal constraints of trade (human interaction) are suspended by the fact that one side of the exchange owns guns. The two most heavily regulated industries are health care and finance. Which industries are currently in the most trouble again?
March 22, 2010, 10:40 amHoward Beale says:
If there is a single person who honestly believe that this will work then I hope they are out of the gene pool.
It is possible to be in favor of health care reform and a social safety net yet be opposed to this legislation for any number of reasons, but the most obvious one is common sense.
Medicare is a single payer system. It’s a noble idea, too. And yet it still managed to go bankrupt (and bankrupt the country in the process) because no matter how much we might wish it were otherwise, there is no such thing as a free lunch.
Obamacare will be like Medicare on steroids. That doesn’t mean that it is not a noble idea.
It just means that it won’t work.
Unfortunately, it’s awfully hard arguing that with someone who thinks Medicare has been a great success.
March 22, 2010, 10:50 amRosie4 says:
The ultra rich have already opted out of major inconveniences of life: they surely don’t fly “first class” as far as I can tell – they fly private, they don’t drive themselves, their income streams are routed outside of the US tax net, and they have private clinics and medicals to take care of them. Anyone remember that Steve Jobs arranged a liver transplant, more or less on demand? Arranging health care in this way legislatively is theoretically offensive in the abstract, but in d concrete- it’s not going to involve any income shifting from anyone wealthy I know. It will involve increasing my taxes and raising my costs on behalf of lots and lots of people who don’t pay taxes. It will establish a have and have not system of health care delivery. Kind of like cashmere used to be, only more significant. Lower standard of living for my kids and their kids, until it’s taken back. Remember when doctors made house calls? You’re going to recall fondly when doctors and PTs were available within a day or two by phone.
March 22, 2010, 10:52 amBut it will not affect the haves in Congress, nor “the rich.”
JohnMc says:
Thales, you must not read enough business journals. We are neither rich, fact we are now a debtor nation who can’t pay its bills. Nor are we technologically advanced as you might think compared to the rest of the world. The University of Beijing will graduate more engineers in a single year than our 5 top institutions by a factor of 2. The vote yesterday will hasten this country’s demise.
March 22, 2010, 10:54 amBart says:
An important thing to remember in all of this is just who makes the big profits in healthcare. In normal times, the much reviled and maligned health insurers make an average 3% profit margin, which is actually pretty pathetic against the overall industry average of 8%. Pharmaceuticals rake in about 16%.
Any so-called reform which purports to reduce costs by curtailing the earnings of the least profitable (insurers) while guaranteeing the profits of the most profitable (drug companies) is laughably, ridiculously, tragically, painfully doomed to fail.
March 22, 2010, 10:59 ammac says:
Anyone who reads Karl Denninger or Mike Shedlock or Barry Ridholtz knows that we just took four torpedoes amidships to an already listing American financial ship of state.
This will sink the nation for the same reason that California will be the first failed American state. The money to pay the bills isn’t there, the people who the system hope to tax to pay it will either evade or escape to a less oppressive system, and there is clearly not the political will to face up to the harsh reality of the situation. There certainly isn’t the will to implement the very tough adjustments that would be necessary to restore fiscal health. So, it’s simple: we’ll either default or hyperinflate the debt. Either one is a death knell for the America I grew up in.
I already live and work overseas. I don’t think I’ll be coming back.
March 22, 2010, 11:25 amLilyBart says:
So many people of my acquaintance spend more money than they make, and seem to believe it will be alright in the end. They are always surprised and angry when they find themselves in financial trouble (How could this happen to me???)
The progressive, big government types seem to be the same way. They want to spend without regard to the long term financial consequences. They too believe that it will be alright in the end.
They are not students of history, I think.
We have made so many promises with Social Security, Healthcare, Public Pensions, and other welfare programs. We DO NOT have the money for all of this. Hard times are coming. Financial consequences will come.
It will be small comfort having government funded health insurance when you don’t have a job, the economy is collapsing, and you can’t find a doctor to treat you.
March 22, 2010, 11:45 amBill of Rights says:
It is quite striking to me that the bill-supporting commenters here point to Medicare part D in order to justify the current expansion of government. Actually one does follow after another, but I see nothing worthy of justification in either part.
While we can espouse the admirable concern of health care for all, the enshrinement of this “right” in a massive, comprehensive governmental program ensures the dilution of freedoms for all. And that is the difference between the true original inalienable rights and this new manufactured one.
While it may seem quaint to the community here that appears to be so enamored of the encroaching governmentalism, I would suggest that you google “Not Yours to Give”. Yes we are already far from that legend of libertarian purity, and now it will be but a distant reminder of our common heritage.
And left unmentioned completely is the governmental takeover of student loans, including mention in the bill of certain circumstances relating down to the pre-school level.
We are witnessing an explosive expansion of government at all levels that is gaining regulative powers at an unprecedented level. We are fast approaching that time when we will be dependent not only on the government, but also solely upon the good will and intent of those within it. We are placing ourselves into exactly the situation the Founding Fathers sought to prevent.
March 22, 2010, 11:46 ammr burns says:
Since health insurance is useless without a means of reaching the providers thereof our next Obamandate shall be: all american (save those living in nebraska, and parts of florida) who do not already own a car with an appraised value in excess of $27,860 with heated leather seats and blue tooth connectivity must buy a new G.M vehicle every under penalty of federal fine.
March 22, 2010, 11:49 amMike K says:
Would you mind if I waited until November 3 to give up ? Take a look at the Facebook page of Stupak’s Republican opponent. He is a general surgeon who has lived all his life in the district and practiced surgery for 37 years. He has never run for office and, before Stupak folded yesterday, he had 140 “friends” on his page. This morning he had 10,000 and growing rapidly. He will be another Scott Brown and there are many more where he came from. Let’s see how this plays out before too much celebration. Remember Catastrophic Care ?
Sorry, Benishek is now over 13,000.
http://www.facebook.com/group.php?gid=287806148754
March 22, 2010, 11:49 amFugate says:
Bottom Line: The Democrats now own healthcare. Now if everything turns up roses, good for them. But do you really think that is likely? Really? Every hiccup in healthcare delivery anywhere – they own it. Medicare cut? (& it will be). Democrats did that. My GP and my drugstore no longer accepts Medicaid patients? Democrats did that. My Blue Cross / Blue Shield Advantage is gone and my monthly fee is going from $98 to over $300? (This is actually happening to the retirees in my company after the bill becomes law). Democrats did that. Upwards of 90% of consumers were happy with their medical coverage. That number has nowhere to go but down.
This bill was not a compromise with big Pharma. Their lobbyists wrote it. The insurance industry is a “silent” partner. Do you really thing they mind getting another 20-30 million customers? You probably think they have to cover pre-existing condition now. Not really. For a comparatively modest fine, they can still refuse coverage. Either way, whatever additional costs they incur will simply be passed on to the usual suckers: the American middle class.
So nice work. BTW, my Aetna and UnitedHealth stock holdings are doing pretty good so far today.
March 22, 2010, 11:50 amSeaDrive says:
“Uncle Sam pays retail” for Part-D drugs, they say. Well no. Part-D is implemented through the public sector. When you buy your Part-D policy, you buy it from an insurance company, not from the government. The insurance company buys the drugs by reimbursing the retail drug chain. The insurance company can, and does negotiate prices with the drug company.
The “no-negotiate” rule keeps Uncle Sam out from between the insurance company and the drug company. There are people who think that Uncle Sam could get a better price out of Pfizer (for example) than Express Scripts or Medco, and they point to the VA as evidence. I don’t know if that’s true or false, but the drug prices for Part-D are basically set the same way as they are for non-Medicare patients.
March 22, 2010, 11:53 amDotar Sojat says:
I have two neighbors who are medical doctors. One will now retire (at age 53), and the other will close out her Medicare/caid practice. Gonna’ be an awful lotta’ Dr. Galts.
March 22, 2010, 11:53 amChristopher Cooke says:
I must say that, in general, the comments on this blog are far more substantive than on Althouse’s blog (most of the comments there are rants).
The big issue here is really two-fold: 1. the expansion of coverage provisions may not work because the costs of the insurance, which everyone must buy, will likely be too high for many, even with the subsidies; 2. more needs to be done on cost controls.
I agree with some who proposed ways to increase competition in the insurance market but disagree that such measures will cover the uninsured. The uninsured are largely poor people, the working poor, or lower middle class who are unemployed or not given health insurance through their work. They won’t be able to afford health insurance unless it is heavily subsidized or provided free of charge. That is just reality. So, as a society, we have to decide whether it is important to ensure they have access to medical care or whether we will leave them to their own resources, which may not be enough to get them basic medical care.
March 22, 2010, 11:57 amLilyBart says:
as a society, we have to decide whether it is important to ensure they have access to medical care or whether we will leave them to their own resources, which may not be enough to get them basic medical care.
That may be true – we as a society may decide to provide health insurance for these people. But will will have to give up something else. Resources are limited and we cannot have EVERYTHING that sounds good. Trade-offs are necessary if we will survice economically.
March 22, 2010, 12:01 pmJoe Y says:
This is an absurd statement:
“Drug makers are going to make money because more people will be insured. Millions will be insured. Millions will be insured.”
The drug makers will sell what the government lets them at the price the government is willing to pay, and that’s it. Patents expire, the drugs go generic, and that’s the end of the story.
All pharma drug development will have to take this into account. It’s actually impossible to explain this to a liberal, but the willingness of Americans to pay full-price for new drugs and technology lowers the US cost-of-living. Why? Because pharma develops their drugs here. They do a vastly disproportionate amount of the R&D, the testing, the marketing, and manufacturing here. They own the patents. These are high-margin products with a huge value-add.
For example, a large concentration of this work is done in New Jersey. NJ is already de facto bankrupt. As the pharma companies start to cut back, the situation in NJ will become hopeless, as only a high-profit industry such as pharma and medical technology can afford to do buisness there.
Who will pay the taxes, support suppliers, and spawn new companies in NJ when medical and pharma stop? Who? No one, that’s who. But good news: A few bucks less will come out of your welfare check for your generic prescription. You can send it to your kids trying to find work in Texas.
March 22, 2010, 12:03 pmRPT says:
Obviously very committed to their professions; if they are able to retire at that age then the practice has been very good to them. Did they attend taxpayer supported med schools?
March 22, 2010, 12:07 pmjesse says:
This is one of the funniest lines I’ve seen in weeks. I would have thought you were serious except that bit made it clear you were trolling.
March 22, 2010, 12:07 pmLilyBart says:
From the Nanny State to the Bully State
http://www.ipa.org.au/publications/1790/from-the-nanny-state-to-the-bully-state
Hope you like what you’ve just bought.
March 22, 2010, 12:09 pmViacalx says:
Wow, everyone is SOOO excited by the new benefits for SOOO many people. Well, I for one don’t care to pay for other folks health care and don’t want other folks involved in my life (lifestyle restrictions) through health care. Especially the IRS.
This orgy of excitement over the benefits is childish in the extreme. As adults, we’ll all have to pay the bill and it will be astronomical. By drawing so much money away from other uses, uses selected by free men and women looking after their own interests, the ensures the recession will get worse and last longer. Assuming it ever ends. Remember that Europe sustained 10%+ unemployment for decades due to the high taxes and overbearing regulation.
So party on now! This “health care revolution” will end most like the French Revolution. Some guy named Napolean came along…
March 22, 2010, 12:19 pmAllan Leedy says:
What?
March 22, 2010, 12:22 pmorca says:
And I for one don’t really mind paying for other folks’ health care if they can’t afford it.
March 22, 2010, 12:22 pmBillB says:
And ignoring the fact that the prescription drug coverage I had as part of my medigap insurance was cheaper and better than Medicare Part D. So it’s a real reach to say that Part D extended drug coverage to those who couldn’t get it…drug coverage was part of a number of the standard medigap policies, until part D was enacted. And now we’re seeing the Feds playing with those policy benefits again to steer people to plans with fewer benefits.
March 22, 2010, 12:24 pmRosie4 says:
A reminder to all – insurance involves sharing financial risk based on objectively determinable factors. Providing health care to those who do not pay for it does not involve insurance. It is paying for the medical care of others. Providing health care for those already ill is not insurance. Deciding what procedures, treatments or drugs will be available to various demographic groups for medical care is not insurance.
March 22, 2010, 12:29 pmRosie4 says:
I need new trifocals – where can I send you my bill? And I wear single vision sunglasses to play tennis. Those too, OK?
March 22, 2010, 12:33 pmDavid V says:
Typically I get skeptical when a question is asked on something that is such a populist opinion (people should have access to health care and the fiscal impact of that should be manageable) and that question is jammed in to a binary framework.
The premise that if you did not support the Part D fiscal free for all that somehow you are 100% happy with this bill (Obamacare(tm)) as great and, oh yeah, Bush was a jerk, neener neener? What is that?
Let’s have a discussion about the root issue. Here, free markets aren’t free. Building an opinion and taking a side on the premise that somehow markets are free is the foundation for bad logic. Part D was based on that idea- the foundation was wrong. This bill has some of the free market belief in there as well. These insurance pools will likely be what prevents us from getting what the populace needs to be successful at being healthy and paying for it.
Something as fundamentally beneficial (from financial to the esoteric ‘peace of mind’) as health care should be free of the fake free market whims. Since the government controls our markets, they should be able to side step them as is done elsewhere (milk).
March 22, 2010, 12:39 pmLilyBart says:
And I for one don’t really mind paying for other folks’ health care if they can’t afford it.
Fine, you pay for it – that’s your choice – I LOVE private charity – practice it myself. But this bill is about compelling (forcing) citizens to pay for other peoples insurance. I understand we will be subsidizing insurance for families making over $80,000/yr.
March 22, 2010, 12:44 pmMH says:
That’s nice. Then go right ahead; what has been stopping you so far? You could have been paying for other people all along, and could still do so in the absence of laws forcing “all” of us (the tax paying all, that is) to pay for others whether we want to or not.
March 22, 2010, 12:51 pmyankee says:
The Republicans have adopted the unprecedented strategy of filibustering virtually every piece of substantive legislation, to the point where the media just report that it takes 60 votes to pass something in the Senate. At their height, there were 58 Democrats in the Senate, meaning even a single Democrat or non-Democrat Joe Lieberman could block any piece of legislation. Since Lieberman is bought and paid for by Big Pharma, as are a number of Democratic Senators, passing any such legislation would have been a political impossibility even when there were 58 Democrats in the Senate.
The support of Big Pharma was vital to passing the healthcare bill; without them on board it couldn’t have made it through. I would have preferred something better but such is political reality. Medicare Part D was better than nothing too, for what it’s worth.
March 22, 2010, 12:54 pmDavid V says:
Which highway service do you donate to? National defense fund?
I am with you by the way- I think that when we pay taxes we should have a checklist of the services we choose to fund for that year. They only drawback being you could only use those services that year.
March 22, 2010, 12:55 pm5th Level Fighter says:
We’ll see about that…
And you think that this bill isn’t “money shoveled to Big Pharma & Big Insurance”? To the contrary, that’s precisely what this bill achieves, not “genuine, affordable health care.”
March 22, 2010, 1:04 pmDougger says:
I objected to Medicare part D for the same reason I object to Obamacare.
It is not the proper role of the federal government.
Social safety nets belong at the State level.
Federalism as a primary principle of our Constitution is being ignored at our peril.
Just because “We Can” doesn’t mean we should.
March 22, 2010, 1:07 pmLilyBart says:
David V:
Funding Roads (actually specifically commerce-related) and defense spending (specifically spelled out in the constitution) are quite difference from ‘government charity’.
When people say they are happy to pay more in taxes for X, or they don’t think they pay enough in taxes, what they usually mean is that they think I should pay more taxes.
I can assure you that I pay enough. The government just needs to make better trade-off decisions about how to spending the money they collect – they don’t need to take an every increasing amount of private property to pay for an ever increasing list of needs and ‘rights’.
March 22, 2010, 1:07 pmMAM says:
If republicans didn’t miscalculate, maybe we’d have a better bill. But death panels, “You Lie”, “baby killer” and socialism seemed to have doomed them to the margins.
Obama played grandmaster chess and the lacking republican leadership was playing grade-school checkers.
March 22, 2010, 1:08 pmDavid V says:
Yes- indeed- like crazy wars and subsidies for trade which both seem to fall under the name ‘government charity’. And there is something in that document about general welfare… but who better to decide what that welfare means than each tax payer with their check box tax payment.
March 22, 2010, 1:18 pmStephen Lathrop says:
That’s not all, either. Not many people know it, but the Defense Department is approaching bankruptcy right now. Without an endless series of taxpayer bailouts it would go out of business, leaving the nation defenseless. Not only that, but DOD has an unfunded liability conservatively estimated at more than $21 trillion (that’s trillion, with a “t”) over then next 30 years. The actual figure could go far higher.
I don’t think intellectuals posting here have any notion how to cope with the contingencies presented by these posts.
March 22, 2010, 1:21 pmmooglar says:
Prof. Bernstein:
I know you addressed your question to your “liberal interlocutors” here, but I will point out that in the wider world of the left there has been substantial criticism of this healthcare bill for being, as you say, a giveaway to the insurance and drug companies. On MSNBC alone, Lawrence O’Donnell, Keith Olbermann, Rachel Maddow, and Howard Dean have all criticized the bill for that very reason. On Friday (I believe) on “Morning Joe” Howard Dean repeated what he has been saying for some time: that this bill is NOT healthcare reform in any meaningful sense.
I admit that many of those who opposed the bill on these grounds did, in the end, support the bill, though tepidly at best. I believe that Democrats felt that either they had to support the bill they could actually pass, or tear themselves apart, the far left infighting with the moderates and both fighting with the Blue Dogs. It would become obvious that the Democrats are divided, ineffectual, and able to find a way to shoot themselves in the foot no matter what advantages they had to start with. (BTW, I believe that, unfortunately, that these things are true).
So, many of those who are really opposed to the bill just passed ended up supporting it to keep the party from self-destructing, as it has been trying very, very hard to do. But there was substantial criticism of going this way from Democrats and who really don’t think this bill is any less of a giveaway than Medicare Part D was. (I am among them).
I also will point out that I don’t like the mandatory purchase requirement at all. I understand the need for it, but I have trouble seeing how you can be mandated to purchase a product. The part that won’t be popular here is that I would much more okay with the mandatory purchase requirement if there were a public option. But without a public option, I really don’t like that part of the bill.
But, in any case, I believe that there are a number of liberals and Democrats who oppose this healthcare bill on the same grounds as Medicare Part D and the grounds you brought up in your post. I haven’t seen many of them here, but there is a substantial faction.
March 22, 2010, 1:26 pmDavid V says:
But this implies our discourse is limited to those that shout the loudest. You, sir, must hate America.
March 22, 2010, 1:30 pmdoodahman says:
Well, if you bothered to actually read progressive material on the web re Obama’s HCR, you would understand that the left has been saying the same exact thing about Obama. Olbermann, Howard Dean, Dennis Kucinich and Michael Moore being in the front. How you could have missed that is a testament to your selective perception. Very effective in shutting out inconvenient facts. And helpful, since that reality does not comport with your desire to view progressives as hypocrites.
Now it’s true that corporate Democrats, who you label as “liberal” support Obama’s HCR, but there is no record to indicate that these are the same people who chastised Bush over Medicare Part D. But then, why limit gut satisfying calumny when all you have to do is mindlessly lump the Democrats into a single amorphouse category. Easier than thinking and investigating, that’s for sure.
March 22, 2010, 1:31 pmG. May says:
Guess that whole “my body, my choice” thing is bunk now, eh?
March 22, 2010, 1:34 pmdoodahman says:
That should be “amorphous.” The editing feature on this blog is impossible to use. I assume none of you noticed because, I guess, self considered geniuses have no need for an editing function. But I do, so I apologize for any uncorrected grammatical or spelling airs……DOH!
March 22, 2010, 1:38 pmChris Green says:
I would have been happy with a heath care bill that didn’t use deceptive gimmicks to trick the people into thinking it would reduce the federal deficit. We can no longer assume (we never should have) that the US economy will grow fast enough so that the debt to GDP ratio is constant.
I don’t want anyone to be without quality health care (just about everyone has access to emergency healthcare in this country). However, there are things that are worse. Piling on federal debt is the most effective way of ensuring that those ‘worse’ things happen. That is why I get worried when what someone says, leads me to believe that something (like healthcare) is more important to them than controlling the federal deficit. It doesn’t mean they don’t pay lip service to fiscal responsibility, or that they don’t think it is important at all. What it means is that if they are fond of a bill, they probably haven’t read enough intelligent criticism of it to realize the long term fiscal implications of that bill, or at least be weary of them.
Reducing debt should be the single most important issue to educated Americans. Every other political or social dream will eventually crash against the shores of reality (a la Greece) if reducing debt is ignored.
I realize this is a rather simple and un-exciting position to take, but it is the best call I can make based on history and current events.
March 22, 2010, 1:41 pmPaul A'Barge says:
DEEMonCrats are retarded.
March 22, 2010, 1:42 pmDavid V says:
How evocative. Care to elaborate? Is it the no federal funds to abortions that has you down?
March 22, 2010, 1:42 pmnoahp says:
I read somewhere that AZ is cancelling its S-CHIP program. NY and CA are on the verge of bankruptcy. Obama proposed a miniscule budget freeze and a toothless budget commision which conveniently will wait until December to report! The only good thing about it is that taxes are delayed until 2011!
But how are the insurance companies to price guaranteed issue and no lifetime limits without state approval. This is not a trick question…I honestly would like to know!
I predict that there will be an intervening fiscal crisis which will force suspension of this farce.
March 22, 2010, 1:43 pm5th Level Fighter says:
Even though I don’t like either option, I agree that a public option is far more amenable than a mandate from a purely constitutional perspective.
March 22, 2010, 1:49 pmChris Green says:
A simple example is this: Person A is very enthusiastic about of particular piece of legislation that will rectify social injustices. When person B asks person A how it will be paid for. Person A says, “Well, if we just spend less on defense, we will have plenty of money to pay for it.” However, if dramatically reducing defense spending is NOT politically possible at the time, then what Person A is really saying is that the legislation they champion is more important to them then reigning in debt.
March 22, 2010, 1:51 pmbibi says:
I think you will find the answer to this if you go an count the number of empty seats at the next meeting of your local rotarians.
March 22, 2010, 1:53 pmLilyBart says:
No, much better to let the economic system collapse under the weight of debt in an attempt to provide everything for everybody. That’s the best and most compassionate thing we can do for the poor.
March 22, 2010, 1:54 pmG. May says:
Not at all. I just find it interesting that large numbers of people want the government’s hands out of uteri, but clearly don’t mind the government groping their entire body. See: mandated health insurance.
March 22, 2010, 1:55 pmnoahp says:
BTW “noahp” is an abbreviation for my fictional doctor hero, Dr. Noah Praetorius played by Cary Grant in “People Will Talk”. I highly recommend this heartwarming story of a doctor who only wanted to “make sick people well”.
March 22, 2010, 1:57 pmLilyBart says:
And, by the way, why do people assume that if we subsidize (or fully pay for) health insurance for everybody, we will all receive the care we need when we need it? I think this is a faulty assumption. It ignores too many hard economic realities..
March 22, 2010, 1:59 pmDavid V says:
Sorry- not following you there. Mandated health insurance is the same the argument over allowing women to choose abortion as an option. I am not making the connection. Please elaborate.
March 22, 2010, 2:13 pmrasqual says:
?? Did you even read the entry above? The insurance companies will get more money still, and the Democrats’ actions did not correct Bush’s errors.
At any rate, this talk of “permanence” is just ridiculous. Are you seriously asserting that something unprecedented in the history of the planet is taking place? Is Obama really a catalyst for the fulfillment of epochal — nay, eschatological — hope? Is this the millennium? Or by “permanent” do you not intend to signify what that signifier actually signifies? In which case, why would you expect anyone to take what you say seriously, inasmuch as you mean something other than what you actually said?
March 22, 2010, 2:13 pmLilyBart says:
Well, if I’m paying for your health care, I’m going to have A LOT of rules you’ll need to follow. I have an investment here now, and I need to protect it by FORCING you to take care of yourseles the way I think you need to. So get ready for it…
March 22, 2010, 2:15 pmDavid V says:
Do go on. Compare and contrast against the current many years successful implementations of health care.
Keep in mind that most of the arguments against wait for care in Canada have been debunked. There is never a wait for urgent care and next to none for non-elective surgery.
March 22, 2010, 2:16 pmSeaDrive says:
Without a doubt, we are in for a states’ rights battle to determine the answer to this question and others.
March 22, 2010, 2:31 pmTonetel says:
You got it.
They are following the same model as the socialists in Europe. Vote for a national health insurance takeover, legalize millions of illegals that will depend on entitlement programs, register them as democrats, and then make every single issue and election about class, race and/or gender.
Obama aims for an FDR style, triple, quadruple? term power grab with permanent democrat majorities, re-elected by workers scared of losing state sponsored benefits and illegals who are soon to get amnesty. There’s a reason they won’t pass any middle class tax cuts, or permanent extension of the Bush tax cuts. Smoke and mirrors called tax credits works much better.
When unrest gets bad enough and when unemployment get high enough (think France and UK) they will declare martial law, suspend habeas corpus, imprison political enemies, confiscate guns, etc. etc.
We’re in tin-pot dictator territory here.
We became a nation over far less government intrusion, we are better than this.
March 22, 2010, 2:31 pmEx parte McCardle says:
Tonetel: call us when the black helicopters touch down, will ya?
March 22, 2010, 2:40 pmDoDoGuRu says:
No one gave “health care” to anybody. Health Insurance is not Health Care.
I’ll leave you to figure out why that’s significant.
March 22, 2010, 2:41 pmSacrastro says:
Brian G.‘s getting a lotta bites today!
March 22, 2010, 2:44 pmG. May says:
So the government is not allowed to regulate how a woman chooses to care for her uterus (ok fine, I follow the logic), but it is allowed to regulate how all of us choose to care for ourselves (the disconnect is mine).
Shorter version? Let’s try this:
Abortion: My body/my choice.
Government response: Ok.
Comprehensive Healthcare: My body/my choice.
Government response: Not anymore.
March 22, 2010, 2:49 pmDotar Sojat says:
Well, RPT, they each came out of a public university med school about $150K or so down, got paid peanuts for their internship and residencies, started actually earning money in heir mid thirties, worked hard in private practice, paid it all off, and lived wisely. I don’t think they have a duty to anyone to keep working under conditions that they may find disadvantageous or intolerable. Unless, of course, you think they should be compelled to continue working for whatever renumeration the government determines.
March 22, 2010, 2:54 pmFederal Farmer says:
This just bolsters my opinion that they could have passed a bill containing the phone book with the title “Health Care Reform” and the partisan rah rah cheering would ensue.
March 22, 2010, 2:57 pmTonetel says:
From Communist Party USA leader Norman Markowitz:
A “single payer” national health system – known as “socialized medicine” in the rest of the developed world – should be an essential part of the change that the core constituencies which elected Obama desperately need.
Britain serves as an important political lesson for strategists. After the Labor Party established the National Health Service after World War II, supposedly conservative workers and low-income people under religious and other influences who tended to support the Conservatives were much more likely to vote for the Labor Party when health care, social welfare, education and pro-working class policies were enacted by labor-supported governments.
But wait, there’s more:
Despite steep odds, the White House has discussed prospects for reviving a major overhaul of the nation’s immigration laws, a commitment that President Obama has postponed once already.
Obama took up the issue privately with his staff Monday in a bid to advance a bill through Congress before lawmakers become too distracted by approaching midterm elections.
[…]
The basis of a bill would include a path toward citizenship for the 10.8 million people living in the U.S. illegally. Citizenship would not be granted lightly, the White House said. Undocumented workers would need to register, pay taxes and pay a penalty for violating the law. Failure to comply might result in deportation.
March 22, 2010, 3:01 pmI’m sure they are just going to bundle the democrat voter registration form along with the Amnesty & ObamaCare sign-up packet given out at the immigration office.
David V says:
Could you possibly come up with something different? Since one falls under the other (abortion (not covered by the bill) is under mandated (with fine if ignored- which is a choice) health care) the direct comparison- as admitted, doesn’t make a whole lot of sense.
March 22, 2010, 3:06 pmDavid V says:
Since we live in a place where we have a mandated minimum wage and that health care is something that taxes should be paying for(by the same logic that there are other services that are paid for out of taxes which provide less direct social and fiscal benefit) and that private practice even in places with government funded health care still thrives- I am for a 100% clamp down on fees and costs associated with something that should not be a commodity in it’s most basic form. Those cost markers, wages and fees should be set by the entity given the power by the citizens, not by other citizens making a profit from them.
March 22, 2010, 3:12 pmLilyBart says:
Do go on. Compare and contrast against the current many years successful implementations of health care.
Keep in mind that most of the arguments against wait for care in Canada have been debunked. There is never a wait for urgent care and next to none for non-elective surgery.
Supply and demand is a bitch. And I’m sure I haven’t see the Canadian wait times debunked – I’ve only seen them ‘bunked’.
I have also seen denial of care ‘bunked’in the UK.
March 22, 2010, 3:17 pmJoseph Slater says:
Dotar Sojat:
Weirdly enough, I know several medical doctors who not only aren’t retiring, but were actually in favor of this bill. Hard to square that with your experience, unless it’s actually the case that the plural of anecdote is not data. Although I do recall a lot of threats to “go Galt” in the right-wing libertarian section of the blogosphere after Obama was elected that don’t seem to have come true.
Tonetel:
So your point is that national health is very popular in Britain but that makes Britain a communist country — or that having health care reform quite unlike that in Britain makes the U.S. a communist country?
March 22, 2010, 3:18 pmFederal Farmer says:
Not to mention that the PM of Canada had to come to the US to get a surgical procedure not available in Canada, where they were going to crack his ribs open to get at his internal goodies.
Who’s going to develop new improved surgeries if those surgeries won’t be paid for? Where will the rich and important in Canada etc fly to now for up-to-date surgical techniques?
March 22, 2010, 3:21 pmDavid V says:
March 22, 2010, 3:29 pmPhil Smith says:
But don’t dare call these guys socialists. That will earn you a rebuke from Sarcastro, whose scorn is rightly to be
March 22, 2010, 3:33 pmlaughed atfeared.Tonetel says:
Neither. My point is that these Marxists who are controlling the democrat party and unfortunately our nation, are modeling their political strategy after Labor and other useful idiots in Europe (where unemployment and unrest rule the day).
The plan is to achieve permanent power by keeping the middle and lower classes dependent on government services, even when those same people were initially opposed those services. It’s easy when you keep them down with high taxes and high unemployment.
March 22, 2010, 3:34 pmyankee says:
Um, no. Being required to pay for insurance is not remotely the same thing as being prohibited from obtaining any particular medical procedure (or being forced to submit to one). If something isn’t covered you have to pay for it yourself, but that’s the same as the current system.
March 22, 2010, 3:35 pmDavid V says:
“More than 75% of patients requiring cancer radiation treatment received that treatment within 28 days of being ready to treat. Let me give you a comparison here – my dad was diagnosed with melanoma in November. If he had been diagnosed in Canada, there is a better than 75% chance that treatment of that cancer would have started before Christmas. Here in the U.S., a guy with the kind of health insurance he has (read: excellent) should have been treated well within that time frame, right? His actual date of treatment: April 15. That’s right, here in the US, where we supposedly don’t have the nasty wait times brought on by nationalized health care, he waited four months longer for treatment than he would have waited in Canada.”
“Statistics Canada’s latest figures show that median wait times for elective surgery in Canada is now three weeks — that’s less time than Aetna’s chief medical officer says Americans typically wait after being diagnosed with cancer.
Canada also has no waits for emergency surgeries. It also doesn’t have 44 million people who are uninsured because everyone has a national healthcare card guaranteeing health care from any doctor or hospital they choose. And it doesn’t burden those with insurance with rising deductibles or co-pays.”
So we have an apples to ranges comparison from you it appears. Here’s some more fun stuff from the most simple of google research.
Earlier in the above article:
Speaking to the Aetna Investor’s Conference 2007, Troy Brennan let these nuggets drop:
* The U.S. “healthcare system is not timely.”
* Recent statistics from the Institution of Healthcare Improvement document “that people are waiting an average of about 70 days to see a provider.”
* “In many circumstances people initially diagnosed with cancer are waiting over a month, which is intolerable.”
* In his former stint as an administrator and head of a physicians’ organization he spent much of his time trying “to find appointments for people with doctors.”
About denial of care here:
March 22, 2010, 3:40 pmIn its sixth in a series of reports on patient dumping, Public Citizen found that 527 hospitals throughout the country violated the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA). That law contains rules that virtually all hospitals in the United States must follow regarding the provision of emergency medical services.
G. May says:
Perhaps because you’re thinking of my comment in the context of abortion coverage/non-coverage in today’s healthcare legislation? Yankee seems to grasp my point, so I’ll adress him/her in my next post.
March 22, 2010, 3:50 pmDon Rodrigo says:
Brian G. says:
“”"” The Republicans lost. Obama and the Democrats won Get used to the permanent Democrat majority, as Democrats will be long-rewarded for having the guts to give health care to everyone in the face of the insurance companies and their big money, and despite the racist Tea party rallies all over the country. “”"”"
Ah “Brian G.” right, Brian Griffin. You’re the dog from “Family Guy.”
So . . . . Did you get to boink Lois yet?
March 22, 2010, 4:02 pmLilyBart says:
David V: Source?
March 22, 2010, 4:06 pmG. May says:
So government establishing that it has no right to prohibit me from choosing to do what I want with my body (legal abortion), has absolutely nothing whatsoever to do with that same government choosing for me how to care for that same body upon threat of financial penalty?
Absolutely correct, but then, that’s not what I’m talking about. What’s not the same as the current system is mandating that citizens will now be required by law to purchase health insurance. My freedom to choose is no more.
March 22, 2010, 4:13 pmdoodahman says:
Can one of you free market extremists please explain what value is provided by insurance companies other than as a rationer of care based on ability to pay (or rather, to sacrifice a decade’s worth of productivity based wage increases)? I would have thought free marketers would recognize and detest rent seeking in a service that involves the suffering of millions.
March 22, 2010, 4:13 pmDotar Sojat says:
David V – Fix prices and fees all you want, but for the nonce some doctors may choose not to work for those fees. Gaia help they should make more than you.
March 22, 2010, 4:15 pmEx parte McCardle says:
I want to call BS on the claim that MDs are going to walk away because of this, anyway not in sizable numbers. My brother-in-law is a urologist in west-central Florida. He makes maybe $250K. If this program ended up cutting his pay by 40%, which is not at all likely, he’d be earning around $150K. All his adult life and all his higher education have been devoted to being a physician. If he were to walk away, exactly what could he then go and do that would provide an equivalent level of income?
March 22, 2010, 4:22 pmLilyBart says:
US News & World Report – July 2009
For example, the median clinically reasonable wait time before receiving neurosurgery is 5.8 weeks. In Canada in 2008 it was 31.7 weeks. For gynecology it’s 5.6 weeks v. 16.1 weeks. And for internal medicine is 3.3 weeks v. 12.5 weeks. Fraser’s hospital waiting list survey measures median waiting times to document the extent to which waiting times for visits to specialists and for diagnostic and surgical procedures are used to control health care expenditures. The report measures the wait times between seeing a general practitioner and a specialist, the time between seeing the specialist and receiving treatment, and the total wait time.
The good news, if there is any, is that Fraser’s 2008 study (and they have been collecting data on wait times for 18 years) indicates the median wait time for those patients seeking surgical or other therapeutic treatment is down by a full week—from 18.3 weeks in 2007 to 17.3 weeks in 2008. Despite the improvement, however, the Fraser data shows many Canadians are still waiting almost four months (121 days) or more before they can receive treatment.
March 22, 2010, 4:25 pmMark Field says:
I thought it meant that Teddy Roosevelt was a communist.
March 22, 2010, 4:26 pmSacrastro says:
I hear Teddy was the inspiration for the stuffed Russian Bear so many budding Commies took to their breasts as they dreamed dark dreams of evil.
March 22, 2010, 4:32 pmLilyBart says:
David V: Above is the Canadian wait times ‘bunked’.
March 22, 2010, 4:36 pmRPT says:
Thanks for the information. I agree that they should not be forced to keep working for any particular amount of compensation they find disadvantageous or unfair. However, they should not be considered martyrs or somehow noble for their choice. They are simply deciding to take advantage of retirement and leisure opportunities that are beyond the reach of most.
March 22, 2010, 4:52 pmCalderon says:
For an alternate example written by a doctor, see here. Because of the fixed costs involved in running an office, change in revenue have greater than proportional effects on income. And while the claim that current doctors are stuck in their profession may or may not be true, current and future college students considering a profession have no such constraints.
March 22, 2010, 4:53 pmDavid V says:
Ah yes, the Fraser Institute:
“The Fraser Institute is a fiscally conservative think tank based in Canada that espouses free market principles.”
Fair and balanced.
To contrast:”A 2009 Harris/Decima poll found 82% of Canadians preferred their healthcare system to the one in the United States, more than ten times as many as the 8% stating a preference for a US-style health care system for Canada”
Wait times:
The median wait time in Canada to see a special physician is a little over four weeks with 89.5% waiting less than 3 months.
The median wait time for diagnostic services such as MRI and CAT scans is two weeks with 86.4% waiting less than 3 months.
The median wait time for surgery is four weeks with 82.2% waiting less than 3 months.
Another nugget:
“Canadian pysychiatrist Dr David Gratzer, who is also employed by the libertarian Cato Institute, was once asked by U.S. congressman Dennis Kucinich if he knew what the wait time for diagnostic imaging procedures such as CT scans and MRIs was across Canada. Gratzer began his reply “I can tell you what the Ontario government said it was for cancer and…” when Kucinich cut him short and gave him the true figure of 3 weeks, just as Gratzer was uttering the answer of “six months” to his preferred question.”
And again, many times here is the states are *longer* than in Canada especially if you have not got the money to afford your way in. We spend more per person than they do, we have higheer infant mortality, we live less long on average, we spend more as a government and cover at least 40% less.
So I’ll have to point out that these claims about Canada and the ruinous state of their health care coverage is greatly misstated. They are doing better with less.
March 22, 2010, 5:19 pmLily says:
You know David V, I tried to get stats from official Canadian Government websites. But all those websites had to say about the subject was how they were working hard to lower wait times. But no stats were provided.
#1 Why would all these websites emphasize their work to reduce a problem if it were not a big problem?
#2 If wait times were something good – and comparable to other systems, they would have provided the figures to support their ‘good work’.
I also saw websites that ‘debunked’ the Canadian Wait Times – they were all left-leaning with a decided point of view.
March 22, 2010, 5:27 pmleo marvin says:
Here’s hoping future generations will see everything we’ve done with clear enough eyes to keep and value what’s worked and get rid of what hasn’t.
March 22, 2010, 5:28 pmnoahp says:
DavidV…I frankly don’t believe your story about a patient with melanoma waiting four months for radiation therapy. To begin with the indications for RT are rare and somewhat dubious in that disease. If there was a good indication then a four month wait is unheard of in the US.
Counter anecdote: I was eating dinner at ASTRO (the main society for Radiation Oncology). One of my companions worked at the Princess Margaret Hospital in Toronto (famous cancer hospital). So I asked him if they were busy. Not at all, he said, the principal obstacle being getting patients started since the support staff wasn’t interested in doing anything.
Reminds me of the old joke about the USSR: “they pretend to pay us and we pretend to work”.
March 22, 2010, 5:37 pmDavid V says:
Even in Canada they make more than I do. What on earth is your point? I have no problem with doctors making money- they seem to do quite well all over the world.
March 22, 2010, 5:44 pmdoodahman says:
Seems to me the issue of wait times is only a concern for people who believe their money entitles them to go to the head of the line. If there are no waiting periods now, it’s because the people who have a more dire need are pushed out of the market by the cost. I can see how that works for you guys.
Not that the lives and suffering of those without means is a factor to be weighed in your calculations. But there you go.
March 22, 2010, 5:44 pmdoodahman says:
Seems to me the issue of wait times is only a concern for people who believe their money entitles them to go to the head of the line. If there are no waiting periods now, it’s because the people who have a more dire need are pushed out of the market by the cost. I can see how that works for you guys.
Not that the lives and suffering of those without means is a factor to be weighed in your calculations. But there you go.
March 22, 2010, 5:48 pmdoodahman says:
Didn’t think you could. Private insurance is rent seeking that thrives solely on the suffering of people. It creates a zero sum game for a service that is not optional, but an absolute necessity.
March 22, 2010, 5:52 pmLily says:
What will really matters: We cannot afford all the entitlement programs, public pension programs, welfare programs we now have.
Our debt is too high to be sustained and will only get worse in the future.
You cannot continue to raise taxes to pay for all of this and expect it will have little impact on the GDP and the overall health of the economy. We will run out of money.
As I said above, having health insurance will be of little comfort when you don’t have a job – and without a doctor who can see you when you are sick. And the poor will suffer the most – they always do – and so many more of us will be poor.
March 22, 2010, 5:54 pmDavid V says:
That’s fine. It’s not my story. Found it by looking online doing research as well as many more wait times that statistically put ours higher than Canada’s. And that is much more than an anecdote.
And the larger point here being that we could take the models that have been in place for years, learn from them and make them better, further reducing costs and upping coverage and employing skilled labor along the way.
But that is evidently a trademark labeled ‘liberal’ or ‘leftist’ idea so we can just counter that with some emotionally evocative rhetoric that steers us away from actually doing anything about the problem- which is a fact no one can or has disputed.
In pure analysis, what we should have done- Single Payer- would have left us on very sound footing as a nation reducing our costs from 16% GDP to 10. But instead we all got mired in the faux debates about Death Panels and fiction about wait times and doctor’s retiring resulting in a flawed bill. But a least it’s a step. And since that is all we can seem to take (and perhaps correctly so according to the Founders), we took it in the direction of protecting the public welfare.
March 22, 2010, 6:00 pmLily says:
Forbes Magazine:
“…at all levels, federal, state, local and GSEs, the total public debt is now at 141% of GDP. That puts the United States in some elite company–only Japan, Lebanon and Zimbabwe are higher. That’s only the start. Add household debt (highest in the world at 99% of GDP) and corporate debt (highest in the world at 317% of GDP, not even counting off-balance-sheet swaps and derivatives) and our total debt is 557% of GDP. Less than three years ago our total indebtedness crossed 500% of GDP for the first time.”
Add the unfunded portion of entitlement programs and we’re at 840% of GDP.
The world has not seen such debt levels in modern history. This debt is not serviceable. Imagine that total debt is 557% of GDP, without considering entitlements. The interest on the debt will consume all the tax revenues of the country in the not-too-distant future. Then there will be no way out but to create more debt in order to finance the old debt.
March 22, 2010, 6:09 pmDavid V says:
It will actually be a fantastic comfort when I don’t have a job. That’s the one thing in here that I can say I am most happy with. And you should be too for the poor people you mention. They get off quite well in this bill- and I for one am very very happy about that because since Reagan, they have had a hell of a time. And there will be plenty of doctors to see you. Given that it will be a place of almost guaranteed employment if you can make it through school, I see the industry growing quite a bit- especially for nurse practitioners (which I have as my kind of de facto PCP and she kicks my Dr.s butt in many areas).
This tiny reform is going to help reduce our costs over the coming years- there is no doubt about that (see the CBO reports). There are so many other ways to do this- get us out of Iraq and Afghanistan to start. End the war on drugs. Apart from the financial bailout, you do understand that the deficit now- for the first time- includes the war budgets. Bush kept them out.
We are getting a clear picture of just what the government is trying to sustain on our behalf and you are right, it’s too much. Too large a hand out to companies that allow jobs to be done overseas for example. All that benefits is the bottom line of the company- it doesn’t benefit the labor force here- it doesn’t give people here jobs. Trickle down has proven to be an abject failure for the country. We gave it 20 or so years. Let’s try something a bit different.
March 22, 2010, 6:13 pmnoahp says:
Ok. But as a retired physician I can tell you with absolute certainty that top down expert driven solutions will not work. Why? Because politics will control reimbursement. Remember the recent flap over mammograms? The govt scuttled back from the expert decision. Politics! But you might have noticed that the American Cancer Society recently recommended against PSA screening. Correct again. But no outcry so hopefully millions of men will be spared millions of biopsies in pursuit of so-called cures. But if there was an organized hysterical men’s health lobby then I dunno.
Deregulation is the answer. As long as there is a dominant third party costs will continue to escalate.
March 22, 2010, 6:19 pmnoahp says:
CBO report proves zip, zero, nada. The CBO is required to score bills based on the assumptions presented to them! If congress says its going to find 500 billion in medicare savings then the CBO must accept that figure no matter ho implausible that might be. Case in point being the ‘doc fix’. This cost containment was passed years ago and undoubtedly the CBO scored as saving huge bucks but Congress has been waving it for years. But the CBO scres it like its real but just last week congress waived it again temporarily!
Gimme a break…arguing with idiots again! Sigh.
March 22, 2010, 6:55 pmSeaDrive says:
I do know of a case of a woman diagnosed with cancer (not sure what kind) and referred to an oncologist, and the earliest appointment she could get was several weeks away. This was in the greater NYC area. We have a lot of great doctors around here, and they all seem to be busy all the time.
Insurance is a system that reduces the financial risk associated with the risk of some adverse health issue. Businesses buy all sorts of insurance for similar reasons. Besides, despite their evil image, they do provide other value to their customers, even if they don’t live up to the promises of managed care. Certainly, their attempts to drive costs down take pounds of flesh from the providers (as well as sometimes hurting their customers).
But I suppose you mean to compare it to a single-payer, treatment for all system. If there is anything that right and most of the left agree on, it is that the provision of healthcare and the payment for healthcare should be in different hands.
March 22, 2010, 7:03 pmDavid V says:
Well nice talking to you too.
Just so I am clear, why am I an idiot? No one reasonable seemed to be able to dispute the 500 bil in Medicare savings over time. Factcheck.org seems to think it’s correct. The only people that seemed to dispute or be angered over the Medicare claims were those who thought that this bill was to address the larger Medicare shortfall
March 22, 2010, 7:12 pmnoahp says:
Single payer would reduce costs to 10% of GDP?? How so? I am sure you can point to countries that spend that amount with single payer but you are talking serious dislocation. Hospitals, nursing homes closing…probably millions out of work. That is serious majic wand bullcrap! 6% of GDP is roughly 750 billion.
March 22, 2010, 7:18 pmnoahp says:
An appeal to authority about the govt plans to save 500 billion? Weak.
Did they save the money they ‘planned’ to save by reducing doc reimbursement?
March 22, 2010, 7:24 pmDavid V says:
Yep- if you did it all at once. And that wouldn’t be smart or an intellectually honest position to take in a discussion.
(Canada, Australia and England, btw)
March 22, 2010, 7:44 pmnoahp says:
The demonization of insurers is a red herring. Granted that everybody hates them. But do you hate your life insurer too? Both are SUPPOSED to be in the same business. That is spreading the rusk. But both are subject to cheating customers otherwise known as the “moral hazard”. If insurers must insure “pre-existing conditions” they are no longer in the insurance business. If they must sell policies with no lifetim caps they are no longer in the insurance business unless they can raise rates to reflect their costs.
Anecdote alert: I’m watching TV with my liberal sister who is appalled that a insurance company is denying coverage for a bone marrow transplant (non-life saving). But if they don’t insist on the letter of the contract then that means higher costs for their customers which then gets them condemmed as well! They can’t win.
March 22, 2010, 7:49 pmnoahp says:
Obama has engaged in breathtaking demogoguery of the insurance companies. The MSM has not called him on it. Supposedly the level of understanding would be higher at VC. I am disappointed.
Full disclosure: I own no insurance stocks and otherwise have no stake in the health care debate other than to see a prosperous future for my sons, nieces, and nephews.
Goodnight.
March 22, 2010, 8:19 pmDesiderius says:
“Full disclosure: I own no insurance stocks and otherwise have no stake in the health care debate other than to see a prosperous future for my sons, nieces, and nephews.”
That you felt compelled to make this disclosure gets to the heart of the present disquiet, for the faithful remnant still concerned about such matters.
An illiberal wind blows.
March 22, 2010, 8:54 pmLN says:
Health insurance stocks up on Monday. Totalitarian fascist socialism turns out to be great for business!
March 22, 2010, 10:28 pmFederal Farmer says:
Wait, isn’t it corporate fascism?
March 22, 2010, 10:35 pmDesiderius says:
LM,
“Here’s hoping future generations will see everything we’ve done with clear enough eyes to keep and value what’s worked and get rid of what hasn’t.”
That was FDR’s plan. Hasn’t quite worked out that way. Experiments require a commitment to truth at some level to be effective. Other commitments are evidently more pressing.
March 22, 2010, 10:51 pmRicardo says:
That’s adverse selection, not moral hazard. In any case, adverse selection is exactly a problem because there are people without insurance. Once you have everyone covered under insurance, the problem disappears by definition. I haven’t reviewed the bill enough to know whether it deals with this in a sensible manner, but that is exactly the argument behind the individual mandate.
The problem with the system up until now is that if you develop a pre-existing condition before you turn age 25 and cannot get employer-sponsored coverage, you are dead in the water once you parents’ plan kicks you out. You automatically become a charity case. Same thing if you lose your job and your COBRA coverage runs out and you don’t live in one of the states with a subsidized high-risk pool (McCain’s former economic adviser Doug Holtz-Eakin faces exactly this problem). There ought to be a way to insure against this risk but there is not.
March 22, 2010, 11:32 pmDavid Schwartz says:
Ricardo: There have been suggestions to fix that problem by providing insurance against that specific eventuality (called “health-status insurance”). See, for example, this CATO publication or this Reason article. (I highly recommend reading the Reason article.)
March 23, 2010, 12:04 amRicardo says:
It’s an interesting article, but I don’t see any evidence that Prof. Cochrane spoke with any insurance actuaries about whether or not it is feasible and the type of risk he has in mind can be priced accurately. Instead, it simply says “If health-status insurance is such a good idea, why don’t insurers already offer it? Cochrane believes that it has been stalled because health insurance is a highly over-regulated market.”
So the problem is that this is more a faith-based initiative than a genuine, viable alternative to the existing setup. Unless health status insurance is mandatory, it still potentially has the same adverse selection problems as the regular health insurance market, albeit one degree removed. But unless there are actuaries and other people with real-world experience in the insurance market who say this could work, I’ll have to rein in my enthusiasm. Prof. Cochrane is a finance economist at University of Chicago and, as far as I know, does not have any particular expertise in the insurance industry.
March 23, 2010, 1:18 amuberVU - social comments says:
Social comments and analytics for this post…
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March 23, 2010, 1:38 amleo marvin says:
I disagree.
I’m not sure why you think that commitment is lacking. Most Americans don’t see it your way, but that doesn’t mean they’re disingenuous. Of course our perceptions are all tinged by our biases, so it would be nice if we had an objective arbiter of truth for judging our social experiments, but we don’t. So what else is new? We muddle through as best we can.
March 23, 2010, 2:09 amDesiderius says:
LM,
“so it would be nice if we had an objective arbiter of truth for judging our social experiments, but we don’t”
All the more reason to keep our experiments anti-social where they belong.
= )
Seriously, that’s exactly the problem with social engineering, and why we were once wise enough to limit our government, so that our free citizens could be the engineers of experiments unimagined. To many of us, and not just conservatives, that era seems to be drawing to a close.
March 23, 2010, 6:03 amneimoller says:
i dont think you have a clue about the bill. even the most basic facts about the cost reduction in it.
it seems to be magical thinking day on volokh though, so i won’t poop the party.
March 23, 2010, 10:38 amDotar Sojat says:
Just sit back, David. We’ll pay for you. Its what you all seem to want. Someone else will pay. Its your right not to have to pay. Sheesh.
March 23, 2010, 10:41 amM. Simon says:
And the Democrats will gain 20 seats in November. If they just believe hard enough and click their heels three times….
March 24, 2010, 4:57 pmGrey says:
It’s pretty freakin’ disingenuous for right-leaners to criticize the bill for being too business-friendly — c’mon now! Republicans fought tooth and nail on this one, leaving their fingerprints. As a result, yes, it is more business-friendly than Democrats would have liked.
March 24, 2010, 5:18 pmleo marvin says:
These dialogs with Brian have a real Crying Game quality to them. How long are you guys going to keep telling yourselves he’s your fantasy left winger? He’s a right wing troll.
March 24, 2010, 10:15 pmleo marvin says:
(Comment “marked for moderation” Because it includes the word “troll?”)
March 24, 2010, 10:21 pm