Will the Left or Right Kill Health Care Reform?

It is far from certain at this point whether health care reform will succeed. Most insiders believe that Congress will enact some form of comprehensive health care reform but it is easy to envision scenarios where they are not successful. The opposition comes mainly from the right, but there is also the view (perhaps as this is more of a man bites dog storyline) that it is the left which will cause health care reform to fail. Cici Connolly of The Washington Post examines how some activists are targeting Democrats:

In recent days — and during this week’s congressional recess — left-leaning bloggers and grass-roots organizations such as MoveOn.org, Health Care for America Now and the Service Employees International Union have singled out Democratic Sens. Ben Nelson (Neb.), Mary Landrieu (La.), Ron Wyden (Ore.), Arlen Specter (Pa.) and Dianne Feinstein (Calif.) for the criticism more often reserved for opposition party members…

Much of the sparring centers around whether to create a government-managed health insurance program that would compete with private insurers. Obama supports the concept, dubbed the “public option,” but he has been vague on details. Left-of-center activists want a powerful entity with the ability to set prices for doctors and hospitals.

But in the Senate, where the Democrats do not have the 60 votes needed to stop a filibuster, members are weighing alternatives such as a nonprofit cooperative or a “fallback” provision that would kick in only if market reforms fail.

Pushing for the public plan does have popular support but Connolly notes that this does not mean that a majority supports the entire agenda of those on the left who see a public plan as a means of transitioning to a single payer plan. She notes that, “While recent polls show high initial support for a government option, the number declines if told the insurance industry could fold as a result.” Many who support providing the option of a public plan also desire to continue with their current insurance.

There are signs that this pressure is influencing some Democrats but others fear this is counterproductive:

One Democratic strategist who is working full-time on health reform was apoplectic over what he called wasted time, energy and resources by the organizations.

The strategist, who asked for anonymity because he was criticizing colleagues, said: “These are friends of ours. I would much rather see a quiet call placed by [Obama chief of staff] Rahm Emanuel saying this isn’t helpful. Instead, we try to decimate them?”

If this effort is based upon pushing Democrats to support the public plan there should not necessarily be adverse consequences on the success of health care reform. Of greater concern is talk among some progressives of voting against a health care reform bill which does not contain a public plan. I can envision scenarios where Republicans have enough votes to filibuster a bill which contains a public plan, but a bill without a public plan could also fail if both Republicans and some progressives vote against it.

The goals should be to reduce the number of people who lack insurance and to reduce insurance problems such as people being cut off when they develop a serious illness. These are serious problems which need to be addressed and there are multiple possible solutions. Ideological battles such as over whether to have a single payer plan should not be used to prevent meaningful reform, even if the reform will inevitably fall short of what some desire.

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  1. 1
    jacksmith says:


    It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.


    We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.

    And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.

    Progressive democrats and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and request that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).

    Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.

    In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!

    If President Obama has to declare a NATIONAL STAT OF EMERGENCY to rescue the American people from our healthcare crisis, he will need all the sustained support you can give him. STICK WITH HIM! He’s doing a brilliant job.



    Join the fight.

    Contact congress and your representatives NOW! AND SPREAD THE WORD!

    God Bless You

    Jacksmith – WORKING CLASS

  2. 2
    Mr. Jeffersonian says:

    I have to be frank I’m not exactly holding my breath for health care reform anytime soon especially when we have a Republican Party that’s now too far to the right, and a Democratic Party that’s never far enough to the left. It will be business as usual just you watch.

  3. 3
    Fritz says:

    How can you blame the Repulican Party at this point?  The Democrats, er, won.  Like everything.

  4. 4
    Ron Chusid says:

    The Republicans can’t pass anything  but they still can block passage of a bill in the Senate.

  5. 5
    Fritz says:

    There are a lot of old Repulicans.  The Democrats should be able to outlast them in a good old-fashioned filibuster.  Bring in the matresses and go at it.

  6. 6
    Ron Chusid says:

    They don’t have physical filibusters anymore. Both parties decided to go with the easy way out. The Senate rules were rewritten so that if a party doesn’t have 60 votes for cloture a measure is considered filibustered. In general anything without 60 votes can be killed in the Senate.

    The rules for health care reform are actually different. Initially they will try for a bipartisan vote–which might mean dropping the public plan to get some Republican support. It now looks like that might not work if they lose enough votes from the left if they make this compromise.

    If they can’t get a bill through the Senate under the normal rules (where 60 votes are needed) the Democrats are threatening to add health care to the budget reconcilliation vote, which only requires a simple majority. Even then it is possible that the Republicans might be able to block a bill with a public plan if they can pull off enough conservative Democrats. While you think that health reform signals the death of the insurance industry, there very will might be enough Senators in the pocket of the insurance industry to prevent a bill which the insurance industry sees as likley to bring about this result.

  7. 7
    Fritz says:

    They should definitely go back to the classic filibuster.  Much more room for entertaining drama.  Or maybe I’m just a Jimmy Stewart fan.

  8. 8
    G.T. Blackwell says:

    I simply cannot fathom why the Democrats consider the threat of a filibuster to be an insurmountable obstacle.  Let the GOP filibuster!  They’ll be digging their own grave.  Nearly 70% of Americans are in favor of a public option.  Does the GOP think their way back into the majority is by siding with the 30% who don’t?  The conventional wisdom says that nothing can pass without 60 votes.  I disagree:

  9. 9
    Fritz says:

    I like the “public option” rhetoric.  It hides the fact that a tax-funded low/no-cost (to the consumer) third-partying solution will move non-government choices into expensive niche markets, just as it did for K-12 education.

  10. 10
    Ron Chusid says:

    The current proposals are for it to be financed through premiums paid by the consumer and for it not to be tax-funded.

  11. 11
    Fritz says:

    Ron — wanna bet how long that lasts?

  12. 12
    Ron Chusid says:

    It is one thing to criticize a plan for what is included in it. It is a completely different thing to make claims about a plan and, when confronted with the fact that this is not what the plan says to then say it will become like that in the future.

  13. 13
    Fritz says:

    Ron –I figure it is a good idea to try to predict the consequences (intended and unintended) of a piece of legislation.
    This is my prediction — once this kind of system is set up, the tax subsidies (which will be there at the beginning, just perhaps hidden a bit) will increase, more and more people will have free (of direct payment) health care, non-government options will wither to niche (and expensive) markets, and the change will be politically impossible to reverse.
    Maybe that will be good. Maybe not.   But I don’t think it makes sense to only comment on the precise wording of this first plan.

  14. 14
    Ron Chusid says:

    Anyone can make a prediction, but you should state it is a prediction, not make a claim that it “hides the fact.”

    As to predicting what will happen, there are a couple of major unknown factors. First we don’t have the final legislation. Second, should it be passed the behavior of the insurance industry is an important factor.  Currently there is little support in Congress for anything which would force the insuranc e industry out of health care. This could certainly change if the insurance industry finds ways out of new legislation and continues to rip off consumers by failing to provide coverage.

    If the insurance companies continues to operate on a business model based upon maximizing profits by denying coverage and dropping those who develop serious illnesses, then it is likely that the industry will be removed from the health care market and they will deserve it. If they provide reasonable coverage then there currently is not enough support in Congress to eliminate them.

  15. 15
    Fritz says:

    So, Ron — any notion of how the premiums are supposed to be calculated for the government plan?  Will they be allowed to alter premiums based on pre-existing conditions?  Web searches instantly go into a morass of mostly opinion pieces.

  16. 16
    Ron Chusid says:

    Premiums should be calculated just like with insuranc e companies. The current proposals are that insurance companies will not be able to charge based upon pre-existing conditions. They will only be allowed to base charges on factors such as community rating and family size.

    Of course as there is no final legislation anything can still change from the proposed legislation.

  17. 17
    Fritz says:

    I look forward to watching the political process regarding what factors a government agency will be allowed to use to alter premiums for health and safety risks.
    I’m sure they will be able to use tobacco use, since that’s the big no-no.  But what about other health and safety risks?   Owning a motorcycle?  Working on a farm?  Being in a high-risk group for HIV infection?

  18. 18
    Ron Chusid says:

    At present it is private plans, not the government, which use health care coverage to alter such matters.  Some plans will even do things like charge a higher rate unless you sit thorugh their classes, meet with their health coach, etc.  They certainly vary rates based on these and far more factors (which they would not longer be able to if proposed health reform measures pass). In other words, you are afraid that the government will start doing what private insurance is already doing.

  19. 19
    Ron Chusid says:

    At present it is private plans, not the government, which use health care coverage to alter such matters.  Some plans will even do things like charge a higher rate unless you sit thorugh their classes, meet with their health coach, etc.  They certainly vary rates based on these and far more factors (which they would not longer be able to if proposed health reform measures pass). In other words, you are afraid that the government will start doing what private insurance is already doing.

  20. 20
    Fritz says:

    Ron — actually I am looking forward to the political battles when various groups think it is unfair for them to be charged higher premiums when they have well-documented risk factors.  The battles will be fought in the political arena, and should be nicely dramatic.

  21. 21
    mike says:

    I advise on several health insurance boards such as http://www.benefitsmanager.net , http://www.bcbstx.info , and http://www.healthinsurancesource.net. I often quote the Switzerland health care system as an example of tough questions that we as a nation will have to answer someday, if we go down the path of nationalized government health care plan. We’ll have to at some point draw the line in the sand and refuse further care for patients receiving critical illness treatments, intensive care unit, trauma care, acute management services, disease management, neonatal intensive-care unit for newborns and seniors in extended care treatment nearing hospice stage . Did you know that premature babies are not resuscitated upon birth if they cannot draw breath in Switzerland? Did you also know that holds true with “senior care” experiencing system failure or multiple organ failures requiring support? Another example, they don’t extend the life of a senior via medical equipment such as intubation or respiration for multiple organ failures. Not to be morbid….they are unplugged and allowed to pass. Anyone in the business of paying claims knows that the single most expensive bill in what carriers call “shock loss” is within NICU for newborns and seniors in acute / intensive care / hospital in the last three months of life.
    The Swiss apparently made decisions made based upon cost vs. quality outcome. Are we as a nation prepared to make that type of decision or to define when to incubate, resuscitate a newborn or a senior? Are we ready to define the conditions and rules of medical procedures with organ failure? With a litigious society I think not. This is why we need TORT REFORM. Without TORT REFORM medical provider costs will never drop. Liability costs with medical providers are nearly half of operating expenses. Humana health plans state that their costs of medical liability and defensive medicine accounts for nearly 10 cents out of every premium dollar collected. Compare that to Humana’s reported pharmaceutical claims of 15 cents out of every premium dollar collected. Or better yet, 21 cents out of every premium dollar collected is paid back to physicians for physician treatments. The cost of litigation is only obvious with Humana health plans. I sit on the board with several other health insurance carriers. Their books all show similar costs. They basically insure a shrinking populace that is mostly made up of people that only buy insurance because they need it. So is mandatory participation such a bad idea?
    I don’t think we are hearing about TORT REFORM because most of the house and senate on the federal level are lawyers and have practicing law firm interest’s. In the healthcare system there is no total innocence. We hear about insurance executives with bonuses, doctors overbilling, hospitals overbilling because the street gang thug got dropped at their ER door with no insurance. The lawyers are there to stir the pot and promise lavish fortune at the end of the PERCEIVED misery chain. Am I saying we don’t need them? No, but I am saying there is clear and documented abuse of the legal system that awards outlandish claims in the millions for a questionable mistake. Are ambulance chasers not sociably recognized as being the most abusive? What about those that educate their clients on defraud and then use the legal system to pirate insurers?
    I sure wouldn’t want to be on the receiving end of these serious decisions that we will have to make. My senator claims that the government would be held blameless but what about the medical provider that has to make the call? What about the insurance payer that has to deny continued care for an infant that will not survive? Without serious TORT REFORM we aren’t going to get costs down or have good people make headway.

  22. 22
    Ron Chusid says:

    Yes, I recently noted in another post that it doesn’t make any sense to talk about complex measures to try to reduce cost while ignoring tort reform.

  23. 23
    Fritz says:

    Tort reform will be hard to do.  The trial lawyers have been very, very civic minded.  In other words, they contribute handsomely to political campaigns.

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