Hold It Hostage – Fix It Later

Filed in National by on December 18, 2009

Food for thought for both the “fix it later” crowd and the “kill the bill” crowd – don’t give up the fight. Use the leverage you’ve gained with your passionate outpouring. Hold the individual mandate hostage (this is something the insurance industry definitely wants):

The only way I can see progressives being able to fix the bill later is if they can hold something the big industries really want hostage. Progressives need something important they can trade in exchange for better reform. The only thing progressives can hold hostage for real reform is the individual mandate. The insurers, providers, drug manufacturers, etc., all want the individual mandate. What company wouldn’t want the government to force people to be its customers?

Progressives should make the rallying cry of “no public option, no mandate” an unmovable demand, now and in the future. Progressives in Congress should refuse to support the individual mandate until it is accompanied by the government guarantee of a decent, cost-effective public health insurance option.

As many in the “fix it later crowd” have pointed out, reform does not really start until 2014, and the individual mandate does not really start until 2015. Even if you believe an individual mandate is essential to make reforms in the Senate bill work, there is no reason we need to pass it now. We have five years before it would go into effect. That is five years to work out a compromise that includes an individual mandate, better reforms, and a public option.

This is a positive use of our time in energy. What I’d like to see:
– Close any remaining loopholes in the bill. Pass the best bill we can get.
– Remove the individual mandate, or put a “trigger” on it
– Push, push and push some more for reconciliation for the public option and Medicare buy-in
– Don’t stop pushing on health care reform
– Start initiatives to fix the problems in the Senate. The Senate is a blockade to progressive legislation.
– Work for “better” Democrats
– Make them feel your wrath

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Comments (12)

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  1. Unstable Isotope says:
    December 18, 2009 at 8:58 am

    Krugman:

    That said, some of the arguments here annoy me — in particular the line I’ve been hearing from some quarters that progressives who say we should hold our noses and pass the flawed Senate bill are just like the “liberal hawks” who supported the Iraq war.

    …

    What’s going on with health care is very different. Those who grudgingly say “pass the thing” — a camp I have reluctantly joined — aren’t naive: by and large they’re wonks who have looked at the legislation quite carefully, understand both its virtues and its flaws, and have decided that it’s a lot better than nothing. And there isn’t much careerism involved: if you’re a progressive pundit or wonk, the risks of alienating the people to your left are at least a match for the risks of alienating people to your right.

    Now, the pass-the-thing people could be wrong. Maybe hopes of improving the new health care system over time, the way Social Security has been improved, will prove to have been fantasies; or maybe rejecting this bill and trying again, a strategy that has failed many times in the past, would work this time. But it’s a carefully thought-out, honest position. And arriving at that position has, in my case at least, required a lot of agonized soul-searching.

    And maybe I’m being unfair, but I don’t seem to see the same degree of soul-searching on the other side. Too much of what I read seems to come from people who haven’t really faced up to what it will mean for progressive hopes — not to mention America’s uninsured — if health care reform crashes and burns, yet again.

  2. Unstable Isotope says:
    December 18, 2009 at 9:05 am

    Ezra Klein: “Five cost controls in the Senate health-care bill”

    1) Bundled payments: A lot of the focus has been on cost controls that work through the insurance system. But costs aren’t rising because insurance is expensive. They’re rising because health care is expensive. The experiments with bundled payments are an attempt to begin addressing those drivers directly

    …

    2) Prudent purchasing: Howard Dean gave this prominent play in his op-ed this morning, and he was right to do so. The only problem is that he said it’s not in the bill, and it is.

    Prudent purchasing means that insurers can’t enter, or stay, in the exchanges unless regulators are satisfied that they’re doing a good job. That works both to ensure a good product, but also to hold costs down.

    …

    3) The Medicare Commission

    …

    4) The excise tax on high-value health insurance: This is, essentially, a tax on the unchecked growth in premiums. The key here is that the threshold at which premium dollars begin getting taxed at 40 percent doesn’t rise as quickly as premiums costs generally rise.

    …

    5) The individual mandate: In the last few days, an odd argument has arisen. The individual mandate, people say, must be sacrificed on the altar of cost control. The truth is quite the opposite. First, the individual mandate lowers average premium costs by bringing healthy people into the system. If the only people buying insurance are the people who expect to need to use it, the average cost will be prohibitively high. But second, the individual mandate is the political spur for future cost controls.

    In a world without a universal health-care structure and an individual mandate, premium increases are a shame, but not much of a political problem. In a world with an individual mandate, large premium increases are Congress’ problem.

    I think #1 is extremely important because it may break the cycle of pay-per-procedure. Not so happy with #4. It seems designed to crapify good plans.

  3. pandora says:
    December 18, 2009 at 9:06 am

    There are people I respect on both sides of this debate. What is really getting on my nerves is the way some kill the billers reject my position and gleefully lump me in with Lieberman and the insurance companies. There are valid points on both sides.

  4. Unstable Isotope says:
    December 18, 2009 at 9:09 am

    Exactly pandora. I’m thinking about how we get progressive legislation through Congress. Making a circular firing squad doesn’t accomplish that. I prefer to focus my passion on things I can do, and not things I can’t do. For the record, I think the policy discussion has been helpful and interesting. I think it makes it much more likely that we’ll salvage something out of the bill.

  5. Rebecca says:
    December 18, 2009 at 11:41 am

    It is far from being over.

    If you are free at lunchtime on Monday come over to Senator Carper’s office with your holiday greeting card. A big crowd will at least make us feel better.

    What: Deliver holiday greeting cards to Senator Carper
    When: Noon on Monday, December 21
    Where: Senator Carper’s office at the Chase Center on North Walnut Street.

    This holiday greeting is being organized by Jen Hill with Opportunity for America (used to be Obama for America). Apparently they have targeted Senator Carper for one last push before the vote. This is something you can DO.

    Please keep your messages on your cards civil.

  6. anonone says:
    December 18, 2009 at 11:58 am

    pandora, I might add that there are those on your side who gleefully classify the “kill the bill” folks as immoral, heartless, and against HCR.

  7. Lizard says:
    December 18, 2009 at 1:07 pm

    You know a conservative argument has carried the day when even those Democrats most ardently claim to help say they would rather not have the helping hand of government in their lives.

    So comes the shocking news on NPR this morning:

    A Washington Post-ABC poll this week showed a majority of uninsured people thought they would be better off under the status quo than under the changes now being proposed.

  8. shoe throwing instructor says:
    December 18, 2009 at 6:34 pm

    The internet killed health care reform, It gave the braindead reason to feel they were experts on the topic, thus bringing the average I. Q. of experts down near the imbecil level.

  9. just kiddin says:
    December 18, 2009 at 7:38 pm

    From the “real progressives at “The Progressive! Governor Dean got it right. Its not nearly good enough. The Senate should take up the House Bill and vote on it with the Reconciliation Procedure.

    Since then, Dean has come under hostile fire from the White House which is getting desperate and mean. Democrats silencing friendly critics is not a pretty sight. Nor is coddling Wall Street as Ruth Coniff notes in her piece, “Obama and the Fat Cats”.

    The majority of people thinking they would be better off keeping this sick corrupt health care system are the most uninformed people on the planet. These are mainly corporate republicans who believe its ok for corporations to rob and steal from you, and the truly dumbed down who bought the fake internet groups rant who were funded by the insurance companies, like Freedom Works and dozens of other fake groups.

    Most of you have never read a book on the topic, you got your information from the internet or from talking points of both parties. The insurance companies are going to win, because we have a Presidunce who is in bed with them, just like he was the Wall Street crowd who put his ass in office. He has turned his back on the majority of progressives thinking they will continue to support his lame ass policies…not.

  10. shoe throwing instructor says:
    December 18, 2009 at 11:02 pm

    There is an often used phrase that is repeated again and again in the health care debate and it drives me nuts, it was quoted here again, the fate of the Uninsured lies in the passage of this bill. That phrase is why we are losing this debate, if this bill does not pass the insured have the most to lose. 40% of companys surveyed plan on discontinuing there health care coverage in the near future, those people who are paying out of pocket will see there premiums continue to skyrocket, and medicare people will incur more and more out of pocket expences. It,s not a minor point, many of the people that oppose this bill think they have nothing to lose, that,s it,s only meant to help the uninsured, so they label it another government hand-out. It,s important that they understand without reform they will be the real losers.

  11. John Manifold says:
    December 18, 2009 at 11:08 pm

    Kleiman gets brutally frank:

    http://www.samefacts.com/2009/12/uncategorized/jane-hamsher-makes-it-official/

  12. Lizard says:
    December 19, 2009 at 9:48 am

    Sen. Ben Nelson to announce support for health-care bill

    The Washington Post ^ | December 19, 2009 | Shailagh Murray
    Sen. Ben Nelson (Neb.), the final Democratic holdout on health care, was prepared to announce to his caucus Saturday morning that he would support the Senate reform bill, clearing the way for final passage by Christmas. “We’re there,” said Sen. Kent Conrad (D-N.D.), as he headed into a special meeting to announce the deal. Democratic leaders spent days trying to hammer out a deal with Nelson, and worked late Friday night with Nelson on abortion coverage language that had proved the major stumbling block. But Nelson also secured other favors for his home state.

    more Bribes and Blackmail

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