Easy Interpretation
Obama and his HHS Secretary send strong signals that co-ops are firmly on the table, just long enough for GOP leaders to say “hell, no,” prove their craven obstinance, and give the Dem majority all the cover they need to pass the law they wanted to pass all along.
A senior Democratic congressional leadership aide said weekend statements were calculated to test Republican responses.
As tea-leaf-reading goes, this one was not difficult to decipher. Nor was it challenging to guess that the negative Republican response to the aforementioned “test” statements, would send the Dems scrambling for ways to accomplish what they want, with or without the Senate’s magic number.
The White House and Senate Democratic leaders, seeing little chance of bipartisan support for their health-care overhaul, are considering a strategy shift that would break the legislation into two parts and pass the most expensive provisions solely with Democratic votes.
The cynical will say it was a Democratic ploy all along: Feign interest in bipartisan support; set up a test to prove bipartisan support is impossible; move forward under the cover of “Hey, we tried.”
I don’t know. I’m still inclined to believe that (1) Obama understands the legitimate value of bipartisan support on the big-ticket items and (2) he would have settled for co-ops if the Republicans had taken the bait.* But they didn’t. And so it goes.
———————
* I don’t care what fiction Sen. Jon Kyle and others want us to accept as reality, the consensus — among the many (many) reports I’ve read on the pro’s and con’s of co-ops — seems to be that co-ops, properly structured, would (1) be consumer run, not government run; (2) inject more competition into the marketplace; (3) avoid the considerable cost and complexity associated with a centralized federal bureaucracy and (4) require little more than modest start-up funding from the feds, to the tune of billions not hundreds of billions of dollars.
Assuming these points of merit are accurate, then co-ops would (1) not add to the size/power of the federal government, and (2) be much less costly to taxpayers than the so-called “public option” that is favored by many Democratic Party leaders.
Net: If you’re a Republican who favors competition and is concerned about taxpayer cost and centralized government, and your ONLY alternatives are Choice A or Choice B, and Choice B is the least centralized, least expensive choice for taxpayers — then you support Choice B. If you don’t support Choice B — and Choice A passes — then you’re just as responsible for the reality of Choice A as its proponents are. Period. End of story. The fat lady sang. Go home.
28 Responses to “Easy Interpretation”
The problem with co-ops is that nobody knows what they would look like. With start-up costs they may end up exactly as expensive as the public option – the proposed public option gets its funding (after start-up) from premiums, not taxpayer subsidies.
But your larger about about bipartisanship is almost certainly true. Obama and the Dems “tried” to reach out to a party holding only 39 seats in the Senate.
Yes and maybe we should wear our Che` Guevara berets that we hide in our closet behind the dirty diaper compost heap, to these town hall meetings as well. Surely they'll snap and shoot somebody proving once and for all that they are wackos gone right round the bend.
Who’s first? Come on, we need those brave volunteers…
Unless I am missing something, co-ops would do little to solve the problem of millions of people being uninsured, would it? Unless you did something like offer to let people pay on a sliding scale according to income (which I don't think has been proposed), we'd still have people driving up costs by ignoring preventative care they can't afford and then ending up in the ER when they get really sick. I know the standard conservative response is – I don't want to pay for these people, but….you already are paying, so what difference does it make whether the payment is to the insurance companies (higher premiums) or to the government (taxes)?
By the way, I just started posting here recently. I'm actually not a moderate myself, but an unrepentant bleeding heart liberal (except on gun control and illegal immigration but for liberal reasons, not conservative ones.) However, having come from a very conservative family and hanging out with liberal friends I am very curious as to where exactly the “middle” is.
Lynnehs wrote: “Unless I am missing something, co-ops would do little to solve the problem of millions of people being uninsured, would it? Unless you did something like offer to let people pay on a sliding scale according to income (which I don't think has been proposed) … “
Good point: I, for one, would be perfectly willing to let people pay on a sliding scale according to income, within reason, plus subsidized or free insurance for the chronically poor, ala Medicaid. With those concesssions, I'd include an individual mandate — i.e., everyone has to have a policy.
All of these are points that could be worked out in the fine tuning. However, to my larger point, if the Republicans refuse to get serious about either public option or co-ops, there won't be any fine tuning, just the Democarts' House Commerce or Senate HELP plan, for good or ill — at which point Republican leadership will be as liable for the result (again, for good or ill) as the Democratic leadership.
This situation is comparable, I think, to members of the voting public who refuse to vote but insist on complaining about the results. I'd say the same thing to them that I'm saying to the Republican leadership: If your choices are A or B, but you choose “none of the above,” then you've essentially deferred your decision to others and have to take responbility for that deferred decision. It's the old adage: No choice is still a choice.
Co-ops are nothing new. Didn't anyone _else_ recall promptly, upon first mention this year of co-ops, that Group Health was a, if not _the_, example used during the early 1990s Clinton health care fiasco?
For those who don't know:
http://www.ghc.org/
As to the current disturbed behavior by Obama and the Dems involving not only co-ops but wavering on the “public option” (rigged “competition” incrementalist federal-takeover maneuver of choice this time; as in the early 1990s, going fully at once to Medicare for All is not sought because the public largely rejects it — how many people still fail to grasp this obvious fundamental issue?), of course one can add to the other observations of Obama's and the Dems' misconduct the likelihood that the earlier weekend's trials of a willingness to concede on the “public option” and an augmentation of support for co-ops instead, is in large part just a testing of the political winds and testing public (and Dem fraction) opinion of stances. In large part it's nothing other than misconduct and disturbed (and inept) behavior, but also may just be an attempt as well to reorient themselves with public opinion (kind of like a less-competent imitation of Bill Clinton's later-1990s successes).
“However, having come from a very conservative family and hanging out with liberal friends I am very curious as to where exactly the 'middle' is.”
On what, health care? The center is wary of governmental overreach (and the behavior by the Dems in Washington has offended moderates or centrists in increasing degrees since the start of the year), but isn't opposed entirely to federal interventionism (that there is federal interventionism now is accomplished fact and long-standing precedent for more of the same), and more importantly to real reform of insurers now (which has been deliberately neglected by the Dems, but which is far more important and relevent to moderates' and other normal people's lives). We're seeing a federal takeover (and worse, additional things that are inept or otherwise causes for concern) rather than the insurance reform that is central and crucial to most people and what should be sought promptly (and which correctly limits the scope of intervention and regulation by the federal government, at least for now). We moderates demand logical behavior in place of the Dems' gross misconduct; this effort should involve insurance, getting reforms of insurance now, which is mainly a regulatory and secondarily a scope-enlarging effort. There is no need for radical and extreme measures such as having the federal government take over everything (especially with an economy that is poor and which exposes hypocrisy by the Dems who also say they need to stimulate and revive our economy), much less have us waste money through largely-dreamy preventive measures (anything involving huge numbers of people will _not_ be cost-effective but will waste money instead) or worse, a larger and _closer_ appearance of the “Nanny State” (politically correct lifestyle choices, etc.).
DLS — Your provided link goes to a Web site home page, not a specific article/item. Do you have a more specific URL that helps support your point re: co-ops being part of the early 1990's Clinton-led debate over health care reform?
Thank you DLS for pointing out the obvious– that we already have co-ops. For that reason, we don't have to wonder about what effect they would have on health care. We already know. We're looking at it.
Pete, I don't have a URL for the Health Security Act book issued to the public. But I can mention something about how Group Health was held up as part of a model for reform then. It was mentioned more than once by the Clintons, and that is why it was in the news at that time. In addition, co-ops were looked at even before HMOs (also part of “HillaryCare”) as part of a future health care system. And with Group Health, it was in the news as a model, and Group Health's leader at the time was part of the Health Security Act (“HillaryCare”) initiative.
“On the national level, President Bill Clinton, in an address to Congress on September 22, 1993, unveiled his plan for universal health-care access via a national 'managed competition' system, which Phil Nudelman [running Group Health at the time] had helped influence through his role on a White House–sponsored committee. Health care — particularly HMOs and managed care — was in the news and Group Health came under scrutiny and into the limelight across the nation. The Co-op was held up — in The New York Times, the Wall Street Journal, ABC-TV's World News Tonight, and NBC's Today Show among many other newspapers, magazines, and news programs — as an example of an established and successful example of managed care.”
http://www.historylink.org/index.cfm?DisplayPag…
Nudelman (running Group Health) was involved in the 1993 plan. See the following 1993 remark:
http://community.seattletimes.nwsource.com/arch…
“President Clinton's blueprint for health-care reform depends mightily on health alliances. As the White House sees it, these huge cooperatives–organized by the states and run by businesses and consumers–will be efficient middlemen who will sell families and individuals a choice of coverage plans. The regional alliances will use their buying clout to drive down prices and ensure quality care. …
Such arguments have already swayed lawmakers in Florida and Washington–two states now organizing health purchasing cooperatives. Governors in each state proposed mandatory enrollment for small-business employees. Without a mandate, says Philip Nudelman, CEO and president of Group Health Cooperative of Puget Sound, regional alliances 'could work toward a two-tier system, with the poor going through a health alliance and the not-so-poor going through a separate system.'”
http://www.businessweek.com/archives/1993/b3341…
A more up-to-date (today) reference is here. Note that Group Health (which changed its nature from the way it was in 1993 to compete with other providers later in the 1990s) isn't necessarily held up as strongly now as an example, but gets a local-area mention now as at least something recognizeable:
["Details ... sketchy" is one of the central defects this 2009 health care reform has suffered all along.]
“Details about these co-ops remain too sketchy to see them as anything more than an idea. Group Health Cooperative here in Washington state offers a strong co-op model. But it's unclear how states would replicate this model, particularly in rural communities.”
http://seattletimes.nwsource.com/html/editorial…
Another timely reference to Group Health (may not be aware of its 1993 role) is here:
http://www.boston.com/news/health/blog/2009/08/…
And here:
http://prescriptions.blogs.nytimes.com/2009/08/…
And:
[Obama has exhibited interest in capitation as a way to control costs]
“In addition to the savings of having an integrated health system, he sees having doctors on a salary as a major reason for low costs at GHC, because 'their incentives are different' than doctors whose income is based on how many expensive procedures they complete.”
http://coopgeek.wordpress.com/2009/06/27/a-clos…
Also, the following guy was involved in health care reform even before 1993. (I recognize the name and the timing, the late 1970s.)
“In 1977, while serving as a consultant to the Department of Health and Human Services in the Carter administration, he designed and proposed the Consumer Choice Health Plan, a plan for universal health insurance based on managed competition in the private sector. The plan, based on the existence of integrated delivery systems such as Kaiser Permanente (KP) and Group Health Cooperative (GHC), provided the foundation for what became the Clinton administration's proposed health care reform plan in the early 1990s. “
http://xnet.kp.org/permanentejournal/sum04/comm…
For the record, I don't see ObamaCare as repackaged HillaryCare. There is more open federal takeover action at play with HillaryCare, but it remains an incremental approach that encompasses use (with the corresponding direction and control) of a preserved (if modified) private sector and avoides anything truly broad and scope and blatant as extending Medicare openly to any group at this time (which is what the public would or should anticipate if anything truly radical were sought). But there is a resemblance to HillaryCare in that large private existing organizations are channeled (shacked) and kept alive to suit the federal government's purposes (avoiding the public's concern about direct government dealings, which even with Medicare or Medicaid raises substantial concerns). It's no surprise that to find an alternative to the incrementalist “public option” that still involves the federal government that co-ops might be sought.
“We already know. We're looking at it.”
Well, there's also our experience with big, bad HMOs and more of interest to us all currently, specifically with health _insurers_ (through which we purchase what still nominally or legally is “insurance,” which can be denied us, but which in reality is _comprehensive_care_) and all along I have lamented that a central defect of the health care effort has been to often call it “insurance reform” but to neglect this in favor of broader, more sweeping, much-sloppier-or-vague, cobbled-hurriedly junk in its place.
Do you realize that not only should co-ops have been understood and made clear to the public beforehand, but the exact _role_ they should have been chosen to fulfill and what people could expect to experience with them, should all have been completed before legislation was even begun? (Not only is the current legislation formative and experimental now, rather than firm and complete, but it's still subject to change! Co-ops are only now being sought in more earnest and considered for promotion because the “public option” is a key feature responsible for the failure of the effort currently. It was little more than the most trivial and token lip service that was paid to it prior to this week.)
Hi, Lynnehs, welcome in to TMV. I think you'll find four different versions of “moderate” here.
1) Moderate = not extremist. Few people think of themselves as extremists, and so we're all moderates. You'll find quite conservative and quite liberal people here, all of whom consider themselves moderate.
2) Moderate = wishy-washy and aimless. People don't consider themselves moderate in this way, because they are principled and consistent of course, but they're here anyway for debate.
3) Moderation = Independent. This version of moderation contains a different set of beliefs for each person, but isn't particularly connected to any major party.
4) Moderate = In between the left and right wings of the Republican party. It's your RINOs and DINOs, progressive Republicans and conservative Democrats, and people who like to find solutions in the middle.
In the end, the web site doesn't have a single voice. People who are more liberal or more conservative generate a lot of the noise (um, energy?). If you are more conservative, then the more liberal people here stand out and you periodically write angry posts about how liberal the site is. If you are more liberal, the conservatives stand out and you get angry about that. As you read more of the bloggers and more of the commenters, you will likely come to realize that some are best skipped.
And that's Paca's Guide to TMV.
Lynne H.S.: “Moderate” on this site normally means “liberal.”
For a long time (since around 1980) liberals have routinely avoided using the word “liberal” because it has become so pejorative. (Why?) They also may try to be deceptive by misusing “liberal” so as to depict or portray true moderates (or “centrists”) as immoderate. (They fail, but they often try to do this.) This site (TMV) is definitely liberal (definitely to the left, often well or far to the left) but we non-liberals are on it, too.
Note that most of us distinguish between “mushy” and “moderate” and use the first word to qualify some who also lay claim to the second. They are not synonymous. (A moderate is not obliged to be mushy, and arguably should _not_ be so; as an academic-oriented friend of mine in Seattle said once, he was glad that in the UK Parliament, “goddammit, the gloves come off!” Mushy people often have only mush to say [not limited to saying anything in a mushy way].) Despite insistence on political bias that some may have here and elsewhere (a part of lefty PC culture, suppressing what's not approved), as we've seen by the media in aiding others in mischaracterizing and “punishing” the public for its opposition to the Dems' health care budding fiasco (self-made!), there's nothing wrong with being forceful when and where merited.
“This site (TMV) is definitely liberal (definitely to the left, often well or far to the left) but we non-liberals are on it, too.”
Just curious, DLS. When you talk about the site being liberal, are you referring to the writers, the commenters, or both?
“the site being liberal, are you referring to the writers, the commenters, or both”
Both, though what probably matters most (because it's what we first see and respond to) are the writers.
The nature of the site (and the writers, and the commenters) is clearly evident.
Hunh. That's interesting, particularly about the writers (and I'm not at all referring to myself here). I'd have said that both are represented here (though I don't know that anybody goes very *far* to the right of center).
My two cents on that question, PM, is that there are a couple of writers here who are pretty far left and quite strident in their rhetoric, without any rightwingers of that ilk. The more moderate, perhaps slightly right of center or at least not left of center writers are all true moderates in tone and in ideology, but there are left leaning folks who write here who are not moderate at all.
That, along with frequency, leads to a tilt- perhaps not very noticeable to readers who hold a lot of left leaning opinions. We tend not to notice when someone that we mainly agree with is immoderate in tone as much as we notice when someone that we mostly disagree with uses immoderate rhetoric.
By frequency, if not self-explanatory, what I mean is that at times the writers who are left or center left are much more prolific than those that are centrists or slightly right of center. Reading ten-twelve posts a day that harp on what is wrong with the GOP (when that really isn't that relevant to current issues since the GOP holds almost no power right now) is grating. Similarly, picking up on every Memeorandum story that highlights whacko extremists from the right wing, or GOP scandals, while ignoring any similar stories that reflect poorly on Democrats, is irritating and if an editor wanted to check for balance he/she would likely find the tone almost propagandistic based on story selection. I do understand though, that the site isn't edited that way, and tilt in story selection is really just a result of the preferences of the various writers.
I'd have said that both are represented here (though I don't know that anybody goes very *far* to the right of center).
Exactly- if you could plot people on a linear scale and have some that are far to the left and an equal or even slightly greater number who are just barely straddling the center line toward the right side- the overall mean is going to be on the left, not in the middle.
Lets see some tort reform on the table. Lets see the Democrats fix the existing single payer program Medicare that is so screwed up before we let government get involved in new programs they can't fix. Lets see them put forth an option to open up insurance competition across state lines. Lets see them achieve some success before we allow them to go in and fail in new areas.
Hi Leonidas, if these changes were implemented, would you then support either co-ops or a public option?
And insofar as the public (more than just this site's participating crowd) goes with health care, perhaps this is also worth a quick glance and thought:
http://pewresearch.org/pubs/1317/would-american…
I was searching Pew earlier for their report showing where liberals, conservatives, and the public overall placed themselves and various Presidential candidates — here it is, finally. (See bottom of page.)
http://pewresearch.org/pubs/693/republican-primary
* * *
Probably the most relevent issue about the coops right now is to what extent they have or never have been seriously pursued as an alternative to the “public option,” but merely surfaced as a fall-back kind of alternative that some at least anticipated might be needed if (or when) the public opposed the “public option.” To what extent is it just some _thing_ to speak of, rather than seriously pursued and designed?
* * *
“the overall mean is going to be on the left, not in the middle”
This is obvious in the case of the “mainstream” media, and is even more of an issue on many a Web site.
“Lets see some tort reform on the table. Lets see the Democrats fix the existing single payer program Medicare that is so screwed up before we let government get involved in new programs they can't fix. Lets see them put forth an option to open up insurance competition across state lines. Lets see them achieve some success before we allow them to go in and fail in new areas.”
I'll add what I've been saying for ages.
* Achieve Medicare reform (and Medicaid, VA, Indian Health reform) before expanding federal health care.
* Achieve insurance reform and try an honest insurance model, honestly, before more government instead.
* Go to state-wide, region-wide, or nation-wide “community rating.”
* Do what is needed to assure that everyone in the “community” can and will purchase insurance.
These things are all simpler, more elegant, more sensible, more rational than what the Dems are doing.
These things are more likely to succeed and to win US public acceptance than what the Dems are doing.
[sigh]
Choose your honest logo, TMV Editors! You have two choices:
http://www.allstar.fiu.edu/aero/images/turn22.gif
http://www.allstar.fiu.edu/aero/images/turn21.gif
“PM, is that there are a couple of writers here who are pretty far left and quite strident in their rhetoric, without any rightwingers of that ilk.”
I'd say we've got two bomb-throwers from the right among the regular commenters, who have perhaps despaired of any meeting of minds and dish up their criticism spicy hot. They are at least able to understand what opposing posters are saying, so their criticisms are often spot on.
They're matched at least five to one by writers on the hard left who inhabit a world of corporate conspiracy theories and Dickensian demons. They're either unable to understand other points of view, or not interested in trying, so they're not ideal for a meaningful exploration of issues. But as you suggest, CS, they make up for it in volume.
DLS-The MSM is not liberal, they are socially liberal and economically conservative just like the New York Times. If you want to see lefty journalism check out democracynow. That is the lefts version of Fox(actually that is MSNBC but democracynow has a habit of not being pure propaganda like Fox & MSNBC). Reminds me that the media is just as liberal as they corporate owners that are major investors in the military and prison industrial complexes allow them to be, which is of course socially liberal because if you judge no one everyone can buy your products.
>>”… I am very curious as to where exactly the 'middle' is.”
>On what, health care?
Well for starters but I meant in general. Thanks, everyone for your comments. Although I'm clearly not in the middle, I think the most useful way for people to be “moderate” as in not extreme is to be able to communicate our differences in a productive way and at least try to find some middle ground where possible. I think the tactics of shouting people down and displaying open firearms, while legal, isn't something that's good for the country. It would be good if Americans could have an actual dialogue on issues without the loony publicity stunts.
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