>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.

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.

http://www.allstar.fiu.edu/aero/images/turn22.gif

http://www.allstar.fiu.edu/aero/images/turn21.gif

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]

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.

http://pewresearch.org/pubs/1317/would-american…

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.

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.

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.

Just curious, DLS. When you talk about the site being liberal, are you referring to the writers, the commenters, or both?

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.

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.

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.)

“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.