The Affordable Health Care for America Act
Nov 8th, 2009 | 82 responses
Yes, it’s an historic achievement:
Health-care reform passed the House, quite literally, at the eleventh hour. It passed with a slim, two-vote margin. But it passed. That is more than has ever happened before. More than Truman or Nixon or Carter or Clinton managed. More than Rayburn or O’Neill or Gingrich managed. It is success, at least for this stage in the process. It is history, even, though it’s hard to sense the importance of the moment when you watch members of Congress spend the day squabbling over the true meaning of the word freedom.
Here it is, all 1,990 pages of it. It was passed by five votes (220-215).
Here is H.R. 3962, the Republicans’ alternative bill. It was defeated by 82 votes (258-176).
Here is the text of the Stupak Amendment (first posted in comments by Leonidas).
Some points of clarification for the above amendment are in order:
- The amendment forbids the use even of nonfederal funds to purchase supplementary insurance coverage for abortion services.
- The amendment places restrictions on the provision of supplemental insurance coverage for abortion services by private insurance companies (QHBP means “Qualifying Health Benefit Plan”), even if those QHBPs are not using federal funds to cover such services.
- The amendment contains exemptions for the life of the mother resulting from a physical disorder or a physical illness or a physical injury, and for pregnancy resulting from rape or incest. Life-threatening mental health conditions, as well as physical problems that a doctor determines will not result in death but will likely have serious health consequences for a woman if a pregnancy is continued, are not included.
Rayne at Firedoglake lists the 64 Democrats who, in her words, “ask[ed] for primary opponents.”
This bill does a lot of really good things. It’s strong, robust health care reform that truly deserves the word “historic.” Having said that, Scarecrow explains how it’s possible to feel thrilled and betrayed at the same time:
It’s like winning a huge battle, but half of your friends were killed or wounded.
36 million more people will be insured or become eligible for Medicaid
There will be a trillion dollars raised to help subsidize this over 10 years.
There will be multiple measures to help control the costs of Medicare
We will stop subsidizing private insurers in Medicare Advantage
Closes the donut hole
Allows Medicare negotation for drugs
Includes the seeds of a public option; lets it expand later, maybe
Prohibits denials based on prior conditions; ends rescissions except for fraud; improves loss ratios
Provides coverage for preconditions in the interim through government program (a hidden public plan)
Provides long-term care coverage (another hidden public plan)
Billions in funds more for education for doctors/nurses
Creates and funds more rural clinics
Begins dozens of health prevention programs, pilots, surveys
Creates entities to evaluate and recommend better treatment, cost saving
And on and on. — more good things, and some bad thingsIt’s a massive achievement, but women, mostly poor, paid an unconcionable price.
82 Responses to “The Affordable Health Care for America Act”
You almost had it described spot on. Let me help you a bit:
The Economically Crippling, Completely Unaffordable, Bureaucratic Boondoggle, Paid On The Backs Of The Next Three Generations Ruining Of Health Care For All Americans Act
There. That's more like it.
I like some of the provisions, such as prohibiting pre-existing condition bans, providing for preventative care coverage, etc.
Having seen how efficient the government is in most other sectors I'm uncertain of the public option, but I am not rigidly opposed. I'd need to see what the final package entiails.
Also, having heard some bloggers around the net talking about how 'the only reason people oppose this is because they are rich and have to pay for it' I would wonder if the reverse question is proper.
IE: If you currently support the proposal but know you won't have to pay anything for it, would your views change if you did have to pay a lot of money out of your pocket ?
Of course any major debate over the provisions is pointless at this junction since we have no way of knowing what, if any, proposal will come out of an eventual conference committee.
I'm uncertain of the public option, but I am not rigidly opposed. I'd need to see what the final package entails.
It entails politicizing medical decisions. Bible thumpers paying for part of your your abortion quite understandably want to prevent it, and I hope no one finds that surprising or unreasonable. Your diet, your smoking, your vaccinations, your contraception, your motorcycling, how much you exercise and so on become matters of legitimate public interest.
Glad to see the Dems are congratulating themselves already. All it takes is one Senate Dem to be annoyed at the take-it-for-granted attitude.
I'm not opposed to many parts of the bill but as a whole all I can say is barf.
Well who cares, time to go on an all twinkie diet now that the taxpayer will have to pick up the tab.
The benefits side of this bill is OK, the fiscal side is not. By delaying fixing the physician payment SGR formula the Democrats were able to hide some of the costs, a move akin to George Bush hiding the war costs off-budget. This allowed them to crow about the plan reducing the deficit, a claim which is patently false.
At the risk of having the abortion question take over yet another thread:
“The amendment forbids the use even of nonfederal funds to purchase supplementary insurance coverage for abortion services.”
Just want to make sure we're clear here: Based on my reading of the amendment, supplementary insurance coverage for abortion services is allowed as long as it is not paid for by federal funds or nonfederal funds that are required to be paid in order to receive federal benefits. What you wrote could be taken to mean that all supplementary abortion coverage is forbidden, which is not true.
As an example, it seems to me that it would still be legal for an insurance company to offer plans that could be subsidized, and then offer optional supplementary insurance for abortion services that could not be subsidized.
Can we agree that that's what it means? I'm not particular interested in debating the merits of the amendment (there are already 2 threads doing that), but at least I'd hope we could agree on the actual meaning of the amendment itself.
As if all that were not already happening and getting worse by the day because of the stratospheric cost of health care increasing astronomically every single day, adding to the $2 trillion dollar deficit — created by George W. Bush over eight years of war, tax cuts for the rich, war, boondoggles for the defense industry, war, a huge new government bureaucracy (homeland security), war, corporate giveaways, and war — out of a surplus given to him by Bill Clinton.
If you currently support the proposal but know you won't have to pay anything for it, would your views change if you did have to pay a lot of money out of your pocket ?
Back when my daughter was in grade school in Montclair, NJ, and the Board of Education was trying to justify draconian budget cuts to an extremely popular, national award-winning public pre-kindergarten program, by darkly warning of higher taxes, my little local group of public preK advocates would come to Board meetings with signs saying, “Raise my taxes — PLEASE!”
And I didn't even have a child in PreK at that time. Maggie was already up several grades. We were one of the lucky families who moved to town before the program was threatened. But I knew how valuable and cost-effective that program was in every way that mattered — not just pedagogically, but it made Montclair a more desirable town to live in if you had school-age children; it increased property values, etc.
I still feel that way about public spending: Of course, I'm willing to pay, if what I'm paying for is producing something of value. The long-term benefits of a health care system that is affordable for all Americans and that begins to lower the cost of health care — which is absolutely breaking this country — are incalculable.
So yes: my views would be the same regarding the House bill if I were still working and paying taxes.
Your diet, your smoking, your vaccinations, your contraception, your motorcycling, how much you exercise and so on become matters of legitimate public interest.
As they already are, and would continue to be, without any public option — without any health care reform at all.
It has been entertaining reading conservative reactions to all of this.
My message to them…if you voted for Bush twice, you are now reaping what you sowed.
Dems wouldn't have the power to do any of this had you not blindly followed Bush into the abyss.
I think the language is very confusing, to be honest. And to be even more honest, I don't understand what you're saying in your next to last paragraph. Wouldn't supplementary insurance for abortion always be optional? No one is forced to buy supplementary insurance that covers abortion.
The salient point here, for me, is that if the concern is that abortion services should not be funded through the money that's appropriated by this legislation to subsidize insurers on the exchanges, then if federal money is not subsidizing a given insurance company's supplemental policy covering abortion, there should not be an issue. It does not seem to me to be the federal government's place to tell private insurance companies what they may or may not cover with dollars that do not come from the federal government.
[...] This post was mentioned on Twitter by GraceBarkwell, Pregnancy. Pregnancy said: #pregnancy The Affordable Health Care for America Act: The Moderate Voice … the life of the mother .. http://bit.ly/1gSRFd [...]
Some fact and some partisan drivel there, Kathy. Lets look more closely.
FACT Bush increased the deficit, his wars were costly, agreed.
FACT Almost all democrats approved the war in Iraq, and although he was responsible for it, they certainly contributed and can't deny it.
FACT Democrats controlled Congress since 2008, Congress controls the purse strings, although certainly the President can influence negoations, still Congress has the final say on the budgets passed.
FACT the 2008 deficit under the Bush Presidency and the Democratic Control of Congress was tripled in one year once the Democrats took control of the White House and is projected to also be triple the 2008 deficit next year.
FACT The surplus enjoyed during the Clinton administration was done with a Republican controlled Congress that cut many of the programs Clinton wanted. They get the lions share of the governments portion of the credit for this. Also the tech bubble which was unrelated to the political environment had much to do with this surplus as well.
Oh please, please, give them primary opponents, the further to the Progressive fringe as possible. And please, please democrats vote for them in the primary. Please make me a happy man.
I get one indisputable fact out of all this:
Under Bush, the country went from a surplus to a $2 trillion dollar deficit. All that stuff about Congress approving the budgets is true, but doesn't change the fact that Bush was the president. Plus, as we all know, unitary executive theory, which was gospel under Bush, says that the president has unlimited authority during war time to get whatever he demands and to do whatever he pleases if it has something to do with national security. And as we all additionally know, not a sparrow fell to the ground from 2000 to 2008 that did not have something to do with national security.
“think the language is very confusing, to be honest.”
I agree with you there, but not any more confusing than most legislation I've seen.
In any case, I think we are both referring to this passage: that supplemental insurance can include abortion coverage so long as it's not paid for with federal funds or “other nonfederal funds required to receive a federal payment, including a State's or locality's contribution of Medicaid matching funds”.
The word “required” is the key for my interpretation of that. Let's say an insurance company has a plan that costs $1000 a month for which government subsidies apply, and then they tack on a $10 a month abortion coverage plan. If they were to require you to buy the $10 a plan in order to purchase the basic plan, that would be prohibited, which makes sense since in effect it is the same as if they would offer you one plan at $1010. But, as long as the supplemental plan is optional, then it is in effect two separate plans, one of which can be subsidized and the other cannot.
That's my interpretation of what that passage means, but if someone can point to an authoritative interpretation, I would appreciate it. However, all of the summaries I've read, including the one from the NY times that you linked to, have language such as that abortion coverage is restricted “through private insurance that is bought using government subsidies”. I don't see a reason why that last part is included if it is restricted entirely from private plans. Also, on the next page there is an entire section about how supplemental coverage for abortions is allowed, which conflicts with your interpretation of the preceding passage.
In fact, I just re-read this passage which pretty much says what I said above regarding optional vs. required: That the supplemental insurance is allowed so long as:
“any nonfederal QHBP offering entity that
16 offers an Exchange-participating health benefits.
17 plan that includes coverage for abortions for which '
18 funding is prohibited under this section also offers
19' an Exchange-participating health benefits plan that
20 is identical in every respect except that it does not
21 cover, abortions for which funding is prohibited
22 under this section.”
“that is affordable for all Americans and that begins to lower the cost of health care”
Outside of allowing Medicare part D to negotiate drug prices, nothing else in that bill is meant to realistically reduce costs or improve competition at the provider level. It increases the use of insurance, and prevents people from escaping that cost, other than by eschewing earning money altogether.
And domestically, how is Obama any better?
“The benefits side of this bill is OK, the fiscal side is not.”
I agree on that. An interesting find in the CBO report via Greg Mankiw: http://gregmankiw.blogspot.com/2009/11/assuming…
That reads to me like CBO talk for “Our numbers are about as likely to hold up as pigs will fly, but we are prohibited from considering the possibility that pigs won't fly.”
Facts are ugly things when they prove you wrong, and these are very ugly to you Kathy, I am sure:
US Deficit Chart
These are the White House's own numbers:
Table 7.1—FEDERAL DEBT AT THE END OF YEAR: 1940–2014—Continued
Gross Federal Debt (Million $)
1995 4,920,586
1996 5,181,465
1997 5,369,206
1998 5,478,189
1999 5,605,523
2000 5,628,700
2001 5,769,881
2002 6,198,401
2003 6,760,014
2004 7,354,657
2005 7,905,300
2006 8,451,350
2007 8,950,744
2008 9,985,757
2009 estimate 12,867,455
2010 estimate 14,456,303
2011 estimate 15,673,873
2012 estimate 16,565,716
2013 estimate 17,440,160
2014 estimate 18,350,010
Here is their 2010 budget tables (information above is on page 128)
THE BUDGET FOR FISCAL YEAR 2010, HISTORICAL TABLES
You are confusing the concept of budget deficits with the national debt, which is the key issue. But if you want, we can show the quintupling of budget deficits in less than a year under Obama. You are letting your love of progressive agendas blind you to the true damage being done to the economy and your daughter's, and any future grandchildren's, financial futures
From the New York Times.
$1.4 Trillion Deficit Complicates Stimulus Plans
http://www.nytimes.com/2009/10/17/us/17deficit….
Kathy,
Just so you are aware, health care costs have outpaced inflation since the 1950's. We have long-standing systemic problems in the system that have nothing to do with GWB. There is no tax rate or spending cut that will make the system sustainable when costs are increasing at three time GDP growth. This bill, while it has a few merits, is simply throwing money at a broken system and will only add fuel to fire of financial unsustainability. And I'm sure when the system finally crashes the Partisans will be pointing fingers at GWB or Clinton or Obama or whatever President they like the least.
Absolutely a verifiably false statement Kathy. You really should either do research before you try to quote facts, or stick to generalities.
No annual Bush budget deficit was in excess of about $450B (not that that high number is a good number, mind you). Obama in his first year has hit $2T, and that is BEFORE Health Care Reform, the “Clunker” initiative, or the upcoming attempts to pass the Waxman-Markey Bill in the Senate. That will just make the numbers even worse.
To be fair, I think we should remove the years 2008-2010 from this table since obviously the debt will increase during a recession and its aftermath. So, we see that the deficit was about 500 billion a year under Bush (for which there is no excuse), but after 2010/2011 the deficit is estimated to be about 900 billion under Obama. And I would trust the actual historical number way more than the white house “estimate” of future deficits (see my previous comment on the CBO report) so it's likely the actual deficit post-2010 will be more than 900 billion.
So I think it's fair to say that Obama's policies will at least double the deficit, even when adjusting for the current recession.
Gee, I thought Congressional representatives were supposed to represent their constituents and not party apparatchiks.
KK's grip on logic is as tenuous as her command of facts. According to her, it's ok to plan for one-to-two trillion-dollar deficits as far as the eye can see because GWB regularly presided over deficits on the order of one-fourth that amount. It's the same Escherian world in which it is possible to expand medical care AND reduce costs by having the federal government start running the industry.
“Life-threatening mental health conditions, as well as physical problems that a doctor determines will not result in death but will likely have serious health consequences for a woman if a pregnancy is continued, are not included.”
And that seriously doesn't concern anyone? “Congratulations on your new baby, but mommy is dead. We miscalculated slightly and thought she'd just end up as a vegetable. But hey, there was absolutely no chance that Joe Biblethumper might have accidentally somewhere unknowingly and obscurely paid $1 toward saving her life!”
Well, your interpretation may be correct. I don't have much of an interest in trying to figure it out, since from my point of view the amendment is a very bad thing from the get-go, and hopefully (again, from my point of view) the Democrats will be able to strip it out in conference after the Senate bill is voted on.
You can do whatever pleases you, AR. If I were a budgets and spreadsheets wunderkind like Ezra Klein or Marcy Wheeler, I could look at that number dump and see exactly what you've left out and/or what you're distorting or misrepresenting. As it is, I can tell you this with certainty:
The status quo is a non-starter. Doing nothing; leaving things as they are, is not an option. I'm sure this plan is not perfect, because no plan is perfect, and I'm sure there will be problems that need fixing along the way, but I also know that a plan that insures 36 million Americans is a lot better than a plan that leaves 50 million Americans uninsured and their number growing every day. I can also tell you that if you think this plan costs too much, you should be supporting single-payer, because that's the best way to cut costs. Barring that, a robust public option is better than nothing. But if we end up, after the Senate does its work and the two bills are merged into one, with a watered-down proposal without a public option, that is ultimately going to cost all of us much more than spending what it takes to do health care reform right.
Just so you are aware, health care costs have outpaced inflation since the 1950's. We have long-standing systemic problems in the system that have nothing to do with GWB.
Whoaaa. I mean, whaaa? Picture Kathy's jaw dropping. I mean…. reeeaallly? You are serious? Wow! I never knew that!
Okay, snark over. Serious response: Yes, Andy. I know that, Andy. I am fully aware of that, Andy. I am so very, very aware that the health care crisis has been building for the last 60 years — almost my entire lifetime, Andy! I know that it was Eisenhower who first tried to solve the health care problem, and I know that various administrations have tried since then without success. This Congress is the first EVER to get a health care reform bill passed. That may be why all these weird little people out here are so thrilled and happy and have some idea that something good has happened.
And yes, you are absolutely correct that we have long-standing systemic problems that predate GWB. GWB did his humble little part, as one mediocre person and very substandard president, to make those systemic problems even worse than they already were, but he did not start the problem. He was only an itty-bitty boy when the problem had its beginnings.
Now, getting to your solution… Oh wait! That's right! You don't have any ideas for a solution. Or, on second thought, maybe that's not fair. You do have a solution. Don't throw money at a broken system. And that makes so much sense, Andy. When a system is broken, it has to be fixed. And you don't fix it by throwing money at it. You fix it using the faith-based repair program: doing absolutely nothing and hoping the problem goes away. Lord knows nothing ever got fixed or accomplished by spending money. NOT spending money — now that's the ticket to making everything better.
Thank you for this little discussion, Andy. It's been…. enlightening.
And what was the deficit on the day Obama took office?
Thank you, Almoderate. It's refreshing to read something that makes sense in the midst of all the gaseous nonsense I'd been reading up until the moment I read your comment.
And obviously you're right that no one has any concerns about that, except the two of us, apparently.
I guess you don't trust the New York Times and their constant right-wing biased figures that these GOP lap dogs posted (and I quoted above) either. They are just another piece of the vast right-wing conspiracy along with the Congressional Budget Office.
Excuse me while I go grab some oxygen after laughing so hard.
Oh another snippet somewhat related.
Health Care Reform: Reich Overboard!
http://www.slate.com/blogs/blogs/kausfiles/arch…
I thought Clinton (curbed by a fairly fiscally responsible Republican majority) did on the whole a pretty nice job, He had a more bipartisan approach than the current administration and the economy, and the people benefited.
“Well, your interpretation may be correct. I don't have much of an interest in trying to figure it out, since from my point of view the amendment is a very bad thing from the get-go”
Fair enough. But just to tie up a loose end, if I am right (and at this point I'm pretty sure I am), that significantly counters your argument that poor women will not be able to get abortion covered because of this amendment. They may have to spend an extra few dollars a month for it (which I understand you object to) but it is far from “impossible” as you put it on another thread as well as the arguments that others have put forth on this thread.
I actually agree that I would have preferred to have seen an exception for if the mother's health is significantly at risk. However, your scenario seems to me to be both extremely unlike and entirely preventable.
Any medical condition that could cause someone to become a vegetable almost certainly can also be considered life-threatening. Can you imagine a doctor saying, “Well, you might become a vegetable, but there is absolutely zero chance of death.”?
Secondly, the mother could have prevented the situation in several ways:
1) By buying the supplemental insurance, I would think would cost not more than a few dollars a month if that.
2) By not getting pregnant (I understand that accidents happen, which is why option #1 is available)
3) By paying for the abortion out-of-pocket. Even if I were poor, if I were to become a vegetable upon birth I'd find a way to pay. And charities such as planned parenthood are there to help.
So, in the end, the scenario you outlined is about as likely to happen as the CBO's numbers are likely to hold up.
“You can do whatever pleases you, AR. If I were a budgets and spreadsheets wunderkind like Ezra Klein or Marcy Wheeler, I could look at that number dump and see exactly what you've left out and/or what you're distorting or misrepresenting.”
I respect you Kathy, but I have to call you out on this one. These are the numbers from the white house. If anytime you are shown evidence that disproves your point you are going to assume there is some misrepresentation and you are really right, then you are not debating in good faith.
“also know that a plan that insures 36 million Americans is a lot better than a plan that leaves 50 million Americans uninsured and their number growing every day”
Should the cost of the two plans be factored into the comparison, or do you believe a plan that insures more people is always better than a plan that insures less, regardless of the cost?
Kathy,
Touche' on your patronizing response! So my apologies for assuming you didn't the fiscal reality, but you are actually one of the few. Most people simply don't know that health costs have always risen faster than inflation and I made a wrong assumption based on your laying so much blame at the feet of one President.
I do actually have ideas, if you cared enough to ask. Unfortunately, the established political parties aren't interested in the kind of systemic reform I advocate for because they each have powerful vested interests. Yes, that includes the party that you seem to identify with. The Democratic plan which you support does nothing to change the existing system – its the equivalent of rearranging deck chairs. Since, as you've now said, you're completely cognizant of the systemic fiscal problems and the unsustainability of the system, one wonders why you support a bill that ignores those problems and the problem of unsustainability and, indeed, is likely to make those problems worse. It would be interesting to hear your defense on that score.
Just so you're clear on where I stand, here is a short list of general reform principles I think are necessary:
1. Get employers out of the health care business. Employer-provided health care favors corporations over small business and is one of the primary factors of wage depression over the last couple of decades.
2. Get rid of the fee-for-service system.
3. Change incentives and increase transparency within the system so that the consumers of health care better understand what they are getting and how much it costs.
Once that is done I would favor a government sponsored national catastrophic insurance plan where government would pay medical costs over a set amount (let's say $100k a year, adjusted yearly, as an example). This would effectively set a cap on what private insurance would pay out and make health insurance operate more like auto and property insurance (ie. your property insurer knows that your house and belongings are worth X amount and know they won't have to pay more than that. For health insurance, there currently is no limit, raising risks and premiums). Then individuals could buy private insurance to cover whatever they'd like and government could assist those with low income to enable them to purchase insurance.
Of course, that's just one idea and one that has flaws, as any plan would. There are other plans that could work, obviously. The bill that was recently passed in the house is not one of those.
The 2008 budget deficit was just under $500B.
The question you forgot:
The 2009 budget deficit is $1.4T
Almoderate,
Your example isn't really accurate. The standard today, for medicare/medicaid at least, is that “life of the mother” means abortion is permissible when a threat to the mother includes “physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself.” The idea that abortion would be denied if it would only turn the mother into a “vegetable” is absurd.
Since, as you've now said, you're completely cognizant of the systemic fiscal problems and the unsustainability of the system, one wonders why you support a bill that ignores those problems and the problem of unsustainability and, indeed, is likely to make those problems worse.
Kathy is hardly alone here, indeed her viewpoint is shared by the majority of Democrats and especially the ones in Congress. It's pretty clear all the left's moaning about Bush's fiscal irresponsibility was just so much hogwash geared towards getting Obama elected. Just as the GOP was happy to embrace big government if it meant getting a pet program, Democrats are happy to embrace dishonest budgeting and huge spending increases if they get their pet programs.
As they already are, and would continue to be, without any public option — without any health care reform at all.
True to an extent, which is one reason the system needs reform that increases individual responsibility. Moving it in the other direction not only robs us of freedom in the abstract, it doesn't work well in practice. “Collective responsibility” is usually realized as “no responsibility at all.”
I'm pro-choice, which means I think women should get to choose about having abortions themselves rather than the choice being made by some religious lobby group. I also don't really think your weight or how much you exercised last week should be any of my business, and I would rather not have a financial obligation to inquire or to manage those figures on your behalf.
I suppose it depends on how you define “a few dollars.” The women who will be denied coverage because of this amendment (if it remains) are the same women who have the fewest extra dollars to spend.
These are the numbers from the white house.
I apologize for the tone of my reply. I am allergic to long lists of numbers, presented in isolation regardless of their origin, in a situation where numbers do not tell the whole story. Indeed, in the instance of health care reform in general and the House bill in particular, the flat numbers do not provide a lot of insight into the merits of the legislation. You also have to ask what the status quo would cost, and in addition you have to ask if the legislation in question is likely to appropriate the money in effective ways. We're not talking about whether the numbers justify purchasing a bigger house or whether we should stay in the perfectly fine but a bit too snug smaller house. We're talking about, literally, an existential crisis that must be addressed effectively. Therefore, the questions, Does this bill lower the cost of health care over time and insure most if not all uninsured Americans?
I think the mind-set that is illustrated by AR's long list of numbers in isolation with no context and no reference to the larger problem is very short-sighted. I will also admit that, in general, I am at a disadvantage with policy arguments that rely SOLELY on numbers-crunching. It's just not my forte. So I suppose I became a bit too defensive at the way AR framed his argument — this is too expensive and here are the numbers to prove it. It boxed me into a corner where the only counter-argument would be more numbers or different numbers, and (a) my mind does not work that way; and (b) I think that argument, in this instance, fundamentally misses the point.
Should the cost of the two plans be factored into the comparison, or do you believe a plan that insures more people is always better than a plan that insures less, regardless of the cost?
Not necessarily, no. And yes, the cost of the two plans should be factored into the comparison — but it's not enough to judge the merits of the two plans just based on the comparative costs. You have to also weigh what the two plans will respectively do. A plan that costs less money but does not solve the problem, or effectively address the problem, is much, much more expensive in the long run than a plan that costs more money at the start line but *does* effectively address the problem and thus will lower costs over time. That's why I hate arguments based purely on arbitrary bottom lines, as AR's argument was. They are short-sighted.
We'll have to wait and see how much sanity drives a push-back in the Senate toward realism.
The most intriguing question will be what happens if the Senate removes the public option. The lib Dems in the House really want it (the federal takeover effort's core), but (the intriguing question is) will they feel ultimately it's to their relative advantage to pass legislation with much else in it, anyway, rather than pass nothing eventually?
* * *
“They are short-sighted.”
Yes, the proponents of a new federal entitlement, and federal takeover of health care truly and obviously are. I wonder how many of them (you) will be agitated and throw tantrums to no short end if legislation ultimately is passed that doesn't include the public option in it, as I stated already, which is unnecessary insofar as any true “reform” is honestly concerned.
And I have no expectation that proponents (you) will yet note, much less act or want the Dems to act, on reforming and rescuing Social Security and Medicare in their current, unsustainable forms they're in now. (The most sensible acts are the farthest away from what such people want, and what they do.)
“I think women should get to choose about having abortions themselves rather than the choice being made by some religious lobby group”
Actually, that's the mainstream position. Few are absolute (100%) prohibitionists, and of course few want their religious views encoded into the US (federal) legal code. This always has been a straw man.
What the mainstream also isn't, either is 100% absolute accepting and defending of all abortions, of all kinds, and the mainstream is not insistent on creating a new federal entitlement to abortion (the mainstream is against it, if this is the question of the moment).
This always should have remained in its correct federal constitutional place, as a state and local issue.
If state laws are not what you want, work to get them changed by your legislators, or by initiative or referendum, if your states have these devices.
You say, “Here is a short list of general reform principles,” then after you list them you say, “Once that is done,” without ever telling us *how* they would get done. And you give no specifics at all about how you would lower the cost of health care so 50 million uninsured Americans could afford it.
Your “government-sponsored catastrophic insurance plan” is a hoary chestnut by now. It completely ignores what the problem is to begin with — that health care costs are catastrophically out of control, getting higher every day, and totally out of the reach of most Americans. The 50 million Americans who are uninsured cannot afford private insurance. That is the point.
The argument that compares health insurance to car insurance is specious, and has been debunked many times before. The value of human life and health is not analogous to a car. A car is optional; my life is not. And it's a good thing that cars are optional, because I can't afford the cost of automobile insurance in my state anyway. I'm glad I can live w/o a car. I can't live w/o my life.
You do not provide sources here, and I am not an accountant or an economist, so I will rely on credible sources:
This is FactCheck.org fact-checking Bush after his 2007 State of the Union address. Under Federal Deficit and Fiscal Discipline:
We don't know how much health care reform will increase the deficit for 2009, because we don't have a bill yet. But to say that the House version will increase the deficit by $1 trillion, or whatever number is being claimed, is misleading. The more important issue is whether and to what extent health care reform will lower the national debt over time.
The “deficit” is the budget gap for one year, right? And the national debt is the accumulated total of yearly deficits, right? So which is more important — “This bill will increase the deficit by $1 trillion!” or “This bill will decrease the national debt over 10 years”?
If you want to make numbers the sole measure of benefit for public policy, then at least apply the numbers in a way that makes sense.