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An Incoherent Truth
Right now the fate of health care reform seems to rest in the hands of relatively conservative Democrats — mainly members of the Blue Dog Coalition, created in 1995. And you might be tempted to say that President Obama needs to give those Democrats what they want.
But he can’t — because the Blue Dogs aren’t making sense.
To grasp the problem, you need to understand the outline of the proposed reform (all of the Democratic plans on the table agree on the essentials.)
Reform, if it happens, will rest on four main pillars: regulation, mandates, subsidies and competition.
By regulation I mean the nationwide imposition of rules that would prevent insurance companies from denying coverage based on your medical history, or dropping your coverage when you get sick. This would stop insurers from gaming the system by covering only healthy people.
On the other side, individuals would also be prevented from gaming the system: Americans would be required to buy insurance even if they’re currently healthy, rather than signing up only when they need care. And all but the smallest businesses would be required either to provide their employees with insurance, or to pay fees that help cover the cost of subsidies — subsidies that would make insurance affordable for lower-income American families.
Finally, there would be a public option: a government-run insurance plan competing with private insurers, which would help hold down costs.
The subsidy portion of health reform would cost around a trillion dollars over the next decade. In all the plans currently on the table, this expense would be offset with a combination of cost savings elsewhere and additional taxes, so that there would be no overall effect on the federal deficit.
So what are the objections of the Blue Dogs?
Well, they talk a lot about fiscal responsibility, which basically boils down to worrying about the cost of those subsidies. And it’s tempting to stop right there, and cry foul. After all, where were those concerns about fiscal responsibility back in 2001, when most conservative Democrats voted enthusiastically for that year’s big Bush tax cut — a tax cut that added $1.35 trillion to the deficit?
But it’s actually much worse than that — because even as they complain about the plan’s cost, the Blue Dogs are making demands that would greatly increase that cost.
There has been a lot of publicity about Blue Dog opposition to the public option, and rightly so: a plan without a public option to hold down insurance premiums would cost taxpayers more than a plan with such an option.
But Blue Dogs have also been complaining about the employer mandate, which is even more at odds with their supposed concern about spending. The Congressional Budget Office has already weighed in on this issue: without an employer mandate, health care reform would be undermined as many companies dropped their existing insurance plans, forcing workers to seek federal aid — and causing the cost of subsidies to balloon. It makes no sense at all to complain about the cost of subsidies and at the same time oppose an employer mandate.
So what do the Blue Dogs want?
Maybe they’re just being complete hypocrites. It’s worth remembering the history of one of the Blue Dog Coalition’s founders: former Representative Billy Tauzin of Louisiana. Mr. Tauzin switched to the Republicans soon after the group’s creation; eight years later he pushed through the 2003 Medicare Modernization Act, a deeply irresponsible bill that included huge giveaways to drug and insurance companies. And then he left Congress to become, yes, the lavishly paid president of PhRMA, the pharmaceutical industry lobby.
One interpretation, then, is that the Blue Dogs are basically following in Mr. Tauzin’s footsteps: if their position is incoherent, it’s because they’re nothing but corporate tools, defending special interests. And as the Center for Responsive Politics pointed out in a recent report, drug and insurance companies have lately been pouring money into Blue Dog coffers.
But I guess I’m not quite that cynical. After all, today’s Blue Dogs are politicians who didn’t go the Tauzin route — they didn’t switch parties even when the G.O.P. seemed to hold all the cards and pundits were declaring the Republican majority permanent. So these are Democrats who, despite their relative conservatism, have shown some commitment to their party and its values.
Now, however, they face their moment of truth. For they can’t extract major concessions on the shape of health care reform without dooming the whole project: knock away any of the four main pillars of reform, and the whole thing will collapse — and probably take the Obama presidency down with it.
Is that what the Blue Dogs really want to see happen? We’ll soon find out.
- Posted in
76 Comments so far
Show AllMy question is: What does it mean to be a Democrat?
It includes "blue dogs" who represent the Industries, but it doesn't seem to speak for ordinary Americans who say they want universal healthcare, peace, accountability etc. Isn't it time Americans get behind a party that speaks for them?
In order to secure US social and econmomic future, National Health Care is the only real option - Those who oppose it do so for reasons that counter the spirit of the American people, and the security of the nation.
National Security requires National Health Care. The biggest threat to any American's security is becoming uninsured thru sickness or job loss. The United States is quite capable of creating a Health Service Branch that could well satisify the demand for health care.
Americans are willing to serve, and serve with honor and compassion. The state of the present health care system forces providers to sacrifice both honor and compassion in order to meet corporate goals. A life of service to others is a calling that should not be "managed" by those who have neither the skill set or compassion necessary to make those decisions. The American people can and will deliver and recieve the best health care on the planet when given the opportunity.
The question that remains - Is Congress willing to lead? Perhaps not. We have the will and the ability to remove each and every individual that impeeds our ability to secure our nation.
Americans do not have a party that 'speaks for them'.
A "Few" have a society that takes very good care of them. They have no needs that are not met, whether they be basic or extraordinarily extravagant.
There was a 'poor light black boy' born in the USA who became so wealthy that he actually changed himself through surgery into an absolute freak, very closely resembling a wealthy 'White Woman' even sounding like one--- while thousands of other 'poor little black boys' could never hope to see a doctor on a regular basis---must less 'tell them' what to make him 'look like'. He could 'buy it'--cause everything is for sale in the USA.
This correspondence could go on for a long time about those 'few' who have a party that speaks for them; but you must understand that the 'party that speaks for them' is the one they 'buy for themselves'---so it could be ANY party---even one that is not named yet.
As long as the USA is a Plutocratic Oligarchy it will be 'a government of the people, by the people and for the people; that 'buy it'. It never really has been anything else.
Now if you are one of those 1%---and actually even the other 'percenters' ---anyone wealthy in America---you can have a pretty good life. If your not, as the majority are not: you can depend upon a struggle from 'cradle to grave', with little or no representation by a 'government' that you can actually depend upon---like the ones who can afford to 'buy it'.
Good Luck America, you really need it.
Ther is no viable party that speaks for the people, and in this present political climate there never will be--American democracy is as much a mith as walking on the moon!
Mr. Krugman, you continue to disappoint this reader. Certainly you have more time and resources to research before you submit your column than I do.
If you had done your homework you'd of easily concluded that the public option going forward is a scam.
ALL the versions of the public option currently being worked on in the congress are being designed to ensure they're NOT competitive with private plans.
Public option no longer means anything at all. We've been baited and switched.
In fact, one of the public options is designed to enroll ZERO people!
http://www.pnhp.org/blog/2009/07/20/
bait-and-switch-how-the-“public-option”-was-sold/
Krugman, screw you and the gatekeeping you skated in with. Single payer is THE option. Nothing else will do. If citizens settle for anything but single payer, within six months they will have major regrets and a case of buyers remorse that will rival TARP.
"But I guess I’m not quite that cynical."
Sorry, Professor, but a lack of cynicism doesn't even come close to describing your naiveté about the so-called "four main pillars of reform" in the circumstances.
I can't do better than the description of the farce and its deceptions that is provided in a recent article written by Helen Redmond:
__
The farce in Washington DC called health care reform makes the blood of single-payer supporters boil. That the Obama administration has crafted and is trying to push through an unfathomable, over one-thousand page piece of shit legislation that in no way ends the health care crisis, and in fact, strengthens the power and position of the private insurance industry, should not be surprising. Obama sold out on the single-payer solution the moment he decided to run for the presidency and accepted campaign contributions from both the insurance and pharmaceutical industry.
[...]
They are betraying what they absolutely know to be true: the private insurance industry must be evicted in order to provide health care to everyone and end the fiscal crisis the multiple-payer system creates. Even the insurance companies know that according to revelations by Cigna whistleblower Wendell Potter. He reports the implementation of a single-payer health care system is what keeps the billionaire CEO’s of insurance companies and Karen Ignagni, the high priestess of America’s Health Insurance Plans (AHIP), awake at night cowering in fear and forced to spend 1.4 million dollars a day to make sure it doesn’t happen. They don’t fear a public option despite their protestations; they accept that due to the depth of the crisis, a few token compromises are in order to stay in business. It’s chump change and in exchange for perhaps losing a little market share, they’re going to get a mandate that legally obligates every person to buy their priced-to-make-profits “insurance products” or be financially penalized. If the Obama bill subsidizes the uninsured going into private plans, that’s millions of new customers to extract profits from and a transfer of taxpayer dollars into insurance industry coffers. The Massachusetts mandate madness gone nationwide.
__
Health care should be local and not in Washington . Prior to the era of R.R. many States had health care facilities which he destroyed . Some of the remnants of these facilities are still intact and could be expanded with some of the stimulus money to provide for all citizens again while increasing employment . If these facilities could be , without too much turf war , be incorporated with the V.A. health care system and include seniors also there would be funds from these two groups which could be augmented with an employee tax to cover most of the rest . If all health care providers are under contract costs would be controlled which is what our present problem is . The AMA and insurers would be against this but that would be fought out in the different States which would spread their anti-forces over a large area and maybe weaken them . This would also relieve some of the health care burden carried by employers which would make them less inclined to move the jobs elsewhere . Thanks to Rep D.K. of Ohio this is possible .
Health care cannot really be other than local at its core. In any case, the central issue actually has nothing to do with health care per se at any level.
In the simplest possible terms it's a question of whether the insurance industry "skim" provides any medical value added. Since it obviously doesn't (and in many cases actually results in health care value being subtracted) why should it be retained as a cost item in the health care ledger ANYWHERE.
Exactly !! It's insane. It really is.
The incoherence is the sound of Krugman (and he's one of the best "the people" have in the power structure) helping to keep the scam going forward. Maybe he's thinking that the current "reform" package being presented is the "best" we can expect for now, but the fact still remains that the only group not represented in Washington by the two major parties remains "the people."
Krugman here is simply keeping that fact alive.
Krugman complains that the Blue Dogs are not making sense. But the interesting thing about the "health reform" debate in Washington is that basically no one is making sense, because nothing other than single payer and cost reduction through correct regulation and increased supply can correct the system.
In effect this is the Waterloo for the right wing control of the economy: health is the one thing that you absolutely positively must be progressive about, or it will apparently sooner or later cost you the whole economy, which in turn will sooner or later cost you the Constitution and the political system. If there is any justice at all in this world, the right wing system will completely go up in flames, due in no small part to the prime tinder provided by the health issue.
That's exactly why it must be defeated with every weapon at their disposal. It potentially calls into question a very wide range of other "socialist" issues regarding private profit versus the public good.
The fear of that possibility is by no means exclusive to the "right wing" of USA Incorporated's dual political facade. It's pervasive and palpable throughout the entire establishment system. If you lose this one, it's unlikely that you'll ever get a second chance short of revolution.
Yes, they always seem to believe in the "domino theory" don't they. But the domino theory has never seemed to be correct in real life. So if the right wing knew what was good for them, they would agree to at least two of the three between single payer, new cost regulation, and increased supply. I am reasonably sure all three are needed, but anything less than two of them is a 100% guarantee of failure. If the right agreed to two out of three and the economy still remained collapsed, at least they could say they tried something on the health front, laugh out loud.
But they definitely do not know what's good for them. All they know is that they think they should win every battle because they think they are right about everything. The fact that by using money and guns they control almost everything has led them to this ultimate arrogance.
But this honestly looks to be their Waterloo. The economy obviously can not handle the level of greed existing in the health industry and especially the health insurance industry. The right wing can enter the "health reform" battle and even seem to win it, but their "win" will really be a massive loss down the road.
[PS RV: The right wing is virtually all of the Republicans and roughly 3/4 of the Democrats.]
Heh. You're right of course. I'm sometimes confused by current political classifications that include the John Birch Society in the center-left. :^)
The Blue Dogs emerged just as the Democrats were running out of excuses for spineless capitulation and ongoing incompetence.
Amazing how that worked out, isn't it?
Ya think Obama will lecture and threaten them like he does the progressives--even when the progressives, more often then not, reflect popular will, whereas the Blue Dogs might as well be Republicans.
Isaiah predicted:
"And thorns shall come up in her palaces, nettles and brambles in the fortresses thereof: and it shall be an habitation of dragons, and a court for owls."
Good morning, U.S. Congress!
And good morning, Obimbo, and the army of prowling sycophants and predators in your administration.
knock away any of the four main pillars of reform, and the whole thing will collapse — and probably take the Obama presidency down with it.
Is that what the Blue Dogs really want to see happen? We’ll soon find out.
Yes, that's what they really want to happen. And if it does happen, then to Obimbo I say: Couldn't happen to a nicer guy.
"And if it does happen, then to Obimbo I say: Couldn't happen to a nicer guy."
Gosh, even as the obstacles to legitimate common sense efforts couldn't be made any clearer, why must we still find it necessary to mock the man who would at least try?
Yes, that is probably what the Blue Dogs really want. And it is a great example of the disease infecting Washington, with which any office holder must contend. Neither you nor I would likely put ourselves into such a thankless position, and why so many politicians inevitably succumb to the graft - if folks aren't going to appreciate what I'm trying to do for them, I may as well get what I can out of it.
In the end, it doesn't just happen to the guy, it happens to all of us.
"knock away any of the four main pillars of reform, and the whole thing will collapse — and probably take the Obama presidency down with it."
Obama had a choice and he took it: accept corporate "bribes" from the healthcare industry and become one of them, or, represent the people and support a creative plan to provide healthcare for all. Remember that he was for "single-payer" before he was against it.
His inept rationalization for not supporting "single-payer" (having to start from scratch) is an affront to the citizenry he purports to represent. Is it not the function of the Executive Branch of government to implement and execute laws and programs passed by Congress?
Cannot a renowned economist, Mr. Krugman, perceive that the "incoherent truth" is that "single-payer" makes his four pillars a moot question?
The demise of the Obama presidency will be of his own doing, and rightfully so.
"Blue Dog" campaign contribution sources:
http://www.publicintegrity.org/articles/entry/1572
His inept rationalization for not supporting "single-payer" (having to start from scratch) is an affront to the citizenry
Good thing he wasn't around for slavery...
Obama:"I agree that, if we were starting over from scratch, then abolishing slavery would be the best way to give freedom to everyone but..."
jlocke:
Great comparison to show what a wishy washy compromiser he really is.
Single-payer advocates: what is your plan for the 444,000 health insurance industry employees who would be unemployed?
"what is your plan for the 444,000 health insurance industry employees who would be unemployed?"
I suggest forced labor on an organic sprout farm.
There would be plenty of jobs in the single-payer system structured as Medicare-for-all; albeit, not for the high paid healthcare industry executives.
Really? Then, aside from the savings associated with the elimination of the highly paid executive salaries, where are the efficiencies?
•HR 676 establishes an American-styled national health insurance program. The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and cost effective health care services regardless of ones employment, income, or health care status.
•With over 45-75 million uninsured Americans, and another 50 million who are under insured, it is time to change our inefficient and costly fragmented health care system.
•Physicians For A National Health Program reports that under a Medicare For All plan, we could save over $286 billion dollars a year in total health care costs.
•We would move away from our present system where annual family premiums have increased upwards to $9,068 this year.
•Under HR 676, a family of three making $40,000 per year would spend approximately $1600 per year for health care coverage.
•Medicare for All would allow the United States to reduce its almost $2 trillion health care expenditure per year while covering all of the uninsured and everybody else for more than they are getting under their current health care plans.
•In 2005, without reform, the average employer who offers coverage will contribute $2,600 to health care per employee (for much skimpier benefits).
Under HR 676, the average costs to employers for an employee making $30,000 per year will be reduced to $1,155 per year; less than $100 per month.
Let me be more specific about my question. Where are the efficiencies of single-payer realized if you employ all 444,000 private health insurance industry employees (minus the few highly paid executives)? Isn't the point to reduce the adminstrative overhead? Any way you cut it, a lot of people are going to be without jobs.
Here's your specificity cyon:
Establishing a national single-payer style healthcare reform system would provide a major stimulus for the U.S. economy by creating 2.6 million new jobs, and infusing $317 billion in new business and public revenues, with another $100 billion in wages into the U.S. economy, according to the findings of a groundbreaking study released today. It may be viewed at www.CalNurses.org.
The number of jobs created by a single-payer system, expanding and upgrading Medicare to cover everyone, parallels almost exactly the total job loss in 2008.
You aren't the first person to ask a question like that.
When the horseless carriage came along, workers in the horse-carriage industry asked a similar question that you asked.
You can pretty much guess what the answer was back then...and now.
So your answer is tough luck? And here I thought that the motivating idea behind a single payer system was taking care of each other. How is your response any different from that of a conservative saying "tough luck" to the public employees who get laid off when their industry is privatized?
Bluedog = Neocon = Greed.
This "Blue Dog" meme is a corporate media myth.
The public option being proposed by the LIBERAL Democrats is a pathetic, empty fraud that will neither control cost nor expand coverage. It's the likes of Waxman, Rangel, and Kennedy who are scamming the American people.
Here's the proper equation: Yellow Dog (Liberal)= Blue Dog = Republican = Neocon = Neoliberal = corporate ruling class.
People out here need to stop taking their talking-point cues from the mass media and actually read some of the articles on CD.
The Blue Dogs have their free, tax-sponsored health care program; why would they want anyone else to have some of it?
I'd say vote them out, but with once-progressives bringing back the heinous Pelosi, I'll not hold my breath.
I sometimes wonder if Americans are too stupid to be allowed to vote.....
Krugman seems to be following some dictat of writing about healthcare in corporate media these days. Otherwise why could he not devote even three sentences to pointing out the the majority of citizens and health care professionals favor a universal care single payer system?? Or does he write it and the Big Brothers at the Times censor it out? Yesterday's Sunday NY Times had two long articles and a single very long editorial on healthcare. In all the writing, nary a mention of single payer or Medicare for all. For the Times, like the rest of the corporate media and the money corrupted Congress, with few exceptions, the medical program that the people favor is unspeakable.
Hopefully the people are watching this whole corrupt spectacle of a morally bankrupt, criminal capitalist system and the political parties, Dim and Repug, who are easily bribed and do its will. Along with the servicing of the corrupt theives of Wall Street to the tune of now $23 trillion!!, the healthcare debacle reveals for all who can see, and not be bamboozled by corporate media spin, the dire situation the citizens now find themselves stuck in.
"So what do the Blue Dogs want?"
They simply want a bipartisan bill, one that satisfies both the medical and insurance industries.
I have some questions.
1. What does employment have to do with health care? Not everyone is employed, and nobody is employed during his entire lifetime. So how much sense does it make to channel health care through employers? None, I submit.
2. Do we really need to determine eligibility? Why not just decide that if you need medical care, you get it. Think of the savings that would bring.
3. Why should the patient be required to pay for care? If you put the health workers on a salary, the cost is the same no matter the treatment. You can eliminate the overhead now given over to coding and all the mechanisms of reimbursement, saving many more millions.
4. Is the public-private distinction useful? I think not. Look at all the people in 'defense' work. Are they in public or private industry? The firm may regard itself as private, but the bulk of its revenue comes from government, so in some sense they are all government employees.
5. Might it not be more efficient in the long run to go back to basics and redesign the system from scratch, as if there were no system in place?
Esteemed Grower of Gorse:
Soundly, concisely reasoned. But you're speaking una lengua extranjera, doomed to fall mutely on the monoreasoning ears in Washington.
Point 5 might make some sense if it were true of any government program. Once they are in place they never are redesigned from scratch. If you look at national health insurance programs in Europe, they all differ depending on the historical conditions under which they developed. Social programs aren't developed according to what's rational, but what's possible under the given circumstances. That's why it's pointless to talk about single payer. It may be the most rational and efficient, but it's also not possible under current political and economic realities.
cyon July 27th, 2009 4:21 pm What's possible is what We the People say is possible. The cost of TARP looked impossible, but it was shoved up our butts through fear and a cowardly CONgress. NOW, it's our turn to push through SINGLE PAYER.
What's possible is what well-heeled interest groups with influential lobbyists say is possible. That's interest group politics in the USA.
cyon...pardon my rudeness, but you don't know what you are talking about. I have lived in five countries and reside in Canada now. Europe's and Canada's social programs and medical programs are not set in stone. They change and evolve all the time. And usually they are developed from humane, rational, and democratic values. (NOT "...what's possible under the given circumstances.")
It is not pointless to talk about single payer. It is the only rational and humane system there is. The rest is corporate greed.
What's rude is not actually paying attention to what I said, and then arguing from your own weaker version of what you say I said. That's called the Straw Man Fallacy. I said they are never totally redesigned from scratch. I did not say that they never change. I suggest you look into the history of the development of these systems. You will find that they form they take now, from totally government run to a blend of public a private, is a function of the historical context in which they first developed. The context in the US currently is a huge private US health insurance industry employing 444,000 people. Do you really think you can eliminate this? If so, then I think a closer look at how interest group politics works in the US would be warranted.
Here's the same response I posted on the John Nichols article today, thanks to AD's idea on the same. I think this approach has powerful merit.....
AD July 27th, 2009 1:53 pm.........AD, I believe you have found the "Achilles Heel"...This is the CONgressional weak spot and is exactly where to get to these greedy bastards. And remember, the taxpayer pays the toll for these CONgressional scam artists. Here's a site I found that explains it pretty well..Could find nada on Wiki...hmmm...wonder why? Now, to get this into the MSM...good luck....See if one pundit has the cajones to to bring this up...Maddow....Olbermann?
http://public-healthcare-issues.suite101.com/article.cfm/
health_care_for_the_us_congress
Can you imagine confronting a rep or senator with one simple question...."Why can't every one of YOUR constituents have the same healthcare that YOU are privledged to have?"
HOW COULD THEY RESPOND INTELLIGENTLY WITHOUT INSULTING THE VERY PEOPLE THAT PUT THEM THERE??
the health care for US Congress, the FEHB system, is not any better a deal than most poeple get from a private employer - and not as good as most unionized workers get.
I'm a government employee and pay about $357 a month for my employee share. If I'm laid off, it goes up to about $1300 a month. So please let off with how the everyone should have the same health plan the US Congress gets. We can do much better than that.
Your linked article is misleading. FEHB is an employer group plan. Employer group plan don't normally wait periods or preexisting condition - at least not the ones I had when I worked for a private employer.
This site says that the CONgress is insured under this plan. Do you have the same insurance as the CONgresspeople have? Maybe they're wrong..it's all the info I could find without a really extensive search. Found nada on Wiki...maybe you can find something better.
Yes. All federal employees, including members of congress and paid staff, get covered under the same employer-employee shared-cost FEHB plan.
www.opm.gov/insure/health/rates/index.asp
Postal workers get the best deals - better than congress - because of their union contract.
And yes, the government (employer) share is "at the taxpayer's expense" in exactly same way a grocery worker's insurance is paid (in full under a some union contracts) at the food buyer's expense; i.e it is their source of revenue.
pjd412 July 27th, 2009 4:02 pm...And what is it that you object to here?