Monday, August 31, 2009

Should Obama take charge of healthcare reform?

That's the question. Now, Bill Clinton tried to do that 15 years ago. It didn't work -- the House and Senate simply ignored him and did their own thing. But Bill tried to ram it through first thing. He didn't wait for Congress to fuck it up first. I think it's fair to say right now that Congress has fucked it up -- they've tried to shove a 10 pound bill into a 5 pound container, and the shit splatting out is confusing enough that it splatted all over the tracking poll. In particular they've lost the old farts because they are suspicious that 1/3rd of the bill is Medicare reform, which they don't view as something needing reform other than the donut hole. Thus the seemingly nonsensical refrain "keep your government hands off my Medicare!" (heh!).

So there's two things possible here. Either Obama can come in and say, "strip out all this other stuff not related to creating universal coverage and make it another bill", i.e., clean it up and make it lean. That's probably his first inclination. His own health care plan during his campaign was similar to the House approach, except worse, so if he said to the House "throw out all that Medicare stuff and any other miscellaneous and make it *only* about insurance and Medicaid reform to give universal coverage", and gave them said cleaned-up bill, they'd probably go for it.

Or Obama can lead. He can say "Enough. You tried, you failed. We will expand Medicare to all." Then the Republicans have to run against Medicare, and if they do that, they've lost. Medicare is the most popular government program aside from Social Security, and anybody running against Medicare is taking on old folks as well as taking on something that's already a known quantity. You can't say Medicare has "death panels" because it doesn't. You can't say Medicare rations care, because it doesn't -- it won't pay for everything, but you can always buy Medi-Gap coverage from private insurers for the things it won't pay for. And the bill would be literally 5 pages long, most of which would be boilerplate around the three paragraph payload, one paragraph expanding Medicare to everybody, the second one which raises the Medicare payroll tax to 4/4%, the third which adds a 5% Medicare surcharge to the income tax for everybody who makes over $500K/year. I've worked the numbers and that would pay for every dime that's currently being paid through private insurance, and leave enough to cover the current uninsured. Three paragraphs. That's all it would take.

Against this, the right wing could not attack Medicare directly like they do the current bill, because then they are attacking prunes, and prunes get upset when you attack their Medicare. So basically the only thing they could do is attack it on two fronts. The first is on a dollars and cents basis: "Medicare is bankrupt", which is a ridiculous argument because not a single Medicare check has ever bounced or ever will because they come directly out of the U.S. Treasury. They will whine that raising taxes in a recession is bad (and I will simply point out that this proposal does not raise taxes -- it simply shifts the already-existing healthcare tax from the private sector to the public sector). And as I've repeatedly pointed out, the U.S. is the least-taxed OECD nation on the planet, we pay an average of 27% GDP in taxes at every level from school board to federal government as vs. an OECD average of around 35% of GDP, so it's not as if we have no leeway for raising taxes if needed. The United States is a long, long, LONG ways from being bankrupt despite all the Republican anti-American ranting about how America is bankrupt blah blah blah. The second attack would be that it would put "hard-working Americans" out of work. Well, given that the work of these "hard working Americans" is to stand between Americans and their doctors and say "we won't pay", good. This is America. Jobs are not guaranteed for life here. Those "hard-working Americans" can simply re-train for jobs that actually add something to the American economy. I understand Subway's is hiring sandwich artists...

So will Medicare For All happen? Of course not. It would piss off too many campaign donors. As Paul Krugman pointed out recently, in America it is the will of the campaign donors, not the will of the people, that is most important. Votes can be taken for granted when the opposition is as batshit crazy as today's Republican Party. Cash cannot. So Congress is going to come back next month, strip some of the garbage out of the current set of bills under Obama's direction, and set up a Bismarkian system that looks like a strange conglomeration of the German and Swiss systems. That's the best we can do in today's U.S. political system, it seems. The Republicans have done their best to make this nation ungovernable, and even that's pushing it. But I can pine for the days when we had an LBJ who actually knew how to lead, who could get important legislation like Medicare, Medicaid, and the Civil Rights Act of 1964 passed despite rabid Republican opposition... even if one of the places he led us was called Vietnam and was national disaster not only for the Democratic Party but for the nation :(. Obama? He ain't fit to lick LBJ's boots in that regard. So it goes...

--Badtux the Health Care Penguin


  1. You keep writing stuff like that and I am not even going to wait for the sun to get over the yardarm before I crack that bottle seal .
    Your point about Medicare for all is almost poetic . Simple system already in place and functioning well , easy to spread the costs ,
    Such a simple solution to countrywide healthcare . I am 11 years away from Medicare , my wife who is younger by 5 years already has it due to a disibility from a few years ago . Man I would love to get in on that plan .
    And true as you said it probably just won't happen .
    Government Of the Business , By the Business And For the Business .

  2. Tux, you make too much sense. I always wondered why they are not calling the public option "universal medicare" or something similar that uses the medicare word. Unfortunately, we have the best government that money can buy.

  3. Bob Loblaw1/9/09 1:03 PM

    Sorry to say that I don't perceive Obama as a great leader (disclaimer - I voted for Hillary in the primary and Obama in the general.) He's able to motivate his fans, but I don't know how much nutsac he truly bears.

    However, I think that Congress is near totally corrupt with corporate money. The corporate takeover that began in earnest under St. Ronald of Reagan is nearing completion. Our country is governed by those with BIG money. Sad.

  4. While I agree that Obama is not the leader/steamroller that LBJ was, remember too that even 1960s-vintage Republicans (and Southern Democrats) would not have tolerated New Orleans being left to decay for 4 years since Katrina !

    It's also amusing to listen to LBJ's speeches promoting Medicare -- his rhetoric about caring for all Americans is too liberal even for Bernie Sanders. And coming from LBJ, who never was a bleeding heart liberal !

  5. BT
    I hope you don't mind me linking and sending this to as many folks as I can. It's as w3ski said:
    Your point about Medicare for all is almost poetic . Simple system already in place and functioning well , easy to spread the costs
    Does it need to be enhanced? I think so in that it does not always pay enough, but it is close. And it seems both of the big changes that Medicare needs (drug benefit and Medicare Advantage) are already on the radar.
    Now of course you are correct, it will never happen.
    1. It makes too much sense.
    2. It costs the least amount.
    3. It costs the insurance industry too much. (boo fucking hoo)
    4. It's too simple. No simple law will do when a complicated one makes congress look like it worked harder. Also simple is harder for lawyers/politicians to fuck up.
    5. And the most important reason? Same as the first - Makes too much sense.

  6. Why exactly did the mighty LBJ settle for covering less than a quarter of the country, again?

  7. LBJ had a lot of help from Humphry marshalling the Democrats and Dirksen marshalling the Republicans to get the Civil Rights Act of 1964 passed.

    In those days, it was possible to reach a bipartisan solution. But it was still a damned tough fight.

    Now. alas, Big Business owns both parties - including BHO.

    JzB the pessimistic trombonist

  8. We could let the private insurers remain (some people - as delusional as they may be - are convinced they've got good coverage), and have a public option that is simply the possibility for any person or business to buy into Medicare.

    But that's not the public option we have now, nor should we falsely name the meager public options that are being debated "like Medicare."


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