"The President basically reduced public option to a marginal welfare program for 5% of population"

[brentspeak]

(edited for copyright purposes-proud patriot Moderator Democratic Underground)

An excellent commentary on Obama's speech: and proposed policy:

http://www.huffingtonpost.com/marshall-auerback/obamas-health-care-speech_b_282901.html


Marshall Auerback

Roosevelt Institute Braintruster
Posted: September 10, 2009 07:43 PM

A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation's health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from "integrated" systems, like the Veterans Administration, that directly provide some health care as well as medical insurance.

Yet Obama is not prepared to grasp the nettle. His speech was even weaker than the spin preceding the joint address to Congress suggested. I thought the Obama people were lowering expectations with a view toward a big positive surprise and they managed to go even lower than the bar they set. He took caricatured positions on single payer in order to create a false "centrist" option. The President has basically has reduced the public option to a marginal welfare style program for 5% of the population, rather than seeing it as a way to break the monopoly of the private health insurance companies, thereby helping to reduce costs. He's basically forcing everybody into a private health insurance run program.

The bad news is that Washington currently seems incapable of accepting what the evidence on health care says. The Obama Admininstration remains under the influence of the health insurance and pharmaceutical industry lobbyists, and is captive to a free-market ideology that is wholly inappropriate to health care issues. As a result, it seems determined to pursue policies that will increase the fragmentation of our system and swell the ranks of the uninsured.

We need affordable health care, not health insurance. Just look what is happening in MA. It's not solving the problem at all, because there was no mechanism introduced to REDUCE HEALTH INSURANCE COSTS. Physicians for a National Health Program's (PNHP) study of the Massachusetts model found that the state's 2006 reforms, instead of reducing costs, have been more expensive than expected. The budget overruns have forced the state to siphon about $150 million from safety-net providers such as public hospitals and community clinics:

[Autumn]

1. Excellent article K/R for truth

:kick:

[Laelth]

16. Agreed. k&r for the truth, even when it's not flattering to one of our own. n/t

:dem:

-Laelth

[chervilant]

72. WTF?!?

So, I am beginning to think General Discussion only works if your post is short and to the point. Apparently, DUers find lengthy, pithy posts too daunting an effort?

I just posted an entire email message from The Pen about Obama's weak, waffling address on 'health care reform' and no one has responded to it, and very few have read it. Is it the title: "Obama's Leech Therapy"? We can't point out Obama's distressing--and wrong--stance on health insurance reform because that would be a betrayal?!? What are we supposed to call his current position?! Isn't he betraying US????

The Pen provided several ways to be activists regarding health insurance reform at the end of their email--but so few DUers have bothered to get that far. Is posting on a blog the extent of your activism?!

[inna]

73. do you have a link to your post? it's EXTREMELY easy to overlook posts on this board.

you seem to make an assumption that people saw but ignored your post, whereas most people get a chance to read only a small fraction of what is posted on here.

it's like lottery in a way, and often people scan for and respond to familiar names (of OPs).

anyway, i'd like to take a look at your post if you can provide a link. :hi:

[Laelth]

74. Are you sure you're responding to the right post?

If so, I am misunderstanding you.

:shrug:

:dem:

-Laelth

[jbnow]

69. Are you kidding? It is not true at all. They have public option wrong.

The plan sure isn't single payer but "The President has basically has reduced the public option to a marginal welfare style program for 5% of the population" isn't related to reality.

5% was an estimate of how many would chose that option.
The only people who are not eligible for it are people who get insurance through their employer.
Anyone else would be free to chose from any option on the exchange. To be on the exchange a plan must meet or exceed set standards, just like public option will.
These include things like
No bias on preexisting conditions.
Can't deny anyone, can't charge more or close anyone due to them. Also a limit to how much more you can charge due to age...a ratio between cost of most and least expensive
No lifetime or annual limit on treatment
Limit on maximum annual out of pocket costs for policyholders
In main house bill it is set pretty high for lower income people, $5000 for individual and $10,000 for family. (Don't know if they get help on that as well as premiums) It might be a hardship it is workable through a payment plan for most of us, it's not a bankruptcy
No copay on certain preventative care or well baby care
I'm not sure if it will include what he is suggesting:
Adult children can be covered on parents policy to age 26
All employer plans must at least meet the minimum standards required of plans on the exchange.
Both individuals and small business are free to buy into any plan on the exchange.
People who are eligible for subsidy can use it toward any plan on the exchange.

If set up like current plans the exchange itself drops prices lower than they are. That is because whatever plan on exchange you join you are part of the big group and rates are set that way. Right now administrative costs included in the premium cost is about 7-10% for largest companies and jumps to 25% for small business and is even higher for individual policies. Theoretically all buyers on an exchange would get big company rate

The article says

rather than seeing it as a way to break the monopoly of the private health insurance companies, thereby helping to reduce costs. He's basically forcing everybody into a private health insurance run program.

Opening ones mouth (or running ones fingers) when you don't know what you are talking about it a bad idea. Maybe listening to what Obama says about it time after time after time would be good.

here

And I do think that having a public option as part of that would keep the insurance companies honest, because if they've got a public plan out there that they've got to compete against, as long as it's not being subsidized by taxpayers, then that will give you some sense of what -- sort of a good bargain for what basic health care would be. (Applause.)

and later

Now, the only thing that I have said is that having a public option in that menu would provide competition for insurance companies to keep them honest.

Now, I recognize, though, you make a legitimate -- you raise a legitimate concern. People say, well, how can a private company compete against the government? And my answer is that if the private insurance companies are providing a good bargain, and if the public option has to be self-sustaining -- meaning taxpayers aren't subsidizing it, but it has to run on charging premiums and providing good services and a good network of doctors, just like any other private insurer would do -- then I think private insurers should be able to compete. They do it all the time. (Applause.)

Then there is here

Every plan should include an affordable, basic benefits package. And if you can't afford one of these plans, we should provide assistance to make sure that you can. (Applause.) I also strongly believe that one of the options in the Exchange should be a public insurance option. (Applause.) And the reason is not because we want a government takeover of health care -- I've already said if you've got a private plan that works for you, that's great. But we want some competition. If the private insurance companies have to compete with a public option, it'll keep them honest and it'll help keep their prices down. (Applause.)

this is the speech the author got the skewed ides from

I just want to hold them accountable. The insurance reforms that I’ve already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear – it would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.

The 5% is an estimate, not a limit. I guess he clumsily worded the way he said it??? Usually he says "If you like your plan you can keep it and then goes on to say 'otherwise you can look up the exchange...'

There are more examples...but I have never heard him talk about the public option without saying what he is accused of not saying

I realized as I was typing this people surely noted the same thing further down the thread, I started responding before I kept reading...but it was a lot of work with my slow typing and HTML and stuff so I will post anyway.
And if kicking for truth the truth should be near the top since it is not in the article.

[liberalmuse]

2. 5%, but it's IN THERE.

And it's a start. Hell, we've not been able to do anything regarding health care reform in so long, I'll be happy if we get our foot in the door. We can go from there. I have no doubt that the Public Option will take off once everyone else sees how it works for the 5%.

[Better Believe It]

5. Employers and individuals won't be free to dump private insurance and buy public insurance

You'll be required to buy private insurance.

If you can't afford it you'll qualify for some bare bones "public welfare" insurance that probably won't be as good as going to the emergency room!

It will be a failed welfare program and will kill any chances of getting single payer Medicare for All anytime early in this century.

[SpartanDem]

13. BS

There are specifc provision about the ability to drop employer coverage

311. HEALTH COVERAGE PARTICIPATION REQUIREMENTS.

An employer meets the requirements of this section if such employer does all of the following:

(1) OFFER OF COVERAGE- The employer offers each employee individual and family coverage under a qualified health benefits plan (or under a current employment-based health plan (within the meaning of section 102(b))) in accordance with section 312.

(2) CONTRIBUTION TOWARDS COVERAGE- If an employee accepts such offer of coverage, the employer makes timely contributions towards such coverage in accordance with section 312.

(3) CONTRIBUTION IN LIEU OF COVERAGE- Beginning with Y2, if an employee declines such offer but otherwise obtains coverage in an Exchange-participating health benefits plan (other than by reason of being covered by family coverage as a spouse or dependent of the primary insured), the employer shall make a timely contribution to the Health Insurance Exchange with respect to each such employee in accordance with section 313.

[LooseWilly]

76. So employers will have to contribute to the Exchange for employees who don't take the employer offer

of health insurance.... but there is no mention that the employer contribution would reduce the payments of the employee... and you believe that this plan will be approved? And that employees will be able to choose a public option from the Exchange even if that would cost their employers money without contributing anything toward insurance companies....


Your snip doesn't mention under what circumstances an employee could choose not to take an employer up on offered insurance... does not mention anything about qualifications for a public option... does not even mention the existence of a public option... and come to think of it, I'm not even sure what proposal you pulled this snippet from. If it's from the HELP committee, then it's pretty much irrelevant, isn't it?...

[Raineyb]

7. We already have medicaid. Having a public option that's just another

welfare program defeats the purpose of getting EVERYONE access to health care.

[Oregone]

8. Itll take off zippy fast and cover everyone, probably following the same trend as Medicare!

I think the government ran postal office is dropping the ball, because we all should of got our damn Medicare for All cards years ago!

[Xipe Totec]

11. It's not a start; it's a finish

Once they pass this they will declare victory and move on.

And the insurance companies will continue to bleed us to death.

[Doctor_J]

27. No, it's an end

a replacement for HC reform, not the start of it. The other 95% of us will be gouged by the private insurers, with no recourse.

[dflprincess]

44. Agreed

the main point of the bill appears to be to shore up another industry whose bubble will burst if the public is not forced to support it.

[Soylent Brice]

51. but, we all see how medicare works. everyone sees how medicare works.

so... now what?

[debbierlus]

63. The problem is that it won't be able to work with such a low enrollment number

And, rates not tied to Medicare.

There is a real danger that a really weak and impotent public option will not be able to provide lower rates then private companies, setting the stage for the Republicans to say 'see, the government program is a failure. Too expensive.'

The type of public option is VERY important.

[Doctor_J]

65. this is probably part of the plan

to construct it in a way that it's guaranteed to break, then say, "See, it' broke". Better let the "private sector" - i. e. death merchants - do it.

[inna]

78. unfortunately, it's just the opposite. the way it is designed right now

suggests that it will cover the most difficult, "unprofitable", "money-draining" patients (those who are refused by for-profit insurance companies) and thus - politically convenient for some - it may serve as a poster child for "failure of government programs" (since it is unable to fully exercise bulk purchasing power and limited to the most expensive patients by design).

[ProSense]

3. What utter bullshit

Yet Obama is not prepared to grasp the nettle. His speech was even weaker than the spin preceding the joint address to Congress suggested. I thought the Obama people were lowering expectations with a view toward a big positive surprise and they managed to go even lower than the bar they set. He took caricatured positions on single payer in order to create a false "centrist" option. The President has basically has reduced the public option to a marginal welfare style program for 5% of the population, rather than seeing it as a way to break the monopoly of the private health insurance companies, thereby helping to reduce costs. He's basically forcing everybody into a private health insurance run program.

More crap from the single-payer distortionists.

Yet Massachusetts seems to be the implicit model.

Mass does not have a public option

"The Clinton health care version at least tried to deal with the issue of portability, so that health care did not get tied in directly to employment (a highly germane consideration in a time of double digit unemployment and mounting economic insecurity). There is no hint of that in the Obama plan. If anything, it represented a retrograde step from what was on offer in last year's campaign via the Clinton or Edwards health care proposals."

Hillary's plan was the ultimate mandate plan and did not include castatrophic coverage.

[Mojorabbit]

4. Great article nt

[Better Believe It]

6. That's why it's being unrecommended by White House/Democratic Party staffers and wannabes.

[berni_mccoy]

9. I love the Misinformation being spread by the left. It's just as bad as the shit from the right.

[Oregone]

10. The cushy gooey center will protect you and give you comfort

[quantass]

14. +1

[Better Believe It]

12. What misinformation? Links please.

[berni_mccoy]

15. OH, Ok, so the OP can say whatever b.s. OpEd they want and provide no FACTs or supporting evidence

But I can't call it bullshit without supporting evidence?

Let's start with the title, which isn't even the title of the OpEd piece.

[seafan]

25. OK, let's start with the title....

The article's title is "Obama's Health Care Speech: Soaring Rhetoric, Scant Imagination".

The OP should be credited, actually, for using a less inflammatory subject line instead of that original headline.



This article really does give another look at unpleasant reality. None of us like it, but it's what we've got.

[Better Believe It]

29. So people shouldn't express their opinions without your approval?

And you never pay any serious attention to opinion pieces and the opinion of others?

You must not read books, newspapers or magazines.

The 5% stat is absolutely factual.

[berni_mccoy]

32. 5% eligibility is about as factual as a thought in your head. The CBO estimates that 5% will CHOOSE

to enroll in the Public Option during the first year the plan is active BECAUSE competitive private plans will be AS AFFORDABLE. That's the whole POINT of the PO: to make Insurance COMPETE with the Public Option. There will 100% ELIGIBLE, and the PO will start with a MARKET SHARE of 5%.

[dflprincess]

46. Link?

You often accuse others of spreading misinformation yet you don't seem to feel the need to back your own posts up with links. I suppose we're just to trust that you are "informed".

[Better Believe It]

52. I have a very nice bridge I'm sure you'd like to buy. It's in Brooklyn!

[Doctor_J]

66. Private insurers are bakrupting the country. If the PO isn't good enough

to compete with the most expensive and lowest quality health care in the world, then it's not being implemnted correctly.

[dflprincess]

Whoops - posted in the wrong spot!

self delete

[Aramchek]

17. it's got to start somewhere

[Oregone]

19. It already has

How can anyone look at Medicare, Medicaid, and the SCHIP bills and think a whole new government bureaucracy needs to be created to make a "start".

[Aramchek]

20. none of those apply to average Americans, the Public Option is the next step in this progression

the PO will be the first program to cover people over 18 and under 65 who aren't in poverty.

there will be more progress as time goes by.

[Oregone]

23. The public option in the "exchange" is also not for average Americans

It will not be an option for most.

Those "starts" need to be extended. We don't need a new one.

[Aramchek]

24. so, you want Medicare for all immediately, right?

that would close down the Insurance Industry in one fell swoop.
that's why it won't happen.

we have to starve the Insurance Industry to death over time.
if we try to destroy it in one blow, it will take our economy with it.

[Oregone]

26. I would take lowering the age limit and covering children to continue that "start"

Which would instantly impact risk pool assessment for the rest of the country.

Anyway, you shouldn't just repeat corporatist fear inducing talking points...at least not for free

Single-Payer: Good for Business
http://www.pnhp.org/news/2004/november/singlepayer_good_f.php

Universal health care would be a boon to the free market
http://www.pnhp.org/news/2007/november/universal_health_car.php

There is also a study posted on the PNHP site which shows a net job increase from single-payer

BTW, thats just a bullshit lie. Even single-payer countries have supplemental private insurance plans. They wouldn't shut down overnight. They would consolidate and transition

[Aramchek]

31. lowering age limit and covering kids would still leave millions uninsured.

I thought you wanted Universal coverage?

>>>They wouldn't shut down overnight. They would consolidate and transition

they would drop from 14% of the economy to what?
how many would be left unemployed by this downsizing?

it has to happen over time for it to succeed in the long run.

when the Public Option is fought for and won, will you still say we lost?

[Oregone]

35. This plan will still leave 37 million uninsured

So, at the end of the day, at least what I suggested is creating dynamic coverage criteria on the most efficient insurance deliverer in the country, such that it could be more favorably re-established later.

You could do what I suggested and cover 5 million more, tomorrow, than the public option will likely cover by 2019.


"when the Public Option is fought for and won, will you still say we lost?"

Probably. It really depends how accessible and affordable such an option ends up being. If premiums are under $200 for a middle class family and ANYONE can EASILY sign up for it, then it will likely be a good thing. Thats all not likely to happen.

[Aramchek]

36. well, at least we can agree that Bob Dylan is a badass?

we'll see what happens with the Public Option.

I think we will get more than you expect, and once it is law it can be built upon much more easily.

[area51]

79. Medicare for all would "... close down the Insurance Industry in one fell swoop...."

Actually, it wouldn't. Nice try, though. They could still sell health insurance for things like face-lifts and tummy tucks, which no reasonable Medicare for all plan would cover. Also, they can go into the car insurance, home insurance, flood insurance, etc. businesses and stay afloat.

[dflprincess]

47. The public option is "starting from scratch"

Yet Obama says we can't have single payer because that would be "starting from scratch" - has no one told him about Medicare?

[polichick]

18. Another unrec thread - more inconvenient truths. k&r nt

[ProSense]

21. Distortions are not truths.

The author is completely disingenous. He slams mandates, and to create dissension, injects Edwards and Hillary, whose plan was mandated coverage with stiff penalities.

[polichick]

22. There are plenty of inconvenient truths in this piece - wake up. nt

[ProSense]

42. No, there are only distortions for people who choose to believe them. n/t

[polichick]

45. ...

[ProSense]

50. Be mature. n/t

[polichick]

55. Nothing immature about that - it's dead on. nt

[Bluenorthwest]

38. Because Obama ran claiming to oppose mandates

and ran ads about how bad Hillary was for demanding them. He's saying the two who wanted mandates lost, and the 'I'm against mandated individual purchase' candidate won. And that is simple fact.

[ProSense]

43. Obama said affordability first.

He has always maintaint that he will not support mandates that don't provide appropriate subsidies for those who cannot afford coverage.

He is not against mandates, as SCHIP mandates coverage for children.

[dflprincess]

48. During the campaign he claimed he was against any mandates

that would force people to buy insurance (like Romney Care). Of course, when he was a state senator he like single payer. The further up the food chain he goes, the more corporate friendly he becomes.

[ProSense]

49. "Obama would consider an individual mandate for adults..."

Obama's plan would only require all children to be covered. Obama would consider an individual mandate for adults once affordable health insurance is available to everyone. To get there, he proposes a national health insurance exchange to help individuals who want to buy private coverage. His plan would also provide federal income-related subsidies to help people buy coverage.

link

[dflprincess]

60. Yes the New York Times refers to this as the "evolution" of his ideas

I'd call it devolution of his position. It does remain true that he wouldn't commit to the mandate for everyone when it was Clinton suggesting it.

HR3200 caps premiums at 11% of income so that must be what is thought to be "affordable". For a single person making $43,000 that's $394/month quite a bit more than people in civilized countries pay - and that's only for insurance, they still may not have access to healthcare.

[depakid]

28. "Washington currently seems incapable of accepting what the evidence on health care says. "

Truer words have rarely been spoken- and they extend well beyond health care....

[juno jones]

30. K&R

The 5% are discussed so cavilierly, like we weren't even in the room.

It is so easy for people who have never been means tested to suggest it for others. Especially for the 5% that they don't belong to.

From what I can see this would simply mandate that I buy whatever crap insurance my employer offers instead of having a government run option.

If I remain outside that system I must meet all the criteria for qualifying for yet another welfare program. Like total assests including a car for transportaion in the $3000-$5000 range and an income that is impossible to live on.

And meanwhile nothing is done to change the system of health for profit, to contain costs or to wean the fatCEOpiggys from the trough.

I could give a shit about insurance industry jobs. Many of them didn't give a shit back when all the good jobs in my home region left for overseas. I wish I were more compassionate, but I've worked hard to make other people's american dreams real for thirty years now. It's time I got a little appreciation from those I've made rich. And it'll ultimately benefit them too because employer-based insurance is a drag on hiring and the economy as well. How can we be expected to 'compete' with such shackles on small buisness?

[Orsino]

33. And 5% is how much more than zero? n/t

[Hekate]

40. ~~**~~

:thumbsup:

[brentspeak]

53. 5% is exactly the number Obama needs to wash his hands clean from any real public option

He can do a victory lap while the average American not among the 5% eligible will lose. It's a way of closing the book on any real reform.

[Orsino]

70. The difference between coverage and none for millions of people?

That will be worth a victory lap.

[Mojorabbit]

71. If you worked in the health care field

and saw how many people were in dire straits needing help you could not in good conscience say such a thing. Truly.

[emulatorloo]

34. I am getting as sick of the HYPERBOLE and EXAGGERATION on the left as I am of it on the Right

[branders seine]

37. Yes.

He did.

[Hekate]

39. So Sen. Tom Harkin, who's actually on the ground, saying we'll have a strong PO by Xmas is wrong?

He's blowing smoke up our orifices?

As reported and discussed at DU:

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=102&topic_id=4057866

and

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=389&topic_id=6542368

and

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=132&topic_id=8652022

[berni_mccoy]

54. Never mind, it's the same old DU Shit Stirrers.

[Bluenorthwest]

41. A plan that can not be freely chosen is not an option at all

It might be public, but it is not an option. The very word option means a thing which can be chosen. If it is not open to all, it is not an option. If it is a safety net plan of last resort, it is not an option. To be an option, one must be able to 'opt' for it, and against something else. If it is assigned to you, it is not in anyway an option.
Calling such a plan an option is mendacious.

[polichick]

59. Exactly - like choosing public college over private...

I was glad to see that analogy used ~ but they missed the fact that there are a great many public colleges and EVERYBODY can apply.

[GivePeaceAchance]

56. But if 50 million are uncovered and population is around 400 million it is 20 million people...

It think he was just selling it to the right that it won't take over everything according to estimates which are only a guess.

[LatteLibertine]

57. I'm going to continue to trust and support President Obama on this

If we get screwed I'm done with politics. This my last hurrah.

[jenmito]

58. Have you EVER started a positive thread about Obama??

[brentspeak]

64. Here's a recent one

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=132&topic_id=8578749

[jonnyblitz]

68. what in FUCK difference does that make? Do you have

problems with CONSISTENCY? How many positive threads is a person required to post before you unhinged fucking O-LOONS consider a criticism from them valid? this line of reasoning is STUPID.

[Skip Intro]

61. Don't get the unrecs. This whole thing isn't about Obama, it's about us.

Though it's probably premature to slam Obama on what any hcr bill he signs will and won't contain or accomplish.

Personally, if we get something that in fact ensures that no one is denied needed treatment due to lack of ability to pay, I'll feel like something was accomplished. Something slightly less than that and I don't know. Something far, far less, and I'll be saddened that it will be all but impossible not to conclude that corporations rule my country.

[debbierlus]

62. We can't pretend the public option Obama described last Wednesday....

as being any type of real alternative to the private insurance companies....

A public option should be open to EVERYONE. Let the American people choose. If the private insurance companies can't compete let them die. The leeches should be excised off the system entirely. A REAL public option is an option that is available to every American.

[KingFlorez]

67. Getting some people covered is better than none

That is one of the goals and this is a good start. It's going to take years to make health care costs lower.

[Laelth]

75. Perhaps not.

The individual mandate will be deeply resented, and it will drive people away from the Democratic Party by the millions. Are you willing to pay that price for this weak, ineffectual plan that will further enrich the insurance industry cabal and that will be paid for, principally, by the struggling middle class?

:shrug:

I'm not.

:dem:

-Laelth

[inna]

77. very good article.

"We are facing a health-care crisis in this country because private insurers are driving up costs with unnecessary overhead, bloated executive salaries and an unquenchable quest for profits -- all at the expense of American consumers," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. "Massachusetts' failed attempt at reform is little more than a repeat of experiments that haven't worked in other states. To repeat that model on a national scale would be nothing short of Einstein's definition of insanity."

Yet Massachusetts seems to be the implicit model. Despite the obvious popularity of Medicare, there was no serious discussion of expanding it as a possible public health care option (as we had suggested earlier) and there was no attempt to use the public option as a means of expanding choice and competition if a worker was unhappy with the health care program offered by his employer.

The Clinton health care version at least tried to deal with the issue of portability, so that health care did not get tied in directly to employment (a highly germane consideration in a time of double digit unemployment and mounting economic insecurity). There is no hint of that in the Obama plan. If anything, it represented a retrograde step from what was on offer in last year's campaign via the Clinton or Edwards health care proposals. Most advanced countries have dealt with the defects of private health insurance in a straightforward way, by making health insurance a government service. Through Medicare, the United States has in effect done the same thing for its seniors. We get the status quo. The paucity of imagination of the proposals themselves were completely at variance with the President's soaring rhetoric, something which is unfortunately becoming a recurrent theme of the entire Obama Presidency.