OK, I want a lot of feedback on this.

[lapfog_1]

and not just snark remarks from the current bill supporters, and not just "that's great" or "good idea" or "+1" from the "kill bill" crowd. Tell me where the argument is flawed, where I have my facts wrong, etc. I'm trying to get something put together to send to a wider audience.


------

Kill this Bill



Kill this bill, but pass another, right now, via reconciliation.

One that expands both Medicare (to 50 or 55) and Medicaid (to cover more of those under 50 without insurance for reasons of either too little money or pre-existing conditions).

Start a new bill, the new patients bill of rights, to be passed by regular business. This is the one where we do all of the non monetary stuff (pre-existing condition regulations, no annual caps on care, no lifetime caps, etc). There was once a bill like this before. Find it and re-introduce it. Or just write a new one.

The new Patient Bill of Rights won't pass anytime in the next 9 months but that's fine, we have the expanded Medicare (which everybody likes and understands) and Medicaid (which will be seen as the moral thing to do). And we can beat the Republicans up over the new "Patients Bill of Rights" (language the populists will like, even some tea baggers).

No mandates (folks, lots of folks, hate this), no "sweeping takeover" of health care. Incremental steps, using popular programs already in place.

It's clean, it's simple, and the Democrats would be heroes, and, best of all, none of this catering to Lieberman and Nelson (which makes the President look like Neville Chamberlain).

And, even better, by passing an expansion of both Medicare and Medicaid (with, say, a 2% income tax hike on those that earn over $200,000 individually, and $400,000 as a couple, to remain budget neutral), those programs take effect immediately, and the 2010 elections will be in the bag.

---------

How do we expand Medicare and Medicaid?

Via reconciliation...

Very easy, you get the Senate parliamentarian (yup an actual civil servant, not elected to the post) to rule on the bill that it a) only affect existing programs, b) does not substantially change the nature of the existing program, and c) can increase or decrease funding for existing programs and raises (or lowers) taxes.

I submit that my proposal meets all those criteria.

George W. Bush got his tax cuts through using this parliamentary procedure. In fact, it's been used by Republicans some 28 times in the last 30 years. (fact check)

Once you have a ruling from the parliamentarian, you now only need 50 votes for passage. (Vice President Joe Biden can break a tie).

Then it's off to the House (no conference) for a straight up or down vote. Then off to the President for signing or veto.

Simple. Very democratic (small d).

It creates no new programs, and it affects the insurance industry NOT AT ALL.

And it can be done in weeks, not months or years. Weeks.

The insurance industry won't care that much about this. Those uninsured people under 50 are people they don't WANT. They might whine a bit about the Medicare over 50 or 55 expansion, but not too much... those old geezers (like ME) aren't that profitable to them anymore, what with our expanded medical needs and such. They will see the handwriting on the wall (Medicare for All) but, hey, when that day comes they may fight. But even if they fight TODAY, we already have 50+ Senators and a majority of the House ready to vote for both of these, and the tax increase.

The new Patients Bill of Rights is where the action will be, because that will affect every insurance company and anyone that currently HAS private health care insurance. This is where we start "bending the cost curve" and "instituting rules and regulations on the industry"... but given the fight we just went through, this one will be much easier. First off, all those uninsured people that the tea baggers didn't want to pay for in the first place... they are gone now. And no mandates to force insurance companies to pick them up. Now we fight over annual caps and lifetime caps and pre-existing conditions and review boards and appeals and stuff. And I bet we can win this battle easily.

But, by the end of January, President Obama can sign the Medicare and Medicaid expansion act of 2010 and by February a lot of people will get covered and receive their insurance cards. A *lot* of people. People that will remember this come November, 2010.... A *LOT* of very happy people. Did I say a LOT!!!

They can't pass the current bill through reconciliation.

Which is why it must die.

It would not be easy to chop it up and pass parts of it through reconciliation.

It's those mandates and profit margin limits (not profit limits, just margin limits) and the state by state exchanges and stuff. The President and the Senate are now married to those ideas, and they can't think of reform without them (just like many of us can't think of reform without the "Public Option"). They have put so much work into the current box that they are in, just a ton of it, that they can't see any other way to go. And my proposal is definitely "out-of-the-box" thinking that scraps a lot of that work. And they are close. But to get this close, they had to compromise and compromise (which the President, apparently, likes to do), and they STILL have ZERO Republican votes for this. They have compromised to the point that they are in the parking lot, the line in the sand is waaaay out there on the beach somewhere.

So, to borrow a phrase... ENOUGH!!!

Kill this piece of crap with it's Lieberman sellout, it's Nelson sellout, it's mandates that nobody likes, and all the rest of it and just say no.

KISS - Keep It Simple and Stupid. The current bill is NOT KISS designed. You need a PhD in Insurance to understand all of it, it's thousands of pages. ENOUGH. Kill it.

Do 90 percent of what this does, only do it with two bills, both of which are easy to understand, one that can be passed right away (so the President doesn't lose face... in fact, he should be the one to address the nation next week and announce this plan). Sure, the flying monkey right will crow for a few weeks, but then, once the new plan is passed and on his desk, everyone will forget those "Waterloo" pundit bullshit remarks. Not to mention that should the current bill pass, those same idiots are going to say the SAME THINGS anyway ("great victory for the Tea Party! The President has met his match!" blah blah blah). So it doesn't matter. So do the right thing.

[ananda]

1. Don't forget..

.. complete healthcare for all women and care for special
populations like the disabled and those who need home
care.

[lapfog_1]

3. Where should I put that?

[Ildem09]

2. bookmarked for when i am far more cogent.. starting to get sleeeeeeepy

[stopbush]

4. Your scenario has absolutely no chance of happening. The Senate bill has the votes to pass,

and it will pass. Then, it's off to conference, merged into a single bill, passed as a single act and onto Obama's desk to become law.

Your ideas have merit, but they are a pipe dream at this point.

[laughingliberal]

7. Well, we all pretty well know that, but doesn't hurt to think about it

Lol. Our dreams are all we have left.

[lapfog_1]

10. Someone will start looking at the polling data.

and the various Dem organizations that are dead set against this bill.

NOW, AFL-CIO, SEIU, and the blogosphere (ok, they probably still discount the blogosphere).

But they can't afford to piss off the ENTIRE base.

They are not gaining support from the right.

So, right now, this is a self destructive course that they are on.

I guess they think "hey, pass it, and the left will get over it and come back to support us when we need them... the left would not want to see a Speaker Bohner or Majority Leader McConnell" and that's true, we don't... but how bad will we care about it in 10 months?

Right this minute, if Rahm Emmanuel appeared at a convention of regular Democrats, he'd be booed off the stage.

[RoyGBiv]

5. Just a few points ...

I'm not going to go through that line by line because most of it has been covered already by liberal politicians, economists, and many other people who have more expertise in these matters than either of us.

1) Reconciliation cannot be done "right now." It's a process that takes time, which is the main thing the WH has against it. Smarter experts in the way Congress works than you or me have suggested the earliest you'd see a reconciliation bill started now would be next summer.

It could be done, but it carries a high level of risk with absolutely no guarantees that what you want to be in it will be. Many of the regulations, that are in the current bill and are required for the kind of reform we want to take place, *cannot* be included in a reconciliation bill because they do not fit withing the terms that allow a reconciliation bill. Reconciliation is not a cure-all. In the present context, it is more of a strategy to be used as a threat, but the other side of the aisle already knows that it won't actually work for what the progressive wing wants, so they don't care, ergo, no threat.

In addition, people suggesting reconciliation are assuming that 50 Senators *want* a kind of public option like they want. That is not only not a safe assumption, it is an ignorant assumption. What many, if not most, people *here* are calling for is something along the lines of single payer. Almost no one in the Senate or the House even suggested that, much less openly supported it. Recall, if you will, that the public option that got shot down was being criticized as a "corporate sellout" even before it was removed. That specific incarnation of a public option you might be able to get into a bill via reconciliation, but it wouldn't satisfy anyone either.

2) Mandates. I know opponents don't want to hear it, and I'm not going to sit here and battle it because I have come across no one who opposes them who offers any argument at all to address the reality. I don't care that "most people" oppose it. The eventual goal of universal coverage doesn't work without a mandate. As has been repeatedly said time and time again, no country in the world with universal coverage allows anyone to "opt out" of coverage. I know the argument against this is that those countries with universal coverage either have single payer systems or other systems that include heavily regulated insurance of the kind that is not a part of the current Senate bill. (Actually, the argument you often see here ignores entirely that several nations include the insurance industry in their systems.) And it is a correct argument, as far as it goes. The problem is that *any* attempt at both increased coverage and lower costs without a mandate will fail.

In short, the individual mandate is essential, whether you pay for it via taxes, via the insurance you buy, or via taxes you pay because you refuse to buy.

No snark.

[lapfog_1]

11. You didn't read my proposal all that carefully.

The only thing I want to pass via reconciliation is expansion of Medicare to 55 or maybe, just maybe 50 and the expansion of Medicaid (which is in the present bill) to cover all those under 55 or 50 who can't get insurance at any price or can't afford what the insurance companies want to charge for it.

No regulations in the current bill would be passed by reconciliation.

I never claimed it was a cure all. It allows the President to "save face" and get a bunch more people covered quickly who can't get insurance right now. People who would be grateful to the Democrats THIS COMING FALL.

I propose NO public option. Only the already proposed AND AGREED TO (by the Democratic caucus in the Senate) expansion of Medicare. An expansion to people aged 55 and up. Would have been IN the current bill except for that traitor Joe Lieberman.

As for mandates. We kick this can down the road a bit. Look there is an "end goal" with my proposal which is NOT stated, namely Medicare for all. (It's in there, just in passing). Medicare for all is mandates done better. But Medicare for all will have to be sneaked up on, bit by bit. Lower Medicare to 55... see, nothing bad happened, no collapse of western civilization. Oops, we still have too many people on Medicaid! I know, let's lower Medicare again, to 45 this time. And raise SCHIP to 25. And so on. It would take time. But hey, the last time we addressed this, men still wore HATS to dinner and I couldn't vote.

You argued eloquently against somebody else's proposal. Not mine.

I'm not trying to propose to do the things you say won't work.

And if it's June for the simple expansion of Medicare to 55 and Medicaid for a larger population of needy via reconciliation, OK, I can live with that.

[RoyGBiv]

16. No, I did read it ...

As I said *in my reply* I did not intend to respond to it line by line. I chose to respond to specific points. I also chose to respond in the context of some semblance of reality, which is why it may not seem directed at your comments specifically. There is no realistic basis for the notion of only expanding Medicare coverage. Even if there were, doing so *by itself* would provide no reform of the health care system at all.

And, I know *you* didn't claim it was a cure-all, but many, many individuals posting their random pie-in-the-sky fantasies on DU do seem to believe that. It's like they heard the word, wrapped their minds around the concept as a measure to oppose anyone who disagreed with them, and gave it the status of the Holy Grail. It isn't. There's a reason it's rarely used, and that reason is not that the party in power at a given time is weak. It's rarely used because what you can do with it is very, very limited. It simply does not fit the needs of health care reform.

Having said all that, what I want is Medicare expanded to incorporate the entire population, so I agree with you in principle. But I know it's not happening right now, so I remain focused on what is and what can happen right now.

[laughingliberal]

6. Will have to examine in more detail later but one thing that jumps out immediately is

the under 50, healthy crowd are the people the insurance companies want. They would love it if the government would take us over 50's off their hands. We would love it, too. I am not opposed to incrementalism at all so long as it is incremental change in the right direction. Some sort of public option or expansion of Medicare which the uninsured or unhappily insured could choose. An expansion of Medicaid to the levels already in the bill. Figure out the funding without taxing those in the working class. I know it would never pass but a great idea to me would be a windfall profit tax on the insurance industry. For God's sake, this is an industry that has seen a 428% increase in profits over a decade. An increase in taxes on those with incomes over $250,000 would not be breaking a campaign promise nor would lifting the cap on payroll taxes. Just a few ideas. Would love to see a way to get people the freedom to have insurance not tied to their jobs. I know it's nice to have employers who pay a good chunk of the premium. I had that most of my life but it has kept wages stagnant for a couple of decades and it enslaves those who would like the freedom to change jobs or go start their own little business. Anyway, I'm rambling but those are off the cuff. Even just starting with the expansion of Medicaid for the poor would be a step in the right direction which could be built on later.

[lapfog_1]

13. I agree with everything you say.

The windfall profits tax always seem to "targeted" by the general public. Yeah, it'd be nice, but an across the board increase of only 2 or 3 percent of the top marginal rate for individuals over $200K would also be a nice kick to the Wall Street types... all of them. Plus, it's needed if we ever want to have a middle class again.

If we went the windfall profits tax, we are poking the bear with a stick. A bear that fought a really good campaign (astroturf and all) this summer. Let's do something this time that doesn't poke the bear for a little while and then only a little, and then a little more, etc. Until the poking stick is really a stake through his heart.

Shrink the industry down to a point where we can "drown it in a bathtub" (where have I heard THAT before!! :rofl: )

But Gradually. Any sudden moves and the bear wakes up and swipes at you.

I think the PO and all the regulations and the mandates and the profit margin restriction and all the rest was poking a big stick at the bear. And we got beat.

[Loudmxr]

8. Sure here is what you do.

Call your friends in the legislature who you have a personal relationship with. It would be nice to know Wiener or Sherrod Brown or their staffs. Pitch them this.

[lapfog_1]

9. That's what I'm planning on.

But it almost has to be a Senator, not a member of the House.

And there are only maybe 3 that have the motive and the cojones to do this.

But the first cloture vote isn't for a number of days.

[eridani]

12. Agreed. And the donut hole in Medicare Part D could be closed instantly the same way n/t

[lapfog_1]

14. Thanks!

Yup, another one that can be done fairly quickly and without too much controversy.

I'll put it in. I'd forgotten about it.

[libertypirate]

15. I was wondering what it would be to like to shove

hr676 down the DLC throats.

http://thomas.loc.gov/home/gpoxmlc111/h676_ih.xml