Krugman: Individual mandates are necessary

[johan helge]

Krugman (http://krugman.blogs.nytimes.com/2010/01/08/one-health-care-reform-indivisible/):

"Start with the proposition that we don’t want our fellow citizens denied coverage because of preexisting conditions — which is a very popular position, so much so that even conservatives generally share it, or at least pretend to.

So why not just impose community rating — no discrimination based on medical history?

Well, the answer, backed up by lots of real-world experience, is that this leads to an adverse-selection death spiral: healthy people choose to go uninsured until they get sick, leading to a poor risk pool, leading to high premiums, leading even more healthy people dropping out.

So you have to back community rating up with an individual mandate: people must be required to purchase insurance even if they don’t currently think they need it.

But what if they can’t afford insurance? Well, you have to have subsidies that cover part of premiums for lower-income Americans.

In short, you end up with the health care bill that’s about to get enacted. There’s hardly anything arbitrary about the structure: once the decision was made to rely on private insurers rather than a single-payer system — and look, single-payer wasn’t going to happen — it had to be more or less what we’re getting. It wasn’t about ideology, or greediness, it was about making the thing work."

[blondeatlast]

1. Stop making sense. It confuses people. As a pre-existing condition "victim"

I've been saying the same thing here and gotten roundly laughed at or booed.

[johan helge]

17. The hate of insurance companies

- which I share - should not make people stop thinking, but it seems to do so.

[grytpype]

43. There are stupid people on the left as well as the right, it's time to admit it.

Every health care system with universal coverage has universal participation, maybe through taxation or otherwise, but everyone has to pay in.

That makes some people here scream and cry...

[Skittles]

56. BECAUSE

with no public option, health insurance in no WAY equates to healthcare

[Cessna Invesco Palin]

69. Uh, what do you think a public option is?

It's health insurance.

[Skittles]

95. A NON-PROFIT HEALTH INSURANCE

TOTALLY DIFFERENT ANIMAL

[FreeJoe]

189. Why no public option?

OK, I'm pretty ignorant about the health care industry. Why can't we start our own Democratic Party non-profit health care provider? How would that be different from the public option?

[endless october]

2. public option is necessary. nt

[johan helge]

11. A public option was not accepted by

Lieberman etc., so the progressives in the Senate had to choose between no health reform and a health reform without a public mandate.

[Skittles]

88. don't call it health reform

with public option it would have been healthcare reform; without it, please call it what it is: health insurance reform

[johan helge]

112. Whatever the name, this reform is a huge step forward

Krugman (http://krugman.blogs.nytimes.com/2009/12/23/simulating-single-payer/#more-6219):

"Let me say that I get especially, um, annoyed at people who say that the plan isn’t really covering the uninsured, it’s just forcing them to buy insurance. That’s missing not just the community rating aspect, but even more important, it’s missing the subsidies. And we’re talking about big stuff: between Medicaid expansion and further support for families above the poverty line, we’re looking at around $200 billion a year a decade from now. Yes, a fraction of that will go to insurance industry profits. But the great bulk will go to making health care affordable.

So how anyone can call a plan to spend $200 billion a year on Americans in need a defeat for progressives is a mystery.

I wish there were a public option in there; I wish there were broader access to the exchanges; I wish the subsidies were even bigger. There’s lots of work to be done, work that may eventually culminate in a true, not simulated, single payer system. But even in this form, we’re looking at something that will make America a more just, more secure nation."

[stray cat]

32. And are you willing to mandate it no matter what it costs?

Either the public option or other insurance and then all will be happy with the idea of a mandate?

[endless october]

40. no matter what it costs?

of course not. if there were a real public option that drives down health care costs, i could see the mandate. otherwise, no.

[pnwmom]

53. But it may not be possible. Obama can't create it by fiat. n/t

[Raineyb]

120. Well he can't create it when he negotiates it away either. n/t

[branders seine]

3. single payer eliminates this kludge

[Freddie Stubbs]

9. So would magic, but neither fo them will happen anytime soon

[WT Fuheck]

144. quitter

[johan helge]

10. Also with single-payer

people must be forced to pay, it's just that then it's called taxes, not mandates.

And: Lieberman etc. would not accept single-payer, so it was not an alternative.

[WT Fuheck]

145. quitter

[johan helge]

150. The reality is simple:

The progressives in the Senate had to choose between no reform and a reform without a public option.

Krugman (http://www.nytimes.com/2009/12/18/opinion/18krugman.html):

"A message to progressives: By all means, hang Senator Joe Lieberman in effigy. Declare that you’re disappointed in and/or disgusted with President Obama. Demand a change in Senate rules that, combined with the Republican strategy of total obstructionism, are in the process of making America ungovernable.

But meanwhile, pass the health care bill.

(..)

The result would be a huge increase in the availability and affordability of health insurance, with more than 30 million Americans gaining coverage, and premiums for lower-income and lower-middle-income Americans falling dramatically.

(..)

Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans.

(..)

Whereas flawed social insurance programs have tended to get better over time, the story of health reform suggests that rejecting an imperfect deal in the hope of eventually getting something better is a recipe for getting nothing at all. Not to put too fine a point on it, America would be in much better shape today if Democrats had cut a deal on health care with Richard Nixon, or if Bill Clinton had cut a deal with moderate Republicans back when they still existed."

[gcomeau]

12. And someone dumping a pallet of cash on my lawn...

...eliminates my worries over my mortgage payments.

Both are approximately as likely to actually happen, so get the hell over it and stop whining let a petulant child already. Single payer wasn't doable. They're still fighting just to keep the votes for THIS for cripes sake, what the hell do you think they could have done that would have got them the votes for single payer?

I am so sick of hearing people on this forum talk about this issue and pretend like basic political realities simply aren't relevant to their criticisms.

[johan helge]

21. Hear, hear (nt)

[blondeatlast]

28. Thank you for rather crudely speaking truth. nt

[Name removed]

45. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Fumesucker]

52. Another "basic political reality" is that this is going to alienate a lot of Dem voters..

Setting the Dems up for greater losses this year and in 2012..

That argument works both ways.

This bill is a Galaxy-Class kluge that will make very few happy and is going to piss off a lot of people.

[Name removed]

62. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Raineyb]

123. Well how the hell is Single payer going to even be an option if DEMS don't even fight for it.

It would be one thing if they actually TRIED and then had to negotiate it away. But they didn't do that, they took it off the table while bending over backwards to listen to anyone who wanted to make sure that the individual got screwed. So don't go around telling people to get over it when it wasn't even considered in the first place.

It wasn't offered then taken back, it just wasn't offered and there's no reason why anyone who was for Single Payer should be satisfied with such half assed shoddy negotiations. And it makes no sense to be mad at people who saw this shit coming th second Single Payer was taken off the table. As unsportsmanlike as it is to say so I told you so. I KNEW this would happen when they didn't even bother to pretend to listen to single payer advocates and the public option is even more pathetic now than it was then. These pols either can't negotiate to save their lives or they weren't interested in reforming a damn thing to begin with. So are they incompetent or are they liars because that's all the choices we have left at this point.

[gcomeau]

190. Bullshit.

You're acting like there's no way they could have known how many votes they could have gotten without going through a big public fight over it to satisfy your need to see it happen.

The Senate leadership has slightly easier ways of figuring that out. They can just FREAKING ASK PEOPLE how they're voting.

If they asked around and and they had, say, 57 votes for cloture on single payer than yeah, sure, go for it and try and sway 3 more people and get it done. But there is absolutely zero chance in hell that that happened. From what I know of how people lean on the Senate on this issue if they had 25 votes I'd be pleasantly surprised. And trying to spend time fighting on the issue when that's the case is just wasting everyone's time and risking not getting any bill passed at all which is criminally stupid. I would have been pissed beyond all belief if I'd seen them do something that idiotic.

I'm firmly of the opinion that single payer is worlds superior to anything either the House or Senate has come up with during this process, but I also don't live in magic fairy tale land where that actually means jack squat if you can't pass the freaking bill. So I let it go about 8 months ago when that became so obvious you have to be deliberately delusional not to acknowledge it, and I lost patience with people insisting on maintaining that delusion about 6 months ago. The fact that it is STILL being so prominently maintained here even now is inexcusable.

[Raineyb]

193. They don't need 60 votes. They could have lowered the cloture threshold if they wanted to

They didn't because they WANT the excuse of not having 60 votes so they don't have to actually DO anything but what their corporate owners pay them to do. They didn't do all they could to get as progressive a bill as possible. And it's straight up bullshit to even claim that they did. You don't take things off the table BEFORE negotiations and claim you're going for the best you can get. You don't exclude the advocates of one system and then credibly claim that you took their view into consideration. The fact of the matter is the DID NOT TRY. And there's no way in hell they're getting a pass for this current piece of shit legislation while telling me it was the best they could do. I saw how they "negotiated" and it was a piss poor negotiation at best.

You think the notion that they didn't try is bullshit? No, what's bullshit here is the notion that the Democratic party did all they could to get a good bill for the public. They may have done all they could to get a good bill for the insurance companies but that's hardly the same as doing what's best for the public and people who are paying attention aren't fooled by this bit of kabuki theater.

[gcomeau]

201. And they get the TWO THIRDS MAJORITY vote to do that where? -nt

...

[WT Fuheck]

146. quitter

[blondeatlast]

168. Word, word, word. nt

[frazzled]

4. I used to think the mandates weren't necessary

But seeing the thousands of posts from people here who don't want to buy health insurance, I have completely changed my mind. You have to require it. Their gambling ends up costing the rest of us a fortune. The system can't work unless everyone (or almost everyone, because there will always be some exceptions) participates.

For those who like to argue the mandate part while completely ignoring the subsidy part that will make this insurance affordable ... well, just screw them. They're dishonest, or stupid, or both.

[DesertFlower]

6. i agree. nt

[Fumesucker]

7. What happens to subsidies when Republicans take power again?

Mandates are forever, subsides are only until the Repubs get control again.

You are going to end up with mandates and no subsidies and little to no regulation of the insurance companies.

I've learned over a fairly long life of paying attention to politics that Repubs are like the monsters in a fright flick, never, ever count them out, because they come back every time.

[frazzled]

13. The subsidies are part of the same bill the mandates (and regulations) are ...

The Republicans would have to get majorities (super-majorities in the Senate) to pass new legislation that would lower or do away with financial subsidies to taxpayers. Sorry, that is NOT going to happen. They might try to put the brakes on increases in such subsidies, but taking away money from people is not politically viable.

[Fumesucker]

23. Where were you for the last nine years?

Sixty is the new fifty only for Democrats..

TARP: Proposed on Sept 19, 2008, enacted Oct 3, 2008

Don't tell me that didn't take money away from people..

[laughingliberal]

16. Yes, I see this future being ignored by those supporting the idiot bill

The mandates will never go away but the subsidies will be cut in the next round of entitlement reform after they go into effect. May not even have to wait on Republicans. Seems some of our DINO's like entitlement reform as much as Republicans.

[jpak]

22. If they try to do that, they will not be in power for long

and the revolt will make the current Tea Parties look like...well...Tea Parties....

[johan helge]

33. That's

a good point. But reducing the subsidies will cost the Repubs votes, so they will probably be a little careful with that.


One important reason the Repubs "come back every time", is that after election victories (1976, 1992 & 1996, 2008), many liberals stop supporting the Democrats (1980, 2000, 2010 & 2012), because they think that will make the Dems become more liberal. What it does, though, is to make the Dems lose elections.

[Fumesucker]

50. It's interesting how this is always framed to blame the liberals..

Why not blame the Democrats for not passing more liberal legislation that would keep liberals interested in voting Democratic?

Even here on DU reflexive hippie-punching is rampant.

[johan helge]

I think Obama should have been more liberal,

and that that would have made him more popular, partly because of better results (e.g. perhaps he could have gotten a bigger stimulus).

But I think liberals that won't support Dems in the 2010 and 2012 elections are also wrong. Their passivity just makes the Repubs smile.

[Fumesucker]

74. It's harder to motivate people through negativity ..

Than it is through positive reinforcement.

Voting *against* Republicans just isn't as motivating as voting *for* something you would really like to see.

When I was a manager I saw this time and again, you can get compliance, to some extent, from employees through fear of negative consequences, you can get enthusiastic cooperation from positive rewards.

Disillusionment is an extremely strong de-motivator, many liberals were highly excited by the idea of an Obama presidency, the reality is quite a letdown.

[johan helge]

116. Everything you write is right,

I think. So I understand that many liberals won't support the Dems so eagerly in 2010 and 2012 as in 2008. But I think they should support the Dems in 2010 and 2012, nonetheless. The time to show disappointment, is in the primaries. But once the Dem candidate is chosen, progressives should support him/her against the right-wing candidates of the Repubs.

[Fumesucker]

121. The best predictor of future behavior is past behavior..

And the past behavior the Democrats is not motivating to most liberals. Obama had a great many liberals fired up in 2008, a lot of them aren't going to fall for the same trick again.

As the old saying goes, fool me once shame on you, fool me twice shame on me.

The Blue Dogs will get the DLC support, Rahmbo will make sure of that.

[johan helge]

126. My impression

(right or wrong?), is that the Blue Dogs tend to come from pretty conservative districts, i.e. districts where the Dems would lose with liberal candidates. If so, the Blue Dogs should be the Democratic candidates in those districts, and should be supported, because they are better than the Republican candidates, and can beat these candidates. E.g., if the Blue Dogs had lost their elections against the Repubs, there would have been no health reform.

[Fumesucker]

132. Personally I would prefer nothing to what we're about to get..

I think we're about to set up the biggest shafting of the American people since NAFTA, something a Democratic president signed.

And if I read correctly I'd probably benefit from the current plan, I just don't want my grandchildren to have this stinking albatross hung around their necks when they have to go out in the world on their own.

[johan helge]

147. Two Krugman quotes

The bill will probably be good for your grandchildren:

Krugman (http://www.nytimes.com/2009/12/18/opinion/18krugman.html?_r=1):

"A message to progressives: By all means, hang Senator Joe Lieberman in effigy. Declare that you’re disappointed in and/or disgusted with President Obama. Demand a change in Senate rules that, combined with the Republican strategy of total obstructionism, are in the process of making America ungovernable.

But meanwhile, pass the health care bill.

(..)

The result would be a huge increase in the availability and affordability of health insurance, with more than 30 million Americans gaining coverage, and premiums for lower-income and lower-middle-income Americans falling dramatically.

(..)

Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans.

(..)

Whereas flawed social insurance programs have tended to get better over time, the story of health reform suggests that rejecting an imperfect deal in the hope of eventually getting something better is a recipe for getting nothing at all. Not to put too fine a point on it, America would be in much better shape today if Democrats had cut a deal on health care with Richard Nixon, or if Bill Clinton had cut a deal with moderate Republicans back when they still existed."


Another quote:

Krugman (http://krugman.blogs.nytimes.com/2009/12/21/what-has-health-care-reform-ever-done-for-us/):

"Health care reform does nothing, they cry — except for covering 30 million people (my remark: including many with pre-existing conditions), ending overpayment on Medicare advantage, making the first real attempt to use medical evidence to guide health care spending, starting up a wide range of pilot projects on cost control while empowering an expert panel to put the results of those projects into effect, providing financial incentives to limit excess coverage, and so on.

But aside from that, you see, it doesn’t do anything."

[Fumesucker]

149. The *insurance* may be more affordable..

But what about the *care*?

I think copays and deductibles are going to go up dramatically for most people.

That's how cost containment is going to be done, make sure that people can't use the insurance they have to buy.

Oh, and this is not the same country and definitely not the same legislature as when the previous social programs were improved.

[johan helge]

155. Perhaps you're right,

but my guess is that if copays and deductibles had made the bill worse than no bill, Krugman (my sole source!) would have mentioned this topic in one of his many blog posts about health care.

But isn't Congress now one of the least conservative ever? And that's an important reason they have finally passed health reform? My impression is that earlier, Democratic majorities in the Congress consisted of many southern conservatives.


What happened when the Republicans tried to destroy Social Security in 2005? They couldn't, because (I assume) then THEY needed 60 votes in the Senate, and the Democrats wouldn't, because Social Security was popular (http://www.nytimes.com/2005/08/15/opinion/15krugman.html).

If the Democrats had not passed health reform, the Dems would need 60 Senators the next time to get anything done. But in the next election, the Democrats will probably lose some Senators to the Repubs. And God knows when the Dems will have 60 Senators again.


So the history lesson is: Get done what can be done now, because then:

1 The Repubs then will need 60 Senators to destroy rights.

2 It's more difficult to get the voters to accept the destruction of rights they have, than to fool the voters into believing that they shouldn't get these rights.

[Fumesucker]

156. Has Krugman mentioned this?

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7428413

Senate Bill: Ensign Healthcare Loophole sets high pre-existing condition penalties.

[johan helge]

161. I don't think he has,

it's a good point.

[LooseWilly]

71. Words out of my mouth. Double plus well said.

[grytpype]

51. +1000

[liberal_at_heart]

136. +1000000

[Name removed]

48. Deleted sub-thread

Sub-thread removed by moderator. Click here to review the message board rules.

[pnwmom]

55. Exactly. The most vociferous against the mandate are proving Krugman's point.

[TransitJohn]

82. I have two kids and make 50k

What susbsidy do I get? Oh that's right, none. I am self employed. Now I have to give 20% of my 50k/year to support insurance company profits. Ain't health care reform grand?

[subterranean]

159. Why do you think you wouldn't get a subsidy?

[TransitJohn]

162. Gee great

I'll get less than 1% of my mandated purchase kicked in.

[subterranean]

165. According to this calculator, the subsidies will cover more than 50%

of the premium for a family of 4 making $50K. Of course, this doesn't include what you'd have to pay in deductibles and co-payments, but there would be maximum limits on those too.

http://healthreform.kff.org/SubsidyCalculator.aspx

[TransitJohn]

Who said anything about a family of 4?

Huh?

[subterranean]

175. The calculator only has options for individuals and families of 4.

I didn't say that fits your exact situation. My point was that your assumptions about the subsidies seem too pessimistic, at least based on the information I've seen.

[TransitJohn]

176. You really think these subsidies will be paid out?

When are they supposed to begin? 2014? IT'LL NEVER HAPPEN....there'll be no money to pay for it....unless they gut Social Security and other entitlements.

[Skittles]

91. the government should not give money to the INDUSTRY THAT IS THE PROBLEM

I am not dishonest, stupid or both

[Raineyb]

129. People don't want to buy it because they know how the insurance companies are.

What's the point of buying coverage if after you've paid the premiums you can't actually pay for the deductibles to see a doctor? Who the hell is going to want to pay a company who is only looking for ways NOT to pay your claim later? Who wants to choose between food and health insurance that they can't afford to use? If we had a national health care system where anyone could walk into a doctor's office and get treatment as well as go to the pharmacy and get any medication they need with no regard to how much money is in their pocket people wouldn't have a problem paying for that. It's called TAXES. But to be forced by the government to come out of pocket after tax to pay a company who will put all kinds of restrictions that have not a blessed thing to do with medical necessity? You're damn right people have a problem with that and with damn good reason. THere is NO good reason to force anyone to pay a for profit corporation for something that ought to be done via the government in the first place. The government should be providing this coverage not the rapacious United Health Care and their ilk who pay their CEO's billions of dollars at the expense of their subscribers.

[Lydia Leftcoast]

172. I don't want to buy health insurance because paying the premiums

for the high deductible health insurance, which is the only kind I can afford, prevents me from getting actual health care!

Geez, how many times do I have to explain it?

If I lived in Japan, I would be paying about the same in premiums as I am now, but I would have NO DEDUCTIBLE, only modest copays.

If there is one change I could make to our whole rotten system it would be to ban deductibles. The insurance company excuse is a myth that there are millions of people who would run to the doctor with every sniffle if they could. That has not been the experience in other countries, though.

Nope, deductibles are just another way for insurance companies to weasel out of paying, which is their favorite thing in the whole world.

Give me insurance with no deductibles and sliding scale copays, and I'll lead the pack rushing to sign up.

[Hippo_Tron]

195. The people here are an exception

Most people have health insurance and most that don't want it but can't afford it (that's what the subsidies are for). What Krugman is saying is that once community rating is passed it will create an incentive problem where people can just buy insurance as soon as they get sick unless there is a mandate.

[ixion]

5. I agree with Krugman on many things...

this, however, is not one of them.

In fact, I think he's about as wrong as you can be.

[gcomeau]

8. Hmmm...

And the compelling argument you have presented explaining how he's wrong has surely swayed me. Bravo.

[ixion]

24. I've presented the same argument since the mandates came about

Turing insurance agencies into quasi federal agencies and giving them the power of the IRS to enforce the purchase of a crappy, over-priced product from a private corporation as a requirement for legal citizenship is ridiculous.

I will never support mandated health insurance. Never. There is no argument you could make that I would find persuasive enough to change my mind here.

[pnwmom]

61. And so you are willing for millions of people with preexisting conditions

to continue to be denied any health insurance because of your objection to mandates?

Because that is what will happen if this bill fails.

[ixion]

72. then ditch the mandates and pass the bill

it's that simple. But don't hold a knife to my throat in order to get me to support them.

[pnwmom]

80. The bill won't have enough votes to pass without the mandate. That was determined

months ago.

[ixion]

164. then I can't support it

sorry.

[Raineyb]

131. The mandate to buy kicks in before the mandate to cover.

So guess who is going to be screwed under this plan anyway? That's right the very people you're claiming to look out for.

[subterranean]

160. I don't think that's true.

Both mandates would take effect in 2014 in the Senate version of the bill, 2013 in the House version.

[laughingliberal]

27. Here's mine

I disagree with Krugman on this. Although, I think Paul is intelligent and is, generally, supportive of some left leaning economic theory he is still a believer in free markets and I trust Wendall Potter more on evaluation of issues involving health care policy. Potter has lived in the belly of the beast and knows all their tricks. He is on record as saying the industry got everything they wanted in this bill and that the 85% MLR is the exact level at which the industry can most manipulate the numbers to avoid detection.

[soleft]

18. Splain please

[ixion]

25. See post #24

thanks

[blondeatlast]

19. What is he wrong about? nt

[ixion]

26. mandated health insurance being necessary

[blondeatlast]

29. Then see my post #1. I have a pre-existing condition--and Krugman is

dead on about my fate without a mandate.

[ixion]

36. while I can sympathize with your condition

I simply cannot support turning insurance agencies into quasi federal agencies. You're never going to convince me that's a good idea.

[blondeatlast]

166. So what will; you do for me? Seriously. Right now, I'm stuck with my cheating, soon to be ex-

husband's COBRA because I am a paralegal and can't get group insurance with my employer.

[ixion]

173. I can offer possible cheap insurance alternative

I have catastrophic coverage (large deductible) that I pay about $140 bucks a month for. No physical required.

Seriously, I would like to see true health care reform, so that you and others would have access to the health care they need. This is not it, however. I simply can't support a mandate to purchase a bad product from an industry with a history of abuse. Ultimately, it will create more problems then it solves.

[Davis_X_Machina]

37. Don't worry....

....if anything....untword....should happen to you while we're waiting for single payer, we are confident that you understand the role your sacrifice, and that of thousands of others, will have played in bringing about that blessed event.

Rest assured we'll have some kind of memorial for you and the others...a Day of Remembrance ...or a commemorative stamp.

Would you like to be on a stamp?

[Raineyb]

133. Well I have a pre-existing condition and this bill will SCREW me.

Krugman is DEAD WRONG about this bill and its mandate.

[Davis_X_Machina]

134. Give me the name of your insurance company...

...the one that doesn't care about pre-existing conditions, and doesn't penalize customers for them, in case I lose my group coverage and have to go on the individual market.

[Raineyb]

139. Individual market? I'm holding on to COBRA because I CAN'T get it on the

individual market.

But mandating that I buy insurance when you don't put controls on the insurance companies doesn't do me any better than the status quo a fact that seems to escape people for some reason. And, by the way the mandate to buy kicks in before the elimination of the pre-existing condition assuming that they don't remove it before it supposedly kicks in. So how exactly is forcing me to buy insurance (with money I DON'T have) while they're allowed to discriminate against people with pre-existing conditions help?

I may be a lot of things but daft isn't one of them and when they put the mandate to purchase before they eliminate the ability to discriminate based on genetics and health history I know exactly what the insurance companies will do which is why I think this bill is shit.

[pnwmom]

63. Why do you think it is unnecessary? nt

[ixion]

76. because health insurance is NOT health care

and mandating the purchase of an over-priced, crappy product from a private corporation is not going to solve the health care issue. It will make it worse, IMO.

[pnwmom]

57. His background in economics and probability makes his opinion

more educated than most of the nay-sayers around here.

[ixion]

79. there are many people with educations, some are right, some are wrong

Personally, I spent 8 years in college, and don't consider myself uneducated. So just because he's an economics prof doesn't mean he infallible, or even correct by default.

Judge an argument on it's merits, not the person presenting the argument.

[Hippo_Tron]

196. He doesn't do original research in health economics or macroeconomics, though

If you ask him he will even tell you he's not an "expert" in these areas. His area of expertise is international trade and thus if he wrote a column on those issues and related to his research I would say that his opinion should be given more weight than the average DUer who hasn't done research on the issue and doesn't have the formal training to fully understand his research and assess it critically.

But when Krugman writes in the New York Times he's writing as a policy wonk, not as a professional economist and there are no shortage of policy wonks here on DU. People can have informed critical opinions of his writings in the New York Times even if they don't have a PhD in Economics. On this particular issue I do happen to agree with Krugman, though.

[jpak]

14. Krugman hates us for our freedoms!!!!111

:evilgrin:

[soleft]

15. Paul Krugman Explains It All to Me

[Kansas Wyatt]

20. So Single Payer would be the best route to go.

Too bad that Multidimensional Chess Player living in the White House threw Single Payer out of building, instead of the Death Merchants.

[Davis_X_Machina]

30. He could have insisted on it....

...and lost on it in the Senate 45-55. Provided there were 60 votes for it to even get to a final vote.

I admire your attachment to purely gestural politics.

[Kansas Wyatt]

38. He could have insisted on Single Payer, instead of insisting...

On HIS HCR/DLC Union Busting SHIT Bill.

After all, he's been threatening anyone who has stood in the way of stopping HIS Bill, because it screwed the American People, all along. Too bad he could not have focused those threats against those who stood in the way of REAL Health Care Reform.

[stray cat]

35. Do you support a mandate for single payer - you have to buy it and whatever price?

[Davis_X_Machina]

39. With single payer, it's called 'paying taxes'....

...and I do it every year anyways.

No compulsory purchase -- and that's what the tax money raised in single payer systems is -- no universal coverage.

'Compulsory' is another way to say 'universal'. 'Universal' is a synonym for 'compulsory'.

Me, I want an NHS-US -- I'm a lifelong Socialist, of the DSA variety -- but I can count votes.

[Kansas Wyatt]

41. They already have a plan set up...

All they had to do was EXPAND it.

I'm not in favor of Barack Obama selling out the American People to save the Insurance Industry from killing itself.

[Davis_X_Machina]

42. Deleted -- slow connection dupe

[grytpype]

49. Obama doesn't do Noble Failure, sorry.

I know the libs wanted Obama to insist on single payer and get nothing.

We would be stuck with the horrible status quo, but he would get the applause of libs everywhere.

They love Noble Failure, but Obama doesn't play that game.

He's going to get the best reform he can out of the dismal, corrupt system we have.

[Davis_X_Machina]

54. Hence the need for President Kucinich. n/t

[Kansas Wyatt]

64. No, Obama CHOSE to target unions to pay for it, rather than the rich.

He has been pushing what the Insurance Industry wanted, and now he wants Working American to pay for it.

He didn't even try to stand up against the corruption, because he was on the side of corruption all along and had always planned on throwing Working Americans under the bus... Or to his fucking Death Merchants.

President Barack Obama, Democrat, just sold unions out across the country.

Too bad he liked Ronald Reagan more than FDR!

No?

Who does he want to pay for his GIFT to the Insurance Industry?
RAH! RAH! RAHM!

[TransitJohn]

68. The status quo is better than this shit bill. n/t

n/t

[Davis_X_Machina]

75. My district is shrinking by ten teachers next year...

...one of them is likely to be me, and with that goes the insurance for me and my family.

I am uninsurable on the individual market -- history of diabetes, depression, hypertension -- under the status quo. I have 13 years to go till I qualify for Medicare.

Thanks.

[TransitJohn]

78. So when you lose your job you'll have the added expense of supporting insurance company profits

That's better how?

[Davis_X_Machina]

86. If my unemployment comes to less...

...than either 133% or 125% of the FPL depends on final bill), I won't pay anything -- I'll be on medicaid. If it's more than that, I'll get subsidies.

The status-quo alternative is to wait till it's emergency-room-serious, then try to get treated as an indigent and/or go bankrupt.

[TransitJohn]

90. Oh so it's okay because everyone else will be supporting health insurance company profits, not you.

As long as you're taken care of, who cares that the rest of the American people are extorted to support shareholder's profits. Thanks, I see where you're coming from now.

[Davis_X_Machina]

97. Medicaid is a federal/state program...

...paid by the states, by state taxes. and by the Federal government from general Federal revenues. I'm guessing you don't pay Maine state taxes, and not one dime of the Federal money paid to my physicians when I lose my job will go to evil insurance companies, provided the UI checks are small enough.

I'll try to make sure I squeak by under the 133%.

[Fumesucker]

105. And of course you are the *only* person who will be paying with subsidies?

I've read enough of your posts to know you're a great deal smarter than the argument you just made.

[Davis_X_Machina]

109. If my unemployment comes to less...

...than 133% of FPL, I won't be buying private insurance with subsidies -- I'll be on Medicaid.

That's not me being disingenuous, that's the Senate bill.

[Fumesucker]

113. My point was that there are going to be a great many others in similar situations..

You made this all about you and it's not..

Eh, I have preexisting conditions and no insurance right now and yet I see this as yet another unfunded mandate from the federal government to the states.

My state is beyond broke and this bill is not going to help them retain teachers, frankly I would rather that my grandchildren have good schools with good teachers to go to than that I get healthcare and I suspect that is going to be at least one of the tradeoffs made in my state.

[TransitJohn]

108. So why are you whining about people who oppose this travesty of a bill then?

I don't get it...you're golden, and don't have any worries.

[Davis_X_Machina]

117. I want everyone else...

...at risk of winding up in a similar predicament to be similarly golden -- and you don't. And single-payer in 2016 won't help me if the worst comes to worst in the fall.

I'll be charitable and assume it's not because you're cheap that you don't want people in such a predicament covered -- that it's really a matter of principle.

[TransitJohn]

122. Here....

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=7429334&mesg_id=7429746

[Kansas Wyatt]

181. I averaged 19.5 hrs/wk for 2009 until September 1, and without work since then.

Type 1 diabetes for 28 years, thyroid disease, hypertension, and chronic nerve pain in a partially paralyzed leg. I'm 41 and will never see a retirement.

Since I hadn't been getting enough work last year and went without any work, I lost my 'Cadillac' insurance coverage on January 1, 2010. I pay out of pocket now for everything and I am unemployed.

This HCR/DLC SHIT Bill is WORSE than the status quo, because what little help they do provide in it, will be CUT & GUTTED by the Republicans when they take just ONE of the House, Senate, or White House... Count on it, they will demand it and they will get what they want. Oh, but they will certainly KEEP the NEW (Cadillac Plan) TAX on the Middle Class in place, which they will later use to offset another tax cut to the rich.

[spoony]

199. I guess he prefers the ignoble type, then. nt

[stray cat]

31. You get one shot - if you don't want insurance you can't buy it later

under any circumstance no matter if you will die from lack of treatment. Everyone has to decide by a certain date and you get no second chance. Is that really better than a mandate?

[DJ13]

34. Krugman is full of Ka Ka

Theres a difference between mandating people buy insurance and taxing people to provide heath care.

The first one is completely immoral, the second is the path all other countries take.

[johan helge]

46. Let's assume you're right,

and it is "completely immoral". Still, it's the best that could be achieved, because of Lieberman etc., and much more "moral" than the situation today.

[DJ13]

65. So immorality is okay if its all you can get from the other side?

Our country does NOT mandate people to buy products.

That pushes the costs onto the individual (you know, the same people who cant afford insurance...) and violates the tenants of "common good" that our country supposedly operates under.

Taxes should have been the only means to fund this as then those without the income to pay for healthcare would get it, paid for by those who make the most money.

People here (the remaining Obama supporters) seem to conveniently forget that Krugman was a Hillary supporter, and has always been for the DLC proposal to mandate health insurance.

If we wanted that kind of corporate sellout we would have been Hillary supporters last year.

[johan helge]

101. Well,

it does mandate people who can afford it, to pay taxes. And individual mandates are just like a tax (if you include the subsidies, the poor pay nothing for the premium, and the wealthy pay more than the middle class), except that the money go to the health care providers via insurance companies, not via the government (as in a single-payer system). Of course, sending the money through insurance companies makes it more expensive. But apart from that, I don't understand the big resistance to mandates.

Don't get me wrong, I hate insurance companies too. And if Lieberman etc. had accepted single-payer, that would have been the best option.

There will always be degrees of immorality, and the Dems should simply choose the least immoral option.

Krugman (http://krugman.blogs.nytimes.com/2008/11/12/hopeful-signs-on-health-care/): "The word I hear, by the way, is that Obama’s opposition to mandates was tactical politics, not conviction".

[DJ13]

114. I don't understand the big resistance to mandates

Lets eliminate income taxes, and replace it with individual mandates that people must write a check once a year to the IRS to pay for government.

Why would that be a bad idea?

[johan helge]

119. Perhaps it's not a bad idea,

because it's basically the same idea as paying taxes, it's just called mandates instead of taxes.

[DJ13]

127. You obviously dont grasp the progressive nature of our tax system

The individual mandate says everyone has to buy X in insurance regardless of income (forget subsidies for now), while an increase in income taxes would have tacked on a few % based on income levels, where the poor who dont pay income taxes wouldnt have been impacted.

The progressive nature of an income taxes would have put the burden for paying for healthcare where it belongs, on those making the most money.

[johan helge]

142. But you can't "forget subsidies for now",

subsidies are a necessary part of a system with mandates. And the subsidies are like this (http://krugman.blogs.nytimes.com/2009/12/26/numerical-notes-on-health-care-reform/):

Income below or at poverty line: The subsidy is 100 % of the premium.

Income 50 % above the poverty line: Ca. 83 % of the premium.

And so on.

[DJ13]

152. You are aware that people pay no income taxes well above the poverty line

I hope?

[johan helge]

158. I'm sure you're right,

the income tax is more progressive than the mandates. But it doesn't have to be so, mandates (including subsidies) can be more progressive than taxes (especially if you include sales taxes). So it isn't mandates as such that is the problem, but that they are not more progressive.

And, mandates with subsidies are better for the poor than the situation today.

[pnwmom]

67. Technically, the penalty IS a tax, and a relatively small one.

Which people can avoid if they have bought health insurance.

And you are wrong about "all other countries" -- a number of other countries with excellent health care systems require citizens to buy private insurance.

[DJ13]

73. Those other countries strictly regulate their insurers and the medical costs

We dont, so this program is doomed to failure.

[pnwmom]

83. Once we get the roof and foundation in place, we can start putting in more insulation and

better windows.

[Fumesucker]

110. The best predictor of future behavior is past behavior..

The USA has a miserable record of regulating private for profit corporations since at least 1980..

I for one don't expect this behavior to change.

[Raineyb]

137. If you build the roof and foundation on sand the house will fall and all your

improvements will be for naught.

[TomClash]

44. But it doesn't work

With or without subsidies it mandates premiums that ordinary people cannot afford. Do the math - for average people it comes to at least 10% of your income. If you don't have health insurance through your employer that's a huge price to pay - brought to you by Congress and the President, none of whom pays a dime in health insurance premiums.

As currently structured, this is a political nightmare - a gift to the Republicans that will keep on giving right through 2012.

[Davis_X_Machina]

47. Which is why the Republicans...

...took over the House and Senate in Massachusetts in 2008, after the Democrats cut their own throats with the passage of a must-purchase, must-issue insurance bill.

Oh wait, that didn't happen.

[TomClash]

70. You're right

Massachusetts is exactly like the rest of the country. Oh wait, it isn't.

:eyes:

[Davis_X_Machina]

77. List all the other states with actual...

...experience under a must-purchase, must-issue system.

Then list all the ones where it doesn't work.

[TomClash]

140. You go first

And try addressing the argument - what does a family of four making $60,000 give up to pay for health insurance?

Do you pay premiums or does your employer? How much do you pay in Maine?

[Davis_X_Machina]

151. My policy...

...costs $13,400 per year for a family of 4. The employer pays 80% of premiums, the individual pays 20%.

So, if I were on the individual market -- and if I were, I'd be uninsurable because of pre-existing conditions -- and were buying the same policy -- which I couldn't without group purchasing power -- I'd be paying 26% of my before-tax income ($52,000) under the status quo to purchase what I have now.

Using the Kaiser Family Foundation's calculator, assuming the Senate bill, a family of four, age 52, and a gross of $52,000, I get:

Annual plan premium: $13866
Cap on premium as % of income: 7.6%
Person/family premium payment: $3928
% of total premium paid by person/family:
Person/family payment as % of income: 28%
Government subsidy: $9958

[TomClash]

186. Even assuming your numbers, that's $4,000 per year

on after-tax income of $35-40,000. So that family is going to pay at least 10% of its after-tax income in health insurance premiums. What purchases do they forgo to pay these premiums? That's my point - it's a 10% tax or pay cut for working families who can't afford it.

[Davis_X_Machina]

191. Cable -- 1250. Teen's car -- $3000. n/t

[TomClash]

200. Hmm

http://dsausa.org/about/where.html :wtf: :shrug:

By the way, here's what a 25 year old single person making $40,000 in NY will be mandated to pay $3,165. So much for change young people can believe in.

[TransitJohn]

58. Individual mandates only make sense

if they're paid into a not-for-profit system. What we're getting is extortion and racketeering...business as normal for our corporate overlords. One more time: health insurance is not health care.

[mdmc]

59. What if they have insurance and can't afford medical treatment?

How is a mandate helpful?
I currently am fully insured with expensive coverage that I cannot afford to utilize.
Mandate that..

Krugman is basically saying this is the best that can be done, it will fail (cause it relies on the same for profit insurers that caused the problem), and then we can look for real (single payer) health care reform.

[Name removed]

60. Deleted message

Message removed by moderator. Click here to review the message board rules.

[TransitJohn]

66. Haha

Nice one. :sarcasm:
No one wants anything free. You don't know what you are talking about.

[pnwmom]

81. Seriously. With some of them, it seems that way. They don't seem to understand

that even if we had single payer, everyone would still be mandated to pay for it.

[TransitJohn]

85. Which we'd have no gripe about.

Learn the difference.

[Davis_X_Machina]

89. Get sixty senate votes, and I'm with you.

Has to be between now and my Medicare qualification (2015), though...

[Fumesucker]

115. There are sixty Democrats in the Senate..

Sixty is the new fifty, at least for Democrats..

Maybe if we had 110 Democrats in the Senate?

[Davis_X_Machina]

124. What are you going to do....

...in this Congress to address the issue?

[Fumesucker]

128. Like I said, we need 110 Dems in the Senate..

Then we might be able to pass something decent instead of this Galaxy-Class Rube Goldberg kluge...

Although given the apparent incompetence of the Dems I have my doubts that 110 Dem Senators could get it done.

[Davis_X_Machina]

130. We both know that's not an answer.

What are you going to do in this Congress, with its present membership, to address the issue?

[Fumesucker]

135. Nothing,,

But if it passes, I'm staying home on voting day next time..

If the Dems are going to fuck me, my kids and my grandchildren I might as well not even bother to vote.

At least the goddamn Repubs don't pretend to be my friends, their perfidy is easier to take.

And before you start, yes I know it's childish but I'm past the point of caring.

[Davis_X_Machina]

138. It is childish, and I guess we'll have to win without you. n/t

[Fumesucker]

141. Give me something to vote *for*..

Negativity and reflexive hippie-punching will only get you so far.

[liberal_at_heart]

125. The whole sixty vote argument is such bull

The republicans never need 60 votes when they want something. The Dems need to stop taking cash from insurance comapanies, grow some spines, and fight for real healthcare reform.

[Skittles]

93. and THAT WOULD BE OK

because it would be NON-PROFIT - what part of the equation are you not getting?????????????

[TransitJohn]

96. The Party's "win" is more important

than really reforming the system. Profits uber alles.

[Skittles]

99. the ignorance of some so-called progressives staggers me

shows me it's not the exclusive domain of freepers

[liberal_at_heart]

98. yes but with single payer you actually get medical care

[Skittles]

102. CORRECT

because there's not the middle-man trying to MAXIMIZE PROFITS

[laughingliberal]

107. Oh, there it is again. Those deadbeat people that want everything handed to them

I doubt 5 % of the population expects any health care system to be free. Even with single payer, of course, there would have been costs shared by most everyone. The point is this bill putting the bulk of the responsibility for raising revenue on the working and middle classes and the mandate to buy an overpriced product from an industry which channels too much into profit and not enough into providing a service to it's customers.

How many more 'welfare queen' myths will America swallow whole before the working and middle classes figure out who's screwing them?

[jsampson]

84. In other countries with mandates, premiums are very, very cheap

Here, they're estimated to be lower by only about $100-300 by 2016. That's nothing.

[liberal_at_heart]

87. People can call me stupid. I don't care. I support single payer

We are the only industrialized country that doesn't have nationalized healthcare and somehow we have bought into the lie that we can't have it. Sorry. I refuse to buy the lie.

[Davis_X_Machina]

92. You can't have it *now*....

...and that's the difference.

Go get 60 votes in the Senate, and I'm with you. But you have to do it between now and 2015, when I qualify for Medicare.

[liberal_at_heart]

106. oh, I already know most Americans have bought into the lie

I have no illusions about that. My husband and I plan on moving to Europe or the UK as soon as we can get our documentation ready and have some money saved up to move. There are lots of things Europe is just more advanced in and I would like to see it for myself. My autisitc son could get behavioral treatment which he does not get here because I can't afford the $50,000 a year bill it takes to treat autism here in the US. My husband is legally blind so we want to try out the public transportation in Europe. They actually interact with people from different countries. They are ahead of us in green technology. Most of the governments over there are more secular than ours. You don't have as many fundies trying to take over the government. There are lots of reasons I would love to move to Europe. Plus my husband and I would like to just travel together and enjoy seeing other parts of the world together.

[grytpype]

103. I would like single payer too. I would like a lot of things.

There aren't the votes for it, not even close. It sucks. A lot of things suck.

[laughingliberal]

111. And they will continue to suck as long as Americans keep buying that piece of kabuki theatre the

President and Senate put on for our entertainment these last months.

[grytpype]

143. Oh, if only everyone was as good and pure and smart as you, that would fix everything, wouldn't it.

[laughingliberal]

153. If more people would quit buying the spin we might quit getting screwed

Remember how we laugh at working class Republicans who keep voting against their own self interests? Well this is now a glass house moment.

[Moochy]

192. Always going for the personal attack.

now i remember why i put your ass on ignore.

[backscatter712]

94. He's right.

In order to have universal coverage, you have to have a mandate, coupled with subsidies for those that can't afford care. Without the mandate, you end up with an adverse-selection death spiral.

I have my problems with the current health care bill, but at the same time, I have to agree that the mandates are absolutely necessary.

[TransitJohn]

100. Universal coverage.

:rofl: Where in this bill is 'universal coverage'?

[johan helge]

171. Mandates is a way to achieve near-universal coverage.

Krugman (http://www.nytimes.com/2009/10/26/opinion/26krugman.html):

"Like the bill that will probably emerge from Congress, the Massachusetts reform mainly relies on a combination of regulation and subsidies to chivy a mostly private system into providing near-universal coverage. It is, to be frank, a bit of a Rube Goldberg device — a complicated way of achieving something that could have been done much more simply with a Medicare-type program. Yet it has gone a long way toward achieving the goal of health insurance for all, although it’s not quite there: according to state estimates, only 2.6 percent of residents remain uninsured."

[laughingliberal]

197. Krugman apparently finds no problem with the numbers of people in MA who keep telling us they have

insurance they can't use cause the out of pocket costs are so high. It's not progress to sell insurance to 97% of the population if half of them can't use it.

[Warpy]

104. People hate being told what to do, but he's right

However, mandates without a public option or Medicare buy in for people over 55 are simply not going to work. They're going to represent a terrible burden on older folks, especially, since those older folks will be paying triple premiums automatically.

As it exited the Senate, it was a terrible bill. It's still better than nothing, although not by much.

Krugman is right, though. Mandates are necessary to widen the pool sufficiently.

[laughingliberal]

198. Triple premiums for those over 50 is right and if they work for a small business that employs a lot

of older workers, they'll be taxed for having a 'cadillac plan.'

[Raineyb]

118. You can't have mandates into for profit health insurance companies

then make the argument that you care about the little person. A forced customer with no cost controls on the part of the insurance company is basically holding the individual hostage. I have no problems with mandates so long as the coverage is publicly provided. This is not and it's basically entrenching the for profit health insurance whose interest is in making as much money as possible by DENYING care to people.

So long as the mandate is for purchase of a policy from some rapacious insurance company whose mission is making money at all costs the mandate is wrong.

[johan helge]

170. The health reform is definitely not perfect, but

the alternative for the progressive Senators was no reform. And reform will, after all, probably save many lives.

[Raineyb]

182. How is further bankrupting people going to save them?

Forcing people to buy insurance with high deductibles and copays will only keep them from seeing a doctor. People don't go without insurance for the hell of it they do so because they can't afford it. This doesn't make it affordable even with subsidies if you have ridiculous co-pays and deductibles you still won't see a doctor.

[johan helge]

185. The subsidies

will make the premiums free (at the poverty line) or less expensive than before. The result should be "more than 30 million Americans gaining coverage" (http://www.nytimes.com/2009/12/18/opinion/18krugman.html?_r=1). Many of those 30 million will of course get more health care because of this.

But I agree, there are also many who will not get health care they need, because of copays and decuctibles. And I don't know how many will be worse off, i.e. having to pay for insurance they can't afford to use, because of copays and decuctibles.

[backwoodsbob]

148. would you guys please stop the spin?

we get it..the message of the day is it will drive costs down...it's bullshit but thats the message of the day.

we get it

[laughingliberal]

154. Or at least pass out Dramamine with it. nt

[ShortnFiery]

157. Krugman: I'm filthy rich and GOT MINE ... Screw You Peasants! eom

[johan helge]

169. Why do so many say silly things? (nt)

[sendero]

163. I'm starting to think.

... Krugman is a simpleton.

Yes, WE GET that healthy people have to pay into the system for it to work. WE GET IT.

What we DON'T GET is why we have to pay into a MASSIVELY INEFFICIENT private health insurance system. Care to explain that one?

[johan helge]

167. Because of Lieberman etc.,

the progressive Senators had to choose between no health reform and this health reform. And the best of those alternatives were this health reform.

The Dems need 60 Senators to pass health reform. If they hadn't passed it now, God knows when they would be able to do it. In the meantime, this health reform will save many lives.



Krugman (http://www.nytimes.com/2009/12/18/opinion/18krugman.html):

A message to progressives: By all means, hang Senator Joe Lieberman in effigy. Declare that you’re disappointed in and/or disgusted with President Obama. Demand a change in Senate rules that, combined with the Republican strategy of total obstructionism, are in the process of making America ungovernable.

But meanwhile, pass the health care bill.

(..)

The result would be a huge increase in the availability and affordability of health insurance, with more than 30 million Americans gaining coverage, and premiums for lower-income and lower-middle-income Americans falling dramatically.

(..)

Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans.

(..)

Whereas flawed social insurance programs have tended to get better over time, the story of health reform suggests that rejecting an imperfect deal in the hope of eventually getting something better is a recipe for getting nothing at all. Not to put too fine a point on it, America would be in much better shape today if Democrats had cut a deal on health care with Richard Nixon, or if Bill Clinton had cut a deal with moderate Republicans back when they still existed.

[Bluenorthwest]

174. Well, if this is what they were able to do, they can do it

but they will also have to live with the mediocrity of their work. Just because they can do no better this is not reason to tell them that is alright, or that we like it, not today, nor tomorrow. They have to live with what they have done, and the fact that it makes them looks so weak, worthless, and out of touch with the majority of Americans who wanted a public option open to all.
So just understand that. You can lead a horse to water, but you can not make him like the half assed job they do in Congress. When watered down garbage is all you can deliver, that is what your reputation will be. Those who did this, I'd not cross the street to support them. It is that simple. They are not worth my support, and they will not have it. The end.

[johan helge]

177. Who are "they"?

I don't think Obama etc. should be blamed for what is the responsibility of Lieberman etc.

"They are not worth my support, and they will not have it." Are you saying you are not going to vote Democratic? Just ten years ago, that attitude in Florida resulted in the Bush catastrophe. It's amazing how little many liberals have learned from that experience. The fight is not about getting everything we want - we can't - but about avoiding the worst.

[GreenArrow]

183. Krugman is no simpleton

He is, however, a stooge for the status quo.

[TheKentuckian]

178. Krugman is lying his ass off

Got your attention? Good.

Obviously, his basic premise is actually correct or close enough as to make no real world difference. For a universal or even a near universal plan everyone needs to be in the system or it will eventually collapse.

Where he is just being completely disingenuous is when he tells the obvious lie that because of the need for everyone to be covered and therefore everyone must be required to be insured is when he stretches the logic to say that "In short, you end up with the health care bill that’s about to get enacted.". That's clearly and utterly bullshit when taken from the most macro view of the situation.

Krugman knows for an example that there is a House bill that is structured very differently. He knows that industrialized nations around the world have drastically different plans in effect, even when they don't go with single payer or a NHS. He is being either very duplicitous or is unable to come down from 50,000 feet.

There is no reason on Earth that we have to mandate people into a loosely regulated system with no enforcement, there is no reason for an anti-trust exemption, there is no requirement to fund based off of health plans, there is no connection between requiring coverage and funneling people into smaller pools with less ability to negotiate by creating state pools rather than national ones, there is no reason to leave an inch of wiggle room on rescissions in light of a mandate, there is no reason to obligate a populace to purchase a private and for profit product without choice in what they are served.

Krugman is bullshitting people because he knows he carries weight but he damn well knows that this bill being the one that is put into place does not have to resemble what can be done within his own logical framework. I have no problem with the basic premise of a mandate but when you pair it with the actual in's and out's it becomes too bitter of a pill to swallow. I believe it is a dishonest tactic to explain the fundamental need for a mandate as a sales tactic for the plan at large.

and

We could just elect to hose the inssurance industry. You can legislate their prices so regardless of who is in or out they have no choice but to charge a fair rate and if the people abuse them, then so what, its not like they've been fair so far.

I'm not suggesting that as the solution but it is possible to do, even if it sternly picks winners and lossers. That shouldn't distract from the real point which is that there is no excuse to have this particular bill be the final product as Krugman infers, since their are a wide variety of plausible solutions that would look very different than this piece of shit and everyone knows including Krugman.

[Odin2005]

179. I usually agree with you Paul, but not this time. The Mandate is ECONOMIC FASCISM.

The ends, no matter how good, do not justify Fascist, Corporatist means.

[Cleita]

180. I'm surprised he thinks this is workable. It's not unless insurance

is non-profit and covers everyone regardless of ability to pay. The Dutch and Swiss systems that they are so fond of pointing to as a model are non-profit for basic care. This plan is far from it and I believe it will bankrupt this country if they don't fix things in the years before it becomes law.

[applegrove]

184. I hadn't thought of that.

[jb24]

187. Nope

Individual mandates would be fine as long as there was a public option. Individual mandates where the only options are private insurance is total bullshit.

[invictus]

188. Paul, the problem is the bill does nothing to control costs. Because of high deductibles, people are

... forced to buy health insurance that they cannot afford to use.

[blueworld]

194. Where is the real world experience he refers to? Numbers please.

Healthy people I know still carry insurance, if they can afford it, because of things like appendicitis, kidney stones, car accidents...if they can't afford it, Krugman should quote those numbers. I want to see the numbers that prove that healthy people will risk their own financial futures, plus their families, simply because they're too lazy to purchase health insurance that's available to them. I don't believe it for a moment.

Is he referring to a VEERRRRYY small percentage of people? If so, that doesn't change the daily actuarial numbers a bit. Even with this aborted reform there will be a small percentage of people who will refuse to get insurance but will probably need health care.

Forcing all people to carry insurance without allowing a public option is a bailout and an impotent attempt at reform. I thought Krugman was a Nobel Economist, not a Nobel Psychic or actuary...I really wonder why he keeps beating this drum? Whatever.