You're The President -- It's Your Choice

[Jeff In Milwaukee]

You're the President and the Congress sends you healthcare reform legislation that is not everything you wanted and, in fact, doesn't contain some key provisions that you had previously demanded.

A veto of this legislation sends Congress back to Square One -- during the off-years elections, no less -- and it will be at least one year (and maybe even more) before new legislation will get back to you in the Oval Office.

FACT: 45,000 are going to die in the next year because of a lack of health insurance.

So what are you going to do?

[VMI Dem]

1. #3 - Grow a pair and quit fellating Joe Lieberman.

[racaulk]

2. !!!

:spray:

[Jeff In Milwaukee]

5. Not very presidential of you...

It's frustrating when you have limited options, isn't it? Guess what -- these are the options open to the President right now.

It's the lady or the tiger, dude. Pick.

[ElboRuum]

9. Oh, see that explains it...

I always wondered why Joe always has this "Mona Lisa" style smile on his face.

[Jeff In Milwaukee]

10. If I were Van Gogh I'd kick your ass for that comparison!

:)

[ElboRuum]

13. Why, was he a friend of DaVinci?

Seriously, the only reason Van Gogh would have a problem with me is because I'd tease him about his lopped off ear.

[Jeff In Milwaukee]

14. Oops!

I was confused because I've been reading that new book "The Van Gogh Code."

Interesting stuff. Says that Jesus and Mary married and then started the first Amway Franchise in the Holy Land.

[ElboRuum]

15. Now THAT I can believe.

Certainly more believable than that whole "Bible" nonsense.

[jgraz]

90. + A Brazillion.

:rofl:

[freddie mertz]

3. Fight for the best bill you can get before caving to the shills.

Can we have that option?

[Jeff In Milwaukee]

8. See Post #7 (nt)

[Tailormyst]

4. Third Choice: Get back out there and fight loudly and proudly for a worthwhile bill.

[Jeff In Milwaukee]

7. Not an option...

Unless you can get a grant to the National Science Foundation and create a time machine really friggin' fast, you don't get a third option.

[ElboRuum]

11. Actually, if you do actually manage to create a time machine...

...it really won't matter how long it actually took to build. Of course, we take that this problem hasn't already solved itself as proof that no one actually built that time machine because if they had, the approprate travel would have taken place and the problem would have been solved.

I've spent way too much time thinking about the implications of temporal paradox.

[Jeff In Milwaukee]

12. Kaboom!

That was my skull...

[T Wolf]

19. Maybe the time machine has been invented (will be?) but the travelers have (wisely) decided

to ignore this time period - kind of a radioactive zone to be avoided because there is nothing worthwhile to be accomplished here (and now). Maybe they only travel between 3000 and future dates.

[Armstead]

20. A time machine might not have been nececessary if he'd aggressively campaigned the first time

[Lydia Leftcoast]

22. Sure you do

Most of the bill doesn't go into effect for three or four years.

If it were that urgent, they'd have it go into effect immediately upon signing.

[Jeff In Milwaukee]

23. No Cop Outs Today...

No wiggle room, no weasel words.

Sign it or don't sign it.

Those are the only two options.

[Lydia Leftcoast]

36. In the real world, as opposed to freshman philosophy class, there are usually more

than two choices.

Let's look at the real world, where the situation is not either-or.

[Jeff In Milwaukee]

37. What real world do you live in?

Sign it or don't sign it. Those are the two options that Obama has open to him.

[Lydia Leftcoast]

40. Don't sign it and tell Congress that they have to reform health care,

not prop up the insurance companies.

Put the insurance companies under the same restrictions that they operate under in other countries, and then maybe we'd have a serious bill. Or tell them that they have those four years to transition into honest lines of work, perhaps selling supplemental policies.

Most of all, no mandate to buy insurance from UNREFORMED private companies. This is absolutely the worst part of the bill and the one that people object to most, unless they're living in an "I believe in whatever Obama does" fantasyland or are so affluent (the kind of person who actually buys $600 sweaters) that paying exorbitant prices doesn't phase them.

[Jeff In Milwaukee]

42. In the time it took to reply to your post, an uninsured person died...

About 900 people are going to die between now and New Year's Day. Wait a year? I hope somebody you care about isn't in desperate need of medical care. But if that person dies, you can take comfort in knowing that he or she died so that you can defend your scruples.

Me? I'm one unscrupulous son of a bitch. If I can get people covered here and now with a piece of shit Senate Bill, I'll get them covered and keep plugging away until I get everybody insured. The ship has hit an iceberg, and your approach is to rearrange the deck chairs until every thing looks good before we we head for the lifeboats.

No thanks.

[Lydia Leftcoast]

45. And signing this bill won't help any of the people who will die before New Year's Day

nor even most of the people who die for lack of medical care during the next four years, because this bill does not guarantee access to affordable medical care. It only requires the purchase of insurance, starting in either 2013 or 2014.

[Jeff In Milwaukee]

47. You tried that canard once today, Lydia...

Regardless of when the reforms take effect, putting it off for a year (or even longer) means the meter keeps running. And just out of curiousity, what do you suppose is the difference between having access to medical care and having insurance? It's the lack of insurance that's keeping these people from getting the medical care they need.

Another uninsured person is dead. Let me know when that starts bothering you, because it's bugging the shit out of me.

[Lydia Leftcoast]

51. Nope, it's the lack of AFFORDABLE insurance

If a company says, "Yes, you with your pre-existing condition can get insurance now, and it will cost you $1000 a month with a $5000 deductible," that's worse than no insurance at all.

[Jeff In Milwaukee]

55. Aside from the illogic...

Expensive insurance that I can't buy is worse than not having access to any insurance at all? Tell that to my diabetes because I'm not sure it sees the fine distinction.

And for the billionth time, this legislation puts caps on premiums and provides subsidies for people who can't afford insurance. And for the billionth time, once we get people covered, we can always put price controls in later. Medicare and Medicaid do this on an ongoing basis.

[Lydia Leftcoast]

60. To take your points one by one:

1. $1000 a month with a $5000 deductible means that you pay $17,000 a year before you get any benefit. If you have diabetes, you're better off spending that $17,000 on office visits, meds, and supplies.

2.
a) The caps on premiums are unrealistically high in the case of the premiums (AND, in a little-noticed provision, they're raising the percentage of income that you have to meet to deduct medical expenses from your income tax from 7.5% to 10%. In other words, if you make $50,000 a year, you have to have $3700 in medical expenses before you can deduct them. The bill would raise that to $4000.)

All subsidies fade out at about $42,000 for a single person, and above that, you can be charged 10% of your income.

2. The subsidies are pure corporate welfare and besides, will require a massive bureaucracy to administer.

4. We can always put in price controls later? On private companies? Even Nixon couldn't manage that one.

5. Medicare and Medicaid are already government programs.

[Jeff In Milwaukee]

74. Do some more research

1) $1,000 a month for premiums? with an 8% cap on my income, that means I'm making more than $150K per year. Enough that I can afford health insurance. $5,000 deductible? The legislation doesn't offer guidance on deductibles, so I don't even know where that number comes from.

2) Medical Deductions. Rarely occur unless the taxpayer is uninsured. Most insurance premiums come from pre-tax wages and aren't deductible in any case. Full Disclosure: In my spare time, I'm an Enrolled Agent with the IRS and of the hundreds of tax returns I've seen, only a handful have ever qualified for the Medical deduction.

3) Subsidies are pure corporate welfare. In a word -- No. It's welfare when you're paying for something and getting nothing in return. In this case, they're being paid to provide insurance coverage. Any why should it require a massive bureaucracy -- any more than Social Security, which mails out millions of check every month and incurs only 2% overhead costs.

4) Nixon actually DID manage that one, and he did it on the entire economy and not just a single industry. And it was done previously during World War II. But as I said, Medicare and Medicaid routinely adjust their payment schedules.

5) Uh....yes. Yes, they are.

[uponit7771]

17. Yes, that will change the mind of Lieberman and Nelson as if they care...very rational post

[Lydia Leftcoast]

41. You guys act as if Lieberman and Nelson were threatening to bring

machine guns into the Senate chamber and mow everyone down if they didn't get their way.

They're just threatening to filibuster, and eventually they'll get tired of it and collapse from exhaustion.

What a bunch of wimps the Democrats are--scared of someone who has threatened to talk at them. :scared:

[Captain Hilts]

6. Take a deep breath and sign it. nt

[baldguy]

16. Sign the bill. Then on Jan 1 start campaigning - yes CAMPAIGNING to fix it.

[Jeff In Milwaukee]

18. Slacker!

He should get out there on December 31st!

Seriously, though. I suppose my assumption was that signing the bill meant IMMEDIATELY (December 26th) starting the process to make changes.

[bdamomma]

44. yes, sign it and then make the necessary changes.

we would never see this with repigs in the majority.

[Lydia Leftcoast]

21. Straw man: Most of the bill doesn't go into effect for three or four years

How about taking the time to craft a GOOD bill (with no corporate representatives allowed within 100 yards of an administration official or Congresscritter) that goes into effect immediately?

Same difference.

[Jeff In Milwaukee]

24. See Post #23

And I would have thought "You're the President" would have been adequate indication that this is a strawman.

But just for the sake of argument, let's say that signing (or not signing) this bill, as flawed and delayed as it may be, will have no effect on 95% of those who would have otherwise died from a lack of health care.

Not signing the bill kills 2,000 of your fellow Americans.

Your move.

[johnaries]

25. Because it will take 3-4 years to implement no matter when it

is signed. The 3-4 years isn't arbitrary, it takes time to effectively implement many of the provisions, especially the ones that require new agencies. However, that does not mean that it can't be improved during that implementation.

This is not a strawman argument, it is very realistic.

[Orangepeel]

26. He should sign it. But he shouldn't pretend it was everything he campaigned on

I think the bill is better than the status quo and I don't think we can get any better given the makeup of the house and senate. So, I think he should sign it.

As to what Obama did or didn't do, it's impossible to say what would have been the best approach. With the egos of elected officials being what they are, a more public harder sell could have resolved them more firmly against reform. That's part of what happened in 1993.

But it is ridiculous to pretend that the bill is the bill he campaigned on, because it isn't. He should own that big compromises had to be made and this is the best we can get.

[krispos42]

27. c) Let it become law without signing it

n/t

[Jeff In Milwaukee]

28. You Mods -- you read EVERY thread on this board!

:)

[krispos42]

32. ;-)

Seriously, though, at this point it seems the best option. Dems and Obama can blame the Repubs for obstructing away reform, and Obama can show a streak of liberalism he's lacking.

:shrug:

It would be nice, but probably won't happen.

[Jeff In Milwaukee]

33. Perhaps a "Non-Signing Ceremony" at the White House...

Where Obama can pointedly say that he will allow this legislation to become law without his official endorsement, and he's putting Congress on notice that the job on health care reform is not done yet.

[Hippo_Tron]

81. That's something that should definitely be considered

I think it wouldn't fly ultimately because you have to declare victory in order to do well in the 2010 elections. But still it's something to think about.

[Exultant Democracy]

29. c. Sign it... then signing statement the crap out of it W style.

[Jeff In Milwaukee]

31. That's a REALLY interesting idea...

I was wondering about that one myself. Now given that we don't want to descend into the lawlessness that WAS the Bush Administration -- even for a good cause -- I wonder what Obama's options might be. Remember that CMS (the Center for Medicare and Medicaid Services which regulates public health programs) reports to the Department of Health and Human Services and that Kathleen Sibelius reports to the President.

Hmmmm.

[mkultra]

30. current:22% healthcare industry disruptors

paid to encourage no reform at all.

[Lydia Leftcoast]

35. WRONG

I am a victim of the health care industry, which is why I want the insurance companies to go into some honest line of work.

[Jeff In Milwaukee]

38. How many people die?

This is a fairly straight-forward question. You apparently don't want this legislation to pass because you've had negative experiences in dealing with the health insurance industry and you would apparently like to drive them all out of business.

Fair enough. That's a reason for your position.

But how many people are going to die? And are you willing to know that those people died because of your implacable hatred of the health insurance industry delayed even an imperfect attempt at getting people the health care they need? I don't want to be harsh with you, Lydia, but we're working with live ammo here. Waiting another year until we get a bill that satisfies everybody -- which may never happen -- means that real people are going to die.

You down with that?

[Lydia Leftcoast]

48. This bill doesn't guarantee ANYONE health care

Sure, it lets people be eligible for INSURANCE who weren't before, but there is no requirement to make it AFFORDABLE. In practical terms, a policy with a $5000 deductible for someone who isn't rich or has ongoing medical needs is UNAFFORDABLE.

Many people with pre-existing conditions have already received offers of insurance--for exorbitant prices.

The prices will remain exorbitant, because in order to keep within the limits required by the new law, the companies will raise the base prices on everyone else.

Get it through your cheerleading head: Every stage of this process has made it clear that this is not a "provide affordable health care for all Americans" act. This is a "preserve the profits of the insurance companies and try to get people to believe that it's for their own good" act.

[Jeff In Milwaukee]

54. You haven't actually read this legislation, have you?

Let's start with something I mentioned up thread. Health Insurance and Access to Medical Care are one in the same thing. If you show up at the door of my hospital suffering from a non-emergency ailment, I'll send you on your way. It's only when your ailment becomes life-threatening that I'm required by law to treat you. And then only to get you stabilized enough to get out the door again. Your cancer? Your diabetes? Not my problem. Unless you have insurance, you go untreated.

This Bill, flawed though it may be, provides expanded access to Medicaid for low-income persons and subsidies for low- and middle-income workers whose employers don't offer health insurance. People will pay no more than 8% of their income in premiums -- and that's thre pre-subsidized price. In other words, it's providing affordable access to medical care.

"The prices will remain exorbitant," you say. Not if we go to work RIGHT NOW to fix the flaws in the current legislation. Get people insured now and put the screws on the insurance companies later. Your position, and that of many people who oppose this bill, is that because there is the possibility of wasteful spending down the road, we should kill the bill until we can be assured it won't happen.

[Lydia Leftcoast]

68. I've read the Kaiser Family Foundation's side-by-side summaries

:shrug:

[Better Believe It]

34. This bill contains exactly what Obama wanted and nothing he was actually opposed to.

So your poll is not ground in political reality and makes no sense.

Just put the rhetoric aside and look at Obama's deal with the insurance industry and Big Pharma.

President Obama has all along supported a health insurance industry/big Pharma bill written by their political whores in Congress.

[depakid]

39. Bogus choices

Veto and get effective legislation through the reconciliation and cut the corrupt ideologues out the equation.

Your post -and your thinking is a prime example of why America is a failing state... and wy your people repeatedly get such raw deals. Hope you're proud of it.

[Jeff In Milwaukee]

43. Those are the actual choices

You just don't like them. Veto this legislation and people will die because of it.

That's the brutal truth.

[Lydia Leftcoast]

50. Enough already with this "people will die" talking point

Show me how they won't die before 2014 if the only insurance they can get is still unaffordable.

[Jeff In Milwaukee]

56. Does that make you uncomfortable?

Sorry about that. But every year we put this off -- and this is the first crack we've had at this subject since 1993 -- another 45,000 people are going to die from a lack of insurance coverage.

I know it's a bit melodramatic and maudlin, but I really am hoping that it's possible to shame people into doing the right thing.

[depakid]

62. So you think that providing (or mandating) junk insurance that people can't afford to use

-and providing market and regulatory incentives that will degrade everyone else's coverage (with major "benefits" that don't kick in until 2014) is going to solve set of problems? Sorry, Charlie.

Band aid on a gaping wound at best.

[Jeff In Milwaukee]

67. I keep hearing that term...

"junk insurance"

and I'm wondering just where you can prove that the insurance provided under this legislation won't be adequate. Because the legislation has specific definitions of who can be an insurance provider and what specfic coverage must be included.

Sect 1302(b)(1) includes the following:

(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.

So if I have insurance premiums that don't exceed 8% of my income AND I'm getting subsidies if I can't afford those payments AND I'm getting the coverage shown above....just what am I supposed to be upset about?

[Lydia Leftcoast]

63. I want to do the right thing, too

and that means providing CARE rather than insurance.

Why not take the money intended for subsidizing the insurance companies and use it to fully fund places like Hennepin County Medical Center here in Minneapolis so that anyone can receive free emergency or critical care AND set up free clinics everywhere staffed by nurse practitioners and PA's to take care of the sore throats and sprained ankles?

[Jeff In Milwaukee]

76. I know you do

And it's wrong of me to give the impression that I think you don't. Especially because Milwaukee and Minneapolis are not that far apart and you could easily come over here and kick my ass. Not to worry - I'm insured!

Interestingly, the Senate Bill DOES have increased funding for community health centers -- you can thank Bernie Sanders for that one. And hope that it survives the conference committee.

[depakid]

53. Acceptance of false choices and innacurate framing is one of the prime reasons

that America has become a failing state.

There was and is no reason whatsoever that health care legislation- especially with all of the talk of reducing the deficit, couldn't be moved through the Senate on a 50 +1 vote via the reconciliation process.

Republicans used the Byrd rule to push through much more dubious propositions.

Instead, you've been sold a bill of goods- increasingly expensive, high deductible, high copay, junk insurance for all- and told that that's all you can get. On the whole- it's effect will be worse than the status quo (and fails to solve any of the underlying root causes) yet so dissatisfied are some with the current morass- and desperate to pass some sort of bill, that they're willing to accept dysfunctional policy that will end up- among other things- lowering most people's standard of living (while padding the coffers of one of the most abusive industries in America).

[Jeff In Milwaukee]

59. A Failing State?

Not to be rude, but you're from friggin' Australia. Seriously.

And here's the reason that we couldn't pass the legislation on a 50 + 1 vote. We didn't have the 50 votes to begin with. Just because somebody is a Democrat doesn't mean they're going to line up for a chance to vote "yes" on progressive legislation. As I've said for about a billion times, there are only 58 Democrats and 1 Liberal Independent. But among those 58 Democrats are 10 who represents states that went for McCain in 2008 and only one of those Democrats is up for re-election.

So those ten can pretty much appease the voters back home and vote against anything they damn well please. Or they can be like Sen. Nelson of Nebraska and demand the sun, moon, and stars in exchange for his vote -- something that may or may not alienate another bloc of Democrats and derail the whole thing and then we start again. If you think this process is simple, you're grossly mistaken.

[Lydia Leftcoast]

65. Depakid lived in Portland for at least some time, which is where I met him

so he's not unfamiliar with the U.S.

I, too, believe that America is a failing state. I'm in my late fifties, and I remember when things worked. Sure, there were problems, some of them serious, but the naked greed and meanness that I see now just wasn't present to the same degree.

The schools were good, the libraries stayed open, it took one income to support a middle-class lifestyle (including owning a house and car and taking vacations), public transit was good, company employees were guaranteed pensions, violent crime was low, and children roamed freely in their neighborhoods.

I grew up in an era when Minnesota alternated between Republican and Democratic control. There was little difference, because both parties wanted the best for the general public and disagreed only on the best means of achieving this.

When I first moved back here after several years of living on both coasts, I attended a Dem event and talked to one of our statewide elected officials, who had been in state government for two or three decades. He told me that the Republicans had gone crazy, that he no longer saw them as interested in the general welfare of the people. He seemed sad and bewildered. "We used to be able to work with them, but now they're out for blood."

That's one symptom of a failing state.

[Lydia Leftcoast]

46. It's the tyranny of low expectations

:shrug:

"Our Team" is in charge now, so we have to believe that they have our best interests at heart, even if it doesn't look like it, because screwing the general public over is part of playing chess. :sarcasm:

[Jeff In Milwaukee]

49. I don't expect you to like it...

Thirty million people don't have health insurance right now. Unless sarcasm is going to get them access to health care, your bitter irony is of little value.

[Lydia Leftcoast]

52. If you can show me how this gets them AFFORDABLE insurance

that actually covers something before 2014, then I'll stop being sarcastic.

You strike me as being young with more experience as a policy wonk than as a patient. I may be wrong, but that's what you sound like.

[depakid]

57. A policy wonk would grasp that the major effects are similar to the Enzi bill

which- in a rare victory, the Democrats managed to filibuster in 2006.

Sound familiar:

The Senate bill forces employers to choose between accepting barebones policies and paying higher rates for adequate coverage. Employers will be given an unpalatable choice, and most employees will have no choice at all. People who need more than barebones coverage could wind up with much higher premiums than they pay today, making health insurance even more unaffordable. This will occur as people who need health care the most—people with health conditions or disabilities—become more and more isolated in traditional, comprehensive coverage, causing their premiums to skyrocket.

http://www.familiesusa.org/assets/pdfs/enzi-bill/Enzi-Bill-Effect-on-States.pdf

[Jeff In Milwaukee]

64. I assume you didn't read what you just posted...

Because the two Bill don't bear even a casual resemblence to each other, aside from a repeated use of the words "health care" and "insurance." It gutted state insurance commissions and essentially allowed insurance companies to write their own regulations.

And the Democrats didn't filibuster this bill (they threatened)

[depakid]

70. The main effects are the same

Both bills create schemes by which tons (and tons more) Americans will end up with high deductible, high copay, junk insurance that they can't afford to use.

State regulations and mandates are thwarted (as credit card companies do) by setting up in the least regulated states in a race to the bottom- threatening hard won protections won by consumers in their home states.

Different mechanisms- same results.

[Jeff In Milwaukee]

73. They're not even remotely related....

Jesus Christ, learn something about this subject before you post this blather. The Senate Bill does NOTHING of the sort. In fact, the Senate Bill creates a new commission to hold down costs.

Seriously now. Until you have something of substance to add to this discussion, I don't have time to respond to you.

[depakid]

75. Oh. please

Both bills do EXACTLY what I mentioned above- with no effective cost control mechanisms- and every incentive for businesses, individuals and insurers to move toward junk insurance.

Indeed, one credible estimate I've seen is that actuarial values on most of these policies- and indeed the only types of policies that will be subsidized is 60% of actual health costs- with large, upfront deductibles that discourage primary and preventative care- and high coinsurance requirements and drug costs that discourage follow up treatment.

(I guess that's one way to prevent overutilization).

While you may (or may not) have some experience walking wards- it seems you also may not have such a keen grasp of economics and regulatory policy.

[Droogie666]

58. It's Not All About The Money!!!!!!!!!!!!!!!!!!!!!!!!!

Healthcare reform is not only about lowering the cost! It's not just about the money for some people! Some people would just like to be able to get health insurance, or not lose their insurance, etc. Pre-existing conditions may not mean anything to some people, especially if they are young and healthy!

[Jeff In Milwaukee]

61. I'm 48 years old and I work in the healthcare industry...

I literally walk through patient wards on a daily basis.

You?

[depakid]

66. If that's true, then you ought to recognize

how the financial inability to access primary care and follow up treatment adversely affects health outcomes- at the same time as it burdens providers with massively inefficient reimbursement schemes.

Ever open one of those medical policy manuals? Pretty thick and convoluted, eh?

Ever seen what the billing departments do with those unpaid accounts?

[Jeff In Milwaukee]

71. That's quite a grasp of the obvious you've got there...

nt

[DailyGrind51]

69. Fuck ideology, hold your nose and sign the bill, then do everything in your power to improve it.

[depakid]

72. But wait! I thought we couldn't revist the legislation for a decade?

Isn't that the thrust of what the Senate bill's proponents are saying?

If that's true- then, how will meaningful "improvements" get through Congress?

If it's not- then why not bag this crap legislation- and run real health reform through 50 +1 reconciliation and get a LOT more of it right- now- and use the issue as a wedge in 2010?

[DailyGrind51]

85. Because "Reconciliation" will only deal with the budgetary aspects of the Bill!

"...Imagine you want to run health reform through the reconciliation process. Here's how it works: Congress includes reconciliation instructions in the budget. Those instructions direct certain committees -- say, the Finance Committee and the Health, Energy, Labor, and Pensions Committee -- to produce health-reform legislation hitting certain spending targets by a certain deadline. Once finished, the legislation is tossed back to the Budget Committee, which staples it together into an omnibus bill and sends it to the floor of the Senate for 20 hours of debate followed by an up-or-down vote.

This, some suggest, is too easy. By making it likelier that legislation passes, it is contradicting the Senate's proud history of implacable obstruction to progress. "If we are going to preserve the deliberative process in this U.S. Senate," Byrd thundered from the floor, "which is the outstanding, unique element with respect to the U.S. Senate, action must be taken now to stop this abuse of the budget process." So he took it, introducing, in 1985, the first version of the Byrd rule.

If you want to know why we do not today have a 50-vote Senate, the Byrd rule is the reason. The Byrd rule imposes a set of sharp constraints on the reconciliation process, limiting what is considered appropriate for reconciliation. The basic theory of the Byrd rule is that any legislation considered under the budget reconciliation process should principally affect federal revenues. A tax cut, for instance, can be considered under the reconciliation process. A new federal holiday cannot. But between those two examples sit crucial ambiguities.

The Byrd rule states that legislation is unfit for reconciliation if it "produce changes in outlays or revenue which are merely incidental to the non-budgetary components of the provision." I asked Jim Horney, a budget expert at the Center for Budget and Policy Priorities, how you define "merely incidental." And what, exactly, is a "provision"?

He sighed. A provision, he said, is "not defined anywhere. It goes well below a title or section of a bill and even below a paragraph. But exactly what it is nobody knows." And the Senate rules offer no more clarity on the definition of "merely incidental." Asked if anyone had developed an accepted meaning, Horney seemed almost apologetic. "No," he said. "Absolutely not."

The matter is not simply academic: The Byrd rule allows senators to challenge the acceptability of any provision (undefined) of a reconciliation bill based on whether or not its effect on government revenues is "merely incidental" (undefined). Thus, if you enter reconciliation with a health-reform bill, it's not clear what's left after each and every provision -- however that is defined -- is challenged and a certain number of them are deleted altogether: the tax portions, certainly. And the government subsidies. But is regulating insurers "merely incidental" to government revenues? How about reforming hospital delivery systems? How about incentives for preventive treatment? Or the construction of a public plan? An individual mandate?

It's hard to say. The ultimate decision is left up to the Senate parliamentarian, whose rulings are unpredictable. Under George W. Bush, Republicans managed to ram tax cuts, oil drilling, trade authority, and much else through reconciliation. But they were as often disappointed: The GOP leaders fired two successive Senate parliamentarians whose Byrd rule rulings angered them.

Taken as a whole, the uncertainty of the reconciliation process transforms it into a game of chicken: If Republicans refuse to cooperate with health reform and force Democrats to resort to reconciliation, no one knows what will emerge out of the other end. Republicans might have no input, but Democrats will be at the mercy of an obscure bureaucrat's interpretation of an undefined Senate rule. It's the legislative equivalent of deciding a bill on penalty kicks.

What should not be missed in all this is the absurdity that is the contemporary Senate. You need 50 votes to pass a bill. You need 60 votes to overcome a parliamentary trick that allows 40 senators to talk about cheese whiz until everyone else heads home for the night. But some priorities -- deficit reduction and the budget among them -- were judged too important to face the filibuster. There was no particular rationale given for that shortcut, but the relevant senators have clung tightly to its terms. Last week, Sen. Robert Byrd, now in his late 80s, reiterated that reconciliation was "a process intended for deficit reduction," and using it for health reform and cap and trade "is an outrage that must be resisted."

But the reconciliation process has been used for plenty that did not reduce deficits. Both of President Bush's tax-cut plans traveled through the process. And the very senators who speak reverentially of the filibuster now, voted for reconciliation then. Judd Gregg, in fact, voted for reconciliation every time it was used in the Bush era.

And even if reconciliation had only ever been used to cut the deficit, an observer might wonder what renders deficit reduction so much more pressing than, say, ending the punishing human cost of the health-care crisis, or saving the planet from catastrophic climate change. Why should cutting programs be exempt from the Senate rules but not saving lives?"

The 50-Vote Senate

Could an obscure Senate rule free Barack Obama from the filibuster and enable health-care reform?


Ezra Klein | March 23, 2009 | web only

http://www.prospect.org/cs/articles?article=the_fifty_vote_senate

[quiller4]

77. I wouldn't have to hold my nose to sign the bill. n/t

[IndianaGreen]

78. If I were President I would have pushed for Medicare for all

and taken the issue to the country.

My first priority would have been jobs, jobs, jobs, using the New Deal as a template.

My second priority would have to bring the troops home and restore the rule of law.

Health care would have followed third.

[DonCoquixote]

130. One thing you overlook

A major obstacle to "jobs jobs jobs" IS the lack of healthcare, which makes jobs jobs jobs expensive to create and maintain.

[apocalypsehow]

79. I've got a question for veto voters: what kind of "progressive" just writes off 45,000 human beings?

:shrug:

That's the scary kind of ideological purity: the kind that tells 45,000 people "sorry you're gonna die, but my petty litmus tests are more important than your lives. Better luck next time!"

I'll tell you what kind: the despicable sort.

[Jeff In Milwaukee]

80. Oh Snap!

I wouldn't go that far. There is a plethora of misinformation out there being circulated by both the Left and the Right. The Right wants you to think that bureaucrats will be setting up Death Panels to chloroform your grandmother, and the Left wants you to think that we're just throwing money hand over fist at the insurance companies.

Give people a week or a month to let this sink in. Once the scent of bullshit drifts off and the blood pressure moderates, I think people will probably agree that while this legislation needs some serious and ongoing improvement, it's a good start toward a genuine system of healthcare in this country.

[bigwillq]

83. Good post.

:thumbsup:

[bigwillq]

82. How many will die between now and 2014?

Or 2012? Or 2013? :shrug:

Since you're so concerned about their well-being. Yes, the bill (if passed) needs time, I guess, to take effect, but it's pretty likely that people will still die waiting for the full benefits to take place. Don't really think that's a sound argument. My opinion, of course.

[Greyhound]

89. See #88. n/t

[Name removed]

91. Deleted sub-thread

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

[Scarsdale Vibe]

84. On what ideological principles would he veto it? Killing poor people?

I know that murdering the poor by denying them health care has become fashionable among some on the left, but I don't think Obama's principles quite conform to the purity trolls on the internet. Kucinich, on the other hand, would have no problem committing mass murder by killing the bill.

[Jeff In Milwaukee]

86. Poorly worded on my part...

What I was driving at was a veto based on the fact that it wasn't a "good enough" bill.

[grahamhgreen]

93. 1 trillion dollars every 5 years

1 trillion dollars every 5 years - if you pass this you


will give big insurance enough cash to crush future reform efforts as well as what little is in the bill.

[Jeff In Milwaukee]

98. Does nobody on this board every actually read and stuff?

A large portion of the funding for this bill goes to the expansion of Medicaid to cover approximately 20 million people. Another large chunk goes to small business in the form of tax breaks if they provide insurance to their employees. Of the subsidies that go to insurance companies, there is a provision that 85% of the payments must be for actual services, and not administrative costs or profit.

Seriously. Read up on the subject.

[Iggo]

87. I'd torture the prisoner, of course.

Oh, wait. Wrong ticking time-bomb scenario? Sorry. My bad.

(I spel gud.)

[grahamhgreen]

94. And THEN give him full medical!

[Iggo]

95. lol...nice one!

:rofl:

[Greyhound]

88. Other. I'd pocket veto this monstrosity and

issue an executive order offering every citizen an opportunity to buy into Medicare.

[Jeff In Milwaukee]

96. Can't be done

A pocket veto works only under limited circumstances (Congress has to be adjourned before the end of a ten-day period after the Bill is passed). And you can't spend a trillion dollars via an Executive Order -- Congress has to appropriate the funding.

[Greyhound]

102. The executive order can indeed open Medicare up

and if Congress dared fail to fund it, the subsequent newly elected Congress would. The order becomes a fait accompli.

What we need is change and that requires a President ready to stand up.

[Jeff In Milwaukee]

104. Must be nice to live in your world....

There is no real-world scenario where your plan is even remotely plausible.

In any case, and per the scenario in the OP, you will have consigned another 45,000 of your fellow Americans to death because it would be AT LEAST one year before a new Congress can be seated and IT ASSUMES that every single offending member of Congress would be replaced (more on that in a second) and that THE NEW CONGRESS would be Democratic and that even if they were, the new Congress WOULD NOT find cause to impeach the President for his insufferable arrogance (the Andrew Johnson Clause of the Constitution) and....after all that's done...it will take a grand total of ONE SENATOR to filibuster and subsequent legislation to death in the next session.

[Greyhound]

106. No of course not. FDR did nothing but sit on his ass for years letting those

good souls in Congress fix the problems they were prevented from addressing before.:eyes:

Your acceptance of false helplessness is just, disheartening. We will get what we deserve and that would be OK if it were limited to the fearful sheeple that make it possible, unfortunately all of us will suffer with you.

[Jeff In Milwaukee]

108. Does anybody on this board EVER read a book?

FDR didn't create the New Deal on the basis of Executive Orders, you boob.

The Banking Act of 1933 - Created FDIC and included Glass-Steagall
National Industrial Recovery Act - Create the National Recovery Administration and the WPA
Social Security Act - Created Social Security

Et Cetera, Et Cetera...

However, Roosevelt DID you an Executive Order to intern the Japanese -- so you'll forgive me about being less-than-enthusiastic about gong that route.

The believe that we should obey the Constitution of the United States is not "the acceptance of false helplessness." It's the fucking law, and you can't rewrite it because you too mule-headed to accept the alternatives.

[grahamhgreen]

92. ideology? The bill is a scam - it will not cover these people. it will create fly by night

subsidiaries that cover nothing.

and it has a 12,000 deductible.

EXPAND MEDICARE IN COMMITTEE.

[Jeff In Milwaukee]

97. Not even slightly true

Here is the required coverage under the Senate Bill. Insurance companies who participate must offer the follow:

(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.

So it's real insurance. And nowhere does it call for a $12,000 deductible. And the bill DOES expand Medicare -- to about 20 million more people.

[grahamhgreen]

99. Links? If they fail to provide, the mechanisms for enforcement are wek. There is no jail time for

CEO's, etc..

As far as the deductible:

Q: Would the health bills reduce my out-of-pocket costs?

* The legislation provides new protections. Under both the House and Senate bills, for example, insurers could no longer impose annual or lifetime limits. In addition, under the House bill, individuals would not pay more than $5,000 a year for deductibles and co-insurance. Families would have a $10,000 limit. The Senate bill sets higher limits. How much so won't be clear for a few years, but if the law were in place today, the caps would be $5,950 for individuals and $11,900 for families. Under both bills, out-of-pocket costs would be set lower for most people who qualify for government premium subsidies.
http://sanders.senate.gov/newsroom/news/?id=ac788749-1c4b-44c2-ae89-7e6468e62994

-------------

Top 10 Reasons to Kill Senate Health Care Bill

3. Many will be forced to buy poor-quality insurance they can’t afford to use, with $11,900 in annual out-of-pocket expenses over and above their annual premiums.

1. Forces you to pay up to 8% of your income to private insurance corporations — whether you want to or not.
2. If you refuse to buy the insurance, you’ll have to pay penalties of up to 2% of your annual income to the IRS.

4. Massive restriction on a woman’s right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court.
5. Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays.
6. Many of the taxes to pay for the bill start now, but most Americans won’t see any benefits — like an end to discrimination against those with preexisting conditions — until 2014 when the program begins.
7. Allows insurance companies to charge people who are older 300% more than others.
8. Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market.
9. No re-importation of prescription drugs, which would save consumers $100 billion over 10 years.
10. The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1,000 a year — meaning in 10 years, your family’s insurance premium will be $10,000 more annually than it is right now.
http://fdlaction.firedoglake.com/2009/12/21/10-reasons-to-kill-the-senate-bill/

PS - do you have a link to the actual bill?

[Milo_Bloom]

103. LOL.

And that list is acceptable?

It is kinda sad how hoodwinked people are.

What is the deductible on those "services"?

How restrictive are they?

If people just read the bill they would understand just how bad this legislation is and what a blight it is on our country.

[Jeff In Milwaukee]

105. I've read the legislation....and you obviously haven't

OK, Smart Guy. What IS the deductible for these services? As you've read the bill forward and backward I'm sure you have the informaton at your fingertips. Post it for us. Right here. Right now.

And hear me now. Unless you post the exact amount of the deductible per the Senate Bill for...say...basic hospitalization, you are absolutely and completely full of shit.

Have at it, Sparky.

Post it. Right here. Right now.

[Milo_Bloom]

107. 5150 per family.

Amazing that is the number chosen, isn't it.

[Jeff In Milwaukee]

110. Link

nt

[Milo_Bloom]

112. Read the bill.

It sets the maximum out of pocket cost at those in section 223 of the internal revenue service code, which is the maximum amount allowed for HSA's

$5150 per family.

[Jeff In Milwaukee]

115. Wrong...

For starters, there will be multiple plans beyond expended Medicare and from the various commercial products available and the Senate Bill does not establish specific deductibles. Your dedictible will vary depending on the plan that you purchase.

The IRC Sec. 223 that you refer to deals with your maximum deduction for a Health Savings Account. And while the Senate Bill certainly allows for out-of-pocket costs to be a deduction on your taxes, that shouldn't be confused with your deductible. And the maximum deduction is $5,950 per family in 2009.

[Milo_Bloom]

116. WRONG. You didn't read the bill.

This is very simple black letter law.

Read sec 3111 (4).

OUT OF POCKET.—For purposes of this
19 section, the term ‘out of pocket’ shall include all ex20
penditures for covered benefits (as provided for with
21 respect to high deductible health plans under section
22 223(d)(2) of the Internal Revenue Code of 1986).


Which states:

(2) High deductible health plan
(A) In general
The term “high deductible health plan” means a health plan—
(i) which has an annual deductible which is not less than—
(I) $1,000 for self-only coverage, and
(II) twice the dollar amount in subclause (I) for family coverage, and
(ii) the sum of the annual deductible and the other annual out-of-pocket expenses required to be paid under the plan (other than for premiums) for covered benefits does not exceed—
(I) $5,000 for self-only coverage, and
(II) twice the dollar amount in subclause (I) for family coverage.


If you had actually READ THE BILL, you wouldn't have gotten this wrong.

[Jeff In Milwaukee]

119. If you could UNDERSTAND the Bill...

You'd know this doesn't mean what you think it does. The IRS lets you establish a Health Savings Account ONLY if you are not covered by an employer's plan AND you are self-covered through a High Deductible Plan.

What you're citing has nothing to do with deductibles under plans people may purchase under this Bill.

I sandbagged you by challenging you to post the deductible for Hospitalization because I KNEW that it was nowhere in this legislation.

[Milo_Bloom]

120. Don't quit your day job.

Obviously, reading legal documents is not for you.

So I proved you wrong and I got sandbagged.

It must be really sad to be cheerleading for legislation you don't even understand.

[Jeff In Milwaukee]

122. Hardly...

You were sandbagged trying to provide an answer that doesn't exist -- even though you claimed that it did.

You were attempting to bullshit your way out of an unsubstantiated position to avoid looking foolish.

Remember the phrase I used? Absolutely and completely full of shit.

Wear it with pride, my friend. You've certainly earned it.

[Milo_Bloom]

125. Unfortunately for you, the answer existed...

and you even got the specific code references to prove it.

Next time, read the bill before you make a fool out of yourself.

[Jeff In Milwaukee]

127. What you posted is NOT a reference to deductibles

Its a reference to tax DEDUCTIBILITY. That's not the same thing and there's no correlation between the two.

[Milo_Bloom]

129. Oh dead god, are you serious????

The section is called OUT OF POCKET and is all about the minimum qualifying coverage under subtitle B.

This is not about tax deductibility at all.

Read section 3111, it has NOTHING to do with tax deductions.

It uses the IRS code as its benchmark for what qualifies as acceptable insurance.

The IRS codes talks about what qualifies as a plan you can use for deductions. (ie, if you plan falls outside those criteria, you can't deduct from your taxes).

[Jeff In Milwaukee]

133. Funny. No Link Here Either....

I guess I'll just have to accept what you're saying at face value.


pssst...Complete and utter bullshit.

[Milo_Bloom]

135. It was no more valid when Joe Wilson said it.

You've been given all the information you requested and the resources to verify it.

Yelling "you lie" from the peanut gallery is as useless then as it is now.

Good luck with your life.

[Jeff In Milwaukee]

137. No Link

Complete and utter bullshit.

[Milo_Bloom]

139. No Link

You lie.

[Milo_Bloom]

114. Actually, make that 10K

The 5150 is the MONHTLY limit per family.

10K is maximum out of pocket per family annually for plans.

Then there are tiers set up for those making 150% of poverty and above

50% of maximum out of pocket costs.
+17%
+15%

So, if you are making 150% of poverty, your deductible is 5K

Great job with the reform there, sparky.

[ZombieHorde]

100. If I was the President, I think I would sign the bill. nt

[Milo_Bloom]

101. NO ONE dies from lack of insurance.

They die from lack of HEALTH CARE.

There is no HEALTH CARE in this bill.

[Jeff In Milwaukee]

111. Jesus, How Many Time Does This Need To Be Explained....

You don't have access to insurance, you don't have access to health care.

Read the link in the OP.

[Milo_Bloom]

113. 100% Wrong.

What you fail so miserably on is understanding that having insurance doesn't give you access to care, because of the out of pocket costs involved.

What is kinda sad is that people I know who can't afford health insurance, do get some care by going to low cost clinics. Once they are forced to buy this defecitve product, they will no longer be able to afford health care, because the money they used to spend going to clinics, will now go towards buying the defective product, with no money left over for the actual doctor's visit.

[Jeff In Milwaukee]

117. Are you this thick professionally?

I work at a hospital and volunteer at a free clinic. The people who go to my hospital have coverage (either through insurance or through Medicare/Medicaid). The people who go to my clinic do not.

If you think that the root cause problem here is that millions of Americans have high-deductible plans, you're a Milo Blooming Idiot. People who have employer-provided insurance typically have reasonable deductibles and people who purchase their own insurance are typically affluent enough to have a plan with a reaonsable deductible (or supplement their insurance with a Health Savings Account).

The bogeyman of "junk insurance," which is all the rage around DU and Fox News these days (go figure), is only a minor problem that will BE FIXED WITH THIS LEGISLATION.

[Milo_Bloom]

118. Still wrong. Maybe b/c you didn't read the bill.

I love the strawman you try to create with "typically".

What you fail so miserably on in this answer is that the problem currently ISN'T that millions of Americans have high-deductible plans, the problem is that all these unisured people who we are supposedly covering will end up in high deductible plans.

[Jeff In Milwaukee]

121. You know less about English that you do about Economics....

"Typically" is not a strawman, it's a qualifier. Does EVERY employer-provided plan have a reasonably low deductible? No, but most of them do. Does EVERY person who self-insures purchase or low-deductible plan or a high-deductible plan with an HSA? No, but most of them do.

And since you have no idea what the deductible is on these plans that people may (or may) purchase at some point in the future -- neither do I -- you're really blowing smoke when you say that these plans aren't affordable because of their high deductions.

And then there's this, and please try to have an honest moment as you answer. Which is better?

No Insurance. Chronic, untreated illness. Disability and premature death.
No Insurance. Successful treament followed by bankruptcy and foreclosure.
Low-End Insurance. $10,000 in medical bills. Survival.

[Milo_Bloom]

124. And it creates more strawmen to wiggle its way out of the mess it created.

First, typically is creating a strawman, b/c it creates a false point to knock down without any backing information.

Second, is your second strawman.

"1) No Insurance. Chronic, untreated illness. Disability and premature death.
2) No Insurance. Successful treament followed by bankruptcy and foreclosure.
3) Low-End Insurance. $10,000 in medical bills. Survival."

If it was a choice of 1, 2 or 3, that would be great, but again, all this could be avoided if you actually read the bill.

1 vs 2 is the choice of the person and wouldn't change with insurance. If someone is choose not to incur bills to not treat a chronic condition, giving them an affordible deductible, currently 5->10K per year, doesn't change it.

#3) assumes that there are no caps on the benefit... but, insurance companies CAN, in fact, cap benefits... so, any chronic condition will also be followed by bankrupcy.


Thanks for playing, next time read and understand the bill you are failing so hard to defend.

[Jeff In Milwaukee]

128. Post Links to Every Statement You've Just Made

I asked once before and you refused to do it.

You're making this shit up and you know it.

Links. For Every Claim. Not just some text that you cut-and-paste out of context and then misinterpret. Actual Links.

I know that won't happen. And you're about to post some grand rationalization for why you shouldn't have to post a link (and I'm sure it will be clever and snarky, because you're such a clever and snarky little fellow, aren't you).

But ultimately they won't appear. And you know they won't appear.

[Milo_Bloom]

131. Okay.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=433&topic_id=88875&mesg_id=93326

There is a link to every statement I just made.


Now, since it is IMPOSSIBLE to deep link into a PDF file on my computer, all I can give you is the CODE SECTIONS (which I have done)

Then you need to look up the code sections, which you were given and READ THEM.

Again:

Read section 3111 of the Senate Health Care bill, specically, section (4) about Out of Pocket Maximums (which I quoted to you specifically)

You will find that it sets acceptable plans as those defined in section 223 (c) (2) (which I also quoted you specifically)


Look, sorry you tried to pick a fight with someone who knows more about this than you, but you are going to have to learn to live with the consequences of your actions.

[Jeff In Milwaukee]

132. No Link

Complete and utter bullshit.

You don't know what you're talking about, you're lying, and you know it.

[Milo_Bloom]

134. You should've quit while you were behind.

Yeah, quotting specific sections of the legislation is "utter bullshit".

Giving you the direct language out of the bill, which you can easily verify by reading it, is "lying".

Whatever, Jeff, good luck with life.

[Jeff In Milwaukee]

136. No Link

Complete and utter bullshit.

[Milo_Bloom]

138. No Link

You Lie.

[TheKentuckian]

109. I'd veto it, I promised the people that I would regulate this industry

and provide competition and increase affordability.

The bill doesn't do what I promised or even a smidgen of what is required. Of course I'd never lose sight of these very essential ideas.

Price controls and choice can be injected minus a PO but instead we leave a predatory monopoly in place.

[Jeff In Milwaukee]

123. Stock up on Sympathy Cards...

You're going to need them.

[Milo_Bloom]

126. Yeah, all the little cheerleaders are going to be sad when they understand what they bought.

[jeanpalmer]

140. Veto it

And start over. Take a new approach. Ditch the insurance model, ditch the PO and single payer, and adopt a Community Health Center approach. Spend a year or two analyzing the ones that are already operating, set up a few that are totally run by the government, and then cookie cutter them all over the country. Also expand them to cover more than primary care. By 2014, we'd have a good start on a system like the UK's, totally not for profit, providing great health care at a truly affordable price. UK does it for $2900 per person. Even assuming $4,000 per person, that would bring total US costs to $1.2 trillion a year. Take $600 billion out of the defense budget and apply it to this health care. That would bring the total annual cost down to $600 billion, or $2,000 per person, something very affordable.

The key to getting affordable healthcare is (1) getting the right low-cost model and (2) cutting back on defense spending and applying the savings to health care.

[county worker]

141. It's too late to do anything but sign it. If I am Obama, I've already shown my hand.

I've stated that I didn't state what I stated during the campaign. To veto the bill would then make me out to be even more of a hypocrite than I am now.

I sign the bill, take credit for everything that is good about it.