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Over the past few days, there’s been a great deal of moral protest, outrage, and even fury expressed at Firedog Lake and The Seminal about the “opt-out” compromise. The basis of the outrage is the idea that we all ought to stand together in health care reform, and insist on the idea of “everybody in, nobody out.” I’m all for that principle. It’s one of my mantras in health care reform. And I’m also all for moral outrage and even fury in the service of a good cause. But if we really all ought to stand together on the opt-out, and advocate for “everybody in, nobody out,” then:
Why shouldn’t we all stand together on enhanced Medicare for All?
Why shouldn’t we all stand together on a Jacob Hacker-style Public Option?
Why shouldn’t we all stand together to reject a House bill (HR 3200) that will leave 17 million uncovered?
Why shouldn’t we all stand together to reject a Senate Bill (the HELP Bill), that CBO has forecast will still leave 34 million uncovered?
None of these questions are intended as arguments for accepting the opt-out compromise now, and against standing together on the opt-out. What they are about instead are the following questions:
Why are we getting so morally outraged about the opt-out’s violation of “everybody in, nobody out,” now, when we didn’t get morally outraged when all these other compromises came down the pike?
And why don’t we get morally outraged now about all the previous “opt-out” compromises that have been made for nothing in return, except even more pushing from the right-wing to water down the reform?
What we need to do now is to get morally outraged at the whole legislative process up till now, and work to defeat everything “on the table” in Congress, and go back to square 1. And square 1 is enhanced Medicare for All. And the first thing we ought to do in the context of pushing that, is to seek a vote on S703, Bernie Sanders’ Medicare for All bill, and, along the way, force a showdown on the filibuster and use the “nuclear option” to get the 60 vote nonsense off the table for good, so we can pass health care reform with a simple majority, and without the need for any deficit-neutral nonsense.
Again, I’m all for outrage, and even fury; but it needs to be directed toward the right things, and they are all the earlier outrages committed in this health care reform legislative process starting with taking Medicare for All, single-payer off the table.
”Everybody In, Nobody Out!
(Also posted at the Alllifeisproblemsolving blog where there may be more comments)
33 Comments
“Why are we getting so morally outraged about the opt-out’s violation of ‘everybody in, nobody out,’ now, when we didn’t get morally outraged when all these other compromises came down the pike?”
Because this one smacks of “State’s Rights,” which is anathema to those who want all power consolidated in a vast Federal government? Just taking a guess..
Couple questions: Do you really think something this big should be decided by a simple majority? Do you really think deficit-neutral is nonsense with our current economy, deficit, and debt?
Hi Grumpy,
I understand the States’ Rights meme, and opposition to it, but I still don’t think it explains the fury, and certainly doesn’t provide a rationale for applying the principle in that case, but not in the others.
Do I really think something this big should be decided by a simple majority? Yes, I believe majority vote should be the principle to decide things in the Congress, and also that majority rule in the Senate is written into the Constitution as the default for Congress. I don’t believe in Calhoun’s concurrent majorities. Also, I think the use of the delaying institutions in the Congress has destroyed our ability to adapt as a society.
We used to laugh at France and Italy, because every few months they had another Government. We celebrated our own political and governing genius. But we’re the ones who have now had a health care reform problem for 50 years. We’re the one whose roads are falling apart. We’re the ones who have banks that are out of control, cause recessions/depressions, and are allowed to charge usurious interest rates to consumers. We’re the ones who have a safety net that people fall through, along with an inability to create enough of an economic stimulus to get people employed. We’re the ones with serious energy problems that cost $750 billion per year in foreign exchange. We’re the ones who manufacture very little anymore. We’re the ones with very serious educational problems whose school systems produce ignoramuses. And in addition to all this we along with others, can’t solve our environmental or climate change problems.
We need a Congress that can do the things it was elected to do. Super-majority rule frustrates the results of Congressional elections and teaches people that their majority voice isn’t enough to change their country, and nothing will ever change. It makes them passive. teaches a very bad lesson, and will reduces the legitimacy and affection for our democracy. In the end ineffective immobilist Government will lead to dictatorship. More on immobilism, the seniority system, and the filibuster here.
Finally, I do think that “deficit-neutral” requirements are short-sighted nonsense. People want to be deficit neutral in domains of Government activity that are less popular with them. So, no one insists that defense department activities be deficit neutral. No one insisted that the Department of Homeland Security activities be deficit neutral. No one insisted that the Bank bailout be deficit neutral. Few insisted on that with respect to the stimulus. Basically, what happens in our political system is that people start worrying about the kinds of expenditures they don’t like, and you hear nary a peep from them about the expenditures they do loke.
More generally, I do think that certain Government expenditures are bad investments and should be avoided. For example, some tax expenditures haven’t stimulated our economy or produce anything useful for the United States. Those ought to be eliminated. Other tax incentives are causing the migration of jobs to other nations and are producing a de-industrialized America. They need to stop. There are lots of military expenditures that need to stop, not jjust in wasteful military contracting, but also expenditures to keep American soldiers and contractors overseas in Europe and parts of Asia. It’s now 64 years since WW II ended. The cold war is over. Our boys and girls need to come home where other nations are capable of defending themselves.
There are many areas where Government expenditures are good investments. Education is one of these. Another is providing free health care for everyone. Others involve re-creating the safety net, re-training people for new employment. Taking action against climate change. Safeguarding the environment. Transforming the energy basis of our economy. These are things we must do and soon, and they are things worth going into debt for.
Our national debt is still a relatively small percentage of GDP compared to many other industrialized nations. Its magnitude is not nearly as big a worry as the economy is. Our experience after WWII when we reduced the national debt as a percent of GDP dramatically, during both the Truman and Eisenhower Administrations, in spite of fighting the Korean War, shows that when your economy is healthy, the national debt declines sharply as a percent of GDP. We saw this during the Clinton Administration, as well.
For some reason, the paragraphing function wasn’t working on my last reply. I corrected it twice, but the paragraphing doesn’t show up.
Couple questions: Do you really think something this big should be decided by a simple majority? Do you really think deficit-neutral is nonsense with our current economy, deficit, and debt?
if you want to see what requiring a super-majority will do for your budget, check out california’s.
yes, deficit spending is the way out of a depression, but if it makes you feel better, medicare for all would be deficit-neutral.
It would be if the bills introduced into the Congress were passed. Of course, some of the more well-off among us would have to do their patriotic duty and get a little closer to paying their fair share of taxes. What a novelty that would be?
i no longer make that kind of money, but the first paycheck i had that bumped me up into the top tax bracket [clinton years, so it wasn't all that high] was so wonderful that i happily paid all the taxes i could, instead of taking all the deductions i could. i was so proud of myself [for making all that money, i had arrived!] and so pleased with life in general that i couldn’t wait to share it.
yeah, i saw the pop thing. i sure wish they’d taken your advice about starting over at square one. there have been a few points along the way where liberals/progressives/democrats could easily and credibly have done that, no matter how hard they’ve worked and led the cheerleading for the public option up to now.
It seems that most people don’t have your reaction to the top tax bracket. They find new ways to use their money instead. If not new ways to spend it, there are always new ways to invest it to get even richer. Investment wouldn’t be so bad. But the problem is that investments have been in the latest country that might provide outlandish returns. That’s been great for building up the rest of the world, but it’s been lousy for the American economy which has been de-industrializing.
Also, thanks for your comment on pop. I think it’s an instance of the difficulty people have in admitting error. Even with the disaster that’s befallen the pre-compromise PO strategy, its proponents, many of whom gave up single-payer on feasibility grounds, just can’t bring themselves to walk it back. If Jane had revealed her plans to start a non-profit, and posed the question to people here about whether it should be pointed toward the PO or Medicare for All long term, I wonder what kind of answer she would have received?
well, i thought your framing was the best [it was you, wasn't it?]. you don’t even have to admit error: once the other side essentially walks away from the negotiation, you’re free to move your own line in the sand back to any starting point you want [with some constraints, but not much really].
on taxes, granted, not many people are actually enthusiastic about paying them, especially in the top bracket, but that tax burden wasn’t all that onerous, especially compared to past eras [and bring back those confiscatory taxes i say!]. but really, quite a number of people, while they do grumble about paying taxes, realize that you do get what you pay for and that paying more taxes is how you get more livable societies.
I agree with all you say, but I’m not sure that we ever had really had confiscatory taxes. The official top marginal tax rates were confiscatory in the Roosevelt, Truman, and Eisenhower Administrations, but the tax loopholes were so prevalent and wide-ranging that the wealthy mostly escaped those tax rates. And yes, i think I did do that framing you mentioned.
i was using confiscatory semi-snarkily. kids these days really do seem to think that rolling back the bush tax cuts would be verging on confiscatory taxation. hehe. when obama first started talking about reagan had some good ideas, i emailed the campaign to say yes! bring back the 50% tax bracket!
you’re right of course. we never really had truly confiscatory taxes, even though it looks like it on paper. but the wealthy remained wealthy all through those years, and if any of them lost all their money it was due to stupidity on their part, not from high taxes.
strongly agree with your second paragraph.
Thanks. I feel strongly about that too. I confess I don’t understand where Jane is coming from.
“if you want to see what requiring a super-majority will do for your budget, check out california’s.”
We’re not talking about budgets.
“yes, deficit spending is the way out of a depression”
Unless you’re already deep in a hole. Interest on the national Debt for 2009 was over 389 billion dollars. Think we might have been able to find a better use for that money like — say — health care?
“medicare for all would be deficit-neutral.”
And if you look out the window you’ll see a flying pig and a riding beggar…
No Grumpy. hipparchia is quite right, the savings from moving the insurance companies out of basic care are so great that when combined with the new taxes specified in HR 676, it is deficit neutral.
Even more important, the amount saved in total expenditures on health care will be around 34% annually. It’s saves about $800 Billion in expenditures in a single year. When projected over ten years, it saves about $8 trillion or more.
In taking enhanced Medicare for All “off the table”, the politicians are being profoundly fiscally irresponsible, as well as irresponsible: from the health care outcomes point of view (single payer nations have much better outcomes than the US), from the economic point of view (the California Nurses Association estimated that shifting to Medicare for All would create 2.5 million new jobs), and from the political point of view (the anti-democratic influence of the health insurance industry on Congress and the grip they have on American politics would be destroyed). In short, this was a real sell-out of the American people to the insurance industry.
flying pigs, are those like flying moneys?
budgets, deficits, taxes, spending, big issues, it’s all interconnected.
yes, agreed, we could [and should] have been spending that money on health care, schools, all kinds of good things, but we’ve been in worse shape in the past deficit-to-gdp-wise and overcame it once govt spending kick-started the economy.
as for deciding by simple majority, 2/3 of the people say they support a medicare-for-all system and this has been true for many, many years. the fact that maybe only the barest majority of politicians would vote for it is more a measure of how much influence the monied interests have in congress, not a measure of how much disruption single payer would supposedly cause. we-the-people just don’t have the kind of $$$$$ it takes to buy a super-majority of congress [lobbyists, otoh, do have that kind of $$$$$] but we-the-people do maybe have half a fighting chance of influencing 50% of them.
as for medicare for all, yes it spends a lot of money, but that’s the pool we as a society have put most of our expensive people into already — the elderly and some of the disabled. adding the rest of us to that pool would not be a huge drain, relatively speaking. hr676 would not only remove the profit-maximizing machinery from health insurance [by nationalizing the bulk of it], but would also severely curb the profit-maximizing machinery from health care. converting investor-owned hospitals back to non-profits and negotiating drug prices at medicaid/vha levels are written into the legislation too.
“flying moneys”? I’m not sure what you mean, like dollars flying out the window? The “flying pigs” thing is an old figure of speech meaning “not a snowball’s chance in hell” (if you’ll forgive my using yet another figure of speech ;)
By the way, did you know that the GAO classifies Medicare as a “high risk” organization “in need of reform”?
gao report
from 1987-2004, health care spending on old folks rose annually by an average of 7.4%, but it rose slightly faster for younger groups. this is the pattern that canada was seeing when they used to have a health insurance system almost exactly like ours. they slowed that way down by switching to single payer.
hr676 would reform these two programs, if not eliminate them entirely.
medicare very much needs to pay specialists less, but to do so by setting lower payments per service, rather than cutting back on the amount of services provided by specialists. this is how other countries get excellent care more cheaply than we do. they have lots of fee-for-service but don’t pay very much for any one service, nor do their specialists [in most cases] make anywhere near as much as ours do.
that payment policies do not foster physician responsibility to provide the most effective services efficiently is a fancy way of saying pay-for-performance, which has not really been shown to save all that much money. if you want physicians to perform better, take the hassle and expense of dealing with insurance companies out of their day [don't know about your area, but most drs here who take medicare patients also take younger patients and thus have to deal with insurance companies].
yep, i’d like to see more prosecution of outright fraud too. nevertheless, in another section of that report, the estimated fraud adds up to about 4% of total medicare spending. the [nonfraud] overpayments to medicare advantage and part d add up to another 4-5% but this much could be eliminated with the stroke of a pen, just by enacting hr676.
yes, nursing homes very definitely need improvement. with all of us in one pool [saves money] paying higher taxes into the system [injects more money into the system], we could afford to do more on this front.
Another great answer, thanks.
Great answer to grumpy, hipparchia.
Great answer to grumpy, hipparchia.
Yep, a really terrific answer if one overlooks the minor point that HR 676 didn’t happen…
if wishes were horses… and when pigs fly… yep.
i mostly just tossed in the flying monkeys because they seemed like another appropriate, if tangential, cultural reference for the topics under discussion.
lets, appreciate your sentiment. I just came from seeing Michael Moore’s Capitalism. He is a good teacher, but strong medicine in terms of consciousness raising. Less eye rolling outrage and eye rolling and full on “we got ROBBED/RAPED, America.” I hope his anger is contagious. The discomfort will blossom to anger among people. He underlines the reality of plutocracy, plutonomy (is that the other name) you speak of. And stresses how the oligarchs have almost ALL the money, but we have the votes. 1% of the population now controls over 95% of the money. But we have 99% of the votes. And all their money does much to divide up and conquer a politically and morally immature populace for sure to protect them, the predators. But maybe not a majority’s worth.
Everybody in, Nobody out. Yes. I intend to say that a lot. If “they” can keep repeaing socialism millions of time, and “they” have Obama and Congress tightly in their pockets, I will do all I can to revive the 80 million who said yes to full out change, before Obama did his bait and switch.
Re opt out, I felt confident that as with what happened to Medicare, sanity will ultimately prevail, and states will opt in. But I am an optimistic still tilting at windmills for single payer. I believe single payer will out. That is why they are so afraid of it. Why Obama can’t let it come close to his round table. It is the only sane option. It will renew itself fiscally. It is fiscally conservative. genuinely, at the same time universal, but the bribed of Congress and the President with his hollow trophy have sacrificed their moral consciences.
My heart knows what is just and right and humane and affordable. Single Payer Medicare for All.
Hi lib, “plutonomy is a new one on me, so I guess I’ll stick with “plutocracy,” rule by the wealthy. I feel the way you do. I’m Mad As Hell and I won’t take It Anymore.” “Enough.” We need to restore the progressive income tax system and remove the extremes of economic inequality we see in this country.
lets, one line flew out at me from the moore movie, how the House voted no on the TARP at first, got so many calls from voters, but then later the Dem leadership in both houses including and especially it seemed Dodd, who was so enmeshed with insurance lobby money (Hartford was once the insurance capital of the world and his wife is a big insurance honcho), made a private deal and agreed on the bailout much to the horror of the rank and file Dems who were feeling a moral outrage like Marcy Kaptur and Dennis K. The leadership had sold out.
Anyway, lets, Moore’s line is “YOU CAN’T REGULATE EVIL”.
I may do a diary entitled that this week. YOU CAN’T REGULATE EVIL. You are welcome to use that, too. This is bottom line about morality. Feelings have got to be drawn into this fight, yes intellect, but feelings and passion because it is about perpetrating evil.
Insurance and Big Pharma must not be rewarded for what they have done. They have killed prematurely 45,000 Americans a year with their system, and Congress, taking profit over the protection of Americans, has them at the table front and center, to accommodate them, and all those accommodations are robbing Americans and killing them. 30 cents of every dollar will unnecessarily go to them for their overhead (not needed) and marketing themselves and their fat cat execs.
And the Congress is willing to set up a Rube Goldfarb crazymaking destructive system because they have profited. And they will sell out America in a heartbeat. When every other industrial nation in the world cares about its citizenry, the governments, more than our elected government.
YOU CAN’T REGULATE EVIL.
As you know lib, I’m not for regulating them, I’m for enhanced Medicare for All, and putting them out of the business of funding essential health care services altogether. By essential health care services, I mean everything covered in HR 676.
As for not being able to regulate evil. I’m not sure about that, In a sense, there has always been an element of evil in the unbridled profit motive. Yet we regulated it successfully for a long time. Then the Radians like Allen Greenspan and others convinced politicians that regulation was passe, so we stopped regulating. An awful lot can be done to restore the way we were, if we will only regulate again, and prosecute and punish when we have criminal economic behavior.
We need to get the CPSC staffed again, and the FDA. We need to get a bulldog at the SEC, and we to repair the regulatory framework again, and then we need to enforce regulation again. Then we can have the discussion about whether evil can be regulated or not.
Common sense, boy I like that. The real outrage should be that the Congress that has caused all this Countries problems is in charge of deciding what we get for healthcare with our money. These people are no longer our representatives, and we all should be able to see that.
Single payer healthcare with new ways other than taxes to pay for it, should be everybodies demand.
They can use our money to fight wars, built and support the worlds largest military, and give our money away like it is water. When it come to something as simple as healthcare for our people, they have the balls to say it will cost to much.
Everything they have done that has gotten us into debt, has cost to much but no complaints there.
No one notices that they don’t care if we have jobs, healthcare, houses to live in, or money to live on. They do care about other countries, the military, Wall Street, and Campaign contributions.
Fix the Congress, and fix all the Countries problems. Support the Congress and sell your country out.
amen!
Over one year and nothing has been done yet, when all they had to do was reinstate the regulation they voted out. Obama is talking but no action yet.
Did You hear now Wall Street is back in business trying to do the same thing with life insurance they did with mortgages. We didn’t fix the problem, jail the crooks, or regulate. So it is a matter of time until they cause the same kinds of problems again.
On top of all of it we rewarded them by bailing them out, but didn’t bailout the people hurt.
Exactly right. Obama should have taken them into receivership, cleaned them up, and then sold them off, while passing the regulations he needed to pass while their lobbying power was gone.
yeah, the outrage over opting out of nearly-worthless option would be funny if the situation weren’t so serious.
thanks for this. a lovely rant.
Thanks hipparchia. I’ve been relieving my frustration. Did you notice that Jane, NYCEve, and Marcy, have started a non-profit called Public Option Please? Nothing like institutionalizing a terrible mistake, so progressives can make it again next time around.
hipparchia, Thanks for adding an awful lot to this discussion.
you always spark the best discussions.