Douglas MacKinnon, former press hack for Bob Dole, asks:
Why do so many on the left have such an unhinged hatred of [Sarah Palin]?
Well, Doug, I just want you to know, that, personally, I don’t have an unhinged hatred of Sarah Palin. Repeat: I do NOT have an unhinged hatred of Sarah Palin. Not in the slightest.
My hatred hinges quite sensibly on her advocacy of a psychotic extreme rightwing ideology, her radical christianism, her courting of organizations that ooze contempt for American democracy, her propensity to lie the way normal people breathe, her enormous pride in her blithering ignorance, her sheer incompetence, and her mind-boggling megalomania.
And truly, Mr. MacKinnon, the Vanity Fair article you object to are the least of the reasons to hate Sarah Palin, even if they make the rightwing love affair with such a repellent personality seem rather…unhinged, if you know what I mean.
For those who are worried about the health care reform that’s being hashed out in congress right now because you believe that single payer is the only answer, I would just ask if you think that France, Holland and Germany should change their systems? They all offer universal coverage, their statistics are far superior to ours and their people would probably kill you before they’d let you change them. And none of them have what we think of as strict “single payer” plans.
Here’s a brief overview of what these three countries have:
Health care in the Netherlands is financed by a dual system. Long-term treatments, especially those which involve (semi-)permanent hospitalization, and also disability costs such as wheelchairs, are covered by a a state-run mandatory insurance. This is laid down in the Algemene Wet Bijzondere Ziektekosten (AWBZ, see article in the Dutch Wikipedia), “general law on exceptional healthcare costs” which first came into effect in 1968.
For all regular (short-term) medical treatment, there is a system of obligatory health insurance, with private health insurance companies. These insurance companies are obliged to provide a package with a defined set of insured treatments [1].
This system came into effect in January 2006. For those who would otherwise have insufficient income, an extra government allowance is paid to make sure everyone can pay for their health care insurance. People are free to purchase additional packages from the insurance companies to cover additional treatments such as dental procedures and physiotherapy. These additional packages are optional.
A key feature of the Dutch system is that premiums are set at a flat rate for all purchasers regardless of health status or age. Risk variances between funds due to the different risks presented by individual policy holders are compensated through risk equalization and a common risk pool which makes it more attractive for insurers to attract risky clients. Funding for all short term health care is 50% from employers, and 45 percent from the insured person and 5% by the government. Children until age 18 are covered for free. Those on low incomes receive compensation to help them pay their insurance. Premiums paid by the insured are about 100 € per month with variation of about 5% between the various competing insurers.
Prior to 2006 (and since 1941) there were two separate systems of (short-term) health insurance: public and private. The public insurance system was executed by non-profit “health funds”, and financed by premiums taken directly out of the wages (together with income taxes). Everyone earning less than a certain threshold income could make use of the public insurance system. However, anyone with income over that threshold was obliged to have private insurance instead.[2].
Germany has a universal multi-payer system with two main types of health insurance. Germans are offered three mandatory health benefits, which are co-financed by employer and employee: health insurance, accident insurance, and long-term care insurance.
Accident insurance (Unfallversicherung) is covered by the employer and basically covers all risks for commuting to work and at the workplace.
Long term care (Pflegeversicherung) is covered half and half by employer and employee and covers cases in which a person is not able to manage his or her daily routine (provision of food, cleaning of apartment, personal hygiene, etc.). It is about 2% of a yearly salaried income or pension, with employers matching the contribution of the employee.
There are two separate systems of health insurance: public health insurance (Gesetzliche Krankenversicherung) and private insurance (Private Krankenversicherung). Both systems struggle with the increasing cost of medical treatment and the changing demography. About 87.5% of the persons with health insurance are members of the public system, while 12.5% are covered by private insurance (as of 2006).
The entire population must pay compulsory health insurance. The insurers are non-profit independent agencies not linked to the State. A premium is deducted from all employees’ pay automatically. An employee pays 0.75% of salary to this insurance, and the employer pays an amount to the value of 12.8% of the employee’s salary. Those earning less than 6,600 euros per year do not make health insurance payments.
To allow full reimbursement of health costs, many employees also pay a voluntary premium (up to 2.5% of salary) to a mutual insurer. In the 1960s, 30% of the population paid for supplementary health insurance. This rose to 50% in the 1970s. By 2000, 85% of the population were paying privately for additional insurance coverage.[5]
In addition to payroll contributions, a general social contribution (or social security tax) of 7.5% (known as the Contribution Sociale Generalisée or CSG) is levied on employment and investment income. Most goes to health insurance.[5]
After paying the doctor’s or dentist’s fee, a proportion is claimed back. This is around 75 to 80%, but can be as much as 85%. Under recent rules (the coordinated consultation procedure [in French: parcours de soins coordonné]) General practitioners (“médecin généraliste” or “docteur”) are more expected to act as “gate keepers” who refer patients to a specialist or a hospital.[5] The incentive is financial in that expenses are reimbursed at lower rates for patients who go direct to a specialist (except for dentists, gynecologists and psychiatrists).
As costs are borne by the patient and then reclaimed, patients have freedom of choice where to receive care.[5] Around 65% of hospital beds in France are provided by public hospitals, around 15% by private non-profit organizations, and 20% by for-profit companies.[5]
England and Canada have more straightforwardly government sponsored “single payer” systems.
All of these systems have their good points and their bad points. But every last one of them is better than what we have in the United States right now in one important respect: universal coverage. They all guarantee that everyone has access to affordable insurance and have created systems to make that happen, which are dependent upon the government to regulate and administer. All of them have changed over time and continue to evolve today. Many of them are facing the same financial pressures we are, but still to a lesser degree. (Aging populations, expensive treatments etc…) The satisfaction rate is much, much higher among citizens of those countries than here. I’ve been sick in those European countries and believe me navigating their systems was a breeze compared to what I’ve experienced in the health care maze here. I would take any of them over what we have now.
So, while I am a proponent of single payer, (which I am defining as medicare for all, even though that too is a private, public partnership) I recognize that there are other ways to get to affordable, universal health care and I’m willing to see what the congress comes up with before I decide to bail on the whole thing.
I don’t know if the plan the congress and administration produces will be any good, but I do know that the concept of having a public plan operating alongside private insurance with mandates, employer contributions and public subsidies did not come out of thin air. Various forms of that kind of system are in place elsewhere and they can work. It remains to be seen if they can pull it off but I see no reason to be reflexively hostile to it at this stage of the game.
I do agree that single payer should have been the leftward position going into this, because it would have given us much more room to maneuver. But then, we all should have backed Dennis Kucinich in the presidential race because he’s the only one who ran with single payer in his platform. That ship sailed two years ago as far as legislative strategy is concerned — and actually probably 60 years ago when Harry Truman lost the first health care battle. I haven’t exactly seen liberals organizing around single payer all these years so we could be prepared for this moment so I’m disinclined to blame the politicians alone for that.
There’s nothing wrong with advocating for the system you want and I’m not saying people shouldn’t do that. I’m not the issue czar telling people what the proper progressive position on things has to be. I’m only pointing out that it is possible to have huge improvement in our system, including universal health care, through other means than single payer (however you define it.) While we debated “socialized medicine” for 60 years, the Europeans have done a lot of experimenting and have figured out various ways to get this done. We don’t have to reinvent the wheel.
Update: Corrente asks a very smart question about the proposed HELP plan and whether or not it will preclude a state or region enacting its own single payer plan. The groups who are whipping the congress on specifics of the public plan should read this. It’s a good idea and will tell us a little bit about the legislative intent here.
Milbank Would Write About This, But He’s Busy Scheduling A Listening Session With The NRA
by dday
I don’t care about any of this, Nico Pitney is still such a dick:
For $25,000 to $250,000, The Washington Post has offered lobbyists and association executives off-the-record, nonconfrontational access to “those powerful few”: Obama administration officials, members of Congress, and — at first — even the paper’s own reporters and editors.
The astonishing offer was detailed in a flier circulated Wednesday to a health care lobbyist, who provided it to a reporter because the lobbyist said he felt it was a conflict for the paper to charge for access to, as the flier says, its “health care reporting and editorial staff.”
With the newsroom in an uproar after POLITICO reported the solicitation, Executive Editor Marcus Brauchli said in a staffwide e-mail that the newsroom would not participate in the first of the planned events — a dinner scheduled July 21 at the home of Publisher and Chief Executive Officer Katharine Weymouth.
The offer — which essentially turns a news organization into a facilitator for private lobbyist-official encounters — was a new sign of the lengths to which news organizations will go to find revenue at a time when most newspapers are struggling for survival.
For all the stories about blogger ethics, I don’t have access to anyone at the highest levels of government that I can sell to corporate lobbyists.
These “salons” have already been cancelled, and look what the Publisher says was the real problem:
“Absolutely, I’m disappointed,” Weymouth, the chief executive of Washington Post Media, said in an interview. “This should never have happened. The fliers got out and weren’t vetted. They didn’t represent at all what we were attempting to do. We’re not going to do any dinners that would impugn the integrity of the newsroom.”
Translation: “And I would have got away with it, too, if it weren’t for you meddling kids.”
Well, I’m glad that whole mess is over. Now the Post can go back to being influenced by lobbyists and setting conventional wisdom in Washington without all that dirty money changing hands.
Update: from digby — just curious about one other little matter: who in the allegedly anti-lobbyist White House agreed to this? And did whoever it was think it might be important to include some non-industry representatives, who can’t afford to pay 25k to eat some stale canapes with wealthy villagers at this intellectual salon where all the “people who will get it done” were gathering? But then perhaps that would be inappropriate. After all, if you have the media, the titans of industry and the White House all under one roof it would be unseemly to allow any dirty hippies in the door. They could light up a fattie right there in the drawing room and start singing “I want to fuck you like an animal” to Ceci Connolly.
And anyway, they are clearly irrelevant to the process. As are the citizens.
Reader JW brought this story about California’s woes from last week-end’s NY Times Magazine to my attention. I think it says it all:
“Our wallet is empty,” Schwarzenegger said in a speech a few days before my visit. “Our bank is closed. Our credit is dried up.” He called for cuts that would, among other things, eliminate health insurance for close to a million poor kids, stop welfare checks for more than half a million families and close 80 percent of the state’s parks. Then he pivoted into empathy mode. “I see the faces behind those dollars,” Schwarzenegger said. “I see the children whose teachers will be laid off. I see the Alzheimer’s patients losing some of their in-home support services.” As I waited for Schwarzenegger in the lobby of the governor’s office, I studied the official portraits of former governors, including those of Ronald Reagan, Earl Warren and Jerry Brown (boldly colored and cartoonish and considered so bizarre at the time it was painted that the Legislature initially refused to hang it). Suddenly I heard Schwarzenegger’s unmistakable voice booming joyously as he led an entourage from his office.“We are going to da beh, we are going to da beh,” Schwarzenegger kept saying.
Schwarzenegger and I then repaired to a tent that he had put up in a courtyard next to his office, which allows him to smoke cigars legally at work (no smoking is allowed inside the Capitol). The tent is about 15 square feet, carpeted with artificial turf and outfitted with stylish furniture, an iPod, a video-conferencing terminal, trays of almonds, a chess table, a refrigerator and a large photo of the governor. Schwarzenegger reclined deeply in his chair, lighted an eight-inch cigar and declared himself “perfectly fine,” despite the fiscal debacle and personal heartsickness all around him. “Someone else might walk out of here every day depressed, but I don’t walk out of here depressed,” Schwarzenegger said. Whatever happens, “I will sit down in my Jacuzzi tonight,” he said. “I’m going to lay back with a stogie.
Maybe Arnold and Maria could invite all of those elderly Alzheimer’s patients who have lost their home health aides to come over and share his jacuzzi and his optimism. Maybe they can feel “perfectly fine” too.
JW points out that the article is a typical snotty hit piece on the California fruits and nuts, but that it does state one particularly egregious false equivalence:
Complicating matters further, the major parties in California are both effectively controlled by their most partisan elements, a byproduct of gerrymandered voting districts that force lawmakers to appeal to their ideological bases. After many earlier failed efforts, a ballot initiative championed by Schwarzenegger finally passed last year that will redraw the districts. But that won’t take effect until after the 2010 census, so for now the two parties are largely controlled by what Bruce Cain at Berkeley calls “the Taliban.” The result? Gridlock in Sacramento, a standoff between the parties of “no more taxes” (Republicans) and “no more cuts” (Democrats).
There is no doubt that Democrats are dysfunctional. But they are not equivalent to the California Republicans who are completely insane. The “cuts” which don’t intrude on Arnold’s beautiful mind when he’s in the jacuzzi puffing on his Cuban, are going to affect real humans in ways that are devastating. Refusing to raise taxes on millionaires because they might get mad and move their companies to Samoa is not even in the same category.
You learn something new every day. According to certain theologians, evangelical teaching says that love isn’t a feeling:
The Christian counselors Sanford sought out while trying to decide whether to stay with his wife or jump on a plane to South America advised him what else love is and isn’t. “Their point is that love is not a feeling,” Sanford told The Associated Press in a tearful two-day confessional. “It’s a choice. It’s an action.” That sentiment might seem cold to many Americans, but it is perfectly consistent with the born-again, evangelical Christian world that Sanford inhabits, says sociologist John Bartowski. “What evangelicals are doing is sort of carving out a subcultural view of love which is not so highly romanticized as we see in movies, that is at odds with the dominant view of love,” says Bartowski, a professor at the University of Texas at San Antonio and author of the book, “Remaking the Godly Marriage: Gender Negotiation in Evangelical Families.” That world view, he says, “divorces” love from emotion, because “feelings are fleeting and not to be trusted.” “Love is something that is cultivated in the trenches of living a day-to-day relationship,” says Bartowski. “That is not a Hallmark moment.”
I guess the only euphoria allowed is the ecstasy you feel for Jesus.
Not that I feel sorry for Mark Sanford. He’s clearly in the throes of a whopper of a mid-life crisis and it’s very difficult to watch someone you know go through one, much less on the national stage. But I do think I can understand how someone like him gets to this point. Repression will do that to you.
I have no idea what’s gone on in that marriage and even if I did, I’m sure I couldn’t fully understand it. Human relationships are always mysterious to some degree, even to the people involved in them. But some marriages aren’t worth saving and from a distance this one sure looks like one of them to me. And it looks as though Sanford is doing everything his rebellious, guilt ridden subconscious is telling him to do to make it impossible to repair. After reading that article ( which I’m sure is simplistic and theologically shallow and yadda, yadda,yadda) I have to say that a little part of me would be gratified if Sanford ends up leaving the whole thing behind and becomes a bartender in Belize or something.
The pleasure nazis are always telling people that nothing but religion and war are allowed to make you feel good. And I just don’t think that human beings are wired to love Jesus and get off on violence alone. I know if it were me, something very fundamental inside me would strike out against all these people telling me that the idea of love and emotional fulfillment in marriage is irrelevant.
The funny thing is that I suppose my position puts me sort of in league with Ross Douthat, the Conservative Catholic Boy Wonder of the NY Times who was just the other day extolling the virtues of the grand passion. But he was saying, naturally, that it’s liberal elites who are a bunch of dried up prigs who have no notion of romance and conservative Real Americans who know how to feel. And perhaps that’s right if what you define as great romance is an 8 1/2 year ilicit affair for which you feel so much giddy excitement and guilt that you end up staging a highly public crash and burn and then submitting yourself to the flaggelation of your tribe. That’s not romance in my book, that’s gothic soap opera. But I guess if you’re Mark Sanford, you take what you can get.
On the other hand, any man over 40 who publicly says stuff like this probably doesn’t deserve any sympathy, because of the turgid dialog alone:
“A whole lot more than a simple affair,” he said. “It’s a love story. A forbidden one, a tragic one, but a love story at the end of the day.”
As you all know, Blue America has been collecting money to run some ads in Arkansas to ask Blanche Lincoln to support a Public Plan. We shot three spots but couldn’t decide which one to go with, so we’ve decided to ask you to make the decision for us, by coughing up yet another buck or two for the ad of your choice.
I haven’t the time right now to weigh in in detail on the Todd Purdham article about Sarah Palin in Vanity Fair, although it is a fascinating, if frustrating, piece. But I will say that I think Ed Kilgore gets to the real question that wasn’t asked and he answers it correctly:
Purdham never gets around to examining in any detail why the Conservative Base loves her so. That’s a strange omission, particularly since the whole piece begins with Palin’s speech earlier this year at an Indiana Right-to-Life event–significantly, her first public appearance outside Alaska in 2009.
In all the hype and buzz about Palin when she first joined the ticket, and all the silly talk about her potential appeal to Hillary Clinton supporters, the ecstatic reaction to her choice on the Cultural Right didn’t get much attention. She wasn’t an “unknown” or a “fresh face” to those folks. They knew her not only as a truly hard-line anti-abortionist, but as a politician who had uniquely “walked the walk” by carrying a pregnancy to term despite knowing the child would have a severe disability. And all the personality traits she later exhibited–the folksiness, the abrasive partisanship, the hostility towards the “media” and “elites,” the resentment of the establishment Republicans who tried to “manage” her, and the constant complaints of persecution–almost perfectly embodied the world-view, and the hopes and fears, of the grassroots Cultural Right. (This was particularly and understandably true of women, who have always played an outsized role in grassroots conservative activism.) Sarah Palin was the projection of these activists onto the national political scene, and exhibited the defiant pride and ill-disguised vulnerability that they would have felt in the same place.
This base of support for Palin–maybe not that large, but very passionate, and very powerful in places like the Iowa Republican Caucuses–isn’t going to abandon her just because the Serious People in the GOP laugh her off in favor of blow-dried flip-flopping pols like Mitt Romney or blandly “electable” figures like Tim Pawlenty. To her supporters, mockery is like nectar. And that’s why Sarah Palin isn’t going to go away as a national political figure unless it is by her own choice, or that of the people of her own state.
She’s got that Nixon Orthogonian thing going on. And it’s more potent than ever in this environment of epic elite failure. I wouldn’t assume that she, of all the Republican freakshow, won’t be the one who survives. It’s highly unlikely that she can transcend that passionate base and actually become president, thank goodness, but she could certainly be the one the party chooses. She is one of them through and through.
Unlike in 1994, when The New Republic allowed an abominable article by Betsy McCaughey to codify the Villager mindset on health care, this year they have one of the brightest wonks in the business, Jon Cohn, driving their coverage. And this article about the pitfalls of a “just pass any bill” strategy is required reading.
Notwithstanding the predictable fits-and-starts of the legislative process, it seems likely that Obama will have a bill to sign by year’s end, thereby accomplishing what the Clintons famously could not. But then what? Having crafted a bill that can pass Congress, will Obama be signing a bill that people actually like? It’s a question best answered by examining another episode of the past–one that, although a mere footnote in political history, is fraught with warnings for today’s reformers.
The episode is the fight over the Medicare Catastrophic Coverage Act, which President Reagan signed in 1988. Its purpose was to plug some of the emerging gaps in the Medicare program: If you stayed in the hospital too long, Medicare just stopped paying the bills. The Act extended hospital coverage indefinitely, capped out-of-pocket spending for beneficiaries, and offered partial coverage of prescription drugs, among other things.
Or at least that’s what the law was supposed to do. After the bill passed with overwhelming, bipartisan support, a backlash developed, memorably culminating in a “riot” of angry seniors who chased a beleaguered Dan Rostenkowski–then chairman of the House Ways and Means Committee–into his car after a Chicago meeting. Less than two years after passage, before the bill’s implementation, Congress voted to repeal the act, again with sweeping margins.
Basically, the program only provided a catastrophic care benefit to a small amount of seniors who faced extended hospital stays, and because of a desire to keep the bill revenue-neutral, all seniors paid for the program in premiums and surcharges. Those charges were modest, but people got the perception that they were paying more for nothing. As Cohn explains, the parallels are eerie.
Fast forward two decades, take a closer look at what’s happening on Capitol Hill, and you may notice some familiar storylines. In order to make sure reform can pay for itself, lawmakers are talking about slowing down implementation, so that the program is not fully on line until 2014. They’re also talking about offering fewer subsidies to help people obtain insurance. In a nod to centrists who don’t like the idea of too much government, there’s a strong push to gut or even eliminate proposals for the public insurance plan, which was supposed to provide security for individuals and competition for private insurers […]
Put aside, for a moment, the policy merits of these moves. The politics are lousy. Obama would be in danger of producing legislation that seems to offer little up-front benefit, particularly for the electorally vital middle class. And if some of these people end up paying even modestly higher taxes to help finance reform they’re not likely to be happy about it. It’s hard to imagine such legislation provoking a backlash that could produce total repeal. It’s not so hard to imagine such legislation creating bad political feelings, the kind that linger around until the next Election Day and pave the way for legislative retrenchment later on.
Let’s bring back the policy merits: they too are lousy. Smaller subsidies along with an individual mandate will strain individual budgets, and a lack of a check on the insurance companies with no public option and a weak national insurance exchange will allow that strain to worsen with ever-expanding premiums. Slowing implementation just keeps in place a broken system causing 18,000 Americans to die every year.
Whatever mash of policies that come out of Washington, in health care – unlike some other legislation – practically the entire population will be intimately familiar with the consequences. It would be nearly impossible to distort the benefits or demonize the negative effects. It will be what it will be. And so designing a policy based on bipartisanship rather than effectiveness is a complete folly. Democrats and the White House have basically put forward this health care reform as a signature accomplishment. If they design something where the benefits aren’t readily apparent, and people’s premiums remain high, the public will get the message.
If Harry Reid and Nancy Pelosi muscle health reform through Congress, if President Barack Obama signs a bill in the Rose Garden and hands the pen to an ailing Sen. Ted Kennedy, if health reform, in other words, passes with fanfare and attention, Democrats own it. This will not be a quiet accomplishment. They will have told the American people that on this historic day, under this historic administration, they have begun to bend the curve and and tame the insurers and guarantee coverage and generally fix this huge problem that so many before have promised action on but so few have succeeded in tackling.
And if, 10 years down the road, the plight of the middle class has worsened and cost growth hasn’t slowed and the only real difference is that more tax dollars go towards low-income subsidies, Democrats will be blamed for that. Their arguments will have less credibility. Republicans will run ads about “the last time a Democrat told you he could reform American health care.” […] If Democrats pass a bill that gets the policy wrong, they run a real risk of losing trust on what’s arguably their core issue. This is high-stakes stuff.
It’s not that I disagree with Digby at all – now is a rare chance to enact universal health care, and we should not shy away from it because it doesn’t meet every single proper contour. But there are undeniable consequences to a bad policy. And, I would add, needless consequences. For once, the most popular policies line up with what will likely be the most cost-effective ones that provide the greatest tangible benefits. I suspect that the CBO will score a public option that uses Medicare rates, like the one in the House, in such a way that proves it would save both the federal budget and ordinary Americans hundreds of billions of dollars. Heck, the studies have already been done. The same with adding subsidies, which would attract more people into compliance with the system and lower the hidden cost of treating the uninsured.
Considering the fact that Democrats need only 50 votes to enact this reform, a fact that even the White House acknowledges, and considering the statistical fact of 60 Democratic Senators, there is absolutely no reason to build the policy around bipartisan support in Washington, but bipartisan support in the COUNTRY. Not only will there be massive goodwill for enacting decent health care reform, but a massive political backlash if that reform is wanting or if conservative Democrats, who are the only ones that can stop the policy at this point, shut it down. Bernie Sanders has this absolutely right.
Look, the Democrats said give us 60 votes so we can come up with something. They gave it to us! I’m not a Democrat, I’m an Independent, but I caucus with the Democrats. They gave us 60 votes. So how many do we need? Seventy? Eighty? I understand that there are some Democrats, without ascribing motives, who are not comfortable voting for a strong public plan period. But I think it is not asking too much that they vote against the Republican filibuster […]
Look, I like Chuck Grassley. But people in the country are not sitting around saying, “We need a good bipartisan bill! That’s what we need!'” They’re saying we need good, universal coverage for every American, man, woman, and child. And it needs to be affordable. If Chuck Grassley and Olympia Snowe and these other nice people I know decide to vote against it, that’s fine. People in America aren’t sitting up nights worrying how they’ll vote. The goal should not be bipartisanship. It’s passing something that is strong and good.
There is good reason for short-term political optics to pass whatever can be passed. But limiting the possible, and sacrificing the long-term benefits of the policy, makes no sense. The Democratic leadership seems to have forgotten how to pressure its caucus, or at least the moderate members. They can withhold re-election funding. They can change committee assignments. They can deny legislation written by particular Senators to come to the floor. They can impose all sorts of hardships, and the threats can be wildly larger than the exchange – just vote against a Republican filibuster. Then you can vote against the bill if you like.
Capitulating to that moderate axis will mean a poor bill that will lose the support of the public. When life and death is at stake, we cannot afford an outcome, nor do we need to.
Update:
from digby…
I hope that nobody thinks I disagree with this on the basis of the post dday links above or this one about the Jon Cohn article he references. Of course we should pass the best possible bill we can pass and we should pressure the Democrats in whatever way we can to do so. I just draw the line at saying that if can’t have single payer there’s no point in passing a bill at all. It’s not just optics. It’s getting universal health care on the books after 65 years of trying. If they can get that with a public option and a legitimate financing framework, we would, in my view, be foolish to say it isn’t good enough and wait for another 20 years for the next bite of the apple.
And for those who say the public option is bullshit and nobody really knows what it is, read this by Jacob Hacker, one of the people who conceived of the idea in the first place. He isn’t an insurance company hack, he’s a progressive professor at Berkeley.
Remember how the Justice Department was supposed to declassify the 2004 CIA inspector general’s report on the “enhanced interrogation program” today? Not going to happen. There’s continued legal wrangling over how much to declassify. The latest I’ve heard is that the declassification could happen tomorrow — happy Fourth of July! — or perhaps next week.
1945 Harry Truman sends a message to Congress asking for legislation establishing a national health insurance plan.
Two decades of debate ensue, with opponents warning of the dangers of “socialized medicine.”
By the end of Truman’s administration, he had backed off from a plan for universal coverage, but administrators in the Social Security system and others had begun to focus on the idea of a program aimed at insuring Social Security beneficiaries.
July 30, 1965 Medicare and its companion program Medicaid, (which insures indigent recipients), are signed into law by President Lyndon Johnson as part of his “Great Society.”
Ex-president Truman is the first to enroll in Medicare.
Medicare Part B premium is $3 per month.
1972 Disabled persons under age 65 and those with end-stage renal disease become eligible for coverage.
Services expand to include some chiropractic services, speech therapy and physical therapy.
Payments to HMOs are authorized.
Supplemental Security Income (SSI) program is established for the elderly and disabled poor. SSI recipients are automatically eligible for Medicaid.
1982 Hospice benefits are added on a temporary basis.
1983 Change from “reasonable cost” to prospective payment system based on diagnosis-related groups for hospital inpatient services begins.
Most federal civilian employees become covered.
1984 Remaining federal employees, including President, members of Congress and federal judiciary become covered.
1986 Hospice benefits become permanent.
1988 Major overhaul of Medicare benefits is enacted aimed at providing coverage for catastrophic illness and prescription drugs.
Coverage is added for routine mammography.
1989 Catastrophic coverage and prescription drug coverage are repealed.
Coverage is added for pap smears.
1992 Physician services payments are based on fee schedule.
1997 Medicare+Choice is enacted under the Balanced Budget Act. Some provisions prove to be so financially restrictive when regulations are unveiled that Congress is forced to revisit the issue in 1999.
1999 Congress “refines” Medicare+Choice and relaxes some Medicare funding restrictions under the Balanced Budget Refinement Act of 1999.
2000 Medicare+Choice Final Rule takes effect.
Prospective payment systems for outpatient services and home health agencies take effect.
Medicare Part B premium is $45.40 per month.
This primer leaves out something very important, however: what happened between Truman’s defeat of universal health care and the enactment of Medicare. There were several interim bills introduced to cover the elderly indigent, one of which was signed into law by Eisenhower. (Here’s a fascinating debate on the subject captured at Newstalgia.)
At the prospect of taking the next step of covering all the elderly and putting a “foot in the door” of socialized medicine, the AMA and the conservatives went into overdrive to stop it, helped by none other than Ronnie Reagan himself:
Operation Coffeecup was kept deliberately low-key and internal to the AMA, its Woman’s Auxiliary, and the trusted friends and neighbors of the Auxiliary women. Reagan’s efforts against Medicare were revealed, however, in a scoop by Drew Pearson in his Washington Merry-Go-Round column of June 17th. Pearson titled his item on Reagan, “Star vs. JFK,” and he told his readers:
Ronald Reagan of Hollywood has pitted his mellifluous voice against President Kennedy in the battle for medical aid for the elderly. As a result it looks as if the old folks would lose out. He has caused such a deluge of mail to swamp Congress that Congressmen want to postpone action on the medical bill until 1962. What they don’t know, of course, is that Ron Reagan is behind the mail; also that the American Medical Association is paying for it.
Reagan is the handsome TV star for General Electric . . . Just how this background qualifies him as an expert on medical care for the elderly remains a mystery. Nevertheless, thanks to a deal with the AMA, and the acquiescence of General Electric, Ronald may be able to outinfluence the President of the United States with Congress.
Reagan’s recorded remarks are quite extensive, and reveal a determined and in-depth attack on the principles of Medicare (and Social Security), going well beyond opposition to King-Anderson or any other particular piece of legislation.
Now back in 1927 an American socialist, Norman Thomas, six times candidate for president on the Socialist Party ticket, said the American people would never vote for socialism. But he said under the name of liberalism the American people would adopt every fragment of the socialist program. . . .
But at the moment I’d like to talk about another way because this threat is with us and at the moment is more imminent. One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It’s very easy to disguise a medical program as a humanitarian project. . . . Now, the American people, if you put it to them about socialized medicine and gave them a chance to choose, would unhesitatingly vote against it. We have an example of this. Under the Truman administration it was proposed that we have a compulsory health insurance program for all people in the United States, and, of course, the American people unhesitatingly rejected this.25
And what was this frightful threat that Reagan perceived as “imminent”?
. . . Congressman Forand introduced the Forand Bill. This was the idea that all people of Social Security age should be brought under a program of compulsory health insurance. Now, this would not only be our senior citizens, this would be the dependents and those who are disabled, this would be young people if they are dependents of someone eligible for Social Security. . . .
First you decide that the doctor can have so many patients. They are equally divided among the various doctors by the government. But then doctors aren’t equally divided geographically. So a doctor decides he wants to practice in one town and the government has to say to him, you can’t live in that town. They already have enough doctors. You have to go someplace else. And from here it’s only a short step to dictating where he will go. . . . All of us can see what happens once you establish the precedent that the government can determine a man’s working place and his working methods, determine his employment. From here it’s a short step to all the rest of socialism, to determining his pay. And pretty soon your son won’t decide, when he’s in school, where he will go or what he will do for a living. He will wait for the government to tell him where he will go to work and what he will do.
Four years later, Lyndon Johnson had a strong mandate and a huge majority and he enacted more progressive legislation than anyone but Roosevelt. But he settled for enacting Medicare, the program Reagan excoriated in that Operation Coffee Cup recording, rather than pushing for universal coverage as Harry Truman had done and potentially losing. Did he do the right thing?
It’s a good question in the abstract. And as a matter of strategy, it might well have been better to wait until they got enough support for universal health care. But for the elderly, poor and disabled people who needed health care at that time, it was undoubtedly the right thing to do. Had they simply allowed the earlier, inadequate indigent legislation to stand, which after five years still wasn’t enacted in all the states, many fewer people would have been covered. And considering where we now know the country was politically headed, we might not have gotten Medicare at all.
Reagan concluded his album with a pitch to the listeners to call their congressmen and said this:
And if you don’t do this and if I don’t do it, one of these days you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.
Ah yes, America is so “exceptional” and free that it takes us decades to do common sense things that other countries do all at once. And even then it’s two steps forward one step back a good part of the time.
Our political system is terrible, and we should change it. And we should work for candidates who are committed to the specific policies we care about and give them an explicit mandate to enact them. The celebrity politics to which we are so addicted is partly responsible for the fact that it takes decades to enact any change — we treat politics like “American Idol” or the Super Bowl and don’t bother to pressure our leaders to take firm stands on issues we care about when we have the opportunity. Changing that is fundamental to creating better policies.
But right now there is a real chance for the first time in 65 years to enact universal health care, however imperfect the specifics of it may be. I’m sure whatever they pass will be inadequate, just as medicare and social security were inadequate when they were originally passed. It seems to be the American way. But if our political and business elites have finally come to the consensus that America should join the first world and create a system that guarantees coverage to everyone, then I think we have to take the leap while we can. History shows that these chances don’t come along every day. In fact, they come along about every couple of decades and we very rarely can even take an incremental step. We need to get universal health care on the books.
