The Enthusiasm Gap - Why Liberals Should Get Behind Congress's Lackluster Health Care Reform Plan

[jefferson_dem]

The Enthusiasm Gap
by Jonathan Cohn
Why liberals should not be disappointed with the current lackluster health care legislation.
Post Date Friday, August 07, 2009

The news about health care is a little confusing these days. While polls show that Americans still support the key elements of health care reform that President Obama and his allies are trying to enact, there have been numerous reports of conservative activists showing up at congressional town halls across the country, protesting those same plans with an energy not matched by the other side.

The imbalance may simply reflect the media's preoccupation with conflict and confrontation. Liberal rallies in favor of reform have garnered no similar attention, although they've attracted hundreds, and in some cases thousands, of people. But I suspect the enthusiasm gap is at least partly real--that the hate for the plans moving through Congress runs much stronger than the love, that the people fighting to stop these bills feel more intensely, and have more determination, than those fighting to pass them.

If so, this ambivalence probably reflects a growing awareness of what the reform bills will do--or, more precisely, what they won't do.

So far, the most ambitious measures are those that passed a pair of House committees in late July. They would, like all the reform plans under discussion, expand health insurance primarily by making it possible for most working-age people to get private insurance. But the changes designed to make that happen--in particular, the creation of a marketplace for buying coverage and the distribution of subsidies for people who need them--wouldn't begin for four years.

<SNIP>

If the possibility of lesser reform doesn't motivate liberals, then maybe something else will: the possibility of no reform. Twice in the last few decades, once during the Nixon era and then again during the Clinton years, liberals largely shunned compromise efforts at universal coverage because they didn't live up to progressive ideals. But holding out didn't lead to better legislation. It led to twenty years of trying to rebuild the momentum for reform, followed by a debate over proposals that are, if anything, less sweeping than their predecessors.

But forget all of the strategic second-guessing. There's a more basic and tangible reason why, even with compromises, progressives should engage fully in the reform battle. It's the fact that tens of millions of Americans go without health care, or endure financial hardship, because they can't pay for sky-high medical bills. If something like the House bill passes, life for these people would get immeasurably better--soon if not right away, for most if not all. They wouldn't have to give up their life savings, endure avoidable pain, or, in the worst of cases, watch a family member get sick and die because affordable medical care was not available. Surely that's a goal worth fighting for.

http://www.tnr.com/politics/story.html?id=5cb3998e-3ee2...

[predfan]

1. For my fellow Tennesseans, I looked it up, just to be sure......enthusiasm isn't killing old folks

[jefferson_dem]

5. But lack of enthusiasm from complacent liberals could result in a shittier bill or no reform passing

Obama will deliver the best (most aggressive) reform package he can...but we need to remember who the real enemies are in this debate.

[John Q. Citizen]

15. Let's see. It's not the insurance companies or pharma, because they are working with us to

insure they get to become richer and more powerful with this reform they have embraced.

So it must be the Repos. They are the enemy, right? Because they know if Obama passes the Romney plan on a federal level that it will be at least 4 or 5 years before costs over take the plan and people benefits start being cut, and during that time the Dems will win big?

I mean we are already getting more money from the health care industrial complex than the Repos are. So if this bill passes we will be probably getting a lot more money.

So why do you suppose there is an enthusiasm gap? My guess is because the whole freaking country wants freedom from the criminal scum bag insurance industry.

My guess is that people want our government aggressively negotiating prices with big pharma and or buying our drugs from other countries if it means cheaper prices for our people.

My guess is that people are tired of crony capitalism whether it's being done by the Dems or the Repos and they can see clear as day that what is being proposed is based on crony capitalism.

that's my opinion.

[Aragorn]

43. you could just be right.

IMO 2

[Better Believe It]

36. So we should support a bill written by the insurance industry and drug cartel

if that's what Congress finally has up for a vote?

[nightrain]

2. nah, we can do so much better than what Congress is offering us. I won't be

transferring my hard-earned life energy (money) to some already-rich health insurance executives.

The moral choice is a single payer. Cheaper and more comprehensive too.

[geek tragedy]

3. What will you do when single payer loses in an up or down vote?

You're indicating that you'll join forces with Rick Scott.

[IndianaGreen]

4. Take away Congress health care!

If the American people can't have the same health (and pension) benefits Congress gets, then Congress shouldn't have either!

That's how the argument should be framed.

[geek tragedy]

6. Members of Congress have private insurance like

all federal employees.

[IndianaGreen]

10. paid for by the taxpayers

the same program should be available to all, financed from general tax revenues. Eliminating one entire carrier battle group would pay for the plan.

[Umbral]

29. When people say this, do they realize it would take an act of Congress to make this happen?

You see and hear it all the time and it's just preposterous.

[nightrain]

11. no, that's your fantasy. I'll keep on fighting for single payer.

[John Q. Citizen]

16. You have already joined forces with the insurance industry and big pharma. If I wanted

Romney care I would have voted for Romney.

But I didn't.

[slipslidingaway]

19. Why have the Democrats not asked the CBO to score HR 676...

they did in the early 1990's but not this time.

[DrToast]

31. It wouldn't get a good CBO score anyway

The CBO only scores government expenditures. So all the private health insurance spending would be moved onto the governments books.

Yes, overall it would reduce total health care spending, but government spending would soar.

[nevergiveup]

8. So you don't give a crap about the millions who would be helped

by a bill that is not single payer? We are not going to get single payer but it is possible to still have a bill that helps those with pre-existing conditions and those with no insurance. I don't get those on DU who want all or nothing and are willing to screw those who are struggling and would be given at least some relief by less than perfect health care reform. I find it to be very selfish.

[nightrain]

12. this is a very tired and dumb argument. Single payer is proven to work. These multipayer

proposals have brought us to where we are--rich health insurance execs, 30% overhead that could/should be going to services, paperwork nightmares for practitioners because of the fragmented way we provide and finance healthcare, etc.

We know that the MA model hasn't worked, so I don't support making it nation-wide. Health care costs are bankrupting people, these plans don't address why costs are so high.

I'm certainly not going to fork over thousands/year, when it costs a Canadian person about $100 a month. That's much more reasonable.

[nightrain]

13. look at your name. "never give up". I imagine that has some meaning to you. So does single

payer to me. I've been working at single payer for more than 30 years. Now do you get "never give up"?

It's certainly not about not caring. You have no idea about my values, but you attack.

[nevergiveup]

21. So if it comes down to a bill that would provide some

relief for millions of people or no bill at all you would want "no bill at all"? I just don't believe this. I doubt we would disagree much on what we truly want in terms of health care. I am totally totally in favor of single payer and am in no way "giving up" but it isn't going to happen at this moment....it is not even on the table...... but we can take steps forward with a public option or some reform that will provide something for those that have nothing. I am really sorry and apologize for the wording of my post. I did not mean to attack you and I would not for a second question your values. I think frustration with all of this is getting the best of me.

[nightrain]

23. thank you for the apology.

Look at MA. It's not working! Want that nationwide? I don't.

We can do better. There is a better way that addresses costs, accessibility, simplifying paperwork and billing. And it is a moral public policy decision. It doesn't enrich corporations! What a deal! Taiwan has done it.

[John Q. Citizen]

17. if I wanted Romney Care I would have voted for Romney.

[Aragorn]

44. wrong example

I don't support the War In Iraq even though it gave a lot of soldiers and mercenaries jobs, and even though it made a lot of money for a lot of corporations ( and elected people too it seems). I am a physician and I see Medicare/Medicaid/uninsured - and do charity work as well. I know that anything except single payer means higher cost to everyone, more profit for pharma/hospitals/insurance companies and a lot of doctors.

I don't support the War In Iraq for religious reasons either.

We all need to make a distinction between whether we would "live with" anything less than single payer or not - and whether that means it is the right thing to do. I for one am tired of the exploitation of people for profit - ESPECIALLY if is done by health care workers.

I carry private insurance - not very good, too expensive - and I pay takes which support Medicare/Medicaid.

Who am I screwing and where am I being selfish?

Maybe you are thinking of 1 of my FB friends who wrote she doesn't agree with having to pay more just because some people won't buy insurance, and thinks the church should do more, not the government.

[jefferson_dem]

9. Now that's real productive.

If you don't get ALL that you want you will accept NOTHING that you want.

[CTLawGuy]

24. that is EXACTLY

why the left is impotent and cannot accomplish anything.

[slipslidingaway]

26. Do you agree that single-payer advocates should be excluded

from the discussions while the corporations get front row seats at hearings and invitations to the WH?

Why blame those who are fighting just to be heard and who want to take the profit motive out of health care.

http://www.citizensforethics.org/files/20090722%20-%20L...

Obama's own doctor of 22 years was invited to the ABC special and then cancelled at the last minute.

[Wapsie B]

7. Real reform

http://www.hr676.org /

This is more of what I want.

[JVS]

14. Well-defined and good plans generate enthusiasm, muddled clusterfucks don't

The administration is screwing this up because the trogs are going to flip out in opposition to any reform, and even people supportive of reform can't get behind what is vague and in the process of being hashed out. It needs more substance for people to be able to know what they'd be backing.

[slipslidingaway]

18. Lack of enthusiasm from liberals, Blue Dogs, Republicans are easy

groups to blame if reform is not passed.

What about the Democrats who silenced groups that pose a real challenge to the insurance/drug companies?

President Obama calls on Karen Ignagni of AHIP to speak on HC reform
http://journals.democraticunderground.com/slipslidingaw...

Imagine if P. Obama had called upon Dr. Maria Angell to speak at the WH summit instead of Karen Ignagni, members of Congress might be pleading for a public option.

Imagine if they were just allowed in the room???

[ncteechur]

20. There will NOT be single-payer in this bill. So I'm going to be happy with a bill that provides

that it is illegal to deny someone coverage because of pre-existing conditions;
for real portability;
provides more options and choices;
and, has some measures of cost controls.

A public option is icing on the cake.

I agree totally with the original author. Don't sacrifice the good for the perfect. There will NOT be a perfect reform bill.
Would I like single-payer?. But it ain't happening this time. But this is a step. It is a tremendous step.

And those who want single payer or nothing are just as bad as those who do not want a public option at all.

[nightrain]

22. oh please... these proposals put more money into an already dysfunctional

way we finance and deliver healthcare. They transfer money from the people to the already rich health insurance and drug maker execs. And, these bills add another layer to an already fragmented and paperwork heavy "system" for practitioners. Dumb. MA healthcare has been proven to not work. I don't support making it nationwide.

[slipslidingaway]

25. "...these bills add another layer..." Health care agency’s payroll bloated

http://www.bostonherald.com/news/politics/view.bg?artic...

"The payroll at the agency steering the state’s controversial universal health care effort has swollen to more than four times its original size in just 18 months - with a top-heavy bureaucracy led by dozens of high-paid managers, newly released records show .

The Commonwealth Health Insurance Connector’s staff and salary explosion - including 17 managers now paid more than $100,000 a year and numerous contracted employees - has continued despite protest from Beacon Hill lawmakers.

“At a minimum, all of the salaries need to be frozen and reviewed with an eye towards cutting them, and there should be a hiring freeze,” said Sen. Mark Montigny (D-New Bedford), vice chairman of the Legislature’s public health committee. “We’re in a crisis. That’s what happens when we’re in a crisis.”

...“The very life of these quasis should be in jeopardy,” said Montigny. “Their only purpose is to provide inflated salaries and bury patronage hires, and they’re generally less accountable and less effective."

[nightrain]

27. thank you slipslidingaway. We Dems don't have to be so desperate

that we promote junk programs.

The bureaucracy that comes with multi-payers is obscene. That money could/should be going to services. Taiwan spends about 4%? on their single payer coordinated system (actual system, not this dysfunctional mish-mash we have).

Who among you are practitioners who deal with the fragmented, multi-layered, varying benefits and exclusions, and denials on a daily basis? I am.

[slipslidingaway]

42. You're welcome and I agree....

not a practioner, just partially supporting a future practioner who recently started her third year.

[Aragorn]

45. me too.

see my posts here as well - I agree 100%. I have already proved I will live with and work with "less" - but I intend to point out that "less" is the correct term. And I don't appreciate the name-calling here or anywhere else. If DU is the height of progressive blogs...

[HopeOverFear]

28. Whoa, boy. This is going to be a long thread.

[Hippo_Tron]

30. I support a strong public option, but...

Any bill that forces community rating and eliminates an insurance company's ability to deny you for a pre-existing condition will make it drastically easier for me and many others to get affordable health insurance. So yes if it comes down to that bill I will support that bill even though we could do better.

[Hello_Kitty]

46. If there's no public option there should be no mandate

I will accept something that places limits like the ones you describe on insurance cos. to make insurance more attractive to purchase but I'm not for forcing people to support private corporations.

[BzaDem]

32. ANYONE who will only accept single payer and still thinks it is a realistic possibility

has the same amount of intelligence as those who are claiming that the Obama plan includes "death panels."

I am so sick of these insufferable fools who respond to any healthcare argument with "but Canada has this and that and I'm not going to accept anything less" and think that they are somehow adding something useful to the conversation. It takes a superficial third-grade knowledge of our political system to know that neitiher single payer nor anything like it will pass Congress this year. Yet these "my way or the highway" people are still taken seriously by thinking people on this board, as if they have a valid point and should be argued and reasoned with. Just look at some of the replies to this thread.

If we are going to attack right wingers whose comments indicate that they are living in a different universe, we should hold our own to the same standard. Both groups are against all healthcare bills that have the potential of being passed by Congress. Both groups would love to kill the only real chance of reform we have in the next two decades. Both groups should be treated no differently.

[nightrain]

33. the single payer movement has been in existence for 30 years.

Single payer is proven to work. Whereas, this multi-payer, fragmented, paperwork-heavy way we have of financing and delivering healthcare is a monstrosity to work with and in.

A real "public option" would have been an improvement, but what is coming out of Congress is a huge give-away to the healthcare corporations and drug makers. It will only increase the bloated, top-heavy, cumbersome dysfunctional "system", and enrich the already wealthy execs. The MA program is broken already, and doesn't deserve to go nation-wide.

Are you a practitioner who has to deal with this fragmented and broken system? Perhaps others have some useful information and perspective that you have not considered. You make some very broad assumptions in your last paragraph. We don't know what the next two decades hold, we don't have to act out of desperation and grasp at a failed reform.

[BzaDem]

34. Do you even understand the concept of "not getting what you want?"

You make a bunch of arguments that say we should switch to a single payer system. However, none of them changes the simple reality that it is not going to happen this Congressional term. The fact that there has been a movement for 30 years just shows the extent of the failure of that movement. Right now, there isn't close to a majority in either house that actually wants single payer. That's right -- even if every House member and Senator voted their true opinions, free of politics, single payer would fail in both houses.

As usual, people like you can't grasp the concept of not being able to get what they want. When someone argues that Single Payer is not going to pass, they don't even try to rebut the argument. They instead completely change the subject to why Single Payer is a Good policy, as if I said that Single Payer was a Bad policy. They just assume that because they want it, it will be enacted. They ignore the fact that a majority of our elected representatives do not want it, despite the best efforts of the single payer movement to change that fact. They want their policy preferences enacted by fiat.

They would be happy waiting another 20 years (the average amount of time between healthcare reform movements going back to Harry Truman) while more and more people suffer under our current system. And that is something they share with the Republicans, who also would be happy with that result.

[nightrain]

35. Actually, there are more supporters of single payer than before.

Single payer folks have a longer-term perspective than this Congressional term.

Just because the current Congress people don't want it, doesn't mean that it won't pass at some point. Education takes a while.

"People like you"? "They"? Try a little harder to listen, rather than assume and judge.

Where the watered-down "public option" has been attempted, it has been a failure, shall we throw more money into that? I don't think so...

We may find that as a "critical mass" of people disgusted with our current healthcare dys-system is reached, that it won't take 20 years. Yes, it's horrible that many people suffer under the current dys-system, do you think the Congressional proposals would be sustainable morally, financially, in terms of access and load for practitioners?

[BzaDem]

37. A "longer-term perspective?" What a crock.

The single payer movement has had since the Truman administration to execute on it's "longer-term perspective." It has had 60 years and it has failed for 60 years. In the mean time, real people are dying due to lack of care. Nixon's healthcare plan was more extensive than any plan that might pass this year. Yet it failed at the hands of a Democratic congress 40 years ago. 40 YEARS AGO. I'm sure the people who have been denied care (and/or have gone bankrupt due to receiving care) over the past 40 years appreciate your "longer-term perspective."

At a certain point, those who prevent reform because it isn't perfect enough start becoming responsible and accountable for the results of the status quo. That time has LONG passed. At this point, you oppose any reform that could feasibly pass and that makes you no better than the right wingers at the townhalls who also oppose any reform that could feasibly pass. There is nothing else to it.

[nightrain]

39. nah. If there was a better proposal in Congress, you wouldn't be

looking for a target in a fellow Dem. I won't be your scapegoat.

These proposals stink. How're you liking the news out of MA? That's what we have to look forward with the crap coming out of Congress. More transfer of money to insurance corporations...

Perhaps if you worked in healthcare you might get it. From what you've said so far, it doesn't sound like you are a practitioner.

More assuming on your part in your posts rather than listening.

And some say only Republicans attempt to eat their own...

[donco6]

56. Snort! Nice try.

"It's just not possible" he said, looking down with pouty lips and puppy-dog eyes. "You'll have to settle for this not-single-payer plan. This plan that actually strengthens insurance companies and makes them even more powerful than they are now. Don't you see? It'll be great . . . I promise!"



"Uh . . . fuck you."

FINIS

[cornermouse]

38. What liberals?

Most of them left after they were tombstoned during the primaries.

You wanted conservative democratic website. You got it.

[Sebastian Doyle]

48. Those weren't Liberals. They were PUMAs

Though I agree this site has taken a sad far right turn lately. All the sympathy for Glenn BecKKK posts are a definite indication of that.

[cornermouse]

50. You went past the pumas wtihout stopping a long time ago.

Its a vicious circle and unfortunately its human nature.

[Sebastian Doyle]

54. I have no intention of debating last year's old news here

But the idea that "Liberals" supported the DLC's poster girl is completely laughable. And a lot of this birther nonsense began with that crowd. When they spun off from this board to that "Crappy Troll Hill" forum, that shit was all over their board.

[cornermouse]

55. You were the one who brought up pumas/last year's news,

I merely replied.

[leftofthedial]

40. this is not health care reform

it is health insurance "reform," at least if you accept "deck chair rearranging" as a possible definition for "reform."

[pgh_dem]

41. It's impossible to be enthusiastic about the opposite of 'the possibility of no reform'

You cater to conservatives, in order to impress the corporate media with your fairness and bipartisan centrifictasticness, and you get idiotic plans that nobody can get excited about (in favor of).
You want liberals to get excited, call me crazy but maybe you have to do something that might appeal to a liberal?
I'll tell you one thing: "This bill isn't EVERY SINGLE THING conservatives want!" is not a rallying cry.

[Sebastian Doyle]

47. There are only two acceptable bills

One is single payer. Taking the corporations out of the equation is the best long term solution, which even the Blue Balled Cowards like Ben Nelson have admitted, despite themselves.

The other is a true public option that forces the insurance corporations to either clean up their acts and compete, or find a new way to defraud the country.

Anything less than that is just further enabling of these criminals and is Not. Fucking. Acceptable.

[Becky72]

49. The New Republic

Hmmm.

[TomCADem]

51. I Don't Know Whether I Want To Match Their Enthusiasm - They Are Threatening To Shoot People

I really support healthcare reform, but we are talking right wing crazies calling unions and threatening to shoot people.

[BlooInBloo]

52. Sorry. This is certain people's chance to declare Obama a failure...

They're never going to pass that up.

[donco6]

53. Strengthening insurance companies moves us further from reform.

No enthusiasm here. And no apologies, either.