From the "Credit where it's due" file.

Sometimes progress is measured in baby steps. Jed Lewison, liveblogging yet another Republican debacle, erm, debate...

6:51 PM PT: So the crowd in this debate ... cheered adultery, lustily ... but that was an improvement, over cheering the death of the uninsured.

Inch by inch...OK, millimeter by millimeter...

Like me, for instance.

Paul Krugman...

By all means criticize the administration. But don't take it out on the tens of millions of Americans who will have health insurance if this bill passes, but will be out of luck -- and, in some cases, dead -- if it doesn't.

Oh, please.

John Aravosis...

Damn, Howard Dean seems to have more backbone that the White House and the Congress combined.

Backbone? What does Dean's attention grabbing hissy fit have to do with backbone? Howard Dean has absolutely no skin in this game at all. He isn't responsible to any constituency and he's totally insulated from the effects of any health care plan whatsoever by his own insurance, personal wealth and membership in an elite ring of "professional courtesy." He's free to completely ignore the plight of the millions who will be denied insurance or lose their insurance, some of whom will suffer early and painful deaths as a result, without the reforms that exist even under the Senate plan as it stands before possible (I'd argue for probable) improvements in conference. It doesn't take backbone to toss bombs out the hatch of a secure bunker.

John Cole gets it...

…you know who will have health insurance even if this bill fails: Howard Dean, Katrina van den Huevel, Ed Schultz, and 99% of the people burning up twitter and memeorandum right now.

And Kos, Hamsher and Arovosis, too.

From the "Me too" file.

Ezra Klein...

...if I could construct a system in which insurers spent 90 percent of every premium dollar on medical care, never discriminated against another sick applicant, began exerting real pressure for providers to bring down costs, vastly simplified their billing systems, made it easier to compare plans and access consumer ratings, and generally worked more like companies in a competitive market rather than companies in a non-functional market, I would take that deal. And if you told me that the price of that deal was that insurers would move from being the 86th most profitable industry to being the 53rd most profitable industry, I would still take that deal.

Me too.

I'm a little astonished at the number of people who seem to have grown faint upon learning that the insurance industry will be making a lot of money in the future. They're making a lot of money now, folks, which is a principle reason why, from the very beginning of this debate, there's been no virtually no discussion of alternatives that would replace, or even significantly displace, the insurance industry.

We'll get real health care reform someday, if we keep up the fight. Meanwhile, even the inadequate health insurance regulation in the Senate bill, which can still be strengthened in conference, is a meaningful step forward for millions of Americans.

A step forward. As in progress.

From the "Don't panic" file...

Mike Lux sheds some (ahem) light over at Open Left, offering sage counsel for following the health insurance (or most any other) debate in Congress. It's all good, but these last bits deserve widespread repetition and attention...

5. Don't assume that anything in either the Senate or House bill is in there for good. Some things are inserted into bills specifically to be traded away at conference committee time.

6. Don't panic over anything, just keep organizing for what you want. A lot of groups are doing list building right now, seizing on real or imagined rumors to try to panic people into signing petitions or giving money. Most of these panic attacks are phony. My advice to activists out there is to just keep working hard on grassroots organizing around the issues you care the most about, and not worry too much over the panic attacks.

Yep.

Don't panic, organize.

I have no doubt…

…that whatever form the health insurance reforms that finally come out of Congress and on to the President's desk take, the bill will be but a pale shadow of the sweeping reform in health care delivery that I think our country needs.

I am dismayed that, in the end, the greatest beneficiaries of those reforms will likely be the health insurance companies themselves. More food is not a cure for tapeworms.

I don't imagine that, assuming something called a "public option" is part of the final bill, that the surviving "public option" will be an option for much of the public.

Still…

I have no doubt that lives will be extended because people with a need for long term treatment will not be denied those treatments because they're coverage has hit a lifetime maximum.

I'm delighted that rescission of benefits, absent actual fraud, at the time of need and denial of coverage because of pre-existing conditions will no longer be features of our health insurance system. It's bad enough that we don't cover people who can't pay for coverage, but it's insane that we've refused to cover people who can, and in the case of rescission, have paid for coverage.

Whatever the final health insurance reform bill looks like, I'm sure it will mean that coverage will be extended and improved for millions of Americans. I'm certain that it will mean saving and extending millions of lives.

If the bill only offers, and it seems certain to offer, the elimination of lifetime maximums, denial for pre-existing conditions and rescission in the absence of fraud, it'll be worth doing.

The heavy lifting for real health care reform will remain to be done, but this is definitely a case where doing damn near anything is better than doing nothing. People's lives are at stake.

Half a loaf?

Maybe so. The health insurance bill passed by the House isn't the bill I'd like to see, and as I expected, isn't one that's going to do a great deal for me. Being required to purchase insurance that I can't really afford and that, because of likely co-pays and deductibles, I can't really use, isn't anything like the single payer plan I've been advocating for decades. Still, as The Littlest Gator says...

I know we had some bad defeats in this. I know they beat up on women as usual, I know it is not single payer, I know that the "robust" public option is not going to be robust enough. But let's just remember-- WE GOT RID OF PRE-EXISTING CONDITIONS! If nothing else were to have passed, this alone, this one thing, is going to save lives, heartache, family homes, family savings. Just that one change.

Nope, it's not the bill I would have written, but it will save lives. It's not the bill the AFL-CIO would have written either, but they're on board because…

It will end the national scandal of medical bankruptcy—the number one cause of personal bankruptcy—by eliminating lifetime caps on insurer payments and limiting annual out-of-pocket costs. Medical bankruptcies affect up to 4,000 families every day in the United States—and 78 percent of them are fully insured.
· It ends abusive insurance company practices, including the denial of coverage based on pre-existing conditions and “rescissions”—the practice of canceling coverage when patients file claims.
· It provides subsidies to help middle-class and lower-income families afford coverage.
· Through an exchange, it offers people a wide range of choices of insurance, including a public health insurance option that competes with private insurers.
· It narrows the “donut hole”—the gap in Medicare coverage for prescription drugs.
· It creates incentives to increase the number of doctors and boosts funding for community health centers.
· It allows young people to be covered by their parents’ insurance up to age 27.
· It creates a new fund to help employers give health coverage to early retirees.
· It provides for efficient, computerized medical records and other tools to streamline medical care and increase quality.
· It cuts costs to the federal government as well as to families, reducing the deficit by more than $100 billion over the next 10 years—thanks, in part, to the existence of a public health insurance option, which lowers costs across the system.
· Ad it’s fairly funded—through employer responsibility and a surtax on the very highest earners, not a tax on middle-class health benefits.

It's also not the bill that the Human Rights Campaign might have introduced either, but they, too, find enough right to get over whatever's wrong, citing important gains for the LGBT community...

· Health Disparities - the bill specifically designates LGBT people as a health disparities population, opening up health data collection and grant programs focused on health disparities related to sexual orientation and gender identity. With collection of data and funding of research, we can better address the specific health issues facing LGBT people.
· Unequal Taxation of Domestic Partner Benefits - the bill ends the unfair taxation of employer-provided domestic partner health benefits, incorporating the language of the Tax Equity for Health Plan Beneficiaries Act. Without this tax penalty, more people will be able to afford employer-provided coverage for their families, and more companies will be able to offer these important benefits.
· Early Treatment for HIV under Medicaid - the bill also incorporates the Early Treatment for HIV Act, which allows states to cover early HIV treatment under their Medicaid programs, instead of withholding treatment for Medicaid recipients until they develop full-blown AIDS, This will dramatically improve the quality of life for low-income people with HIV, as well as saving taxpayers money and reducing the transmission of the virus.
· Comprehensive Sex Education - the bill provides funding for comprehensive sex education programs that focus not only on abstinence, but also reducing teen pregnancies and sexually transmitted diseases. After more than $1 billion wasted on failed and discriminatory abstinence-only programs, this funding will provide youth, including LGBT students, with the tools they need to live healthy lives.
· Non-discrimination - the bill prohibits consideration of personal characteristics unrelated to the provision of health care. HRC worked with a coalition of civil rights groups to develop and lobby for this language and we believe it will help protect LGBT people from discrimination in the health care system, where there are currently no federal protections for our community.

There's going to be a lot more to do - including moving the discussion from insurance to care - as we go forward, but first, let's get this done. It's worth doing, no matter what it doesn't do. It's not time to stop, but this is a place to start.

Opting in to "Opt-out."

I'm not too troubled by an opt-out compromise, for a variety of reasons. Neither is jnfr, who points out one of the best...

"... the politics of it are beautiful. Let the Republicans go home and tell their voters that they can't have health care for ideological reasons. I dare them to."

I double-dog dare 'em.

From the "Me too" file.

Dr. Dean on "opt-out" public option proposals in the Senate...

"If this is what it takes to get 60 votes I say go for it."

Me too. Again, I don't expect to get much personal benefit out of any of the proposals likely to come out of Congress. If I'm to be forced, though, to make a contribution to an insurance company for a minimal plan rendered inaccessible to me by co-pays and deductibles, I'd prefer to make that contribution to a public entity. Since I'm reasonably confident that Washington would be an opt-in state, that option should be available to me.

It's politically important to get some kind of insurance reform package done this year, but universal health insurance is only an incremental step on the path to a universal health care. If insurance reform is unevenly or imperfectly implemented, that incrementalism carries the blessing of impermanence. The opt-out plans I've heard about seem like about 2/3 of a loaf, and I've been expecting no more than a half all along.

So, yeah, me too. For now.

Map of the day.

Via The Gavel...


We don't need a public option to compete with the free market, we need a public option to create a free market.

From the "When you put it that way…" file.

NYT-CBS News poll…

"Would you favor or oppose the government offering everyone a government administered health insurance plan -- something like the Medicare coverage that people 65 and older get -- that would compete with private health insurance plans?"

Favor 65%
Oppose 26%

Good question…

...from Paul Krugman...

How bad does a bill have to be to make it too bad to vote for?

The subject, of course, is health insurance reform, which is problematic to begin with. Nobody's really talking about health care at this point. That discussion would be about a single payer or national health plan. For folks like me, who believe that the private health insurance industry is a, if not the, central problem with our system today, all of the bills under serious consideration are "bad" bills to the degree that their central focus is preserving the private health insurance industry's profitability.

Perhaps an even better question is how good does a bill have to be to make it good enough to vote for? If the eventual bad bill includes elimination of pre-existing condition exclusions, lifetime maximums and cost-driven cancellations, it would be, at the least, a better than nothing bill. If the same bill includes a personal mandate without a public option, would it still be good enough, for the time being, at least, to vote for?

Probably. As an uninsured worker still seven years away from our current single payer for seniors health care system, I don't really expect to get any personal benefit from anything under current discussion. Any premium I might be able to afford, publicly or privately administered, would almost certainly include deductibles and co-pays that would make it essentially worthless to me. While some fret about the healthy young who would duck insurance costs without a mandate, the simple fact is that most of us who live without health insurance or health care do so simply because at the end of the month there's no money left for health expenses.

Sill, while I'm an advocate for replacement, rather than reform, of the current system, there's no doubt that even elementary reforms like those mentioned above would be a benefit to millions, if not to me.

So how bad does a bill have to be to make it too bad to vote for?

Worse than most anything we're hearing about so far, I'm afraid.

Riddle me a riddle.

What grows five times faster than your paycheck?

Magpie has the answer over at Pacific Views.