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"Jobs, Jobs, Jobs" or Health care. What's a Dem to do?

Races for the Senate, U.S. House, etc. and other issues of national importance.

Re: "Jobs, Jobs, Jobs" or Health care. What's a Dem to do?

Postby ArturoBandini » Thu Jan 28, 2010 6:33 pm

Read the whole sentence: "The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States" I think that that final condition is pretty important - think about what "the United States" meant to the framers of the Constitution. It was an infant, tenuous thing, and more of a political and geographic entity, instead of the culture/national self-image that we have today, in addition to the political and geographic bits. If the framers had meant to secure the Welfare of "the citizens of the United States", then they could have simply said that.
The Ninth Amendment is fairly vague and there was considerable debate over whether to include it or not, over precisely the kind of disagreement we have right now. I would argue that the 9th Amendment is also too easily stretched to fit over anything someone bothers to call "a right", in the sense that the Federal government is compelled to protect such a right at unspecified cost. If we're talking about health insurance, then it's my right to purchase (or otherwise procure through employment or mutual arrangement) health insurance, but not the responsibility of the federal government to provide it for me. Likewise, I can choose to not exercise my right by not purchasing anything. An analogous example explicitly from the BoR - freedom of the press is not subsidized by the government through issuance of blog hosting and newspaper columns to every citizen; citizens use their own resources to exercise free speech to a degree of their choosing.
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Re: "Jobs, Jobs, Jobs" or Health care. What's a Dem to do?

Postby acereraser » Thu Jan 28, 2010 6:38 pm

Henry Vilas wrote:
Ned Flanders wrote:"Welfare" didn't mean then what it means to Dims now.

Go on. I'd love to hear more about the constitutional meaning of and limitations on that word.


At the time of my posting, Ned Flanders is online and browsing this forum, so I'm guessing he saw your post but will not reply, as it calls for actual analysis, which serves him no purpose. Too close to the facts for his kind of anti-logic.
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Re: "Jobs, Jobs, Jobs" or Health care. What's a Dem to do?

Postby Cortez » Fri Jan 29, 2010 6:36 am

Huckleby wrote:
Cortez wrote: Yes - better value out of our health care dollar (for one). It is the most important part, i.e. an insurance mandate = putting the wagon before the horse.


It certainly is logical to reform a system before dumping more people into it. I take a long term view on health care, so I would be satisified to delay health care expansion if I knew it was a firm commitment.

Cost control can only be done with the Dems and Repubs working together. The rub is that Dems & Repubs are diametrically opposed on the role of the federal government in health care. I don't see how they can work on cost control until that battle is decided. That's why the cost control will have to be done in the next round.

The other political advantage of expanding coverage first is that the increased demand on the health care system creates great pressure for Congress to cooperate and act.

It is not exactly clear what cost control strategies will work. The current reform bill has dozens of pilot programs to test approaches. Each of those is written-up in the bill, which help explains how it got to be 2000 pages long.

Massachusetts implemented their universal coverage plan by explicitly delaying cost control. The mixed results are described well here:
http://www.nationaljournal.com/njmagazi ... 8_1479.php

That's what I'm saying. I just think that we should prove our care model significantly reduces costs and improves service before we try implementing a nationwide plan. Health care was one of the few things I was excited about going into 2009. I thought, surely the Democrats are going to come up with a plan that lives up to the promise of the goal. I think what we got has taught everybody a few things about what they want out of health care reform.

So where we ultimately disagree is the part where you feel expanding coverage first is the way, while I feel reforming the care model first is preferrable. If each of us could have our wish, I think the difference is that you would still get what you want through my position but I don't think we'd ever get a reformed care model by mandating insurance.

As far as the future of health care reform... I don't think this giant political battle is required. I believe the right idea will transform the system far more quickly and effectively than sweeping acts of congress. Congress can fund little pilot "general health" clinics without any opposition at all, in target cities like Chicago, open to everybody; free if needed, or if the patient has insurance or Medicare the funds go into feeding the programs instead of the hospitals. The program director's focus is to increase the speed, efficiency and cost effectiveness of care, with the secondary goal of reaching enough of the public to significantly reduce the number of insurance and medicare dollars feeding into emergency rooms and hospitals. Start with one office with the target of three to five more in the same city over the next six years, and the aim of constantly improving the care model to better serve the public (currently the goal is to prop up a care model that captures a maximum amount of dollars). Remake the model, put it in competition with existing hospitals, then service starts taking over profit's turf. Using the money we are already spending we recalibrate health care to focus on service not profit. With each successful step, we move further into profit's territory, beyond general health, into vaccine disbursement, labs and testing. As public clinics grow, large hospitals gradually shrink down to specialized centers until these are no longer needed either. If its cheaper, better, more efficient general care, the public will make it happen on their own by their choice, and gladly. And you could start that with a single earmark.
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Re: "Jobs, Jobs, Jobs" or Health care. What's a Dem to do?

Postby Cortez » Fri Jan 29, 2010 7:07 am

Huckleby wrote:
Cortez wrote: "Saving" jobs was never the point, especially not government jobs or union give aways - Democrats were supposed to create jobs.


If the Feds had not bailed out the states it would have been ugly, led to a deepening of the recession. Saving jobs counts too, even if it is mislabeled as "stimulus."


I just don't agree with that. Well... I can agree in part because your statement reveals a core problem: state's spending budgets are ugly. It is going to deepen the recession if states don't stop. States continue to raise the roof on spending even as revenues drop. Here in Wisconsin we saw a 6 billion dollar deficit and a vast loss of employment even as $5 billion in free money from the Fed got shat out the window.

And I disagree on the greater point that the stimulus "saved" the states. Most of these states are still posting billion dollar deficits anyway. States were able to lavish millions of dollars on groups who will thus be economically poised to assist the Democrats who paid them in the coming elections. The rest of us are no better off; worse off in fact. The states are still bankrupt. Next year they are going to be more bankrupt. This November will tellingly be the first visible evidence of our stimulus dollars at "work". No wonder people are pissed.

(paid for by the Wisconsin Teacher's Union) (Which still wants more money).
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Re: "Jobs, Jobs, Jobs" or Health care. What's a Dem to do?

Postby fisticuffs » Fri Jan 29, 2010 10:11 am

I just think that we should prove our care model significantly reduces costs and improves service before we try implementing a nationwide plan.


So you are for it if it can be proven but your against the PILOT programs in the health care bill. PILOT PROGRAMS. How do you think these things are proven? PILOT PROGRAMS are not implemented nationwide.

(paid for by the Wisconsin Teacher's Union) (Which still wants more money).


Yeah fucking teachers. Driving around in their Mercedes SUV's. Vacationing in their summer homes. I mean what do they even DO? Teach kids? Kids are dumb wouldn't you think it would be an easy job. Surely the guy trading debt for debt is more valuable to our society. Teachers. The real terrorists.
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Re: "Jobs, Jobs, Jobs" or Health care. What's a Dem to do?

Postby Huckleby » Fri Jan 29, 2010 12:12 pm

Just a couple more points about cost, Cortez:
In October the House Republicans submitted a comprehensive health care bill to be analysed and scored by the Congressional Budget Office. I give them credit for having the nads to do so, it would be easier to hide behind broad slogans. Their proposal is philisophically in line with what you have posted.

The Republican plan received high marks for controlling cost of premiums, the CBO gave them a generous allowance for the effects of tort reform, HSAs, etc. Although the stabilized costs allowed some people to acquire insurance, overall the percentage of uninsured remains constant for 10 years out. And what's more, they did zilch about fixing insurance practices, the insurance companies were allowed to continue to control costs by excluding sick people from the pool, and rescinding policies of people who get sick.

What kind of society do we want to be?

Now, if we were to follow such a cost-control-first plan, we would have to trust that the Republicans will cooperate on expanding coverage after 10 years, or whenever the system is deemed efficient. But how can a system designed to save money by rationing care for the working poor and chronically sick ever correct itself?

You may sincerely intend to expand coverage after cost control, but its not likely to happen as a practical and political matter.

Universal coverage costs in the short term, saves in the long run. I can't prove that statement, its not necssarily intuitive, I'm repeating what I've read. You have to get everybody, especially the healthy, into the risk pool to garner efficiencies. Perhaps if we look at other countries who have implemented universal coverage, say Japan and France, and notice that they are spending half per capita while getting better health outcomes, we might be willing to trust the theory.
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Re: "Jobs, Jobs, Jobs" or Health care. What's a Dem to do?

Postby Cortez » Fri Jan 29, 2010 12:45 pm

Huckleby wrote:Just a couple more points about cost, Cortez:
In October the House Republicans submitted a comprehensive health care bill to be analysed and scored by the Congressional Budget Office. I give them credit for having the nads to do so, it would be easier to hide behind broad slogans. Their proposal is philisophically in line with what you have posted.

Aw man... More agreement and more disagreement, where to start. Firstly, the Republican plan is a far reach from what I think is optimal. Now a little tit for tat: you mention you don't have faith that Republicans would push for universal care after cost reforms and I agree; but not as much as I agree that Democrats wouldn't bother reducing costs after guaranteeing covrage. If the Dems bill passed today and we had to predict the odds that Democrats will (some day) substantially reform costs of practice, I would say the chances are about one in a hundred that Democrats would seriously address the costs anytime in the next 20 years. The Republican plan is not ideal to me either.

I say we need a model that thinks beyond the monstrosity. I say "model" but I mean "models" where the best ideas compete with each other and with current providers. I'm not opposed to insurance money helping fund it in the beginning, but I am opposed to a solution that has anything to do with insurance in the end.

We don't have "police insurcance"; we don't have "fireman insurance" - we have police stations; fire stations, and if the insurance industry had anything to do with these services, the nation would be in "policeman debt" as well as "hospital debt". Insurance... Mandating insurance is a bad thing. As far as I'm concerned, that idea is far too conservative. I'm not saying its your idea, it was the Democrats' idea in congress, I'm saying that even letting insurance companies have a seat at the table when you're reforming health care is a bad idea; we don't need their leeching in the future if we want medicine to truly be a service.
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Re: "Jobs, Jobs, Jobs" or Health care. What's a Dem to do?

Postby Huckleby » Fri Jan 29, 2010 1:13 pm

Cortez wrote: you mention you don't have faith that Republicans would push for universal care after cost reforms and I agree; but not as much as I agree that Democrats wouldn't bother reducing costs after guaranteeing covrage.

controlling health care costs is inevitable and unavoidable under any scenerio. expanding coverage is a choice that may or may not happen.

Cortez wrote: I am opposed to a solution that has anything to do with insurance in the end.

We don't have "police insurcance"; we don't have "fireman insurance" - we have police stations; fire stations, and if the insurance industry had anything to do with these services, the nation would be in "policeman debt" as well as "hospital debt".

The insurance companies are not the reason costs are soaring. But I really don't care whether insurance companies survive or not, there are many models that can work, including the single payer model that you imply.
The country can not get to where you want to go in one step, you have to start somewhere.

Cortez wrote: Insurance... Mandating insurance is a bad thing.

How bad? We keep hearing how 85% of U.S. citizens already have insurance, so they are totally unaffected.

Then there are the people who don't have insurance now, and will get it via subsidies. Surely they aren't complaining.

Finally we're left with people who can afford insurance but aren't currently buying it because they figure they aren't going to need it. These people are free loaders on society. If somebody chooses not to buy fire insurance and their house burns down, society does't step in and buy them a new house. But if a health care freeloader gets into an auto accident, society pays to put them back together again.

Mandates may rub people the wrong way as a matter of principle, but practically speaking they cause little or no harm and they make perfect sense. Which is why Scott Brown supported them in MAssachusetts.

The hope of a mandate/subsidy system is that it will ultimately morph into a system where basic health care for all is paid out of taxes, that's a very small step away from subsidies.
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Re: "Jobs, Jobs, Jobs" or Health care. What's a Dem to do?

Postby ArturoBandini » Fri Jan 29, 2010 4:14 pm

Henry Vilas wrote:
Ned Flanders wrote:"Welfare" didn't mean then what it means to Dims now.

Go on. I'd love to hear more about the constitutional meaning of and limitations on that word.

Henry, I'm interested in talking about this. I feel like I've described my perspective on the intent of the word 'welfare', as it appears in the Constitution. Care to give your interpretation? Also, please don't try to bait me with any neocon fodder - I'm not going to bite.
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