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Sunday, September 06, 2009



Neither of those would be good bets for Obama KB. If he does not outline reform that is meaningful and includes an effective public option from day one, the Democratic base will start looking for someone who will. So I can agree with you only if "best bet" is the least bad of the loses he could encounter. But there are ways he could still win, or at least go down fighting and garner a bit of respect for trying.

He must realize this is neither the issue nor the time for Clinton style triangulation. The Democratic base knows what it wants and is in no mood for a watered-down proposal designed to appease moderates and the Right. They see no bipartisanship to cultivate and after electing huge majorities in both houses of congress, see no reason to try.

In fact, some in the base believe if Obama were to drop all current proposals and opt instead for capping malpractice awards and allowing companies to sell across state lines, the Republican caucus would still balk. Their goal is to get rid of Obama, period. And they see fighting any kind of reform as their key to success. Thus, the only way to get any kind of bipartisan support is to sell reform in Republican-represented states and districts and force office holders to respond to their constituents. And the same goes for swaying "moderate" Democrats.

What is appalling to me, then, is that the administration has failed to offer a coherent message thus far. There are four bills reported out of committee and all contain the elements important to Obamas base. Instead of developing some message control and trying to sell these goals, they have thrown out conflicting statements and waffled at every turn. That's neither salesmanship nor leadership and if Wednesday night is more of the same, meaningful reform is dead for now. And while Republicans did their level best to kill it, elected Democrats will be the ones who let it die.


If I believed YOU still had the capacity for SHAME I'd say SHAME ON YOU.
But I won't.


A.I.: I can understand the need to blame the President's problems in part on the unreasonableness of Republicans, but it's stilly to claim that the Democrats in general or Obama in particular have been less partisan. Besides, the problems in getting moderate Democrats on board surely suggest what the polls are telling us: that a lot of Americans have grave reservations about the current healthcare reform efforts. Maybe it's not the parties that are the problem; maybe it's the people.

I think that the Administration has been very awkward in the process; however, switching sides for the moment and defending the President, maybe he has failed to present a coherent message because no such thing is possible. What should Obama have said from the beginning, and what should he have offered? Isn't the real problem that no one can figure out how to expand coverage to include millions of new people and guaranty everyone's coverage against loss without raising the costs and narrowing the choices for most Americans, and adding massively to the Federal debt? The Clintons ran into these same problems last time. Are all Democratic Presidents bad messengers? If so, the problem might be in the message.


Pulsamsara: apparently you missed something. Let me fill you in. This is a republic. Criticizing the chief executive is not considered shameful. If you are unclear about anything else, like, say, tying your shoes, I can help you with that.


I didn't mean to imply I blame Obama's problems on Republicans. They've made their intent pretty clear from the start, but Obama and the Administration keep pretending some sort of meaningful, bipartisan compromise is achievable--particularly in the Senate Finance Committee. It isn't and it's probably past time to get on with the business at hand with or without Republican support.

White House lack of message and equivocation left Democratic members of congress in limbo over the break. A public option and reform in general is controversial and without solid support from the White House, it's hard for House and Senate members to promote and defend it back home. The question becomes: Why promote anything if Obama might drop it anyway?

Contrary to your claim, the public option combined with an insurance exchange as is being proposed would increase choice. Other countries insure all for less and we should be able to do that too. Done correctly, there is no reason this should add to debt. The message is complicated and that is a problem. But that problem is exacerbated when no unified message is offered in the the first place.


A.I.: I think that extending insurance coverage to millions of Americans without restricting the choices that insured Americans now enjoy, and without raising their healthcare fees, taxes, or adding to the public debt, is impossible. Whether other systems do deliver the same care we get for less, the question is how we can move THIS system to a better one, not how we can become Japanese or Candadian.

Evidence for my view is that we are well into the second great attempt to the healthcare system and we are stick pretty much where we ended up last time. Maybe Obama can wave his magic wand, but so far no one has produced a plan that comes close to doing what you say can be done. Like the Loch Ness Monster, maybe the reason it's so hard to find is that it ain't there in the first place.


As individuals trying to buy insurance in SD, people basically have only two choices: Welmark Blues, or Dakota Care. As a state employee, how many choices do you have? The fact is, there is damn little choice in SD or in virtually every market in this country. The big insurers have divided up the nation and have virtual monopolies in over 90% of markets much like the Mafia families of yore had in cities.

By contrast, federal employees choose between a variety of insurers and between high- and low-end plans each offers. That is real choice and that is what is proposed with insurance exchanges--especially if a public option is part of those exchanges.

Why anyone who doesn't profit from the insurance industry would defend the former over the latter is beyond comprehension. We must be paying professors really well if you're perfectly happy spending what, $3 to $4,000 out-of-pocket plus another $8,000 or so from your employer for "insurance" that on top of that requires co-pays when you actually seek medical care.

Or maybe you're talking about choice of service providers. PPO's pretty much limit that. So tell me, what wonderous choices are there for people to "enjoy"?

You very well may be right that there isn't the political will to make significant changes. But that doesn't mean those changes could not have dramatic, positive effects. In profit and overhead alone, we pay from about $1,200 to $3,000 more for private insurance than is paid for medicare. We pay untold dollars more because there is no real incentive for insurers to negotiate lower service costs as long as those costs can be passed along to customers through higher premiums. And with little or no competition in so many markets, that's exactly what happens.

So don't tell me the monster of over-priced American health care can't be found. He's in plain view and he's picking our pockets as I type. The problem is, no consensus has been formed on how to slay him, in large part, because a bunch of ideologues say the sword of government must be left in its sheath.


A.I.: Okay, I won't tell you what you don't want me to tell you. But I can't help noticing that when the Democrats in the House drew up a plan to do what you say can be done without cost, it looked to cost a bundle. If Obama's speech tonight offered any hope on that score, I missed it. And you mention "competition in so many markets." Well, isn't one of the reasons for the lack of competition in many states the fact that insurance can't be sold across state borders? This is a classic case for federal intervention (see James Madison). But President Obama isn't the least bit interested. He likes competition only when it comes from the state.

The problem may indeed be ideologues. But they are on both sides. Tort lawyers, on the other hand, are on one side. It is pretty clear that President Obama won't offend that constituency, no matter how urgent the "season for action" may be.

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