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Go Home The Enthusiasm Gap

POLITICS AUGUST 7, 2009

The Enthusiasm Gap

BY JONATHAN COHN

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.

Even when fully implemented, many million people would still lack coverage. According to the Congressional Budget Office, at the end of the next decade, 97 percent of legal residents--and 94 percent of people here overall--would have insurance. Although that would be a lot more than the percentage of insured Americans now--today 84 percent have insurance--it's not truly universal. And the coverage would not be as comprehensive as what people in other countries have. There'd still be substantial co-payments and deductibles; people could still owe thousands of dollars in out-of-pocket expenses if they get really sick.

As a fan of single-payer health insurance--a scheme that would, if properly designed, cover everybody with relatively small exposure to out-of-pocket costs--I certainly understand the ambivalence. It's tempting to think of what might have been, if only the bill writers had raised their ambitions and pushed a more pristine, more far-reaching measure.

But there's a reason they didn't: Health care reform is politically difficult, particularly given the setup of American government. (The U.S. Senate, with its overrepresentation of small states and use of the filibuster, make it hard to pass anything.) It’s easy to forget, but the reform scheme Bill Clinton tried to pass in 1994 would have come pretty close to achieving most of the goals reformers now seek: It would have given generous insurance to just about everybody, by radically reorganizing the way medical care is doled out. That ambition was also a major factor in its demise.

Maybe that means those of us on the left should dwell a bit more on what reform still would achieve--even if it's not everything we hoped. The bills that passed the House committees might not mean every single American would have insurance. But they would mean that every single American could get insurance if he or she wanted it. Insurance companies couldn’t deny coverage to somebody because of pre-existing medical conditions--nor could they cancel a policy retroactively, after a large claim, as insurers have been known to do. In fact, that change--an end to the practice of "rescission"--would happen right away.

The insurance people get under reform would be relatively good insurance, too: The House bills, for example, would limit out-of-pocket expenses to $5,000 for an individual or $10,000 for a family. That's still more than people in other countries pay, yes, but it’s a far less than what many Americans end up paying today once they get a chronic or catastrophic illness. And keep in mind the exposure would be a lot less for lower-income people.

Besides, it's not as if it will be impossible to scale up these reforms later on. If Congress passes and the president signs a bill putting in place the key institutional elements of reform now, they can always revisit, and strengthen, the measure later. During the 1980s, Henry Waxman almost single-handedly expanded Medicaid to its current levels by gradually making more people eligible and securing the funding to pay for them. All he needed was the institutional structure--the program, the rules, and the basic funding stream--on which to build the new coverage. The fact that Waxman is a chief architect for this year's program ought to give liberals confidence that, once again, these reforms needn’t represent the upper limit of what might be achieved over the next few years. They are a start, and a very good start, but not a finish.

Of course, it's not a given that any of this will happen. We're still waiting to see what comes out of Senate Finance Committee, the last of five committees with jurisdiction over health reform. There, a bipartisan group of six senators are trying to hammer out a deal--and their progress has been slow. They seem likely to disgorge legislation that reaches even fewer people and offers even skimpier benefits. But the senators on the Finance committees, just like all members of Congress, respond to political pressure. The more pressure they feel to be ambitious, the more ambitious they will be. And that’s important, since Congress must eventually reconcile all the committee bills, taking into account whatever Finance produces.

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.

 

Jonathan Cohn is a senior editor of The New Republic. This column is a collaboration between TNR and Kaiser Health News. KHN is an editorially independent news service and is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization, which is not affiliated with Kaiser Permanente.
 

 

 

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54 comments

In my opinion, the comment that "The imbalance may simply reflect the media's preoccupation with conflict and confrontation." should not have been dismissed so lightheartedly. After all it is media preoccupation with sensations that made Obama what he is now. Should the media turn their backs on him, he would be done for.

- Chris

August 7, 2009 at 1:23am

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Hey bud, We don't want "scaled up" healthcare. Keep your hand off my healthcare. There are a few ways to skin a cat, and to pay for medical help for the poor, we can do alot of things short of throwing out the best and most innovative health system in the world. No, we don't have single payer. But those who do die waiting for treatment. Just wait until it's your mother, son, sister!

- spk2moi

August 7, 2009 at 1:34am

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you don't get it. it is all about obama getting control over perhaps the largest sector of the u.s. economy. everything else is window dressing..my best friend roomed next to obama at occidental college for two years, and he knows what this under achieving student is about...he wants to run the world by diminishing the united states, and he is well on the way to doing this.

- john wade

August 7, 2009 at 3:07am

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Or the enthusiasm gap could be due to the fact that Republicans are just more ... uh, boisterous, especially when armed with fresh myths that encourage them to shout out their disapproval and be generally disruptive. So far it's worked beautifully.

- Anon

August 7, 2009 at 3:10am

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I'm so relieved to know the leftist plan to take over the health care system of our country is not socialism. What convinced me it's just good, innocent people was the caption credit under the photo in this article. Whew! That's a load off of my mind.

- Cactus Jack

August 7, 2009 at 3:55am

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I'm one of many who had high hopes for health care reform back in the 1990's when the Clintons took on this complex, almost overwhelming issue. This time around, however, I'm sitting on the sidelines unwilling to support any reform that doesn't sharply reduce premiums. Talk of 'bending the curve' by Obama isn't enough. Not when existing premiums total $ 18000 annually for a family plan. My husband is a small business owner. I work as a para-professional to keep our family insured. I happen to like my job but resent the outsized consideration - and price -that keeping my family insured represents. Those of us who are well insured are grateful but we're largely insulated from the cost of our coverage until we face a lay-off, job change, or in my case, an extended medical leave. Universal coverage is an admirable goal - I want to support it but what many of us want to see now - is the reining in of medical costs and insurance premiums. I'll support any plan that demonstrates it will reduce health care costs not just control them.

- twinmom

August 7, 2009 at 5:13am

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So why not support a separate, low cost, mandatory catastrophic health insurance policy for all? Everyone pays into a private pool of choice, its taken out of your paycheck, and if you don't pay for a regular plan on top of that, then you get the bare minimum, with waiting lines at a clinic and no frills.

- Parker

August 7, 2009 at 6:55am

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Mr. Cohn's argument is precisely what conservatives fear most about this bill, i.e., that its the first step towards the entire health industry placed under government control. Also, in Mr. Cohn's attempt to tug at the heartstrings of all those well-meaning citizens who believe quality health care is a god-given right, he makes no mention of costs or rationing of care or the drag such a plan will put on the growth of the economy. Nor does he mention the stifling of health-care innovation, pharmaceutical development, and elimination of choice inherent in such a scheme as the one under consideration.

- Robert Gruber

August 7, 2009 at 7:43am

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I wouldnt be suprised if people didnt start showing up at town halls with screwdrivers to remove the hinge pins from locked doors to get in and set off fire alarms to clear out the reserved seating union thugs since the dems are claiming fire code to keep out legitimate voters.

- retired military

August 7, 2009 at 7:55am

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If only the bills being discussed were more progressive... yeah, that's the ticket!

- Right Again

August 7, 2009 at 8:17am

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"That's still more than people in other countries pay, yes, but it's a far less than what many Americans end up paying today once they get a chronic or catastrophic illness. And keep in mind the exposure would be a lot less for lower-income people. " 70% of people are happy with their own insurance. They should keep it. Why not a tax to pay insurance CO's for catastrophic coverage for the poor. Not all will get sick. Mandate a cheap catastrophic for the people who can afford insurance but don't buy it because they are young but might have costly accidents. Make insurance portable for those who have it on the job but change or lose their jobs. Since we know so much more about our gene's in illness People don't want a govt. board dictating treatment that should be tailored to us. Personalized. Cost cutting methods will humiliate patients and DRS. Kaiser Permanent has tried that. At one time they decided to see 4 patients at a time in one room. each had To say why they were there in front of other people. Very embarrassing.

- elle cole

August 7, 2009 at 9:20am

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How sad that the most effective and persuasive advocate for health insurance reform isn't POTUS but a relatively unknown journalist. Has Obama persuaded anyone on this issue to move in a direction he or she wasn't already willing to go? On any issue?

- mumbles

August 7, 2009 at 10:10am

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You, like a lot of your "progressive" friends just don't get it ---- we don't want the government to run health care. We like true competition in the marketplace, and we don't trust the government to effectively handle our health decisions. They can;t get rid of the Medicare and Medicaid waste there is now. And if you cackle that only the "rich" will pay for it ---- remember the Alternative Minimum Tax that was only supposed to be paid by the "rich?'--- a tax on folks making over $150,000 that was never adjusted for inflation? Well, my self-rmployed $81,000 income for a family of five qualified me as "rich" on my '08 tax return. Sure didn't feel like it after taxes, health premiums, tuition, and mortgage, etc. We'll all be hit with that Health care tax sooner or later.

- Connie

August 7, 2009 at 10:32am

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Jonathan - I fully agree that no individual should be forced into financial ruin as a result of a catastrophic accident or illness. I just happen to believe that there are better ways of solving this issue rather than a Government run single payer system. And I believe that honest bi-partisan negotiations will eventually lead us there (although I also admit I may be naive in that belief). The problem is, people on both sides are lying. Readers of TNR are all well aware of Republican lies. What they are too easy to ignore are lies coming from democrats. Here is one example. You say the following: "Besides, it's not as if it will be impossible to scale up these reforms later on. If Congress passes and the president signs a bill putting in place the key institutional elements of reform now, they can always revisit, and strengthen, the measure later." Now I don't think you are lying. You are stating your honest beliefs. But if you are correct, then Obama is lying. He has said, over and over, to people who are worried about exactly that possibility, that their health care will not be affected. And yet, he has also said in the years leading up to his election, that he is for a single payer system. Barney Frank and other progressives have stated that this is just the first step. So who and what are average people, who simply have legitimate concerns about their own health care and want to be told the truth, suppose to believe? Is it Obama when he says "no change to existing coverage". Is it the RNC and whatever distortions they throw out? For what it’s worth (and I suspect for most of your readers it is not much) I have lived for many years in various countries and traveled to many more. Regardless of what you say, I do not believe that on an issue as complicated as this, the US can simply pick out the best ideas from other countries and magically transfer those ideas and systems to the US. It just does not work that way in the real world. The bad always comes with the good. No system is perfect. And before I get attacked personally by the TNR army as some idiot right winger, let me just say I am simply one person trying to understand the impact to me and my family while at the same time, being completely open to solving the very real problems facing millions of Americans who do not have health insurance. I just wish people on both sides would spend more time telling the truth.

- FrankD

August 7, 2009 at 11:23am

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The Country is in the midst of a horrific recession, abnd we have added trillions to the Goverenment's debt in unprecedented numbers. It is the height of irresponsibility to try and enact another gigantic government entitlement program that will add even MORE to the choking government debt, especially when the CBO has said that it will cost another trillion dollars. The nation needs to trim costs, including health care costs, not spend us even further into debt.

- huffinpuff

August 7, 2009 at 11:48am

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It is peculiar hearing people say that 'don't trust the government to effectively handle our health decisions.' Would they rather such decisions be made by the CEO of Enron? Of AIG? Or any other large corporation? Where is this fantasy that corporate America will have better decisions for your health care coming from? If you want an idea of how 'efficieintly private corporations handle such things, just look at the recent bankrupcty filings containing the names of 'insurance' or 'health.' I would far rather have a bureacrate controlled by an elected official responsible for making decisions than a bureacrate operated by the failing company seeking to continue its multi-million dollar payments to its CEO. If there is one place the competition does not belong, it is in providing health care to people. Why would I want to go to some place that is seeking to serve up the lowest priced and poorly paid workers for surgery? I would far rather have the ability to rely on care meeting standards established and enforced by the federal government.

- lazarus

August 7, 2009 at 12:25pm

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The dichotomy here is fairly simple: Social, we're-all-in-this-together kinds of people, and individualistic, I'll-take-care-of-myself kinds of people. The problem with the health care "reform" advocates is that they assume that all of us are, or ought to be, or ought to be forced to be, of the former group. I'm very much an individualist. I'm perfectly willing to pay for the services I receive from society--so long as I can choose, ala carte, from a menu of services. I'm fine with paying for roads, but I don't need government health insurance, I don't want government health insurance, I don't want to be forced to pay for someone else's government health insurance, and I don't want government presence in the health business to raise my costs or reduce the quality of the medical service I get. So, Mr Cohn, if you can devise a reform of health care that meets my needs--i.e., keep it among people who want it and leave the rest of us out of it--sure, I'll support it. Otherwise, I'll oppose it. Which I do. It would be a very good thing, in my opinion, if only those who support Liberal do-goodery were taxed to pay for it--it's easy to vote for goodies when someone else pays for them. I suspect, though, that if the costs of entitlements were borne exclusively by their supporters, the number of such supporters would sink dramatically and quickly.

- Henry Miller

August 7, 2009 at 12:28pm

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The first sentence of this article: "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,..." What polls are these? What are the key elements of Obama's 'health care reform', since he hasn't proposed a plan? The House has a bill, it authorizes the Federal Government access to every bank account to withdraw funds to pay for 'healthcare'. Do people support this key element? The House plan mandates compulsory conseling for all Americans 65 years old and older. Do people support this key element? Do people support the 'public option', which is designed to eliminate private health plans? Do people support the at a minimum Trillion dollar cost? Obama promised verbally no new debt with his non-existent plan. An obivious lie. Do people support the House plan to insure illegal aliens? Just trying to figure out, what the people support. DS's.

-

August 7, 2009 at 1:03pm

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I'd like to seem more responsibility placed on individuals and that may require reinstituting the stigma that used to be attached to self-destructive behavior. A little stigma for obesity, out-of-wedlock pregancies, and sedentary life-styles might go a long ways in diminishing health care costs. Put teeth into this by charging higher premiums for obese and seriously overwt people so there are real consequences for poor health behavior. Call it "incentivizing" or any other such PC slang. No free deliveries for non-married women or illegal aliens. Lets get this country back to taking responsibility for ourselves!

- heidi

August 7, 2009 at 1:10pm

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The problem with medical care isn't a matter of deciding who to rob to pay for care for people who can't afford it. The problem is that medical care is just too damned expensive, period. Congress needs to address that issue. They haven't. The same thing goes for public school education. It costs, right now, about $12.5K per year to send a kid to public school. There is no way that the overwhelming majority of people who have kids can afford that, so the government has to steal from everybody else. Both medicine and education operate under antiquated paradigms that we simply can no longer afford.

- plaasjaapie

August 7, 2009 at 1:52pm

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Almost all of the first 13 comments are from the conservative "can't do" class that are pushing for no real reform. It's not at all clear that the best way to counteract this group is to request less reform. We could easily end up with legislation that covers no more than are presently covered... at a significant increase in cost similar to the "reforms" passed under Bush.

- George

August 7, 2009 at 1:59pm

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Radicals on the Left/Right cannot be reasoned with. The issue is the Centrists and Swing Voters...and Obama has lost them on the health care issue. The problem is: 1. Obama squandered credibility on the failed Stimulus Bill, the bailouts (necessary but unpopular), and Cap & Trade. 2. Obama's tactic of trying to ram this 1,300 bill through in two weeks backfired big time. People saw what happened when the Stimulus and Cap & Trade were reammed through (weren't read) and aren't about to let it happen again. 3. Obama tried to do too much at once; people are scared and are questioning his administration's competence/priorities. 4. The Congress is waaaay too far Left, and it doesn't appear Obama has any control over them. 4. Obama did not articulate a specific health care vision. There are multiple bills in congress and nobody is quite sure exactly what's being proposed. 5. Instead of crafting a "half loaf" solution that people could understand and accept, they've crafted a Liberal's dream with every Left wing bell/whistle included. Centrists simply won't buy it. This is what a President gets when his congress is too ideological and when he can't control them. We need health care reform...but not the bills currentl working their way through congress.

- JohnR

August 7, 2009 at 2:05pm

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No one is suggesting the government "run health care". No one. Lay off the myth-making coming from the right-wing and think for yourself. You say you like true competition in the marketplace? That's not what you have now. You have competition all right - competition for healthy premium payers. Insurance companies are not interested in covering sick people! I assume you have good coverage - and you will until you or your employer can no longer afford the premiums (it'll happen) or you have a serious health problem at which point your coverage will be terminated. Then perhaps you will understand why thinking folks see the need for change.

- justsayinagain

August 7, 2009 at 2:42pm

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Connie, if you don't want the government to run health care then I suggest that you not sign up for Medicare when you become eligible. Also, if you have parents who are eligible, tell them to leave the program because it's socialized medecine that eliminates true market competition and they should just get health care on the open market like the rest of us. If your parents can't buy health insurance because they are elderly and frail, or the costs of any such insurance are more than they can afford, you should volunteer to cover their additional expenses out of your pocket, like the true-blue free marketeer you are. If you aren't so sanguine to these suggestions, perhaps you should reconsider your fierce opposition to government policies that are designed to make health care accessible and affordable to those under age 65 who don't currently have it.

- wildboy

August 7, 2009 at 2:56pm

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I've had a bad feeling all along that national healthcare would be torpedoed, or at least made so lame that it was not worth the tag "reform". There are just too many powerful inteterests which have too big a vested interest in making certain that they continue to control the heatthcare system and continue to make zillions off of it. People were more interested in the OJ Simpson trial to care last time healthcare was debated, this time its Michael Jackson and the arrest of Prof. Gates. There is always a distraction to throw at them.

- frilz1

August 7, 2009 at 3:37pm

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One thing that I would like to see out of Obamacare is decoupling health insurance from employment. Now I know any health care system needs to efficiently eliminate useless eaters who don't even have jobs, but having health care as something employers provide does not lead to less of a problem of moral hazard. What it does do is kill job growth when employers decide they'd just rather not create or fill a position or outsource work to Asia than pay for health insurance for a new hire. But whatever. The current system has the advantage that it keeps theplebs in their place.

- Sam Jew

August 7, 2009 at 3:47pm

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I don't want my health care dictated by a for profit private health insurance company that pays it's CEO an officers huge salaries and golden parachutes.

- Jman

August 7, 2009 at 3:56pm

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Thanks for agreeing with us.

- Henk

August 7, 2009 at 4:19pm

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I have been an RN for 35 years and work for a group of cardiologists. The comments above about "free markets, competition, and making your own health care decisions," are so divorced from the actual reality that patients face it is hard to realize we are talking about the same subject. Conservatives mostly have a fantasy about health care, and seem to be fighting to preserve it. It is essentially impossible to have a constructive discussion about health care that pits fantasy against reality.

- Terrydactyl

August 7, 2009 at 4:44pm

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if health care reform will not happen this time, it's what people of US deserve. Your people are simply not involved in the process and that is because most have no clue what this reform would bring. Fix your education and try again in 14 years, if no go then, in 28 years time you will get human health care - meaning, you DO NOT have to die unless you can pay. Majority of US population simply does not care, thus they deserve private health care.

- veikko

August 7, 2009 at 4:50pm

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There is indeed a lot of grassroots energy in favor of health care reform - it just doesn't make for exciting YouTube videos. An example: One week before a couple dozen conservatives disrupted Congressman Lloyd Doggett's event in Austin and attracted national attention, I was at a pro-reform rally with Doggett and over 500 other supporters in Austin. I guess we were too well-behaved for YouTube and CNN, but we had way more people there than the conservatives had in their mob.

- Peter

August 7, 2009 at 5:38pm

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I'm just waiting for someone to get shot at one of these townhall meetings. I honestly don't care whether reform gets passed. We all live in this country for one reason only. When the going got tough in Europe our ancestors got smart and LEFT. I'm going to greener pastures and I'll let the states wage war over the scraps of the Union. It was a grand experiment. To bad human nature ruined it in the end.

- DixieWrecked

August 7, 2009 at 6:00pm

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So why have there been no serious market based reforms proposed for healthcare in the past 40 years? Government now directly pays for about 50% of healthcare. Medicare Part D is clearly an example of how not to put a "market based" system in place. As much as I dislike dealing with some of the bureaucracy associated with the military insurance (Tricare) I will say that it is efficient, effective, and patients seem to like it despite a lack of “market based incentives”, and good care is delivered across the system. One could almost argue that health care might fall into the same category as fire protection, in that a certain level of protection should be mandated and regulated.

- Dr P

August 7, 2009 at 6:31pm

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This completely contradicts what the President is NOW telling everyone. He NOW says he doesn't support single payor healthcare...though he's recorded multiple times in the past supporting it. You just essentially confirmed that he still want Single Payor...all he has to do is put the structure in place...and then later increase the pressure to make it happen. Thanks for the clarification. I vote NO.

- Peyton

August 7, 2009 at 7:50pm

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What is sad is how easily the Insurance Mafia have convinced a significant minority of Americans that the issue is about helping poor people, or expanding coverage, or killing old people. The real issue is the spiraling costs of health care, the fact that insurance companies are dropping coverage to even wealthy people if they get sick, adding lifetime and annual coverage caps, denying claims, and the fact that our economy is being held hostage to benefits that used to be affordable and an unquestioned part of an employee's benefit package. The status quo is killing Americans left and right and 62 percent of bankruptcies are caused by medical emergencies to insured people. These insurance companies are vampires sucking the blood out of America, but by using the themes of greed, dog whistle racism, brownshirt thug tactics and the selfishness of a substantial base of ignorant Americans unworthy of the designation they are bribing and cajoling the media into supporting vampirism.

- Dick Hertz

August 7, 2009 at 8:36pm

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What I can't understand is the talking point from the left is " America pays more of GDP for healthcare" than anyone. So if this is true why does Obama need another Trillion Dollars?

- Dennis D

August 7, 2009 at 10:55pm

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When you say "overrepresentation", are you referring to states like Deleware, Rhode Island, Hawaii? You also omitted the fact that a block of "Democrats" oppose this legislation. This article is pink meat.

- Trey

August 8, 2009 at 4:37am

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Parker -- I agree with your suggestion with one big difference. The mandatory separate coverage should be for the bare basics rather than the catastrophic, then folks could get insurance to cover specialists, surgical procedures, terminal and serious disease treatment, etc. If we cover the basics -- prenatal; all child care; annual physicals and routine check-ups; immunizations; basic prescription drugs; mammograms, colonoscopies and other screemings; fitness and exercise initiatives -- with absolutely no out-of-pocket expenses, we will (1) be a healthier, more productive society, (2) give everyone the best chance of reaching advanced age without a chronic, debilitating cndition, (3) have less need for catastrophic treatments, (4) reduce costs by having large pools wih negotiating leverage, (5) cover the uninsured with the basics, and (6) manintain a vibrant and important role for private insurance and free market efficiencies.

- Buzz B

August 8, 2009 at 8:05am

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Suppose you're 62, eligible to draw Social Security but still three years short of Medicare. If you don't have health insurance now, you're screwed. Your only hope is staying healthy until you're on Medicare. And during those three long years while you try to beat the odds, you'll be worrying that Obama and the Democrats will gut Medicare and cave-in to Big Pharma on prescription drug prices. Why should any person in that position have any enthusiasm for Obama or the Democrats in Congress? Two generations from now, historians will conclude that a single-payer system -- the only solution that covers everyone; the least cost solution -- would have been easier to pass because it offered clarity, certainty, and clear improvement for everyone. Instead, Obama and the Democrats, who remembered everything from the Clintoncare debacle but learned the wrong lessons, have bungled the opportunity by offering change without improvement in the form of almost a half-dozen thousand-page bills that won't help those who need help the most until after the next presidential election. Our nation is committing civic suicide.

- James Conner

August 8, 2009 at 4:44pm

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spk2moi -- We, as tax payers, already pay for health care for the poor. It's people like my husband and myself -- small business owners who have seen health insurance costs for ourselves and employees increase 5 fold over the last decade (with another 9% increase just announced by our insurer), the self-employed, employees of businesses that do not, or no longer can afford to, provide employee health coverage -- that is, people in the private sector who do not, like 1/3rd of Americans (veterans, employees of state, local, and the federal government, the elderly, Medicaid recipients, etc.) have some form of tax payer supported health coverage or the other 1/3rd of Americans lucky enough to work for the (dwindling number of) large employers who offer some kind of group coverage -- who are most concerned about health care reform. We understand that the system we "enjoy" compromises this nation's economic competitiveness, hinders new business formation, limits labor mobility, and is increasingly pricing too many people out of the market and limiting their access to timely care. Do you have a solution for that problem? Or is this issue nothing more to you than an opportunity to vent your resentment of "the poor?"

- esmense

August 8, 2009 at 5:07pm

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We do not have the "best" health care it ranks way down the list and innovation is falling quickly as well. We have a badly broken system if you don't believe me try to price shop for elective surgery sometime.

- Zach

August 8, 2009 at 8:53pm

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These comments from the anti-health reform readers very nicely illustrate the point of the article! All bluster and no understanding. It's very simple. The market doesn't work for health care. Why? Because your demand for health care is infinitely great when it's your own life at stake. Most of the time, in the sad tales you read about people denied essential coverage, the consumer has gotten exactly what he or she paid for, right there in black and white. But that doesn't make these horrors more acceptable, if you have any humanity at all. See, the market doesn't work when the consumer does not know what he is buying. And few of us can predict our own future need for medical care. It is truly a rigged game. The health insurance companies, like Vegas casinos, exist and prosper because they predict better than the individual consumer how much the consumer will cost. I pray the grownups in the government now after all these long years will succeed, and the naysayers will choke on their vitriol.

- DnFMcKnnn

August 8, 2009 at 9:40pm

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Americans will get the health care they deserve. The comments reflect for the most part the worst effects of the Bush-Reagan era of "what's in it for me, f**k everyone else" mentality that is what America is about now. We are so consumed with avoiding doing anything that will potentially move our cheese, and believe that we have a great health care "system". Well, the Republicans managed to convince the Southern redneck community that they really had their interests at heart, and forged a voting bloc based on mutual self-interest. The same is happening now in the healthcare debate, only this time the Republicans' virulent, anti-communitarian, and anti-democratic propaganda hate speech is being transmitted via the web. Finally, it is as if the election campaign has never ended and we only know who wins from who can defeat the other's legislative agenda, not their control of government. Once again, this country, as any other, deserves exactly the pain and benign neglect that has left its health care in the hands of plutocrats and billionaires, and has fooled most of the people all of the time by saying no direction or control is the best system you could wish for. Tell the 48,000,000 uninsured that, and then tell the rest who haven't a clue about what good medical care amounts to. In the end, of course, Obama is right: he doesn't need any better health plan -- he has the best there is -- why should he want to change it so other people could have what he has? That logic just can't go down with the "me" generation. Why would some rich guy want to share the wealth? Must be a commie or a socialist...trying to trick us...go shout 'em down...yeah... and shoot-'em down if they want to tax us for health care.

- PeterK

August 9, 2009 at 1:27am

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I really didn't think it was a "healthcare" reform (now evidenced) and I do not believe it is a health"insurance" reform either. With the onslaught of retiring "boomers", the D party MUST pass this thing to refill the coffers. It appears the 1.6 trillion redistribution would keep FDR's and LBJ's plans alive and give political cover for the 2012 elections.

- James Schenken

August 9, 2009 at 12:25pm

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I DO have single payer: TRICARE. Never once have I been denied medically necessary care. Can you say that about your insurance company health care? I think President Obama needs to push harder. We need to get the insurance companies off our medical dollars. Just WHAT do they provide for their 20% off the top, anyway? They're just another layer of bureaucracy. Why is an insurance company bureaucrat better than a government bureaucrat?

- Rev Chris Miller

August 9, 2009 at 1:59pm

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Progressive don't want the government to "run" insurance coverage. What we want is for there to be a single payer so that you go to the doctors of your choice, and they get reimbursed by the government, without paying 20% to push the paper, which is the TOTAL of what health insurance does. That's what Medicare and TRICARE are. The VA is a government RUN program (and it is rated nationally as the BEST health care system in the US...even William Kristol has said this, just last week or so.) That's government RUN health care. Too many people are so scared of the "big bad country" and yet they claim to be patriots. You as a citizen are part of "they". Why does everyone assume such bad faith on the part of the "other side?" No one in our national leadership: Republican OR Democrat is out to "destroy" the country. We have honest differences of beliefs in how to get there, but to say the other person is out to destroy the country is a shame. It is going to lead to real violence if we don't tamp down the angry rhetoric. Pr Chris

- Rev Chris Miller

August 9, 2009 at 2:08pm

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Mandatory health care coverage is unethical and wrong. It uses force (government) to transfer wealth from healthy people to sick people. The more sick you are, the more you get relative to what you put in. The healthier you are, the less you get out of it. Perfect health, you get nothing from it. The AMA says 80% of health costs are related to behaviorial decisions like smoking and obesity. So mandatory health care amounts to subsidizing the bad decisions of the sick while punishing the good decisions of the healthy. Consequently, you will get more bad decisions and less good decisions. When the financial reality rears its head, the government will necessarily respond by dictating behavior and lifestyle; if you do X, you will be denied treatments (so we can meet financial goal Y). In the UK, the emergency room patients are lined up in the street outside the hospital so the hospital can generate more favorable entry-time metrics. Why should giovernment be involved in health care? All government brings to the table is force and legal compulsions. How is that useful? This is all about leftist's dream of a world where people can do anything they want but not have to face the consequences of their actions. Reality always wins, however, and that means it will get ugly.

- a. dender

August 10, 2009 at 12:42am

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To spk2moi - Yes, I'd very much like to speak-to-toi and all your ilk who are so afraid of single payer healthcare. You do realize, don't you, that all other Western democracies have a version of single payer healthcare and that their populations are healthier and live longer than Americans? I am opposed to Obamacare, but not because of the inclusion of a Public Option, but because Obama allowed the health insurance industry to write the damn legislation and they now have a bill which will enrich them and largely maintain the status quo; no serious reduction in the numbers of uninsured will even start before 2013; there will be no improvement in the number of underinsured Americans; the insurance industry & Big Parma can charge whatever they want and the American treasury will be open to them; and I am also opposed to Obamacare because Big Insurance and Big Pharma have succeeded in gutting any Public Option to the point where it can't be a threat to them at all. If the Canadian experience of single payer healthcare is any guide, then, yes, with single payer healthcare you could experience some waiting lists, BUT think for a moment about the fact that American hospitals are serving a population where almost 20% of the people have no insurance and often don't even see a doctor for emergency care, and a further 30% of the population is underinsured and can't take advantage of the availability of joint replacements, or cataract surgery, or hernia repair because they can't afford the co-payments. If you add these people to the system (we're talking about OVER one hundred million people) then of course they would have some effect on wait times. What this means is that the current American system allows you the privilege of no wait times only because you live in a country that is willing to allow one third of its population to live without adequate medical care. But is it so bad in Canada? There are horror stories, but for every horror story about the Canadian system, Americans can tell many more about their own experiences with healthcare that is controlled and rationed by greedy insurance corporations who grab 30% of all the American healthcare dollars paid in by hardworking people who can never be sure that the system will be there when they need it. Is it so bad in Canada? Well, less than one half of one percent of Canadians waiting for elective surgery cross the border to get healthcare in the US or Mexico. The majority are treated and treated well in Canada. Canadians are free from the tyranny of the corporate insurance company lackeys whose job it is to deny coverage. Canadians are free to change jobs, or quit jobs or go back to school with no fear that they'll lose their health insurance. Canadians are insured from womb to tomb, even if they are born with medical problems, and no matter how many illnesses or accidents they or their family have. You may be sitting pretty now, spk@moi, but if you are an American with a private insurance plan, you are potentially just one layoff away from personal bankruptcy. You probably also have a policy with a lifetime cap that the insurance company will pay out. If you have a family on this policy, you had better hope they all stay healthy, because one bout of cancer + one serious automobile accident = no more coverage for life. That's right: no more coverage for life. After you sell everything you own and liquidate your savings and your kids' college funds, then you can go on welfare and be eligible for Medicare. What a great system! You'll be happy then that there is a shiny medical fortress in your town with all the latest topnotch equipment and no waiting lists, and that is absolutely not available to you.

- LDW

August 10, 2009 at 1:46am

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Free market competition will not decrease healthcare costs, as has been amply demonstrated in America where healthcare is now the most costly in the world per capita, even though over one third of the population is underinsured or has no insurance at all. Americans have to get the insurance industry out of the primary healthcare industry. In Canada, many companies offer supplementary health insurance policies that give the insured things like private hospital rooms or chiropractic which are not covered by the public plans. Americans should be calling for single payer healthcare. Ask yourself which you would rather be facing: the possibility of having to wait a few extra weeks for a joint replacement, or the possibility of finding yourself deeply in debt and with no medical coverage whatsoever?

- LDW

August 10, 2009 at 2:00am

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Enough with the right-wing scare tactics! How can these people rationally think that CEOs of profit-driven big insurance care anything about people's health? They don't! Big insurance execs care ONLY about profits! Why should people be forced to waste their income on supporting the high priced salaries of insurance company execs? How is that any better than paying lower-salaried bureaucrats? Here's my suggestion - if people fear a government take-over of healthcare, then let them buy the product from private sector insurance companies - and give the rest of us an option for insurance run by nonprofits or by state government if we so choose. Competition is the American way! Let's let everyone choose whatever insurance plan they wish. Let's let everyone have the choice of whatever board-certified doctor they wish. Let's divorce healthcare coverage from employment - that only encourages job discrimination against people who are older or have existing conditions. It also makes American companies less competitive against foreign companies. Instead, just simply have a fixed percentage of one's earnings going into a pool that pays a fixed amount for each and EVERY person to be covered according to their own wishes. And please put reasonable caps on the amount of punitive damages that people can get from malpractice lawsuits. Please limit the amount of awards that can go to lawyers. Why must doctors be forced to pay enormous costs in malpractice insurance, thereby driving up the costs for everyone and also requiring a lot of unnecessary tests? Finally, let's let more people into medical schools in order to increase competition among doctors and thus drive down costs and eliminate any waits that develop to see a doctor. But enough with the scare tactics! That is just crazy! If there are problems - and the current system has a great many - then let's fix them!

- BenS

August 10, 2009 at 2:54am

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I do not really know how health care should be reformed - not an expert. I do know, out of prior experience, what it should not be like, and that is a clone of "free", government provided, health care - the Soviet Union style. Unfortunately, everything I have heard from Obama's mouth, so far, sounds a lot like what I enjoyed back in my former motherland. Should this version of health care reform pass, it would really suck for millions of un-suspecting Americans.

- Alexander Gorshteyn

August 10, 2009 at 3:34am

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Have they killed the provision to charge employees income tax on employer-provided insurance?

- Paul

August 10, 2009 at 9:55am

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There is no "true competition" in the health care marketplace Connie. In many states it's a private monopoly that is neither competitive or effective.

- Pnaut

August 10, 2009 at 3:00pm

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I don't understand what you people don't get! If you like your health care plan you have right now, you can KEEP IT! Obama's new plan is an OPTION, not something forced upon "unsuspecting" American citizens. I am a 16-year-old girl with a dad who is on the edge of losing his job. If he does get to keep it, his boss is going to drop buying his employees health care in November. This will mean that a simple trip to the doctor's is going to cost my family a heck of a lot of money after that! Sure, you guys can keep your health care plan you have. But for someone who is unemployed, it would be REALLY nice to have an option that they can afford. If you don't like it, then you don't have to take it!

- Julia

August 11, 2009 at 8:46pm

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