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Here are some reasons why.
That's the scuttle, according to Fox News.
House Speaker Nancy Pelosi said Monday President Obama will soon propose a health care bill that will be "much smaller" than the House bill but "big enough" to put the country on a "path" toward health care reform. A senior administration official told Fox Obama's proposal will be introduced Wednesday.
"In a matter of days, we will have a proposal," Pelosi said, pointing to Obama's forthcoming bill. "It will be a much smaller proposal than we had in the House bill, because that's where we can gain consensus. But it will be big enough to put us on a path of affordable, quality health care for all Americans that holds insurance companies accountable."
Melody Barnes, a top Obama domestic policy adviser, did not dispute Pelosi's characterization of the new plan as smaller in scope - and quite possibly in cost - than either the House or Senate health care bills.
"It's going to be matter of drawing on these different ideas and coming up with the right proposal," Barnes said in an exclusive interview with Fox. "That's what my colleagues are working on. That's what they're talking with Congress about. We'll see what it looks like when the proposal is sent forward."
Asked how White House staff is putting the new proposal together, Barnes said they are "borrowing" from conversations at Thursday's health care summit.
"We're going to be borrowing from those conversations ... to come up with a bill that we hope can receive bipartisan support," Barnes said.
When asked if White House staff, as Press Secretary Robert Gibbs indicated Friday, would work on GOP ideas for health reform over the weekend, Barnes identified two: tort reform and allowing insurers to sell policies across state lines.
Well, it's about time. Obama could have saved himself a wasted year — and perhaps saved Ted Kennedy's Senate seat for the Democrats — by doing this sometime in early 2009. That's what president's normally do when they'd like to enact major reforms: They submit a bill that lays out clear priorities, and then lets Congress mess around with it, but not too much. Instead, he let Pelosi and Reid come up with a plan from scratch that turned into the monstrosity that polls show the American people are overwhelmingly against.
Time will tell if this last-ditch effort to save his No. 1 domestic priority will bear fruit. But if Obama is expecting this bill to be "fast-tracked," he's kidding himself. If Obama really wants what he presents Wednesday to be passed, it has to start winding its way through the legislative process all over again — which means it needs to be taken up by several relevant committees in both chambers, get debated, marked up, sent to the floor, debated again, voted on, and, if passed, have the differences reconciled in a conference committee. Oh, and it would have to survive a filibuster in the new 59-41 Dem/GOP ratio in the Senate.
Yes. Important legislation can be passed in a matter of a few weeks. The Patriot Act comes to mind, but that's hardly a model Democrats can defend considering they've complained for years that it was passed and signed into law too quickly (while nonetheless passing up nearly every opportunity to correct the abuses and errors they say are in the law). One could argue that The Patriot Act was an "emergency," necessary to equip the federal government to respond to the threat of international terrorism that hit home on 9/11. What's the emergency here to get health care reform passed? That Democrats might lose their majority in eight months? No sale.
Also, the devil will be in the details. While I'm encouraged to see that Obama appears to be on board with malpractice insurance reform and allowing interstate health insurance sales, those proposals have to be substantive. Allowing a Californian to purchase health insurance plans that people in Arizona buy is meaningless if California's rules for what must be covered in a plan still hold. And we must also see what is in Obama's plan. A lot of it could still be objectionable (in fact, I'm counting on it).
Will Obama's plan be honest in its cost, free of the trick of "scoring" it with 10 years of tax increases but six years of benefits to make it "revenue neutral" but phony? Will the Medicare "Doc Fix" be included so it reflects the real cost of "reform"? Those are key questions. And if it also includes the vast federal bureaucracies to micromanage the health insurance market from Washington, I don't see Republicans getting on board. Not now.
The irony is that if Obama proposed his own "much smaller" bill in February 2009, he'd probably have his "health care reform" already — and with enough Republican support to truly call it bipartisan. But only now, in an incredibly weak position, is Obama reaching his hand up toward Republicans asking to be saved — the same Republicans he treated with contempt for 12 months. I would not be surprised if Republicans decline to pull him up and save his political bacon ... and take their chances with voters in November while carrying the label of "obstructionists."
(HT: The Corner)
Comments
Emergency
How about 45,000 American deaths per year?
This is what I don't get about Conservatives and the public in general. Conservatives (well, all politicians to an extent, but you really see it with Republicans) love to stoke the fires of fear, especially with regards to terrorism. They totally blow the threat out of proportion. And the public buys it. They sign away all sorts of rights for some impotent mirage of protection from a death that is statistically less likely than being killed by a cop. But do we bat an eye for any of the 123 people who die every day because they don't have health insurance? Of course not. Because they aren't on TV.
To put it another way, every 35.5 days the same number of people die due to lack of health insurance as US soldiers have died in the entirety of the Iraq War (about 7 years).
RE: Emergency
Your numbers are bunk. See here for a dispassionate debunking of such studies, and here and here for more spirited denunciations of the nonsense.
I know you won't believe them, but what the hell.
Oh, and while the anecdotal stories in the CNN story are sad, if one wants to be more accurate, those folks died because they chose not to purchase health insurance and chose not to go to the hospital when they were feeling ill. I know a freelance photographer doesn't make a lot of money, but he makes enough to buy his own plan. I don't make a lot, and I bought my own plan. My wife bought her own health insurance when she worked as a waitress and artist when she got out of college.
By the way, those plans an would be cheaper if individuals got to buy insurance with pre-tax dollars like employers do. But I suppose that's irrelevant. Let's just pretend putting the government in charge of our health care will "save" 45,000 lives a year. It's more outrageous!
45k probably too high
Your first two links lead to the same source, where the study implies that there is no decrease in chance of mortality from buying health insurance. Sounds like the best solution is to just have no one buy insurance. Sweet! Budget Balanced.
But in all seriousness, that study (by UCSD's Richard Kronick no less, who was Clinton's Senior Health Care Policy Advisor in 93-94) poses a strong counter-argument. I was probably a bit hasty in plucking the 45k number off of the first page of Google's search results, so I took a closer look at Kronick's study.
Politifact.com noted this study when they updated their rating of Rep. Bill Pascrell's (D-NJ) statement that "22,000 uninsured die annually." (They updated their rating from "true" to "half-true" based on the results of Kronick's study, which looks to have come out after Pascrell's comment FWIW.) In their notes to their update, the included this quote from the study which I find telling:
So here is one study from a respected scientist and published in a credible journal which concludes that there is not a significant difference in mortality between insured and uninsured, but the researcher himself finds the results counter intuitive and hypothesizes that it could be due to our public safety net. In other words, uninsured people don't die more probably because of our Good Samaritan-like society. We don't like letting people die, so we do what we can to save them. If we are going to do this anyway, wouldn't it be more efficient to insure them up-front, where all but the most destitute will contribute at least something to the premium, instead of waiting for them to show up at the ER?
Your third link just quotes the study from the first two links, adding nothing new to the discussion.
But the best is your fourth link, which sites this Johns Hopkins study (unfortunately they only give away the abstract for free :/) Here are the results and the conclusion from that study:
This study actually contradicts Kronick's (not directly, they were studying different datasets*). The title of that article you linked to was "Does Lack of Insurance Cause Premature Death? Probably Not." And, in all fairness, they do have a point. This study does not prove causation, but the correlation between lack of insurance and a nearly 40% higher chance of a child dying should give all of us serious pause.
Kronick's study certainly re-opens the debate, but so far most (all but Kronick's?) of the studies point the other way. Probably 45,000 a year is too much. But is 10,000/year an acceptable number? How about 5,000?
You're right. Just like I chose not to buy a Lincoln Navigator this year (and one next year, and one the year after that).
I agreed with this point a long time ago. I don't know why you keep feeling the need to bring it up.
*On the topic of different datasets, Karen Davis of the Commonwealth Fund "said that the existence of Kronick's study 'doesn't convince me yet not to use the IOM study,' but she added that 'if I saw a few more, I might be convinced. I tend to believe things when I see multiple studies using different databases and methodologies come to the same conclusion.'" And so far we have seen more studies conclude that lack of insurance does impact mortality.
Of course, this post fascinated me. I ask:
Should they be using "associated" where everyone is using the word "caused" here? Because (heh) I'm thinking, "being uninsured causing increased mortality might be too strong a statement to make." Heck, it took decades to show that cigarettes caused cancer, as opposed to just being associated with cancer, and there was a mechanism in place there.
Here, I don't see the mechanism for causation in place.
RE "cause"
The only place I see "cause" being used is in the title of John Goodman's (no, not that John Goodman, another one) blog post. And like I said, I agree that none of these studies show causation, but the majority (i.e. all but one) show a correlation between lack of insurance and mortality rates.
But, one mechanism could be "people without insurance are less likely to go to the doctor when they are sick." Influenza kills something like 36,000 per year. It's quite possible, even likely I would argue, that some of those people either delayed going to the doctor or did not go at all because they didn't have insurance.
Inapt analogy
Death rates from flu in the U.S. are rising among people age 65 and older — who have "socialized medicine" in the form of Medicare. Many of the deaths occur in nursing homes (again, which are largely financed by government; I recall from an edit board meeting a few years back that nursing home care is about 90-percent funded by either Medicare or Medicaid).
And flu kills plenty of people in Western Europe and Canada, where universal health care is a right.
Nice try, however.
RE Inapt analogy
It was an example, not an analogy.
Nice try, however.
So is it your assertion that people without medical insurance don't get the flu?
Like Obama should have submitted his own legislation a year ago, we should have had this discussion a year ago. We would have HCR all figured out by now. If only we get people to drop their health insurance, we can wipe out the flu with and not negatively impact mortality rates!
You say example, I say analogy
No, the point is that your example has no relationship to the facts. It's all well and good to say, "People may be dying of the flu because they don't have health insurance," when the largest group of people dying from the flu *DO* have health insurance.
Again, I'm leaving this thread in the search for intelligent life.
I could go further
But I'm tired of talking past you.
Death from flu
I made my last post from my Blackberry while at lunch, and was going to come back to the office and post an addendum. I was probably more sarcastic than I should have been.
Wry said he saw no mechanism for a causal link between mortality rates and lack of insurance. I responded that one possibility is that people without insurance may not go to the doctor as soon, or at all, when they get sick. I brought up the example of influenza because A) it is relatively common, meaning a lot of people with and without insurance get it each year; and B) it is deadly (yes, more deadly in the elderly, but it still kills on the order of 3-5000 people under 65* (complete study here).
My point was that the flu is one example of a way in which lack of insurance could lead to someone's death. Another possibility would be an inflamed appendix. Or a staph infection. Or any of a number of other diseases, infections or injuries.
But you seem to think that because mostly old people die from flu, and they have Medicare, my point that there could exist a causal link is invalid. But that's just bad logic. Not only do the non-elderly die from the flu (your own link notes that flu death rates in the 0-24 month age group are the same as the 65+ year age group), but Medicare doesn't cover all medical expenses. (pdf)
I don't think we are talking past each other. At least, I am hearing what you are saying. I apologize for being a bit of a wise-ass, but I get the feeling that you simply disregard my points without giving them due consideration. I know I read posts of yours (or Zaius) with a small amount of prejudice ("He's going to suggest the free-market can solve the problem, I just know it"), and I imagine that a similar situation exists on the other side of the debate ("He's going to propose the government regulate it. Pshaw!"). Perhaps this provokes us to a hastier reply than is warranted at times. But I feel that I have recognized your points here (and Zaius' in re the 45,000 figure) and presented compelling ripostes your arguments.
*I'm getting the range 3-5000 from the bottom part of the chart. They come up with 51,203 all-cause flu deaths (which seems high compared to the CDC figure of 36,000) with 7,224 of those being in the 0-64 age range. I prorate that total to the 36,000 level. I've read elsewhere that the CDC estimates that 90% of flu deaths occur in the 65+ age range, which would but the under 65 group at about 3600 deaths per year.
I was probably more sarcastic than I should have been.
"I was probably more sarcastic than I should have been."
This is never, ever true.
More sarcastic?
Oh sure, crywalt. That's a reasonable idea.
"There's a reason we don't quote Hitler when we discuss highway spending. It just puts too much noise into your signal." Joel, 2010
Mechanisms, & A Strange Proposal
Good brainstorming, Khab'. Once we have carefully thought about a relationship, putting our fingers on possible -- and reasonable -- mechanisms, the real fun begins. Maybe a meta-analysis for openers. But we start by looking for relationships (again, reasonable ones, not like finding connections between social security numbers and mortality) and then investigating causality.
A pity more common folk don't get this yet; but I am doing my part -- 6 to 10 students per year at a time.
My stance on "universal healthcare" is neither surprising nor rare, at least until a think-tank hires me to come up with a novel approach. And gives me the power to implement it. So:
(1) take the flawed federal programs already in place, and improve them, possibly expand them, if they can be expanded while being improved. Sadly, this particular congress has not instilled much confidence, in me, that they can manage any sort of medium-size legislation properly, let alone the big stuff.
(2) Explore the consequences -- yes; there will be consequences -- of banning the practice of disallowing "pre-existing" conditions, or of compelling insurance companies to insure all takers. Help insurance companies provide a rational way for individual families to "pool" into larger groups (like companies do), to spread the insurers' risks reasonably, and lower premiums for the group members.
(3) When the idea of federal compulsion of the insurance companies fails, explore the idea of expanding the previously-flawed-but-now-improved federal programs to provide minimal coverage to those who cannot afford private insurance.
(4) Provide benefits only to legal citizens and residents. Isn't it strange how we have to state this nowadays, as if it isn't the only normal, sane way to run a nation? I know -- weird!
(5) get used to the idea that 100% coverage, like 100% student success, or 100% certainly in statistics, is not economically practicable. Stop people from shilling for it.
RE Relationship to the facts
Let me try this one more time, in simpler language so that maybe you can understand. I said:
"Influenza kills something like 36,000 per year."
This is a well established fact. Are you disputing this number?
I then said:
"It's quite possible . . . that some of those people either delayed going to the doctor or did not go at all because they didn't have insurance."
This is not a fact, but a hypothesis. And there is plenty of anecdotal and survey data in support of this hypothesis.
If you have some facts that counter this hypothesis, I would be eager to hear them. But if you only have straw men to build up and beat down (e.g. "most flu deaths are the elderly, who have insurance"; "people in Europe get the flu too"), then perhaps you should continue your quest for intelligence.
(Man, I keep getting sucked into this vortex)
Influenza kills about 36,000 Americans each year. So K hypothesizes that the death totals may be inflated by people who haven't seen a doctor because they lack health insurance. Interesting hypothesis. Except it turns out that the groups most susceptible to flu deaths in the U.S. are the elderly, who have health insurance provided by the government. (It would likewise be interesting to see how many deaths among the nonelderly are low-income people who have coverage thru Medicaid; I haven't seen those totals.)
It's also the case that flu kills people in countries that have universal health insurance.
So if your hypothesis is that universal health care would prevent flu deaths, I find the evidence lacking.
If your hypothesis is something else, I'd like to know what it is and see some evidence, not just something that flew into your brain and flowed from your fingers into your Blackberrry.
My plan worked! ;)
I find your lack of
faithreading comprehension disturbing.I am not saying that insurance completely prevents flu (or any other disease, infection, etc.) deaths. I am hypothesizing that some of the people who die from the flu did not go (or delayed going) to the doctor because of lack of insurance and subsequently died. Remember, the whole point of the hypothesis was to show Wrymouth a possible mechanism for causality between un-/under-insurance and mortality.
I've include 4 or 5 sources in my argument with you. You have provided one.
EDIT:
You continue to ignore the following fact. I can only conclude it is because you are unable to refute my argument.
--Medicare does not cover all medical costs; approximately 10% of elderly Medicare beneficiaries delay getting care due to cost. (Here's another source which confirms this number from the .pdf I linked to earlier.)
We'll see
I agree Obama should've taken a more active role in all of this at the outset -- though I don't blame him for the approach he took. The conventional wisdom a year ago was that the Clintons failed at their health reform bid in the nineties in large part because they were dictating terms to Congress. The reality is that there's no easy way to do this project.
But I think it's unlikely that if only Obama had come forward with a smaller bill a year ago we'd be done now, with a reform bill passed. There's a presumption there that the Republicans are standing entirely on principle in this matter -- that they don't have an interest in obstructing Obama on health reform for the sake of obstructing Obama on health reform. We know that's not true. That's not to say there aren't principled objections to reform. It's just that they're not the only reasons Republicans have stood in the way.
If we do indeed end up with "half a loaf" reform, Obama's probably played this as well as can be played. If he was going to start big and have it whittled down by Republicans and scaredy-cat Dems, there was no point -- from the liberal perspective -- to starting out with half a loaf.
Obama may wind up the winner
If he gets half a loaf. In the process, however, he squandered massive amounts of political capital, and revitalized an Republican/free market opposition that had its tail between its legs a year ago.
Again, if Obama gets something that puts the nation on the path to socialized medicine, er, universal health care, then I suppose the Obamacrats can claim some sort of victory. But half-measures in early 2009 could have humiliated the opposition rather than energizing it.
So I'm delighted The One was such an incompetent boob!