StanCollender'sCapitalGainsandGames Washington, Wall Street and Everything in Between



Robert Reich Is Having Deja Vu, Too

01 Sep 2009
Posted by Andrew Samwick

But he doesn't quite realize it.  In his latest post (h/t Mark Thoma), he laments the way Democrat "ideas" couldn't persevere against the onslaught of Republican "discipline."  Change a few details, and he's talking about failed Social Security reform in 2005:

I say the Democrats' "idea" but in fact there was no single idea. Obama never sent any detailed plan to Congress. Meanwhile, congressional Dems were so creative and undisciplined before the August recess they came up with a kaleidoscope of health-care plans. The resulting incoherence served as an open invitation to the Republican right to focus with great precision on convincing the public of their own demonic version of what the Democrats were up to -- that it would take away their Medicare, require "death panels," raise their taxes, and lead to a government takeover of medicine, and so on. The Obama White House -- a veritable idea factory brimming with ingenuity -- thereafter proved unable to come up with a single, convincing narrative to counteract this right-wing hokum. Whatever discipline Obama had mustered during the campaign somehow disappeared.

Being "coherent" enough to overcome "hokum" ought to be the minimum standard for legislation on this scale.  Like it or not, if you want to use the tools of a democratic government to reorganize markets for health care, you need more than an idea factory and staged townhall meetings.  You need some discipline yourself.  And we're not talking about Ironman triathlon level discipline.  We're only talking about government level discipline: white papers, Congressional hearings, and, critically, a forum in which the ideas in the bills that are moving through Congress are shown to be better ideas than the alternatives.  We haven't seen that at all.  In particular, show me why the bills moving through Congress, with all of their attendant costs, are better than a simple reform consisting only of:

  1. Community rating
  2. Guaranteed issue
  3. Ex post risk adjustment
  4. An individual mandate, with Medicaid for a fee as the backup option

And spare me the whining about how the Republicans don't have a better plan.  They don't have the White House.  They don't have the Senate.  They don't have the House.  They don't have to have a better argument than the claim that the Democrats' plan isn't better than the status quo.  It's not as if the Democrats shot down Social Security in 2005 and have now done something better.

Miles Law?

I can't remember if it is Mile's law that dictates "Where you stand depends on where you sit." But I do remember that when President Bush pushed for reforming Social Security Nancy Pelosi and Harry Reid were quite explicit in killing any efforts of reform without presenting alternatives. I thought that was an unfortunate position for them to take just as I think it is unfortunate that the republicans have decided killing health reform is more important than trying to participate in the process in order to achieve a more favorable outcome.


I don't think the comparison is apt

The point of Bush's Social Security reform was to fundamentally change the nature of Social Security from a DB to DC system. Some would call that undermining or trying to "destroy" the Social Security as we know it. Agree or disagree with the dramatic rendering, but we all know that was the motivation.

The purpose of the Democrat's Health reform is not to blow up our current system health insurance any more so than the "simple reforms" you suggest would. And I would suggest that the Republic proposals: to replace the employer based system with an individual market, and to encourage more consumer directed plans are at least as radical a change.

So what are we talking about here? The public option? Government already pays for close to 50% of all care anyway, what is so radical about another public plan. I happen to agree that it would be simpler to make buying-in to an improved Medicaid (or Medicare) as the public option. But if you think that's no biggie, what's the fuss?

Is it the idea of an exchange? I have to think you are in favor of a national marketplace for plans that are subject to the regulations you favor, rather than the balkanized version we have now, or the credit card system where companies operate out of the state with the most conducive regulatory structure.

Is it changing the payment system under Medicare to encourage integrated, organized care systems. Your colleagues at the Dartmouth Atlas, as well as the folks who run the best health care systems in the country think that is the most critical component. Is setting up MedPAC the base commission of health care too troubling.

Surely you are not worried about increased funding for comparative effectiveness or health IT?

Yeah, there are a lot of pieces and a lot of things have to change and the more you add to the bill the longer it gets and the harder it is to explain. But which part is equivalent to ending health insurance as we know it?


As We Know It

The closest President Bush got to a proposal was Model 2 of the 2001 Commission report.  It restored it to solvency through future benefit reductions and allowed the option of a carveout personal account.  It would not "destroy" Social Security as we know it, nor would it "strengthen" it as the President claimed.

The "simple reforms" I suggest are a small subset of what has been proposed -- the ones that focus on insurance reform.  They leave the delivery of health care services alone, except for what happens due to increased competition in the marketplace, which I think will be to lower costs.  They do not require additional public funds, except for small administrative costs of implementing the system and any subsidies that the federal government wants to pay through Medicaid to encourage greater enrollment of low-income households.

I do not claim that the House proposal would end health insurance as we know it.  It simply involves more public funding and less private choice than the simpler alternatives.  I am a fan of neither outcome.


Fair enough

Thanks for the reply. I think that's is a fair description. Certainly some people view socializing health insurance a unacceptable as turning social security into a privatized defined contribution plan. It's also fair to say that in neither case did either side propose to take their proposed reform to the logical extension. No matter how much they might have wanted the outcome, Bush wasn't proposing total privatization, and the democrats are to where near proposing single payer.

I am very curious as to why you want to leave health delivery reform alone. Aren't the public funds needed to cover (a) those already covered, and (b)those proposed to be newly subsidized paying too much for what they are buying. Or do you not believe your colleagues on the Dartmouth Atlas project.

I guess I am trying to figure out whether you thingk insurance reform is sufficient.


>> It's not as if the

>> It's not as if the Democrats shot down Social Security in 2005 and have now done something better. <<

They sure have. They preserved the status quo.

Who knows how much longer the bubble economy would have lasted if Wall Street had a bottomless pool of SS money to play with, to say nothing of the carnage that would be inflicted upon peoples' retirement savings when it all inevitably blew up.

Preserving the status quo headed off a massive upward transfer of wealth in the future. As it happens, the transfer happened anyway, via TARP rather than SS...sigh...


Hmm, wonder why Reich wonders

Hmm, wonder why Reich wonders why some people were wary of the supposedly win-win, "all gain, no pain" healthcare "reform" being sought by the Obama Administration.

Could it be that Obama and other advocates of "reform" have been incessantly claiming, all evidence and expert opinion to the contrary...

...that we can somehow substantially reduce projected federal spending on healthcare while expanding federal coverage to 47 million more people without making changes that would adversely affect the quality of anyone's healthcare (but rather just by eliminating pure "waste")

...that "If you like your health care plan, you can keep your health care plan", even though new regulations would change policies and a public option would result in millions of Americans losing the current health plan their employers are providing.

...that a broad expansion of preventive care will contribute significantly to offsetting the cost of expansion of coverage to 47 million more people, even though the experts have concluded to the contrary http://blogs.abcnews.com/politicalpunch/2009/08/congressional-budget-exp...

...that if the cost of expansion of coverage is fully offset over a 10-year period, it means it doesn't worsen our fiscal imbalance problem, even though deficits would be higher beyond the 10-year window due to the higher growth rate of the expansion of coverage (due to excess cost growth of healthcare) vs. the growth rate of the offsets.

...that the "reform" package as a whole is needed to reduce projected federal spending on healthcare, even though the expansion of coverage that is at the heart of "reform" will increase federal spending, not reduce it, even if there are other, distinct elements of "reform" intended to contain costs (medical IT, comparative effectiveness, even the public option).

...[related to the preceding point] that federal spending will net out lower from covering the uninsured due to elimination of cost-shifting, even though the cost of covering the currently uninsured would far exceed the savings from reduced cost-shifting.

...that insurance companies are largely responsible for our high level and growth rate of healthcare costs, and that government is much better at containing costs, even though (1) consistently 88% of all private insurance premium dollars go to paying claims (per HHS data), the balance going to all expenses and profit, (2) the oft-cited figure of Medicare's 2% administrative expense as a percent of claims paid is bogus -- in itself and for purposes of comparison with private insurers -- and way off from an apples-to-apples figure for a number of reasons that have been clearly presented in the media and of which Obama and company must be aware, and (3) administrative expenses are a small portion of total cost, and Medicare devotes fewer administrative resources to control of waste, fraud and abuse than do private insurers, and does a poor job of such control.

I could go on, but those are a few points off the top of my head.

Surely opponents, too, have engaged in their own silly hyperbole and misleading statements, but it is absurd for Reich or Obama or any other advocates to think or pretend that advocates of "reform" have generally been straight-talkers and opponents generally crazy myth-peddling deceivers.

Obama would have been better off -- on healthcare reform and on everything else throughout his term(s) -- if he had leveled with the American people with straight talk, acknowledging trade-offs and sacrifices instead of making extremely dubious claims that everybody wins (except the evil insurance companies), which left the door wide open for suspicion and criticism (some justified, some not) and which has permanently damaged Obama's credibility.


It sort of illogical to say

It sort of illogical to say the plan all gain no pain when the cost of reform is being made explicit. The cost is roughly $100 billion a year over 10 years. In relative terms that is not very painful, but no one is pretending anything is free.

Then again what is your estimate of how much we currently spend on health care for no additional benefit to our health or well-being (you can all that waste or whatever you want). Many estimates put that figure at about 1/3 of our total spending or close to $600 billion a year. Are you suggesting that we would be worse off by eliminating the $600 billion of non-productive activity?

Another question: if something has a net cost to the government but a much larger net savings to society, should be reject it?

So what is the cost of doing nothing different.
-You continue to pay the cost of uncompensated care which will increase as more people lose their insurance
-Institute of Medicine estimates that 20,000 die due to lack of care or inadequate care because they have no insurance. Presumably that will increase as more people lose their insurance? What is the cost of that?
-More people will not be able to keep their current health plan because their employers will simply drop their coverage, fire them, or change their company provided plan to something quite different. (I am guessing that some portion of these will then be forced into the gasp government plan known as Medicaid when things really go downhill).
-Continued "excess cost growth" for everyone

As for your other points:
If you redefine prevention to only include detection and treatment at early stages then no you will not save money. If you actually use prevention to mean primary prevention, preventing diseases from occurring in the first place (think getting people to not start smoking) then the social cost-benefit is positive. We know that we can prevent central line infections in hospitals (costing us maybe 3 billion a year) with the ridiculously cheap intervention of requiring medical personnel to adhere to a 5 point checklist that fits on a 3x5 card. There are many other examples.

I don't know who spends more on administration, but are you suggesting that eliminating all the activity that insurers spend on trying to prevent adverse selection is not going to save them money.

How can the public option cause people to lose their current plan. In the current legislation the company has a choice of providing what they provide or allowing their employees to use the exchange. Once in the exchange, employees could choose an option public or not. (and we already know that no republic will ever choose the public option) So do you mean to say that allowing firms to use the exchange will be worse for employees? Are you suggesting that the status quo choice made by employers is currently optimal for employees?

OK I guess I should really bother. If you assume that expansion of coverage cannot be offset through cost reduction over the long-term then nothing really will convince you.


JoeDC, Re: It sort of

JoeDC,

Re: It sort of illogical to say the plan all gain no pain when the cost of reform is being made explicit. The cost is roughly $100 billion a year over 10 years. In relative terms that is not very painful, but no one is pretending anything is free.

Obama and other advocates of this “reform” incessantly claim that this “reform” is necessary because our currently projected long-term federal spending on healthcare is too high. Thus, they are obviously implying that projected federal spending on healthcare will be lower with this “reform” than without it, although they are generally careful to avoid being clear, preferring instead deliberately vague language like “bending the curve” that gives the impression that they are talking about reducing projected spending when they are probably really just talking about reducing the growth rate after increasing the spending base by expanding federal subsidies to achieve universal coverage. Despite this implication regarding the long-term, they implicitly acknowledge that “reform” would have a net cost over the 10-year period, so they present offsets. But they pretend that achieving deficit-neutrality over 10 years means that this “reform” will not exacerbate our long-term fiscal imbalance, even though the growth rate of the new entitlement will be higher than that of the offsets, resulting in higher deficits beyond the 10-year window. They also ignore the fact that even if this “reform” were actually deficit-neutral over the long term (which it isn’t), it would still make our fiscal imbalance problem harder to solve, since it would use budgetary sacrifices to offset this new entitlement rather than for deficit-reduction, requiring even greater sacrifices to address the long-term fiscal imbalance we already face.

And another part of the bogus “no pain” pretense is the assertion/implication that the offsets from cuts in projected Medicare spending and anticipated savings from all other cost-containment measures will have no adverse effect on the quality of anyone’s health care. They pretend – and it’s just bogus -- that we can pay for most of the federal cost for this expansion of coverage by (1) some miraculous, precision cutting of massive amounts of waste without an adverse impact on the quality of anyone’s healthcare plus (2) huge savings from a broad-based expansion of preventive care (despite expert findings to the contrary) and (3) savings from reduced cost-shifting by providers to the federal government for uncollectable charges to the currently uninsured.

So yeah, they are presenting their “reform” as “all gain, no pain.”

Re: Then again what is your estimate of how much we currently spend on health care for no additional benefit to our health or well-being (you can all that waste or whatever you want). Many estimates put that figure at about 1/3 of our total spending or close to $600 billion a year. Are you suggesting that we would be worse off by eliminating the $600 billion of non-productive activity?

Of course in an ideal, theoretical world in which we could precisely target all the pure waste and eliminate all that “fat” without cutting into any “muscle” (i.e., adversely affecting the quality of healthcare for at least some people), then obviously we’d be better off eliminating that waste, because, by definition (in the sense of this conversation), “waste” is a an expenditure of a resource for no benefit at all. But, notwithstanding wishful thinking, the reality is not thus. We simply cannot massively expand federal coverage/subsidies and lower projected spending just through elimination of pure “waste” (i.e, without adversely affecting the healthcare of at least some people). This bogus claim/implication is really the newest version of the oldest trick in the political phony-fiscal-responsibility book: the claim/implication that we can get everything we want without any sacrifice just by “eliminating waste, fraud and abuse”.

Another question: if something has a net cost to the government but a much larger net savings to society, should be reject it?

We should not necessarily reject it. There are plenty of things government spends money on that provide benefits to society that are worth the cost. But that is, of course, a very different argument, and should not be conflated with the question of the budgetary impact.

Re: So what is the cost of doing nothing different.

-You continue to pay the cost of uncompensated care which will increase as more people lose their insurance

If your point is that it costs the federal government or even all (private and public) insurers more if those people are uninsured vs. if the federal government pays to cover them, the experts say otherwise. Sure, there is cost-shifting, and sure, emergency room provision of non-emergency care is inefficient (I assume), but insured people consume much more healtcare in dollar terms than uninsured people. Also, under universal coverage, only some of the reduction/elimination of cost-shifting would result in savings to the federal government. So the reduction of cost-shifting should indeed be netted out of the cost of providing coverage, but it falls far short of fully offsetting that cost.

-Institute of Medicine estimates that 20,000 die due to lack of care or inadequate care because they have no insurance. Presumably that will increase as more people lose their insurance? What is the cost of that?

Not sure what you mean by “cost” – monetary or non-monetary. Regarding the latter, obviously such occurrences are tragic.

-More people will not be able to keep their current health plan because their employers will simply drop their coverage, fire them, or change their company provided plan to something quite different. (I am guessing that some portion of these will then be forced into the gasp government plan known as Medicaid when things really go downhill).

To some extent I, too, assume the above will occur, but it may be overstated because increasing health insurance costs mostly come out of wages rather than increasing employer labor cost. Essentially (albeit roughly and imperfectly) the market sets the “price” for total compensation for an individual. If an employer ends up spending more for health insurance for that individual, the employer will offer less in monetary and other forms of compensation. Roughly speaking, if I pay you monthly 100 bananas (represending health insurance premiums for your coverage) and 100 oranges (representing your wages or salary) to perform some job for me, and then the price of bananas goes up, I’ll either pay you fewer bananas or fewer oranges, rather than either (1) eating the cost and increasing the cost to me of your total compensation, or (2) firing you. The market price for your labor is now perhaps 80 bananas + 100 oranges, or alternatively, say, 100 bananas + 90 oranges, or whatever, but it is less than 100 bananas + 100 oranges.

Again, we need to come back to whether or not the federal government and/or total (private and public, or privatley + publicly insured) will spend more or will spend less over time if we expand coverage vs. if we don’t.

If you redefine prevention to only include detection and treatment at early stages then no you will not save money. If you actually use prevention to mean primary prevention, preventing diseases from occurring in the first place (think getting people to not start smoking) then the social cost-benefit is positive.

Well, you are mixing two concepts here: monetary savings and cost-benefit. But if you are implying that this “primary prevention” saves the government money over the long term, you are apparently wrong, because (as cold as this sounds) when we factor in the savings from forgone Social Security benefits, Medicare benefits, etc. from younger deaths, smoking does not cost the government money. See http://www.law.umaryland.edu/marshall/crsreports/crsdocuments/97-1053_E.pdf and http://www.nber.org/papers/w4891 and http://content.nejm.org/cgi/content/full/337/15/1052

We know that we can prevent central line infections in hospitals (costing us maybe 3 billion a year) with the ridiculously cheap intervention of requiring medical personnel to adhere to a 5 point checklist that fits on a 3x5 card. There are many other examples.

ok, so perhaps we should have such a regulation. What does that have to do with creating a new health insurance entitlement for tens of millions of people?
I don't know who spends more on administration, but are you suggesting that eliminating all the activity that insurers spend on trying to prevent adverse selection is not going to save them money.

I’m saying that claims from “reform” advocates of the extent to which administrative costs (including the above) and profit of private insurers are contributing to our high health insurance cost and high growth rate thereof are, at best, way, way out of proportion, based on fundamentally flawed methodology (in many cases deliberate) that presents as apples-to-apples comparisons that are actually apples-to-oranges, and largely misses the point regarding the relative degrees to which various factors contribute to cost. See my prior comment for a bit of elaboration. “All the activity that insurers spend on trying to prevent adverse selection”, if it has a net cost to the system at all, is negligible, probably a fraction of 1% of premium revenues for the industry as a whole, although probably higher for the individual and very small business insurance market.

How can the public option cause people to lose their current plan. In the current legislation the company has a choice of providing what they provide or allowing their employees to use the exchange. Once in the exchange, employees could choose an option public or not.

I’m simply saying what just about every analyst has said: many millions of people will find their current health plan no longer available to them. See http://www.factcheck.org/2009/08/keep-your-insurance-not-everyone/

So do you mean to say that allowing firms to use the exchange will be worse for employees? Are you suggesting that the status quo choice made by employers is currently optimal for employees?
I’m not saying anything one way or the other on those questions (although, as a note, I think different people will consider themselves better or worse off, respectively); I’m just saying that Obama’s repeated reassurance is bogus, and the public should have a chance to judge the merits of “reform” based on valid assumptions, not based on false assurances from the president.

OK I guess I should really bother. If you assume that expansion of coverage cannot be offset through cost reduction over the long-term then nothing really will convince you.

Your exasperation is misplaced (and IMHO ironic). I want to pursue the most valid assumptions possible and take a rational and objective approach. If you do, too, then perhaps one or both of us can learn something important from sharing information, analysis, opinion, etc.


Good points all

Although I would also add that Obama’s also been playing games with the cost of his plan by phasing it in over five years so that the we don’t get to see what the annual cost is until year six of the ten-year projection. It’s a common enough tactic (Bush 43 did something similar with Medicare Part D) so that people don’t suffer from “sticker shock” at seeing how much the “public option” is really going to cost when it goes into effect.

If Obama really can squeeze out $600 billion of “waste” from the current public system, let him have at it. What they seem to have proposed is largely another round of reimbursement rate cuts to providers which if past history is any indication means fewer providers willing to take on new Medicare patients which is unfortunately timed to happen about when the baby boom generation starts to go on Medicare.

Oh and I think it should go without saying that the “47 million uninsured” grossly overstates that actual number of Americans without health insurance coverage. For one thing the survey is of people who have at any time been without health insurance coverage (including sort term lapses of coverage such as job changes) which is not the same as 47 million people being without health insurance at any given moment. For another it includes about 9-10 million people who are already essentially covered by Medicaid and/or SCHIPS but don’t enroll until they need to go to the doctor. Another 9-10 million are non-citizens which may require a different type of reform than what’s being proposed. That leaves us with a lot of young (and relatively health people), a lot of people making more than $50,000 a year, and some people who are sick and can’t afford health insurance. I think any plan that wants to talk about “universal coverage” ought to start by breaking down “who are the uninsured” and talking about these specific situations. IMO we’d probably make a huge dent in the problem just by letting small businesses (which employ about 60% of people who don’t have health insurance) form association health plans like Bush tried to do and encouraging people (especially the young) to get high-deductible policies that cover catastrophic illnesses and have lower monthly premiums.


As follow-up to my comment,

As follow-up to my comment, and to the last paragraph in particular, Krauthammer (granted, a partisan, but one who happens to get it right on this one) puts it well today:

With answers so slippery and implausible and, well, fishy, he began jeopardizing the most fundamental asset of any new president -- trust. You can't say that the system is totally broken and in need of radical reconstruction, but nothing will change for you; that Medicare is bankrupting the country, but $500 billion in cuts will have no effect on care; that you will expand coverage while reducing deficits -- and not inspire incredulity and mistrust. When ordinary citizens understand they are being played for fools, they bristle. http://www.washingtonpost.com/wp-dyn/content/article/2009/09/03/AR200909...


I think this is a good

I think this is a good pragmatic approach but the individual mandate, which is required for a functioning market, will be very difficult to get past current Republican thinking.

If it were possible to bring in the mandate it would be relatively low-cost to move to universal coverage. The legislation should ensure that every American (meaning 100%, not 99.99%) would be covered under one of the following options:

- Employer-based coverage
- Individual mandate
- Subsidized individual mandate
- Medicaid/Medicare

The cost to the government would mainly depend on the level of subsidies for the working poor.

Those under the individual mandate who do not buy coverage would be placed in a plan at random (or a buy-in Medicaid), and would be charged for the service through the tax system.


Real Insurance Reform

The reforms that have been discussed have largely focused on building on the existing system as opposed to transitioning away towards a more rational system. Employer based healthcare is something we should be moving away from. Additionally, we should be moving toward a system based on real insurance, i.e. catastrophic insurance, as opposed to all of this first dollar stuff.


And spare me the whining

And spare me the whining about how the Republicans don't have a better plan. They don't have the White House. They don't have the Senate. They don't have the House. They don't have to have a better argument than the claim that the Democrats' plan isn't better than the status quo. It's not as if the Democrats shot down Social Security in 2005 and have now done something better.

Brilliant! I've been saying the same thing for weeks. Where is the Democratic remorse for killing social security reform?


Um...those 4 points pretty

Um...those 4 points pretty much *are* the core of HR 3200. The only difference is the use of subsidies instead of "Medicaid for a fee". That has a very good reason; lower-middle-income families coulldn't afford insurance without it.


Being "coherent" enough to trump "hokum."

Being "coherent" enough to overcome "hokum" ought to be the minimum standard for legislation on this scale...

You need some discipline yourself [via]... white papers, Congressional hearings, and, critically, a forum in which the ideas in the bills that are moving through Congress are shown to be better ideas than the alternatives. We haven't seen that at all.

Well said.

CBS poll: "two-thirds of Americans remain confused about the health reform proposals on the table ... many Americans cannot volunteer anything they especially like or dislike about the proposals. Asked if there's anything they like, 40 percent cannot name anything..."

Reality is the health bill has not been blocked by far-right loons and Repubs, who don't have the votes to block anything.

Reality is the bill is stalled because *independents*, the reasonable middle-of-the-roaders, have turned solidly against it -- all polls agree. The claim that "far-right loons are blocking reform" is just a story the frustrated left is telling itself to avoid facing who's responsible for this mess.

Why has the middle turned? I'm part of it, a life-long independent, and Obama easily could have had my support (especially as I am self-employed in NYC and paying the highest health insurance rates anywhere) *if* he'd done anything like what he'd promised to do.

Remember what that was? Bipartisan, even "post-partisan" consultation ... and transparency (legislation posted on the Internet, etc.) ... in designing a sensible reform.

~~ NY Times~~
At a January, 2008 Democratic primary debate, he vowed that health care reform would be achieved "not by negotiating behind closed doors" but rather by "broadcasting those negotiations on C-SPAN."

In a 2008 interview with The San Francisco Chronicle, he elaborated that his C-SPAN commitment would ensure that "the public will be part of the conversation ... so if a member of Congress is carrying water for the drug companies" by opposing price negotiations, they will be "shamed" into abandoning those industry-beholden positions... [...cough...].
~~~
So how's that all worked out?

1) Bipartisan, post-partisan? Obama just handed off writing "his" entire reform to Dem committee chairs who are left of the Dems in congress they lead, who themselves are left of average Dem voters, who are left of the middle. How post-partisan!

2) Transparent? Who knows what's in the dang 1,100+ page thing? Who can know? Where are the provisions explained? (Harry Reid actually quipped that it doesn't really matter since you need a PhD to understand so much of it that most of the Dems in Congress don't understand it either. Ha! Ha!)

Even now (well, as of a few days ago, has it changed?) there is no published copy anyone can refer to.

But people are supposed to rush to support ... not just they don't know what, they can't know what?

3) Sensible??!! Who sensibly rushes to restructure one-sixth of the entire US economy by August?? Without knowing what's in the bill doing it? When it was written by the most partisan collective of politicians on one side of aisle?

Hey, Congress is $70 billion into General Motors. Could a bunch of Congressional committees have redesigned GM's product line by August? (That's not much compared to 1/6th of the economy.) Small businesses spend more time on their business plans than that. A lot of people spend more time on their tax returns than that.

Partisan, opaque & madly rushed -- many people in the middle have been getting the feeling: "political power grab". And they are right.

Hmmm... "We have to get this 1,000+ page bill -- restructuring 1/6th of the entire economy the way we and our own particular supporters want -- approved by August, before anyone has time to examine it, or the people will then have time to read it and not like what's in it, and then we'll lose 'momentum'". If that's not a working example of "partisan political power grab" then what is?

One doesn't have to be a loon or a partisan ideologue to vote against that.

One has to check one's common sense at the door and be ideological to vote for it.

So say the independents.

It is the loss of the middle-of-the-road, reasonable independents that's threatening the seats of the Blue Dogs and of House Democrats from moderate districts, so that as Charlie Cook put it:

"the situation this summer has slipped completely out of control for President Obama and Congressional Democrats ... a consensus is forming that the chances of Democratic losses going higher than 20 seats is just as good as the chances of Democratic losses going lower.."

And that's what's stopped the progress of this bill through a Congress that is 60% Democratic both Senate and House.

Not "phoney talk about about death panels" (or even Stan's "death squads") from the far right -- no matter how much the left wants to believe it.




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