Covering 30 Million Americans

That's what the bill being debated in the Senate would do. It wouldn't have a public option, and it apparently wouldn't enable those age 55 and older to buy-in to the Medicare program.

To provide some context, though, it's worth noting what wasn't on the table coming into the Senate debate: A robust public option, the type of program that would have a significant impact on the overall healthcare market. The leadership in the House of Representatives tried to pass a robust public option, one tied to the rates set by Medicare, but it just couldn't find the votes.

Unable to get a robust public option through the House, the Senate looked to other opportunities, including Medicare buy-in and a non-robust public option. The latter, as scored by the CBO, would enroll only 3 or 4 million people -- not too dissimilar from the 6 million number the CBO projected would enroll in a similar non-robust public option in the House. As designed by either the House or the Senate, such non-robust public options would have higher premiums than private plans available under the exchange.

So the question stands, is it better to kill a bill that would provide 30 million Americans with health insurance (in addition to the 4.1 million American children already extended coverage under the expanded SCHIP legislation passed through the Congress and signed into law by President Obama earlier this year) for lack of a non-robust public option, the premiums of which are projected to be higher than in private plans, or to back a bill without either a non-robust public option or a Medicare buy-in provision? Frankly, I'm not sure I ultimately come down the same as Howard Dean on this one, though I'm still hoping to learn more.

Tags: 111th Congress, healthcare reform (all tags)

Comments

125 Comments

Re: Covering 30 Million Americans

I agree with you that the bill is worth passing.  To be fair, however, the weak public option would have higher premiums only because the CBO projected that those that enrolled in it would, on average, be less healthy than the pool at-large.  Which is to say, a bill with a weak public option would still clearly have been better than what is now on the table.  

by HSTruman 2009-12-15 12:14PM | 0 recs
Re: Covering 30 Million Americans

I disagree...passing a terrible bill that will hurt plenty by mandating coverage with no way to actually cut costs is a mess..

by BuckeyeBlogger 2009-12-15 12:24PM | 0 recs
Re: Covering 30 Million Americans

I have always supported a public option, but the watered-down version(s) the Senate has considered were never going to be a huge cost-saver.  The excise tax in the Senate bill, in contrast, is projected to cut costs by a much larger margin; which is why the CBO projects that the Senate bill would reduce the deficit by more than 600 million over the second decade after the bill is passed.  The Senate bill is not, by any stretch, perfect.  But it clearly does start to address cost issues.  

The mandate complaint strikes me as a non-issue.  We should push for better subsidies, so that more people can actually afford coverage, but I fail to see how the tiny penalties the Senate bill imposes are such a big deal.  

by HSTruman 2009-12-15 12:35PM | 0 recs
Re: Covering 30 Million Americans

and what is to stop the insurance monopolies from just increasing premiums by the amount of the subsidies? especially when people are forced by law to buy it?

this is just a giant giveaway designed to line the pockets of insurance execs even more.

by jeopardy 2009-12-15 12:38PM | 0 recs
Re: Covering 30 Million Americans

That's a point you should take up with holy Joe Lieberman.

If you manage to convince him, excellent. If not we're stuck at the same place.

by vecky 2009-12-15 12:56PM | 0 recs
Re: Covering 30 Million Americans

we don't have to support something bad despite the fact that the White House runs to immoral Joe every time he throws a hissy-fit

by jeopardy 2009-12-15 01:01PM | 0 recs
Re: Covering 30 Million Americans

The penalty is up to $2250 for a family. The fines would be collected by the IRS through tax returns.....firstly, I have a real problem with the IRS collecting more taxes and going after people given their abyssmal and abusive history. Secondly.....Where is the income limit? I havent seen it. Does it assume that a family of four making even $70,000 can afford it? If you live in certain parts of the country and pay prop taxes in the double digits on top of income taxes and high cost of living,  even $2250 could be a a burden. The fact is you cant impose mandates unless you can guarantee affordable access.....

by BuckeyeBlogger 2009-12-15 12:42PM | 0 recs
Re: Covering 30 Million Americans

The penalty is phased in and is much, much smaller than that for the next several years.  If I'm not mistaken, the number you are citing is for an entire family approximately ten years from now, right?  

As far as a burden goes, call me crazy but I tend to think that people want to purchase insurance and that, for many income levels, the subsidies being considered will be sufficient to allow them to do so.  If they aren't, then we will need to revisit all of these issues.  Which, incidentally, is usually how this stuff goes.  Social Security, as originally passed, was not the robust program we have today.  But it created a structure that was then improved upon.

by HSTruman 2009-12-15 12:49PM | 0 recs
Re: Covering 30 Million Americans

The mandates only kick in if insurance is judged to be affordable based on your income.

So if you have an income of $70K a year and there is a plan out there that costs $400 a month (4,800 a year) but you refuse to buy it and go without insurance, your tax deductions are reduced by $750.

Most people would say that someone earning 70K a year can easily afford 4800 for something as vital as health insurance. Most sane people that is...

by vecky 2009-12-15 12:52PM | 0 recs
Re: Covering 30 Million Americans

Conversely if you earn 50K a year and the only plan available to you is in the range of 15k, then your not mandated to buy it.

by vecky 2009-12-15 12:54PM | 0 recs
Re: Covering 30 Million Americans

in which case it is not covering people.

do you understand that?

by jeopardy 2009-12-15 01:05PM | 0 recs
Re: Covering 30 Million Americans

Clearly it's covering some people.

by vecky 2009-12-15 01:08PM | 0 recs
and if no one can afford insurance

how are insurance companies going to make money?

The exemptoins were put in place in Massachusetts to prevent overcharging and it's worked, to an extent.

healthcare is naturally expensive, there's no way around that, that's why even a bill with a strong public option costs a trillion dollars. We never really focused on the cause of that...doctor's salaries and administrative costs to run hospitals.

by ND22 2009-12-15 01:15PM | 0 recs
Re: and if no one can afford insurance

ok, i think i figured out where you are lost.

if somebody can afford, say, 4k/year, and you give them 4k/year subsidies, the insurance companies will now be able to charge them 8k year (4k subsidies, 4k what they can "afford")

by jeopardy 2009-12-15 01:18PM | 0 recs
Yeah they can't do that

because then they'd be exempt, even if they get subsidies

by ND22 2009-12-15 01:23PM | 0 recs
Re: Yeah they can't do that

explain please.

are you saying that the subsidies will necessarily cover 100% of the costs? Is this for 100% coverage?

by jeopardy 2009-12-15 01:28PM | 0 recs
Ok

If a person's afforability level is 4k a year, they are exempt if they cannot find a policy that is 4k a year, therefore if an insurance companies charges 8k a year, the customer can drop them to find some other one on the exchange...any other company would be jumping on the chance at getting another customer at 4k a year.

by ND22 2009-12-15 01:34PM | 0 recs
Jumping on the chance

would presume healthy competition.  I wouldn't go that far without some basis.

by orestes 2009-12-15 01:37PM | 0 recs
Re: Jumping on the chance

The situation however is a better than the status quo. At least here the working poor have some sort of choice.

by vecky 2009-12-15 01:46PM | 0 recs
Re: Jumping on the chance

Choice?  Ha- expensive health insurance with no assurance that it will lead to actual health care.  Go and ask the working class how they feel about this plan.  Tell them they'll pay a few thousand dollars a year for health insurance with added deductibles if they actually use it, with the potential for being denied care and having to fight with the insurer and let me know how they respond.

by orestes 2009-12-15 02:03PM | 0 recs
Re: Jumping on the chance

How is the working class doing in MA?

Most are happy to have some health insurance rather than none, and the subsidies do help.

by vecky 2009-12-15 03:32PM | 0 recs
the exchange forces some competition

while I agree the anti-trust exemption repeal is needed (and this can always be revisited before the exchanges are up), the exchange will force some competition, or it wouldn't really be an exchange.

by ND22 2009-12-15 05:16PM | 0 recs
Re: Ok

umm, in most states they are operating as monopolies.

by jeopardy 2009-12-15 01:40PM | 0 recs
Re: Yeah they can't do that

The subsidy the affordability exemption aren't linked.

The affordability exemption i believe applies to the total health care costs, i.e: premiums + deductibles. How much of that is covered by a subsidy is beside the point.

by vecky 2009-12-15 01:48PM | 0 recs
Re: Yeah they can't do that

are you talking about the exemption from having to buy it?

if so, that doesn't address the point that insurance companies can just raise prices on anybody, including those with subsidies

by jeopardy 2009-12-15 01:57PM | 0 recs
Re: Yeah they can't do that

That was true even with the medicare buy-in and the PO (the PO only applied to the individual non-insured market).

by vecky 2009-12-15 03:35PM | 0 recs
Re: Yeah they can't do that

yes, the PO was week. it would only serve as competition for a (growing) part of the country. I was hoping it could be strengthened before it was signed into law.

And I was against the medicare buy-in because it lacked any sort of premium containment.

But at least those had SOMETHING good in them.

The current bill doesn't. And don't give me this "it covers more people" or "preexisting conditions stuff". The insurance companies can just price people out of it.

This bill is a complete and total sham that does nothing but further enrich the very people who are causing so much misery in this country already.

by jeopardy 2009-12-15 03:59PM | 0 recs
Re: Yeah they can't do that

Your looking at it the wrong way.

This bill provides subsidies to poor working class people to purchase health care. That's huge.

Yes, this money is going to go to private insurance companies, but most of the money was going to go to them anyway. The PO was never expected to have more than a small share of the market.

by vecky 2009-12-15 04:10PM | 0 recs
Re: Yeah they can't do that

vecy, we've been over this over and over and over, and so have other people.

Insurance companies are just going to raise prices.

I don't know any other way to say it to you. They are not going to just keep the prices the same for people who all of a sudden have more money to spend on health insurance.

by jeopardy 2009-12-15 04:20PM | 0 recs
Re: Yeah they can't do that

They are going to raise prices anyway.

Without the bill = raise prices.

With the bill = raise prices, but atleast a few million people now have insurance.

None of you have told me how we can get a getter deal...

by vecky 2009-12-15 04:36PM | 0 recs
Re: Yeah they can't do that

there is no evidence whatsoever that more people will even have insurance.

they can just price out the people they don't want as before, and they can just raise prices by the subsidy amount

i guess you have a lot more faith in the insurance companies to do the right thing than i do

by jeopardy 2009-12-15 05:51PM | 0 recs
Re: Yeah they can't do that

" there is no evidence whatsoever that more people will even have insurance. "

WTF, now your just making stuff up.

The CBO says more people will have insurance. Do you have better figures?

by vecky 2009-12-15 06:17PM | 0 recs
Re: Yeah they can't do that

the CBO hasn't scored this new compromise.

That's for one with the weak PO.

SO how about YOU stop making stuff up.

by jeopardy 2009-12-16 06:10AM | 0 recs
Re: Yeah they can't do that

True enough, but the CBO score was based on the subsidy not the the presence of the PO (the SFC bill had similar numbers with no PO).

I'll wait for the CBO score, but other than not being as cost friendly I doubt it will effect the numbers very much.

by vecky 2009-12-16 07:34AM | 0 recs
Re: Covering 30 Million Americans

who is it going to hurt? There are some cost controls in the bill, however conservatives stripped out the main ones - the PO tied to medicare. it's still better than the status quo.

by vecky 2009-12-15 12:35PM | 0 recs
Isn't this the bill you wanted?

You seemed to have made the case against the public option before.

by ND22 2009-12-15 12:36PM | 0 recs
Re: Isn't this the bill you wanted?

I can agree to a public option as long as there are proven cost controls in the plan. without cost control measures, no plan will work....it will only lead to increased costs....

by BuckeyeBlogger 2009-12-15 12:43PM | 0 recs
So why were you arguing against it

a few weeks ago when there was a public option that controls costs...more so, why are you not in favor of a single payer plan which is not only control costs, but will eliminate them for most?

by ND22 2009-12-15 12:51PM | 0 recs
I have a hard time taking you seriously

you were here two weeks ago shilling that eating fruit would solve the healthcare crisis and here you are complaining about there not being a public option now. It doesn't make any sense.

by ND22 2009-12-15 12:53PM | 0 recs
Re: I have a hard time taking you seriously

He's a conservative. He's going to oppose the bill no matter what. Logic, arguments and evidence aren't important.

You can be sure if the PO was in the bill he would be screaming socialism and death panels.

by vecky 2009-12-15 12:58PM | 0 recs
which he was doing

like a month ago!

by ND22 2009-12-15 01:04PM | 0 recs
Re: I have a hard time taking you seriously

Your comment that I said eating fruit would avert a healthcare crisis is oversimplified to say the least. I have always said I am for any option that retains choice, and controls costs and doesnt make the US Government the sole decision maker in healthcare. What will work in this country is a public option while maintaining private options as well. A plan that focuses on preventive care, healthcare education and an emphasis on personal responsibility. A plan that includes greater user and implementation of Healthcare IT and tort reform. Not one of the plans offered up offered any mix of those.....there was never a public plan on the table that clearly showed cost controls....it was all smoke and mirror....

by BuckeyeBlogger 2009-12-15 01:49PM | 0 recs
Re: I have a hard time taking you seriously

The CBO, which is awfully conservative in it's estimates, found the original senate bill (which you were against) did control costs. And not just insurance costs, but actual health care costs.

by vecky 2009-12-15 03:38PM | 0 recs
No, sorry, you haven't

I have always said I am for any option that retains choice, and controls costs and doesnt make the US Government the sole decision maker in healthcare.

and yet you opposed the very bill that did all that, why?

by ND22 2009-12-15 04:41PM | 0 recs
(Comment Deleted)

This comment has been deleted by an administrator.

by judybrowni 2009-12-15 12:27PM | 0 recs
Re: Covering 30 Million Americans

any bill that forces people to buy insurance from anti-trust exempt monopolies without doing anything to ensure that those monopolies don't just turn around and charge more is an affront to progressive values.
by jeopardy 2009-12-15 12:36PM | 0 recs
Re: Covering 30 Million Americans

That's true. But this is not a progressive bill. it's  moderate compromise bill - there not being 60 votes in the senate for a progressive bill.

by vecky 2009-12-15 01:00PM | 0 recs
Re: Covering 30 Million Americans

yes, and it immoral

by jeopardy 2009-12-15 01:08PM | 0 recs
Re: Covering 30 Million Americans

And the current system is not?

So your solution is to wait till there are 60 progressive votes in the senate?

by vecky 2009-12-15 03:39PM | 0 recs
Re: Covering 30 Million Americans

are you kidding?

if anything, YOU are the one arguing that only small changes without real reform is ok, not me.

The system as it stands is utterly broken and this bill doesn't change that much if at all.

by jeopardy 2009-12-15 04:22PM | 0 recs
Re: Covering 30 Million Americans

I'm saying it's a first step. I'm saying it's a step worth taking rather than starting form scratch which is essential where we've been since 1968.

There simply aren't 60 votes for the PO. Even in the House is barely passed with 50.5% of the vote.

by vecky 2009-12-15 04:38PM | 0 recs
Re: Covering 30 Million Americans

no, it is not a good first step.

it's a giant giveaway to the evil bastards that run the insurance companies and there's nothing in the bill to suggest that it will save the common person a single dime since insurance companies can just raise rates by the subsidy amount if they want

by jeopardy 2009-12-15 05:52PM | 0 recs
Re: Covering 30 Million Americans

If it helps a family of 4 afford HC without having to resort to bankruptcy and going on welfare is it really so bad?

I mean even with the PO a majority of the money would still go to evil bastards that run the insurance companies. And most of the PO money would go to the evil bastards that run the hospital administrations.

Btw, you do know the subsidy amount is a percentage of the total costs, not a fixed amount right?

by vecky 2009-12-15 06:20PM | 0 recs
Re: Covering 30 Million Americans

I don't know how many times I have to repeat myself to you - IT DOESN'T DO THAT.

If there are no real price controls, it doesn't help anybody except the insurance executives thazt bought the blue dogs

by jeopardy 2009-12-16 06:11AM | 0 recs
Re: Covering 30 Million Americans

Doesn't do what? Dosn't provides subsidies to the working poor and lower middle class to purchase Health Insurance? In effect the largest middle-class tax break these guys will ever see, I believe one of the largest in US history?

I get it there aren't any price controls - but there aren't any price controls existing currently. We can continue to work on getting price controls into legislation without sinking this.

by vecky 2009-12-16 07:37AM | 0 recs
Re: Covering 30 Million Americans

I agree with you that the bill could and should have more price controls, including a strong public option tied directly to Medicare rates, but it's just factually wrong for you to repeatedly claim the bill has "no" cost controls.  T

he single biggest cost control is the excise tax, which the CBO scoring assumes (and a broad range of economists agree) will reduce total health care expenditures and result in a corresponding increase in real wages.  The mandate, which no one around here seems to like, is also scored as a cost saver because it brings more healthy people into the pool.  Measures like these are why the CBO scoring indicates the bill will save more than 100 million over the first decade after it's passed and nearly 700 million during the second decade after its passed, even while assuming that all of the assorted delivery reform and preventative care mechanisms the bill includes will fail.  

You may not like those policies, which is fair enough, but they clearly do start the process of controlling costs.  

by HSTruman 2009-12-16 09:07AM | 0 recs
Re: Covering 30 Million Americans

This bill, as I understand it, will NOT "cover 30 million more Americans."

This bill will force 30 Million or so Americans to BUY private insurance which they can not afford, even with the inadequate subsidies provided, while doing not much, if anything, to hold down costs for them or the rest of the public.  I assume many of these so-called 30 million will, in the end, refuse to buy something they can not afford, so the 30 million figure becomes an illusion.

How would like to be forced to buy a product from a private, for profit company that you really can't afford or be faced with a penalty? Not much?  Neither would I, nor millions of voters.

What would you think about politicians or a party that forced you to buy a product from a private, for profit company that you really can't afford?
Would you vote for them again?  No? Neither would I.

by mjshep 2009-12-15 12:47PM | 0 recs
Re: Covering 30 Million Americans

The plan in Mass, whose structure is similar, is very popular despite the fact that it does far less to control costs than the bills currently being debated.  That suggests to me that your political fears are overstated.  As to the 30 Million people number, that's based upon the CBO's estimates, which tend to be ridiculously conservative.  That may well be wrong about the number of folks that ultimately purchase insurance, but there's no factual reason to think that's the case.  

by HSTruman 2009-12-15 12:51PM | 0 recs
Re: Covering 30 Million Americans

I agree the 30 mill figure is conservative. As in the MA plan more people signed up for it then expected, particularly poorer people even though they were exempt from the mandate.

The bill also includes significant savings to medicare that were not possible in the MA legislation.

by vecky 2009-12-15 01:02PM | 0 recs
Re: Covering 30 Million Americans

well said.

by BuckeyeBlogger 2009-12-15 01:49PM | 0 recs
Re: Covering 30 Million Americans
This healthcare reform is a MESS!!!
More reasons to look for another candidate to replace Obama in 2012.
  1. This whole thing is screwed up due to his inept leadership (or lack of any leadership).
  2. A good chance that the Republicraps will take over Congress in 2010 or 2012. A very good chance that he will be easily beaten by a strong GOP candidate.
  3. I am suspicious of why it was that Rahm Emanuell and Obama went down this road and took on the insurance lobby EXACTLY the way that Hillary did in 1994. Why would anyone go down the same path to failure unless they were going to get rich....
I will be direct--Obama and Emanuell  knew that the insurance lobby would fork out easily over $1 Billion to defeat any reform--maybe Rahm wanted to share in that pie--a good bet that when he and Obama are beaten in 2012, that he won't worry--his Tel Aviv bank account will be full of lobbyist money over this -- of course, the uninsured here will not have any coverage either....or he will wind up as a spokesperson for the insurance companies just like his Congressional Buddy Billy Tazin did a few years ago.   The sad thing is that this is the last chance for uninsured to get coverage.  In a few years, over 100 million people will not be covered.
by hddun2008 2009-12-15 12:53PM | 0 recs
Re: Covering 30 Million Americans

Is it worth it?

ABSOLUTELY NOT!!!

If we fold on this, we fold on every other progressive cause, because they'll assume (just like they're assuming now) that ultimately we'll 'come home to roost' come election time.

But not this time.  I WILL NOT VOTE for a Democrat, not now, not in 2010, not in 2012 if they pass this watered-down pile.  

I will sit on my hands, rather than elect someone who will not represent us when it matters.  It doesn't really matter if a GOP nut gets in - they'll do just as much for us as the idiots under Obama.

by MtnFrost 2009-12-15 12:58PM | 0 recs
and that gets you progressive how?

by ND22 2009-12-15 01:04PM | 0 recs
Re: and that gets you progressive how?

When the Republicans became the opposition party.

by vecky 2009-12-15 01:49PM | 0 recs
Re: and that gets you progressive how?

We never were a democracy, we are a republic. The founders never intended nor did they design this nation as a democracy. When we become a democracy we will have failed their original intent.

by BuckeyeBlogger 2009-12-15 01:55PM | 0 recs
Re: and that gets you progressive how?

Ummm, we are a Democratic Republic. Democratic refers to the 50+1/majority rule thingy, and Republics means the head of state is not a monarch (no divine right).

WTF is wrong with you conservatives?

by vecky 2009-12-15 03:42PM | 0 recs
Re: and that gets you progressive how?

Here is a little lesson...In the strictest sense of the word, the system of government established by the Constitution was never intended to be a "democracy." This is evident not only in the wording of the Pledge of Allegiance but in the Constitution itself which declares that "The United States shall guarantee to every State in this Union a Republican Form of Government" (Article IV, Section 4). Moreover, the scheme of representation and the various mechanisms for selecting representatives established by the Constitution were clearly intended to produce a republic, not a democracy.

To the extent that the United States of America has moved away from its republican roots and become more "democratic," it has strayed from the intentions of the Constitution's authors. Whether or not the trend toward more direct democracy would be smiled upon by the Framers depends on the answer to another question. Are the American people today sufficiently better informed and otherwise equipped to be wise and prudent democratic citizens than were American citizens in the late 1700s? By all accounts, the answer to this second question is an emphatic "no."

by BuckeyeBlogger 2009-12-15 04:06PM | 0 recs
Re: and that gets you progressive how?

"Are the American people today sufficiently better informed and otherwise equipped to be wise and prudent democratic citizens than were American citizens in the late 1700s? By all accounts, the answer to this second question is an emphatic "no." "

See... this is why I say WTF is wrong with you Conservatives... you just went out and condoned slavery, racial discrimination, and advocated against universal-suffrage.

If you want to back and live when women couldn't vote and a black man was counted as equivalent of 3/4th please go ahead and feel free to do so (I suggest Saudi Arabia). Don't take the rest of us and our Constitution and Democratic Republic with you.

by vecky 2009-12-15 04:15PM | 0 recs
Re: and that gets you progressive how?

Why do you always rip off random webpages and act like it's your own thoughts?  Here's a hint: when you have more than 5 words in a row with no misspellings, people can tell it's not really you writing.

by Steve M 2009-12-15 04:16PM | 0 recs
Re: and that gets you progressive how?

Perhaps some more on the question. My response was simply to state that most people believe we are a democracy...we are not..

Mackinac Center for Public Policy

Posted: April 18, 2001
Democracy or Republic?

By Lawrence W. Reed

The following is a response by Mackinac Center for Public Policy President Lawrence Reed to a high-school debate student's questions about the Electoral College and the nature of American government.  Students regularly use the Mackinac Center's Ask the Debate Coach web feature for help developing powerful cases based on sound principles of economics and political science.

If we are a democracy, why does a person from Wyoming's vote count almost three times more than someone from California? If small states like Wyoming think they wouldn't have any weight in a popular vote election, why was the popular vote split by a number very close to that of Wyoming's population?

I've written several articles on the Electoral College, and I am happy to answer your questions one at a time. Your first question: If we are a democracy, why does a person from Wyoming's vote count almost three times more than the vote of someone from California?

Answer: The premise is incorrect. We are not a democracy. We are a republic--which is a representative form of government that captures the best elements of democracy while jettisoning its worst. Too many people throw around that term "democracy" without understanding what it means. If they understood it, they would realize that they're probably not advocates of its purest form, which would mean that we decide every matter by majority vote. Perhaps ancient Athens for a brief time came closest to this, but no society of any size and complexity can practice this form of governance for very long. It's unwieldy and unworkable, endlessly contentious, and disrespectful of certain inalienable rights of individuals who may find themselves in the minority.

People like the sound of "democracy" because it implies that all of us have equal say in our government and that a simple majority is somehow inherently fair in deciding all or virtually all issues. Upon closer examination, it should become very apparent that subjecting every decision of governance to a vote of the people is utterly impossible. Many decisions have to be made quickly; many decisions require knowledge of the issue that few people possess or have the time to become expert on; and many decisions don't belong in the hands of any government at all.

An example of the last point: Suppose someone says, "I just don't like people with red hair. I think we should confiscate their property. Let's have a vote on that." A democratic purist would have to reply, "All in favor say aye." A person interested in securing and protecting individual rights would have to say, "That's not a proper function of government, and even if 99 percent of the citizens vote for that, it's still wrong and illegitimate. There's nothing about mob rule that makes such a decision legitimate. There is never, anywhere or any time, any justification for any government to take someone's property just because he has red hair, and no pile of votes or dimpled chads can change that. Is that anti-democratic? Yes, it is. Some things, like individual rights, are infinitely more important than the notion that Jim and Sally Taxeater want to stick their grubby little fingers into Joe Taxpayer's pockets."

So if I were in a debate on this subject, I'd be tempted to say, "We're not a democracy any more than we're a divine right monarchy. Period. Next question?"

A republican form of government modifies pure democracy considerably. It provides a mechanism whereby almost anyone can have some say in some matters of government. We can run for office. We can support candidates and causes of our choosing. We can speak out in public forums. And, indeed, a few matters are actually decided by majority vote. But a sound republic founded on principles that are more important than voting (like individual rights) will put strong limits on all this. In its Bill of Rights, our Constitution clearly states, "Congress shall make no law . . ." It doesn't say, "Congress can pass anything it wants so long as 50 percent plus 1 support it even if none of the voters know a thing about the issue." How brainless and destructive that would be! If some debater wants to say "We're a democracy" then you could fire back, "Then explain why there's a laundry list of things our Constitution says not even Congress can make a law about."

Bottom line: We are not Ali Baba and the 40 Thieves. We are not a pack of wolves and a handful of sheep voting on what to have for lunch. We're a republic with certain limitations on what the mob can do to others who are not members of the same mob.

The Electoral College, for all the reasons expressed in my previous article that you can certainly feel free to use, was one way the Founders reined in the democratic mob rule impulse. It's the rules of the game. The reasons the Founders created it are sound ones: to protect states' rights and our system of federalism, so crucial to keeping the national government in check; and to prevent a presidential campaign in which the candidates simply cater to a handful of vote-rich populous states and ignore everybody else, which would be tremendously divisive and destructive of national unity and any sense on the part of all the people that the election winner is indeed "legitimate."

Your second question: If small states like Wyoming think they wouldn't have any weight in a popular vote election, why was the popular vote split by a number very close to that of Wyoming's population?

The Founders did not so micromanage the Electoral College process as to deny a state the right to make its own selection of a presidential winner more "democratic" if they choose to. If a state wants to adopt a process whereby electoral votes are parceled out according to the winner by congressional district, instead of a statewide winner-take-all approach, then it can do so. A few states have indeed adopted that approach and it has much merit to it. I personally would favor that modification in winner-take-all states, including my own of Michigan, but not by national decree. It should be left, as the Constitution provides, for each state to decide. Rather than open up the presidential selection process to the potentially disastrous and confusing direct popular vote everywhere (with all the attendant problems I wrote about in my article), advocates of abolishing the Electoral College would be better advised to focus their energies on this slight modification. Doing away with the College altogether and substituting a national popular vote determination is extreme, unwise, and unnecessary.

Good luck in your debate!

Lawrence W. Reed
President
Mackinac Center for Public Policy

by BuckeyeBlogger 2009-12-15 04:11PM | 0 recs
Re: and that gets you progressive how?

I happen to have read Plato so I know more about "pure democracy" than you probably think.

I merely said we are a Democratic Republic. This may shock you, but Republics are not necessarily democratic - take the USSR for instance.

When people say we are a democracy, they mean we are a democratic republic. Most people know we don't have a "pure democracy" where all citizens meet in a forum and scream at each other all day. To think otherwise is an insult to their (and your) intelligence.

by vecky 2009-12-15 04:30PM | 0 recs
Actually, in this case, Buckeye is right

the United States is not a true democracy, it isn't because you can't have a federal republic like ours and be a true democracy.

The Senate is designed to make the STATES equal, not the people. Each state is not equal, therefore in the Senate people in Wyoming and North Dakota are worth more than those in Texas or California...this is undemocratic. What makes it even more undemocratic is that it was originally not a directly elected body.

by ND22 2009-12-15 06:04PM | 0 recs
Re: Actually, in this case, Buckeye is right

No one ever said the US was a "true/pure" democracy.

Hell the United Kingdom is a democracy even though it has a partially unelected upper house and a whole unelected Head of State. (They at least don't have any of this 60 vote nonsense).

by vecky 2009-12-15 06:24PM | 0 recs
Re: Actually, in this case, Buckeye is right

The unelected upper house has little power and the unelected head of state has NO power.

Our Senate has ALL the power.

by ND22 2009-12-15 06:39PM | 0 recs
Re: Actually, in this case, Buckeye is right

Only because of the 60 vote thingy.

by vecky 2009-12-15 07:33PM | 0 recs
about 1787

when the founding fathers established a powerful upper house of Congress which at the time wasn't even directly elected.

by ND22 2009-12-15 05:18PM | 0 recs
Re: Covering 30 Million Americans

Yes, because Democrats loss in 1994, 2000 and 2002 and 2004 pushed them more to the left...

Everyone knows that when Gore lost to Bush because of Nader the Democrats ran more to the left than right... ya right...

by vecky 2009-12-15 01:04PM | 0 recs
Re: Covering 30 Million Americans

You're right. When Democrats lose an election, they run to the center; when the GOP loses, they double down on stupid. Over time that has pushed the course of our discourse to the right.

This is a center-right country. The debate is largely framed within  a center-right framework. Look at the single payer system debate. Broach that subject and you're accused of being some sort of doctrinaire Marxist even though both the VA and Medicare system are single-payers systems.  They work well. The VA is the best health care delivery system in the United States and yet we can't even have a debate about extending these programs because we get shouted down not just from the other party but from within our own party.

My feel is that a loss in this healthcare debate will push the Democratic party to the right even more.

by Charles Lemos 2009-12-15 01:41PM | 0 recs
Re: Covering 30 Million Americans

I wouldn't go that far. There are center-right countries that function well. Korea for instance. Singapore is another. But the right here has its own uniquely dangerous qualities.

by Charles Lemos 2009-12-15 02:13PM | 0 recs
Re: Covering 30 Million Americans

Japan recently elected a left-of-center candidate. Interesting to note he ran on a platform of opposing US bases in Okinawa, but after being elected he compromised with the Obama admin and US will troops remain on the island.

Undoubtedly Japanese leftists are feeling all betrayed and are sulking at home this very minute.

by vecky 2009-12-15 04:21PM | 0 recs
Re: Covering 30 Million Americans

More from Walt Williams

"Are We a Republic or a Democracy?
by Walter Williams  (January 5, 2005)

We often hear the claim that our nation is a democracy. That wasn't the vision of the founders. They saw democracy as another form of tyranny. If we've become a democracy, I guarantee you that the founders would be deeply disappointed by our betrayal of their vision. The founders intended, and laid out the ground rules, for our nation to be a republic.

The word democracy appears nowhere in the Declaration of Independence or the Constitution -- two most fundamental documents of our nation. Instead of a democracy, the Constitution's Article IV, Section 4, guarantees "to every State in this Union a Republican Form of Government."

Moreover, let's ask ourselves: Does our pledge of allegiance to the flag say to "the democracy for which it stands," or does it say to "the republic for which it stands"? Or do we sing "The Battle Hymn of the Democracy" or "The Battle Hymn of the Republic"?

So what's the difference between republican and democratic forms of government? John Adams captured the essence of the difference when he said, "You have rights antecedent to all earthly governments; rights that cannot be repealed or restrained by human laws; rights derived from the Great Legislator of the Universe." Nothing in our Constitution suggests that government is a grantor of rights. Instead, government is a protector of rights.

In recognition that it's Congress that poses the greatest threat to our liberties, the framers used negative phrases against Congress throughout the Constitution such as: shall not abridge, infringe, deny, disparage, and shall not be violated, nor be denied. In a republican form of government, there is rule of law. All citizens, including government officials, are accountable to the same laws. Government power is limited and decentralized through a system of checks and balances. Government intervenes in civil society to protect its citizens against force and fraud but does not intervene in the cases of peaceable, voluntary exchange.

Contrast the framers' vision of a republic with that of a democracy. In a democracy, the majority rules either directly or through its elected representatives. As in a monarchy, the law is whatever the government determines it to be. Laws do not represent reason. They represent power. The restraint is upon the individual instead of government. Unlike that envisioned under a republican form of government, rights are seen as privileges and permissions that are granted by government and can be rescinded by government.

How about a few quotations demonstrating the disdain our founders held for democracy? James Madison, Federalist Paper No. 10: In a pure democracy, "there is nothing to check the inducement to sacrifice the weaker party or the obnoxious individual." At the 1787 Constitutional Convention, Edmund Randolph said, " ... that in tracing these evils to their origin every man had found it in the turbulence and follies of democracy."

John Adams said, "Remember, democracy never lasts long. It soon wastes, exhausts, and murders itself. There was never a democracy yet that did not commit suicide." Chief Justice John Marshall observed, "Between a balanced republic and a democracy, the difference is like that between order and chaos." In a word or two, the founders knew that a democracy would lead to the same kind of tyranny the colonies suffered under King George III.

The framers gave us a Constitution that is replete with undemocratic mechanisms. One that has come in for recent criticism and calls for its elimination is the Electoral College. In their wisdom, the framers gave us the Electoral College so that in presidential elections large, heavily populated states couldn't democratically run roughshod over small, sparsely populated states.

Here's my question. Do Americans share the republican values laid out by our founders, and is it simply a matter of our being unschooled about the differences between a republic and a democracy? Or is it a matter of preference and we now want the kind of tyranny feared by the founders where Congress can do anything it can muster a majority vote to do? I fear it's the latter."

by BuckeyeBlogger 2009-12-15 04:08PM | 0 recs
Re: Covering 30 Million Americans

I understand people's frustration.  But I wonder whether you really think making sure progressives aren't taken for granted is worth functionally denying 30 million people health insurance.  

The fact that Joe Lieberman, Ben Nelson, and Olympia Snowe effectively get to decide what's possible riles me as much as anyone.  But blowing up this bill doesn't strike me as the best way to ensure that progressive policies are enacted in the future.  As Ezra Klein has noted, past failures to pass health care reform have resulted in more timid proposals in the future.  If we don't pass something now, with 60 votes in the Senate, I doubt we'll pass anything for at least another decade.  And the next proposal will likely only be worse.  

by HSTruman 2009-12-15 01:05PM | 0 recs
Re: Covering 30 Million Americans

I thought they were going to go to the GOP anyway if this bill passes.

by vecky 2009-12-15 03:43PM | 0 recs
if the 30 million Americans

get junk insurance with co-pays they can't afford when they get sick, and millions of other Americans find their employer-provided health insurance becomes less comprehensive because of the excise tax, this won't look like such a good deal.

by desmoinesdem 2009-12-15 01:05PM | 0 recs
Re: if the 30 million Americans

Compared to single-payer nothing looks like a good deal.

by vecky 2009-12-15 01:09PM | 0 recs
I mean compared to the status quo

I recognize that single-payer was never on the table. I would be willing to accept a bill that is an improvement on the status quo. I don't think this one is.

AHIP and PHRMA are salivating over this bill. That tells you most of what you need to know.

by desmoinesdem 2009-12-15 01:25PM | 0 recs
Re: if the 30 million Americans

I have always enjoyed your work, whether I agree with it or not.  But I don't understand why you are so convinced that (a) the insurance that will be offered is "junk" or (b) that the excise tax is going to be such a terrible thing.  On the latter issue, in particular, there seems to be broad consensus among economists that reductions in benefits will result in corresponding higher wages.  I admit that isn't necessarily the most intuitive proposition, but when Ezra Klein and Megan McCardle agree it's true, I tend to think it probably is.  

At all events, if you can spell out your reasoning, I would be interested to hear where you're coming from.  

by HSTruman 2009-12-15 01:09PM | 0 recs
with no competition

for the private insurers, who have monopolies in most markets, I do not have faith that the new regulations will be enforced. That means in all likelihood skyrocketing premiums, more out of pocket expenses and continuing denials of coverage for medically necessary procedures.

All reasonable means to improve the insurance companies' conduct have been removed from this bill (that includes repeal of the anti-trust exemption).

by desmoinesdem 2009-12-15 02:44PM | 0 recs
Re: if the 30 million Americans

 You do understand that none of the Health Reform proposals have ever meant 'free healthcare' for families of four with income of $54,000, right? You do realize that most people have health insurance and pay premiums and co-pays right now, and that reform for those people are much more about caps and denials of overage? Your arguments seem to imply that the PO meant free healthcare or dramatically reduced costs for premiums and co-pays for those currently covered or priced out of te market, which is not the case. and never was the case. That is the free pony dream plan that never eisted exept in the imaginations of people not paying close attention. Costs will rise. Hopefully slower, but maybe not. The key is making those not covered participate and to do away with the denials and caps. Universal coverage through universal participation.

by QTG 2009-12-15 01:18PM | 0 recs
impressive straw man there

I have never said reform has to mean free health care to be successful.

I have said that there needs to be some meaningful competition for insurers. Remember, in most markets one or two companies have a virtual monopoly. We are not giving consumers any new choices here, and I do not believe the insurance companies will improve their conduct.

by desmoinesdem 2009-12-15 02:45PM | 0 recs
Re: impressive straw man there

Well what to do. 58 Dems agree there needs to be more competition, even those who don't favor a gvt. run plan.

However 1 Dem - Nelson, doesn't care as long as he gets Stupak. And Lieberman doesn't care about competition, he thinks there is enough (his actual words). Then there are the republicans who don't care at all, even Snowne thinks the insurance companies should be given another chance.

So your stuck at 58... where are you going to go from there?

by vecky 2009-12-15 03:49PM | 0 recs
reconciliation

as I have written many times. The process has flaws and risks but would be better than passing this bill in its current form.

by desmoinesdem 2009-12-15 04:14PM | 0 recs
Re: reconciliation

50 votes for reconciliation? I have my doubts, but I hope it's true...

by vecky 2009-12-15 04:23PM | 0 recs
Re: reconciliation

Another problem with reconciliation is the 5 year sunset period. In other words the PO will have to be renewed in 5 years otherwise it will go away. Since the PO is only likely to come on board in 4 years I think the chances of it being renewed are about the same as us passing a PO then anyway.

by vecky 2009-12-15 04:40PM | 0 recs
Re: reconciliation

10 years, not 5.

by Steve M 2009-12-15 05:27PM | 0 recs
It depends

it can be either or, I'm not sure what the stipluations are, but it can be five or ten years.

by ND22 2009-12-15 06:05PM | 0 recs
Re: It depends

It depends on the budget rule that was passed earlier. That says 5. It used to be 10, but that was changed after the Bush tax cuts.

by vecky 2009-12-15 06:25PM | 0 recs
Re: Covering 30 Million Americans

Covering 30 million at the cost of reducing the coverage of everybody else  is not worth it and will be the consequence.

There is just no reason for the insurance industry to change its economic model. So what will happen is just what has been happening. Coverage will get worse, deductibles will increase and any subsidies will go right to the bottom line.

by Judeling 2009-12-15 01:11PM | 0 recs
Re: Covering 30 Million Americans

I guess we can argue that not having coverage at all is better than having coverage which is not as good as one would like.

by vecky 2009-12-15 01:13PM | 0 recs
Re: Covering 30 Million Americans

you know that that is not the argument people are making.

you are now arguing in bad faith

by jeopardy 2009-12-15 01:49PM | 0 recs
Re: Covering 30 Million Americans

Kill the bill.

Start Over.

Are those made in better faith?

by vecky 2009-12-15 04:24PM | 0 recs
Re: Covering 30 Million Americans

yes

by jeopardy 2009-12-15 05:53PM | 0 recs
Re: Covering 30 Million Americans

That's the exact same argument made by the GOP. Maybe I was wrong all along - all they wanted was a truly better bill.

by vecky 2009-12-15 06:26PM | 0 recs
Re: Covering 30 Million Americans

If this bill could guarantee that 30 million Americans will get affordable health coverage, I would support it.  However, all the bill appears to mandate is INSURANCE coverage.  If the bill puts all sorts of restrictions on the insurance industry to ensure they do not raise rates indiscriminately, continue to deny coverage, etc., then it would be a good bill.  I am not hearing that any of these things are included.  If this is the case, this "reform" is worse than no reform.  With no reform, the insurance industry will ultimately collapse within 10 or so years (esp. given the state of the economy) and real reform would be required.  This is not to say that I do not want good, effective reform today, but if we can't get it, let's try some other creative means.

by orestes 2009-12-15 01:16PM | 0 recs
Re: Covering 30 Million Americans

So let's do this today, then in 10 years when the insurance industry collapses we can push for the PO or even single-payer.

by vecky 2009-12-15 01:25PM | 0 recs
Re: Covering 30 Million Americans

I don't see the necessary controls being included.  I think many people who are presently opposed would embrace this option if there were tight regulatory controls on the industry.  That would be a fair exchange- no rescission, no pre-existing conditions, price controls, etc.  

by orestes 2009-12-15 01:40PM | 0 recs
Re: Covering 30 Million Americans

agreed 100%

if there were good price controls, then I would support this for sure

by jeopardy 2009-12-15 01:51PM | 0 recs
Re: Covering 30 Million Americans

What sort of price controls would you like? Should the HHS set prices for insurance?

by vecky 2009-12-15 03:51PM | 0 recs
Re: Covering 30 Million Americans

that's one way.

another would be actual competition, hence the PO or maybe Medicare expansion (no, not for just people over 55)

by jeopardy 2009-12-15 04:04PM | 0 recs
Re: Covering 30 Million Americans

There supposed to be some sort of non-profit tightly regulated thingy in the bill. I'll have to see details on it before passing judgment.

by vecky 2009-12-15 04:25PM | 0 recs
Re: Covering 30 Million Americans

Essentially, this is McCain's subsidy plan with a twist-- mandate that individuals get the coverage. I don't understand why we can't ditch the mandate in it?  It's politically toxic to frame acceptably, and hurts us among youth I would bet.

Obama was at his best in those debates when he was saying how McCain's plan would do nothing to lower the costs.

by Jerome Armstrong 2009-12-15 01:28PM | 0 recs
Re: Covering 30 Million Americans

The subsidies McCain had in mind were tiny compared to what even the Senate bill contemplates, so I think your comparison is misplaced.  And the suggestion that the bill does nothing to control costs isn't supported by the facts.  Both the excise tax AND the individual mandate are scored as cost-savers by the CBO, the latter because it will change the composition of the insurance pool.  That's why the Senate bill reduces the deficit slightly over the first ten yeras and by more than 600 million over the second ten years.  And that's if we assume that none of the delivery reform proposals that the bill will try out will work.  

As to the politics of a mandate, the Mass plan has proved to be quite popular thus far.  Maybe mandates will ultimately be a huge issue, but available evidence certainly doesn't support that hypothesis.    

by HSTruman 2009-12-15 01:46PM | 0 recs
Re: Covering 30 Million Americans

The mandates aren't a financial issue, most of the folk affect by the mandate have enough of an income that for them not buying insurance is stupid.

It's a political issue - how to frame it. It's like Joe the plumber reacting badly at being told taxes for those who make over 150k a year will go up, even though it will benefit him as an unemployed sort of plumber.

by vecky 2009-12-15 03:56PM | 0 recs
Re: Covering 30 Million Americans

Well, not the youth - they can stay on their parents plans till 27 (or 26).

I agree to ditch the mandate - or tweak it so it applies only to those with income in excess of 100k. Not that it will make much difference because folk with that much income don't mind paying top dollar for health insurance.

by vecky 2009-12-15 03:53PM | 0 recs
Re: Covering 30 Million Americans

Considering how fat-headed some Americans, especially those inside the Beltway, are getting 30 milion uninsured covered is an accomplishment in itself.

Joe must go.

by spirowasright 2009-12-15 01:33PM | 0 recs
Re: Covering 30 Million Americans

from another blog:

Is protecting consumers from insurers dropping/denying coverage over pre-existing conditions not progressive?

If the bill actually did this, you might have a point. The problem is, it doesn't. Sure, the bill requires insurance companies to accept customers with serious illnesses. But it does not require the insurance companies to pay even one dime to treat those illnesses. This is a huge problem, to say the least.

Under this bill, you will be required by law to keep giving money to a private insurance company even as you slowly die because that company won't pay for your necessary medical care.

What the fuck is progressive about that?

by jeopardy 2009-12-15 01:38PM | 0 recs
Re: Covering 30 Million Americans

WTF... that is all just made up.

by vecky 2009-12-15 01:50PM | 0 recs
Re: Covering 30 Million Americans

 Quite a bit of that today.

by QTG 2009-12-15 02:00PM | 0 recs
Re: Covering 30 Million Americans

Likewise, when the bill says people with pre-existing conditions have to be covered... perhaps they will be covered with a blanket or tarpaulin, instead of an insurance policy.  I read it on some other blog.

Those loopholes are everywhere, I tell ya.

by Steve M 2009-12-15 02:47PM | 0 recs
Re: Covering 30 Million Americans

whiskey tango foxtrot? UR foxtrot oscar sierra.

by lojasmo 2009-12-15 05:47PM | 0 recs
Re: Covering 30 Million Americans

What are you talking about? The bill passed by the House is much better than the Blue Cross Blue Shiled/Cigna Subsidy of 2009 Bill in the US Senate. Just attach the healthcare to the budget reconciliation process in the Senate.

Problem Solved.

by bsavage 2009-12-15 01:40PM | 0 recs
Re: Covering 30 Million Americans

You make it sound as though the bill just heaps blessings on 30 million Americans without cost.

What is the Democratic argument that to get this coverage voters have to pay a $700 monthly bill to the insurance companies.

Will Americans asked to pay that bill think the system just got reformed?  with no limit on how high that bill can get?  

It's just as likely coverage will be eliminated to save money in the future if Republicans are in charge as it is for true insurance cost control measures to be enacted in the future.

you are looking at this through rose colored glasses.  Kill the Bill.  

by TJ1 2009-12-15 01:53PM | 0 recs
Re: Covering 30 Million Americans

Where did that $700 a month bill come from? Is it just another one of those made up figures?

by vecky 2009-12-15 03:58PM | 0 recs
RE:

Health "coverage" for 30 Million does not necessarily equate to health "care" for 30 Million Americans.

Do you want to know what this bill DOESN'T do, aside from not including a Medicare buy-in or a public option?

It puts no cap on premiums... subsidies may offset costs, but they do nothing to prevent premiums from being raised frequently.  And if the answer is to keep increasing the amount of subsidies to keep up with rising premium costs, well, goodbye deficit neutrality and hello "They're bankrupting America!!" GOP attack ads.

And while it may provide regulations to address pre-existing conditions and rescissions, it does not limit the health insurance companies ability to continue to deny claims.  Sure, it says that claims denials have to be based on "fraud" or "misrepresentation", but guess who gets to arbitrate what constitutes those things?  The insurance companies.

So if you forgot to report having that wart removed from your toe when you were 7 years old and you need chemotherapy when you're 47 years old, guess what?  DENIED!!!

And what are you gonna do when they deny a claim on absurd premises?  Sue them?  Yeah, good luck with that.  Hopefully you can afford to get lawyered up, and if you're lucky, maybe you won't keel over and die before you can get a courtroom decision.

What this bill will do is give 30 Million people the opportunity to carry around a little card that says "health insurance".  If you're lucky enough to always be healthy and never need complicated or expensive medical care, maybe you'll see some miniscule benefit from it.  If you get really sick and require expensive healthcare, having that card will not be a guarantee that your healthcare costs will be covered, anymore than is the case now.

Believe it or not, a fairly significant number of medical bankruptcies happen to people who HAVE HEALTH INSURANCE!

We've constantly framed this issue as being a matter of needing to provide insurance for the uninsured, but the bigger problem is and always has been addressing the crappy and unreliable nature of health insurance.

This bill does not address the root problem - that health insurance companies exist for one reason, and one reason alone - to make money.  They don't exist to provide healthcare or make the sick get better.  They exist to make money.  As long as your sickness isn't going to affect their bottom line, you'll be "covered".  The second your illness proves to be a threat to their profit margins, they will weasel out of paying for your healthcare costs, as they ALWAYS HAVE!

And this bill does NOTHING to prevent them to continue their practice of routinely denying legitimate claims under the nebulous and difficult to disprove assertion that the insured misrepresented their situation to the insurer.

In short, the bill does absolutely zilch to guarantee that your "coverage" will actually cover anything they don't want it to cover.

But it will fine you $750 if you decide that you aren't willing to play ball with a scumbag industry that has given no reason to be trusted to do the right thing in life or death situations with those who have their "coverage".

by Obamaphile 2009-12-16 02:33AM | 0 recs
Re: RE:

 And we all get to help pay for the uninsured and unhelmeted 25 year old motorcyclist's emergency care when he prangs his crotch rocket. Win-Win.

by QTG 2009-12-16 02:38AM | 0 recs

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