ObamaCare: Reid’s public option gamble
[Posted by Karl]
On Monday, Sen. Maj. Ldr. Harry Reid submitted a draft healthcare bill including a “public option” with an opt-out provision for states to the CBO. Allahpundit summarized most of the main points, but they are worth further exploration.
Reid apparently does not have 60 votes lined up for the public option, though Reid thinks he will have them after the CBO scores it. This move was supposedly forced by the hardcore liberals in the Senate, though this could still be the kabuki by which Reid sheds responsibility for a later failure to include the public option. Either way, the ball is now in the moderates’ court.
Allahpundit correctly notes that this proposal loses Sen. Olympia Snowe. Howard Fineman may not think that’s a big deal. Jay Cost, looking at ideological scores, suggests the White House wanted Snowe on board to woo Sen. Susan Collins and keep Sen. Ben Nelson on board. I think it is more the latter, and that the same applies to the next two Senator’s to Nelson’s left — Evan Bayh and Blanche Lincoln. Although Chris Bowers hears that Bayh is a solid vote for cloture, Bayh has suggested he might filibuster, though maybe not now. Ben Nelson supposedly opposes the idea of a national public option with an opt-out for the states. Both Bayh and Nelson have each received more than $470,000 from the health insurance industry since 2006. And Lincoln has not committed to vote to bring Reid’s proposal to the floor. Any one of these Senators could scotch Reid’s proposal after the CBO scores it — and may cite reasons other than the public option for doing so, at least for public consumption (though I doubt a lone Senator would do this; it’s more likely if two or three of them choose this course of action). It would be like Sen. Joe Lieberman saying his concern about the Senate bill is based on the deficit — not the insurers that dominate his state.
Bob Laszewski still thinks that there ultimately will not be 60 votes for a robust public option with an opt-out, because of the barriers to opting out. At least two of the analysts solicited by National Journal also see the opt-out as a ruse, while Paul G. Ginsburg notes that a robust public option with an opt-out could cause “an extensive pattern of distortions.” While some, like R.J. Eskow (a lefty not thrilled with the opt-out proposal) believe that the most conservative states are the most likely to opt out, Ginsburg notes that states with the highest rates relative to Medicare are likely to opt out in response to pressure from providers, which would likely affect the CBO scoring (and it will be interesting to see what sorts of assumptions CBO makes along these lines). Michael G. Franc notes that the 41 states with mixed or total Democratic control are unlikely to opt out today, but wonders whether Reid’s proposal — if it became law — would not turn state legislative and gubernatorial elections between now and 2014 into referendums on ObamaCare. State officials — already chafing at the way prior drafts of ObamaCare would burden their Medicaid programs — might be wondering the same.
In sum, a Senate bill with the public option is not quite a done deal. However, for the sake of argument, let’s assume that Reid can get such a bill to the floor. He can only do so by getting moderates to burn political capital — voting for cloture before voting against the public option or the bill in total. Voting for things before voting against them tends to hurt people on Election Day, as the moderates undoubtedly know. And the remainder of the bill may be difficult to pass, regardless of the public option. Including the public option (an idea so good that House Speaker Nancy Pelosi wants to rename it) may please liberals today, but it increases the risk that the bill collapses of its own weight on the Senate floor.
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Update: Joe Lieberman: I’ll filibuster Harry Reid’s plan. Heckuva job, Harry! (Self-link to honor Patterico’s Politico boycott. –K)
Update x2: Reid says Lieberman is the least of his problems, which Dems better hope is a bad bluff. Bayh can imagine the Reid bill failing before it gets to the Senate floor. Lincoln says she’s still opposed to public option. Neither Bayh nor Lincoln is talking about a filibuster — pols always want maximum flexibility — but making such comments at this particular moment is not an accident, either.
–Karl
“…which would likely affect the CBO scoring (and it will be interesting to see what sorts of assumptions CBO makes along these lines)”
The CBO is widely presented as an honest broker, providing unbiased estimates of likely future costs. On the basis of its estimates on health care proposals to date, I don’t see it that way (Robert Laszewski among others has looked at some of their numbers e.g. on Cadillac Plan Tax revenues, and found them wanting).
Thought experiment: What would happen if the green-eyeshades at CBO reported that “Leadership’s favorite provision X will cost $110 billion/year by 2019 (not $40 billion as they claim), favorite item Y will cost $90 billion (not $15 billion)”? And on down the line.
Would Sens. Reid, Byrd, Durbin, and Schumer express their delight at CBO’s hard-nosed integrity? Would Reps. Pelosi, Van Hollen, Hoyer, and Clyburn applaud CBO’s political independence?
Moody’s and S&P got paid by the issuers of mortgage-backed securities to rate those securities. Remind me: How’d that work out?
AMac (c822c9) — 10/27/2009 @ 7:41 amThis bill is just a turd dropped on the public. Pelosi wants to rename it, but a turd stinks just as bad no matter what you call it.
PCD (1d8b6d) — 10/27/2009 @ 7:46 amThe interesting thing is that it is looking very likely that republicans are about to win in not only VA, but NJ as well. my prediction is that if the GOP takes NJ, then that will lead to democrats freaking out completely and backing away from any real reform. and i say that hopefully, of course.
A.W. (b1db52) — 10/27/2009 @ 7:52 amIf you can’t trust the CBO, who can you trust? Golf anyone?
Corwin (ea9428) — 10/27/2009 @ 8:01 amGood point, A.W.
I believe that if what you say regarding the elections comes to pass, then the dims WILL freak out (popcorn anyone?) and pass nothing (crossing my fingers!)
Federal funding for abortions will be another sticky wicket for them, I hope.
Charlotte (dad663) — 10/27/2009 @ 8:07 amSomeone will surely correct me if I am wrong, but it was always my ubderstanding that the CBO only scores things based on the numbers and assumptions provided them by Congress, which is how they could claim that the Baucus plan was “deficit-neutral”, rendering that term meaningless.
JD (d46097) — 10/27/2009 @ 8:32 amJD, once again you bring a tad bit of reality to the scene. How could you? Shame! 🙂
GM Roper (85dcd7) — 10/27/2009 @ 8:38 amHarry Reid has long shown himself incapable of actually herding the Democratic Senate to date. This move seems just bizarre. With Reid’s history, there is no reason to think he knows something we don’t …
SPQR (26be8b) — 10/27/2009 @ 8:40 amThe entire bill is a political sham. All the assumptions it contains are political assumptions. They are trying to cover each voting member’s needs politically. The actually legislation sets up a regulatory bureaucracy that will, someday, write the law. Congress has been doing this for decades but it has gotten so extreme that no Senator knows what the bill will actually do. For example, if a state “opts out” of the public option, do its residents still have to pay the taxes that fund it ? Nobody knows. I can assure you that I know. Congress may fail to cover a medical condition but collecting taxes is a feature second only to getting elected.
Mike K (2cf494) — 10/27/2009 @ 8:50 amThe CBO has done better than I would have thought, actually. The biggest issues are their use of static analysis (for example, they assume nobody drops the “Cadillac Plans” so the expected revenues actually materialize) and the 10-yr window. The taxes start immediately while the benefits don’t start for a few years and are phased in. Of course it’s going to look “cheap” using that methodology, but when CBO extends out another decade, it looks awful. It isn’t their fault that the Dems focus on years 1-10.
Cankle (8aa31a) — 10/27/2009 @ 8:57 ammike K
well, and the opt out is a sham. it is only allowed if the FG says that there are enough choices in a given state. how often do you expect that to happen.
The radical left is going to mat on this because they are hoping to use this as a way to destroy the market. they are greeks bearing gifts on this. they hope to give the public option advantages that will make it crush all other competition. and it is possible. That is what has happened in our schools, for instance. no one thinks the public schools are very good, but they dominate the k-12 market anyway. Why? because it is hard to beat “free.” so right now in D.C. it would be cheaper and the students would get a better education if, rather than funding the public schools, each student was given their per-capita share of the district’s school budget to spend on a private school of their choice, but of course no one wants to do that.
Now ideally it could end up being like the university system. of course there are things to criticize there, but the “public option” is competitive with the private options and i dare say that the competition makes both kinds of universities better. Of course this white house is so incompetant, there is a good chance that it will really end up more like the post office, which obama paradoxically praised as a model of public/private competition.
still i am hoping to see christie win in NJ and moot all of this. if he wins, i predict it is the end of the radical liberal agenda of this president and this congress.
As for the CBO, don’t bet on them calling a halt to this. when they did previously they made sure to twist their arms. it is becoming a mantra that the obama deals with politics “the chicago way” a la the untouchables. All i can say is if only obama could be as tough on iran as he is on fox news.
A.W. (b1db52) — 10/27/2009 @ 9:02 amOn the CBO:
CBO generally does not score things bassed on assumptions provided by Congress. CBO has certain assumptions and conventions that Congress then games (e.g., savings from not doing the doc fix). CBO’s scoring on the Cadillac tax is unusual, and I may get around to dealing with it in depth. Overall, however, I tend to agree with Cankle that CBO has been better than might have been expected overall. This is mostly due to the fact that Orszag set up the dept. that did most of the healthcare numbers by December 2008, before Orszag moved to OMB to serve Obama. Had the CBO flip-flopped on much in the span of a few months, they could have been publicly pilloried as total hacks.
Karl (f07e38) — 10/27/2009 @ 9:09 amWhat kills me is that Dems like to tax things they don’t like (I live in SF where they want to tax soda now), yet they won’t admit that taxing things changes behavior. They want people to do less of certain things (smoke, drink, get fat), but when things like Cadillac Plans are taxed, they assume no one will ditch them. Talk about hypocrisy.
Cankle (8aa31a) — 10/27/2009 @ 9:20 am….Which reminds me of one of my favorite Reagan lines describing the Dems (paraphrasing): “They say if it moves, tax it; it moves too quickly, regulate it; if it stops moving, subsidize it”. Awesome.
Cankle (8aa31a) — 10/27/2009 @ 9:23 amAs for whether Reid knows something we don’t, Dana Milbank’s account of the Reid presser backs the notion that this is a gamble, not a sure thing. The only question is how calculated the risk is.
Karl (f07e38) — 10/27/2009 @ 9:26 amcankle
The biggest stupidity liberals have is that they utterly fail to understand that people change their behavior or why.
For instance, i joke that DC is run as though they have no idea that all you have to do is drive 10 miles in any direction and you are out from under their thumb.
Or the new rules on executive pay for bailed out companies. apparently they don’t realize that people can quit their jobs and go work for someone else, or what that fact means for them.
indeed, they demonstrate a basic incomprehension of how incentives work in general. for instance, remember the ubiquitousness of those annoying automatic seat belts? blame the government. they were trying to phase in air bags on the theory that they would save your a– even if you didn’t buckle up. btw, that proved to be untrue–they actually make the car more dangerous if you don’t buckle up. but anyway, at one point they required everyone to have such “passive” restraints and offered two options: automatic seatbelts, or air bags. they predicted 50% would go for airbags, and 50% would go for auto seatbelts. but in fact auto seatbelts were cheaper something like 90% of cars had them.
and of course the sin taxes, of which this is clearly of a kind, is another example. they state that their goal is to reduce the usage of those things, but when budgeting they make no attempt to guess how much their taxes will reduce consumption. frankly government is endemically idiotic when it comes to business and the only thing that makes republicans better on this subject is they at least pretend to understand that and prefer that the government get out of the economy.
A.W. (b1db52) — 10/27/2009 @ 9:27 amDoes the CBO ever amend their budget predictions if/when faced by outside groups bearing better data? It’s a double-edged sword to be sure; but given the significance of a $900B bill, are all factors being considered and weighed appropriately?
As much as I have been heartened by (some of) the CBOs more recent estimates, I am still reminded of how the Feds predicted Medicare costs/savings. Not too mention their expectations on Cash-for-clunkers. Was there a thought to how the secondary, used-car market might be affected?
Corwin (ea9428) — 10/27/2009 @ 9:46 amCorwin
more basically they thought that the initial money for cash for clunkers would last six months. idiots.
A.W. (b1db52) — 10/27/2009 @ 9:51 amWord is that Pelosi is going to change the name of “the public option” to “free beer.” This is expected to be followed by the re-naming of “cap and trade” to “hot sex.”
Tully (c2f070) — 10/27/2009 @ 10:11 amindeed, they demonstrate a basic incomprehension of how incentives work in general [or most anything outside DC]
How quick y’all forget. The vast majority of these politicians and bureaucrats were the dorks and dorkettes elected as our class idiots from grade school through college. You really expected them to suddenly wise up? Worse, 60-80% of them went on to law school[figures provided by the CBO]. Then the ones who couldn’t make it in the law business went into politics.
political agnostic (0b6fbc) — 10/27/2009 @ 10:13 ampolitical agnostic
certainly we are not talking about people with alot of real world experience, although that isn’t everything. mitt romney put in that idiot health care plan in massachusetts and he used to run Staples (the company, yes). so real world experience is not a panacea.
A.W. (b1db52) — 10/27/2009 @ 10:17 amAnd how many times are innocent misspellings and phrasings so revealing of underlying truths?…
CBO generally does not score things bassed on assumptions provided by Congress…[fishy numbers are the norm]
…the CBO flip-flopped on much in the span of a few months…[not unusual behavior per above]
Pure short-pants humor, Karl. Your post here is another example of well researched and expertly detailed exposition. Always worth taking the time to absorb.
political agnostic (0b6fbc) — 10/27/2009 @ 10:28 amBtw, on renaming these things, what a confession that they just don’t believe in consent by the people. they can’t win the argument on the weight of ideas, so instead they rename everything and hope to confuse people long enough to sneak it by us.
A.W. (b1db52) — 10/27/2009 @ 10:34 amI think Romney may have tried to enact the left’s health care plan to see if it could be made to work. Paul Krugman is still praising it.
But the experience in Massachusetts, which passed major health reform back in 2006, should dampen conservative hopes and soothe progressive fears.
Like the bill that will probably emerge from Congress, the Massachusetts reform mainly relies on a combination of regulation and subsidies to chivy a mostly private system into providing near-universal coverage. It is, to be frank, a bit of a Rube Goldberg device — a complicated way of achieving something that could have been done much more simply with a Medicare-type program. Yet it has gone a long way toward achieving the goal of health insurance for all, although it’s not quite there: According to state estimates, only 2.6 percent of residents remain uninsured.
So, Medicare style single payer is still their ideal.
There are, of course, major problems remaining in Massachusetts. In particular, while employers are required to provide a minimum standard of coverage, in a number of cases this standard seems to be too low, with lower-income workers still unable to afford necessary care. And the Massachusetts plan hasn’t yet done anything significant to contain costs.
But just as reform advocates predicted, the move to more or less universal care seems to have helped prepare the ground for further reform, with a special state commission recommending changes in the payment system that could contain costs by reducing the incentives for excessive care.
There are the essential facts.
It is popular.
It hasn’t restrained cost.
Low income workers still can’t afford insurance
It is the basis for single payer to come.
Then they will act to eliminate “unnecessary care.”
Sarah Palin told you this in a lot fewer words.
Mike K (2cf494) — 10/27/2009 @ 10:49 amIt is vital for all who value human freedom, and the subservience of the State to the people, to oppose the misnamed “health reform” effort in general, and the government option in particular. It has been painfully obvious for some time that the President cares not for the health and welfare of the American people; if he did, the plan would contain tort reform, the single greatest action that could lower the cost of medical care. This is his effort to obtain Government domination of 15% of the American economy by hiding his collectivist goals behind a veneer of humanitarianism. I have no crystal ball as to the future, and as to whether this back-door nationalization of the health care industry will succeed. What I do know is that if it does succeed, it will be the first of many actions aiming to give control of the total economy to the Government, and making Americans servants of the State rather than vice versa. Incidentally, for those who think I am too harsh in holding that the President is not motivated in the slightest by humanitarian considerations, consider the following: he has two half-siblings in Eastern Africa who have serious health problems, and has not provided one cent to their aid. That one fact should tell any impartial person everything that needs to be known about the President’s fundamental character.
Ed Burke (4d15b9) — 10/27/2009 @ 10:53 amBtw, i will make an amused observation about the conservatives saying it is unconstitutional. There is a very specific precedent on point that for some reason conservatives aren’t mentioning. its one of about 10 cases that literally almost every lay person minimally informed about life in america knows about: Roe v. Wade.
I mean at its core, Roe v. Wade is about the right of a person to control their medical destiny. Now people can rightfully criticize its application to abortion, on the theory that the right to medical care doesn’t include murder. but i think to most americans, if you left abortion out of it, they would find that central holding uncontroversial.
So isn’t this health care law a fundamental violation of those rights? um, yes, they are. And even if abortion is provided, freedom is not and that is a problem.
And i am stunned that democrats actually state that they think the federal government has the police power. no, they very specifically don’t. now the limits on federal power are largely illusory, but they do exist and courts do at least pay lip service to them.
A.W. (b1db52) — 10/27/2009 @ 11:23 amBTW, just updated the post with the news that Lieberman will filibuster final passage of a bill with the public option. He also says he wouldn’t filibuster a motion to proceed to the bill. But that’s Joe twisting the knife. In all probability, the bill would proceed under an agreement allowing for the filibuster of amendments, which would require 60 votes to remove the public option. So Reid will be under bigtime pressure to yank it from the bill now. Alternatively, Reid could take another run at Snowe by switching to a “public option with trigger” plan.
Karl (f07e38) — 10/27/2009 @ 11:29 amThe real problem is not health insurance companies, but health care costs. Think about it, why do we need medical insurance in the first place? Why do we not need insurance to buy a car, or a house, or food? A commenter on the Huffington Post, of all places, figured it out.
And I suspect that many other Americans are figuring it out too.
Michael Ejercito (6a1582) — 10/27/2009 @ 11:39 amWait a minute, where’s Eric (not Blair) with his expertly – timed meme again? Something about how his Lord Gingrich must be obeyed? Idiot.
Dmac (5ddc52) — 10/27/2009 @ 11:40 amWhoops, wrong thread – my apologies.
Dmac (5ddc52) — 10/27/2009 @ 12:02 pmI think Barcky wants to win in Afghanistan, but cannot afford to piss of his Leftist base and sycophants for fear of losing them on destroying healthcare and cap&tax.
JD (40bf6b) — 10/27/2009 @ 12:11 pmMichael E.
Yeah, that commenter was brilliant: price controls! That’ll solve it! *rolls eyes.*
What we need is more capitalism, not less. right now our insurance is tied to our employers. tying is an anti-competitive tactic, but it is actively promoted by the government. end it. make it as easy to buy your own insurance as it is to buy it through your company.
Second, we need to let insurance companies compete across the US.
Third, we need to control malpractice costs. We need to impress upon ourselves that barring really massive incompetance, doctors should not be punished for choosing this noble profession. besides the well-publicized examples of defensive medicine, the cost adds to our medical bills because the cost of malpractice insurances is inevitably passed on to consumers.
And more fundamentally, we need to reform our justice system. just today the governator insanely signed a bill to give free lawyers in certain circumstances. sigh. like as if cali isn’t enough in the hole. The correct solution is the british system: loser pays. That is, whoever loses the suit pays the other side’s attorney’s fees. a meritorious suit by a poor person might be taken on commission, while a person in a particularly weak suit would understand that there is a price to frivolous suits: they have to pay both their own lawyers and the winner’s lawyers. do that one thing and overnight our entire justice system would change, for the better.
Of course it won’t happen, but its a far more sensible solution that price controls which will inevitably screw things up even more.
A.W. (b1db52) — 10/27/2009 @ 12:34 pmJD
Btw, i think barrack is a complete weenie peacenick who was talked into a corner on afghanistan. liberals for years talked tough on afghanistan, and put down iraq. afghanistan is the real fight, and iraq was a distraction, or so it went. i think it was bull. they didn’t want to fight either war, but were resigned to fight afghanistan, so they made the best of it.
oh, and we just found out that this is the deadliest month in afghanistan in years. so suddenly we are debating whether to lose afghanistan and the terrorists start killing more of our soldiers. gee, its almost like as if the terrorists were aware of that debate and want to help the pro-lose-the-war side make their case.
And klien claims that the right it borderline seditious. sheesh.
A.W. (b1db52) — 10/27/2009 @ 12:42 pmReid apparently does not have 60 votes lined up for the public option, though Reid thinks he will have them after the CBO scores it.
The facts are being fixed around the policy.
Brother Bradley J. Fikes, C.O.R. (d11b4b) — 10/27/2009 @ 1:24 pmBTW, not to be snide (okay, maybe a little snide), I’m wondering where Myron is to lecture me about “signs of progress” today.
Karl (f07e38) — 10/27/2009 @ 1:31 pmI’m not at all sure that malpractice reform will save all that much money. (ducks !)
I agree that a system similar to the old airline flight insurance would be better but has anyone noticed that nobody buys that anymore ?
A single payer system will solve the problem through sovereign immunity. (Just kidding, but not really).
The California tort reform would do it but even in Alabama, which used to be Trial Lawyer Central, (Remember the BMW suit ?), it is getting economically inefficient to do malpractice suits for good lawyers. I used to be an expert for a very good plaintiff’s lawyer in Alabama. He told me several years ago that he was the last one in his firm to take those cases as the payout was so poor and the expenses (Me) so high. His partners had told him to phase out.
I think a lot of it is increasing sophistication by juries. Even in Alabama.
The thing that is killing us is first dollar coverage for routine stuff plus increasing bureaucracy as they try to regulate behavior.
MIke K (2cf494) — 10/27/2009 @ 1:40 pmMike K: there is a Price-Waterhouse(?) study floating around (I’ve lost the link) that conservatively estimates total cost savings of $250 – $300 Billion over ten years based upon a nationwide cap on punitive damages.
Someone with better Google-fu may be able to find it.
BJTexs (a2cb5a) — 10/27/2009 @ 1:54 pmFunny that Reid decided to stop dragging his feet on a public option after pro-reform groups in his state started taking brutal shots at him for his inaction (in a year where he’s up for reelection, if I’m not mistaken) – particularly in light of Michael Franc’s observation (via Karl) that the inclusion of an opt-out clause might turn “state legislative and gubernatorial elections between now and 2014 into referendums on ObamaCare.”
So Reid starts worrying about his own reelection prospects in Nevada, and more or less immediately revives a public option with a provision that might cost a great number of his allies their jobs in the years to come.
These people are weasels, man.
Leviticus (30ac20) — 10/27/2009 @ 1:59 pmThe really sad and infuriating part in this whole debate is the fact that whether or not a bill is passed will be far less dependent upon how it works or how it is funded and far more dependent upon how a relatively small number of Senators feel about their reelection prospects.
Instead of enlightened legislative language we get enlightened self interest. I’m really, really beginning to develop a white hot hate for politics in general.
BJTexs (a2cb5a) — 10/27/2009 @ 2:04 pmLeviticus, I have known some real weasels and I doubt they’d appreciate your comment.
SPQR (26be8b) — 10/27/2009 @ 2:04 pmleviticus
hey, hey don’t put them down for that. if they are weasels, then they can be shown that it is in their interest to kill health care reform and they just might do it.
what i fear more is ideological committment to health care reform. those kinds of people are like suicide bombers against the economy.
not that they are bad as the terrorists, but i am just noting a metaphorical similarity.
Mike K
i work in health care. i can’t disagree more. i can’t tell you how often we are sued based on theories that are literally impossible. As in, even if their version of events are acurate, a person simply can’t be harmed that way.
And besides if we had tort reform, then maybe we never would have heard the name “John Edwards.” Case closed.
A.W. (b1db52) — 10/27/2009 @ 2:06 pmReid has clearly been unfit for the position he holds for some time, just why is it that the Democrats don’t replace him in his role in the Senate?
SPQR (26be8b) — 10/27/2009 @ 2:15 pmMike K: there is a Price-Waterhouse(?) study floating around (I’ve lost the link) that conservatively estimates total cost savings of $250 – $300 Billion over ten years based upon a nationwide cap on punitive damages.
I may be wrong because of being in California but I have done an awful lot of expert witness stuff for both sides and I don’t see the nuisance suits. I do see incompetence in lawyers, usually the plaintiff side. I also see some malpractice which should be dealt with by the medical boards but they are atrocious. They are just incompetent. I used to be an expert for the medical board and for the Medicare peer review organization. The real crooks are so hard to deal with for the state. They get good lawyers and the assistant AGs are so often generalists.
Anyway, I have no objection to tort reform but I practiced surgery for 30 years and got sued, seriously, once. We won and were awarded costs. I had some nonsense suits from the trauma center; once I checked and had 12 or 13 wrongful death suits filed against me. I had never been served and we wrote to the law firms and threatened them with malicious use of process action unless they dropped them. They dropped them.
The OBs, especially in other states, are getting screwed and places like Florida are atrocious but that is politics. The Florida Supreme Court is as bad on malpractice reform as it is on Bush vs Gore. And for the same reasons.
I have seen some really bad care in places.
I was talking to my sister a couple of days ago. My brother-in-law, who is a retired cop in Chicago, had a major stroke about 10 years ago. He can walk and talk but doesn’t use his left arm and cannot drive. All he does is sit in his chair and watch TV. My sister, out of the blue, started telling me about how he was scheduled to have cataract surgery done and it was really difficult.
I said why in hell is he having cataract surgery done ???? He is unable to have to have it under local as he is unable to hold still. He was going to have a general anesthetic, plus they would have to stop his anti-coagulation ! His stroke was an embolus from atrial fibrillation and another one would finish him off. I said, “Why are you doing this ???”
The doctors had told her he had cataracts and that was reason enough. That is crazy ! He doesn’t read and can’t drive. Because of his stroke the whole left visual field is gone. He can only see the right half of the world. Most of his TV watching is sleeping anyway. He has NEVER COMPLAINED about his vision!
I was really upset. I spent most of an hour on the phone with her convincing her that he didn’t need this done. She thinks doctors are all honest. After all, her brother is one.
There is a microcosm of our cost problem.
I’m sitting here getting ready to review the case of a death of a young woman as a result of bowel injury during hernia repair. Shit does happen.
MIke K (2cf494) — 10/27/2009 @ 2:40 pmI have a friend who has DUI on his record, and as a consequence has to pay more for auto insurance.
As it turns out, 44,000 people die each year due to medical mistakes, far more than those killed by drunk drivers each year. Maybe this has something to do with medical malpractice insurance premiums.
Michael Ejercito (6a1582) — 10/27/2009 @ 2:52 pmKarl: It’s nice to be missed. 🙂
The Lieberman threat to the public option is real. I’ll acknowledge that. I believe he is the only one in the caucus who would actually join a GOP filibuster, b/c of his ties to insurance as well as his contempt for the Democratic base.
I don’t believe anyone thought Harry Reid had all the votes lined up yet for a public option, and I never said he did. And I have never said there would be a robust public option.
I still think reform will win final passage, with some kind of vestige of a public option or a public option with an opt-out (which Republicans correctly note is simply another public option.) A “trigger” I see as the third contender.
Lieberman has said he will vote to proceed to debate, and from our side’s perspective, that’s something to work with for now. The goal on the floor will be to get him to cloture on a final vote, and I believe there are several modifications of a public plan short of scrapping it that might get him Nelson, Landrieu and that whole crowd there.
I’m less worried about Bayh and Lincoln than others are, but perhaps I should be. I think they are hoping to be able to hide behind the CBO report.
It’s useful to recall that all these politicians — save for Lieberman — are Democrats, not just conservatives. I think that’s a bit more major than some on the other side want to acknowledge. These Dems know that a vote against reform will severely damage the Obama presidency and the party and lead them into the same ugly, primary fights Crist and that woman in NY-23 are going through. Being hated by your base is no picnic! Ask the GOP leadership.
Allahpundit is correct in that Snowe is done for now. She might not be back unless the trigger makes a comeback and during floor debate, it just might. Snowe also gives Dems in the senate cover, b/c in the crazy world of Washington a lone vote from the other party counts as “bipartisan.” Of course, no one else in the country thinks that way.
For now, I’m very happy to see Snowe sidelined. Pre-Lieberman, she and Nelson were the biggest threats to the public option.
You guys can celebrate a tiny victory with Lieberman’s comments, but, at the end of the game, I’d still rather be the team driving with a chance for victory than the team defending.
Myron (6a93dd) — 10/27/2009 @ 3:59 pmYour definition of “victory” is from a different dictionary.
JD (c75da2) — 10/27/2009 @ 4:17 pmAs usual, Myron moves that goalpost so far away that you have to squint to make out the outline.
Dmac (5ddc52) — 10/27/2009 @ 4:50 pmI do give Myron credit for showing up, however. And he should be worried about Bayh and Nelson. A few days back, Chris Bowers of Open Left got 2 lists of possible defectors; Bayh and Nelson were the only two on both lists.
Karl (6aa6ff) — 10/27/2009 @ 4:55 pm“I don’t believe anyone thought Harry Reid had all the votes lined up yet for a public option, and I never said he did. And I have never said there would be a robust public option.”
Myron – Usually you just make sure you have all the bases covered with weasel words in your comments.
daleyrocks (718861) — 10/27/2009 @ 5:10 pmMy Prediction — write this down and remember you saw it here first:
Reid will end up voting against cloture himself.
It will be obvious that the bill lacks 60 votes, but liberals will demand a vote on cloture to hold everyone “accountable”.
Reid, about to be administered the “Last Rites” in Nevada, will end up voting against cloture when he realizes his vote won’t matter in the outcome, and in an effort to save himself at home.
Shipwreckedcrew (7f73f0) — 10/27/2009 @ 5:29 pmWouldn’t that be hilarious, Shipwrecked? I would just laugh myself hoarse if that does happen.
SPQR (26be8b) — 10/27/2009 @ 5:34 pmWhat is really sad is that this has nothing, nothing to do with health reform.
Mike K (2cf494) — 10/27/2009 @ 5:56 pmMichael Ejectero:
I clicked your link to Puffington Host and now have to take a shower. Gadzooks. What a pile of filth they run over there.
gnholb (710dbc) — 10/27/2009 @ 6:02 pmMike K,
Has it ever?
Karl (6aa6ff) — 10/27/2009 @ 6:15 pmMost of the commenters there would not be able to find their asses with two hands and a roadmap.
But that one commenter was spot on. Why do we need health insurance to afford health care, but not auto care, home repairs, or hunger care (food)?
Michael Ejercito (6a1582) — 10/27/2009 @ 6:17 pmMichael Ejercito.
My apologies for so badly misspelling your last name. Maybe my head is still spinning from the trip to OZ after clicking the link to HP.
gnholb (710dbc) — 10/27/2009 @ 6:17 pmBayh is an interesting case.
One of the yoogest insurers, Anthem/Blue Cross is based in Indiana, and there is significant Big Pharma interests there, too. Ought to be a slam dunk against this claptrap, eh?
The problem is he is Senator for life, unless he kills a hot girl by driving into Lake Monroe. The only calculus driving good ‘ol Evan is presidential. If he thinks it will be better to be a “pragmatist,” he will vote against. If he deems it necessary to appease the base, he votes for.
He was very much a pragmatist governor. He has very significant special interests who will be killed by this legislation, in any form. Yet, he vacillates or does the Obama – takes no position. This has nothing whatever to do with the merits, nor the interests of his consitituency. Nothing.
Ed from SFV (4b493e) — 10/27/2009 @ 6:52 pm