A micro-picture of what is wrong with out health system

So, my wife has been sick, and she was kinda worried it could be strep, so we took her took a local medstop yesterday. She went in, got tested. It wasn't strep, instead this is what was written on her Patient Education Form:

VIRAL PHARYNGITIS (Sore Throat)
Your throat pain is due to an infection called 'Viral Pharyngitis', commonly known as 'Sore Throat'. This is a contagious illness. It is spread through the air by coughing, kissing, or by touching others after touching your mouth or nose. Symptoms include throat pain worse with swallowing, aching all over, headache and fever. This illness does not require treatment with an antibiotic. [Emphasis added]

So, the doctor gave her two prescriptions, one of which was for Amoxicillin (an antibiotic). Why? No real reason. It won't treat the sickness. It merely adds to the costs of health care in this country. If taken, it stands the chance of creating antibiotic resistant bacteria. It will certainly decrease the taker's antibiotic effectiveness for the next six months. And, there is also the slim chance of a major health consequences.

Why do I write about this? Because when we talk about the health care system, we usually are talking about the major actors: insurance companies, hospitals, pharmaceutical companies, and the various governmental agencies and laws. And all of those are tied in together, but we also need to start changing the way that cost-benefit analysis of individual doctors. On some level we can say this requires patient knowledge (knowledge to know when to ignore a prescription), but that is obviously unrealistic. Anyway, this is another example that we have two problems with our health care system. One is that we are usually underinsured, and underprotected. The other is that people who are insured are frequently given too much care. If you want to know more, read Jonathan Cohn's Sick as a good place to start.

My probable last post on health care reform

As you know, health care reform was signed into law today. This will probably be my last post about health care reform, so those of you who didn't like that aspect of my blog can celebrate as well.

I was trying to think of what sort of post I should make. A retrospective explaining what happened? How we got here? A post on what in contained in the bill?
Well, if anyone wants that, they can ask for them. Otherwise, I am going to make a post about what is to come.

But before I do, I want to address the concern that has come up by a few people that at the last minute women were thrown under the bus to get health care passed. I'm not happy by what happened, but that is certainly not what happened. So, to recap: When the original House health care bill passed, it passed with severe restrictions on women being able to get insurance that would support abortions. The senate passed a health care bill, and it contained language that restricted federal money going to pay for such insurance products, but did not limit the ability to get those insurance products through the exchanges. This senate bill, in effect, maintained the status quo on abortion. For those of us who believe the status quo is too restrictive on a woman's ability to get an abortion, that is obviously a disappointment. However, we should clearly admit that what was being maintained was the status quo, not some sort of regressive restrictions. Well, then we ended up in the situation where the House had to pass the senate bill, with restrictions on what changes could be made to the senate bill. That was pretty good in this case, because from a pro-choice standpoint the senate bill was easily superior than the house bill. The problem was, the house was having trouble assembling the votes for passage. The pro-life group, led by Stupak, were originally leveraging to get some level of increased restrictions on abortion in exchange for there votes. After some going back and forth, someone (Pelosi, at the very least, maybe aided in this move by Obama, it is unclear) laid down the law. No way were abortion restrictions going to be added. Then Stupak et al's best option was that Pelosi was going to be able to find the votes elsewhere. Which she was unable to do. So, Stupak and his gang were in an awkward position. They clearly wanted health care to pass, but had made public statements taht would make it hard to support. So, Obama agreed to pass an executive order that basically says, we will enforce the senate bill's stance on abortion. That gave Stupak the political cover to vote, and the rest is quite literally history.
Now, I don't like the optics of Obama seeming to give his stamp of approval on the status quo, but that is all that happened. And moreover, no new restrictions were added that were not already in the senate bill. Part of the outrage comes from the over the top response from NOW. I don't understand what inspired that statement, and I have both sympathetic and unsympathetic ideas. Anyway, if you read the statements released by both NARAL and Planned Parenthood, I think you get a better idea of what happened (you can read all three statements here).

So, now to what comes next. The senate has to pass the reconciliation package, but that seems very likely. Also included in that reconciliation package is a overhaul of the student loan system, another failed initiative from the Clinton years. It hasn't been getting as much attention, for the obvious, but is still important. Republicans are talking about repealing it, but the electoral math just isn't there. This bill will have to be very unpopular (more than it even is right now), and stay that way for a while in order for the republicans to really be able to repeal it. I obviously don't think that will happen. The lawsuits are already beginning. They seem unlikely to go anywhere. The objections of telling the states what to do seem unlikely to move the supreme court (if no other reason they don't want to give up their ability to tell state courts what to do), and the individual mandate is covered well by existing law (not only the interstate commerce clause, but more particularly Congress's ability to control tax law). For the supreme court to repeal this, would require a level of absurdity far beyond the Bush v Gore fiasco. I guess what I am trying to say is that we will have far bigger problems than health care reform it the Court repeals it.

The things that can improve the reform the most are better subsidies, better caps on out of pocket expenses or controls to lower deductibles even more, and federal regulation of the exchanges. Sadly those cannot go through reconciliation. What can go through reconciliation is a public option. A strong public option never had the majority votes in the house, or majority votes in the senate. But a weak (level playing field) public option just might, assuming the dems still control the house after midterms.

Outside of health care, there are some legislative goals that seem possible in the nearish future. A national broadband plan is possible (see this and this), some sort of movement on carbon pricing is still possible, but it always seems unlikely, tax reform, and Chris Dodd's financial regulation bill has made it out of committee and will be proceeding to the floor after senate takes up health care, but that seems like a long shot of passing. Harry Reid has also promised to work on filibuster reform (assuming he is still part of the senate) at the beginning of next congress, which will probably be necessary to get any of these through.


And that is kinda that.

Health care passes

It passed. Just in case you haven't heard. I might try to write a longer post on this tomorrow. If you are curious about anything, put it in questions and I will try to respond to it when/if I make a post on this tomorrow.

Health Care Vote

Today is the debate (on-going) and vote on health care bill. It is close, but it looks like the votes are there for the bill to pass. The actual vote is being scheduled between 6pm and 10pm et tonight. You can watch the debate on cspan live.
It isn't really interesting, except that everything we know about how a bill becomes law is just wrong. Schoolhouse rocks, West Wing, my civics class, my AP gov class, etc did not teach me anything about how the bill becomes law.

Why I'm angry at Howard Dean

This post is going to make most of the political liberals and progressives who read this blog pissed at me. But, I'm in an angry mood tonight, so here we go. Oh yeah, those of you who wonder why I am interested in US policy mechanisms and question my radicalism will probably also be annoyed I continue to post stuff like this.

The health care bill that I have touted on this blog (see here and here) continues to have an uncertain future. There are any number of people who have dropped the ball that have brought us to this point. I should probably write a series of blog posts blasting them for their failures, but right now I am angry at one man in particular: Howard Dean.

Let me begin a bit further, a flash back to the summer and the death panel nonsense. One of the things I wondered at the time was how it was that people believed such obvious lies. Let me precise, not how could people believe the government might want to kill you, but the lie that death panels were being discussed in the health care bills. That is a matter of fact, and the facts just weren't there. But thing is, most of us aren't going to read thousands of pages of legalese, and we depend on our information from trusted sources. At the time I wondered what would happen if I was lied to by a trusted politician, amplified by trusted media personalities, with a series of lies/misinformation/and distortion spreading throughout trusted political blogs. Especially if such a lie reaffirmed my basic belief system. And this is, of course, what was happening to conservatives with Palin/Fox News/Hot Air etc. I was, I admit, a little shocked to see the same thing happen to progressives only a few short months later with the kill the bill crowd.

Progressives had become increasingly disillusioned with health care reform, many of them feeling betrayed for never having single-payer as a serious option (may I ask, single-payerists, why do you believe the system of Canada is better than Germany's? Or France's better than Japan's? or Spain's better than Sweden's?). The senate bill ended up having both a public option and a medicare buy-in option stripped out. There were lots of senators to point fingers at, but the main pointing going to Joe Lieberman. An obvious malcontent, it became clear that he was willing to put the health of millions of Americans and the financial stability of millions of families and the country as a whole in danger out of pique. Out of an obvious personal animosity toward progressives/liberals, and also a desire for attention and relevance. This included going against policies he had advocated as long ago as 2008.

At this moment the kill the bill crowd went into overdrive. Spurred on by Howard Dean, particularly in this outrageous editorial in the Washington Post. Then Keith Olbermann joined in, adding this special comment (one filled with a litany of factual errors and distortions, and weird phrase about fetishes vs. bondage), and of course Daily Kos and Fire Dog Lake got into it, and we had a wonderful version of death panels on our side. Now, maybe I believe in Howard Dean's influence too much, maybe all of this would have happened even if Howard Dean had promoted the bill. But I doubt it, Dean is a liberal hero, and considered as an health care expert. Both of those have been true for many good reasons. And the liberal turning against the bill may be the least factor in anything (it certainly isn't the only factor). Still, I can't help feeling that liberal turning against the bill have played a rather large part in our current situation, and in a Congress feeling like they can get away with passing nothing, or a stripped down version. And so, I have often pondered why Dean turned against the bill.

The most obvious answer would be to take him at his word. Except, his words have been rather incoherent to me. The bill is more radical than anything that has been done in Vermont, it is in many ways more radical than what he proposed when he was running for president in 04 (there was, obviously, no public option in that proposal). The editorial I referenced before contain several distortions, and at least one flat out factual error (as I talked about before, he claims there is no prudential purchasing power, and that Kerry is the expert on that, but there is and it is Kerry's version. And that is one of the few actual policy points brought up). So, what is going on? Is Dean lying, or wrong? Either way, his credentials as a health care expert become a bit more suspect, no?

But what if this isn't, ultimately, a policy disagreement? Or, to be more precise, what if this is only minorly a policy disagreement, and majorly a personal issue? That would certainly explain why his policy arguments are confusing, unsatisfying, and often incorrect. What personal issues are these? Not sure, but here are a few. The fact he and Rahm Emmanuel have no love lost following the 50 state strategy he decided to pursue as DNC (a strategy I agreed with). His being snubbed by not being invited to the press conference of announcing Tim Kaine as the new DNC. His obvious disappointment for not getting a cabinet position with Obama, which was intensified after Daschle dropped from HHS and Dean wasn't asked next. As a matter of fact, after Daschle dropped I thought Dean was the obvious choice. The man obviously has been treated as an outsider by the White House on the issue he feels is his. Lieberman isn't the only whose desire for attention and childish pique has hurt the chances of health care. I know that is probably a low blow. And I generally have respected and liked Dean, and maybe should go to believing he is just grossly incompetent instead. If health care fails, there will be a lot of blame to go around. A good chunk of that will fall on Obama's head. But some of it will have to fall on Dean, and to all of those who have misinformed the liberal/progressive base of the Democratic party.

Yeah, this isn't go to go over well. Going to hit publish post anyway.

More on health care: Why the insurance industry hates it edition

Two notes before I get into this post. First, if you haven't heard about the earthquake in Haiti, it is really, really terrible. According to a few different blogs, Peter Hallward (who would be the guy to ask) suggests making contributions to Partners in Health . I know most of you are poor grad students, but just in case someone following this blog wants to contribute something, there you go.

Second note is that maybe whining and complaining about minor things in H&N's new book isn't the best use of my time or energy. However, I still am not sure what real comments on the book will or won't make the review cut, so I'll just post more stuff when I finish writing the review (which, Peter, it should be done by the end of this weekend if you are curious).

NOW TO HEALTH CARE REFORM!

Now, as I suggested before, many of those on the left who are in the kill the bill crowd are more motivated by hatred of insurance companies than they are by wanting to help people. This view, whereby dramatic reforms are measured not by the amount of good they will do, but by the amount of harm to the insurance companies is just about as backwards of a way to judge a bill as I could possibly come up with. I'm not a fan of insurance companies in this country, I'd love to see some harm fall on their heads. But at the same time, it isn't a zero sum game (indeed a recent post by Reinhardt on community ratings reveals how central insurance is in Switzerland, Netherlands, and Germany). But what has really shocked me in these discussions is that the current health care bill is not an unmitigated give away to the insurance companies that many people keep arguing it is. Yes, insurance companies got their way with getting rid of the public option, and that is not good news. But, here is a list of things that insurance companies don't want that will be in the current bill.

(1) Community ratings: Right now people on the individual market are charged rates, well, individually. This basically means that if you seem to cost insurance companies at all, either you just will not be allowed insurance or will be able to get insurance at absurdly high prices (frequently meaning you still don't get insurance). Community ratings mean you can't charge people different rates out of the exchange (except for some controlled differences in age and smoking habits). This is obviously both the key to expansion of coverage and at the same time something insurance companies really don't want.

(2) Actually paying for people who get sick: Right now one of the main ways that insurance companies make money is by, frankly, not spending money on actually sick people. Now one way is to allow sick people into insurance, but what happens when people get sick or injured that they are covering? We all know the answer, try to find ways to kick them off their insurance rolls and put caps on annual and lifetime expenditures on these people. All of these practices are expected to be banned in the final bill (though there could end up being some annual caps, but I hope not).

(3) No, you can't cheat: Obviously insurance companies are going to want to cheat at all of this. What is good news is that the exchanges will act as prudential purchasers (I covered this in the first health care post). This means the exchanges will not be a come one come all to insurers, but will be able to regulate who can join. If it seems that insurance companies are trying to get over, they can be kicked out. This not only is a good penalty, but provides a fiscal incentive to behave in the first place.

(4) Insurance companies really do want to have to compete with each other. In the status quo, they basically don't. Not only are there many geographical locations where there is only one or two insurance companies to choose from, but the insurance companies do everything in their power to remain opaque to the buyer. That means, in Braudelian terms, the insurance market isn't a market, it is an antimarket. Prices are not set by any market forces, but by command. There are a lot of things in the bill to change all of that. Not only will the exchanges have several insurers to choose from, but the information cost for finding out things about insurance companies will be lowered. We are talking about the amazon-ification of insurance purchasing, where you can find reviews from other people about goods and services. Also, insurance companies will be forced to post information online in ways that are accessible to purchasers.

(5) Competition from non-profit insurers: As I've said elsewhere, several systems in the world don't depend on competition from a public insurance option, but from competition between non-profit and for-profit private insurance companies. In every exchange there will be at least one non-profit private insurance company.

(6) Actually have to spend money on medical care: 85% of every premium dollar has to be spent on medical care, or they have to cut you a rebate check. (In some cases only 80%, but those will the minority cases, not the majority). This is pretty huge in and of itself.

So, let's recap. Currently we have a system where insurance companies don't have to take you if you are sick, and they come up with ways not to pay for your medical care if get sick. They are able to insulate themselves from market pressures, and can use your premium dollars for anything they damn well please. And there is zero fiscal reasons or market reasons for insurance companies not to act as evil as they can. Indeed, all the pressure goes in the opposite direction. All of this changes under the health care bill being considered. That doesn't sound like a great deal, even with a larger customer base, for the insurance companies to me. I'm sure they would prefer the status quo. And indeed, their recent behavior to fund a campaign against the health care bill that won't even include a public option means I'm probably right on this one. Now, does this mean the bill is only bad news for the insurance companies? No, it isn't. Does it go as far as I would like? Duh, of course not. But the status quo is much better for insurance companies and much, much worse for everyone one else.

However, I hear that things are not looking good in the (unofficial) conference. It looks like Democrats might not be able to overcome what Freud referred to as "the narcissism of minor differences."

Factory Farming and Health Care

This interview with Michael Pollan from The Daily Show reminded me of a post I meant to write before the holidays, following up on my last post about health care reform, but never got around to it. In it Pollan makes the argument that the reforms of the bill will make it so that insurance companies become more interested in your health, because future profits will come from that, not from figuring out more ways to deny you care or not even let you have insurance in the first place. In this, Pollan foresees a possible near future where big agriculture (mostly big corn) is taken on by big health insurance. And if you look at the lobbying of these organizations, it is pretty profound. The farm lobby donated $65 million during the 2008 election cycle, health care came in at $167 million, the second largest lobby organization around (the largest you ask? Why, that'd be finance with an easy win at $475 million). Now Pollan is mostly talking about things like high fructose corn syrup, which is certainly bad for you, but cheap sweetners have nothing on cheap animal products for our collective health.

One almost doesn't know where to begin. Well, at minimum diets high in animal products are the number one causes behind heart diseases, cancers, and strokes. It is also estimated that there are 76 million cases of food borne illnesses a year in America, almost all of which are caused by factory farming. Furthermore working in a slaughterhouse is still the number one profession for on job injuries, including the number one cause of chronic injuries. None of this covers the severe and often chronic conditions that the pollutions from factory farms give to the people that work on them and live around them. To give one example, children raised next to factory farms have asthma rates exceeding 50 percent, and children raised near factory farms are still twice as likely to get asthma as other children. Meanwhile factory farms basically serve as laboratories for ever deadlier flus and bacteria infections while at the same time destroying the ability of medicines to effectively treat those viruses and infections through use of antibiotics for non-medicinal purposes.

Health care costs are rising faster than the GDP in most countries, particularly fast in the US. There are lots of reasons for this; pay for service systems, an increased technological medicine, the costs of medical schools and the high costs of physician payments, the intense costs of end of life care, etc; but one of the reasons is we are simply sicker. You can not give a fuck about the lives and well-being of other animals, and still realize that we absolutely have to take a stand against factory farming. There are absurdly high costs to cheap meat and cheap animal products. People are getting sick, people are dying, we are destroying the planet, and bankrupting the country so someone can get a cheeseburger for two bucks (or however much they cost). We could do more for health care and national health care cost control than the most liberal utopian single-payer system if tomorrow we banned factory farms. Hell, even if we just effectively regulated them and stopped the government subsidies.

The health care bill that is coming out means that some of those externalized costs by factory farms get paid collectively. It means that not only insurance companies, but to some degree all of us become slightly more invested in the health and well-being of each other. In a rational world that would probably mean we turn against factory farming, but in the world we live in it will probably mean more broadsides against cheap sugar rather than against cheap meat (not that it's an either/or situation).

Health Care Reform

I mostly stay away from talking about policy discussions on this blog (at least policy discussions that doesn't concern other animals). But this post isn't going to involve either a discussion of theory or animal rights. Rather, it is concerned with the current health care reform debate raging on in the US.

And before I get much further into this discussion, I want to address my radicalism with my desire to see health care reform pass. I do not believe that important social transformation will occur within the state, or within the interests of capital. Those who want to see a 'fundamental' shift health care reform will actually be more disappointed and disillusioned than I am. This also, I think, shifts how I judge a bill. I do not weigh the present bill against a fictitious 'ideal' and then if it gets too far away from this platonic wet dream declare the present bill a failure and a fraud and not worth passing. Such a mindset seems utterly absurd to me. Especially coming from a crowd that until a few years ago were proudly calling themselves a reality based community. Instead, I compare the bill against the status quo. If the bill does a net good, we should probably pass it. A net bad, we probably should be opposed to it. From this criteria of comparing the senate bill to the status quo, not only does it do a net good, it is an exciting bill. So, I want to talk about some of the cool and interesting things about the health care bill that no one seems to want to talk about, and then I want to address some of the concerns that some liberals have regarding the health care bill.

(1) Long term, we are going to have to bend the curve of the cost. Otherwise, the whole thing falls apart. The major way this is going to happen, long term, is going to be changing the delivery system of health care. Right now health care in this country is a pay for service system. That means doctors and hospitals are reimbursed for specific services, aka procedures and tests. They get paid for what they do onto you, not for what they do with you. And not for smartly figuring out what is wrong. These tests have costs, both financially and physically. We have to move away from this system toward an integrated system (something like what is practiced in VA hospitals or the Mayo Clinic, for examples). We know this, but what we don't know is exactly how to change reimbursements on a large scale to make this happen. We have a lot of ideas, but very little data. What the senate bill contains is a wealth of pilot projects, funding for studies, and the mechanisms to gather the data from these projects and studies. It also contains mechanisms that allow programs deemed successful (both medically and financially) to be fast tracked for larger structural reform in medicare. This is huge. Systematic costs from a pay for service organization are hurting medical systems from all around the world. We have to face this, both for better medical outcomes and also for financial reasons. This bill puts us in the right direction to start dealing with these concerns long term.

(2) The bill also contains a lot of funding for data gathering and distributing for best practices for doctors. This is important, because there is very little out there that really centralizes what are considered best medical practices. But essentially a google brain for doctors is going to be built. This will likely save many lives, and will also improve the quality of care and treatment patients have.

(3) A compromise that will likely pass will be the implementation of national private non-profit insurers set up by the Office of Personnel Management. The details are not fully known, but this is important. The important part of the weakened public option was never the public part, but the non-profit part. Several health care systems with great results (Germany, Japan, etc) depend primarily on private non-profit insurers. I would love a system in which for profit private insurers, private non-profit insurers, and public non-profit insurers all competed against each other. But the system without the governmental insurers will still be a pretty good system.

(4) The senate bill also contains a provision that will require congress and all the staffers etc in congress to join the exchange. This is important because it directly means that Congress is invested in making sure the exchange is strong and competently working.

(5) Prudential purchasing power. One of Howard Dean's many factual errors in his recent op-ed against the health care bill is his claim that it doesn't have prudential purchasing power. He's just wrong, it does. Specifically what this means is that the exchange will not be a come one come all to insurers. There will be regulators who will get to decide what insurers get to be part of the exchange (and all of that potential money) and which ones don't. So, for example, if you decide to jack up your premiums in the exchange you have to submit that proposal to the regulators and publicly post the information on your website. The regulators can decide to bar you from the exchange for those practices. They can also bar you if they feel you are engaging in behaviors that discriminate against people who need health care, or are in anyway trying to rig the system to create more healthy people under your insurance system than people with chronic conditions.

(6) The senate bill also includes a series of regulations that make sure the people that need health care the most can get it, viz. abolishing annual and lifetime caps, banning discrimination based on pre-existing conditions, making sure premiums are collective rather than individualistic so you can't jack them up on particular individuals out of the market (some allowances are made here for smoking and age, but even those are fairly strongly regulated), caps on out of pocket expenses, making sure that all insurance products will cover certain things so that people are not routinely underinsured, and quite a few other regulations.

(7) The individual mandate is one of the keys to all of this. If you remember back to the primary, you might remember Paul Krugman siding with Hillary Clinton on the individual mandate over Barack Obama. Why? Because the economics are solid and crystal clear: the individual mandate is necessary if you want the exchange to work. Here is a short blog post from an economist on why the mandate is necessary. To make it even shorter, if only sick people are in the exchanges, then insurance prices skyrocket because the risk pool becomes too high for insurers. This is both how the model works out theoretically, and empirically. Furthermore, as Ezra Klein has remarked several times, the individual mandate makes everything in the exchange a public policy question. It means that things like keeping premiums lower will have a strong voter support, which otherwise could be lacking and allow insurance special interests to continue to rig the system in destructive ways. Being opposed to the individual mandate guts the only mechanism for providing health care insurance outside of an employer based system. Which means if you are opposed to the employer based system and believe the bill doesn't do enough on that front, being opposed to the individual mandate is plain incoherent. It dooms the exchange to failure, which means we cannot shift to an non-employer based system in the future (which is again, something we all want). Now, obviously there is a price concern with all of this. However, not only are there certain exceptions put into the individual mandate, but there are subsidies to help people pay for insurance. Which means the individual mandate also operates primarily as a progressive tax, the poorest will pay the least and get the most amount of help to pay, etc. This means that health care costs will stay below 10 percent of someone's income (and usually much more than under 10 percent).

(8) We currently have 46 million people uninsured in this country (that is roughly one is six). And uninsured people, among other problems, are more likely to die. The current estimate is that about 25 thousand people probably died because they didn't have insurance this year, alone. Medical bills are the number one cause of bankruptcy in this country, in 2007 62% of all bankruptcies were due to medical bills. While neither of these problems will be fully solved, both of them will be significantly reduced. I am dumbfounded how anyone on the left can be callous enough to not face these facts and want to do something about them. And yet it seems many people on the left hate insurance companies more than they care about those folks who are need.

(9) Obviously, the senate bill is far from perfect. But if we look at the history of some of our most important progressive bills, like social security or the Civil Rights Act, the original bill was not particularly great. However, by making things into necessary issues of public policy and laying down an infrastructure, they got better. These are the important elements we need in the original healthcare bill. Because the alternative has been everytime health care reform has been purposed, it has gotten less ambitious. Progressive victories mean that future structures have a chance of being improved in ambitious ways, meanwhile failure simply means that the next time around everyone dials down expectations.

(10) Right now we have a strange world where Howard Dean and Sarah Palin, Keith Oblermann and Glenn Beck, Markos Moulitsas and the 'fine folks' of National Review's The Corner are all in agreement: Kill the bill! This makes no sense to me, both sets of people cannot be correct on this one. Also, look at the objections from the left's bill killers. There are complaints about the political process, hatreds of the sith lord from Connecticut, feeling let down and betrayed by Obama, and things they wish were in the bill. What is missing? Policy objections. Or at least, policy objections that exist in reality instead of the land of death panels. Meanwhile, if you look at Ezra Klein, Jay Rockefeller, Kevin Drum, etc you see a concern for the policy implications of the bill. I don't understand how feeling disillusioned with the president translates into the bill being not worth passing. Also, this means we are not having discussions that could make the bill better, like the need to raise subsidies and lower the cap on out of pocket expenses.



If there is anything I can do to respond to questions I will. But if you care about progressive legislation, I have trouble understanding being opposed to health care reform as it stands.