Krugman: "History is about to be made — and everyone has to decide which side they’re on."

[ProSense]

The Defining Moment

By PAUL KRUGMAN
Published: October 29, 2009

O.K., folks, this is it. It’s the defining moment for health care reform.

Past efforts to give Americans what citizens of every other advanced nation already have — guaranteed access to essential care — have ended not with a bang, but with a whimper, usually dying in committee without ever making it to a vote.

But this time, broadly similar health-care bills have made it through multiple committees in both houses of Congress. And on Thursday, Nancy Pelosi, the speaker of the House, unveiled the legislation that she will send to the House floor, where it will almost surely pass. It’s not a perfect bill, by a long shot, but it’s a much stronger bill than almost anyone expected to emerge even a few weeks ago. And it would lead to near-universal coverage.

As a result, everyone in the political class — by which I mean politicians, people in the news media, and so on, basically whoever is in a position to influence the final stage of this legislative marathon — now has to make a choice. The seemingly impossible dream of fundamental health reform is just a few steps away from becoming reality, and each player has to decide whether he or she is going to help it across the finish line or stand in its way.

For conservatives, of course, it’s an easy decision: They don’t want Americans to have universal coverage, and they don’t want President Obama to succeed.

For progressives, it’s a slightly more difficult decision: They want universal care, and they want the president to succeed — but the proposed legislation falls far short of their ideal. There are still some reform advocates who won’t accept anything short of a full transition to Medicare for all as opposed to a hybrid, compromise system that relies heavily on private insurers. And even those who have reconciled themselves to the political realities are disappointed that the bill doesn’t include a “strong” public option, with payment rates linked to those set by Medicare.

But the bill does include a “medium-strength” public option, in which the public plan would negotiate payment rates — defying the predictions of pundits who have repeatedly declared any kind of public-option plan dead. It also includes more generous subsidies than expected, making it easier for lower-income families to afford coverage. And according to Congressional Budget Office estimates, almost everyone — 96 percent of legal residents too young to receive Medicare — would get health insurance.

So should progressives get behind this plan? Yes. And they probably will.

<...>

For this is the moment of truth. The political environment is as favorable for reform as it’s likely to get. The legislation on the table isn’t perfect, but it’s as good as anyone could reasonably have expected. History is about to be made — and everyone has to decide which side they’re on.

[Cha]

1. As Dean says.."It's a good start" and

Dean is also adamant that it gets enrollment before 2010 so Americans can see it's WORKING.

[John Q. Citizen]

8. Dean is adament? Oh well then. Wait. i thought he was adamant about a strong public option? Not

that adamant I guess, eh?

Do you have proof that Dean is adamant? Because without proof, why should I believe a syllable?


Just wondering.

[BklnDem75]

14. Funny how proof is needed for Dean...

But for Obama, any ole unnamed source will do.

[John Q. Citizen]

15. Funny ha ha or funny weird and Halloweenie?

(cue either laugh track, or cue clanking chains and squeaking door)

[BklnDem75]

18. Funny strange

and I prefer the dancing thriller zombies

[Cha]

16. Don't believe it.

[John Q. Citizen]

17. I'll have to think about it. I mean he said the public option was non-negotiable, now he's willing

to negotiate on it.

I'm thinking Dems, wishy washy as ever. No backbone, won't ever go to the mat with their regressive wing ever. Roll over and take it without the vasoline and say, "I know he really loves me, he just can't show it when I burn the toast."


Very inspiring.

No wonder the left loses on everything every time. And then you say adamant.

I wouldn't call that adamant. Unless you have proof. Cause anybody can post anything on the internet.

[BrklynLiberal]

2. I respect Mr. Krugman very much. His opinion can influence me.

however...I will not make a judgment on the House Bill. I am going to wait to see what comes out of the House/Senate bargaining.

I am disappointed with the House bill...but could live with it for a while if the Senate does not totally castrate it.

[Hekate]

3. Howard Dean and Paul Krugman both have my respect. I am cautiously optimistic....

... that progress is being made.

Hekate

[Mojambo]

4. This legislation is good enough to keep me from urging my reps to vote against it

But it's not good enough that I will actively encourage for its passage either.

I'm kinda "meh" on the whole thing I guess.

[SKKY]

5. I know what we're getting, and I know what we want...

...for some reason, this seems like a win for the Republicans to me. Lindsey Graham said, during the Soto-mayor confirmation, that "...elections matter." And I agree with him. So, why are we settling? We should get Medicare Part E, and if that means going through reconciliation, then so be it. I don't understand the insistance on bipartisanship.

[benny05]

6. Most of the time, I agree with him

This is one time I don't. I'm very disappointed, and maybe he is masking his own disappointment in this particular column.

It's not much better than it is now. And prescription drugs aren't dealt with at all.

[eridani]

7. This is not universal coverage

It is baldfaced theft, a holdup giving my money to the same people who ratain the right to deny care.

[John Q. Citizen]

9. Yes, it provides the criminal class with a trillion in tax dollars a decade and much more in

unfunded mandates.

It's actually Romney Care.

Are we supposed to believe that Romney Care is historic?


I'm sorry, I think Romney Care is a bad idea. It's not working, it's caused the cost of insurance in MA to skyrocket, and peoples benefits are being cut.

Why on earth would we want it for the whole country. We didn't want Romney, why would we want his signature program?


And now that Pelosi has aborted the Kucinich Amendment which would have allowed a state to set up hier own single payer system, what is left in there to be in favor of?

I oppose funding private insurance companies with tax dollars.

I oppose forcing people to buy products from private insurance companies.

[eridani]

10. Some European countries have mandated private insurance

However, that works only because the government dictates price and coverage ranges. That's why in the Netherlands adults pay only 100 euros/month with NO age rating, HO deductibles and NO copays.

[John Q. Citizen]

12. Yes, they are run as quasi public entities, with prices controlled and

products and procedures overseen by government regulators.

That's not going to happen here. Here we can't make any move to stop the rapacious and criminal behavior of an exalted health insurance company without paying out a trillion dollars in bribes to the crime lords.

It's obscene.

Everyone taking that money from those scum should be arrested, kicked out of congress, and put in jail.

Anywhere or anytime else it would be called bribery, since that's exactly what it is.

[Sirveri]

19. This bill caps per person costs.

The real question is how those caps are derived, but for the individual cost is capped at 12% of income for premiums, and that rate only applies at 400% above the Federal Poverty Limit (FPL). It also caps annual costs at 5k(single)/10k(family), those also are tiered to 400+% FPL. At 133%-150% FPL the maximum premium rate is capped at 1.5-3% and 500/1000 for annual expenses. The penalty for not buying into the system is 2.5%.

The real question is how these caps are maintained, is the excess premium surcharge picked up by the government, or do they force the health insurance companies to eat it. It wouldn't surprise me to learn that it's a back door feeding frenzy for the health insurance companies. But at least it also protects the common worker.

I did a fairly lengthy dissection of the bill here:
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6888775&mesg_id=6888775

But nobody bothered to read it.

[eridani]

20. 12% is an absolute outrage, IMO

Single payer would have a 4.75% tax.

[Sirveri]

25. 12% is the absolute maximum. You need to compare to FPL.

Run the FPL levels. While I agree with you in principle that 12% is still a bit too high, that isn't my current ultimate issue with it. My issue is that the FPL is flat across the lower 48, meaning that people living in higher cost of living areas will end up paying more for health insurance than people living in low cost areas. 40k for a single person in SF is almost nothing, 40k for a single person in middle of nowhere Kansas is more than enough to afford the 12% cap.

[tinrobot]

24. Doing some math... it's not that bad, actually.

Federal poverty for one person is $10,830. 400% of that is $43,320

-- Someone who makes $43,320 would pay $5198/yr or $433/mo max
-- Someone who makes $60,000 would pay $7,200/yr or $600/mo max
-- Someone who makes $80,000 would pay $9,600/yr or $800/mo max
-- Someone who makes $100,000 would pay $12,000/yr or $1000/mo max

...and so on, basically it's 1% of your yearly income per month. Over $43,320, take two zeros off last years 1040 to determine your payment. For families, the FPL would be higher and the corresponding rates lower.

At first glance, I think "Damn, that's a lot, I can't afford that!" After I settle down, I realize that those numbers are maximums. The real number could easily be less if you're healthy or want to defer costs with some sort of copay (up to the cap, of course.)

As for the maximums, if I had a pre-existing condition and my life depended on insurance for medical care, I'd be jumping for joy to get rates like that. Right now, a pre-existing condition bad enough to deny coverage could easily be a bankruptcy or a death sentence. So, while it's not wonderful single payer nirvana, it will be better than what we have now.

I also like the $5K/10k cap. It means insurers can't bill you like crazy for stuff that wasn't "pre-approved" or whatever.

[JTFrog]

11. K&R

[Tom Rinaldo]

13. I am with Krugman on this

IF we can hold onto the progress contained in the current versions of the House and Senate bills. That is still far from certain. I will not back a trigger to nowhere.

[bunnysoft]

21. Krugman is a Very Awesome Economist when he praises Obama. But when he criticizes him...

The protests rain.

I believe he's always a Very Awesome Economist.

[HopeOverFear]

22. K & R

[lumberjack_jeff]

23. Dean and Krugman speak for me. n/t