Nation-Building

And there it is - officially the law of the land: Television networks actually broke their daytime coverage to show the historic signing . Vice President Biden is reputed to have added, "This is a big f$%king deal" - seriously ! (no s^!t, Joe.) There was a moment yesterday of well-deserved recognition for Speaker Pelosi, who has cemented her place in the ranks of the greatest Speakers of the House in history: And the Republicans held a press conference of their own today: heh. Also, The Republicans have officially introduced legislation to repeal the health reform. That legislation reads, in full, Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. REPEAL OF PPACA. Effective as of the enactment of the Patient Protection and Affordable Care Act, such Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted. Dante at Daily Kos sum...

Conservative opponents to health reform have been pushing a recent poll ostenibly conducted by the New England Journal of Medicine which claims that doctors are indeed opposed to health reform. This even got play on Fox News by Bill O'Reilly a couple days ago: This seems to contradict an earlier poll by NEJM that found that doctors actually did support health care reform , including both public and private options, by an overwhelming majority of 69%. In fact, that NEJM poll found that support dropped to only 27% when the public option was removedn and only private options remained. So what's the deal with this new NEJM poll? Well, as it turns out, it wasn't actually by NEJM - but rather by a physician recruitment firm, The Medicus Firm, and published in Recruiting Physicians Today , a free advertiser newsletter dedicated to physician employment headhunting. NEJM strongly distanced itself from any affiliation with this poll: Media Matters for America contacted the New Engla...

The public option is almost assuredly not going to be in the final package for health reform, and that's a good thing because it's existence imperils passage of this historic and incredibly progressive legislation . It represents a huge - and long overdue - leftwards shift for American social policy, despite the public option's absence. And note again that the PO would not have been available to everyone anyway, so how progressive was it really? The ultimate progressive health reform would have been single-payer insurance, but that was taken off the table (with good reason) by President Obama. However, since Medicare is already a single-payer system, it's possible to leverage that existing system for creating a "single payer option" which would not be as disruptive as true single payer, would provide a more genuinely public option than the public option, and possibly even help reduce structural deficits. That would simply be to allow people under age 65 to ...

Have you ever had COBRA health insurance coverage? It's the stopgap insurance coverage you get after you leave a job, intended to fill the gap in your coverage until you find a new job (and doesn't last forever, which is why extended unemployment still leaves people uninsured. This in a nutshell why single-payer/Medicare for all is a better system than our employer-provided insurance model, and why since we are stuck with employer-provided insurance, why we need universal insurance coverage reform.) As NPR - exclusively - reminded us today , the "R" in COBRA stands for none other than budget reconciliation, the very process currently being painted as a "nuclear option" by establishment Republicans desperate to stop the health reform train. In fact, as it turns out, budget reconciliation has a long history of being used for health care legislation : health care and reconciliation actually have a lengthy history. "In fact, the way in which virtually all o...

There's an alarmist poll out from Investors Business Daily that makes the shocking claim that almost half (46%) of America's doctors will quit under Obama's proposed health care reform plan. The implications of such a finding - which runs counter to the American Medical Association's own support of President Obama for reform - are that one result of reform would be that America's doctors would revolt. But does this poll make any sense? It turns out that the poll was a mail-in questionaire, not the usual phone-based poll. This is important because of selection bias; doctors who are predisposed to feeling threatened by proposed health care legislation will be more likely to respond. Also, mail-in responses tend to be skewed towards older repsondents, who also are more likely to be skeptical, or at least more willing to retire. The poll itself was terribly written; one of the questions read, "Do you believe the government can cover 47 million more people and it ...

I've been reading Tyler Cowen , Ezra Klein , and the League on the matter of the Baucus bill and am frankly bothered by the way in which progressives seem to be losing sight of the main goal of health care: to bring affordable coverage to 100% of all Americans. This is a goal that the vaunted public options does exactly zero to achieve, and it strikes me might actually be undermining these basic principles instead. It should be noted, again, that the public option would only be available to a small fraction of citizens who are either ineligible or unable to afford private insurance. So the scope of the public option is limited to begin with, and certainly will be constrained so heavily that it will never, ever be the stealth road to single-payer that most of the progressives who are intent on making it a litmus test seem to think it will. The problem is that the bipartisanship-obsessed reformers like Baucus are trying to trim the overall bill's cost below arbitrary limits as ...

After making an exhaustive case for the argument that the problem with American healthcare is not a lack of money, but a system whereby doctors are incentivised to overtreat patients rather than manage their long term health care, Philip Longman of the Washington Monthly reveals a solution that lies right under our noses. A solution that no one on the Democratic Presidential stump seems to be talking about. The cure to America’s health care crisis is a system that’s already up and running right here in the United States, with facilities in every state, plus the District of Columbia and Puerto Rico. It is, in fact, the largest integrated health care system in the United States, and it points the way to the future. Most of its doctors have faculty appointments with academic hospitals—over the years, two have won the Nobel Prize for medicine. The system’s innovations have included the development of the first artificial kidney, the cardiac pacemaker, the first successful liver transplant...