Aww, look at the corrupt puppets of the establishment try and convince us we're not getting raped in the ass here.

Shut the fuck up, Goldstein. There is clearly nothing you think is worth holding on to, and you need to stop pretending that you're a progressive.

If you don't stand for the public option, you're not a fucking progressive, so stop running your mouth pretending to be one.

That is uncalled for. Don't trash talk one of the best progressive journalists around just because she is trying to make the best of a bad situation.

The fact of the matter is that while the public option is important there are plenty of other aspects of healthcare reform that progressives need to hold on to. We can't look at this as an all or nothing issue. As Alinsky said (roughly) if we can get 18% of what we want on an issue, its better than getting nothing. And the way our reactionary political system works it is a lot harder for the left to get much more than 18% of what we want than the loons on the right.

I agree with redflagflies that name-calling is wrong and doesn't solve anything. And I agree with RFF and Dana when they hope that useful things will be salvaged either explicitly or implicitly in exchange for the cave-in on a public option. But the record of this administration of compromise and retreat on the stimulus, financial reform, and cramdowns doesn't leave me very hopeful. Happy to be proved wrong by a new-found profile in courage struck by the president, but not betting on it.

Please calm down & stop cussin', soullite.

FWIW, here's what i'd consider to be a fair trade in exchange for dropping the public option:
(1) National exchanges with strong requirements for community rating, transparency & consumer protection.
(2) All exchanges must allow the choice of buying into Medicare, or your state Medicaid program (if it meets the exchange's minimum coverage requirements) on an equal footing w/ any private plan (i.e. no subsidies beyond what you'd qualify for anyway).
(3) Sen. Wyden's Free Choice amendment that lets individuals avail themselves of the options available through the exchanges, whether or not their employer participates in them.
(4) A Federal guarantee of valid health insurance claims above $25,000 per person in any given year, but only for insurance that's purchased through the exchanges (with a requirement that at least half the resulting savings are passed on to consumers through lower premiums). This would provide a strong incentive for insurers & employers to get in rather than holding out, and together w/ the Free Choice amendment offers a tangible benefit from health reform for people who don't think they want to change what they've got.

I don't think extending Medicaid w/ a higher income cut-off is a good trade for a variety of reasons, which all stem from the limitations of Medicaid as a state-based safety-net program.

I'm also inclined to think it's more important in the long run to negotiate for a higher minimum standard of benefits & coverage (which, once they're set, would be hard to reduce) than more generous subsidies (which can and will be ratcheted back if the costs get too high) - i think the trick is to set up a structure in which the cost containment pressure, when i comes, gets applied to squeezing inflated prices & unnecessary care rather than cutting people off and/or shifting costs from the govt to individuals.

So if the public option will almost certainly be bargained away, the question then becomes: What health reform goals should progressives hold absolutely fast to, as the ground shifts?

me senses a listserv breakfast topic?

echoing the disdain for soullite's language though

Euthanasia is the best thing that could happen to this health insurance "reform". At the end of the day, the only "benefit" to the American people is a MANDATE to purchase a faulty product from a for-profit company. The result will be even more of our hard-earned dollars flowing to the pockets of big pharma and big insurance.

"progressive journalists making the best of a bad situiation"... Holy shit. Is that ..ok??
@soullite: sorry, been on vaca.. did the progressive movement get pistol-whipped??
And when do you get at Rahm with some of that??
And everyone else, when the fuck is it ok to ask wtf??

So if the public option will almost certainly be bargained away, the question then becomes: What health reform goals should progressives hold absolutely fast to, as the ground shifts

The more I think of this question, the more laughable it becomes. Progressives can "hold absolutely fast" to anything they want; as has been evidenced, there is no real consequence.

It's time to recognize progressive arguments as little more than the wishlists they are.

One danger of national coops is a race to the bottom in services offered. Remember that one proposal of the right is to defang state regulations requiring that, for example, contraceptive services be included in any insurance offered. They'd like an insurer based in Mississippi to be able to offer insurance in California. National coops would run into this question immediately, and it could have the effect of devaluing many hard-fought gains in liberal states.

"I wrecked the Chevy you gave me two years ago, and I wrecked the Ford you bought for me last year. Dad, it is only reasonable that you buy me a Rolls-Royce."

The government has done such a wonderful job at health care in the Veteran's Administration, and such an efficient management of Medicare. It is only reasonable that we have a public option - if not a single-payer system!

Good List DG.
It is what reform is all about.
The cost issue is the elephant in the room however.

Please do not allow dirty mouthed children(comment 1)to post, it is insulting to adult readers.

I am bloody sick of pundits and commentators who START from the limits of the possible and then bargain down.

We need the President to forthrightly state that health care is a human right for residents of the richest country on earth. How complicated is that? And then designs a program to get that and fights for it.

Instead, we have political leaders who look at the opposition and start giving away the high ground by refusing to point out that the right's reluctance to enact health care is simply MURDER.

Give them some of their own medicine and I'll believe you care about enacting health care reform. Otherwise, this is just a dishonest charade among charlatans, designed to engage the plebes in theatrics signifying nothing.

What fraction of "medical-related bankruptcies" can be attributed to people running up against lifetime insurance caps? My sense is that it represents a small fraction of the total.

Participation in a national Health Insurance Exchange requires a national presence. That would make the barriers to entry into the market tremendous and therefore limit competition. What we need is adequate pooling of sufficient size for risk norming. Even that need could be moderated with some sort of reinsurance for catastrophic health incidence as a way to spread risk. The advantage to facilitating workable smaller pooling structures is that it also facilitates the creation of health providing/insuring organizations that use salaried health professionals instead of billing for procedure-reimbursement models. These have been shown to be some of the most efficient and best healthcare models. Non-profits and non-profits co-ops versions of this model are viable options but probably not if they have to become national entities to even get in the game.

If you plan to spend what would be large amount of taxpayer money to provide health insurance to those who broke our immigration laws that you intend to reward with legal residence, then you ought to include those costs in a way that accurately represents them. In fact the whole ten-year window for cost estimates should be replaced with one that represents some sort of full implementation so that the timing of costs and revenues doesn't distort getting a good estimate of the ultimate costs embodies in any legislation.

The subsidies need to be constructed in a rational way and within budget constraints. There should be smooth transitions, avoiding the qualification cliffs that can result in what amounts to massive effective tax rates. If that means the subsidies have to be less and people have to pay more, so be it. In fact insulating people from the outrageous cost of healthcare makes it more difficult to push through changes necessary to control costs. If it's not their money, people don't care.

I'm taking for granted here that reform is still likely to prevent insurance companies from denying coverage due to pre-exisitng conditions, and that any legislation will do away with the practice of capping a policy-holder's lifetime health spending, which has contributed to shameful rates of health-related personal bankruptcy.

Why are you taking any of this for granted? How about asking some of your Blue Dog Democrats and Republican Congresspeople:

1.) Will you insist that health care reform prevent insurance companies from denying coverage due to pre-exisitng conditions?

2.) Will you guarantee that health care reform will do away with the practice of capping a policy-holder's lifetime health spending?

And while we're at it:

3.)Will you guarantee that no one will lose their coverage because they lose their job?

3.)Will you guarantee that no one will be denied their health care because they get ill?

4.) Will you guarantee that people will no longer lose or be denied coverage based on age?

Has any Republican or Blue Dog publicly agreed to those terms? Has Max Baucus?

In fact, it seems obvious that most Republicans disagree with those conditions outright. Their objective is to kill reform and then, none of these elements will become law.

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