My cardiologist has a patient who's

    chief of staff for a well known  Congressman  . Told him  she supported Obama and wanted to root for Obamacare , and had read the bill.

     And couldn't understand it.,

    He replied, neither could he.

    Maybe the problem is not that Obamacare  does  have  a mandate or doesn't have a public option. Or whatever. It's that it doesn't have  an actual plan. 

    The knock on Hillarycare had been  that Ira Magaziner and HIllary  went off by themselves , designed a plan without the benefit of advice from Congress and therefore it failed.

    Obamacare seems to have reversed the process. At least as reported, it seemed  the drafters  stapled  together any proposal  from any legislator who would  vote for it ( and some who wouldn't)and called that the bill.. AOBTW , it passed

     And we're stuck with it.

    So what's to be done?

    For starters, not replacing it with Boehnercare .We cried for whips oh Lord and you sent us scourges..

    We can try and fix it, But only if it exists.

    Sure  we could  go back to the drawing board and design a better one. With every bell and whistle. Probably look like Hillarycare. And certainly suffer the same fate in next year's House..

    Or we could fix the things that are easy to fix.Like  renovating a faded hotel: a better neon sign, clean rug in the lobby , new cocktail lounge.

    Or do nothing.

    The House of Lords throughout the War

    Did nothing in particular

    And did it very well

     Democratic majorities come. And  go . And  come again..So we could  get whatever benefit we can out of Obamacare as is, where is. And in 2016 we fix it.Think of all the papers ground out by think tanks in the interim! Some of them might be worth reading.

    But if we let this puppy die there'll certainly not be a replacement in my life time.Probably not in yours.

    Comments

    You know, I keep hearing this.  I keep hearing from folks (like my mother, for one) who say, "My doctor [knows someone who] has read the entire bill and there are all these things in it that no one knows about, or can't explain..."

    It almost makes me think none of us will know what is in the bill in its entirety until 2014.  I seem to recall a PDF file somewhere that several people put together that has every word of the entire bill in it put into searchable mode.  Was it Erica at TPM who shared it with us earlier this year?  I can't remember now...but, to be honest, I'd love to know every provision in it myself.


    I just want to be able to get my prescriptions filled.


    I really did read the whole thing ... I think I did every version but the final markup (by that point, why bother). I wouldn't characterize it the way you have exactly. It sure wasn't perfect but the product that came out of the House was workable ... I would characterize that product the way you are viewing what we ended up with. It was even decent out of the Senate HELP. Equally important (in terms of indignation over lameness) - between the two chambers they got EVERYTHING they needed to merge into a perfect final bill that would only need an up/down vote in reconciliation ... if that was what they wanted to do. They gave Obama every piece he needed to decisively win ... had he wanted to pull the trigger.

    And it was a fair compromise. Folks like me gave in on mandates in exchange for the cost controls of the national exchange and public option (getting caught up in an absurd feeling of good will). Folks like Hamsher relented on Single Payer and fell right in line fighting for the Public Option which Obama promised them he would certainly pass - if only they weren't unreasonable and stuck with the team. The corporatists got their mandate (which Obama had campaigned against - corralling many independent votes like mine). And Democrats who don't really give a damn what their team does as long as everyone's loyal got a bunch of happy campers to fill their nice big tent. Everyone gave and everyone got. It is a much broader coalition than just some "professional left". It was a true centrist compromise. Clunky but not terrible.

    The bill was (is) not that hard to understand once you get into the flow of cross-referencing the bits that refer to other sections. And people have done really thorough breakdowns of the math ... which largely match what I found. They've done expose' after expose' of why the insurance industry did what it did - and how AT&T already has plans to save $4 billion annually by taking the penalty hit and just dumping their employees into the subsidized market. I don't dislike it because it gives me some sort gratification to hate on Obama. I genuinely believe we're screwed.

    In my mind, for the Democrats It's not a question of "having a starting place" anymore. That was the self-justification for passing crap in the first place - so that ship's already in the water. It is now a matter of having a responsibility to follow through with the promises Democrats made when they were telling everyone to STFU - and actually make it better and fix the damn thing before it consumes us.

    Now you are talking about not even trying to do a thing until 2016?!? That's more than a half-decade away. See, this is why a lot of us told the people claiming "Oh no, really! We'll start working RIGHT AWAY to make it better." they were full of shit. And you are right of course we'll honestly be lucky if Democrats (or the new GOP administration) move on it even that quickly.

    Until the Democrats fix some of the seriously dangerous situations created by the legislation, we are ALL better off having *someone* win in the fight against mandates. First corporate-unfriendly thing those pieces of elephant-dung have done in three decades; I say more power to 'em. If someone knocks those out I will become more a supporter of the thing. Democrats should think about that as you knee-jerk equate losing the mandates to losing all the reforms. It is very possible that the outcome could be a net electoral benefit by eliminating a serious source of friction between Democrats and the voters.


    God, but I hate it when you're right.  Seriously, though, thanks KGB for having read through it.  Can you recall who it was that created the PDF versions with searches?  I could swear it was "Erica"...I'd love to find those links again, if you know where to find them.


    Breaking off one leg of a stool usually upsets the whole stool. I don't see how the mandate is severable (not in the legal sense) from the rest of the reforms, including the real lynch pin: cost control. Without the mandates, the coverage pool averages much older and much more expensive per unit of care delivered.


    First congratulations on knowing what you're talking about.

    For understanding, what caused the "clunky but terrible" draft to change into "crap"?. From the reference to Jane Hamsher I infer the  CBT  still had the public option which suffered crib death  later on.

    I've had  a fair amount of exposure to National Health systems for various reasons  including  that there's usually been some member  of my family  in the UK for the last 30 years.

    Of course it works despite Maggie's best efforts.  Say what you will about Blair and Brown the infamous 2 year UK  waiting lists which we heard about endlessly from shock radio simply required a government that didn't want to have 2 year waiting lists. 

    The UK system where a doc is part of the public option on Monday and sees private patients on Tuesday was a key concession from Nye Bevan to the medical establishment and maybe illustrates the difference between designing a Health Plan and having one emerge from  435 congressmen with staple guns. 

    Bevan spent 18 months in negotiation with the docs , who initially hated his guts.When he died 15 years later the pages overflowed with testaments from his most bitter former  opponents....

     


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