Health Care Reform Passes, Pigs Fly

pig-flySo, the health care reform was passed last night owing to a bizarre compromise is which Bart Stupak persuaded President Obama to issue a meaningless executive order proclaiming that the law passed by both Houses of Congress says what Stupak has spent months pointing out it doesn’t say.

The basic facts, from NYT:

With the 219-to-212 vote, the House gave final approval to legislation passed by the Senate on Christmas Eve. Thirty-four Democrats joined Republicans in voting against the bill. The vote sent the measure to President Obama, whose yearlong push for the legislation has been the centerpiece of his agenda and a test of his political power.

After approving the bill, the House adopted a package of changes to it by a vote of 220 to 211. That package — agreed to in negotiations among House and Senate Democrats and the White House — now goes to the Senate for action as soon as this week. It would be the final step in a bitter legislative fight that has highlighted the nation’s deep partisan and ideological divisions.

[…]

After a year of combat and weeks of legislative brinksmanship, House Democrats and the White House clinched their victory only hours before the voting started on Sunday. They agreed to a deal with opponents of abortion rights within their party to reiterate in an executive order that federal money provided by the bill could not be used for abortions, securing for Democrats the final handful of votes they needed to assure passage.

[…]

The health care bill would require most Americans to have health insurance, would add 16 million people to the Medicaid rolls and would subsidize private coverage for low- and middle-income people, at a cost to the government of $938 billion over 10 years, the Congressional Budget Office said.

The bill would require many employers to offer coverage to employees or pay a penalty. Each state would set up a marketplace, or exchange, where consumers without such coverage could shop for insurance meeting federal standards.

The budget office estimates that the bill would provide coverage to 32 million uninsured people, but still leave 23 million uninsured in 2019. One-third of those remaining uninsured would be illegal immigrants.

The new costs, according to the budget office, would be more than offset by savings in Medicare and by new taxes and fees, including a tax on high-cost employer-sponsored health plans and a tax on the investment income of the most affluent Americans.

Actually, most of those savings depend on the kindness of future Congresses, a rather neat trick.

Politico summarizes the Stupak deal:

House Democrats moved toward a decisive series of votes on health reform Sunday night after a cadre of anti-abortion Democrats signed onto an agreement with the White House — finally putting the Democrats over the 216-vote threshold to pass President Barack Obama’s top legislative priority.

The announcement by Rep. Bart Stupak (D-Mich.) and a half-dozen colleagues came just after Obama said he will sign an executive order reaffirming a ban on federal funding of abortions.

[…]

Earlier in the day, Stupak (D-Mich.) told Democratic leaders that he would vote for the bill after receiving assurances that Obama will issue the order and that he would be able to state his concerns about abortion funding in the bill in a colloquy on the House floor before the vote. Later, Stupak and Waxman took to the floor to put into the record that the bill is meant to completely prevent the use of any federal dollars to pay for abortion.

Except, of course, that it isn’t.

At any rate, the immediate fallout of all this is that, for a day at least, pigs are flying :

  • The Obama Executive order (see Mark Ambinder for the text) amounts to a signing statement — yet another case of Obama adopting a practice he roundly criticized his predecessor for using.  It’s an Alice in Wonderland document stating that the law says what it doesn’t say.
  • NOW has issued a statement titled “President Obama Breaks Faith with Women.”

    The National Organization for Women is incensed that President Barack Obama agreed today to issue an executive order designed to appease a handful of anti-choice Democrats who have held up health care reform in an effort to restrict women’s access to abortion. Through this order, the president has announced he will lend the weight of his office and the entire executive branch to the anti-abortion measures included in the Senate bill, which the House is now prepared to pass.

    President Obama campaigned as a pro-choice president, but his actions today suggest that his commitment to reproductive health care is shaky at best. Contrary to language in the draft of the executive order and repeated assertions in the news, the Hyde Amendment is not settled law — it is an illegitimate tack-on to an annual must-pass appropriations bill.

  • Mark Steyn and Matt Yglesias agree, using almost precisely the same language, that, “If Barack Obama does nothing else in his term in office, this will make him one of the most consequential presidents in history. ”  (They differ substantially in how they interpret said legacy.)

Normally calm commentators are having uncharacteristically heated reactions to the proceedings.

Megan McArdle, who supported Obama’s election but opposed most of his campaign promises, thinks the chicanery used to get this bill past will be the norm from now on.

Regardless of what you think about health care, tomorrow we wake up in a different political world.

Parties have passed legislation before that wasn’t broadly publicly supported.  But the only substantial instances I can think of in America are budget bills and TARP–bills that the congressmen were basically forced to by emergencies in the markets.

One cannot help but admire Nancy Pelosi’s skill as a legislator.  But it’s also pretty worrying.  Are we now in a world where there is absolutely no recourse to the tyranny of the majority? Republicans and other opponents of the bill did their job on this; they persuaded the country that they didn’t want this bill.  And that mattered basically not at all.

[…]

What I hope is that the Democrats take a beating at the ballot box and rethink their contempt for those mouth-breathing illiterates in the electorate.  I hope Obama gets his wish to be a one-term president who passed health care.  Not because I think I will like his opponent–I very much doubt that I will support much of anything Obama’s opponent says.  But because politicians shouldn’t feel that the best route to electoral success is to lie to the voters, and then ignore them.

As someone who opposed Obama, it’s hard for me to blame him.  He campaigned on a massive overhaul of the health care system and got as much of it passed as he could.  From my perspective, this bill is far less damaging than one Obama would have wished for.  One could take him to task for the cynicism of the executive order — and, indeed, I do — but it’s hard to blame him for it after more than a year of fighting.

David Frum, in a post titled “Waterloo,” writes that “Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.”

It’s hard to exaggerate the magnitude of the disaster. Conservatives may cheer themselves that they’ll compensate for today’s expected vote with a big win in the November 2010 elections. But:

(1) It’s a good bet that conservatives are over-optimistic about November — by then the economy will have improved and the immediate goodies in the healthcare bill will be reaching key voting blocs.

(2) So what? Legislative majorities come and go. This healthcare bill is forever. A win in November is very poor compensation for this debacle now.

Frum’s partly right on the first point — I don’t see a 1994 style turnover, although I do see major GOP gains and most of the bill’s provisions don’t kick in until 2014 — but he’s almost certainly right on the second.  The bill’s unpopular on the whole but almost all of the parts Republicans object to will be hard to undo unless, as Megan suggests, they’re willing to go kamikaze to do it.

Still, Frum, NPR’s Mara Liason, and others who are comparing this to 1994 seem to miss one major fact:  Clinton was going for something much more fundamental than this — a single payer system.   Obama wanted that outcome as well but didn’t fight for it, knowing it was impossible.

That said, there’s a reason this fight took this long.

Passage of the bill represents the biggest change in domestic policy since the enactment of Medicare and Medicaid in 1965, says Sara Rosenbaum, who chairs the department of health policy at George Washington University. “We have now fundamentally transformed American society,” she says. “We have gone from assuming many people will not have insurance to expecting that people will have insurance.”

The $940 billion bill seeks to extend health coverage to most Americans. Medicaid, the federal-state program that provides health insurance to the poor and disabled, will be expanded to cover all adults earning less than 133 percent of the federal poverty level.

Private health insurance will be made available to individuals and small companies through exchanges that will be run by the states. Individuals who do not buy insurance face fines, as do most employers who do not offer coverage to workers.

Bill sponsors predict that all but about 5 percent of non-elderly Americans will ultimately be covered. Half of those currently uninsured will receive coverage through the expansion of Medicaid and half through private insurance through the exchanges — often with subsidies that make up the bulk of the legislation’s projected costs.

It’s massively expensive and the funding mechanisms are promises, not law.  Nor does it do much to address the most fundamental problem of our current system: the ticking time bomb of exploding costs colliding with an aging population.   But it’s a massive change in our system.

FILED UNDER: Congress, Health Care, US Politics, , , , , , , , , , , ,
James Joyner
About James Joyner
James Joyner is a Security Studies professor at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. Mike says:

    As much as I did not want to see this pass and as much as I think we waste too much gov’t money, it is time to raise taxes to pay for this thing (whatever it is). Spending money we do not have isn’t smart and we have been doing it for entirely too long.

  2. Stan says:

    Like the barking of the dog in the Sherlock Holmes story, the most significant thing in your post is something that isn’t there, a discussion of what HCR will accomplish. The bill will bring medical insurance to more then 30 million people and financial security to everybody who has health insurance now and can’t afford to lose it because of a pre-existing condition. The possibility that this is a good thing seems to be beyond your comprehension. Why this is so is beyond me.

  3. Pete says:

    For Mike and Stan: You guys are correct. Can’t wait to hear your comments in ten years, when the financial consequences of this legislation are being debated.

  4. Ottovbvs says:

    I’m a lapsed Republican who jumped ship about 14 years ago when I perceived the GOP was heading in the direction of craziness but I often drop by here because you Jim always have an insightful take on the state of play that leans Republican but is not off the wall. The reality is that the patchwork solution was the only solution given the patchwork nature of the US healthcare system. A complete makeover was not possible politically, economically or managerially but don’t kid yourself that now it’s passed that the implementers are not going to have their finger on the scales. You might not agree but they’re going to have plenty of time to do it because Obama absent a disaster over the next three years is clearly heading for a second term. In the short term (ie. November) the outcome depends on many other things than healthcare like the economy, jobs, perceptions of competence etc. And the Republicans have given lots of hostages to fortune which provide masses of raw material for those campaign ads.

  5. Dantheman says:

    While I read McMegan regularly, I think she’s the one around the bend on this one. What “chicanery” was used to pass this bill which had never been used before? What did the Democrats do which can be mentioned in the same breath with the Republicans’ tactics to pass Medicare Part D, where they left voting open for 3 hours instead of 15, and threatened Congresscritters on the floor of the House with retailiation against their election campaigns?

  6. Dantheman says:

    15 minutes, not 15 hours in the last comment.

  7. john personna says:

    My general feeling is that I dislike the bill, but wanted progress. So this is less distasteful an outcome to me than a Republican victory.

    It would have been very different if Republicans had proposed a market-efficient social medicine system .. say, voucher based.

  8. James Joyner says:

    Like the barking of the dog in the Sherlock Holmes story, the most significant thing in your post is something that isn’t there, a discussion of what HCR will accomplish. The bill will bring medical insurance to more then 30 million people and financial security to everybody who has health insurance now and can’t afford to lose it because of a pre-existing condition.

    That’s mentioned twice in the post, actually.

    I’ve written hundreds of posts on the subject over the past 15 months or so; this wasn’t intended to be a treatise on the problems with the bill, simply a summary of what’s happened over the past 24 hours.

  9. James — you have been using the phrase or its analogues: “Savings dependent on future Congresses, a nice trick…”

    That statement applies to any law that has applicability for more than two years, from the appropriations for a new aircraft carrier (see USS United States being appropriated, paid for, and then cancelled afterwards) to tax rate changes.

    The big thing in HCR that makes these promises of cuts somewhat more credible than handwavium is two things. First, HCR is now part of the budgetary baseline, and as the Dems are committed to at least a soft version of PAY-GO, deviations from that baseline are procedurally more difficult than a 218:217 vote. Secondly, the cuts are fairly widespread and they have distributed enough interlocking goodies that assembling an effective coalition against those cuts but also against the attendant goodies will be difficult.

  10. Ben says:

    I think the right really failed in working against this legislation (well, obviously). The things democrats said this bill will do sounded like good ideas to me.

    I’m not playing dumb here, obviously there are any number of ways, if only from a conservative perspective, that this bill is a disaster, but they didn’t seem to really take the approach of talking about those things, instead is was death panels and abortion and whatnot.

    Basically, I feel like I know what democrats want me to know about this legislation, whereas I don’t think republicans ever really effectively communicated legitimate counterpoints.

    To the chagrin of many, I’m sure, it really does look like they should have taken the Frum, Douthat (whomever) approach and attacked this in a serious, substantive manner, or at least told better lies.

  11. Eric Florack says:

    a discussion of what HCR will accomplish

    Well, yes, let’s discuss that; what will it accomplish?

    We have less health care, fewer doctors, longer wait times, all of these points in ample evidence in every situation where government driven health care has taken over. The history of the thing should have been alarming enough to cause the vast majority of Americans to reject the bill. (Oh, wait… they did that. Never mind)

    We have more government bureaucracy, including a large expansion of the IRS, a debt load that makes our debt heretofore seem minuscule by comparison, and an inability to react a global military situations as they arise, even within our own borders.

    Yep. Big accomplishments.

  12. john personna says:

    We have less health care, fewer doctors, longer wait times, all of these points in ample evidence in every situation where government driven health care has taken over. The history of the thing should have been alarming enough to cause the vast majority of Americans to reject the bill. (Oh, wait… they did that. Never mind)

    I’m afraid Eric that you fear the wrong things. We will have more healthcare, but it will cost us a higher percentage of our incomes and a higher percentage of GDP.

    This isn’t because Obama has changed the system, it’s because he has extended it.

    Maybe it’s fair to say Republicans and Democrats were backing different softs of status-quo. The Republicans wanted a frozen one (just as much “socialism” as we have now) and the Democrats wanted a continuation (an extension of government mandates on private insurance).

    Neither party was willing or able to reinvent the system cleaner or simpler.

  13. Franklin says:

    Eric,

    I was in debate class in high school. The opposition would always try to use this ridiculous butterfly effects to claim that, for example, some minor change in our federal prison system would lead to worldwide economic collapse and catastrophe.

    That’s what you sound like right now. It’s so silly that we can immediately ignore it, rather than having to go through the trouble of actually coming up with counter-arguments.

    But perhaps you know that?

  14. Eric Florack says:

    You call it what you will, Franklin. But as you do, be sure to include in your estimates, a quick look at the Canadian military. Every place where cradle to grave government has taken over, the result has been invariably military cutbacks to the point of strangulation. Take Canada as an example: The Canadian military, dedicated as its people are, find themselves in the state of zero funding. They’ve become something of a laughingstock, which is a shame, really.

    The same thing also has been happening in Europe for several years now. The history of the thing is incontrovertible. Those who don’t learn from history…. well, you know.

  15. Herb says:

    McMegan went off the rails last night. I hope she had a few stiff ones, cried herself to sleep, and woke up with a renewed sense of, well, reality.

    We have less health care, fewer doctors, longer wait times, all of these points in ample evidence in every situation where government driven health care has taken over.

    Since yesterday? You need a couple stiff ones too, Eric?

  16. floyd says:

    12 hours into our 3800 page revelation, it is reported that doctors cuts have been restored, thereby exposing the outright fraud on the reports of deficit reduction.
    Provisions to control private rates have been removed from the bill, encouraging huge rate increases.
    Drug manufacturers have been given 12 years without generics ,thereby encouraging huge increases in drug prices!
    Gee! Only 3797 pages to go!
    “When pigs lie” they do it with only one wing!

  17. Bill H says:

    Every place where cradle to grave government has taken over, the result has been invariably military cutbacks to the point of strangulation.

    And that has hurt them exactly how? Are they in danger of being invaded? Is anyone bombing them with unmanned drones? Are their ships being stopped at sea and their sailors impressed?

  18. john personna says:

    Eric seems arrested in the argument that this is “socialism” and so now we get everything that comes with “socialism.” I suppose that will work as a meme for The Stupid Party. For that they don’t really need a better (or even an actual) health care plan. They can just be against “teh socialism.”

    Geez. And I was just starting to wonder if the Republicans could actually run on a “repeal” to something that everyone knows is broken. Maybe they can, if there are enough Erics out there.

  19. floyd says:

    What about the financial security of everybody who has health insurance now and won’t be able to afford to keep it, preexisting condition or not.
    The government’s answer? Encourage higher rates, while committing armed robbery.
    There will naturally now be Obamacare proponents everywhere running helter-skelter to destruction with their fingers in their ears, now that there is nowhere “left” to go.

  20. Eric Florack says:

    Eric seems arrested in the argument that this is “socialism”

    For so it is. I tend toward the truth, ya see.

    What about the financial security of everybody who has health insurance now and won’t be able to afford to keep it, preexisting condition or not.

    Don’t delude yourself into thinking this was ever about healthcare, per se’.

  21. Pug says:

    What “chicanery” was used to pass this bill which had never been used before?

    This is a reasonable question. The bill passed the Senate with 60 votes and passed the House 219-212. Straight up majority votes in the Congress. How duplicitous!

    I guess what the Bush team always said is true: Elections have consequences.

  22. john personna says:

    Eric, last week we had government regulated private (and non-profit) insurance. With this bill we still have government regulated private (and non-profit) insurance. The line has moved in level of regulation, but as someone tried to remind you a day or two ago, there has been no change in ownership. My local hospital will remain an independent (Presbyterian!) organization.

  23. James Joyner says:

    James — you have been using the phrase or its analogues: “Savings dependent on future Congresses, a nice trick…”

    That statement applies to any law that has applicability for more than two years, from the appropriations for a new aircraft carrier (see USS United States being appropriated, paid for, and then cancelled afterwards) to tax rate changes.

    In this case, though, most of the painful parts of the legislation don’t go into effect unless they’re positively enacted down the line. That’s a different animal.

  24. Eric Florack says:

    John the situation you describe is not unlike what Germany had under the national socialists. A defacto ownership.

    And in any event, as government involvement increases private ownership disappears, as we’ve seen in other countries where government runs healthcare. Will it happen overnight? No. But it will now happen. That’s the way that got paved last night.

  25. anjin-san says:

    John the situation you describe is not unlike what Germany had under the national socialists. A defacto ownership.

    Ah, so Obama is not a marxist after all, he is a nazi! I see. And fire is raining from the sky, and dogs are sleeping with cats.

    Meanwhile, the market is fleeing in terror up 40 points. Guess investors are not seeing the national disaster that has driven bit to hysteria.

  26. john personna says:

    I understand that is the reduction Eric. As I said a day or two ago, some conservatives want to pretend that what we had yesterday was “free market” and what we’ll get tomorrow is full-on “socialism.”

    That kind of thing wears thin. Why oh why can’t we have a conservatism that is honest about where we stand? Can you say “yes, we have a mixed economy”?

    Why are vouchers for schools a “market solution” while vouchers for health care are “socialism”?

  27. anjin-san says:

    Why are vouchers for schools a “market solution” while vouchers for health care are “socialism”?

    Because when one has no actual ideas, slogans and buzzwords are all that is left.

  28. john personna says:
  29. Herb says:

    John the situation you describe is not unlike what Germany had under the national socialists.

    And once again, Mike G’s prediction has come true.

  30. Zelsdorf Ragshaft III says:

    Anjin dim, if you cannot tell the difference between vouchers for schools, which are already paid for by taxes, and medical coverage which is not. Your intelligence, or lack thereof, is more along the lines I think it is than what you deem.

  31. anjin-san says:

    medical coverage which is not

    I will keep that in mind the next time I drive by the county hospital.

  32. Have a nice G.A. says:

    Wow, some of you people still support this pathological lier and his pathological lier friends in Congress and in the Senate and their naive anti grasp of historical evidence of consequence. I feel bad that you have wasted you lives and thank for making a loser like me see that he is so bad after all.

    It’s kind of like blowing your pay check on liqueur and drugs, waking up hating yourself like lowest peace of trash the world has ever known, and then flipping through the channels and coming across the Jerry Springer show.

    Good God do I pitty you, poor fools.

  33. Eric Florack says:

    Ah, so Obama is not a marxist after all, he is a nazi! I see

    I said “Socialist”.

    As I said a day or two ago, some conservatives want to pretend that what we had yesterday was “free market” and what we’ll get tomorrow is full-on “socialism.”

    Explain to me… making sure you use direct quotes… where I ever made such an argument.

    Why oh why can’t we have a conservatism that is honest about where we stand? Can you say “yes, we have a mixed economy”?

    Of course! The discussion at hand is on the question of increasing the role of socialism being a good thing or not. I suggest our goal should be eliminating it. Apparently there are others, some of which are in control of our government, who think otherwise.

  34. TangoMan says:

    BTW, the good old Health Care Expenses vs. Life Expectancy graph.

    Still as worthless as ever. GIGO.

  35. Michael says:

    I hope we can at least all agree that this proves that you need more than an angry mob with tea bags to effect policy?

    If the Republicans had offered a counter-strategy, rather than pinning all their hopes on anti-government populism, the debate all these months could have been about costs and rights, rather than death panels and tea parties.

  36. john personna says:

    Tango, don’t you at least want to save some money? Is it worth 7x the expenditure of Czechoslovakia to (maybe) add one year of expected life?

    (I think what works, what moves countries to the high left of the graph, is to give everyone basic health care, nothing too fancy, nothing too expensive.)

  37. TangoMan says:

    John,

    The underlying assumption of that graph is that Health Care Expenses are the key determinant of Life Expectancy. If an academic model doesn’t reflect reality then we’ve walked through the Looking Glass and are operating in a “Garbage, In; Garbage, Out” universe.

    For a model to make sense you need to control factors so that the relationship you want to investigate, say how spending influences life expectancy, is isolated from other variables that influence life expectancy.

    Is it worth 7x the expenditure of Czechoslovakia to (maybe) add one year of expected life?

    Do you really imagine that the difference in spending is directed to profit and waste in our system which is not present in the Czech system? Really?

    (I think what works, what moves countries to the high left of the graph, is to give everyone basic health care, nothing too fancy, nothing too expensive.)

    That’s a fine hypothesis. Let’s test it. That graph doesn’t test it because it doesn’t control for significant variables. Look at those countries, Japan, Iceland, Korean, Sweden, the Czech Republic, etc. They have lower levels of gun violence, lower incidences of traffic accidents due to higher levels of both urbanization and population density and they’re far more culturally and racially homogeneous. Control for these obvious factors, and then test your hypothesis, and then let’s talk because we’ll actually be looking at the relationship of expenditures to life expectancy.

  38. anjin-san says:

    I said “Socialist”.

    Actually, no. You said:

    John the situation you describe is not unlike what Germany had under the national socialists.

    Germany + national socialists = nazis.

    If you are going engage in this kind of vile name calling, at least TRY and be a man and stand behind your own words. Lying about what you said a few posts up is both cowardly and silly.

  39. Eric Florack says:

    If the Republicans had offered a counter-strategy, rather than pinning all their hopes on anti-government populism, the debate all these months could have been about costs and rights, rather than death panels and tea parties.

    While technically accurate, there’s a problem with that assessment of yours. Primarily, the problem is that it assumes that the legislators are responsive to the will of the people. This was not a matter of the electorate being swayed one way or the other. Even the polling data that task is already been accomplished. No, this case is different. The electorate and it’s wishes didn’t matter to the legislators.

    There’s a number of theories floating around about why that’s so. Personally, I figure the easiest way to figure out what’s going on there, and just why the democrats felt they could ignore the will of the electorate is rather simple. All one need do is look at the agenda of the Obama administration. The next thing on their agenda is immigration reform. Which given we’re talking about the far left translates to “amnesty”. With the immigration reform push, it is estimated that we will see something on the order of between fifteen and 30 million new democrat voters, which will effectively wipe out any backlash against the democrats for the Healthcare debug Cole. Is there anybody who seriously considers that such an honesty beneficiaries would not immediately become lifelong democrats?

    Germany + national socialists = nazis.

    Hardly a lie. They are still socialist. Regardless of your wanting to admit it, or not. One is equal to the other, again, what do you like it, or not.

  40. Eric Florack says:

    I will keep that in mind the next time I drive by the county hospital.

    The county hospital has exactly what to do with the federal constitution and it’s limitations on the federal government?

    Do you really have that much problem holding onto the thread of a conversation?

  41. steve says:

    From Greenwald today.

    “Minority Leader John Boehner mourned: “We have failed to listen to America. And we have failed to reflect the will of our constituents. And when we fail to reflect that will — we fail ourselves and we fail our country.” GOP Rep. Mike Pence thundered: “We’re breaking with our finest traditions . . . . the consent of the governed.” That the health care bill destroys “the consent of the governed” because it is opposed by a majority of Americans has become the central theme of every talking-points-spouting, right-wing hack around.

    Of course, these are the same exact people who spent years funding the Iraq War without end and without conditions even in the face of extreme public opposition, which consistently remained in the 60-65% range. Indeed, the wholesale irrelevance of public opinion was a central tenet of GOP rule for eight years, as illustrated by this classic exchange between Dick Cheney and ABC News’ Martha Radditz in May, 2008, regarding the administration’s escalation of the war at exactly the same time that public demands for withdrawal were at their height:

    RADDATZ: Two-third of Americans say it’s not worth fighting.

    CHENEY: So?

    RADDATZ: So? You don’t care what the American people think?

    CHENEY: No. I think you cannot be blown off course by the fluctuations in the public opinion polls.

    For years, the explicit GOP view of public opinion was that it is irrelevant and does not matter in the slightest. Indeed, the view of our political class generally is that public opinion plays a role in how our government functions only during elections, and after that, those who win are free to do whatever they want regardless of what “the people” want.”

    I wonder how long it would take to Google and find complaints about Clinton governing by polls?

    Steve

  42. anjin-san says:

    The county hospital has exactly what to do with the federal constitution and it’s limitations on the federal government?

    I was responding to this comment, which was about services being funded by taxes:

    if you cannot tell the difference between vouchers for schools, which are already paid for by taxes, and medical coverage which is not.

    Perhaps you are having trouble keeping up with our conversation. Or maybe you have just appointed yourself as some kind of pissant chat monitor. The pissant part certainly suits you.

  43. anjin-san says:

    Hardly a lie. They are still socialist

    I have no doubt you know a lot about nazis. You are not all that far from their worldview after all.

  44. john personna says:

    Tango wrote:

    The underlying assumption of that graph is that Health Care Expenses are the key determinant of Life Expectancy. If an academic model doesn’t reflect reality then we’ve walked through the Looking Glass and are operating in a “Garbage, In; Garbage, Out” universe.

    Charts don’t have underlying assumptions ;-). They just show correlations. From those correlations people do try to draw causations, but I don’t think this chart shows any clear causation.

    What it does raise is a question of declining returns. Did we really need to spend 7x Czechoslovakia to rise above them by one year?

    And of course it does raise the question all conservatives want to avoid: who do so many countries manage to rise above us while spending less?

    Well, I guess many are happy to throw BS answers at that last question, but those BS answers really beg the 7x question.

    Back at you, if health care expenses aren’t doing it, why are we paying them?

  45. Michael says:

    Hardly a lie. They are still socialist.

    Not really, they were fascist.

  46. Eric Florack says:

    I was responding to this comment, which was about services being funded by taxes:

    I know. Thing is,, Anjin, you can’t draw a direct comparison since there may or may not be limits at the levels of government under the federal for psending on such… but there clearly is at the federal level, where powers are enumerated clearly and as clearly, limited in scope. That’s a point liberals seeming will never understand.

    I have no doubt you know a lot about nazis. You are not all that far from their worldview after all.

    Nah, I’ll leave that to Obama and his minions.

    @ Steve;

    Perhaps your arguments would be more impressive if you’d leave out the quotes from one of the most dishonest voices in blogdom today.

  47. floyd says:

    “”I hope we can at least all agree that this proves that you need more than an angry mob with tea bags to effect policy?””
    “””””””””””””””””””””””””””””””””””””
    Even a blind pig occasionally finds an acorn.
    Congratulations,Michael!

    Be careful about advocating violence though.

  48. Michael says:

    Even a blind pig occasionally finds an acorn.
    Congratulations,Michael!

    Be careful about advocating violence though.

    What the frell? I’m not even sure if you’re agreeing with me, or the tea partys, but when did I every advocate, directly or indirectly, for violence?

    Violence is the last refuge of the incompetent.

  49. Michael says:

    Also, that’s a stupid analogy, pigs forage by smell, do being blind wouldn’t drastically reduce the odds of one finding food.

  50. anjin-san says:

    at the federal level, where powers are enumerated clearly and as clearly, limited in scope.

    Yet you spent the Bush era cheering as federal power was expanded…

  51. floyd says:

    Micheal;
    Not a stupid analogy, an ironic one, those who originally coined the phrase were nearly as smart as you, not quite, but that would be impossible now wouldn’t it?
    So, can I assume you can smell a rat with the “healthcare” bill… or at least something fishy? Or do you think that smell is truffles?

  52. Michael says:

    Not a stupid analogy, an ironic one, those who originally coined the phrase were nearly as smart as you, not quite, but that would be impossible now wouldn’t it?

    It’s no more ironic than rain on your wedding day, please stop using pop music to pad your vocabulary. While you’re at it, stop the passive-aggressive ego baiting, it won’t work, and it just makes you look petty.

    So, can I assume you can smell a rat with the “healthcare” bill… or at least something fishy? Or do you think that smell is truffles?

    I don’t like the health care bill, I think I’ve said this on multiple occasions. However, I don’t think it’s a socialist plot, a slippery slope, or the end of liberty as we know it. I just think it’s a bad bill. My biggest complaint is that instead of the Republicans explaining why it’s a bad bill, and writing a better one (like they did in 1993), they sat back and hoped that an angry, semi-racist, anti-government would carry the debate for them.

  53. Eric Florack says:

    Yet you spent the Bush era cheering as federal power was expanded…

    Specifics would be nice.

  54. Eric Florack says:

    Not really, they were fascist.

    And would you care to point to any significant differences between the two in outcome?

    They are equals.

  55. Michael says:

    And would you care to point to any significant differences between the two in outcome?

    Socialists desire to redistribute the means to produce wealth from the few to the many. Fascism desires exactly the opposite, to give total control over the means of production to the few.

  56. TangoMan says:

    Back at you, if health care expenses aren’t doing it, why are we paying them?

    If a small house, say the kind that was typically built in the 1940s, is sufficient for providing shelter to a family then why do we buy and build larger houses today for families that are smaller in size?

    Because we’re richer. Healthcare, like housing, and dining, is a superior good. As people’s income’s rise they tend to want to consume more superior goods. The aspects of healthcare that count as superior goods are timely service (few waitlists requiring months of waiting), more technology, less dealing with conditions and more addressing or solving of medical conditions.

    Look, the freakin’ Amish don’t believe in health insurance and they pay for their own consumption of health care, minimal as that is, and their longevity has been historically superior to the American norm, and today is about on par with the American norm.

    Blacks tend to have higher levels of infant mortality and liberals posit that this is the result of their being poor and being denied full-boat prenatal care. Hispanics have about the same income level as blacks yet their infant mortality rate is better than the Caucasian rate. What happened to the spending (prenatal care) leading to better outcomes (lower infant mortality rate) causality?

    What it does raise is a question of declining returns. Did we really need to spend 7x Czechoslovakia to rise above them by one year?

    It only raises the question of declining returns if you use life expectancy as the sole metric.

    Look at Hungary, Slovakia, the Czech Republic and Korea. They spend about the same amount on health care, they seem exhibit physician visits that are close to identical and yet their longevity varies tremendously.

    This whole dynamic reinforces my point that we can have a system with differential levels of care, just as every other consumer good or service comes with differential quality or quantity so as to span a large price range. The Amish have modest consumption of health care and they pay for their health care out of pocket and yet they live just as long as most Americans. They serve to falsify the hypothesis that spending determines longevity.

    We’ll never get prices under control so long as everyone is entitled to demand health care without suffering any price consequences. There is no pricing discipline involved.

    who do so many countries manage to rise above us while spending less?

    I don’t avoid this question at all, surprisingly I find it is liberals who run from the room when I introduce factors which help in explaining why we spend more for worse (longevity) outcomes. Most liberals I run across are heavily invested in a simplistic model of health care financing and don’t want to modify their viewpoint.

  57. floyd says:

    “”It’s no more ironic than rain on your wedding day, please stop using pop music to pad your vocabulary. While you’re at it, stop the passive-aggressive ego baiting, it won’t work, and it just makes you look petty.””
    “””””””””””””””””””””””””””””””””””””””

    The above is pretty convincing evidence that it did work![lol]

  58. Eric Florack says:

    Socialists desire to redistribute the means to produce wealth from the few to the many. Fascism desires exactly the opposite, to give total control over the means of production to the few.

    Laughable, given what we see in every socialist state. Do try again, using reality as your source this time.

  59. Michael says:

    Laughable, given what we see in every socialist state. Do try again, using reality as your source this time.

    Can you give me some specific examples of socialist states you would like me to use as reference?