Health Care Reform

A false choice, of course... by dtmos · 2010-03-19 00:48 · Score: 5, Insightful

Nothing is as bad for the future of America as Fox says.

BTW, I've seen thousands of comment trolls, but I think this is the first story submission troll I've seen.

Re:A false choice, of course... by Farmer+Tim · 2010-03-19 00:54 · Score: 5, Funny

We have nothing to fear but Fox itself.

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Blank until /. makes another boneheaded UI decision.
Re:A false choice, of course... by Anonymous Coward · 2010-03-19 01:00 · Score: 5, Insightful

The truth is, the non-left of the American public (i.e. centrists, libertarians, independents, right, etc) would better trust the government to run healthcare if they actually had a better track record of running other programs. Find any government agency that's tried to do exceptionally well and you'll find that the smaller the scope of their responsibility the better they did. Medicare, Medicaid, Social Security, Postal Service, any regulatory agency - you get the picture. The federal government simply doesn't have a good resume; you can't blame the unbiased peoples for not loving the idea of the government running yet another program.
Re:A false choice, of course... by Pojut · 2010-03-19 01:00 · Score: 5, Informative

Full bill: http://www.scribd.com/doc/28572002/Reconciliation-HR-4872-Full-Text
CBO report: http://www.cbo.gov/ftpdocs/113xx/doc11355/hr4872.pdf
Get to reading!

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Living With a Nerd
Re:A false choice, of course... by Kagura · 2010-03-19 01:03 · Score: 5, Insightful

Except Fox. Fox is bad for America.
Just because Fox says the health care reform is bad doesn't mean that we should therefore support the reform. It disappoints me that this is the first comment I saw when I opened up this page. The point of this article is to discuss the reform in a constructive manner, not to bash entire ideologies just because they are not your own.

I am temporarily residing outside the U.S. at this time, and I haven't been paying attention to the argument. My mind is still malleable on this, so convince me one way or the other! Now, let's get back to a real discussion regarding the pros and cons of health care reform!
Re:A false choice, of course... by linzeal · 2010-03-19 01:13 · Score: 5, Insightful

You must be new here. When political stories hit Slashdot it is usually a bare knuckled ugly showdown between Anarchists, Liberals, Republicans and the Libertarians with the truly insane individual thrown in for good measure.

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An Education is the Font of All Liberty
Re:A false choice, of course... by KDN · 2010-03-19 01:16 · Score: 5, Insightful

Full bill, but not the final bill. Deals are still being made. Even the CBO says that the numbers are preliminary. And frankly, 10 years of taxes and 6 years of benefits means they are cooking the books.
Re:A false choice, of course... by amplt1337 · 2010-03-19 01:34 · Score: 5, Interesting

First off, this isn't health care reform. It doesn't change all that much about the health care system. It's health insurance reform.
To that end, there are some small gains: insurance companies will be forbidden from doing some seriously awful things, like retroactively revoking the insurance of patients who get expensive illnesses, on the flimsiest of possible excuses (and in some cases based on faulty data that they refuse to investigate further).
In exchange, there are a lot of parts that are a big giveaway to insurance companies: because we've focused on giving everyone insurance instead of giving everyone health care, individuals are forced to buy insurance, but with inadequate oversight to ensure that insurance companies don't just gouge prices. Further, there isn't any choice for an insurance plan governed by democracy instead of stockholders, so we can probably expect that the small number of insurance companies will behave oligopolistically and raise prices, as usually happens when a small number of huge players control the market.
There will be some savings relative to the current system -- on the government's part -- but nothing like what could be achieved by a system that allows everyone to buy in to Medicare (and couples that with Medicare reforms like more careful monitoring of doctors who prescribe medically needless tests & procedures to make more money, and allowing Medicare to negotiate lower prices for its prescription drug benefit). The present bill is probably slightly better than not having it, but only very slightly.

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Freedom isn't free; its price is the well-being of others.
Re:A false choice, of course... by Chrisq · 2010-03-19 02:02 · Score: 5, Funny

I think the issue the OP has with Fox has nothing to do with the Healthcare bill. A position that I also support.
maybe not nothing, if Fox raises your blood-pressure that much you might have a personal interest in health care provision.
Re:A false choice, of course... by raddan · 2010-03-19 02:07 · Score: 5, Insightful
When our government starts taking away our liberties (forcing people to buy health care, taking away private property to give to another private party are just two examples)
I'm guessing that you chose those two examples because they are hot-button issues, but the reality of it is: you never had those liberties, but because they never affected you, you thought that you did.

Eminent Domain predates the founding of this country. It sucks, especially when it affects you (my great-grandfather's farm was largely seized to build a school), but there are many, many cases where there is indeed a greater good served by it. The discussion really shouldn't be "should we have it?" but "when should we have it?" Eliminating it is not practical.

You already pay for health care, but like so many other things (roads, police, schools, car insurance), you don't see those costs directly. If, for instance, you saw an itemized car insurance bill explaining that most of your insurance money goes to paying out drunk driving accidents, or say, minor scratches on someone's Lexus, you would probably be pissed off (fun story: I bumped a Lexus once with my car-- it cost the insurance $1200, for a SCRATCH-- given that my insurance bill for the year is roughly half that, who do you think pays for it? Hint: you). Now there are many, many reasons why health care costs are going up. Medical practitioners are in short supply, medicine and equipment are very expensive (sometimes for good reasons, sometimes not), but most importantly, because the ratio of healthy people to sick (and by sick, I really mean, people needing care) people is swinging rapidly toward more sick people: baby boomers.

If you're insured, you're paying for them already. Because I work for a large company, and they have good bargainers, we only pay about $300/mo per single employee. I contribute half of that. But ever try to get insurance yourself on the private market? Good luck affording it!

Now, it can (and should) be argued that health insurance itself is part of the problem, and I agree. Insurance is supposed to be a hedge against catastrophe. You know, brain cancer. The kind of thing where the expense is so astronomical, that it would ruin you. Instead, we have insurers covering viagra (only actually necessary in very rare cases-- I have a friend with a rare pulmonary disorder, and strangely enough, viagra is an effective treatment for her) and elective surgery, because people don't want to pay for them themselves. This abuse has done nothing to control costs. It's a travesty that an out-of-pocket visit to your general practitioner can cost you a week's wages. I had an X-ray done recently-- it was $1000. We're talking about 19th century technology here, people. So anyway, now it covers the routine stuff, but often not the catastrophic stuff. They'll deny you coverage! WTF!

But hey, this is what we have. Do we:
- Dive in and fix the problem?
- Let everyone get increasingly fucked over
Keep in mind that while there are millions of people who can't get healthcare at all, due to cost, the CEO of United Healthcare recently received a 1 billion dollar (US) bonus. That, my friends, is fucked up. This man could personally pay for doctor visits for hundreds of thousands of people.

As many people here have said, they're trapped in their bad employment situations because they have a sick spouse or child. Imagine having to go to work someplace where they treat you like dirt for years on end because, without them, your loved one dies? That is slavery, plain and simple.

Personal health is a prerequisite for a healthy economy. If that guy could leave his job for a better one, without worrying that it would end his wife's leukemia treatments, or
Re:A false choice, of course... by MR.Mic · 2010-03-19 02:19 · Score: 5, Funny

One does not simply walk into Slashdot.
Re:A false choice, of course... by timeOday · 2010-03-19 02:24 · Score: 5, Informative
Now, let's get back to a real discussion regarding the pros and cons of health care reform!
This thread, and news coverage at large, are incredibly sparse on what the plan actually is! So here it is:
INSURANCE MARKET REFORM
- The legislation would require substantial insurance market reforms that would bar insurers from excluding people for pre-existing conditions and prevent them from arbitrarily dropping policy holders.
- Insurance exchanges would be created where small businesses and individuals without employer-sponsored coverage would be able to shop for coverage. Plans offered on the exchange would have to meet minimum benefit requirements.
- The proposed changes would allow dependent children to remain on their parents' health policies until age 26.
- The Senate bill requires insurers to spend at least 85 cents of every premium dollar on medical care in small group markets and 80 cents in large group markets. The proposed changes also would require Medicare Advantage insurers to spend at least 85 percent of revenues on medical care.
COVERAGE MANDATES, SUBSIDIES AND MEDICAID
- Individuals would be required to obtain health insurance. Those who fail to purchase coverage would face fines of up to 2.5 percent of income by 2016.
- Firms with more than 50 workers who do not offer medical coverage could face fines of $2,000 per full-time employee.
- Federal subsidies would be provided to help people with incomes up to 400 percent of the poverty level purchase coverage on the exchange. Proposed changes would sweeten those subsidies for lower income people.
- Medicaid, the government healthcare program for the poor, would be available to everyone with incomes up to 133 percent of the poverty level, which stood at $10,830 for an individual and $22,050, for a family of four. Many states have eligibility requirements below those levels.
- The proposed changes would get rid of a special deal to help Nebraska pay for the expanded coverage and boost aid to all states.
FINANCING
- The final proposal makes some adjustments to the revenue measures in the Senate-passed bill.
- The Senate bill included a 40 percent excise tax on high-cost health insurance plans. The proposed changes would delay implementation of the tax until 2018 instead of 2013. The tax would kick in on plans costing $10,200 for individuals and $27,500 for family coverage. A higher threshold is allowed for plans covering mostly women, older workers and retirees as well as those in high-risk professions.
- The bill calls for raising the payroll taxes for Medicare, the government health insurance plan for the elderly, to 2.35 percent from the current 1.45 percent for individuals earning $200,000 or more and for couples earning $250,000 or more. The proposed changes would apply the tax to some investment income as well for those high-income groups.
- The bill would impose fees on medical device manufacturers, insurance providers and brand name pharmaceuticals. The proposed changes would delay implementation of those fees.
MEDICARE
- The legislation would freeze payments to insurers that provide coverage to Medicare patients in 2011 and begin reducing the subsidy in 2012.
- It would also gradually close the gap in drug coverage for Medicare beneficiaries by 2020. Those who enter the coverage gap, the so-called doughnut hole, in 2010 will get a $250 rebate. In 2011 they would get a 50 percent discount on brand-name drugs.
Re:A false choice, of course... by svtdragon · 2010-03-19 02:26 · Score: 5, Informative

This bill is the minimum that can be done to remove recission and pre-existing condition clauses without destroying the system.

The economic logic is as follows: We want to regulate the insurers such that they don't exclude people based on pre-existing conditions. This makes sense.

However, once you try to apply that in practice, it gets hairier: if you cease to enable insurers to do that, then you get what's called an "adverse selection death spiral", wherein some healthy people drop coverage (since they know they can get it back as soon as they get sick) which worsens the risk pool. Because it's worse, those remaining members left in this new risk pool get charged higher premiums. These higher premiums cause more healthy people to drop coverage (since they're getting less for their money) which causes a repeat of the same cycle. As this goes on, the price of insurance gets so astronomical that only the sickest have it and nobody can afford it because the cost approaches the cost of the procedure you're supposed to be insured for.

The way we work around this is the unpopular part. We put a mandate on everybody that says "alright, since they can't kick you out anymore, you can't game the system: everyone has to be insured". Whether it's better to do this by putting the mandate on individuals or on employers is debatable, but what's on the table is an individual one.

Now that we're mandating everyone have insurance, we need to address its affordability, since mandates to buy things that people can't afford don't really work. This is where the subsidies (ie, costs) come in. This package is basically $900bn in subsidies for people who have trouble affording comprehensive insurance--including everyone from the average joe to a reasonable percentage of the slashdot crowd. The latest bill has caps on premiums set as follows: "[f]or people who buy insurance on the exchanges, a family of four making $88,000 would have a cap of 9.5 percent of their income." The penalty for not buying insurance is $695/person/year with exemptions for financial hardship, etc.

The $900bn comes by way of medicaid as well as direct subsidies.

The rest, once those things are in place, are to cut costs/cut the deficit and regulate insurers. But the above is by far the bulk of the bill. While I personally wouldn't mind killing the insurance companies so we can institute a single-payer system, if you want pre-existing conditions gone, this is what you get.

Somewhere in between. by FlyingBishop · 2010-03-19 00:53 · Score: 5, Insightful

But then everyone knew that already.

I expect it will at least mitigate my issues getting health insurance after getting kicked off my parents' plan, so there's that.

As for the Republicans' complaints, I'm not really clear on what there is in this bill the Republicans didn't argue for. If the left had written the bill, it would dismantle the insurance industry and set up single payer. The only thing it's missing is tort reform, and the fact is that tort reform is a red herring. It accounts for 1-2% of healthcare expenditures, and that sounds about right. There should be a process for handling legitimate malpractice claims, and it's never going to be free.

Very expensive half-assed bill by jjo · 2010-03-19 01:00 · Score: 5, Insightful

As you might expect, this bill is heavy on the benefits and light on the necessary pain. There's virtually only one effective cost-control measure, the tax on high-cost health benefits, and that has been pushed off so far in the future that it will be killed before it sees the light of day. The bill recognizes that coverage of pre-existing conditions requires an individual mandate, but then implements it in a half-assed way that won't achieve the objective of forcing healthy people to get coverage. (It also puts a dual drag on job growth by both raising taxes on private investment and directly increasing the cost of employing people. Way to go.)

I would much prefer a bill that provided funds to the states to let them structure their own solutions to the health-care problem, as Massachusetts has done. But the top-down command-and-control midset in Washington is too strong for that.

Re:It is bad, wrong way to go about it by dorre · 2010-03-19 01:01 · Score: 5, Interesting

The most important thing is not if the government is able run health as efficiently as possible. The important question is who earns money on what. In case of 100% private health care, everybody (even insurance companies!) earns money when someone is sick. In the case of government run health care the government loses money if people are sick. So they have an incentive to keep people well and only recommend useful medications. I think that's the important incentive here to take into consideration. Do people really want a system where the doctor earns more money if you're more sick and so on?

Well, lets see by SmallFurryCreature · 2010-03-19 01:02 · Score: 5, Interesting

How has private industry done so far with american healthcare? Cost more, gets less. Yup, that is a sign of success.

Oh and how has private industry been managing the economy?

It kinda amazes me that people with a healthcare system that is useless in the middle of a global recession all under the management of private industry, then dare to ask whether government can run things.

Imagine a discussion in North Korea: "Can private industry be expected to handle food production?"

Answer: "Who knows, but the question is silly when the current system is such an obvious mess".

Sometimes you got to take a chance. Do anything because when you are nose deep in shit, chances are anything is an improvement.

Can the government do a better job? It would be hard to imagine how they can screw it up even more.

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MMO Quests are like orgasms:

You may solo them, I prefer them in a group.

Re:Health care: break the MD cartel by Dr_Barnowl · 2010-03-19 01:05 · Score: 5, Insightful

Your supply is high. In the UK we have 1.5 doctors per 1,000 people, in the USA, 2.4. Of course, we treat our doctors like crap.

The USA spends more per head on medical care than the rest of the world but gets poorer service. Either your efficiency is really low, or too much is getting creamed off the top as profit.

Part of the efficiency problem is that due to your liability culture you throw too many tests and treatments at things.

Part of the profit problem is that your medical system is run like a business that considers 15% a low profit margin.

Dear readers with mod points... by twoallbeefpatties · 2010-03-19 01:06 · Score: 5, Insightful

I do not have anything of actual use to say about this bill, other than common talking points, unsourced blather about what this bill will accomplish, and vague appeals to antiauthoritarianism. But please mod me +5 Insightful like you're doing with everyone else, just to be fair.

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Libertarians somehow believe that private businesses should be stronger than governments but weaker than individuals.

Re:Single payer system by TyFoN · 2010-03-19 01:08 · Score: 5, Informative

The US spends more money in percent of GDP in health care than any other country in the world. The Greece debacle is more about a government that increased wages and welfare to a point that the economy could not sustain, but it has nothing to do about health care specifically.

bad by Beer_Smurf · 2010-03-19 01:14 · Score: 5, Insightful

Read it for yourself. What I read is a wet dream for the insurance companies and penalizes anyone who is self-reliant.

Re:Wrong forum by sageres · 2010-03-19 01:18 · Score: 5, Funny

/agree mod the parent :-)
obligatory welfare joke:
A guy walks into the local welfare office, marches straight up to the counter and says, "Hi . . . You know, I just HATE drawing welfare. I'd really rather have a job".

The social worker behind the counter says, "Your timing is excellent. We just got a job opening from a very wealthy old man who wants a chauffeur/bodyguard for his nymphomaniac daughter. You'll have to drive
around in his Mercedes, but he'll supply all of your clothes. Because of the long hours, meals will be provided. You'll be expected to escort her on her overseas holiday trips. You'll have a two-bedroom apartment above the garage. The starting salary is $200,000 a year".

The guy says, "You're bullshitting me!"

The social worker says, "Yeah, well, you started it."

Not so. by gbutler69 · 2010-03-19 01:25 · Score: 5, Informative

Study after study has completely debunked the myth that high malpractice insurance is due to frivolous lawsuits. High malpractice insurance is for the same reason their is high medical insurance. The insurance companies made bad investments and lost their shirts now they're raking everyone over the coals while still pulling down 20 to 40% profits.

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Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.

Re:This bill has nothing to do with health care. by Cimexus · 2010-03-19 01:25 · Score: 5, Insightful

You know, you're right. And I say this as an Australian living with our wonderful (and I'm not being sarcastic) universal, single-payer health care system here.

In the past on Slashdot, when the issue of US healthcare reform has come up, you inevitably get all the Canadians/Europeans/Australians/New Zealanders on here going "OMG of course you should reform - your system sucks, and ours works pretty well". It seems like a no-brainer ... why would you not want to move to a system like ours. It's cheaper, more efficient, everyone is covered, health insurance is not tied to your employer, and the health outcomes returned are better. I was one of those people ... it seemed absolutely crazy (as in, literally mind-bendingly insane) that someone would want to oppose moving from the overpriced, inefficient and inequitable system you currently have to a system like most of the rest of the world employs.

BUT... ...now that I actually ~read~ something about the proposal itself, I see why Americans are debating it so much. It isn't really giving you guys a system like that in CA/EU/AU at all! Rather, it's just modifying the current system somewhat. It isn't really a fresh, new or particularly efficient system. It's tacking something onto what's already there ... giving it a coat of paint if you will, but not really addressing the underlying problems. It's not introducing a single payer system like in most other developed countries. And although I would personally still support it on balance, had I been an American, I would agree that it's not really a straightforward decision and it does have some significant flaws.

So to non-Americans mystified at the opposition to this, take a read of the actual proposal. It's not a stark choice between "the system they have now" and "a system like in other countries". Rather the proposal is for something kinda inbetween, which runs the risk that it may not work as well as ~either~.

no reform. by roman_mir · 2010-03-19 01:29 · Score: 5, Informative

This is not a 'health care reform'.

This is not even an 'insurance reform'.

What is going to pass is a few regulations that are supposedly going to make it not possible for an insurance company to drop coverage, to do rescission and a few more items. - This is good.

Here is what you are not going to get:

1. No optional public insurance against private insurance, the prices will not go down. Worse than that, what is happening is private insurance is raising prices to offset any of the new changes that will be coming with this 'reform'. Does not look good.

2. You probably are going to get a mandate, which is unfortunate given that you will have no public option. You will be forced to buy into expensive private insurance, there will be no choice or it looks like you will get some sort of a fine. Does not look good.

3. No cheaper drugs imported from other countries. The bill was introduced earlier this fall, but Obama actually killed it very very personally because he signed a deal with the manufacturers to do this: no competition from cheaper imported drugs AND the patents are to be extended from 5 years to something like 12 years. Does not look good.

4. Looks like US is one of the backwards countries that will try to limit women's access to health care they need. You going to get the 'reform' that will prevent any private insurance coverage for women that includes abortion. This is no joke, even for those who have coverage today, looks like they will actually lose it with this 'reform'. Does not look good.

The other part of it, the cost of it, that's a moot point. It was calculated that if Medicare was provided as a buy in for anyone at all, at cost (at cost - means whatever it costs, but no money is made for profit), or if there was a public option, then the reform could even save money. The way it is going to happen with no public negotiations with hospitals, no public negotiations with drug manufacturers, no import of cheaper drugs, no generics because the patents will be extended, well, I don't know if this will be cost neutral. It does not matter really, if US just cut its WAR cost, it's defense contractors costs they could probably fund the entire reform in health insurance and there would be enough money for the public education reform. Of-course that's not going to happen.

Anyway, Pelosi and Obama and the rest of them are lying sacks of shit. They do not want to take a vote on the public option, they will not take a vote on Grayson's proposal to just allow anyone to buy into Medicare at cost. This is not a health reform, this is just a little chunk of 'change' you were promised. Take it and be happy, cause you are not going to get anything better at all.

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You can't handle the truth.

Re:I don't have health insurance. by MartinSchou · 2010-03-19 01:33 · Score: 5, Funny

I live in a country that has government-run universal insurance, and I deal *directly* with my doctor, too. I'm not sure why you believe this isn't possible.

Brain-washing and indoctrination.

Listen. Just because the person you meet and discuss intimate details with at the "doctor's" office is wearing a lab coat and a stethescope, it doesn't mean he or she is a doctor. They are actually just civil servants who have hidden microphones and very discrete ear pieces, that allows what you're telling them to be heard by a 13-person death-panel, who will then instruct the "doctor" what to do.

The death-panel consists of:

3 lawyers
5 bean counters
1 veterinarian (there are no real doctors outside the US)
3 politicians
1 organ broker (whose job is to sell your organs)

This is how socialized "medicine" works. The only medicine involved with it, is making sure your body is sold off in parts to raise money for the party leaders! WAKE UP AND SMELL THE ROSES! Actually, those aren't roses but the perfumes used to cover up the stench of rotting corpses in the streets.
</sarcasm>

Re:Neither. by je+ne+sais+quoi · 2010-03-19 01:56 · Score: 5, Insightful

Or have you forgotten the new Prescription Medicine Reform where people can get "free" medicine?

You mean the one that will cost about a trillion dollars that isn't paid for:

Simply stated, the bill cost a fortune, wasn't paid for, is complicated as hell, and doesn't do all that much--though it does include coverage for end-of life-counseling, or what Grassley now calls "pulling the plug on grandma." In their 2009 report to Congress, the Medicare trustees estimate the 10-year cost of [the republican medicare bill[ as high as $1.2 trillion. That figure--just for prescription-drug coverage that people over 65 still have to pay a lot of money for--dwarfs the $848 billion cost of the Senate bill.

This is typical of Republican governance, they bitch and moan all the time about fiscal responsibility, but they acted in the most inconceivably fiscally irresponsible way again and again during the decade or so they were in power. Now we the taxpayer and the democrats are at least attempting to clean up after the unmitigated spending spree that was the Bush Administration and Republican Congress (Iraq war, tax cuts for the wealthy, "free" prescriptions drugs) and are getting dinged for not being fiscally responsible? If this is a joke, it's not funny.

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Gentlemen! You can't fight in here, this is the war room!

True, but I still oppose the bill by einhverfr · 2010-03-19 03:23 · Score: 5, Interesting

The insurer will probably place the burden of proof on you that your heart attack wasn't related to your diabetes. Meanwhile, you're in the hospital and racking up five-figure bills and, oh yeah, you've just had a heart attack. Have a nice day!

That's the problem, and it is a real problem. However this bill is not the answer. The answer is regulation at the state level.

The US health insurance industry is currently regulated by individual states. Different states have different rules. However, one element to the current system is that the state government (which is more responsive to the needs of citizens usually than the federal government) tends to have offices for dealing with these sorts of complaints. Additionally, the same offices take complaints from doctors about lack of authorization for procedures. While this means that some states have better health insurance requirements than others, it means there is a clear point of contact when a problem exists that needs to be resolved quickly.

The problem with this bill is it entirely supplants the state health insurance regulation structures and replaces them with a shiny new federal system. There is no way that the main protections that the states offer against insurance abuses will work right away in the federal system. By pre-empting a fairly mature system of state regulation, this bill will not save lives but rather cost them.

The secondary problem is that the bill has inadequate cost control provisions. In Massachussets, after they passed a similar bill, health insurance rates went up. We can expect the same here. Quite frankly, I have no idea how I will afford it when the rates go up. Right now, when insurance companies raise their rates, I can drop off until they lower them again. This bill makes me part of a captive market.

The real underlying problem left unresolved is that we have inadequate consumer protections in the areas of health care and health insurance. While this bill purports to improve these conditions, it fixes, IMO, the wrong problems and leaves major issues unresolved. Why is it that I have more consumer protections when getting my car repaired than in obtaining non-emergency medical care?

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LedgerSMB: Open source Accounting/ERP

Re:This bill has nothing to do with health care. by Eskarel · 2010-03-19 03:24 · Score: 5, Insightful

I have Australian and American citizenship, I have lived in both countries and experienced both health care systems.

The US bill is not single payer public health insurance, it would be better for the American people if it was, but the reality of the situation is that such a system cannot pass in the US as things stand. The Republicans are against anything the Democrats do, more than half the Democrats are in the pockets of big corporations and the Libertarians are always up in arms about anything at all which costs them money no matter how large a benefit it might provide society at large. That's not even taking into account the Tea Party and all the crazies that have come out of the woodwork because Dick Cheney proved to the American people that the government was out to get them and made every right wing conspiracy theorist and Militia member seem sane.

That's not even counting the Americans of all political persuasions who are irate because Obama can't magic more than 11 million jobs out of his ass to fix unemployment. I mean presuming an average salary of 40k a year that'd involve finding 440 billion dollars a year somewhere, but never mind.

Single payer health insurance cannot pass in that environment it's too radical, too different, too much like the government actually doing something useful with the tax dollars. Never mind the fact that the US pays almost twice as much in terms of percentage of GDP than any other western nation, has poorer health outcomes, and leaves more than 10% of its population uninsured, it just won't pass.

As such this bill, which is very much imperfect is the best the American people can really hope for. Yes it leaves the insurance companies intact, yes it's full of corruption, pork, and special interest anti-abortion clauses, and yes it will probably mean that individuals who believe that they can cover the couple of grand a night for a hospital bed if they get sick might have to take on some of the burden of minimizing the insurance risk pool to keep down costs.

On the other hand it will give 30 million Americans insurance, require insurance companies to insure people with preexisting illnesses, and remove the bonds forcing people to keep a job at any cost to keep their insurance when they need it. It would also save the insurance companies from their current death spirals by bringing healthy people back into the risk pool which would in turn reduce over all costs. It would do this while, at least according to projections, actually lowering the deficit.

This is an ugly bill, and there are things about it which will need to be fixed, sections which are almost unconscionable. It will also require tort reform, medical practice reform, and educational reform to along with it to give it its greatest potential. Despite all that it is miles ahead of the current situation, and the best we can hope for. If Republicans had been more willing to vote yes, or there was more cost to minority filibusters we might have had a better one, with less pork, lower costs, and better results, but that's not the reality of the situation. This bill is the best the American people are likely to get under the current circumstances, and while it doesn't affect me personally I have a lot of family and friends who would be helped out tremendously by its passage.

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