On health care, I have no idea what our basic guiding principle is. Seriously, I don’t.

We have tried ineffectively to stretch free market rhetoric to health care without appreciating that health care is already too far removed from a free market for the analogy to make sense. Real markets are sensitive to price. Health care isn’t. The insurance companies hide the cost of actual care from the consumer.

. . . A well-developed Republican health reform effort could have addressed the high cost of health care — actually the most glaring issue in our system — in a way that would have served as a kind of tax cut for the already insured. And in lowering costs, we could have covered the people who wanted health care but couldn’t afford it — the nub of the uninsured problem.

Ruffini concedes that Republicans “brought a knife to a gun fight,” but the metaphor actually misses the point Ruffini works so hard to make. Democrats laid the ground work for a policy debate, heaving sheaf upon sheaf of data, assessment, and conclusion upon the table. In their favor, in this case, was the general awareness among Americans that our current system isn’t all that hot.

Republicans meanwhile tried–and arguably succeeded, at least on this point–to recast the battle as one of politics, rather than policy, and they simply said “No.” But before the real political battle could be redefined, Republicans needed to neutralize the policy debate, and they never did. That’s at the heart of Ruffini’s observations, and as such, he could have pointed out that Republicans brought an orange to a gun fight. In other words, by refusing to engage even an iota on the policy at hand, Republicans ginned up for a fight but left all their weapons at home.

Republicans on Tuesday rolled out all of the obstructionist tactics they promised as the Senate kicked off its final health care showdown, beginning 20 hours of debate on the reconciliation bill meant to amend the comprehensive legislation signed into law on Tuesday. GOP tactics to stall the measure included introducing headline-grabbing amendments to the bill (like a proposal to prohibit Viagra coverage for sex offenders), and blocking Senate business on issues unrelated to health care.

Even as the GOP pulls out all the stops . . .

Emphasis mine. Kudos to CBS for not pretending that Republican efforts today are anything but angry and political, to the point of blocking unrelated business.

But here’s the thing: if the Supreme Court decided to overturn decades of precedent and strike down the mandate even though Kevin Drum says they shouldn’t (hard to imagine, I know), the insurance industry will go ballistic. If they’re required to cover all comers, even those with expensive pre-existing conditions, then they have to have a mandate in order to get all the healthy people into the insurance pool too. So they would argue very persuasively that unless Congress figures out a fix, they’ll drive private insurers out of business in short order. And that, in turn, will almost certainly be enough incentive for both Democrats and Republicans to find a way to enforce a mandate by other means.

Drum’s post raises the point that, even if the attorneys general swayed the Supreme Court to interpret the individual mandate as unconstitutional, repeal would only go as far as the individual mandate, not the entire act. And as Kevin points out, the insurance lobby is unlikely to sit idly by.

The eventual consequences of fighting the Patient Protection and Affordable Care Act are far reaching and difficult to foresee. Serious conservatives seem to be aware that, now that the act is law, it’s not going to go away. David Frum certainly thinks so. And the US Chamber of Commerce has already distanced itself from political efforts to repeal the act. Stay tuned.

I don’t pretend that the current bill is a balm to all health care problems, but on the basic underlying premises, the pending legislation is an epic move in favor of insuring more Americans and providing insured Americans more security and confidence in the services they can expect.

Of course, I’m unapologetically in favor of a single-payer system, and I’d rather see that. But I see no fault, given the reality of checks and balances in our political system, in starting with a bill that’s simply better than the current framework and working through a series of legislative efforts to improve again upon that. I also recognize that certain American tendencies are immutable, among them, potentially, a chronic aversion to single-payer health care. So yeah, I think this bill is a step forward.

Jane Hamsher is also unapologetically in favor of a single-payer system, and she says that this bill is a burden on the American middle class.

A middle class family of four making $66,370 will be forced to pay $5,243 per year for insurance. After basic necessities, this leaves them with $8,307 in discretionary income — out of which they would have to cover clothing, credit card and other debt, child care and education costs, in addition to $5,882 in annual out-of-pocket medical expenses for which families will be responsible.  Many families who are already struggling to get by would be better off saving the $5,243 in insurance costs and paying their medical expenses directly, rather than being forced to by coverage they can’t afford the co-pays on.

Emphasis mine. I think Hamsher raises a fair point. Many families would be better off saving $5,243 in insurance costs annually, if nothing goes wrong. After that, though, I’m not sure that Jane’s assessment holds water. In 2009, for example, the Milliman Medical Index (pdf) found that the average American family of 4 consumed $16,771 in medical care and services. Given these numbers, $5,243 looks like a bitter but efficacious pill to swallow.

At any rate, the Firedoglake facts appear fairly well sourced, though I might use them to draw completely different conclusions. I encourage readers to take a look.

Every single one of you at some point before you arrived in Congress and after you arrived in Congress have met constituents with heart-breaking stories. And you’ve looked them in the eye and you’ve said, we’re going to do something about it — that’s why I want to go to Congress.

. . . Every single one of you have made that promise not just to your constituents but to yourself. And this is the time to make true on that promise.

The president, I think, spoke to the kernel of idealism that once took root in every hardened incumbent before he or she ever served in public office. It’s one thing to wax poetic about the historic proportions of the bill that’s scheduled for an up or down vote tomorrow on the House floor,  and Obama did plenty of that, to be sure. But the president balanced ambitious political cheerleading with an appeal to the most intimate type of promise a campaigning politician makes to a constituent, and then Obama balanced that again with an appeal to each representative’s conscience.

I know this is a tough vote. I’ve talked to many of you individually. And I have to say that if you honestly believe in your heart of hearts, in your conscience, that this is not an improvement over the status quo; if despite all the information that’s out there that says that without serious reform efforts like this one people’s premiums are going to double over the next five or 10 years, that folks are going to keep on getting letters from their insurance companies saying that their premium just went up 40 or 50 percent; if you think that somehow it’s okay that we have millions of hardworking Americans who can’t get health care and that it’s all right, it’s acceptable, in the wealthiest nation on Earth that there are children with chronic illnesses that can’t get the care that they need — if you think that the system is working for ordinary Americans rather than the insurance companies, then you should vote no on this bill. If you can honestly say that, then you shouldn’t support it. You’re here to represent your constituencies and if you think your constituencies honestly wouldn’t be helped, you shouldn’t vote for this.

The president also stated flat out “Now, I can’t guarantee that this is good politics.” And he singled out Betsy Markey and John Boccieri as representatives who have looked at this measure from every angle and evaluated the politics as well as the policy and decided to vote with the majority caucus in favor of reform. Betsy Markey may well be a one-term representative. I hope it’s not so, but Colorado’s 4th District may in fact be more comfortable with Markey’s predecessor, archconservative culture warrior Marilyn Musgrave, than with Markey. But Markey also gets what this bill is about, and she gets it that she can’t vote no on this bill and then come home to her district with her head held high.

In the end, the president had to reach the people for whom a yes vote tomorrow really won’t be good politics and convince them (or effectively remind them) that voting yes is the right thing to do, even if every political survival bone in their bodies is screaming and shaking to vote no. This has been his agenda for the past week, culminating in his trip to the Hill today. We’ll know tomorrow whether he’s succeeded or not.

The caucus electorate is a very exotic one. These are people who tend to be dedicated members of their political party, uh, party regulars, party loyalists. In the Democratic party they tend to be more liberal than the Democratic party generally. In the Republican party they tend to be more conservative than the Republican party generally.

And that’s when it dawned on me that, probably, the same can be said for protestors. By and large, people who take time to picket a government office or set up on a street corner with political signage do not reflect mainstream Americans.

Health Care Reform Protestors (image via Wikimedia Commons)

This is purely anecdotal conjecture, but Loevy’s observation about the caucus goer confirms for me the veracity of my statement about protestors. And I’m glad that it does, because the whole realization explains for me, at least in part, the vitriol and malevolence we’re seeing today in protests surrounding health care reform.

Most Americans are not as angry and mean as some of the protestors we see on the cable news, just like most Americans do not attend party caucuses. Most Americans likely also have strong feelings, one way or another, about health care reform. Most Americans, I am hopeful, still believe there’s room for respectful discussion, or even respectful argument, without such demonization of differing view points. But the protest crowd, like the caucus electorate, is a very exotic one, and more extreme in its beliefs than the party generally.

First off, I’d like to thank Betsy Markey (again), who was specifically targeted at the end of this ad in local markets, for not caving to the Chamber’s predictable, distorted, anti humanitarian efforts to defeat health care reform.

Second, I’d like to point out that not all Chambers of Commerce are in agreement with the US Chamber of Commerce. Consider this:

[A] delegation from the San Francisco Chamber of Commerce met with House Speaker Nancy Pelosi and other lawmakers to voice strong support for cap and trade legislation and the core principles of the Senate’s health care bill. The delegation included United Airlines, Pacific Gas & Electric, and several small businesses. “The San Francisco business community has a different perspective on some key issues that are currently being considered in Congress,” said San Francisco Chamber vice president Rob Black, explaining why he’d chosen to circumvent the US Chamber’s lobbyists. “We wanted to be able to communicate with [Pelosi] directly the San Francisco businesses community’s perspectives on both those issues.”

Along with the San Francisco Chamber–one of the ten largest Chamber affiliates—ever more businesses and trade groups are distancing themselves from the Chamber’s partisan tactics. Earlier this month, a Microsoft representative publicly repudiated the Chamber’s position on climate change, writing that the Chamber “has never spoken for nor done work on behalf of Microsoft regarding climate change legislation.” And business groups that together count more members than the US Chamber does–groups that include the US Womens Chamber of Commerce, the US Hispanic Chamber of Commerce, and the South Carolina Small Business Chamber of Commerce–have signed a pledge in support of the Consumer Financial Protection Agency, which the US Chamber opposes.

Prominent business groups aren’t the only ones divided by health care reform. Increasing factionalism is evident among Democrats, where uber-liberals like Jane Hamsher are determined in their attempts to derail reform for not being progressive enough.*

Also, consider this:

The National Catholic Reporter is joining American nuns and the Catholic Health Association in breaking with the Bishops and endorsing the health reform bill, offering the observation that “the bishops have to be clear that some of their talking points might lead honest observers to question their competence — or worse.”

If health care reform efforts have value in addition to improving health insurance coverage and health access for millions of Americans–and reducing the national deficit by $138 billion over the next 10 years–it’s that the issue appears to be forcing socially progressive announcements among groups that would probably rather not spar with their partner organizations if they didn’t have to. But the thing about sweeping legislation is that various members of various interest groups will speak up, and that’s clearly been the case within the Chamber and various offshoots of the Catholic Church. Looking ahead, these rifts may only widen as socially progressive, people-first legislation is introduced in America. The same goes for financial regulation, environmental policy, education reform, what have you.

*Hamsher is deeply concerned about abortion restrictions, and I think her position is defensible if one’s only consideration in weighing the bill’s merits has to do with access to abortion. Generally, however, I think it’s pretty indefensible to judge such a broad bill through such a narrow lens.

This bill will be the single largest deficit reduction bill in 27 years.   It will most likely be the single largest deficit reduction measure I vote for as a Member of Congress.

That’s why I’m voting for this bill.  There are things that this bill does immediately that I could not, in good conscience, oppose: it ends denial of coverage for people with pre-existing conditions and prevents health insurance companies from dropping people from coverage when they get sick.

Some of the other hightlights of what this bill will do are:

• It allows people who are 26 and younger to stay on their parents health care plans.  As a mother of three children under the age of 26, that is an important issue for me.
• It closes the donut hole in Medicare Part D, which will lead to lower drug costs for seniors and guarantees that Medicare benefits will not be cut, all by saving money from withing the Medicare program by weeding out waste, fraud and abuse.
• It eliminates annual and lifetime limits on all insurance coverage and guarantees that insurers cover preventitive care for afflictions like cander and diabetes.
• Additionally, more than 30 million new people will benefit from health insurance coverage withing the next ten years.  Out of pocket costs for premiums and medical expenses will finally be made affordable for individuals and families.  There are strong private health insurance options covered by this bill, with state exchanges and more benefit plan options.

Quite simply, this is a better bill than the legislation I opposed last fall and it does more to contain costs while providing increased health insurance coverage.

Emphasis mine. Good on you, Betsy Markey, for legislating with your conscience. The people of Colorado’s 4th District are well served.