Health care bill signed. VP Biden says it’s a big fucking deal.


  1. Patrick Enders said:

    Joe is right – and nothing succeeds like success:

    WASHINGTON — Americans by 9 percentage points have a favorable view of the health care overhaul that President Obama signed into law Tuesday, a USA TODAY/Gallup Poll finds, a notable turnaround from surveys before the vote that showed a plurality against it.

    By 49%-40% those surveyed say it was “a good thing” rather than a bad one that Congress passed the bill. Half describe their reaction in positive terms, as “enthusiastic” or “pleased,” while about four in 10 describe it in negative ways, as “disappointed” or “angry.”

    The largest single group, 48%, calls the bill “a good first step” that should be followed by more action on health care. An additional 4% also have a favorable view, saying the bill makes the most important changes needed in the nation’s health care system.

    March 23, 2010
  2. john george said:

    Patrick- Success in passing the bill doesn’t necessarily translate across the board into success in reformoing the health care industry. There is an old saying, “The proof is in the pudding.” Now that we at least have some point from which to move forward, perhaps the real changes can begin to come about. One nice thing about our form of government is that there is no legislation so inept that it cannot be changed or adjusted as need be later. That thought in itself is probably what gives us all hope in this scenario. Our country and economy is so intertwined that even the multi-trillion dollar wall street welfare bundle didn’t bring things down, so this will likely not show any effects upon the economy for some time. In fact, my impression of the whole thing is that it is going to take some time to figure out what actually was passed and how it is going to affect our everyday lives.

    March 23, 2010
  3. Patrick Enders said:

    I agree, and for once I find myself in the 48% plurality who thinks passing this bill is “a good first step.” There is definitely much more work to be done.

    In my post, I was thinking of the supposed political price that Democrats were going to pay for passing this bill “against the will of the majority of Americans,” as many Republicans have claimed.

    As the public learns more about this new law, I expect public sentiment will continue to follow the recent trend, until soon an outright majority will approve of it.

    (That’s not to say that the Democrats won’t lose seats in the election this year. They will lose at least some, and maybe even many. However, it will not be because of health care. Rather, it will be because they won in a landslide the last time around, and their hold on many of those lean-Republican seat would be tenuous even in good times – and these are not good times, and the Democrats haven’t made it all better yet.)

    March 23, 2010
  4. John S. Thomas said:

    Of all the adjectives… Way to lead Joe!

    March 23, 2010
  5. BruceWMorlan said:

    Well, people love the other third rail too … Social Security. But the numbers suggest we do not have the political stomach to pay for either of these programs. Creating another entitlement program seems to me to be insane. And not allowing insurance companies to underwrite their risk seems to be an indicator of an innumerate ruling class. I would not own stock in an insurance company at any price.

    March 25, 2010
  6. Paul Zorn said:


    Could you explain a bit more about insurance companies not being allowed to underwrite risk? Meanwhile, others seem not to share your aversion to insurance stocks, which have generally risen in recent months. Or is this just the “innumerate ruling class” at work?

    Creating a new public entitlement for, say, iPods, would indeed be nuts, even though we all seem to love them.

    But health care is different for many reasons. Here are two: (i) Government has for decades been spending hugely on medical care, so the “entitlement”, wise or unwise, is hardly “new”. (ii) Assuring access to health care is quite arguably a public purpose, like education or police or national defense. Whether that access is provided through private insurance, through a national health system (as in the UK), or in some combination (as we’ve had here for decades) matters, but so does the principle of the thing.

    March 25, 2010
  7. Bruce W. Morlan said:

    Hi Paul. Good to hear from you.

    Underwriting (I thought) was the term used to describe the process of charging people for insurance according to the actuarial tables’ predictions of their risk. So people with DWI convictions pay more for auto insurance. The popular press has indicated that pre-existing conditions will be covered. Since the end result is that companies will have trouble making ends meet, I expect either Federal bailouts of the insurance industry (and you thought bank bailouts were unpopular) or I would expect an end to private insurance companies. Its sort of a Markov process with an absorbing state.

    The princpled wrong of having the government and industry responsible for paying for health care is an accident of history that is not solved by expanding government health care coverage through a new entitlement program.

    As for declaring health care a public good to be covered by the government, well, THAT is the proper place to start the discussion. I could see us arguing that point and reaching a consensus and modifying the Constitution to make it part of our (citizens) agreement. Maybe the better short term solution would have been to expand Medicare and Medicaid as stop-gaps (with a sunset in 5 years) and actually start that Constitutional debate as an eventual solution to the problem.

    March 25, 2010
  8. Paul Zorn said:

    Hi, Bruce,

    Thanks for the definition. But here’s my question: Do you really expect the new law just to bar insurance companies from using actuarial information? I doubt it.

    True, the new law requires insurance companies to underwrite a somewhat different risk pool, which will probably include some riskier and some less risky members than before. And (I’m just guessing) it may impose some new restrictions on how actuarial information is used. But such restrictions are not new — health insurers are already, unless I misunderstand, limited in using or acquiring genetic information in setting rates, even though genetics must be strongly linked to expected health costs.

    More to the point …   As you well know, statisticians and actuaries are very smart, and so can be expected to be able to set and adjust premiums appropriate to any risk pool, and under almost any set of legal constraints. I don’t see how present legislation would change that.

    March 25, 2010
  9. Jane Moline said:

    Bruce: I don’t think a constitutional amendment is necessary to give our citizens access to health care like every other developed nation in the world has been able to do at less than half the cost–they have preexisting conditions in France, too, yet they seem to be able to give better health coverage to more people at a lower cost than we do–

    So I think we have a lot of fat to cut out of the system–overpaid service providers and insurance companies–and if that means we have to go to universal health, well so be it–it has not ended any European governments who do it better than us.

    Frankly, I think your idea of a constitutional amendment is a bit ridiculous.

    I do think health care should be de-linked with employment–that is one of the big problems, as it is costing business too much (just ask GM) and it should not be a burden that businesses bear alone.

    As for being a principled wrong for government and industry being responsible for health care, I agree with the industry part but the government is us and we are the government and I think it is appropriate that we be responsible for health care for all citizens.

    March 25, 2010
  10. Patrick Enders said:

    There are some left-leaning thinkers who believe that the Affordable Care Act will (gradually) accomplish the de-linking of employment and insurance that you are hoping for.

    Take a look at this piece by Matt Yglesias:

    March 25, 2010
  11. Scott Oney said:

    And yet they still can’t figure out why we don’t trust them with our health care.

    March 25, 2010
  12. David Ludescher said:

    Bruce: Interesting concept. What is a “Markov process with an absorbing state”?

    Paul: My guess is that nearly every actuarial calculation is going to say that the health care bill will make care more expensive. Trying to provide more health care benefits is a good and right thing to do. However, all indications suggest that our approach will be quite expensive. It is basically more of the same thing that has already made health care very costly.

    When I go to the doctor, I rarely ask how much something is going to cost. I do check my policy to see if the insurance company will pay. If they will pay, I am much more likely to go. When I do go, the bill is always adjusted downward because the insurance company has negoitated a lower rate. So, having insurance actually raises the cost for health care on the whole. And, because I am greedy, I don’t really care if others have to pay more so long as I get the coverage that I want. In the end, everyone suffers. Insurance rates go up; less people can afford coverage.

    Yeah, this is a big f—ing deal. So was going to war in Iraq. I’m just afraid that 7 years from now, there will be a lot of opposition, everyone will be blaming everyone else, and Democrats will be complaining that they relied upon faulty information from the Congressional Budget Office about the real impact. C’mon, these same folks who voted overwhelmingly to go to war in Iraq and weren’t smart enough to figure out there weren’t weapons of mass destruction.

    March 25, 2010
  13. Jane Moline said:

    Bruce: if the insurance companies would just put all of their customers in a pool your point would have some merit. The fact is if I work for a big company, my insurance cost is small, but if I am self-employed, my insurance cost is huge–I am still the same me–the insurance companies are using their actuarial excuse to cheat me and subsidize their bigger pools–not fair, not right, and not even actuarialy (That is a big word sorry if I misspelled.)good policy (see what happened in California, where the healthy self-employeds decided to dump their policies rather than pay to subsidize the big pools). So if the insurance companies can’t handle it, we can just go to universal health, which works in every other developed nation in the world and doesn’t bankrupt them–many pay 1/3 per capita what we do for health care and have much better results.

    And David L, you have identified part of the problem–if you don’t know how much something costs, how can you make a decision about whether or not it is worth doing? Insurance companies have contributed to the high cost of medicine in this country with their reimbursement policies and pricing–and they deserve what will come because of their ill-conceived decisions.

    March 25, 2010
  14. Jane Moline said:

    Scott: I don’t know who you are referring to in your comment, but I don’t trust the insurance companies and I do trust that we must make major health care reforms-of which this bill is just a start.

    March 25, 2010
  15. Paul Zorn said:


    A Markov process describes a system that toggles among various “states” with known probabilities. The states might be, say, Minnesota, Wisconsin, Florida, and Death, with known percentages of people who move annually to or fro among these conditions (1.4% of Wisconsin moves to Florida, 0.3% of Minnesota moves to Wisconsin, … ). Over a long time, the population distribution might stabilize, with income and outflow matching year by year. The story problem is to find this long-term stable distribution.

    An absorbing state in this context is the proverbial roach motel: You can check in but not out. Hint: One of the “states” above is absorbing.

    What this all has to do with health care is not clear to me …

    Bruce, you say:

    The princpled wrong of having the government and industry responsible for paying for health care is an accident of history …

    Re the boldfaced typo … do you mean “principal” (as in the most important wrong) or “principled” (as in an error of principle)? Either way, you conflate two very, very different things — the role of government and the role of industry. It’s perfectly possible (I’m one example) to be for one and against the other. Do you really see no difference?

    Re this:

    … Maybe the better short term solution would have been to expand Medicare and Medicaid as stop-gaps (with a sunset in 5 years) and actually start that Constitutional debate …

    I’m fine with a Constitutional debate, though I don’t see the need for one. And I’m even finer with extending Medicare/Medicaid. But such a solution seems to have been dismissed right out of the blocks as wild-eyed radicalism. Go figure.

    March 26, 2010
  16. David Ludescher said:

    A constitutional debate may be coming with the states that have threatened to sue. The debate is probably long overdue. Ever since the Civil War (or, as I saw it displayed at one war memorial in the South – the War of Northern Aggression) when Abe Lincoln used the power of the federal government to invade the previously sovereign states of the South, the federal government has taken an increasingly authoritarian position regarding the use of its power.

    Not only is the states versus the federal government debate overdue, but the idea that the people have a “right” to receive benefits from the government has come to be an increasingly popular idea although it has absolutely no support in the framework or the words of the Constitution. If we are going to agree that everyone has the right to some health care, it would be wise to define what that “right” is, and codify it.

    March 26, 2010
  17. Phil Poyner said:

    My former representative, Gabrielle Giffords (D – AZ), had a glass door and side window of her Tucson office either kicked or shot out. Way to stay classy, Arizona!

    March 26, 2010
  18. Patrick Enders said:

    That is to say: that constitutional debate was settled years ago… and will only be changed if the conservatives manage to add one more radical to their majority on the Supreme Court.

    These lawsuits are, for now, all about anger and political posturing.

    A few interesting posts on this from my reading this morning:

    Also, to have a constitutional debate, you need to have two sides with distinct, but coherent, perspectives. As it is, the members of the “tea party” are not exactly consistent in what they do, or do not, want from government:

    March 26, 2010
  19. john george said:

    Here’ a different perspective, possibly more related to Griff’s original post theme. Take a look at this link:

    Seems this 14 year old from California is taking on the VP for his lapse in verbage. Interesting that this type of language has become so common place that we become dulled to it. Leave it to 14 yr. old to point out that the king doesn’t have any clothes on.

    March 26, 2010
  20. Bruce W. Morlan said:

    Paul, thanks for explaining Markov processes – very clever use of states as states. And since Minnesota is heaven on earth I presume it was the absorbing state!

    (Actually, the absorbing state is the Federal government and the transient states are the insurance companies and the entities are the coverages being insured. That’s why I said we might see yet another bailout on the horizon.

    As for principled, I meant it as spelled. You taught me long ago to use spell checkers whenever possible. And as for conflating industry and government. I put the two together not from confusion, but rather from analogy.

    The so-called gold-plated health insurance plans given to some workers by their relationship with their industries has distorted the market place for health care in a manner similar to the distortion that the retirement planning industry had experienced thanks to the Social Security system (I use past tense because in recent decades the writing on the wall has been “Do you want to count on Social Security for your golden years?”, so it has turned into a marketing gold mine). The bottom line issue is that counting on your employer and counting on government both tend to separate cost from the benefactors in a bad way, and in a way that makes it hard for the unaffiliated non-participants (independent businesspeople, the working poor, etc.) to compete for the limited resources (medical care). Worse, in the case of government, the urgings of each special interest only serve to accrete more and more benefits to the bill until the system collapses in bankruptcy. But we did not get to hear much about that.

    And Jane M. is exactly right when she identifies the unresolved question as is it appropriate that we be responsible for health care for all citizens?

    That question was never debated, we spent the whole discussion on how to nationalize health insurance without ever being allowed (in any meaningful way) to ask should we nationalize health insurance? Simply pointing to various other countries as saying “see, they did it” fails to account for differences in demographics, differences in objectives and differences in choices.

    March 26, 2010
  21. David Ludescher said:

    Patrick: Actually, the debate is not settled, nor will ever be settled. Whether states have to obey edicts of the federal government depends upon the nature of the dispute. (I suppose that the feds could resolve the state’s rights dispute the way they did in the Civil War.)

    The question of whether citizens have the “right” to demand health care from their government will require a constitutional amendment, otherwise it is just a law which can be changed the next administration.

    March 26, 2010
  22. Patrick Enders said:

    I agree that it is “just a law that can be changed” the next time that a Congress and the President agree to change it.

    March 26, 2010
  23. David Ludescher said:

    Patrick: That means that health care is not a right.

    March 27, 2010
  24. Patrick Enders said:

    All ‘rights’ are tentative at first. But in a decade or two, health care may seem as much a right as the other ones that we have already embraced. We (collectively) get to decide what is a right, and that concept has evolved (largely to expand the concept) over time, and will likely continue to evolve (if past trends hold true, to further expand the concept).

    March 27, 2010
  25. Paul Zorn said:


    You write:

    … is it appropriate that we be responsible for health care for all citizens? … That question was never debated, we spent the whole discussion on how to nationalize health insurance without ever being allowed (in any meaningful way) to ask should we nationalize health insurance?

    Indeed, how much responsibility government should take for health care is a key one. But I don’t follow your assertion that “we” were never “allowed” to ask such things. Who’s disallowing us? True, the health care bill debate often got pretty woolly, and sometimes flirted with madness. But the main question of public responsibility was, and remains, implicit in the discussion.

    And then:

    Simply pointing to various other countries as saying “see, they did it” fails to account for differences in demographics, differences in objectives and differences in choices.

    Yes, different countries have different demographics, values, etc. But please be more specific. Can you cite some specific demographic or value differences between the US and all other rich countries that could account for us spending about twice per capita what they do?

    March 30, 2010

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