Category Archives: Health care reform

Oh honestly Roger . . .

You’re not even pretending anymore or you’ve run out of graphic magic tricks.

Fox graphics intern was told there'd be no math.

If you’re planning a journey into the health insurance exchanges . . .

. . . you might benefit from visiting  Health Sherpa, given the Looking-Glass world of health insurance at present. Since I don’t need insurance, I didn’t go deeply in, but it looks like a very very useful tool.

They describe themselves thusly:

The Health Sherpa is a free guide that makes it easier to find and sign up for health insurance under the Affordable Care Act. We only use carefully vetted, publicly available data.

The Health Sherpa is not affiliated with any lobby, trade group or government agency and has no political agenda.

 

Why Medicare works and Obamacare might not

Picked this up at Andrew Sullivan’s site. More at the link.

Mike Konczal blames Obamacare’s technical problems on the law’s design. He contrasts Obamacare’s form of social insurance, which he labels “Category A,” with previous forms of social insurance, such as Medicare and Social Security, which he labels “Category B”

http://sullydish.files.wordpress.com/2013/10/social_insurance_category.png

Did we take a giant step forward, and then two . . . (you know the rest)

The whole story of the ACA roll out is yet to be reported in depth, but this morning in his Wonkbook email, Ezra Klein provides a credible – and disturbing – overview of what led up to the massive failure of the web portal. There’s a lot more at his Wonkblog at the Washington Post.

The best news for Obamacare is that almost everyone — including the Obama administration — realizes the crucial online portal is currently a disaster. . . Actually, that’s been the problem: President Obama didn’t know that. Nor did White House chief of staff Denis McDonough. Nor did Health and Human Services Secretary Kathleen Sebelius, who will be testifying to that fact next week.

It would be one thing if Obamacare’s problems had been unknowable. But they weren’t. Staff at HHS and CMS saw this coming for months. Insurance companies began predicting a mess long ago. But the bad news was shaded and spun as it made its way up the chain of command. The alarming failures seen in the (inadequate) load tests were written off as bugs that would soon be fixed.

As Lena Sun and Scott Wilson reported, “Days before the launch of President Obama’s online health insurance marketplace, government officials and contractors tested a key part of the Web site to see whether it could handle tens of thousands of consumers at the same time. It crashed after a simulation in which just a few hundred people tried to log on simultaneously.”But staff was terrified to speak on the record, or even on background. Some of the concerns slipped out, like in this Wall Street Journal story. . . . As Jonathan Cohn writes, “the management failures here were real and took place on multiple levels.”

Obamacare has a chance because those management failures are over. The White House now has a brutal clarity about the depth and extent of the system’s problems.

. . . Managers up and down the chain realize their careers are in jeopardy if they deliver sunny reports that prove false.. .For all that, no one actually knows whether the system will be fixed in the next few weeks — the crucial window, experts think, before the problems begin to degrade the risk pool and raise premiums.

So far, there’s been huge improvements in the number of Americans able to get into the site and create accounts, but insurers aren’t reporting much improvement . . .

The White House is optimistic that the problems will be solved in time. . .  If there’s a reason to believe them, it’s that they’ve learned how dangerous unfounded optimism is.

Did Obama really hand this off and assume it would be okay? Or did he ride HHS for progress updates but never insist on hearing the downside reports? Did Sebelius do the same thing?

Will the very same Administration that succeeded in taking took us a step closer to the century long  battle for universal health care also be the Administration responsible for its failure?

I think it’s a fair question.

Priorities people, priorities!

According to The Wall Street Journal, developing the health insurance exchange site so far . . .

. . .  has cost at least $360 million, and possibly as much as $600 million.

Then there’s the F-22. Developing that baby cost a mere $42 billion and while the planes themselves are a steal at only $150 million per, it was nine years before a single production model was delivered to the Air Force.  Wikipedia:

During the development process the aircraft continued to gain weight at the cost of range and aerodynamic performance, even as capabilities were deleted or delayed in the name of affordability

F-22 production was split up over many subcontractors across 46 states, in a strategy to increase Congressional support for the program.[29][30] However the production split, along with the implementation of several new technologies were likely responsible for increased costs and delays.[31] Many capabilities were deferred to post-service upgrades, reducing the initial cost but increasing total project cost.[32]Each aircraft required “1,000 subcontractors and suppliers and 95,000 workers” to build.[33] The F-22 was in production for 15 years, at a rate of roughly two per month.[34]

Now that’s some bureaucracy there! It’s really a marvel the thing flies.

Liberal media provides cover for Obama

Just as the right wing noise machine always says, that liberal media will spin every which way to make their guy look good. Like with this screaming front page at Huff Post right now:

obamacare

 

Of course, I will allow as they aren’t calling for impeachment, so there’s that.

Sorry Kathleen, your day must come to an end

https://i2.wp.com/upload.wikimedia.org/wikipedia/commons/5/5c/Kathleen_Sebelius_official_portrait.jpgShe really needs to step down. Soon.

Someone must pay the political price; it’s the distasteful way of the world.

So just get it over with.

Anxiously awaiting an explanation . . .

. . . for that ACA website clusterf*ck. Official statements aren’t of much use yet, although I expect there will be hearings down the road.

I’m deeply curious about what went into the thinking, and then what went on behind the scenes with the legions of technocrats who built the site. They’re the ones who usually get it right and this time they got it so so wrong.

Most puzzling and bizarre – why does the site block users from browsing unless they register an account? Have the designers never visited a retail website? Shopping comes first, establish an account comes second, sign up (or add to your cart as we know it) is penultimate and finally it’s time to pay up and the transaction is done.

A puzzlement. Soon there will be some in-depth investigative reporting in reputable media outlets on how it went wrong. I look forward to reading those stories.

Ready. Aim. Fire. USA! USA! USA!

How many ways can we cripple our own future . . . and how easily are we manipulated into cooperating in our own destruction, believing it to be salvation instead? Ahh . . .

A recent column by Ruth Marcus takes a look at that phenomenon with the antipathy towards the health care mandate, now headed to the Supreme Court.

Even I am surprised by the extent of the negative poll numbers. What doesn’t surprise me is that they are the result of misinformation. When the details of the health care law are polled, they do well. And when the financial benefits to taxpayers are explained . . . . well, the opposition should dissolve, but it doesn’t because the entrenched meme of government overreach has taken deep root.

The Obama administration’s brief defending the constitutionality of the health-care law come early on. “As a class,” the brief advises on Page 7, “the uninsured consumed $116 billion of health-care services in 2008.”

On the next page, the brief drives the point home: “In 2008, people without insurance did not pay for 63 percent of their health-care costs.”

And that $116 billion is of course paid for by those who do have insurance – in higher premiums and in taxes.

An individual mandate was essential to make the plan work. Without that larger pool of premium-payers, there is no feasible way to require insurance companies to cover all applicants and charge the same amount, regardless of their heath status.

. . . “People don’t understand how the mandate works at all and they don’t understand why it’s there,” Kaiser’s polling director, Mollyann Brodie, told me.

Brodie suspects that it’s too late to change minds. “This law as a whole has really become a symbolic issue to people and they really aren’t open to information,” she said.

The Court may very well uphold the mandate. And we should shudder at the consequences to us if the other provisions of the bill are left in place, and the funding mechanisms stripped out.

But Congress and its corporate overlords won’t give up. The flames must continue to be fed, the people must be kept agitated. The rational path must not be taken.

Fire. Aim. Ready. As usual.

LET ME I ADD: An earlier Post story (can’t locate link) reported that employer-sponsored health insurance premiums have risen faster than incomes in every state in the union – while consistenly delivering skimpier benefits. We can certainly look forward to more of this is the mandate is struck down.

Crow? Or eat your words? The Right has chosen.

Politifact has named their Lie of the Year for 2011“Republicans voted to end Medicare”.

Sayeth the right wing media today: Politifact heroically speaks the truth! It accuses Democats of perpetrating the biggest lie of the year. Wow! See? We told you so.

Sayeth the right wing media before today: They’re liberal leaning! Don’t trust what they say! Well known liberal bias! Tool of the librul media! Rush said so!

And so it goes.

(The 2010 and 2009 choices indicted Republicans, and on the same subject but, well, you know . . .)

Thanks, I needed that!

Via friend Jane here are six minutes liberals need to watch. In the liberal view, there are two sides to Obama, which we’ve created as promise vs. reality. Lately we’ve been focused on  the ‘why doesn’t he do more!’ side.

Here’s a calm, rational Democrat reminding us of ‘the promise’ side. Save this one to watch periodically if you haven’t time now. An outtake from him about the volatility in the Middle East these days:

I haven’t seen a single image of a [US] flag being burned. Before 2008, that would have been unimaginable.

Obama gives good speech

POSTED BY ORHAN

Measured and persuasive, last night President Obama was the soul of moderation, rationality, and responsibility as he made the case for passing his version of the debt deal. But he did leave a few items out of his story:

He blamed his predecessor for squandering the budget on two wars and a prescription drug program. But he neglected to mention that he continued those wars, and expanded American military operations into new countries; meanwhile he secretly bargained away the public option with the same pharmaceutical companies that had benefitted from the drug program he criticized.

He pointed out that Americans making under $250K would see no tax increase at all. But he neglected to mention that those same Americans will be in fact paying more, by having to make up for the cuts to Social Security and Medicare out of their own pockets.

He called his plan a balanced approach and said no one would be required to sacrifice too much, while acknowledging the cuts would be “painful”. But he neglected to mention that he was planning Social Security and Medicare cuts as far back as January 2009; the kind of cuts a Republican president could never push through.

Obama’s narrative of reason and compromise heroically standing up to the Tea Party’s barbarian hordes was quite stirring, and if one ignores the fact that he just happened to shit-can fundamental Democratic principles and programs as the first step in the process, quite true. No doubt at this moment, Democrats are battling tooth and nail to get his version of the debt ceiling deal passed, a deal they would have fought to the death if proposed by George W. Bush.

All in all, it was an excellent speech; classic Obama.

Granny won’t die

Quality not quantity is  something we simply cannot tolerate in Medicare. But according to this story from today’s New York Times (via my Herald-Tribune), that’s just what’s coming your way under the new health care law.

For the first time, Medicare will soon track spending on millions of individual beneficiaries, reward hospitals that hold down costs and penalize those whose patients prove most expensive . . . A major goal of the new health care law, often overlooked, is to improve “the quality and efficiency of health care” by linking payments to the performance of health care providers. The new Medicare initiative, known as value-based purchasing, will redistribute money among more than 3,100 hospitals.

And surprise, surprise, the hospitals are all hot and bothered. Apparently we will all now die.

Charles N. Kahn III, president of the Federation of American Hospitals, which represents investor-owned companies, said . . .  the administration was “off track” in trying to hold hospitals accountable for what Medicare spends on patients two or three months after they leave the hospital. “That’s unrealistic, beyond the pale,” Kahn said.

. . . .For years, federal health officials have emphasized the importance of higher-quality care, mentioning efficiency as an afterthought. Now, alarmed at the trajectory of Medicare costs, they emphasize efficiency as an equally important goal.

This part of Medicare reform is aimed at reducing the growth of spending and cuts into the out of control “fee for service” culture that drives hospital costs. It’s been a goal of reformers for years,  if not decades. It starts next year.

Whatever the argument will be, expect one from the Republicans becauseany positive result interrupts their script and their script says Medicare must not be saved.

RomneyCare: The Spin Begins

POSTED BY ORHAN

Anticipating the coming 2012 campaign, FactCheck.org takes a detailed look at the results of the 2006 Massachusetts health care law. Because of the similarities to the federal bill, much spin is predicted. FactCheck summarizes its findings:

  • The major components of the state and federal law are similar, but details vary. The federal law put a greater emphasis on cost-control measures, for instance. Massachusetts is just now tackling that.
  • The state law was successful on one big goal: A little more than 98 percent of state residents now have insurance.
  • Claims that the law is “bankrupting” the state are greatly exaggerated. Costs rose more quickly than expected in the first few years, but are now in line with what the Massachusetts Taxpayers Foundation had estimated.
  • Small-business owners are perhaps the least happy stakeholders. Cheaper health plans for them through the state exchange haven’t materialized, as they hoped.
  • Despite claims to the contrary, there’s no clear evidence that the law had an adverse effect on waiting times. In fact, 62 percent of physicians say it didn’t.
  • Public support has been high. One poll found that 68.5 percent of nonelderly adults supported the law in 2006; 67 percent still do.

The article is long but worth a read. Check the section “What Happened to Premiums?” (The short answer is that overall they went down — but, of course, it’s much more complicated than that.) Prepare to consume mass quantities of hot air in the lead-up to the election.

Joe Bageant, 1946-2011
Joe Bageant, author of the incomparable Deer Hunting with Jesus and the recently-released Rainbow Pie died yesterday following a four-month struggle with cancer. He was 64. Joe wrote about poverty and class in America with humor and love. His work will live on.

A random thought

If the Courts uphold the ‘individual mandate’ in the new health care law . . .  Medicare for All could be more viable.

The best reason ever for unconstitutionality of health care reform. Ever.

Rep. Steve King (R-IA), frequently makes himself the story by being controversial. For instance, he’s said that Obama using his middle name when taking the oath of office was “bizarre”. (Where King is concerned, perhaps we can be thankful that – as far as I know –  he’s only ever served on sub-committees, although that may have changed in this new Congress.

TPM brings our attention to an argument King made this very day – about why the new Health Care bill is unconstitutional and doesn’t come under the commerce clause.

“After Rep. Jared Polis (D-CO) said that health insurance counts as interstate commerce . . . . King argued that there are people who never even use health care . . . “There have always been and likely will always be, babies that were born, lived and died within the jurisdictions of the individual states,” he said, “who never cross a state line, access no health care and therefore do not impact interstate commerce. “

He offered up babies as an example. When challenged on that, he found some compelling proof; King shot back at Polis with this: “I hate to tell you but they show up in garbage cans around this country, sir.”

Okay.

Treat thyself, patient

UPDATED BELOW:

Hideous medical stories of death and destruction abound and did especially take flight during the health care debate. In fact, I expect everyone can name someone who had a terrible encounter with the medical-industrial complex. Most of them are epic or at least end up causing great harm.

But for me, the real problems are quietly embedded in everyday treatment. Two stories and both probably arise from fears of legal liability (yup, I’m a  liberal who favors malpractice reform as do many of my tribe – though not in the form of caps):

Story number one happened to me. I did something stupid to myself at 11pm Friday night, causing a grievous though not threatening injury to myself. A good deal of blood was involved and I wasnt able to clean or bandage it by myself. So what do you do at 11pm? You get in the car and head to the Emergency Room.

A puzzlement? (Not really.)

Upon arrival, I found that my information was still in their computers from a similar visit about eight years ago. This impressed me mightily. I was shown to a cubicle/room and a clerk came in with clipboard and paperwork and began to ask for my info. I politely pointed out that we’d just pulled it all up on their computers down the hall. Didn’t matter. The clerk was required to take it all again to be sure I was me. (cuz people everywhere wound themselves so they can go to the emergency room in the middle of the night.) Okay. I went along with it.

Next, a very nice young man with a big x-ray machine came in. I said you must have the wrong room – I certainly don’t need any x-rays,  just help with some bandaging actually. This very nice young man leaned down, looked and said yeah, I can see that. But. But. But the doctor wants the x-rays and well, that’s pretty much that. It’s clear that if I reject the x-ray (which you can) your ‘treatment’ will take a wholly different and not particularly friendly turn. So we x-ray which by the way produces the first and worst pain I’ve yet had in this episode.

And now . . . drum roll . . . comes the doctor. Very nice. I ask why the x-ray. He solemnly says it’s better to be sure. He looks at wound. He does not touch. He says nurse will be right in. She comes some time later. Doesn’t look. Doesn’t touch. Has more paperwork. Asks if I have a living will (this actually takes my breath away). Insists upon info re who to call  in emergency. I’m still bleeding, though it’s slowed a bit, and I’m losing patience. Nurse leaves.

Finally, an ‘aide’ arrives with bottles of solutions and bandaging stuff. And she irrigates, and she fiddles a bit, and she bandages. And then she starts to put a special orthotic shoe on my foot. And here we go again “I don’t need that” and  ‘doctor says’. I’m out of my league here.

The best part is walking long corridors to exit the hospital and long parking lot to get back to my car. You know what actually would have been appreciated? A lift in a wheelchair would have been appreciated.

The entire matter could have been handled by the aide in 15 minutes. After all, she was the only one who actually treated me.

Story the second: My sister is in Ireland. She had a question re some prescription med she has with her and emailed me Wednesday night asking me to get an email address for her dermatologist. She didn’t want to screw up the prescription. I called them next day.  They absolutely would not give out an email address. They were firm about that. Even when you’re out of  the country – no email address. Sorry.

So I went about just trying to get her questions answered. Hah. Couldn’t speak with the doctor – even tho the clerk was going back and forth between me and him. Final word – they will not give me any info about her or her treatment without a signed release form. (they were fully aware I was her sister – I”m also a patient) I actually said to the woman on the phone at one point, “well, I’ll email my sister in Ireland and let her know that there’s no help from here.” That got her attention and she went back to the doctor but returned with the same message. Nope. Nada. Can. Not. Do.

I then tried ‘how ‘bout I ask you some hypothetical questions about medical treatment, you know, an academic question”? Nope. Nada. Can. Not. Do. And I guess we can add Will. Not. Do.

And so it went. Neither situation responsive to the medical situation or the patient’s needs. Responsive to only one thing of course – scared to death of  litigation.

Count up the pennies and time and effort that went into both those episodes.

This stuff makes me wonder if ourf beleaguered troops in Afghanistan have to go through this nonsense when the run into an IED. I wonder because today is the 260th day of the ninth year of the war there.

We don’t need no stinkin’ reform

From the Washington Post today:

Anthem Blue Cross withdraws big CA rate hike

The Associated Press  Friday, April 30, 2010; 2:17 AM

 LOS ANGELES — Insurance giant Anthem Blue Cross, the company criticized by President Barack Obama when it proposed raising rates for Californians by as much as 39 percent, withdrew plans for the proposed hike Thursday.

Los Angeles-based Anthem made the decision after an independent audit determined the company’s justification for raising premiums was based on flawed data, state Insurance Commissioner Steve Poizner said.

The decision also came one day after Anthem’s parent, Wellpoint, Inc. of Indianapolis, announced its first-quarter profit soared by 51 percent.

Moving right along

It seems Rep Bart Stupak has announced his retirement. (For the sake of my party, I hope to god he doesn’t go to work for an insurance company!) From the Atlantic Online just now:

“Rep. Bart Stupak (D-MI) plans to announce his retirement today, Democrats briefed on his decision said. Stupak, the leader of a pro-life faction within his party, had received death threats and was under intense political pressure after he agreed to support the Democratic health care reform legislation even though pro-life groups insisted that it would allow federal funds to be used for abortion.

Stupak negotiated a compromise with the White House, which resulted in President Obama’s issuing of an executive order clarifying the executive branch’s view of the subject. For that, Stupak was called a traitor to the pro-life cause. Stupak has represented Michigan’s first congressional district for 18 years. He will make public his decision at a press conference later today.”

I guess 18 years of stalwart adherence to a cause is not enough for these people. Do they understand that without political compromise we’d be in a permanent state of war? Can they not get around the fact that compromise is the only thing that keeps us functioning as a republic?  No. They do not.

 

Encore worthy

I love this woman.

Gunfight at the OK Congress

Here are the Dems following their leader into the House today, Pelosi holding the gavel she then used to call the session to  order. John Dingle is in there (D-MI). He used that very gavel to call for the vote in 1964 1965 – on Lyndon Johnson’s major legislative accomplishment, Medicare. Dingle succeeded his own father in his House seat. Both Dingles introduced health care reform at the start of every congress in which the father or son sat – a period of nearly 70 years. This is a big day for John Dingle. And for us.

If I can only stay awake

A bug has taken up residence somewhere in my respiratory tract causing much coughing (nasty sound), an unwelcome and very distracting headache, and – thankfully – a proclivity to fall asleep. I’ve been indulging myself all day so far but as evening approaches here in the Eastern time zone, I must remain awake and watch this wonderful health care debate unfolding in the House.

All the congress critters are there; they’re all being very predictable and making the expected speeches. But – inch by inch – one notices something unfolding. It’s all theatre now which I shall enjoy in spite of knowing how it ends. At least how today’s episode ends. The final fat lady won’t be singing tonight. But even with the Senate vote to come, this is the important one.

An important vote. An important day. Also, the 163rd day of the ninth year of the War in Afghanistan.

Boehner is a joke

House Minority Leader Boehner finally has his beloved health care negotiation out in the public sphere. For almost a year, he’s been condemning the White House and the Dem majority (the ones we elected) to stop meeting ‘behind closed doors’ and make the negotiations public, where the American people could see them.

Finally, as they always do, the Democrats capitulated, although not exactly the way Boehner wanted it. He calls tomorrow’s meeting “a six-hour taxpayer-funded infomercial on ObamaCare”.

Perhaps Mr. Boehner could explain to me what exactly was the way he wanted it?

Good morning my friends at FOX

I rarely tune into Fox and Friends in the morning. But Mica B on MSNBC chases me away because she is so irritating. And CNN talks to their audience as if they were in seventh grade. The Fox crowd at least provides entertainment. Like the cryon across the bottom of the screen this morning while The Gretchen was almost yelling at Sen. Schumer about the Medicare bribe in the Senate health care bill. (She was really enjoying herself!).

The cryon? Here’s what it said:

OBAMA WHITE HOUSE PLOTTING FOR 2012

None of that planning stuff for them. Planning is for pussies.

(We know there aren’t any pussies in Afghanistan though, there are only real men and woman – often boys and girls – there, and they still fighting on the 138th day of the ninth year of the War.)

UPDATE: Fox is not alone in their choice of verbs. Our friends at Politico are also using it – wonder who was first? Their headline is:

WH privately plots 2012 campaign.  They also tell us it’s an EXCLUSIVE!  

Here’s how they open: President Barack Obama’s top advisers are quietly laying the groundwork for the 2012 reelection campaign . .

Somebody really needs to do something about this outrage.

As Chris Bowers said: I see.

Lifted in its entirety from Open Left:

On February 8th, Republican House leader John Beohner sent a letter to the White House, demanding that the White House post online any health care proposal it wished to discuss at the health care summit:

If the President intends to present any kind of legislative proposal at this discussion, will he make it available to members of Congress and the American people at least 72 hours beforehand?

So, four days later, the White House accepted this demand, and announced it would post a legislative proposal online more than 72 hours before the summit:

Since this meeting will be most productive if information is widely available before the meeting, we will post online the text of a proposed health insurance reform package.

So, naturally, the next day, Boehner attacked the White House for giving into his demand:

“A productive bipartisan discussion should begin with a clean sheet of paper,” Boehner said in a statement.

I see.

Stinkin’ liars

If health care fails to pass, it will mark the most remarkable victory of an industry lobbying effort in my life. The very saddest part of it will be that these people – who work against American interests – convinced Americans to go along.

Let’s never forget: corporations do not have any national allegiance. Corporations have no moral imperatives.

Read it and weep

Enough said? Just how batshit crazy are we anyway? Comes from here. With  hat tip to Andrew Sullivan.

Quick thought

and one that doesn’t belong here on Christmas Eve. However . . . The Senate passed the  health care bill 60-39. And everyone will say ‘but that’s a partisan bill, it’s only Democrats supporting  it.”  True. The citizens of the United States elected 60 Democrats. And so it goes.

Home for the holidays? Bah humbug.

I actually stayed up last night to hear the roll call on the 1:00 am vote on the Senate’s health care bill. (It passed with exactly 60 votes.)

And the second last speaker before the vote was GOP leader Mitch McConnell. And he, like the speakers before him, deplored – deplored I tell you – how the Dems were “sneaking this vote and doing it in the middle of the night.”

The 1:00 am time for the vote was expected by all news organizations and heavily covered in the days leading up to last night’s vote. And the Senate arguments have been on teevee – my teevee anyway – for almost a month. Sneaky.

Why 1:00 am? Reid could have held matters over till midday or afternoon today of course. But all the Dems wanted to wrap it up so they could hit the airports and be homeward bound this morning. The GOP, on the other hand, had absolutely no plans to go home at all and would have been absolutely thrilled to stay a few more days and prevent that sneaky, middle of the night stuff.

UPDATE: Hard as it is to believe, I got something wrong here. So I take back all that stuff about jumping on planes. Seems the actual floor vote is still scheduled for before Christmas, which probably means Christmas Eve. Although I have no idea why it has to stall like that. Did they not vote last night to move to a vote?

But the balance of what I said – about the feigned outrage at the ‘sneaky middle of the night vote’ – continues to be true.

Coming down to the wire

Nate Silver has written an important follow up to his earlier post  (referenced by me here) about health care reform – this one details what’s really out there, what each of the proposals means, what the arguments are – for and against – and why liberals should still support whatever emerges.

” . . .  So, we’ve talked a lot about what the bill is not. It’s not structural reform. What is it, then? At the end of the day, it’s a big bleeping social welfare program — the largest social welfare program to be implemented since the Great Society. And that’s really what it’s been all along: fundamental reform like single-payer or Wyden-Bennett was never really on the table. The bill comes very close, indeed, to establishing what might be thought of as a right to access to health care: once it’s been determined that people with pre-existing conditions cannot be denied health care coverage, and that working class people ought to receive assistance so that they can afford health care coverage, it will be very hard to remove those benefits. It’s the sort of opportunity that comes around rarely — and one that liberals will greatly regret if they turn down.