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June 11, 2009


No doubt a complex restructuring of health care financing will be subject to amendment in the future, but there's a good chance these amendments wouldn't go to the heart of the program, because fundamental changes are hard to unwind.

For example, if a government-run insurance plan underprices existing plans, it will put a lot of those plans out of business. Privatizing that government plan would be akin to privatizing Social Security--basically a non-starter. (Look at how Bush's plan to privatize even a small portion of Social Security was demagogued.) Similarly, if profits on pharmaceuticals are significantly reduced, as may well happen under government-imposed cost controls, financing of new drug research would probably shift from private companies (which will have less incentive to pursue such research) to the government. Once that mechanism is in place, it's tough to reverse.

All this suggests that boldness by Obama could make his fundamental design more rather than less subject to change by future Congresses. (An interesting side question is whether what may be the boldest part of Obama's plan, the government-run insurance alternative, might be abandoned in light of the AMA's apparent resistance to it.)

Right winger "Rob" doesn't realize that a significant amount of "drug research" is already done with government financing, either through direct grants, government coordination of research, grants to University research departments, etc.

Many of these public government research grants are than coopted by private industry in ways that cuts out the investor, American taxpayers, from the profit or even the benefit as the taxpayers pay twice, once for the research and then a second time for overpriced meds.

David Broder always finds a way of arguing that Republicans should get their way and Dems should compromise.

I pray that no one in Obama's circle is taking him seriously.

The notion that a 100 percent satisfactory bill should be rejected to fruitlessly fish for Republicans votes that are NOT going to happen is foolish.

The only problem with a 52/48 Senate vote is that it would have to be done through the reconiation process in order to avoid Republican obstructionism.

The reconciliation process (as I understand it) has a 10 year sunset window. Republicans used the reconciliation process on a number of things in order to avoid compromising with Dems in the expectation that after 10 years the Republicans could just do it again.

So if the Dems use the reconciliation process to pass a 100 percent satisfactory bill (hopefully with a single payer universal healthcare plan) it would be fine for 10 years. If it's a success it will be interesting to see the Republicans not support it. If it's a failure, well, then a 10 year automatic sunset would be perfect, it was given a try and either failed or succeeded on it's own merits.

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