Ted, we deserve a specific head count as to the specific numbers of R's and D's in the Senate of 1964 and a clarification as to who really was filibustering. True, southern dems were opposed, but wrongly it is the republicans who are tagged as anti-civil rights. Percentage wise, were not more republicans in favor of the bill?

indeed, back then nixon and reagan had not yet turned the reactionary democrats in the south into the reactionary fascists republicans of the present. so what do the labels demorat or pooplikan actually stand for?
and why this piece months into the debate when far sharper pieces and better analyses of the bill itself have been written by any number of columnists??

An example of the legislative finesse used in 1964: the proposed bill was split into various coherent parts and assigned to different committees, each of which had a clear purview over that part's subject matter. Washington State Senator Warren Magnuson's Interstate Commerce Committee got the section banning discrimination in interstate public transportation and lodging. Magnuson held exhaustive hearings, let the opposition rant, and then got a majority vote reporting that section of the bill out of committee with a "do-pass" recommendation. It also helped that the Democratic leadership pitched the bill's passage as being a memorial to President Kennedy.

"In 2010 we all favor some form of health care reform..."

Yes.
And most of us favor the government getting the hell out of it!
Maybe some leaders are beginning to get the message.

"The Civil Rights Act had a moral clarity about it, which, in the end, could generate consensus support in the Senate."

True. After all, our nation's founding document states that "all me are created equal..." It is the duty of our government to see that enforced. There is no such corresponding duty for government to be totally embroiled in healthcare.

Another important factor in all this was LBJ's personality and his ability to bully and cajole.

I think that this piece misunderstands the role of moral clarity in the discussion. For the rank and file supporters of health care reform, health care is the number one moral issue in America today, or at least very close to that. One only needs to attend a single health care rally to understand this. Tens of thousands of Americans die every year because of our dysfunctional health care system. I was thinking about a woman I met recently whose daughter was laid off, and of course lost health coverage as a result. She is uninsurable due to diabetes. According to some Republicans, the position of this unfortunate woman is akin to that of the careless driver who crashes into a tree and then tries to buy auto insurance. You can't listen to shit like that and tell me that health care is not a moral issue.

Like many Democrats, I am frustrated with how Harry Reid has been running the show. He allowed the bill to collect the taint of wheeling and dealing. He shied away from many of the key issues that ought to be addressed in a health care bill. Incidents like the Jim Bunning affair raise questions about whether Democrats are actually in charge.

However, I do think that all of the points in this article about White House involvement are spot on. I fully expect that a bill would have been signed by now if the President had been engaged LBJ-style from the beginning.

To equate the civil rights struggle of the 1950’s and 60’s to the health care reform efforts of today is to compare apples with oranges. The social and political contexts were and are hugely different. The Civil Rights Act of 1964 was shaped as much by the events in the streets of America, that riveted the attention of the country on the obvious inequalities between white and black, as it was to Congressional action: Rosa Parks, March on Washington and Dr. Martin Luther King’s speech, burning of black churches, Birmingham church bombing, lynching of three civil rights workers, sit-ins, freedom rides, George Wallace blocking the school house door, etc. By the time the Act (largely written by northern congressman) came to a vote and passed, a large majority in Congress, Republicans as well as Democrats, recognized that the old social order was no longer explicable or sustainable. Contrast that to today when the Republican Party can lock up, say NO to everything, and bet that voters who enjoy health coverage will not be moved to help their neighbors who do not, and will return them to power. So, yes health care reform is a moral issue, albeit different from civil rights. The most relevant comparison is that it also directly impacts a similar small minority (about 10 percent) of our population. And indirectly the majority, since without it the future fiscal and social health of the nation is in jeopardy. The latter point has yet to be understood.

Cooperation has been difficult because Reid and Pelosi seem to think (at least, they project this) that anyone who disagrees with them is simply motivated by a sinister intent. Pelosi, especially, gets in front of the cameras with her thousand yard stare and lecturing tone and makes silly assertions like "We will do this" without ever explaining why she wants to do it. She simply assumes that everyone knows that she has a monopoly on virtue and so she never has to explain herself.

The President has also hindered this effort by first getting key players on board (the insurance companies, the drug companies) and then throwing them under the bus when it suited his rhetorical purposes of the moment.

Mr. Van Dyk is correct in pointing out that everyone wants the health care situation in this country improved. But not all change is progress. As he suggests, the Democrats would have served the nation far better to break this into discrete components and debate them on their merits. As far as I can tell, they didn't even hold any hearings to discover what works well and what doesn't in other countries. They just plowed mindlessly ahead, rolling their hands with glee at the prospect of subsuming a huge segment of the American economy to government (read: their) control.

If the President was smart, he'd be the one calling time-out and demanding that this process start over in a sane and rational manner. But, I fear, he's too blinded by his ambition and ideology to admit that he went about this in wholly the wrong manner. If you see yourself incapable of making mistakes, you'll never learn from them.

I agree with dbreneman above that Obama is totally blinded by his ideology. My prediction is that the health care bill will fail and I sincerely hope that it does. The legislation is a total hairball. The poll numbers show the American people are opposed to Obamacare by a margin of 54% to 41%. So why are they trying to ram it down our throats?

One of the problems with the current bill is that it is unclear what its objectives are. Is it to reduce costs? Is it to expand coverage? Is it to reform health insurance? Is it all of the above?

I am getting really tired of Obama bashing the health insurance companies. They just provide insurance; they are not in charge of our health care. Health insurance companies make a profit of about 3.7% of revenues. This is significantly less than most other companies. Their profits are not out of line. The reason health insurance is expensive is because of medical costs, not insurance profits. The medical costs and administrative costs make up the other 96.3% that the insurance companies must pay. Costs go up so insurance companies raise their rates. What would you do if you were an insurance company? The best way to lower insurance costs is to generate more competition and the best way to do that is to reduce the state barriers, but that's another topic.

Yes, America needs to make many improvements to its health care system. But let's make intelligent changes that work well for the long-term. And let's not rush into something that is not well thought out. Some of the current proposals do not kick in for many years.

Nice Freudian typo:
"all me are created equal..."

And, taupe, in the case of insurance companies the profit percentage owes at least some to the fact that insurance companies invest the proceeds of their income from premiums. It is at least theoretically possible for an insurance company to pay out all premium income to pay claims and yet make a profit because of successful investment. I am sure that at least part of the 3.7% profit you mention would be due to investment income and not exclusively to premiums.

The enthusiasm with which our President and countless commentators attack insurance companies is demagoguery of the rankest kind.

Van Dyk's article is based on two fallacious premises. First, he rejects the concept of majority rule, and all but openly embraces the idea that the minority should rule, through the use of the filibuster. To Van Dyk, it's not a problem with Republicans opposing reform, but with Obama for not finding some way to satisfy them.

Secondly, Van Dyk appears to have not followed closely, or even to be completely unaware, of the efforts made by the Senate Finance Committee over a period of months to craft a bill a- that is to say, even one- Republican senator could support. The depth of these efforts is well illustrated by the bill that passed out of the Senate, the very least that can be done at this point to address the health care crisis. Understandably, Van Dyk does not name any Republican senators who might have been wooed to reform- doing so would have shown the spotlight on the fact that they simply could not be persuaded.

The most likely explanation for Van Dyk, and some of the apparently well-to-do commenters here, is that they simply don't understand the problem. There are a number of ways to state the problem- healthcare that costs, per capita, twice as much as in any similar country, a healthcare industry that bids fair to consume a fifth of the GDP within 20 years, almost 50 million uninsured, or over 20,000 people dying each year because they lack healthcare insurance.

But let us ignore the troubling details, apparently so difficult to master, and simply address Van Dyk's question- how could the Civil Rights Act pass? I would suggest that the American people, who had seen President Eisenhower forced to send troops to Little Rock, and had seen President Kennedy assassinated, had simply had enough. Republicans still viewed themselves as the party of Lincoln, not Jefferson Davis, and liberal Republicans from the north (a now extinct species) joined with liberal Democrats to pass the Act.

If Van Dyk is really in favor of reform, he has a mighty funny way of showing it. Given the bully pulpit of a column at Crosscut, you or I might research the issues and try to make them plain to readers. Van Dyk, in contrast, swaps e-mails with old friends and then reports they all agree- nobody today is as great as they were. I don't think that's very helpful.

My preferrence for a presidential priority is not healthcare reform. Other issues contribute more directly to all rising costs of living, including healthcare. Health insurance, pharmaceutical and medical service industries can and should reform various practices that discriminate based on ability to pay, (your money or your life). But, it seems we are beating around the bush by not directly addressing issues which drive up (pun intended) all costs of living.

Energy (including Fuel Energy) and Transportation are more critical issues that must be addressed first and foremost. They incur extravagent and senseless waste. Centralized medical services on First Hill add to transportation costs. Parking structures add cost. Advertizing to attract patients who drive from far flung neighborhoods add cost. In an emergency, the nearest life-saving hospital should be reachable soonest without resorting to an ambulance.

Our economic system encourages boom and bust cycles of rabid profiteering and inevitable recession. Healthcare is a maudelin sideshow suitable for melodramatic TV shows. More after a word from our sponsors, Chrysler, Kia, Suburu and Jaguar. Ask your doctor if a Mercedes Benz is right for you. Tired of the same old grind? Let Boeing's new 787 fly you away to a healthy retreat in exotic Hawaii and let Hertz Rent-a-car put you in the driver's seat. Don't forget to support our troops!

It’s obviously impossible to get Mr. Van Dyk to see how different Congress and the Republican Party are in 2010 compared with 1965 (for instance, any congressional leader could tell him that it’s impossible for a President or congressional leaders to enforce party discipline the way they could back then. But the writer remains totally blind to the fact that the Republicans last year decided from the start (and some admitted it) that they were not going to cooperate with the Dems on any comprehensive health reform unless it consisted SOLELY of insurance deregulation and caps on med mal suits (I guarantee that few or no Republicans would have voted yes on the “bipartisan” Wyden-Bennett bill if Obama and the Dems had brought it to the floor of Congress; Republican Bennett might well his seat to a Tea Party candidate for cosponsoring that bill).
I’ll point out once again the history of the 1965 Medicare legislation. Mr. Van Dyk and Republican leaders keep claiming that no major legislation ever passed Congress without bipartisan support. According to the nonpartisan Politifact.org, no House Republicans supported the original Medicare legislation in 1965 until it reached the House floor for a final vote (when 70 Republicans voted for it). In the Senate, there was some -- though limited -- GOP support, with four of eight Republicans on the Senate Finance Committee backing it in committee; only 13 Senate Republicans voted for the final bill. So Medicare clearly would NEVER have been created if Democrats had waited for Republican support -- and that was in the days when there were still quite a few Republican liberals.
My question for the writer now: Will you and your e-mail buddies take satisfaction in having argued against the Democrats' admittedly imperfect health reform efforts even if it means that Americans have to wait another 15-20 years for another try? In the meantime, of course, you guys get to enjoy your government-paid retirement health insurance.

At last, Ted has laid the groundwork for agreement! Left, right, bipartisan, lunatic libertarian or raving Communist - I bet we can all agree with his statement that Harry Reid is a "destructive bumbler"!

But for the rest of his arguments, he might as well be schooling us on the mechanics of the Missouri Compromise. He is talking about a Senate and array of political forces that don't exist in this country any more. The centrist mass media - the NY Times, Newsweek, Time, ABC/CBS/NBC, etc. - has been swamped by the blogosphere, talk radio, and other targeted media. Campaigns are hugely expensive, and dominated by lobbyists and national PACs. There simply are no liberal Republicans anymore. I'm sure some of the deplorable aspects of current politics - spin, oppo, character assassination, dirty tricks - were around back then, but they seem to be with us constantly now. Many, many people have observed that Congress, our parties and our politics are highly polarized. I just don't see how Ted's memories of waiting out the Southern Dems until the moderates Republicans signed on to the Civil Rights Act have any relevance to the situation today. The die were cast when the stimulus bill was weakened, modified, bulked up with low-yield tax cuts, and still didn't get Republican votes. That should have told everyone what the environment was. I guess we have to look to other authors and other political traditions to tell us how to move forward in THIS environment.

Interesting comments representing several viewpoints.

Of course politics has changed since the 1960s and the drive toward civil rights and Great Society legislation. But, if you think the environment was less partisan then on sensitive issues, think again. The sruggle over civil rights issues---as exemplified by the filibuster
against the 1964 Civil Rights Act---was far more intense than anything we see today. So was debate about war/peace issues in a Cold War period.

Both parties, not just the Republican Party, tend to be dominated today by fierce partisans. The "moderate middle" has shrunk in the Congress but it still holds the balance of power on key legislation---witness the role being played now by moderate Democrats on health legislation. President Clinton thought he could govern on a one-party basis. His health-care plan failed, however, because it could not get sufficient Democratic support and was withdrawn. Thereafter he took special care---as previous Presidents had---to seek Republican and moderate Democratic support for
his other legislative initiatives. President George W. Bush reached out for Democratic co-sponsorship on No Child Left Behind and Medicare drug-benefit legislation, and got it in particular from Sen. Ted Kennedy.

The fundamentals have not changed. Successful governance still depends on a reachout by the governing party, Democrats or Republicans,
to moderates in the other party and to independents, who now outnumber both Democrats and Republicans. It is a waste of time to blame the opposition party, in this case Republicans, for opposing legislation on which they have important substantive differences with the majority party. Any President, and congressional leadership, attempting to govern on a one-party basis will be in the same uphill position as Obama, Pelosi, Reid now find themselves. True in the 1960s, true now.

Mr. Van Dyk's generalization that health care reform supporters are "frustrated and mystified" is accurate – as far as it goes.

But much stronger words -- for example “outraged” and “embittered” -- apply to those of us who supported Medicare expansion or some other single-payer alternative: we who set aside our oft-burned, reflexively shy aversion to the Democrats' post-Kennedy serial treachery and voted for Obama accordingly.

Mr. Van Dyk is therefore to be commended for his insight – and perhaps still more for his courage – in attempting to open a discussion on the troubling contradictions between Obama the candidate and Obama the president.

Even allowing for the opportunities of maneuver created by the self-serving avoidance of detail that characterized Obama's campaign for office, the president's failures have undermined so much popular hope he is justifiably acquiring notoriety as Barack the Betrayer.

In this context – and here is what elevates Mr. Van Dyk's work to genuine courageousness -- the implicit issue is not whether Majority Leader Harry Reid is a “destructive bumbler” but rather whether such bungling (not just by Reid but by the entire Democratic coterie) is truly accidental.

Especially given the unprecedented degree of political sophistication that characterized the Obama campaign – the adjectives “breathtakingly brilliant” and “daringly Machiavellian” each apply equally -- it is increasingly difficult to believe the political genius that came to fruition in November 2008 could suddenly have deteriorated into the operational imbecility we have witnessed ever since.

Instead – and this increasingly seems the only rational explanation for the glaring discontinuity between the Democrats' achievements in 2008 and their failures in 2009 – I cannot but suspect what is presented as a valiant struggle to enact health care reform is in fact a clandestine effort to produce the diametrically opposite result, perhaps even to ensure the ensuing obstructions are so formidable they can never again be challenged.

Such a scam – a variation on the Enron method – has an obvious beneficiary: the notably parasitic branch of capitalism that in 2008 favored the Democrats with 57 percent of the $157 million it spent on de facto bribery disingenuously disguised as political contributions.

(See OpenSecrets.org, “Securities and Investment: Long-Term Contribution Trends,” http://www.opensecrets.org/industries/indus.php?ind=F07 )

Here again is documentation of ugly truth -- how government and governance at every level of the United States are corrupted to a single purpose: the perpetuation of capitalism – absolute power and unlimited profit for the Ruling Class, total subjugation and bottomless poverty for all the rest of us.

Not that “change we can believe in” would be the only Big Lie ever used to seduce the U.S. electorate.

Let us never forget how President Johnson claimed to be the 1964 peace candidate even as he and his henchmen manufactured the Gulf of Tonkin incident -- the bogus provocation of a full-scale Southeast Asian war.

LBJ's Big Lie killed 56,681 U.S. soldiers in the decade of fighting that followed his 1964 election and sentenced at least another 1,178 soldiers to death by incurable wounds.

By comparison, if “change we can believe in” truly is a Big Lie, it is killing 45,000 U.S. children, women and men every year it denies us the human right of health care, which would make it the biggest and most malevolent Big Lie in U.S. history.

First, let's leave the House out of it, shall we? Long ago, the House Dems passed health care reform with a public option, cap and trade, and financial institution reform. But they believe in majority rule and one-man-one-vote over on that side of the Capitol.

By definition, the atmosphere in the 1960s was less partisan, because both parties had more diverse memberships and elected officials. They did not vote in lock step with their party, as far as I know.

Which Republican senator would have been willing to carry water for any Obama health plan? Grassley? Enzi? Collins? Was there any arrangement of proposals that could have split off anyone except Collins and Snowe? Ted, when we are judging the motives and possibilities of working with Jim DeMint, I tend to believe what DeMint himself said.

The Dems didn't even put single payer on the table to see what Americans thought of it. They didn't insist on the public option, or Medicare buy-in which made tremendous sense. They bent over backwards, in opposition to their base AND their mandate from the voters. Remember, the voters? Because politics is about more than smooth passage of legislation - it's about representing the voters. Obama and the Dems ran on health care reform (and also, may I add, on reproductive choice regardless of ability to pay, whatever Stupak may think). Harry Reid, in particular, has not used the leverage of his office or caucus to remind anyone of that. Lieberman is still chair of Homeland Security, and Blanche Lincoln is in line for Agriculture. I don't think there's anything wrong with reserving committee chairmanships for loyal Democrats who are in the mainstream of the party.

Finally, I guess it is easier to get Dems to cross the aisle than Republicans, simply because Dems believe in government as an honorable attempt to improve the public welfare. Since Reagan, the R's don't. And your examples of No Child and Medicare drug coverage are hardly shining examples of successful legislation - one full of unfunded mandates for the states, and the other simply unfunded, without promoting competition or price controls for drugs. I would call those failed examples of bipartisanship.

Van Dyke: "Of course politics has changed since the 1960s and the drive toward civil rights and Great Society legislation. But, if you think the environment was less partisan then on sensitive issues, think again. The sruggle over civil rights issues---as exemplified by the filibuster
against the 1964 Civil Rights Act---was far more intense than anything we see today."

Oh? The split was North-South, not D-R, with the old South (mostly Ds)dragging its heels. Here's the voting record on the Civil Rights Act of 1964, from Wikipedia:

Vote totals in "Yea-Nay" format:

The original House version: 290-130 (69%-31%)
Cloture in the Senate: 71-29 (71%-29%)
The Senate version: 73-27 (73%-27%)
The Senate version, as voted on by the House: 289-126 (70%-30%)

By party:
The original House version:
Democratic Party: 152-96 (61%-39%)
Republican Party: 138-34 (80%-20%)

Cloture in the Senate:
Democratic Party: 44-23 (66%-34%)
Republican Party: 27-6 (82%-18%)

The Senate version:
Democratic Party: 46-21 (69%-31%)
Republican Party: 27-6 (82%-18%)

The Senate version, voted on by the House:
Democratic Party: 153-91 (63%-37%)
Republican Party: 136-35 (80%-20%)

By party and region:
Note: "Southern", as used in this section, refers to members of Congress from the eleven states that made up the Confederate States of America in the American Civil War. "Northern" refers to members from the other 39 states, regardless of the geographic location of those states.

The original House version:
Southern Democrats: 7-87 (7%-93%)
Southern Republicans: 0-10 (0%-100%)
Northern Democrats: 145-9 (94%-6%)
Northern Republicans: 138-24 (85%-15%)

The Senate version:
Southern Democrats: 1-20 (5%-95%) (only Senator Ralph Yarborough of Texas voted in favor)
Southern Republicans: 0-1 (0%-100%) (this was Senator John Tower of Texas)
Northern Democrats: 45-1 (98%-2%) (only Senator Robert Byrd of West Virginia opposed the measure)
Northern Republicans: 27-5 (84%-16%) (Senators Barry Goldwater of Arizona, Bourke Hickenlooper of Iowa, Edwin L. Mechem of New Mexico, Milward L. Simpson of Wyoming, and Norris H. Cotton of New Hampshire opposed the measure)

Suggested additional reading: This (Thursday) morning's Wall St. Journal essay by Michael Barone, editor of the Almanac of American Politics, outlining the difficulties of getting a House Democratic majority for
pending health legislation. Barone also discusses the number of safe-seat Democratic congressional districts (such as Nancy Pelosi's in San Francisco and Jim McDermott's in Seattle) as compared to those in which incumbent Democrats will face real challenges for reelection this fall.

This piece by Van Dyk, and much of the discussion, has a "let's get lost in the trees" feeling to it, because the Republicans, and some "centrist" Democrats, are wrong about health care.

They are factually wrong. We do not have the best health care in the world, nor are Americans any happier about their system than other industrialized nations. Malpractice suits are not the problem, in fact, after capping damages California learned that malpractice suits are not even a problem- no improvement was obtained. The federal government already subsidizes health care, by exempting employer-provided coverage from taxation, and the richer you are, the bigger the subsidy you get. It is not the case that any American who needs care can get it at the emergency room, in fact, we have now learned that not having coverage is the primary cause of many deaths every year. It would be difficult to find any statement by a Republican about this subject that is actually true.

And they are morally wrong to have lied so consistently and so stridently to the American public about this. Being ignorant is not a moral failing (well, actually it is, but let that pass) but consciously lying about things like "death squads" is.

But let us imagine for a moment that "all is fair in love and war" and there is no moral odium to be attached to an earnest effort by Republicans to cheat the American public and reward the industries that put them in office. Where, in this mess, are we to find the bipartisan principles that all high-minded people can agree on? Good luck with that one.

This "walk in the trees" that Van Dyk proposes, that we may lose sight of the overall shape of the forest, also invites us to lose sight of an even larger principle- that this is a democracy. Harry Reid's "bumbling", if any, has consisted of his not being able to make the voice of 70% of the people in the country prevail over an entrenched oligarchy.

Now, you personally may be happy to be ruled by an oligarchy, but there are two problems with this- one, that the country is not structured as an oligarchy, and such rule is by nature illegitimate, and second, that democracy has prevailed around the globe because it works better than oligarchies.

And all the quibbling in the world about familiar but anonymous individual trees won't change that.

A couple of questions.

To lorenbliss, You make some strong statements about capitalism. Question: What system would you prefer instead of capitalism?

And a question for serial_catowner: If America does not have the best health care in the world, then which country does? I think America does by quite a margin. On balance we have more qualified and experienced doctors, more and better tested drugs, etc.

Here's an interesting letter from Sue Robinson on Camano Island, sent to the editor:

Interesting piece today on why the President has made what looks like such a mess of health care reform. I have followed this issue very closely. As one who admired LBJ, worked as a political reporter and in Democratic politics, may I offer a few observations:

First, my personal choice would have been allowing everyone to sign up for Medicare. Or allowing everyone to sign up for the very wide variety of health policies offered to federal employees. My personal choice would have been to disconnect health insurance from employment. That is a $300 billion annual tax expenditure no matter how high the individual income is. But, this was never going to happen.

The Democratic party is different today. It is not our party anymore. Gerrymandered districts and left-leaning leadership make it so. The huge growth and power of public employee unions make it so. Meanwhile, President Obama has never operated outside of a pretty corrupted one-party system - that's what Chicago is. He spent very little time in the Senate before he began running for President. He brought people into the White House with him who had similar Chicagoland experience. There is just no actual experience here in working across the aisle, and painfully short experience in actual governing.

And yes, Harry Reid has been unhelpful. But Pelosi and Obama made majority public support impossible with legislation that fully protected public unions, created 188 new agencies, boards and commissions to monitor and regulate every damned thing on the health care planet, slaughtered small business and robbed the Medicare Trust Fund of $500 billion to pay for it. Meanwhile they sucked up to Big Pharma and the insurance companies even to the extent of banning drug importation from dangerous countries like Canada, failed utterly to correct the destructive and unequal tax treatment between employer-provided insurance and the beleaguered individual market, failed to support even minimal reform like allowing purchases across state lines so that people like me do not have to pay for critical mandates like hot oil massage therapy in this one-party state, failed to face down the trial bar and the outrageous cost of defensive medicine, and lied like hell when they opined that people who like their current insurance can keep it. Democrats have lost seniors for a generation on this one. They have lost non-public employee middle America for a generation.

What I have observed in all of this is heartbreaking and scandalous. And now, as soon as this health care debacle is finished, President Obama is moving on to Cap and Trade and immigration reform. The man is one term President and he deserves to be.

--Sue Robinson

I love all of these numbers that say "xxxxx million die each year because they don't have adequate health care."

Guess what --- we are all going to die some day. The real question is who pays for us while we are alive. Do we make our own choices, and pay for those choices ourselves? Or does the government force (ie, tax) others to pay for us?

I'll take my chances --- and pay for my own healthcare. Please don't force me to pay for yours.

So now Mr. Van Dyk is criticizing President Clinton for developing a health reform plan and failing to get Congress to pass it? Didn’t Clinton do precisely what the writer has urged President Obama to do from the start – present his own plan and sell it to Congress and the American people? And look how successful Clinton’s approach was, running into the exact same stone wall from conservative Dems and all Republicans that Obama ran into 15 years later. It was that Clinton experience that led Obama and his team to work with congressional leaders to draft the legislation. That effort is now precariously poised between success and failure. Mr. Van Dyk and the various commenters need to recognize that even if the Obama administration and congressional leaders had played this game flawlessly, comprehensive health reform would still have been devilishly difficult to pass, for reasons better informed observers than Mr. Van Dyk, such as Humphrey Taylor of the Harris Poll, have clearly laid out. But one huge reason is the unwavering opposition of Republicans to comprehensive reform featuring expanding coverage and controlling costs, and those of us who’ve been tracking health care for many years knew from before Obama was elected that Republicans would take that position, just as they did in 1993-94. Bipartisanship, at least on this issue, is Mr. Van Dyk’s pipe dream.

Ok, I'm on a really slow dial-up, so I'm not going to spend the rest of my life proving we don't have the best health care. To give just one example, we have today the life expectancy at birth of a Cuban or German, at 77 years, but less than the French, at 78- in site of their cigarette-smokin' ways.

Ezra Klein covered a lot of this last year, but unfortunately has not linked the posts he did with graphs. That said, for someone like Sue Robinson, who is so factually challenged, a good move would be to check Ezra's sidebar for the categories of older posts where he has covered this in depth for several years- well enough that you'll find him at the WaPo.

The question always arises, what is the best healthcare? If it's the cheapest, we lose, weighing in at about twice the per capita expenditure of European nations, even while they cover everyone and we have 40 million uninsured. We don't live the longest, we don't have the best surgical outcomes, we don't have the lowest infant mortality, and we're not any happier with our healthcare. To really get in the woods about all this, just google 'world health statistics' and start digging. I don't support pdf, so I found the UN site was the first to give me tables in html. There's also a U of W site with links to just about everyone, and how great would that be, to be an undergrad today with everything at your fingertips!

I'm thinking that for most people the best way to learn about this would be to read Ezra Klein and Matt Yglesias daily for healthcare posts. There are a lot of different angles to look at and doing it in small pieces is probably easier than trying to figure it out all at once with graphs and tables.

serial_catowner: The correlation between life expectancy and healthcare quality is minimal at best. Life expectancy is impacted by genetics, geography, lifestyle, eating habits, exercise habits, etc. How can you possibly use this as a meaningful measure of health care quality? The same is true of infant mortality. And cheapest means cheapest, not the best.

I doubt statistics can decide the answer to health care quality. But think about this. Where do people go to get elective surgery? Do they fly to Britain? to France? To Germany? To Sweden? To Canada? Absolutely not. They come to the US. Why? Because we have the best healthcare in the world. The Premier of Newfoundland, Canada is flying to the US for heart surgery this month.

No, our healthcare is not free and not everyone has health insurance, but that does not diminish the quality of our health care.

I get really tired of everyone bashing our healthcare quality when it truly is the best in the world. They trot out statistics about infant mortality and longevity. I think the reason people do this because they want to see a change in the health care system. Our health care system has many problems. But our health care quality is the best in the world.

Yes, I thought about discussing the difference between mortality and morbidity. Briefly, mortality is a very crude metric, while morbidity involves the actual cost of care and loss of productivity (not to mention the pain and disability of the patient).

But it would be very hard for us to accurately measure morbidity in America, because we have so many uninsured. For various reasons they are likely to be suffering poor health and poor productivity, but they're off our screen- we only measure our successes!

Actually, of course, there are some people who try to get good measurements, and thus, in today's Guardian, we find this:

"The death rate of women giving birth in the US is worse than in 40 other countries, including nearly all the industrialised countries, Amnesty International said today in a report that describes the country's approach to maternity care as 'disgraceful and scandalous'."

You may get really tired of how people trot out statistics, but to me there's a difference between being number 1 and being number 40.

If the browser supports html you will find the article here.

Two points for taupe (with my regret for a response unavoidably delayed by computer problems):

Apropos health care, the U.S. health care system probably is -- for the dwindling number who can afford its deliberately exclusionary prices -- the best in the world.

But for those of us who cannot afford to pay such obscenely prohibitive de facto extortion – for those of us sentenced to agony and death by the fact the United States malevolently insists health care remain a privilege of wealth rather than the human right recognized everywhere in civilization – it is undoubtedly the worst system in the world.

Apropos capitalism, I regard it much as the architects of the New Deal regarded it: a paradox of good and evil combined.

On the one hand, capitalism is deadly dangerous to human freedom because the capitalists' core value -- infinite greed exalted as maximum virtue – forever threatens to concentrate wealth and power in the hands of a tiny aristocracy and thus reduce everyone else to slavery.

(This is precisely what is happening in the United States, why the American Dream is dead beyond any hope of resurrection and why Jobless Recovery is forever.)

On the other hand, the incentives provided by capitalism will no doubt remain essential to our collective material betterment until we re-evolve beyond the infantile what's-in-it-for-me syndrome – the savagely selfish moral imbecility that for perhaps the past 3600 years has metastasized ever deeper into human consciousness, thus replacing the ethos of community characteristic of so-called “primitive” societies and deliberately exterminated accordingly.

Probably the best analogy for capitalism is nuclear energy. Properly confined in a reactor or some other control mechanism, it is beneficial in ways we are still discovering. Allowed to run amok, the result is invariably Chernobyl.

Communism sought to suppress the what's-in-it-for-me syndrome and failed save in those realms that preserved substantial elements of community consciousness.

The New Deal caged the what's-in-it-for-me syndrome in a regulatory structure – the reactor analogy again – and forcibly channeled it in beneficial directions.

That's the sort of mixed economy I favor.

But government and governance in the United States – during the New Deal our protector against aristocratic excess -- has been reduced at every level to a single purpose: perpetuation of the most tyrannosauric capitalism ever unleashed – absolute power and unlimited profit for the Ruling Class, total subjugation and bottomless poverty for all the rest us.

And the resultant economic reality – lavish bailouts for the Ruling Class; permanent joblessness, bankruptcy and homelessness for the Working Class – is prima facie evidence capitalism has morphed into the sort of pure evil that may not be possible to exorcise by anything short of an apocalypse.

To evoke Dorothy from "The Wizard of Oz," albeit with the text slightly altered, "we're not in the 1960s anymore." Partisan rancor is at its highest, and strategic advantage, i.e. filibusters of even average legislation, holding up judicial appointments, and embarrassing the party that's in power in efforts to show they're incompetent and to return one's own party to power has taken precedence for many members of Congress, and I suggest most members of Congress, than the welfare of the nation, even if it means leaving out facts and reinventing history, e.g. suggesting that the reconciliation process they used themselves to pass two tax cuts was something new and circumventing the rules. To borrow from Ted, it is inconceivable, in the early 2010s, that legislation of this magnitude would be possible on even a two-party basis. The use of filibusters is at a record level, and single Senators are holding up appointments and legislation! That being said, I agree with Ted's description of what LBJ's process would have been and the suggestion that President Obama should have done similarly. I've always felt that it was a mistake for the administration to farm out this important-to-them legislation to Majority Leader Reid and Speaker Pelosi, bpth arguably more liberal than the President and neither of whom was (or has been for that matter) elected nationwide and then wondering why: (a) it took so long; and (b) it didn't turn out quite the way they wanted. It's the same thing many "managers" do, which is dump off the project, then wonder why it doesn't turn out they way they envisioned when they didn't provide the vision and didn't shepherd it! The President has recently begun to do this, and the forthcoming weeks will tell whether he waited too long or not. His own re-election probably hinges on it, as well as next November's elections.

To lorenbliss:
What are you referring to exactly when you use the terms Ruling Class and aristocracy?

The fact that prosperous citizens of other countries with socialized medicine travel to the US for treatment indicates that the market has spoken. People who can afford to do so will pay more to be treated in the US. The problem in the US is not our health care, which is excellent, but how we pay for it, which sucks. We're in an enviable quality position; we merely need to make the system more inclusive.

There are two critical health care issues facing the US today. The first is existing condition exemptions, and lifetime caps in payments. If the government requires all insurance companies to insure those with existing conditions, there is no competitive-pricing "penalty for virtue". That solves that half of the problem. Having the government act as the insurance companies' re-insurer for high-risk or high-expense patients solves the problem of lifetimes caps while keeping premiums reasonable. That solves the other half of the problem.

The second, and most difficult problem is making insurance affordable for those who want it but cannot afford it. Tax-deductible medical savings accounts coupled with high-deductible policies can go a big way towards solving that problem. The government can even seed the savings accounts of those at the bottom end of the income scale with direct deposits to their accounts.

The big "problem" (as Congress sees it) with these solutions is they they do not centralize massive amounts of new power in the nation's capitol. That's why they aren't part of the current health care proposal. That proposal is 10% help for people and 90% power grab from people. The current plan should be scrapped and a new plan, mindful of the needs of the people, not the covetousness of the Congress, should prevail.

Well said, dbreneman. I agree wholeheartedly.

One of the big problems with the healthcare discussion is that we are poorly defining the issues. As I see it, the two problems are (1) figure out a way to help those with no insurance and those with pre-existing conditions and (2) figure out a way to reduce the costs of healthcare and health insurance. We will never solve these issues if we mis-define the problem. For example, if we state the problem as having poor healthcare, which is not the problem, then we will never achieve a solution. This is why I push back hard on those who say we have bad healthcare.

This is the problem with the current health care debate in Congress. Is the goal to reduce the costs of health care? Is the goal to include everybody? Is the goal to help reduce the deficit? The current proposed bill is a huge hairball and will not help the country. We need to move on and figure out ways to solve the many problems associated with health care on a more incremental basis.