washingtonpost.com
Economy Department with Ezra Klein

Ezra Klein
Washington Post Business Blogger
Thursday, June 25, 2009 12:00 PM

Ezra Klein writes a Post blog about economic and domestic policy, and he was online June 25 at noon ET to take your questions about collapsing banks, cap and trade, health care reform and pretty much anything else you can attach a chart to.

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Ezra Klein: Morning (afternoon?), folks. I'm Ezra Klein, and I'll be your chatter today. Let's get started, shall we?

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Boston: Is it dangerous for a political leader to make promises about job levels in a free market economy when in reality that politician has very little control over it? What other politicians, besides Obama, have crawled out on that limb during difficult U.S. economic times? Do you think he would like to reword his previous statements?

Ezra Klein: Probably. If I remember this week's presser correctly, he refused to make more predictions, and I'd judge that wise. But I'd add one wrinkle to your comment: Presidents don't have much control over macroeconomic events. But they're blamed for them anyway. And Obama is in a bit of a weird position, as the stimulus was a direct jobs program. So he's in a tough spot.

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Healthcare Rationing: This seems to be the new Republican mantra to thwart healthcare reform this go-round. However, I noticed in the news the other day that Steve Jobs got a new liver. Pretty quickly, I might add. As opposed to everyone else that sits on a waiting list for who knows how long. Wasn't a value judgment made here, that Steve Jobs life is more valuable than someone else on that waiting list, so he's bumped to the top? Or that "money changed hands" and Stevie gets a liver but the next guy on the list didn't because he doesn't have the cash? Seems to me we are already rationing and picking and choosing who gets care under our current system.

Ezra Klein: We are indeed. And I don't really know the specifics of Jobs' liver transplant except to say that I didn't realize androids from the future even had livers.

I don't even have a real point to make in response to this question. I just wanted to link to Steve Pearlstein's OnLeadership roundtable in which a lot of rich and, presumably, smart people discuss whether Jobs should have disclosed the operation. I found their answers interesting, but couldn't figure out a natural way to link on the blog. So I'm doing it here!

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Moscow, Idaho: What's a good climate policy blog, Ezra? I've checked out Grist, but I'd like something that hits the science a little harder.

Ezra Klein: I quite like TNR's the Vine, too. But if you want more science, check out Joe Romm's Climate Progress" and Real Climate. They've got more science than you can shake a pocket protector at.

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Princeton, NJ: I used to be in favor of the elimination of for-profit health insurers because they serve no useful purpose and they waste about $400 Billion each year. Now we discover that on top of that, they are out & out crooks.

Why has Medicare for All (HR676) received no (zero, zilch, nada) coverage in the Post?

Ezra Klein: I can't speak to the Post. But I think the reason HR 676 -- the single-payer bill in the House -- hasn't received coverage is because it's not moving forward in the legislative process. In general, news organizations, for better or for worse, direct their political coverage towards things that are *happening* as opposed to things that are *important*. Put another way, reporters try not to be normative. Similarly, three years ago, no one cared about the Senate Finance Committee's health care ideas. Nothing was happening with them.

This of course does get to one of the problems in the media, which is that if they were doing a lot of reporting on HR 676, maybe it would be likelier to pass. The news business has never quite figured out how to reconcile the fact that they have a lot of agency with the fact that they do their best to deny their agency.

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Lawrence, Kan.: Why is socialized medicine such a dirty term?! I want health care like Sweden, except better! We popped a man on the Moon, what's the problem?

Ezra Klein: Not only that, but I'll bet you that Neil Armstrong got his health insurance through the government. And he seemed pretty fit.

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Washington, D.C.: I'm confused as to why so many people seem to continue to hold Obama in such high regard. The economy continues to perform poorly. Job losses continue to mount. The economy continues to slow or stagnate. The stock market is barely above the level it was at when he was elected. His "stimulus" has been a failure from what I can tell. He hasn't done anything about Iran other than make a few pretty speeches with his beloved teleprompter. In my view, he's been entirely ineffective. Why all the glowing love for him? Isn't there anyone in his administration that can think straight well enough to do something?

Ezra Klein: I think the question you have to ask is "compared to what?" The economy is performing poorly, but more or less poorly than we might have expected a year ago, when serious commentators thought we had a real chance of another Great Depression? Lifting us into mere recession territory is, arguably, a tremendous achievement. Moving from really bad to not very good doesn't leave in an excellent place, but it's still a large improvement.

As for the stimulus, that money largely hasn't been spent yet. It's a funny thing: People think the government is so skilled at spending cash. But it's actually really hard to spend that much money very quickly. It's sort of like a kid who's great at eating candy but ends up totally confused when asked to polish off the contents of Wonka's outlet store.

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Boston: Comment: If the Dems want to tax my health insurance I'm done with them.

Ezra Klein: It's a fair position. Sadly, I don't think they're going to tax your health insurance nearly enough. because just to be clear, taxes are zero-sum. The employer tax exclusion is a subsidy to people with employer-benefits from people who are unemployed, who are buying health insurance on their own, or who can't afford it at all. And that group is economically worse off. Why should they be subsidizing those lucky enough to have employer benefits?

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Ezra Klein: Here's a question for all of you: I have a couple dozen songs left on Emusic this month. Any suggestions?

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Steve's liver: He didn't get it as fast as it seems because we just learned about his need and his transplant at the same time. He's been on the list for a long time. The lists are based on need and likelihood of recovery. The folks who maintain the lists are very ethical and do not sell positions. Jobs got great treatment because he has great health care -- which is what I want for everyone regardless of their employment status.

Ezra Klein: As I said, I have no details on Jobs' transplant.

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Boston: Ezra: With respect to a progressive (ie., including a public option) healthcare bill, there's been much talk of late about the possibility of using reconciliation to circumvent the filibuster. But what about the conference committee? Could you envision a scenario whereby, say, the Senate sends a public option-less bill to conference, and receives back a bill WITH a public option? Any thoughts?

Ezra Klein: Yep, it's entirely possible. It's important to distinguish, though, between reconciliation and conference committee. Reconciliation is a way of fast-tracking budget bills past the filibuster. The problem is that it can only be used for things that directly change federal spending. You could use reconciliation to increase Medicaid eligibility, for instance. But you probably couldn't put a rule barring private insurers from discriminating based on preexisting conditions.

Conference is where the House and the Senate agree on a single version of the bills they've just passed. In general, the Senate's bill is more moderate and the House's bill more liberal. Republicans, in the Bush era, were very skilled at using conference to make bills more conservative (Medicare Part D is the archetypal example where something bipartisan left the Senate and something heavily partisan was returned). There's no reason Democrats couldn't do the same. The question is whether they could then get the votes needed to pass the resulting bill.

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I'm stumped: What's the argument for single payer for someone like me who likes the idea of insuring everyone, hates the idea of government being in charge of industry - god forbid the physician profession go the way of public school teachers (I say this as a former teacher myself).

Ezra Klein: There isn't one, pretty much. Single payer is probably quite a bit cheaper, but if you don't want the government involved, it's not the policy you're likely to support. Although under single payer, gov wouldn't employ doctors.

But we're not going to have single payer at any point in the near future, so this is a bit moot. What we might have is a system in which you can see how a public options performs against private options. If it proves itself better, you might find yourself rethinking your position.

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Atlanta: I've been listening to "Philosophy" from Ben Folds Five's self-titled album on repeat. Good stuff.

Ezra Klein: I'm just going to publish some of these recommendations.

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Alexandria, Va.: It seems like advocates of the "public option" are having a hard time making the case that it will introduce needed "competition" because to the layperson it seems like, aren't there multiple private plans, and don't they compete with each other?

How would you phrase this distinction in a way that makes sense to the layperson?

Ezra Klein: Private insurers make money by denying you care. A government insurer would not have the same incentive. Why shouldn't people be able to choose between those two styles? It's not crazy for me to want to be insured by someone who's not interested in boosting their stock price by rejecting my health care claims.

Another way to think of this is that private insurers are like a fire department that loses money every time they put out a fire and so try and find ways to not respond to calls. If anyone wants to start such a fire department and try to make money off it, I wish them all the best. But I don't want them to be my only choice when my house is burning down.

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Cleveland: If it came back more liberal in the conference bill, is it still subject to the filibuster?

Ezra Klein: Yes. But for reasons I don't totally understand, conference bills generally aren't filibustered. Honestly, though, I'm a bit hazy on this question. I'll look into it.

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Republicans, in the Bush era, were very skilled at using conference to make bills more conservative : Even a better example is Phil Gramm's Commodities Modernization Act which lead to the Enron loophole, oil speculation and Credit Default Swaps. Believe it or not it was never debated in either house, but the whole bill was added in conference in a footnote!!!

Ezra Klein: Yep.

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Any suggestions? : Bach's Italien Concerto is a killer. Lots of great performances.

Ezra Klein: You know, I listen to very little classical. Maybe I should start.

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Vienna, Va.: It's pretty clear we spend a lot of money in the U.S. that in many cases doesn't go to better quality care. I think you've said that, conservatives have said that -- we have pretty broad agreement. But the data that proves that comes from Medicare. So why do liberals like yourself want to copy a deeply flawed single-payer system like Medicare, which encourages the kind of behavior Atul Guwande pointed out in The New Yorker piece? (this also offers you the chance to link to your interview with him).

washingtonpost.com: An Interview With Atul Gawande

Ezra Klein: I'd actually like to reform Medicare pretty substantially. But you know why the data is from Medicare? Because private insurers won't let anyone look at their claims data. So we don't even know how to evaluate them to better their practices. Meanwhile, medicare has actually exhibited less cost growth than private insurance. So we can say pretty firmly that they're doing something right, or at least righter, than the privates.

But look, I don't want a full single payer system where private insurance is outlawed. I'd like something more like the French system, where gov provides basic benefits and private insurers compete to offer supplemental insurance. Or I'd like a very strong public plan that anyone can buy into. But I want people to have the choice.

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Washington, D.C.: Are you and Jonathan Cohn actually the same person writing under two pseudonyms?

Ezra Klein: No! We just agree on, well, everything. This morning, we were on TV together. Shortly thereafter, one mutual friend e-mailed the two of us. "My TV was on mute," he wrote. "So I don't know what you were saying. But I assume it was a spirited and possibly even contentious debate."

Smartaleck.

Also, have people read Jon's book Sick? It's the best introduction to these issues you're like to find.

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the girl can sing: Neko Case

Ezra Klein: This is true. She can indeed sing.

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private insurers are like a fire department that loses money every time they put out a fire: In colonial Philadelphia, there was no fire department. Each fire insurance company had its own private fire department. When you bought insurance, you got a medallion to put on your house. If a fire truck from the Green Tree company came to a burning house that had a Penn Mutual medallion, they would let it burn to the ground. After this happened a few times, a municipal fire department was established, a socialized fire department

What Conservatives fail to realize is that some things like health care are best done by cooperation, by government, while some things are best done by individuals. Their problem is that they cannot distinguish one from the other.

Ezra Klein: Yep. I don't think health care should be a primarily market good. Consumers simply don't have the power (or, for that matter, the expertise) to say no, which means they don't have the power to force the market to function effectively.

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Arlington, not Stockholm: Sweden has much higher taxes than the US. And Sweden's health care system is in massive short-term financial straits. We already don't have enough money and a lot of debt.

Ezra Klein: You don't want to compare our financial straits, though, do you? Because if you do, this site will let you do it. On health care spending, we'd *love* to be Sweden.

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Washington, D.C.: Ezra,

Though I often disagree, I appreciate your persepctive on the health care reform debate. The response from those advocating for the more liberal versions of reform to the "rationing" talking point has been that we already ration in the U.S. -- by ability to pay. This is true; not every person can get every drug or treatment they want, especially if they lack an insurance plan.

However, one of the key problems facing Medicare and the U.S. system generally is that we consume a lot more health care than other countries. So, we do ration somewhat, but not as much as other places. And the vast majority of Americans have a plan, and are fairly happy with their plan (even if they think the system as a whole needs reform); much of this happiness stems from the fact that this majority is not the group being asked to ration (ie, why HMOs haven't been successful in controlling costs). So, when someone says "OMG rationing!" I think what they mean is that they are concerned that a new plan will call for drastically more rationing that the U.S. currently engages in, and will ask the majority of people who are currently mostly not subject to such a regime to have their care rationed. How do you address those concerns?

Ezra Klein: In part, by disagreeing with the premise. We don't consume much more care than other countries. A wide variety of studies have looked at this issue (look up McKinsey's analysis of why our hc costs so much more, or the Health Affairs paper "It's the Prices, Stupid") and concluded that our spending is not the function of utilization but prices per unit. It's not, in other words, that we buy more stuff, it's that we pay more for what we buy.

As for the second part of your question, current trends have health care spending reaching 100 percent of GDP by 2082. That can't happen. Spending less on health care -- call it rationing or not -- is inevitable. The question is whether we do it with intelligence and compassion -- figuring out what's worth spending on and directing resources to that -- or dumbly and cruelty by letting 100 million people become uninsured even as we spend endless cash in the last year of life.

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Jupiter, Fla.: Hi Ezra,

As a longtime reader, I know you have already done what I am about to ask so I apologize in advance. Anyhow, can you list the...I don't know...top three (?)...articles, books, essays, etc. that you would recommend for a person trying to get a handle on the our health care crisis. What is the best place to get the kind of numbers/figures to prove to my very well-off family members that they are not seeing the problem as it manifests in us here in the working class?

Ezra Klein: Keep an eye on the blog. I'm going to do a comprehensive version of this hopefully this week.

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Falls Church, Va.: "Private insurers make money by denying you care. A government insurer would not have the same incentive."

This is a joke, right? In your blog you keep arguing that the public plan will impose stricter cost controls (i.e., it will deny more care). You keep talking out of both sides of your mouth depending on which question you're addressing, and that's hurting your credibility when you argue for the public plan.

Ezra Klein: I think you misunderstand me. Stricter cost controls are not, in this context, denials of care. It's more the Wal-Mart theory of cost control: You use your massive market share and market power to bargain down lower prices. This is what other countries do (it's why our seniors reimport American drugs from Canada, who negotiates lower prices for its citizens). In the private market, Wal-Mart negotiates prices down to much lower levels. We don't call that "denying their customers products."

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Cleveland: Re: Emusic: Don't know your musical tastes, but I have really been liking Ben Folds' "Songs for Silverman" lately. There are some excellent songs, especially "Sentimental Guy" and "Bastard" (will that get past the moderators? :)

washingtonpost.com: Yes.

Ezra Klein: The moderators have smiled upon you.

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Washington, D.C.: At dinner recently, some family members had a (sometimes heated) debate about whether it's fair or accurate to say that President Obama's stimulus package "passes a massive debt on to our children."

What's your take? Fair? Misleading? Strictly accurate but incomplete?

Ezra Klein: Accurate but incomplete. We did borrow money to fund stimulus. But we borrowed money at dead-low rates and we blunted a much largewr recession and we made important investments for the future. When a small business borrows money to get itself through a tough time, that's a debt for its future. But there's nothing intrinsically wrong with that. The question was whether it was a wise expenditure. I think it will prove to have been smart, but the jury, obviously, is still out.

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Ezra Klein: Speaking of music, you know what I've been liking lately? The Gaslight Anthem's "59 Sound." Listening to it now, in fact.

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Baltimore: From someone with excellent employer subsidized health insurance: People are stunned when I say this, but I would willingly be taxed on the employer subsidy (it amounts to income, after all) if it meant that I could buy decent coverage on the open market if I lose my job. And I would be doubly willing to be taxed if it meant that private insurers would agree to look at all the nation like one big risk pool and sell insurance regardless of age or prior health issues. (Just like they sell it to the company I work for, which has many, many employees around the nation.)

Ezra Klein: I think this is an important point. A lot of people who benefit from the employer health care subsidy now find themselves penalized by it when they lose their job or strike out on their own or see their employer fold. There's really just no reason to discriminate between people who get their health care from their employer and people who want to buy it elsewhere.

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very strong public plan that anyone can buy into: But this still leaves the waste and criminality of private insurance. Most people have no choice; their employer chooses. This won't change under a public option.

Ezra Klein: This is also an important point, and something I'm really worried about. The Dems and admin are much too interested in preserving employer-based insurance. They're so interested in it, in fact, that they're likely to restrict people's choices and make it so you can't buy into the health insurance exchanges (where public and private will compete) if your employer doesn't want you to.

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Health care Today, an Example...: I took my fiancee to an Urgent Care place on Saturday because she was very ill. We both have insurance through our respective employers. We waited two hours before they could see her. She was back there for two more hours.

When she finally came out I asked "what's up?"

She Replies "I have the flu, there's nothing they can do for me."

I said "Oh, well what took so long?"

"After they told me I had the flu, they ran every test on me under the sun to make sure I didn't have strep, mono, etc...and they say I should go get a chest X-ray."

This is why health care in this country costs so much.

Ezra Klein: Yep.

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Trading and bank bonuses: Has anyone gone through the unusually strong bank results at places like Goldman and others who hope to pay very strong bonuses this year to understand what is driving their profits? How much of it is from the trading desks on the other side of unwinding trades of positions held at AIG, Lehman, etc.? I heard stories that undermanned AIG traders were throwing their hands up and doing almost any trades to get the positions off their books which ended up being incredibly profitable for the trading desk on the other side.

Ezra Klein: That's possible. Felix Salmon and Noam Scheiber have had some good posts on this topic. A lot of it has been, as you imply, from smartly arbitraging the financial crisis.

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Buenos Aires, Arg: Funky C "Chocolate" - from the album Joya (I like the whole album, as well).

There's an ongoing debate here in BA over the use of bus lanes by taxis. Are taxis sufficiently public transportation-y to use a bus lane?

Ezra Klein: No. My lord, who would argue otherwise?

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Orlando, Fla.: Would it be possible for people ideologically opposed to health reform to tank the system through obstinate fraud? I'm thinking of intentionally slow administrators, citizens who constantly seek needless care, etc just to prove a point reform would fail.

As for emusic the newest Anathallo is brilliant. They're great live too.

Ezra Klein: Sort of a version of Rush Limbaugh's Operation: Chaos (where Republicans voted in Dem primaries)? I have trouble seeing it. For one thing, they'd have to first buy into the public plan. For another, getting a colonoscopy, or lumbar surgery, is no fun.

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New York, N.Y.: If Congress cannot agree on a bipartisan bill this summer, what are the chances the Democrats would resort to reconciliation in the fall? And is there any likelihood that they would bend to exclude the currently-discussed public plan in favor of a co-op alternative and/or an exchange market?

Ezra Klein: Hard to say. It depends on whether a deal isn't done and health reform is popular and repubs look obstinate or it's not done because the initiative has crashed and burned. Clinton's bill, remember, never even came up for a vote.

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New York, NY : Ezra, can't we just appoint you the pro-reform healthcare go-to guy for all TV interviews on this subject? I mean, I've seen some horribly misinformed (and/or misinforming) Democrats on the tube lately -- and don't get me started on the Luntz-talking-point Republicans. Seems like you really have the goods on what's going on, etc. I'll start calling bookers and producers now, if you like!

Ezra Klein: I'm all for crowdsourcing my self-promotion.

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Emusic: My last emusic download was Tortoise's "Standards" album. Seriously awesome stuff.

Ezra Klein: I'll check that out.

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Long Beach, Calif.: I've heard information that Sen. Conrad is open to changes that would make his co-op compromise health care plan a more viable alternative to a strong public plan. What would you need to see changed to truly be supportive of such a plan? If those changes were made, who would still be opposed to such a compromise and why?

Ezra Klein: I wrote a post the other day saying that Conrad was moving in a very encouraging direction. I'd want national purchasing power, government seed money (this is a whole new thing, after all), and an enduring governance board.

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The Dems and admin are much too interested in preserving employer-based insurance. : It's not that they WANT to, but that they have to so as to avoid being labeled socialists. We can't do what's the most efficient because Rush Limbaught will call us names.

Ezra Klein: Fair point.

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Public plan: Ezra, I'm a liberal, but I'm surprised that liberal commentators are saying things like:

"why are the insurance companies afraid to 'compete' with the public option?"

This seems like an incredibly disingenuous line of reasoning. Like the way the Post Office "competes" with UPS? I know it's a tired analogy, but it's valid. They don't compete. The service at the Post office is terrible, every honest person admits UPS and FedEx would do it better, and the government has just made it illegal for UPS and FedEx to have certain services. Why would the government's concept of "competition" be different for health care? Why are we supposed to believe that?

If you love competition so much, do you support a Nationalized Airline to "compete" and force American Airlines and Delta to "improve"?

Maybe I'm not as liberal as I think. But if health care ends up "competing" like UPS and the Post Office, I think you'll find a lot of liberals who realize they weren't as liberal as they thought.

Cast it in moral terms, in public policy terms, whatever. But don't lie to us and call it "free market" and "competition".

Ezra Klein: But it's not valid unless you set the rules that way. Medicaid, for instance, doesn't lock private insurers out of providing health care for poor people (they just choose not to do so). No one is suggesting that they set the rules such that it is illegal for private insurers to offer private health insurance. So the analogy doesn't hold.

What comes here, of course, is the slippery slope argument that gov. will do it later. But if the Dems can barely get 60 votes for a weak public plan now, what makes you think they'll get 60 votes to massive strengthen it later?

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Would it be possible for people ideologically opposed to health reform to tank the system through obstinate fraud? : My reading indicates that plenty of Brits felt that way when national health care was introduced. Now the most conservative Tory expects full healthcare to be part of what the governement provides for every citizen. Did we hear any conservative PMs lobbying to eliminate them? No. They like it and it works.

Ezra Klein: Yeah, the popularity of single-payer and socialized systems in other countries is really startling. Margaret Thatcher support the National Health Service! Strongly! No one has ever given me a convincing answer of why other countries seem to like their dystopic hellspawn systems better than our glittering example. To put it more sharply, there are some countries, in recent years, that have built socialized system. No countries have replicated our model. Weird, huh?

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Ezra Klein: I think that's it for me. Thanks folks, this was fun!

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