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We are hearing far too much of this from our elite news media:

And the fact is that the American people, who want all the benefits and want the free lunch, and don't want a single gray hair on the beautiful head of Social Security or Medicare touched, and basically don't want to pay for it, I mean, the old line is, we elect Republicans because we don't want to pay for it and we elect Democrats because we want everything that government is going to give us.

Instead, we should be hearing more of what Chris Hayes is saying. The Villagers are already playing into the right wing frame, that there is a crisis brewing, that the baby boomers are going to bankrupt the country, that health care costs will chew up our budget and our GDP over the next 20 years, and everybody batten down the hatches and hang on because, well...it's a crisis, stupid.

No, it's not a crisis, and thankfully there is one adult in the room who is asking why everyone is setting their hair on fire before the complete package of reforms built into the ACA come to pass. What he is saying is what we all need to keep hammering on. Here's the list:

1. Medicare is in about the same shape it has been in since its inception. It's solvent for 11 more years without touching anything. That's standard solvency now and yesterday for Medicare.
2. We spent an enormous amount of time and political energy on the Affordable Care Act, which is a 2,000 page bill, as the Tea Party and Republicans are fond of pointing out. The Affordable Care Act has consumer protections and Medicare reforms written into it. The consumer protection piece is about 60 pages. The other 1,940 pages are Medicare reforms intended to control the rising cost of health care.
3. We will not know whether those reforms are effective for three to four years. What we know today is that Medicare spending has decreased over the last three years, and that's before all of the ACA reforms take hold.

This is the conversation that isn't happening anywhere else. Note Megan McArdle's shocked reaction when Hayes actually dares to say that everyone is setting their hair on fire years early.

You know why it is that conservatives make such a big deal out of the Independent Payment Advisory Board (IPAB)? It has nothing to do with death panels and authoritarianism, despite what they whine about in public. It is because it will quite likely end the medical gravy train so many have been on for so long, without decreasing quality of care.

I repeat: Without decreasing quality of care. It will end practices like charging uninsured patients $3,000 for a colonoscopy that costs $300. It will begin to end unnecessary tests and procedures which are performed because fee-for-service medicine requires more and more services to maintain profitability. This is why conservatives hate it with an undying passion. It actually limits and controls costs.

These same Very Concerned Conservatives are so very concerned about Medicare costs that they are going to block the IPAB's fast-track funding required in the ACA. Via The Hill:

The House is set to vote Thursday afternoon on rules for the 113th Congress. The rules package says the House won't comply with fast-track procedures for the Independent Payment Advisory Board (IPAB) — a controversial cost-cutting board Republicans have long resisted.

The rules package signals that Republicans might not bring up Medicare cuts recommended by the IPAB — blocking part of a politically controversial law, and resisting Medicare spending cuts.

Let's review the bidding here. Republicans are making the rounds and gladhanding with the likes of Pete Peterson, rending their garments and claiming our children and grandchildren will be saddled with too much debt, too much debt because their parents and grandparents had the temerity to get sick and require Medicare coverage, while they are aggressively blocking the ONE SINGLE THING that will likely contain those costs.

Tell me more about how we must cut, cut, cut in order to avoid a terrible horrible future after they sit down and get out of the way. When the ACA reforms take hold (whether the House likes it or not), that cost curve will likely bend sharply downward.

Republicans are hoping they can distract us long enough with their incessant crying and stalling so they can gut it before the reforms happen.

Don't let them win.

Angela Braly, the CEO of Wellpoint, called for health care reform at a meeting in Indianapolis.

One of them most powerful women in the nation is calling for health care reform. Wellpoint CEO Angela Braly says she supports guaranteed coverage for everyone - as long as everyone gets and stays covered [...]

"The high and rising cost of health care in America is just not sustainable," Braly said. She said the current system, including Medicare, which is administered by the federal government, was inefficient and promotes quantity over quality. She also said it posed "a real threat to the social and fiscal obligations of the government and to the health and prosperity of the American people."

"We believe insurance companies have a role to play. We can and are making a difference," Braly said. She said Wellpoint's strategy was moving beyond processing claims and managing risk, noting employee incentives when customers get healthy.

Braly says the what worries her most about the plan currently under consideration is the "public option."

This is, essentially, the insurance company-approved argument for health care reform. They see it as forcing everyone to buy their coverage, making refusal to buy their insurance a crime, and offering no competition to their monopoly over it. I'm sure they don't want to see that anti-trust exemption of theirs lifted either, the one that has led to 94% of the individual insurance market becoming "highly concentrated" in the hands of one or two companies.

Braly kept talking about how the current system is inefficient and leads to skyrocketing costs, as if she has no agency over that whatsoever. There are issues with how the fee-for-service system promotes quantity of medical care and not quality, but that's due to the profit incentive, which is exactly the same in the insurance market. Braly's argument seems to be that it's doctors and hospitals at fault for chasing profit in health care, but insurance industry CEOs like her are good samaritans and innocent bystanders who just so happen to do the same thing. If a profit-driven health care system is wrong, then it's pretty much wrong across the board. And she actually advocated for an outcome where insurers would be "free to offer a range of choices," while worrying about a public option... which would just be another choice, one that could deliver quality coverage at a lower cost.

Braly tried to argue that health insurance profits aren't all that big:

According to Braly, the difference between the Medicaid or Medicare payouts and actual costs are shifted to the private plans, costing you $1,500 a year. Add that to the $1,000 a year shifted to the private plans to cover the uninsured and it costs you a total $2,500 a year.

"Sounds a lot like the Fannie Mae for health care and I think we all know how that experiment is going," Braly said [...]

"If you completely eliminated insurance company industry profits which is clearly the aim of some, you would pay for two days of health care in America and in the process you would eliminate the market mechanism to control costs and improve quality of health care being delivered," Braly argued.

I don't know what any of this means. The market mechanism in health care has not controlled costs in America whatsoever, yet throughout the industrialized world we see public programs that control costs and provide better health outcomes. Private industry has begged off completely from limiting health care costs through any means other than denying coverage to their customers and rationing. Health care spending in Medicare and Medicaid is lower than spending through the insurance market. And insurers have used the employer market effectively to confuse employers and employees alike about the true cost of their service. Braly throws out "Fannie Mae" for health care, but the current system is clearly "Goldman Sachs" for health care - where the relentless drive for profit at the expense of people creates a spending bubble that nobody ever bothers to burst until it's too late.

In the end, Braly calls Wellpoint a "supporter" of health care reform. That's funny, I would think that a company committed to health care reform wouldn't illegally force their employees to lobby against it.

Consumer Watchdog in Santa Monica has asked California Atty. Gen. Jerry Brown to investigate its claim that UnitedHealth Group and WellPoint Inc. pushed workers to write their elected officials, attend town hall meetings and enlist family and friends to ensure an overhaul that matches their interests [...]

WellPoint, whose Anthem Blue Cross unit is the largest for-profit insurer in California and employs 8,000, took a more overtly negative tack.

"Regrettably, the congressional legislation, as currently passed by four of the five key committees in Congress, does not meet our definition of responsible and sustainable reform," Anthem said in a company e-mail last week. The proposals would hurt the company by "causing tens of millions of Americans to lose their private coverage and end up in a government-run plan."

The appeals amount to illegal coercion under California law, Consumer Watchdog research director Judy Dugan said. "While coercive communications with employees may be legal, if abhorrent, in most states, California's labor code appears to directly prohibit them," said Dugan, citing sections forbidding employers from "tending to control or direct" or "coercing or influencing" employees' political activities or affiliations.

Insurance companies like WellPoint support health care reform, all right - completely on their terms, and guaranteed to provide them a financial windfall. Anything else would be unacceptable, and they will take any tactic - no matter legal or illegal - to stop it.

Take a look at this ad from America's Health Insurance Plans, the insurance industry lobby.

See what's missing? The words "public option." Or really, any attack on the current plan in Congress at all. The spot associates AHIP with a reform banning denial of coverage for pre-existing condition in exchange for getting every American covered, gently asks for the final bill to be bipartisan, and... that's it.

Similarly, Olympia Snowe, who signed on to the letter calling for a delay in the deadline for reporting a health care bill out of the Senate, positively called for a public option on day one in a speech this weekend in Maine.

What this shows me is that we have now moved beyond the public option as the fulcrum point for the health care debate. We don't know what form it will take or how accessible it will be to all Americans, but if there's a bill signed by the President, it will include a public option. The major players have given up on that score and moved on to other issues to try and derail health care, particularly costs. We've seen much more criticism about cost controls and surtaxes on the wealthy over the last week than any discussion of the public option.

That's because those other facets of the policy don't poll as well as a public option does. They're also harder to explain and quantify. And the forces defending the status quo have found a much easier path by arguing for more delay, questioning costs, lying about the impact on small businesses, claiming that Democrats are engaging in class warfare, raising specters about rationing, and generally using that fiscal scold pose, saying we cannot pay for health care reform while protecting federal health care funding for their districts and localities. On the far right fringe you have lies about how the bill "outlaws private insurance," but in general, the status quo forces think they can trap the bill with a discussion about its cost, not its function.

Of course, the larger effort here is to destroy the Democratic agenda and basically ensure a first term without substantive accomplishments. And Obama is right to use Jim DeMint's "Waterloo" line against him, make it famous, and condemn those who would turn an urgent need for tens of millions of Americans into a game of political hardball:

Just the other day, one Republican Senator said, and I’m quoting him now, “if we’re able to stop Obama on this, it will be his Waterloo. It will break him.” Think about that. This isn’t about me. This isn’t about politics. This about a health care system that is breaking America’s families, breaking America’s businesses and breaking America’s economy. And we can’t afford the politics of delay and defeat when it comes to health care. Not this time, not now. There are too many lives and livelihoods at stake.

What we may see is a brief scaling back on the deadline, which should still leave enough time to report a bill out of both houses in September and reconcile them by October. But the fights ahead for health care appear to be playing out over cost and who pays. The public option is in the bill, as long as it gets dragged over the line.