On September 30, 2008, the Centers for Medicare and Medicaid Services (CMS) agreed--after several missed and extended MA deadlines--to grant Massachusetts a three-year, $10.6 billion Medicaid waiver which would allow the state to continue its fiduciarily irresponsible health insurance law. According to the Associated Press, this new waiver would allow MA to spend $4.3 billion more than its prior waiver. (Adding up to a total of $21.2 billion in expenditures over the next three years on its health insurance law.) If the federal waiver had fallen through, what Mass. calls its health care "reform" would have been jeopardized.

The message is, MA thought it could get away with just running to its 'rents for more money in lieu of imposing any cost controls. The power drunk legislature thought the coffers were flush with cash, that the party would never end.

This is the plan your thumb sucking Congressmen have in store for you. Only where will they go when CA, with a population 6x that of Massachusetts, needs its own Medicaid waiver? Or Texas (w/ a pop. 5x of MA)?

China cut off the credit card. It's going to come out of your hides in the form of a debased currency.

" . . . buried at the last minute in hundreds or thousands of pages of legislation by congressional leaders who don't want their own constituents to understand the compromises they have made with powerful Washington lobbies."

It isn't a problem of holism or trying to fix too many things at once (gee imagine ad hoc piecemeal engineering anything--final product isn't gonna work very well) it's a problem of our "citizen legislators" not willing to do their duty and stand up to corporate lobbyists and forge solutions that benefit "the most" rather than the "biggest political contributors".

America is broken. It has a two tiered systems laws and morals--one for the little people and another for the powerful. Alas it was always such. Just wish they wouldn't feed people all that bullshit about how "exceptional" America is and all that "bootstrapping mythology". A giant Ponzi scheme economy and political system isn't all that exceptional in human history. In fact it's probably the antithesis of the word exceptional except in the sense of being exceptionally corrupt.

Mr. Lind, this whole mess of an article needs a rewrite.

Yes, the cap and trade agreement needs to fail, for whatever reason. I suspect foes of the environment (including Obama) want it to fail.

The worse prospect is that the bill will pass and we'll be saddled with a cap and trade system that 1. enriches polluters and 2. fails to curb carbon. This ain't sausage, it's spam. It will discredit cap and trade.

I think people may need to form their own private cooperatives, corporations or non-profits to effect cap and trade principles.

It's obvious the Democrats and Obama understand the economic power of cap and trade, but they are cynically using this tool to increase their corporate and elite donations. I also expect Obama's post-Presidency payoffs will dwarf Bill Clinton's haul for this cynical sellout.

And we, and our children, will pay the true cost.

Remember that joke about how many French soldiers does it take to defend Paris? We don't know, because it has never been tried.

Most of the examples cited don't really seem comprehensive -- at least not by my definition of the word. Maybe creating the Federal Reserve System was. Maybe the original National Labor Relations Act.

We don't really, genuinely try to implement the Big Idea very often. Instead, we try various levels of incrementalism in the name of bipartisanship, compromise and other suchlike motherhood and apple pie values. We open the door to precisely the kind of picking apart that gets you five separate bills none of which, even when added up, equal the original intention.

Piecemeal and incremental reform will not work with health care. Period. As long as we leave the moneychangers (the insurance industry) in charge of the temple, they will continue to entrench their position and undermine any incremental reform that affects their bottom line.

Centrism is really one of the worst things about American politics. It stifles innovation and brands boldness as radicalism.

Piecemeal reform usually happens through the furnace of our two party system. When we have one party rule we get waste and fraud. The stumulus bill is a fine example of this. It has yet to be tested and proven to have worked. Though we daily hear about the waste in the bill. There was no one to keep the spending in check or at least hold the wasters accountable. And so it goes for reform in our country. The citizens of this country are skeptical of a government that of late has not been trustworthy to solve our ills that it may have caused. But through large sweeping legislation they will get it done? This is why healthcare and cap and trade are stuck. The Dems are getting weak knee'd and shot their wad in the stimulus bill. If they would have used good judgement in the stimulus they may have been given a pass to solve health care and the environment. The American citizen wants to trust those that have been elected but time and time again come away shaking their head at special interests getting to the trough first and the taxpayer holding the bill. Trust has to be earned. Until then we all should be skeptical of any large legislation and should question our governments motives.

Yes, this article is a mess. Mr. Lind is conflating omnibus with comprehensive. Not the same thing at all. A kitchen sink or laundry list of schemes and approaches may comprise an omnibus but it is not necessarily or even likely to be comprehensive. If you disaggregate all these elements and pass them individually with their "own majorities" you are likely facing decades and passing a lot of bad ideas.

With this reasoning we would never have passed Social Security or Medicare. Too comprehensive, too big.

I see that one of Salon's resident trolls has already weighed in denouncing SS and etc in his/its first published letter. Fine. People like him should be treated as if they weren't part of the system, had invested it all in the market bubble and are now broke.