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Rob Kailey is a working schmuck with no ties or affiliations to any governmental or political organizations, save those of sympathy.

The Health Reform Bottleneck (and why I'm still optimistic we have a bottle opener)

by: Matt Singer

Mon Aug 24, 2009 at 07:48:05 AM MST


I got a surprised email last night, surprised because Max Baucus in a recent conference call with Demo county chairs endorsed a public option. The emailer was looking for confirmation.

I should clarify, though. Max, of course, didn't endorse a public option in this call. He reiterated his support for a reform he has publicly supported since the release of his white paper last November. As far as I know, what is surprising is not Max Baucus supporting a public option, but anyone thinking he doesn't because, as far as I know, his office has never told anyone that they don't support it.

Let me add some caveats now. I don't think his office puts the public option as the keystone of reform. Neither, clearly, does the White House. Nor do a ton of reform "experts," a stance that either undermines the meaning of that word or explains the prioritizing of Max and the White House.

There are other concerns as well. First, we actually have to pass a bill. Joe Lieberman is now being an extraordinary douchebag (like Max Baucus and the public option, this is not a new stance, but merely the reemphasizing of a long-held position) and saying we can't afford health reform (as Ezra explains in that link, Lieberman is full of crap).

Lieberman is hardly the only problem in the U.S. Senate. Kent Conrad appears to be a pain in the ass. Evan Bayh has been quiet for a while but could almost certainly rear his ugly head. Check the full whip count, spot Tester and Baucus as public option supporters, and you're still a few enchiladas short of a combo platter.

Assuming Joe Lieberman is willing to filibuster health reform for containing a public option (a stance that would not surprise me in the least) and that a handful of other Senate Democrats would consider it and that Ted Kennedy may be too sick to make the vote...we probably get Snowe to support cloture and maybe Collins. After that...where do the votes come from?

In comments recently, someone said something along the lines of "as I've said all along, if Democratic leadership could just get their caucus in line, none of this would be a problem." Well sure and if we already had a functioning universal health care system, none of this would be a problem either. Assuming the solution to the problem usually solves the problem.

The problem is that the Democrats haven't united. The second problem is Senate rules that let us pass a public option with 50 votes but would probably make it difficult to get meaningful insurance regulations with any fewer than 60. We have a solution here, too: split the bill into multiple bills. Reconciliation is an option going into motion, an option that may also force the hands of Lieberman, Grassley, Enzi, etc.

The third problem is that some Senators, including Max Baucus, are damn committed to including Republicans like Chuck Grassley every step of the way. But let's be extremely clear right now, this is only a problem if we take care of problem 1. If we have 60 votes except for one or two D Senators who are balking while waiting for more bipartisanship, then this third issue moves from "potential" to "actual" problem.

Right now, Max Baucus is blocking healthcare reform in the same way that I'm fighting a land war in Asia.

I'm down in Billings briefly, having just celebrated my grandmother's 80th birthday. She's a hell of a woman, I should note. She taught me the value of generosity and family. If I become one-tenth the person she has been in her life, it'll be an accomplishment.

Although I try to avoid talking work too much with my family, we had a short conversation yesterday about healthcare reform. There had been a number of jokes about death panels and someone asked me what I honestly thought was going to happen. I responded, as I often do, that the decisions at this point are largely outside my control and not anything I can really know, but that I hope we get something passed soon.

This surprised my family, which has (reasonably enough) bought into the argument that more discussion and debate is good, which it would be if discussion and debate are what we would get with more delay. But as the whole death panel episode shows, more delay doesn't mean more reasonable disagreements or good faith efforts to improve the bill. It brings new rounds of bullshit arguments used to divide and scare the public into opposing a bill that I think a majority would find, on net to be an improvement.

And the resources being used to answer questions and clarify this stuff is simply a pittance right now compared to the bullshit filling the airwaves.

But let me end on a positive note. The work that Max Baucus has been doing for months (years?) will prove helpful, I think, as we move closer to resolution. He'll be able to help keep wayward Dems like Conrad in the fold and pull over the Snowes and Collins of the world if this stuff changes gears quickly. A split the bill option for legislating is being taken more seriously, with folks like Chuck Schumer talking it up publicly.

We're still well on track for passing significant and meaningful health care reform this year, including a public option. That fact is pretty astounding. It is good news for this country, for all the currently insured who risk getting screwed by their insurance companies or risk losing their employer-provided insurance due to inflation, for all the currently uninsured who will have far more affordable access, and for everyone else who will, over time, benefit from improved quality and cheaper services...

It is bad news for some others. It isn't yet clear who exactly, although various pieces of the health industrial complex will hurt over time. It is bad news for Bill Kristol and probably for Mark T.

But for the vast majority of us, this will be progress of an historic sort. And, yes, even Max Baucus will be due a shit ton of credit.

Matt Singer :: The Health Reform Bottleneck (and why I'm still optimistic we have a bottle opener)
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Thanks for checking in from Etherville .. (0.00 / 0)
Define "significant", "meaningful", and "public option". The stock market has far more to say about supposed "reform" (also needs a definition) than the Congress. The stock market says we're screwed. Again. By Democrats.

By the way, the recalcitrance of Republicans towards any kind of reform plays right into the hands of right wing Democrats. Why, it's as if the leadership of both parties is on the same page. Given that there are only 30-35 Democratic senators that lean towards liberalism in any significant way, getting 58 to vote for "reform" (your word) can only mean that "reform" (my word) died along the way.  


Faith in the markets, eh, Mark? (0.00 / 0)
And I think you're right. It should only take 30 votes for the Senate to pass a bill.

On what planet do you live?

Community rating and guaranteed issue are a big deal. An alternative to private insurance is a big deal. Health insurance exchanges are a big deal.


[ Parent ]
You're adjusting your success threshold (0.00 / 0)
down, further and further Matt. What will you ditch next month? The co-op? The exchange? Without a mandate and subsidies (read: bailout, gold rush, giveaway, public trough... etc.), the insurers will not allow Congress or Obama to regulate them into accepting community rating and guaranteed issue.

Community rating and guaranteed issue mean nothing, if the alternative to private insurance is a co-op, and there is no public option on the exchange. If there is a mandate mixed into this, then how does it become affordable? You've got to have subsidies for those at the medicaid cutoff, up to 4 times poverty. And you're not going to create a new entitlement without holding costs down.

And an exchange in a place like Montana is meaningless without a public option (let's see?... my choices are Blue Cross and Allegiance and New West--I already knew that ). And a co-op with maybe 25,000 members in Montana will be prohibitively expensive as it will have no clout, and will be comprised of an expensive group to underwrite. I don't buy Klein's idea that the exchange is the most important part of this equation.

So unless reform successfully tackles the problem of the uninsured (full universality--everybody covered), I will call it a failure . The whole push for reform begins to unravel as you excise out pieces of it in order to make it palatable to the likes of Lieberman and Ben Nelson and Conrad.

With your abbreviated list of goals, I'd be hard pressed to find any progressives that would support it--much less the "left of the left." Even Obama and other leaders have said that if the reform isn't comprehensive, then it cannot solve the huge issue of cost containment.

And if you can't contain costs, well then the doctors and the pharmaceuticals and the hospitals and the insurers have won. And if they all win, well then the consumer has lost.

What you seem to be hoping for is that the majority of current insurance policy holders will see a minimalist bill that might, just might lower their costs a little bit as the best possible thing. The "what's in it for me?" question put to the middle class, with the answer being that the potential for a small savings, with little risk, is better than the potential for larger savings with a bit more risk.

What you list is not an acceptable tradeoff to qualify as reform. And if Obama tries to sell it as such, he will continue to lose his progressive base, and with it his chance to win in '12. If Obama wants to trade his progressive base and the left in order to capture the middle class, then a reform bill like the one you outline is the way to do it.

I'll be happily sitting on the 3rd party bandwagon next election, though, if what you outline is all that is to pass for reform, and Obama signs it.


[ Parent ]
"Faith in the markets"? (0.00 / 0)
I also have faith in street signs.

Stock markets reflect investor attitudes, not always rational, but real enough. The market says health insurance companies will not be hurt by Obama.

You've given up one goal after another, all along saying it's important to have a goal. What good is community rating if we still have to pay insurance companies 30 cents on the dollar to insure us?

What good is guaranteed issue if they merely treat it like they do COBRA, making it so expensive as to be meaningless? And it isn't me, but Howard Dean who predicts that the exchanges, which hardly work anyway, will be crushed by the insurance companies.

But then again, you will probably back off on these items too, because it's important to get a bill, right?

In the end, you want to say that Democrats accomplished something, and are not the problem. You're an excellent manifestation of why Democrats are the problem.  


[ Parent ]
I think you misread the statement by the county chairs. (0.00 / 0)
It was not to break the news that Max said that he favored a public option.  Yes, he's said that for awhile.  He has said that he favors it, but doesn't have the votes.  I asked him about the idea in his white paper on getting more people on Medicare i.e. people 55-64.  That's about 33 million.  He just doesn't know how to do it and how to pay for it.

Kip Sullivan calls the people in Washington involved in health care reform as the "Yes buts".  One of the points of forming a coalition of concerned counties is to get the message out that county officers represent people who are hurting. We must be seen as honestly advocating for reform for all Montanans with something that is non partisan and a basic human right. The way I've found for people in my county to listen to me is to be honest and not just some party hack.   Here's a response from a ex Republican on my website:

As an ex-republican who supported Obama with my money and my vote I kept wondering why he and the Democratic party machine didn't capitalize on this perfect opportunity to buck the medical industrial complex lobbyists and support HR 676.

As a fiscal conservative, I see Medicare-for-All (HR 676) is a way to reign in the costs of health care by eliminating insurance profiteering and obscene administrative costs then redirect the savings toward actual health care. In this way we could provide basic health care to all American citizens without adding one dime to our total health care spending.

I am glad to see a bit of grassroots backbone from the democrats, because they were about to lose Independent voters like me who expected Obama to buck the syatem and create real, meaningful change---not promote the same tired old stuff Baucus has been pushing.

Remember, Democrats, you need Independent votes to preserve a working majority in the upcoming elections ---don't take us for granted and just expect us to toe the party line.

This is the beginning of a movement to educate Montanans as to the economic and moral value of Medicare for All.  And it calls for an honest discussion.


While the intent of the Coalition may not have been to make news (4.00 / 1)
about Baucus' statement on the public option, we need to amplify the fact that he said the words. Because his actions have all pointed to him providing a solution without a PO, so the general public--at least those that having been paying some attention, has been to assume that Baucus doesn't support a PO.

Those of us who are steeped in the details, as they exist, in this debate all know that Baucus has mouthed the words, and at least put them into print once, "i support a public option." But we all know that his committee is not going to report out a bill with a PO. So most of us just think that he really has no backbone, being the leader of the finance committee and all, to make it a backbone of his version of reform.

Baucus could ditch his quest for bipartisanship, and get a bill out of Finance with a PO in a heartbeat. It's just that he chooses to negotiate with people who believe the dems are out to "pull the plug on grandma" instead of pushing good policy. He has seriously misplaced priorities here, as everybody can see that he will not get any republicans on board for the final effort to reform health care. Politics and getting a win over Obama is more important to them than doing the right thing for the american people.

Max, you say you support both a PO and bipartisanship. You can't have both. Which is it going to be?


[ Parent ]
I guess we are "making a splash" according to Daily Kos (0.00 / 0)
http://www.dailykos.com/story/...

McJoan just front paged this and quotes me and quotes Matt.
McJoan is still hoping like Matt that Baucus can do the right thing. I'm more in the Matt Taibbi crowd. Look for his latest Rolling Stone article.  He thinks right now all  we will get is no pre-existing conditions.  But no reason to give up yet.
http://www.democraticundergrou...


[ Parent ]
I too would like a definition of "Public Option" The proponents seem to run away when asked for one (0.00 / 0)
That strikes me as either dishonest, cowardly, or perhaps both.

This article at the url in the LA times says that the insurance industry is euphoric about the reforms contained in both HR3200 and the Senate HELP bill. It's an interesting piece.

Healthcare insurers get upper hand
Obama's overhaul fight is being won by the industry, experts say. The end result may be a financial 'bonanza.'
http://www.latimes.com/news/na...



Asked and answered. (0.00 / 0)
Steve, that question has been answered, and every time you pressure for more.  Simply put, that's a Republican tactic.  It's called "moving the goalposts".  No answer given will satisfy you.  You want what you want.  Fine.  Pretty much everybody here accepts that.  The problem lies with you because you won't accept what others are willing to.  The framing of your question is obvious:  it isn't a public option until Steve W. SAYS it's a public option.

The 'industry' is using the same tactic as you are in the other direction.  If someone's running book on who will win between the two of you, I'm betting on them.


[ Parent ]
That's entirely unfair Wulfgar. Did Matt ask you to interceed for him? Is he hiding out? (0.00 / 0)


[ Parent ]
I was in a car all day (0.00 / 0)
How do I define a public option? Well, I would define it as an insurance plan operated by a public entity, e.g. government controlled. That's to say that it is a pretty broad definition and there are better pieces and worse pieces.

How do you define single payer?


[ Parent ]
Actually (0.00 / 0)
It's entirely fair.  I have answered your question before.  So has Jay.  You simply refer to bills already written and not those negotiated in the world of tomorrow.  Great ... until you start demanding as you have here that others defend things that aren't written.  I haven't been unfair at all, Steve, and I defy you to show how I have been.

[ Parent ]
No, it's unfair to you because by your own admission health care isn't your issue. You wouldn't be (0.00 / 0)
able to answer the question if you wanted to.Which you don't. So why are you? I didn't ask you. And I don't want you to. Because you don't know anything about it. I don't even think we've met.

Dang it , i left my time-machine on the bus. Now I can't refer to bills written/negotiated/whatever/ in the world of tomorrow, can I?

Good point!


[ Parent ]
How is what you wrote, (0.00 / 0)
"The problem is that the Democrats haven't united."

Any different from what I wrote:

"as I've said all along, if Democratic leadership could just get their caucus in line, none of this would be a problem."

???

It takes leadership to unite the dem caucus. Unless you're writing in the passive tense. Then I guess no one has to take responsibility if the "Democrats haven't united."

Words are powerful Matt. And politicians know how to use them to best effect. But dumbing down an argument through the use of a passive voice, and dissing me for using an active tone is just... silly and counterproductive.


H.R. 676 is "historic," the rest is spin. (4.00 / 1)
It's time to compare the elements of H.R. 676 to the elements of Baucus-care.  How about it Matt?  Your crystal ball is no better than anyone's.  What would be helpful, however, is a fair side-by-side analysis for folks confused by statements like this:  "We're still well on track for passing significant and meaningful health care reform this year, including a public option."  People understand Medicare, and H.R. 676, because it expands Medicare.  So, how does your "significant and meaningful" stack up on 1) cost containment, 2) access for uninsured (pre-existing conditions, working poor,etc.)and 3)portability for unemployed, and others on the move?  Regardless of the outcome, these are the issues people are interested in.  I think understanding the issues trumps understanding Baucus's self-inflicted political problems any day.  How about some meat on those policy bones once in a while?    

That's a good one. (0.00 / 0)
People understand Medicare, and H.R. 676, because it expands Medicare.

What about all them folk showing up at town halls telling the government to keep their socialism out of Medicare?  I'm not sayin' you're wrong ... oh wait, yeah I am.  I would definitely like some proof that people "understand" HR 676, and if that's the case, an explanation for why it's molded in the House frig for so long.

It's time to compare the elements of H.R. 676 to the elements of Baucus-care.  How about it Matt?

'Scuse me?  Which one of you ran for the House?

How about some meat on those policy bones once in a while?

As a commenter here, you have the ability to write a diary.  Instead of slamming Matt for not posting what's in your head, how about you post what's in your head?  


[ Parent ]
Time for humor (4.00 / 1)
This is for all those posters, like me, who have begged, cajoled, raged, and ranted to move the health care debate in a meaningful direction while being told to basically STFU by the excuse makers here.  

http://apnews.excite.com/artic...

Young Obama backers AWOL from health care fight

Aug 24, 2:27 PM (ET)

By BETH FOUHY

NEW YORK (AP) - Add this to President Barack Obama's problems in selling his health care overhaul: A lot of the tech-savvy activists who helped put him in office are young, feeling indestructible and not all that into what they see as an old folks issue.

It's a crucial gap in support and one the White House may have to correct if Obama is to regain the momentum and get Congress to act on his top domestic priority.

Matt Singer, a 26-year-old founder of the liberal group Forward Montana and an activist in the health care trenches, has tried to engage young people.

"Right now we're seeing a big conversation with seniors, but you're not seeing the same mobilization among young people who are President Obama's core constituency," Singer said. "The age demographic most supportive of reform has not been engaged, and it makes me very nervous."

...
Singer, of Forward Montana, echoed that but said Obama must move quickly to inspire his core supporters.

"To win, you've got to turn out your base. In this case, it's the pragmatic youth who trust Barack Obama and say, 'This seems reasonable to me,'" Singer said.

And for sure don't miss the "wisdom" of Celinda Lake -- the same Celinda Lake who earlier urged Montana's writers not to use phrases like "universal coverage" and "single-payer" because it didn't fit in with Max's white paper.


Maybe I'm missing what's funny (4.00 / 1)
I mean it when I say youth are Obama's base on healthcare. They ain't ideologically dedicated to single-payer, are strongly supportive of a public option, and are the age demographic least likely to be insured.

They're unique in the healthcare debate in not being to the right or the left of Obama, but nearly precisely where he is.

By the way, George, if I wanted anyone on this to STFU, I have the power to do that at anytime. I'm amazed that my disagreement with you had such a huge impact that your ranting was for naught.


[ Parent ]
Humor is in the eyes of the beholder, Matt (0.00 / 0)
It's been both interesting and instructional to watch so many of the readers and commenters on this blog rebel against those who are running it because of their distinctly non-progressive positions on the health care debate -- arguably, the most important issue before the nation.  

For some of us, it's somewhat humorous to see the whole shuffle to the left you and others are trying to do now that your scuttle to the middle has failed miserably -- and predictably.  Suddenly, Ms. Lake is trying to find the message to motivate the masses that she advised them not to use earlier -- in favor of a more middle-of-the-road, DC operative, Max Baucus oriented goal.  

It must be obvious -- you got burned, dude.  Now, in your own analogy, you're in the raging whitewater and backpaddling against the current, having ignored all advice to keep to the left if you're going into these rapids.  

Maybe it's not funny -- maybe it's tragic.  But you got your asses handed to you...and have yet to even admit your mistakes...so laugh or cry, your choice.  


[ Parent ]
I got burned? By whom? (0.00 / 0)
Certainly not anyone who you think...

So far we're closer to meaningful health care reform than we ever have been in history and I still think we'll get it done.

I think youth haven't been engaged adequately nationally and I think youth outreach should step up. I specifically think that should happen because I find young people to be more, what's the word, malleable than other voters and accepting of a variety of solutions, including the ones moving through Congress right now...

Keep declaring defeat.


[ Parent ]
The Pyrite Plan (0.00 / 0)
Matt - You kind of remind me of the novice prospector who comes into the assay office, plunks down his poke and declares "it's gold!"  The assayist shakes his head and says "No, that's pyrite -- it's worthless."
"Can't be worthless," says the novice, "I got this off Yosemite Baucus' place and he says it's gold. Ol' Max wouldn't be a' foolin' me, would he?"

As we all know, pyrite's common name is "Fool's Gold."
What we're being offered right now by old Yosemite Max is the Pyrite Plan -- coming and going.  It's OK with me if you want to haul the poke o' pyrite around, but don't expect all of us out here to believe it's gold.

I have always applauded your efforts to get the young people involved in politics, Matt.  You know that.  But the best way to do that is give them something credible to work FOR.  Which may be why you're experiencing the disconnect of the once-fired up young Obama supporters -- the real CHANGE we were promised has been compromised to almost nothing on the wars, government transparency, health care, privacy, and on and on. Without substantive, REAL change (which the nation truly needs), it's tough to stay engaged.  You know, kinda like standing in the icy stream panning all day for a poke o' pyrite.    


[ Parent ]
HR676 is how i've been defining it for a while. Or I would point to Canada. (0.00 / 0)
A system that covers everyone with comprehensive coverage, tax funded, mostly fee for service.

The reason I ask is it seems that "The Public Option' has come to mean almost anything. HCAN has been calling the pool in the HELP Bill a "Robust" Public Option even though it is fifty separate mini public options operated by private insurance companies. It has no cost containment, according to the CBO

So by your definition FDIC insurance would be "The Public Option"?

Or Medicare Would be "The Public Option?" So then we wouldn't need to pass any legislation at all, since it was passed in the 1960s? We already have "The Public Option?"

I think that at some point the people who promoted the public option, (and that would include you, though you have backed away some from your prior strong and persuasive early support) are going to have a big problem when a lot of pissed off people feel like they were snookered.

Do you foresee that possibility?

I remember our conversation last winter, and how many of the people at the Badlander were in favor of pushing for single payer and how you kind of attempted to shift people over to considering a large muscular Medicare like pool open to everyone that would offer insurance below private market rates that could then eventually  and possibly crowd out the private insurers. I mean you were kind of a sales person for the idea, right?



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