Families USA summarizes the amendments that the Finance Committee made to the Chairman's Mark. There's a mix of good (basic health plans for under 200% of poverty, enrollment simplification, only one exchange per state) and bad (lower subsidy levels) and some other stuff.
Families USA does good work, though, and their reputation as health wonks is well deserved. The full thing is an easy-to-read four pages.
The Congressional Budget Office has released its "score" of the Senate Finance Committee's health care bill. The bill actually reduces the deficit by over $80 billion over the next ten years and by more over time. It also likely leaves about 6% of the population uninsured.
The Finance bill is unique as I understand it in being long-term budget positive according to CBO projections, but it also seems to me that the score could be improved by adding a public option, which is still possibly in the cards, and that the outcome would be improved both by a public option and by taking some of those savings and routing them toward subsidies to achieve universal coverage.
Ezra thinks that this score will be sufficient to get the bill out of the Finance Committee, which is the most conservative committee in the Senate.
Remember, before this bill heads to the floor of the Senate, it will be merged with the HELP bill authored by Ted Kennedy (negotiators will include Harkin, Baucus, and the Administration). That merging is overseen by Harry Reid.
Note, of course, that the Senate still has issues if Reid opts for a public option in the bill when it hits the floor. Max Baucus has been where he is because of the desire to break the filibuster. Reid can pursue a different route: daring Joe Liberman, Ben Nelson, Mary Landrieu, Blanche Lincoln, and Kent Conrad to filibuster health reform.
Either way, once bills come out of the House and the Senate, into conference we go. Whatever comes out of there heads back for up or down votes but the Senate can still filibuster if some Dems and all the GOP decide to deny health reform an up-or-down vote.
Finance Committee stalled out with some GOP antics today (check Sen. Debbie Stabenow deliver the best "your mom" punchline of all time in the video below) so public option comes up Tuesday (Monday is Yom Kippur):
Huffington Postnotes that with Sen. Ted Kennedy's replacement headed for the Senate soon, pressure is increasing for commitments from Democrats to support an up or down vote on health reform. Basically, the call is to prevent Republican filibusters on the bill from succeeding it.
If the bill isn't filibustered (and Democrats alone have the power to prevent a filibuster), a majority determine the fate of the legislation.
Majority rule -- quite the concept.
Note: Neither Max nor Jon has given any indication EVER that they would be part of a filibuster. The problem Democrats on this are more like Kent Conrad, Mary Landrieu, the Nelsons, and Blanche Lincoln. Joe Lieberman is a problem, but he ain't a Democrat.
I feel like I've had this conversation a lot lately with many progressives getting all sad sack and declaring defeat on the public option. Listen to your President, schoolkids: the public option lives.
As countless others have noted, our senior Senator bent over backwards, watered down his legislation, all in search of a bipartisan bill...and was left with 0 Republican backers. So that's point number one, it is increasingly clear that even Olympia Snowe is going south on even the most agreeable of health care reform offerings. The path to a bipartisan bill is not through negotiations (there is possibly a different path through popular legislation).
That said, there is some praiseworthy material in Max's bill. For example, the public option that people are seeking would "live" in the health insurance exchanges, which are themselves absolutely crucial to meaningful health insurance reform (exchanges will make it possible for individuals and small groups to pool their purchasing power more like large groups and also provide clearer choices for consumers purchasing insurance), are open to a lot more people and employers. In the House bill, for example, you get kicked out of the exchanges if your business grows to larger than 20 employees. In the Baucus bill, you'd have to be given access until you have 50 employees, possibly until you have 100, and eventually anyone would be able to buy-in. In other words, the Baucus bill gives a platform where, with a public option, the option would actually be an option for everyone, individuals, small employers, big employers, etc. That's big.
I'm also a fan of this idea, which I basically think of as insurance reciprocity. Rather than either putting up firm walls that don't let insurance plans cross state lines or tearing down all the walls between states and creating a credit-card-deregulation like nightmare in the insurance system (as Rep. Rehberg and others have advocated), the Baucus plan would allow Montana to permit, say, Californian insurers to sell policies in Montana if we deem California insurance to be regulated enough to satisfy us (note, it might be regulated differently than Montana plans, but still be deemed sufficient by our regulators). Again, this allows for bigger pools and more competition, especially for places like Montana. So that strikes me as good and smart.
The Medicaid and CHIP provisions are also apparently very well-written.
With most other stuff, except for the public plan and a significant change to the employer responsibility section, progressive complaints here are on the margins: subsidies should be more significant, penalties on the individual mandate should be lower, the community rating constraints should be tighter, and the out-of-pocket limits should be lower.
That's all fixable. It isn't fixable without increasing the costs of the bill a bit, but the bill is so fiscally responsible that we can increase its cost and still have it be reducing the deficit (!). So that means we have some room to work.
The bigger problems are that the bill needs a meaningful employer mandate and meaningful competition. Meaningful competition here is a code word for a public option, because no one has yet structured a meaningful alternative to the public option to actually achieve its goals. As is clear, the public option is also a political necessity to building the movement necessary to pass a bill, if the strategy is an outside (pressure) one as opposed to an inside (negotiations) strategy.
There's also some room for feedback on the financing measures, I'm sure, but I haven't really read the relevant material there yet.
Final thought: the biggest problem both with the delivery reforms that Max's bill includes AND with the public option (except for a Medicare-like public option that has its own problems) is that CBO doesn't have a way to score them as providing savings and so presumes that they won't save money. But both Max's Medicare reforms and a real public option will probably result in real cost savings and a public option AND improved access to primary and preventive care will be popular with people. There's some things that can't be scored that easily.
Anyways, check Ezra's five ways to improve this bill. But my friends who are saying this bill needs to die are wrong. It has some excellent stuff in it. It needs amendments, but don't throw the baby out with this bathwater.
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.
The public option is now more politically important than policy important.
That's a testament to its political importance, though, not to its non-importance policy-wise.
Even though the public health insurance option may not be the most important policy innovation being considered by the Congress in the health care debate, it is almost certainly key to maintaining public support for passage of a bill.
That new Survey USA poll shows pretty clearly that Americans continue to favor reform and that Americans believe public plan choice is important.
Unsurprisingly, the demographics most supportive of reform are also the groups most supportive of the public option. But there is very, very little evidence anywhere that stripping the public option will win the bill backing from individuals who don't have it.
At some point, these bills will be clear enough to be evaluated by the public. At this point, a public option appears a necessity to maintain public support. Can we pass a bill that the public opposes? Theoretically, yes. In practice, I think it is difficult.
The flip side, if the final bill is backed by 55% of the public, Republicans will have a far tougher time opposing it.
Finally, haven't watched it yet, but Jon Stewart apparently kicked Betsy McCaughey's ass on the Daily Show last night. It couldn't happen to a more deserving liar.
New idea floating in the healthcare ether: split the bill.
A public option can almost certainly be adopted under Senate reconciliation rules, since it is heavily related to the budget. But many of the other most crucial pieces of reform -- the exchange (where the option would likely live) and insurance regulations -- cannot.
So split the bill: pass the regulations and exchanges and subsidies, etc., via a normal process, break the filibuster, etc.
Then, go back and pass the public option via reconciliation.
Now, it should be clear that just putting this option on the table will likely cause the Congressional GOP to flip out even more, since any bill without a public option will now be a stalking horse for a later public option bill (now even no public option is a public option, HA!). But it is hard to see how Nelson, Bayh, Conrad, or Lieberman could maintain a filibuster of a public option-less bill.
Finally, because I want to be berated for being insufficiently progressive, I wanted to highlight Paul Starr's "Sacrificing the Public Option." Starr, one of the founders of The American Prospect and a damn notable liberal intellectual (author of Freedom's Power: The True Force of Liberalism) basically says that if the public option goes away, so be it. Better to have regulations and exchanges, which require 60 votes, than to get a public option and no regulations or exchanges...and we can always come back for the public option via reconciliation.
So my advice to progressives is to chill, at least on this matter. To get health-care reform through the Senate, the public option is almost certainly going to have to be dropped. Perhaps, after House-Senate conference, some version will survive; for example, if the House bill includes a public plan and the Senate bill includes health co-ops, a logical compromise would be to give states a choice between them. But if no public option survives this year, it can be enacted separately later.
If health-care reform passes this year, a lot more will need to be done to make it work. But if it dies this year, it will be very dead indeed. The opponents of reform understand that, and the supporters must too.
Every once in a while, I realize that my take on things is apparently a bit different from others. The last few days, I've written what I think are hopeful takes on the state of the healthcare debate, that we're getting closer to a good bill even as the chances for a bill dim somewhat as the GOP turns into pure opposition (an outcome that was, yes, always very likely).
In response, I'm told that I can't seek bipartisanship, that the real problem is the Democrats for being...something (I have a tough time following Mark T's arguments these days), that the real problem is the Democrats for trying to work with the Republicans (I sort of agree, but there is something to be said for working in good faith for a while), and that I'm a fount of pessimism.
So let me just say it this way, I think the GOP is making a gamble here. They're closer to losing their ability to worsen the bill and they're about to double-down on their very public arguments to kill it completely. That means it is time for a big ol' debate on the merits of this bill, which will likely be pulled to the left as the GOP leaves the table.
That also means that the passage of a bill, which I think comes out of the process with a public option, potentially even a fairly strong one, depends on our ability (our as in the grassroots progressive movement) to keep our shit together and stay focused.
I think we're in something like mile 21 of the marathon. In recent weeks, progressives seem to have sat down and shut up, insufficiently pleased with the state of the bill to say anything and insufficiently worried it would water down further to say anything, and we ended up in a debate about whether faceless bureaucrats would be pulling the plug on grandma (as opposed to faceless insurance bureaucrats pulling the plug on people not covered by Medicare).
Update -- I'm learning in comments that a public option, community rating, subsidies to buy insurance, Medicaid expansion, etc., aren't worth fighting for. All of these things are very much still in play and most of them are almost accepted facts at this point that will be in a final bill. Things like the public option are in the middle of a series of different decision-making processes -- mostly House Rules Committee, House Floor, Senate Finance, Senate Floor, eventually conference. But the idea that there is nothing going on worth working for is patently absurd.
There's a reason you don't see, for example, the AFL-CIO throwing in the towel on healthcare reform. It's not because they're dipshits.
Imagine if the Greeks had been so brilliant as to hide their Trojan Horse full of soldiers inside a second larger Trojan Horse!!!!1!1!
That's what Jon Kyl thinks co-ops are, in a Huffington Post story that laid plain, once more, what an indescribably ridiculous political party the GOP has become.
First, the public option was a terrible idea because it is supposedly a Trojan Horse for single-payer. Now private co-ops are a terrible idea because they are a Trojan Horse for a public option. I imagine soon we'll be outlying private insurance because it is just a Trojan Horse for health insurance cooperatives. Or something.
Bottom line, though, if the co-ops are off the plate because Republicans won't back them generally and Grassley won't back anything that a whole bunch of Republicans won't back and, don't forget, a whole lot of Democrats think the cooperative idea is kind of inane anyways since cooperatives are already legal and some currently exist, I think this just reemphasizes my earlier point: we're getting steadily closer to a good bill as we get a little closer to a chance of no bill at all.
I've long thought about health care reform this year being about two fundamental goals (at least for me) -- getting a bill passed this year and making that bill as progressive as possible. Those two goals can be in tension and I list the former as I do for a reason -- I see it as the priority.
Others, no doubt, have other goals. Conservatives seem to have the opposite goals of mine -- making sure a bill doesn't pass and making any bill that might as terrible as possible.
Some progressives share my second goal, making the bill progressive, but only support the goal of passing a bill based upon its contents.
Max Baucus, I think, downplays the progressivism of the bill (doesn't discount it, just downplays it) and has a third goal: bipartisanship. The third goal seems motivated both by some deep-seeded principles and also by his sense of history, that bipartisan bills tend to survive longer than partisan bills. But I think (and hope) that for Max, bipartisanship plays second-fiddle to getting a bill passed.
Well, for people who share my goals, there's a few things going on today that increase the chances of a more progressive bill, but possibly do it at the risk of making a bill's passage more dangerous. Here's the news:
The Left Reasserts Its Voice. I'm not just talking about the folks like the PCCC, MoveOn.org, etc. I'm talking about 60 House Democrats restating that they will oppose any healthcare bill that lacks a public option.
Conservatives Move the Goalposts Again. It isn't just a public option that they oppose, the right-wing movement is now opposing co-ops. Apparently, private associations of citizens are now government bureaucrats or something. Probably death panels. I don't know. But the lunacy of the right is becoming more clear even as Sen. Grassley has apparently decided to double down on the Chuck's Insanity Sauce he keeps pouring all over reform. He's now pledging to vote against a deal he cuts if his Republican colleagues don't like it. Do the math -- not even co-ops are acceptable to Republicans and Grassley won't accept what is unacceptable to Republicans.
The options for what health care can look like this year are narrowing. Any bill acceptable to enough Republicans to keep it bipartisan in the Senate is likely to face death in the House. Any bill acceptable to enough House Democrats to survive the lower chamber is likely to face a wall of partisan opposition in the Senate.
It has gotten harder in the past week to pass a healthcare bill this year.
I just got off the Colorado River about 5 days ago after 16 days of rafting through the Grand Canyon -- a pretty incredible journey for anyone who has the opportunity to go. I'd highly recommend it.
I'll be honest, I was really hoping we'd have a bill out of the Finance Committee by the time we returned, even if the bill wasn't everything I wanted. The clock is ticking and we're getting closer to the point where the perfect (or even the less-than-perfect-but-damn-amazing) can easily become the enemy of the good.
There's a reason the White House is starting to hedge its bets on the public option. Frankly, near as I can tell, the message war hasn't been going that great and the votes just don't really appear to be there in the Senate (especially considering that only 43 Senators publicly say they support it; some of those "supporters" are likely to be perfectly happy to see it die).
That's not to say that the public option is dead. The Progressive Caucus's bullheadedness in the House may prove strong enough to outweigh Chuck Grassley's misguided bullheadedness in the Senate.
But we're getting to the point where we have a very difficult needle to thread and time is limited. Opponents of reform also are having an easier time right now than supporters given that supporters don't yet know exactly what we're supporting (which is a challenge).
Prior to rafting the Grand Canyon, I'd never sat at the oars much on a raft. I ended up rowing for about 2/3 of the river including almost all of the big rapids. And I learned something about hitting rapids on a river the size of the Colorado. Especially in the fast moving water of the large rapids, your ability to move directions or change position in the middle of a run is virtually impossible. You really have about two ways to impact your ability to get through the whitewater: your setup in picking your line and your skill in facing the waves and laterals coming at you and punching through them.
Prior to hitting the big water, you spend a lot of time ferrying from right to left or left to right, choosing which direction to point your boat, and then, on the big rapids, pushing forward to hit the waves and get through them quickly.
We've been lining up for this rapid for some time, but at some point, we've got to start pushing forward. The worst thing to do is to end up in the middle of a rapid trying to backferry out of it or indecisive about your line and trying to move across the river in the middle of it.
I'm not positive this is an especially apt legislative metaphor, but the parallels were striking for me. It is time to find our line, pivot into the laterals, punch through, get spun a bit, but keep the boat upright and all the passengers on-board. For the most part, we pulled that off on the Colorado. Let's see if we can do it in DC now.
Final thought: I've been a big fan of the public option for years now for a variety of reasons. I really think that the policy innovation there is one of the more brilliant things to come out of academia in a while. That said, a reform bill with key insurance regulations, a health insurance exchange, and much-needed subsidies for the purchase of health care by uninsured individuals -- these are all very much worth fighting for and significantly better than a number of proposals considered to be the left flank of the Democratic Party's serious proposals as recently as five years ago. Our worst case scenario this year isn't the passage of a "bad bill." It is the passage of no bill.
Update - Paul Begala offers similar thoughts from last Thursday, only without the river references.
Update 2 - Mark T says no bill this year is an opportunity to oust those dastardly people like Chuck Grassley, Max Baucus, and Kent Conrad. Let's stew on that a bit.
Grassley is up for re-election next year and despite his complete pain in the ass nature right now while representing a state significantly more liberal than Montana, he faces no meaningful challenge. In other words, no high-profile Democrat in Iowa is willing to take the fight to him to make his obstinacy a danger to his political career.
As for the saber rattling at the other two, count me as skeptical. No one has mounted a serious campaign against Max Baucus since Dennis Rehberg and Max emerged from that one the victor.
Running serious electoral campaigns takes a talented candidate, a smart team, and a ton of hard work. It isn't just about posting some comments on blogs. It's about fundraising, door knocking, phone calls, etc. If we can't even make Grassley feel the heat right now, what the hell are liberals going to do elsewhere?
Make no mistake: no bill this year means no bill for a while. It probably also means a significantly more conservative Congress next year and for the indefinite future, so when health care inevitably arises again in 5-10 years, as it will due to necessity, the final bill we get will be far to the right of the possible this year.
I'm not saying don't push for a better bill. I'm just saying don't cut off our noses to spite our faces.
After hearing about my foolishness and naivete regarding the forest bill, I was interested to see this article by Pat Williams.
I mean, I'll take it as granted that Pat Williams might be, like me, a malleable sell-out scoundrel. He might also be Montana's most progressive lawmaker of the modern era. Potato, potahto.
Since writing about the forest bill, I've gotten a couple notes and had conversations with people very familiar with the forest bill's content and the process behind it. My understanding is that the "talkers" of the critics are either deeply misleading or, in some cases, just not true.
I've been struck during this process how amazingly similar the health care, global warming, and forest debates are. With health care, the question is private/public or single-payer. With global warming, the question is cap-and-trade or carbon tax. With forest, the question is Tester bill or complete wilderness protection.
Except those really are all fake choices that really say that the choice is private/public or nothing, cap-and-trade or nothing, the Tester bill or nothing.
Perfect: enemy of the good.
Again, this isn't to say that there aren't devils in the details to focus on, but the question at this point for much of the left is whether we're ever going to take yes for an answer.
The health care bills under consideration institute important insurance regulations like community rating and guaranteed issue, subsidize coverage for low-income families, ease purchasing through exchanges, and (hopefully) bend the cost curve over the long-term.
Cap and trade actually worked better than anticipated when instituted for sulfur dioxide and, while imperfect, will reduce carbon output in this country. Action by the U.S. will help stoke other nations to take steps as well, creating a positive feedback loop.
I still know less about this forest bill, but so far the voices I trust on lands management and conservation are increasingly telling me thumbs up on the bill.
While reading up on Steve Kelly's, let's say quixotic, run against Pat Williams in '94, I came across this piece. Interestingly, the piece basically recounts how efforts to shore up Williams' left flank also resulted in Williams moving to the right to prove his independence from the Clinton White House. Some of the quotes are marvelous, though:
With progressive
congressmen like this, Kelly asked, who misses the likes of Ron Marlenee?
[...]
"The Clinton administration was retreating from its campaign pledges to protect our public lands and Pat Williams played a key role in pushing them in that direction," Kelly told me. "Williams repeatedly voted against mining reform, grazing reform and measures to end subsidies to multinational timber companies. Worst of all, from my point of view here in Bozeman, Williams sponsored anti-wilderness legislation that condemns 4 million acres in Montana to logging and mining. Cy Jaminson's record spoke for itself. He never pretended to be anything but what he was: a voice for pillage."
[...]
"If these independent political campaigns cause some conservative Republicans to get elected, well at least we don't have to guess where they are on an issue," said Larry Tuttle, director of the Portland-based Center for Environmental Equity. "Frankly, when it comes to changing the incentives that lead to environmental destruction, evironmentalists often have more in common with the National Taxpayers Union than with many incumbent Democrats."
So that's the result of left vision, as near as I can tell: the '94 Gingrich revolution, Denny Rehberg, and George W. Bush.
I'm not interested in walking down that path. So, yeah, call me malleable.
One of the most frustrating things to watch in the entire healthcare debate is the discussion of "bipartisanship" raging in Washington, D.C. As I've written here before, the beltway media has an unhealthy fixation on whether or not proposals are drawing support from Republican members of Congress as a test of bipartisanship, as opposed to whether Republicans have access to the table (they do) and whether grassroots Republicans and conservatives support the proposals being written (they do).
Fortunately, there are indications that at least here in Montana, some of that beltway partisanship can be put aside. Look no further than Bob Brown's op-ed this morning for proof. I've tried excerpting it, but it just doesn't work that way. Go read the whole piece.
The statewide town hall that is being co-sponsored by a bunch of groups tonight, including Forward Montana, American Cancer Society Cancer Action Network, SEIU, and others, has Republican Sen. John Brueggeman as Master of Ceremonies.
And here's the thing -- I am nearly positive John and Bob and I don't see eye-to-eye on all of the elements of what should happen. But there's a fundamental reasonableness still present that makes quite a bit of difference.
The other bit of difference is life experience. Bob Brown relates a story of his perspective as a teacher watching hard-working independent contractors who lacked his employer and his union. John Brueggeman is someone who has worked union and also squeezed out a living self-employed. They're also not stupid. And, at some point, if you've seen how radically different the system treats two similarly hard-working people in different lines of work, you start to wonder just who created such absurdities.
I'm rambling now, but I want to applaud Bob Brown for standing up on this issue. Bucking your own party involves inviting some criticism (something Max Baucus knows well himself). But there is a time and place for political courage. And if ever there was a fight where we needed some courageous Republicans to buck their party in high-profile ways, it is in this fight for health care reform.
So a big thanks, Bob -- this kid from Billings thinks you done good.
Well, it's happening, apparently. I woke up at 3:30 this morning with health care reform on the brain and haven't been able to fall back asleep. Hopefully, this doesn't become a recurring pattern between now and passage of a bill because it may be a while.
If you've been reading the national health reform blogs lately, you already know: health care reform is in danger right now. This is for two big reasons:
Congressional Budget Office estimates are not coming in where we'd like them to. See Ezra Klein and Jon Cohn for more.
Republicans in the Senate are being giant jerks in this process. See Jon Cohn and E.J. Dionne for more.
My impression from talking to people closer to the fight and with more experience than me is that my feeling that we're seeing some of the worst elements of the '93 fight reemerge is correct.
In other words, we're starting to experience some of the things that derailed healthcare reform last time. This isn't surprising. Even moderate reform is extremely threatening to a number of interests, not the least of which is the Republican Party. Despite claims to the contrary, the Massachusetts plan has been fairly popular locally, as has Medicare Part D nationally.
That's not to say, of course, that the Massachusetts plan or Medicare Part D are great models. They're not. If healthcare reform is modeled on them and not fixed, not only will we have a ton of unnecessary confusion and difficulty in our healthcare system, we'll also have failed to take some of the stronger steps we need to ratchet down healthcare inflation.
But it is worth being honest that even a Massachusetts style system would be a significant improvement over the status quo -- and it would probably be a popular one. And popular policies are precisely what the GOP needs to derail.
Matthew Yglesias, one of the straight-up sharpest minds I think I've ever encountered, notes often that one of the features of American government is sheer number of veto points. It is way easier for policies to die in our country than to be passed. On health reform alone, at least five committee chairs have claim to jurisdiction, reconciliation may prove inadequate, multiple rounds of floor votes, filibusters, etc. A bill, to pass, must survive all of these points. A bill, to die, need only fail in one of them.
Where do we go from here? That's a good question -- and it means being honest about where "here" is. The Finance Committee is reportedly reworking its legislation. The HELP Committee is doing the same through mark-up. Those reworks will eventually emerge and be merged. Meanwhile, a separate process is moving through the House, a process that should give us a far more progressive bill.
Assuming legislation gets through each chamber, those bills will head for conference committee and the final package will reemerge. What will it look like? My crystal ball ain't telling me. What I do know is that if we can keep the process on track, we're going to be seeing the Finance Committee bill merged with not one, but two different more progressive pieces of legislation -- a fact that should give us progressives hope. And I also know that if we try to shut down the process now, we definitely all lose.
So, today, I think, we bite the bullet, put our head down, get our shoulders into it, and keep working.
While 2010 will be chock-full of exciting races at all levels of government. In 2009, though, there will be two marquee races across the country: the gubernatorial races in Virginia and New Jersey. Republicans are favored in both races, but both races should come down to the wire, and Democrats can hold both seats - with your help.
In Virginia, Democratic State Senator Creigh Deeds won an impressive, come-from-behind victory for the nomination this past Tuesday, demonstrating a strong ground game. The Republican nominee will be far-right-winger Bob McDonnell. The best description for McDonnell's brand of Republicanism is that he is a Pat Robertson disciple. You can learn more about McDonnell at TheRealBobMcDonnell.com. Deeds and McDonnell have tangled before, in the 2005 Virginia Attorney General race, where McDonnell barely edged Deeds by 323 votes (yes, just 323 votes - that's not a typo with zeroes missing) out of over 1.94 million votes counted. This race will be exceptionally close, so every single dollar contributed and every single hour spent volunteering will make a real difference. A bit of good news is that the first poll taken after Tuesday's primary, by Rasmussen Reports, shows Deeds with a 47-41 lead over McDonnell, but this could just be due to a primary bump. Rasmussen's last poll showed McDonnell leading Deeds 45-30. Your support will help Deeds sustain his new lead.
In New Jersey, Democratic incumbent Governor Jon Corzine will square off against Republican former U.S. Attorney Chris Christie. Christie is very much at home in the Republican Culture of Corruption. Republican Christie has faced scandals involving no-bid contracts, abuse of the state pension system, pay-to-play, and even allegedly cutting a deal to get his younger brother's sentence reduced after being implicated for fraudulent trading practices on Wall Street. Despite Christie's mountain of scandal, New Jersey's lagging economy has hurt Governor Corzine's poll numbers. Recent polling gives Christie a 7 to 13 point lead over Corzine. Research 2000, May 25-27: Christie 46, Corzine 39; Rasmussen Reports, June 4: Christie 51, Corzine 38; and, Quinnipiac, June 10: Christie 50, Corzine 40. In other words, Christie has an edge, but the fundamentals of the race moving forward favor Governor Corzine. As the economy gradually picks up over the coming months and voters learn more about Christie's corrupt background, New Jersey's blue state status will shine through and Governor Corzine should tighten the race back up. Your support will help Governor Corzine tighten the race up even faster.
Below are the links to how you can connect with the gubernatorial campaigns (and - please - contribute anything you can to these campaigns, and spread the word!). Republicans are expecting (and expected) to win both of these races. However, after being upset in the NY-20 special U.S. House election and losing a U.S. Senator to a Party switch, the GOP is reeling. Losing either (or both!) VA-Gov or/and NJ-Gov would be a major body blow and simply crush Republicans heading into the 2010 calendar year. If Democrats across the country are able to support these Democratic campaigns, we can flush the conventional wisdom down the toilet and deliver two more embarrassments to the Rush-Newt-Cheney Republican Party and two more losses to the Michael Steele RNC.
There's an obvious logic to bipartisanship, particularly when you're pursuing large reforms in a closely divided republic. But I'd like to see some transparent calculations about the worth of bipartisanship. The question of Republican votes, after all, isn't whether they are, all else being equal, a good thing. It's whether they're worth the tradeoffs necessary to attain them.
Broder and the Post editorial board focus other portions of their arguments on the importance of cost controls, for instance. So it would be interesting to see them explain how many Republican votes you have to gain to justify losing a policy that would lower the costs of health insurance by nine percent a year, as the Lewin Group estimated a "level-playing field" public plan would do. And how many Republican votes are worth sacrificing a policy that would lower the cost of health insurance by between 20 percent and 30 percent a year, as the Commonwealth Fund estimated a "strong" public plan would do?
So let's estimate the cost of bipartisanship and determine whether or not it is actually worth it, assuming the Lewin Group and Commonwealth Fund crunch their numbers roughly accurately.
The annual premium for an employer health plan covering a family of four averaged nearly $12,700. The annual premium for single coverage averaged over $4,700.
Let's hedge a bit and estimate savings from a "level-playing field" at 6% and from a strong public option at 10%.
That works out to a level-playing field saving a "typical" family of four (or the breadwinner's employer or some combination thereof) $762 a year on premiums under a level playing field and $1,270 a year with a strong public option.
You can do the math for the individual, but it is a significant sum of money.
In otherwords, if bipartisan means no public option, than bipartisan means the Congress deciding that your family would be better off $1,000 poorer every year.
And that's the typical family with employer-provided coverage, so for the people trying to fend for themselves on the small group or (heaven forbid) the individual market, the savings would be even bigger.
That's not to say that there aren't tradeoffs. If Chuck Grassley opposes a bill AND said bill passes, in all likelihood we are on the road to serfdom. Note, of course, that it will be a slightly richer serfdom than our current free prosperity, but serfdom just the same. Or something. And stuff.
The ultimate irony here is, of course, that the conservative objections to healthcare reform so far have focused largely on the concern about choice and cost. Of course, the proposals on the table to offer a new public option (choice!) that would cut expenses (cost!) for Americans is being treated as anathema.
It makes one think that these Republicans aren't so worried about choice and cost as they pretend to be. Or they've invented a new economics that would put new math to shame in its mindlessness.
Matthew Yglesias can't stand to watch Sen. Tom Coburn unfairly bash the Veteran Health Administration and responds with a deluge of studies favorable comparing the VHA with Medicare, private managed care, Johns Hopkins, and the Mayo Clinic.
At a meeting Forward Montana convened some time ago, one participant asked why we don't just open up the VHA to anyone who wants in. The problem strikes me as mostly one of scalability. The VHA is a relatively small system compared to, well, the entire country. Expanding it to cover everybody or even a much larger number of people would threaten the quality of care it currently provides.
But the thing is, the VHA works. With its government-employed doctors and nurses, its government-run clinics and hospitals, its government-decided rationing and cost controls, it gets good health outcomes. This hasn't always been true, but the VHA is currently the best healthcare system in the country, which is to say we could probably learn a ton from it.
But don't hold your breath waiting for our Congressman to do that. He's still too busy stoking fears about socialized medicine to see anything there worth studying.
Meanwhile, I should note -- socialized insurance, like what we have with Medicare, also does pretty well, although currently not quite as well as the VHA. And Medicare, which seems to have less internal reform authority than the VHA (can someone confirm or deny that for me) needs to make some much-needed changes in its reimbursement structures (as do most private insurance and managed care operations in the U.S.).
3 big pieces of news on the health care front today, at least in DC:
Left. A House subcomittee will hold a hearing on single payer. I believe this hearing is specifically on HR 676, one of two single payer bills in the House. No word yet that anyone in the House is submitting the proposal for CBO scoring either.
Right. Sen. Mary Landrieu is tacking rightward and openly opposing a public option, although she has not indicated that she'll oppose a final package with a public option, which is really the key. If Landrieu, Nelson, and other conservative Dems will support a bill with a public option and a majority of the Senate supports keeping a public option in the bill, a filibuster can be ended and the bill can be passed without reconciliation either.
The plan's public insurance program would compete with private industry, with rates paid to doctors and hospitals at a level above those charged by Medicare, said House Ways and Means Committee Chairman Charles Rangel, a New York Democrat.
An outline of the plan also says Democrats drafting the House bill will propose new restrictions on insurers, including caps on out-of-pocket health-care expenses in policies to protect consumers from bankruptcy. The legislation also would bar insurers from excluding people based on pre-existing conditions, according to the outline, a copy of which was obtained by Bloomberg News.
Small, "low-wage" businesses would be exempt from the mandate that employers provide coverage, and small firms providing insurance benefits would also get a new tax credit, according to the outline.
Note -- AP reports describe the House Dems plan as taxing existing health benefits, but it isn't clear from what I've read elsewhere or heard that this is actually part of the plan and not just confusion on the AP's part.
