"If you're only talking to people you agree with, politics will always disappoint you."
At work, at home, at any point, I am a process guy. Matt Singer and those devoted to voter rights are process folk. That is what it is all about. That is what Obama is devoted to.
Hi, my name is Rob Kailey, and I am an addict. Less than 2 weeks after telling myself that I was done with the website FireDogLake, I am about to post a link to that website. (The "pay for membership and Jane's manicures" model of blogging I find truly repugnant.) However, being an addict, I read a diary over there this afternoon which peaked my interest a great deal.
David Swanson pens a diary titled "Is Obama Even Worse Than Bush?" Provocative, no? Like an addict, I clicked the link expecting to find another PUMA-Freeper mash of debilitating disappointment. That part is actually in the comments. But David's post is indeed provocative, and actually worth a read. What he lays out is a case for the impeachment of President Obama. I don't agree with much of it, but it's absolutely worth your time to read it. So go do that.
Here's his deal. He argues that the Unitary Executive has become extra-legal, beyond the law, and that those powers once accepted will never be given up. I agree. Here's where I show that not only am I an addict blogger, I'm a bad blogger. I don't meticulously catalog of tag my posts, and I have no index file of my comments. So, please trust me on this, and hopefully some of the longer term members will validate. Back in late 2007, early 2008, when I was arguing even at this site with right-wingers, there was great concern on my part about Chimpy's power grabs. In the debate about FISA renewal, I continually asked our rightward compatriots "Do you really want Barack, John or Hillary to have those powers?"
That's really what it boils down to. Powers granted become the norm, and are used and not given up. I had hope (is that trademarked?) that Obama would actually give up some of that Executive power. I had none that Clinton would, and I wrote as much at the time, born out by Secretary Clinton's actions over the last several weeks. And now we see the truth of it; No President will give up power once attained. That isn't surprising. It also isn't cause for a freak out. It is what it is.
So, Swanson's call for impeachment actually has teeth. The President has and is using powers that under scrutiny could be illegal. I was attracted to his argument because he posts about the position and the situation, not the man. That is important to keep in mind. Ultimately, I disagree with him based on some assumptions he makes concerning motivation (a true failure of the Professional Left), and the message that such conveys to the American people. Swanson calls for a "true" democratic republic. I concur. Swanson's argument relies on claims that the President is much of a figurehead, our defacto King, much as the founders saw the position. Again, I concur. But if that's the case, then impeaching the President won't fix what's broken in our representation. The Presidential office is taking power from somewhere, and that would be Congress. So fixing things? That would involve fixing Congress. Yes? It could well be argued, and has on the blogs, that it would also involve fixing our media, our social structures and most of all, our economy. Impeaching the President would assist none of those efforts, and in fact would hinder them all.
The racial issue still hangs out there. Many Americans are asking why so much bitterness is spewed at our black President, and many Americans are asking for impeachment because we have a black President. As much as Swanson wants to remove 'the man' from 'the office', you really can't. An impeachment is not taking back power for the branch which should hold such. It is taking away the position of a man, who, to date, is still well favored.
Still, I find that diary intriguing, and present it to you folks here. What do you think?
Matt wrote about Ryan Lizza's piece on the failure of climate-change legislation in the Senate, and found in it reason to "abolish the rules" of the Senate, which are "making our nation ungovernable." You probably know filibuster reform had me at "hello," so I put the article on the back burner, only slogging through it today.
Spoiler alert! I'm going to give away the ending, so if you want to be surprised, stop reading now!
The bill failed because of a combination of partisan Republicans, commercial interests' control of Congress, and fearful Democrats with a too-steady eye on polling numbers:
In September, I asked Al Gore why he thought climate legislation had failed. He cited several reasons, including Republican partisanship, which had prevented moderates from becoming part of the coalition in favor of the bill. The Great Recession made the effort even more difficult, he added. "The forces wedded to the old patterns still have enough influence that they were able to use the fear of the economic downturn as a way of slowing the progress toward this big transition that we have to make."
..."The influence of special interests is now at an extremely unhealthy level," Gore said. "And it's to the point where it's virtually impossible for participants in the current political system to enact any significant change without first seeking and gaining permission from the largest commercial interests who are most affected by the proposed change"....
As the Senate debate expired this summer, a longtime environmental lobbyist told me that he believed the "real tragedy" surrounding the issue was that Obama understood it profoundly. "I believe Barack Obama understands that fifty years from now no one's going to know about health care," the lobbyist said. "Economic historians will know that we had a recession at this time. Everybody is going to be thinking about whether Barack Obama was the James Buchanan of climate change."
Quite the shocker, eh? Okay, maybe not. But certainly the failure of climate change legislation is the icing on the cake of the systematic failure of government, finance, and media. Sure, in DC-land, it was collateral damage in its strange Kabuki theater, but climate change is the biggest crisis we've ever faced, our response to it here and now likely determining whether our planet will be habitable for humans in the next generation or so. (Sorry, kids. A bunch of Senators didn't like the idea of hurting coal industry short-term profit.)
So House Republicans defeated a bill that would have provided health care for the workers that rushed to New York City after 9/11 to help with the recovery and cleanup work. You know, the people George W Bush used as a prop for his famous bullhorn at Ground Zero speech.
Why? Well, according to Texas Representative Joe Barton, it's up to New Yorkers to take care of their own mess.
Hey! Ho!
This is the appropriate response:
Naturally, this kind of anger isn't expressed by the Democratic policy-makers. Instead, we're seeing a lot of folks cave on key issues that represent the will of a majority of American voters. Here's Paul Krugman, on Obama's tendency to "alienate {his} friends" and "woo...people who will never waver in their hatred..."
What explains Mr. Obama's consistent snubbing of those who made him what he is? Does he fear that his enemies would use any support for progressive people or ideas as an excuse to denounce him as a left-wing extremist? Well, as you may have noticed, they don't need such excuses: He's been portrayed as a socialist because he enacted Mitt Romney's health-care plan, as a virulent foe of business because he's been known to mention that corporations sometimes behave badly.
The point is that Mr. Obama's attempts to avoid confrontation have been counterproductive. His opponents remain filled with a passionate intensity, while his supporters, having received no respect, lack all conviction. And in a midterm election, where turnout is crucial, the "enthusiasm gap" between Republicans and Democrats could spell catastrophe for the Obama agenda.
The same could be said of politicians closer to home. Here's some advice: you won't win any elections by demoralizing your base, and pandering to those that won't vote for you anyway.
Update -- Worth noting -- Congressman Rehberg is among those who voted against this bill.
Yesterday, President Obama met with Senators at the White House and pushed them to pass comprehensive, clean energy and climate legislation. Still, the skeptics are spinning a monotonous web of negativity regarding what is achievable on this front. And, not surprisingly, the "mainstream media" once again has been asleep at the wheel in setting the record straight. Fortunately, we know that when this President rolls up his sleeves, he gets stuff done and delivers on his promises. One thing’s for sure; President Obama is anything but an underachiever!
Along these lines, President Obama held a press conference following the G-20 summit in Toronto. In response to a reporter’s question regarding how he would achieve his deficit reduction goals, the president responded:
For some reason people keep being surprised when I do what I said I was going to do. So, I say I’m going to reform our [health care system], and people say well gosh that’s not smart politics maybe we should hold off. Or I say we’re going to move forward on [Don’t Ask Don’t Tell] and somehow people say well why are you doing that, I’m not sure that’s good politics. I’m doing it because I said I was going to do it, and I think it’s the right thing to do. And people should learn that lesson about me, because next year when I start presenting some very difficult choices to the country I hope some of these folks who are hollering about deficit and debt step up cause I’m calling their bluff.
To that list of accomplishments, we could also add:
Creating or saving 2.2-2.8 million jobs, well on the way to Obama’s February 2009 pledge that he would "create or save 3-and-a-half million jobs over the next two years."
Reforming Wall Street (likely to pass Congress any day now)
Overhauling the student loan market
Reaching a nuclear arms treaty with Russia
We could go on and on, but you get the point: anyone who continues, at this point, to be "surprised" when President Obama gets things done when he puts his mind to it is deep in denial. Or, as a previous president might have put it, they are wildly "misunderestimating" our 44th president.
Clearly, as we’ve seen over the past two years, underachieving is not a problem Barack Obama suffers from. Of course, even a superachiever like Barack Obama has an awful lot on his plate to deal with. And right now, one of the most important things on Obama’s plate is figuring out how to push comprehensive clean energy and climate legislation through the U.S. Senate. Along those lines, yesterday, Obama met with a group of Senators on this issue, reportedly holding firm in his call for putting a price on carbon emissions.
The question at this point is, will President Obama roll up his sleeves and deliver on another of his major campaign promise (as well as a major challenge facing our nation)? Given the long list of accomplishments mentioned above, it certainly wouldn’t be smart to bet against him. The fact is, Barack Obama usually succeeds in whatever he puts his mind to.
Given the nation’s increased focus on energy and climate issues – and the increased support by the American people for taking strong action as a result of the Gulf of Mexico oil disaster – now is clearly the time for boldness and for bluff calling by our nation’s leaders. Today, President Obama has the opportunity to demonstrate once more that, when he rolls up his sleeves, he accomplishes what he says he’s going to do. In sum, today is clearly the moment for President Obama to prove the doubters and naysayers wrong – to call their bluff - yet again!
As President Obama prepares for his meeting tomorrow with Senators at the White House to discuss clean energy and climate change legislation, he might want to check with the White House staff on an important matter first. No, not the details of the legislation, although that's important of course. Instead, what President Obama might want to make absolutely sure about is the non-trivial matter of whether the White House air conditioning is in tip-top shape. I say "non-trivial," but these days it's more like "life or death." How hot is it in the Washington, DC area? As NBC Washington puts it, "We're Talking Spontaneous Combustion." (UPDATE: it's more likely this is apocryphal than literally true, but it sure feels like plants could catch on fire these days in Washington, DC!)
How hot is it? It's so hot that dead plants are spontaneously combusting in Frederick, Md. Don't believe it? Just ask Frederick County Fire Marshal Marc McNeal, who told the Frederick News-Post that excessive heat caused a dead plant to catch fire Sunday afternoon in a hanging planter on the rear deck of a townhouse.
The hanging basket fell to the deck and burned some vinyl siding, causing about $3,000 in damages.
It has definitely been hot in the Washington region. Monday will be the 10th day in a row that we've reached 90 degrees or higher, and this will be the 17th day of the month that the thermometer has reached 90.
NBC4 meteorologist Tom Kierein said that when it's all said and done, June 2010 likely will be the hottest June on record in the District.
Dead plants catching on fire in the hottest June on record in the Washington, DC area? Sadly, this may not be an aberration, but a frightening sign of things to come in a global warming world. True, we shouldn't draw broad conclusions about the earth's climate from one heat wave in one specific geographic area, as certain climate change deniers dishonestly did during last winter's "snowpocalypse" blizzards. However, when we see month after month, decade after decade of record-setting heat globally, it starts to get a bit hard to ignore.
In fact, climate scientists are not ignoring these heat waves and other phenomena. Earlier today, for instance, The Project on Climate Science reported that the "record-breaking heat wave" we are currently experiencing in the eastern United States "is consistent with climate change." According to Tom Peterson, Chief Scientist for NOAA's National Climatic Data Center, "We're getting a dramatic taste of the kind of weather we are on course to bequeath to our grandchildren." Of course, as The Project on Climate Science points out, "individual heat waves can be driven by a number of factors." However, they conclude, "more frequent heat waves are one of the more visible impacts of climate change already underway in the United States" and "will occur more frequently in the future."
In sum, if you enjoy record-setting warmth - not to mention the stronger storms, mass extinctions and "record sea ice shrinkage" in the Arctic that go along with that warmth - you have a lot to look forward to! If not, then you should contact your Senator and let him or her know you want climate action now.
Come to think of it, perhaps we should all hope for the White House air conditioning to be broken tomorrow - or turned off on purpose - so that the Senators meeting there get a taste of what the planet will feel like everywhere if they don't do something about it now. When you think about it, a bit of Senatorial sweat and a few stained shirts is not too high a price to pay if it results in long-overdue, comprehensive clean energy and climate legislation on the President's desk sometime this sweltering summer. Is it?
Gotta say, I'm a big fan of this letter from Attorney General Steve Bullock to Republican legislators regarding their call for him to waste taxpayer resources on a ridiculous lawsuit.
Some of my favorite excerpts:
Like you, I take seriously my oath of office to "protect and defend the constitution of the United States, and the constitution of the state of Montana," as well as to "discharge the duties of my office with fidelity."
[...]
I have analyzed these claims as I analyze constitutional challenges to our own laws, with the understanding that overturning the constitutional judgment of a popularly elected legislature grave matter in a constitutional democracy.
Although your letter is short on legal specifics [...] [emphasis added]
[...]
As Justice Scalia explained in Raich, "[w]here necessary to make a regulation of interstate commerce effective, Congress may regulate even those intrastate activities that do not themselves substantially affect interstate commerce." Id. at 35 (Scalia, concurring).
[...]
The lawsuit you urge me to join does claim that States participating in the federal Medicaid program must provide coverage, but also concedes that States may "avoid the Act's requirements" by "drop[ping] out of the Medicaid program." Florida v. Sebelius, Complt. fl 40. Although this choice would leave millions of people uninsured, it is a choice any of the States may make if they disapprove of how Congress wants federal Medicaid funds spent, and this choice is consistent with the Tenth Amendment. See New York v. United States. 505 U.S. 144 (ree2).
But it is really the ending of the letter where Steve Bullock reminds Scott Sales not to try to play with the big kids where he is clearly out of his depth:
The lawsuit also presents serious standing and ripeness issues, given that it appears to be filed based more on the timing of the November 2010 elections than the date in2014 when individuals and states might first be subject to the Act's requirements.
Therefore, I have concluded that once you take the politics out of these issues, there is no credible constitutional claim. So, like nearly three-quarters of my Democratic and Republican colleagues in state Attorney General offices across the country, I have not joined the lawsuit. We are not alone in our bipartisan opposition to politicizing the Constitution and the courts in this way. Eighteen of your Republican counterparts in the United States Senate sponsored a similar health insurance reform bill in 1993, see 5.1770,103rd Cong. (1993), and I do not doubt their fidelity to their constitutional oath. Lawyers and constitutional scholars across the political spectrum have determined, as President Reagan's former Solicitor General Charles Fried has said, that the lawsuit is "simply a political ploy" without legal merit.
As legislators, you understand as much as any citizen the importance of resolving our heartfelt policy differences through the democratic process. Montana's decision not to join these lawsuits will not change the outcome if, contrary to nearly a century of precedent, the Supreme Court takes the surprising step of striking down this law and taking the country back to the days when the farm bill and social security were constitutionally suspect. Most importantly, however, Montana's decision not to join these lawsuits leaves these critical questions of national policy in the hands of "We the People" and our elected representatives, where these decisions belong.
State Senator Roy Brown is one of the 74 Republican lawmakers calling on Steve Bullock to waste his office's resources by joining other states in a likely futile lawsuit to strike down the new health care bill.
KULR-8 has the Billings Senator on video. In that clip, he makes two notable arguments, both of which are patently false:
First, that every single person in this country buy a product. There are huge classes of people not required to buy any product. Individuals insured through their employer or by another government program (including Medicaid, which will be available to all low-income Americans by the time the individual mandate kicks in) or for whom the purchase would represent a financial hardship are exempt from the mandate. In other words, the tax for not having insurance only applies to working Americans who make too much to qualify for Medicaid and choose to remain uninsured. They pay an extra tax in exchange for having access to the insurance regulations and protections, like the end of pre-existing condition discrimination, available under the bill to all Americans.
If you don't buy insurance you get fined and if you don't get fined you go to jail. Actually the law explicitly prevents people from being jailed:
The law specifically says that no criminal action or liens can be imposed on people who don't pay the fine. If this actually leads to a world in which large numbers of people don't buy insurance and tell the IRS to stuff it, you could see that change. But for now, the penalties are low and the enforcement is non-existent.
Enforcement would occur through the holding of tax refunds or other mechanisms presumably in the meantime.
There are two things unfortunate about this. The first is that Roy Brown is calling for Montana taxpayers to spend a bunch of money pursuing crackpot legal theories based on his factually incorrect understanding of a law. The second is that KULR-8 didn't factcheck claims made by a partisan looking to score political points.
Max Baucus's team just shared a new website featuring Montanans helped by health reform. Two examples -- a small business providing insurance that will receive tax credits (worth noting -- the employer mandate doesn't apply to businesses with fewer than 50 employees; there's been a lot of confusion bout that) and a Billings woman escaping the donut hole of the Medicare prescription drug bill.
I've heard other stories, mostly about young adults eligible to get on to their parents insurance again, sometimes at a very crucial period of their lives.
I find these stories shocking, though, since my understanding was that only BCBS's CEO would benefit under this bill. Maybe I've been misinformed.
Let me start this by giving a nod of approval to the President, the Speaker, the Majority Leader and, yes, our senior Senator, who, along with a whole bunch of other folks, showed pretty crucial leadership to getting a bill passed. Lord knows it wasn't always a pretty process, but I can't imagine that things looked much nicer in the days of working to pass Social Security or Medicare.
But there's something else interesting about all of this, which is that the issue that Republicans were planning on turning into Obama's Waterloo is in the process of kicking them in the ass. Polls numbers are already quickly moving in favor of the bill and its champions. Here's why:
An Actual Landmark Achievement. In the words of Joe Biden, this is a big fucking deal. Literally. And no matter how painful the compromises are, this is a boost for the progressive base that feels it has waited a year to see the fruits of victory here they are.
The Right Can't Get More Mobilized. And, at some point, I think the crazy train has to lose a little bit of steam. That much anger has to result in heart attacks or something, right?
Moderates May Still be Uneasy with Dems, but They Don't Want a Tea Party Majority. The behavior of Republicans in the past week and its on-going operations of running on repeal of the bill, suing to stop its implementation, etc., doesn't look good. No one wants a bunch of children running the Congress.
There's still only one serious political party in the country. It was the one that has enough seats in Congress to disagree with itself and still pass a bill. I'm increasingly of the mind that it wouldn't be absurd to see some GOP Congressmen go down this fall.
There's still a lot of talk out there that the bills that went through the House last night don't really address the cost of health care. I'm still never sure what critics mean when they drive this point. The only two limitations on costs that didn't make it into this bill are (1) Universal budgeting, which was never seriously considered in this Congress (this is a big way of how single-payer and voucher schemes both control costs, by having the entire annual budget approved by Congress), and (2) a public option, which in its serious, cost-cutting-through-monopsony-power mode, was never approved by either chamber.
There's a bunch of other stuff, though, and Ezra walks through the five most proimising. These changes include Medicare programs to reform payment systems away from fee-for-service. If it works, private insurance will be under fairly significant pressure to follow suit, in large part because the transparency under the exchanges will strengthen competition while the regulations will protect consumers from fake insurance.
The only public option that ever scored significant savings was the one tied to Medicare. That one died way back before the full House moved to a vote. It's still a good idea, but it is only one of many.
And the bottom-line is that the bulk of the other ideas to contain costs are in this bill. Comparative effectiveness, MedPAC, capping the subsidies for the employer-based system, payment reform, etc. There's a whole lot of folks who disagree that these will lower costs in the long-term, but they're every bit as proven and sound of ideas as the public option when it comes to long-term cost containment.
Jay and others are probably offended that I'm referring to their criticisms on this front and disregarding research and science. Fine. I'm gonna call that one like I see it. The President didn't fight the House on the excise tax and payment reform because the issues were political winners in the short term. He did it because they're among the most likely ways to actually contain costs in this country.
Holy shit. This is actually happening. The goal that evaded Teddy Roosevelt, FDR, Truman, Johnson, Nixon, Carter, and Clinton.
From everything I can tell, the pieces are set and a vote in the next 4-5 days on comprehensive federal health reform is likely to be successful. Ezra has a good run down of the particulars of the bill:
Legislation that covers 32 million people. A world in which 95 percent of all non-elderly, legal residents have health-care coverage. An end to insurers rescinding coverage for the sick, or discriminating based on preexisting conditions, or spending 30 cents of each premium dollar on things that aren't medical care. Exchanges where insurers who want to jack up premiums will have to publicly explain their reason, where regulators will be able to toss them out based on bad behavior, and where consumers will be able to publicly rate them. Hundreds of billions of dollars in subsidies to help lower-income Americans afford health-care insurance. The final closure of the Medicare Prescription Drug Benefit's "doughnut hole."
But wait...there's more!
But you also get the single most ambitious effort the government has ever made to control costs in the health-care sector. According to the Congressional Budget Office, the bill cuts deficits by $130 billion in the first 10 years, and up to $1.2 trillion in the second 10 years.
That deficit reduction piece is absolutely crucial for a whole host of reasons.
There are some people out there pretty furious about this legislation. I hear talk that it doesn't really control costs (still haven't figured out how comparative effectiveness research and bundling aren't important parts of controlling costs) or that it forces people to buy terrible insurance (the same terrible insurance that it monumentally improves and that so many of us currently fight like hell to hold on to despite rate hikes).
Anyways, I've been working off-and-on on federal health care reform since late '06. This just feels damn good. One more vote to go in the House. One more in the Senate. A signature from the President.
Health care reform is entering the final stretch in Congress. All sorts of stories will be written in the next few days, but the bottom line is that the Congress is about to pass the most significant economic justice legislation in 40 years and the most fundamental rewrite of our social contract since the New Deal and Social Security.
Like Social Security, Medicare, and, well, everything, this bill is a process, not an end-point. But the expansions of Medicaid, the creation of health insurance exchanges paired with meaningful regulation to make insurance function more like a regulated utility than the ferocious beast it has become, and the subsidies to make insurance affordable are all huge immediate gains for low- and middle-income Americans.
Combine all of those moves with the strong attempts to control costs -- bundling of prices, comparative effectiveness research, etc. -- and we've got something that just may keep people insured for the long term while also being the single biggest piece of deficit reduction legislation passed in the history of this country.
Damn. I know there are a lot of complaints out there, but we stand at a major turning point of American history. The future will build upon this point in a few ways:
Creation of a public option. Count me skeptical that we'll get it in this bill. But the public option is an easier thing to pass in the future than the framework in which it would live and, over the long-term, it is important, but nearly as important as the insurance market regulations and subsidies that will make insurance fair and affordable. We can get back to this and probably in better form than the compromised version we'd get today.
State experimentation. One of the amendments that both Ron Wyden and Bernie Sanders helped insert allows states to take the revenue streams under the bill and implement alternate models of reform, so, yes, California, New York, or even Montana could pass, for example, a single-payer plan and use the federal funds to make it happen.
Implementation of further cost control. This last piece will be the hardest, but it may prove the best. Focusing especially on bundling and comparative effectiveness research, which both create the opportunity to cut costs while increasing quality, we may be able to significantly restrain health care spending while improving health outcomes.
The wonderful people at Families USA, a progressive outfit that has been working on health reform for something like 25 years, put out a report on the effect of health reform on Montana. Over 100,000 Montanans will get insurance. Pre-existing condition discrimination will be a thing of the past.
Good news on the health reform front, where the President announced on Super Bowl Sunday that he plans an open meeting at the White House with Congressional leaders from both parties and cameras from C-SPAN for a conversation about improving and passing the health care bill.
If they want to take a pass on being able to provide input, let them pass. Hold the summit, ask for their ideas, let the President outmatch them once again, and pass the Senate bill and a corrective bill through both chambers, on party lines if need be.
I continue to see people screaming bloody murder over the health care legislation moving through Congress. I don't have the numbers handy, but a poll (CNN, I think) recently found a narrow plurality opposing the House legislation, with a notable portion of those opposing it for being too conservative (worth noting, of course, most opposition was actually from the right or was self-described non-ideological).
The Senate bill, by most accounts, is a more conservative bill. It is financed primarily not by an explicitly progressive tax, but by an excise tax on health plans that will hit Goldman Sachs executives for sure, but will also hit a lot of working class union members who have negotiated health benefits for years.
The subsidies for purchasing coverage in the Senate bill are lower than I would like, meaning near-term affordability isn't what I would hope (of course, it also means less of a public transfer to private insurance companies, which I suppose is OK).
With all that in mind, people have been asking me a lot lately why I'm still supportive of the bill. For me, it really cuts to a few things:
The underlying structure of the bill -- subsidies, insurance exchanges, insurance market regulations, etc. -- are the right underlying reforms to make a public/private system work. They also may take us a bit closer to single-payer and certainly do not move us further away (e.g. single-payer supporters may not get what they want in this bill, but it does not foreclose victory down the road, which is important).
There are some very smart political incentives built in. For example, members of Congress get thrown into the exchanges with a lot of the rest of us, helping guarantee that the incentive down the line is for them to maintain high quality and affordability (relatively speaking on the affordability, a lot of members of Congress happen to be very rich and all are higher income than the majority of Americans).
The biggest point of all is that the Senate bill is extremely serious about costs over the long-term. What should worry just about everyone in the healthcare debate is how completely unsustainable the current system is. It isn't just that it is expensive or that administrative costs run too high. Those administrative costs don't even begin to explain the wild inflation that occurs in America's healthcare sector. You simply cannot have costs in 17% of your economy rise at rates 5-10% faster than the economy as a whole in perpetuity.
My friend Jay Stevens wrote a while ago that his problem with the excise tax was that it penalized spending on healthcare and that we should be happy to encourage people to spend more on healthcare. If healthcare actually improved health, I'd be inclined to agree that it is worth subsidizing. But the correlations are relatively weak (and the odds that hospitalization can hurt or kill you are unfortunately high). Under these circumstances, reducing healthcare spending and allowing ourselves to spend more money on other things (perhaps sporting equipment or healthy local food, both of which can be expensive but would do more in general to improve health than more heart surgeons) would be a good thing.
Does the Senate bill do this? We don't know. But it does everything it can to "bend the curve." Is that good for progressives? Depends on what you mean by progressive, but anyone concerned that health insurance is too expensive for low-income people and tthe middle class should hope that the low- and middle-income people of 20 years in the future have better choices. That requires bending the curve. And by all accounts, the Senate bill works harder to bend the curve than the House bill.
The Senate bill isn't just deficit neutral. Over the next twenty years, by CBO's (rough) estimates, it will reduce the deficit by three-quarters of a trillion dollars. That, as they say, is real money. It does that by long-term holding federal spending on healthcare steady even as massively expanding federal assistance to help low-income and middle-class Americans purchase insurance.
Even better news: CBO has at times been known for being woefully pessimistic. They overestimated the cost and underestimated the impact of tradeable permits for reducing SO2 pollution (which helped clean the air in my (and Dennis Rehberg's) hometown of Billings -- maybe "cap and trade" ain't such a bad idea, Mr. Rehberg). They overestimated the cost of Medicare's prescription drug benefit. And they routinely admit that they can't "score" the cost of key provisions of health care bills that may further reduce spending because these are experiments and folks like CBO approach experiments conservatively.
A couple months ago, a "meme" flew around Facebook as millions of social networkers changed their status to read "No one should die because they cannot afford health care, and no one should go broke because they get sick." Both the Senate and the House legislation accomplish these goals. If we want to establish additional corollaries, such as "No insurance executive should make money" or "No brain surgeon should make more than $250,000 per year," we could have done that. But those goals aren't really as important, either policy-wise or politically.
Soon, we'll pass a bill that should effectively end medical bankruptcy in America and guarantee baseline health care access for all citizens (too low a bar, I agree, for a variety of reasons). Over the long-term, this bill will likely ensure that we need not ever turn back on that promise and that we may even expand on it, just as we did over time with the promises of the civil rights acts and Social Security.
Mike Dennison has a good and informative story out this past weekend with the short version of what health reform will do for most Montanans in difficult situations: make their lives better even if it is hard to know precisely what will improve until 2013.
For some folks, this is another major black eye for an already deeply flawed bill. For many of us, though, this is simply another foreseen frustration inevitable with major system changes in a huge sector of the economy.
The health care bill will have a handful of immediate changes. Although the structure of the national high-risk pool is currently unclear, it should provide some near-term help for the currently uninsurable. In the slightly longer term, the exchanges and the subsidies and insurance regulations should make coverage affordable for basically everybody and near-universal coverage will be the standard in the U.S. And we'll also put some key systems in place to actually bend the cost curve on health care -- which eventually will mean fewer procedures, devices, and drugs that aren't improving our health.
What marked me most about the Dennison piece wasn't the sadness of the young woman at the end when she hears that no help is coming for three or four years, it is that based on these five (representative?) stories, help is actually on the way. It's been a long time since anyone could say that on the health care front.
Here's some heartening news for Montanans: Max Baucus, who had voted against two public option amendments in committee for fear that they would induce a filibuster, is back on board coming out of the negotiations he participated in with Senators Reid and Dodd and the White House:
I included a public option in the health reform blueprint I released nearly one year ago, and continue to support any provision, including a public option, that will ensure choice and competition and get the 60 votes needed to pass the Senate. Success should be our threshold and I am going to fight hard for the 60 votes we need to meet that goal this year.
As Talking Points Memo notes, this statement leaves Max some wiggle room. But Max has always been the negotiator creating wiggle room on this stuff. That's been his job -- to make sure the bill passes.
Right now, we're on track to get a bill passed with a public option while overcoming a filibuster. I know there are still naysayers in comments (and as I wrote below, I still want improvements on the employer provisions and the affordability) because the Eeyore wing of the progressive movement is alive and well, but this is a victory.
What's more, it is a victory that would not have been possible without this whole insane hand-holding process. How do we know that the White House and Max bent over backward far enough seeking GOP support? Newsweek's Howard Fineman is calling it pointless. When the conventional wisdom becomes that Republicans obstructionism is worthy of being dismissed, we're in good shape.
We're closer now than we've ever been to passing systemic health care reform. It's a massive down payment on fixing this system. I, like many others, have gotten frustrated during this process, but damn if we don't keep getting the ball down the field at the crucial moments.
Interesting story this morning as negotiations have apparently wrapped up in the Senate. Multiple outlets are now reporting that the Senate bill moving to the floor will have a national public option with a state opt-out clause. Interestingly, this is happening despite apparent reservations from...the White House.
So Harry Reid and Nancy Pelosi appear to be showing some decent spine in the last couple weeks.
On a worse front, the bill appears set to feature an employer pay or play provision that penalizes the hiring of low-income individuals by small businesses. It also isn't clear what subsidy levels will be like.
But still, we've got some progress.
Update - Two other thoughts:
I'd prefer no opt-out clause. with what is happening in the House, we may get a straight national public option -- that'd be good.
Still, worth keeping in mind that Medicaid is actually an opt-in program -- and all 50 states have Medicaid.
