Remember, the public option IS the compromise

by: Jay Stevens

Fri Oct 23, 2009 at 18:13:57 PM MST

...Max Baucus held a meeting.

Here, stories begin to diverge. Depending on who you talk to, Baucus either held a routine, informational meeting telling the Senate moderates and members of the Senate Finance Committee what's going on, as he's been doing fairly regularly, or he held a meeting in which he tried to rally Senate moderates to change Reid's mind. Or maybe there's no difference between the two. The first to really speak out after the meeting was Sen. Ben Nelson, and, as one staffer pointed out, Nelson didn't need Baucus to remind him that he was opposed to a national public option. Soon enough, Olympia Snowe was also making firm statements against the public option, and threatening a filibuster.

Sort of astounding for a Senator who claims to support the public option. In fact, right now, we have to assume that Max Baucus is actively working against the public option.

This week, George Ochenski wrote a pretty d*mning op-ed in the Missoula Independent, accusing state Democrats of lining up to praise Baucus' efforts on healthcare and his bill because of money. Campaign money. Oodles and oodles of cash. And you know what? He's got a point.

But money isn't everything. Votes matter, too. And I guarantee they can't have both Baucus' money and widespread support among voters, especially those of the Democratic base. Because this bill, without a robust, widely-available public option, is going to affect a majority of Montanans' not one single bit, except to raise their premiums. Many, if not most, voters will wake up the day the bill goes into effect, and still find rejected claims due to preexisting conditions in their mailbox along with a stiff little premium hike to cover those the insurers will be forced to cover. (You know how they'll frame it, too. Those "shiftless""irresponsible" ones, the "parasites" who don't take care of their health.) And a lucky few union families will find a nice fat tax hike in their pay stub, too.

The bill without a robust public option is a kind of welfare program for the poor. Which is fine. But it's been framed as healthcare "reform." And when people hear "reform," and want "reform," and you give them something else that's definitely not "reform," you know what their reaction will be.

It will destroy the Democratic party.

So. Montana Democrats. You either stick with Baucus and drive off a political cliff, or you ditch him and find another way to raise money. H*ll, if you come out strong and hard against Baucus and for the public option, raising money probably won't be an issue.

And, frankly, Baucus isn't the only one who appears to be against us. Also from Klein's piece:

On Thursday night, Reid went over to the White House for a talk with the president. The conversation centered on Reid's desire to put Schumer's national opt-out plan into the base bill. White House officials were not necessarily pleased, and they made that known. Everyone agrees that they didn't embrace Reid's new strategy. Everyone agrees that the White House wants Snowe on the bill, feels the trigger offers a safer endgame, and isn't convinced by Reid's math. But whether officials expressed a clear preference for the trigger, or were just worried about the potential for 60 votes, is less clear. One staffer briefed on the conversation says "the White House basically told us, 'We hope you guys know what you're doing.'"

Frankly, I hope the White House knows what it's doing. Because from here, it looks like they're pushing for the clusterf*ck.

Health care reform links...

by: Jay Stevens

Tue Oct 20, 2009 at 09:20:08 AM MST

Open Congress put up S.1796 - the Senate Finance Committee's health care legislation - on its site.

Max Baucus thinks a "watered down" version of the public option could get 60 votes in the Senate:

"This issue is alive and we are looking at it to see what makes the most sense," the senator declared on a conference call with reporters. "The major overall goal here though is to get health care reform that passes the Senate, gets 60 votes, and I just don't know if there is 60 votes for the most pure kinds of the public option. There may be 60 votes for the less pure kinds."
The less pure kinds, Baucus explained, were co-ops, a public plan triggered by economic conditions and an insurance structure that allowed states to opt in or out of a public option. He seemed to find the last option the most intriguing.

A. Co-ops and a trigger are not a public option, even "watered down."

B. Why does anyone care what Max Baucus thinks anymore? Frankly, he shouldn't be involved in the creation of the final bill the Senate votes on. His role now is to vote for cloture on whatever bill the leadership crafts.

Be sure to check out "This American Life" and its two-part series on healthcare reform: "Someone Else's Money," on the health insurance industry; and "More is Less," on the reasons behind the rising cost of health care in the US.

Here's the SNL sketch where the "Rock Obama" makes Max Baucus bark like a dog, and then throws him out the window:

I have to admit, I enjoyed watching the Rock rip off Mitch McConnell's arm...heh heh.

Links...

by: Jay Stevens

Fri Oct 09, 2009 at 10:22:56 AM MST

Just when you thought the issues around the Flathead Lake Boat Crash couldn't get any more asinine, they do.

James Conner has the details of that night's incident - apparently Barkus thought he was heading in the opposite direction than he actually was, and was pulling a u-turn at 45 mph in the dark in treacherous waters when he struck the lake bank. Dan Testa, too, has a good roundup of that night's events - two scotches and an unknown amount of red and white wine for Barkus. Just the thing for a chilly night out on the lake.

Now Barkus' lawyer is challenging the .16 BAC results - which, I know, is his right to do and probably a smart legal maneuver. But Barkus is also planning on finishing out his Senate term, as if nothing's happened here, as if he hadn't just boozed up and almost killed himself and four others on Flathead Lake.

The crash was a good sign he's got a problem, eh? I mean, for most of us, this would be a kind of, I dunno, a wake-up call, wouldn't it?

That's the way I'd see it if it were me. I'd be apologizing my *ss off to the friends and family of those I injured through my loathsome behavior, I'd cooperate with the authorities and plea bargain my way into a just punishment, resign my public office because of the deficiency of my character, and I'd check myself into a rehab clinic, ASAP. I mean, wouldn't most people feel some remorse, and want to repent and work to rehabilitate themselves?

Instead, Barkus is still out there, still a drunk, and, probably as soon as he's walking again, back behind the wheel. And he'll be passing laws over you. So much for personal responsibility.

*  *  *

As always, there's plenty of news from Hardin.

The Billings Gazette got its hands on the "memorandum of understanding" between Hardin and the APF - which it had to get by court order, apparently because it's pretty embarrassing to Hardin officials - that revealed the city did have an agreement with Hilton's company to have the APF supply Hardin with a police force for $250K. The contract toned the language down, but the memo certainly explains the Hardin Police Force decals on APF SUVs.

Naturally, with all the furor over these SUVs, Hardin is looking to start its own police force.

But the American Police Force takeover of the Hardin jail only looks dead. While Hardin put the deal with APF on hold after revelations of Michael Hilton's checkered past, a mysterious APF investor stepped forward (anonymously, of course) and noted the firm would still pursue the Hardin jail contract, only without "Captain" Michael Hilton on board.

Whee!

A Double Trojan Horse

by: Matt Singer

Tue Aug 18, 2009 at 16:03:35 PM MST

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.

Obama's Bozeman town hall meeting

by: Jay Stevens

Sat Aug 15, 2009 at 07:02:11 AM MST

I'd point you to the various summaries of Obama's speech in Bozeman, but better to read what he said. For me, the biggest news was that he reaffirmed his commitment to the public option, and his continued advocacy for a surtax on the wealthy (as opposed to taxing health care benefits) as a means for paying for health care reform. You'll notice that both stances differ substantially from where Baucus (apparently) stands.

Which brings me to Matt Gouras' excellent analysis on the visit:

By making a rare presidential visit to Montana, Barack Obama has put even more pressure on the rural state's senior senator, Max Baucus, and his panel to produce bipartisan health care legislation in just a month's time.

Given the context of this visit - the fact that Baucus' committee is essentially single-handedly holding up health care and gutting provisions that the Democratic caucus thinks crucial to reform - you can't help but think Obama's visit is intended to put pressure on Max by appealing directly to his constituents. And then there's this from the Gouras report:

For his part, Baucus doesn't appear worried that a bipartisan group of six senators has already blown through several targets for producing a Finance Committee bill. The veteran senator has told Obama that "it will be ready when it's ready" - even if that means waiting until September.

Heh. Tough words, eh?

Probably as a result of signals from the White House, which Jane Hamsher helps us interpret. The WH, through Emmanuel, is blaming Baucus for the logjam in Congress, and he and Jim Messina are being set up to take the fall if all fails, and for any untoward deals cut in Baucus committee with the health-care industry. (Wasn't it in the Indy's profile that Baucus said his whole life prepared him for this legislation? Little did he know how prescient that comment may be...)

So now Obama's in Montana playing "good cop."

Oh, and in case you want a good laugh, check out Montana GOP chair (and Missoulian!) Will Deschamps lame attempts to put forth positive policy on health care:

Deschamps said the current system does have problems, but he doesn't think the federal government ought to be the one trying to fix it. Asked what role central government should play in health care changes, Deschamps said he "didn't have a hard and fast answer."

He said the government should use other means to change health care.

"Maybe they should spend their time in the (public relations) end of it," he said. "They should promote healthy living."

Some people can afford health insurance, but choose not to buy it, he said, particularly young people who don't think they'll get sick.

"There ought to be some way to encourage them to buy health insurance without government interference," he said.

That would lower premiums for everyone else.

Uh...okay...so basically stick with the status quo. Cool.

Nixon lives!

by: Jay Stevens

Fri Jul 24, 2009 at 05:56:27 AM MST

But here's the thing: Gates broke no law. He shouldn't have been arrested.

Matthew Yglesias nails it:

Meanwhile, note that racial motivations or there absence have really nothing to do with the nature of Officer Crowley's misconduct. What happened basically is that Crowley accused Gates, whether for good reason or not, of breaking into his own home. Gates, pissed off, offended Crowley. At which point Crowley, even though he was now perfectly aware that Gates was not guilty of anything, decided to exact revenge by manipulating the situation to create a trumped-up disorderly conduct charge. That's not professional policing, and it's not a good use of the City of Cambridge's law enforcement resources. That's why the charges were dropped, and that's why it's fair to say that Crowley was acting stupidly racial issues aside.

It seems clear to me that race did play a part in this arrest: someone called the guy in, probably because of his skin color. No doubt Gates was belligerent and rude. But there's no law against being rude. To me, this is really a story about a minor abuse of power.

Predictably, righties have swarmed all over this story and have created a familiar narrative for the incident. The arresting officer, Sgt. Crowley, is a salt-of-the-earth blue-collar good guy, a hero! For trying to save a black man, even! Mouth-to-mouth! He even taught a class on how not to do racial profiling, fer chrissakes! And then come all these elitist dandies to crucify this poor man and defend the ungrateful privileged uppity black man...it's enough to make yer blood boil, ain't it?

Recognize the pattern? Sure you do. It's the age-old Nixonian strategy of shaving off blue-collar votes by invoking the fear of black privilege. Only these people get to fold a president into their narrative...

Boniek Compares Obama to Hitler, Clarifies that He Meant It in a Sorta Good Way

by: Matt Singer

Wed Jun 24, 2009 at 13:14:23 PM MST

Boniek at one point equated Obama with Hitler, Mao and Stalin, saying each loved his country in his fashion, with disasterous consequences. "He's ruining the country I love," Boniek said of Obama. "He doesn't know what freedom is."

"Hitler should be remembered for more than being a mass murderer," Boniek said last week.

"The point I'm trying to make" is that no matter what Obama is doing, "it shouldn't impugn his love for his country," Boniek said of Obama.

Wow.

"Hoping for a little more audacity"

by: Jay Stevens

Mon Jun 15, 2009 at 13:23:49 PM MST

What really seems to be the push is for the government to take over our health care and make it a single payer system with the government in charge.

Why in tarnation would we want to do this. The government all ready provides all the health care for the Indians in our country and look how screwed up that system is. The government run Veterans Health care is in no better shape than the Indian Health Care system.

WITH THESE TWO EXAMPLES OF OUR GOVERNMENTS ABILITY TO RUN HEALTH CARE, WHY WOULD WE WANT TO LET THEM TAKE CHARGE OF THE WHOLE COUNTRIES HEALTH CARE? CAN ANYBODY ANSWER THIS SIMPLE QUESTION?

First, Sam, a single-payer system is not the VA and Indian health care systems writ large. Those are examples of government-run health systems, not health insurance. A single-payer system is one in which a single entity - public or private, profit or non-profit - distributes all the insurance policies in the health-care system. Your question is flawed. Single-payer advocates do not favor letting government "take charge of the whole countries health care." Just the insurance.

Which isn't a bad thing, given the cost-effectiveness and quality of care of, say, Medicare, as opposed to the insanely high inefficiencies and administrative costs of private insurers.

Second, VA health care for one is not as bad as you make it out to be. In 2006, the VA hospital system was the best in health care. That should make you pause when you read articles about poor care at those hospitals - likely the care is worse at your local private hospital...only they don't talk about their problems in the newspaper. In fact, as Atul Gawande recently reported, the more market incentives are inserted into the health care providers' pay, the worse and more expensive treatment is. If there is poor service at VA hospitals, it could be because many of them have been privatized - like Walter Reed. And no doubt the influx of returning Iraqi and Afghani war veterans have taxed the system.

As for Indian health care...well, as the very article you linked to points out, most Native Americans on reservations don't have health insurance. That is, the poor, government-funded care American Indians do receive is much better than what private health care facilities would provide on reservations - which is nothing. Ask yourself: wouldn't there be more incentive for health care providers to treat impoverished Americans if the country had universal coverage? That is, even the poorest among us would have her health care bills paid by an insurer. And if there's a single problem with clinics on reservations, it's that they lack the funds to treat the number of patients that need care. The problem here is inadequate funding, not government bureaucracy. (And again, I'm paraphrasing the article you linked to.)  

Of course, all of Sam's questions and misconceptions would have cleared up by a few minutes' Googling - or even a careful reading of the articles he linked to. But the the problem here is anti-health-reform conservative propaganda reinforcing already existing prejudice, not a lack of information.

And, frankly, it's against these prejudices that Obama needs to use his bully-pulpit. These misconceptions need to be slain if we're going to have real and effective reform.

Watching Bill Maher rake the president over the coals for his lack of substantive advocacy for real reforms, I realized that he's right on: Obama's been sitting back, playing insider politics, the passive player in health care reform, as well as any other meaningful reform that needs to be done to solve the myriad pressing problems plaguing the country.

Maher:

And like Lindsay [Lohan], we see your name in the paper a lot, but we're wondering when you're actually going to do something.

Sorry, folks. But this president is not fighting for real health care reform. It's nibbling that leaves insurance companies still running the show.

And the banks. The banks that brought us to financial ruin and got bailout money are laughing at us about how easy it was to get back to business as usual.

And scientists keep saying that, if we want to keep living - you know, on Earth - it's kind of essential we reduce carbon dioxide by forty percent in the next ten years. Obama's bill? Calls for four percent.

This is not getting the job done. And this is not what I voted for. And this is why I don't want my president to be a TV star. Because TV stars are too worried about being popular and too concerned with getting renewed. Oh, you can relax about that one, Mr. President. The party is doing everything to ensure you'll get re-elected. The Republican party!

Speaking of the Republicans. If you can't shove some real reform down their throats now...then when?

Folks, Barack Obama needs to start putting it on the line in the fights against the banks, the energy companies, and the health care industry. I never thought I'd say this, but actually, what he needs in his personality is a little George Bush. He needs to stop worrying about being loved and bring out that smug, insufferable swagger that says, "suck on it, America!"

George Bush had horrible ideas. Torture, deregulation, pre-emptive war, tax cuts for the rich. But he pushed them through in their full measure, never mind Congress, or the Constitution, the Geneva Convention...Magna Carta...Hamurabi's code...

The point is, he didn't care if it made him unpopular with every human on the planet not named Cleetus or Fred Barnes. Which it did. What we need to do is marry the good ideas that Barack Obama has with a little bit of that Bush attitude and certitude. I'd love it if Obama came out one day and said, "Jesus told me to fix health care!"

In conclusion, Bush was bad. But he never cared if he were seen out at a restaurant having a burger with Dick Cheney. If he wanted a burger, he picked up the phone in the White House and said, "I'm the president! Bring me a burger!" And they would say, "sir, this is NORAD. Would you please stop ordering burgers into the red phone."

I'm glad Obama is president, but the audacity of hope part is over. Right now I'm hoping for a little more audacity.

Kathleen Sebelius Defends Public Option, Opposes Single-Payer

by: Matt Singer

Fri May 08, 2009 at 10:51:03 AM MST

I've gotten a few emails and seen the single-payer protest clip that is below. I have to admit to being underwhelmed. If I was in Congress, I'd be inclined to give single-payer a look. But I'd probably also end up where I am now, supportive of a mix of public and private insurance options for people.

The strangest thing, though, is this idea, both here in Montana and nationally, that Max Baucus is thin line standing between America and single-payer health care. That if only Max Baucus would invite a single-payer advocate to a Finance Committee meeting that Chuck Grassley's perpetual frown would turn upside down and that we'd all move to candy mountain with Charlie the Unicorn and the healthcare would be free and have sprinkles.

But I digress.

The place we're at in health care reform right now is that there is some broad consensus among leading Democrats, ranging from Barack Obama to Kathleen Sebelius to Ted Kennedy to Max Baucus to Howard Dean, of what health care reform looks like. It includes some Medicare reform; a "connector" or "exchange" to help people navigate the insurance market; significant regulation of private insurance including guaranteed issue, community rating, and some guaranteed benefits package to be determined; and a public health insurance option in some form. To various extents, all of these players are negotiating with Republicans, pharmaceuticals, hospitals, doctors, insurance executives and others to work out something that can get passed. I'm not privy to all of those negotiations or strategy. In all likelihood, most of the readers of Left in the West aren't either.

But that's the consensus framework. There are other approaches we could, in theory, take. We could try the McCain plan. We could try single-payer. We could model the French limited multi-payer or the British NHS system. Or whatever. But we're not doing those things either.

Occasionally, people ask me why I'm supporting what I'm supporting, as though what Matt Singer supports is newsworthy in the slightest. I don't think what I support is either interesting or important.

To some extent, the constant "I have a plan" nature of policy discussions in America is good in terms of promoting serious long-term policy thought. But it isn't very useful in terms of actually getting something passed this year, which is what we're currently trying to do. For most of us, the relevant conversation on November 1st of last year was Barack Obama or John McCain, Denise Juneau or the crazy lady, etc., etc.

At some point in politics, the questions we face become binary. Healthcare reform isn't quite there yet where we crunch down to: vote to pass it or vote for the status quo. But we're at least to the later portion of the primaries, where the contestants have been winnowed down to a narrow field and, perhaps unsurprisingly, those candidates are marked more by their similarities than their differences.

Big changes in American politics take years and huge amounts of work. Even unsuccessful attempts at big changes in American politics take years and huge amounts of work. And the most incredible thing about is that even the most "powerful" players -- people like Barack Obama, Ted Kennedy, and, yes, Max Baucus -- are more caught in the storm than creating the winds.

That isn't to say we don't have power. All of us have a lot more power to kill reform than we do to get something passed. It is easier for Barack Obama to veto a bill than to pass one, for Ted Kennedy or Max Baucus to shut down an option than to get consensus for one, for a single Senator to help filibuster than to get cloture, and for activists decide that they would rather demand a full loaf than get 2/3 of one and as a result not even get a crust.

This has turned into a rant, so I'm going to stop. I'm more than happy to take feedback in comments here and, as folks may have noticed, the diary and comment options give even single-payer advocates (and even libertarians) the ability to write whatever the hell they want here (although the community can shut down comments). So by all means, let 'er rip.

Rehberg says Obama is working too much

by: I can't fight this feeling

Wed May 06, 2009 at 18:42:16 PM MST

Speaking specifically about President Obama, Rehberg said, "He's moving too fast. He's trying to do too much. It's time for the president to slow down."

I guess when you're the guy whose own Chief of Staff said your top accomplishment was cutting the birthday cake for Billings' birthday (and you haven't had a non-public sector job in over two decades) tackling health care, the economy, unemployment, two wars and a pandemic may seem a bit ambitious.

Missoula Indy:

"Time and again," Rehberg has backed legislation that matters to Montanans, Iverson says. He's sponsored bills to recognize Billings' 125th anniversary, push for a water project in Fort Peck, and congratulate Carroll College's football team for its 2007 league win. Most importantly, supporters say, Rehberg co-sponsored the CLEANUP (Clean, Learn, Abolish, Neutralize, and Undermine Production of Methamphetamines) Act to focus federal authorities on the meth problem. The bill is still in committee.

"That's a major policy accomplishment," Iverson says.

Max Baucus Talks Health Care Reform; Followed by Paul Begala, Karen Tumulty, and Norm Ornstein

by: Matt Singer

Fri Mar 27, 2009 at 11:09:18 AM MST

There were some positive notes -- he spoke highly of a public health insurance option and didn't take using the reconciliation option off the table; he said he wants it to be bipartisan, but not at the expense of a good bill, etc. For more of a roundup, check out my tweets on it either on Twitter or Facebook (where you can comment).

At the heart of the conversation, as always of late (it seems), was the public health insurance option. Unsurprisingly, private insurance companies REALLY, REALLY hate it. So do Republicans. But here's what I don't get. Virtually all of the cost control measures being discussed -- from monopsony negotiating power to comparative effectiveness and moving away from fee-for-service -- rely on a public health insurance option, either directly or indirectly through modeling good insurance behavior (and imposing it on a wildly uncompetitive insurance industry).

So if we take the public health insurance option off the table, the question becomes -- how do we control costs without it? In theory, we can do one of three things:

1. Hope insurance companies adopt better cost control practices on their own.
2. Impose fierce regulations so that private insurance basically becomes a publicly-controlled, privately-profitable industry, but where meaningful competition DOES NOT EXIST.
3. Throw people to the wolves.

Compared to a straight-forward public option, these all strike me as asinine choices. Number two strikes me as the most likely compromise point, but I can't see why either liberals or conservatives would rather end up here than with a public health insurance option (although I can see why private insurance companies would).

Note: this is the justification for even having a relatively toothless public health insurance option -- one prohibited from negotiating and required to operate without public subsidies. Such an operation could still apply market pressure by embracing the moves away from fee-for-service and deploying comparative effectiveness research.

Am I missing something?

Update -- As with the panel at CAPAF, I still don't know if anyone has a realistic answer to this other than extremely fierce regulation of insurance companies. Again, insurance companies are probably OK with that alternative. Guaranteed revenue streams make up for harsh regulations. But both quality and cost will suffer for it because of the elimination of market incentives. We'll instead be hoping that government gets it right.

To put it another way, this solution -- government deciding exactly how insurance will work with private companies getting the profits -- has all the worst aspects of central planning and capitalism run amok.

Who Is Uninsured? More than 1 in 3 Non-Elderly Montanans

by: Matt Singer

Thu Mar 19, 2009 at 11:22:00 AM MST

Those numbers come from Families USA, a great outfit that advocates on behalf of health care consumers.

The vast majority of these uninsured individuals were working (or are minor children of working parents).

There's no age breakdown for Montana, but the national data is startling:

The likelihood of being uninsured declined among adults as they grew older. The percentage who were uninsured was highest among 19- to 24-year-olds (49.5 percent) and 25- to 44-year-olds (36.3 percent).

I should also note that excluding the over-65 population in these conversations is actually crucial to get an accurate picture. All elderly Americans are insured through Medicare. While in need of some tweaks, Medicare works pretty darn well. The question is what will we do for the rest of us. And just baseline access to insurance is very, very far from reality.

Commonwealth Fund Outlines (Relatively) Easy Steps to Begin Healthcare Reform

by: Matt Singer

Mon Mar 16, 2009 at 09:35:21 AM MST

Commonwealth's proposal is outlined here in a nutshell:

This report from the Commonwealth Fund Commission on a High Performance Health System offers recommendations for a comprehensive set of insurance, payment, and system reforms that could guarantee affordable coverage for all by 2012, improve health outcomes, and slow health spending growth by $3 trillion by 2020-if enacted now to start in 2010. Central to the Commission's strategy is establishing a national insurance exchange that offers a choice of private plans and a new public plan, with reforms to make coverage affordable, ensure access, and lower administrative costs. Building on this foundation, the report recommends policies to change the way the nation pays for care, invest in information systems to improve quality and safety, and promote health. By stimulating competition and delivery system changes aimed at providing more effective and efficient care, the policies could yield higher value and substantial savings for families, businesses, and the public sector.

While I'm at it, check out Ezra Klein's interview of Andy Stern, head of SEIU and one of the people at the center of the hardcore push for reform. Lots of interesting nuggets in there on SEIU's strategy, Max Baucus's surprising aggressiveness, and NFIB's conversion from opponent of reform in '93/'94 to very, very worried about costs today (worried about costs? The more progressive solution, the better the cost containment).

Single-Payer Advocates in House May Draw Line on Public Health Insurance Option

by: Matt Singer

Fri Mar 13, 2009 at 12:41:36 PM MST

A Public Option, but How is it Structured

by: Matt Singer

Thu Mar 12, 2009 at 09:59:50 AM MST

Both Max Baucus and Barack Obama have made public their commitments to work on a bipartisan process on health care reform. That's smart policy-wise and smart politics. But there's a downside: it gives partisan opponents the ability to hold a bill hostage. First and foremost, the goal here needs to be passing a good bill. Hopefully, good and bipartisan don't become competitive values, but we'll see.

One area of contention here is a public health insurance option. Chuck Grassley, Mitch McConnell, and other Republican Senators are saying no-way, no-how.

Interestingly, the New America Foundation today rolled out a proposal to try to find a way to get GOP buy-in to a public option. I say it is interesting because New America's proposal is strikingly similar to what was proposed to me just days ago by a conservative intimately familiar with health care reform.

Here's what they offer:

It is possible to structure a new insurance marketplace so that public and private health plans compete on a level playing field. This will require separating the oversight of the public plan from that of the managers of the marketplace or exchange(s). It will also require that all rules of the marketplace-benefit package requirements, insurance regulations, and risk adjustment processes-apply to all plans equally, whether public or private. Finally, this model requires that we address cost growth containment systemically and avoid relying heavily on the public plan's potential market power. In turn, this will require a commitment on the part of policymakers to acquire a health information infrastructure, develop best practice information, and encourage re-aligned incentives that promote high-quality, efficient care for all.

Update -- JC finds some things to object to:

Here's a handful of quotes from just the Summary of "A Modest Proposal for a Competing Public Health Plan."

1) The public plan cannot be Medicare.
2) The public plan may not be subsidized using additional government revenues.
3) the public plan cannot require providers to serve public plan patients as a condition of participating in the Medicare program.
4) The public plan should not be required to use Medicare payment rates.
5) individuals should be able to apply subsidies to the public or private plan of their choice.

Those provisions can all be the starting point for intense debate and contention. I don't think I need to start in on them at this point. Suffice it to say there are contradictions (#2 says "may not be subsidized" while #5 says "subsidies" can be applied to private plans), and the potential value of a large public plan 's economies of scale are lost. In short, many of the things that make a public plan attractive are lost in the desire to prop up the private industry.

But those who wanted to see the public insurer act as a soft single-payer system -- where the benefits of massive market share are used to aggressively bargain down costs -- won't be too pleased. The reason that government-run systems arguably work better is that they use monopsony bargaining power to control costs. Take that away, and the public insurance option becomes a lot of fury over what amounts to one more non-profit insurance option.

The Other Side of the Taxing Benefits Debate

by: Matt Singer

Thu Mar 12, 2009 at 09:01:49 AM MST

That said, even though Max Baucus's proposal isn't akin to John McCain's, there are good reasons it has a lot of people upset (I should note here that tax deductibility is not one of the areas I've given a ton of thought to in this realm). This letter from the NEA to Rep. Rob Andrews, who chairs the same subcommittee that Pat Williams did when Pat passed out both Clintoncare and a single-payer bill back in the '93/'94 effort, explains those concerns quickly:

Guarantee that the employee tax exclusion for health benefits is not limited or capped in any way. Over the course of their careers, many public education employees have traded salary increases for the long term security of a comprehensive health plan.  Telling hard-working employees that benefits will be cut or that they will pay more taxes would unfairly penalize them. A tax on salaries above a certain amount would also be unfair to experienced educators who, after decades of dedicated service, have climbed to the top of their salary schedules. Limiting or capping the tax exclusion for health benefits could have a disastrous effect on public education by discouraging highly qualified workers from entering or staying in the profession.

Health care is a huge, difficult subject. And most of this stuff is more complicated than it looks on first blush. We'll keep trying to help navigate the weeds of it here on Left in the West.

Baucus on Health Care Tax Deductibility Changes

by: Matt Singer

Wed Mar 11, 2009 at 19:40:26 PM MST

So here, in full after the jump, is the section on "Tax Incentives for Health Coverage" in all of its glory, released last November:

Clarification on Max, Tax, Wealth, and Health (by Dr. Seuss)

by: Matt Singer

Wed Mar 11, 2009 at 13:14:01 PM MST

When asked why Baucus favors taxing health benefits instead of increasing taxes for the wealthiest of Americans, Matsdorf said Baucus would prefer "to try and first pay for health care reform with health care dollars."

As explained by Finance Committee staffers working on health care reform, narrowing the tax exemption for health benefits may take two forms: Eliminating the benefit for people earning above a certain amount, such as $250,000 a year, or capping the amount of health benefit that is tax-free.

So, those who end up paying taxes on health benefits could be very wealthy people, those with a very "rich" or valuable health policy, or both.

People with average incomes or average health benefits probably wouldn't be affected.

Exempting employer-provided health benefits from taxation also is "regressive," committee staffers say, because it's usually more valuable to wealthier taxpayers.

Fund health care through tax reform, not taxed benefits

by: Jay Stevens

Wed Mar 11, 2009 at 08:44:41 AM MST

Sen. Max Baucus says he'd prefer funding health care reform by taxing people's health benefits rather than phasing out tax deductions on the richest Americans....Currently, the portion of health benefits that are covered by a person's employer is tax-free income. Baucus said last week that taxing those benefits should be considered. That way, health care reform would be funded with health care dollars.

Baucus says taxing health benefits wouldn't necessarily be harmful to lower- and middle-class Americans.

President Obama is proposing to phase out income tax deductions for people making more than $250,000 a year. Baucus has told Obama he doesn't like that idea.

According to a Reuters report, "critics say the tax break encourages workers to seek a more generous benefit package than they might want if it was taxed." That is, by instituting a tax on benefits, workers would seek cheaper, less comprehensive health care.

Frankly, that's the same old "moral hazard" rationale that got us into this health care mess in the first place. Malcolm Gladwell eviscerated this argument years ago; the "moral hazard" rationale is responsible for the Byzantine paperwork that has driven up administrative costs for health care, and has encouraged people to avoid routine checkups or treating minor illnesses and injuries -- which leads to more emergency care and higher treatment costs later. Basically we should be encouraging people to have good and comprehensive health care. Healthy people are less of a burden to the system; illnesses and injuries treated early reduce long-term treatment costs. Comprehensive health care for all saves money in the long run.

Taxing all health benefits is also regressive tax policy. That is, it affects middle-income families and small businesses disproportionately. It's also the same policy that John McCain was slammed for by Obama during the election. And to be honest, Obama's proposal -- phasing out health care benefits for those making over $250K -- isn't all that hot, either. We should be encouraging people to have health care, not punishing them for it.

But let's face facts. Health care reform will cost money. So...how do we go about raising the funds needed?  

Dr. Dean: Real Reform is Public Health Insurance Option

by: Matt Singer

Tue Mar 10, 2009 at 12:37:46 PM MST

The Commonwealth Fund has more good reasons:

According to the Commonwealth Fund, a public coverage program similar to Medicare would reduce projected health care costs by about $2 trillion over 11 years, and lower premiums by about 20% on average. Within a decade, 105 million people would be enrolled in the public plan, and about 107 million would have private insurance.