Obama and Congress
The Baucus Health Care Plan: Who Will Vote for THIS?
Published September 16, 2009 @ 03:58PM PT
You’ve heard endlessly about how you need 60 votes to pass anything in the Senate. (It’s the number of votes required to end a filibuster.) You’ve even heard the number 60 used to justify why the Senate Finance Committee is jettisoning something as popular as the public option from their bill. As Sen. Kent Conrad said again and again on TV, there are “not 60 votes in the U.S. Senate” to pass a public option. But given the reaction to Sen. Max Baucus’ bill, crafted in secret with a bipartisan “gang of six” including Mr. Conrad, the magic number is not 60. It’s 12.
That’s the number of votes it would take to vote this mess of a proposal out of the Senate Finance Committee. And it’s not at all clear that it will get those 12 votes.
In a post later tonight, I’ll go over my reactions to the policy, although I’m going to have a hard time besting Shadowfax’s summary, “As for the bill itself: it pretty much sucks.” Or even Ezra Klein’s reaction to the “free rider” provision: “This isn't just the worst policy in the bill. It's one of the worst policy ideas I've ever seen.” We were expecting this bill to be substantially weaker that what we’ve seen from the House, the Senate HELP Committee, or President Obama’s less detailed blueprint. But we were expecting them to be weaker for a political end –- to get the 60 votes needed for passage, and entice bipartisan support.
Yeah. That’s not going to happen.
The gang of six was originally a gang of seven, with more Republicans than Democrats. But then Orrin Hatch dropped out. The end result of the gang of six's months of negotiations -- months where their deliberations stalled reform and helped its popularity sink in the polls -- is that very few of the members now support the compromise they helped create. Mike Enzi and Chuck Grassley are openly airing their disunity after spending most of August bashing health care reform. Look for them to bring hundreds of amendments to the table. Olympia Snowe, the best hope of a Republican vote, said she won’t immediately support the compromise she had one of the biggest hands in crafting. And Republican leadership, in the form of Sen. Mitch McConnell, calls it “yet another thousand-page, trillion-dollar government program”... even though the actual Chairman’s Mark is a mere 223 pages and the CBO says it will only cost $774 billion. (I understand. Math is hard.)
The co-op meant to replace the public option as a compromise to Republicans and the insurance industry hasn’t solved the politics of the situation either. Republicans have been deriding it as government-run health care all the same. AHIP warms over the same language they used for the public option, calling it, “a new untested government-created co-op that could disrupt the quality coverage on which millions of Americans rely today.”
But the best part is Democrats and progressives are not amused either. Sen. Jay Rockefeller -- excluded from the secret negotiations despite being the #2 ranking Democrat on the committee, as well as chair of the Subcommittee on Health -- says there is “no way” he can vote for it. Sen. Ron Wyden, also on the committee, seems to also have big problems with how the bill defines “affordable health care”: “I don't know very many working-class families who you can look in the eyes and say: 'Do you have that kind of money in your checking account?' -- because they don't.” Sen. John Kerry has expressed milder reservations, but it’s not a home run for him. We haven’t even heard from Sen. Charles Schumer yet, who’s been an outspoken supporter of the public option and against the co-op. Ditto Sen. Robert Menendez.
Normally you would count on progressive organizations to push reluctant senators to back health care reform. But that’s a huge question mark for the Baucus plan. The AFL-CIO, AFSCME, and MoveOn have all unleashed highly critical statements. Health Care for America Now called the bill a failure and “a gift to the insurance industry.” So count them out.
If there are zero or one Republican votes, then the bill can’t even be voted out of committee without holding onto 11 or 12 of the 13 Democrats. Ironically, the huge concessions to get to 60 votes may kill any chance Baucus has of getting to 12.
(Photo credit: The Senate Finance Committee home page).
The Public Option: Popular Everywhere But the U.S. Senate
Published September 14, 2009 @ 10:34PM PT
Many sound notes of exasperation that the public option continues to be the focal point of the health care fight, both on the right and the left. But at this point, their exasperation is itself becoming exasperating. At its core, we’re talking about a policy point that, despite eight months of pummeling, remains popular except in the halls of the United States Senate and the corridors of the headquarters of the insurance companies. It is the latest incarnation of the people vs. the powerful -– and I’d say folks have a right to be angry that the people seem to be losing.
Two bits of news today reinforce the unmistakable trends of continues popularity and support. Washington Post-ABC News released their latest poll, finding support for health care reform in general is split right down the middle. But giving people the choice of private insurance or the ability to voluntarily buy into a high-quality, government-administered public health insurance plan, similar to Medicare, scores better at 55%. But that’s the tip of the iceberg! When actually described correctly as being an option available only to those who don’t already have insurance, support jumps to 76%. It’s like the August of our discontent never happened.
One of the canards about the public option is that physicians won’t support it because they’ll refuse its presumably lower negotiated payment rates. But today’s New England Journal of Medicine should put the lie to that once and for all. A survey by email and phone of 2,130 physicians (well above the 800-1,000 sampling of most polls) finds tremendous support among doctors for the public option -– 63% of doctors support health reform that incorporates a choice between public and private coverage, whereas only 27% prefer reform where private insurance is the only option. Even surgeons, slightly more conservative and skeptical of reform by nature, come in at 59%.
Oh, and tomorrow the AFL-CIO is set to endorse a public option formally, after their incoming president has warned darkly about primary challenges for Democrats who vote against it.
Now I should note that popularity does not always correlate to the right policy, particularly on something as complex as health care. But let’s review. All three major Democratic nominees for president endorsed a public option two years ago. This year, so did the leadership in the House and the Senate, as did all but one committee chair with jurisdiction over health care. The last committee chair released a blueprint with a public option months ago, before changing his mind. 100 members of the House are threatening to vote against a health care bill that doesn’t contain it. The Senate Majority Leader is for it, as are the number two (Durbin) and the number three (Schumer) Democrats in the Senate. A still-popular President of the United States devotes a significant portion of his health care stump speech to it. Progressives are for it. Labor is for it. Doctors are for it. The American people are for it.
What’s on the other side? Entrenched Republican resistance that has already said jettisoning the public option isn’t enough for them to vote for the bill. And an insurance industry that’s dishing to Business Week about their ability to influence centrist senators like Baucus and Conrad and Blue Dog congressman like Ross.
It’s one thing to year in and year out lost to the lobbyists and special interests whose money and influence control the levers of power. It’s quite another to have our noses rubbed in it.
(Photo credit: The White House, via Sen. Max Baucus' web site.)
Why Taxing Insurers to Pay for Health Care Is Lame
Published September 14, 2009 @ 05:22PM PT
When I listed out my 9 surprises in President Obama’s health care speech from last week, I noted that the President now seemed to support Sen. Max Baucus’ method of raising new money for health care reform: putting a tax or set of fees on insurance companies. I also gave my verdict on the idea: “lame.” Some of you understandably wanted more than a monosyllabic analysis, so here goes. Taking the money to pay for health care reform out of the insurance industry in taxes and fees will be no different than taking it out of the American taxpayer. The rest is smoke and mirrors.
Baucus’ proposal would impose a $6 billion fee upon the health insurance industry at large, similar to other industry fees in his plan (pharma, medical device companies, etc.) He would then also add a 35% excise tax on insurance plans above $8,000 for an individual and $21,000 for a family plan. Superficially, it seems like an ideal compromise. Combine the ideas of liberals like Kerry and Rockefeller, who wanted to raise income off insurance companies, with conservatives like Grassley and Snowe, who wanted to create a disincentive towards gold-plated insurance plans, and you have some common ground.
But problem one is this idea isn’t as populist-friendly as the liberals would like. What happens now when states increase taxes and fees on health insurance? That’s right, they get passed on to the consumer. As Bob Laszewski writes today, “I have run a health insurance business… Do you know what the insurance companies do with these taxes? Since they are tied to premiums they pass them through directly to the policyholder who pays these premiums.” Keep in mind that because most insurance plans are chosen by the employer, not the individual, there’s not actually a guarantee you’d be hitting only wealthy Americans with this new tax. For example, unions for most industries typically consist of middle-class workers (teachers, garment workers, police officers, fire fighters, nurses, hotel workers, etc.) but they negotiate for generous health insurance policies likely to be affected by this tax. Is it a progressive tax if you’re as likely to hit a member of the NYPD as you are an analyst at Goldman Sachs?
You’ll recall that Baucus’ original idea for revenue also targeted the so-called “Cadillac” insurance policies. The Senate Finance Committee had toyed with removing the employer tax exemption on health benefits so they’d be taxed like regular compensation, or at least putting a cap on it so insurance plans above a certain threshold would be taxed. The idea again was to make it more obviously costly to get expensive insurance. The hope was that transparency would lead to workers putting pressure on their employer for less generous plans. This was a favorite idea of the Congressional Budget Office, as it would create economic pressure to keep costs down. But that’s where we hit problem two -- it's not as effective at doing this as the conservatives would like. This new tax accomplishes the goal of making “Cadillac” plans more expensive, all right, but it completely loses that transparency. A tax on the insurance company which is passed on to you as a higher premium is not obviously different than a higher premium just because –- which is the system we have now. The cause and effect connection is obscured, making it less likely consumers will learn the lesson.
To be clear, I don’t think it’s the worst idea for raising revenue. If this winds up being the only expedient way of paying for health reform, the benefits would still outweigh the costs. I don’t think it’s harmful; just lame.
(Photo credit: http://www.flickr.com/photos/greaterfalls/ / CC BY-ND 2.0)
Guys, Obama Supports the Public Option (Still)
Published September 12, 2009 @ 07:19PM PT
Because so many conservatives consider giving private insurance competition in the form of a public health insurance option to be a non-starter while so many progressives proclaim any bill without a public option is a non-starter, the level of conflict couldn’t be higher. And the new gravitates to conflict stories like moth to a flame. Reporters are convinced that President Obama will drop his insistence on a public option in health care reform as part of negotiations imminently, and are watching him like a hawk so they can be the first to report on it when he does. Commentators rack up fees proclaiming the imminent demise of the public option. Yes, even on NPR and MSNBC. And yet, in every public statement -- including today -- Obama spends a lot of time defending it and saying it's part of his plan. Still.
In short, what gives?
I feel like I’m stuck in health care Groundhog Day. I’m literally having the same conversation about President Obama and the public option over and over again. I went back and checked out this post of mine from February 27, when the blogosphere was ablaze that Obama was about to drop the proposal. Suffice to say, it didn’t happen then, which is why we’re still talking about whether it's happening today.
I can’t prove, obviously, that somewhere within the sanctum sanctorum of the White House that high-ranking officials aren’t preparing a “Sorry, we tried” speech. But I do know these three points:
- Say what you want about Obama, he’s pretty up-front about when he’s going to disappoint his progressive base on make-or-break issues. In 2008, he deviated wildly from his previous statements to vote for the reauthorization of a FISA bill that allowed for warrantless wiretapping. It was a blow for liberals and civil rights. But he then proceeded to explain his reasoning in-depth in public statements and interviews, including having his foreign policy advisory team answer questions on his Web site for hours. Obama has also been up-front about what he’s giving up on health care. We knew from the minute he took office that single-payer was off the table. We knew, despite progressive hopes to the contrary, that there’d be no additional funding for abortion or undocumented workers or a roll back of the Bush Tax Cuts for health care. We knew the requirement that every American buy coverage or pay a fine, which he had campaigned against, was now likely to be part of reform. We knew because he told us.
- The dude is expending a lot of energy defending a policy that people say he’s about to drop. It's pretty easy to tell the difference between something he weakly supports and something he strongly supports. On Wednesday, has not Rep. Joe Wilson proven to be an ass clown, the main story of the day would have been Obama's seven-minute defense of the public option. Today in Minnesota, he devoted a couple of paragraphs to it, in contrast to medical malpractice (not one word) or the John McCain idea of high-risk pools for those with pre-existing conditions (not one word) [Correction: he did mention this pool for those with pre-existing conditions. I missed the reference the first time.] On his brand-new “Obama’s Health Care Plan” page on whitehouse.gov which only went up 3 days ago, he mentions it again. If he’s not seriously trying to get it, he’s wasting a huge amount of time making it look like he is.
- The fact that commentators seem to have reached a consensus is uncompelling to me. According to pundits, we should be talking right now about how well President Hillary Clinton is doing. Or we should be talking about how prudent it was or was not for President Obama to put off tackling health care for a few years to focus on the economy.
Look, getting a public option is going to be the hardest part about reform, and the sexiest fight for the news. Winning a public option still has a lot more to do with who’s in the Senate than who’s in the White House. But the surest way not to get it is to stop asking for it.
(Photo credit: Official White House Photostream on Flickr.)
Blame Joe Wilson, Not the Immigrants
Published September 11, 2009 @ 10:31PM PT
Too many people wanted to know what I thought about Rep. Joe Wilson for my taste. The answer is I didn’t think anything much of him before President Obama’s address on Wednesday, and think even less of him now. Aside from heckling the sitting President of the United States during a nationally televised address, he hadn’t done anything of substance. His one contribution to the health care debate –- proclaiming the president was lying when he said illegal immigrants would benefit from health care reform –- was all anger and no accuracy. Despite the national fascination, he was utterly irrelevant to health care reform.
Until today, of course, when first the centrist Democrats of the “gang of six” and then the White House capitulated to the concerns of the heckler. Apparently we reward you in the United States Congress for being an ass clown. (Some would joke it’s probably a requirement.)
Wilson’s continued assertion that he was set against health care reform because it would benefit those here illegally was false in a way that defies logic. The House bill expressly reserves the tax credits for low- and middle-income people to afford insurance premiums in the Exchange to “an individual who is lawfully present in a State in the United States” (Sec. 242 (a) (1). Sec. 246 takes it a step further and proclaims, “Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.” This is as open-and-shut as it gets, and even nonpartisan sites like FactCheck.org, prompted by Wilson’s outburst to check again, concluded, “They receive no government funds for this and cost the taxpayers nothing.” This was a net political win. The opposition to health care reform embodied in Wilson looked both unreasonable and wrong.
So why, then, did both Sens. Kent Conrad and Max Baucus publicly re-open the issue as though Wilson had made a legitimate claim? Baucus’ framework document already said, “No illegal immigrants will benefit from the health care tax credits.” That’s pretty damn clear. But when confronted with an unsubstantiated, inappropriate, angry outburst from an idiot, Conrad began a-thinking: “We really thought we’d resolved this question of people who are here illegally, but as we reflected on the President’s speech last night we wanted to go back and drill down again.” In their totally improvised new regulation, when you apply for a tax credit, you’ll need proof of citizenship... because apparently using your previous year’s tax return as proof that you qualify for a tax credit isn’t enough paperwork or proof that you’re a tax-paying resident. If it’s just to really double-dog guarantee that no undocumented worker gets an affordability tax credit, it’s redundant and needlessly bureaucratic. If it’s a move to prevent that immigrants aren’t paying for health insurance even with their own money, it’s a libertarian’s nightmare. As Ezra Klein writes, “there's a reason Best Buy doesn't have a citizenship requirement and Safeway doesn't ask for papers. It's cumbersome and inefficient and, at the end of the day, we want people to spend money on things anyway.”
Conrad later clarified to say he only meant there’d be a citizenship requirement for the tax credit –- so he’s merely being redundant. But honestly, combined with the hugely problematic and needlessly weak ideas negotiated into Baucus’ framework document, it makes me wonder who Baucus and Conrad won’t roll over for. What's next -- specific legislative language that forbids an assassination squad going after Sarah Palin's baby?
But then, it got worse. Baucus and Conrad, I understand. But this leaves me speechless:
A White House spokesman, Reid Cherlin, said that the president’s proposals would bar illegal immigrants from purchasing private insurance through the new government marketplace, known as an exchange, and that verification of immigration status would be required for anyone seeking to purchase coverage.
Yes, that would be the White House overreacting worse than conservative Democrats. And you know what? Joe Wilson is still wrong! He will continue railing against funding the health care for undocumented workers even despite these redundant and potentially oppressive changes. His argument had zero basis in fact -- you can’t have less than a zero basis in fact. This nets no new vote for reform. And it makes the health care bill that Joe Wilson wasn’t going to vote for anyway a little worse for all of us -- including those of us who were born here, were naturalized, or are here through work visas, who now must verify our own papers before buying health insurance.
I guess you can get pretty far in life just being an ass clown.
(Photo credit: http://www.flickr.com/photos/notionscapital/ / CC BY 2.0)
For more on health care reform as it relates to immigration reform, please see these previous posts:
A Public Health Insurance Option By Any Other Name
Published September 10, 2009 @ 09:32PM PT
In reaction to President Obama’s big speech on health care reform, Senator Chuck Grassley could only say the president “passed up a big opportunity” to eliminate the public health insurance option. Given that Obama gave a spirited defense of the public option, a proposal that polls better than reform as a whole and whose removal would spark open rebellion among the liberal lawmakers he needs to pass any plan, I would say he openly chose to do the exact opposite of said “big opportunity.” But there was one opportunity involve Obama and the public option that he clearly passed up –- the opportunity to give it a less sucky name.
This is sadly one stereotype that Democrats too often live up to. We cannot compete with Republicans in coming up with awesome names for big initiatives. No Child Left Behind. The Clean Skies Act. The USA Patriot Act. Operation Iraqui Freedom. The policies may have been deplorable, but man, those were some damn cool names. FDR's lucky that he came up with the "New Deal" early, because most of the new deal programs wound up being alphabet soup: the FDIC, the SEC, the WPA, the NLRB, the CCC. That's not even trying. What have been modern-day Democrats' best efforts this year? The American Recovery and Reinvestment Act (yawn), the Lily Ledbetter Act (an important name, but one that reads like a nursery rhyme), SCHIP, and the pieces of health care legislation that read like we threw buzzwords down on the page and rearranged them. It's like a word challenge -- come up with a name that incorporates “Choice”, “Health”, “Affordable” and “America” and you got yourself a bill. The one attempt to rebrand the effort as “Health Insurance Reform” instead of “Health Care Reform” was, frankly, no improvement at all. It went over about as well as trying to call the stimulus something else after we’ve already called it the “stimulus” for months. I understand the idea –- bring the focus on curbing the abuses of the insurance industry into sharp relief –- but it appears to have been rightly ignored by anyone not reading directly from talking points. Last night, Obama was back to saying the topic of the day was “health care.”
But nowhere is Democrats' apparent lack of concern over branding more apparent than the public health insurance option. I’ll grant you, it’s loads better than the original name of “the public plan,” which is so vague that it was easily mistaken for health care reform in general. At least it’s got “health insurance” in there, so you vaguely know what part it involves. It’s got “option” in there, which screams “no one gets forced into this.” But it’s about as uninspiring a name as “affordability tax credits.” I can’t tell you how many meetings, panel discussions, or volunteer brainstorming sessions I’ve gone to that have been sidetracked by someone trying to come up with a better name. The people in a position of power to do something about it –- Congress and the President –- just haven’t been trying. The Senate Health, Education, Labor and Pensions Committee renamed their public option (yay!), but they renamed it "the community health insurance option." How was that an improvement? Who got reassured by that, other than people who have had bad experiences with their local public library? Honestly!
It’s not that there have been a shortage of more creative names. Jacob Hacker originally came up with Public Plan Choice (Ok, that’s still lame.) Maggie Mahar came up with Medicare Part E (“for Everyone”). Chuck Schumer came up with “Plan USA.” Some bloggers on Daily Kos suggested we call it the Kennedy Health Plan. But the one thing that we know about the public option is that the more they find out about it, the more they like it. A more descriptive name won’t win over people dead-set against any government competitor whatsoever. But it sure would make the sales pitch easier for those who legitimately don’t know what it is or how it would help.
Come on, folks. Throw Axelrod and the real life equivalents of the cast of Mad Men into a room. Come up with a better name. To coin a phrase, just do it!
(Photo credit: http://www.flickr.com/photos/bbaunach/ / CC BY 2.0)
9 New Surprises in President Obama's Speech
Published September 09, 2009 @ 11:09PM PT
A week ago, before tonight’s presidential address before Congress was even confirmed, I asked if President Obama had anything new to say about health care reform. I asked it even knowing that in many ways, it was the wrong question. The reality was he didn’t need to say anything new -- all it needed to be was new for most of the country. All he needed to do was say it better.
Not that the content of the speech being mostly rehash is at all a bad thing. If you read this blog regularly, or even every-so-often, you’re far more deeply enmeshed in the contours of this debate than, I believe, most Americans are. Although Obama’s town halls have been televised, although there was the press conference dedicated to health care, and the night of Q&A on ABC, although there have been op-eds, and blog posts, and Web casts and radio interviews a-plenty, most people just haven’t had the time to follow it. As a result, not everyone knows that the uninsured aren’t just sad unfortunate folks completely unconnected to us, but that our skin is in that game as well, with at least $1,000 hidden cost for uncompensated care for those of us with insurance.
People may know about pre-existing conditions, but they haven’t heard the story of Robin Beaton, the Texas nurse whose acne years prior was used an excuse to drop her health insurance precisely when she needed it the most to fight breast cancer. People know costs are going up but don’t realize, as the president said, “Our health care problem is our deficit problem -- nothing else even comes close.”
And they don’t hear nearly enough, nowhere nearly enough about the moral deficit of not fixing health care reform: “That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America.”
Health care reform doesn’t exist in a vacuum. It’s not a good idea because it’s ideological or because the Obama plan is how anyone would build a system from scratch. It’s a good idea only to the extent that it solves an immediate problem. The structure of Obama’s speech was therefore elementary: you need to know the problem first, then you need to know how the solution relates to it, and then you need to be shown how all the stuff the media fixates on -- bipartisanship, “death panels,” illegal aliens, you name it -- how that doesn’t even relate to either the solution or the problem. Did Obama get a big enough audience or make a big enough impression to sway public opinion? Time will tell.
But since novelty is the spice of life, I have to share the nine things that I had legitimately not heard before, either from a policy or political perspective. Not all of them were positive, mind you, but I have to confess that the answer to the question of my earlier post -- does Obama have anything new to say about health care -- is yes.
