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.
That either means that politicians have failed in a major way to explain its benefits to the people of Montana (I mean beyond the readers of this blog) or that people are seriously upset about some of the worst provisions in the bill.
What's could be getting Montanans so riled up? Could it be the excise tax on good health care plans? The kind of plans that we were told we could keep if we like are now subject to a 40% excise tax on the value of health plans- plans with a value of $8,500 for individuals and $23,000 for a family.
When you look beyond the talking points, however, you find that this is also going to tax plenty of Buicks: plans for teachers, nurses, firefighters, miners, for example.
It gets even worse for those in high risk blue-collar professions like miners and firefighters. Unfortunately the retiree and high risk occupation threshold amounts were reduced by $500 and $2,000 for individuals and families, respectively, thereby worsening their financial hit under the excise tax. We're talking about workers who have already in many cases sacrificed wages to get better benefits.
The bill does have the advantage, according to the Congressional Budget Office, of being deficit-neutral. In fact, the CBO claims it will reduce the deficit over 20 years. But just because we can afford a vehicle like these at LoserCars.com doesn't mean it's a good idea to buy it.
This provision of the bill will actually harm millions of middle class Americans who already have health insurance.
There may be a piece of paper somewhere on which this bill looks good (please, somebody show it to Montanans). But it's not looking like this bill is going solve the problem.
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.
The results of the MSU-Billings poll, released Tuesday, offer some interesting insights into how Montanans view the issue of health care reform beyond the narrow and specific questions posed to us in the poll. In my opinion, the poll should have included more health care reform questions (and less about wolves and bears) since health care is one of the biggest issues facing Montana and the nation.
One way to interpret the results would be to conclude that the health care reform plan of a Democratic president is profoundly unpopular to the people of Montana.
A second way to look at the poll results, however, would be to compare the approaches to reform of the two major figures who have been the most outspoken on this issue: Senator Baucus (who has tirelessly worked on this issue and should be commended for his efforts) and Governor Schweitzer (who has been an unabashed proponent of progressive reform, praising the Canadian system in the media and at public events-including at President Obama's town hall meeting in Bozeman.)
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.
Pogie is on a tear today, noting the media's love for Dennis ReTweet, the first time a prominent politician in Montana has gotten such kind treatment for so clearly mimicking his party's line through a new technology.
But the bigger problem here isn't that Rehberg is simply using the right-wing playbook out there to kill health reform. We've known that for months.
As the Independent is covering, things are getting a bit hot in Ward 2 in Missoula, where incumbent councilman is coming shockingly close to implying he's got the backing of popular Missoula Mayor John Engen.
The local Dems have responded by filing a complaint with the Montana Commissioner of Political Practices over Hendrickson's practice, since Engen has fully endorsed Roy Houseman (who, I should note, is a friend and an all-around badass).
I'm of 2 minds on this:
What Hendrickson is doing is really quite unacceptable. It definitely skirts ethical lines to imply endorsements you don't have and goes even further when you imply that someone supporting your opponent actually prefers you. So I'm certainly not defending Hendrickson's behavior. That being said...
The Commission of Political Practices is a quasi-judicial body that should have limited power to evaluate truth claims in political campaigns. I don't think that there should be legally empowered bodies that gain the power to factcheck campaign ads. In fact, I find that pretty horrifying.
The Democrats who have filed this complaint are friends, pretty good friends in fact. That said, I'm not a fan -- and I hope they reconsider. This act has real 1st Amendment consequences.
All that being said, the Commissioner and the courts should protect the 1st Amendment. And John Hendrickson shouldn't willfully mislead voters.
Update: (from Jay) Keila Spitzer has a post up about this, too, with quotes from Hendrickson and council member, Jason Weiner...
The good news remains that health care reform is largely on track. We've passed the low point that any bill is likely to hit in terms of the public option and some other key progressive priorities and we're in the process of improving the bill.
But people have no doubt seen the commentary in the last 48 hours regarding the fact that we don't have 60 votes for cloture in the Senate yet. As I have been before, I'm fundamentally optimistic about this. I think the CBO scoring of the merged bill will come back favorable. I think scores on amendments to remove the public option will put the deficit burden on opponents of the public option. I think choice is fundamentally popular and that Republicans and the sell-out Democrats are facing an uphill battle against polling.
All that being said, the fact that we can't move to a consensus point yet on the public option means that progressives have less leverage on three other important points: financing mechanisms, subsidies for affordability, and the strength of the employer mandate. That may be the reason for the foot dragging. Who knows?
But a few other thoughts:
I don't know if Max Baucus has been trying to gut this bill like a fish or busting ass to strengthen it back to his white paper while making sure he has the votes to move forward. I do know that the general momentum in this fight right now is with reformers and specifically with public option advocates and that is both a result of progressive pressure, progressive insiders, and the slow and steady work of Max and his staff and others like him in Congress.
The last 48 hours should have proven that while the problem in DC is with 40 given bad votes that require a bill that "runs the table" with Dems and the two Independents, that still means that putting together a bill that can pass is a damn tough thing to do. Both the Senate and the House will be moving toward floor consideration of their respective bills soon. That is historic. It is amazing. But we don't have the votes for cloture yet.
The Senate is a uniquely messed up institution. If you've been in the weeds, you've read that Joe Lieberman has agreed to let the health care bill be considered...because the world's greatest deliberative body requires sixty votes for debatee to even begin if a single Senator objects. This same body requires 60 votes to end debate in such a manner that the most unpopular political party in the history of the country or something can literally find one grandstanding member of the majority and lock down the chamber. Why no one has launched a full-frontal assault on the chamber's structure and existence in American political life is, frankly, beyond me.
Anyways, I know I keep getting described as a fool in comments. Maybe I am for having the policy stances that I do. But so far this game is playing out close to how I imagined it...and I think we're on the path for an OK bill.
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.
I just got this email from Congressman Rehberg's office forwarded to me outlining his concerns about a public option:
He has concerns about a new "public option" because he's worried that employers will stop offering health benefits, which would force too many people into a public system, which the government will not be able to pay for, so instead of making the system better for those who it isn't working for, we've made it worse for everyone.
Reality check: employers already are increasingly dropping health benefits as costs skyrocket. That's all the more reason to fix the individual market -- and also to have a meaningful employer mandate that reduces the number of individuals dropped from current coverage.
But there isn't a single proposal for a public option where people would be forced into it. Once again, for the folks at home, the public option would be one of many options housed inside a health insurance exchange. The exchange would be the likely stopping place for individuals buying insurance on the individual or small group market. By imposing guaranteed issue, community rating, and a reinsurance to reweight the risk pools, the idea is to create a pretty competitive marketplace and reduce administrative overhead of offering individual plans.
Within that exchange, one of those plans would be publicly administered and publicly accountable. Under the (likely) House plan, it would also leverage Medicare's network to be established and pay rates slightly higher than Medicare. Under the (likely) Senate plan, it would simply be a government run health plan, may be national (good) or a set of state-based (not as good), may be an option everywhere (best), everywhere that hasn't opted out (OK), or everywhere that has opted in (bad), or it might be triggered by the lack of affordable insurance (bad). Or it might not exist at all (booooooooooooooo).
But there simply isn't a proposal out there that would do what Rehberg's office is claiming.
Beyond that, Rehberg continues to say he wants insurance companies to be able to compete across state lines. Max's bill actually allows for that, just not in the willy nilly manner that credit card companies currently compete. It would just give states the authority to approve insurance companies based in another state to enter their market (Montana could say they think Washington State's regulations are sufficient for Washington insurance companies to sell their product here). The national public option proposal is based in large part on the advantage of pooling across state lines. Rehberg says he supports tax credits. That's a backbone of the major Democratic proposals. He calls for HSAs but then says he wants resources for prevention. HSAs really don't incentivize prevention. The Democratic bills actually make prevention a reality.
Beyond that, Rehberg is really worried about the cost. Fine, get out there and champion comparative effectiveness research and make it clear that the government will only subsidize proven cost-effective medicine and paying for the rest will be up to the individuals paying out-of-pocket for insurance or care. I'm all for being hard-minded in how we cover people.
The problem is that the entire Republican Party is either ignorant as dirt on these actual policy questions or more dishonest than Pinocchio. Either way, these answers are utter bullshit and Montanans deserve a hell of a lot better.
As if the striking defeat of abortion bans in South Dakota and Colorado last year (and the failure of a ban in Montana to even get on the ballot) weren't clear enough, out-of-state zealots are headed for Montana this week for what they call a "Personhood Conference." (This thing is sure to be a fascinating bunch of out-of-state total extremists--reporters won't want to miss it.)
Why us? National groups are focusing their attention on the states because Congress wants no part of something this extreme. They are coming to Montana because our low population and cheap media rates make us the perfect target to force their extremist experiment on the nation without spending a lot of money. Also, we actually elected a member of the Constitution party to our state legislature who backed previous failed bans.
The thing is, they don't have local support - the Montana Right to Life, Montana Catholic Conference, and the Montana Family Foundation have all said in the press that they want no part of this.
Even Republicans are starting to come out against these efforts to force their big government extremist agenda on the rest of us though state ballot initiatives.
Women in Montana (and especially Native women) don't want to give the government control over whether and when we have children. In addition to the out-of-staters, it will be interesting to see if any local officials actually show up. The personhood conference website touts Senator Jonathan Windy Boy (D-Box Elder) as supposedly attending.
Why would Windy Boy attend? He may be confused. When asked what the reason is for his anti-abortion rights votes in the legislature Windy Boy has said "my uncle had 23 children and he told me to go forth and multiply."
I love kids as much as the next gal. However, 23 kids! That's five more kids than the Duggars. What if each of those kids all had 23 kids, how much is 23 x 23? 529 I think. And 529 x23 = 12, 167. In just three generations this family could be 12,000 strong. Two hundred eighty thousand strong in four generations.
The conference website lists Senator Windy Boy's phone number--give him a call and tell him that if he's against abortion, he should vote to increase access to affordable birth control and medically accurate sex education in his district to prevent unintended pregnancy in the first place instead of aligning himself with wing-nuts.
Families USA summarizes the amendments that the Finance Committee made to the Chairman's Mark. There's a mix of good (basic health plans for under 200% of poverty, enrollment simplification, only one exchange per state) and bad (lower subsidy levels) and some other stuff.
Families USA does good work, though, and their reputation as health wonks is well deserved. The full thing is an easy-to-read four pages.
The Congressional Budget Office has released its "score" of the Senate Finance Committee's health care bill. The bill actually reduces the deficit by over $80 billion over the next ten years and by more over time. It also likely leaves about 6% of the population uninsured.
The Finance bill is unique as I understand it in being long-term budget positive according to CBO projections, but it also seems to me that the score could be improved by adding a public option, which is still possibly in the cards, and that the outcome would be improved both by a public option and by taking some of those savings and routing them toward subsidies to achieve universal coverage.
Ezra thinks that this score will be sufficient to get the bill out of the Finance Committee, which is the most conservative committee in the Senate.
Remember, before this bill heads to the floor of the Senate, it will be merged with the HELP bill authored by Ted Kennedy (negotiators will include Harkin, Baucus, and the Administration). That merging is overseen by Harry Reid.
Note, of course, that the Senate still has issues if Reid opts for a public option in the bill when it hits the floor. Max Baucus has been where he is because of the desire to break the filibuster. Reid can pursue a different route: daring Joe Liberman, Ben Nelson, Mary Landrieu, Blanche Lincoln, and Kent Conrad to filibuster health reform.
Either way, once bills come out of the House and the Senate, into conference we go. Whatever comes out of there heads back for up or down votes but the Senate can still filibuster if some Dems and all the GOP decide to deny health reform an up-or-down vote.
Finance Committee stalled out with some GOP antics today (check Sen. Debbie Stabenow deliver the best "your mom" punchline of all time in the video below) so public option comes up Tuesday (Monday is Yom Kippur):
Huffington Postnotes that with Sen. Ted Kennedy's replacement headed for the Senate soon, pressure is increasing for commitments from Democrats to support an up or down vote on health reform. Basically, the call is to prevent Republican filibusters on the bill from succeeding it.
If the bill isn't filibustered (and Democrats alone have the power to prevent a filibuster), a majority determine the fate of the legislation.
Majority rule -- quite the concept.
Note: Neither Max nor Jon has given any indication EVER that they would be part of a filibuster. The problem Democrats on this are more like Kent Conrad, Mary Landrieu, the Nelsons, and Blanche Lincoln. Joe Lieberman is a problem, but he ain't a Democrat.
I feel like I've had this conversation a lot lately with many progressives getting all sad sack and declaring defeat on the public option. Listen to your President, schoolkids: the public option lives.
As countless others have noted, our senior Senator bent over backwards, watered down his legislation, all in search of a bipartisan bill...and was left with 0 Republican backers. So that's point number one, it is increasingly clear that even Olympia Snowe is going south on even the most agreeable of health care reform offerings. The path to a bipartisan bill is not through negotiations (there is possibly a different path through popular legislation).
That said, there is some praiseworthy material in Max's bill. For example, the public option that people are seeking would "live" in the health insurance exchanges, which are themselves absolutely crucial to meaningful health insurance reform (exchanges will make it possible for individuals and small groups to pool their purchasing power more like large groups and also provide clearer choices for consumers purchasing insurance), are open to a lot more people and employers. In the House bill, for example, you get kicked out of the exchanges if your business grows to larger than 20 employees. In the Baucus bill, you'd have to be given access until you have 50 employees, possibly until you have 100, and eventually anyone would be able to buy-in. In other words, the Baucus bill gives a platform where, with a public option, the option would actually be an option for everyone, individuals, small employers, big employers, etc. That's big.
I'm also a fan of this idea, which I basically think of as insurance reciprocity. Rather than either putting up firm walls that don't let insurance plans cross state lines or tearing down all the walls between states and creating a credit-card-deregulation like nightmare in the insurance system (as Rep. Rehberg and others have advocated), the Baucus plan would allow Montana to permit, say, Californian insurers to sell policies in Montana if we deem California insurance to be regulated enough to satisfy us (note, it might be regulated differently than Montana plans, but still be deemed sufficient by our regulators). Again, this allows for bigger pools and more competition, especially for places like Montana. So that strikes me as good and smart.
The Medicaid and CHIP provisions are also apparently very well-written.
With most other stuff, except for the public plan and a significant change to the employer responsibility section, progressive complaints here are on the margins: subsidies should be more significant, penalties on the individual mandate should be lower, the community rating constraints should be tighter, and the out-of-pocket limits should be lower.
That's all fixable. It isn't fixable without increasing the costs of the bill a bit, but the bill is so fiscally responsible that we can increase its cost and still have it be reducing the deficit (!). So that means we have some room to work.
The bigger problems are that the bill needs a meaningful employer mandate and meaningful competition. Meaningful competition here is a code word for a public option, because no one has yet structured a meaningful alternative to the public option to actually achieve its goals. As is clear, the public option is also a political necessity to building the movement necessary to pass a bill, if the strategy is an outside (pressure) one as opposed to an inside (negotiations) strategy.
There's also some room for feedback on the financing measures, I'm sure, but I haven't really read the relevant material there yet.
Final thought: the biggest problem both with the delivery reforms that Max's bill includes AND with the public option (except for a Medicare-like public option that has its own problems) is that CBO doesn't have a way to score them as providing savings and so presumes that they won't save money. But both Max's Medicare reforms and a real public option will probably result in real cost savings and a public option AND improved access to primary and preventive care will be popular with people. There's some things that can't be scored that easily.
Anyways, check Ezra's five ways to improve this bill. But my friends who are saying this bill needs to die are wrong. It has some excellent stuff in it. It needs amendments, but don't throw the baby out with this bathwater.
I got a surprised email last night, surprised because Max Baucus in a recent conference call with Demo county chairs endorsed a public option. The emailer was looking for confirmation.
I should clarify, though. Max, of course, didn't endorse a public option in this call. He reiterated his support for a reform he has publicly supported since the release of his white paper last November. As far as I know, what is surprising is not Max Baucus supporting a public option, but anyone thinking he doesn't because, as far as I know, his office has never told anyone that they don't support it.
Let me add some caveats now. I don't think his office puts the public option as the keystone of reform. Neither, clearly, does the White House. Nor do a ton of reform "experts," a stance that either undermines the meaning of that word or explains the prioritizing of Max and the White House.
There are other concerns as well. First, we actually have to pass a bill. Joe Lieberman is now being an extraordinary douchebag (like Max Baucus and the public option, this is not a new stance, but merely the reemphasizing of a long-held position) and saying we can't afford health reform (as Ezra explains in that link, Lieberman is full of crap).
Lieberman is hardly the only problem in the U.S. Senate. Kent Conrad appears to be a pain in the ass. Evan Bayh has been quiet for a while but could almost certainly rear his ugly head. Check the full whip count, spot Tester and Baucus as public option supporters, and you're still a few enchiladas short of a combo platter.
Assuming Joe Lieberman is willing to filibuster health reform for containing a public option (a stance that would not surprise me in the least) and that a handful of other Senate Democrats would consider it and that Ted Kennedy may be too sick to make the vote...we probably get Snowe to support cloture and maybe Collins. After that...where do the votes come from?
In comments recently, someone said something along the lines of "as I've said all along, if Democratic leadership could just get their caucus in line, none of this would be a problem." Well sure and if we already had a functioning universal health care system, none of this would be a problem either. Assuming the solution to the problem usually solves the problem.
The problem is that the Democrats haven't united. The second problem is Senate rules that let us pass a public option with 50 votes but would probably make it difficult to get meaningful insurance regulations with any fewer than 60. We have a solution here, too: split the bill into multiple bills. Reconciliation is an option going into motion, an option that may also force the hands of Lieberman, Grassley, Enzi, etc.
The third problem is that some Senators, including Max Baucus, are damn committed to including Republicans like Chuck Grassley every step of the way. But let's be extremely clear right now, this is only a problem if we take care of problem 1. If we have 60 votes except for one or two D Senators who are balking while waiting for more bipartisanship, then this third issue moves from "potential" to "actual" problem.
Right now, Max Baucus is blocking healthcare reform in the same way that I'm fighting a land war in Asia.
I'm down in Billings briefly, having just celebrated my grandmother's 80th birthday. She's a hell of a woman, I should note. She taught me the value of generosity and family. If I become one-tenth the person she has been in her life, it'll be an accomplishment.
Although I try to avoid talking work too much with my family, we had a short conversation yesterday about healthcare reform. There had been a number of jokes about death panels and someone asked me what I honestly thought was going to happen. I responded, as I often do, that the decisions at this point are largely outside my control and not anything I can really know, but that I hope we get something passed soon.
This surprised my family, which has (reasonably enough) bought into the argument that more discussion and debate is good, which it would be if discussion and debate are what we would get with more delay. But as the whole death panel episode shows, more delay doesn't mean more reasonable disagreements or good faith efforts to improve the bill. It brings new rounds of bullshit arguments used to divide and scare the public into opposing a bill that I think a majority would find, on net to be an improvement.
And the resources being used to answer questions and clarify this stuff is simply a pittance right now compared to the bullshit filling the airwaves.
But let me end on a positive note. The work that Max Baucus has been doing for months (years?) will prove helpful, I think, as we move closer to resolution. He'll be able to help keep wayward Dems like Conrad in the fold and pull over the Snowes and Collins of the world if this stuff changes gears quickly. A split the bill option for legislating is being taken more seriously, with folks like Chuck Schumer talking it up publicly.
We're still well on track for passing significant and meaningful health care reform this year, including a public option. That fact is pretty astounding. It is good news for this country, for all the currently insured who risk getting screwed by their insurance companies or risk losing their employer-provided insurance due to inflation, for all the currently uninsured who will have far more affordable access, and for everyone else who will, over time, benefit from improved quality and cheaper services...
It is bad news for some others. It isn't yet clear who exactly, although various pieces of the health industrial complex will hurt over time. It is bad news for Bill Kristol and probably for Mark T.
But for the vast majority of us, this will be progress of an historic sort. And, yes, even Max Baucus will be due a shit ton of credit.
The public option is now more politically important than policy important.
That's a testament to its political importance, though, not to its non-importance policy-wise.
Even though the public health insurance option may not be the most important policy innovation being considered by the Congress in the health care debate, it is almost certainly key to maintaining public support for passage of a bill.
That new Survey USA poll shows pretty clearly that Americans continue to favor reform and that Americans believe public plan choice is important.
Unsurprisingly, the demographics most supportive of reform are also the groups most supportive of the public option. But there is very, very little evidence anywhere that stripping the public option will win the bill backing from individuals who don't have it.
At some point, these bills will be clear enough to be evaluated by the public. At this point, a public option appears a necessity to maintain public support. Can we pass a bill that the public opposes? Theoretically, yes. In practice, I think it is difficult.
The flip side, if the final bill is backed by 55% of the public, Republicans will have a far tougher time opposing it.
Finally, haven't watched it yet, but Jon Stewart apparently kicked Betsy McCaughey's ass on the Daily Show last night. It couldn't happen to a more deserving liar.
