What do folks think of the latest suggested compromise for the public option?
This idea — which has a lot of liberals excited — would create a Federal public option. But it would also allow any individual state government to decline making the public option available to their citizens.
The hope is that conservative Democrats like Ben Nelson, who oppose a public option, would be willing to vote for this, since it essentially punts the public option decision to state legislatures. (Both Nelson and Lieberman have said this idea is “worth looking at,” which isn’t a commitment, but it is the most positive comment they’ve said about any public option proposal so far). At the same time, more liberal senators would (one hopes) be able to get a reasonably strong public option for their own constituents.
What’s nice about this policy, I think, is that it’s easily adjustable. If the public option turns out to be a disaster, this would make it relatively easy for states to drop it. But if it is in fact successful, then it would be easy for states without it to change their mind.
Of course, the devil is in the details, and this proposal is so new that there aren’t any details to look at yet. And the conservative Democrats may yet decide to oppose it, or water it down to the point of uselessness.
Another idea being floated that’s gaining a lot of interest — and could possibly get some Republican votes — is a two-year tax break to companies that either hire new workers or bump up their part-time workers to full-time. There seems to be a fair amount of economic evidence that this policy could jump-start hiring, so I’m for it.
The biggest fear expressed by people has been that poor Southern states will be most likely to opt-out, meaning we’re not helping the people there. I get that, but think that the most likely outcome is that no state will opt-out once the bill is passed, just like nobody turned down stimulus money. Once it’s passed, it’s a cheap alternative that nobody will be willing to deprive their citizens of, even as they complain about the heavy jack-boot of Uncle Sam.
As you said, devil’s in the details, but I think this is a plan that could a) pass and b) get the public option to the most people the quickest, unlike, say, a trigger plan.
I myself don’t view the public option as the deal-breaker (I’m more concerned that subsidies are robust), but I’d rather it was in than out. I think this gives us the best shot of getting it passed, and we should take it.
In some sense, it will be like Medicare, in that states themselves are responsible for implementing it; and I seem to recall that there was an opt-out option for Medicare which no state has ever dared think about implementing. So in that sense, it might work.
Another possibility is to lower Medicare/Medicaid eligibility thresholds in any states which do opt-out of a public option, to mitigate the effect on their citizens.
Strikes me as a total weasel move, punting the actual decisionating down to the state legislatures, but since the 24-hour news nets barely even know that state legislatures exist, it’ll be easier for them at that level with the peanut gallery looking at oh I don’t know the forged art in the White House, it’ll be easier for the ledges to do the ONLY SANE GODDAMN THING than it is for the fucking utter reject cowards at the national level.
So in that regard I guess it’s pragmatic but Jesus H. Christ in a motherfucking sidecar.
(There was a reason I was no longer paying any attention to the news. Was it the effect on my vocabulary? Or blood pressure? Hmm.)
Ray,
There were a number of states that opted out of Medicaid. Arizona was one. They finally got around to it something like 20 years after the rest of the country, and they have to this day extremely low income limits for qualifying. I don’t know much else about it.
As a compromise, I’m not crazy about this, but if the choice is no public option or opt-out public option, I’d rather see opt-out. I’m kind of concerned about mandating people buy insurance without a public option available.
If they go this route, in most states they’ll be on board right away, but in some states it will be really controversial and they won’t do it. If the public option proves successful and beneficial, the states that opted out will come in one at a time, with a lot less fanfare than we’re seeing now. And 20 years from now, someone will post a YouTube clip of some presidential hopeful who was then a state senator decrying the public option, and it will be so anachronistic that it won’t even hurt that person’s political prospects.
As for the ‘tax breaks to create jobs’ idea, I’d be in favor only if it was paid for by an increase in income taxes on the super rich. Otherwise it would likely be much more efficient to create jobs via direct government investment (say into solar energy or wev).
These look like the sorts of proposals that I enthusiastically support until someone says “well, here’s how it hurts poor people and homosexuals” and I have to change my mind.
Until then, though, I like the opt-out idea, it’s the sort of thing that actually shows the benefit of not having too strong a central government: on the one hand, if it turns out Kansas (or wherever) can get along just fine without a public option, they can do so without it affecting me, and on the other hand, if people/pols in Missouri or wherever don’t want any part of a public option because the president was born in Kenya, they get the consequences of their behavior without it affecting me.
I’m someone who considers a public option/”Medicare for anyone who wants it” to be an essential. Otherwise, what we’re talking about is just another way to funnel tax dollars to a rich bunch of bastards, turning heath care into another quasi-power like the military industrial complex.
On the other hand, voters in the “red states” seem hell bent on supporting government policies that would turn the United States into a military junta/ plantation economy. It’s been shown time and again that states that vote Rebublican majority GET more Federal money than they pay in Federal taxes, a simple proof that these people VOTE AGAINST THEIR OWN INTEREST in the majority.
So I’m actually kind of thrilled at the precedent a “public option opt out” would set. It would let the “blue states” live a 21st century existence, and we could just sort of let the deep south and the fly-over zone drift back into the 19th Century.
Maybe they’d oft out of highway funding too. More money for MY state’s roads. Let them opt of of Federal money for education; let Texans forget how to read, Marylanders can use the money instead.
Instead of letting 35-40% of the population drag the rest of us down, let’s just give them the option to just go to hell. Here in Maryland, we can look across the border at Virginia and shout “Ya know, you DID have the option to be civilized.”
The tax credit thing is a scam. Companies will simply lay off a large percentage of their work forces a week or so before the law goes into effect, and then hire them back and claim the tax credit. It won’t create any net jobs, but it will increase corporate profits at taxpayer expense, which is why the plan is gaining traction with Republicans and corportist Dems.
A real solution to the jobs problem is to just do what FDR did, which is have the government hire millions of people for public works projects. A more likely solution is expanded wars in Iraq and Afganistan and new wars in Pakistan and Iran to make use of all the idle, out-of-work young people in America.
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I’m totally for a public option being punted to the states (I think its a good compromise and the federal government could provide incentives for adoption). I’m not so big on the hiring tax credit. I think, all too often, that the government uses tax breaks to try and shift behavior and it backfires.
Take the estate tax as an example. It started out that the government’s intent was to keep an American Aristocracy from developing by taxing wealth that the rich accumulated over a lifetime. All we’ve done is create a huge burden for family businesses and provide corporate welfare for life insurance companies that market “second-to-die” life insurance as a way of avoiding the estate tax.
The reason most family businesses don’t owe estate tax is that they have paid thousands of dollars a year to tax preparers and insurance companies who play a shell game with the IRS using tax exemptions. Llife insurance companies spend millions of dollars a year on lobbyists to keep the estate tax in place. Warren Buffett didn’t testify in favor of the estate tax out of the goodness of his heart. His company owns several insurance companies.
Its time for Congress to stop supporting insurance companies and get serious about progressive tax reform. We need to overturn the estate tax and put in place a progressive income tax that reaches 95% on income over $4 million. That’ll stop corporate gluttony and increase our tax base in the meantime.
A public option for some is better than for none. But I would encourage commenters who would gleefully see red states drown to remember that not everyone in a conservative state is an asshole. Even in the reddest of red states, at least a third of the population votes blue. And even though they may be assholes, they are all human beings, and if we are going to argue that we, as citizens, should be entitled to basic health care, then that entitlement should extend to asshole citizens, too.
Two concerns about the opt out:
1) It undermines the principle that access to health care should be universal.
2) It seems like killing a fly with a sledgehammer. My guess is that those states most likely to opt out would be red states represented in the Senate by Republicans who aren’t going to vote for a public option under any circumstances. If the opt out is the only way to get a public option, then I’m for it, but perhaps political energies would be better spent using more conventional political arm-twisting to pressure the handful of conservative Democrats needed to end a forthcoming filibuster.
For insights into who might be most affected by states opting out, check out the Census Bureau’s recent study on coverage in red versus blue states: http://www.nytimes.com/2009/10/10/business/economy/10charts.html?scp=3&sq=health%20insurance%20coverage&st=cse
Two things I’d really like to see: naturally occurring testosterone taxed as a pre-existing condition, and no federal tax money going to the purchase of Viagra or Viagra-like medicines until the concience clauses and the Hyde Amendment are repealed.
I can practically promise you that if state legislatures get to opt out, Tennessee will opt out, since it is the home base of a number of huge health care and health insurance corporations who stand to lose from genuine competition. Which, considering that I live in TN and am woefully underinsured, does not thrill me. Nor do I see how it will help the uninsured folks in TN — and we have a large number of them here.
And as for the idea that no one turns down free money, my Congressman made a big point of how he wouldn’t submit any proposals to be part of the stimulus package that would benefit the district, since that would be wrong. So we didn’t have to turn anything down; it wasn’t there for us to take. Don’t ever bet against the ability of politicians to grandstand their constituents into needless troubles.
And as for the idea that no one turns down free money, my Congressman made a big point of how he wouldn’t submit any proposals to be part of the stimulus package that would benefit the district, since that would be wrong. So we didn’t have to turn anything down; it wasn’t there for us to take. Don’t ever bet against the ability of politicians to grandstand their constituents into needless troubles.
Well, there’s a difference between “proposals to be part of the stimulus package that would benefit the district,” i.e. earmarks, and refusing to accept money from generally-applicable programs that your constituents are eligible to receive. One can make a principled stand against earmarks as a constitutionally-dubious method of allocating funds that Congress has appropriated.
Personally, I think it’s better to leave the details of allocation to the Executive once Congress has stated what the money is supposed to be used for in a broad sense. For example, Congress should definitely make clear that the money it has appropriated for sex education is not supposed to go to abstinence-only education, but the contract for writing the sex ed textbooks should go through the normal bidding process through the Department of Education rather than being assigned to a publisher in a particularly powerful Congressman’s district.
It’s not within a federal Congressman’s power to turn down money that’s been allocated to a state; that’s a matter at the local level. Interestingly, you’ll notice that Republican governors were the ones saying they wouldn’t take the stimulus money, but Republican legislatures overrode them. The more local it gets, the more a rep in the state house will have to go home to the 5,000 people who make up his entire district and explain why he voted against taking free money from the feds.
@Brian: That’s a mighty broad brush you got there. I guess I shouldn’t bother giving to Democrats at the national level anymore, since we don’t matter. In fact, that whole bit sounded an awful lot like Roy Moore shrieking about ECLs trying to take Jesus away from people.
@nm: Like you I’m from a southern state (Alabama) and words can’t express how thrilled I am by the reaction to this considering how hard we’ve fought for health care reform. It’s always heartening to know just how rapidly your “allies” will abandon you when it’s convenient. Especially when it means that your state opting out will force you (thanks mandates!) to pay soaring premiums to the very people they claim are the heart of all that’s evil.
If y’all think Alabama, Mississippi, Tennessee, Texas, and possibly Georgia and the Carolinas won’t opt out, you’re sorely mistaken. Of course since our electoral votes don’t count toward blue candidates, we cease to exist. Which sounds an awful like another group I know, now that I think about it…
Sure that’s an insulting thing to say, but if you don’t like how the shoe fits, stop trying it on.
IGMFU: Not just for conservatives anymore.
Denise;
I grant your points. In a perfect world, we could drag the Red States into the 21st Century, with their majority of self hating cretins kicking and screaming the whole way.
But I’m from Maryland. A blue state, one of the first you hit as you flee the south along the east coast. We’ll take in refugees as they flee the self-inflicted hell that Virginia and the Carolinas have decided by majority vote to become. Plenty of room on our eastern shore.
When the village you’re in gets over over run by vikings, you move. That’s the rule.
JThompson, what’s your solution for the fact that a viable, nation-wide public option appears to have almost no chance of passing the Senate? Would you prefer no public option at all, to an opt-out public option?
I can’t tell if the folks who are protesting against the idea of an opt-out public option just don’t believe in the states as meaningful political entities, or if they’re opposing federalism simply in this instance.
If someone claims “how hard we’ve fought for health care reform,” does that mean he’s actually worked on convincing his neighbors to vote against their state legislator if said legislator won’t commit to voting for the public option to be available in that state? Some politics is still local.
Would the states that opt out of the public option be opting out of the mandate to have insurance?
Ever lived in a place with a time-limited incentive for hiring? The result: unskilled labour firms get very good at constructive dismissal of employees nearing the end of the tax-incentive period.
It’s a good idea, but not without hidden gotchas.
Rosa,
The insurance companies will balk at the requirement that they insure people notwithstanding pre-existing conditions, and stop their abusive rescission practices, if there isn’t a mandate that people carry insurance at all times. This is perfectly logical: in the absence of a mandate, it’s in my self-interest not to buy insurance, but instead to pay for medical care as I need it, until I find out I have a significant, expensive condition (a risky pregnancy, a lump in my breast, a blockage in my heart), at which point I apply for insurance and demand my federal statutory right to be covered notwithstanding this pre-existing condition. “Moral hazard” is just a fancy phrase for “selfish interest.”
I think, as with the stimulus funds, state legislatures will be hard-pressed not to accept the public option as their constituents organize and clamor for it.
PG – I understand why insurance companies want the mandate. But my question about the opt-out (tied to JThompson and some other commenter’s worries about their own states) is if the stick (mandate to buy insurance) is ALSO opt-out.
It seems like a no-brainer that a mandate with no public option will just raise costs for everyone who buys insurance – that’s what happens, for instance, with car insurance, and that’s not really a mandate for everyone, just everyone who wants to drive their own car.
Over 60% of All US Bankruptcies Attributable to Medical Problems
Most victims are middle class, well educated and have health insurance
August 2009 issue of The American Journal of Medicine
In 2007, before the current economic downturn, an American family filed
for bankruptcy in the aftermath of illness every 90 seconds; three-quarters of them were insured. Over 60% of all bankruptcies in the United States in 2007 were driven by medical incidents.
The share of bankruptcies attributable to medical problems
rose by 50% between 2001 and 2007.
http://www.amjmed.com/webfiles/images/journals/ajm/AJMMedicalBankruptcyJun09FINAL2.pdf
They are crushing the overall markets from coast to coast – skimming as much of the froth off the top of the middle class as they can so much so that we can’t even afford movie tickets anymore. And they have an anti-trust exemption (like baseball) – the whole insurance industry is an albatross around the neck of the entire economy.
Paul Burke
Author-Journey Home
@Ampersand: Like Rosa said, I consider the mandate + opt out throwing us under the bus. If our backward leaders opt us out of health care, I want to be opted out of a mandate. If that happens, I won’t like it, but I’ll be ok with it. It’s mostly the mandate + opt out that’d make me angry with the Democrats.
Telling us we have to pay the health insurance companies or pay the government isn’t going to endear anyone to anyone. Especially since the fine is actually cheaper than the insurance. So what you’re going to get is a whoooole lot of lower-middle class people getting introduced into the criminal justice system because they can’t afford the insurance or the fines. I’m not willing to destroy the middle class in one part of the country for the sake of the middle class in another.
I don’t imagine it’ll look good for the Democratic party as a whole once the stories start trickling in about how the mandate annihilated families by forcing them to sell their only car and/or stop feeding their children so they could pay their “Not having enough money or living in the right state.” fines.
A large part of my hostility is also from the sheer number of Democrats that are openly saying what amounts to “Good! Let all those people from the south die! They’ll stop voting Republican then!”.
It seems like a no-brainer that a mandate with no public option will just raise costs for everyone who buys insurance
Is the idea that without a public option to keep rates competitive, the insurers will raise rates secure in the knowledge that people have to pay whatever they charge, even if rates get to the point of making self-insurance (i.e. paying out of pocket as you go) a more sensible option?
Yes, that’s exactly the idea. If there is no public option, private insurers will just keep raising rates up to what the market will bear, and if the fines are actually high enough to make people buy insurance they will provide a floor for insurance costs, but there will be no ceiling.
The idea of a low-cost option guaranteed by the government to reflect actual cost, coupled with a mandate for healthy (cheap) people to buy in, is that it lowers costs over the whole system and passes that lower cost on to people who buy in. If you have just the mandate, you have the possibility of lowering costs to the insurer but no way to make them give that back to those buying in.
So what you’re going to get is a whoooole lot of lower-middle class people getting introduced into the criminal justice system because they can’t afford the insurance or the fines.
What exactly is the income level we’re thinking about here, at which people can’t afford the fines but will be expected to pay them? At least in the House bill (HR 3200, Sec. 401), the tax is a percentage of adjusted gross income (i.e. the income on which you’re expected to pay taxes, which is the money you made minus the standard exemption, various deductions, etc.). To be precise:
IRC SEC. 6012. PERSONS REQUIRED TO MAKE RETURNS OF INCOME.
6012(a) General Rule. -Returns with respect to income taxes under subtitle A shall be made by the following: 6012(a)(1)(A) Every individual having for the taxable year gross income which equals or
exceeds the exemption amount…”
So what’s the household income point at which someone will be subject to this tax, but also would be selling a car in order to pay this tax?
If you have just the mandate, you have the possibility of lowering costs to the insurer but no way to make them give that back to those buying in.
One thing to be said in favor of a bill 1000+ pages long, they will have covered a lot of possibilities.
The downside of 1000+ pages is that even after having read it, I don’t remember everything in it, so I forgot to tell the person who was brandishing this WSJ editorial at me that HR 3200 Sec. 102 grandfathers in existing enrollees of insurance plans that otherwise would not meet the new law’s requirements.
As I look at the WSJ editorial page (something I generally avoid), I find myself in reluctant agreement with them that tax breaks for hiring are not the best way to encourage job growth. Though I’d like to point out that a temporary suspension of the payroll tax — something that puts more money in employees’ pockets each week to go spend, while also making employing them cheaper for the employer — as a method of boosting the economy is something I’ve favored since the last recession.
If someone claims “how hard we’ve fought for health care reform,” does that mean he’s actually worked on convincing his neighbors to vote against their state legislator if said legislator won’t commit to voting for the public option to be available in that state? Some politics is still local.
It does in my case.
@&:
Assuming for the sake of argument that a public option with an opt out clause is preferable to no public option, the opt out question is basically a tactical one – what’s the best way of getting a public option through the Senate? From this point of view, the central issue is whether you are correct that “a viable, nation-wide public option” has “almost no chance of passing the Senate.” What’s your reasoning on this point?
On a more idealistic note, there does seem to be a disturbing amount of “Good! Let all those people from the south die! They’ll stop voting Republican then!” going on in this discussion. Note that, according to the Census Bureau study I referred to previously, the districts with the lowest rate of health insurance coverage tend to be districts in Republican states that have high poverty rates and large ethnic minority populations, and that vote Democrat.
@ 33,
At least from me, the willingness to allow for states to choose not to offer a public option to their citizens is not at all based on a desire to have “all those people from the south die!” I grew up and still have nearly all my family and many of my friends in Texas. Texas was one of the loudest in opposition to the stimulus, until Gov. Goodhair was faced with the prospect of actually declining $17 billion, at which point he accepted every penny under the guise of it really just being Texans’ federal tax dollars returned to them.
Rather, I would:
(a) like for some form of the public option to pass, which currently seems unlikely, considering that it’s not in the Senate bill that just got out of committee and that’s a pretty big thing to have to get reconciled in conference. If even the Democrats on the Senate Finance Committee wouldn’t vote for the public option amendment to the Baucus bill, how do you think it’s going to manage to avoid filibuster and pass the Senate? Olympia Snowe is going to scare like a hare if the bill has a public option that states are forced to accept. And
(b) predict that, just as with the stimulus, many states currently bitching and moaning about having to accept the federal government’s rules will have legislatures that discover their constituents would like to be able to buy into the government insurance program, and we’ll see an about-face on this issue among many red states.
@34:
1. If adding an opt out clause doesn’t significantly improve the chances of passing health reform with a public option, then whether it is good policy is irrelevant. (I’m leaning in favor if it came to that, incidentally.)
2. You overestimate the significance of the Baucus Bill (the conservative one coming out the Finance Committee).
Here’s where we’re at in the legislative game: The Senate Democratic leadership needs to synthesize the Baucus Bill with the Kennedy Bill (the more liberal one coming out of the HELP Committee that includes a public option). Then that synthesis can be amended on the Senate floor. Meanwhile, the House Democratic leadership is merging three bills into something that looks a lot like the Kennedy Bill. Then a compromise will be made between that and whatever came out of the Senate process.
In short, any health care legislation that passes will be a compromise between the Baucus Bill and two other pieces of legislation, both of which include a public option. And the Senate floor is more liberal than the Finance Committee. And the House is more liberal than the Senate. And public opinion is behind a public option.
3. There are several procedures by which the Senate could pass a bill: by a 60-vote filibuster-proof majority; by 50+Biden (after convincing 60 senators to vote for cloture); with 51 votes during budget reconciliation (the public option could also be passed this way separate from the main legislation, I believe).
In short, Senate Democrats haven’t begun to use up their procedural options.
4. There is a concerted effort to sway conservative Democrats (and who knows, perhaps the odd Republican?). There are ad campaigns being run and demonstrations being held targeting Senators who are out of sync with public opinion in their state. There are calls to relieve Democrats of committee chairmanships if they don’t vote for cloture. (Granted, this would require Harry Reid showing more, let’s call it chutzpa, than we’re accustomed to seeing, but you never know.)
More importantly, President Obama is meeting regularly with conservative Democrats, presumably using every bit of coercion, bribery and moral suasion at his disposal to steer them his way. He’s the best thing that’s happened to the party in a long time, and he knows how to use it. And he’s staked both his own and the party’s domestic policy credibility on health care reform. And he favors a public option.
In short, it’s not yet clear what the floor vote count is. Does Dick Durbin even know for sure?
Side note: The toughest one to cajole into breaking a filibuster would seem to be Baucus himself – leads in health industry campaign contributions, and not up for re-election until 2014. But maybe he wants an ambassadorship or something.
5. Granted, it’s a close fight. However, not all of the options outlined above have been played out yet, and an opt out clause involves a substantial compromise in terms of the number of people actually helped by this legislation. How many seats will it buy, and why make that compromise now?
The problem isn’t so much getting it procedurally through the body. The problem is that Democratic Congresscritters are (rightly) terrified of seeming to “shove the bill through”. Everybody knows it’s going to have some terrible consequences; even a competely-drawn bill would cause terrible disruptions and offer all kinds of ammo for political opponents. So it’s very difficult to vote for it without being able to say “but look, it was bipartisan!”
Here’s what Congressman Halftrack will hear on his TV if he votes to ramrod a party-line bill through:
“Because of the Health Care Reform Bill, little Jenny Linderman wasn’t able to get her leukemia drugs on time. Little Jenny Linderman died. Congressman Halftrack voted for the Health Care Reform Bill. He killed little Jenny Linderman. Do you want Congressman Halftrack to kill YOUR little girl? Vote against Congressman Halftrack. He is bad.”
@35,
I’m not sure why Robert is fantasizing about little Scandinavian girls unable to get their leukemia drugs (is there something tucked into one of these bills about preventing people from using existing medications?), but yes, there are significant political problems with passing the public option during budget reconciliation or using other dubious procedural maneuvers to pass the bill. I’m not sure how you imagine there are 60 votes in the Senate for a nationwide, no-opt-out public option, given that the Finance Committee votes showed that there are three Democrats (Baucus, Conrad, Lincoln) who are opposed to both the Rockefeller and the Schumer versions of a public option, and I haven’t heard of a single Republican senator who favors it.
Robert’s assumption that it’s all down to a craven desire for personal reelection seems unlikely, given that Sen. Carper of DE (Biden’s seat-warmer, who is stepping aside for Biden Jr. to run) voted against the Rockefeller proposal but for the Schumer one. Every now and then, someone actually has an opinion about legislation beyond whether it gets him reelected. Sometimes it’s even based on what he thinks is good for the country. Craziness!
@PG: Ever tried to get insurance for a sick kid or spouse? The mandate fine is going to be a lot cheaper than that.
Even if the mandate is 2 grand (The insurance companies are certainly pushing for it to be a lot higher than that.), for a family of 4 that’s still 8 grand a year. For people that couldn’t afford medical care in the first place.
As for our politicians seeing the light: I’ve been having nightmares about seeing “Governor Roy Moore” in headlines for a while now. I don’t think it’s likely to happen, but it’s a definite possibility. There’s a lot of support for it. These people are crazy and certainly not above sacrificing lives to prove a point.
Er, that seems like a rather cynical and bloodthirsty attitude to attribute to people here.
Personally, I’m interested in hearing more about whether the opt-in option would help get the public option included in legislation, because:
1) barring universal health care, which I think is the only option that really fits with my morality, I at least want to see the public option as a half-measure;
2) if making the public option opt-in for states might get it passed, I’ll take that as a half-measure of a half-measure in hopes that it can be improved to a whole measure later; and
3) if residents of states that opt out are angry about being denied the public option, I’d hope they’d communicate their displeasure to their state officials, and then vote them out of office if said officials didn’t do the will of their electorate, or do an end-run around them via ballot measures.
I don’t want anybody to suffer because of the hard-headedness of politicians; lacking a way to ensure that, I’d at least like to see the inevitable suffering directed in a way that might force some of the politicians to change their positions or lose their jobs and, in the same blow, decrease the overall leval of suffering.
The problem with section 116 is that enforcement will come after the fact (that is, if the company raises rates so much they make too much money, the Commissioner will fix it with fines or changes to future years) and the money won’t go back to the people who had to pay for coverage or pay fines, in general – there might be litigation that returns money back to defrauded people, but it’s mostly between the insurance companies and their regulators. The power of citizens in that case is very diffuse – you can vote for officials who will put pressure on the regulators.
What the public insurance option is for is to give people the ability to vote with their feet – the only real options citizens have vs. the insurance system is individual action (becoming really rich, or adopting alternative care, so you can comfortably pay for all care out of pocket) or cooperative action on a scale as large as corporate medicine – that is, the government.
And I forgot to say – i do appreciate you actually quoting the bill. I have not read all of it, and having concrete facts in the discussion is really helpful.
@36:
Could be, but I don’t buy it:
1. There’s little indication that there will be substantial bipartisan support in the Senate for any health care reform legislation, so concern for appearing bipartisan is moot.
2. If Republicans are going to pull the “little Jenny Linderman” tactic, they will do so regardless how the bill passes or what it’s effects are. (And if the health care reform that passes is popular, they won’t have much interest in attacking it after the fact.)
3. I find it doubtful that voters in 2010 or 2012 will care more about Senate rules of procedure than health care reform.
The one way Democrats could fuel criticisms of health care legislation after the fact would be to pass a bill that sucks. Even then, it’s not clear to me that that any horrible consequences produced by bad legislation would have come to light by fall 2010.
In short, good legislation breeds political success.
@37:
1. Persuading 60 Senators to vote for cloture, only 50+ of whom go on to vote for the bill, is not “dubious,” it’s simply the Senate rules of procedure. It’s even pretty easy to sell to the public – “no matter where you stand, this important issue deserves a straight up or down vote!” The other option I mentioned, pushing a public option through budget reconciliation, is more controversial, but once again I doubt that voters care that much about procedural rules.
2. Strictly speaking, the Finance Committee votes showed that those three Democrats voted against the public option amendments in the Finance Committee. That could mean that all three are firmly opposed to the public option. It could mean that they favor minimal health care reform, and therefore want to bargain from a more conservative position when it comes to synthesizing the two Senate bills. It could mean that they can be bought but wish to be bought dearly. Only Chuck Schumer knows for sure, and he ain’t telling.
In short, votes in committee (or anywhere else) are not final statements of a legislator’s policy position. Legislators bargain.
As just one interesting example, there is some evidence (Democracy Corps Survey) that Republican Senator Olympia Snowe could be moved on this issue, specifically that an overwhelming majority of people in Maine support a public option, that they prefer a universal public option to one with an opt out clause, and that voting against health care reform would hurt her in the next election. (See also Pan Atlantic Poll)
3. Passing a bill in the Finance Committee has given very strong momentum to passing health care reform. If presumption is that reform will pass, it’s easier to make conservative Democrats look like they’re getting in the way of progress if they block legislation over the public option issue.
4. Filibusters can have a political cost. If conservative Democrats refuse to vote for cloture, they and filibustering Republicans can be portrayed as engaging in political shenanigans instead of seriously addressing the central domestic policy issue of our time, etc. The question becomes how long they can hold out under intense political pressure.
Note that President Johnson managed to persuade Southern Democrats to vote for cloture on the 1964 Civil Rights Act (after a 57-day filibuster, I might add!). There’s no way conservative Democrats voting for a public option today would face that level of political cost to themselves.
My question stands: How many Senators could be swayed by an opt out clause who cannot be swayed by other means?
Phil, Phil, you ignorant slut, how many people did you sleep with to get this job, anyway?
[Phil and I are old friends for anyone drawing the wrong conclusion from that line.]
1. There’s little indication that there will be substantial bipartisan support in the Senate for any health care reform legislation, so concern for appearing bipartisan is moot.
They don’t want to appear bipartisan. They want Republican votes to make it impossible for their Republican opposite number candidates to say “see, look what the Democrats AND ONLY the Democrats did”.
It’s like taking your little brother with you to commit a crime. It’s not so much that you want his help, as that you want to make it unattractive for him to rat you out.
2. If Republicans are going to pull the “little Jenny Linderman” tactic, they will do so regardless how the bill passes or what it’s effects are.
True. But the Dems aren’t worried about the effects of the bill; they’re worried about leaving the Jenny Linderman window open, by not having Republicans on board.
The Dems aren’t hoping that the bill will be wonderful and so that thus the Jenny Linderman tactic will fail because of its implausibility; they’re hoping that Republicans will get on board so that the Jenny Linderman tactic will not be deployable in the first place – similar to how Bill Clinton couldn’t go after George Bush for being a draft dodger.
3. I find it doubtful that voters in 2010 or 2012 will care more about Senate rules of procedure than health care reform.
Nobody cares about Senate rules of procedure.
In short, good legislation breeds political success.
You are so cute I could eat you with a spoon.
George Bush served honorably. Al Gore and John Kerry, as I recall, did bring it up wrt his son.
To address your actual post, how many people are going to fall for “the Democrats rammed this through” if it makes them better off? Victory has a thousand parents and all that. I don’t think Democrats need to worry more about making it look good than about improving people’s lives.
Then again, I also think businesses can make money by serving customers (within reason), so, shows what I know.
how many people are going to fall for “the Democrats rammed this through” if it makes them better off?
Whether it makes them better off will be an interesting subject for many future discussions, but within the timeframe of 2010 and to a lesser extent 2012, it is very unlikely that any of the bills under discussion are going to make anyone better off, simply because they won’t have taken effect. The bills haven’t even passed, but the 2010 election season starts in earnest in about three months; most of the provisions don’t start until 2013.
So the image of “how it was done” will swamp the “this bill saved/killed my baby!!!” reactions for quite some time.
Phil:
1. I think the Senate is something of a black box. There are a bare handful of Senators who might or might not vote for health care reform. I don’t know if (for example) Ben Nelson would actually refuse to vote for closure if a strong, full public option was included in the legislation that the full Senate will vote on. No one can know that for sure, other than Nelson himself.
But I think it’s plausible that he would. He’s in a highly conservative state, and he’d be welcomed by the Republicans if he switched parties; there are real limits to how much pressure the Democratic leadership can put on him. (He’s the mirror image of Olympia Snowe as far as that goes.)
Furthermore, Nelson probably strongly wants to be able to show results to his constituents. He needs to be able to either say that he killed the public option, or that he gave Nebraskans the right to opt out of it. It’s very possible that Nelson would vote against health care (including not voting for closure) if he can’t claim to have gotten a major concession some other way.
So we can’t know for sure that it’s true that a full public option can’t pass. But we can’t rely on it not being true, either. And a lot of fairly smart, liberal people who watch the Senate closely seem to believe that there might not be 60 votes for closure if there’s a full, strong public option.
* * *
2. Regarding Senator Snowe, she did vote for health care reform in committee, and she almost certainly will vote for the final legislation, since they’re almost letting her write it. (And I’ve seen it argued that this is a good thing, since her being willing to vote for it makes Nelson’s vote less important, and if you look at the amendments they’ve proposed and voted for, she’s seemingly a bit to the left of Nelson on this issue).
What I’m curious about, which your link didn’t address, is why Senator Collins — who faces the exact same electorate as Snowe — isn’t a potential vote for health care. Neither one of them has to face voters in 2010 (Snowe faces reelection in 2012, Collins in 2014). Collins is less popular, so if anything she should be more sensitive to going against what Maine voters want than Snowe.
* * *
3. In theory, filibusters can have a political cost. In practice, however, the Republicans have been filibustering routinely for the last year, and they don’t seem to be facing much cost.
Robert, I don’t think Democrats think there’s any hope of getting Republican support for this bill, apart from Olympia Snowe’s vote. I do think that Democrats think that visibly working hard to get Republican support, but failing to get it, might benefit Democrats among some independent voters.
In other words — contrary to what Phil wrote in @42 — even without Republicans voting for the bill, Democrats can still hope to appear more “bipartisan” than Republicans, for the sake of voters who think being “bipartisan” is important. Quoting from the first Maine survey Phil linked to:
Of course, that won’t work with strongly Republican voters — but it might work with more persuadable voters. I don’t think it’s self-evidently foolish of Democrats to give it a shot (looking at it solely from the perspective of trying to limit the extent of the likely Democratic losses in 2010).
You’re right that passing health care won’t make a big difference to elections in 2010 or 2012 (although iirc some of the bill’s provisions will take effect by 2012). But it could make a big difference in the long term. I continue to think that in the short term, what’s going to make the biggest difference is whether unemployment is heading up or down in the months leading up to the elections.
In practice, however, the Republicans have been filibustering routinely for the last year, and they don’t seem to be facing much cost.
I occasionally watch C-Span because I have no life, and I haven’t seen any filibusters. Which bills have Senate Republicans filibustered this year?
Of course, that won’t work with strongly Republican voters — but it might work with more persuadable voters. I don’t think it’s self-evidently foolish of Democrats to give it a shot (looking at it solely from the perspective of trying to limit the extent of the likely Democratic losses in 2010).
And as everyone from Jon Stewart to George Will has noted, we need to get health care reform passed in the next 12 months, or it won’t happen — it’s very unlikely that with unemployment this high, Democrats will be able to retain all of the Senate seats they currently hold (particularly considering that four of them are held by unelected appointees filling in for Clinton, Obama, Biden and wossisname).
PG, I was technically incorrect — they’ve been using the threat of the filibuster, and since Reid has seemingly settled on a strategy of never allowing a bill to come to a vote unless he has the votes for cloture, there have been few successful filibusters this year. There have not been any cases where the Senate has been kept continuously in session for a filibuster.
Which isn’t to say that the filibuster isn’t a very effective tool for Republicans — they’ve successfully constrained the Democrat’s agenda to a huge extent.
That said, the Republicans did have a successful filibuster just a couple of days ago. And the Democrats have needed to invoke cloture multiple times, such as in the confirmation of Harold Koh, and to pass the Lily Leddbetter Fair Pay Act.
Re: “we need to get health care reform passed in the next 12 months, or it won’t happen…”
I agree that this Congress is the best shot the Democrats have at passing health care, for the reason you state. Did I seem to be saying anything that contradicts that? If so, I misspoke.
Amp, I didn’t intend the “need to pass it this year” as a contradiction of what you were saying, just as an amplification or extension (hence the “And” rather than “But” :-)
I am not quite sure at what point debate becomes filibustering. At the extremes, it’s obvious; e.g. when senators start talking about stuff that has absolutely nothing to do with the measure under discussion, or when a single guy is giving a Qaddafi-length speech. These actions clearly meet the definition, inasmuch as they are deliberate obstruction of a vote on the measure. But in the article you linked, Mitch McConnell evidently thought there was real debate occurring: “Minority Leader Mitch McConnell (R-KY) said that Reid was making too big of a deal out of this vote. He thought members were very close to reaching an agreement on a list of amendments to take up and encouraged Democratic leaders to continue those talks instead of forcing an end to the debate.” So that seems more like an “in the eye of the beholder” situation for determining whether there’s a filibuster occurring.
@43:
1. Hi Rob.
2. I don’t disagree. However, this seems to boil down to a difference between the Republicans saying “This bill was completely partisan!” and the Republicans saying “This bill was overwhelmingly partisan!” A real political consideration, to be sure, but a rather minor one.
Furthermore, you’re basically claiming that if health reform gets one Republican vote, Republican politicians will not denounce the bill as partisan. That assumes levels of moderation and party discipline that don’t really characterize the Republican Party at present.
3. I stand by this point. Allow me to clarify what I mean by it: Some opposition to health care reform is just that. Some of it is driven by opposition to Obama. Much of it, however, is driven by uncertainty. If a health care reform bill passes, and voters see that it’s actually working (more people are covered, their insurance rates haven’t skyrocketed, the government hasn’t killed their grandmama), that will take the steam out of the opposition. Even legislation that simply avoids obvious negative consequences could have that effect. Legislation with immediate bad effects, by contrast, would be politically disastrous for the Democrats.
This underscores the importance of passing a health care reform bill that actually works.
As you yourself note (43), health care reform won’t have any real effects before the midterm election. This pretty much leaves us with reform legislation being blamed for things that had nothing to do with it. Since that will happen no matter what the legislation does and how it was passed, it’s not a real political consideration.
Furthermore, success breeds success. I suspect that if Obama can get a major health care reform passed which doesn’t have immediate catastrophic results, it would give him (and the Democrats) the reputation for being able to get things done. This, in turn, would make it easier for them to get other things done. This would be great for liberals, bad for conservatives.
In short: I agree with Jim DeMint to the extent that, if Obama fails on health care reform, it will be his Waterloo. Or maybe his Leipzig. But if he succeeds on health care, it could very well be his 13 Vendémiaire.
Sorry, I’ve been looking for an excuse to use that line for quite a while now.
@46&47:
1. At last! The person to whom I addressed my original post is actually responding to it!
2. If I may say so, you do a lot of dodging the question here. I know the Senate is something of a black box. I’ve been saying as much all along. If the Senate weren’t something of a black box, I wouldn’t have had to raise my question in the first place. And the reason I’m raising it because this fairly smart, liberal person who watches the Senate closely was hoping that some other fairly smart liberal people who watch the Senate closely would be able to help him assess the competing health reform strategies being proposed by smart, fairly liberal people who watch the Senate closely.
In short: I know we’re just playing armchair legislative strategist. Answer the damn question already.
3. To be fair, you do provide a decent answer in your comments on Ben Nelson. If I understand you, the political logic goes something like this: The opt out clause could buy the cloture vote from Senate Democrats who are interested in retaining their Senate seats, do not have Senate leadership positions that can be taken away, don’t have anything else they want in exchange for a cloture vote, and whose constituencies oppose the public option.
To this might be added that adding the opt out clause allows them to give their state the policy option it prefers (assuming the state government agrees), and further to claim to have supported states rights and all that good stuff.
The cost of doing this would be that a number of U.S. citizens would remain uninsured.
The question remains: how many “Ben Nelsons” are there, and how many conservative Democrats (and perhaps Republicans) who are vulnerable on health care with their own electorates? Can anybody offer a halfway decent estimate?
4. Regarding Senator Collins, I don’t know either. I suspect it has something to do with her being less visible than Snowe, and the fact that she won’t be up for re-election until the middle of the next presidential term.
5. As already noted (48-50) the Republicans have been merely threatening filibusters. I’m guessing, however, that Reid would be pressured to make them actually filibuster on health care reform. Besides, it isn’t just the political cost to Republicans I’m talking about here, it’s the cost to Democrats who refuse to vote for cloture.
6. Just for the sake of clarity, you (unintentionally) misrepresent my view here. I completely agree, it’s fairly easy for Democrats to pin partisanship on Republicans, I’ve been saying as much for months. This, of course, provides yet another reason why Republican support is not in itself of great political value.
Vulnerable Conservatives Update!
Strong evidence that opposing health care reform would seriously hurt Joe Lieberman’s re-election chances can be found at FiveThirtyEight.com.
Phil:
On the Republican side, Olympia Snow might refuse to support cloture if the bill includes a full, strong public option.
On the Democratic side, Ben Nelson, Evan Bayh, Mary Landrieu and Blanche Lincoln are the wavering votes, or so I’ve seen other people claim. All of them oppose a public option, and all of them are conservative Democrats from relatively conservative states.
And Joe Lieberman, who has already shown — with his support of McCain in the presidential election — that he’s willing to buck his constituent’s preferences, even on the most prominent issue that exists. Given Lieberman’s age, it’s possible that retirement is an acceptable outcome for him, and he feels free to vote his heart. Don’t get me wrong, I expect that when push comes to shove he’ll vote for the legislation, but I don’t think that it’s safe to assume he’s a safe vote. (Not that you are assuming that, but some people seem to be.)
Regarding number 3, I agree with everything you wrote, except for this:
No, that’s not correct. The cost of doing this would be that a number of U.S. citizens wouldn’t have access to the public option. But not having access to the public option is not the same as being uninsured.
The rest of the health care bill — the individual mandate, no more refusing people for pre-existing conditions, and subsidies to help low-income people pay for health insurance — would apply in all states. Those are the parts that are responsible for making nearly all citizens insured.
The other compromises necessary to get the right-wing Dems plus Snowe to vote for cloture could potentially be a lot worse than an opt-out public option, or even no public option at all. For instance, if we end up with a strong individual mandate combined with cheap-ass subsidies or lousy insurance (by which I mean, insurance with high co-pays and deductibles), that would mean we’d be forcing people to buy lousy insurance that they couldn’t afford to use. Then the Democrats would deserve to get slaughtered at some future election.
This Congress, they have been — and that’s possibly only because Reid has been giving up on bills (or, rather, compromising them until he has 60 votes — which is why the stimulus bill was smaller than it should have been) without making them do a filibuster. In the prior congress, Republicans filibustered about 60 bills, which is an all-time record. (Read this article, starting from about halfway down — look for the big red “Gumming Up The Works” heading.)
It would cost the conservative dems to vote against cloture — but given their states, I’m not certain it would cost them more than they can recover from. And the Democratic leverage against them is limited, plus Reid seems incredibly reluctant to ever play hardball with the right-wing dems.
Regarding #6, sorry I misunderstood you.
I’m currently visiting Emily Care Boss, by the way. She’s living on this amazing farm in middle of nowhere, Massachusetts — there’s a big farmhouse, and a barn that’s been converted to living quarters, and wood stoves for heat and fabulous stars at night. Plus horses and sheep. It’s pretty neat.
Woo! Tell her your buddy Myca found Breaking the Ice to be awesome.
—Myca
Damn, the world is small sometimes. I’ll let Em know.
Vulnerable Conservatives Update 2!
&:
Thanks for a good response (54). I have a bunch to say about it that unfortunately will have to wait until later – my job and all that, you know how it is.
In the meanwhile, I just caught an AP item announcing that Republican Senator Susan Collins of Maine has just switched to the pro-health care reform camp (as one would expect based on public option in that state). Check it out: Another GOP senator open to health overhaul
Phil
PS: Hi to Emily from me.
@54:
Here’s my rough assessment of what the Senate floor looks like right now, based on what you just wrote about Democratic “wavering votes” and other information I’ve dug up:
1. According to The Hill, Tom Harkin, Chair of the HELP committee, just counted 52 Senators at the Senate Democratic Conference who favored the public option and “about five” who were against it. Since the two independents caucus with the Democrats, I’m assuming Bernie Sanders is one of the 52, and that all 52 are willing to vote for cloture. If I’m correct, all that’s left is to find the remaining eight cloture votes.
2. We have no idea who the “about five” Democratic opponents of the public option are. I’m guessing Ben Nelson (Nebraska), Evan Bayh (Indiana), Mary Landrieu (Louisiana), Blanche Lincoln (Arkansas), Kent Conrad (North Dakota), and/or Max Baucus (Montana).
3. Lieberman (Connecticut), Susan Collins (Maine) and Olympia Snowe (Maine) provide three additional maybe votes on cloture. So maybe 55.
4. Assuming Lieberman was one of Harkin’s “maybes,” that leaves one or two Democrats unaccounted for. Who are they? My guess is that they must come from among the following:
• Akaka (Hawaii)
• Begich (Alaska)
• Bennet (Colorado)
• Byrd (West Virginia)
• Cantwell (Washington)
• Carper (Delaware)
• Dorgan (North Dakota)
• Hagan (North Carolina)
• Inouye (Hawaii)
• Johnson (South Dakota)
• Kohl (Wisconsin)
• McCaskill (Missouri)
• Bill Nelson (Florida)
• Pryor (Arkansas)
• Salazar (Colorado)
• Shaheen (New Hampshire)
• Specter (Pennsylvania)
• Udall (Colorado)
• Warner (Virginia)
These are all Democrats who have been listed as members of Bayh’s “Moderate Caucus,” or of Bayh’s “Gang of Seventeen,” minus Senators already accounted for. Anybody want to venture a guess as to who’s already on board?
5. Summary: The way to get health care reform through with a public option is to convince two more Democrat to vote for cloture (presumably from the list above), along with Lieberman, Snowe, and Collins. Furthermore, it will be necessary to sway three from among Ben Nelson, Bayh, Landrieu, Lincoln, Conrad, and/or Baucus (perhaps more).
Admittedly, this does make either an opt out or a trigger clause appear likely, if not inevitable.
Thoughts anyone? I would love feedback on any of the individuals named.
7. Agreed. I was looking for a concise way of stating the specific policy costs of the opt out clause, and I botched it. I probably should have gone with “The cost of doing this would be a less adequate health care reform for several states” and left it at that.
Note that one of the policy costs would be the possibility that an opt out clause undermines the whole policy. Which returns us to the actual topic of this discussion…
I can’t see either Spector or Cantwell voting against health care. Ever since Spector was threatened with a primary fight, he’s been a fairly reliable liberal vote. And I don’t think Cantwell’s voters are conservative enough for her to get away with it.
Carper is possibly another one who’s against the public option; he’s been pushing ideas to weaken it for a while.
Udall voting no would surprise me, though I’ve been out of Colorado two years.
&59:
Tom Carper does look like a good bet for a missing “maybe” vote. According to Delaware Online, Carper “does not endorse a nationwide public option and is a proponent of co-operatives and state or regional approaches to health reform.” The Delaware Democratic party is currently putting serious pressure on all three of their congressmen to support a “robust public option.” Meanwhile, Rasmussen Reports claims that support for reform is stronger in Delaware than in the U.S. as a whole (and Rasmussen polls tend to yield more conservative results than other major polls).
Note, however, that Carper did vote for the Schumer public option amendment in the Finance Committee, although he voted against the Rockefeller amendment. Judging by his stated “Health Care Principles,” I’m guessing he’s trying to juggle frugality with “bending the cost curve.”
&60:
In affirmation of your judgment, I popped over to Mark Udall’s Senate website, and the first item I saw was a speech that begins “Our health care system is unsustainable – costs are rising out of control, leaving too many Americans uninsured or at risk for losing their insurance. It’s time to act on health insurance reform to make insurance companies keep their promises to consumers. That’s why earlier today, I joined nine other members of the freshman class for a series of speeches to make the case for why health insurance reform is crucial.” I think we’re safe counting him as on board.
It is worth noting that the seven conservative Democrats (including Lieberman) that we’ve identified are not only a minority within the 60-member Democratic Caucus, they are a minority within Bayh’s 15-member Moderate Caucus. In other words, even conservative Democrats lean towards strong health care reform measures.
I recall Rachel Maddow claiming that no Democrat has ever broken ranks to support a filibuster. Does anyone know if this is true?
This cartoon made me laugh:
http://i.usatoday.net/news/opinion/cartoons/2009/October/e091009_2_davies.jpg
Ironically, it’s because of the doom and gloom from the GOP and insurers that merely avoiding “obvious” negative consequences is sufficient, or at least a big step in the right direction.
Special Vulnerable Conservatives Challenge!
The following is a list of every Senate Republican (minus Collins, Snowe and Lieberman): Alexander, Lamar – (R – TN), Barrasso, John – (R – WY), Bennett, Robert F. – (R – UT), Bond, Christopher S. – (R – MO), Brownback, Sam – (R – KS), Bunning, Jim – (R – KY), Burr, Richard – (R – NC), Chambliss, Saxby – (R – GA), Coburn, Tom – (R – OK), Cochran, Thad – (R – MS), Corker, Bob – (R – TN), Cornyn, John – (R – TX), Crapo, Mike – (R – ID), DeMint, Jim – (R – SC), Ensign, John – (R – NV), Enzi, Michael B. – (R – WY), Graham, Lindsey – (R – SC), Grassley, Chuck – (R – IA), Gregg, Judd – (R – NH), Hatch, Orrin G. – (R – UT), Hutchison, Kay Bailey – (R – TX), Inhofe, James M. – (R – OK), Isakson, Johnny – (R – GA), Johanns, Mike – (R – NE), Kyl, Jon – (R – AZ), LeMieux, George S. – (R – FL), Lugar, Richard G. – (R – IN), McCain, John – (R – AZ), McConnell, Mitch – (R – KY), Murkowski, Lisa – (R – AK), Risch, James E. – (R – ID), Roberts, Pat – (R – KS), Sessions, Jeff – (R – AL), Shelby, Richard C. – (R – AL), Thune, John – (R – SD), Vitter, David – (R – LA), Voinovich, George V. – (R – OH), Wicker, Roger F. – (R – MS)
The question is, are any of them politically vulnerable on health care reform?
I’m particularly curious if anyone knows anything about public opinion in Florida, Indiana, Iowa, New Hampshire, and Ohio. (Striking geographic distribution, ain’t it?)
Addendum
An interesting variant on this question: How will this play out in Ohio, given that that Voinovich is retiring from the Senate and is therefore free from re-election pressures?
Data point re: state-based public option changing people’s minds in favor of the public option:
Interesting post on this subject, from Ezra Klein:
Less optimistically from Klein: at the moment, Snowe is saying that not only would she refuse to vote for a bill that includes a public option, but she also would support a filibuster against it.
Public option with opt out just got more likely sez NYT just now.
I think Snowe’s being coy. And it’s not like the Democrats need her.
I would love to see the full list of Senators Snowe and Nelson are speaking for.
Citing this survey of support for Massachusetts health reform, Paul Krugman argues that it is more important “to get the principle of universality established” than to implement a flawless health care policy. Arguably, this goes against some of the arguments I made earlier (51, pt.3) in this regard. Thoughts? Can the American public be expected to be as nuanced in its opinions as the people of Massachusetts?
Can the American public be expected to be as nuanced in its opinions as the people of Massachusetts?
I think we can expect the American people as a whole not to be much like the people of Massachusetts with regard to most highly-contested political issues. There’s now a majority in Massachusetts that favors legal recognition for same-sex couples; that’s not the majority position of the country as a whole. Massachusetts at best is a predictor of sentiments in the Northeast and on the West Coast, and for economic issues also maybe some heavier-government states like Michigan, Illinois and Ohio. But if you polled people in Texas saying, “People in Massachusetts like this plan,” some of them would automatically assume the plan must be bad because those people in Taxachusetts like it.
There has been a concerted effort on the right to paint the Mass. reform as a fiscal disaster. If you try searching the WSJ editorial archive for the last year for the words Massachusetts and health, you’ll find everything from high-level financial analyses to individual Massachusetts residents bewailing how they were forced out of an insurance plan that worked fine for them but didn’t meet the new state standards.
And now Ben Nelson is saying that even Schumer’s public-option-with-state-opt-out” is “too risky.”
ETA: People were speaking on another thread about newspaper style guides — I wish to goodness that the Washington Post would revise theirs so they wouldn’t end up with stupid, misleading statements like this: “The House plan also proposes a 5.4 percent surcharge on income over $500,000 for individuals and $1 million for families, a levy that would affect 0.3 percent of taxpayers but raise an estimated $460 billion over 10 years, Democrats said.”
Rates aren’t set on “individuals” or “families.” They’re set for “person filing as single” and “married couple filing jointly.” A single mom with two kids constitutes a “family,” but she’s still going to pay at the rate for an “individual.” Argh.
They just said on the Rachel Maddow show that Reid now has 58 for a public option with an opt out. The Huffington Post says everyone is saying 58 or 59. Everyone mentions Landrieu, the Nation guy on Rachel Maddow said Landrieu and Nelson, this guy says Landrieu and Bayh.
@72: True, but left-right preferences aren’t the issue here, willingness to fix a suboptimal version of a preferred policy rather than discarding it is.
Wow, speculating about the Senate floor vote at this point is like shooting at a moving target. Which doesn’t mean I’m going to stop.
Ezra Klein and others are suggesting that the White House is skeptical of Reid’s ability to put together 60 votes. As was widely reported yesterday, Pelosi is no longer sure she has the 218 House votes required for a “robust” public option. And to make the public option issue even more serious, following a conversation with a colleague yesterday morning, I now have a six-pack riding on the matter.
I remain optimistic. Politico notes that Landrieu and Lieberman are on board. Also, the quotes from Pelosi in the same article indicate that at the very least a more moderate public option will pass the House. Further, it’s not clear that White House questioning translates into strong doubts about Reid.
Meanwhile, FiveThirtyEight.com makes an interesting argument that wooing Snowe may be as much about getting Bayh and Nelson on board as it is about bipartisanship. Allow me to suggest an additional implication of this: if winning over Snowe would provide sufficient political cover for Bayh and Nelson, it is easier to win over both of them, because Snowe is electorally more vulnerable on this issue than either of them. (Plus, what about Collins?)
On a related note, one of the repeated concerns I hear from skeptics is that Reid lacks the, let’s call it fortitude, to push through a public option. I would suggest that the fact that he plans to include it in the Senate compromise bill, and is therefore calling moderates’ bluff, shows that he has grown said fortitude.
In short: If you favor a public option, call and/or write your Senators and ask them to put whatever pressure they can on Senate moderates. Remember, now there’s beer involved.
Phil,
@72: True, but left-right preferences aren’t the issue here, willingness to fix a suboptimal version of a preferred policy rather than discarding it is.
Willingness to have government fix stuff is part of the left-right divide. Specifically, I can tell you that many Texans are sincerely bought into the idea that it is better for something in the market to be sub-optimal than to have the government get involved in it.
@76:
Fair enough. The implications of this are that, if the public is equally “nuanced” everywhere, we would expect a flawed health care reform to continue to receive support in left-leaning states (ones that support government programs), but to lose support in right-leaning states (ones that are suspicious of government programs). In other words, contrary to my earlier more pessimistic prediction, even a flawed health care reform would continue to receive support in most states, since most states lean left on this issue.
But the question remains: can the public in left-leaning states be expected, like that in Massachusetts, to support reforming an inadequate version of a desired policy rather than abolishing it? That is, is the public equally “nuanced” everywhere?
It strikes me – why not just let each state offer its own public option? This isn’t really an economic subsphere that requires the federal government’s unique skillset, is it? Colorado can offer “nothing, or nothing with a kick in the teeth”, Mass can offer premium goldplated wonderfulcare, California can cover holistic pet yoga, whatever – everyone can do their own thing.
Wouldn’t that be a beautiful compromise?
Robert,
A “public option” is government-brand health insurance. It competes with private insurers. There is no state doing it now, and it would be foolish for low-population states to want to do this on their own rather than having it run at a federal level where economies of scale allow the government to do the same thing the big, national private insurers do, which is negotiate rates from providers and pharmaceutical companies that are significantly lower than the “retail” price for these goods and services. I used to work for one of the big national health insurers, albeit in a division that focused on Medicare, Medicaid and CHIP enrollees, and if a government doesn’t have the purchasing power to get those costs down, it can’t compete with the private insurers that do.
Robert, if you want a compromise that allows states to choose, why not a national Public Option, but states can opt out if they want to?
That way, Colorado can avoid having the federal government tainting your health care with efficiency and affordability, but small states that want an effective national program to be part of, still have that option.
Rather than force an all-or-nothing choice, Amp, I’d go with maximum freedom of choice. Let the states design their own plans and compete for participants – let a thousand flowers bloom. Well, fifty, anyway.
PG, if small-pop states can’t do it on their own, let them form regional compacts to get the powers of numbers.
No one has proposed a forced all-or-nothing.
AllowingFor states to form statewide (or regional) insurance plans isn’t illegal. If a state wants to do that, it can go ahead.But that’s not a reason not to have a nationwide option, as well. Then we’d have even more choice!
And, in fact, I’d say that this right here is a great explanation of why opposition to this isn’t about choice.
“I want more choice! I can only do that through offering fewer options!”
Yeah. That’s … er … stupid.
—Myca
The goalpost moves once again. Slightly.
Ben Nelson now favors a public option with an opt in, sez NYT. Man! this is dragging.
as a red state inhabitant, I am extremely concerned that the opt-out will hurt people here who need affordable healthcare . Either we all have fair access to healthcare , or we don’t. This country doens’t need more divisions. How is a nation where half the country gets access to a public option, and the other half doesn’t, “equal protection” under the law?
this is definitely a punt to the state legislators. what a cosmic wimpout, as it were.
Opt Out is In! Sez The NYT 12 minutes ago.
Based on direct quotes in the Huffington Post, Landrieu will vote for cloture, while Nelson is still being coy. The New York Times article cited in the previous post quotes Snowe as saying she won’t vote for it, but I maintain my doubts. And once again, what about Collins?
I agree, it might — at least, for those red states that choose to opt out. (I bet that it won’t be all that many — just as the red state governors who threatened to refuse stimulus money all eventually took it.)
There will still be subsidized private-market health care, and an expansion of who’s eligible for Medicaid. So more folks will be able to afford health care, than would have been able to afford it if there was no health care reform. But maybe it would be a bit more affordable still if the public option was available in their state.
Unfortunately, the alternative seems likely to be no public option at all, for anybody — which wouldn’t make the folks in red states any better off. At least this way, there will be a public option that exists, and folks in red states can pressure their local governments to make it available.
How do you see opt-out as hurting citizens of the states that opt out? I can see how it won’t be helping them, but I’m not sure I understand how it hurts them given their current situation.
How is a nation where half the country gets access to a public option, and the other half doesn’t, “equal protection” under the law?
Because there isn’t a Constitutional right to Federal Government-brand health insurance, and the statutory right will be written such that states can choose whether their residents may participate?
This seems like a rather sloppy use of the phrase “equal protection.”
Jake,
Everyone concedes that the public option will require funds from the federal government at its start up. Its proponents declare that it will need just a little time to be established on a sound footing, and will be self-sufficient henceforward. Skeptics note that the federal government’s other big insurance program, Medicare, draws heavily on general revenues rather than relying solely on the receipts from the specific line on your paycheck that says “Medicare tax.” Even if the proponents are right, in the short run the entire country through the federal government is loaning money to a program that not the entire country will benefit from. It’s the stimulus argument all over again: if Texas sends money to the federal government, it’s stupid for Texas not to grab that money back again. (And this of course was Gov. Goodhair’s explanation for accepting stimulus funds after all: that money is really just a refund of Texans’ money back to them! Never mind that our tax dollars were long ago spent and the stimulus is deficit spending.)
Okay, PG, I see that. But my question remains – how does this hurt those w/o health insurance in the states that opt out? They don’t get health insurance now, they won’t get it if their state opts out. How does that hurt them?
Jake,
Because they’re paying for a program for which they never can be eligible so long as they reside in that state? I wouldn’t like to be paying for a national Medicare program through my federal income taxes if my state didn’t allow its residents to participate in Medicare.
I don’t want to get ahead of the game here – the Senate could always remove the public option on the floor, they could replace it with a trigger, they could kill the bill entirely. However, assuming that Reid got his head-count right (he’d better have, it’s his job), and assuming the opt out is not eliminated in Senate-House negotiations (seems likely, given how close this has been in the Senate), it looks like, pending disaster, we’re getting health reform legislation that includes a public option with an opt out clause.
If this turns out to be the case, which states do y’all think are most likely to opt out? (Note that this is a way of assessing the actual harm of the opt out clause. As noted previously, I have a bit of a problem with it in principle but still find it better than no public option at all, in part because I’m inclined to think few states will actually opt out, for reasons just given by others.)
Plus, I’m still interested in speculation on how the actual Senate floor vote will turn out. Will Snowe change her mind? Is Collins secretly on board?
Thoughts?
@93:
I’m going to take a risk and predict that Snowe will vote for the final bill, that she’s being, as I’ve said before, coy. My reasoning is that the Maine public is strongly behind the public option, she’s up for re-election in 2012, she strikes me as smart enough to realize that health care reform without a public option is a scam, and her voting record does not indicate that she’s particularly conservative ideologically.
One factor that could work against this is that she could be interested in promotion within the Republican party. On the other hand, she does retain the option of switching parties.
I don’t have time to blog it right now, but I really recommend this article at Politico, about the subsidies fight lurking behind the public option debate. IMO, the subsidies are actually more important than the public option — but the two issues are linked, because a stronger public option would help pay for more generous levels of subsidies.
@95:
Informative piece, thanks for the recommendation. I don’t have the time to comment on the budgeting and related policy concerns that comprise most of this article at the moment. However, I do want to comment that this serves as an important reminder that the next step after getting the public option on the table is to prevent the whole thing from being sabotaged. Once again, the importance of good legislation. Fortunately, a lot of people appear to be paying attention.
A couple of political comments regarding the article. It is true that Obama “needs a win,” and I agree that he likely is “willing to settle for a cheaper bill and a weaker public insurance option” in order to achieve one. I also agree that the Senate will be pulling for a cheaper bill than the House.
However, I don’t share the alleged worry on the part of Pelosi and Reid “about the base not turning out in 2010.” Passing any sort of health care reform counts as an accomplishment for the President and will count to the credit of the Democrats for being able to get something done. As discussed earlier, none of the actual effects of the policy will be felt by 2010 anyway.
Meanwhile, what the party needs to do politically is tack to the left.
Granted, the Republicans have a chance to make gains in the midterm, ’cause that’s what midterms are for. Their base will be highly mobilized, ’cause that’s what the minority party base does in midterms. That will happen regardless what Obama does, because they really hate him.
However, the Republicans are exceptionally weakly positioned to take advantage of a mid-term election. Their approval rating is at a mere 20% say some polls, an historic low. They haven’t found their unifying idea yet. (They just need to keep plugging away at the deficit issue until it finally sticks, but that will take a while.) They are in the middle of a leadership struggle. There are already a few cases of conservative candidates running against each other. I mean, they may pull it together or catch a lucky break, but they might not. And it’s not as if the majority never gains seats at midterm.
What the Democrats can do to help themselves is tack left. They can afford to lose some votes to the right, and the Republicans just aren’t that appealing to independents right now. More importantly, shifting leftward, combined with playing up the real fear of the far right, can mobilize Democratic activists, and thereby voters. And Obama is real good at mobilizing voters.
I expect a bunch of relatively simple measures will be taken to please the left in the near future, perhaps ending “don’t ask don’t tell.” What’s it gonna do, piss off Fox News viewers?
Big picture: I’ve been saying for quite a while that Obama’s political task for his first term is relatively simple. He needs to avoid a major screw-up before 2010. By 2012 he needs to convince people that things will be getting better soon, and to have one or two accomplishments under his belt, and then people will give him a chance to finish the job.
Two minor amendments to my previous entry:
1) I wrote that the Republicans “approval rating is at a mere 20%,” I meant to say “a mere 20% of adults self-identify as Republican.”
2) I wrote that there “are already a few cases of conservative candidates running against each other.” I am actually only aware of one, the race in upstate New York between Scozzafava (R), Hoffman (C) and Owens (D). It will be interesting, however, to see what kind of precedent it sets for 2010. Might I add that, assuming that moving further to the right is a bad move for Republicans, this race suggests that Palin is of limited use to the Republican party as a whole.
If unemployment is still above 9% on Election Day 2010, the Democrats are going to get hurt in the midterms no matter what legislation they pass. You can’t have 10% of voters looking for work and unable to find it without damage to the party in power. It just leaves too much room for Republicans to spin about how the stimulus/ deficit spending/ health care reform burden on employers/ increased tax on cigarettes/ whatever was bad for the economy and decreased the availability of jobs. Even if every economist in the country lines up and denounces the Republican spin as crap, it will still work on people who are angry and looking for a way to make sense of things going wrong for them.
Some of the effects of health care reform may be in place by 2010 — because Democrats have the mid-terms very much in mind.
I really wish they had done what Wyden suggested and made the Public Option available to anyone who wants it. I think a lot of people are mistakenly thinking that if they have insurance and don’t want it, they’ll be able to switch to the Public Option. Unfortunately, that doesn’t seem like it’s going to be the case.
There’s an argument that people’s perception of the direction of unemployment matters more than unemployment itself, when it comes to elections. So if unemployment is high but widely seen as dropping, the Dems will do much better than if it’s high and staying that way.
I think the Democrats are going to get creamed in 2010; the question is how badly. Even if unemployment is dropping by then — which I doubt — the demographics of mid-term elections is that older voters are much, much more likely to vote. And older voters tend to be conservative and dislike Obama.