Wednesday, June 24, 2009

Health Care: Bipartisanship???? Edition

Ezra Klein: Should Democrats Fight for the Public Plan?

The Washington Post put a poll into the field last week with a substantial health-care portion. Here's the part that will interest all of you:


I don't think there's anything surprising in there. A solid majority support the public plan in theory. If you say it'll drive their other insurance options out of business, they turn against it. But imagine you had asked that question the opposite way. The reason private insurers would have been driven out of business, after all, is because the public plan would offer much lower premiums. If you asked poll respondents, "What if having the public plan lowered your insurance premiums by 20 to 30 percent," my hunch is you'd see a sharp shift toward support of the policy.

And that's not, it should be said, an idle thought about polling. In the long term, the fortunes of Democrats will be decided by whether people like health reform after it passes. If the program is a huge success, if costs go down and coverage shoots up, then that will do much to bind voters to Democrats. (This was the argument that Newt Gingrich and Bill Kristol made in 1994, and they were probably right about it.) If it's considered a flop, or simply an uneven success, there will be little long-term gain from passing the policy and potentially even some long-term harm.

At yesterday's press conference, Obama made a telling remark in reply to Chuck Todd's questioning on Iran. "I know everybody here is on a 24-hour news cycle," he said. "I'm not." Some policies that might be controversial now are likely to prove popular later. Some policies that are popular now are likely to be a failure later (see the Iraq war for an example of political coup turning to an electoral embarrassment). The question asked in the poll above has to do with the short-term politics of health care. In the long run, however, it's assuming a situation in which the public plan makes health coverage so much cheaper for individuals that they abandon private insurers in droves. It's hard to imagine that outcome being unpopular, as it's an outcome that Americans would have to choose.

Conversely, you could imagine an outcome more pursuant to the poll above but much more problematic for Democrats in the long run. Health reform is enacted, and it promptly drives up the deficit. But now Democrats have ownership of the health-care system. They, after all, passed a major reform in 2010 that they promised would lower costs. It didn't. People begin to blame them for problems in the system. A charismatic Republican with a working knowledge of the issues -- Bobby Jindal, say? -- runs on a conservative health reform platform and begins to recapture the issue from the Democrats.

Which is all to say that passing health reform is different from passing a successful health reform. And certain policies which may be controversial in the legislative period might be extremely important to the implementation period.

Ezra Klein: Dr. Klein's Health Insurance Relationship Advice Corner

As something of a follow-up to the last post, I want to point out a different poll result that helps explain why reformers can't attack private insurance too aggressively. There is, among a lot of liberals, a sense that people really really hate their private insurance coverage and are desperate for an escape hatch. But there's not much evidence of that in the polling:


About 80 percent of the population is some strain of satisfied with their health insurance. About 19 percent isn't. That's not an uncommon result. And those aren't the sort of numbers that let you detonate the system. Indeed, I occasionally compare this to having a friend in a bad relationship. You see his girlfriend being ruthlessly critical of him, standing him up, badmouthing him behind his back, isolating him from his friends, and generally being a crummy partner.

But he insists that he's happy in the relationship.

Demanding your friend to break up with his beloved probably isn't the way to go about your intervention. But maybe you introduce him to some nicer girls. Maybe you gently point out some examples where he's been mistreated. Maybe you try to take him out more often. Maybe you try to expose him to couples with a healthier bond. That's sort of the theory behind health reform. The situation is objectively quite grim, but people are attached to it anyway, and it's neither possible nor effective for reformers to simply change that by fiat. But it's entirely possible to offer better options and alternatives and then let people make the choice for themselves.

JedL: The only bipartisanship that matters

Ed Kilgore makes an important point: on health care reform, there's a large gap between Congressional Republicans and grassroots Republicans.

Congressional Republicans are uniformly against a public option, but as Kilgore points out, about half of Republicans who don't live or work in DC support a public option.

it's worth emphasizing that the two most credible surveyors of public opinion on this subject, the Kaiser Family Foundation and CBS/New York Times, have both found that at least half of self-identified Republicans favor a well-described public option.

Kilgore argues that the implication of this is that there are two models of bipartisanship when it comes to health care reform: Congressional bipartisanship, and what he calls grassroots bipartisanship.

Congressional bipartisanship means political compromise with Republican leaders who have a far more rigid position than the GOP rank-and-file. Grassroots bipartisanship means delivering on a public option supported overwhelmingly by Democrats and even by a majority of Republicans and independent voters.

That leaves Senate Democrats with two choices:

  1. They can pursue Congressional bipartisanship, which will put them at odds with their own base and likely create political cover for Republicans who might otherwise have issues in their base, or
  1. They can pursue grassroots bipartisanship, which will put them on the side of an overwhelming majority of Americans and create a schism within the Republican-leaning electorate.

It's really a no-brainer. Grassroots bipartisanship is the only bipartisanship that matters, and it's good to see Senators like Kent Conrad begin moving in that direction.

Anonymous Liberal: Bipartisanship on Health Care Makes No Sense

Whenever I hear someone call for a "bipartisan solution" to the health care crisis in America, I just want to pull my hair out. It makes absolutely no sense whatsoever. It's like calling for a bipartisan solution to the next presidential election.

Health care policy is a definitional issue in American politics. For as long as I can remember, the Democratic party has fought to increase the government's role in providing health care coverage for Americans while the Republican party has fought to reduce the government's role. The Democrats are responsible for Medicare, Medicaid, and S-CHIP; the Republicans fought all of those initiatives. On a policy level, the Democrats believe that the best health and cost outcomes can be achieved by increasing access and encouraging widespread use of routine and preventative medical care. Republicans, on the other hand, have routinely identified the problem as over-consumption of care. Their proposals to fix the system inevitably involve significant deregulation with the goal of encouraging the use of high-deductible policies to try to discourage personal consumption of health care. Nearly every Democrat (including the blue dogs and "centrists") believes this to be bad policy.

In other words, there is virtually no common ground between the parties. The parties don't even see eye-to-eye regarding basic goals and policy assumptions. So why on earth would anyone believe that there is a bipartisan solution to health care? If one side believes the answer is behind door #1 and the other believes it is behind door #2, the correct answer is never to walk into the wall between the doors. Yet any conceivable "bipartisan solution" to health care would amount to exactly that.

Furthermore, as a simple political matter, it makes no sense to seek Republican support. First, it's a quixotic quest. Putting aside the fact that the Republicans are determined to uniformly oppose any significant Obama initiative, on this particular issue, there are actual principles and core beliefs underlying that opposition. Yes, there is a lot of standard Republican propaganda and demagoguery as well, but beneath all that disinformation is an actual philosophical disagreement. I happen to think that Republicans are dead wrong about health care, but I don't question that their beliefs are genuinely-held.

At the end of the day, no matter how willing the Democrats are to water down their proposal, they are unlikely to get any Republican support. And even if they were able to woo a few Republicans, it would not provide any meaningful political cover. The Democrats would still own the final bill.

Which is fine, because there is virtually no political downside here. The Democratic party is already identified with the issue of health care. It's one of its chief strengths. Despite their reluctance to support anything progressive, the reason red state Democrats like Ben Nelson get elected at all is because of issues like health care, where most people side with the Democrats. And it's not like what's on the table now is particularly radical. We're talking about providing people with a choice, giving them a public health insurance option if they want it. Not only is that idea already wildly popular, but it has virtually no political downside. Republicans and the insurance industry will do their best to demonize such a policy, but at the end of the day, no one is going to be upset that they are being presented with more options, and many people will be immensely thankful for it. Once the dust clears and the bill is passed, there is almost no political risk.

So the goal here should not be bipartisanship. The goal should be come up with the policy that is most likely to be effective and then browbeat every last Democrat in the Senate until they're on board. I don't say that about every issue, but on this one, there is no other sensible option.

Think Progress: Grassley: In Order For Health Care To Be ‘Bipartisan, ‘We Need To Make Sure There Is No Public Option’

On MSNBC this morning, Norah O’Donnell asked Sen. Chuck Grassley (R-IA), the ranking Republican on the Senate Finance Committee, “what needs to be in” a health care reform bill “for it to be bipartisan.” After saying it needs to be paid for, Grassley declared, “We need to make sure that there’s no public option.” When O’Donnell double-checked that Grassley was saying that a public option was a dealbreaker for Republicans, he replied, “Absolutely.” Watch it:

By claiming that a public option would destroy bipartisanship, Grassley is ignoring the preferences of a strong majority of Americans. Earlier this week, a New York Times/CBS News poll found that a public health insurance option (which would lower costs and improve quality) is supported by 72 percent of Americans, including 50 percent of Republicans.

Additionally, Grassley’s antipathy to a public plan flies in the face of his own constituents. In May, the Des Moines Register Iowa Poll found that 56 percent of Iowans support a public plan:

More than half of Iowans support a public health insurance plan, and almost half of the state’s residents who aren’t already insured say they would consider enrolling.

The Des Moines Register Iowa Poll, conducted March 30 to April 1 by Selzer & Co. of Des Moines, showed 56 percent of Iowans support creation of a public plan, 37 percent oppose the idea and 7 percent are unsure.

During his press conference yesterday, President Obama indicated that a public option was not “non-negotiable.” In a meeting with Senators yesterday, White House Chief of Staff Rahm Emanuel reportedly said that the White House wants a “bipartisan” plan and is “open to alternatives” on the public plan.

Krugman: Obama messes up on health care, big time

Really bad news on the health care front. After making the case for a public option, and doing it very well, Obama said this:

“We have not drawn lines in the sand other than that reform has to control costs and that it has to provide relief to people who don’t have health insurance or are underinsured,” Mr. Obama said. “Those are the broad parameters that we’ve discussed.”

There he goes again, gratuitously making a big gift to the other side.

My big fear about Obama has always been not that he doesn’t understand the issues, but that his urge to compromise — his vision of himself as a politician who transcends the old partisan divisions — will lead him to negotiate with himself, and give away far too much. He did that on the stimulus bill, where he offered an inadequate plan in order to win bipartisan support, then got nothing in return — and was forced to reduce the plan further so that Susan Collins could claim her pound of flesh.

And now he’s done it on a key component of health care reform. What was the point of signaling, right at this crucial moment, that he’s willing to give away the public plan? Let alone doing it at the very moment that he was making such a good case for it?

Maybe there’s a way to recover from this. But it’s up to the health reform activists to stiffen the administration’s spine. Obama may be satisfied with “broad parameters” — but the rest of us aren’t, and have to make that known.

  • Sargent: Dem Senator Denies Rahm Said Obama Ready To Nix Public Option

    A key Democratic Senator who met with Rahm Emanuel last night is denying an explosive report saying Emanuel privately signaled the White House’s willingness to take the public option off the table to get health care reform done.

    A spokesperson for Senator Kent Conrad tells me that Emanuel was making a far more general comment and was “in no way” talking about doing away with the public option.

    This story has been raging since Bloomberg reported Conrad and fellow Senator Max Baucus’s claim that Emanuel had told Senators that Obama could nix the public option. Bloomberg quoted Conrad saying Emanuel and Obama are “open to alternatives” to a public plan.

    Not so, says Conrad spokesperson Chris Thorne, who emails:

    Conrad says Emanuel was speaking in reference to the need to overhaul the health care system as a whole — to forge compromise and get a bill to the president’s desk. It was in no way a comment on the president’s willingness to do away with a public option.

    It’s also worth noting that the Bloomberg story only paraphrases Conrad’s claim. And it seems unlikely that Rahm would explicitly take the public option off the table during negotiations.

    It’s true that Obama himself at the presser yesterday refused to rule out backing reform without a public option. But Emanuel was alleged to have gone considerably farther in his private conversation with Senators. It’ll be a bit of a relief to backers of a public option that Senator Conrad is denying Emanuel ever said it.

SusanG (DK): ABC head rebukes Republicans for whining

Forty Republicans worked themselves into a high dudgeon this week over ABC's temerity in offering the President of the United States a forum to discuss health care with the American people. So irked were they that they did what they do best -- formed a group on the fly with a high-falutin' name (the Media Fairness Caucus), and then promptly began issuing intimidating letters.

The primary recipient, however, refused to play the game. David Westin, chairman of ABC, slapped right back at the group's claim (PDF) that airing a health care forum was "unprofessional and contrary to the journalistic code of ethics to present the news fairly and independently."

Westin called bullshit:

"Sadly, some inside government and within the private sector see every issue as material for a sort of political high theatre, to be used to gain votes or energize political bases or simply to raise funds. I would have thought that a subject as important as the health care received by the American people would rise above this sorry spectacle. Our citizens need and deserve more. We are proud to be making a serious effort to go beyond mere punditry or stylized, bipolar debate; we are proud to work for a network and a company willing to devote valuable airtime to serious consideration of a subject so worthy," Westin wrote.

Undaunted, the Republican National Committee forged ahead, launching a cable ad carrying the same lame message.


Some opponents of a public option in health care reform seem to have a new strategy: pretend they know what Americans want -- and ignore evidence to the contrary.

On Fox News this morning, for example, Sen. Jim DeMint (R-S.C.), arguably the chamber's most far-right member, insisted, "Americans don't want more government in health care."

Yesterday, House Minority Leader John Boehner (R-Ohio) made the same argument in a bizarre piece in the Washington Examiner: "The President's proposal would empower bureaucrats -- rather than patients and doctors -- to make key medical decisions, limit treatments, and ration care, raise taxes, and kill jobs. The American people simply don't support it."

Putting aside the absurd policy argument here, what's interesting is that these conservative Republican leaders seem convinced they know better than anyone what "the American people" want.

If there was evidence to back up their claims, we could at least have a debate. But how many more polls need to be released before GOP leaders realize the public isn't with them on this issue? On DeMint's point in particular, a recent national CNN poll found 72% of Americans said "they favor increasing the federal government's influence over the country's health care system in an attempt to lower costs and provide health care coverage to more Americans."

Republicans think the 72% are wrong? Fine. They hope to change those Americans' minds? No problem. But to simply make up public attitudes based on their personal beliefs is silly.

We're left with the new GOP talking point on public attitudes and health care reform: don't believe your lying eyes.

Yglesias: Baucus Regrets Not Including Single-Payer in the Health Care Mix

I think you rarely see a sitting Senator be as reflective about the legislative process as Max Baucus is here when he says he regrets that the idea of a single-payer health care system was left out of the mix:

He conceded that it was a mistake to rule out a fully government-run health system, or a “single-payer plan,” not because he supports it but because doing so alienated a large, vocal constituency and left Mr. Obama’s proposal of a public health plan to compete with private insurers as the most liberal position.

I thin that’s right. Framing effects are important in politics. The public-private competition is supposed to be a compromise between the pristine vision of single-payer and the desire of private insurers not to be put out of business. It creates a situation in which insurers are challenged to prove that single-payer advocates are wrong, rather than simply assert it. But with no single-payer plan in the mix, this gets lost, and the compromise becomes the leftmost anchor of the debate. A single-payer plan couldn’t possibly have passed, but I think having hearings on single-payer and having one committee draft a serious single-payer bill that gets a serious CBO score would have been a useful exercise. In particular, it would have focused the mind on the costs involved in rejecting this option.

Meanwhile, it would be nice if David Herszenhorn, who wrote the article, understood the difference between a “single-payer plan” for health insurance and “a fully government-run health system.” The concepts are quite distinct and correspond to the difference between a health-insurance company and a hospital. Single-payer means the government is the insurance company, government-run health system means that the government would actually run the health system. Both exist abroad (Canada is single-payer, the UK is government-run) and at home (Medicare is single-payer, the VHA is government-run) and they’re very different.

1 comment:

  1. Sorry, wvng, right after you posted that on Swampland I took off of work and went to a friend's place.

    But I'm not a good commenter on health care anyways. No matter how hard I try I can't wrap my head around the financial aspects of it.