Health Care Sunday: killing health care reform Edition

digby: A Present From Teddy

Here's a little piece of surprising good news that's floating under the radar in the health care debate:

WITH LITTLE FANFARE, a new public program to help pay for long-term care for adults is moving through Congress. The premium is low and the coverage is good.

Largely geared to personal and health services provided in the home, though it extends to nursing home care as a last resort, the new coverage is built into the emerging formula for national healthcare reform.

The need for home care is immense. More than 10 million Americans receive home care, and the number will rise rapidly as the population ages. Estimates hold that 75 percent of us will need home care at some point during our lifetime.

This kind of medical/social service is of inestimable benefit to the chronically ill, the elderly, the mentally disabled, and to adults recuperating from a temporary illness. Home-based personal assistance would allow many of them to return to work. And it would be a godsend for the 90 percent of Americans who have had no meaningful protection against this medical expense.

[...]

The long-term care program has the backing of President Obama as well as about 100 organizations for the disabled, elderly, and workers, along with 80 percent of voters queried in opinion polls.

This is Kennedy's baby and it's a really good idea. Commercial long term care insurance, which only rich people have anyway, is expensive and terrible. This is one of those things that will make a huge difference in many people's lives if it actually happens. And it's happening completely under the radar, a sort of secret bequest from the man who's been pushing for universal health care for more than 40 years.
h/t to bb

Benen: NOT BACKING DOWN....

Following up on the last item, here's the provocative line from President Obama's multimedia address this morning:

"I don't believe that government can or should run health care. But I also don't think insurance companies should have free reign to do as they please. That's why any plan I sign must include an insurance exchange: a one-stop shopping marketplace where you can compare the benefits, cost and track records of a variety of plans -- including a public option to increase competition and keep insurance companies honest -- and choose what's best for your family."

Now, for the last several weeks, administration officials have walked a careful line on this. The president and his team have said they'd like a public option, they support a public option, and they believe a public option makes sense. When asked, however, whether they'd still support a reform package even if it doesn't have a public option, the White House tends to say, "We don't want to draw any lines in the sand."

This morning, we heard a different message. These weekly addresses are written pretty carefully -- it's not just the president riffing or speaking extemporaneously during a media interview -- and it seems pretty clear that "any plan" that reaches the president's desk "must include" an exchange with consumer options, and those choices need to include a public option.

The president didn't include an explicit veto threat, but it's my understanding that "any plan" and "must include" are phrases meant to serve as a step forward on White House policy.

Also note the larger context here. With skeptical Blue Dogs, CBO pushback, and Senate "centrists" slamming on the brakes, one might expect the administration to start abandoning key priorities and preparing to accept a watered down package that would be easier to pass.

Instead, we have OFA taking out ads targeting Senate Dems and House Dems, while the president is making it pretty clear that he expects to see the very same public option that Republicans and "centrists" have a problem with.

Obama, in other words, is pushing back. When one might expect him to start walking back expectations, he's playing a little hardball. Good.

Krugman: The six deadly hypocrites

Will the destructive center kill health care reform? It looks all too possible.

What’s especially galling is the hypocrisy of their claimed reason for delaying progress — concern about the fiscal burden. After all, in the past most of them have shown no concern at all for the nation’s long-term fiscal outlook.

Case in point: the Medicare Modernization Act of 2003, which denied Medicare the right to bargain for lower drug prices, locked in overpayments to private insurance companies, and did nothing, nothing at all, to pay for its proposed outlays. How many of these six self-proclaimed defenders of solvency voted no on the crucial procedural vote? One. (Joe Lieberman, to my surprise.)

And let’s not forget that Ben Nelson, who appears to be the ringleader, has fought tooth and nail against competition from a public option — which would almost certainly save a significant amount of money, as well as providing much-needed competition.

If the Gang of Six really does kill reform, remember their names; they will bear the responsibility for vast, unnecessary suffering over the years to come.

Benen: WITH SO MUCH ON THE LINE....

In 1993, Bill Kristol privately advised congressional Republicans to do whatever it took to "kill" the Clinton health care reform initiative. It wasn't that the policy proposal was a bad idea; it was that passage would help the Democratic Party for years to come. The GOP, he said, for the sake of its own future, couldn't compromise or negotiate with the majority.

Sixteen years later, a wide variety of Democrats are working hard to convince Republicans to support reform, despite the built-in incentive for seeing reform fail. Mark Kleiman noted that a few too many Democrats seem to have forgotten the recent past, and worse, seem oblivious to the larger electoral dynamic.

For Gingrich and his allies, the health care debate wasn't really about health care: it was about destroying the power of a Democratic President.

It's not surprising that the Republicans have remembered that lesson, but it's disappointing that the "centrist" Democrats have forgotten it. This bill is make or break for the Democratic Party....

Matt Yglesias added:

In 1993, we had a new president elected on a promise of providing access to high-quality affordable health care to all Americans. In 1994, that promise went down in flames. The result of that failure was not only substantively bad, but politically disastrous for Democrats. Now it's 2009 and we have a new president elected on a promise of providing access to high-quality affordable health care for all Americans. It's pretty clear that Republicans remember that dealing a humiliating blow to said president by blocking reform will be politically useful to them.

And it's curious that many centrist Democrats -- particular those now eager to delay action on a bill and give special interests and the right more time to kill it -- don't seem to remember this.

All of this sounds about right. Republicans don't want to reform the health care system and don't want President Obama to be the president who finally delivers the overhaul Americans have been waiting for over the last several decades. The GOP has every possible reason to see this initiative fail, but that hasn't stopped some Democrats from a) insisting that Republican support for a reform effort they oppose is paramount; and b) making it easier to see their own party's efforts fail.

It occurs to me, then, that there's at least a possibility that "centrist" Democrats -- Blue Dogs, New Democrats, Lieberman, et al -- might not see failure as such a horrible option here. In other words, they may realize that coming up short on health care, letting this opportunity slip away, and hurting millions of Americans in the process may be devastating for the Democratic majority, but these same "centrist" Democrats may prefer a smaller majority, or perhaps even a GOP majority to "balance" the Democratic president. They may very well disagree with the party's leadership on most issues, and think the best course of action is taking away their power by undermining the party's agenda.

It seems odd that these "centrist" Democrats would forget the lessons of 1993 and 1994. But alternatively, are we sure they have forgotten those lessons, or have they learned those lessons all too well?

Benen: THE POTENTIAL FOR PAIN FROM THE GANG OF SIX....

Yesterday, six Senate "centrists" insisted that any momentum health care reform might have had come to a complete stop. The group -- two Republicans, three Democrats, and Joe Lieberman -- said lawmakers need more time. It wasn't entirely clear what they intend to do with more time, but they want it anyway.

Paul Krugman thinks these "centrists" have the capacity to kill the entire reform campaign.

Will the destructive center kill health care reform? It looks all too possible.

What's especially galling is the hypocrisy of their claimed reason for delaying progress -- concern about the fiscal burden. After all, in the past most of them have shown no concern at all for the nation's long-term fiscal outlook.

Case in point: the Medicare Modernization Act of 2003, which denied Medicare the right to bargain for lower drug prices, locked in overpayments to private insurance companies, and did nothing, nothing at all, to pay for its proposed outlays. How many of these six self-proclaimed defenders of solvency voted no on the crucial procedural vote? One. (Joe Lieberman, to my surprise.) [...]

If the Gang of Six really does kill reform, remember their names; they will bear the responsibility for vast, unnecessary suffering over the years to come.

Krugman's point about the Medicare Modernization Act of 2003 is of particular interest, because the votes are illustrative. This was a terrific example of the wrong way to tackle any kind of health care reform -- Bush demanded the change and asked Congress to act quickly; Republicans didn't even try to figure out a way to pay for hundreds of billions of dollars in new costs; insurance companies made a bundle; and "centrist" Democrats, hoping to prove how bipartisan they are, went along.

Now that real reform is within reach, however, some of these same senators have suddenly discovered concerns they didn't have when Bush was doing the asking.

Postscript: This is, by the way, especially interesting when it comes to Roy Blunt of Missouri. In 2003, Blunt not only voted for the Bush Medicare proposal, it was also his job to cajole other House Republicans into voting for it. Six years later, Blunt no longer thinks Medicare should have even been created in the first place.

Benen: ORSZAG SETS THE RECORD STRAIGHT....

Fox News' Chris Wallace asked OMB Director Peter Orszag this morning if the administration will be "rationing" health care by establishing a commission of doctors and medical experts to oversee medical practices. Orszag, thankfully, called this a "canard" and pointed to the status quo.

"The fact of the matter is, right now, politicians and insurance companies are making decisions," Orszag explained. "We're saying, we want doctors to be making decisions."

Wallace said once these physicians start "making decisions," they'll be in the business of telling consumers which medical treatments they can and cannot have. So, Orszag turned the question around: "Do you think that politicians are currently rationing care? Or insurance companies are currently rationing care? There are no set of decisions that this commission would have that is not currently resting with either members of Congress or insurance companies."

Now, Orszag rejected the idea that the status quo, in fact, "rations" medical care. I disagree with that. But his larger point is fair -- if the current system is already rationing care, then the concerns about doctors and medical experts overseeing medical practices would itself be a valuable improvement on the status quo.

Expect to have this come up quite a bit. On "Meet the Press," David Gregory asked HHS Secretary Kathleen Sebelius if federal bureaucrats may not want to pay for some medical procedures.

It may not happen to hosts of national news programs much, but in reality, plenty of Americans find that their insurance companies decide not to pay for treatments all the time. In fact, they have a financial incentive to do just that.

Who gave media anchors the idea that insurance companies reflexively approve payments on everything?

• Yglesias has some more thoughts on “Rationing”
  

  Thinking about the “rationing” question in health care it’s worth trying to get clear. Sometimes there are shortages of something relative to demand—think of a huge oil shock—and the government decides it wants to impose price controls. That, in turn, leads to shortages. So you can attempt to ameliorate the shortages by rationing. Everyone is only allowed to buy so much gas. During World War II, Great Britain had comprehensive rationing for lots of staple food products—you were only allowed so much sugar, so much tea, so much bacon, etc. That’s rationing.

  Now consider something else. If you’re a parent in Montgomery County Maryland, you pay taxes to the county and you get to send your kids to very good public schools. But even though the schools are good, they won’t just do anything you want. Your kid can learn Spanish at government expense, but the taxpayers won’t foot the bill for your kid to learn Burmese. But you don’t normally hear anyone say that the presence of a “public option” for elementary and secondary education involves “rationing” of foreign language instruction. If people have the means and want to arrange private lessons for their children of various kinds nobody is stopping them. And certain forms of this sort of supplemental instruction—Hebrew school in synagogues, Sunday school in churches, piano lessons or Kaplan test prep—are quite common.

Yglesias: Orszag: Calls to Delay Health Reform are an Effort to Kill It

Faiz Shakir has the video of Peter Orszag making the point that a lot of folks arguing that we need to slow the health reform train down don’t actually have any ideas to contribute, they’re just trying to kill reform:

ORSZAG: We have to remember: there are some who are advocating delay simply because they don’t have anything to put on the table. The typical Washington bureaucratic game of — ‘if you don’t have a better alternative, just delay in the hope that that kills something’ is partly what’s playing out here.

Faiz reminds us that this is the explicit strategy of some in the GOP:

A strategy memo authored by GOP consultant Alex Castellanos suggests that “it is crucial for Republicans to slow down what it calls ‘the Obama experiment with our health.’” The memo concludes, “If we slow this sausage-making process down, we can defeat it, and advance real reform that will actually help.”

Orszag was kind enough not to drag House Blue Dogs or the Senate’s “Gang of Six” into this critique. Still, it is what it is. For 2009, the key Republican Party priority is to kill health care reform. For July of 2009, the key Republican Party tactical gambit is to advance the cause of killing health care reform by pushing for delays. And reality doesn’t suddenly change when the party labels flip. Democrats who are spending July of 2009 pushing for delay in health care reform are joining in a tactical gambit whose purpose is to advance the cause of killing health care reform.