Monday, November 23, 2009

Health Care Monday: Dog Food Edition

QOTD, Mimikatz:
America may well have lost the ability to solve problems because too many people have a vested interest in their continuation.
Kevin Drum: Dog Food Explained!

So how did the Senate's provision forcing members of Congress to buy health insurance through the exchange end up in the final bill? A reader emails to explain:

The provision in the health care bill was added by Sen. Chuck Grassley. He originally wanted it to cover all federal workers — not just the Congressional ones — and obviously that created a bit of a stir. Baucus tried to placate him by adding language to say that federal employees may enter the exchanges, but that didn't work. So then Grassley offered his amendment saying, members of Congress and their staffs must use the exchanges. Perhaps he thought this would lead to an embarrasing fight, but Baucus said, "fine," and then that was that. As far as I know, the House version just says, members of Congress may enter the exchanges if they want to.

So there you have it. More here.

Ezra Klein: Reform begets reform

This is a good point from Fred Hiatt:

[M]aybe the country isn't all that divided -- most of us would welcome common-sense improvements in health-care delivery and insurance -- but the system feeds on and exacerbates our differences. The advent of the 60-vote rule in the Senate has magnified the already formidable checks and balances built into the Constitution, with the disproportionate blocking power it awards small and rural states. Cable television and the Internet have empowered those with the greatest intensity of feeling. The self-serving redistricting habits of the political elite, designed to protect incumbents, have left most legislators vulnerable only to primary challenges from the extremes of their respective parties.

Whichever explanation appeals to you -- and no doubt they all contain some truth -- the perception of paralysis increases the urgency of passing health-care reform. Failure would damage the Obama presidency, and it would also deepen the fear, here and abroad, that America is stuck.

To put this slightly differently, the failure of this health-care reform bill will not be taken as evidence that people should try other health-care reform bills with much more severe -- and thus unpopular -- cost-cutting measures. It will be that even a popular president backed by the largest Senate majority since the 1970s couldn't pass a fairly modest health-care bill. If you don't believe me, just ask the Republican presidential candidates if any of them are preparing detailed plans to privatize Social Security.

"Doing" health-care reform proves something important: Health-care reform can be done. That's not an argument for a bad bill, as Hiatt is careful to say, but it's an argument for recognizing that an imperfect bill is the beginning of a necessary process, while a damaging defeat ends any hope of one.

Benen: LEVERAGE....
Jonathan Cohn wrote a good lay-of-the-land piece last night on the state of the health care reform fight, noting, among other things, the "unambiguous." "unyielding," and "obstinate" efforts of center-right Democrats undermine the Senate bill.

But Cohn's point about reform's champions is the one I keep mulling over.

To be sure, Liberals can flex their muscle, too. Bernie Sanders made very clear, in his own statements over the weekend, that he wasn't guaranteeing to give his vote -- particularly if conservative Democrats (and former Democrats) extract even more concessions.

Sanders is right to play hardball like this, but, at the end of the day, it's hard to imagine he'd cast the vote to kill health care reform. He simply cares too much about the people even a weakened bill would help. The same goes for Sherrod Brown, who's emerging as a leading voice for progressives. Their interest in helping their fellow man is, in strategic terms, a great weakness.

I not only think this is right, I think it's a dynamic that will inevitably shape the debate over the next month (or more). We're dealing with a series of upcoming negotiations in which conservative Dems' indifference gives them leverage. In other words, Lieberman, Nelson, & Co. don't much care if this once-in-a-generation opportunity implodes, while reform advocates care very much. These rather obvious bargaining positions create a playing field that is anything but level.

Put it this way: imagine there's a big meeting with every member of the Democratic caucus in both chambers. You stand at the front of the room and make a presentation: "If health care reform falls apart after having come this far, tens of millions of Americans will suffer; costs will continue to soar; the public will perceive Democrats as too weak and incompetent to act of their own agenda; the party will lose a lot of seats in the midterms and possible forfeit its majority; and President Obama will have suffered a devastating defeat that will severely limit his presidency going forward. No one will even try to fix the dysfunctional system again for decades, and the existing problems will only get worse."

For progressive Democrats, the response would be, "That's an unacceptable outcome, which we have to avoid."

For conservative Democrats, the response would be, "We can live with failure."

This necessarily affects negotiations. One contingent wants to avoid failure; the other contingent considers failure a satisfactory outcome. Both sides know what the other side is thinking.

Yes, progressive Democrats can force the issue, keep the bill intact, and force Nelson, Landrieu, Lieberman, and Lincoln to kill the legislation, in the process making clear exactly who was responsible for the debacle. But that's cold comfort -- the goal isn't to position center-right Dems to take the blame for failure; the goal ostensibly is to pass a bill that will do a lot of good for a lot of people.

The push for more "compromise" isn't going to be pretty.


It's always encouraging when a lawmaker in a precarious position has his/her priorities straight.

"If you get to the final point and you are a critical vote for health care reform and every piece of evidence tells you if you support the bill you will lose your job, would you cast the vote and lose your job?" CNN's John King asked Sen. Michael Bennet of Colorado on Sunday's State of the Union.

"Yes," Bennet bluntly and simply replied.

Bennet was appointed by Colorado Gov. Bill Ritter to replace Sen. Ken Salazar, who stepped down from the Senate to serve as President Obama's Interior Secretary. Bennet, who was superintendent of the Denver public school system prior to his appointment, will have to seek election to the seat for the first time in 2010.

Now, I wasn't especially impressed with the question. We haven't seen King pressing his Republican guests on the price they may pay as a result of opposing health care reform. Indeed, the question for Bennet is premised on the notion that supporting health care reform is somehow a risky, politically dangerous thing to do. The framing of the question has a decidedly GOP-friendly spin.

Regardless, Bennet's response sent the right signal -- lawmakers who care more about keeping power than using it are looking at their responsibilities the wrong way. Good for him.


How concerned are Democratic leaders about keeping the 60-vote Senate caucus together on health care reform? They're already making contingency plans, hoping to replace defectors with the Maine Moderates.

Anxious that Saturday's party-line Senate vote to open debate on a health care overhaul gives them little maneuvering room, Obama administration officials and their Congressional allies are stepping up overtures to select Senate Republicans in hopes of winning their ultimate support.

The two moderate Republican senators from Maine, Susan Collins and Olympia J. Snowe, say Senator Harry Reid, the majority leader, reached out to them after he unveiled the Senate measure, encouraging them to bring forward their ideas and concerns.

Ms. Collins also received a personal visit from a high-level Obama emissary, Interior Secretary Ken Salazar, a former senator who worked closely with her on various issues as part of a bipartisan coalition.

Now, at first blush, this seems pointless. Probably second blush, too. Snowe and Collins not only oppose the Democratic proposal, they both just voted to filibuster a motion to have a debate on the bill. Collins said yesterday that she'd like to find a way to "rewrite the bill in a way that would cause it to have greater support." The two may be slightly less conservative than their GOP colleagues, but they don't exactly sound like prime targets for across-the-aisle outreach.

On the other hand, there are four members of the Democratic caucus -- Nelson, Landrieu, Lieberman, and Lincoln -- who are being just as obstinate as Snowe and Collins, if not more so. Indeed, all things being equal, it's probably fair to characterize Snowe as being to Lieberman's left on health care reform (Lieberman thinks even a trigger would be going too far in generating competition for private insurers).

With this in mind, the outreach to the Maine senators seems to have less to do with asking, "How can we make this vote bipartisan?" and more to do with asking, "What can we do if Lieberman decides to betray us?"

Of course, it's not just Lieberman. His center-right Democratic cohorts will all make painful demands to undermine the bill. The fact that Snowe and Collins are still on the radar screen, though, signals that the leadership is keeping its options open.

Back in July, we talked about an op-ed Sen. Blanche Lincoln (D) of Arkansas wrote for the Arkansas Democrat-Gazette. It wasn't perfect, but the center-right senator struck some encouraging notes:

Individuals should be able to choose from a range of quality health insurance plans. Options should include private plans as well as a quality, affordable public plan or non-profit plan that can accomplish the same goals as those of a public plan. [...]

Unfortunately, opponents of reform, who have no real plan for improving health care, are already using the tired arguments of the past. They say that Congress is trying to create "more government" or a "Washington takeover" of health care, which will raise your taxes, get between you and your doctor, and eliminate private insurance. It's a strategy that spreads misinformation and generates fear to preserve the status quo. Arkansans should not be misled by those who oppose real reform.

Of course, that was several months ago, before Teabaggers went berserk in August. But as Igor Volsky noted, as recently as yesterday, Lincoln's own website argued, "Individuals should be able to choose from a range of quality health insurance plans. Options should include private plans as well as a quality, affordable public plan or non-profit plan that can accomplish the same goals of a public plan."

That was the senator's official position a day after Lincoln stood on the floor of the Senate, "promising" to join a Republican filibuster of health care reform "as long as a government-run public option is included" in the bill.

After Volsky's post, Lincoln's office changed the senator's official position, scrubbing the page of any references to allowing consumers to choose among competing plans.

But given that the reasoning behind Lincoln's conservative position on reform has gone largely overlooked, perhaps, the next time the senator is addressing reporters, someone can ask her, "So, why were you for giving consumers the choice of a public option before you were against it?"

Yglesias: Thousands of Uninsured Arkansans Seek Free Medical Care

It’s not a coincidence that states with elected officials who are dubious about health reform tend to have the largest number of uninsured people. The same political culture that produces high uninsurance rates at the state level normally also produces federal officials who are hostile to measures to broaden access. But as long as the spotlight’s on Arkansas:

According to the Arkansas Department of Health, around 450 thousand Arkansans lack health insurance. More than a thousand of those uninsured made their way to Little Rock’s Statehouse Convention Center on Saturday for the National Association of Free Clinics “C.A.R.E.” event. [...] According to the NAFC, more than 90 percent of those who came on Saturday had three or more life-threatening conditions, such as hypertension, diabetes, cardio-vascular, and pulmonary disease. Dr. Kimberly Garner, who works for the Veteran’s Administration in North Little Rock and was one of the volunteer physicians at the clinic, says those kinds of numbers illustrate the need for change.

As of 2008, 19.2 percent of non-elderly Arkansans were uninsured (Arkansas seniors, of course, avail themselves of government-run health insurance), a bit higher than the national average. Many of those people would be made much better off by the health reform bill that passed the House or by the somewhat different one that passed the Senate. But Blanche Lincoln says that unless Democrats agree to kill the idea of introducing a public option into the mix, she’ll vote against a bill that would otherwise help many of her constituents.

Think Progress: Gun Lobby Mobilizes Against Health Reform By Claiming Obama Administration Will Issue ‘No Guns’ Decree
On Friday, Gun Owners of America sent out an action alert to its 300,000 members warning that the Senate health care bill “would mandate that doctors provide ‘gun-related health data’ to ‘a government database,’ including information on mental-health issues detected in patients, which could jeopardize their ability to obtain a firearms license.” The alert also warned its membership that the “wellness and prevention” provisions in the health care bill would allow the Obama administration to issue a “no guns” decree:

Finally, as we have mentioned several times in the past, the mandates in the legislation will most likely dump your gun-related health data into a government database that was created in section 13001 of the stimulus bill. This includes any firearms-related information your doctor has gleaned…or any determination of PTSD, or something similar, that can preclude you from owning firearms.

And, the special “wellness and prevention” programs (inserted by Section 1001 of the bill as part of a new Section 2717 in the Public Health Services Act) would allow the government to offer lower premiums to employers who bribe their employees to live healthier lifestyles — and nothing within the bill would prohibit rabidly anti-gun HHS Secretary Kathleen Sebelius from decreeing that “no guns” is somehow healthier.

The so-called “gun-related health data” is actually anonymous statistical information to help researchers develop health programs and initiatives that serve specific population groups or further the study of various conditions and medical needs. Section 2705 of the Senate health bill permits employers to vary insurance premiums by as much as 30 percent for employee participation in certain health promotion and disease prevention programs, but stipulates that the employer wellness program must be “based on an individual satisfying a standard that is related to a health status factor.” Gun ownership does not fall into this category.

This fear-mongering should be seen as the continuation of a multimillion dollar effort launched by the gun lobby to portray Obama as “a threat to the Second Amendment rights.” Prior to the election, the NRA claimed of Obama, “[N]ever in NRA’s history have we faced a presidential candidate…with such a deep-rooted hatred of firearm freedoms.” Since the election, the NRA and other gun groups continue to misinform voters about Obama’s gun policy proposals, claiming that unrelated policies — like the economic stimulus — are part of a broader campaign to strip gun rights.

“I’m not going to take away your guns,’’ Obama has repeatedly said. Nevertheless, sensing an opportunity to gain more members and fuel gun sales, the gun lobby has preyed on people’s fears by making up false claims.

  • from the comments:
    Art says:

    They are really reaching now.

    Hey! Did you hear the health bill will fund the rebuilding of the Berlin Wall?

    Whoa! I heard the health bill will give Texas back to Mexico!!

    Watch out! It’s said that the health bill will outlaw Christmas!!

    EnnuiDivine says:


    It was also outlaw meat!
    And mandate soy consumption!
    And make heterosexuality marriage illegal!

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