Sunday, November 22, 2009

Health Care: push comes to shove Edition

David Broder isn't sure if health care reform will cut the deficit, and as such, isn't sure if he likes the bill pending in the Senate. Minority Leader Mitch McConnell (R-Ky.) was delighted to see the column, and called the writer a "distinguished senior columnist" with important "reservations as a citizen."

Senate Majority Leader Harry Reid (D-Nev.) replied, "To focus on a man who has been retired for many years and writes a column once in a while is not where we should be."

Technically, Broder never exactly retired, and continues to churn out fairly predictable content (next week's column: politicians should be more moderate). But in his latest item, Broder doubts that the Senate's reform plan will achieve the promised deficit reductions. The columnist is aware of the CBO report, but reads it in such a way as to conclude that "the promised budget savings may not materialize."

Broder's Washington Post colleague Ezra Klein seems to think Broder should have taken a closer look at the details.

The net increase of $160 billion in the first 10 years is part of CBO's analysis, not a caveat to it. It doesn't mean the bill doesn't cut the deficit, it just means that overall spending is larger before you add revenues into the equation. Moreover, the CBO continues: "during the decade following the 10-year budget window, the increases and decreases in the federal budgetary commitment to health care stemming from this legislation would roughly balance out."

In other words, the revenue and the savings grow more quickly than the costs. Extend that line out further and, yes, federal spending on health care falls as a result of this bill. In other words, the bill satisfies Broder's conditions. But he doesn't come out and say that.

Instead, he pivots to the now-traditional argument that Congress won't be able to stick to the savings and revenue measures in this bill. That, however, is another way of saying that Congress can't cut health-care costs and the American government will go bankrupt. For one thing, that's not a very good reason not to at least try and avert that outcome. But if Broder's position is that we face certain fiscal collapse, then the only real question is whether we would prefer that 30 million Americans had insurance in the meantime, or went uninsured over that period.

Reading Broder's column reminds me of listening to center-right Democrats complain about the bill for no apparent reason. Harry Reid crafted a modest, affordable bill that would significantly reduce the deficit, cut systemic costs, and steer clear of massive tax increases. This is what the center-right says it wants. And yet, they're reluctant to take "yes" for an answer.

Broder's argument seems to be, "Well, maybe policymakers won't follow through and do what the legislation explicitly mandates they do." By any reasonable measure, that's simply not an argument.

Madrak (C&L): Nate Silver: We Shouldn't Be Celebrating Just Yet on Healthcare Reform

Nate Silver on why we shouldn't celebrate just yet:

Needless to say, it would have been very, very bad news for the Democrats if the motion to proceed to debate on their health care plan had failed tonight. But I'm not sure how newsworthy this really is. The potential hold-outs, like Lincoln and Ben Nelson, are going to have much greater leverage later on, when the bill nears its second major procedural hurdle: the cloture motion to proceed to the final vote.

And there's some bad news for Democrats too: Lincoln has joined Senators Ben Nelson and Joe Lieberman in making a fairly explicit threat to filibuster a bill that contains a public option. Mary Landrieu, on the other hand, sounds a little bit more open to compromise. But this impromptu Gang of 3 -- Lincoln, Nelson, Lieberman -- could be a tough one for progressives to penetrate.

Yeah, it's going to be ugly by the time they get done dealing away any real hope of competition for the insurance companies. I'm not optimistic about the short-term results here and I have to keep muttering to myself that this will be good for our children and grandchildren - probably.

Kurtz (TPM): Where Does This Leave Us?

The takeaway from today's debate is that the conservative Democratic senators have not budged on a public option. They've been persuaded not to block the bill from going to the floor for debate, but beyond that it doesn't appear any deal has been struck to get their votes on the next and more important cloture vote.

You might attribute that in part to the Dem holdouts wanting to enjoy their moment of maximum leverage for as long as they can, right up until the next vote later this year. But it's wishful thinking to conclude that's the only thing going on here. Blanche Lincoln's floor speech in particular seemed to foreclose her being able to plausibly turn around later and vote for a public option. You can't come out as strongly against it as she did and then vote for it anyway without seriously compounding your political problems back home.

The only reasonable reading of today's developments is that while the Dems will get 60 votes this evening they are still short of the 60 they need to get to a final vote on a bill that includes an opt out public option. Couple that with the fact that there is 100% guaranteed to be a health care reform bill in some shape or form passed by the Senate, and you're left with somebody needing to strike a deal to get this done.

We reported earlier that, according to one Senate aide, Sen. Chuck Schumer has been trying to map out a compromise that would switch the public option from an opt out version to some form of triggered public option that would satisfy the Democratic holdouts (and maybe Olympia Snowe). This apparently ticked off some of the opt out proponents in the Senate, though Schumer's office is vigorously denying to us that Schumer has had any role in any such negotiations.

Pissed at Schumer? Really?

No one's been as committed to the public option as Schumer, and our reporting has suggested that it's very unlikely that the public option would be in the bill today were it not for Schumer's efforts. But for all his work to get a public option through, Schumer is still a pragmatist, and surely he's known for several days what's becoming obvious to all of us today: they don't have the votes. So I'm not sure I get why anyone would be pissed at him for trying to come up with a compromise that gets the votes and preserves as much of the public option as possible.

I mean I "get it" -- emotions are raw and no one who's pushed hard for public option is going to be happy to see it watered down more. But at this point you're just denying reality if you think all that the Dems need to do to get the waverers to come around is stand together in a show of unity. Lieberman is a no. Snowe is a no. Nelson, Landrieu and Lincoln are tepid at best. Whatever peer pressure could be brought to bear is heavily diluted when you're four votes short. If it were one lone holdout, maybe. But four?

I don't have any independent knowledge about whether Schumer's been trying to forge a compromise. But it sure wouldn't surprise me. I'd be more surprised, given what we now know about the lack of votes (or, more precisely, what we've pretty much known but have had confirmed today), if Schumer were not trying to find a compromise. Somebody's got to. This isn't one where you get to just pick up the ball and take it home with you. You still have to play, even if the outcome is guaranteed to disappoint.

Late Update: A couple of developments this evening that suggest this compromise Schumer is exploring may be where the action is at.

At his presser following tonight's vote, Harry Reid said, "I welcome Sen. Schumer, Landrieu and Carper -- Landrieu said that they're working together on a public option that's acceptable to [all parties]."

Not long after that, Schumer's spokesperson emailed us with a markedly less defensive statement, in light of Reid's comment:

Leading up to tonight's vote, some senators expressed a desire to discuss the public option currently in the Senate bill. Of course, Senator Schumer did not rule that out. But no such talks have yet taken place, and there is not any compromise at hand beyond what Leader Reid has already inserted into the bill. Senator Schumer remains a strong proponent of the opt-out, level playing field public option.

That sounds like the pragmatic Schumer gearing up to go to work.


Sen. Ben Nelson (D-Neb.) has a few thoughts about the kind of changes he'd like to see on the health care reform bill. In fact, he has two pages of ideas, which he's already delivered to Senate Majority Leader Harry Reid (D-Nev.).

"There is not a lot of explanation there. These are just items," Nelson said.

What's on it? Public option, abortion, and CLASS Act, among other things.

"There will be a lot of discussion back and forth about what might get enough votes," Nelson said after the vote. "There will have to be fairly significant changes for others as well, not just me.... Nuance will not be enough."

I haven't seen the actual list, but at this point, I'm not altogether sure what any of this means. Nelson hasn't included "a lot of explanation" with his demands? Wouldn't "a lot of explanation" be helpful under the circumstances?

He isn't exactly a rookie. If Nelson has some specific ideas about policy improvements, he should, you know, craft legislative language, put together proposed amendments, start seeking co-sponsors, etc. Handing Reid a list of "just items" doesn't sound especially constructive.

For that matter, it'd be helpful to know if this is a list or a ransom note. Does Nelson intend to join a Republican filibuster if only some of his list is addressed to his satisfaction?

As the process moves forward, keep in mind that Nelson appears to have a hierarchy of concerns in mind. Just a few days ago, the conservative Democrat said he doesn't like the existing restrictions on abortion funding, but added, "If there's no public option, perhaps some of the [abortion] problem goes away."

In other words, Nelson has a list, but his top target is the public option. I suspect the other center-right members of the caucus are thinking along the same lines.
Atrios on The Last Honest Man
The senator from Connecticut lies, and the Village pretends not to notice... every time...
Beutler (TPM): Lieberman Repeats Claim That Public Option Not Part Of 2008 Presidential Campaign

Sen. Joe Lieberman (I-CT) raised hackles among liberals earlier this week when he claimed that the public option wasn't a part of the 2008 presidential campaign. He repeated that claim to reporters tonight, though acknowledged, when pressed, that then-candidate Barack Obama did in fact include a public option in his campaign health care proposal.

"This is a kindof 11th hour addition to a debate that's gone on for decades," Lieberman told reporters tonight. "Nobody's ever talked about a public option before. Not even in the presidential campaign last year."

I asked in response, "How do you reconcile your contention that the public option wasn't part of the presidential campaign given that all three of the [leading Democratic] candidates had something along the lines of the public option in their white papers?'

"Not really, not from what I've seen. There was a little--there was a line about the possibility of it in an Obama health care policy paper," Lieberman said.

(That line read, "Specifically, the Obama plan will: (1) establish a new public insurance program, available to Americans who neither qualify for Medicaid or SCHIP nor have access to insurance through their employers, as well as to small businesses that
want to offer insurance to their employees," and went on from there.)

I said, "And at the time Senator Clinton, and John Edwards also had..."

"Edwards probably had it more than anybody else," Lieberman said. "But Clinton, Obama, McCain--I don't see it. Anyway, I'm opposed to it."

Mark Kleiman on Madison’s revenge

Except for George Voinovich, who didn’t vote (and is retiring in any case) every Republican in the Senate, including alleged “moderates” Grassley, Snowe, and Collins, voted against even allowing debate on the health care bill. This after every Republican in the House save Anh Cao voted against reform; even Cao’s vote didn’t come until after the bill already had the 218 votes it needed to pass from Democrats.

Your high-school civics teacher no doubt told you that you should “vote for the person, not the party.” Madison and Hamilton, who hated what they called “faction,” would have agreed. All three of them were wrong. Party is the only mechanism by which voters can influence actual outcomes.

Alas, the idea that nonpartisanship is somehow the morally superior position lingers in our civic religion. Just the other night an otherwise intelligent dinner companion proudly informed me that she was an independent.

Even if you prefer to vote for a politician who genuinely thinks for him- or herself, at the national level that option is no longer available. There used to be genuine Republican liberals (such as Jacob Javits, Mac Mathias, Mark Hatfield). No more.
Every Republican on the Hill was happy to stand back and let the Beloved Leader and his wrecking crew trash the Constitution.

When push comes to shove the Republicans all vote like reactionaries, and the “centrist” Democrats are mostly worthless opportunists with “for rent” signs on their foreheads, on the Joe Lieberman-Ben Nelson model.

On Election Day, there’s only one question to ask: “Which side are you on?” If the Democratic candidate in your district is a flat-out crook or lunatic, good partisan hygiene may require that you vote against him. But don’t be seduced by a “moderate” Republican. As the yokel said when he saw the rhinocerous, “They ain’t so such animal.”

Yglesias: Coal Groups Want to Block Health Reform to Kill Clean Energy

One crucially important, but not-so-well-understood aspect of American politics is that business groups in the U.S. tend to behave in a highly ideological, highly solidaristic manner rather than as narrow interest groups. For example, check out this interesting item from my colleague Lee Fang:

Corporate front groups and large business trade associations are funneling their resources into defeating health reform. Even though health reform will lower costs for small businesses and boost worker productivity economy-wide, it appears that corporate entities influenced by major polluters are hoping that the defeat of health care legislation will slow President Obama’s agenda and derail their true enemy: clean energy reform.

The West Virginia Chamber of Commerce, which is largely backed by the coal industry, candidly revealed this strategy in a letter released today to Sens. Jay Rockefeller (D-WV) and Robert Byrd (D-WV). The Chamber of Commerce demanded that the senators use “their clout and seniority” to obstruct the health reform debate until cap and trade legislation is taken off the table and the EPA is barred from regulating carbon dioxide as a pollutant. As Ken Ward of the Charleston Gazette noted, Rockefeller has already rejected a similar proposal of blocking health reform unless the EPA stops reviewing mountaintop removal permits. The coal lobby has also pressured West Virginia state legislators to pass resolutions opposing clean energy reform.

Part of what’s interesting about this is that, as a matter of logic, you could easily imagine trying to run this play in the other direction. The WV Chamber of Commerce could be working with Senators Rockefeller & Byrd to cement a broad, bipartisan alliance between WV legislators in which the Republicans join with the Democrats to support health reform and the Democrats join with the Republicans to protect the state’s coal interests. There’s nothing, in other words, particularly obvious, natural, or inevitable about this kind of linkage. But American business has a very strong tendency toward forming a broad ideological alliance against all forms of regulation and public services. You might, for example, think that “real economy” firms would want a well-regulated financial system but business groups show no signs of anything other than hostility to efforts to better-regulate the main banks.

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