Wednesday, January 20, 2010

Where we're at

Drum: The Choice

After reading stuff like this and this, it's looking increasingly clear that jittery Dems aren't willing to do the obvious now that they've lost their 60-vote supermajority: Pass the Senate healthcare bill intact along with promises to make changes later this year via reconciliation (which requires only 51 votes in the Senate). Partly this is because the Senate bill delays implementation of its major structural changes for years, which means that anyone running for reelection this November will take plenty of potshots from Republicans but have nothing substantive to brag about in return.

That's the theory, anyway, but Jon Cohn provides a laundry list of immediate tangible changes that would make good campaign fodder:

Seniors will see the Medicare “donut hole” start to shrink.

Families will get to keep kids on their policies past high school, until the kids are 26.

Preventative services will have "first-dollar" coverage, meaning you'll pay nothing out-of-pocket — that's right, nada, zilch — when you get a regular checkup.

People who are uninsurable because of high medical risks will get access to catastrophic policies, as a stopgap until full coverage becomes available in a few years.

The government will set up a website with information about different insurance plans, letting people compare benefits in standardized, plain English terms.

It will also make investments in the health care workforce — spending money to train or hire new primary care doctors, nurses, and direct care workers.

Insurers will have to fess up about how much money they divert from patient care to overhead and profits — and to set up systems for appealing coverage denials.

People will have the right to go to the emergency room — and women the right to see an obstetrician/gynecologist — without prior approval.

The list goes on.

I'll add one other thing: the idea of going back to the drawing board and trying to pass a few little piecemeal reforms is suicidal. It's one of the worst ideas I've ever heard. One of the big problems with healthcare reform is that the public is sick of the process. The last thing they want is for Congress to spend several more months flailing around on it. What's more, does anyone seriously believe that Democrats would get any Republican votes for a smaller bill? That's just a fantasy. Oh, they'll happily negotiate and delay, since that not only makes Dems look hapless and craven, but prevents them from getting anything else done in the meantime. It's a twofer. But when it comes time to vote? Every single one of them will invent some reason that the smaller bill is still fatally flawed. The final vote will be 59-41 and months will have been lost for nothing.

Realistically, there are only two choices now: either pass the Senate bill or else wait another 15 years for any kind of serious healthcare reform. That's it. That's the choice.

Krugman: Fools On The Hill

So, will health care reform fail because a lazy candidate didn’t bother campaigning and didn’t know her Red Sox? (Yes, there were national factors at work, but Nate Silver makes it clear that a better candidate would have won easily). It’s up to the House, which can and should just pass the Senate bill.

Unfortunately, quite a few representatives seem to be in panic mode. And that’s just dumb.

First of all, the strategy of playing Republican-lite, and hoping that you’ll be left alone, has been tried — and failed disastrously. Remember 2002?

Second, David Axelrod is right: the campaign against HCR has been based on lies, and the only way to refute those lies (and stop them from being rolled out again and again) is to pass the thing, and let people see it in action. It’s too bad startup is delayed under the Senate bill — but even so, that’s what you have to do.

Finally, Democrats have to realize that politics isn’t just about where you stand on issues, it’s about perceptions of a party’s character. The rap on Dems has always been that they’re wimps — and giving in on such a central part of the party’s agenda, emerging from two years in power with nothing major to show for it, will play right into that perception.

Just do it — pass health care. Then move on to confronting the bankers.

Drum: Email Dump

Email from my old college roommate:

What is wrong with Democrats? I'm not talking about losing in MA. Sure, it's an unforced error, but it happens. I'm talking about the self-destructive spasms that follow.

And this from a friend:

I can't decide which is worse — watching what happened yesterday, or watching them react to what happened yesterday today. I can barely turn on my computer. It's so pathetic.

And another:

There is nothing in the Democratic conference that inspires confidence. They are simply not trustworthy. At all. Make no mistake: This failed for lack of leadership. And I guess the leaders have to reap the whirlwind or whatever.

And another:

Frankly, I don't know which is worse — the finger pointing, or the calls for slowing down, restarting, or scrapping HCR. You can find more professionalism in your local student council race. To call this amateur hour actually dignifies the whole thing.

And finally this from a Senate staffer over at Josh Marshall's site:

The worst is that I can't help but feel like the main emotion people in the caucus are feeling is relief at this turn of events. Now they have a ready excuse for not getting anything done. While I always thought we had the better ideas but the weaker messaging, it feels like somewhere along the line Members internalized a belief that we actually have weaker ideas. They're afraid to actually implement them and face the judgement of the voters. That's the scariest dynamic and what makes me think this will all come crashing down around us in November.

And remember: I and my readers are mostly the sober, pragmatic sorts. Willing to compromise. Sensitive to political realities. Etc. And even we're disgusted. I can't remember ever being as embarrassed to be a Democrat as I am today.

Beutler (TPM): U-Turn: Frank Says, With Assurances, He'll Vote For The Senate Health Care Bill

In an interview with TPMDC this evening, Rep. Barney Frank (D-MA) reversed course--apologizing for a harsh statement he released last night in the wake of the Massachusetts special election, and saying, explicitly, that if he's assured the bill will be fixed down the line, he'd vote for the Senate health care bill.

"I'm easy. I'm strongly inclined to vote for the thing, even though I don't like the health care tax thing," Frank told me. "But you know, I was ready to vote for the bill when I had people on the left yelling at me not to vote for it. So you know I'll vote for any of it... to try and move the process along."

Frank was quick to qualify his remarks, though, noting that a vote from him would require promises from leadership and the White House that at least one controversial element of the legislation would be fixed in subsequent legislation. "I take it back...I would want assurances that we were going to amend the health care tax piece," Frank said.

Last night, Frank cast significant doubt on whether Democrats could conceivably pass a health care bill at all. In a statement issued after Sen.-elect Scott Brown's (R-MA) victory last night, Frank said "I am hopeful that some Republican senators will be willing to discuss a revised version of health care reform. Because I do not think that the country would be well served by the health care status quo. But our respect for democratic procedures must rule out any effort to pass a health care bill as if the Massachusetts election had not happened."

That statement created a bit of confusion: Did Frank think the election was a referendum on health care and that Democrats should abandon the plan? Or did he simply think it would be inappropriate of Democrats to ram a compromise bill through the Senate in the window between Brown's victory and his swearing in. Tonight, Frank laid any doubt to rest.

"I should not have put out a statement late in the evening last night when I was upset because I didn't really--I think I overstated the pessimism," Frank told me. "I really was worried--I put out a new statement--I was worried about some Democrats doing crazy things, like 'don't seat him', 'let Kirk's vote go.' I was worried about that."

Frank laid out a specific, potential way forward for health care, which he acknowledged would be fraught with difficulty. But, he noted, if it fails, Democrats should return to the Senate and ask one moderate Republican if she really wants to be the person who says, "no way, no how," to health care reform.

"The one thing is--you might be able to get the Senate bill through the House if there were assurances and agreement on what subsequent amendments would be," Frank said. "That's going to be very tricky, but that's one possibility."

Frank is talking, roughly, about Plan B, which Democrats have been discussing since the electoral situation in Massachusetts began looking dire. How exactly would that work? Frank explained:

"You have to pass the Senate bill as is and the President signs it. Then people have to be assured that you can get the amendments through the House and the Senate," Frank said. "Because then the argument would be, 'Look, the bills already passed so now the question is whether you're willing to amend it or not.'"

One way to do that would be through the filibuster proof budget reconciliation process. "The alternative would be, people are talking about using reconciliation: 51 votes to get the agreed on amendments in the Senate."

The problem, Frank noted, is that reconciliation can only be used for some measures--revenue and spending measures, with implications for the federal budget--and not others. Some elements of the fix, then, could be passed through reconciliation, requiring only a simple majority in the Senate. The trick would be to get the other contentious measures--abortion, immigration--fixed through the regular order.

"Those would need 60 [in the Senate]--and the question is can you get the House votes without the assurance that you're going to get those."

So what if it fails? What if, despite these hypothetical assurances, the House can't muster the votes for the bill? Frank says, look to Maine.

"I just had somebody in Maine tell me this--I wonder whether Olympia Snowe wants to be the person who says nothing happens," Frank told me. "It's one thing for her to vote no when she thought it was going to pass."

I think people are underestimating the pressure people like Olympia Snowe are going to feel. She voted for a version of it. Is she going to want to say, "Never ever ever, and I'm in charge of their not having been any change, and pre-existing conditions, and lifetime caps, etc etc."

Frank says if Democrats can't seal the deal on health care reform, they may still be able to accomplish other agenda items like financial regulatory reform, and jobs legislation. But, he said, a success on health care reform, without abrogating the accepted norms in Congress, would be much better politically than outright failure.

"A bill being passed [is in Democrats' best interest]--as long as it's being done in a way that's invulnerable to charges that it was jammed through, or the rules were disregarded. That's what I was afraid of was a disregard for the procedural rules: Bending the Byrd rule out of shape, or doing something with Paul Kirk's vote while awaiting certification--those things would be fatal."

Democrats will huddle to discuss plausible ways forward tomorrow morning. Speaking as one of the members who left last night's health care caucus feeling pessimistic and aggrieved, he thinks fellow progressives and other Democrats will be calmer tomorrow, having had a chance to mull things and come to terms with the new reality.

"It's probably better."

The atmosphere will be better?


Beutler (TPM): Labor Coalesces: Pass Senate Health Care Bill, But Only If It's Fixed Quickly

The most influential labor organizations in the country have arrived at a common solution to the Democrats' health care conundrum: Move forward, pass the Senate bill through the House, but only if a separate, filibuster proof bill codifying a crucial changes is passed post haste.

"Step one: The House should pass the Senate's health insurance reform bill - with an agreement that it will be fixed, fixed right, and fixed right away through a parallel process," writes SEIU President Andy Stern at the Huffington Post.

Reform can work -- the Senate bill can serve as the foundation for reform and include at minimum the improvements the Administration, House, and Senate have negotiated. We cannot squander the opportunity to make real progress. The House and Senate must move forward together. And, there is no reason they cannot move forward together to make those changes through any means possible -- whether through reconciliation or other pieces of moving legislation.... There is no turning back. There is no running away. There is no reset button.

The AFL-CIO has a functionally similar, but tonally tougher take. "We don't want the House to pass the Senate bill as is," AFL-CIO spokesman Eddie Vale tells me. "It needs to be paired with a Senate [bill]--through reconciliation--that makes fixes."

Such a pairing, according to Vale, should be "simultaneous, or almost side by side."

Functionally, these are nearly identical positions. Vale says an outreach effort to disgruntled progressives and members supportive of organized labor is ongoing. "From the very beginning we have been discussing and communicating these decisions with members, progressives...and are of course continuing to do so now."

Unclear is how large a time lag between the two bills labor would accept. As to whether passing a reconciliation bill to amend the Senate bill is feasible, union officials see a ray of hope. "If the House passed the Senate bill, could reconciliation, that process, be used to fix things that might be improved upon? Yes," Budget Committee Chairman Kent Conrad (D-ND) told reporters today. "Would I support it? I can't know that without knowing what would be included in the package."

Drum: Facing Reality

Over at the Economist, some random unidentified blogger says that Democrats should modify their healthcare bill in order to attract some Republican votes:

Suppose you had just woken up from a year-long hibernation and somebody gave you the logistical picture described above. You would come to one of two conclusions: 1) the bill in question was deeply flawed, because otherwise surely at least one member of the opposition would support legislation that seeks to improve what is almost universally accepted to be an expensive and slipshod health-care system. Or 2) The country has been paralysed by party politics, such that not even one rogue or idiosyncratic or centrist or mischievous Republican would cross party lines to support the Democrats' bill. Option two strikes me as more unlikely, but we're all operating as if it were the case.

I see an opportunity, however miniscule, for the Democrats to take this time to re-work the bill in a way that would have broader appeal — not a way that has more giveaways to business, as they seem to have that under control all on their own — or, at the very least, to make a stronger case for the bill they do have. Optimistic, or dangerously naive?

Of all the fantastical notions that have been floating around today, this is the one that strikes me as the least grounded in reality. (Which, in fairness, the Economist's blogger seems to dimly grasp.) So as long as we're waking up from a year-long hibernation, let's recall a little bit of history.

For starters: Republicans have never had any interest in serious healthcare reform. George Bush was president for eight years and never proposed anything. Congressional Republicans never proposed anything either — and when Democrats took power, they opposed even incremental changes like SCHIP expansion. The Republican candidate for president in 2008, John McCain, was plainly uninterested in healthcare reform, and when he finally felt like he had to propose a plan of his own, it was so transparently weak and unworkable that no one took it seriously.

Now fast forward to 2009. Congressional Democrats start work on healthcare and Republicans have two choices: (a) work with Dems to try to produce a bill that's a little more to their liking or (b) try to kill it completely and run the risk that Dems pass a more liberal bill on a party line vote. Option B was a big gamble since healthcare reform seemed likely to pass, but they chose it anyway because killing reform completely was their preferred outcome.

The idea that there are even a handful of Republicans who are interested in improving "what is almost universally accepted to be an expensive and slipshod health-care system" just isn't supported by the evidence. That's because this is nowhere near universally accepted. Republicans think we have the best healthcare system in the world. Their unanimous preference is to leave it alone, and Democrats really don't have any bargaining chips big enough to get them to change their mind. As Jon Chait put it in response to a Mark Penn column that also suggested a bipartisan approach: "I'm trying to think of what it would take for them to accept a public plan. The total abolition of all taxes on income over $200,000? Even that probably wouldn't be enough."

This fantasy that there are Republican votes for a more moderate bill really needs to end. There are no Republican votes for healthcare reform, no matter how moderate or conservative it is. They're opposed to healthcare reform. They've always been opposed to healthcare reform. They're Republicans! There's nothing wrong with them being opposed to healthcare reform. And they are. Full stop.

Going down this path would be dangerously delusional. It would waste time, piss off voters even more, and accomplish nothing. It's time for House liberals, labor unions, lefty activists, Blue Dogs, Democratic pro-lifers, and fence-sitting centrists to all face reality: the only way to pass healthcare reform of any kind is for the House to pass the Senate bill as is and then work to improve it later during the budget reconciliation process. It's not perfect, but it will work. Nothing else will.

Booman: The Real Failure
Congressional Democrats and the White House are getting a lot of advice today. Almost all of it is self-serving. I might have some advice, but I mainly have a few observations.

As someone who spent 2005-2009 documenting the behavior of the Bush administration and the Republicans in Congress, I can tell you that we've never suffered from such a period of sustained unethical and even criminal behavior in our nation's history. That those characters were also almost comically inept and incompetent only made matters worse. They were so bad, in fact, that it didn't require any kind of ideological battle to defeat them. People just wanted change.

We've had bad administrations before. We've even had failed administrations before. But we've never had quite the toxic brew that we experienced in the second term of the Bush administration. They left the country heavily indebted, with a cratering financial sector, escalating unemployment, a housing crisis, and internationally discredited while bogged down in two unpopular wars in Asia. But you know all this.

The problem, as I see it, is that the Obama administration attempted to treat the Bush administration the same way all other incoming administrations have treated an outgoing administration of the other party. That is to say, they treated them as members of the permanent Establishment in good standing. Their punishment was being stripped of the offices and accouterments of power, nothing more. Where possible, members of the Bush administration were retained in the interest of comity and continuity. Republican members of Congress were invited into the cabinet. Crimes were not investigated, or were put off to another day.

There were many fine reasons, both practical and political, for taking this road, but they ignored they magnitude of the rot at the heart of our country after eight years of Bush and Cheney in power. They ignored the very nature of the Republican Party that Bush and Cheney bequeathed upon the nation.

Obama wanted to rise above petty partisan bickering and rule by consensus. But the other side was so corrupted that this proved impossible. And, I think, this phenomenon goes beyond mere partisan politics to extend to Wall Street, and to our culture more generally after eight years of terrorization and regulatory neglect by our government. Our media is thoroughly corrupted, as well.

Above all, the political cost that Obama has paid has come from his failure to articulate the nature of the beast he defeated. And, I think, this is partly due to his failure to understand the depth and breadth of the cancer that is feeding on our Republic. To be sure, it has metastasized into the Democratic Party, too. But that wouldn't be a problem if not for the complete rot in the other party.

A narrative needs to be told about the degree to which the Republicans screwed up this country, flouted the law, violated privacy and civil rights, and took the money and ran. Until the Obama administration is willing to tell the American people the truth about the biggest threat we face (which is not the threat of terrorism) and to behave like they are serious about defeating the Republicans and driving them into the ground, we are going to lose elections to lightweights like Scott Brown whenever our own candidates are less than satisfying.

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