Friday, March 19, 2010

HCR Friday

Nancy Pelosi.
"I never stop whipping."
Email Of The Day

From the staff of Senator whose support we can’t afford to lose.

...[W]e got more than 300 teabagger calls today. My intern cried. We got TWO (2) pro-reform calls today. I hate to beg, I really do. But y’all are doing a better job of whipping Members than anyone else. PLEASE KEEP CALLING.

You know what to do.

Switchboard: (202) 224-3121

Guide for first-timers here.

Why People Don't Understand Health Care Policy.
Take it away, Chris Cilizza:
That meeting also made plain the wide policy gap between the two parties; Democrats were focused primarily on expanding coverage, while Republicans were fixated on controlling costs.

Meanwhile, the Congressional Budget Office says [PDF] the Democrats' plan is the biggest deficit-reducer in 15 years:

CBO and JCT estimate that enacting both pieces of legislation—H.R. 3590 and the reconciliation proposal— would produce a net reduction in federal deficits of $138 billion over the 2010–2019 period as result of changes in direct spending and revenue... [it would also] reduce federal budget deficits over the ensuing decade relative to those projected under current law—with a total effect during that decade that is in a broad range around one-half percent of GDP.

The bill also reduces Medicare expenditures by 1.4 percentage points a year. Which is to say, Cilizza's descriptions of the two sides is pure b.s., and, sadly, they appear in an otherwise sensible article.

Republicans have consistently opposed many cost control measures, from an independent medical advisory commission to insurance exchanges, while touting ideas like malpractice reform that do reduce costs but only by small amounts. And malpractice reform policies are in the bill! Read David Cutler. Cillizza literally refuses to believe that someone could care about reducing costs and expanding coverage at the same time, despite the bare facts.

-- Tim Fernholz

Ezra Klein: Democrats get the bill, and the score, they needed

The question people generally ask about the final health-care reform vote is, "Won't it be politically difficult for many House Democrats to vote yes?" But with the release of the CBO report (pdf), I'd flip that question a bit: Won't it be substantively difficult for many House Democrats to vote no?

If you're a liberal House Democrat, here's what you'd be voting against: Legislation that covers 32 million people. A world in which 95 percent of all non-elderly, legal residents have health-care coverage. An end to insurers rescinding coverage for the sick, or discriminating based on preexisting conditions, or spending 30 cents of each premium dollar on things that aren't medical care. Exchanges where insurers who want to jack up premiums will have to publicly explain their reason, where regulators will be able to toss them out based on bad behavior, and where consumers will be able to publicly rate them. Hundreds of billions of dollars in subsidies to help lower-income Americans afford health-care insurance. The final closure of the Medicare Prescription Drug Benefit's "doughnut hole."

If you're a conservative House Democrat, then probably you support many of those policies, too. But you also get the single most ambitious effort the government has ever made to control costs in the health-care sector. According to the Congressional Budget Office, the bill cuts deficits by $130 billion in the first 10 years, and up to $1.2 trillion in the second 10 years. The excise tax is now indexed to inflation, rather than inflation plus one percentage point, and the subsidies grow more slowly over time. So one of the strongest cost controls just got stronger, and the automatic spending growth slowed. And then there are all the other cost controls in the bill: The Medicare Commission, which makes entitlement reform much more possible. The programs to begin paying doctors and hospitals for care rather than volume. The competitive insurance market.

This was a hard bill to write. Pairing the largest coverage increase since the Great Society with the most aggressive cost-control effort isn't easy. And since the cost controls are complicated, while the coverage increase is straightforward, many people don't believe that the Democrats have done it. But to a degree unmatched in recent legislative history, they have.

The Medicare Prescription Drug Benefit didn't try to offset its costs. It just increased the deficit. And Medicare and Medicaid were passed in the days before the Congressional Budget Office even existed. For health-care reform, Democrats have gotten the toughest scorekeeper in Washington to bless their effort, and though many don't think that's good enough, it's a lot more than anyone else has ever done.

People pay a lot of attention to the difficult politics of health-care reform, but at the end of the day, the task of writing the policy will be seen as the harder, and more consequential, element of this effort. But it worked. Democrats got the score they needed, and now they can go to their liberals and say that this is closer to universality than we've ever been, and they can go to their conservatives and say this does more for deficit reduction than has ever been done, and both things will be true.

If this bill does pass on Sunday, that, and not deals or polls or rides on Air Force One, will be why.

Ezra Klein: Mike Pence's confused response to the CBO report

"Only in Washington," said Rep. Mike Pence, "can you spend a trillion dollars and say you’re gonna save the taxpayers' money.”

And only in Washington can such willful obtuseness be considered a professional attribute. You can believe that the savings in the Democratic plan will work as CBO thinks they will work, or you can disagree with that. But let's not pretend there's something complicated about the theory of spending money and saving money at the same time.

Let's say I own a graphics design firm. But all our computers are very old. A lot of time is wasted waiting for Adobe Photoshop to load and compute. So I decide to upgrade all of the computers. Costs a lot of money. But since my designers can now do more projects in a day, my firm is actually making more money. So yes, I can spend money and increase my bottom line at the same time. Investing in order to secure efficiencies is not a new concept.

The health-care example is a bit more complicated because the thing we are spending money on (coverage) is not the thing that's saving us money. But it's not that much more complicated. Let's say I want to hire new people at my graphics design firm. But first I need to make room in the budget. So I move our offices to a cheaper area of town, I stop providing free lunch for the staff, I raise prices slightly and I implement a variety of painful managerial changes that substantially streamline our operations. This not only pays for the new hires, but saves money above and beyond that.

No one would argue that these hypotheticals are impossible. Or, if they did, they would be out of touch with basic economic concepts to a truly unseemly degree. But that's what Pence is implying above. Presumably, he's just misleading his audience because it's easier to play to ignorance than to explain his actual critique of the bill. But that's not a good thing either.

Chapter and verse ...
History awaits health reform's passage March 18: Rachel Maddow reviews the news of the CBO score of the Senate health reform bill and talks with former Vermont Governor Dr. Howard Dean about the contents of the bill.

Visit for breaking news, world news, and news about the economy

Last night, House Majority Whip James Clyburn (D-S.C.) was asked whether his caucus has the 216 votes it needs to pass health care reform. He said he believes so. This morning, House Majority Leader Steny Hoyer (D-Md.) was asked the same question. He said he doesn't think so, but was confident about success "by Sunday."

Watching this process unfold is not for the faint of heart.

I'm deeply skeptical of this, but the New York Times reported this morning that the leadership is so confident about securing a majority, the Speaker's office is now in the process of trying to figure out which vulnerable Dems to give passes to.

Yes, the 11th-hour vote tallying is under way at a brisk pace in offices from Capitol Hill to the West Wing, with Ms. Pelosi and her lieutenants keeping hour-by-hour tabs on wavering Democrats.

But as the week inches along, with momentum steadily building to a Sunday vote, the party leaders are also beginning to decide which politically endangered lawmakers will be given absolution to vote no. [...]

There are, of course, very few votes to spare. Yet there are some. And even most Republican leaders concede that the mystery is not so much whether Democrats will reach the magic number of 216, but rather whose names will be included as yes votes in the final count.

That's about the most optimistic assessment for reform supporters I've seen, which is probably why I find it so hard to believe.

The good news for proponents is that there are now three Dems who voted against reform in November who are going to support the bill. Dennis Kucinich (D-Ohio), who announced his switch on Wednesday, was first, and two more -- Tennessee Blue Dog Bart Gordon and Colorado's Betsy Markey -- made the same switch yesterday afternoon. Illinois' Luis Gutierrez and Ohio's Charlie Wilson, who were threatening to switch from "yes" to "no," both said they'd vote to pass reform, too.

But the news was not all good. New York's Michael Arcuri, in a rather shocking display of cowardice, declared on his website that he would oppose the bill he supported in November. Illinois' Daniel Lipinski signaled his intention to follow Bart Stupak's lead. Ohio's Zack Space is leaning "no," despite supporting reform in the past, and in a head-scratcher, Stephen Lynch of Massachusetts, a member of Speaker Pelosi's whip team, declared that the reform bill isn't liberal enough for him, and declared his opposition.

And, of course, Bart Stupak is still Bart Stupak.

Expect a busy day.

Marshall: Lynch: Still a No
Even after a 40 minute meeting with the president yesterday, Rep. Lynch (D-MA) is still a no on Health Care Reform. Looking like a pretty likely primary challenge to come.
Sargent: SEIU To Yank Support For Arcuri, Will Search For Challenger

It appears SEIU is dead serious about this business about yanking support for House Dems who vote No on the health bill.

The SEIU bluntly informed Dem Rep Michael Arcuri of New York yesterday that it’s pulling support for hiim in the wake of the news that he’s an all-but-certain No, I’m told. And the search for a primary or third-party challenger is underway.

Jerry Dennis, the president of SEIU local 200, which represents 14,000 workers statewide in New York, called Arcuri yesterday and deliered the news, SEIU spokesman Matt Nerzig tells me.

“Jerry called him yesterday and told him it’ll be very difficult to support him come next election if he’s not on this bill,” Nerzig says. “The search for alternatives has already begun.”

“This guy won by two percent with our support and 1199 support against a moderate republican last time,” Nerzig continues. “It’ll be very difficult for him to win reelection next time without us.” Arcuri won with 52% of the vote in 2008.

It’s worth reiterating that this threat is very real. Because of the powerhouse Working Families Party in New York, a labor-backed third party challenge could be a career-ender for these pols.

Separately, in a bit of good news for Dem vote counters, Rep Charlie Wilson, a former Yes who was thought to be undecided, will vote Yes again, a good get for Dems because he shared the Stupak dozen’s concerns.

“I am confident that the language in the Senate bill ensures that there will be no federal funding for abortions,” Wilson said. “I am confident that the Senate language upholds all of my pro-life values.”

Dennis G.: John Barrow: Profiles in ______________

John Barrow is a Congressman from Georgia’s 12th District. He has been in Congress since 2004 when he won election in 2004 when he ran for Congress in the 10th District that includes my old stomping grounds of Athens, GA. After that election, the Republicans in Georgia took a tip from Tom DeLay in Texas and engaged in some rogue mid-decade reconfiguration of Congressional Districts. The new 10th District was designed for Barrow to lose the seat in 2006 and so he moved to Savannah and ran in the newly drawn 12th District. He had a close race in 2006 and held onto the seat by a narrow 864 votes. In 2008—riding Barack Obama’s coattails—he easily won re-election with 66% of the vote.

Tonight, John Barrow faces a choice. He is an old friend and I worry that a cowardice born of ambition is about to lead him to vote NO on HCR.

He needs to hear from some folks about this vote—and soon.

I’ve known John Barrow for years, decades really. Back in the day (as the kids say), John and I both lived in Athens, Georgia. I published an alternative newspaper there and John was a lawyer and a member of the Athens City Council. In 1989-1990 I worked to support unifying the local Governments of Clarke County, Georgia and the City of Athens into one new Unified government: Athens-Clarke County. It was a hard fought campaign, but we won the Unification Vote and then a progressive slate of candidates won control of the new local government. John was one of those progressives and he represented the Fourth District of the A/C Government for many years. Over many elections and legislative battles, I supported him and wrote many an editorial upon his behalf.

I left Georgia in the late-nineties, but I would stop in and visit John when I came back to Athens from time to time. When I heard that he was running for Congress in 2004, I gave him my support and did what I could do to help him win. When he had his close race in 2006, I did what I could to support him as well. I was happy to see him win.

I’ve been playing phone tag with John for the last few months on HCR. I’ve heard him on my voice mail and I’ve spoken with members of his team. I have to say that as of tonight, I am not encouraged by what they’ve been saying. More troubling are the reports I’m hearing from other contacts in Georgia that John Barrow is leaning to a “NO” vote on HCR. To some longtime friends he has been ‘apologizing’ as he talks about his upcoming vote. These are not good signs.

While some whip counts have Barrow listed as undecided, others list him as a firm “NO”. My effort to find out where he stands is—so far—disappointing. It looks like Barrow may be a NO vote and the worst part of all of it is that his reason is just cowardice born of ambition. It would pathetic if the stakes were not so high.

John has been a back-bencher in Congress. It is hard to see anyplace where he has made his mark in his almost six years in the place. In some ways this makes sense given the difficult District that he is in, but it is not that difficult for a Democrat—the GA-12 went for President Obama by 54.09% of the vote in 2008 and that margin carried Barrow back to Congress. If Barrow’s goal was just re-election he could vote YES on HCR and most likely do just fine come November, but I’m hearing that he has his eyes on a bigger prize. It seems that his ambition for higher office is the force that is driving him towards a NO vote.

The talk in Georgia is that John wants to run for the Senate in 2014 and that he thinks a NO vote on HCR will be smart positioning for that race. He seems to be making the bet that a NO vote on HCR will be forgotten by then. Hell, he seems to be making a bet that Democrats will forget his betrayal by the fall and support him with DCCC money, fundraisers, grass roots support and ground troops for his re-election. He seems to feel that even if he votes to kills HCR that Democrats will still rally to support him in November and that they will support him again in 2012 and then get behind him when he runs for the Senate in 2014.

John Barrow needs a little dose of reality.

He needs to hear that voting NO on HCR will only place him on a fast track to the END of his ambitions. He needs to hear that a NO vote is a betrayal that will not be forgotten. He needs to hear that a NO vote will lose him support in every election from here on out. He needs to know that Democrats will not support him for anything if he votes NO. HIs fear of a NO vote needs to become greater than his fear of a YES vote when it comes to his ambitions. I wish my old friend was a fellow who put doing the right thing first, but he is not. Fine. If ambition is his motivation, he needs to know that a NO will be his end of his political career.

I keep hoping that I will hear that John Barrow will be a vote FOR HCR, but I feel a need to let an old friend know that there will be a price for his calculated cowardice if he votes NO on HCR. This vote will be John Barrow’s test. He has a choice between a Profiles in Courage moment or a base capitulation to the fearmongers of the Right. I want him to do the right thing.

This is a message that I have left for John and one that I will tell him if he returns my calls. It is a message that I hope you will share with him as well.

I know John. He is a decent fellow, but he is driven by his ambitions. That’s fine as far as that sort of motivation goes, lots of politicians are driven by ambition. Many have done excellent things because of that motivation. But many, many more have let their ambition trump their integrity. And from time to time a vote comes along that shines a light on every backbencher trying to just skate by to the next election and forces them to decide between courage and cowardice.

That light is now firmly focused on John Barrow. On Sunday he will cast a vote that will either be a Profile in Courage or a Capitulation to Chicken-shit Fear.

If you are in the 12th District of Georgia, give Barrow a call:

Washington, DC / p: (202) 225-2823 / f: (202) 225-3377

Augusta, GA / p: (706)722-4494 / f: (706) 722-4496

Milledgeville, GA / p:(478) 452-4611 / f: (478) 451-0717

Sandersville, GA / p: (478) 553-1923 / f: (478) 553-9215

Savannah, GA / p: (912) 354-7282 / f: (912) 354-7782

Vidalia, GA / p: (912) 537-9301 / f: (912) 537-9266

If you are in Georgia outside of the 12th District, give John a call as well and let him know that his dreams of running for the Senate in 2014 are dead if he votes NO on HCR.

And if you are in the rest of the Nation, call and ask him to put the needs of our Nation above his ambition.

You might also call the DCCC at (202)863-1500 to let them know that you will not be able to send them any money unless they can guarantee that none of your money will go to any weasel who votes NO on HCR.

If Barrow votes NO, I would rather see the 12th District in Republican hands than see John re-elected. Such a cowardly act can not be rewarded.

Fortunately, if Barrow votes NO there is an alternative. He has an opponent in the Democratic Primary, Regina Thomas. She ran against him in 2008 and took 24% of the vote. I suspect that if John Barrow decides to votes with the Republicans to kill HCR she will do much, much better this year.

I will keep trying to get up with my old Athens-Clarke County Commissioner and see if he can explain to me where he stands on HCR. In my conversations with his aides, they just repeated Frank Luntz talking points and then wedged on about the importance of supporting John in November to “hang on to” a Democratic Majority in the House so we could make progress on passing a Democratic agenda in the future. Well, Health Care Reform has been a core item on the Democratic agenda since way before John or me were born. We have a chance to fulfill that goal within the next few days. John has a chance to be part of that if only he can find where he left his backbone.

Perhaps some calls will help him locate it.

I hope my old friend will do the right thing and vote YES. We shall see in a few days what he does. And then we will know what needs to happen next.

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