Killing Health Reform With Kindness
Ezra Klein observes that Arlen Specter says he’s for the Wyden-Bennett approach to health care reform but also says he’s against eliminating the tax exemption for employer provided health care. Inconveniently, eliminating said deduction is part of the Wyden-Bennett plan. That’s how you pay for it.
My great fear is that this is how health care reform is going to die. A handful of very conservative members of congress may position themselves as “against” reform. But many people on the center and the right are going to say that they’re all for reform. They’re just going to be against particular things such that reform is impossible. When Barack Obama proposed reducing tax deductions for wealthy taxpayers, that idea died a swift and sudden death on the Hill. And you also don’t see Senators who are eager to start taxing health benefits. Nor do I see Senators who are eager to pay for health reform with steep cuts in defense spending or a new VAT or by raising income tax rates to above their Clinton-era levels. But I’m having trouble thinking of any other possible sources of revenue.
In other words, with all that stuff off the table, health reform dies.
Insofar as I’ve heard this discussed at all, it’s sort of been in the form of concern-trolling where people say progressives shouldn’t be expending so much energy on defending the idea of a public plan. But we should be clear on who the real villains are here—Senators in the center who killed the Obama administration’s revenue concept without either putting a new revenue concept on the table or admitting that their actions are imperiling health reform. Thus far, people have been very eager to build “momentum” for reform by trumpeting all the different people and groups who say they’re for reform. But you need to watch out for a scenario in which reform’s false friends kill it with kindness. If there’s a battle between white hats and black hats we can fight the battle and perhaps win. But if we let too many black hats inside the tent, then reform’s false friends can kill universal health care with kindness. In other words, as far as I’m concerned anyone who’s “for” health reform but “against” all the ways of paying for it is against reform. Someone who’s really for reform—like me—is for paying for reform through any reasonable measures.
37 Responses to “Killing Health Reform With Kindness”
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May 4th, 2009 at 6:13 pm
In other words, as far as I’m concerned anyone who’s “for” health reform but “against” all the ways of paying for it is against reform
Tell it to David Broder. Or the cable news anchors. Or make sure that whenever people like Ezra are on the box, they bring it back to this point.
Remember, the script for this has nothing to do with the policy, but all to do with the kabuki, and who appears to be the most “bipartisan”. That requires loud advocacy inside and outside Congress for single-payer, i.e. for putting private insurers out of business altogether for most healthcare.
(Or for removing Senators’ health benefits.)
If it’s framed around creating a plan that satisfies Arlen Specter from the outset, then it’s a death of a thousand cuts. (Forget about Mutual of Omaha Nelson.) If it’s framed around creating a plan that leads to something that Specter is squeezed into accepting, as far as cloture is concerned.
May 4th, 2009 at 6:18 pm
I haven’t read up on or followed the pending legislation yet, but my initial impression is negative towards cutting the business tax deduction for offering employee health insurance. It just doesn’t smell right, though I realize we do need to fund new commitments. Until and when we want employers not to be the insurer of first resort for Americans, we certainly shouldn’t take away the current tax incentives we offer for that good behavior.
I’m not saying my mind won’t change about this after reading up on the legislation and ongoing debate, but I can definitely see how on a surface level people won’t like this, employers won’t like this, and the surface level is where most people reside.
May 4th, 2009 at 6:18 pm
From what I can see so far the Obama administration is going push health reform through come hell or high water. They will not throw it out there and move on while it dies a death of a 1000 cuts, as happened in 1994 under the Clintons.
May 4th, 2009 at 6:21 pm
This is Specter Syndrome, pure and simple: talking piously out of both sides of the mouth while preserving a reactionary center-right policy agenda, enabled by a sycophantic Beltway press corps.
May 4th, 2009 at 6:28 pm
Wait, wait.
I was assured by everybody on the left that implementing health-care reform will cost less money. You know, because those health insurance companies make a profit. And they have all that paperwork. Etc. Etc.
After all, we keep seeing those graphs showing how all those other countries with universal coverage spend less on health care than the US does.
Now you’re telling me it will cost more money? What gives?
May 4th, 2009 at 6:28 pm
re: Specter, you wanted him, you got him.
I thought that Obama was going to pay for Health reform with cap and trade?
May 4th, 2009 at 6:35 pm
also enabled by timid progressives who are afraid to make the arguments on behalf of their position.
the argument – or non-discussion – about single payer illustrates the point.
most democrats and progressive politicians have pretty much taken a single payer option off the table.
this makes no sense.
even if the goal is ultimately to incorporate a public option into the existing system, at this juncture, that policy goal is dramatically hurt because single payer is supposedly off the table.
in most negotiations, it helps to aim high and settle somewhere lower. in this instance, the smart position is pushing for single payer, while willingly settling for a public option. if you give up on a negotiating position before you’ve even entered negotiations, you will always end up losing.
democrats act as though they know nothing about negotiating from a position of strength. and with a little party discipline, they would have more than enough political muscle to push a public option through.
and if they fail at this point, the question has arise: if not now, when?
May 4th, 2009 at 6:39 pm
Straight up man,
This is why we need the blogosphere, to put the Bayh’s and the Specter’s feet to the fire.
I hate the Blue Dog Coalition. It sounds like something for closeted homosexuals who want to appear tough so people don’t question their “manhood,” because they’re ashamed to be who they are. Oh wait, I’m describing the GOP.
May 4th, 2009 at 6:42 pm
This is a case where you flip Sun-tzu. Keep your enemies close but keep your friends closer.
May 4th, 2009 at 6:49 pm
Please, yes.
Just a couple years where people aren’t on employer provided insurance, where analogs to the “doc in a box” can emerge because the silence on them is broken, where many or most of the useful prescriptions are Wal-Mart (boon to the poor) cheap and we can wean ourselves from this public-private bloodbath into something that looks like a free market. If we somehow dodge your totalitarian bullet, I will be a pig in shit for the rest of my days. Oh, to not have the thugs usurp another huge chunk of freedom!
May 4th, 2009 at 6:53 pm
Matt, you have it backwards. You believe universal coverage is the first step to health care reform. Not so according to Obama. He would first require insurers to provide coverage to all that seek it at so-called community rating so nobody can be denied coverage (or charged excessive premiums) because of a pre-existing condition. The next step would be pursued, not by Obama, but by the insurers. What’s the next step? Universal coverage, so that the well and the sick, the young and the nearly old, would all have insurance, thereby spreading the risk for the insurers. Once the insurers favor “reform,” the way to pay for universal coverage will seem much less of an obstacle. Give your adversary a reason to support your goal. That’s smart. That’s Obama.
May 4th, 2009 at 6:55 pm
The republicans and 1/5 of the democrats are bought by the insurance industry so we cant get real reform we only get half assed measures that can’t even pass.
May 4th, 2009 at 6:59 pm
Ah, Soycheese McMises is here with his Quack Boys fixation. Next up, he’ll be celebrating the sellers of patent panaceas, only $5 a bottle, at the local state fair.
May 4th, 2009 at 7:21 pm
Al, the claimed savings are to American society as a whole, not to the government. If we save money that’s being spent by individuals and companies but have to raise taxes, that’s still a net savings if the taxes are lower than the expenses saved.
Also, as Oakchair says, we’re not going to be to save as much money because there are too many powerful interests blocking the way to the best systems. Improving the health of Americans and eliminating this sort of insanity is worth it even if we end up having to pay a bit.
May 4th, 2009 at 7:31 pm
@11 – I think your right. After 50 years of futility, the idea is that you have to get buy in from some traditional opponents and change the equation. Stress the opportunity to make more money and spread greater amounts of risk across a larger pool to the insurance industry. Explain the benefits of getting a good proportion of health care costs out of business to the business interests. If you could pass health care without going outside of the Democratic tent then it would have passed years ago.
May 4th, 2009 at 7:41 pm
The smart thing to do — if it were possible, (and it may well not be possible, and I admittedly have little knowledge of the niceties of the legislative process) would be to pass UHC as a recession-fighting measure. In other words, honestly admit upfront we’re not sure how to pay for it, but more importantly, we’re not bothered by the fact that we haven’t decided how to pay for it, because paying for it via borrowing is good economic policy for the next two or three years. And then, in, say, 2012, as Americans grow accustomed to health care security, we decide how to pay for it. By that time the constituency for keeping the entitlement will be sufficiently strong to fight back the right wing opposition to the taxes to pay for it.
May 4th, 2009 at 7:45 pm
Worked with the stimulus.
May 4th, 2009 at 7:48 pm
Until and when we want employers not to be the insurer of first resort for Americans, we certainly shouldn’t take away the current tax incentives we offer for that good behavior.
A) As I understand it the various proposals in this area are to cap — not eliminate — the tax exemption for employer-provided benefits. Simply removing this tax break in one fell swoop isn’t remotely possible, politically (although if the cap isn’t indexed to inflation, the value of the tax break would indeed erode toward nothingness in the fullness of time; still, this would take many years).
B) So, given “A” what’s not to like about curbing tax code support for employer-provided health insurance? Tying health care to employment is a pretty bad idea, after all (something even many conservatives will admit).
May 4th, 2009 at 7:50 pm
But I’m having trouble thinking of any other possible sources of revenue.
Well, there’s always cap and trade. Oh, wait a minute, I forgot that if we don’t give away emissions permits the rapture will be delayed.
May 4th, 2009 at 8:12 pm
As much as I rag on Al when goes into the race card stuff, he asks a very pertinent question:
This is how you sell single payer. All the half-assed “bi-partisan” watered down crap that gets trotted out will end up saving little or nothing (or worse). If you want the best care for the least cost, single payer is the obvious choice. Thanks for joining the team Al.
May 4th, 2009 at 8:18 pm
B) So, given “A” what’s not to like about curbing tax code support for employer-provided health insurance? Tying health care to employment is a pretty bad idea, after all (something even many conservatives will admit).
Given A it sounds a lot better, and like I said, I’m not up on all this at the moment, just responding to what Matt wrote, specifically “eliminating said tax deduction is part of the Wyden-Bennett plan”.
May 4th, 2009 at 8:33 pm
It seems to me that we just poured something like $800 billion down the rat holes at AIG, BofA, Citi, etc. so their executives and investors can have gold-plated lives, including health insurance. Maybe, just maybe, the political will can be found to spend similar amounts of taxpayer money to help out the rest of us. I’d vote for a 100% tax on any compensation over $1 million given to employees of bailout recipients, retroactive to 2008! That might get the ball rolling.
May 4th, 2009 at 10:22 pm
Too bad for them. At some point its going to dawn on most folks that we’re spending way too much on defense. To continue to spend $500 billion a year, which is more than the rest of the world combined, is insane. We don’t need it. It may be tough to wean the military-industry complex off the gov’t teat but it needs to be done. It’s the only way.
May 4th, 2009 at 11:01 pm
great post.
http://politicsdecoded.com/2009/05/05/mediabias/
May 4th, 2009 at 11:51 pm
Why not a tariff? It would in effect be like a VAT, but much easer to sell. When Microsoft sells a copy of XP to Canada, there equivalent of a VAT (GST) is tacked on to the price of Office and pays for their health care. Same thing happens in Europe. Sense the US doesn’t have a VAT a tariff would be the equivalent.
May 5th, 2009 at 1:10 am
matt, please tell me the title of your post is based on a quote from Dr. Steve Brule…
May 5th, 2009 at 2:30 am
Obama is against raising any taxes on 95% of Americans, must be trying to kill with kindness.
May 5th, 2009 at 5:39 am
/me cues Joan Osborne’s Smiling Faces…
May 5th, 2009 at 6:48 am
In other words, honestly admit upfront we’re not sure how to pay for it, but more importantly, we’re not bothered by the fact that we haven’t decided how to pay for it, because paying for it via borrowing is good economic policy for the next two or three years.
This is why I say all of you progressives are lying, fake Keynesians. You aren’t sure how to pay for it now, but in the name of “stimulus” we need it now. If we’re not in recession we can afford it. So, it doesn’t matter what’s happening with the economy or how expensive a program is (except the Iraq War) as long as the government is spending the money, it’s a good idea.
May 5th, 2009 at 7:25 am
I’m reminded that Barack Obama campaigned against at least a version of this idea. And people at CAP were, quite rightly I thought, busy highlighting its problems. Can someone explain what’s different about the McCain and Wyden proposals? And how do they differ from Jacob Hacker’s/EPI’s plan?
May 5th, 2009 at 8:49 am
I’ve always held the hard-hearted view that it’s best to wait until the current “system” visibly collapses of its own weight, whereupon there will be a politically irresistible public demand to do this right- a full-on public system that, while it could well have a private component like Germany’s, definitely does NOT include the current parasitic insurance companies. I haven’t changed that view, and we’re getting closer to the collapse all the time. A half-assed joke of a “reform” that keeps things lurching a long for a while longer is the worst possible outcome, but it’s all we’re going to get under current political conditions. So quite frankly I’m hoping for total failure to pass anything.
Also, what Joe @ 23 said. That’s where the money is, as Willie Sutton would say..
May 5th, 2009 at 9:09 am
It will cost less – less than what people and employers are currently paying in premiums and co-pays. However, there needs to be some way to fund it, unless we’re going to just keep charging everyone their insurance premiums, which makes no sense.
May 5th, 2009 at 9:42 am
Specter mentioned recently that seniors should reconsider expensive, late-in-life medical treatments. In other words, just go ahead and die, you useless old people.
Pretty horrendous, considering he’s 79 and receiving lots of expensive treatment for his cancer recurrence on the public dime.
The Senate is doing its damnedest to kill off those who can’t fill their campaign coffers. I hate these craven toadies just as much as they hate the average, non-leisure class American.
May 5th, 2009 at 1:09 pm
This is why I say all of you progressives are lying, fake Keynesians. You aren’t sure how to pay for it now, but in the name of “stimulus” we need it now. If we’re not in recession we can afford it. So, it doesn’t matter what’s happening with the economy or how expensive a program is (except the Iraq War) as long as the government is spending the money, it’s a good idea.
Healthy Markup: Pay back is fair play in my book. Reagan used the economic turmoil that greeted his arrival in Washington to great effect by putting us on a ruinous path of stagnating wages, growing economic inequality, eroding social mobility, and massive public debt. Why shouldn’t liberals use this crisis to right these past wrongs? Moreover, unlike conservatives and their voodoo economics, liberal advocacy of Keynesian measures happens to have the virtue of being correct on the merits.
May 5th, 2009 at 2:54 pm
The pharmaceutical industry is the major cause of the inflated cost of health care, according to a report from AARP. Where is the legislation regulating that industry? If we can tell banks how much they can pay their executives, shouldn’t it follow that the government can do the same with an industry much closer to most of us?
Likewise, private insurance companies can charge whatever they choose, and we have very limited choices over who gets our money. They, on the other hand, are allowed to choose who they will insure.
Our employers have been forced to insure their workers in order to have enough “healthy” employees to keep their business running. Need I add that this makes it impossible for our businesses to compete with the rest of the industrialized world where medical care is paid for by all of its citizens?
Jobs exist where the entrepeneur can make a profit. As the stockholders become more and more greedy, we lose again as the workers’ income stabilizes in direct proportion to the increases in dividends.
And then we have the military, industrial, congressional complex — “our” representatives are owned and operated by MONEY. Were this not true KBR would not have been given yet another no-bid contract ($35 Billion) to do the shoddy work they are famous for.
The MIC complex is prepared to and will lie and cheat to move us to fright if we ask to reduce their budget. A standing army is bad for democracy. It costs more than we can afford, and their sole purpose is to kill other people.
Republicans aren’t the cowards they appear to be with their constant appeasement of the demands of the GREAT MILITARY. No, they are more concerned with the political contributions of the war mongers among us.
Has anyone else noticed that this Democratically controlled government is doing as little as possible to create real change in any area they poke their tiny thoughts?
Change we can believe in? If we fail to hold those money-grubbing critters accountable we deserve what we get — more of the same, with a nicer label.
May 5th, 2009 at 3:29 pm
[...] May 4th, 2009 at 6:18 pm I haven’t read up on or followed the pending legislation yet, but my initial impression is [...]
May 5th, 2009 at 5:16 pm
Specter has come out in favor of Norm Coleman in the past little while.
We got a pretty crappy present – I say, given all that and his health care position that we take it to the returns desk at GOP HQ and say “he’s defective, take him back.”