My Health Reform Provision
This socialist ambulance from the UK drives on the wrong side of the road. (CC photo by gwire)
Yesterday, Ezra Klein offered his prediction for health care reform:
In 2006, it would have been a great deal. But as the legislation winds its way through the Senate, there will be unpleasant compromises, and unconscionable omissions, and the constant knowledge that though this is progress, it is not sufficient, and the people who stand in the way of a better bill are frequently incoherent or disingenuous. And that will be terribly frustrating for supports of the effort. The result will probably be a historic win when compared to the status quo, but I doubt it’s going to feel like that for supporters of the initiative.
This is a pretty good generic description of how congress works, but I think it may be wrong. I think the dynamics of the health care issue—particularly the financial dynamics—lend themselves to a strongly bivalent outcome. That’s because to the extent you crack down on private sector interests (progressive!) you free up money that can be used for subsidies and Medicaid expansion and the like, which is also progressive. And if it looks like a comprehensive health reform is likely to pass, I think two or three or six Republicans will want to hop on board, since there’s no use getting on the wrong side of history. At the same time, if you lose the momentum I think the coalition for reform could very quickly start rolling downhill. If Republicans think there’s any chance of blocking anything from passing, then their interest in a compromise will dry up instantly. If you have a weak-or-nonexistent public plan, then you can’t afford to provide much in the way of new benefits to people. And if you have a plan that doesn’t provide dramatic new benefits, but does piss off union leaders and Democrats from high-cost states (this is the Dianne Feinstein issue), then suddenly it’s not clear who the constituency for your bill is. The piranas will circle, and the whole thing can collapse.
Consequently, my take is that we’ll either get a very strong progressive bill or we’ll get a real legislative train wreck. Ezra’s analogy was to the stimulus bill, but my analogy would be to comprehensive immigration reform—tons of moving pieces mean you can lurch from dramatic change to hopeless coalition breakdown and back again very rapidly.
31 Responses to “My Health Reform Provision”
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June 24th, 2009 at 2:31 pm
I’m perfectly happy with that bivalent outcome, in fact I think it’s ESSENTIAL that nothing at all pass if a strong progressive bill can’t pass. The pressure for real reform will only grow as the system visibly crumbles before everyone’s eyes, and a crap Blue Dog bill that essentially is nothing but a bailout for Big Insurance would be both a counterproductive diversion and a tragic waste of resources.
June 24th, 2009 at 2:35 pm
If Republicans think there’s any chance of blocking anything from passing, then their interest in a compromise will dry up instantly.
Probably so. And if this is the case Obama is thus smart to signal he’s open to compromise — because the logical extension of such willingness is that some kind of bill will pass, given the numbers for the Democrats. This was one of the problems of the Hillarycare fiasco.
June 24th, 2009 at 2:41 pm
matt,
for someone who is so insightful at times, your naivete is sometimes stunning.
unfortunately i think erza is absolutely correct.
and the white house statement on the public option – which amount to an obvious caving in – are the first step in the direction erza predicts.
in fact, i’ll go one step further. the final bill will actually enrage progressives, not simply disappoint them.
what obama seems to be moving towards is the worst possible kind of bill: he is going to mandate coverage while not providing a public option.
which is exactly what the insurance companies want and exactly what will harm americans.
we will end up with “reform” that will actually make a bad situation worse.
June 24th, 2009 at 2:48 pm
Blue Dogs will sway the legislation. They’ll tilt it toward Repugnicants before they lean in a progressive direction.
June 24th, 2009 at 2:56 pm
frankie d:
what obama seems to be moving towards is the worst possible kind of bill: he is going to mandate coverage while not providing a public option.
he’s made some pretty strong statements supporting the public option, no? But then again anonymous lefty critics have often been correct in their analyses of Obama ever since the Presidential primary. (/sarcasm)
June 24th, 2009 at 2:57 pm
I have a different set of predictions for health care deform.
1.) The “government plan” won’t be government run
2.) The plan will be financed on the backs of individual workers and health care providers, not a progressive tax. This spineless Congress can’t take away carried interest from private equity underwriters (PEU’s).
3.) For-profit health care companies will win in the rollout, i.e. safety net providers will remain stressed.
4) 15-20 million people, illegal immigrants and the chronically noncompliant, will remain uncovered
The above will come out of conference. Sure, there will be lost of bait & switch in varying plans, but the end game will be a royal screwing. The wealthy and corporations will win on the backs of the middle class and workers.
Look at the 20 year history of worker pensions. Defined benefit plans went the way of the dinosaur. When times got tough, employers cut their match for 401(k)’s.
The great health insurance dump will occur slowly, but Obama’s reform will set the stage. Workers will be the boiled frog, funding their health insurance and retirement.
June 24th, 2009 at 3:00 pm
Blue Dogs will sway the legislation. They’ll tilt it toward Repugnicants before they lean in a progressive direction.
Well, I don’t think there’s much chance Democrats in the House will allow a crappy bill to leave their chamber. So I continue to believe a key factor is the dynamic of the conference committee, as in, how will the negotiations go, and to what extent can something leaving the senate be modified? Can a public option-less bill acceptable to Senate grandees have a public option grafted onto it?
June 24th, 2009 at 3:01 pm
Poptarts, listen to Obama’s strong words in yesterday’s press conference:
President Obama called for a “public option that’s not profit driven.”
On the Ed Show, White House Health Care Communications Director said “if you have a not for-profit alternative.”
The White House shifted to co-op, which is nothing like a government run plan. We’re being bait & switched, now a common Obama practice.
June 24th, 2009 at 3:02 pm
Blue Dogs will sway the legislation.
Blue Dogs in the House? I don’t see that.
June 24th, 2009 at 3:06 pm
alan is absolutely correct.
this is classic obama.
make strong statements, but leave a little bit of wiggle room.
then cave in at the opportune moment.
according to statements from senators who met with rahm emanuel yesterday, obama is open to alternatives to a public option.
i don’t see what the controversy is all about.
he has plainly signaled that he is ready to dump the public option.
and on good morning america i saw him tell diane sawyer that his thinking on mandates had “evolved” so that he now supports them.
again, all you have to do is listen to what he is saying.
the final bill doesn’t have to have a public option.
i believe that mandates will have to be part of the bill.
consumers will be squeezed and screwed.
mandated to buy insurance from private insurers who will continue to do what they’ve been doing all along.
how much more obvious does obama need to be?
June 24th, 2009 at 3:10 pm
Workers will be the boiled frog, funding their health insurance and retirement.
Workers already fund their health insurance and retirement. Both major retirement programs are financed by payroll taxes. Actually, on that score there is some hope, as over the long terms an increasingly large portion of Social Security’s bills will be paid out of the (more progressive) income tax.
Wearing rose colored glasses isn’t called for. But neither is the utterly morose pessimism I hear all the time these days on progressive blogs. The fact is conservatives have had most of the political momentum over the last thirty years. The edifice they built isn’t going to be taken down overnight. But the demographics favoring progressives are clear. And it’s likewise clear that working Americans are increasingly ignoring the fallacious arguments from the right attacking the desirability of a robust government role in bolstering economic security and economic justice.
We deserve to lose if all we can do is cry in our beer about the unfairness of it all.
June 24th, 2009 at 3:20 pm
@Jasper — please, we’ve just been rolled once again by Obama. He’s all big talk and no delivery. I wonder how many times you’re gonna get rolled before you wake up. Obama could have achieved a public option for us, but instead, he’s just forcing us all into the jaws of the private insurance scammers (and a scam it surely is to pay premiums only to be dropped when you actually get sick).
This ain’t change I am ever going to be suckered into believing in. I just can’t believe that we were so close and then he goes and caves in, without even a real fight. This guy is worse than Bush in some ways — at least with Bush we knew where he was coming from.
June 24th, 2009 at 3:22 pm
progressives did much more than cry and complain.
largely because of their efforts, dems enjoy a huge advantage in congress and have a democratic president in the white house.
that didn’t happen because of whining and crying.
and actual legislation matters. when the time comes for certain legislation to be drafted and passed, the particulars matter and simply implying that the specifics do not matter is illogical.
it will matter greatly if obama caves in on a public option.
we can pretty much bet that health care reform will not happen again for a long, long time.
look at what happened after the passage of medicare.
when people who are elected to do one thing, turn around and do something else – as obama has done repeatedly – then their voters can rightfully feel betrayed.
June 24th, 2009 at 3:24 pm
Oh and by the way, how popular do you think Obama’s gonna be when people start getting the screws put to them to either pay up to the private insurers or pay a fine to the govt? Lord knows I have enough disposable income to pay for a bogus healthcare scam. I wonder if they’ll charge us vig if we’re late on our fine payments?
June 24th, 2009 at 3:26 pm
alan is absolutely correct.
this is classic obama.
I think classic Obama (like Reagan) is to limit his expenditure of political capital on what his real priorities are. He hasn’t spent much political capital on gay rights, torture, Guantanamo, and domestic surveillance, because he quite rightly realizes it all depends on the economy, stupid. Don’t get that right and nothing will get done, because he’ll be an unpopular president sliding into the second half of his first term with little prospect of reelection: a lame duck, in other words.
Obama did expend a fair amount of political capital on the stimulus bill, and he managed to get an $800 billion behemoth enacted that probably deserves more credit than any single action by anybody else for saving the global economy from disaster.
My own reading of the tea leaves is that healthcare reform (a subject obviously connected to the economy) is his other big priority. I think the administration is clearly going to do its damnedest to get the best possible bill passed. It won’t be a perfect bill. But very clearly Obama strongly favors the adoption of a public option. He’s been absolutely clear about this. I don’t why there’s any confusion as to his preference on this score. I can understand confusion about his tactics, and only time will tell whether he’s correct. But as Ezra wrote yesterday, he may be better off refraining from high-velocity lobbying until later in the summer, as a president’s megaphone, while quite large and powerful, is usually best employed for short periods of time.
June 24th, 2009 at 3:33 pm
Wearing rose colored glasses isn’t called for. But neither is the utterly morose pessimism I hear all the time these days on progressive blogs.
They’re drama queens. They crave the drama. And they’re speaking truth power, man! And they’re anonymous so can’t immediately right them off after seeing their constant handle.
I’ve become acclimated/inured to it. It’s like background noise. What, we’re 5 months in? And already Sotomayer, stimulus package, financial regulations, pulling out of Iraq, closing Gitmo, Ledbetter bill, bypassing filibuster on health care, Cairo speech, Panetta at CIA, etc. etc etc.
And then just today Spy Satellite Program Is Eliminated
http://www.nytimes.com/2009/06/24/us/24brfs-SPYSATELLITE_BRF.html?_r=1&ref=us
The Obama administration is planning to eliminate a spy satellite program at the Department of Homeland Security that had produced concerns about domestic spying, officials said. The program would have given state and local law enforcement officials access to high-resolution imagery from spy satellites to aid them in disaster relief efforts, bolster border security and help secure major events like the Super Bowl. The program, the National Applications Office, was first proposed two years ago by the Bush administration but had not yet begun operations. Civil libertarians and some influential lawmakers had criticized it. Officials said the homeland security secretary, Janet Napolitano, ordered a review of the program shortly after she was confirmed. The decision to close the office was first reported by The Associated Press.
He gets no credit but that goes with the territory.
June 24th, 2009 at 3:33 pm
apologists like jasper are hilarious.
we’ve been told all along that obama was hording his political capitol for a health care fight.
but it looks like he is going down on that front without much of a fight.
exactly what is it that is going to make obama go to the mat and fight for the people who voted for him?
exactly what policies will he actually bust heads over?
again, every thing was supposedly on hold until health care was muscled through, and he sure isn’t using much muscle to get what his voters obviously want.
June 24th, 2009 at 3:37 pm
@jasper and @poptarts — I’m guessing you don’t know the latest — that Obama has taken the public option off the table by informing the senators that he can take or leave it.
June 24th, 2009 at 3:50 pm
I’m hoping Matt is correct on this one.
The key voting block will be liberal House democrats. House Republicans will vote against any bill. Liberal Dems can either join with House Republicans and kill a bad bill or go along to give Obama a big win. Senate amendment which would have blocked release of the torture photos was nixed by liberal dems refusing to support the supplemental war funding bill.
June 24th, 2009 at 4:12 pm
@jasper and @poptarts — I’m guessing you don’t know the latest — that Obama has taken the public option off the table
Obama has most certainly not “taken the public option off the table.” Even if this latest rumor were true (Conrad says he was misquoted), a willingness to compromise on the part of Obama doesn’t mean he doesn’t strongly prefer the inclusion of a public option, or that liberals can’t prevail over centrists. It simply means at this stage of the game he’s open to signing a flawed bill. Some people would argue Obama is wrong to say he’s open to compromise at this point. But as Matt points out, it may well be that that a stated willingness to compromise will prompt some lawmakers to reckon that the odds of passage thereby increase, and that, in, turn, increases the odds for the budget-friendly implications of public option.
June 24th, 2009 at 4:17 pm
My impression from doctors and free-market types is that government health care-whether a public plan or single-payer works by simply paying health care providers less money for their services. They already claim that Medicare/Medicaid reimbursement rates are too low. Would ‘better’ doctors simply not accept these lower payment options? Would that be allowed?
June 24th, 2009 at 4:24 pm
Would ‘better’ doctors simply not accept these lower payment options? Would that be allowed?
Well, ‘better’ doctors would be allowed to drink coffee and play Minesweeper, if they’re prepared to cut off their nose to spite their face.
June 24th, 2009 at 4:32 pm
@jasper and @poptarts — I’m guessing you don’t know the latest — that Obama has taken the public option off the table by informing the senators that he can take or leave it.
Link? Quote? When asked, he said he wouldn’t confirm that a public plan was make or break. And guess what, politicians often do that kind of thing where they won’t go on record, just to avoid gotchas. It’s a defense mechanism.
@whatever, get that weak shit out of my face!
June 24th, 2009 at 5:30 pm
When asked, he said he wouldn’t confirm that a public plan was make or break. And guess what, politicians often do that kind of thing where they won’t go on record, just to avoid gotchas. It’s a defense mechanism.
wrong. politicians make that kind of statement when they want to signal that they will compromise on a particular issue.
when negotiating anything, you ALWAYS let it be known where the dealbreaker lies. maybe you don’t even get to the point of having to deal with it, but you might. and if the other side knows where your dealbreaker is, it makes for better negotiations.
i’ve never heard that kind of explanation regarding dealbreaking provisions in talks or negotiations.
by saying, a bill is a dealbreaker if it doesn’t include a public option, then every negotiation would have to include it.
by saying that he will not commit to it, he’s saying, yes, i would sign a bill without one.
what is so tough about that?
June 24th, 2009 at 7:14 pm
Re: Look at the 20 year history of worker pensions. Defined benefit plans went the way of the dinosaur. When times got tough, employers cut their match for 401(k)’s.
The great health insurance dump will occur slowly, but Obama’s reform will set the stage.
Why should healthcare be tied to employment? Isn’t that one of the biggest problems with our system? No other country links healthcare to jobs the way we do. If Obama’s reform ultimately sets that link on its way to extinction (while providing an alternative and banning obnoxious insurance practices like recission and individual rating) that’s a net plus for crying out loud!
June 24th, 2009 at 8:12 pm
In a competitive world, we can no longer afford to waste our resources on the luxury of compromising with Republicans. So no health care reform unless it cuts costs fast. Next, 25% off Defense. Next, real cap and trade that cuts oil imports.
These are needed because we need make our economy competitive. Period. No compromises. We are like people with too much credit card debt, only its our labor costs and our costs of silliness in healthcare and defense. We can preserve our standard of living ONLY if we do these things. Our president needs to grasp this.
Ezra is the human embodiment of the weakness of the wonk. You see, the wonk wants legislation and policy implementation, no matter what. So no bill is worse than a bad bill.
I am a citizen. I am deeply concerned that after 10 years without job growth, our country is now 20 years into a massive loss of assets and income. Central to this is our economic uncompetitiveness in value creation sectors – manufacturing and exportable services. Central to that uncompetitiveness is the fact that our labor costs are overlaid by the spending of 16% OF OUR ENTIRE GDP on health care.
IT HAS TO STOP. IT HAS TO BE REVERSED. That will take real change, real pain, and really different approaches to the whole thing.
Bottom line, as a country we no longer have the resources to overpay for health care, because the cost of health care is causing our unemployment, and if we go into long term 10-12% unemployment, we cannot fund our government, we cannot pay off our debt, we cannot educate our children, and two generations from now we will be Russia.
That is why single payer would be best. That’s why the MINIMUM we can afford is 15% of our population in a well funded, aggressive as hell public plan.
June 24th, 2009 at 8:19 pm
Matt’s post has given me hope. We are in the lurching back and forth phase. Like a basketball game, up 10 down 10. After three and a half quarters of desultory back and forth ball -game tied. Now, with 6 minutes left, we need to close the game out with a 27 to 3 run.
It’s possible. Obama strikes me as a scoring 2 type, a guy who can take over the game late and dominate. There is a big but, of course. But if the opposition double and triple teams him, gets the ball out of his hands, can Obama’s teammates step up? Doubtful.
June 24th, 2009 at 8:58 pm
[...] of my favorite bloggers–Ezra Klein and Matt Yglesias–offer contrasting predictions as to what will be of healthcare [...]
June 25th, 2009 at 2:18 pm
I think I go with Matt’s forecast but with almost certainty it’s going to happen. Why….. because defeat for the admin on this would be a disaster on their signature issue. And if push comes to shove they have the means to muscle it through. Secondly, it will have the public option. Why……because without it there isn’t the faintest hope of getting cost savings and no one understands this better than Orzag. At the moment we’re seeing kabuki theater. Obviously some conservative Dems who are big recipients of industry dollars want to water it down but all their democratic colleagues know who they are and simply aren’t going to let them get away with it. At the moment they are going through the motions of working with the Republicans. They have to do this they can’t just shut them out. But the bottom line is the admin and the great mass of the Democratic representation in congress want this and are determined to get it. There’s another factor, the vast majority of the country wants it and expects it. I’m not sure the centrist Republicans want to be standing in the way of this train.
June 25th, 2009 at 2:21 pm
Having surfed a few of the comments here from Democrats it’s no wonder we’re so often accused of being frightened of our own shadows. Talk about defeatism.
June 25th, 2009 at 2:49 pm
if it looks like a comprehensive health reform is likely to pass, I think two or three or six Republicans will want to hop on board, since there’s no use getting on the wrong side of history.
The problem with this analysis is that the Republican party is dominated by Conservatives and Conservatives, by their nature, exist to be “on the wrong side of history”. Many “centrist” Dems are also Conservative and will side with the Republicans. The result is that we will see the “legislative train wreck” a progressive result was never a real possibility.