Health Care: What’s in it for Me?
Jon Cohn and Kevin Drum ring the alarm bells about something that I think the Democratic Party leadership is overlooking to a dangerous degree—the possibility that by the time they’re done trimming Barack Obama’s health care philosophy down to something acceptable to Max Baucus and Kent Conrad that you’ll be left with something that the public doesn’t actually support. A public option, for example, is wildly popular with the public and supported by almost seventy percent of voters. But it doesn’t have nearly so many fans in the United States.
And as Kevin says, absent a public plan or really generous subsidies, “[m]ost people will just see higher taxes funding better coverage for the poor, and you don’t have to be the world’s biggest cynic to understand that this isn’t going to be overwhelmingly popular.” Now to be clear, people actually would, under this scenario, benefit from a variety of regulatory changes that congress wants to make. But the benefits of those changes would be cumulative over time, and not like a nice Christmas present to voters. Under the circumstances, you could easily imagine any number of Senators who have thus far not been allowed to dominate the political process—ordinary, mainstream Dems who don’t sit on the Finance Committee—looking at the final bill and kind of shrugging. Reducing the long-run trajectory of health care costs is an obsession for DC health policy wonks, but there’s very little evidence that it’s high on the public’s list of concerns. If you don’t do anything to make middle class health care cheaper in the short run, or to open up some new options to people, then you may have appeased some of reform’s critics at the cost of producing a bill with few real fans.
38 Responses to “Health Care: What’s in it for Me?”
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July 1st, 2009 at 12:59 pm
I hope to hell you meant to include the word “Senate” at the end of that.
July 1st, 2009 at 1:01 pm
That same poll says that 72% don’t want to pay more than $500 in increased taxes a year. Since the public overwhelmingly doesn’t want to pay more than $500 a year, that’s what Congress should do, right Matt?
July 1st, 2009 at 1:12 pm
Having noted this before, I will repeat my prior conclusion: I suspect a lot of Senate Democrats are basically trying to have it both ways. They want to create the impression during the process that they are faithful bipartisan/moderate types. But then they still want a popular plan to be passed, for which they will subsequently take credit as generic Democrats.
And if I am correct, there is no need for “progressive” Democrats to compromise too much on the final bill (whatever else might be said during the process). That is because I strongly suspect that in the end, they aren’t going to lose many, if any, Senate Democrats–certainly not enough to lose a reconciliation vote.
July 1st, 2009 at 1:13 pm
Having noted this before, I will repeat my prior conclusion: I suspect a lot of Senate Democrats are basically trying to have it both ways. They want to create the impression during the process that they are faithful bipartisan/moderate types. But then they still want a popular plan to be passed, for which they will subsequently take credit as generic Democrats.
And if I am correct, there is no need for “progressive” Democrats to compromise too much on the final bill (whatever else might be said during the process). That is because I strongly suspect that in the end, they aren’t going to lose many, if any, Senate Democrats–certainly not enough to lose a reconciliation vote.
July 1st, 2009 at 1:14 pm
…most people will just see higher taxes funding better coverage for the poor…
Even with public option, that’s the case, isn’t it? Most non-elderly people are covered by employment-related private health insurance, and will continue to be after a public option is enacted. They may see some increase in their take home — if public option competition successfully keeps premium inflation in check — but that, too, won’t happen overnight.
I actually think the biggest immediate benefits to reform — in terms of popularity with the public — are likely to be things like guaranteed issue, community rating, and, perhaps most importantly, national quality of coverage standards to eliminate nightmares like the one reported in today’s NY Times.
Again, most people already have private health insurance, and most people — if polls are to be believed — are apparently even fairly happy with it.
Of course, the peace of mind from simply knowing it’s literally impossible to be without coverage should also be a popular benefit — but I think (if we’re successful in actually enacting true, guaranteed, universality) this will take some time to sink in. And the popularity and political benefits flowing from such a change also substantially depend on the ability of Democrats to get the message and marketing right. Never a safe bet.
July 1st, 2009 at 1:14 pm
Here’s the solution: Outcome-based rationing. Problem solved.
July 1st, 2009 at 1:15 pm
That same poll says that 72% don’t want to pay more than $500 in increased taxes a year. Since the public overwhelmingly doesn’t want to pay more than $500 a year, that’s what Congress should do, right Matt?
No, the logical response is to:
(A) do a better job informing people how much they are already paying for medical insurance, including through their employer; and
(B) consider making any additional taxes progressive, at least overall.
July 1st, 2009 at 1:16 pm
It is ridiculous to assume that the middle class public who have insurance aren’t going to benefit from a public option. We have had a wealth of recent stories about how many PPOs have virtual monopolies in their states and regions, and about abusive practices by the insurance industry. Just today in the NYT there is a big story about abusive catastrophic policies that do not actually cover what they claim to cover. And how being “underinsured” is one of the leading causes of bankruptcy. A robust public option can only force the PPOs and HMOs to clean up their act or die. Only good can come of it.
As for whether the public is interested in rising health care costs. Perhaps not in the mega public policy sense. But I can guarantee you that every middle class family that is currently receiving subsidized insurance through their employer is acutely aware and concerned about rising health care costs. The fact that MY write this belies his age and marital status. I teach at a public HS in Texas. Every year at the beginning of the school year we sit through the annual presentation by the HR department about the insurance options and cost changes for the upcoming school year. Trust met there is plenty of angst among most of the staff about health care costs. Especially from those who depend on the school insurance plan to cover their families. A young single parent low on the salary scale with a family might see nearly 1/3 of their paycheck go to health insurance. They may not give a shit about the meta public policy issues. But they care about what it is costing them. And every year it goes up and up for what amounts to less and less coverage. And that is for coverage that is subsidized by about 50% by the district.
You will be hard pressed to find middle class families with employer-based insurance who are not concerned about the costs and co-payments. Perhaps a few small industries or sectors have really great benefits packages. But they are certainly not the norm.
July 1st, 2009 at 1:17 pm
I really hope progress is made with today’s town hall. I will be all ears. If you’re going to be at work during the town hall, the app I always use on my iPhone for White House updates will be streaming it, so you can listen to it conveniently here: http://www.iheartradio.com/whblive. Hoping for the best today.
July 1st, 2009 at 1:24 pm
That is because I strongly suspect that in the end, they aren’t going to lose many, if any, Senate Democrats–certainly not enough to lose a reconciliation vote.
Fifty-one should be a slam dunk. I just hope they can use reconciliation if forced to. I think that’s very much an open question. I’m personally pinning more hopes on the conference committee.
July 1st, 2009 at 1:30 pm
Fifty-one should be a slam dunk. I just hope they can use reconciliation if forced to.
I actually think the first sentence answers the second. Provided the “progressives” don’t blink, the only way reconciliation doesn’t get used is if the 50th Senator necessary decides to stand on principle against using reconciliation. I just don’t see that happening.
That said, I agree the more likely outcome at this point is just that a decent bill emerges from conference, and that is that.
July 1st, 2009 at 1:34 pm
@1 J
Thanks for the clarification.
Matt, you should be sending gifts to the commenters who figure out what the hell you are trying to say and then share with the rest of us. Without them, your blog would be even more unreadable.
July 1st, 2009 at 1:35 pm
WTF does that even mean?
July 1st, 2009 at 1:38 pm
The omission of the word “Senate” just may be my new all-time favorite Yglesias typo. Matt, you do realize that in this economy, you could get a summer intern to proof-read your stuff for free, right?
July 1st, 2009 at 1:41 pm
Bush’s Medicare drug benefit is slated to cost roughly $1 Trillion over the next 10 years.
I’m genuinely puzzled as to why Senators think the American people will blanch at a $1.5 trillion plan that will fix the ENTIRE healthcare system.
I’m even more puzzled as to why “centrist” Senators think giving up everything people LIKE about the bill (subsidies), and adding things people will DISLIKE about the bill (tax on benefits) is worth moving the price tag from $1.5 trillion to $1 trillion.
Idiots.
July 1st, 2009 at 1:49 pm
I actually think the first sentence answers the second. Provided the “progressives” don’t blink, the only way reconciliation doesn’t get used is if the 50th Senator necessary decides to stand on principle against using reconciliation.
DTM: this gets a bit thick into the weeds of congressional procedure for me, but my understanding is that certain provisions the eventual senate bill is likely to contain would make using reconciliation problematic, and that, in turn, requires a favorable ruling from the Senate parliamentarian. Now, as a matter of practice, I’m given to understand the majority party can tell the parliamentarian to rule in the manner it needs him to rule, but I think it’s dangerous to assume a Democratic majority led by Harry Reid will operate in the same manner as a GOP-majority lead by a Trent Lott or a Mitch McConnell. But one can always hope.
July 1st, 2009 at 1:51 pm
Matt, you do realize that in this economy, you could get a summer intern to proof-read your stuff for free, right?
Yes, but interns drink coffee and use electricity. Who needs that when you have a readership with ESP. Or make that YSP.
July 1st, 2009 at 1:54 pm
Has anyone ever seen Yglesias update a post to correct his copy? Even when the comment thread is full of WTF?
Has anyone ever seen Yglesias acknowledge a comment?
Wait a second…Yglesias…isn’t here….We’re alone, with only each other to rely upon to make sense of it all.
Wow, total flashback to when I stopped believing in God.
July 1st, 2009 at 2:11 pm
But it doesn’t have nearly so many fans in the United States Elliot the Uranian.
July 1st, 2009 at 2:39 pm
It’s even worse
…than MY presents it. Some of the most important regulatory changes that Congress would make to benefit folks who currently already have private insurance, would be ways to address the problem of under-insurance. If you do this under the current framework, through the private insurers, they will have to charge higher premiums to cover the increased outlays associated with actually insuring people completely, instead of gulling them into paying premiums for what only looks like complete coverage to the unwary. Ditto for stopping inappropriate rescission, and just about any other regulator benefit that the already insured would enjoy under reform.
Unless you save money by cutting out the middleman, if the “reform” we get leaves these private insurers in place, every bit of that reform, and not just paying higher taxes for the currently uninsured who can’t afford insurance, will mean that these already insured will pay more. It’s ironic that we’re not doing single payer out of concern that precisely this group, the already insured, are so attached to their current insurance that forcing on them other arrangements, even cheaper and better other arrangements, can’t be part of reform because that risks alienating them. In the end, the zombie reform these political butchers stitch together starting from that ridiculous “path dependence” premise, will sink its political chances precisely because it will alienate the already insured.
July 1st, 2009 at 2:41 pm
There are web pages out there dedicated to Spoonerisms. Somebody needs to start a list of the all-time greatest Yglesyisms.
Just off the top of my head, there’s this one today, and the one about Uranians, and the infamous “School Shooting in Denmark” (which still bears that title….)
I know there have been lots of others, including ones where the Yglesyism had the effect of changing the meaning of the sentence 180 degrees.
Maybe we could get a wikipedia page for this?
July 1st, 2009 at 2:50 pm
DTM: this gets a bit thick into the weeds of congressional procedure for me, but my understanding is that certain provisions the eventual senate bill is likely to contain would make using reconciliation problematic, and that, in turn, requires a favorable ruling from the Senate parliamentarian.
My understanding is that once the Senate passed the budget resolution back in April with the reconciliation instruction on health care (setting the October 15 deadline), it was a done deal. But I am also no expert in this area and could easily be wrong.
July 1st, 2009 at 2:51 pm
J,
You mean like this?
http://yglesiaserrata.com/
July 1st, 2009 at 3:04 pm
I take this as an indication that Matt is becoming so entangled in the Beltway viewpoint that he believes that people outside of DC are a bunch of foreigners. Like we’re all French or Finnish or something. It was inevitable that this would eventually happen.
July 1st, 2009 at 3:40 pm
If this is true:
Reducing the long-run trajectory of health care costs is an obsession for DC health policy wonks, but there’s very little evidence that it’s high on the public’s list of concerns
then I don’t see why the popularity of the plan should be of any concern.
I am not the iphone app spammer from comment #9
July 1st, 2009 at 3:48 pm
DTM writes:
http://yglesiaserrata.com/
Hey, that’s great!
Except … it doesn’t have this one yet. Nor the “Uranians” post. Nor the “School Shooting in Denmark [er, Germany]” one either. Lots of random typos, but I was looking for something more like a “ten best” list.
So I guess I’d say, nice idea, but the implementation needs some more work. This is why I think a wiki format would be good — we could update it ourselves.
July 1st, 2009 at 3:49 pm
We pay out of pocket every month for our private insurance through my wife’s work. Damn sure we’d dump that for a decent public option.
July 1st, 2009 at 3:54 pm
yeah, the refusal to use an editor is like being in a band with a drummer who won’t use the click-track, or a bass player who won’t use a pick.
its just like … why?? why won’t you do this incredibly basic thing???
July 1st, 2009 at 4:10 pm
A public option, for example, is wildly popular with the public and supported by almost seventy percent of voters. But it doesn’t have nearly so many fans in the United States.
I guess United States voters are mostly in the thirty percent of…worldwide voters who don’t support it. Glad to get that info!
July 1st, 2009 at 4:29 pm
Yglesias is far too intellectual to be a drummer, but the click track analogy works for me.
I’ve liked all of Matt’s various blogs, largely for the interesting set of commenters he’s attracted. I don’t really care about the misspellings as much as the ‘WTF’ typos that throw off the meaning of the argument.
But the lack of proofreading is really starting to come off somewhat disrespectful towards his readers. C’mon Matt, slow down a little and just proof the damn posts.
July 1st, 2009 at 4:43 pm
But the lack of proofreading is really starting to come off somewhat disrespectful towards his readers.
I really think Matt mostly holds his readers in contempt. It only seems to be other bloggers that hold any away with him, and I guess they haven’t seen fit to put pressure on him to do anything about all the uncorrected errors.
July 1st, 2009 at 4:56 pm
folks are also forgetting something that will end up hitting most citizens as a very unpleasant surprise: the individual mandate.
if – or when, as i anticipate a real disaster of a bill – people understand that they will be mandated to buy health insurance, as they must buy car insurance now, they will be very upset.
extremely upset.
what is amazing is how dense politicians are to this probability.
they really think that we are stupid and that as long as they can say that they passed a “reform ” bill, that people will support it.
they are in for a rude awakening.
July 1st, 2009 at 6:04 pm
Two things that will be quite popular with the middle class: Some sort of healthplan (if only government-paid COBRA) for the unemployed so that they won’t lose coverage if they are laid off, and mandatory community rating with all that entails so they need not worry about being denied coverage if they do get sick.
July 1st, 2009 at 6:05 pm
Re: folks are also forgetting something that will end up hitting most citizens as a very unpleasant surprise: the individual mandate.
That only affects a small minority of the population since most people are already covered at work, or by various public programs like Medicare.
July 1st, 2009 at 6:29 pm
Don’t forget the “elliot”
July 1st, 2009 at 6:41 pm
JonF Says:
July 1st, 2009 at 6:05 pm
Re: folks are also forgetting something that will end up hitting most citizens as a very unpleasant surprise: the individual mandate.
That only affects a small minority of the population since most people are already covered at work, or by various public programs like Medicare.
=============================================================
Yeah, but isn’t part of the plan to tax as income the benefits of the people covered at work to subsidize the new programs?
July 1st, 2009 at 10:36 pm
Yeah, but isn’t part of the plan to tax as income the benefits of the people covered at work to subsidize the new programs?
Define “the plan”. Some people have advocated this measure. Among others, Obama has not.
July 2nd, 2009 at 6:21 am
Re: Yeah, but isn’t part of the plan to tax as income the benefits of the the people covered at work to subsidize the new programs?
Maybe, but only upper income people or lavish plans.