Splitting Health Reform
It’s been my understanding for a while now that the Senate Democratic caucus has no interest in trying to bully the parliamentarian into letting them use the budget reconciliation process to force through a health reform package that contains substantial non-budgetary elements. But this Mark Schmitt post from last week contains a valuable reminder that the non-budget elements of health reform actually tend to be the less controversial ones, indicating that you might be able to get a much more progressive bill by basically splitting health reform into component parts.
One bill, a filibusterable non-reconciliation bill, would set up the basic framework of a health insurance “exchange” on which individuals and small businesses could get insurance. It would feature an employer mandate, some kind of sad co-op, and some not-very generous subsidies. It would be subject to various kinds of regulation including the White House’s key eight points of consumer protection. It’s a bill liberals would find horribly disappointing, but you could imagine it getting sixty votes in the senate.
Then if you get that done, all you need is a second bill. At that point, changing the co-op rules to make it work like a real public option, making the subsidies more generous, expanding Medicaid, and other wholesome progressive stuff all becomes budget-relevant material that can be done through reconciliation with only fifty votes. It’s not clear at this point that the public option has fifty votes in the senate, but it’s close, and I’m reasonably certain that the votes could be found if the procedural path existed.
49 Responses to “Splitting Health Reform”
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August 18th, 2009 at 10:00 am
I was going to write, “Don’t reconciliation bills have to reduce the deficit?”
But Google quickly answered that question for me in the negative. http://mediamatters.org/research/200908050006
August 18th, 2009 at 10:03 am
I was going to write, “Don’t reconciliation bills have to reduce the deficit?”
The idea is that once you’ve passed the first bill, the public option *does* reduce the deficit. It saves $150 bil or so, if I recall. Which makes it all the more amusing that deficit hawks like Kent Conrad are the ones opposing it.
August 18th, 2009 at 10:03 am
If we don’t have 50 votes for a public option from Democrats why are we still talking about it? I would like a public option, but if its dead its dead.
August 18th, 2009 at 10:04 am
It seems a but like gaming the system, and seems to rely on the idea that republicans wouldn’t notice what you are doing (and we are not as stupid as you think we are), but I have to say it sounds like a good plan. Which is likely why I am reading more and more about this sort of idea of multiple bulls in the past few days.
August 18th, 2009 at 10:12 am
Note how Yglesias elides the point that Schmitt wants to give the store away to private insurance companies in 2009 and thinks there will be somehow then be the will to enact difficult reform in 2010.
Just say no to the lies coming from Mark Schmitt, Kent Conrad, Tom Daschle, and Matthew Yglesias.
Their lies helped the top 4 private health insurance companies stocks surge in the stock market yesterday.
They’re a bunch of shills willing to lie to help private health insurance companies screw the citizenry and the public treasury. The left should help them with their lies and the efforts to profit.
No public option should mean zero money for the industry.
(And again, I know why Conrad and Daschle are lying. They’re getting paid by the heath insurance industry to lie. Why is Yglesias lying? Is he getting paid now, or is he just auditioning for a health insurance industry job in 2010? Has Tom Daschle promised Matthew a high paying job?)
August 18th, 2009 at 10:12 am
I was thinking about the same thing the other day, but of course the entire thing relies on Republicans and moderates not deciding to sink the first bull as retribution for being gamed on the second.
Of course, said Republicans and moderates might well be better off allowing both bills to pass, and then railing against the dirty backroom politics of the liberal Democrats and Fast Eddie Obama. I’ll take it – they get a talking point and we get health care reform!
August 18th, 2009 at 10:15 am
We have 48 solid votes for the public option, and 7 unknown votes, according to Nate Silver. So it’s not a guaranteed win, but it’s silly and wrong to claim that it’s dead. If you’re generous, the opponents have 45 votes. It’s likely to already have the 50 votes.
August 18th, 2009 at 10:16 am
“If we don’t have 50 votes for a public option from Democrats why are we still talking about it? I would like a public option, but if its dead its dead.”
The public option would easily get 50 Democratic votes in the Senate as part of a larger bill.
Yglesias is lying on the topic for reasons he ought to explain. He wants the public option to go away so the health insurance industry can profit.
Is UnitedHealth paying him the way they’re paying Tom Daschle?
August 18th, 2009 at 10:16 am
Is anyone else seriously worried for Petey’s sanity?
August 18th, 2009 at 10:20 am
“it’s silly and wrong to claim that it’s dead”
Of course it’s wrong, but it’s profitable for “Democratic” pundits to falsely claim the public option can’t pass in 2009.
August 18th, 2009 at 10:22 am
I’m confused, are there 41 votes against cloture for real health care reform? I know Baucus and Conrad don’t like health reform that doesn’t involve hand holding with Chuck Grassley, but have they ever come out and said that they would block a floor vote on health care reform that had a public option or whatever? Do you realistically think that Collins or Snowe would be the one vote that killed health care reform?
This “60 vote” bs only matters if centrist dems are committed to filibustering health care reform that they didn’t write. Has that ever been threatened, or even contemplated?
August 18th, 2009 at 10:25 am
“Is anyone else seriously worried for Petey’s sanity?”
Which part is insane, Ted?
- That UnitedHealth is paying Tom Daschle to go on cable news as a “Democrat” saying that no healthcare bill that doesn’t have 70 – 80 Senators in support can pass?
- That the WH’s trial balloon about dropping the public option on Sunday caused health insurance companies to shoot up in value on Monday?
- That Yglesias keeps lying about the nature of the legislative process on healthcare for reasons he ought to explain?
August 18th, 2009 at 10:27 am
@11: Honestly, it’s unclear. I think Nate Silver has some of the best vote-counting threads, but it ends in ambiguity. Senators don’t like to come right out and say how they would vote in advance.
The other question that’s out there is whether the Senate would stand for the sort of “divide the bill” tactic MY is proposing here. E.g., one risk is that moderates, getting wind of the tactic, would refuse to vote for the first bill.
August 18th, 2009 at 10:31 am
Petey, I don’t disagree with you about the pervasive influence of corporations. That’s definitely the problem we’re confronting on this issue — bluntly, some of these guys are bought. OT, but I’ll even admit that your points about GE are beginning to raise questions in my mind about MSNBC.
But the third of your points — the one about MY — is the part where you’re sliding over the edge. It doesn’t make sense to accuse someone of lying unless the matter is so well-documented that no one could, in good faith, have a different opinion. And when you get into the weeds of the legislative process, that’s just clearly not the case. Good-faith disagreement is very possible, and indeed likely, so the boldfaced references to “lying” just come off as crazy.
August 18th, 2009 at 10:33 am
Ted: The reconciliation bill would have to reduce the deficit or leave it unchanged. In the Senate any bill which increases the deficit is out of order according to a rule of the senate. To pass such a bill you have to change the rule (for the stimulus the new rule allowed an exception just this once). So reconciliation or no, filibuster or no, to add to the deficit you need 60 votes in the Senate.
Matt: Your division into 2 bills didn’t mention one very very key issue — the individual mandate. There are 2 possibilities, you ask liberal senators to vote for a mandate with meager subsidies forcing poor people to say not blow money of food or you try to pass a bill with the 8 fold regulatory reform and no individual mandate.
The second approach will not work — it has been vetoed by Karen Ignani (head of the health insurance lobby AHIP). The insurance industry has two conditions
1) no public option
and
2) universal health insurance which means an individual mandate too.
It is clear that the senators needed to get to 60 take orders from Ignani.
To get 60 votes a bill must include not only an employer mandate but also an individual mandate.
Now one division would be all of the bill except for the public option (gets 60 votes)
Then add a public option. This gets scored as costing negative 150 billion over 10 years by CBO and can be passed via reconciliation. <
The problem with this division is that the 60 vote bill would add 150 B to the deficit or, heaven forfend, the final deal would reduce the deficit and we can’t have that.<
August 18th, 2009 at 10:37 am
The other question that’s out there is whether the Senate would stand for the sort of “divide the bill” tactic MY is proposing here. E.g., one risk is that moderates, getting wind of the tactic, would refuse to vote for the first bill.
Not just moderates, actually. The Senate is an institution that works on a degree of personal trust and goodwill, gentleman’s agreement, and decent interpersonal graces. The notion that senators would stand to try to hose their own colleagues in as major and substantive a way is, frankly, risible.
I can’t possibly imagine any senator, save for the very most liberal, standing for this sort of shenanigans. This isn’t the House, where the members sitting across the aisle are safely “enemies”, you know.
August 18th, 2009 at 10:39 am
Adam @2:
[O]nce you’ve passed the first bill, the public option *does* reduce the deficit. It saves $150 bil or so, if I recall. Which makes it all the more amusing that deficit hawks like Kent Conrad are the ones opposing it.
Like nearly all Senators, Kent Conrad’s priorities are 1) get reelected, 2) appease large donors, 3) be popular among his constituents, and finally, 4) legislate according to his conscience. He’s been reelected by ever greater margins since 1986, most recently in 2006 (so he won’t have to run again until 2012) with more than twice the votes of his challenger. So 1) is taken care of. As for 2), his large corporate donors are in general probably mildly in favor of deficit reduction to prevent increases in interest rates, but the big bucks he’s gotten from health insurers counteract that (http://www.fivethirtyeight.com/2009/06/special-interest-money-means-longer.html). The benefits of a public option are, for his donors, diffuse, while the costs are, to an important subset, immense.
August 18th, 2009 at 10:42 am
I really quite imagine how someone like Baucus or Wyden and Conrad could vote for this sort of tactic and still be able to face their colleagues in a gentlemanly manner.
August 18th, 2009 at 10:43 am
I say, Myles, you’re right. Backstabbing in the Senate — among scholars and gentlemen? — frankly risible.
More to the point, they have a gentlemen’s agreement not to p*ss off their contributors.
August 18th, 2009 at 10:44 am
While the Repubs scuttle any chance for meaningful reform, the Dems and their supporters are wondering how best to orchestrate defeat, and arguing with each other over the best color of the white flag to be used for the celebration of the loss.
August 18th, 2009 at 10:45 am
“It doesn’t make sense to accuse someone of lying unless the matter is so well-documented that no one could, in good faith, have a different opinion.”
A repetitive series of posts intentionally distorting the state of play of healthcare on the Hill qualifies as lying in my humble opinion.
Matthew clearly doesn’t support the left fighting for what the language will be in the final healthcare bill. His only interest in getting a bill, which will thus consist of language entirely written by the healthcare industry. Fine. Folks can obviously disagree on priorities. But the fact that Matthew has bizarre priorities doesn’t make his lying about the legislative state of play not lying.
August 18th, 2009 at 10:47 am
I don’t think there is enough trust for the White House and the Dem leaders to take this course. If the progressive caucus is willing to scuttle any bill without a public option; I don’t see them voting for a bill without it trusting that they will have the opportunity to vote for a public option later.
For the life of me, I cannot understand why Obama and the senate persist in seeking Republican support. Maybe this a long term strategy designed to ease the toxic environment between the two parties. But I think they are badly underestimating the degree to which Republicans and the corporate elite are willing to destroy the country to keep their privilege. History is replete with examples of cultures/countries that died out because the ruling class was more interested in ruling than in survival.
August 18th, 2009 at 10:56 am
Rather than using the second bill to establish a public plan and expanding Medicaid, it would be better to eliminate Medicaid and move Medicaid patients into the public plan. Ideally universal care should provide the real benefits of insurance to all, including those on Medicaid, rather than keeping some in a second class plan.
August 18th, 2009 at 11:05 am
There are two possible explanations for Obama’s bizarre fixation on bipartisanship for its own sake, even at the cost of diluting his agenda to the point that it becomes no more than a pretense of change that fools only the extremely loyal devotees.
He may be so naive as to think that the Republicans at heart want to rid the body politic of the constant bickering that comes out of Washington and support Obama in ushering in a new era of cooperation between the main political parties, even if it results in a Democratic Presidency and Congressional majority for a long time.
Or he may be a closet puppet of the establishment who is there to provide cover to the Wall Street and the insurance companies and the defense industry by whispering sweet nothings in the ear of the liberal supporters of the Democratic Party while the status-quo continues to persist, albeit under a different label.
As the health care debate unfolds it is becoming exceedingly difficult not to give a second thought to giving some credence to the second alternative.
August 18th, 2009 at 11:12 am
The second approach will not work — it has been vetoed by Karen Ignani (head of the health insurance lobby AHIP). The insurance industry has two conditions
1) no public option
and
2) universal health insurance which means an individual mandate too.
It is clear that the senators needed to get to 60 take orders from Ignani.
To get 60 votes a bill must include not only an employer mandate but also an individual mandate.
But bringing this back to 60, you seem extremely confident that Conrad and/or Baucus and/or Bayh and/or ??? (you didn’t name names so I’m guessing) are so committed to this that they would vote against cloture on a democratic sponsored bill on the floor. Is that really true? What evidence do you have for this? I haven’t seen anything from even the most conservative democrats committing to BLOCK such a bill.
August 18th, 2009 at 11:13 am
Imho, what’s happening isn’t that the WH, or Dem leaders, are “seeking Republican support.” What’s happening is that some irritating centrist Dem senators from MT and ND, et al, are using “bipartisanship” as cover for an aggrandizement of their own personal power.
Not that I care what Democrats think about Obama. He’s not in a primary; it doesn’t matter. Believe he’s a Cylon for all I care. But if you live in MT, or ND, or LA, or AR, please do call your #$%^&( Senator.
August 18th, 2009 at 11:13 am
Not really. Using the filibuster to require all legislation to need 60 votes for passage is gaming the system. That isn’t what the filibuster is for.
This tactic is a technically allowable means to circumvent the misuse of the filibuster.
August 18th, 2009 at 11:16 am
This tactic is a technically allowable means to circumvent the misuse of the filibuster.
Technically allowable, and very ungentlemanly; thus, won’t happen in the Senate.
August 18th, 2009 at 11:19 am
Does anyone else but Petey think that Petey’s description of the legislative process is more accurate than Matt’s?
Anyone?
La la la la la, they can just click their heels together! I don’t want there to be a de facto 60-vote rule, so I’m just going to pretend there isn’t one.
August 18th, 2009 at 11:19 am
…and call people who say there is one “liars.”
August 18th, 2009 at 11:36 am
Petey doesn’t take well to people disagreeing with him. Particularly when he is wrong.
Anyway, if you opt for this strategy–which as yet I am not convinced is necessary, since I also don’t see much evidence that any Senate Democrats will actually join a filibuster of a conference report on health care–I would strongly advise packing as much of what you want as possible into the first bill. Indeed, in some sense I think this is automatically the strategy: I think budgetary concerns are going to legitimately push Congress to keep making the public option/co-ops more competitive and more aggressive on costs over time. But the better you start out with, the quicker that process.
August 18th, 2009 at 11:49 am
Petey’s shtick is really weird. It’s not that different from his approach in the primaries, first supporting Kerry and then coming completely unhinged in the Obama-Clinton debate.
Obviously, its not possible to be that confident you know where the 51st or the 60th Senate vote lies for any given bill. It’s probably even more difficult to say how much those votes can move based on the application of political pressure from various actor (eg: the president). What we have seen historically is that it is very difficult for the president to get his legislative priorites passed, unless they are corporate giveaways, tax breaks, or wars. Bush certainly didn’t get anything else done and he didn’t even have to worry about a filibuster. So I am really not sure why Petey is convinced Obama is driving this process and certainly don’t see why anyone who believes otherwise must be lying. But it does fit in with what we have seen from Petey in the past.
August 18th, 2009 at 12:25 pm
The Senate is an institution that works on a degree of personal trust and goodwill, gentleman’s agreement, and decent interpersonal graces.
i.e. it’s a circlejerk to rival the ones at Miley’s prep-school.
August 18th, 2009 at 12:27 pm
Note how Yglesias elides the point that Schmitt wants to give the store away to private insurance companies in 2009 and thinks there will be somehow then be the will to enact difficult reform in 2010.
Petey: Your use of language here makes it sound as though there’s no difference between having to get 60 votes and having to get 50 votes. I’d say there’s a huge difference here. So, while I’m glad most folks in the House (and even a few in the Senate) are swinging for the fences, I’d still rather get a less than perfect, Switzerland-style bill that does a lot of good (via wide-ranging re-regulation of the health insurance industry and a pile of subsidies) — and delivers a political win to Democrats — than have a repeat of 1994.
Again, while no doubt challenging, there’s every reason to believe that augmenting this year’s imperfect legislation with a deficit-focused bill that only requires 50 Senate votes via reconciliation is a feasible strategy. But I realize that wouldn’t be as much fun as slitting our collective wrists.
August 18th, 2009 at 12:40 pm
Anyway, if you opt for this strategy–which as yet I am not convinced is necessary, since I also don’t see much evidence that any Senate Democrats will actually join a filibuster of a conference report on health care…
I echo DTM’s thoughts. I mean, at this point, barring something unforeseen, worst-case scenario probably means “Switzerland” instead of “France” this year — with fiscal pressures steadily nudging us toward France with the passage of time. (And yes, Big Insurance will continue to fight tooth and nail to block a public option, but not even Big Insurance is as powerful as the bond market — especially when only a simple majority is needed to assuage the fears of said market). And, of course, this “worst-case” scenario may not come to pass: House Democrats are making it pretty clear anything emerging from their chamber is likely to have a a public option. So the real action — as has been increasingly clear now for many weeks — will be in the conference committee.
August 18th, 2009 at 12:52 pm
So the real action — as has been increasingly clear now for many weeks — will be in the conference committee.
But the shitfest of the Senate Finance Committee — as well as Gun-Toting Nutjob August — is going to set the context for the conference committee.
August 18th, 2009 at 1:03 pm
[...] the original post: Matthew Yglesias » Splitting Health Reform Tags: a-public-option, august-18th, education, health, iran, legislative, matt-yglesias, obama, [...]
August 18th, 2009 at 1:18 pm
But the shitfest of the Senate Finance Committee — as well as Gun-Toting Nutjob August — is going to set the context for the conference committee.
I’m not sure what “set the context” means in this case. Here is the basic situation: since no Democrat actually benefits from killing the health care bill entirely, the logical outcome in conference is a compromise within the Democratic Caucus. The Senate Finance Committee basically represents one end of that spectrum, with the other Senate and House committees, plus the leadership in each house and the Administration, filling out the rest of the spectrum. Once that group compromises amongst itself, there is no real reason to expect the Senate Finance Committee in particular to get whatever it wants.
So, sure, the better the bill out of Finance, the better the bill out of the Senate, and the better the final bill out of conference. But again, that doesn’t mean the final compromise will just be whatever Finance decides.
August 18th, 2009 at 1:18 pm
But the shitfest of the Senate Finance Committee — as well as Gun-Toting Nutjob August — is going to set the context for the conference committee.
I’m not sure what “set the context” means in this case. Here is the basic situation: since no Democrat actually benefits from killing the health care bill entirely, the logical outcome in conference is a compromise within the Democratic Caucus. The Senate Finance Committee basically represents one end of that spectrum, with the other Senate and House committees, plus the leadership in each house and the Administration, filling out the rest of the spectrum. Once that group compromises amongst itself, there is no real reason to expect the Senate Finance Committee in particular to get whatever it wants.
So, sure, the better the bill out of Finance, the better the bill out of the Senate, and the better the final bill out of conference. But again, that doesn’t mean the final compromise will just be whatever Finance decides.
August 18th, 2009 at 1:44 pm
This plan runs into same basic problem all the others do: A substantial portion of the party base does not trust the party establishment at all. We do not trust that this healthcare plan is really the best deal we could get. We don’t trust the White House is even serious about healthcare reform in any way beyond as a photo-op (remind you of anyone?). We will not trust that the second half of the ’split’ bill would ever actually get passed.
In fact, the entire reaction of the left towards this Presidency can basically be summed us as this: We just don’t trust that you’re really on our side. Triangulation seems like a brilliant strategy right now, doesn’t it?
August 18th, 2009 at 1:47 pm
Petey is right. For all his alleged wonkery, when the shit hits the fan, people like Ezra and MattY are Hacks. They do not support a realistic policy. Anyone who thinks regulations will work in the current ethical environment is just deluding themselves. No, what they care about are the optics of Obama failing on such a big issue. How will that impact his effectiveness, his support amongst the public, etc.
That’s the sign of a lot of things, but it’s certainly not the sign of an actual wonk.
August 18th, 2009 at 1:58 pm
I’m not sure what “set the context” means in this case.
That the noise shapes the signal. The ongoing stuff — right now, the Baucus Caucus, then the full Senate — gets the media coverage, and whether you like it or not, the well-worn scenario is that the struggles to get a bill out of the Senate will define the outer limits of the final reconciled version more than what happens in the House, even with the Blue Dogs pulling their usual shit.
This will be accompanied, of course, by the cablenewsers paying great heed to the opinions of noble bipartisans like Chuck Grassley and Jim DeMint.
It’s a question of who gets the last word in public.
August 18th, 2009 at 2:59 pm
[...] down to defeat over this? Some liberals are beginning to question the wisdom of this. For example, Matthew Yglesias has popularized an idea to split health care reform into more than one bill: One bill, a [...]
August 18th, 2009 at 4:49 pm
i.e. it’s a circlejerk to rival the ones at Miley’s prep-school.
You should try getting that asinine, comical hatred out of your heart; it truly is not good for your health. It verges on pathology.
August 18th, 2009 at 5:40 pm
Oh, Miley, you’re so funny.
August 20th, 2009 at 10:49 am
[...] Jon Cohn points out, Yglesias had this idea a few days [...]
August 20th, 2009 at 11:28 am
[...] would make it possible to create an exchange and set up new insurance regulations. As I pointed out a few days ago one way around that is just to split the [...]
August 20th, 2009 at 2:41 pm
Why can’t just those why pay taxes get health benefits…how b’out that Obama and the rest of the health care reform starters??? NO seriously, this I could be in favor of, but not just letting any old person that comes to America, even the illegal’s to get health care and our taxes go up the roof???? No, sure, I will cont. to fight this…
August 21st, 2009 at 12:39 am
I’m sorry to say it doesn’t amaze me that, having failed to persuade the public on the merits of “Health Care Reform”, the left will openly discuss ways of slipping it in surreptitiously or ramming it home using parliamentary maneuver. Imposing your will on people who have rejected your ideas is called “fascism”. Even if you tell yourself, in your benevolent wisdom, that it’s “for their own good”.