Matt Yglesias

Maine Republicans Want Conservative Challenger to Snowe

It seems Olympia Snowe might be more comfortable in a different political party:

This Public Policy Polling survey of Maine isn’t all that surprising: She has a 46/40 disapproval/approval rating from state Republicans. By a whopping 27 points, those same Republicans say they’d back a “conservative challenger” to Snowe in the 2012 GOP primary. Voters who picked the McCain-Palin ticket in 2008 and self-identified conservatives all oppose Snowe and want a challenger; basically everyone else in the state has a more positive view of Snowe, the poll found.

I don’t know whether these results are “surprising” or not, but I think they ought to change our understanding of the prospects of bipartisanship in health reform. This means that when you’re thinking about whether Snowe will support a bill or not, the issue ultimately comes down to not triggers versus non-triggers, or employer mandates versus free rider fees, but whether Snowe wants to remain a Republican or not. Based on this polling, a Snowe who votes for a comprehensive health care overhaul is basically not going to be viable as a GOP primary candidate. Conversely, a Snowe who votes for comprehensive health reform and switches parties would remain a very popular general election candidate with a safe seat.

Incidentally, this poll inspired me to look up who’s important in Maine GOP politics aside from Snow and Susan Collins. Turns out the top Republican in the State Senate is Kevin Raye, who’s also proprietor of Raye’s Mustard Mill, which is one of Maine’s finest food products. I don’t know much about the guy’s politics, but he makes great mustard!

The Power of Thinking Small

Ezra Klein asks Olympia Snowe if there are health care ideas that she likes, but that she doesn’t think are politically feasible. Something like how many people would prefer a single-payer system or the Wyden-Bennett approach but recognize that the votes in congress just aren’t there. She says:

I don’t know that I have anything in that category. I believe we should build upon the current system. We don’t want to disrupt that. I’m traditional in my approach towards reforming health care. Given the size and the amount of money we spend on it, I think it would be far too disruptive to upend the system. I think it’s preferable to build on what has worked well in our system and change the egregious practices in the insurance industry. I think the skepticism of that industry has been understandable and I share it, that’s why we really need to look at all facets to ensure they live up to certain standards and perform. But if they don’t, I think a trigger could be a powerful lever in that regard without having the government involved at the outset.

It’s probably helpful in some ways as a practical politician to let the contours of your ambition be totally circumscribed by practicality. But also a bit sad. A relatively small number of somewhat right-of-center senators have an enormous amount of practical power at this point in time. If more of them had more in the way of vision and ambition, they might really be able to get great things done. But the tendency is for them to be much more split-the-difference compromisers than big thinking radical centrists.

Olympia Snowe Strikes Again

Olympia Snowe looks set to reprise her roll in hobbling the stimulus bill in exchange for providing the key pivotal vote for it by killing John Kerry’s amendment, “Empowering State Exchanges to be Prudent Purchasers.” Jon Cohn explains:

In the bills that passed three House committees and the Senate Health, Education, Labor, and Pensions (HELP) Committee, the exchange would be a “prudent purchaser.” In other words, it would have a staff that bargained with insurers to bring down premiums — and that made sure all plans lived up to strict guidelines for coverage and customer service. In effect, any insurer that wants to offer coverage through the exchanges has to get the equivalent of a “Good Housekeeping Seal of Approval” from the administrators. This is precisely how it works in Massachusetts.

By contrast, the Senate Finance bill envisions much weaker exchanges. Instead of choosing which plans to make available, the exchange administrators would, by law, have to accept any plan that meets a relatively minimal set of standards.

There are several problems with this. One is that it’s going to be a mess for consumers. Another is that it threatens to turn the exchanges into playgrounds of implicit risk-shifting efforts wherein companies try to design policies specifically around dissuading high-need people from signing up. Thus ever-more burden is going to be placed on the untested risk-adjustment machinery that’s supposed to even this all out. Ezra Klein observes that Jon Kingsdale is basically the only person in America’s who’s run anything like the exchanges envisioned in all the different bills—he does the job in Massachusetts—and he views the prudent purchaser rule as absolutely essential. Against that Snowe is pitting, I guess, her intuition that this is too much government involvement.

Snowe Eying Arbitrary Health Care Cuts

One mistake I think you can fairly tag Barack Obama with was endorsing Max Baucus’ $900 billion total price tag for health reform in Tuesday’s speech. That number was already low, and as Steve Benen points out the nature of certain “moderate” senators seems to be that whatever’s on the table always needs to be scaled back for no real reason to some different lower round number. Thus:

Another Republican negotiator voiced concerns to Fox. Sen. Olympia Snowe, R-ME, said there is still concern about the size of the package which is carrying a near $900 billion price tag. “Maybe we could shrink that to $800 billion or below,” the moderate senator said, citing a skeptical public with bailout fatigue and concern for rising deficits.

Maybe!

It’s difficult for me to understand how turning a deficit-neutral $900 billion program into a deficit-neutral $800 billion program should alleviate concern for rising deficits. If you want to take more of a hammer to deficits, what you need to do is propose something considerably more ambitious than Baucuscare—either a single-payer plan or Wyden-Bennett or something else equally dramatic. You can just take the Baucus plan and slice off $10 billion a year at random, but this leaves the deficit the same and just gives people less health care. Unless, of course, you try to find the savings through adopting the sort of robust public option which Snowe opposes.

Maine-Friendly Health Reform

Cape Elizabeth, Maine (cc photo by janeinmaine)

If Olympia Snowe is genuinely both seriously considering embracing health reform and integral to reform’s prospects then doesn’t it seem like in some ways the winning legislative strategy is not so much to haggle over substantive points as to just haggle over pork? After all, we’re talking about an enormous bill—tens of billions of dollars a year in spending, plus tons of regulatory changes—and Snowe represents a very small state.

Maybe we want to spend $1 billion to build a new Comparative Effective Research Center in Portland? I like comparative effectiveness research. And it has to be done somewhere, right? And Portland’s nice. Or we could subsidize lobstermen. Or mandate that all insurers cover logging-related injuries. It’s understandable, I suppose, that Snowe is reluctant to be the only Republican who votes for a reform bill. But it becomes a lot easier to cast that vote if you can legitimately say that voting no would be turning down a great opportunity for your state.

Senators Mobilize to Protect Insurance Industry from Competition

Olympia Snowe (R-ME) and Mary Landrieu (D-LA)

Olympia Snowe is open to a compromise on a public option, but she wants a “trigger” mechanism in order to protect private health insurance firms from the threat of “unfairly” needing to compete with cheaper alternatives:

In an Associated Press interview in Portland, Snowe said it would be unfair to include a government-run health insurance option that would take effect immediately.

“If you establish a public option at the forefront that goes head-to-head and competes with the private health insurance market … the public option will have significant price advantages,” she said.

A significant price advantage is, of course, a good thing if you’re interested in delivering quality affordable coverage to everyone. Cheaper is a good thing. But not to Senator Snowe. As Chris Bowers says “It is pretty amazing that many moderates and industry figures are actually arguing that the problem with including a public option in health care reform legislation is that a public option would lower the cost of health insurance.” Unfortunately, it’s not just a handful of moderates. The more liberal of the two Senate committees working on health reform has come up with a weak public option that would do some good but ultimately lack significant cost advantages over private insurance.

It’s worth noting that in Maine (see PDF) 78 percent of the insurance market is controlled by a single firm, WellPoint.