From the Vivaldi Gloria — Et in terra pax hominibus bonae voluntatis. And on earth, peace to men of good will.
Monthly Archives: December 2009
Pass the Bill II
I heartily agree with Joan Walsh here:
There is a genuine and justified concern among progressives that this bill enshrines an alarming corporatist Democrat view of “reform”: Make nominally liberal social-service expansions safe for the private sector. That is absolutely what is going on.
But that’s as far as the Democrats and the progressive movement have taken us to date. We have a lot more work to do. In my opinion, left and center Democrats need to compromise now, make good on their campaign promise to pass the bill and insure millions more people. And then progressives need to challenge the corporatist pillars of the party in rhetoric, legislation, and in elections, in 2010 and 2012, and beyond.
I said before the 2008 elections that one election would not turn America into progressive paradise. I said it would take many elections and many years of pushing elected officials back to the idea that they represent people and not corporations. The 2006 and 2008 elections were not the culmination of a great progressive effort, but just the beginning. I think we’re going to have to have a substantial turnover in Congress, and not just among Republicans, before we get legislation that doesn’t stink out loud.
However, in the meantime, we have a genuine crisis on our hands. People are dying who shouldn’t have to die. People are being financially ruined by medical bills. The bill as it is, like it or not, will make a huge difference in the lives of millions of people.
It’s as if you see people drowning in the ocean, but in order to save them you’ve got to rent a boat from some unsavory character who will use the money for an unjust cause. As I said in an earlier post, if we had a reasonable expectation that killing the current bill would inspire Congress to go back to the drawing board and come up with a better one, then I’d say kill it. But there’s no way that would happen. The reality is that it’s this bill or the status quo for at least a decade.
I also think that killing the bill plays into the Right’s hands. Killing this bill will do nothing to help the cause of progressivism going forward. Killing this bill is, ultimately, what the corporate interests want. Yes, the corporate interests like the compromised bill better than a progressive bill, but they’d like no bill at all even more.
Someone has said that on the Left, wonks tend to be for the bill and activists against it. Without naming names, it seems to me that many of those activists against it are people who have no personal experience with life without health insurance. Maybe I’m wrong about that. However, for me, living with the status quo for another ten or fifteen years is unbearable, considering the millions of Americans who have no insurance unless this bill is passed.
By all means, let’s complain loudly about the parts of the bill we don’t like, such as the giveaway to Big Pharma. Keep pushing for improvements, before and after the bill is passed. Let President Obama know we are disappointed he didn’t push harder for the public option. But don’t kill the bill.
Pass the Bill
The Senate bill is flawed, no question. Ezra Klein goes over some of the strengths and weaknesses. Ezra documents that with all its flaws, the bill would still be a huge, positive benefit for millions of Americans, putting them at far less risk of health or financial disaster.
The bill as written should reduce the federal deficit and help rein in spiraling health care costs. “And the bill does all this while covering more than 30 million people, ending the ability of insurers to discriminate based on preexisting conditions, creating a new and more competitive insurance market, taking the first steps away from fee-for-service medicine, and much more,” Ezra writes. He concludes,
In the world where we pass the bill, most everything gets somewhat better, if not good enough. More people have insurance. The insurance industry ditches its worst practices. Fewer families go medically bankrupt. More people catch diseases early, when they can be cured, rather than late, when they become fatal. People who would otherwise have died live. The medical system begins the process of updating itself for the 21st Century, and responding to the cost pressures it’s placing on the rest of the country.
The world in which we kill the bill is a world in which everything just continues to get worse, and politicians are scared away from the issue for decades. A world in which we pass the bill is a world in which things get better, and politicians remember that they can pass big pieces of legislation that take on, or begin taking on, big problems.
If we had a reasonable expectation that Congress would start over and come up with a better bill next year, it would make sense to kill this one. But you know they won’t do that. You know it would be many years before they take up health care reform again. It’s been, what, 15 years since the last attempt?
Think of this bill as a foot in the door. Once provisions begin to go into effect, once people realize their lives are less in jeopardy, there are no death panels, and Soviet tanks don’t appear in the streets, most Americans will support it, and more reforms will be possible. Yes, I agree with Digby that a large portion of Americans are so lost in their mythic fantasy land they wouldn’t recognize reality if it showed up with fireworks and a brass band. But I think that while most Americans can be confused and bamboozled about new or foreign things, once they have direct experience with something they are not so easily fooled. They saw through George Bush’s Social Security privatization scheme, for example.
So, yes, pass the bill.
Next: Senate Reform?
Apparently the Senate took some sort of procedural vote on health care reform in the middle of the night, and it passed. The bill itself didn’t pass, mind you; the vote was a procedural vote that clears the way for another procedural vote. They’ve got at least two more of these procedural votes to go before they get to the real vote, which is expected to happen on Christmas Eve.
At the New York Times, Paul Krugman asks if Congress is capable of making hard choices and acting responsibly. He argues in particular that the Senate must change its parliamentary rules — which are not spelled out in the Constitution, rightie hysteria to the contrary — so that a year like this one in the Senate cannot happen again.
The Senate rules as they are assume that most senators are not crazy. The Senate has always struggled with some level of corruption and incompetence, but when the nation faced a crisis most senators were capable of responding responsibly and rationally. That is not to say that these responsible and rational people always made the best choices, but you could see they had responsible and rational reasons for choosing as they did.
But now the body politic is infested with some sort of social pathology called “movement conservatism,” which is neither responsible nor rational and exists, like a virus, merely to replicate itself. Although there are many vested interests pulling its strings, ultimately movement conservatism is a brainless organism that is killing its host.
The vested interests themselves are not working in their own long-term best interests, since an impoverished and backward America is not conducive to profits. Nor is a dead planet. So one could question whether there is any intelligence at all directing the Right.
That said, Krugman explains the differences in the parties —
Some conservatives argue that the Senate’s rules didn’t stop former President George W. Bush from getting things done. But this is misleading, on two levels.
First, Bush-era Democrats weren’t nearly as determined to frustrate the majority party, at any cost, as Obama-era Republicans. Certainly, Democrats never did anything like what Republicans did last week: G.O.P. senators held up spending for the Defense Department — which was on the verge of running out of money — in an attempt to delay action on health care.
More important, however, Mr. Bush was a buy-now-pay-later president. He pushed through big tax cuts, but never tried to pass spending cuts to make up for the revenue loss. He rushed the nation into war, but never asked Congress to pay for it. He added an expensive drug benefit to Medicare, but left it completely unfunded. Yes, he had legislative victories; but he didn’t show that Congress can make hard choices and act responsibly, because he never asked it to.
Righties have no interest in governing, in the same way that small children have no interest in nutrition, and if you put them in charge of government they behave like the proverbial children in a candy store. Thus, the whole country is being Californiaized.
Once upon a time — the 1960s, to be precise — threatened or actual filibusters affected only 8 percent of major Senate legislation. After the Dem takeover in 2006 this figure soared to 70 percent. I suspect this year it has been higher. Like I said, the Right exists only to sicken its host. (Of course, in the same period of time the number of registered lobbyists in Washington has grown from 50 to 23,000, I’m told.)
And the filibuster is not the only procedural trick the Right has used to screw up the Senate. It appears that using procedure to stop the proceedings is about all they do.
Krugman makes some suggestions for amending the filibuster without abolishing it outright.
For a more radical proposal that I do not necessarily endorse — and which would require a constitutional overhaul — Charles Lemos decries the way in which people in rural parts of the country are overrepresented in the Senate. So often, the senators who stand in the way of progress, both parties, are from states with very low populations. Lemos argues that these low-population senators are the ones most under the influence of lobbyists and do the most damage. Lemos acknowledges that changing the way states are represented in the Senate isn’t going to happen without tearing the country apart.
Even so, there’s an argument to be made that Senate reform must become a priority, because without it nothing else can be a priority. Even if it’s killing us.
Broad Nonpartisan Agreement — Against
NOW, Rep. Bart Stupak and the National Right to Life Committee are against the abortion “compromise” that helped put together an apparent 60-vote majority for the Senate health care bill.
The “compromise” allows states to block any insurance policy that offers abortion coverage to be offered on the insurance exchange in that state. Further, in all states if an individual receiving federal help to pay for insurance coverage chooses a policy that covers abortion, she’ll have to pay for the abortion coverage with a separate transaction. Brian Beutler explains,
Put another way: If you’re buying insurance with help from the government, and the policy you want to buy covers abortions, you have to write two checks (or authorize two credit card transactions, etc.) for your plan. If the plan costs $1000 a month, and the insurer plans to sequester $50 to put into a pool that covers abortions, you have to make one payment of $950 and a separate payment of $50.
One of the arguments made against Roe v. Wade over the years is that the decision to criminalize or legalize abortion should be made by states, not the federal government. Just let the states decide, they say, and we’ll abide by that. But does anyone honestly think the Fetus People would respect any state’s decision to legalize abortion?
Further, this morning the Right is still screaming that, somehow, the bill provides for “federal funding of abortion.” Exactly where they are seeing this federal funding is a mystery to me. It must be lurking behind the death panels.
As for the rest of the bill — Nate Silver thinks progressives really did have a positive impact on the bill, even though we may feel everything we wanted was traded away.
For instance: the CLASS Act has survived; the ban on lifetime coverage limits was restored; there was no tinkering with the Medicaid provisions; there’s some Ron Wyden like amendment to permit workers to opt out of their employer-provided coverage and purchase insurance on the exchanges instead; the abortion language in the Senate’s bill is milder than that which is already in the House’s (to an extent that may actually be a problem); a provision to allow people to purchase insurance through non-profit programs organized by the OPM was inserted, and some decent medical loss ratios were established. …
…From a policy standpoint, indeed, I think the kill-bill / public-option-or-bust strategy has helped to push the bill toward an optimal outcome. Certainly not optimal in the sense of “the best bill that the Senate could possibly have passed”, or “the best bill that progressives could have hoped for”. But in terms of the best bill that the Senate was actually going to pass, given the 60-vote requirement, an unpopular Congress, and an inexplicably lackluster performance from the White House, this is probably fairly close — especially if some further concessions can be realized in conference with respect to the magnitude of the subsidies.
Of course, the actual vote hasn’t been taken yet, and we still don’t now what will happen in reconciliation.
See also Eztra Klein, “The Congressional Budget Office scores the amended Senate bill“; Dan Wasserman, “Hey kids — What’s up with health reform?“
Such a Deal
Word is that Sen. Ben Nelson has agreed to vote for the current version of the Senate health care reform bill in exchange for a lot of money for Medicaid. The federal government will pay for new Medicaid recipients in Nebraska for ever and ever.
There is also a “compromise” on abortion that dumps the issue of funding elective abortions on the states. States can choose to prohibit abortion funding in the insurance exchanges in their states. Further, health plans that do pay for abortions must segregrate premiums from federal money somehow.
This is not good enough for John McCormack of the Weekly Standard, who complains that at least 13 states would continue to fund abortion, and we can’t have that. So much for states’ rights.
Senate Dems say they now have 60 votes, which means that a Republican filibuster cannot stop a vote on the bill, and maybe they’ll pass it. Of course, then they have to reconcile that bill with the House bill, and that’s going to take another war.
So what’s in the Senate bill? Shailagh Murray and Lori Montgomery write for the Washington Post:
Instead of a public option, the final product would allow private firms for the first time to offer national insurance policies to all Americans, outside the jurisdiction of state regulations. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress.
I want that out of the final bill, for reasons I’ve explained several times in earlier posts.
Starting immediately, insurers would be prohibited from denying children coverage for pre-existing conditions. A complete ban on the practice would take effect in 2014, when the legislation seeks to create a network of state-based insurance exchanges, or marketplaces, where people who lack access to affordable coverage through an insurer can purchase policies.
Insurers competing in the exchanges would be required to justify rate increases, and those who jacked up prices unduly could be barred from the exchange. Reid’s package also would give patients the right to appeal to an independent board if an insurer denies a medical claim. And all insurance companies would be required to spend at least 80 cents of every dollar they collect in premiums on delivering care to their customers.
Every American would be required to obtain coverage under the proposal, and employers would be required to pay a fine if they failed to offer affordable coverage and their workers sought federal subsidies to purchase insurance in the exchanges. Reid’s package would offer additional assistance to the smallest businesses, however, increasing tax credits to purchase coverage by $12 billion over previous versions.
See also Steve Benen.
Newsweek’s Predictions for 2010
Newsweek‘s top ten predictions are online. Read the article for Newsweek‘s reasoning — the comments are mine — but here are the predictions.
- Pelosi keeps the house — Dems lose some House seats in the midterm elections but keep their majority. I say probably yes.
- GOP Ousts Reid — a Republican will take Harry Reid’s Senate seat. I think this is highly possible, and the Left should be finding a progressive challenger for the Dem primary. Who should be next majority leader, assuming Dems keep the majority?
- GOP Blocks Immigration Reform — if “reform” doesn’t involve fences and cattle prods, they’re agin’ it. Although the real reason their agin’ it is they want to keep their undocumented household help.
- California Stays Blue — Republican challengers for Senate seats will lose.
- Palin Gets a Talk Show — Bravo, Lifetime, or Fox? I say Fox.
- Florida Elects Sen. Crist — rightie challenges of Gov. Crist will backfire, and Crist will be elected to the Senate. We’ll see.
- Senator Dodd Loses Connecticut Seat — maybe the Left ought to be looking for a primary challenger there also.
- Obama Gets Second Court Pick — he’s bound to get another pick before 2012, anyway.
- Obama Does Nada on Gay Rights — probably true.
- Dems Steal Texas Governor’s Mansion — Houston Mayor Bill White will win the gubernatorial election by a nose. That would be sweet.
Senate Shenanigans
By now you’ve probably seen the video in which Sen. Al Franken declines to allow Sen. Joe Lieberman to drone on past his 10 minute allotted time. Well, it wasn’t just Lieberman, and it wasn’t just Franken. Sen. Mark Begich (D-Alaska) similarly declined to allow Sen. John Cornyn (R-Texas) to go over 10 minutes.
It turns out the freshman Democrat from Alaska was acting under orders of Sen. Harry Reid, D-Nev., the Senate majority leader, who said he had grown tired of what he deemed Republican delaying tactics.
Begich, who as a junior member of the Senate is required to preside over the chamber frequently to learn its rules, had been asked to limit everyone to 10-minute speeches to speed up proceedings. Another freshman, Sen. Al Franken, D-Minn., treated Sen. Joe Lieberman, I-Conn., much the same way Thursday.
OK, but … so little, and so late.
For another exhibit in the “IOKIYAR” museum, see Paul Kane and Lori Montgomery in the Washington Post:
Senate Republicans failed early Friday in their bid to filibuster a massive Pentagon bill that funds the wars in Iraq and Afghanistan, an unusual move designed to delay President Obama’s health-care legislation.
On a 63 to 33 vote, Democrats cleared a key hurdle that should allow them to approve the must-pass military spending bill Saturday and return to the health-care debate. After years of criticizing Democrats for not supporting the troops, just three Republicans supported the military funding.
Proof that atheists are on to something — Eric Kleefeld reports for TPM:
The Family Research Council Action PAC held an extraordinary “prayercast” event last night, praying for the intercession of God to change Senators’ minds and stop the health care bill. …
…Co-host Lou Engle focused the event as a protest against abortion, alleging that the bill would result in government funding and promoting it, and likening their prayers to Biblical figures who worked to stop the genocide of the Jews. “But the Bible’s very clear that prayer affects government,” said Engle. “Esther’s three-day fast changed public policy; Daniel’s fast changed public policy; and it’s the same, yesterday, today and forever, and that’s why we’re here.”
Does that mean they’re going to fast until the health care bill is defeated (she said, hopefully, thinking that this could take a while)? Apparently not; they’re just going to pray a lot. Anyway, I’m saying that any self-respectful wrathful omnipotent being would have sent enough lightening bolts to vaporize the lot of them by now. Yet members of the Family Research Council are still corporeal.
On the plus side, Susie Madrak’s report on yesterday’s blogger conference call on health care (which I skipped, sorry) is reassuring.
The Mandate Fight Is the Wrong Fight
The health care “debate” among progressives has crumbled into a fight over the mandate to purchase insurance. This is the wrong fight. We all need to refocus and look at the bigger picture.
At Firedoglake, Jon Walker writes that the Senate bill with a mandate is unacceptable because the Senate bill’s provisions for insurance industry regulation are weak. Well, worse than weak. Jon Walker is right about that. And the Senate bill with no public option, no regulation of the insurance industry, and a mandate to purchase insurance would be a mess that would mostly benefit the insurance industry.
But the Senate bill would not be the final bill. There’s a House bill, remember? And the House bill is much stronger in the regulation department. The House bill strips health insurance companies of their antitrust exemption and outlaws price fixing, bid rigging and “market allocations†by health insurance companies. With those provisions, we’d end up with something that is closer to the systems in The Netherlands and Switzerland that Jonathan Cohn writes about at The New Republic.
No, it wouldn’t be exactly the same, but it would be close enough to be a big improvement over what we have now. It would be a big improvement over what Mitt Romney established in Massachusetts, because there would be much stronger regulations than a state could impose.
If by some miracle, someday, we really got somewhere with universal healthcare, it’s going to be some variation of single payer or some kind of mixed public-private system that mandates insurance purchase, as is done in The Netherlands or Switzerland. In other words, there will either be universal coverage provided by a government or through an individual mandate. Nothing else is possible.
Jon Walker is right to say that the Senate bill provisions are way different from what works in Switzerland. But if we ever did get a fair and workable system short of single payer, a mandate would be a necessary part of that. That’s because caring for the uninsured is one of the biggest factors driving up cost for everyone. And if a substantial part of younger, healthier people are opting out of the risk pool, it drives up premiums for everyone else.
So if hell does freeze over and we get a shot at passing a reasonable universal health care bill that is something like what they’ve got in The Netherlands and Switzerland, it will have to include the individual mandate. And all the arguments against the mandate progressives are making now will be hauled out of mothballs and used against it.
But insurance industry regulations are essential also. Without the regulations in the House bill there really is no reform, just a big social welfare program that funnels money into private industry.
So put aside the mandate for a moment. As I see it, there are three issues we should be discussing (in my order of preference):
1. Insurance industry regulations in the final bill. Instead of fighting to take out the mandate, we should be fighting to put in the regulations from the House bill. The Senate bill is completely unacceptable on that score.
The Senate bill even has the ridiculous “buying insurance across state lines” provision, which is an invitation for the insurance industry to set up shop in Texas and sell junk policies to the young and healthy. Older and sicker people would be left behind in higher-risk pools, driving up their premiums. And the young folks might pay premiums for years before making a claim and finding out they’ve been ripped off — Dear Policy Holder: This policy doesn’t cover whatever it is you have. Sorry.
If we can’t get traction with regulations, the next option is —
2. Go to reconciliation. I’d say do this before going to a final bill without regulations. However a healthcare bill passed under reconciliation would have to be rewritten so that it would reduce the federal deficit over five years by at least a billion dollars and be deficit neutral after that. Plus, any part of the bill that does not significantly impact the budget could not be included in the bill. Most people who understand how this works say you’d lose insurance industry regulations and other good stuff with reconciliation, although you could include the public option. So reconciliation is not a magic bullet that will make everything the way we want it to be, but it might give us something somewhat less obnoxious than the current Senate bill.
3. Kill the bill. This really is a nuclear option, because if the bill is killed it may be years before we get another shot at reform. But if the final bill is mostly the Senate bill as it is now, we’re better off without it. If this weakens the Obama Administration, so be it; the President might learn something, and he’s got three more years to change his modus operandi. But this has got to be followed up by a very strong effort to defeat every “centrist” Democrat up for re-election in 2010 and 2012.
These three issues are what we should be discussing, not the mandates.
Why Progressives Are Nuts to Oppose the Mandate
For years progressives (like me) have asked why we can’t have a health care system more like those in other countries. Well, folks, listen up — Jonathan Cohn writes,
The Netherlands and Switzerland require their residents to purchase health insurance from private carriers. Residents who do not are subject to fines. Yet most knowledgeable followers of health care policy have only good things to say about the Dutch system and mostly (though not always) good things to say about the Swiss counterpart.
The Dutch system, in particular, is widely considered among the world’s best and achieves most of the goals liberals in this country want: The insurance is universal and comprehensive, access to care is convenient and easy, the quality of medicine is high.
Cohn argues that if the public option is politically untenable, we should be pushing Congress for insurance regulations similar to the Dutch and Swiss systems. Then we might actually end up with universal health care similar to what they have in The Netherlands and Switzerland. That wouldn’t have been my first choice, but it’s a damn sight better than what we have now But the mandate is essential to that.
Cohn explains why the mandate is essential here, but see also Ezra Klein and Nate Silver. Please read Klein’s and Silver’s arguments before commenting here. I don’t have the time or energy to explain this for you.