In my survey, the numbers for and against the public option are about 80%-20%. Overwhelming support, to be sure, but upper-middle class students are hugely over-represented.
That being said, in the open-ended "Why or why not?" section (which you may choose to answer or not) I'm seeing only about 1 in 20 comments about why the public option is a bad idea. Since the rates of the follow-up question are pretty skewed, I've got to assume there's a strong emotional response to the public option; basically, unless you know what it is and are thoroughly convinced that it would be a good idea, the default decision seems to oppose it. Some comments even seem to express that sentiment: "I don't think I'm well informed enough to pick, so I can't support it."
That's fine, but unless you have a strong emotional affinity for the private ensurers, it's an interesting default to have.
Friday, October 30, 2009
Thursday, October 29, 2009
Los Angeles + Public Option = <3
In research for a class project, I deployed a two-pronged survey, utilizing both paper and online versions to reach the most people possible. The online version obviously reaches a more limited crowd, as it's limited by who's following me on Twitter and who happens to be in my email address book, but I cast a much larger net with my surveys distributed by hand.
To reach the broadest possible audience, I set up shop outside the LA Municipal Courthouse on Grand, just south of downtown. I figured this would draw people from the greatest geographical area and personal background, since everyone gets parking tickets and jury duty summons. To figure out which demographics were most supportive of the public option, I asked about race, education, and household income. A Spanish version of the survey made sure that I could get even more diversity in respondents.
So! Who likes it most? Everybody, apparently. LA is a coastal Californian city, which obviously leans to the left, but I had a grand total of one respondent who was philosophically opposed to the public option. Besides him, everyone from the Hispanic mother with 2 children to the fellow striding to his Mercedes, bluetooth earpiece abuzz, thought it would be a great way to bring down costs. I was surprised by the number of respondents that said health care was a moral imperative: regardless of their thoughts on the free-market system, health services for citizens were broadly seen as the responsibility of the state and a necessity. Thus, affordable premiums and broad coverage took precedence and support was nearly universal.
This was honestly surprising to me. I mean, I feel that way, too, but I make an effort not to say that "health care is a Right." That never makes constructionists very happy. I had several good conversations with folks that made it clear that laziness is not a factor, here. It's sadly argued that everyone should just go get a job for employer coverage, but anyone who's tried to find a new job right now knows just how fallacious that argument is. If jobs are not available, what are the alternatives? If people's budgets are already stretched as far as they can go between rent and food, there is no option but to lower costs. Regardless of how much people stated they had followed the ongoing debate, they grasped the urgency of the situation (in my far-from-unbiased opinion).
The opinions expressed online were very similar, but that was no surprise. Distributing my survey that way selected for my fellow college students, but I assumed that they would have a more liberal, idealistic outlook. Apparently not, though! If nothing else, I figured that the folks leaving the courthouse would have a chip on their shoulder regarding bureaucracy, having just dealt with some petty fine or a day of jury duty. Instead, they differed to the government on making health care affordable and accessible.
Unfortunately this limits what I could possibly write about for my school project; there don't seem to be any convenient demographic lines to draw, and I don't get to call poor people selfish or rich folks heartless or make any convenient generalizations.
Bringing in competition just rocks too hard, apparently. Let's do this.
To reach the broadest possible audience, I set up shop outside the LA Municipal Courthouse on Grand, just south of downtown. I figured this would draw people from the greatest geographical area and personal background, since everyone gets parking tickets and jury duty summons. To figure out which demographics were most supportive of the public option, I asked about race, education, and household income. A Spanish version of the survey made sure that I could get even more diversity in respondents.
So! Who likes it most? Everybody, apparently. LA is a coastal Californian city, which obviously leans to the left, but I had a grand total of one respondent who was philosophically opposed to the public option. Besides him, everyone from the Hispanic mother with 2 children to the fellow striding to his Mercedes, bluetooth earpiece abuzz, thought it would be a great way to bring down costs. I was surprised by the number of respondents that said health care was a moral imperative: regardless of their thoughts on the free-market system, health services for citizens were broadly seen as the responsibility of the state and a necessity. Thus, affordable premiums and broad coverage took precedence and support was nearly universal.
This was honestly surprising to me. I mean, I feel that way, too, but I make an effort not to say that "health care is a Right." That never makes constructionists very happy. I had several good conversations with folks that made it clear that laziness is not a factor, here. It's sadly argued that everyone should just go get a job for employer coverage, but anyone who's tried to find a new job right now knows just how fallacious that argument is. If jobs are not available, what are the alternatives? If people's budgets are already stretched as far as they can go between rent and food, there is no option but to lower costs. Regardless of how much people stated they had followed the ongoing debate, they grasped the urgency of the situation (in my far-from-unbiased opinion).
The opinions expressed online were very similar, but that was no surprise. Distributing my survey that way selected for my fellow college students, but I assumed that they would have a more liberal, idealistic outlook. Apparently not, though! If nothing else, I figured that the folks leaving the courthouse would have a chip on their shoulder regarding bureaucracy, having just dealt with some petty fine or a day of jury duty. Instead, they differed to the government on making health care affordable and accessible.
Unfortunately this limits what I could possibly write about for my school project; there don't seem to be any convenient demographic lines to draw, and I don't get to call poor people selfish or rich folks heartless or make any convenient generalizations.
Bringing in competition just rocks too hard, apparently. Let's do this.
Compromise in the House (Dems)
The liberal Dems in the House seem to be ready to move forward with a new compromise, despite earlier insistance that they would oppose anything short of a Medicare-tied P.O.:
I like this. Fight for what you want, stand together, rally the troops, but face the political reality when it rolls around. I promise, I'm not just supporting this because of partisan loyalties; this combination of conviction and pragmatism is admirable and how negotiations SHOULD be carried out.
If the GOP caucuses approached the debate this way, the opt-out compromise should seriously be enough to garner their support. The public-option itself is a compromise from single-payer systems. Now, to let states ultimately decide should most accurately manifest the opinion of constituents. That's what they want, right? It feels more and more like the right isn't even reading these suggestions anymore. They've figured out the "fighting" bit, but forgot about the second half of negotiating: reaching an agreement.
Speaker Nancy Pelosi will unveil a bill Thursday that falls short of the liberal vision of a public option -- and the liberals, so far and somewhat surprisingly, are going along with that.
After months of public hand-wringing and strident proclamations in support of the strongest possible government-run health coverage, liberal Democrats are bowing to the reality that party leaders don't have the votes.
So Pelosi will unveil a bill that creates a public option but one that would allow doctors and hospitals to negotiate rates with the government. Liberals wanted a bill tethered to Medicare rates.
I like this. Fight for what you want, stand together, rally the troops, but face the political reality when it rolls around. I promise, I'm not just supporting this because of partisan loyalties; this combination of conviction and pragmatism is admirable and how negotiations SHOULD be carried out.
If the GOP caucuses approached the debate this way, the opt-out compromise should seriously be enough to garner their support. The public-option itself is a compromise from single-payer systems. Now, to let states ultimately decide should most accurately manifest the opinion of constituents. That's what they want, right? It feels more and more like the right isn't even reading these suggestions anymore. They've figured out the "fighting" bit, but forgot about the second half of negotiating: reaching an agreement.
Wednesday, October 28, 2009
Survey!
Howdy!
Help me collect some data with this very quick survey:
http://qtrial.qualtrics.com/SE?SID=SV_cYLK0lNo9cTXkNu&SVID=Prod
Help me collect some data with this very quick survey:
http://qtrial.qualtrics.com/SE?SID=SV_cYLK0lNo9cTXkNu&SVID=Prod
Collecting 60 votes
With Monday's announcement by Senate Majority Leader Reid (D-NV) that the final bill would include a public option (with the opt-out option for states) the struggle for 60 votes has heated up. Finding 50 votes to actually pass the legislation doesn't seem to be much of a problem, with the opt-out compromise giving solace to many Democratic senators at risk in more conservative districts. After all, if they can keep their constituents safe from the scourge of government-run health care, why not let other states make up their mind?
All in all, I'm very happy about this compromise both practically and politically. Since I have faith in the public option itself, its success in liberal states in comparison to the continued health care costs in the conservative ones that opt out will serve as a political boost for the Left. Trying to argue that private-only insurance is better on principal while a neighboring state might actually have a better situation on the ground would be a boon for Democrats come election time. This monolithic opposition would finally be called out by reality.
We have to get the plan through first, though. Joe Lieberman (I-CT) came out yesterday saying that not only would he vote against the final bill, but would fight its vote for cloture (the 60 vote threshold that would end the inevitable filibuster and actually bring the bill up for a vote). Whether or not Reid shows some backbone and finally strips him of his committee positions and caucusing privileges remains to be seen until after the fight: bringing down the hammer on him now would guarantee an enemy until the end of the debate, though Lieberman is going to be a consistent opponent regardless. Similarly, Olympia Snowe (R-ME) and the other potential GOP crossovers have decided, to the surprise of no one, that they're greatly offended by this disregard for bipartisanship and shall pout. Snowe even said she didn't want the bill to proceed to the floor for the debate/amendment process, which is just depressing. If anyone has given up on compromise and collaboration, it's her.
Again, there's an uphill battle here. It was a pretty gutsy move to include the public option (though the opt-out compromise makes it a very reasonable middle road) and it remains to be seen if 60 votes can possibly be gathered.
Update: Oh, and Evan Bayh (D-IN) has decided along with Mitch McConnell (the Minority Leader) and other Republicans that the procedural cloture vote (needs 60) is materially the same as the final vote on the bill (only needs 50). Why this is, he doesn't say; cloture is a vote to bring about a vote. How can he possibly equate the two?
...and WHY?
This comes back to what is an ongoing problem with the Democrat's cohesiveness as a caucus. If he had a reasonable fear of retribution, that if he was responsible for health care reform's failure that he would be stripped of all his privileges, we'd be seeing a very different situation. It's nice that he feels beholden to his constituents, but the utter lack of coordination and effective whipping in the Democratic Party has let this kind of activity proliferate. Before Snowe gave the Finance Committee bill a pass, the Republicans had been 100% unified in their opposition. They have suggested no actual plans, yet were able to all agree that there was no merit to any suggestions coming from the Dems. The amount of fury poured onto Snowe for her "betrayal" has been hefty, no doubt. Where is this level of anger for Bayh?
He's not even being bipartisan! He's not introducing some new idea or a pragmatic way forward. Instead, he's taken the procedural filibusters that have gotten so out of hand and given a nice little push down the progression towards absurdity. Thanks for making a further mockery of our legislative process, sir.
All in all, I'm very happy about this compromise both practically and politically. Since I have faith in the public option itself, its success in liberal states in comparison to the continued health care costs in the conservative ones that opt out will serve as a political boost for the Left. Trying to argue that private-only insurance is better on principal while a neighboring state might actually have a better situation on the ground would be a boon for Democrats come election time. This monolithic opposition would finally be called out by reality.
We have to get the plan through first, though. Joe Lieberman (I-CT) came out yesterday saying that not only would he vote against the final bill, but would fight its vote for cloture (the 60 vote threshold that would end the inevitable filibuster and actually bring the bill up for a vote). Whether or not Reid shows some backbone and finally strips him of his committee positions and caucusing privileges remains to be seen until after the fight: bringing down the hammer on him now would guarantee an enemy until the end of the debate, though Lieberman is going to be a consistent opponent regardless. Similarly, Olympia Snowe (R-ME) and the other potential GOP crossovers have decided, to the surprise of no one, that they're greatly offended by this disregard for bipartisanship and shall pout. Snowe even said she didn't want the bill to proceed to the floor for the debate/amendment process, which is just depressing. If anyone has given up on compromise and collaboration, it's her.
Again, there's an uphill battle here. It was a pretty gutsy move to include the public option (though the opt-out compromise makes it a very reasonable middle road) and it remains to be seen if 60 votes can possibly be gathered.
Update: Oh, and Evan Bayh (D-IN) has decided along with Mitch McConnell (the Minority Leader) and other Republicans that the procedural cloture vote (needs 60) is materially the same as the final vote on the bill (only needs 50). Why this is, he doesn't say; cloture is a vote to bring about a vote. How can he possibly equate the two?
...and WHY?
This comes back to what is an ongoing problem with the Democrat's cohesiveness as a caucus. If he had a reasonable fear of retribution, that if he was responsible for health care reform's failure that he would be stripped of all his privileges, we'd be seeing a very different situation. It's nice that he feels beholden to his constituents, but the utter lack of coordination and effective whipping in the Democratic Party has let this kind of activity proliferate. Before Snowe gave the Finance Committee bill a pass, the Republicans had been 100% unified in their opposition. They have suggested no actual plans, yet were able to all agree that there was no merit to any suggestions coming from the Dems. The amount of fury poured onto Snowe for her "betrayal" has been hefty, no doubt. Where is this level of anger for Bayh?
He's not even being bipartisan! He's not introducing some new idea or a pragmatic way forward. Instead, he's taken the procedural filibusters that have gotten so out of hand and given a nice little push down the progression towards absurdity. Thanks for making a further mockery of our legislative process, sir.
Friday, October 23, 2009
Comparing the Bills! (Senate Finance Cmte + House)
Hurray! Today we have a delightful comparison of the two leading bills being reconciled by Democratic leadership, courtesy of Ezra Klein:
(emphasis in the original)
Not a whole lot to add; Klein's a thorough guy.
To clarify on the mandates, though: an individual mandate would make it the responsibility of each person to get insurance, like the system we currently have for car insurance. Obviously this is difficult for the less affluent, though, which is why the subsidy rate is so important. The 3x subsidy funding in the House bill would go straight into the pockets of the families that need insurance most but couldn't afford it (or the new penalties for not having it).
The employer mandate would work in conjunction with the individual one by requiring that businesses offer their employees coverage. This also broadens coverage, brings in more competition, and would also be helped by a robust public option. With these mandates to bring in vast numbers of new customers, a non-profit force to drive competition will be that much more important.
Unfortunately this isn't a strictly finance- or health-based debate. I don't really have a lot of ideology invested in this: if it covers more people, with more stability, for less, let's go for it. We're just so behind the ball on this compared with other industrialized democracies... We cover fewer people and pay 150% for no discernible improvement in outcome. I can only hope that more of the stronger House bill ends up in the final product, but this is such a fragile, ideological balancing act that I'm not sure how optimistic to be. Are we close enough to the 2010 elections? Will legislators' votes on health care reform be the ultimate decider when they roll around? And would any Republicans cross over anyway, no matter how watered-down the bill is? Given the complexity of the political situation, I plan to sit tight, encourage the strongest bill, and hope that it makes it through the grandstanding and posturing that will assail it until the very end.
From what I’m hearing, the specifics will look something like this. The Senate Finance Bill gets to 94 percent coverage. The House bill will hit 96 percent. The Senate Finance bill spends a bit over $450 billion on subsidies to help people afford insurance. The House bill will spend more than $700 billion. The Senate Finance bill doesn’t have an employer mandate. The House bill does. The Senate Finance bill funds itself by taxing family health-care benefits over $21,000. The House bill funds itself by taxing incomes over $500,000. The Senate Finance bill expands Medicaid. The House bill expands Medicaid by more. The Senate Finance bill costs $829 billion. The House bill costs $871 billion.And the rumor is that there are some other goodies in there, but I’ve not been able to confirm that yet.
The House bill, in other words, will cover more people at a more affordable cost to individuals. It can do this for a number of reasons, but the big one is that it saves a lot of money by including a strong public option and a real individual mandate. The combination of those two policies allows the government and individuals to pay a bit less while encouraging employers to pay a bit more. Its funding mechanism is a whole lot more popular than taxing health-care plans, but it will also do less to “bend the curve.”
(emphasis in the original)
Not a whole lot to add; Klein's a thorough guy.
To clarify on the mandates, though: an individual mandate would make it the responsibility of each person to get insurance, like the system we currently have for car insurance. Obviously this is difficult for the less affluent, though, which is why the subsidy rate is so important. The 3x subsidy funding in the House bill would go straight into the pockets of the families that need insurance most but couldn't afford it (or the new penalties for not having it).
The employer mandate would work in conjunction with the individual one by requiring that businesses offer their employees coverage. This also broadens coverage, brings in more competition, and would also be helped by a robust public option. With these mandates to bring in vast numbers of new customers, a non-profit force to drive competition will be that much more important.
Unfortunately this isn't a strictly finance- or health-based debate. I don't really have a lot of ideology invested in this: if it covers more people, with more stability, for less, let's go for it. We're just so behind the ball on this compared with other industrialized democracies... We cover fewer people and pay 150% for no discernible improvement in outcome. I can only hope that more of the stronger House bill ends up in the final product, but this is such a fragile, ideological balancing act that I'm not sure how optimistic to be. Are we close enough to the 2010 elections? Will legislators' votes on health care reform be the ultimate decider when they roll around? And would any Republicans cross over anyway, no matter how watered-down the bill is? Given the complexity of the political situation, I plan to sit tight, encourage the strongest bill, and hope that it makes it through the grandstanding and posturing that will assail it until the very end.
Speaking of interacting with the public...
Ok, see, here are the issues that arise when talking to the public. If all Congress did was broadcast the non-partisan cost analysis of new programs, we wouldn't be in the bind that we're in today. Instead, we have this:
This is the charming, constructive debate we're engaging in. The point where I start getting confused is when I can't tell if she's being disingenuous or not. Surely she can't actually believe this to be the case? Between the CBO estimates that money will be saved, the inevitable cost-reduction for consumers, and the plans for the public option to be a self-sustaining plan, is this a genuine fear of hers? If so, she hasn't been keeping up with the most basic analysis of the legislation she's voting on. If not, she's engaging in bad-faith arguments, evoking fear rather than reasoned opposition that you could rationally compare side-by-side with the arguments FOR the plan.
This is nothing new; every day my RSS feeds dump these little stories into my brain about a deceptive talking point from this side or a fallacious argument from that. It's all part and parcel of the daily political drama. The thing is, I enjoy it. I seek it out. I want to see all this so I can get a sense of how the plans are moving forward and what's going on down the road. What about the people that aren't political junkies, though? I have the privilege of getting to hear these grandstanding opinions either bolstered or refuted across the blogosphere.
If I were, instead, interested in finding out what would be the best way forward to ensure health care for my family and wasn't interested in the legislative process, I'd be SOL. There's the country that I know and love going bankrupt and death panels on the one hand and skyrocketing premiums on the other. Is it too much to ask that we try to generate genuine support from constituents?
"I think if you asked, do you want a public option but it would force the government to go bankrupt, people would say no."
- Sen. Landrieu (D-LA)
This is the charming, constructive debate we're engaging in. The point where I start getting confused is when I can't tell if she's being disingenuous or not. Surely she can't actually believe this to be the case? Between the CBO estimates that money will be saved, the inevitable cost-reduction for consumers, and the plans for the public option to be a self-sustaining plan, is this a genuine fear of hers? If so, she hasn't been keeping up with the most basic analysis of the legislation she's voting on. If not, she's engaging in bad-faith arguments, evoking fear rather than reasoned opposition that you could rationally compare side-by-side with the arguments FOR the plan.
This is nothing new; every day my RSS feeds dump these little stories into my brain about a deceptive talking point from this side or a fallacious argument from that. It's all part and parcel of the daily political drama. The thing is, I enjoy it. I seek it out. I want to see all this so I can get a sense of how the plans are moving forward and what's going on down the road. What about the people that aren't political junkies, though? I have the privilege of getting to hear these grandstanding opinions either bolstered or refuted across the blogosphere.
If I were, instead, interested in finding out what would be the best way forward to ensure health care for my family and wasn't interested in the legislative process, I'd be SOL. There's the country that I know and love going bankrupt and death panels on the one hand and skyrocketing premiums on the other. Is it too much to ask that we try to generate genuine support from constituents?
Opt-out Option Looking Promising!
It's looking like the unified Senate bill will have the opt-out plan that got me so excited earlier, which is great news. Besides giving the states the option to participate or not, it looks like the public plan would be run by a non-profit board:
This is the kind of nuance that needs to be quickly shown to those on the fence. The greatest concern, I believe, is that a public option would require more spending by the federal government. In an age of TARP, bailouts, upcoming energy and banking regulations, and a deficit of historic proportions, fiscal responsibility has become an ultimate tipping point for the plan.
The CBO (our non-partisan price-tagging office) report, of course, said that the Senate Finance Committee bill would pay for itself and even yield a $81 billion surplus, but if the addition of a public option could be insulated from federal coffers that would put many people at ease. To be able to assure constituents that their Medicare benefits and our financial stability are secure would be a great help. America's Libertarian culture is pervasive, but not all-encompassing. There are some folks out there that object strongly just on principal of government interference, but I think the majority of the opposition could be convinced through arguments of common sense cost-effectiveness.
Here's to the battle ahead.
We ought to have a non-profit board--it could be appointed by the President but a non profit board. They'd have to retain earnings, create a retained earnings pool, so that if they run into financial problems later on the financial needs of the plan could be met by the retained earnings, not by the federal government.
- Sen. Carper (D-DE)
This is the kind of nuance that needs to be quickly shown to those on the fence. The greatest concern, I believe, is that a public option would require more spending by the federal government. In an age of TARP, bailouts, upcoming energy and banking regulations, and a deficit of historic proportions, fiscal responsibility has become an ultimate tipping point for the plan.
The CBO (our non-partisan price-tagging office) report, of course, said that the Senate Finance Committee bill would pay for itself and even yield a $81 billion surplus, but if the addition of a public option could be insulated from federal coffers that would put many people at ease. To be able to assure constituents that their Medicare benefits and our financial stability are secure would be a great help. America's Libertarian culture is pervasive, but not all-encompassing. There are some folks out there that object strongly just on principal of government interference, but I think the majority of the opposition could be convinced through arguments of common sense cost-effectiveness.
Here's to the battle ahead.
Wednesday, October 14, 2009
What's next?
So, what do we all do in the wake of the final reform bill leaving committee? I'm not even sure myself, so here's another case of learning on the fly.
First, a review. My ecstatic tweets yesterday centered on Olympia Snowe (R-ME) crossing over as the sole Republican to show a smidge of qualified support for any of the plans on the table right now. Of course, the bill would have moved on anyway (since the Senate Finance Committee breaks down 13-10, advantage: Dems) but it could potentially open the door to other GOP support.
In short, yesterday was undoubtedly a big day legislatively. The question is whether or not it was also a big day politically.
Regardless, with even Snowe saying that no one should take this as any more than a "go-ahead" for the weakest plan available, it's time to start grinding sausage. It took a while looking around to find out what had to be done to reconcile these bills from all the different committees: high school civics leaves the process at subcommittee -> committee -> floor debate/amendments, and none of my poli sci classes found it important enough to ever fill me in on. Basically, the ultimate period of reconciliation is, well, reconciliation. It's a famously-opaque process that a bill tumbles through after being approved by both the House and the Senate before trundling off to the President's desk.
In this case, it's apparently just "up to each chamber of Congress" to unify their committee bills (2 for Senate, 3 for House). After that, Pelosi and Reid will have to pull some major teeth to get their legislation on the same page. How they'll decide whether or not to have make-or-break issues like the public option will come down strictly to which will garner that extra vote or two as they try to keep the liberal and conservative poles of their own party from walking away. It's tough maintaining a majority.
Once this unified bill hits the respective floors, only the amendments added during debate will need to be reconciled after the fact. I'm glad that we'll get to see that bill as a starting point, but I expect the debate process to send the legislation off in very different directions; if the Dems had the unity of the GOP, this wouldn't be a problem. Ideally, when Pelosi and Reid declare, "Behold, the sacred reform is here!" the Democrats would fall in line, make some bureaucratic amendments, and line up lock step to ensure passage. Instead, we'll probably have a weak public option thrown in by the more-liberal House, while the Senate continues to water things down and "saves costs" by cutting subsidies to poor families. We'll see legislation unify and diverge again, I think.
One thing to note yesterday, though, is the health insurance lobby (AHIP) has finally come out against the reform efforts. It tried the whole "sitting semi-cooperatively in the back of the room" strategy, but with reform finally gaining momentum and a sense of inevitability, they commissioned a study to show how espensive this is by none other than PricewaterhouseCooper, none other than the notorious folks that provided data for Big Tobacco. The fire is finally under their butts; the millions of new, mandated customers will be great, but this is not meant as a windfall to insurance providers, and they've finally realized that perhaps profits will decrease. Fancy that.
Since the insurance companies were never the darlings in this debate, their open opposition could come as an enemy to unite against for Democrats and even some Republicans. The bickering over the public option, reimbursement rates, and taxes could fall to the wayside as the urgency for passing health care reform heats up. The attitude could evolve such that the bill might not be perfect, but must be passed as a first step towards fixing a situation that's gotten utterly out of hand.
So, yesterday was a big day. Legislatively, huge (in such a public, drawn-out struggle). Politically, just another day in the life. Normandy looms, so to speak.
First, a review. My ecstatic tweets yesterday centered on Olympia Snowe (R-ME) crossing over as the sole Republican to show a smidge of qualified support for any of the plans on the table right now. Of course, the bill would have moved on anyway (since the Senate Finance Committee breaks down 13-10, advantage: Dems) but it could potentially open the door to other GOP support.
In short, yesterday was undoubtedly a big day legislatively. The question is whether or not it was also a big day politically.
Regardless, with even Snowe saying that no one should take this as any more than a "go-ahead" for the weakest plan available, it's time to start grinding sausage. It took a while looking around to find out what had to be done to reconcile these bills from all the different committees: high school civics leaves the process at subcommittee -> committee -> floor debate/amendments, and none of my poli sci classes found it important enough to ever fill me in on. Basically, the ultimate period of reconciliation is, well, reconciliation. It's a famously-opaque process that a bill tumbles through after being approved by both the House and the Senate before trundling off to the President's desk.
In this case, it's apparently just "up to each chamber of Congress" to unify their committee bills (2 for Senate, 3 for House). After that, Pelosi and Reid will have to pull some major teeth to get their legislation on the same page. How they'll decide whether or not to have make-or-break issues like the public option will come down strictly to which will garner that extra vote or two as they try to keep the liberal and conservative poles of their own party from walking away. It's tough maintaining a majority.
Once this unified bill hits the respective floors, only the amendments added during debate will need to be reconciled after the fact. I'm glad that we'll get to see that bill as a starting point, but I expect the debate process to send the legislation off in very different directions; if the Dems had the unity of the GOP, this wouldn't be a problem. Ideally, when Pelosi and Reid declare, "Behold, the sacred reform is here!" the Democrats would fall in line, make some bureaucratic amendments, and line up lock step to ensure passage. Instead, we'll probably have a weak public option thrown in by the more-liberal House, while the Senate continues to water things down and "saves costs" by cutting subsidies to poor families. We'll see legislation unify and diverge again, I think.
One thing to note yesterday, though, is the health insurance lobby (AHIP) has finally come out against the reform efforts. It tried the whole "sitting semi-cooperatively in the back of the room" strategy, but with reform finally gaining momentum and a sense of inevitability, they commissioned a study to show how espensive this is by none other than PricewaterhouseCooper, none other than the notorious folks that provided data for Big Tobacco. The fire is finally under their butts; the millions of new, mandated customers will be great, but this is not meant as a windfall to insurance providers, and they've finally realized that perhaps profits will decrease. Fancy that.
Since the insurance companies were never the darlings in this debate, their open opposition could come as an enemy to unite against for Democrats and even some Republicans. The bickering over the public option, reimbursement rates, and taxes could fall to the wayside as the urgency for passing health care reform heats up. The attitude could evolve such that the bill might not be perfect, but must be passed as a first step towards fixing a situation that's gotten utterly out of hand.
So, yesterday was a big day. Legislatively, huge (in such a public, drawn-out struggle). Politically, just another day in the life. Normandy looms, so to speak.
Sunday, October 11, 2009
Let the states decide?
As the Constitution says, those powers not expressly written as the responsibility of Washington are, by default, differed to the states. Could this also work with health care?
States on their own wouldn't be able to stem the rising tide of premiums and costs; Massachusetts' "RomneyCare" hasn't pushed the nation's private insurers to work more efficiently. An idea that has been floated recently, and received a certain amount of bipartisan support (which is a huge deal in this polarized debate) is to set up a government public option but let state legislatures decide whether or not to offer the program in their state. This, to me, seems like a perfect solution. States like California with a healthy Democratic majority (though with such a deeply polarized Assembly, there would be little to no crossover) would be able to pass it, while those states that felt like opting out would be able to.
The key to this, of course, would be to keep the opting in and out fluid. States should be able to drop the plan if it is excessively hurting their insurance companies, and if a state feels like its neighbors are benefiting it should be able to join in the fun.
Unfortunately, this wouldn't leave it up to the voters. I haven't seen anything about running a referendum to decide such matters, and I think that would be most productive (since public support far outstrips congressional support for a government plan) It'd be delightful if there wasn't such a disconnect between Congressmen and their constituents, but given the outspokenness of the opposition, it's pretty understandable. Besides, state legislators are ultimately beholden to those constituents, and they would do their best to read their district before making an impulsive decision on the matter.
The last little caveat is that some of the states most likely to forgo the public option need it most; some states in the South are only served by one or two insurance companies, and breaking those monopolies would make a huge impact on coverage and pricing.
Having an initial run of the public option, though, could finally bring a spirit of pragmatism to the debate. If people in the more conservative states can talk to family and friends in other areas of the country and hear real-life experiences, we can, as a nation, decide if this is the way forward.
States on their own wouldn't be able to stem the rising tide of premiums and costs; Massachusetts' "RomneyCare" hasn't pushed the nation's private insurers to work more efficiently. An idea that has been floated recently, and received a certain amount of bipartisan support (which is a huge deal in this polarized debate) is to set up a government public option but let state legislatures decide whether or not to offer the program in their state. This, to me, seems like a perfect solution. States like California with a healthy Democratic majority (though with such a deeply polarized Assembly, there would be little to no crossover) would be able to pass it, while those states that felt like opting out would be able to.
The key to this, of course, would be to keep the opting in and out fluid. States should be able to drop the plan if it is excessively hurting their insurance companies, and if a state feels like its neighbors are benefiting it should be able to join in the fun.
Unfortunately, this wouldn't leave it up to the voters. I haven't seen anything about running a referendum to decide such matters, and I think that would be most productive (since public support far outstrips congressional support for a government plan) It'd be delightful if there wasn't such a disconnect between Congressmen and their constituents, but given the outspokenness of the opposition, it's pretty understandable. Besides, state legislators are ultimately beholden to those constituents, and they would do their best to read their district before making an impulsive decision on the matter.
The last little caveat is that some of the states most likely to forgo the public option need it most; some states in the South are only served by one or two insurance companies, and breaking those monopolies would make a huge impact on coverage and pricing.
Having an initial run of the public option, though, could finally bring a spirit of pragmatism to the debate. If people in the more conservative states can talk to family and friends in other areas of the country and hear real-life experiences, we can, as a nation, decide if this is the way forward.
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