Healthcare Fantasyland

by: Chris Bowers

Fri Oct 09, 2009 at 00:55


We are clearly living in a health care fantasy land.

Hours before the CBO score of the Finance Committee bill was released, 150 House Democrats sent a letter to Nancy Pelosi saying that they opposed a tax on high-cost health insurance plans. This renders such a tax dead on arrival, as it is opposed by more than 75% of the entire House of Representatives (150+ House Democrats plus 170+ House Republicans). Such a plan happens to be $201 billion of the $829 billion in funding for the Finance Committee bill, or 24% of all its funding.

Despite this, not only is the CBO score on the Baucus bill still taken as meaningful, but it is hailed nearly universally in the press as a major breakthrough on health care.

This is a demonstration of the pure nonsense that has come to dominate our political discourse. Clearly, the nearly consensus belief among political media is that the House of Representatives, one half of the legislative branch, does not matter in the slightest. Over 75% of the House can oppose the major funding mechanism for a piece of legislation, and yet the report on the cost of that legislation is still taken seriously. And not just seriously, but as a major breakthrough.

The House of Representatives no longer exists. Hell, no one in the Senate exists outside of about four or five members of the Evan Bayh's Conservadem coalition. If Max Baucus or Tom Carper like something, then immediately that something is viewed as a major legislative breakthrough even if it is opposed by 75% of the House of Representatives.

And the same thing can be said about the current opt-out plan. Not a single one of the four Senators who are a major worry for cloture on health care reform with a public option--Evan Bayh, Blanche Lincoln, Mary Landrieu, and Ben Nelson--have come out in favor of this proposal. And yet, somehow, this idea is hailed as a means to get to 60 votes.

Pardon my asterisk, but how the f*ck is the opt-out idea any better a means to get to 60 votes if none of the four Senators who were holding up the other ideas have come out in favor of this idea? It hasn't gained any f*cking votes, and yet it is hailed as a means to reach 60. That is pure bullsh*t.

Not to mention that we don't even know what kind of public option is in the opt-out "compromise." How can we claim that the opt-out compromise is better than the Schumer level playing field compromise when no one has even told us exactly what type of public option is in the opt-out compromise? The public option in the opt-out might actually be the level playing field compromise for all we know, which we don't because no one has written it down or even introduced it as legislation. Just because Sam Stein in the Huffington Post called it "robust" does not make it an actual proposal for a public option better than the level playing field.

So the House doesn't matter, actually gaining votes in the Senate doesn't matter, and actually seeing what sort of public option would be in the opt-out doesn't mater. All that matters are CBO scores for health care bills that Max Baucus likes or compromise ideas that Tom Carper likes, even though Max Baucus and Tom Carper are already guaranteed to vote for cloture on health care reform with a public option.

This is perverse. We have really gotten to the point, even in the progressive blogosphere, where any idea floated by any Conservadem is hailed as a way to get to 60, even if that idea has not demonstrated any ability to get more votes, even if that idea has been demonstrated to be opposed by 75% of the House of Representatives, and even if the idea hasn't been written down.

Our new system of government is apparently based on Conservadem trial balloons. Forget representative democracy and reaching majorities in either branch of Congress--if Max Baucus or Tom Carper like something, then it must be passable.

Chris Bowers :: Healthcare Fantasyland

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Thank you (4.00 / 4)
You said it better then I could.

I am also still pissed that none of the reforms are going to happen until 2013 and it will take 6 whole years for them to be fully rolled out. It is crazy to think of this as any kind of reform at all. It really is a cruel joke.  


Instead of some far off day in 2013 (0.00 / 0)
They should make it go LIVE on Labor Day, 2010.

Now that's good politics.


[ Parent ]
The spite option is a joke (4.00 / 1)
I'm already starting to hear that a number of red state House Democrats, some progressive, some not, are livid that this is even being considered. They see it as worse than a trigger and are not going to support it if it were pushed on them via conference committee.

I can imagine there'd be several Senate Dems hailing from red states who would feel the same way.

As you note, there's a lot of fantasy at work here, but the spite option is perhaps the most absurd and senseless example of the lack of political sense going on here.

There are still a lot of progressives who doubt their own power, who are unwilling to use their own power, and who have still internalized the belief that the best they can get is whatever scraps are handed down from the conservadem table.


Ideas (4.00 / 1)
The "level playing field" idea didn't mean a damn thing, either, until, you know, it did.  That is how ideas work.  If the blogosphere can't be a place to discuss ideas, then what the hell good is it.

Or perhaps we can't discuss ideas until someone writes down the official CBO readable text.  That way we would "know" what kind of option would be included with an opt-out plan.  Cause we certainly couldn't have any opinions on the various forms it would take, that would be too much for our little brains to handle.


Serious question - (4.00 / 3)
is this "level playing field" thing about making things "fair" for the very insurance industries that have been fucking us over with gusto for decades?

[ Parent ]
Exactly (4.00 / 2)
No using Medicare to set costs.  No government money.  Just another insurer, but one run by the government.

[ Parent ]
I not arguing with discussing it (0.00 / 0)
What I am arguing with are the claims that the opt-out plan is now superior in terms of its ability to pass and in terms of the public option is offers, even though there is no evidence it is either.

[ Parent ]
The opt-out directly neuters Kent Conrad's argument against the public option (0.00 / 0)
which is, that reimbursement at medicare+5 would bankrupt the hospitals and providers of his state, because medicare rates are too low in North Dakota already.  

Cantwell tried to address this argument by proposing a change to the medicare reimbursement formula that rewards more efficient states more, but that's a crapshoot; there's no guarantee that a given state will outperform other states by that metric indefinitely.

Allowing North Dakota to opt-out of the public option kills Conrad's sole remaining argument for why he should withhold his vote.  It also pre-empts Ben Nelson or Blanche Lincoln from making an argument that they voted against the public option "because it would hurt their states."  Regardless of whether that argument was ever valid or not, the opt-out takes it completely off the field.  Removing arguments that allow people to vote against you is powerful politics.

And the reason advocates and reporters have consistently described the new idea as "a robust public option with an opt-out" is that by mooting so many of the arguments against a public option, this "compromise" allows you to pass a stronger public option that you would have been able to otherwise, all else being equal.  The response to "this will bankrupt my state!" can be either "well fine, we won't use medicare rates we'll use negotiated rates" or "well fine, your state can opt out."  You don't need to offer both compromises.  The opt-out is a replacement for the level-playing-field compromise, not an addition.  Or at least, it could function as a replacement and not an addition, since it addresses the same rhetorical concerns from the same people.  It remains to be seen whether the 51 (55?  I haven't kept track since 51) senators who endorsed a level-playing-field PO are also willing to endorse a robust PO.  It's possible they won't; the robust PO is stronger stuff, and there may or may not be 51 senators willing to compete with insurance companies that aggressively.  But the opt-out gives any such fence-sitters an argument too: "if our state doesn't like it, we can always leave."  By neutralizing various arguments against a PO, and replacing them with an argument for a yes vote ("we'll try it, and our state can always opt out"), the opt-out obviates the need for these other compromises that have been considered.

This is why the reporting has consistently described the compromise as "a robust PO with an opt-out," because the opt-out is designed to address the same concerns that the original compromise (level-playing-field, Rockefeller vs Schumer) did.   And many pro-PO people think it will also deliver better outcomes, because as with the stimulus, very few if any states will actually wind up opting out, and even if they do for a short while, an opt-out instead of negotiated rates delivers a better proposal for the rest of us.  

It is true that no hostile senator has yet raised his hand and said "the opt-out wins my vote."  These are the people with the strongest negotiating positions; even if it's true they're not going to say so on the first day.  But it's clear that the opt-out completely annihilates Kent Conrad's stated reasons for opposing the bill, as well as several other stated reasons that Nelson, Lincoln, or Baucus could try to offer.  That's why people are excited about it.  It has the obvious potential to win votes, even if Conrad didn't immediately surrender to it on TV.


[ Parent ]
Well, Kent Conrad's been all over the map on why he's against the public option (0.00 / 0)
First he was against Jay Rockefeller's Medicare + 5 PO because it used Medicare rates which he thought was too low in ND. (Does he not realize that the cost of living in ND is probably way lower than in CA or NY?)

So then when Chuck Schumer's non-Medicare rates PO came up, that should have destroyed his argument right then and there.  But instead, he voted against that too, because it was "government".

So that should mean he's against any PO, since any PO is by definition a government program.  And yet he's a big fan of the French single-payer system, which he mistakenly thinks is privately-insured, based on a book he apparently misread a couple of weekends back.

I can't believe this man is one of the key players in this whole process.  We might as well have handed this country to Joe the Plumber.


[ Parent ]
The House Is Only Irrelevant Because It's Run By Dems (4.00 / 8)
If Newtie were still in charge over there, it'd be the only game in town.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

Well, to be fair... (0.00 / 0)
Most of the stuff that Newt passed in the house never saw the light of day.  The Senate killed a lot of their stuff, too.  That's only because the house versions were so batshit crazy that even Republican Senators couldn't go along with it.  Remember, back in the 90's, there were some Republican moderates... enough to slow down the house considerably.

Right wingers back then liked it about as much as we like our conservadems now...

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!


[ Parent ]
Small 'c' conservatism (4.00 / 2)
The Senate tends to be much more small 'c' conservative than the House.  Typically, this also means big 'C' political conservatism, but not always.  The House is more radical -- both ways.

[ Parent ]
2001-2005 GOP legislative playbook (4.00 / 3)
1) House drives agenda items, often as adjunct arm of Bush WH. Policy must have support of the majority of the majority in the body. Dumps them on Senate.

2) Senate moves whatever can get throw to passage, almost regardless of content. Getting to conference was the sole goal.

3) GOP alone writes final version at conference, holding to the 'majority of the majority' rule.

It wasn't just the Newt era -- the House GOP, either directly or as proxy for the WH, drove much of the policy agenda in the Bush era too.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans


[ Parent ]
Blue Dog Madness (4.00 / 3)
At Drinking Liberally tonight, I thought heads might explode over the notion that there "must be compromise" between Liberals and the vested interest sectors between Blue Dog devils and the republican position of NO!

Aaaaiiieee!  WTF does holding a big majority count for if you just piss it all away for nothing?  


Is this where Dems stand? (4.00 / 1)
"Our new system of government is apparently based on Conservadem trial balloons. Forget representative democracy and reaching majorities in either branch of Congress--if Max Baucus or Tom Carper like something, then it must be passable."

Burrr!  I'm not alone in wondering where our democracy has gone.  I feel so sold out by both parties that I feel there there's nowhere to go.  I think my activism for the Dem party has come to an end.  They don't stand for us, so I don't stand for them.  


Come on!! ... (4.00 / 3)
How dare you not bow down to Co-Presidents Carper and Baucus!!

Throw a tent over it and charge admission... (4.00 / 4)
the whole thing's a fucking circus.

It'd actually be kind of funny if it weren't so damn tragic, and so many people weren't suffering and dying while these overpaid, overfed fuckweasles dick around enjoying how oh-so-very-important they are.


Even the lobbyists seem to be on our side... (0.00 / 0)
They are complaining that the Baucus bill doesn't cover enough people!

http://news.google.com/news/ur...

I think we truly have landed in bizarro world!

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!


Your thoughts on this? Is the medicaid thing truje? (4.00 / 2)
No State Will Ever Opt Out of the Public Option

How can I know this?  Because it's already happened before: Medicaid and the Interstate Highway System.  Between our experience with those, and the more recent lessons of the stimulus fall-out, it's clear that once a federal benefit has been conferred on the states, internal practical and political considerations make it impossible for the state government to reject it.
...
Let's start with Medicaid.  It was created in 1965, and is solely for poor people.  The feds pay for half or more of each state's means-tested health care program.  But the states still have to make up the difference.  They can opt out if they want.  Every state has been in Medicaid since 1982.  None have ever dropped out.  True, Arizona wasn't in until 1982, but that's partly because for a state to get in, they had to actually set up a program.  

Now obviously, a lot of those states' political leadership was against the Medicaid bill, and even more would have been opposed to any attempt at setting up a program independently to help poor people with their health care.  But once the benefit was there, there it stayed.

Likewise, the Highway Trust Fund is opt-outable -- you just have to refuse to conform to federal requirements about alcohol and traffic laws.  And at the time the national speed limits and drinking age issues came up, there was all kinds of talk about resistance.  And yet they all fell into line.

http://www.dailykos.com/storyo...

I'm against this opt-out thing, but things can change if the opt-out is a trigger that's guaranteed to fire.


Medicaid puts federal money into private insurers' pockets (4.00 / 4)
No corporate interests opposed it.

Powerful corporate interests would oppose a state-run federally funded public option, because it would directly compete with private insurers and put them out of business. They would force opt-outs by buying off state legislatures.

Don't tell me that can't be done. I live in "blue" California, where gay marriage is unconstitutional and an absurd thirty-year old law prevents us from raising taxes to deal with the budget crisis, and we're cutting every social service--education, firefighting, health care--and just making things worse.

If things are so broken here, just imagine how bad they are in the so-called "red" states.

As for the federal highway system, again, there were powerful corporate interests in favor of that--namely, the car companies. So of course, it went through.

The better analogy to the public option is Medicare. It is a single payer program. Everyone eligible--those over 65, and some people with disabilities--are auto-enrolled. If you want to give up Medicare part A, you have to give up Social Security benefits too. If you're not working and want to opt-out of part B, you have to pay a penalty.

Medicare is truly federal, and states weren't given the option to bow out of it. Everyone eligible is covered--that's the only way it can realize the necessary cost savings to make it work.


[ Parent ]
But by that same token (0.00 / 0)
Medicare is enormously popular and Republicans don't dare to touch it, even though they wish they could, and even though they vociferously opposed it from the beginning.

In fact, Republicans are now posing as the defenders of Medicare!  Can you imagine in forty years the Republicans vigorously supporting and defending the public option? (Of course, they'll do so when liberals finally get around to creating Medicare for All - "they'll pay for this new radical government takeover by cutting money for the public option!")

I think it's true that generally, a popular program that works, once established, is hard to get rid of.  That's why all the Republican assaults on Social Security and Medicare have mostly failed (except for Medicare Part D which was more of a Trojan horse-style offensive).  The danger with an opt-out is that states can vote to opt-out before the PO even goes into effect - in other words, before the program has had a chance to prove itself.  If we're gonna have an opt-out PO, it had better be 1.) Very robust, e.g. Medicare buy-in and 2.) Going into effect some time before states can vote to opt-out.


[ Parent ]
it amazes me (4.00 / 4)
how quickly the Democratic base, including such highly respected figures as Dean and Krugman, are buying into the essential premise of the teabaggers.

That's what the opt-out plan says: Congress is too impotent and divided to  make this decision, the federal government is powerless to act and solve this problem for all of us in an equitable way, so let's just throw it all back onto the states and let 'em sort it out.

With an attitude like that, why don't we just dissolve the Union? Shouldn't we give the states the chance to opt out of Medicare? Social Security? The federal highway system?

Or opting out of EPA standards. I don't want some Washington bureaucrat telling me I can't dynamite the mountains and choke the streams black with coal waste! It's my coal, I should be able to mine it however I want!

Or how about opting out of hate crimes laws? God forbid the federal government should come into my state and take away my God-given right to terrorize people whose skin is a slightly darker color than mine.

How far are we going to go with this idea?

I'm just shocked at how little faith the self-styled left has in the American system--a federal system, not a confederation, as we decided during the Civil War--at how ready they are to just throw entire states full of innocent people on the mercy of the insurance companies, in the selfish hope that they might get theirs by bartering away what belongs to others.

So many supporters of this plan are expressing satisfaction at the idea that it would punish the red states--that somehow it would finally force the voters in those states to see reason, when they see the opt-in states eating federal cake while they choke down the shit their own states dole out. The vengefulness and smug superiority behind this reasoning really amazes me.

And the cruelty. These people are proposing to deny health care to those who need it, and for what? Purely political reasons. Purely because they don't have the balls to stand up for what's right.

If this is what America has come to, then I have little hope for the future.


Yeah, (4.00 / 2)
I was mildly surprised to see Krugman's positive response. Maybe he hasn't thought it through.

While I too see the allure of throwing the republican red-staters into the arena and making them fight to the death for a band-aid, and if I could do that for only republican voters I would, there's still lots of decent people in those states who don't deserve to be sold out like this.

And, as others have pointed out (Krugman himself was one of the first, during the stimulus "negotiations"), this is yet again the stupid Democrats negotiating only with themselves, "compromising" only with themselves.

It's idiotic, cowardly, and despicable.

http://attempter.wordpress.com


[ Parent ]
Compared to what? (4.00 / 1)
Remember, Chris' whip count and declaration we can pass the Public Option is based on the "level playing field" version, not the robust version progressives are demanding.

Isn't it worth considering a robust version with the opt-out as an alternative to the "level playing field" version?  Does it have the votes?  I don't know.  Regardless of what Chris says, that doesn't make it stupid to talk about.  Perhaps it does have the votes.  No one will know until it is discussed a bit and someone asks and counts.  A week ago the same was true for the "level playing field" version.

Personally, I think the robust public option with state-level opt-out is better than the "level playing field" version.  But there are good arguments the other way.  I could be convinced otherwise.  That is kind of what these discussions are for!  And perhaps there is still a chance to past the pure(r) robust version as is, but going by Chris' posts it doesn't sound like it.

But Chris is dead wrong to think it is "fantasy" to be discussing this.


[ Parent ]
I don't think anyone is really arguing that this compromise is the ideal (0.00 / 0)
just that they think, as I do, that it's better than all the other compromises that have been put out there so far - namely, the trigger and the co-op, both of which virtually guarantee that there would be no PO for anyone.

If the opt-out is attached to a super-strong PO, like a Medicare buy-in, then it may very well be better than a Level Playing Field PO with no opt-out.

I think the trigger's/co-op's day may finally be over, as it seems the Senate is willing to at least pass Level Playing Field.  Now the question is, do we have a strong PO or a Level Playing Field one?  I'm all for the strongest PO possible and I think we get closer with a strong one that at least has a chance of being in every state than a weak one that will be in every state.

Ideologically, I'm very against the idea of states being able to opt-out of federal programs.  But I think this is one case where the pros may outweigh the cons.  Obviously, let's first try to go for a strong PO with no opt-out.  But I'm glad that we may end up with this compromise instead of one of the other truly awful ideas that have been thrown out there.


[ Parent ]
Positive reactions to the opt-out are due to frustration (0.00 / 0)
with middle-America controlling the rest of the country's lives. I think opt-outs are a great idea too if rational states benefit from a truly robust public option. At some point you need to tell the obstacle states, "you don't want a public option? Fine, you're the weakest link. buh-bye." What's driving the teabagger movement is not so much an opposition to the public option but a realization that their low-population, small-economy state exercises a disproportionate amount of power in federal policy. The most effective way of dealing with that type of mentality is neutralizing that power. There's basically ten states holding up the rest of the country because of over-representation in the senate. Those states will calm down and sign-up to a public option begrudgingly once they realize they don't control the rest of the country anymore. It's a psychologically appealing solution to the problem, even if the policy is less than desirable.  

 


grayson (4.00 / 2)
http://www.huffingtonpost.com/...

"we have to remember olympia snowe is not the president"
niether is baucus or nelson,  

whatever you think people owe you, that is what you owe people


Can the Compromise Be A Slap in the face? (0.00 / 0)
I mean, who is at the table and smart enough to know that if a compromise is needed for Conservative Senators... that taking the position of "no compromise" is actually not as good as offering a compromise that is truly more progressive?

Do we have any smart and hardcore Liberal heads at that bargaining table?

I don't mean a compromise that says:
"better than an Opt-out, how about if you don't want any kind of government heath care functioning in the U.S., Americans will in 24 hours be able to forfeit their citizenship and get transplanted to the libertarian paradise of Somalia"
...in other words, go F*ck yourself...

But one that could actually get sold with a straight face.

How about:
"For the sake of simplification, every American gets enrolled in the Public Option and can very easily opt into one of the private options"  

John McCain is dishonest


Just another tail to chase. (0.00 / 0)
Trial balloons, indeed.

Which balloon to grab at as it floats away, which tail to chase, which bill and/or amendment to support or oppose, etc., etc....

It's all obfuscation at this point, which pisses me off. The division within the party on the left of the party on the right seems more destructive than the division between the two.

I wish we could vote no confidence and throw all the bums out on their cans.


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