As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Friday, June 19, 2009

Coalition Of The Killing Health Care Reform

I'm officially worried about health care reform because of the hands in whom the reform rests. Max Baucus has reverted to his old self. Spooked by a CBO price tag of around $1.6 trillion dollars over ten years for his initial version of a reform bill, he scaled it way back, limiting the subsidies that people would receive to pay for insurance and eliminating the public option (here's the draft). If the best you can call it is comprehensive incrementalism, that's not exactly the slogan on which you can stir people to action.

The numbers tell the story. In that plan, subsidies reached 400 percent of poverty. In this plan, they've been cut to 300 percent. In that plan, Medicaid eligibility was as high as 150 percent of the poverty line. In this plan, it's 133 percent for pregnant women and children, and 100 percent for childless adults. In that plan, the "gold" coverage was 93 percent of a person's estimated expenses, and "bronze" coverage was 68 percent. In this plan, those numbers are 90 percent and 65 percent, respectively. That means people with a low-cost plan might be covered for only 65 percent of what they're likely to need.

You're talking about forcing people to pay for health insurance, giving them less than what they need to afford it, and providing penalties if they don't. It's no surprise that this tracks perfectly with the plan from the health insurance industry. In fact, it's actually WORSE. And Baucus is actually looking to weaken it further through blessed bipartisanship.

Seven senators have formed a bipartisan group to find consensus on health-care reform legislation, a sign of fresh momentum after a week of setbacks.

The group, dubbed by its members as the "Coalition of the Willing," includes Finance Chairman Max Baucus (D-Mont.) and the ranking Republican on the panel, Sen. Charles Grassley (Iowa). Others who attended the first meeting this afternoon in the Capitol included Sen. Jeff Bingaman (D-N.M.), Senate Budget Chairman Kent Conrad (D-N.D.), and GOP Sens. Orrin Hatch (Utah), Olympia Snowe (Maine), and Mike Enzi (R-Wyo.), the ranking minority member of the Senate health committee.

As Atrios notes, "The last coalition of the willing helped cause the deaths of hundreds of thousands of innocent people in a war based on lies."

Here's the paradox. I'm guessing that the CBO score rose because health care costs continue to rise and we really can't wait to bend that cost curve. But there's a simple reason that the initial health care reform plan got a bad CBO score. That's because it didn't include the kind of rebust public option that could drive down costs 20-30%. Or the kind of comparative effectiveness research that could reduce overtreatment and put costs in line with effectiveness. And so the options for Baucus, when faced with a bad score, was to do less or actually to do MORE. Because the MORE reform that you enact, the MORE savings you get in the long run.

When the Lewin Group looked at various health proposals last year, it turned out that the one that did the best at controlling costs was Pete Stark’s bill:

Creates a new public health insurance program administered by the federal government to provide everyone with multiple choices for health coverage. Under the Stark bill (H.R. 1841), employers would either offer their employees coverage or pay into a fund to cover their employees through the new public program.

This doesn't mean all is lost, actually. In the House, Nancy Pelosi has repeatedly called for a public option, and the three committees working in tandem on the bill will provide one when they roll out their legislation. In fact, Pelosi has intimated that no legislation could pass the House without a public option, because "if it’s not real, it’s no use doing." Donna Edwards said the same thing here:

CENK UYGUR: Representative Edwards, of course you don't speak for the entire house, but you are inside the Democratic caucus. And what is your sense of the caucus? Will they insist on the house signing on the public option, or is that still negotiable?

DONNA EDWARDS: Well, I have, we've had a number of conversations in a variety of caucuses, you know that the tri-caucus, which is the Black caucus, the Hispanic Caucus, I mean, Asian Pacific Islander caucus, actually came up with a set of ideas and principles for healthcare reform, as did the progressive Caucus and a strong public option was part of that. Well if you add the numbers together, those caucuses, if you don't have those in the fold, then you don't have a bill.

CENK UYGUR: All right, that's pretty clear. And let me ask you one last thing, if somehow the bill does pass through without a public option and Barack Obama declares victory. "Hey, we got healthcare reform. Yeah we didn't get the public option, but we got healthcare reform overall." Is it a sham?

DONNA EDWARDS: Well I think it will be doggone near impossible to define reform as real reform, lasting reform for the American people if it doesn't have a public option. And I'm coming from a standpoint where I actually believe that we ought to have a single-payer healthcare system and I think that it's been very unfortunate that in some ways that has been taken out of the game, and off of the table. As a result, we are here scratching and clawing for a strong and robust public option. And I'm willing to do that, but it must be strong, it must be robust, it must cover everybody, and it must cover prevention, and it's got to be competitive.

However, clearly the Senate bill is in terrible hands, and there's still the nagging problem of how to pay even for a $1 trillion dollar bill. The various ideas run up the flagpole just don't seem to have broad support. For reasons of bipartisanship, Democrats in the Senate are destroying whatever merits the bill could have, to make the bill palatable to the kind of health industry CEOs that live to steal. You can see how this might go. Senators stiff-arm real reform. The House stiff-arms any half a loaf. And nothing happens.

That would be unacceptable to the President. And so his mission must be to sell the damn bill. He was elected in large part on this kind of plan, and he needs to impress that upon weak-kneed Senators who live in perpetual fear. Without tangible reform, people are just going to give up on the Democrats and it would be hard to blame them.

It simply amazes me that Democrats could last eight years of frantically chasing whatever the hell Republicans want to talk about that week as if the Earth will crash into the sun if America don’t solve whatever problem right now and act as if they slept through the whole thing. Remember how putting aside whatever you were doing for what felt like a solid month to argue whether we should invent some new government power to stop one man in Florida from letting his brain dead wife pass on? Then there was the time Republicans convinced a swath of America that stretched from Fred Hiatt to Tom Friedman to Matt Yglesias that if we didn’t attack Iraq tomorrow Saddam Hussein might hit the east coast with radioactive al Qaeda terrorists dropped from remote control planes powered by biological weapons! You know how they did that? Sales. Whatever crappy policy the Republicans wanted to pass, they sold the hell out of it. We can agree that Republicans couldn’t govern their way out of a room with no walls, no floor and no ceiling, but god knows they could sell.

Watching Democrats try to fix health care I see a photo negative of the Bush years. Here is an issue with obvious urgency. Setting aside our shameful infant mortality rate, uninsured rate and other statistics, medical bills are by far the leading cause of personal bankruptcies. Insurer misconducy wrecks lives every day in every city in America. The right options are obvious and relatively few in number. Huge majorities support doing the right thing [...]

Democratic politicians have dropped on this issue. I hear that Obama supports the public option. That would mean more if it felt even a little more urgent than his idea that we should have a college football playoff series. Ted Roosevelt didn’t call it the bully pulpit because it lets you chat on the radio for five minutes a week.

Congressional Democrats who wet their trousers at the thought of legislating without permission from Republicans are an order of magnitude worse. The liberal media is AWOL. When was the last time you saw a third party ad on TV that made you feel anything at all?

Anyone who can find evidence of message coordination on this issue wins a prize. Hell, I’ll give partial credit for proof that Democrats went into this with a coherent sense of what they want. Belaboring the obvious, people who care about what they’re doing normally enter negotiations with some firm goal in mind. Most would agree that it is moronic to make negotiating itself the point. Yet how is that any different from kicking off a ‘health care reform’ initiative without any firm idea of what the reform will entail? Reform is a process. Pick a goal and fight for it.

In my opinion, if Democrats cannot treat even a half-victory like the public plan as more important than Mitch McConell’s anguished, fake tears then they don’t deserve to win.

Mike Lux says this is just part of the troubles and it can smooth over. And Nate Silver believes that if the President takes hold of the debate we would see some rapid movement. I wish I shared their optimism.

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