Public Option Finance Committee Live Debate

(Bumped)

I'm listening to the public option debate in the Senate Finance Committee at this link. I guess I can embed it right here:

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Chuck Grassley is going on and on with his series of lies about the public option. All you need to know is that it saves hundreds of billions of dollars, and everyone who presumes to be worried about the total cost of the bill and at the same time rejects the public option is full of it.

Jon Walker has a good liveblog going. Earlier, Jay Rockefeller went to town on the Baucus bill:

10:24 - Rockefeller quoted in his defense of the public option former Cigna excutive Wendell Potter who called Baucus's bill the, "the Insurance Industry Profit Protection and Enhancement Act."

10:33 - Rockefeller pointed out that while the private insurance companies will receive a half trillion dollars in federal money, there is no requirement in the Mark for the private insurance companies to spend that money on care. The House bills has an minimum 85% medical loss ratio. Baucus's bill has no minimum medical loss ratio

10:37 - Rockefeller is putting the private health insurance industry on trial. He is going through all the different ways private insurance companies screw over their costumers and deny claims.

Chuck Schumer just now asked Grassley what he thinks of Medicare. He called it "part of the social fabric of America." It wasn't in 1964! Maybe in 40 years, the public option will be part of the social fabric of America. Grassley is dancing.

Bill Nelson interjects saying "how in the world do you make that leap" that a public option will lead to single payer? Grassley uses the Lewin Group statistics, not based on the public option plan on offer - also Lewin Group is owned by United Health Group and not an unbiased source.

...just to be clear, it's likely for us to lose this one. But this debate, according to Schumer, will revitalize the debate for the Senate floor. Hopefully Schumer will ensure that the floor amendment on the public option will only require a majority vote. Robert Reich has a good story on this as well.

...Orrin Hatch is trading off of the decades-old demonization of government from the Reagan era onward, saying that DC bureaucrats cannot manage health care. Well, I eagerly await Hatch, essentially a DC bureaucrat, recusing himself from all health care votes this session, including participating in any filibusters, because he clearly considers himself such a bad manager. Incidentally, the reason we're doing health care reform right now is because private management of health care has failed.

...Bob Menendez comes out for the public option. I think he may have been on the fence until now. That's another member of the leadership, the head of the Democratic Senatorial Campaign Committee, for the public option. He's the guy who delivers resources to Senate candidates, including incumbents, so that's notable.

...Note the states Menendez singled out for having no competition in the insurance market - Maine, Wyoming, Iowa, Montana, North Dakota. Every one in the Gang of Six!

...Conrad is up. Calls his co-op crap "the public interest option"! His main complaint is the Medicare reimbursement rate, which is more of an issue than I made of it last week. We'll see if he votes yes on the Schumer amendment, which does not tie a public option to Medicare rates. I think there's a way to meet halfway on this. Tying the public option to Medicare rates saves lots of money, but it could save half that by equalizing the reimbursement rates in some states.

...Nelson asks Conrad to change the name of his co-ops to something even more indecipherable.

...Bingaman is up. He's getting some clarifications. Rockefeller is getting a little fed up with the distortions of his amendment.

...Bingaman supports a public option, but it looks like he'll only vote for the Schumer "level playing field" public option instead of Rockefeller's. That's a cost, according to the CBO, of $85 billion dollars, if you look at the House bills. So I'm sure Bingaman will come up with $85 billion in new funding to make up for that, right?

...Schumer is making a very strong case for the public option. Of course, his plan would score lower and save less money, which he admits.

...TPM has that exchange between Schumer and Grassley, where Grassley calls Medicare part of the social fabric of America.



John Ensign is dredging up that Belinda Stronach (Canadian MP) came to the US for health care canard. He won't mention that she raised money for adding the cosmetic surgery she needed - COSMETIC, not the care itself - in the Canadian health care system.

Then Ensign claimed that US health care is great because if you take away every car accident and gun death, it turns out our preventable death rate is excellent. Which is just about the stupidest thing I've heard yet in this debate. Is John Ensign calling for a total gun ban in the United States?

...Debbie Stabenow's going to wrap up the debate before a lunch break. Stabenow frames the public option as "the grand compromise," which it is.

Gangs Of Washington

Charles Grassley, having been kicked out of the Gang That Couldn't Shoot Straight, has posted a flyer on the Senate's grey utility pole seeking out members for a new Hole-in-the-Wall Gang:

Sen. Chuck Grassley (R-Iowa) said Wednesday he's begun reaching out to other colleagues in both parties about reshaping the health bill through amendments on the Senate floor.

Grassley, the ranking member of the Senate Finance Committee, said in a conference call with Iowa reporters that he has had conversations with senators not on either committee handling health reform legislation about assembling a new bipartisan agreement.

"I've had discussions with senators that aren't on the committee that could possibly work with us to try to get back into a bipartisan mold," Grassley said. "I think, though, that it'd be very helpful for people who aren't on the Finance committee or even the HELP committee...would kind of take the bull by the horns themselves and try to coalesce around something that could eventually become more bipartisan."

Grassley, who said that the health care bill may "pull the plug on Grandma," tried to raise money in his own state to "defeat Obamacare" and claimed that it would have left Ted Kennedy without treatment, seems like the perfect candidate to lead a group seeking to improve the health care bill.

I'm thinking he may find some takers, though. The Senate Wanker Caucus can seat up to 60, depending on the policy. Witness, for example, Bill Nelson, trying transparently to preserve corporate welfare for insurance companies.

Mr. Nelson, a Democrat, has a big problem. The bill taken up this week by the committee would cut Medicare payments to insurance companies that care for more than 10 million older Americans, including nearly one million in Florida. The program, known as Medicare Advantage, is popular because it offers extra benefits, including vision and dental care and even, in some cases, membership in health clubs or fitness centers.

“It would be intolerable to ask senior citizens to give up substantial health benefits they are enjoying under Medicare,” said Mr. Nelson, who has been deluged with calls and complaints from constituents. “I am offering an amendment to shield seniors from those benefit cuts.” [...]

Mr. Nelson said he had received 56,000 telephone calls, letters and e-mail messages on the legislation since June.

Some of those callers have been mobilized by insurance companies.

Humana, one of the nation’s largest insurers, has urged subscribers to contact their members of Congress and register their opposition to the cuts. “Millions of seniors and disabled individuals could lose many of the important benefits and services that make Medicare Advantage health plans so valuable,” Humana said in a recent letter to beneficiaries.

Medicare Advantage is quite simply corporate welfare and nothing else. The government pays private companies on the average 14% more than it would to produce the exact same coverage on their own, for no increase in quality, despite Nelson's claims. It's a pure subsidy.

Pair Grassley with the Nelson twins, a Lieberman, maybe a Mark Warner, and who knows? They could put the old gang back together.

Who Could Have Anticipated?

Republicans decided to attack the individual mandate today, specifically hitting the notion of penalties for not buying insurance.

WASHINGTON -- Senior Republicans challenged Democratic plans to require nearly all people to carry health insurance, sharpening attacks on the first day of Senate Finance Committee debate over legislation to overhaul the nation's health-care system.

The criticism underscored Republican concerns that the legislation represents unwarranted government intrusion into private matters, and highlighted the partisan divide over the White House's top domestic priority. Put on the defensive, the committee's chairman, Sen. Max Baucus (D., Mont.), cut in half the maximum penalty for families that don't have health coverage to $1,900 from $3,800 per year.

Advocates of a coverage mandate say it is needed to ensure that young, healthy people get insurance and contribute to the system. They say this will ease costs associated with an influx of less-healthy people who are expected to get coverage under the Baucus legislation.

Republicans, who are trying to slow Democratic efforts to pass a health overhaul by the end of the year, rushed to criticize the proposal.

Iowa Sen. Charles Grassley, the Finance Committee's senior Republican, said the mandate is among the reasons that he couldn't support the bill despite months of negotiations with Mr. Baucus. "Individuals should maintain their freedom to chose health-care coverage, or not," he said.

"This bill is a stunning assault on liberty," said Sen. Jon Kyl of Arizona, the Senate's second-ranking Republican.

Now of course, Chuck Grassley is full of it. And the Republicans did agree to mandates months ago. But any Democratic official surprised by the intensity of this complaint needs to leave Washington permanently. These are the people who call the repeal of tax breaks a tax increase. They call a reduction in growth of defense spending a spending cut. Their logic has never had to subject itself to the rigors of consistency.

What's more, Obama argued against mandates in the primary campaign. And without a public option, there's a compelling argument to be made that mandates for private insurance is a forced monopoly. Furthermore, it was always going to be the case that criminalizing someone for not having insurance would be unpopular. As Richard Kirsch says, the public option makes mandates popular.

Baucus (D-Mont.) has tried to remedy the situation by halving the penalty on families who decline to buy coverage and increasing the subsidies to those middle-class families purchasing insurance. But Kirsch insists that, without the ability to choose a government run option, consumers - and by extension the politicians who represent them - will turn sour on the mandate.

"We did a poll in Maine and in 91 swing House districts," said Kirsch. "We found that if we asked people if they supported a requirement to buy health insurance they said no. But if we said, 'Do you support a requirement coverage between private and public?' they said yes."

"Conservative democrats are going to be attacked from the right on the mandates but what makes the mandates popular is the public option."

This is especially true if the coverage subsidies are too low.

So really, this is a problem of the Democrats' own making.

...to be clear, I believe in mandates because the system won't really work without them. But from a political standpoint, mandates on just private coverage are a loser.

Baucus Deep-Sixes The Gang Of Six?

Yesterday the White House basically shut down the Gang of Six talks, when Robert Gibbs said that Mike Enzi's comments over the weekend showed that he had "walked away from the table." In truth, they probably knew this for weeks, and were just looking for an excuse to end things. Now Max Baucus is largely saying the same thing, that this months-long process has been something of a charade, and that reform will happen with or without the GOP.

U.S. Sen. Max Baucus of Montana says a health care overhaul will happen this year even if Republicans back out of bipartisan talks under growing public pressure and that the death of Sen. Edward Kennedy could help hold together a compromise deal [...]

"I think the chances are still good," Baucus told The Associated Press in an interview Monday. "I talked to them, and they all want to do health care reform. But the sad part is a lot politics have crept in. They are being told by the Republican Party not to participate."

If it falls apart, Democrats will have to turn to the "nuclear option" — forcing through an inferior bill through a process that only requires 51 votes instead of 60, Baucus said.

Using budget reconciliation is not a "nuclear option," it's been used dozens of times in the past, including to achieve Republican tax cuts and other goals. That's just the AP accepting Republican frames.

But overall, the content here is a good sign. While Baucus still believes that a bipartisan bill would be superior to something pushed with a majority - I don't know why he thinks that, though I have some theories - he acknowledges that something must pass and he cannot wait forever. Indeed, as the Republicans have basically vowed to derail any reform bill, there is no such thing as the "superior" bipartisan option. So we're looking to reconciliation.

Meanwhile, Mark Begich kinda sorta supported the public option yesterday, meaning we're that much closer to the necessary votes in the Senate. There are issues with using the reconciliation process, which I'll get into in a later post.

The bipartisan circle jerk is falling apart. More lawmakers are signing on to the public option. Health care events are ramping up throughout the country.

I wouldn't say the tide is turning, but there are slightly better signs.

The Nelson/Landrieu Conundrum

A recent AARP poll shows 79% support for a public option competing with private insurance companies, although the poll question is kind of odd and doesn't reflect what's on offer. Nevertheless, other polls that accurately depict the public option show support in that range. However, that is not equally spread throughout the country. For instance, in a conservative state like Nebraska, more people don't support a public option (by a plurality) in health care reform, for whatever reason, and Democrat Ben Nelson gets 56% support for his handling of health care thus far. We don't have hard data on Louisiana, but Mary Landrieu, who has actually more strongly opposed a public insurance option than Nelson, may also be more in line with the interests of her state than some realize.

Speaking before what was described as a friendly crowd at the Monroe Chamber of Commerce yesterday, Sen. Mary Landrieu said she was opposed to much of the Democrats' legislative agenda.

Asked under what circumstances she would support a public option, Landrieu responded, "[v]ery few, if any. I'd prefer a private market-based approach to any health care reform that would extend coverage," according to the Monroe News Star.

"I'd like to cover everyone -- that would be the moral thing to do -- but it would be immoral to bankrupt the country while doing so," Landrieu said. The public option as currently conceived is expected to be a deficit reducer.

Dishonest? Absolutely. But out of step? Perhaps not.

What can we realistically expect from Democrats like this in red states? Obviously, under a "split the bill" scenario, they could signal support for the more broadly popular elements of reform, like insurance regulations, while opting out of the more controversial elements that only require a 60-vote standard. Or, they could simply opt to allow cloture, the wish of the majority of their caucus, while voting against the final bill. Markos polled this in the case of Nelson:

If Ben Nelson joined Republican Senators in filibustering and killing a final health care bill because it had a public health insurance option would that make you more or less likely to vote for him or would it have no real effect on your vote?

	More	Less
All	21	15
Dem	7	24
GOP	31	9
Ind	19	15

We can assume Nelson will vote against any bill with a robust public option. The big question is whether he will join Republicans in filibustering such a bill. Nebraska Republicans would sure love that, but at the end of the day, they'll vote for a real Republican in a contested election. Nelson would gain a small sliver from Independents, per this poll, but his real danger is among Democrats -- where he would lose a full 17 points of support [...]

If Nelson was to play this properly, he'd vote against any robust public option (and be justified doing so, given his constituency), but allow an up-or-down vote on the bill. Given the political realities of his state, that's the best we could hope for.

How can we position this so that Nelson comes around to this reality? I would look at how Republicans are pressuring Chuck Grassley. Grassley has something only the caucus can give him - the ranking membership of the Senate Judiciary Committee or the Budget Committee. And so he feels the pull from his members to not join in any bipartisan deal. Nelson and Landrieu both have pretty low seniority at the moment, although there's been a near-historic amount of turnover in the Senate recently. But if they have any designs on better committee assignments, or eventual chairmanships, the caucus should inform them of how they would do best to stay in their good graces. This pressure, by the way, should theoretically be much stronger on a Max Baucus or Kent Conrad, who already have that seniority. In addition, Landrieu and Nelson should be asked, pointedly, if they want to go down in history as having stopped access to health care for all Americans for a generation.

Fighting Baucus And Grassley From Within

The only way you can really get to a Max Baucus or a Charles Grassley is by threatening their job security. In particular, Grassley is up for re-election next year, in a state that went for Barack Obama by a fairly hefty margin. If I didn't know better, I'd say that Rep. Bruce Braley, chair of the Populist Caucus in the House, is setting himself up for a challenge to him.

Grassley used scare tactics last week at a town hall meeting in Iowa to convince voters that optional coverage for end-of-life counseling in the House health care reform bill would force people to "pull the plug on grandma" (even though he supported a nearly identical end-of-life counseling provision in a 2003). Earlier this week, Grassley told reporters that even if a health care plan included the changes he's been pushing for, he likely wouldn't support it if it didn't attract the support of more than a few of his GOP colleagues. Today, the Washington Post reported that Senator Grassley has begun calling for "scaled back" health care reform.

For someone who claims he wants to help forge a bipartisan health care plan, Senator Grassley sure isn't acting very bipartisan. In fact, he's been behaving like someone who wants to see meaningful health care reform defeated [...]

Senator Grassley is in a stronger position than just about anyone to bring Republicans on board with Democrats to achieve the health care reform we need. But when he uses the same rhetoric as pundits advising Republicans to "just kill it" and a Republican Senator who wants to make health care President Obama's "Waterloo," why would the President or Senator Baucus think he is their ally in achieving meaningful health care reform?

Sadly, it appears that Senator Grassley has decided to put his party before what's best for the people of this country.

The Des Moines Register has already floated the rumor about a "mystery" Democratic candidate willing to take on Grassley. Braley has certainly become more vocal in his criticisms. And the fact that Grassley immediately released a statement attacking Braley shows that he is sensitive to this rumor. I don't know if an announced challenge would put Grassley on the defensive, but it sure couldn't hurt.

As for Baucus, he doesn't come back up for re-election until 2014. But Montanans are split on his actions on health care to this point. 42% approve and 44% disapprove. Baucus has previously been fairly popular in the state, now a public option is more popular than he is, and if he helps to kill a health care reform bill, his numbers will plummet. The Montana Democratic Party is trying to cover for Baucus by sending around the Paul Begala article telling Democrats to accept half a loaf, but based on the polling, that's not working.

I'm not certain either of these two arrogant members of the House of Lords are reachable, but the road to reaching them runs through their home states.

Baucus Caucus: Less Health Care For America NOW

The six-headed Presidential hydra, also known as the sub-group in the Senate Finance Committee, has decided to ignore everybody and keep working diligently to do absolutely nothing on the health care bill.

Senate health-care negotiators agreed late Thursday to ignore the increasingly strident rhetoric from Republican and Democratic leaders and to keep working toward a bill that can win broad support from the rank-and-file in both parties, according to sources familiar with the talks.

In a conference call, the three Democratic and three Republican members of the Senate Finance Committee agreed to redouble their efforts to craft a less costly alternative to the trillion-dollar initiatives so far put forward in Congress. They discussed the possibility of also reining in the scope of their package, the sources said.

The senators rejected the idea of imposing a deadline on their negotiations, and they agreed to talk again Sept. 4 -- four days before lawmakers are scheduled to return to Washington from their August break. The consensus, one participant said, was "to take your time to get it right." [...]

Before leaving for the month-long recess, Baucus had pegged the cost of the negotiators' ideas at less than $900 billion over the next decade. Thursday's discussions focused on driving that cost lower, the sources said.

Their draft bill was already woefully short in terms of subsidies for those who can't afford insurance. The Gang of Six wants to drive them even lower.

I'm sure the people most enamored of themselves did reject having a timeline on their circle jerk. But look who is making these decisions. Chuck Grassley has basically said he'd vote against his own bill, even if he gets everything he wants, if he cannot get more than 80 Senators total on board. The #2 ranking Republican in the Senate has already said that votes for reform aren't coming. So Grassley, one of the key negotiators here, has admitted that he won't support anything the Gang of Six does. Mike Enzi is probably stronger in that direction. Olympia Snowe admitted today that the public option was never on the table in this Gang of Six, and that co-ops are worth exploring, even though two months ago she called them worthless. Kent Conrad has been ideologically opposed to the public option for as long as anyone can remember, and came up with co-ops, in all likelihood, as a way to steal seed money for the "non-profit" Blue Cross of North Dakota, which has captured 90% of the market in his home state. Max Baucus admitted as far back as March that the public option was nothing but a bargaining chip. Jeff Bingaman hasn't been getting nearly enough heat for being part of this charade, but he has talked the talk on co-ops as well.

These six Senators, who come from states representing 2-3% of the population, have proposed ideas out of step with 77% of the public, and think they're entitled to hijack the entire process in Congress to serve those ends.

The question is what to do about this. 270,000 people listened to the President's strategy session yesterday, and over 5,600 supporters have contributed almost $350,000 to lawmakers standing up for the public option. These six lawmakers, most of whom probably want no bill at all, know that the longer they hold up the process the harder it becomes to pass anything. Harry Reid needs to use whatever means necessary to force a bill out of the Senate - discharge petitions, going around the committee of jurisdiction, whatever. At that point, we're talking about a conference committee. Which is what Obama has asked for all along. The problem is a matter of trust, as Paul Krugman put it today.

...Chris Bowers is right that this is the worst part about it - the Senate Finance Committee has decided to take two additional weeks off before meeting again. They are so bound and determined to get health care right that they'll do nothing for weeks, presumably in the hopes that health care reform will die on the vine and they won't have to do anything at all.

The New Math

Remember when the right-wing started calling the nuclear option the "Constitutional option?"

Now the nuclear option equals anything less than 80 votes in the Senate.

President Grassley told me so.

Lower Your Sights

Paul Starr tells us all to give up on the public option. Paul may be very smart and right on the merits, but he fails to understand the political contours of the debate.

Because the public option has stood no realistic chance of being enacted in the form it was conceived, its main value all along this year has been as a bargaining chip. The proposal will now have served a valuable political purpose if, by sacrificing it, the White House is able to provide enough cover to Democratic senators from red states to get a bill out of the Senate Finance Committee, through the upper chamber, and into conference with the House.

The Republicans have focused their opposition on the bugaboo of "government-run health care." By jettisoning the public plan, swing Democratic senators can tell their constituents that they prevented a government takeover. This argument will not sway die-hard right-wing voters, but it may suffice for many others and thereby help give those senators confidence they can vote for the bill.

Some liberal members of Congress are still insisting the public option must be part of health reform. They should continue to say so -- their protests may make the ultimate concession all the more valuable. But if any of them actually do vote against the final bill and prevent it from passing because it fails to offer a public option, they will help to ruin the best chance in years to put health care on a path toward reform. And they will do severe damage to the presidency of Barack Obama.

Um, it hasn't swung one Republican, who keep talking about "Trojan horses." This is why the leadership has now resorted to talking about splitting the bill.

Furthermore, this idea that liberals are pawns in Paul Starr's Great Game just will not sit will with the only people out there fighting for this bill. As we saw in polling yesterday, support for reform collapses without a public option. That's the reality of the situation, folks, and to try and decouple the public option now will just remove all the energy from the fight, all the support, leaving the White House in the unenviable position of trying to pass something without any public engagement on their side. The legislation is shaky enough as it is, before cutting all the public support off at the knees. That would be suicide for the bill.

Max Baucus has been saying that the public option is a bargaining chip to get insurers to embrace other reforms since March. There's no question that he and the White House saw it that way. But we're now in August, and support is collapsing, and the only thing holding this bill together are progressives, who don't really want to be humiliated anymore. Especially when we know that offering an individual mandate without a viable public insurance option would be political suicide.

Keeping in mind that this anonymously sourced report could be total bunk, it's worth pointing out that axeing the public option and requiring individuals to purchase coverage under a private health insurance plan would be a horrible political miscalculation. If you think we're having problems selling health care reform now, just wait until we try to explain why all adults under 65 will be required to purchase health insurance from the private sector with no public option.

Oh, you're not interested in making that argument? I didn't think so.

When coupled with a public option (or the sort of rigorous regulatory regime which isn't under consideration), a mandate achieves universal coverage and cures the free-rider problem. But without the public option, the private sector will have a monopoly on a product the public is required to buy, and over the long-run you'll almost certainly see premiums skyrocket and quality of care plummet.

Progressives don't support a public option because they're four year-olds and they reflexively support anything conservatives oppose. They support it because they want to see an end to the private insurance monopoly that's put the squeeze on them for decades. And no, the bill as designed currently wouldn't do that to the degree it must to reverse incentives, because it firewalls out those who get coverage from their employers; but these kinds of things have the tendency to evolve over time, and it's crucial that it's put into place now. Without doing so, Democrats are once again putting themselves at risk with losing a generation.

But on a political level, the left has been betrayed over and over again on the things that matter to us the most. The village is pleased, I'm sure. But the Democratic party only needs to look back eight short years to see just how destructive it is to constantly tell their left flank to go fuck themselves.

In 2000, I recall standing in line to see Al Gore speak here in LA and I was inundated by a bunch of young, impressionable lefties, inspired by the globalisation movement and Ralph Nader's message. We sparred for some time, me telling them how third parties don't work, and them having none of it. They had no political experience except what they saw as a betrayal of liberalism and they found Nader's analysis of the two parties as being in bed with corporate interests extremely convincing. And it was very hard to argue that point, although I did try valiently, knowing as I did that while both parties were corporate whores, the Republican Party, being insane, wanted to actually kill large numbers of people in foreign countries, put the church in everyone's bedroom and give everybody's money directly to the wealthiest people in the nation. But I didn't convince any of them. And we know the result.

At the time nobody believed that an incumbent Vice President in a roaring economy would have a race so close that the Republicans could steal it. But we know differently now don't we? And you would think that the Democratic establishment would also know that because of that, it may not be a good idea to alienate the left to the point where they become apathetic or even well... you know. It can happen. It did happen. Why the Democrats persist in believing that it can't happen again is beyond me. Perhaps they internalized all the villager CW about Al Gore being a bad candidate, but the fact remains that if a slice of the left hadn't been so disgusted by the New Democratic, mushy centrism of the Clinton years, he would have won.

Obama mobilized a whole lot of young people who have great expectations and disappointing them could lead to all sorts of unpleasant results. Success is about more than simply buying off some congressional liberals or pleasing the village. It's worth remembering that a third party run from the left is what created the conditions for eight long years of Republican governance that pretty much wrecked this country.

And that's where we're at right now. Obama can pretend Chuck Grassley is acting in good faith and renounce the public option in the name of bipartisanship (that's a really brilliant move by Grassley, by the way, he's playing in the big leagues), or he can support the people who elected him and believed in his message of change. I think those 60-odd million are more important than Sen. Grassley's feelings, but what do I know, I don't live in Washington.

I do know this: alienating your key supporters right when they're needed the most is a recipe for disaster.

As If They Had A Choice

The NYT reports that "Democrats Seem Set to Go It Alone on a Health Bill". In plain English, this means that "Democrats want a health bill." There was never going to be Republican support for anything calling itself health reform that Democrats and the President would support. You could whittle and whittle and whittle the bill down to nothing and it wouldn't matter. Somebody in Washington finally figured this out:

Rahm Emanuel, the White House chief of staff, said the heated opposition was evidence that Republicans had made a political calculation to draw a line against any health care changes, the latest in a string of major administration proposals that Republicans have opposed.

“The Republican leadership,” Mr. Emanuel said, “has made a strategic decision that defeating President Obama’s health care proposal is more important for their political goals than solving the health insurance problems that Americans face every day.”

Ya think? Jon Kyl said yesterday that “There is no way that Republicans are going to support a trillion-dollar-plus bill.” Chuck Grassley admitted that he wouldn't vote for his own compromise and legitimized the "death panels" smear despite having voted for it in the past. You're just figuring out that Republicans view their jobs as blocking any legislation at all costs?

We're starting to hear this meme from the right that liberals are interested in negotiation and compromise with Iran and North Korea, but not with Republicans. Well, we've done the negotiations. They led to nothing for months. And the meme itself is false.

In foreign policy, liberals often believe that disputes with foreign actors can and should be settled through negotiation and compromise. That's because international relations isn't a zero-sum affair. Conflict is costly to both parties, good relations bring benefits to both parties, so disagreement is generally amenable to compromise. Ideological disagreement isn't zero-sum either. Neither conservatives nor progressives are wedded to principles that require defense of wasteful Medicare spending. But partisan politics is zero-sum. A 'win' for the Democrats is a 'loss' for Republicans. And the predominant thinking in the Republican Party at the moment is that inflicting legislative defeats on Democrats will lead to electoral defeats for Democrats. That makes the GOP hard to bargain with.

I would say "impossible." They're convinced it's 1994, and they're not needed by virtue of the numbers.

So where to go from here? Well, Democrats in the Senate could demand that their members join no Republican filibuster of any health care measure supported by a majority of their ranks. They can choose to not support the final bill if they wish. They should not keep it from a final vote. That's the simple solution. If that process winds us up with a public option in the House and a weak co-op option in the Senate, the conference committee could actually produce a positive result, provided Harry Reid puts the people on the conference with jurisdiction over the bill, like health subcommittee chair in the Finance Committee Jay Rockefeller (strong public option supporter) and retirement and aging subcommittee chair in the HELP Committee Barbara Mikulski (supporter).

That bill would easily pass the House. The Senate is trickier. But the conference report can't be amended. It can't be changed, or held up in committee. It can be filibustered, and it can be voted against. Those are the options. If three Democrats opposed the legislation and wanted to kill it, they would literally have to filibuster it (this is assuming that Democrats have 60 votes, which is not certain given Kennedy's health). That would be a very hard thing to do at that stage in the game. It would isolate the obstructionists, ensuring funded primary challenges and the enduring enmity of the Senate leadership and the White House. Kent Conrad can say that there aren't enough votes for a public option and imply that he's just protecting the final bill from defeat. But is he willing to be one of those "no" votes? Is he willing to filibuster? That's a different game indeed.

At this point, no Democratic Senator has committed to joining a Republican filibuster, an important distinction. The conservaDems should be asked if they plan to do so.

If that fails and President Nelson (who likes to shout at public option supporters in the media off camera) or some other newly elected President tries to torpedo the bill, there's the option of splitting reform into two bills, with the filibuster-able stuff in one bill, and stuff relevant to the budget packed into a bill that can be achieved with 50 votes in budget reconciliation. That makes those provisions likely to be subject to a sunset, but once a public option, expanded Medicaid, increasing subsidies and other budget-relevant things get enacted, I submit it will be hard for any Congress to allow them to expire. Failing that, there's the straight reconciliation path, which contra Chris Matthews is not "blowing up Senate rules" but part of them (someone who's never talked a word about Senate rules in his whole career should probably not start now), but which could get messy if elements not relevant to the budget got excised.

Or, Democrats could behave like Republicans and rule by fear and questioning opponents' patriotism. But that's, er, unlikely.

The point being, there are options, and lots more open up when you recognize the large majorities in both houses of Congress cancel the need for bipartisanship inside Washington.

Maybe If Obama Changes His Party Registration

Maybe then we can get those nice Republicans to go along with the White House's plans. Apparently what Kent Conrad made up in the middle of the night during a staff brainstorm session isn't really their cup of tea, either.

“PUBLIC OPTION” BY ANY OTHER NAME IS STILL GOVERNMENT-RUN HEALTH CARE

SO WHAT IS A “CO-OP”?

Co-Ops Would Be Funded By Federal Government. “Senator Kent Conrad, a Democrat, proposed creating nonprofit, member-operated health cooperatives to compete with insurers … The government would offer start-up money -- Conrad said $6 billion would be needed -- in loans and grants to help doctors, hospitals, businesses and other groups form nonprofit cooperative networks to obtain and provide healthcare.” (“Q&A – Co-Ops In Focus In U.S. Health Care Debate,” Reuters, 7/30/09)

Co-Ops Would Be Regulated By Federal Government. “Advisory board makes recommendations to HHS Secretary who makes final decisions about approvals of business plans … Business plans must meet governance standards, and eligible applicants must meet the standard for non-profit, participating mutual insurance.” (“Senate Finance Committee Draft Proposal,” 6/19/09)

Co-Ops Would Force Individuals Who Want To Join To Go Through State Governments. “Co-op membership would be offered through state insurance exchanges where small businesses and individuals without employer-sponsored plans would shop for health coverage.” (“Q&A – Co-Ops In Focus In U.S. Health Care Debate,” Reuters, 7/30/09)

Federal Government Would Use Co-Ops To Monopolize Health Insurance. “[T]hese co-ops sound a lot like a health-care Fannie Mae and Freddie Mac, which Congress created because there was supposedly no secondary mortgage market. The duo proceeded to use their government subsidy to dominate the market and drive out private competitors.” (Editorial, “Fannie Med,”The Wall Street Journal, 7/30/09)

The leader of the Republican Party said basically the same thing today, actually admitting that "there is no reason to have this kind of liberal reform without a public option."

Who could have predicted? Why, it's almost as if it's not the particulars of the bill at all that upset the GOP, but the very act of passing a bill at all. In this environment, it seems so perfectly sensible to try to fashion compromises with Senators who won't vote for any bill even if they get everything they want out of it.

I think the White House should really mull over the party-switch idea. After all, it would show the President's commitment to post-partisanship. Sure, some of the more officious Democrats may be disappointed, but think of the great David Brooks op-eds!

The Grassley Maneuver

So, here's how this went. Chuck Grassley, who has in his history shown absolutely no indication of being a moderate in the US Senate, by virtue of seniority and the bold leadership of Captain Ineffective Max Baucus, somehow has a position of prominence on health care reform. And most recently, he's used it to claim that the end-of-life counseling benefit in Medicare in the House bill would "pull the plug on Grandma," furthering the intent of the paranoids who want to block any reform. He blew this up so much in an already overheated debate that the Senate Finance Committee reportedly dropped that provision from their version of the bill. And after that was completed, after the Twitter fight with Arlen Specter and all the rest, Grassley decides to completely retract the statement.

The retraction was buried deep in this Washington Post article on Grassley’s role, with a spokesperson admitting Grassley doesn’t really believe what he said about “grandma”:

Grassley says he opposes that counseling as written in the House version of the bill, but a spokesman said the senator does not think the House provision would in fact give the government such authority in deciding when and how people die. The House bill allows patients to decide for themselves if they would like such counseling.

Let’s be clear: By clarifying that Grassley doesn’t think the House bill would “give the government such authority in deciding when and how people die,” his spokesperson completely repudiated his widely discussed claim. This goes much farther than Grassley did in a statement released Friday clarifying he’d never used the words “death panel” and was merely worried about “unintended consequences.”

So Grassley made a wild and unsubstantiated charge, got an untold number of people riled up about it, excised it from his bill, and then admitted the whole thing was a lie. But none of this matters now, considering the damage done, and the retraction won't even get much attention.

Welcome to the American political system.

...Also, the key negotiator on the Senate Finance Committee will vote no on a plan even if he gets everything he wants, as long as other Republicans don't go along with it.

Keep negotiating with crazy and see how that works out.

You Have Every Right To Fear Chuck Grassley

This is the guy who is the lead Republican negotiator on the health care bill.

One of the three Republican senators working on a bipartisan health care bill perpetuated a particularly outrageous untruth about the legislation on Wednesday.

Appearing at a town hall in his home state of Iowa, Sen. Chuck Grassley told a crowd of more than 300 that they were correct to fear that the government would "pull the plug on grandma."

"There is some fear because in the House bill, there is counseling for end-of-life," Grassley said. "And from that standpoint, you have every right to fear. You shouldn't have counseling at the end of life. You ought to have counseling 20 years before you're going to die. You ought to plan these things out. And I don't have any problem with things like living wills. But they ought to be done within the family. We should not have a government program that determines if you're going to pull the plug on grandma."

Why is he in the room? Why is he NEAR the room? Why should we expect any health care bill that passes through his hands to be sufficient?

The Actual Business Of Health Care

The teabag rallies are theater, but some actual substance has made its way into the health care debate this week.

First of all, the President has openly considered a partisan process to pass health care reform.

President Obama urged Democratic senators on Tuesday to persevere in trying to get a bipartisan deal on health care, but left open the possibility that they might have to pass a bill with only Democratic votes if Republicans stood in the way.

At lunch with Democrats at the White House, Mr. Obama vowed to respond to Republican attacks on his plan, which aims to guarantee insurance for all Americans while slowing the explosive growth of health costs.

The Senate majority leader, Harry Reid of Nevada, said there was “absolute unity” among members of the normally fractious Democratic conference.

“Everyone recognizes that we are going to do, if there’s any way humanly possible, a bipartisan bill,” Mr. Reid said. “We don’t want to do a partisan bill, and we hope our Republican colleagues acknowledge that. We’ll continue to work with them as long as we have to.”

I take the nods toward bipartisanship is simply what you say. The news here is Obama suggesting they must not be an obstacle. And frankly, it's about time. Chuck Grassley today actually referenced Ted Kennedy's brain tumor to try and whip up a fear of rationing. And he's one of the Republicans in the midst of bipartisan talks! They are simply not bargaining in good faith.

In an interview today with Chuck Todd, Obama reinforced the deadline for those talks in the Senate Finance Committee.

"I am glad that in the Senate Finance Committee, there have been a couple of Republicans--Chuck Grassley, Mike Enzi, Olympia Snowe--who have been willing to negotiate with Democrats to try to produce a bill. But they haven't yet. And I think at some point, sometime in September, we're just going to have to make an assessment."

He says he'd "prefer" a bipartisan process. And I'd prefer dinner every night at Nobu. But I can't get that. So I eat what I can get. Obama's saying the same thing. I think everyone's ready to go to war on this. And you will see arm-twisting to end cloture like you wouldn't imagine.

Meanwhile, Jay Rockefeller is doing a good job savaging the Finance Committee talks, talks which he has been shut out of even though he chairs the Health Subcommittee on the panel. Rockefeller's tough talk will push the debate in that committee to the left, just as liberals in the House are pushing Nancy Pelosi and the leadership to the left and drawing a line on the public option. And the September deadline enforces the whole process, telling Republicans like Grassley they can either have input or watch a bill get passed without them.

That's the theory, anyway, we'll see how it works in practice.

Couple other things. Health Care for America Now has a good report personalizing the health care debate and explaining what reform will bring for every type of family. And the White House has apparently secured a win in the all-important budget nerd battle:

The White House scored a point today in its ongoing battle to convince establishment Washington that health-care reform will succeed at cutting costs even as it expands coverage. The White House and budget director Peter Orszag, as well as the House Blue Dogs, are very bullish about allowing an independent board to pursue cost-cutting measures in Medicare. But when CBO scored the measure to determine if it would be succesful, they produced a very lukewarm estimate. Today, though, a group of health-care experts sent a letter [PDF] to Obama arguing that IMAC, the independent cost-cutting board, would be very effective if done right -- and nine of the signatories are members of the CBO's Panel of Health Advisers, nearly half the membership. It's a good sign for the White House, and will help push the message that, while CBO's scores are important, the assumptions made in that office are not carved in concrete.

The CBO simply should not be the final arbiter on questions that are really outside their purview.

Glide Paths

I trust Orrin Hatch to know a bit more about his fellow Republicans than Max Baucus:

Sen. Orrin Hatch (R-Utah), who has a long history of teaming up with Democrats on healthcare legislation, says Democratic healthcare reform plans now under consideration are “out of this world.”

Hatch also told The Hill in a Friday interview he would be “shocked” if Sens. Chuck Grassley (R-Iowa) and Mike Enzi (R-Wyo.) sign onto a healthcare deal with Democrats given the current trajectory of the legislation.

Seems kind of futile to keep negotiating with two people who will never agree to your terms. Unless your goal, too, is delay.

What this delay has started to cause, according to Jon Cohn, is a change in rhetoric from the White House that could signal a major change in the scope of the bill.

The trouble is the Senate, where the last committee to consider reform, the Finance Committee, remains exactly where it has been since early summer: Stuck. The committee remains divided over several issues, chief among them how to come up with the approximately $1 trillion (or more) it will take to pay for coverage expansions in the first ten years. And while some of the problem seems peculiar to the makeup of that committee--and the determination of its chairman, Max Baucus, to include Republicans who are highly suspicious of the whole enterprise--the same problem exists in the overall makeup of the Senate, where not even all Democrats are yet on board with the kind of effort the party leadership in mind.

On Sunday, Ceci Connolly of the Washington Post reported that administration officials have changed their rhetoric--and that some now talk, quietly, of putting the country on a “glide path” to universal coverage rather than achieving it in the next few years. This is an important development although not an unexpected one. The White House and its allies plan for all contingencies. There has always been a “Plan B” in case the support for full coverage, along with comprehensive reform, wasn’t there. And there have always been key players--both in the White House and Congress--who have thought maybe “Plan B” should be “Plan A.” After a rough few weeks, when the president’s poll ratings began to slip and the opponents of reform managed to gum up the works in Congress, such an outcome seems increasingly likely.

We have a pretty good idea of what that would mean, in terms of policy. Leaks out of the Finance Committee suggest that, absent support for a program with all of the funding and regulation reform needs, legislation would be far from ideal. It’d mean less financial assistance both for people who don’t have insurance and those who now struggle to pay for it. It’d mean less financial protection for people who get sick. It’d mean less choice for people who want a range of options, including a public insurance plan, from which to choose. (For more details, the Center on Budget and Policy Priorities has a full analysis.)

Working- and middle-class people, many of them now struggling to pay for insurance or at risk of financial catastrophe in case of illness, would be the ones to receive less in a watered down reform. This makes for both bad policy and bad politics, in no small part because the two are closely related. A reform that the middle class perceives as offering few benefits at substantial cost would be a prime candidate for rollback in coming years.

The delay caused people to believe that enthusiasm for reform in Washington had slipped, which caused a similar loss of enthusiasm throughout the country. And this led the White House to scale back their rhetoric (which I actually think is a good thing - make it bite-sized for public consumption), as well as potentially scaling back the whole policy. Sounds pretty well-coordinated to me.

It's almost as if Grassley and Enzi are following a design to hold up any bill and let the cracks in the Democratic coalition come to a head.

I hope I don't get hungry on more than that half a loaf for the next few years.

A Compromise In The Other Direction

While the deal reached between Henry Waxman and a core group of Blue Dog Democrats on the health care bill in the House Energy and Commerce Committee was reported as offering modest concessions, in truth the subsidies would have really dried up for families making between 300-400% of federal poverty level. Progressives revolted, mainly because the subsidy climb-downs attack the larger idea of offering affordable health insurance for everyone, the central goal of the program. So they revolted, and Waxman had to re-bargain with everyone to get a decent compromise of the compromise.

Liberals and a small core of conservative Democrats set aside long-standing ideological differences early Friday to cut a deal that should allow the House Energy and Commerce Committee to approve a sweeping health care bill, breaking a two-week deadlock that threatened President Barack Obama’s top domestic priority.

Blue Dog Democrats on the committee, who are the linchpin in the House health care debate, agreed to allow their liberal colleagues to cut billions from existing government-funded health care programs in order to restore some $50 billion to $65 billion in subsidies set aside in the bill to help middle-income families purchase coverage.

This final agreement should clear the way for committee passage later today. Energy and Commerce is the last of the three House committees to consider the bill, so passage will put the package in the hands of party leaders for a titanic fight when Congress returns in the fall over the government's role in health care [...]

The Blue Dogs preserved one of their main objectives: de-coupling the so-called public plans from Medicare, a change that gives health care providers the right to negotiate payments with the government.

Those rates were only scheduled for the first three years anyhow. My guess is that will be returned when the House bills get merged from all three committees in September, especially if progressives keep up the pressure. What's important now is to get the Energy and Commerce bill out of committee.

Let's understand how this happened. Blue Dogs held out for a deal. Progressives, instead of taking it to get the larger goal, revolted and got 57 names on a letter vowing not to support any Blue Dog compromise. The Blue Dogs, who came into this wanting to kill the public plan option, ending up voting it out of committee in Energy and Commerce and allowing for expanded subsidies. And progressives are STILL not satisfied, as it should be, because Medicare rates and providers should be tied to the public plan over its entire lifespan, and the plan (and the insurance exchange) should be available to everyone regardless of employer.

Moreover, the liberals also expressed a political concern, saying House leaders had compromised too early. “Under the agreement, private insurers are coming off unscathed,” said Representative Peter Welch, Democrat of Vermont.

He added, “They do quite well — too well, frankly.”

Representative Eliot L. Engel, Democrat of New York, said, “The public plan was eviscerated” under the deal announced Wednesday to get the bill moving again in the Energy and Commerce Committee.

Mr. Engel was less than enthusiastic about the resulting legislation. “It’s not a terrible bill,” he said, “but it’s not what I had hoped for.”

There was an abortion policy amendment in the committee that tries to split the difference by affirming that insurers "would not be required or forbidden to cover abortion." I'd prefer that the public plan be accorded the same benefits toward the most widely used outpatient procedure in America that 90% of all private plans cover, and we'll see where that debate goes.

Also hurting the Blue Dogs' cause is this WaPo front-pager, almost unquestionably meant to coincide with progressive discontent over the compromise, showing the amount of health industry money these so-called fiscal conservatives are swimming in.

The roiling debate about health-care reform has been a boon to the political fortunes of Ross and 51 other members of the Blue Dog Coalition, who have become key brokers in shaping legislation in the House. Objections from the group resulted in a compromise bill announced this week that includes higher payments for rural providers and softens a public insurance option that industry groups object to. The deal also would allow states to set up nonprofit cooperatives to offer coverage, a Republican-generated idea that insurers favor as an alternative to a public insurance option.

At the same time, the group has set a record pace for fundraising this year through its political action committee, surpassing other congressional leadership PACs in collecting more than $1.1 million through June. More than half the money came from the health-care, insurance and financial services industries, marking a notable surge in donations from those sectors compared with earlier years, according to an analysis by the Center for Public Integrity.

A look at career contribution patterns also shows that typical Blue Dogs receive significantly more money -- about 25 percent -- from the health-care and insurance sectors than other Democrats, putting them closer to Republicans in attracting industry support.

Most of the major corporations and trade groups in those sectors are regular contributors to the Blue Dog PAC. They include drugmakers such as Pfizer and Novartis; insurers such as WellPoint and Northwestern Mutual Life; and industry organizations such as America's Health Insurance Plans. The American Medical Association also has been one of the top contributors to individual Blue Dog members over the past 20 years.

Progressives are running the absolute right game in the House, forcing compromises in their direction and making sure they will be heard in this debate. Unfortunately, on the other side of the Capitol, you have health care policy literally in the hands of Chuck Grassley, who is promising his party he won't strike a deal on any bill with Democrats while SITTING IN ON MEETINGS AIMED AT STRIKING A DEAL in the Senate Finance Committee. The unicameral legislature concept is looking better and better every day.

Smiles On A Summer Night

Meet the men and women determined to deny you quality health care:

The fate of the health care overhaul largely rests on the shoulders of six senators who since June 17 have gathered — often twice a day, and for many hours at a stretch — in a conference room with burnt sienna walls, in the office of the Senate Finance Committee chairman, Max Baucus, Democrat of Montana.

Mr. Baucus says his group will produce the bill that best meets Mr. Obama’s top priorities, broadly expanding coverage to the uninsured and curtailing the steep rise in health care spending over the long term, what policy makers call “bending the cost curve.”

Still, if the three Democrats and three Republicans can pull off a grand bargain, it will have to be more conservative than the measures proposed by the House or the left-leaning Senate health committee. And that could force Mr. Obama to choose between backing the bipartisan deal or rank-and-file Democrats who want a bill that more closely reflects their liberal ideals.

Already, the group of six has tossed aside the idea of a government-run insurance plan that would compete with private insurers, which the president supports but Republicans said was a deal-breaker.

Instead, they are proposing a network of private, nonprofit cooperatives.

They have also dismissed the House Democratic plan to pay for the bill’s roughly $1 trillion, 10-year cost partly with an income surtax on high earners.

The three Republicans have insisted that any new taxes come from within the health care arena. As one option, Democrats have proposed taxing high-end insurance plans with values exceeding $25,000.

The Senate group also seems prepared to drop a requirement, included in other versions of the legislation, that employers offer coverage to their workers. “We don’t mandate employer coverage,” Senator Olympia J. Snowe, Republican of Maine and one of the six, said Monday. Employers that do not offer coverage may instead have to pay the cost of any government subsidies for which their workers qualify. In the House, centrist Democrats have temporarily stalled the health care bill, many lawmakers want to see what Mr. Baucus’s group produces before voting on tax increases in the House bill.

I'd just like to dial everybody back for a second and note that this is the Senate Finance Committee. In practice this hasn't been honored, but in theory the group has jurisdiction over the financing of Medicare and setting up the revenue stream for a health care bill. Since pretty much everything costs something, that mandate has expanded into writing an entire bill. But in an ideal world, the Health, Education, Labor and Pensions Committee would write the health care bill, and the Finance Committee would direct how to pay for it.

But that wouldn't sit well with Presidents Baucus and Grassley and their kitchen cabinet.

As for the merits of the policy, Jacob Hacker is talking about House Blue Dogs in this op-ed today, but the points are largely the same:

The main worry expressed by the Blue Dogs is that the Congressional Budget Office has predicted that leading bills on Capitol Hill won't bring down medical inflation. The irony is that the Blue Dogs' argument -- that a new public insurance plan designed to compete with private insurers should be smaller and less powerful, and that Medicare and this new plan should pay more generous rates to rural providers -- would make reform more expensive, not less. The further irony is that the federal premium assistance that the Blue Dogs worry is too costly is the reform that would make health-care affordable for a large share of their constituents.

The Blue Dogs are right to hold Obama and Democratic leaders to their commitment to real cost control. But they are wrong to see this goal as conflicting with a new national public health insurance plan for Americans younger than 65. In fact, such a plan, empowered to work with Medicare, is Congress's single most powerful lever for reforming the way care is paid for and delivered. With appropriate authority, it can encourage private plans to develop innovations in payment and care coordination that could spread through the private sector, as have past public-sector innovations [...]

Many Blue Dogs fret that a new public health insurance plan will become too large, despite the CBO's projection that the overwhelming majority of working people will have employer coverage and that the public plan will enroll less than 5 percent of the population. Their concern should be that a public plan will be too weak. A public health plan will be particularly vital for Americans in the rural areas that many Blue Dogs represent. These areas feature both limited insurance competition and shockingly large numbers of residents without adequate coverage. By providing a backup plan that competes with private insurers, the public plan will broaden coverage and encourage private plans to reduce their premiums. Perhaps that's why support for a public plan is virtually as high in generally conservative rural areas as it is nationwide, with 71 percent of voters expressing enthusiasm.

What's funny is that chucking the employer mandate will probably lead to employers dropping coverage if the costs become prohibitive, sending workers into the insurance exchange and, if it exists, the public plan. Under the Senate Finance proposal, however, the public plan is eliminated, and private markets make out like bandits. They force everyone to buy their insurance, and they get more individuals buying coverage, who have less bargaining power than group employers. And because of the obsession that the bill cost no more than $100 billion annually over ten years, that coverage may lack proper subsidies, have lower benefits or increased out-of-pocket costs for the individual.

It's good to see these Senators so happy, however.

...Angry Bear:

"Officials also said a bipartisan compromise would not subject companies to a penalty if they declined to offer coverage to their workers. Instead, these businesses would be required to reimburse the government for part or all of any federal subsidies designed to help lower-income employees obtain insurance on their own."

This would be the most regressive tax ever. If I am an employer and I don't provide health insurance then my tax liability is higher if the family income of my employee is lower. More regressive than a poll tax (Baroness Thatcher must be put out that she didn't think of it). What's worse it depends on family income.

Let's say I don't provide insurance and have two job applicants, one who is a single mother and the other a man with a low salary but a high income wife (say Bill Clinton when he was working as governor of Arkansas for $30,000 per year). I hire the guy, because he can't get subsidized health insurance, so I don't have to give him insurance or pay him a dime.

This is the Baucus Grassley jobs only for people who don't need jobs preliminary draft bill of 2009.

...This is also worth noting:

[I]t does strike me as worth noting that when you read a puff piece in The New York Times about the Gang of Six bipartisan dealmakers in the Senate that vast power is being wielded by people who, in a democratic system of government, would have almost no power. We’re talking, after all, about Max Baucus of Montana, Kent Conrad of North Dakota, Jeff Bingaman of New Mexico, Susan Collins of Maine, Mike Enzi of Wyoming, and Chuck Grassley of Iowa. Collectively those six states contain about 2.74 percent of the population, less than New Jersey, or about one fifth the population of California. The six largest states, by contrast, contain about 40 percent of Americans.

Transfer Of Power

The remaining House committee to finish work on the health care bill, the Energy and Commerce Committee, has repeatedly delayed their markup sessions this week, as Henry Waxman negotiated with the several Blue Dogs on the committee over changes to the bill. Talks seemed to reach a breakthrough when Waxman agreed to add expanded power for MedPAC, an independent board that could make recommendations on public medical spending and face an up or down vote in Congress. But despite that, there's been delay.

And that's because the Blue Dogs want to sequence the votes. They want the Senate to go first with whatever comes out of the Finance Committee over there rather than take a vote on something that won't be part of the final bill. Nancy Pelosi said as much yesterday:

House Speaker Nancy Pelosi has been pretty adamant: She would prefer to pass a health care bill by early August, and would be willing to hold the House in session past a scheduled recess to get there. But she's also unwilling to move unless the Senate does...something.

'[I]f we're done, and they're not done and they're gone, what is the point?" Pelosi said in a meeting with reporters yesterday. "It's interesting to me that people are saying, 'Don't leave until it's done.' I don't know how much more we can do if the Senate is not going to move."

This reflects a general frustration with the holdup in the Finance Committee, particularly the secrecy of them and how long they have played out. As far back as February, Max Baucus talked about a markup session in June. And he consistently agreed to that throughout the next several months. Now he hasn't only help up the process, but he doesn't even plan to run it by the Democratic caucus once he introduces it:

However, the level of consultation with Democrats stands in contrast with how Republican negotiators are briefing their Members. Senators said Enzi, who is the ranking member on the Health, Education, Labor and Pensions Committee, briefs leaders every day on the talks. And all three of the GOP negotiators have agreed to brief the entire GOP Conference before they sign on to any deal with Baucus.

But Democrats said Baucus is unlikely to run any deal by his caucus before he shakes hands on an agreement with Republicans.

On the stimulus bill, we had Presidents Nelson and Collins dictating the size and scope of the bill. Now there's been a transfer of power. Presidents Baucus and Grassley are large and in charge. And virtually nobody in the Democratic leadership has challenged this hijacking of the process, outside of off-the-record grumbles. In particular, nobody has mentioned that they've gone well outside the confines of their mandate:

I would have thought that the role of the Senate Finance Committee was to figure out how to finance necessary health care reforms in a responsible fashion. It wasn't their job to make the major "policy" calls about what reform entails. That's the job of the Senate Health, Education, Labor and Pensions Committtee, and the respective House Committees, and they've already defined what they want and are in basic agreement.

No, Finance's job was to look at the range of financing options -- some from Tax A, some from Tax B, a bit from Tax C, plus Savings X, Savings Y, etc. -- and then choose. Put together a package that's fair and that does the job. But apparently, the entire Congressional leadership is waiting for President Baucus and President Grassley to tell them what the substance of reform will be.

So, what have the two Co-Presidents produced so far? Zero. Nada. Zilch. Unless you count delay.

Did you know that last November, you all voted for Max Baucus and Charles Grassley to become Presidents of the United States of Health Care?

UPDATE: Jane reports that a deal is coming from the Finance Committee shortly, and that it'll use John Kerry's suggestion to tax insurance companies for their most expensive plans, and that it won't have a public plan. As Scarecrow said, since when does the Finance Committee dictate policy provisions?

Jane believes that the Senate bill could come together quickly, and that when Harry Reid reconciles the Finance bill with the HELP Committee bill, that he will drop the public plan. I would say that, since it's completely at Reid's discretion, the pressure is on him to include that in the merged package or not. Either way there will be an amendment to either strip it or add it back in. If Reid includes it, that amendment may need a 60-vote threshold to strip it, and if he doesn't, it may need 60 votes to put it back in. So Reid has every opportunity to advance the prospects of a public option. Jane also says:

Anyway, as was always going to be the case, the only hope for the public plan is coming out of the House. And the only hope of forcing the Senate's hand is if there is a roadblock in the House that can't pass a health care bill without one. It puts them in the position of tanking health care because they petulantly insist on refusing to give in on something that 76% of Americans want, and the public pressure becomes enormous.

So please tell members of the House to stick around and fight, because with 50 million people in this country uninsured, it isn't All About Them.

The best way to stop the delay tactics from the Finance Committee is to refuse them an out by putting passage of a bill ahead of the August recess.

...and Harry Reid abdicates his responsibility as a leader of the caucus...

Senate Majority Leader Harry Reid said today that the Senate would not attempt to pass sweeping health care reform until after returning from the August recess.

“It’s better to get a product that’s based on quality and thoughtfulness than on trying to just get something through,” Reid told reporters.

Reid said the Senate would try to complete a package in the fall.

The article makes it sound like Republicans asked for a delay, and Reid AGREED to it.

Should we just let Mitch McConnell be Majority Leader at this point?

...I should mention that I haven't seen reports of that Baucus/Finance Committee/public option deal anywhere else. Things are very fluid and I still feel that most stakeholders in the debate are resigned to something called "public option" in the final bill. Whether it's good or not remains to be seen. But conceding the recess and allowing the Finance Committee to delay and dictate the terms is unconscionable.

Blood Sausage

It's probably easier just to not parse every statement coming out of the Congress on health care. This is the sausage-making period, and it's rarely pretty. But everyone is reporting that, a day after Harry Reid asked his caucus to support the majority's goals by not supporting a filibuster and told Max Baucus to drop bipartisan efforts on the health care bill that would lose Democratic votes, he reached out to a limited group of Republicans and asked them for help on the bill. And Max Baucus and Charles Grassley, according to the LA Times, continue to move forward on their centrist bill in the Senate Finance Committee.

Well, sure. This is the talking phase, and I wouldn't expect a stonewall of silence at this point. Chasing exactly what will remain in the bill or not is like chasing a rainbow.

However, a couple elements to the chatter seem significant. Politico adds up the numbers:

But taxing health benefits to pay for an overhaul? That's still dead, Democratic leaders made clear again Wednesday.

And another thing that's increasingly in doubt: any hopes of getting a health reform bill voted out of the Senate by August, a byproduct of the leadership's decision to lay down the law on finding a new way to pay for it.

Reid's move blows a gigantic hole in efforts to find $1 trillion to pay for health reform - and set off a scramble Wednesday to come up with a replacement for the suddenly missing $320 billion over 10 years.

And if Democrats thought taxing health benefits was unpopular, the second-least-popular idea might be a tough sell, too - a straight-up income tax hike on people making more than $250,000 a year. That idea gained new currency in the Senate and the House Wednesday in part because it would not divide the Democratic base as much as taxing health benefits, which could hit the middle class, and unions strongly oppose it.

Sin taxes on sugary sodas and drinks were back on the table - despite being dismissed weeks ago as too small to be worth the fight it would take to pass them. A few Democrats were talking again about resurrecting President Barack Obama's plan to lower income tax deductions for wealthy Americans, an idea that died barely weeks after Obama first floated it earlier this year.

It does look like changing the employer deduction is right out (which is kind of a shame - I support capping that deduction). But if we're only talking about $320 billion to go, then they should just adopt the Obama Administration's plan to return the rate of deductions for charitable donations to where it was in the Reagan Administration. It's the most defensible (I envision rhetoric like "you mean you give charity for the tax break, not out of the goodness of your heart?") and has already been vetted by the White House.

Now, to get a bill that spends more than $1 trillion a year, you might need something else. But add in the charitable deduction piece and you're up to $1 trillion, which is definitely a better place than I thought.

There's also the wrangling over whether Democrats will join Republican filibusters. Dick Durbin implored the caucus on this:

If they will stick with us on the procedural votes, we at least know that we can move forward.... They may vote against final passage on a bill, they may vote with Republicans on an amendment. That's entirely their right to do. But this idea of allowing the filibuster to stop the whole Senate.... We ought to control our own agenda.

Just making this public is probably part of the strategy. Sadly, plenty of Democrats have swallowed the notion that procedural votes equal the votes themselves:

"Most Senators vote their conscience and they do what they think is right. They didn't come here to be told what to do by somebody else," moderate Sen. Evan Bayh (Ind.) said [...]

"You know how this place operates. Very often, it's the procedural votes that determine the substantive outcome. Sometimes not, but it's not uncommon that that is the case. So those votes on procedural issues will be cast as if they are the ultimate substantive vote," he said.

That's really only true if someone like Evan Bayh believes it. He can separate procedure and the final vote to his constituents if he wanted to. So we can only conclude that he'd rather not.

Good to know.

The Ever-Circling Trigger

Olympia Snowe, one of the few Republicans who may support a health care overhaul, has returned to the concept of a "trigger" for the public option, delaying its implementation and allowing the insurance industry an effective monopoly.

Sen. Olympia Snowe, a key figure in shaping federal health care legislation, said Monday that a government-run plan that would take effect if the private insurance market fails to deliver affordable coverage could bridge the partisan divide that threatens to derail President Barack Obama's efforts to reform the system.

Snowe, R-Maine, said she's working with Sen. Chuck Schumer, D-N.Y., to establish that kind of a framework in the bill expected to emerge next month from the Senate Finance Committee.

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

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

Responding to Snowe's comments, Schumer spokesman Brian Fallon said the Democrat will continue to seek a consensus with Republicans but believes there must be a public option that "is available to all Americans from the first day."

Schumer will talk with anyone, but his principle of a public option on day one is completely at odds with Snowe's concept. By the way, Schumer's vision of a public option, which apparently appears in the Senate HELP Committee's draft legislation, isn't good enough. It's the "level-playing-field" option that forsakes Medicare bargaining rates for a public insurance plan, turning it into a weak non-profit that won't drastically impact the marketplace.

But Snowe's concept, which would undoubtedly set an unrealizable standard to prevent the public option from ever coming into existence - that's how it works with Medicare Part D, which has a trigger as well - is a complete non-starter. And keep in mind, EJ Dionne informed us yesterday that the main GOP negotiator in the Senate, Chuck Grassley, will not sign onto a deal if only Snowe supports it, which means it would have to move to the RIGHT of Snowe's concept. And those Republicans are out there today demonizing the public plan as a "Washington takeover".

Fortunately, Democrats have been warning the GOP that they're willing to go it alone on health care if they remain unhelpful, using budget reconciliation requiring only 50 votes. There's still hope that the debate over the public option and health care reform generally will remain internally focused. But seeing Snowe step out on the trigger is worrying.

Meanwhile, consistent with my belief that more than the public option matters in this debate, here's Ezra Klein on health insurance exchanges, a concept that would add competition to every health care marketplace. Any public option would live in here, but it would also break the mini-monopolies in various regions, by offering an exchange that would allow consumers to choose from a variety of policies. The idea is to create a true insurance marketplace. However, if a national exchange gets whittled down to a state-based one, then it's effectively no different than current rules for the individual insurance market.

The strong version is national, or at least regional. It's open to everyone: The unemployed, the self-employed, and any business, no matter the size, that wants to buy its workers in. There's risk adjustment to reduce the incentive for cherrypicking. And all this means that each exchange has many tens of millions of people, giving it tremendous advantages in scale, simplicity and standardization. With tens of millions of potential customers, insurers are eager to participate, and they will bid aggressively to ensure they're included in the market and compete aggressively to make sure they're successful within it. Over time, the combination of increased efficiencies and greater competition drive down costs in the exchange, which will lead more employers to use it, which will in turn give it more scale and bargaining power.

The weak version is state-based. It's open to only the unemployed, the self-employed and small businesses. Risk-adjustment, if it exists at all, is crude. With such a limited pool of applicants, insurers aren't driven to compete, and the efficiencies of scale and competition are minimal. It never really grows, and instead exists as a marginal policy to mop up those who aren't covered by employers.

"Strong exchanges now!" doesn't exactly make sense on a bumper sticker, but it's plenty important.