The Public Option Has Become The Ballgame On Health Care

Ed Schultz is reporting on a new NBC poll showing that Americans, for the most part, want a public option in their health care plan. Here's a link.

On health care, the public remains open to persuasion. Without being told anything specific about the Obama plan in the survey, about a third of people said it's a good idea, about a third said it's a bad idea and the rest had no opinion. When given several details of his approach, 55% said they favored it, versus 35% who were opposed.

There was also support for the Democratic push to let people sign up for a public health-care plan that would compete with private companies, one of the toughest issues in the health-care debate. Three in four people said a public plan is extremely or quite important. But when told the arguments for and against the plan, a smaller portion, 47%, agreed with arguments in support of the plan, with 42% agreeing with the arguments against it.

At the same time, nearly half the participants said it was very or somewhat likely that their employer would drop private coverage if a public plan were available.

He was extremely animated, saying that Americans need to get in the face of their representatives and let them know exactly what they want - a strong public plan option to keep insurance companies honest and force a driving down of costs in the system in general.

In addition, people want no part of taxing health care benefits. In other words, the Obama Administration, which has come out in support of a public plan option and against taxing health benefits (or at least lukewarm to it), is getting the politics right. But Congress is not. They're offering half measures and calling compromises not run by the public sector as the "public option."

Chuck Todd's more measured response, which I also generally agree with, was that Americans will support a plan that has something tangible they can touch and feel, and the public option has supplied that space. MedPAC or e-health records will never do that, and taxing health benefits - which is not even really what's being proposed, we're talking about limiting or capping the exclusion - would tangibly feel like the taking away of something. I know that some health care wonks discount the importance of a public plan, but clearly, from a political standpoint, it's the whole ballgame.

...As usual, Ezra Klein makes a crucially important point here. The public option is ALREADY a compromise away from single payer. So the Schumer plan or the Kent Conrad co-op plan would represent a compromise of a compromise of a compromise.

Ducking The Debate

I just saw Howard Dean on The Ed Show asked about "taxing health benefits" (which is an oversimplification), and while he corrected Ed Schultz by saying that the reform discussed is capping the employer deduction, he said "I don't want to get into a debate about paying for this." Sigh.

If progressive advocates aren't willing to talk about how the hell we're going to pay in the short term for health reform, it won't happen. Period. The Administration has committed themselves to a fiscally responsible approach that is deficit-neutral in the short term. Peter Orszag talks about "Medicare and Medicaid savings" without explaining that as ending these lunatic Medicare Advantage payments where insurers get to privatize the system. To the average person that rightly sounds like paying for health care by cutting Medicare and Medicaid. That just won't play politically. And nobody agrees on the other revenue raisers. At some point this will all break down.

This belt-and-suspenders approach means we are not just banking on the long-term impact from the game changers to protect the budget. We also are demanding quantifiable cuts, efficiencies, and revenue-raisers so that the budget is not adversely impacted in the medium-term. That is to say, if the long-term savings from the game-changers materialize as expected, we wind up with a more efficient health care system and a better fiscal position. If they don’t, then at worst, we have a deficit-neutral plan that will not worsen our fiscal situation.

Everyone is talking in generalities about those cuts and efficiencies and revenue-raisers, in a way that will surely doom this reform when the specifics arrive. The Council of Economic Advisers report today is great, and it states very clearly the savings to families and the general budget from enacting meaningful health care reform.

We estimate that slowing the annual growth rate of health care costs by 1.5 percentage points would increase real gross domestic product (GDP), relative to the no-reform baseline, by over 2 percent in 2020 and nearly 8 percent in 2030.

For a typical family of four, this implies that income in 2020 would be approximately $2,600 higher than it would have been without reform (in 2009 dollars), and that in 2030 it would be almost $10,000 higher. Under more conservative estimates of the reduction in the growth rate of health care costs, the income gains are smaller, but still substantial.

Slowing the growth rate of health care costs will prevent disastrous increases in the Federal budget deficit.

Slowing cost growth would lower the unemployment rate consistent with steady inflation by approximately one-quarter of a percentage point for a number of years. The beneficial impact on employment in the short and medium run (relative to the no-reform baseline) is estimated to be approximately 500,000 each year that the effect is felt.

Expanding health insurance coverage to the uninsured would increase net economic well-being by roughly $100 billion a year, which is roughly two-thirds of a percent of GDP.

Reform would likely increase labor supply, remove unnecessary barriers to job mobility, and help to “level the playing field” between large and small businesses.

All of this is true, and makes health care pay for itself. One that doesn't appear in the bullet points of the executive summary is that wage growth would likely ensue because your raise is being plowed into paying for unaffordable employer-based health care.

But as long as the commitment to deficit-neutral policies in the short term remains - and there aren't 60 Senate votes for an unfunded mandate, regardless of what the President wants, which is why Orszag is saying this - you're going to have to find the money. And everyone shies from that debate. You see Ed Schultz, who plays a liberal on TV, get all worked up about "taxing health benefits" because the unions, frankly, don't want their hard-bargained health care benefits touched. In truth, capping the tax exclusion makes sense because it's a huge cash windfall ($246 billion in 2007 alone on this subsidy), but it runs into dicey politics. So does capping the charitable deduction. So does a value-added tax. So does any revenue-raiser, and so do cuts to Medicare and Medicaid, especially when they're explained so horribly.

Howard Dean needs to talk about how the hell we're going to pay for this. So do progressives generally. We always shy away from the responsible taxation argument, and it's about to kill health care reform.

A Peek Into The Machine

I just came across an astonishing interview on The Ed Show with Pennsylvania Governor Ed Rendell about the potential Specter-Sestak primary. It's a combination of a threat, Newspeak, muddled and often contradictory logic, and a depiction of how the spoils system works in government, particularly a machine state like Pennsylvania. It's really something, and it looks almost staged, like an infomercial designed to bash Sestak's chances in public. Here's a transcript.

Schultz: Do you think Joe's got a shot?

Rendell: I'm an admirer of Joe Sestak. I'm going to work hard to get him re-elected when he runs for Congress next year, not for the Senate. Joe should not run for the Senate in the Democratic primary, he'd get killed. And let me tell you why he'd get killed. Number one, Arlen Specter's been going around PA for three decades, as the Senator. He goes into every one of the 67 counties each and every year, and he holds town meetings, and he does constituent service, and he's never asked whether people are Republican or Democrat. Last three weeks or so, we've been having regional conferences with elected Democratic Party chairs, and elected Democratic officials, in every region of the state. It's unbelievable how many of them know Arlen personally, and admired him and supported him, even though he was a Republican in the past. You can't buy that, and you can't overcome that in one campaign. It's been thirty years. Number two, Arlen Specter will raise two, three, four times as much money as Joe Sestak. Number three, Arlen Specter has the support of the President and the Vice President, a President who's got a 90% approval rating among registered Democrats in Pennsylvania. Joe Sestak does not want to be one of the candidates who ran against Bob Casey in the Democratic primary, when the whole governmental establishment was for Bob Casey. He doesn't want to be marginalized, he doesn't want to get 15, 18%. Joe should run for Congress again, establish some seniority, his time will come. He's a terrific guy, his time will come, but it's not this year.

Schultz: Governor, you're very strong with that answer tonight. It almost sounds as if Joe Sestak would be making a fool of himself if he were to try this. Would you go that far?

Rendell: Well, I wouldn't say making a fool of himself, of course, Joe's a terrific guy, and he's got great credentials. But he's being talked into it by people on the extreme of the party, and they're good people, and they care about the right issues, but they don't represent the broad slice... this is a conservative state. I know people shake their heads when I say that, but the Democratic Party in Pennsylvania is more Bob Casey's party than it is Ed Rendell's party. I won because I was a great regional candidate, Ed, and I won re-election because I think I did a good job. But this, our Democrats are middle-of-the-road Democrats, with the exception of the Southeast. And Arlen Specter appeals very much to them. And it's not so much who I support, or who Bob Casey supports, it's all these party chairmen and all these elected officials that Arlen's been taking care of for years. And most people think that Arlen's supported our constituencies, and he has, over the years.

Schultz: So the infrastructure of the party in PA, would, no matter what side it is, is going to be with Arlen Specter. So the question begs, is anybody willing to step up and tell Joe Sestak, don't do this? That we've got a good enough guy, that he's gonna be good on the issues? Because Mr. Sestak was on this program, and the point that he made, he didn't like the idea that there was someone in the party, including yourself, including the President and the Vice President, that were willing to anoint Arlen Specter because he'd been around for a long time.

Rendell: Well, we anointed Bob Casey because he was a good candidate and he had been around for a long time, even though he was a young age, he started very young. Ed, it's not a question of anointing. In the end, people decide, not me, not even the President. People decide. But when they hear from the President that we need Arlen Specter. When people understand that Arlen Specter single-handedly saved the stimulus program for this country and put his political rear end on the line, when they understand that ten billion dollars more for NIH, to help us do research on every incredible disease that we're facing as a human race. People understand, and they like Arlen Specter and they understand that he's who the President wants. Look, I'm the last person to tell Joe not to run, because people told me not to run when I decided to run for Governor, because no one from Philadelphia had been elected since 1914 as Governor. So I'm not about to say to someone don't run. But I think Joe should think about what Arlen has done, the things that, the alliances that he's made over the years, the constituent services operation that has that's second to none, and the fact that he does have the support of Democrats, particularly the President.

Schultz: Well, labor has told me that they're not going to sit this thing out. Now, would this competition make Arlen Specter a better Democrat when it comes to voting on Employee Free Choice Act, free trade issues, and also health care reform? What about those three?

Rendell: Well, it's interesting. Both Joe Sestak and Arlen Specter are trying to broker a compromise on the Employee Free Choice Act, because they know they're aren't enough votes right now. There are at least, and you know this better than I do, Ed, how many Democratic Senators will not vote for the Employee Free Choice Act as is?

Schultz: Well, they're a little nervous about it, there's no question about that. But I think-

Rendell: Arlen and Joe are both trying to make some changes in the Act so that everyone can support it so they can have a broad base of support. So I think Arlen Specter has been for our constituents for the longest time. You know he's been called a RINO, a Republican in name only, and in fact there's a lot of truth to that. He's always been there for poor people, for working people. And he's been there for labor! He ran against a good Democratic Congressman, Joe Hoeffel in the 2004 election, and organized labor was for Specter. Arlen is going to do the right thing on the Employee Free Choice Act, just like he did on the stimulus. He's going to try and broker a compromise. Ironically, Joe's doing the same thing in the House. So, look, these guys are very much the same. Joe Sestak's not a liberal Democrat either.

Schultz: No, he's not. But he is better to labor, and he is, wants a public option on health care, and he is not the free trader that Arlen Specter has been. I think your analysis and your take is great, you know, I don't want to go against you on anything. I always want you on my team. You've got Pennsylvania down, there's no question. But from my instincts, I think Americans are tired of the good old boy network. And I love competition, and I think competition makes people better, that was my Op-Ed last night...

Rendell: And you're right about that, except, we will lose a terrific Congressman. Joe Sestak runs against Arlen Specter, he's out of the Congress, after just two short terms. We will lose a terrific Congressman, and when he loses to Arlen, he fades into political obscurity. He's a guy who should be there for us. We don't have a deep bench among Democrats in Pennsylvania, we need Joe to stay in the Congress and do the work he's been doing.

So, Sestak would get killed because Arlen backslaps all the party chairs and everybody loves him, and he'll raise a lot more money (a veiled threat alluding to what Rendell will tell local donors) and the President wants him in. Then he says that the dirty hippies are pushing Sestak, but Pennsylvania Democrats are conservatives and Arlen Specter, a 30-year Republican, suits them fine, and Rendell (the noted hardcore lib) only snuck in on a technicality, but Arlen's a good guy because he invented the stimulus package himself and he's supported everything Democrats have supported forever, because he's the Dennis Kucinich of the Keystone State. And then Schultz asks why are you choosing for the voters, and Rendell disavows doing that at all - no telling somebody not to run from him - and proceeds to say that Specter's "who the President wants," even though it doesn't matter who the President wants because people decide.

Then Schultz asks whether the pressure is good or bad, and Rendell says that Sestak and Specter are exactly the same on Employee Free Choice, "same" being defined as the fact that one supported it and one said he wouldn't support it in the curent form. But it's all fine because a lot of Democrats don't want to pass the bill - including Specter - and Arlen will "do the right thing" on that because he loves poor people. Anyway, Joe Sestak and Specter are exactly the same - never mind the hippie morons - and when Schultz talks precisely about the areas where they differ and says that competition is healthy, Rendell makes the most open threat of the interview, warning that we'd lose Sestak's Congressional seat (a district Obama won 56-43), and Sestak will fade into oblivion (with a not-so-gentle push from Rendell, of course).

This pretty much is how things are run in Pennsylvania, as I understand it. Rendell recounts with pride how he cleared the field for Bob Casey in 2006. If Rick Santorum, sensing a loss, switched parties then, Eddie probably would have cleared the field for him, too.

Me, I support democracy. And if Ed Rendell wants Arlen Specter to beat Joe Sestak and stay in the Senate, he has a means to do that. He has a vote. We'll see how it turns out next year.

...C&L has the vid: