When Faced With A Parliament, Act Like A Parliament

Ron Brownstein has been unusually perceptive of late, but this isn't quite right.

America is steadily moving away from the ramshackle coalitions that historically defined our parties and toward a quasi-parliamentary system that demands lockstep partisan loyalty. It is revealing that Obama is facing nearly unanimous Republican opposition on health care just four years after President Bush couldn't persuade a single congressional Democrat to back his comparably ambitious Social Security restructuring.

Bush couldn't persuade many Republicans either. Republicans held the majority in 2005 when he tried to privatize Social Security, and they never even brought a bill through a committee. In this case, votes will be held on the floor of both houses on health care.

The truth is that one side acts like a Parliament while much of the other thinks we still live in the days of bipartisan consensus. Both parties have different visions of how to govern, and despite that giving Villagers the willies, it's OK and expected. But if you have one side bending over backwards to work together, and the other side unyielding, the debate necessarily tips in favor of that unyielding side, as a matter of basic physics.

Brownstein does acknowledge this to an extent:

Today, these centrifugal forces most affect the Republican Party. The Right has more leverage to discipline legislators because conservative voters constitute a larger share of the GOP coalition than liberals do of the Democratic Party. The Right's partisan communications network also remains more ferocious than the Left's.

The GOP's homogenization has been accelerated, moreover, by its losses in swing areas since 2006. Far fewer congressional Republicans than Democrats must worry most about moderate public opinion. Fully 31 of the 40 Republican senators, for example, were elected from the 18 ruby-red states that twice backed Bush and also opposed Obama. Just four Republican senators were elected by states that voted Democratic in at least two of the past three presidential elections. (Not coincidentally, those four include Maine's Olympia Snowe and Susan Collins, Obama's best GOP prospects on health care.) By contrast, 22 of the 59 Democratic senators were elected by states that voted Republican in at least two of the past three presidential elections.

But again, this is truly wrong:

Party-line governing is intrinsically flawed. Any bill that must pass solely with votes from the majority party can't realistically incorporate ideas that divide the party. And that fact of life rules out half the tools in our policy toolbox. Though medical-malpractice reform would advance Obama's cost-control goals, for instance, it's impractical to include it in legislation that must pass solely with Democratic votes. Legislation is more balanced when both parties shape it.

The entire Rube Goldberg formation of health care reform, the likes of which we see in all the Democratic bills, are fundamentally Republican ideas. They basically mirror a bill by Republican Senator John Chafee from 1994. The same on climate change and its market-based cap and trade formation. Democrats have very liberally borrowed from the bipartisan "policy toolbox," often to a fault. They haven't added ideas like privatizing everything (yet) or handing out cash to industry (only in part) or forcing poor people to live on cat food, but those are not what I would call the sharpest tools in the shed.

Because of the rump Southern faction taking over the GOP, and because of... well, people like Ron Brownstein, telling us that bipartisanship conquers all and hippies must be punched in the face repeatedly, the trajectory on all these issues has moved sharply to the right over the past few decades, such that a bill like Max Baucus', a virtual handout to the health industry (who love it), can be described on the right - and taken seriously by the media - as a government takeover of health care.

You need look no further to see how Democrats deal with these issues than Jeffrey Toobin's article in this week's New Yorker on the Obama Administration's judicial nominees:

The Obama Administration wanted to send a message with the President’s first nomination to a federal court. “There was a real conscious decision to use that first appointment to say, ‘This is a new way of doing things. This is a post-partisan choice,’ ” one White House official involved in the process told me. “Our strategy was to show that our judges could get Republican support.” So on March 17th President Obama nominated David Hamilton, the chief federal district-court judge in Indianapolis, to the Seventh Circuit court of appeals. Hamilton had been vetted with care. After fifteen years of service on the trial bench, he had won the highest rating from the American Bar Association; Richard Lugar, the senior senator from Indiana and a leading Republican, was supportive; and Hamilton’s status as a nephew of Lee Hamilton, a well-respected former local congressman, gave him deep connections. The hope was that Hamilton’s appointment would begin a profound and rapid change in the confirmation process and in the federal judiciary itself [...]

But then, as the first White House official put it, “Hamilton blew up.” Conservatives seized on a 2005 case, in which Hamilton ruled to strike down the daily invocation at the Indiana legislature because its repeated references to Jesus Christ violated the establishment clause of the First Amendment. Hamilton had also ruled to invalidate a part of Indiana’s abortion law that required women to make two visits to a doctor before undergoing the procedure. In June, Hamilton was approved by the Judiciary Committee on a straight party-line vote, twelve to seven, but his nomination has not yet been brought to the Senate floor. Some Republicans have already vowed a filibuster. (Republican threats of extended debate on nominees can stop the Democratic majority from bringing any of them up for votes.)

“The reaction to Hamilton certainly has given people pause here,” the second White House official said. “If they are going to stop David Hamilton, then who won’t they stop?”

The answer, of course, is that they will try to stop everyone and everything, if only to gum up the works and force the majority to move more slowly on its priorities. The new Republican Party comes up from the mold of the college Republicans, taught early to use every dirty trick, every strategy, not to govern but to beat your opponent. They may have poisoned American politics and taken it completely away from the high-mindedness where Villagers like to think it has always been (it hasn't), but there's really only one way to deal with that. Brownstein concludes:

But with Republicans operating as a parliamentary party of opposition, Democrats will have to pass health care reform virtually, if not entirely, alone. That leaves them with a binary choice: Democrats can either fragment into stalemate or function as a parliamentary majority party by unifying enough to advance their agenda. The choice would seem straightforward. If one side in a firefight is operating with military cohesion and the other devolves into ragged, undirected units, it's not hard to predict which will suffer more casualties.

That's just an obvious sentiment, though from the looks of things, one with which Democrats have not yet reconciled themselves.

The Unceasing Disaster That Is Max Baucus

This is it. A year of planning. Three months of intensive bipartisan discussions. Weeks of preparation for the public. And Max Baucus is going to deliver his health care bill... without a single Republican vote. Which anyone with a brain could have told you would be the outcome right from the start.

Senate Finance Committee Chairman Max Baucus (D-Mont.) will release his long-awaited health care reform bill Wednesday – but without the Republican support he has sought for months.

Baucus tailored his proposal to win the backing of some Republicans, hoping to keep alive the possibility that Congress would pass a bipartisan bill.

But after months of closed-door talks, none of the three Republicans involved the bipartisan Gang of Six is expected to declare support for the bill Wednesday.

Baucus said he was still hopeful the bill will emerge from the committee vote with bipartisan backing.

Get that? Baucus wrote a Republican bill, essentially, one that is a gift to the insurance industry, and he got nowhere. And for his efforts, he got blasted by Charles Grassley, who disapproves of the "process." See, he wanted another year or two at the bargaining table delaying a final product, anything else is just a power grab. By the way, Baucus is still "hopeful" for a bipartisan vote. Which means what, he'll add in riders criminalizing abortion and commemorating Rush Limbaugh Day?

The GOP freeze-out on the Baucus bill includes Olympia Snowe, who's actually concerned, like many Democrats, about the weak affordability standards.

But let's not lose sight of why Snowe balked at the Baucus framework. For one thing, she's concerned about the financing mechanism, which she believes would hit Maine hard. But just as importantly, Snowe also believes (as I do) that Baucus' plan offers weak and inadequate subsidies. "The affordability question is crucial," Snowe said. "It's a central component, because at the end of the day people have high expectations they will have access to affordable health insurance."

In other words, one of the leading Republican negotiators on health care reform believes Baucus' plan is too conservative.

More Democrats have spoken up about the affordability concerns, which fall on the poor and middle class. At best, the weak subsidies would force loads of Americans to opt out of the mandate, making the bill useless. At worst, people would be forking over large portions of their income to private industry for substandard coverage. It's just another version of the middle-class squeeze.

Mr. Norton, 49 years old, is an adjunct professor at a local community college who earns about $40,000 a year. He's also one of roughly 200,000 Massachusetts residents who remain uninsured despite a state law requiring residents to have health insurance.

"I can't use up all of my savings just to buy mandatory insurance," Mr. Norton says. It's like penalizing "the homeless for refusing to buy a mansion." [...]

An independent contractor, Mr. Norton doesn't get benefits through the state-run Quinsigamond Community College where he works. His wife's employer, a dental practice, covers her, but not dependents. With a combined income of between $60,000 and $70,000, the family goes without cellphones for Mr. Norton and his teenage daughter, and a needed roof repair, but still makes too much to qualify for subsidies.

The cheapest plan available to him and his 16-year-old daughter costs $464 a month, or $5,568 a year, and comes with a $2,000 deductible per person.

"It's insurance you can't possibly use," he says, referring to the thousands of dollars he'd pay in premiums and deductibles before the coverage would kick in.

Baucus has an anodyne op-ed putting the best face on his plan. Those who've taken a look at it know better. And it has to be improved before getting out of the Senate.

...here's the Baucus chairman's mark. It's mostly in plain English.

60 Again Shortly?

We're getting closer to Massachusetts being able to appoint an interim successor until the special election that will be held January 19 fills the slot once held by Ted Kennedy. I didn't think Massachusetts lawmakers would be constrained by appearances on this one. Plus, they are fulfilling the expressed desire of the electorate to have two Senators, including one who shares Ted Kennedy's beliefs and policy positions.

By the way, the whitewash of Kennedy from a liberal lion into the great conciliator and compromiser who would have bargained away the public option in a second is truly insidious. Jed Lewison, who was there during the Medicare Part D fight, has some good thoughts on this over at Daily Kos. In short, Kennedy opposed the Medicare deal because it became an industry trough-feed at the end. Despite this, conservatives keep parroting this "compromiser" spin, particularly with respect to that vote.

The reason for Fox's lie couldn't be more obvious: they desperately want Democrats to cave on the core elements of health care reform, and they think that creating a false narrative about Ted Kennedy will make their wish come true.

Ted Kennedy probably wouldn't want us to pass meaningful health care reform solely to honor his legacy. In fact, of all the reasons health reform needs to be passed, that's probably not even on the list.

But Ted Kennedy's passion for health care reform does inspire us to achieve the goal of universal, affordable coverage. And the record shows us that despite his best efforts, Republicans cannot be trusted to be fair partners in the process of getting there.

More.

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.

Must Have Had A Restful Vacation

Robert Gibbs appears to be on his game today. In response to Fourthbranch's rantings on Fox News, he gave the appropriate rejoinder:

I’m not entirely sure that Dick Cheney’s predictions on foreign policy have borne a whole lot of fruit over the last eight years in a way that have been either positive or, to the best of my recollection, very correct.

In other words, why would you give a crap what Dick Cheney has to say?

Later, asked about Mike Enzi attacking health care reform while also serving as one of the key bipartisan negotiators, Gibbs replied:

"In Senator Enzi's case, he doesn't believe there's a pathway to get bipartisan support and the President thinks that's wrong," Gibbs said. "I think Senator Enzi's clearly turned over his cards on bipartisanship and decided that it's time to walk away from the table."

Now it's time for the President to walk away from the table. Not sure if Gibbs' new, more aggressive approach signals something similar from Obama, but I know that the base would reward such feistiness.

The Meaning Of Compromise

I think everyone expected Republicans to pre-emptively accuse Democrats of politicization in the wake of Ted Kennedy's death. (By the way, please politicize my death.) But that's just the far edge of the Overton window, the bluff so Democrats won't try to take comfort and inspiration to pass the cause of Kennedy's life. The far more insidious tactic, proffered by the right in a coalition with the bipartisan fetishists in the media, is to revise Kennedy's legacy as that of the ultimate centrist, in a fashion, the bipartisan dealmaker, the Great Compromiser. They've done a full-court press on this:

Senator Judd Gregg is already hinting at the idea. In an interview with the Boston Globe, Gregg hailed the bipartisan support for legislation he and Kennedy created together, adding that Kennedy knew how to “move the ball down the road with conservatives like myself.”

Meanwhile, Karl Rove hailed Kennedy on Fox this morning for being “willing to compromise.”

Other GOPers are floating the idea in The New York Times anonymously, in a discussion of how to navigate the politics of Kennedy’s death:

Republicans also noted that Mr. Kennedy, though an ideological liberal, was a legislative pragmatist who worked with Republicans to strike compromises on difficult subjects like health care, education and immigration. They said they saw little such reaching across the aisle in his absence.

Any member of the United States Senate with a long record will have many moments of compromise, whether between the parties or intra-party. But the idea that Kennedy should be remembered for "making the right concessions," solely in the context of bipartisanship, is a media projection helped along by a right wing who wants to blame Kennedy's absence for political polarization and the eventual death of a health care bill. We see this today with Steven Pearlstein's eleventy-billionth column arguing for the wise, high Broderist, split-the-baby approach:

And while there will be plenty of liberal Democrats who will be fuming about all the compromises forced upon them, somewhere from above will come a familiar voice with that distinctly Boston accent, whispering, "The dream will never die. Take the deal."

Notwithstanding the fact that Kennedy's staff wrote the HELP Committee version of the bill, and Kennedy himself labored over it, and that includes a public option, misses the point of Kennedy's legislative style, which continued to focus on broadening his goals and moving ever forward even when the odds weren't on his side. As Jonathan Cohn writes:

But this notion that Kennedy's liberal reputation somehow belied his pragmatism--a notion already gaining traction in the media, which has turned non-partisan accommodation into a fetish-- misses the point. Kennedy compromised on means, not ends. He would negotiate because it helped achieve his broader goals--signing on to NCLB, whatever its cookie-cutter standards, because it would send money to schools in poor, underfunded districts; embracing the Medicare drug benefit because, however poorly designed, it'd save senior citizens from having to choose between medicine and food.

It was precisely because Kennedy's devotion to his notion of social justice was so clear and dependable that he could make such deals stick. Liberals trusted him because we knew he wouldn't sell out the broader cause. If it was good enough for Kennedy, we figured, it was good enough for us. We knew he didn't see pragmatism as an alternative to ideology. It was just a necessary method of fulfilling it [...]

In the hours since Kennedy's passing, his speech to the 1980 Democratic convention--his most memorable oration, along with the RFK eulogy--has gotten a lot of play. Typically the networks show the final quote, in which he promises to continue his crusade even as he gives up his quest for the presidency. But the more important passage is where he invokes Franklin Roosevelt as an unabashed defender of the common man against the forces--and, yes, the people--who would disregard his well-being. Like FDR, Kennedy was not afraid to talk about values, to talk about right and wrong. Now that Kennedy is gone, who will pick up that torch?

Blue Dogs and ConservaDems have high praise for compromise these days, but their version of it basically preserves corporate goals and sells out their constituents in the exchange. Kennedy's version was precisely the opposite. His concern was "the least among us," the poor, the elderly, the disabled, the sick, the oppressed, the downtrodden, the less fortunate. He tried to get something for them, whenever possible. Pundits can call that "bipartisanship" but they ought to understand what that means.

The deviousness of the conservative project, to lament Kennedy's passing because now wild-eyed ideologues (like Max Baucus?) will go crazy, is clear. The true scoundrels, however, are those in the press trying to position the life of the man who did as much to advance the causes of the voiceless as anyone in the history of the Senate as someone who preferred half a loaf. Democrats should take a better lesson.

No, mere words cannot honor Ted Kennedy's memory. To pretend otherwise would be to cheapen his legacy, to lie about who Ted Kennedy really was. He was, for the vast majority of his life, a fiercely ideological public servant. It was his commitment to that New Deal social compact which defined him, which made him relevant to you and me. And his actions, not his words, were what marked him as the greatest Senator of his era. To attempt to honor Ted Kennedy without striving to further his life's work is simply impossible.

When Paul Wellstone died they told us that we couldn't celebrate him him as a political actor, that to do so would be crass and opportunistic. But the entire reason we knew Paul Wellstone, the reason we were crushed by his passing, was his political activism. It would have been a lie not to celebrate that legacy. It would have been crass to act as if Paul Wellstone hadn't been first and foremost a progressive hero, to feign nonchalance over political concerns as we eulogized the man, and in so doing stripping him of his essence. Likewise, it would be a lie today to pretend that the reason we loved Ted Kennedy had nothing to do with his leadership for working people. And it would be crass to attempt to celebrate him with mere words, rather than the action he demanded from us in life. How can we not "politicize" his legacy? The man was who he was because of his wholehearted commitment to his politics. The real obscenity -- the real opportunism -- would be for his political opponents to now try and depoliticize a quintessentially political life.

...George Steph agrees: Kennedy would have ditched the public option. Amazing how Kennedy's beliefs, after his death, line up perfectly with the beliefs of the blow-dried commentariat, n'est-ce pas? Lawrence O'Donnell, by the way, has a different perspective:

"Senator Kennedy...is not an easy compromiser on health care reform. In 1994, I was in the room when he told the president that he believed the strategy should be a Democrats-only strategy and that we should not be trying to reach out and get Republican votes."

Rubber, Meet Road

We know that the entire conservative movement is laboring tirelessly to block meaningful health care reform this year. They are armed with lies, false outrage, and the ability to whip their supporters into a frenzy with carefully deployed buzz-words. And this goes too for those pretending to engage in bipartisan talks in the Senate Finance Committee's Baucus caucus:

Mike Enzi, one of three Republicans ostensibly negotiating health care reform as part of the Senate's "Gang of Six," told a Wyoming town hall crowd that he had no plans to compromise with Democrats and was merely trying to extract concessions.

"It's not where I get them to compromise, it's what I get them to leave out," Enzi said Monday, according to the Billings Gazette.

Enzi found himself under attack at the town hall simply for sitting in the same room as the three Finance Committee Democrats. Republicans in the crowd called for him to exit the talks. He assured conservatives that his presence was delaying health care reform.

"If I hadn't been involved in this process as long as I have and to the depth as I have, you would already have national health care," he said.

"Someone has to be at the table asking questions," Enzi said. "If you're not at the table, you're on the menu."

His alibi for being in the same room as Democrats is that he's there to block reform. So with each day Baucus and Kent Conrad and Jeff Bingaman stay in that room, they enable this obstruction.

I've been saying this for months, but you don't have to wonder any more about the GOP's role in health care reform. And I mean the whole GOP. They exist solely to block it. So if the Democrats actually want a bill, they'll have to get it over, around and through Republicans, not with them. Thinking anything different is just living in a dreamworld.

This comes back to the leadership of the President. This WaPo story is on a completely different subject, but it gives voice to the frustrations of millions upon millions of Obama supporters. They're wondering whether their President bears any resemblance to their candidate.

In recent weeks, as even staunch supporters of the Obama administration's $787 billion two-year stimulus package have questioned the program's lagging pace of job creation, a small but increasingly restive group of African American municipal officials in Southern states have complained that not enough money is reaching communities like those found in the chronically impoverished Delta. Their ranks include (Greenville, MS mayor) Hudson, who frequently encounters constituents steadfastly loyal to Obama but nonetheless asking when help from his administration is coming.

Hudson's life has changed significantly since the president's election. The White House Office of Intergovernmental Affairs has made her a regular participant in conference calls with other mayors and leading county officials. But with her new access to the powerful in Washington have also come reminders of the expectations that follow any charismatic figure entrusted with the presidency. "I know things have been a little slow for some people," she says. "People see me in our Wal-Mart here and ask, 'We have a new president: When is it all going to get started? When are there going to be jobs?' . . . People here were anticipating that there was going to be a big package of jobs and money with a wrapped bow signed 'Obama' at the bottom."

In other parts of the rural South, local government representatives have also given voice to the mounting frustrations of their communities. The objections are wide-ranging -- everything from stories of confounding red tape in the stimulus program's application process to a general lament that federal officials have sometimes overlooked small communities devoid of the kinds of staffing, computer resources or technical expertise needed for preparing sophisticated grant proposals.

People may not know the ins and outs of the legislative process, but they know they voted for hope, and they want help. Some of the calls may be impractical or rushed, but people thought they were voting for a new era of leadership, and seven months in, they're waiting for that leadership to take hold. In a sense, Obama is a slave to a legislative process that resists change in very significant ways. At the same time, he is not impotent. He can forcefully rebut the fiscal scolds who use every opportunity to argue against something new, whether the economy is booming (don't mess with a good thing) or in crisis (don't add a burden now). He can figure out the legislative means to navigate the bottlenecks of the Congress, bypassing committees or using reconciliation or breaking filibusters.

Nobody says it'll be easy. But at this point, failure to pass anything will demoralize the base and leave progressive change in the waiting room for perhaps another generation. From a political perspective, the Democrats have no choice. And they have no partner on the other side of the aisle. They're going to have to take the leap themselves - and given that, they'd better make any reform the best it can be, or even passage won't save them.

Gang Of Six Member Recognizes That Bipartisanship Is Dead

Jeff Bingaman, the least vocal member of the Gang of Six, is resigning himself to the reality that his bipartisan funfest is nothing more than a charade, and anyone who actually wants to pass health care reform is on the Democratic side of the aisle.

Sen. Jeff Binagaman (D-NM)--one of the six members of the Senate Finance Committee who have been hashing out a health care reform bill for months--says that if bipartisan negotiations go nowhere, he'd support an effort to circumvent a filibuster and pass legislation without any Republicans.

"If we are unable to do it any other way, that is an option. It is a very difficult option," Bingaman told a crowd of about 200 at a town hall event in Albuquerque yesterday. He was referring to the possibility that Democrats will pass health care reform through the so-called budget reconciliation process.

The acknowledgment signals that even those members of Congress most invested in passing bipartisan health care reform are well aware that those efforts might not bear fruit.

"I don't think that that effort [at bipartisanship] is what is stymying progress," Bingaman said.

"It may well not succeed, but it has been worth the effort, and we are continuing with it."

I obviously don't agree that it's been worth the effort, but if you're a Democrat who really doesn't want to pass health care reform without bipartisan cover, it has. But the moderates made a tactical error. They now risk passing no bill at all because Republicans won't budget one inch to help them. They've allowed the town hall meeting craziness narrative to take hold, to the extent that even liberals like Russ Feingold are proclaiming that there will be no bill until Christmas. The legislative fight has become a test of mettle, and if Democrats lose their most vulnerable members will simply be wiped out next year. So now they really have to do this on their own. You wouldn't see Democrats openly talk about waiving the Byrd rule if that wasn't the case.

Should Democrats use the procedure known as reconciliation, the assumption has been that certain elements would have to be stripped out of the bill and passed separately, because a Senate rule known as the Byrd Rule only allows reconciliation for legislation that costs or raises substantial amounts of money. That would include the expansion of Medicare or Medicaid, revenue-raising tax provisions, and even the creation of a public health insurance option, depending on how it's written. But non-budget-related items -- most of the new insurance industry regulations, for instance -- would presumably be put in a separate bill that would go through regular order -- and would therefore need 60 votes to overcome a filibuster.

Passing two separate bills, however, is seen by some Democrats as too much of a lift for the slow-moving Senate.

But there's another alternative, according to Martin Paone. Paone, who served as a Democratic Senate floor staffer for 29 years, has been advising Democrats as they craft their legislative strategy. He proposes that Democrats try to get 60 votes to waive the Byrd Rule -- which would then allow the inclusion of those non-budget-related provision in one bill that would require only 51 votes for final passage [...]

Conservative senators such as Mary Landrieu (D-La.), Ben Nelson (D-Neb.) or Olympia Snowe (R-Maine) could, in voting for a Byrd Rule waiver, put themselves on the record as being in support of popular insurance industry reforms, while still opposing final passage of the bill -- a political strategy that may be appealing to them.

This happened in both 1990 and 1997, under Democrats and Republicans. The world didn't end.

Mike Lux has a primer on the best practices to get a good bill through the sausage-making process. Let's check off where we're at on them:

• Hold the progressives in the House to only vote for a public option. So far, so good. They've signed multiple letters, taken multiple pledges, sent a very clear message about their determination. They need to stay strong.

• Get the Democrats in the Senate to accept that this will have to be a Democrats-only bill. This seems to be moving in the right direction. Schumer sent exactly the right message over the weekend, and it's clear things are beginning to head that way.

• Split the bill into two parts in the Senate, with the public option and the financing going through the reconciliation process. Democats are sending signals that they are moving in that direction as well.

• Get enough Senators on board for the public option. The whip count DFA and we at OpenLeft have been running shows us at 45. We need five more, and there are several Democrats I think are prime possibilities to come along if this is the path we go down.

• Above all, don't panic. There will be some rough days ahead. Certain Senators will keep saying we can't get this done, and pundits will continue to shed the worst possible light on each day's events. But we just need to hang tough, hold strong, and keep working.

Everything's moving in the right direction, actually, and on #3 we're seeing the Senate take a look at an even bolder line. But panic is always in the air when you're dealing with Democrats.

...Shep Smith is going to get fired.



The last thing I'm worried about is that Republicans will be able to stop the budget reconciliation process. Nobody really cares about Senate procedure and you can't build a movement out of it. They're trying to scare Democrats into not using it, and that may work, but everybody knows that the GOP is full of crap on this one. Even Shep Smith.

Those Who Fail To Learn History

It's hard to actually single out the dumbest conservative tripe you hear in a given day, but this is pushing it.

President Obama might not be aware of this but FDR passed Social Security with massive Republican support -- 81 Republicans voted in favor of the measure in the House and only 15 against while 16 Republicans voted in favor in the Senate and just 5 against. Johnson's Medicare package was only marginally more contentious. Just 13 Republicans voted in favor of Medicare in the Senate to 17 against, but in the House, more Republicans (70) voted for Johnson's Medicare plan than against (68).

Scott Lemieux' Shorter version might suffice, but just to expand a bit. In the 1930s and 1960s there were progressive Republicans and Dixiecrats. The same Southerners yelling that Obama is a Birther would probably be Democrats 40 years ago. Mississippi's James Eastland was far crazier than anyone serving in Congress today, and he was a Democrat. You can take African-American Massachusetts Senator Edward Brooke, a Republican, or John Lindsay or Mark Hatfield, as the example on the Republican side.

The parties did not experience much ideological purity until post-Nixon's Southern strategy. Hell, even in 2004 Zell Miller was still a Democrat. It took a long, long time, but this has pretty much finally shaken out, and now you have an arch-conservative Republican Party. Finding votes among them is an impossible task for any Democrat. Meanwhile, not only has political polarization increased over time, but Republican moderates have been purged from their party:

It’s also worth noting that if you look specifically at, say, Barack Obama’s success in wooing moderate Republicans from New England he’s doing a great job. His stimulus bill secured the support of literally 100 percent of the GOP congressional New England caucus. And the odds that his health care bill will secure the support of 50 or 100 percent of New England Republicans remains good. The issue is that there are only two of them. And this is no coincidence—very recently there were a lot more. I think it’s quite plausible to speculate that had Robert Simmons and Chris Shays spent their time swearing up and down Connecticut that they were eager to vote for universal health care and a tough cap and trade bill and were just chomping at the bit to find a President they could work with that those two gentlemen would still be serving in the United States House of Representatives.

By the way, Matt Y. also offers the lesson of James Eastland, who was the Democratic chair of the Senate Judiciary Committee in the 1960s:

Another moral of the story is that Eastland’s chairmanship of the Judiciary Committee obviously made passage of the Civil Rights Act of 1964 impossible. Senate Majority Leader Mike Mansfield and President Lyndon Johnson dealt with this by just . . . not letting the bill get bottled up in committee and bringing it to the floor instead. The sky didn’t fall! Leading politicians decided that justice was more important that the dead hand of Senate procedure and they brought the bill to the floor where it was voted on.

Somehow, this leads me to think about Max Baucus and the Senate Finance Commitee...

Jon Kyl - Objectively Pro-Discrimination

Under current law, health insurance companies can deny you coverage if they decide you actually might use a doctor. They can discriminate against broad classes of Amercians based on what they call in insurance-speak a "pre-existing condition." They can even go back after you turn in a claim and find some typo in your medical history form that allows them to dump you from the coverage rolls.

Jon Kyl, the #2 Republican in the Senate, thinks this is all fine and dandy.

The distance between the parties' leaders on health care was made clear on Tuesday when the No. 2 Republican in the Senate held a conference call with reporters.

Asked by ABC News about a package of insurance market reforms that have been endorsed not only by President Obama but also by the insurance industry, Sen. Jon Kyl came out against all three proposals.

In particular, the Arizona Republican signaled that he opposes requiring insurance companies nationwide to provide coverage without regard to pre-existing conditions; requiring them to charge everyone the same rate regardless of health status; and requiring all Americans to carry health insurance.

"One of the concerns I have about the approach of the Democrats ... is an assumption that there has to be a national mandate on all insurers to do various things," Kyl told ABC News when asked for his position the three issues.

"Those are techniques that states can, and some have, used in the past with fairly disastrous consequences," he said.

Part of what community rating would ban is allowing companies to charge women more money for health insurance, because they may use more care. And actuarial statistics show that the poor have a higher propensity for sickness due to environment and food choices, which means that they are discriminated against at a higher proportion in the insurance market. That's the system Jon Kyl wants to keep in place - a segregated system where large segments of society cannot even have the option of health insurance.

Even the insurance industry supports guaranteed issue and community rating. They want that along with a forced-market monopoly, with no competition from a public insurance option, so that the government can subsidize their businesses and turn people who cannot afford health insurance into criminals. But that would be LESS RADICAL than what Jon Kyl is proposing.

These are the people with whom we must engage in bipartisanship, or so it is told.

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.

What Obama Wants

Robert Gibbs sez Obama "wants" a bipartisan bill. I want a recording session with Styx. (That's right, Styx) It's not going to happen, however. So he can "want" something all he wants, even say it publicly, but if he wants a bill, he's going to have to go it alone. And I think Obama recognizes that.

The President has also said that he "wants" a public option in the bill. It's funny how it's given as Beltway conventional wisdom that reality is intruding on the ability to get a public option, but not on bipartisanship. Especially when you look at the numbers, with no Democrat committing to filibuster health care reform, but 64 Democrats in the House vowing to vote against any bill without a public option. Beltway types aren't really good at math.

Maybe they can read a poll.

Just 34% of voters nationwide support the health care reform plan proposed by President Obama and congressional Democrats if the so-called "public option" is removed. The latest Rasmussen Reports national telephone survey shows that 57% oppose the plan if it doesn't include a government-run health insurance plan to compete with private insurers.

There are multiple positive elements to be gained from a health care reform bill as set out by Congress - Families USA lists ten of them very succinctly right here - but the lack of messaging from the White House created a vacuum, and the public plan slid into that space. It cannot be bargained away at this point, as it's become synonymous with reform. Clamping down on insurers is great (though who, exactly, will do that?), and I want to see Medicaid expanded and subsidies for those who can't afford coverage and real competition through an exchange. And modernizing health care delivery and Medicare spending, cutting waste from the system and securing give-backs from providers is all awesome. But the politics of the situation are such that the public option can no longer be decoupled from the bill. Indeed, the intensity and energy around the public option is the only thing sustaining the bill, as it completely changed the conversation from right-wing tea partiers and gun-toting loonies to policy considerations. Even with supporters outnumbering the opposition, the town hall meetings gambit was a losing bet and it would have threatened reform severely. Obama has a chance to deliver on what he says he "wants" now, which would burnish his credentials among the base and create the energy needed to drag legislation over the finish line.

I guess it all depends on what he wants: bipartisanship, or a public option.

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.

Energy And Commerce To Mark Up - HC Out Of All Committees By The Recess

After reports overnight of no deal with House Blue Dogs, now there are reports of a compromise being reached and a markup session in the Energy and Commerce Committee scheduled for just a couple hours from now.

Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) has cut a deal to reconvene his committee and vote on the Democrats' sweeping health care bill, with a goal of completing work by the time lawmakers leave town for the summer on Friday.

There won’t be a vote before the full House before the August recess, but the committee breakthrough – after tense negotiations with Blue Dog Democrats – is a significant step for the Democrats.

"After two weeks of very long and intense negotiations, I'm proud to report that we've reached an agreement that will allow health care reform to move forward," said Arkansas Rep. Mike Ross, a top negotiator for Blue Dog Democrats on the Energy and Commerce Committee.

After all this, the Blue Dogs will only allow four of their members to vote on this package in committee.

And here's what they got for their troubles:

The Blue Dogs also succeeded in cutting $100 billion from the overall cost of the bill, bringing the total price tag under $1 trillion. The legislation will now exempt small businesses with a payroll less than $500,000 from paying for any government-sponsored health coverage - double the $250,000 in the initial draft. Doctors and other health care providers would also be allowed to negotiate their payment rates with the government-sponsored health care arm.

The new version of the bill also has a breakthrough on the concept of health care “co-ops,” seen by some as an alternative to a public plan. States would be allowed to create co-ops for residents to buy private insurance. But the Waxman-Ross deal will also keeps the "public option" of government-sponsored health care.

That first paragraph has internal contradictions all over it. The Blue Dogs "succeeded" in cutting costs from the bill - but the two subjects mentioned ADD to the bill's costs. Exempting more small businesses from the employer mandate means less money from small businesses that do not provide insurance for their employees. And allowing providers to negotiate payment rates with the public option, as well as opt out of the network, means higher costs and less choice for individuals who purchase their plans. It's not really fiscally responsible. It also doesn't explain where those cuts came from. I'm hearing that this comes through "enhanced delivery system reforms" and cutting the expansion of Medicaid as well as the "affordability credits" for those who lack insurance. I'm guessing that they lowered the subsidy level to 300% of the federal poverty line. Matt Yglesias argues that not many people in between 300-400% FPL lack insurance, but it would still provide an additional burden on their bank accounts.

Where would this compromise leave health care reform? All three committees in the House will have passed their bills, but members would go home for recess while those bills get merged by the leadership. That puts the House trajectory on line with the Senate, where the Finance Committee is making progress toward a goal of passing their bill out before the recess. So in that intervening month, while progressives and conservatives do hand-to-hand combat in town hall meetings and on the airwaves, Nancy Pelosi and Harry Reid have to figure out what to keep in and out of the various bills, for floor votes in September.

Meanwhile, the White House has released eight guarantees that would emerge from any health care bill, which all sound like insurance reform, the line they've been using recently, and which don't include anything to really transform the system.

* No Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

* No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

* No Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

* No Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

* No Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.

* No Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

* Extended Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.

* Guaranteed Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

OK. These are all solid reforms that would help a lot of people. But they are incremental reforms at the edge of the policy. I understand the thinking - these are the consumer-based reforms people will actually see. But they'd see a public option in competition with an industry that currently denies coverage and does everything they can to get out of paying for treatment. I fear that nothing more fundamental is being attempted out of a fetishistic need for bipartisanship that trumps common sense and the actual prevailing political reality.

Over at Senate Finance, judging by the reports coming of the committee, a solonic gang of six -- three Democrats, including chairman Max Baucus of Montana, and three Republicans, including ranking member Charles Grassley of Iowa -- are turning out a bill whose resemblance to anything the president has championed is accidental and incidental. To secure Republican support, they oppose a public plan. To secure Republican support, they oppose employer mandates, even on the largest corporations. (And many of America's biggest employers are retailers with a proven record of not providing coverage to their workers: Wal-Mart, our largest, employs 1.4 million Americans, most of whom it does not cover.) The solonic six may end up requiring employers to fund subsidies for employees who need them, but that could create the bureaucratic nightmare to end all bureaucratic nightmares -- 700,000 Wal-Mart employees, say, bringing their tax returns to work so management can investigate ("You sure you reported all your income?") and stall ("Doesn't your spouse work at Home Depot? Why don't they pay the subsidy?") and investigate and stall.

Sounds like a plan to secure universal coverage by the middle of the next century [...]

Problem is, bipartisanship ain't what it used to be, and for one fundamental reason: Republicans ain't what they used to be. It's true that there was considerable Republican congressional support, back in the day, for Social Security and Medicare. But in the '30s, there were progressive Republicans who stood to the left of the Democrats. Nebraska Republican George Norris, who for decades called for establishing public power companies to compete with price-gouging private companies, was the father of the Tennessee Valley Authority. In the '60s, Rockefeller Republicans supported civil rights legislation and Medicare.

Today, no such Republicans exist. In New England and New York, historically the home of GOP moderates, Republicans occupy just two of 51 House seats. Nationally, the party is dominated by Southern neo-Dixiecrats. In their book "Off Center," political scientists Jacob Hacker and Paul Pierson compared congressional Republicans of different eras and concluded that a Republican House member in 2003 with a voting record that placed him at the median of his party was 73 percent more conservative than the median GOP member of the early '70s.

Max Baucus, then, isn't negotiating universal coverage with the party of Everett Dirksen, in which many members supported Medicare. He's negotiating it with the party of Barry Goldwater, who was dead set against Medicare. It's a fool's errand that is creating a plan that's a marvel of ineffectuality and self-negation -- a latter-day Missouri Compromise that reconciles opposites at the cost of good policy. Obama should thank the solonic six for their work, and, as much as is politically practicable, ignore it.

Exactly. You don't negotiate with crazy.

There's still a fight to be had on the public option, the design of the insurance exchanges in which a public option sits, and several other features. Ultimately the Blue Dogs appear more nervous than obstructionist, so August will be consequential. I hope OFA is ready.

...Really, negotiate with this?

This unidentified man decided he was doing the Tea Party-anti-reform effort a real solid by hanging freshman Maryland Democratic Rep. Frank Kratovil in effigy [note the creepily expert knotted noose] with a placard "Congress Traitors The American [and a word that looks like "idol"].

The event — a rally in Salisbury, Md. on the Eastern Shore — was attended by members of the business-funded Americans for Prosperity, a group that includes James Miller, a Federal Trade Commission chairman and budget director during the Reagan administration.

...More info on the Waxman-Blue Dog deal. They lowered the rate of the subsidy between 300-400% FPL, rather than eliminating it. And as stated above, the public option remains, albeit weakened because it can't use Medicare bargaining rates at all, but rates negotiated by the Health and Human Services Secretary.

Mad Max

Sen. Baucus emerges from the bipartisan crypt and comes up with a health care bill that cannot possibly work.

After weeks of secretive talks, a bipartisan group in the Senate edged closer Monday to a health care compromise that omits a requirement for businesses to offer coverage to their workers and lacks a government insurance option that President Barack Obama favors, according to numerous officials.

Like bills drafted by Democrats, the proposal under discussion by six members on the Senate Finance Committee would bar insurance companies from denying coverage to any applicant. Nor could insurers charge higher premiums on the basis of pre-existing medical conditions.

But it jettisons other core Democratic provisions in a reach for bipartisanship on an issue that has so far produced little.

Amusingly, at this moment the Chamber of Commerce and PhRMA jumped in to call for passage of health care reform. Probably because this bill wouldn't touch their profits or do anything for the consumer.

We expected Baucus' bill to have co-ops substituted for the public option. It's one of the three bills out there, and was always going to be the worst. But they jettisoned the employer mandate, taking the "shared" out of the shared responsibility that most reform bills have offered. Even WAL-MART supports an employer mandate. They did include the MedPAC proposal and the excise tax on insurance companies offering expensive plans and even a potential fee on medical device manufacturers and drugmakers.

This is precisely the kind of proposal you would expect from Baucus, some Republicans, and the head budget guy in Congress sitting in the room:

They have met for hours in recent weeks in Baucus' office, joined by aides and outside advisers such as actuaries summoned to explain arcane details of insurance. Douglas Elmendorf, head of the Congressional Budget Office, has also attended.

It's all driven by costs and not people, so the coverage subsidies are lower (300% FPL). And yet, the money that would be gained from an employer mandate is foregone because Baucus doesn't want to upset corporations. The money that would be saved from a robust public option is foregone because he doesn't want to upset the insurance companies. As long as the arbitrary $1 trillion dollar number is reached and the special interests made happy, Baucus can live with a forced mandate to the people to buy unaffordable insurance with crappy benefits without the choice of a government-run option. And of course, we're not even coming close to talking about the kinds of real savings that would come with health industry providers accepting less in reimbursement payments. Nor are we talking about radical change to achieve savings, like ditching the fee-for-service model.

Even when doctors order costly treatments with serious side effects and little evidence of their being effective, as studies find is common, patients are loath to question the decision. Instead of blaming such treatments for the rising cost of medicine, many people are inclined to blame forces that health economists say are far less important, like greedy insurance companies or onerous malpractice laws [...]

Medicare data shows that (the Mayo Clinic and the Cleveland Clinic) generally provide less expensive care and appear to deliver better results. Armed with this data, the doctors who run the groups have been lobbying Congress to make their model a bigger part of health reform. Two weeks ago, 13 such groups released a letter saying that recent versions of proposed legislation did not control costs enough.

Their goal is to weaken the fee-for-service system. In its place, doctors might receive a lump-sum payment to treat a patient with a certain condition, based on average costs elsewhere and on what scientific evidence had found to be effective. Hospitals with especially good outcomes might earn bonuses.

Advocates say such a system could ultimately give doctors more control. Rather than having to organize their schedules around the tests and procedures that insurers agree to reimburse, doctors could opt for the treatments they deem most effective. “It’s a lot more accountability, which is why it’s scary for physicians,” said Dr. Mark McClellan, a former head of Medicare under George W. Bush. “But in some ways it’s also more autonomy.”

If Max Baucus and his compatriots were intellectually honest about controlling costs, they would offer this. Instead, he neglects elements that would cut costs, unless they have to do with restricting access and making ordinary Americans suffer, in which case he enacts them gladly.

I hope that, once this bill is out of Baucus' hands, that we can understand he doesn't run national health care policy. The Senate can actually vote for better alternatives if they choose.

Forget Bipartisanship

The Senate HELP committee held four weeks of markup hearings on their health care bill. They accepted 160 Republican amendments. They allowed virtually every amendment, every concern of Republicans to a free and open vote. And in the end, the bill split entirely along party lines.

A Senate committee became the first congressional panel to advance healthcare reform legislation this year, marking a significant step toward the achievement of President Obama's foremost domestic initiative.

On a party-line, 13-10 tally, the Senate Health, Education, Labor and Pensions (HELP) Committee voted to move its portion of the upper chamber's healthcare reform legislation to the floor [...]

HELP Committee ranking member Mike Enzi (R-Wyo.) slammed the bill and the partisan nature of the panel's proceedings. "The bill lays the groundwork for a government takeover of healthcare," Enzi said.

I don't know how many times you have to say this. Republicans will not vote for health care reform. If so much as one of them does, I would be stunned. And it appears that the political staff in the White House understands this as well.

Both Axelrod and White House Chief of Staff Rahm Emanuel said taking a partisan route to enacting major health-care legislation isn’t the president’s preferred choice. Yet in separate interviews, each man left that option open.

“We’d like to do it with the votes of members of both parties,” Axelrod said. “But the worst result would be to not get health-care reform done.” [...]

Emanuel, making a theoretical case for a party-line vote, offered a definition of bipartisanship based not on roll-call votes but on whether Democrats have accepted Republican ideas during the process of negotiations.

He said Democrats already have passed that test, pointing to Republican amendments that the Democratic-controlled Senate Health, Education, Labor and Pensions Committee has adopted.

“That’s a test of bipartisanship -- whether you took ideas from both parties,” Emanuel said. “At the end of the day, the test isn’t whether they voted for it,” he said, referring to Republicans. “The test is whether the final product represented some of their ideas. And I think it will.”

Now Republicans will stick out their pinkies and rattle their teacups about the shocking partisanship on display, and whine about how they've been shut out of the process. But they would always say that, and predictably, it's not true.

This is the right approach, and now the President needs to collect the votes necessary for passage. Organizing for America released an ad today that will air in key states, targeting moderate Democrats and a few moderate Republicans, and imploring them to get health care done. It has no specifics, but collects a series of health care horror stories and shows the broken nature of the current system.



This will be the toughest lift of the Obama Presidency, but if he really wants it, he can get it done.

...Here's the acting chair of the HELP Committee, Chris Dodd, offering to accept 64 amendments by unanimous consent, but the Republican leader refuses to allow it in an effort to drag out the process. This is the minority's entire raison d'etre on this bill.

Whittling It Down To Nothing

Unlike in 1994, when The New Republic allowed an abominable article by Betsy McCaughey to codify the Villager mindset on health care, this year they have one of the brightest wonks in the business, Jon Cohn, driving their coverage. And this article about the pitfalls of a "just pass any bill" strategy is required reading.

Notwithstanding the predictable fits-and-starts of the legislative process, it seems likely that Obama will have a bill to sign by year's end, thereby accomplishing what the Clintons famously could not. But then what? Having crafted a bill that can pass Congress, will Obama be signing a bill that people actually like? It's a question best answered by examining another episode of the past--one that, although a mere footnote in political history, is fraught with warnings for today's reformers.

The episode is the fight over the Medicare Catastrophic Coverage Act, which President Reagan signed in 1988. Its purpose was to plug some of the emerging gaps in the Medicare program: If you stayed in the hospital too long, Medicare just stopped paying the bills. The Act extended hospital coverage indefinitely, capped out-of-pocket spending for beneficiaries, and offered partial coverage of prescription drugs, among other things.

Or at least that's what the law was supposed to do. After the bill passed with overwhelming, bipartisan support, a backlash developed, memorably culminating in a "riot" of angry seniors who chased a beleaguered Dan Rostenkowski--then chairman of the House Ways and Means Committee--into his car after a Chicago meeting. Less than two years after passage, before the bill's implementation, Congress voted to repeal the act, again with sweeping margins.

Basically, the program only provided a catastrophic care benefit to a small amount of seniors who faced extended hospital stays, and because of a desire to keep the bill revenue-neutral, all seniors paid for the program in premiums and surcharges. Those charges were modest, but people got the perception that they were paying more for nothing. As Cohn explains, the parallels are eerie.

Fast forward two decades, take a closer look at what's happening on Capitol Hill, and you may notice some familiar storylines. In order to make sure reform can pay for itself, lawmakers are talking about slowing down implementation, so that the program is not fully on line until 2014. They're also talking about offering fewer subsidies to help people obtain insurance. In a nod to centrists who don't like the idea of too much government, there's a strong push to gut or even eliminate proposals for the public insurance plan, which was supposed to provide security for individuals and competition for private insurers [...]

Put aside, for a moment, the policy merits of these moves. The politics are lousy. Obama would be in danger of producing legislation that seems to offer little up-front benefit, particularly for the electorally vital middle class. And if some of these people end up paying even modestly higher taxes to help finance reform they're not likely to be happy about it. It's hard to imagine such legislation provoking a backlash that could produce total repeal. It's not so hard to imagine such legislation creating bad political feelings, the kind that linger around until the next Election Day and pave the way for legislative retrenchment later on.

Let's bring back the policy merits: they too are lousy. Smaller subsidies along with an individual mandate will strain individual budgets, and a lack of a check on the insurance companies with no public option and a weak national insurance exchange will allow that strain to worsen with ever-expanding premiums. Slowing implementation just keeps in place a broken system causing 18,000 Americans to die every year.

Whatever mash of policies that come out of Washington, in health care - unlike some other legislation - practically the entire population will be intimately familiar with the consequences. It would be nearly impossible to distort the benefits or demonize the negative effects. It will be what it will be. And so designing a policy based on bipartisanship rather than effectiveness is a complete folly. Democrats and the White House have basically put forward this health care reform as a signature accomplishment. If they design something where the benefits aren't readily apparent, and people's premiums remain high, the public will get the message.

If Harry Reid and Nancy Pelosi muscle health reform through Congress, if President Barack Obama signs a bill in the Rose Garden and hands the pen to an ailing Sen. Ted Kennedy, if health reform, in other words, passes with fanfare and attention, Democrats own it. This will not be a quiet accomplishment. They will have told the American people that on this historic day, under this historic administration, they have begun to bend the curve and and tame the insurers and guarantee coverage and generally fix this huge problem that so many before have promised action on but so few have succeeded in tackling.

And if, 10 years down the road, the plight of the middle class has worsened and cost growth hasn't slowed and the only real difference is that more tax dollars go towards low-income subsidies, Democrats will be blamed for that. Their arguments will have less credibility. Republicans will run ads about "the last time a Democrat told you he could reform American health care." [...] If Democrats pass a bill that gets the policy wrong, they run a real risk of losing trust on what's arguably their core issue. This is high-stakes stuff.

It's not that I disagree with Digby at all - now is a rare chance to enact universal health care, and we should not shy away from it because it doesn't meet every single proper contour. But there are undeniable consequences to a bad policy. And, I would add, needless consequences. For once, the most popular policies line up with what will likely be the most cost-effective ones that provide the greatest tangible benefits. I suspect that the CBO will score a public option that uses Medicare rates, like the one in the House, in such a way that proves it would save both the federal budget and ordinary Americans hundreds of billions of dollars. Heck, the studies have already been done. The same with adding subsidies, which would attract more people into compliance with the system and lower the hidden cost of treating the uninsured.

Considering the fact that Democrats need only 50 votes to enact this reform, a fact that even the White House acknowledges, and considering the statistical fact of 60 Democratic Senators, there is absolutely no reason to build the policy around bipartisan support in Washington, but bipartisan support in the COUNTRY. Not only will there be massive goodwill for enacting decent health care reform, but a massive political backlash if that reform is wanting. Bernie Sanders has this absolutely right.

Look, the Democrats said give us 60 votes so we can come up with something. They gave it to us! I'm not a Democrat, I'm an Independent, but I caucus with the Democrats. They gave us 60 votes. So how many do we need? Seventy? Eighty? I understand that there are some Democrats, without ascribing motives, who are not comfortable voting for a strong public plan period. But I think it is not asking too much that they vote against the Republican filibuster [...]

Look, I like Chuck Grassley. But people in the country are not sitting around saying, "We need a good bipartisan bill! That's what we need!'" They're saying we need good, universal coverage for every American, man, woman, and child. And it needs to be affordable. If Chuck Grassley and Olympia Snowe and these other nice people I know decide to vote against it, that's fine. People in America aren't sitting up nights worrying how they'll vote. The goal should not be bipartisanship. It's passing something that is strong and good.

There is good reason for short-term political optics to pass whatever can be passed. But limiting the possible, and sacrificing the long-term benefits of the policy, makes no sense. The Democratic leadership seems to have forgotten how to pressure its caucus, or at least the moderate members. They can withhold re-election funding. They can change committee assignments. They can deny legislation written by particular Senators to come to the floor. They can impose all sorts of hardships, and the threats can be wildly larger than the exchange - just vote against a Republican filibuster. Then you can vote against the bill if you like.

Capitulating to that moderate axis will mean a poor bill that will lose the support of the public. When life and death is at stake, we cannot afford an outcome, nor do we need to.

...a perfect example of what I'm talking about:

"Only 26 percent of likely voters in Massachusetts believe health care reform has been a success and just 21 percent believe reform has made health care more affordable, according to newly released poll results," The State House News Service/Boston Herald reports. "The Rasmussen Reports poll of 500 likely Massachusetts voters, taken in April, also found only 10 percent said the quality of health care is getting better under the reform law rules here."

Simply put, the poor can't afford the premiums and the subsidies are too low. Also, Massachusetts is too small a state to really impact costs. So an overhyped reform gets a negative connotation.

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.