Against Comprehensive Incrementalism

Nancy Pelosi understands that her place is in the home in the health care reform debate is to position her caucus at the left edge of what is possible to get 218 votes. Everything she has been doing recently has moved toward that goal.

Speaker Nancy Pelosi is not among those praising Sen. Max Baucus (D-Mont.) for bringing his healthcare bill in well under President Barack Obama’s $900 billion limit.

Pelosi (D-Calif.), an advocate of the government-run health insurance option left out of the Senate Finance Committee chairman’s bill, criticized the means by which Baucus kept costs down.

“The savings come off the backs of the middle class,” Pelosi told a closed-door caucus meeting. “This is why we need a strong public option going into conference with the Senate.”

By contrast, Blue Dogs want to "pre-conference" the bill, so they don't have to take a tough vote. That's ridiculous and a corruption of the legislative process. The House reflects to a far greater degree the concerns of the American people; there's absolutely no reason that it cannot stake out its priorities with a vote.

The problem with simply accepting and rubber-stamping the Senate Finance Committee bill is not only that it isn't generous and doesn't cover as many people as needed. The real problem is that it's not going to feel different to the vast majority of people. Maybe that's a virtue, in some respects, but in the sense that health inflation will continue to ascend, costs will still rise, medical bankruptcies will still not be avoided, and the whole thing will be a "comprehensive incrementalism" rather than a sweeping change, I think people might look back and say, "what was the fuss about?" Now, I think Ezra is right here:

Which is only to say that this is not the end. That's true also for the House and HELP bills. All these proposals are major improvements for the uninsured and those left out of the employer-based market. That means they're major improvements for those who are hurting the worst. And in constructing exchanges and beginning the hard work of delivery system reform and creating a system of subsidies and an individual mandate, they're building the foundation of a better health-care system. But as they embark on that project, they're leaving most of our current health-care system virtually untouched, which means most of the systemic problems will remain unsolved.

I think that project can start now, particularly in the area of competition with the insurance industry in the form of a public option. Until we discover that this is all that is possible - and I don't think we're they're yet - Pelosi is absolutely right to engage and strategically position herself at the left edge.

The House still doesn't seem to grasp how to pay for the bill, knowing simply that they don't want to piss off labor with the tax on high-end insurance plans. A tax on "windfall insurance profits" would have a similar effect, however. And a public option that could lower costs would decrease the amount of people hit by the high-end insurance plan tax.

The real danger here is that the comprehensive incrementalism is so incremental that the industry decides the plan doesn't cover enough people, and they start breaking their own promises. This is what's intimated here. While I do subscribe to the "if the health industry hates it, well it must be good" theory, I think there's a real danger of not controlling rising costs because of the thinner risk pool. And that could incentivize insurers to continue their worst practices. More reform is really a cumulative answer to these problems, and we should not stop halfway.

The Senate Progressive Block

Jason Rosenbaum has the news on that secret letter I was talking about yesterday that Senate Democrats were pushing, demanding that Harry Reid include a public option in the bill that comes to the floor. We now have the letter, and it calls for a "robust, Medicare-like" public option, which is right where the House Progressives have drawn the line. The letter has 30 signatures:

Sherrod Brown (D-OH) John D. Rockefeller (D-WV)
Russell D. Feingold (D-WI) Patrick J. Leahy (D-VT)
Daniel K. Akaka (D-HI) Tom Udall (D-NM)
Kristen E. Gillibrand (D-NY) Roland W. Burris (D-IL)
Ron Wyden (D-OR) Debbie Stabenow (D-MI)
Barbara Boxer (D-CA) Sheldon Whitehouse (D-RI)
Michael F. Bennet (D-CO) Dianne Feinstein (D-CA)
Jack Reed (D-RI) Jeff Merkley (D-OR)
Frank R. Lautenberg (D-NJ) Benjamin L. Cardin (D-MD)
Al Franken (D-MN) Robert P. Casey, Jr. (D-PA)
Barbara A. Mikulski (D-MD) Daniel K. Inouye (D-HI)
Edward E. Kaufman (D-DE) Arlen Specter (D-PA)
Maria Cantwell (D-WA) Robert Menendez (D-NJ)
Bernard Sanders (I-VT) John F. Kerry (D-MA)
Herb Kohl (D-WI) Paul Kirk (D-MA)

Some VERY interesting names on this list. Michael Bennet. DiFi (!). Arlen Specter. Newest Democrat and former pharma lobbyist Paul Kirk. Ron Wyden.

To be sure, nobody here is saying that they won't vote for a bill without a public option in it. But these would be the main possibilities for such a strategy. And you would only need 11 of these 30 to pull that off. And really, you would only need one, if you're tying it to a 60-vote filibuster-proof hurdle.

Despite the rumors and compromises being floated, it is NOT a given that Harry Reid puts a public option in the merged bill. This show of support by fully 1/2 of the caucus - and with public option supporters who voted it out of committees not on this list, the real number is higher - is very important to reaching that goal.

Everyone Loves An Opt-Out

Here we have yet another compromise on the public option that sets moderates in Washington stirring. The "opt-out" national public option, which would offer states a chance to eliminate it for their own jurisdiction, is gaining support on Capitol Hill. Chuck Schumer says it's being "very seriously considered". Max Baucus says through an aide he would consider supporting it. Howard Dean said he'd support it if he were a Senator. Richard Kirsch from HCAN says it's better than triggers, co-ops and opt-ins, which is faint praise but praise nonetheless.

I think there's some good and bad to it. We don't know what the opt-out would look like - a referendum? Gubernatorial veto? Federal waiver? A policy bill with a hurdle in state legislatures? Tied to funding? - and how easy it could be surmounted, as well as how easily gamed by special interests. Insurance companies are spending $1 million a day to beat the public option in Congress, you don't need that much to beat it in the states. Would this have a chilling effect on all federal legislation, with every big bill subsequently requiring a state opt-out, balkanizing the country? Or would every red state Governor bluff at opting out, and then, after seeing the numbers for how this would really help people, grudgingly accept it? We also don't know what kind of public option this would bring into being. Would it be Chuck Schumer's weak conception with no tie to Medicare bargaining rates? Or a robust public option with Medicare + 5% rates and Medicare's provider network? I think Nancy Pelosi is doing something very smart by scoring both versions just so the fiscal conservatives can choke on the numbers.

Speaker Nancy Pelosi (D-Calif.) will submit multiple versions of the House's healthcare bill for cost estimates, she announced on Thursday.

The first proposal will include a "robust public option," which would tie doctor reimbursement rates to that of Medicare plus five percent. The remaining two drafts submitted for the Congressional Budget Office's consideration would include a public option based on "the negotiated rates that some in our caucus have supported and which was passed by the Energy and Commerce Committee," the speaker explained during Thursday's press briefing.

"And then we'll see back from the CBO what the scoring is on all of that," Pelosi said. "And, of course, we have promised not a dime to the deficit. This is our promise. We will not take a bill to the floor, the president will not sign a bill that adds a dime to the deficit."

We already know that the CBO considers the robust version to save $85 billion more than the weak version, so this will just cement that even more.

All the while, House Progressives, which have formed a block requiring a straight national public option with no opt-out and ties to Medicare rates, continue to say they won't compromise, won't blink, and claims that they have the votes they need to pass their plan in the House, although some have questioned the numbers.

I think the strategy should be maximalist - pass the best of what you can in the House, and the best of what you can in the Senate, so that when the two bills are merged, you at least are dealing with the best possible from both chambers. A merger, for example, could see a Medicare-tied public option with the opt-out clause.

However, the nagging feeling is that nobody wants to stop the public option, or at least nobody wants to be responsible for it. In that case, shouldn't the plan for supporters be to say to them, "We dare you to kill this"?

The Blue State Public Option

Sam Stein has a pretty major development:

Senate Democrats have begun discussions on a compromise approach to health care reform that would establish a robust, national public option for insurance coverage but give individual states the right to opt out of the program.

The proposal is envisioned as a means of getting the necessary support from progressive members of the Democratic Caucus -- who have insisted that a government-run insurance option remain in the bill -- and conservative Democrats who are worried about what a public plan would mean for insurers in their states.

"What folks are looking for is what gets 60 votes," said a senior Democratic Hill aide. "The opt-out idea is very appealing to people. It has come up in conversations. I know personally that a handful of members have discussed it amongst themselves."

In conversations with the Huffington Post, sources have said that while the opt-out approach to the public plan is in its nascent stages it has been discussed with leadership in the Senate. It was pulled out of an alternative idea, put forth by Sen. Tom Carper (D-Del.) and, prior to him, former Senate Majority Leader Tom Daschle, to give states the power to determine whether they want to implement a public insurance option.

But instead of starting with no national public option and giving state governments the right to develop their own, the newest compromise approaches the issue from the opposite direction: beginning with a national public option and giving state governments the right not to have one.

Essentially you'll end up with a blue-state public option, with the possibility of a few referenda to remove it in the states that allow ballot initiatives. Although, as we saw on the stimulus, threatening to opt out of a federal program is far easier than actually doing it. I'd guess that most states would go ahead with it.

As compromises go, this is about as good as anything that's been discussed, certainly better than triggers, co-ops or Tom Carper's "opt-in" proposal. It needs to be a good public option, one with Medicare's provider network and hopefully some relationship to Medicare rates, but if that's the case then it probably even beats Schumer's weak natonal proposal.

The entire exercise is to get to the conference committee with some kind of public option in both houses. That way, getting something out of conference is virtually assured. If you have no public option in the Senate bill, you're not going to get one in the final bill. That's just an educated guess. So Democrats are trying to figure out something that can get through a Senate vote. It's a difficult lift.

Outside pressure remains a factor here. But we're now talking about which kind of public option to have, not whether or not to have one at all. That's a better place to be.

That All-Important CBO Score

The CBO score for the newest version of the Senate Finance Committee bill is in, and the word incrementalism comes to mind.

According to CBO and JCT’s assessment, enacting the Chairman’s mark, as amended, would result in a net reduction in federal budget deficits of $81 billion over the 2010–2019 period (see Table 1). The estimate includes a projected net cost of $518 billion over 10 years for the proposed expansions in insurance coverage. That net cost itself reflects a gross total of $829 billion in credits and subsidies provided through the exchanges, increased net outlays for Medicaid and the Children’s Health Insurance Program (CHIP), and tax credits for small employers; those costs are partly offset by $201 billion in revenues from the excise tax on high-premium insurance plans and $110 billion in net savings from other sources. The net cost of the coverage expansions would be more than offset by the combination of other spending changes that CBO estimates would save $404 billion over the 10 years and other provisions that JCT and CBO estimate would increase federal revenues by $196 billion over the same period [...]

By 2019, CBO and JCT estimate, the number of nonelderly people who are uninsured would be reduced by about 29 million, leaving about 25 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants). Under the proposal, the share of legal nonelderly residents with insurance coverage would rise from about 83 percent currently to about 94 percent.

We have an $829 billion dollar paid-for bill that lowers the deficit over time, but leaves 25 million residents uninsured, 2/3 of them American citizens. The bill doesn't cover as many people because Senate amendments reduced the penalties for non-compliance with the mandate and increased the hardship exemption. Without a public option, I actually agree with that, but it narrows the risk pool, and insurance companies don't want that because they'll be forced to cover a higher ratio of sick people, in their opinion. They could all handle this by increasing the subsidies, but Obama basically put a cap on the bill at $900 billion, and the more conservative Finance Committee went even lower than that. There's also a "trigger" of sorts that will reduce subsidies to people by a fairly large amount:

In the aggregate, the Senate finance bill reduces the deficit. But there are a couple individual years when it increases it. The CBO thus estimates that "the failsafe provisions would require a reduction in exchange subsidies averaging about 15 percent during the years 2015 through 2018." That's a very bad thing, particularly in the first years of the plan. It means that, with no warning, subsidies will be cut by 15 percent, and insurance that families were able to afford the year before will become totally unaffordable. That needs to be changed.

That's not the only problem with the exchanges. An amendment in the Finance Committee basically eliminated all policy benefits to them:

In the bills that passed three House committees and the Senate Health, Education, Labor, and Pensions (HELP) Committee, the exchange would be a "prudent purchaser." In other words, it would have a staff that bargained with insurers to bring down premiums--and that made sure all plans lived up to strict guidelines for coverage and customer service. In effect, any insurer that wants to offer coverage through the exchanges has to get the equivalent of a "Good Housekeeping Seal of Approval" from the administrators. This is precisely how it works in Massachusetts.

By contrast, the Senate Finance bill envisions much weaker exchanges. Instead of choosing which plans to make available, the exchange administrators would, by law, have to accept any plan that meets a relatively minimal set of standards.

Jon Kingsdale, who runs the Massachusetts exchange, calls that a recipe for "policy disaster," as consumers faced a dizzying array of more expensive, less regulated choices. "It would be like telling your grocery store they have to offer every single kind of bread baked by every single bakery. ... The exchanges would be nothing more than an automated Yellow Pages."

Cappy McGarr, who ran an exchange that failed in Texas, says that the exchanges will fail if they don't attract a considerable market share. Making them user-unfriendly like this is a sure way to have people just run in the other direction. And firewalling them from employees of bigger businesses is another. Insurers outside the exchanges will only need to use good marketing to entice consumers into their web, especially if the exchanges are not designed well.

If Congress now creates new exchanges, as seems increasingly likely, it must prevent this phenomenon by setting two national rules: Insurers have to accept everyone and have to charge everyone the same rates regardless of health status.

Such rules would force insurers to spread risk. But enforcement would also be difficult. Every aspect of health insurance — from the rules for underwriting and setting premiums to the marketing of policies — would need to be monitored stringently to prevent companies from steering all bad risks to the exchanges.

It would be smarter for Congress to revisit the idea of creating a public plan that could provide an attractive choice for consumers and real competition for private insurers, to give them the incentive to offer good coverage at affordable prices.

Max Baucus trashed Ron Wyden's effort to design the exchanges better (there's now documented proof of this), significantly weakening them.

Igor Volsky has more. To me, it's no wonder that Republicans are starting to concede on this health care bill. Aside from the fact that they can't stop it, they know that Baucus-care isn't all that likely to work, which will help them in the long run.

...is this a good starting place? Maybe. I'm worried about its survivability. We've seen a lot of exchanges die off over the years, and while there will be some default position toward making this viable in the short-term, if for example Obama loses in 2012 I could easily see a repeal, given that the exchanges wouldn't even be in place by then.

The Secret Letter

I'm hearing from sources about a letter to Harry Reid from a collection of liberal Senators, led by Sens. Jay Rockefeller and Sherrod Brown, insisting that Reid publicly commit to putting a public option in any health care bill that reaches the Senate floor. There's a big difference between having a public option in the bill before the fact or trying to get it in by amendment. It's likely that amendments to the bill will require a 60-vote threshold, therefore it would take 60 votes to get a public option into the bill if it's absent, or 60 to get one out of the bill if it's present. Nobody has said that there are those numbers of votes to do either of those actions. So whether the bill comes to the Senate floor with a public option or not is a crucial decision. The four people in that room making that decision are Max Baucus of the Finance Committee, Tom Harkin of the HELP Committee, Harry Reid and someone from the White House. A lot of this will depend on the White House's inclination, and they certainly floated their support over the weekend. But Reid's public statements have been noncommital.

The liberal faction in the Senate, led by Rockefeller and Brown but also for the first time including Sen. Barbara Boxer, want a real commitment. According to sources, Sen. Reid will meet with this faction at 5pm ET. Senator Reid's office confirms that this meeting will be held today. So presumably, some kind of accommodation will be offered, although the liberal Senators in the meeting will seek a definitive commitment, I'm told.

There have been various talks from public option supporters in the Senate about wanting to see it in the final bill, but this is the furthest it has gone, to my knowledge. Some Senators, like Sen. Boxer, are going on the record insisting a public option for the first time. Of course we don't know what form this "public option" will take - the Wall Street Journal reports today that Tom Carper's state-based approach is gaining support among Senate moderates, and Debbie Stabenow in a press conference today confirmed that this is a possibility:

In a press conference this morning with other Democratic senators, Sen. Debbie Stabenow (D-MI) -- member of the Senate Finance Committee and a supporter of a robust public option -- says it's a "broad definition."

"The states are one way to go," she said

Sen. Robert Menendez (D-NJ), who also sits on Finance and supports a public option as enthusiastically as Stabenow does, added, "There are state options that are devised in such a way that only a region of the state is included, in which case that's not really a significant public option."

"If the whole state is included in a public option -- they have that option -- well that's a much more significant standard than some that have been proposed," Menendez told reporters.

I would assume that Reid may offer this as a compromise inclusion in the bill. We'll see if the Brown-Rockefeller faction will take the deal. Certainly they are pushing very hard for a higher standard than that. And with the House of Representatives close in getting majority support for a public option using Medicare +5% rates, perhaps that gives them some leverage too.

...Greg Sargent reports that Nancy Pelosi just floated a lesser public option with negotiated rates, not Medicare +5%, to the Dem caucus, prompting outrage. I'm seeing a convergence here, with the Senate pushing up from the rank and file to get any public option into the bill, and the House pushing down from the leadership to get a public option that can pass the Senate.

Nelson Playing Possum?

Chuck Schumer remarked yesterday on the dynamic facing moderate Dems with respect to health care and the public option:

So if you have a conference committee where the House has it strongly, almost rock solid, in their bill, and the Senate...if we don't have it in the bill there are 54, 55, 56 Democratic senators for it, how are they going to report back a bill without it?

This is the key question. Everybody wants to agree on jettisoning the public option, but the debate got so far away from the White House and Congress that the public option became synonymous with reform, and now nobody wants to be the one to excise it from the bill. You've even got Shep Smith going off script and slamming Republicans for distorting the public option debate. Nobody wants to put the stake through its heart.

But before everyone congratulates themselves on how health care reform "won" because conservaDems wouldn't dare to kill it, check out what Ben Nelson told Brian Beutler earlier today:

With a 60-seat majority in the Senate, Democrats are poised, theoretically, to prevent Republicans from filibustering key agenda items. Liberals and health care reformers see that as a potential bulwark against Republican obstruction and are pressuring party leaders to enforce unanimity on key cloture votes, so that nominations and major bills (like health care) can be decided by a simple majority. And just how are they doing on that score?

Sen. Ben Nelson (D-NE), one of the Senate's most visible centrists, tells me leadership hasn't said anything about it to him.

I asked, "Has leadership been in discussions with you and other moderates about voting with the party on procedural votes?"

In a statement that will bedevil liberals, he responded, "I don't know about others, but not with me."

There's almost no way that's true. And if it is, the Democratic leadership should collectively resign. There's almost nobody in the caucus whose vote needs to be assured OTHER than Ben Nelson. My suspicion is that Nelson is deliberately misreading what's been said to him to set himself up with the ability to leverage his opposition into concessions. With 60 Democratic votes, it really only takes one to vote down cloture. Everybody has the potential to demand something from reform. And Nelson is just allowing that to continue.

Meanwhile, he's being smartly squeezed back at home:

The Nebraska Democratic Party put the state's senior senator, Ben Nelson, in an awkward spot on Saturday by passing a resolution making support for a government-run insurance option a central aspect of its platform.

In a nearly unanimous vote at a committee meeting in Fort Omaha Metro Community College, about 70 attendees approved language that urges members of Congress "to vote for such health care reform proposals that contain a robust public option at all stages of the legislative process including conference and reconciliation, and encourage legislators to pass such reform."

Nelson remains one of the highest-profiled U.S. Senate Democratic holdouts on the public plan, even recently declining to commit to voting against a Republican filibuster of legislation that included the provision.

Officials at the Nebraska Democratic Party said the committee vote was not meant as a rebuke of the senator, who has historically taken a conservative approach to public policy issues. More an encouragement to all Democratic state legislators.

North Dakota Democrats just did the same thing, putting pressure on Kent Conrad - the resolution actually supports single payer with a public option as a "fallback". I don't know if these Senators are reachable, even by their home states, but it's worth a shot.

Point being, I don't think we can just assume that the Dems have 60 locked up for cloture just yet. There's a long way to go.

We Made Him Do It

I agree with most everyone that it's good to have this out there:

Despite months of seeming ambivalence about creating a government health insurance plan, the Obama White House has launched an intensifying behind-the-scenes campaign to get divided Senate Democrats to take up some version of the idea in the weeks just ahead.

President Barack Obama has long advocated a so-called public option, while at the same time repeatedly expressing openness to other ways to offer consumers a potentially more affordable alternative to health plans sold by private insurers.

But now, senior administration officials are holding private meetings almost daily at the Capitol with senior Democratic staff to discuss ways to include a version of the public plan in the health care bill that Senate Majority Leader Harry Reid, D-Nev., plans to bring to the Senate floor later this month, according to senior Democratic congressional aides.

Among those regularly in the meetings are Obama's top health care adviser, Nancy-Ann DeParle, aides to Reid, and Senate finance and health committee staff, both of which developed health care bills.

At the same time, Obama has been reaching out personally to rank-and-file Senate Democrats, telephoning more than a dozen lawmakers in the last week to press the case for action.

If the "left of the left" didn't agitate and activate folks throughout the debate, this story wouldn't exist. And neither would the public option. The White House is now trying to save face by getting something they can call the public option into the bill. They cannot not have it, at this point. The pressure has been ratcheted up too high.

So there will be a public option in there, I'm convinced of that now. The question is what will it look like? Chuck Schumer seems to be saying that Tom Carper's state-based network would maybe be the answer. That's really no worse than Schumer's level-playing field version. None of them will have the scale and scope to really compete with insurance companies. But all of them can be expandable. And that's what's important at this point.

It took several months of banging on these politicians just to get a weak version of a public option in a position to possibly succeed. Meanwhile some conservative can just say the word "ACORN" and get their federal funding revoked. There's a definite imbalance there. But progressive power is at least imaginable, and hopefully when this passes and the world doesn't go up in flames, it will get easier.

The Waiting Is The Hardest Part

Determining whether a public insurance option will be in the final health care bill from Congress has been excruciating, and it's not about to get any better. I guarantee you it's going to look dead and buried or a rock-solid cinch about half a dozen more times before this is over. Here's what happened just today:

• Raul Grijalva said that his public option whip count is down to 46, from 60. And he wouldn't announce the names, which made it look like he was shielding the members who dropped off. Bad!

• Later, 51 Democrats in the House write to Steny Hoyer and Nancy Pelosi affirming their strong support for the public option. Good!

• Harry Reid backed off his remark that the final bill will have a public option. Bad!

• Later, we learn that the Grijalva whip count is probably bigger than 46 members; they just stopped the whip count once they had enough votes to block anything without a public option. Good!

• There's now a new whip count of all members of the Democratic caucus, on a public option tied to Medicare +5% rates. So far 170 members of the caucus support this. Good! But they need 218 for passage. Bad! But they're not done yet and Chris Bowers hears it's higher. Good!

• Andy Stern says there will be a price to pay for any Democrat who joins a Republican filibuster of a health care bill, regardless of whether a public option is in there or not. Good!

• Nobody wants to be the one to kill a public option. That's actually good! But they'll try to call whatever compromise that's inoffensive to the insurance companies a public option as a way out. That's bad!

I would recommend David Waldman's piece, because I think it's closest to the actual scenario on the minds of the Senate and the White House right now. Chasing this rumor or that can make you weary, however.

Senate Finance Committee Post-Mortem

The Senate Finance Committee actually finished with their markup of the health care bill late last night. They will wait until the CBO submits a revised score based on the amendments, and then there will be a final vote next week. So, how did we do?

Well, we know that there will be no public option in the bill. Maria Cantwell's amendment for state-based purchasing pools between 133-200% of the poverty level passed. Most of the right-wing amendments, other than adding money for abstinence-only education (which I'm guessing will get stripped down the line), went nowhere. The Committee even voted down all the amendments attacking undocumented immigrants, including rolling back one that would have prevented legal immigrants from buying into the exchanges for five years, which would have been utterly senseless.

On the other hand... the bill did delay and reduce financial penalties for those Americans who choose not to buy insurance, softening the stringency of the individual mandate (there are also lots of hardship exemptions). That's good politically in a sense, but does blunt the impact of the mandate, which will probably lead to higher costs with a smaller risk pool. I agree, however, that nobody should be forced to buy a plan they can't afford. Overall, this will help with the politics of the bill.

The real disappointment was the rejecting of Ron Wyden's Free Choice Act on a technicality.

About one in the morning, Wyden's Free Choice Act came before the committee. But it never came up for a vote.

Instead, Max Baucus effectively ruled it out of order. The reason? It didn't have a full CBO score. This came as a surprise to Wyden and his team, who'd gotten the amendment scored by the CBO, and had been in endless negotiations with Baucus, the White House, employers, and labor over the past week. If the score was in fact partial, as Baucus and Conrad claimed, you'd think someone might have mentioned it. No one did [...]

To understand the Free Choice Act, you need to understand that the exchanges are currently closed to businesses over 100 employees. In many states, they'll be closed to businesses over 50 employees (the Finance Committee's bill lets states choose their threshold, either 50 or 100). And in all states, they're closed to individuals who are offered "affordable" coverage by their employer. If I don't like the insurance The Washington Post is offering, or I feel I can get a better deal on the exchange, I am simply not allowed to go use the new network and take my pick from the many plans offered.

That's a real shame, that we continue to prop up a broken and inefficient delivery system of employer-based health care because nobody, neither business nor labor, wanted to risk messing with the status quo. As a result, the insured get less choices, businesses continue to bear a large health care burden, and nobody but insurers really win. It makes little sense for businesses to want to stay in the health care business and for labor to assume that they would keep their gold-plated health benefits at the expense of a broken system forever - which didn't hold in the case of the automakers. Jon Cohn has more.

Overall, the bill was improved by the markup, but remains flawed, particularly by the absence of a real public option, but also through the affordability questions, which were only slightly improved. There's still a long way to go to make this tolerable.

Pauline Kael Syndrome

This John Boehner quote, where he says he hasn't met one person who supports the public option, reminds me of the famous quote that has been attributed over the years to Pauline Kael, though there's compelling evidence that it was apocryphal. The quote usually goes like this: Kael was told that Nixon bested George McGovern in a landslide in 1972, and Kael replied, "How can that be? No one I know voted for Nixon!" It's often used by Republicans to prove how East Coast elites who read or write for the New York Times are so out of touch with everyday 'Murcans.

In this case, it's the conservative who is deeply out of touch with American needs and desires. Like the stereotype of Kael, for Boehner to say that proves he self-selects a very narrow band of people as his companions, the sample of which bears no resemblance to the public at large. And people have rightly pounced on the quote. Here's a testimonial from a woman in Boehner's district, from Oxford, Ohio, who has consistently argued for a public option to Boehner's office. Health Care for America Now is gathering signatures of people who support a public option in the hopes that Boehner will meet with one of them. And Americans United fit this into a narrative of an out of touch Republican leader:



It was simple to find statistics like 57% of Ohioans supporting a public option, to throw into avid golfer Boehner's face. Even garlic lovers slammed Boehner for calling the public option as unpopular as a garlic milkshake (I've been to Gilroy, CA, home of the Garlic Festival, and everyone there swears by the garlic ice cream and milkshakes).

The narrative has really started to turn. It's the Republicans who look out of touch and out of ideas to deal with America's health care crisis. Alan Grayson started this ball rolling. And John Boehner's Pauline Kael impression cemented it.

...the Facebook group, "Hey John Boehner, I'm an American and I support a public option!" has over 1,000 members in the first five hours, and is growing.

...The Progressive Campaign Change Committee also has an ad up and is encouraging Boehner to meet with folks in his district.

Cantwell Amendment Passes

It's not much, but for people making between 133-200% of the federal poverty level it's a good start.

Senator Maria Cantwell (D-Wash.), taking a page from a program originating in her home state of Washington, has successfully maneuvered an amendment through the Finance Committee that comes close to a public option while not quite getting there.

The program, which made its way into the finance committee bill by one vote, would affect those above the 133% of the federal poverty line (those below this threshold are currently covered by Medicaid) up to 200% of the FPL. This would include a family of four earning up to $44,000.

Rather than handing over the $6500 health insurance subsidy that these people would have qualified for under the initial Baucus plan, that money would be handed over to the states to create a negotiating fund to be controlled by the state.

Participants would not get their insurance from the state through some sort of state operated public insurance option. Rather, the state would combine all this federal subsidy money and use the clout of controlling this large sum of cash to negotiate with private insurers on behalf of participants in order to get them the best deal.

It’s something of a collective bargaining approach for those in a low income bracket, with the state functioning as the local labor negotiator.

I wouldn't call it "close to a public option." It's a good policy to bundle federal monies together and allow states to bargain with it, and it will allow for competition at that low end. Of course, insurers might have to raise prices on everyone else to compensate for either lower rates on that pool, or missing out on having them in their systems. But there are caps for that, theoretically, and I would have expected those insurers to push to the max of those caps anyway. So overall, this is a good policy, and I'm glad Cantwell got it through.

Among Democrats, only Blanche Lincoln voted against it.

What's In A Name?

What's In A Name?

by dday

Harry Reid is now saying there will be a "public option" in any final health care bill. I'm sure nobody knows precisely what he means by that.

U.S. Sen. Harry Reid, D-Nev., said today there will be a "public option" in whatever health insurance reform bill comes out of Congress.

"We are going to have a public option before this bill goes to the president's desk," Reid said in a conference call with constituents, referring to some kind of government plan.

"I believe the public option is so vitally important to create a level playing field and prevent the insurance companies from taking advantage of us," he said.

Tom Harkin said almost exactly the same thing today - and he said that Republicans wouldn't be at the table when the two Senate bills get merged together.

Here's the good news about this. Reid is acknowledging that he absolutely cannot get away with having a final bill without something he can call a "public option." And progressives have done a good job of very specifically separating out triggers and co-ops as something that would not fit that definition. This is almost entirely due to grassroots activism. The public option would have been thrown out months ago if nobody was advocating for it from the bottom up. It was certainly not the intention of anyone in Washington to go into October with this issue still up for grabs. They were perfectly content to jettison it to protect insurance industry profits.

That said - there is no definition here for what public option means. And if you asked Sen. Reid point-blank, I'm sure he wouldn't give you a definition. He wants something that he can call a public option so the grassroots can be satisfied. What will that be? Probably not co-ops or triggers because they've been too well-defined by the grassroots. There are other alternatives coming in their place.

Tom Carper is pushing the idea of giving the states the ability to create a public option, which states could then link together for increased bargaining power. They wouldn't be able to use Medicare bargaining rates and they wouldn't have Medicare's provider network. And being state-based, they wouldn't have much leverage to gather the client base necessary to force a lot of competition with the private market. Of course, a lot of the "public options" out there offer weak, "level playing field" provisions similar to Carper's amendment. Jon Cohn says that actually, this is already in the bill:

One interesting question is whether the proposal is already redundant, thanks to an amendment that another member of the Finance committee, Ron Wyden, introduced that Chairman Max Baucus accepted before the hearings even began.

It's Wyden amendment C8, which appears on page two of the modified bill Baucus introduced formally for markup:

Amend Title I, Subtitle A to allow a State to be granted a waiver if the state applies to the Secretary to provide health care coverage that is at least as comprehensive as required under the Chairman’s Mark. States may seek a waiver through a process similar to Medicaid and CHIP. If the State submits a waiver to the Secretary, the Secretary must respond no later than 180 days and if the Secretary refuses to grant a waiver, the Secretary must notify the State and Congress about why the waiver was not granted. – Insert at the end of b)(1) ―and with citizen input through a referenda or similar means;‖ – In b)(2) strike ―a‖ and insert ―this‖ – Insert b)(4) ―the State submits a ten-year budget for the plan that is budget neutral to the Federal government.‖ – Insert at the beginning of c)(2) GRANTING OF WAIVER.— The Secretary shall approve the plan only if it meets criteria consistent with that of the America’s Healthy Future Act, including that it shall lower health care spending growth, improve the delivery system performance, provide affordable choices for all its citizens, expand protections against excessive out-of-pocket spending, provides coverage to the same number of uninsured and not increase the Federal deficit.

What does the gobbledygook mean? Wyden's staff says it's designed to encourage state experimentation. I haven't yet gotten an official reading from Finance Committee staff on their interpretation.

But my own reading, which I've run by a few analysts, is that it gives states the ability to implement coverage schemes that bolster coverage, control costs, and improve quality at least as well--and hopefully better than--the Senate Finance bill. That would include creating a public option. (You could even read it to allow a state-based single-payer plan.) So it's the Carper amendment, but without the restrictions.

Cohn notes that the HHS Secretary would have to rule, in the Wyden Amendment, on whether any state proposal met the proper criteria. Which means that, under a Republican Administration, you could see nothing helping people allowed to go through, or even scale-backs to benefits (though there is presumably a federal floor).

Still, maybe this is what Reid will determine as a "public option." Or maybe he'll dump Wyden's amendment and pick up the Carper idea and call that a public option. Or maybe Maria Cantwell's proposal, which allows states to negotiate on behalf of the uninsured below 200% of poverty level for a basic plan, will fit the bill, even though it sounds like a good policy but in no way a substitute for the public option.

The point is that all the activism and advocacy has gotten us far further than we would normally be in this debate. But there are still plenty of compromises out there that politicians will call "the public option" as an escape valve. It will be important to see these policies for what they are, instead of applying the name and being done with it.

Finance Committee Follies

So how's that Finance Committee doing on health care?

Well, they did manage to beat back a requirement that people show a photo ID to use the exchanges or access subsidies, though the enforcement requirements in the bill still deny undocumented immigrants the ability to but insurance on the exchanges, which is pitiful, and restrict LEGAL immigrants from doing the same for five years. So it's a win without a victory.

In better news, Max Baucus continues to be pushed to the left on affordability.

In a push to lock down votes, Senator Max Baucus, the Montana Democrat and chairman of the Senate Finance Committee, is pulling together a last-minute package of changes to his health care legislation aimed at addressing the chief concern among his fellow Democrats: that health insurance be made as affordable as possible for moderate-income Americans.

“There’s an effort to solve people’s problems,” said Senator John D. Rockefeller IV, Democrat of West Virginia, who has been a critic of the bill. “How far that’ll go, we’ll see.”

Among the proposals under consideration is an amendment by Senator Maria Cantwell, Democrat of Washington, that would create a “basic health plan” for Americans earning less than 200 percent of the federal poverty level, or $44,100 for a family of four. The proposal would let states develop or expand various existing insurance programs that now typically cover people who qualify for Medicaid. Small states could develop plans jointly.

The Baucus bill would already expand Medicaid to Americans earning up to 133 percent of poverty, and Ms. Cantwell’s proposal would effectively expand it further. But because her plan is expected to be cheaper than providing subsidies to those low-income people to buy their own insurance, it could save money that could be used to make other provisions of the bill more generous.

The Cantwell Amendment sounds pretty good at first blush. While not a public option, it's a proven idea (Washington state has this) that would reduce costs up to 200% FPL that can be used to increase subsidies above that level. UPDATE: Ezra Klein has a good interview with Cantwell about her proposal. She claims it would hit 75% of the total uninsured.

But I really like what Jay Rockefeller's cooking up - a legitimate floor for what insurance companies must spend on treatment and care.

This is delectable politics. Fresh off a meeting with Ob-Rahma, Jay Rock has come back to the Senate and demanded 90% loss ratio for any coverage the subsidies pay for. "Loss ratio" is insurance-speak for what they actually have to spend providing actual health care. That means the insurance companies can't steal 20% of our tax dollars to pay for executive salaries. They get 10%.

They're peeing their pants right now.

But I suspect Jay Rock has offered this as an outcome of his meeting with Ob-Rahma. I'm sure at that meeting they said, "Jello Jay, We'd like you to pitch other ways to save money. We'd like to come up with a way to keep costs down."

And voila!!! 90%!!! Insurance companies have to actually provide health care without gobs of executive subsidies. We're actually going to demand a certain amount of health care in exchange for the half trillion MaxTax!!!

There's no way to vote against this and still claim that you are on the side of the people instead of the insurance companies. With the cost savings in the bill, not to mention the ease of using the exchange to advertise services, insurers should easily be able to spend 90% of all premiums and still make a health profit. The only problem with this is enforcement, and how you get compliance from insurers who lie about loss ratios currently.

The Finance Committee will consider all these amendments and have a final vote on the bill next week, with Harry Reid bringing a merged bill to the floor the following week. We now know the schedule - time to make sure the best bill gets out.

Here's A Thought, Take The Popular Option

Kevin Drum is as shrill as he gets, which is to say, measured, polite, and miffed.

In case you missed it, Jon Stewart had a good riff on this last night. His question: Why are Democrats so lame? It's a good one! They have a huge majority in the Senate, the public is strongly in favor of a public option, and yet....for some reason they can't round up the votes to pass it. Hell, they can't even round up a normal majority to pass it out of the Finance Committee, let alone a supermajority to overcome an eventual filibuster.

If Democrats really do lose the House next year (about which more later), this will be why. If they don't pass a healthcare bill at all, they'll be viewed as terminally lame. If they pass a bill, but it doesn't contain popular features that people want — like the public option — they'll be viewed as terminally lame. At a wonk level, a bill without a public option can be perfectly good. But wonks aren't a large voting bloc, and among people who do vote, the public option is very popular. So, um, why not pass it?

I will minimally defend Democrats. The Finance Committee has a 13-10 split, which is a bit less of a majority than the 60-40 overall split. Stewart's point was that Democrats had a supermajority and didn't use it in the Finance Committee is inaccurate. Furthermore, there's no such thing as a supermajority in the patently undemocratic confines of the Senate. Because the public option isn't popular among land as well as people, it doesn't have 60 votes in a Senate organized around land. There's also the problem of unanimous opposition from an entire political party, which really does represent a crisis of governance.

That said, yes! Democrats are lame! Especially in this case, where they have a popular policy that also happens to be the policy that best brings down costs and provides competition in the insurance market. As for Drum's point that a bill without a public option can be good at a wonk level, he's talking about something like the Swiss health care system, where private insurers exist without a public alternative, but are strictly regulated. Which is perfectly fine except for a few things:

1) It is the second-worst system in the world in terms of costs, rivaled only by... the United States.
2) We have no history of regulatory strictness, in fact we have the opposite history, so actually pulling off a regulation-based check on the insurance companies is a real long shot.
3) The Swiss have higher co-pays, insurance premiums and out-of-pocket expenses than Americans, which politically would not fly at all. People are already crushed by the burden of high-dollar health care here.

The truth is that the difficulty of Democrats to include a public option - though I don't think it's dead yet - reflects the breakdown of our political system and the influence of corporate money. The Swiss have their health care plan because they put it in place relatively recently, and the large health interests didn't want a public component. It's the same here, and frankly politicians in both parties have been bought off.

As I said, I don't think this is quite over. Labor won't budge on their insistence on a public option, and for a White House obsessed with keeping their majority that's a big deal - lose the support of the AFL-CIO and you lose seats, period. What's more, progressives understand the pressure points now - mainly, the White House and Harry Reid. If he includes a public option in the merged Senate bill it will be very hard to get it out, and then Senators will be faced with the unpleasant choice of filibustering a bill that has the overwhelming support of the Democratic caucus and the White House to protect insurance company profits.

I'd make two calls today - Reid's office and the White House switchboard.

Tracking The Public Option Through The Senate

Those who have been paying attention understand that today was actually a pretty good day for the public option. We learned that Sens. Wyden, Carper and Nelson (FL) support it in some form, and that there are at least 51 votes for it in the Senate. However, yesterday Chuck Schumer did acknowledge that there aren't 60 votes at this time. Ezra Klein asks the right questions:

There are two questions here. The first is "60 votes for what?" Do they not have 60 votes in favor of a health-care plan that includes a public option? Or do they not have 60 votes against a filibuster of a health-care plan that includes a public option? If it's the former, that's okay: You only need 51. If it's the latter, that's a bigger problem. But I'd be interested to hear which Democrats will publicly commit to filibustering Barack Obama's health-care reform bill. If that's such a popular position back home, why aren't more Democrats voicing it loudly?

Second, why give up the public option now? If these moderates want to kill the measure, let them get full credit for doing so on the floor. They can sponsor an amendment to strip it out of the final legislation and go home to their districts having played a clear and undeniable role in the elimination of the public option.

The former is really the question. There are definitely 51 votes for a public option. It's unclear whether there are 60 for a final bill with a public option. And more specific than that, are there 60 to allow a vote on a final bill with a public option?

Mary Landrieu has come the closest to saying that she would filibuster a bill with a public option. Ben Nelson and Joe Lieberman are probably right with her. But I'd sure like to see them try to defy the President and doom a health care bill 40 years in the making over one provision. Reconciliation is always an option, given that you would only need 51 votes, but it's highly unlikely to get a public option that way. The main reason is that the Budget Committee would control the process, and Kent Conrad just voted against public option amendments yesterday, and would be highly unlikely to allow one to go through a 51-vote process. Heck, he doesn't want reconciliation at all. So Chris Bowers surmises that Harry Reid and the White House are the real pivot points right now, when the Senate merges the bill from their two committees:

The next step in the process does not actually involve Kent Conrad's Budget Committee, as I had previously reported (the Budget Commitee only comes into play with reconciliation). Instead, a source on the Hill confirms to me the Senate HELP and Senate Finance committees will be merged by an informal, behind the scenes process involving the four major players in the Senate: Tom Harkin (Chair of HELP), Max Baucus (Chair of Finance), Harry Reid (Majority Leader), and the White House. Together, these four will meet and decide what sort of bill to send to the Senate floor for debate and amendments.

During this process, we can guarantee that Harkin will push for a HELP or Schumer-like public option to be sent the floor, while Baucus will push for no public option to be in the bill at all. Given his recent statements, the best bet is that Reid will probably push against a public option too, and instead favor either triggers (which he has called a good idea) or co-ops (which seems to be the sort of public option he likes best). With two against and one in favor, this means that the only way a public option ends up in the bill that is sent to the Senate floor will be if the fourth major player, the White House, demands it.
It is all up to the White House now. If it pushes for a public option to be included in the health care bill sent to the Senate floor, then a public option will pass as part of health care reform (at that point, all we would need are 60 votes for cloture, and from what I hear we have 57 already). However, if it allows a health care bill to go to the floor without a public option, it is pretty unlikely that a public option will pass as part of health care reform.

Bowers doesn't think any floor amendment would need less than 60 votes, and while there are conflicting reports on that, he's probably right. He also doesn't think conference committee is an option, but I'm not sure I agree there. The House will almost certainly pass a bill with a public option. So it would depend on the White House umpiring that argument in committee. And that will almost certainly be decided by what they think can pass. If the Progressive Block in the House holds firm, and looks like a higher mountain to climb than getting 3 Democrats just to flip on cloture, the White House could go the other way at any step of this process.

Igor Volsky thinks we may see a new compromise floated:

Instead, the very same Democrats who defeated the national program during mark-up, will likely resurrect a discarded idea floated by the New America Foundation and momentarily embraced by the White House. That compromise will create a network of public options modeled on state employee benefit plans. The proposal could be triggered by Snowe’s amendment if reform did not meet a low affordability measure, but any state-based proposal would lack the market clout to lower overall health care spending, reform health care delivery, or hold private health insurers accountable.

Today may have been the death of the public option and the birth of state-based public options.

State-based plans won't have the economies of scale to really pressure insurers, but neither would Schumer's "level playing field" public option. Therefore, given that we're going to have to improve whatever inevitably comes out of the legislation, I'm inclined to say this is better than nothing. Apparently Tom Carper has started floating this behind the scenes.

I'm not as optimistic as Robert Creamer, but I do think that the public option still has a chance to survive in some form, and can be improved after the fact.

Blanche Lincoln's Backward Thinking

Arkansas Senator Blanche Lincoln didn't even have the courtesy to show up to vote down the public option today, instead voting no by proxy in the Senate Finance Committee. She released this statement about her no vote.

Arkansans have told me they support health care reform that forces insurance companies to cover pre-existing conditions and prevents them from dropping coverage when you become seriously ill. We can achieve these goals, stabilize the cost of coverage for Arkansans who have health insurance, and expand coverage to the uninsured and underinsured without creating a purely public, new government program, which most Arkansans do not support. I have promised my constituents that I will fight for health insurance reform that is deficit neutral, now and in the future, and that creates more choices for small businesses and their workers and the self-employed. These are important priorities that I believe we can achieve.

In addition, I am working to ensure that requiring Americans to purchase health insurance does not result in a personal windfall for health insurance company executives. My amendment would cut the tax shelter, from $1 million to $500,000, of what businesses are able to deduct for executive compensation. This is a fair policy change aimed at lowering insurance costs to consumers and reassuring them that insurance companies are not receiving excessive tax breaks while at the same time profiting from a government mandate.

First of all, the part I boldfaced is not true. In fact, Daily Kos did a Research 2000 poll just two weeks ago showing that Arkansans favored a public option by 55-38, with independents supporting it by roughly the same number (56-34) and Democrats overwhelmingly in favor, 81-14.

Second, Lincoln is in trouble for re-election. The Rasmussen numbers out today show her losing to all challengers, topping out at around 41% of the vote. While the Kos/R2K poll was more favorable, she still never beat 47% in any of those polls, and her fav-unfav numbers were 43/49. She's going to need some help from Democrats to win re-election.

I know that national Democrats would probably actively work for her defeat given today's votes. The Senate campaign committee is pretty much an incumbency protection racket, but they may be stretched fairly thin in 2010. Most important, Blanche Lincoln needs to win over her fellow Democrats in Arkansas. This will anger them, and the attempt at faux-populism by including an amendment to cut the tax shelter for health insurance company executives cuts pretty hard against her vote to roll back the estate tax for the richest families in America. There will probably be competition to Lincoln's left, and because it is likely to come from the fairly robust Arkansas Green Party, it will show up in the general election, not just a primary. Therefore, it is deeply in the interests of Lincoln to keep the Democratic base in Arkansas satisfied with her performance, and given the poll numbers, that points to supporting a public option. But she did not do that today.

The real test here is whether Lincoln would vote to filibuster the health care bill if a public option is included on the floor via amendments. If she does, it is more likely to hurt her in 2010 than help her, which I don't think she fully understands.

The Other Health Care Fires

The public option vote was expected, and we'll see a lot more wrangling and floor amendments and other votes before that's done. Supporters picked up Tom Carper and Bill Nelson, so progress was made, actually. I'd like to look at some of the other aspects of the bills moving through Congress, which also have important implications, and what the progress looks like on those fronts:

• Byron Dorgan, Kent Conrad's colleague from North Dakota, will fight to stop the White House/Big Pharma deal from getting implemented. He's going to offer amendments to the final bill to allow reimportation of prescription drugs from Canada, at a savings of $50 billion dollars over 10 years. Surely the free-traders won't have a problem with that, and if they do, they can put a pool together and find the $50 billion that we're otherwise wasting by restricting such a common-sense measure.

• Jay Rockefeller is looking to extend the bill protections to "self-insured" health plans. I just found out about this a couple weeks ago. Apparently, 70 million people in America work for large corporations which self-insure. They have health insurance companies to administer the billing, but the corporation is taking on all the risk themselves. And, they reap the profits, too. These corporations have essentially turned their employee health care into a small profit center. And none of the regulations in the bill would impact these 70 million, simply based on who their employer is. Those employees should have the same protections, regardless of how "well" the self-insured market is working currently.

• In terms of pernicious amendments, anti-abortion activists want to block the exchanges from providing reproductive choice as part of their health care coverage. That would include private companies, and would represent the government telling private insurers what they cannot cover. That's fine to free marketeers because it would restrict legal medical services like reproductive choice. It's complicated, but the anti-abortion types want to use the Hyde Amendment to say that anyone getting subsidies to use the exchange couldn't buy a plan which covers abortion. Thing is, Jon Cohn writes that taxpayers already subsidize plans that offer reproductive choice:

Remember, the single largest tax subsidy in health care today is the tax break for employer-sponsored insurance. If you have insurance through your job, then you're getting government assistance just as surely as if Washington wrote you a check. And if your policy happens to cover abortion services--which about half of you do, according to the Kaiser Family Foundation's annual benefits survey--then the taxpayers are helping to subsidize it.

I'm not trying to accuse abortion rights opponents of hypocrisy or inconsistency. I'm sure they'd eliminate everybody's subsidy if they could. By trying to keep funding out of the exchanges, they're trying to hold the line--to keep more abortions from happening. I don't agree with their position, but there's nothing illogical about it.

But I suspect a lot of voters think the distinction makes sense for a different reason. They have mixed feelings about abortion, so they like the idea of supporting choice in principle while opposing taxpayer funding. The trouble is, it's not a meaningful distinction because of the employer tax subsidy, which (much to my regret, for unrelated policy reasons) is here to stay.

This is a larger attempt to overturn Roe v. Wade without going to court, basically.

• House Democrats will probably add the tax on high-dollar insurance plans into their funding mechanism for health care. Unions hate it, because they've given up wage increases for high-quality health care. But the employer deduction, as Cohn says above, is very pernicious and inefficient, and taxing insurance plans is a way to get at it. I would think that companies would welcome cash payouts over maintaining such high-price health care benefits. Hijacking health care reform to save parochial interests, when we should be moving away from employer-based health care entirely, doesn't make sense.

Public Option Vote In Moments

John Kerry just laid down the real killer argument in this whole debate - those opposed to the public option are fearful that it would be too successful and Americans would like it too much. They're protecting insurance industry profits over serving their constituents. Given how good Kerry is at talking about the public option, I'm wondering why he barely said a word about health care during the 2004 campaign. He could have been President if he managed to wind up this kind of moral authority.

We'll have a vote shortly...

...Max Baucus will vote against the amendment because he has to protect his bill and he doesn't think that the public option can get 60 votes. Well, with him voting against it, of course it won't get 60 votes! That is a total cop-out. He's also saying "Rome wasn't built in a day" and we have to start laying the foundation for health care reform, alluding to the notion that it could be added later. His argument is a total process argument to protect insurance industry profits.

...Rockefeller NAILS Baucus. "We shouldn't say that process makes more difference than people. I don't buy it when somebody says, 'I just want a health care bill, I don't care what's in it.'" Rockefeller says he's astounded that Republicans are satisfied with $480 billion dollars in new subsidies being given to insurance companies, on top of everything they're already getting. Money spent on health insurance companies and not people's care. "What is wrong with giving people a choice?"

The final vote in this committee will reflect the opinion of 13 Democrats and 10 Republicans. In the Senate we have 60 Democrats and 40 Republicans. This is not a representative sample.

Rockefeller says "If they (Republicans) want to talk about sliding to a single-payer system, there's no better way to get there than to do nothing."

...Rockefeller: "The public option is on the march."

Here's the vote on the Rockefeller amendment: Rockefeller, Aye; Conrad, No; Bingaman, Aye; Kerry, Aye; Lincoln, No; Wyden, Aye; Schumer, Aye; Stabenow, Aye; Cantwell, Aye; Bill Nelson, No; Menendez, Aye; Carper, No; Grassley, No; Hatch, No, Snowe; No; Kyl, No; Bunning, No; Crapo, No; Roberts, No; Ensign, No; Enzi, No; Cornyn, No; Baucus, No.

8 Ayes, 15 Nos. Conrad, Lincoln, Bill Nelson, Carper and Baucus have been ferreted out. We'll see if anyone flips on the Schumer "level playing field" amendment.

...Bill Nelson just agreed to vote for Chuck Schumer's "level playing field" amendment. And during Schumer's remarks, he thanked Tom Carper for helping "move us toward consensus." So we may pick up a couple votes here. Of course, the "level playing field" amendment, which doesn't tie a public option to Medicare rates, saves $85 billion less over 10 years than the Rockefeller amendment.

This pretty much confirms that there are at least 50 votes in the Senate for a triggerless public option, based on past whip counts.

...Kent Conrad saying that the Schumer amendment reflects a "significant improvement" on the Rockefeller amendment... so will he vote for it? I'm thinking no. "The place where we still have a difference is whether the non-profit option is run by the government." He's sticking with his crappy co-ops. Conrad says that Schumer is moving much closer to package that can get 60 votes on the floor, but he won't help move it, of course.

...Schumer amendment vote coming right up. Max Baucus once again says that "the public option can't get 60 votes, so I won't vote for it." It's the "innocent bystander" theory of government. Why, if only a Senator like Max Baucus had a vote on the bill, surely it could attract the necessary votes!

..here's the vote: Schumer Aye; Rockefeller Aye; Bingaman Aye; Kerry Aye; Cantwell Aye; Stabenow Aye; Wyden Aye; Menendez Aye; Bill Nelson Aye; Baucus No; Conrad No; Carper Aye; Lincoln No; All R's no.

So Carper and Nelson flipped. Amendment fails 10-13. Only Lincoln, Conrad and Baucus against it.

...In the end, I'd say this is a pretty good outcome for the hopes for a public option, actually. Ron Wyden, Tom Carper and Bill Nelson are now on the record supporting a Schumer-like public option. Add that to Chris Bowers' whip count and the Washington Independent whip count, along with Paul Kirk coming out in favor, along with Claire McCaskill, and you have 50 definite yes votes, plus 1 (Mark Warner) who says that he wouldn't vote against the bill if a public option was in there. Mark Begich is a lean yes, as is Jon Tester and Mark Pryor, but you don't even need them. 51 votes are secured for some type of public option. So you could pass a public option through reconciliation as a pure deficit reduction play and would be assured, 100%, of 51 votes at a minimum.

There will be a fight for another day.

The Wanker Caucus

Ben Nelson thinks that the health care crisis is worth taking our time, and we should cut focus on cutting everyone's coverage for now and wait until later to expand coverage. Because those 47 million uninsured can wait. He also offered a stirring defense of minority rule:

Nelson appeared to settle on 65 Senate votes as a figure that would provide him a comfort level in terms of establishing a level of bipartisan support for a bill.

"I think anything less than that would challenge its legitimacy," he said.

A minimum of five Republican votes would be required to reach a total of 65 senators.

Sixty votes would be sufficient to clear a Republican filibuster and win passage of the legislation.

"It would be a tremendous mistake to jam it through with 50 votes" under the Senate's arcane budget reconciliation process, Nelson said.

Yes, it would be a mistake to assert the proposition that majorities can pass legislation. That would be an assault on democracy.

As David Kurtz, notes, Ben Nelson has never received 65% of the vote in his elections, so I'm sure he'll resign.

But Nelson is practically a single-payer advocate compared to Artur Davis.

Davis, D-Birmingham, said Democratic House leaders should listen to their members and President Barack Obama, who has said there is room for compromise on the public option.

"The idea that it's the holy grail of this debate is wrong," Davis said.

"Public option can't pass the Senate," Davis said. "I'm interested in something that can pass and Barack Obama can sign." [...]

"We need a new bill. The Senate is moving in that direction," Davis said. "Unfortunately, the House is not moving in that direction. What I see in the House is some hardening of the battle lines. That's discouraging."

"I'm not for penalizing any of our small businesses or any businesses ... especially during a time when you have an ongoing recession," Bright said, a point Davis echoed.

"Frankly, the House leadership seems wedded to keeping that in," Davis said. "And the more you look at it, the more indefensible that is."

Artur Davis is running for Governor of Alabama. He'll probably introduce a bill to hang immigrants before too long.