On The Health Bill, The Truth Will Out

By Big Tent Democrat, Section Other Politics
Posted on Wed Dec 23, 2009 at 08:34:00 AM EST
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And it has regarding the division between proponents of the Senate bill and Senate bill skeptics. Scott Lemieux writes:

I think Nate Silver's decimation of the reconciliation dodge is definitive. Granted, I roughly share his ideological priorities [. . .]

(Emphasis supplied.) Of course, having established himself as a proponent of the regulatory reform framework, there is little reason to read any more of Lemeiux's post. It ends up being a confession, much like President Obama's yesterday, that he did not really care one way or the other about the public option. Silver's "decimation" is really just an argument for the "regulatory reform framework" over the public insurance reform framework:

I think that the Senate's bill is quite a lot better than the status quo, and quite a lot worse than the ideal. I also think that the inclusion of a weak public option -- which is really all that was on the table -- would have made very little difference. A robust public option would have made more impact, but is still a long ways from the optimum policy. [. . .] If your lone objective were to end up with something that you could call a public option, then yes -- reconciliation offers some possibility of that. But I don't see how you're likely, on balance, to wind up with a better bill -- losing the guaranteed issue provision alone would probably outweigh the inclusion of a public option.

Silver, as usual, is disingenuous in his framing of the issue. But then so have been most all of the participants in the debate. Of course a public option was not "the lone objective," but it was a central and essential part of the main objective of many - to set in motion public insurance reform.

For proponents of the regulatory reform framework, the public option mattered not at all. As someone who believe the regulatory reform framework is doomed to failure, losing the regulatory reforms is as meaningless to me as losing the public option is to them.

In the end, the truth will out - as President Obama and the supporters of the "historic" Senate bill have been smoked out - they never cared about the public option - they were not against it, but they did not care if it was included or not. And vice versa for the public option supporters, they were not against the regulatory reform on offer - but they did not care if it was included or not.

There is of course one aspect of the Senate bill both sides agree on - expansion of Medicaid eligibility. Interestingly enough, this is a public insurance reform and it is the easily the most proven and cost effective reform measure in the entire bill and would be even if a public option were included.

One clear advantage for reconciliation would have been the ability to have an even larger expansion of Medicaid eligibility. The only advantage that following regular order presented was the ability to enact regulatory reforms. If you value them and do not value public insurance, then this Senate bill was definitely for you. If you did not value them and wanted a further expansion of public insurance, then reconciliation was the way to go.

And this was always true. Which leads to my ultimate objection to the regulatory reform supporters -- they were never honest about the fact that they did not care about the public option. Now with President Obama's public repudiation of the public option, the truth will out - neither Obama nor his cheerleaders in the Village blogs ever cared about a public option. Well, they got the bill and the reform they wanted. For them, this is a historic bill. If it fails, they will have no excuses. Of course, 10 years from now, no one will remember these arguments, but the Democrats will pay the price politically, both now and in the future, if it fails. Let's hope the Village bloggers are right this time.

Speaking for me only

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On The Health Bill, The Truth Will Out | 28 comments (28 topical)

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Puhleeze (5.00 / 2) (#1)
by Ga6thDem on Wed Dec 23, 2009 at 08:19:07 AM EST

is everybody sick of the Obamapologia now? It seems there's no limit with people like Silver who will make up any excuse for him. It's disgusting.

We had a lot of moderates (none / 0) (#4)
by Militarytracy on Wed Dec 23, 2009 at 08:48:21 AM EST

and even centrists and even center rights who started blogging during the Bush Years :) Having such a loser to blog against caused us all to not notice many differences amongst ourselves :) A lot of these fools calling themselves progressives, they either don't know what one really is or they're liars too.


The word (5.00 / 4) (#13)
by Ga6thDem on Wed Dec 23, 2009 at 09:46:40 AM EST

"progressive" is for people who have no vaules. Call me a liberal any day of the week.


: Well I've already confessed to having (none / 0) (#14)
by Militarytracy on Wed Dec 23, 2009 at 10:01:08 AM EST

compromised standards :)

: YES (none / 0) (#27)
by cal1942 on Wed Dec 23, 2009 at 08:25:38 PM EST

n/t

well poblano (5.00 / 1) (#3)
by lilburro on Wed Dec 23, 2009 at 08:45:41 AM EST

admittedly doesn't know what he's talking about:

I don't understand the confidence here, and it smacks to me of wishful thinking. I'm not a process wonk, but the overwhelming opinion among people who are is that, although the public option might survive the reconciliation process, things like the ban on denying coverage for people with pre-existing conditions, the additional regulations on insurers, and the creation of the health insurance exchanges would almost certainly not. Plus, the bill would have to be deficit neutral over five years and would be subject to renewal every five years.

So basically his HCR background is "I believe every word Ezra writes." Great.

The most interesting part of this debate is the ideological split. The problem is that people who don't want and did not want the PO don't want to acknowledge they are not ideologically the same as Jane Hamsher et al. For some reason they still want to call themselves progressives. If you're not progressive like us, then you are crazy.

If you want to stand behind the idea of the insurance exchange, own it. And explain to me how on God's earth it is a "progressive" idea.

And I have a few questions for Exchangers:

Explain to me how the government is going to effectively regulate a "farmer's market" of insurance, especially considering that the major players will be preexisting gigantic insurance companies with overwhelming influence on DC players?
How is the insurance exchange any more effective at reforming insurance than the PO? As it stands the insurance exchange does basically nothing. Is it really feasible to expect it to grow? Remember, none of you ever gave a damn about our camel's nose arguments.
How do the plans offered in the exchange not deteriorate in quality over time as a way of attracting people who want to save money? Aren't the exchanges essentially dependent upon really really strong government regulation?

in defense of Ezra (5.00 / 1) (#16)
by souvarine on Wed Dec 23, 2009 at 11:55:48 AM EST

To be fair, Ezra Klein supported Edwards in the primary on ideological grounds. He looked closely at each candidate's health care plan and identified Hillary Clinton's as the most progressive and Barack Obama's as the least. He criticized Obama's plan for it's market based, conservative approach. Once the primary had sorted out to Obama and Clinton, Klein settled on Obama as his candidate. Given his ideological preferences, his knowledge of each candidate's actual ideological position, his experience with communication strategies from his work on the Dean campaign, and his familiarity with the health care issue, that decision was hard to understand (after eliminating each rational explanation all that remained was gender bias).

Once Obama was our nominee and president Klein began defending Obama's proposal on it's own terms. Not because it was his ideal, but because it was the best that was likely to pass under Obama's administration.

Like most of Obama's domestic policies his health care plan is the DLC plan. The DLC never included a public option, they saw the national health insurance exchange as a market friendly response to the failure of Clinton's managed competition in 1994. The idea was to build a regulated pool of customers large enough to be attractive to private insurers. Insurers would have to follow the rules of the pool in order to participate, and then competition among those insurers would keep prices down.

If you don't believe the government can effectively regulate private insurance then none of the proposed plans will satisfy you. The most liberal proposals start from the assumption that any plan has to preserve the existing employer based private insurance system to survive politically.
The public option was devised by Jacob Hacker to operate within the insurance exchange and to push it in the direction of public single payer. Obama proposed an exchange and public option so limited and constrained that it could not compete with the private insurance companies. He never intended the exchange to expand and compete with private insurance. BTD is right, Obama's focus is a regulatory framework that largely protects private insurance, the exchange was a sop to convince his dimmer supporters that he was a secret progressive.
The exchange is predicated on strong, but voluntary, government regulation. Obama hopes that the threat of an expanding exchange will push private insurance to reform itself, and the need for the exchange will disappear. Most Democrats believe that employer provided private health insurance will continue to collapse, and the individual mandate will force the exchange to expand. The assumption is that, like with Medicare, public pressure will balance out the insurance companies and steadily improve the quality of coverage provided within the regulated exchange.

Gender Bias?! (none / 0) (#22)
by Socraticsilence on Wed Dec 23, 2009 at 04:46:25 PM EST

please as someone who read Ezra from the Pandagon days, I thought his decision between Clinton and Obama was relatively simple to understand-- Iraq and political organization-- Ezra liked (but didn't back) Dean in 04, he had mentioned time and time again about Iraq, and he clearly liked the way the Obama camp was organized. People keep underplaying this- Obama got the youth vote largely due to Iraq and Organization, much as Clinton got the Older vote largely on Healthcare and Nostalgia/gratitude for the 1st Clinton Admin. -- Its starting to get really old hearing people misjudge the priorities of younger voters-- to most of us Healthcare wasn't the major issue-- Iraq was- it was our friends who had served and come home scarred mentally and physically, much as healthcare was personal to those who were in the older age groups. (And before anyone mentions it- frankly, I like what Obama's done on the foriegn policy front, most of the people I know who signed up to serve post-9/11 did so to fight in Afghanistan and the accept the mission.


: umm (none / 0) (#24)
by lilburro on Wed Dec 23, 2009 at 04:54:08 PM EST

didn't Ezra support going into Iraq?
Why does a healthcare blogger not support someone with a better healthcare plan?

: gender bias. (none / 0) (#26)
by souvarine on Wed Dec 23, 2009 at 08:24:48 PM EST

Ezra Klein worked on the Dean campaign. He got his start with Joe Rospars (and if you've ever worked with Joe you would know what I'm talking about).
Now perhaps Ezra was so naive as to think Iraq was a distinguishing factor between Obama and Clinton, and maybe he got carried away by visions of an organizer president. But neither of those fit the policy wonk who actually cares about the issues he discusses.
Perhaps you are thinking of someone else.

Pertaining to the quote (none / 0) (#6)
by TeresaInSnow2 on Wed Dec 23, 2009 at 09:05:36 AM EST

I'm pretty sure the denial for pre-existing conditions will most certainly be dropped in negotating the final bill no matter what else happens. Why? Because if it exists, then for many people in the individual market (like me), it makes more sense to drop the insurance they already have, pay the tax penalty and add insurance once they get sick. This will be risky for people who think they might contract an emergency illness such as a heart attack. But for someone like me who is genetically more likely to develop cancer than have a heart attack, it may very well be a better risk to opt out of insurance, pay the tax, pay my own way medically (as I already do with my high deductible insurance that I keep in case I get cancer because of pre-existing conditions issues) and opt back in when they get sick.

So the pre-existing conditions help is going to go....next, I'm thinking.

When it's all said and done, I predict the mandates will be left, not much of anything else.


I'm positive it will not be dropped (5.00 / 1) (#8)
by Big Tent Democrat on Wed Dec 23, 2009 at 09:08:31 AM EST

: Good (none / 0) (#19)
by TeresaInSnow2 on Wed Dec 23, 2009 at 02:54:41 PM EST

Then I'm going to cut my costs by about 3/4 by dropping insurance and paying the tax. I gotta use their lousy policy as much to my gain as possible.

I reject the idea that "progressive" (none / 0) (#7)
by Big Tent Democrat on Wed Dec 23, 2009 at 09:08:09 AM EST

equal support for pubic insurance reform.

This is an question of efficacy, not ideology.

At least for me. If I thought that regulatory reform would work, IDEOLOGICALLY, I would support that over public insurance as I am a rather corporatist DLC Dem on the issue of government intervention.

I do not favor government intervention for the sake of it. I favor it when it is the best policy, which is not always the case. Here it is.


: well (none / 0) (#9)
by lilburro on Wed Dec 23, 2009 at 09:21:53 AM EST

Call public option supporters whatever you want, progressive, liberal, etc. But they are a different breed than people who have been advocating for regulatory reforms and killing or letting the PO die. The public option may be more effective but it is doubtlessly rooted in a liberal ideology. Unless you were coming from a liberal POV you wouldn't have invented it.

: Efficacy is in my opinion (none / 0) (#12)
by Militarytracy on Wed Dec 23, 2009 at 09:38:50 AM EST

a primary definer in being a progressive. I think I feel comfortable as a progressive because I was raised by Democrats who were also small business owners. I've seen all sides of the coins. I was always taught that "bad business" or working only to get over on someone and not actually using my talents to produce something useful and of quality that I'm proud of wasn't only self destructive eventually, but it also was bad for my local economy. I don't find anybody arguing for efficacy though in this debate.

Poblano a Great Post (none / 0) (#21)
by norris morris on Wed Dec 23, 2009 at 04:37:27 PM EST

Thanks for your terrific post. The exchanges are pipe dreams.

Judging from the efficacy with which Team Obama ran the Senate caper,loaded pork to buy votes, terrorized the spineless Senators, screwed up the Olympic bid [for even being naive enough for going],shill War in Afghanistan with no end goal or rational strategy,declare the embarrassing failure in Copenhagen as a victory,and give himself a B+, my opinion of Obama is that he is not a leader.

Forget charisma. It's not there anymore. He just has refused to engage in the job of being President and how to create a connection with Americans that leads them to successful progressive change. Or any real change.

The HC debate and fiasco has been playing without a conductor.

The triggers and exhanges are not real and to make them real there is no strategy and plan for implementing these and who will run them, and what they will cost and what regulatory body will prevail over these?

So it's bait and switch and the fix has been in from the begining.


And of course, what Silver says about (5.00 / 2) (#15)
by andgarden on Wed Dec 23, 2009 at 10:13:45 AM EST

Reconciliation is wrong on process and politics. Tom Harkin on Saturday (PDF):

We could have emulated the Republicans. We could have emulated what they did when they were in the majority in 2001. I was here. I remember it well. When they came up with this crazy tax package that cut taxes for the wealthiest in our country, stole the surplus we had built up under President Clinton by the year 2000 where we were looking at surpluses on into the future, and they came up with all of these big tax cuts for the wealthy, guess what they did. They didn't involve us at all. They did reconciliation where they only needed 51 votes. Under reconciliation, under the rules of the Senate, as the Presiding Officer knows, there is no filibuster. You cannot filibuster a reconciliation bill under the rules.
So if they had done their tax bill in 2001 like we are doing this, we could have delayed. We could have had some input into that, but they said no. They just went right to reconciliation. We could have done that with this bill. We could have done that with this bill.

I remember having discussions with members of our caucus and others saying: No, no. And the President, President Obama, wanted to do this as bipartisanly as possible to involve the minority in a constructive process. So that is what we decided to do, to do it in a very constructive, open process. What it has gotten us is total--total--obfuscation and delay and trying to kill the bill by the minority. But we will persevere. We started this open process, and we are going to finish this open process. The die is cast.

: You Believe Obama? (none / 0) (#23)
by norris morris on Wed Dec 23, 2009 at 04:48:04 PM EST

Simply stated this strategy along with Obama's
ham handed absence and refusal to lead has created this mess.
While we're at it lets give some of the blame to the most spineless bunch of political whores I've watched in a long time. They even managed to make the ruthless Republicas look like Pros at governing and sticking to their convictions.
As a woman who fought hard for women's freedon of choice and equal protection, this end run on RoevWade is despicable beyond comprhension.
Obama will be responsible for Democrats being in the wilderness for a long time. He doesn't begin to know how to fight, and is a timid puppet ruled by Axelrod/Rham who have "handled" him badly.
Listening to Obama's denials re: the Public Option are cringe making as is the mangled mess of this HC bill.

thanks, BTD (none / 0) (#2)
by kempis on Wed Dec 23, 2009 at 08:22:30 AM EST

Your clear-eyed, logical analysis of the politics at play on this issue has kept my head from exploding. Sadly, they don't do much to change reality, since reality is crafted by those who prefer their waters muddied. But I appreciate your ability to cut to the fundamentals, sans b.s.

At this point, as you say, there is nothing to do but hope for the sake of the country that the glass-half-fullers are right. I find it hard to imagine, but then I've been wrong before.

Lying is the new confession huh? (none / 0) (#5)
by Militarytracy on Wed Dec 23, 2009 at 08:50:12 AM EST

I might have an updated defintion of insubordination........but dude?

Obama's a Compassionate Conservative (none / 0) (#10)
by Dan the Man on Wed Dec 23, 2009 at 09:27:18 AM EST

Compassionate conservativism is the government helping private corporations make lots of money in order to help the people a little bit, while rejecting rules/regulations which would cut down on their profits. See the wikipedia definition of compassionate conseravatism: "A compassionate conservative might see the social problems of the United States, such as health care or immigration, as issues that are better solved through cooperation with private companies, charities and religious institutions rather than directly through government departments. As former Bush chief speechwriter Michael Gerson put it, 'Compassionate conservatism is the theory that the government should encourage the effective provision of social services without providing the service itself.'"

A good example of this during Bush's term was Medicare part D. This helped seniors pay for drugs while preventing the government from negotiating drug prices - so drug companies could make more money. Similarly, the current health care bill helps give the health insurance companies lots of money while having no effective cost control mechanism which would cut their profits.


I think this is an ideology (none / 0) (#11)
by Militarytracy on Wed Dec 23, 2009 at 09:31:00 AM EST

that is incorported into the Hamilton Project as well. Funny how well that action verb works very well in that sentence.


Medicare Plan D is a ripoff (none / 0) (#25)
by norris morris on Wed Dec 23, 2009 at 05:10:14 PM EST

Anyone extolling Medicare Plan D isn't a senior or doesn't understand the Plan. As a senior I can say it a vile rip off.

I take 5 meds a day. Two are generic and afordable, but the others put me in the donut hole within 4 months. So, for 8 months I continue to pay premiums and GET NO REIMBUSEMENT
UNTIL I REACH AN UNREACHABLE CAP that would re-start reimbursement. So far since it's inception, I've been sookered by the donut hole.

The Republicans put this crapola bill over at Midnight as Tom Delay and Billy Tauzin [now chief lobbyist for BigPharma that Obama made his secret drug deal with] pushed three votes on this bill until they got necessary cave ins. You see they were defeated on the first 2 votes and illegally ran a third after intimidating the pols and finally got this sucker put over on seniors.

Now Obama is playing in the same sandlot having made a nefariously rotten Drug and Insurance deal with the same Billy Tauzin, lobbyist for BigPharma.

If you think Medicare PlanD is a good bill, I urge you buy into it and see just how awful it is. And if you get real sick and need heavy duty meds, lotsa luck. You'll need it 'cause many drugs are not even covered in the formularies of most senior Medicare Plans purchased through private insurers like mine...AARP, [but United Heakth Care is the real insurer]. We MUST buy this crap through private insurers or remain completely uninsured re: drugs. I'm actually considering opting out.

Like all private Health insrance it's designed to give you as little as possible.


Part D (none / 0) (#28)
by KLCarten on Thu Dec 24, 2009 at 12:35:38 AM EST

I have Part D, the thing is you have to find the insurance company and plan that suits you and your medical situation. I take 11 different medications daily. All of mine are generic and cost $5 except two which cost me $10 due to limits. I could change both to different types, but for now it works for me.

I pay $65 a month for Part D, and I still have close to $300 left before I hit the donut hole. I have the gold plan, I pay probably double of most plans, but I have generics paid even if I reach my donut.

It takes alot of time and research to find the right part D. I am guessing that the exchanges will be the same way. It was a huge pain in deciding what plan was right for me.

I did not have the money to pay for my scripts if I did not have part D. The only good thing was I helped my mother in law with hers, she had a tough time figuring out which was best for her.

I hope you have better luck in finding a different plan that suits you needs better. There are so many and after awhile they all start looking the same.

Good Luck.


: AARP's Medicare Plan D (none / 0) (#29)
by norris morris on Thu Dec 24, 2009 at 06:49:14 PM EST

United Healthcare runs the Supplementary Medicare Plan and Plan D the Medicare Drug plan. The Medicare Plan D drug plan with a new raise costs $80 a month if you take their best plan in New York. All plans offered by AARP and backed through United Healthcare which is designed to screw you by putting you in the donut hole ASAP when you reach their cap. The drug that costs me $7.00 as a generic is also figured by AARP to the price they had to pay to buy it. Believe it.
So it's the add on tnat gets your cap used quickly. If you are on more expensive tier drugs, forget it.
I pay the $80 all year but get nothing after cap is reached. After that one must reach a high of around $5000 out of pocket, and possibly I might reach that by Dec.
Guess what? Year's up!!! So you basically get nothing. If you take generics, you can buy them for the same price without AARP[United Healthcare].
So Obama's deal with BigPharma is a screw job our Senate and House let him get away with.

OT--another health care truth from UK (none / 0) (#17)
by mollypitcher on Wed Dec 23, 2009 at 01:35:58 PM EST

Mentioned our health care debate to a UK friend. Here's her up-to-the-minute report on how hard it is to get a doctor's appt. over there:

"When I found a breast lump I saw my doc on a Tues. - my Doc said she was sure it was a cyst but would refer me anyway, but as a non-urgent case, so I'd prob have to wait 5 or 6 weeks. I received an appointment the Wed. of the following week. When I said my GP had classed me as non-urgent, so how long would I have waited for an urgent appointment, the reply was "about 2 days".

This excuse is as bad as 'Well It's Not Perfect' (none / 0) (#18)
by Ellie on Wed Dec 23, 2009 at 02:27:08 PM EST

... to "answer" ANY and ALL criticism of real flaws, rather than address the particular area the criticism (or in the Obama-HC"R" case, even skepticism) raises.

NTM: the PO isn't a teensy thing.