Political Bargaining: Reconciliation, Health Reform, Subsidies And The Public Option

By Big Tent Democrat, Section Other Politics
Posted on Thu Sep 10, 2009 at 11:07:59 AM EST
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I written for weeks now about the irrationality of certain "progressive bloggers" regarding political bargaining. Matt Yglesias' latest gives a clue why:

It’s worth noting, after all, that even the versions of health reform in congress that do include a public option would be better for the insurance industry than no bill at all. It seems to me you ought to be able to look an insurer executive or lobbyist in the eye and tell him, “I’m casting a vote that will help you get even richer” even while voting “yes” on the House version. To hold out for Baucuscare or nothing requires a sort of disturbed mindset that I’ve puzzled over before. And it’s striking that the people holding this position not only haven’t given any sort of actual reason for their view, but they’ve barely been asked to give a reason.

The reason why no one asks them is because people like Ezra Klein and Matt Yglesias (and Jon alter and Joe Klein) provide Obama and the Media cover to tell progressives to give up on the public option (indeed, the insurance industry now cites to Klein.) Forget about the merits of Klein and Yglesias' views on the substance (and I find their views quite weak), their complete obtuseness on the subject of political bargaining has been a wonder to behold. They truly appear to be clueless about it. The Steny Hoyers of the "progressive" blogs. "Serious" people. More . . .

People like Charles Schumer, Anthony Weiner and the Progressive Block must wonder if anyone knows how to play this game.

Schumer has, on a number of occasions, talked expressly about the reconciliation option. For two reasons imo. First, to take away leverage from President Snowe, Ben Nelson, Max Baucus and other recalcitrants. Second, because I think he genuinely believes that is where we are going to end up anyway. He has trying to legitimize it politically.

Anthony Weiner, a Schumer protege, has talked up single payer is the best option, and the public option as, at best, a compromise that he would be able to accept. He tried to move the political spectrum on the issue. Remember, Weiner was known as a "moderate" when this all started.

For the Progressive Block, this is all new territory. They have never mattered this late in the game on any major issue. So they are trying to figure out how to play it. Hopefully, they will understand that they have only one play, if there is going to be a "health care reform" bill, it has to have a public option.

Now, if someone offers a bill that increases Medicaid coverage and offers subsidies for health insurance for the working poor, take it of course. But not with mandates and other "health care reform" provisions. Medicaid funding and subsidies for the poor are just funding issues. they are not reform issues.

If the insurance companies want a mandate, they know the price - a robust public option. Take it or leave it.

As I wrote before Leave the Gun (Mandates), Take the Cannoli (the Medicaid funding and subsidies for the working poor). We'll do health care reform at a more "measured pace" if we must.

Speaking for me only

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Political Bargaining: Reconciliation, Health Reform, Subsidies And The Public Option | 34 comments (34 topical)

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Nailed it (5.00 / 4) (#1)
by gyrfalcon on Thu Sep 10, 2009 at 11:16:37 AM EST

BTD, I don't always see things the same way you do, but on this issue I've been sitting here repeatedly shouting "YES!!!" at my computer with nearly every new post.

Thank you. Your clarity on this is fantastic.

A public option that would actually (5.00 / 1) (#2)
by inclusiveheart on Thu Sep 10, 2009 at 11:19:57 AM EST

be open to the greater public or it really isn't an "option" as advertised.

Either you accept the (5.00 / 2) (#3)
by Big Tent Democrat on Thu Sep 10, 2009 at 11:22:10 AM EST

"casmel's nose under the tent" idea, or not.

If you do not, you should hope that the process falls apart.


I'm still trying to figure out (5.00 / 2) (#20)
by Anne on Thu Sep 10, 2009 at 12:13:16 PM EST

if the part of the camel's anatomy that is under the tent is its nose, or if it's the other end, and the camel just ate a Costco-sized can of beans, and, well, you can take it from there. If it isn't the camel's nose under the tent, there's a good chance that there's going to be a significant exodus from the tent when the, um, fun begins.

In all seriousness, given Obama's insistence on anything health-care related having to be revenue-neutral, and given that some of the programs mentioned - Medicaid and S-CHIP - are run by the states, which have to find funding at a time when many state governments are already laying off employees, instituting furlough days, cutting services, I just do not see how piecemeal expansion of programs that would help the poorest and the sickest stands a chance of happening; either we have comprehensive reform that addresses the underlying problems that got us where we are, or we look at opening up Medicare in stages, starting with the uninsured and those 55-64, and gradually expanding it to be open to anyone who wants it.

Do you still have funding issues? I'm not enough of a numbers person to know the full answer to that, but given that the structure exists, there would be no additional layers of bureaucracy, it wouldn't take four years to set up, you would be adding younger and presumably healthier people to the existing elderly pool (all people who aren't insured are sick), I don't see how it would be the same kind of financial boondoggle as what is currently being proposed.


: And (none / 0) (#23)
by TeresaInSnow2 on Thu Sep 10, 2009 at 12:25:50 PM EST

you're creating government jobs with good health insurance!
Although I'll say as I always do that Medicare is yet another beast they're trying to drown in the bathtub.

: Expanding Medicaid in the current bills (none / 0) (#27)
by MO Blue on Thu Sep 10, 2009 at 12:43:47 PM EST

This is something I can't get a clear picture of how it is going to work. IIRC something like 13 million additional people would be allowed Medicaid coverage. Is the federal government going to pick up more of the tab for these people or will the states be responsible for their share of the costs?
Does anyone know the answer to this?

I am still debating what I should (none / 0) (#4)
by inclusiveheart on Thu Sep 10, 2009 at 11:36:00 AM EST

hope for, but I still think that at least asking that the public option be an option open to all at this stage of the game is probably better than not asking at all.


Oh certainly (5.00 / 1) (#6)
by Big Tent Democrat on Thu Sep 10, 2009 at 11:36:48 AM EST

Heck, ask for single payer.

Weiner is doing it the right way,


Ha. Glad to see (5.00 / 3) (#13)
by Cream City on Thu Sep 10, 2009 at 12:07:24 PM EST

we now agree on that -- aim high, and maybe we can land in the middle. Start in the middle, and we only work down.


In light of your essay, I did think it odd (none / 0) (#18)
by inclusiveheart on Thu Sep 10, 2009 at 12:11:39 PM EST

that you would take issue with me expressing a desire for a fuller policy than what was discussed in the speech last night.


I thought you were questioning (none / 0) (#22)
by Big Tent Democrat on Thu Sep 10, 2009 at 12:20:08 PM EST

acceptance of the public option.

Weiner does not. Take Weiner's stance and I think you and I would be on the same page.


: I do take Weiner's stance. (5.00 / 3) (#26)
by inclusiveheart on Thu Sep 10, 2009 at 12:41:01 PM EST

The past few months have made me more committed to talking about single payer than ever before. I thought I could live with the Public Option, but I am not thinking that way as much anymore. The weirdest thing that happened recently was that I was talking with someone well to the right of me about all of this and when we reviewed the options, my friend seemed more open to single payer than any of the other options being proposed. I think it was the simplicity - and familiarity that single payer offers in that it would be essentially an expansion of Medicare coverage to all - as we were discussing it anyway.
I don't understand why someone smart didn't sit down and figure out what they could offer if everyone in America chipped in $50-$100 a month and then figured out how a progressive scale on top of a minimal base would or could deliver. That's where I would have started my planning, but I wasn't invited to the planning party and the really smart people who are supporters of single payer weren't either. I am grateful for Weiner's contribution to the debate. I wish the entire progressive caucus was voicing his talking points instead of trying to appease the president by holding back.

Why Big Insurance would always say no (5.00 / 1) (#33)
by pluege on Thu Sep 10, 2009 at 06:06:42 PM EST

to the public options:

1) their greed is insatiable. Sure they'll make even more obscene executive pay under mandates and a "robust public option", but why settle for more when they can have obscenely more. More greed first, last, and always is their mantra.

3) regardless of what the numbers say in the near term, everyone knows that any enactment of a public option is the fork in the road that eventually leads to the end of private health care insurance, except for glamor coverage of the ubber wealthy. "For-profit" and providing reasonable health care services at a reasonable cost are completely contradictory concepts - they can not coexist.

BTD, I am torn on believing (none / 0) (#5)
by jeffinalabama on Thu Sep 10, 2009 at 11:36:37 AM EST

the camel's nose idea. The Big Dog mentioned it yesterday morning, and after hearing him, I was hopeful. But I don't think that the same type of leadership or desire currently exists in the oval office, at least not for health care.

As such I am conflicted. But leaning toward the 'do no harm' adage. To me, today, it looks like failure is the best option, based on the choices.

I don't want think this way. I'll wait and see, but nothing might be better than the alternative.

In that respect BTD is being smart (5.00 / 1) (#7)
by cawaltz on Thu Sep 10, 2009 at 11:43:30 AM EST

he's already separating funding from reform. If reform were to be tossed, it would still leave funding people without health care on the table through existing programs such as Medicaid, SCHIP, or Medicare. Heck if I were the Democrats if the GOP balked at reform I'd try for expansion of the existing programs again. As long as they are going to get accused of attempting to "expand them into national care programs(and the GOP did indeed make that charge)" they might as well open it up. They can get the funding from taxing the top 10% a little more and asking Paris to forgo another diamond collar for Fido.


: And then Obama can thank (5.00 / 1) (#14)
by Cream City on Thu Sep 10, 2009 at 12:08:54 PM EST

the Repubs again for all their good ideas! And do it with a straight face again. I suspect that was fun.

I'm definitely in the "do no harm" camp (5.00 / 2) (#15)
by MO Blue on Thu Sep 10, 2009 at 12:10:11 PM EST

There is quite a bit on the table at the moment that would IMO do a great deal of harm if implemented.

One of the things in the Baucus plan would allow the insurance industry to go to a 70% - 30% or even a 65% -35% split on coverage after deductibles . This could very well become the industry standard for all policies except for Cadillac plans. Under those circumstances, each year more and more people would fall into the category of those who have insurance coverage but cannot afford to use it.

Even without that split, it looks like people might be forced to purchase junk insurance that they cannot afford to use even if they manage to pay the premiums.

Charging people 60 and older 5 times what they charge a 20 year old will have more ramifications than just putting that age group in a position that they cannot afford insurance.

Just a few of the things that are of major concern to me.

What's the ratio now (5.00 / 1) (#21)
by gyrfalcon on Thu Sep 10, 2009 at 12:14:41 PM EST

of over 60 to 25? I know that we already pay much more for health insurance as we age, but I don't know what the actual ratio is.


TeresaInSnow2 provided a (none / 0) (#24)
by MO Blue on Thu Sep 10, 2009 at 12:32:33 PM EST

link to Washington States insurance plan. I don't know how representative it is but the ratio ranged from 4.3 to 3.6 (depending on coverage) when comparing those <25 to those 60 - 64. At lease one of the House bills limited the difference to 2x the rate.

That's kind of what I thought (none / 0) (#29)
by gyrfalcon on Thu Sep 10, 2009 at 03:39:34 PM EST

So this "5 times" figure isn't some draconian new thing dreamed up by Baucus, it's just building in preservation of the status quo.


I guess I'm a little pickier with my math (none / 0) (#30)
by MO Blue on Thu Sep 10, 2009 at 04:04:06 PM EST

5 times is more than 4.3 x by .7 and more than 3.6 by 1.4. On a $300 a month premium for <25, the .7 increase would cost an additional $210 per month - $2,520 annually and the 1.4 increase would cost an additional $420 per month -$5,040 annually. Those increases would come as a real burden to poorer 60 - 64 years old.


Also, those increases would (none / 0) (#31)
by MO Blue on Thu Sep 10, 2009 at 04:13:42 PM EST

substantially increase the dollars the federal government would have to pay out in subsidies for qualified people in the 60 - 64 age bracket. That will not be pocket change by any means. Since Obama has sworn to come up with additional budget cuts to keep HCR deficit neutral, will that mean the Medicare budget will be cut further as more boomers fall into that group.


: Bingo! (none / 0) (#32)
by suzieg on Thu Sep 10, 2009 at 05:10:38 PM EST

ABC reporting 16 Dem Blue Dog Sens... (none / 0) (#8)
by magster on Thu Sep 10, 2009 at 11:48:04 AM EST

and Lieberman are being summoned to WH to meet with Obama.

Is this:

a) asking for their support for PO in reconciliation
b) asking them for a united PO-less "alternative" to PO that Obama will push as his own.
c) a fantasy football draft for the Blue Dog fantasy league.

: I figure he's poking around (5.00 / 1) (#9)
by cawaltz on Thu Sep 10, 2009 at 11:55:11 AM EST

to see which side is more likely to fold. It would be interesting to hear what kind of bones he is willing to toss them in order to get something called reform under his belt.

Senator Claire McCaskill (none / 0) (#10)
by KeysDan on Thu Sep 10, 2009 at 11:58:01 AM EST

is quoted as being happy that the president talked about "handcuffing" the public option. Without handcuffing, she continued, the public option could morph into a comprehensive plan (God forbid), which most moderates can't support. I am not sure what her desired handcuffing entails

Remember this guy? (5.00 / 1) (#17)
by lilburro on Thu Sep 10, 2009 at 12:11:20 PM EST

"Why would it drive private insurance out of business? If private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business? That's not logical."

Why did this guy disappear?


Ask her who she is going to lobby (5.00 / 1) (#19)
by MO Blue on Thu Sep 10, 2009 at 12:12:58 PM EST

for after she fails to be reelected in 2012.


: What's the firm Daschle & wife (none / 0) (#25)
by oldpro on Thu Sep 10, 2009 at 12:40:39 PM EST

lobby for? That one. Or two.

I'd ask Claire (none / 0) (#11)
by cawaltz on Thu Sep 10, 2009 at 12:00:13 PM EST

if she understands the difference between can't and won't.


I'd ask her what the H*LL is wrong (5.00 / 1) (#12)
by nycstray on Thu Sep 10, 2009 at 12:03:00 PM EST

with a comprehensive plan.


: Comprensive = inclusive (5.00 / 2) (#16)
by Cream City on Thu Sep 10, 2009 at 12:10:17 PM EST

and it has been quite clear that McCaskill has been happy, instead, to find herself in such an exclusive club. One of the villagers now.

: I'd ask her what the H*LL is wrong (5.00 / 1) (#28)
by Spamlet on Thu Sep 10, 2009 at 02:05:40 PM EST

with her.

the progressive plan (none / 0) (#34)
by Bornagaindem on Thu Sep 10, 2009 at 06:38:43 PM EST

would be medicare for all. That is where the bargaining should have begun- and then you can negotiate for a middle ground (perhaps). When your lead guy (obama) already gives everything away before you even get to the bargaining table (ie medicare for all, an individual instead of a business mandate , no negotiating for drugs by medicare ) you can't come to the middle ground. You can only come to somewhere right of center. That is not why I elect democrats- oh but then we didn't really elect one did we.