More On Progressive Bargaining: Bad Bluffs

Nate Silver provides an intelligent and cogent response to my post on political bargaining. Silver disagrees with my comparison of the union bargaining on the excise tax with progressive bargaining for, to take the most obvious example, a public insurance program:

Armando brings up the counter-example of the unions who, he claims, "were willing to 'kill the bill' unless they received major concession on the excise tax issue" and indeed received "major concessions." Let's look at this case, because it turns out to be pretty instructive. I can think of at least three fundamental differences. First, the unions were worried about something -- a tax -- that was more linear in nature than something like a public option. [. . .] Secondly -- and this is the much more important point -- the unions could make a much more credible threat to walk away from the bill. [. . .] Finally, the unions actually had the more, rather than the less, nimble position. It's not clear that they directly threatened to kill the bill, for instance; they simply made clear to the White House that they would be very unhappy if the excise tax was not scaled down and let the White House fill in the blanks.

I do not find these distinctions persuasive. First, a public insurance program option on the exchanges is concrete and as seemingly malleable as adjustments to an excise tax. Second, why is it that unions could make a much more credible threat to walk away than progressives? Third, it is simply wrong to believe that the unions were not blocking passage of the Senate bill without an excise tax fix. More . . .

Let's dig a little deeper into Silver's argument, particularly his points 1 and 2 because I think they truly reveal the problem with progressive bargaining. Silver writes:

[U]nions could make a much more credible threat to walk away from the bill. This is because, with a sufficiently cumbersome excise tax, the health care bill could reasonably be seen as a bad deal for unions [. . .] The unions were acting out of naked self-interest: threatening to walk away from a deal that would have been bad -- for them. Progressives, conversely, were threatening to walk away from a bill that would nevertheless have accomplished objectives of enormous magnitude and for which they've traditionally advocated. [. . .] Even if you were able to make the case that a bill without a public option was worse than the status quo -- and the kill-billers always struggled greatly with that -- it would be such a counterintuitive one (from the standpoint of "traditional" liberal values) that the counterparty in the negotiation would have trouble believing that you were arguing in good faith.

(Emphasis supplied.) There are two major errors in Silver's thinking here. The first is the belief that the killing of the Senate bill would necessarily jeopardize the Medicaid expansion and other funding initiatives in the health bills. Progressives should have realized, as the discussion of "scaled back bills" after the Brown win in Massachusetts made clear, that the Obama Administration was going to deliver some type of health bill. Here is where the reconciliation option was key. The unequivocally progressive parts of the bill were going to get passed, or would have a strong chance of passing, even if the Senate bill died. They would have passed through reconciliation. Indeed, what has never been controversial in this entire process is those parts of the bill that progressives most cherished - the Medicaid expansion. It is why I never think of its inclusion as a result of progressive bargaining. Similarly, the Nelson Fix had nothing to do with progressive bargaining and everything to do with the political fallout from the Cornhusker Kickback. When you find money on the street, you did not earn it, even though it goes in your pocket. The Medicaid expansion was found money for progressives. And I believe was not in serious jeopardy in the bargaining on the health bills.

The second error Silver makes is his belief that the unions were not blocking the passage of the Senate bill in the House after the Brown win in Massachusetts. They absolutely were. The Pass The Damn Bill movement had a very difficult time understanding this obvious point. And indeed, today we have the amusing spectacle of Chris Bowers claiming that progressives won when the White House capitulated on its demand to have the House pass the Stand Alone Senate bill. Hell, as I remember it, the Left Blogs were whipping for passage of the Stand Alone Senate Bill. Hard to see that as a victory for them.

One last error Silver makes really gets to the heart of the image of progressives as extremists out of touch with the mainstream, a view they seem eager to internalize. Silver writes:

Progressives would do well to realize that their batting average in these situations is going to be pretty low. To assert that there should be an equivalence between those people on the left and Blue Dogs is wrong, because the position of the Blue Dogs is usually closer to that of both the median voter and (more relevantly) the median Congressperson. There are certainly exceptions -- particularly as political space is not always unidimensional. But in a two-party, plurality voting system like that in the United States, the ability of those on either end of the political spectrum to exert direct influence over policy is inherently going to be limited.

(Emphasis supplied.) I think that is generally untrue and it certainly was false about the public option. Indeed, the public option REMAINS much more popular than almost every part of the health bills that are actually going to be enacted (I think.) It actually stands as a testament to the ineptitude of progressives. Fighting for a very popular initiative, they still could not muster a bargaining strategy that could work.

I certainly accept Silver's point that the bargaining strategies I have argued for carried risk. And not insignificant risk. But to get in the game, progressives will have to take some risk. No risk, no reward. Certainly if you believe that status quo of the political bargaining dynamics is unacceptable, you must be willing to try something new.

In the end, Silver's argument is basically progressives will always be ineffectual bargainers and that's just the way it is. Perhaps so. I think it does not need to be that way. But at the least we can all agree that progressives right now are largely ineffectual.

I count that as progress (pun intended) in this discussion.

Speaking for me only

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    Well, two progressives (5.00 / 2) (#2)
    by jbindc on Fri Mar 19, 2010 at 09:45:59 AM EST
    Apparently learned how to bargain, although I don't know how much bargaining is left on the table.

    While the Dems picked up two votes yesterday from members who originally voted NO the first time around, they lost 2 more - Reps. Michael Arcuri (D-N.Y.) and Stephen Lynch (D-Mass.).

    And this is not a good sign of potential blowback to come:

    Lynch, in particular, was a blow to reform supporters, since the former union president had not been on any watch lists of potential vote flippers. He ripped the Senate-passed measure as a "surrender" to insurance companies, and he held fast to his opposition even after a meeting at the White House with President Barack Obama on Thursday afternoon.

    Bravo! (5.00 / 1) (#7)
    by observed on Fri Mar 19, 2010 at 09:49:50 AM EST
    Wow. Lynch is my Congresscritter. (5.00 / 1) (#25)
    by dk on Fri Mar 19, 2010 at 10:06:26 AM EST
    I have to say at first blush I'm impressed, if he's actually voting no for liberal reasons.

    Lynch has the reputation historically for being one of the most conservative Dems in the MA house delegation (he used to be against LGBT equality and had a poor record on women's equality).  But I had just been reading, for example, that he's come a long way on LGBT rights (he chairs the house committee dealing with Washington DC issues, and won praise from gay rights activists for keeping the Republicans in the House from interfering with DC's decision to permit gay marriages).  

    Also, his electoral support relies very heavily on rank and file union voters.  I wonder too how much it has to do with the reality of the major disconnect between union leadership and the rank in file that played out in the MA senate election.


    mine too (none / 0) (#27)
    by CST on Fri Mar 19, 2010 at 10:16:05 AM EST
    he will be getting a call.  Not pleased.

    Then again, I have never liked Lynch, and will continue to work against him in the next election.  He is absolutely the most conservative Dem in the MA house.


    I guess our calls will (5.00 / 2) (#37)
    by dk on Fri Mar 19, 2010 at 10:35:27 AM EST
    cancel each other out, then.  Such is democracy, right? :)

    Bravo 2 (5.00 / 1) (#40)
    by lambert on Fri Mar 19, 2010 at 10:43:24 AM EST
    If denying coverage to adults with pre-existing conditions doesn't kick in 'til 2014, what does that say about the priorities of the bill?

    I may (none / 0) (#19)
    by Capt Howdy on Fri Mar 19, 2010 at 10:03:45 AM EST
    have to break my usual commenting schedule and be around on sunday.

    We all know (5.00 / 1) (#21)
    by jbindc on Fri Mar 19, 2010 at 10:05:26 AM EST
    it's going to pass - Obama is "too big to fail".  But, that doesn't mean it's necessarily a good thing.

    I'll add (none / 0) (#53)
    by CST on Fri Mar 19, 2010 at 11:04:21 AM EST
    Lynch is NOT a progressive.

    Well, I would argue that (none / 0) (#57)
    by dk on Fri Mar 19, 2010 at 11:08:56 AM EST
    voting against this bill because it is a big giveaway to for profit insurance is a valid progressive position.  

    I'm not saying that Lynch might not have other less progressive reasons for voting no.  Given his record there is certainly reason to be skeptical.  But IMO debating whether someone is or is not "a progressive" doesn't interest me too much.  At this point I go from vote to vote.  If someone votes in a way I consider progressive I will support them.  If they don't, I won't.


    then every republican (2.00 / 1) (#63)
    by Capt Howdy on Fri Mar 19, 2010 at 11:21:48 AM EST
    should be up for your support.  right?

    So all the Democrats in (5.00 / 3) (#66)
    by dk on Fri Mar 19, 2010 at 11:33:37 AM EST
    Congress voting for the bill are now Republicans because they are voting for a big giveaway to insurance companies, right?

    That was a silly question, of course, but it's just the flip side of yours.  That's part of the reason I feel no there's no purpose in cheerleading for a team, and have just decided to develop opinions on bills, reward those with my vote (that's all I've got) if they vote the right way, and punish if they vote the wrong way.  

    I didn't much appreciate the for us or against us stuff when W was president, and I don't appreciate it coming from you or anyone else either.  I suppose the bullying tactic of questioning one's loyalty to the cause (whatever cause) works to silence some people.  Never really had that effect on me, I must say.


    it was not a silly question at all (2.00 / 1) (#69)
    by Capt Howdy on Fri Mar 19, 2010 at 11:37:21 AM EST
    you said:

    If someone votes in a way I consider progressive I will support them.  If they don't, I won't.

    it sounds like every republican in congress is voting the was you consider progressive.

    and you may not appreciate it but sadly it often come down to with us or against us.
    I am a lot more comfortable with that regarding the health care fight than the war.  that how politics works isnt it?


    IMO, it only comes down (5.00 / 2) (#70)
    by dk on Fri Mar 19, 2010 at 11:39:38 AM EST
    to for us or against us if you care more about personalities than about issues.  

    You're right; it wasn't a (5.00 / 2) (#78)
    by Anne on Fri Mar 19, 2010 at 12:02:41 PM EST
    silly question, it was a gratuitous question, as dk explained quite clearly what his (if not a "he" please forgive me!) criteria are; asking it served only to set up the odious with-us-or-against-us construct for no reason other than to get a rise out of people.

    If I believe it's a bad bill, that the legislation is not "progressive," I don't have to believe in other people's reasons for voting "no," nor do I have to subjugate my own political leanings to someone else's as a condition of their voting the way I would on a specific bill.  Nor do I have to accept their alternative plan.  In fact, before I would consider supporting a Republican no-voter, I would have to know what their alternative is, and if it's some variation of free-market nonsense and health savings accounts and tax credits, I'll just take the "no" vote and reject the rest.  


    I know (none / 0) (#85)
    by Capt Howdy on Fri Mar 19, 2010 at 04:27:02 PM EST
    you will

    Uhhhhhm, ... no ....... (5.00 / 1) (#80)
    by Yman on Fri Mar 19, 2010 at 12:48:08 PM EST
    Republicans and progressives can oppose a bill for very different reasons, hence dk's statement of surprise that Lynch appears to be voting against the bill "for liberal reasons".  Sames as with Kennedy-Kyl (CIRA) immigration reform bill.  Conservatives didn't want a pathway to citizenship for illegal/undocumented immigrants.  Progressives didn't like the points-based system, limited family reunification and aspects of the guest worker program.  It all depends on your reasons for opposing or supporting a bill.

    Really not a difficult concept.


    Yes it is (none / 0) (#81)
    by Socraticsilence on Fri Mar 19, 2010 at 01:00:27 PM EST
    but he's basically echoing Shaedegg, who I don't see many people believing is a true progressive.

    First off you are uncharacteristically kind (5.00 / 3) (#3)
    by Militarytracy on Fri Mar 19, 2010 at 09:46:27 AM EST
    Or perhaps you actually desire for people who would believe Nate to for one moment rethink this.  Nate Silver has never struck me as dumb.  In reading this writeup I could not help laughing out loud three different times.  Parsing utter B.S. to attempt to stay relevant in a current conversation isn't just for Fox News anymore.  Secondly, does he really not understand the climate that Unions live, breathe, and survive in?  The Unions got concessions because they draw lines in the sand, they say NO, they put their foot down....they are very practiced at it too, they are proud of it, and the ability to negotiate is built directly into their existence or they can just evaporate.  It is all they exist for.  And I guess Progressives exist purely for esthetic purposes, a conversation piece when the real world has run out of important things to talk about or has had too many maritinis and begins to wax nostalgic about where we could have gone after the 60's.

    Seems to me the unions, in the setting (5.00 / 1) (#11)
    by oculus on Fri Mar 19, 2010 at 09:52:33 AM EST
    of influencing federal legislation, have more power than the Progressives.  The former can withhold campaign donations and getting out the vote.  The Progressives don't have anything except their own votes apparently.

    The Progressives could tie up get out the vote (5.00 / 1) (#33)
    by Militarytracy on Fri Mar 19, 2010 at 10:30:08 AM EST
    But instead all they do is talk about how everyone must constantly hold their nose and vote for the next POS.  We've done that so many times now, it is completely worn out.....if a functional life is a balanced life.....we can no longer hold our noses and vote for the next POS.

    By "Progressives" I meant (5.00 / 1) (#48)
    by oculus on Fri Mar 19, 2010 at 10:58:12 AM EST
    people in Congress such as Feingold, Kucinich, Weiner, et al.

    The unions and the progressives (5.00 / 1) (#39)
    by inclusiveheart on Fri Mar 19, 2010 at 10:39:47 AM EST
    are something of a force to be reckoned with when they team up, though.

    The reality is that Democrats are so shell-shocked from the past twenty years of assualt that they have a difficult time forming natural alliances.  The minute the GOP comes out railing against unions, even some of the most progressives run and hide.  What no one did on the progressive side was to articulate a clear vision of what real healthcare reform would consist of - except maybe Anthony Weiner who isn't really so progressive as he is smart and pragmatic.

    The messaging from the Progressives was all wrong.  They ran around talking about "choice" and "competition" which are ideological arguments.  They FAILED to enumerate all of the good reasons for creating offering a universal public insurance program - they FAILED to explain to people what they could get out of such a program.

    They allowed the President to walk all over them and probably took him at his word that he wanted a public option.  "Tut, tut," he said to them, "Just let us get through some things and we'll add the public option."  They FAILED to see that they were being misled and manipulated out of using their power of persuasion - and their powerfully persuasive argument for a public option.  They acted like chumps.  And it is not at all surprising that they are folding under the pressure of claims that if this bill doesn't pass, it will mean "the end" of the Obama Presidency.

    Well, I just saw a stat on Obama's numbers being at 46% approval on MSNBC today.  I would argue that now that the media has lasered in on both the mandate and the excise tax, the Progressives probably aren't helping by going along to get along - and may not be helping Obama at all.  But we'll see.  Time will tell.


    The unions (5.00 / 1) (#45)
    by gyrfalcon on Fri Mar 19, 2010 at 10:54:08 AM EST
    have no interest in alliances with "progressives" because they don't want to get tied to people who always, always, always cave.  They know they're better off on their own.

    Well, that's all part of the shell-shock (5.00 / 1) (#50)
    by inclusiveheart on Fri Mar 19, 2010 at 11:01:10 AM EST
    over the past two decades.  I'm not saying that the Unions have any fewer issues with alliances when I cite the Progressives' tendency to run for the hills and hide.  The GOP did a masterful job of employing the divide and conquer technique on the Democratic Party and their traditional allies for decades.  Seems to me that Obama has continued that assault.

    You know it comes up in conversations (5.00 / 1) (#58)
    by Militarytracy on Fri Mar 19, 2010 at 11:13:13 AM EST
    You know it comes up at the Union meetings.  Think about it....you are trying to feed your family, get kids to college, then at the next union meeting it gets brought up doubling up with some progressive outfit on a specific issue that has a huge track record of perfecting the cave.  Running with losers will set you up to lose.  They don't study how to win, they don't even know how to win.........they stand around sipping gin and tonics talking about the best way to digest losing in case we lose all the fecking time.  I hate it!

    Heh. (none / 0) (#86)
    by mentaldebris on Fri Mar 19, 2010 at 04:42:41 PM EST
    And I guess Progressives exist purely for aesthetic purposes, a conversation piece when the real world has run out of important things to talk about or has had too many martinis and begins to wax nostalgic about where we could have gone after the 60's.

    I think you pretty much nailed it. Sadly, Progressives seem to be perfectly content to relegate themselves to this status.

    My guess is we laughed at the same three points. Nate is great with the numbers and I trust him on election stats, but the second he delves into deeper analysis he has a tendency to stick close to the Village myths, which means ignoring the facts on the ground. For instance, the PO is not some liberal "controversial" construct (except in the Village) and has been popular with more than half of the nation since last year.

    Only someone who consumed the Village Koolaid and found it good can come up with an analysis that ignores that reality. If nothing else, the Village does love to ignore any reality that gets too close to populism or liberalism.


    Organization and communication (5.00 / 5) (#8)
    by Cream City on Fri Mar 19, 2010 at 09:50:27 AM EST
    in a hierarchical structure, well-established, are key.  Commentary misses the significant differences between unions as organizations vs. the amorphous "Progressives."  Who is their clear leader?  Where is there headquarters?  What is the address and phone number and other contact info on the news releases from the pr office, quoting the elected head of the United Progressive Workers of America?

    An amorphous movement is a proto-movement until it gets organized as needed by politicians, media, etc.  See:  American history. :-)

    cx: their hq (none / 0) (#10)
    by Cream City on Fri Mar 19, 2010 at 09:51:02 AM EST
    Must have more coffee. . . .

    Amen sister (none / 0) (#13)
    by Militarytracy on Fri Mar 19, 2010 at 09:56:09 AM EST
    Either we take up a residence somewhere on some damned map or or or or we continue to argue amongst ourselves in cyberspace.  The women's groups though that actually have an address, they don't even turn out to protest anymore.  All they do is collect funds...that's it.  Oy!

    Aside: I am watching another (5.00 / 2) (#31)
    by Cream City on Fri Mar 19, 2010 at 10:28:01 AM EST
    proto-movement, the education rights movement, from an "up close and personal" perch at one of the sites that has made a lot of news lately  -- but not here, interestingly, despite flagrantly repressive police actions.  Those very actions, though, and the new media of cell-phone videocams are starting to make an impact as the videos are going viral.  One capture two days ago now hit a national news site today . . . and now I note that national news media are contacting student leaders.  Why?  Because they have a coalition in the movement of many organizations, but they also have a clearly defined supra-organization and with a hierarchy of leadership, contact info, etc.

    Even if "Progressives" got it together sufficiently to plan events for months ahead, put out posters on the web and email and Facebook, and then turned out many thousands across the country on a single day to march -- and even if dozens got mauled to the ground and handcuffed and arrested -- who would media contact to speak for them?  Where?  How?  

    In sum, Progressives are not a movement, not one that can exert power via the media to pols.    


    Got links? (none / 0) (#41)
    by lambert on Fri Mar 19, 2010 at 10:45:14 AM EST
    That sounds interesting.

    Google education rights (none / 0) (#55)
    by Cream City on Fri Mar 19, 2010 at 11:04:30 AM EST
    and Berkeley (of course:-) and more -- the most arrests were in Milwaukee, I think -- for the events of education rights day, two weeks ago.  See also SDS, Inside Higher Ed, etc., and CNN especially gave it a lot of coverage for days. The ACLU and the NLG, the National Lawyers' Guild, are assisting in students' defenses (and others are assisting in training for the future).

    Sorry; there are so many links, so many videos on YouTube and elsewhere that I don't know where to start.  It is mushrooming -- and, as we knew in the '60s, it is the season.  Warm weather ahead can bring out more students, faculty, staff, etc. (it is a coalition) -- and especially as we enter the season of campuses announcing their tuition increases, and at the same time as announcements expected of more pay cuts.

    Of course, that combination finally is exposing the standard lie of legislators and campus administrations, always bought by the media, that faculty and staff salaries are the cause of tuition increases.  I await those announcements to see if media will buy it again or actually may figure out the lie this time.


    Right on (none / 0) (#34)
    by ruffian on Fri Mar 19, 2010 at 10:30:44 AM EST
    Without leadership to set the priorities, the breakup of issues that Silver says doomed the bargaining power occurred -  some progressives not wanting to doom the 'good parts' of the bill even without the PO, others not wanting to hand Obama a loss on this, and on and on.

    There are some progressive organizations trying to set these priorities - I'm on their email lists, but I can't even remember their names at the moment - that's how little traction they get in the MSM and online.


    Linear (5.00 / 1) (#16)
    by theetruscan on Fri Mar 19, 2010 at 09:58:44 AM EST
    I think you've misinterpreted what Silver meant by linear. It seems he means that the excise tax can be increased or decreased in a linear manner, whereas (from a political perspective at least) a public option is binary. Either there is, or there is not, a public option, whereas there can be an excise tax of any size.

    Ah (none / 0) (#18)
    by Big Tent Democrat on Fri Mar 19, 2010 at 10:02:17 AM EST
    I see now. That makes sense.

    I'll update my post.


    I edited my piece (none / 0) (#24)
    by Big Tent Democrat on Fri Mar 19, 2010 at 10:06:17 AM EST
    to address Silver's actual point on the "linearity" of the excise tax.

    Thanks. That adjective caught my eye (none / 0) (#28)
    by Cream City on Fri Mar 19, 2010 at 10:19:23 AM EST
    as meaningful but I was muddling about it until your excellent explanation.

    Must have yet more coffee. . . .


    Obama (5.00 / 2) (#17)
    by kidneystones on Fri Mar 19, 2010 at 10:01:49 AM EST
    has done a masterful job of getting the insurance companies the new customers they want and making sure they can raise rates as much as they like.

    He's a far better negotiator than people generally give him credit for.

    Were he a Democrat, there might be some reason to cheer. Domestically, he takes the side of the rich. He's one of them. On FP, he's absolutely clueless.

    His closest political international ally is a Russian. That's like tea-party hyperbole, and yet the source is evidently the WH.

    Is he a good negotiator or is he (5.00 / 2) (#43)
    by inclusiveheart on Fri Mar 19, 2010 at 10:51:00 AM EST
    just taking what is his for the moment?

    Meaning that I see a corollary between the progressive failure and their desire to prop up a Democratic President.

    Healthcare isn't the only issue where the Progressives are keenly aware of major gaps in White House policy and philosophy of governing, but are still trying to put a good face on what the White House is doing - or not doing - whatever the case may be.

    Sheila Jackson Lee was on last night talking about the jobs bill.  The gist of what she said was that she thought it was awful, but that Obama is doing a great job and it was wonderful to have the jobs bill.  She sounded like a confused fool, the issue was, of course, clouded as a result of the unhappy/happy talk, and the Democratic posistion - the progressive position - lacked credibility as a result.

    I think that the Progressives are killing him with kindness - but not in the sense that Obama is going to eventually roll in their direction - I'm thinking they're helping to destroy his presidency by allowing him to fail to meet the needs of the people and by talking him up while he is failing.  The next two years are going to be very interesting, imo.


    I hope (none / 0) (#56)
    by kidneystones on Fri Mar 19, 2010 at 11:05:54 AM EST
    you're not accusing me of talking him up.

    He's about getting a second term and getting his face on Mt. Rushmore.


    Not at all. (none / 0) (#60)
    by inclusiveheart on Fri Mar 19, 2010 at 11:18:29 AM EST
    Just making a distinction between the default power position he is in and his negotiating skills.

    No pre-existing conditions ban for adults til 2014 (5.00 / 2) (#29)
    by lambert on Fri Mar 19, 2010 at 10:22:54 AM EST
    Ugh. So try not to die 'til then, mkay?

    temporary high risk pool (none / 0) (#36)
    by CST on Fri Mar 19, 2010 at 10:35:06 AM EST
    starts in 2010, so people will have access to something in the interum.

    34 states (5.00 / 1) (#47)
    by jbindc on Fri Mar 19, 2010 at 10:55:21 AM EST
    Already have high risk pools for those with pre-existing conditions.  How will this temporary stop-gap measure help those who already have access?  It may lower the price a bit, but right now, I know so many people who aren't sure how they are going to make their mortgage payments next month, that even if the insurance prices are stabilized, I don't see how this new program helps if the ones in place haven't already?

    "Something" (none / 0) (#42)
    by lambert on Fri Mar 19, 2010 at 10:47:37 AM EST
    Well done!

    Sorry, to expand (5.00 / 1) (#44)
    by lambert on Fri Mar 19, 2010 at 10:52:40 AM EST
    (I'm in a rush to go somewhere in RL).

    Check out the transcript at the link. It shows the priorities.

    I guess my analogy for whatever Rube Goldberg interim program they've cobbled together would be the massive FAIL of housing assistance. There's no reason for me to have confidence in it at all.


    I report (none / 0) (#52)
    by CST on Fri Mar 19, 2010 at 11:02:47 AM EST
    you decide.  Just trying to get the facts out there.

    The pre-existing condition ban in regular insurance kicks in at the same time as the mandates.

    Also, without this bill, that pre-existing conditions ban would happen when exactly?


    Doesn't matter (5.00 / 1) (#73)
    by lambert on Fri Mar 19, 2010 at 11:42:59 AM EST
    Since the insurance companies are still in existence, they'll game it anyhow, and in fact it's their fiduciary responsibility, as profit making entities, to do so. They already know how.

    Where would one go and whom would (none / 0) (#54)
    by Anne on Fri Mar 19, 2010 at 11:04:24 AM EST
    one call "the day the legislation is enacted" for entry into this high-risk pool?  How much will it cost?  Will the coverage be subsidized, and more important, what will the coverage consist of?

    I know that in my state, one cannot just enroll in the high-risk plan; one first must apply for and be rejected for coverage by a private insurance company, so it isn't like you just pick up the phone or fill out a form and - voila! - instant coverage.

    The rationale for why the pre-existing conditions element, for adults, cannot take effect until 2014 is that first, everybody has to be in the system - it's tied to the mandate - and all of that needs to be phased in.  But why doesn't that same rationale apply to children?  Why are they different - because the stories of sick children pack a bigger punch than that of sick adults?  Too much potential for Snidely Whiplash ads excoriating the evil Congress for not being sufficiently caring?

    I mean, please explain - if there is a credible explanation - why adults have to wait, because I don't think the glib explanations offered so far make any sense.


    It won't happen (none / 0) (#59)
    by jbindc on Fri Mar 19, 2010 at 11:16:28 AM EST
    "the day the legislation is enacted" - it's 90 days after.

    Oh, well that makes all the difference... (5.00 / 2) (#62)
    by Anne on Fri Mar 19, 2010 at 11:21:28 AM EST
    I'm sure they'll have all the answers by then.

    But it's going to take them 4 years to get the exchanges going and prohibit non-coverage for pre-existing conditions for adults.

    It all makes sense now.

    And yes, my eyes are rolling - not because you provided the correct info on the high-risk pools, but because, well - you know why, I don't need to spell it all out.


    If you want your eyes to really roll (none / 0) (#67)
    by jbindc on Fri Mar 19, 2010 at 11:34:39 AM EST
    Here's the whole 2409 page Senate bill, passed in December.

    Subtitle B, Section 1101 is the relevant section.

    Here's the fun part:

    (d) ELIGIBLE INDIVIDUAL.--An individual shall be deemed to be an eligible individual for purposes of this section if such individual--

    (1) is a citizen or national of the United States
    or is lawfully present in the United States (as determined in accordance with section 1411);

    (2) has not been covered under creditable coverage (as defined in section 2701(c)(1) of the Public Health Service Act as in effect on the date of enactment of this Act) during the 6-month period prior to the date on which such individual is applying for coverage through the high risk pool; and

    (3) has a pre-existing condition, as determined
    in a manner consistent with guidance issued by the Secretary.

    So, if you have a pre-existing condition that has been covered under an employer-sponsored group plan, and you lost your job 18 months ago, so you applied for and continued your insurance through COBRA, but your 18 months are now up, my reading of this is that you would not be able to join this temporary high risk pool. Which means, you are screwed until 2014.


    Or wait six months, as it (5.00 / 3) (#72)
    by Anne on Fri Mar 19, 2010 at 11:40:28 AM EST
    says you cannot have had coverage for the six months prior to the date on which you are applying.

    Never really thought about this, but how does one prove the negative of not having coverage?


    90 days after (none / 0) (#65)
    by CST on Fri Mar 19, 2010 at 11:29:12 AM EST
    legislation is enacted (I must say, having these discussions on TL has caused me to become much better informed on what's actually in the bill).
    Although only the senate bill, I'm not sure if the reconcilliation packege changes this at all.

    It doesn't say anything about applying and being rejected, although it does say you can't already have insurance for 6 months prior to applying.

    There are guidelines on how much the coverage can require in terms of premiums and out of pocket expenses.  The cost limits are hard to find, the bill I'm looking at tells you to look somewhere else for the exact limits, IRS code and another bill.  I am willing to bet that it's fairly weak tea.  The subsidies (tax credits and cost sharing?) don't start until 2014.

    I assume adults have to wait and children don't for exactly the reason you describe, the gut factor.  The excuse for adults is they don't want people to wait until they get sick to get coverage, so that's why it's tied to the mandate.


    Since (none / 0) (#68)
    by jbindc on Fri Mar 19, 2010 at 11:36:55 AM EST
    There is no reconciliation bill at this, point, I think we have to go with the Senate bill, since the House is going to "deem" it passed.

    umm (none / 0) (#71)
    by CST on Fri Mar 19, 2010 at 11:40:09 AM EST
    pretty sure the CBO just scored a reconciliation bill, which means it exists somewhere.

    But yea, for practical purposes senate bill makes sense.  And for all the regulatory changes I believe they will stand as they are in the senate bill.  I don't know how the funding/costs will change though.


    You're right (none / 0) (#75)
    by jbindc on Fri Mar 19, 2010 at 11:47:58 AM EST
    My bad. But I don't think these details changed in the reconciliation.

    Medicaid is 64% privatized. (5.00 / 1) (#32)
    by lambert on Fri Mar 19, 2010 at 10:29:14 AM EST

    So the mandate plus Medocaid expansion is a two-fer for a prime constituency of the Democrats: The insurance companies and for-profit providers, who win coming with the mandate, and going with Medicaid.

    That would also explain why Medicare -- as a workable and loved rights-based single payer health care program, as opposed to an assets-based welfare program -- was never on the table, but Medicaid expansion was.

    This policy choice has nothing whatever to do with any "cherished" goal by progressives (link on that?). Just follow the money.

    I'm not sure that is what that slide shows... (none / 0) (#64)
    by masslib on Fri Mar 19, 2010 at 11:23:04 AM EST
    I think it may say rather that many states have their own managed care programs for Medicaid recipients, not that they subsidize private managed care programs.

    Let me check... (none / 0) (#74)
    by lambert on Fri Mar 19, 2010 at 11:47:10 AM EST
    ... with Hipparchia. Thanks for the QA if I messed up.

    Well (none / 0) (#77)
    by Ga6thDem on Fri Mar 19, 2010 at 11:57:06 AM EST
    I can't speak for other states but it is privatized here. There is a company that contracts with the government to handle medicaid. It's privatized here in Ga and it's a poor program that's why I can't get too excited about expanding it.

    Well, does it "handle" Medicaid... (none / 0) (#79)
    by masslib on Fri Mar 19, 2010 at 12:26:18 PM EST
    or does it process the paperwork for Medicaid.  There's a difference.  The government isn't in the business of paperwork.  Often administrative tasks are outsourced.

    It's (none / 0) (#82)
    by Ga6thDem on Fri Mar 19, 2010 at 02:25:45 PM EST
    a private HMO that decides who you see and all. They have authority for approvals etc.

    About 60% of Medicaid recipients are ... (none / 0) (#87)
    by RonK Seattle on Fri Mar 19, 2010 at 07:08:01 PM EST
    ... in managed care variations (meaning they have an assigned Primary Care Physician who in theory refers them to specialists as medically indicated).

    A minority of these (about 44%) are enrolled with commercial Managed Care Organizations (MCO's). The majority are in Medicaid-only MCO's (such as networks of safety-net hospitals).

    The actual "privatized" share is on the order of 26%.


    I checked: 71% in "managed care" (none / 0) (#83)
    by lambert on Fri Mar 19, 2010 at 03:34:04 PM EST
    But that's not necessarily "privatized," though a great deal of it is. If anybody has a breakdown (we're looking) do share.

    Thanks for the question!


    it sounds like (none / 0) (#1)
    by Capt Howdy on Fri Mar 19, 2010 at 09:38:50 AM EST
    Silver agrees with the thrust of the comment thread yesterday about limp and ineffectual liberals.

    In the end, Silver's argument is basically progressives will always be ineffectual bargainers and that's just the way it is. Perhaps so. I think it does not need to be that way.

    you are correct that it doesnt "need" to be that way but I think in fact it is.  you want to fix the problem it seems and he is admitting the problem will likely never be fixed and is suggesting work arounds.

    you are actually both right.

    As long as Nate Silver is considered (5.00 / 2) (#5)
    by Militarytracy on Fri Mar 19, 2010 at 09:48:04 AM EST
    some sort of progressive voice....they will remain ineffectual bargainers and that's just the way it is :)

    personally (5.00 / 2) (#15)
    by Capt Howdy on Fri Mar 19, 2010 at 09:58:32 AM EST
    I think its sort of like celebrities talking about politics.  you become famous for one thing, in Silvers case crunching numbers, and end up talking about anything and everything.

    Examples: Dee Dee Meyers and (none / 0) (#26)
    by oculus on Fri Mar 19, 2010 at 10:15:41 AM EST
    Bill Bennett on TV the other night talking about HCR.  Who cares what either thinks on this subject?

    Parity re zingers: (none / 0) (#4)
    by oculus on Fri Mar 19, 2010 at 09:47:06 AM EST
    "kill-biller" and "Cornhusker kickback."

    Can it be that liberals with hefty incomes (none / 0) (#6)
    by observed on Fri Mar 19, 2010 at 09:49:20 AM EST
    are poor representatives of the cause?
    I'm not saying rich people have to be conservative, but a lot of the concerns of liberals are related to the well-being of the less well-off. If your relation to the problem is second hand, it's only natural that your motivation will be less.
    On the other side, conservatives glorify wealth for its own sake; hence, the more they are worth, the more they are motivated to the cause (of screwing the bottom x percent).

    This is why unions are more effective: the leadership is responsive to a membership which really feels economic pain.
    This is also why modern journalism sucks, IMO.
    The reporters who have the most influence make so much money that they don't have the  drive to go out and really dig for stories.
    Correct me if I"m wrong, but one of the truly great investigative reporters alive, Murray Waass, is very middle class. In fact, a few years ago, he was looking for donations to pay for health insurance, IIRC.

    Yes, rich liberals (none / 0) (#12)
    by Militarytracy on Fri Mar 19, 2010 at 09:53:12 AM EST
    comfortable liberals....in the greatest number, don't give a flying feck outside of civil discourse that they think makes them look distinguished and intellectual and humane :)  

    Discussing HCR with a friend who doesn't (none / 0) (#51)
    by oculus on Fri Mar 19, 2010 at 11:01:11 AM EST
    read blogs.  Reads WSJ everyday.  Watches TV news.  I objected to excise tax on "Cadillac" health care plans.  She sd.:  have to have that to pay for less-well-off people to have health insurance.  I sd. I would rather be taxed, not have employers dumb down plans and fail to pass the savings on to employee.

    Yes (none / 0) (#49)
    by gyrfalcon on Fri Mar 19, 2010 at 10:58:20 AM EST
    Same with Blue Dogs, when you think about it. A Blue Dog is by definition somebody who's on thin ice because he/she is a Dem. representing a conservative district and knows he/she will lose the job if h/s votes the wrong way.

    The "progressives" have no such skin on the line because their progressive constituents never make them pay the price if they cave.


    one thing everyone misses ... (none / 0) (#9)
    by nyrias on Fri Mar 19, 2010 at 09:50:31 AM EST
    does anyone have any idea of the NUMBERS of vote we are talking about?

    The unions command a voting block that politicians do care about. Can the progressive say the same thing?

    If the PO is scrapped, can the progressive rally enough votes in the next election to make a difference?

    If you can't make the politicians believe that, you have NO negotiation power. It does not matter if you stand firm or if you concede everything away. If you don't have the numbers, no one takes you seriously.

    They have a pretty powerful voting (5.00 / 3) (#46)
    by inclusiveheart on Fri Mar 19, 2010 at 10:55:04 AM EST
    bloc in the House and as BTD points out the PO is hugely popular.  I think that counts for something, if it is used properly and with force - neither of which happened.  The bottom line is that the Progressives didn't want to challenge the President - and that's pretty much what happened.  Without the resolve to go even as far as challenging the President and using his public against him, they were never going to get anything of significant value out of these HCR negotiations.

    I can't believe how arrogant the Senate is (5.00 / 2) (#61)
    by Militarytracy on Fri Mar 19, 2010 at 11:19:49 AM EST
    I can't believe how arrogant Reid is on simply denying that anyone wants the PO or that it should even be considered.  There should be a way for the Senate to pay for this blatant arrogance, there really needs to be consequences here on this issue and this legislation.

    Reid is trying to protect the Democrats (5.00 / 1) (#76)
    by inclusiveheart on Fri Mar 19, 2010 at 11:49:17 AM EST
    in his caucus who would not vote for a Public Option from public scrutiny.

    It is a game with all the wrong priorities.


    Great question (none / 0) (#35)
    by ruffian on Fri Mar 19, 2010 at 10:33:39 AM EST
    Silver is a stats guy, so maybe his opinions that the progressives will never be effective bargainers have the number disparity at their root, even if he does not say so.

    Whipping public opinion (none / 0) (#14)
    by Demi Moaned on Fri Mar 19, 2010 at 09:56:11 AM EST
    It actually stands as a testament to the ineptitude of progressives. Fighting for a very popular initiative, they still could not muster a bargaining strategy that could work.

    That's true AFAIG. But to take the lesson here, you'd need to convert that popularity into actual pressure on members of Congress. In other words, whipping up public sentiment over the importance of the issue. That's no small feat when the mass media organizations are eager to promote the most absurd right-wing assertions but give very little space to ideas that stray beyond the DC-insider consensus in the other direction.

    I've got an idea (none / 0) (#20)
    by Sweet Sue on Fri Mar 19, 2010 at 10:04:33 AM EST
    Let's put Hillary Clinton in charge of everything.
    Then, Obama could be a nearly flawless domestic President, too.

    Ugh (5.00 / 1) (#23)
    by Big Tent Democrat on Fri Mar 19, 2010 at 10:05:39 AM EST
    Stop the crap please.

    Sorry (none / 0) (#22)
    by Sweet Sue on Fri Mar 19, 2010 at 10:05:38 AM EST
    That comment was intended for another post.
    Time for my restyasis.

    Silver is right!! (none / 0) (#30)
    by lambert on Fri Mar 19, 2010 at 10:24:27 AM EST
    The public option is not "linear."

    Your typical p.o.s. is not, indeed, "linear." It's roughly spherical and far too soft.

    "Progressives" were competent on polling (none / 0) (#38)
    by lambert on Fri Mar 19, 2010 at 10:38:57 AM EST
    They got good polling results by confusing the so-called "public option" with Medicare, an actually functioning and loved plan. Of course, this polluted the discourse completely and endangered Medicare's branding, but as an inside-the-Beltway Versailles play, it was perfectly competent.


    What Silver is saying without actually saying it (none / 0) (#84)
    by Maryb2004 on Fri Mar 19, 2010 at 04:11:20 PM EST
    is that he believes (and therefore the "counterparty" could reasonably believe) that the Union negotiators could walk away (or threaten to walk away) from the table without their stakeholders making them pay any price later.  They could easily explain to their stakeholders why they were doing this and they would be believed and supported.

    He doesn't believe (and therefore he thinks the "counterparty" wouldn't believe) that the progressive caucus could do that.  

    He believes that progressives would be forced by their stakeholders to pay a price (or believed that they would pay a price)if they threatened to walk away.

    A few points about this:

    First,why does he believe this?  The progressives are all from safe districts.  They can very safely play hardball for progressive values.  They aren't going to lose their seats.

    Second, the progressives (as you so clearly point out) couldn't lose.  Because they were ALWAYS going to get the baseline medicare expansion.  They would have fought for getting that through reconciliation and they would have won and their stakeholders would have applauded that victory.

    Third, (and somewhat less clearly) I think it still comes back to defining who the "counterparty" is.  Personally, I can't think of a counterparty in this negotiation (Republicans, Blue Dogs or Obama) who shouldn't have understood points one and two.   But Silver seems to think the "counterparty" (undefined) would not understand these points.  

    I think the problem with the progressives is the same problem that Silver has - they do not have in their minds a clear definition of who the "counterparty" is and they have, therefore, created some imaginary counterparty who they have imbued with superpowers.   Or possibly who they have imbued with such stupidity that they think they are unable to read the tealeaves.  

    If the Progressives had kept their eye on the ball from day one they would have (i)realized that the only counterparties who mattered to THEM in this negotiation were Obama and a few non-progressive Democrats, (ii)Obama and the non-progressive democrats weren't stupid and would realize the progressives were from safe districts, and (iii) the progressives were always going to be able to claim victory on the baseline progressive goal of expanding medicare.

    Once you realize that, the only question is how long you string along the non-progressive democrats in the process to get them to the point where THEY can't afford not to pass a bill that they never wanted in the first place.  There is always that point.  At some point a party who is otherwise lukewarm to the whole idea has so much time and money and effort and emotion invested in the process that THEY can't afford to go back to THEIR stakeholders and explain why they put so much time and money and effort and emotion into a deal that they then killed claiming they never wanted it in the first place.  Explaining becomes harder than just getting it done.   It always reaches that point.  You just have to be patient.

    As the unions were.

    WH deal a thumb on scales? (none / 0) (#88)
    by good grief on Sun Mar 21, 2010 at 02:39:46 PM EST
    Indeed, the public option REMAINS much more popular than almost every part of the health bills that are actually going to be enacted (I think.) It actually stands as a testament to the ineptitude of progressives. Fighting for a very popular initiative, they still could not muster a bargaining strategy that could work. (BTD)

    Did it make a difference in ability for progressives to "muster a bargaining strategy"  that Obama (with Baucus) put the fix in to make sure the PO never stayed alive to make it into not just the Senate Finance Committee bill but the final bill we see today (largely the same bill) when the WH made a deal with hospital and pharma lobbyists way back in June 2009 as reported by the NYT Aug 13, 2009? Did that WH deal act as a thumb on the bargaining scales, as it were? How were progressives to counter that backroom insider trading, especially since there was no wider reporting on that kill-the-PO deal over the ensuing 7+ months and even today, even on Talk Left?

    I refer to the NY Times story Aug 13, 2009, then 7+ months later Huffpo in three posts (here, here and here), then finally Ed Schultz on his show March 15, 2010 and two days later (four days before the final vote when the bandwagon to pass HCR with mandate and no PO was in full swing, content bargaining virtually closed, only vote counting going on), Jane Hamsher columned the news of the June 2009 WH deal to kill the PO.  

    "If a [news story] falls in a forest and no one is around to hear it, does it make a [difference in passing HCR with a mandate but no PO exactly as health industry wanted]?