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July 29, 2009

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Um von? Did you actually read the Klein post you cited above? You know, the one that says:

It would be nice if there were seven Republican votes sitting ready to sign onto the Healthy Americans Act. That would make it an excellent potential compromise. But having followed this legislation for years now, I've seen no evidence of that fact. Instead, Republicans sign on with the caveat that they oppose the things the bill actually says it will do, but support the general idea that Republicans should be consulted on health care reform. Indeed, the lesson of the Healthy Americans Act, as I've seen it, has been that there are a lot of Republican votes for the appearance of being for something on health reform. But there aren't many Republican votes for actual health reform.

Hey, I love Wyden-Bennett, but I don't see any indication that there exists Republican support. The mere presence of Republican cosponsors doesn't mean much regarding a bill that everyone thinks is a political dead letter, especially since some of the cosigners publicly express great concerns about very large significant chunks of Wyden-Bennett. I mean, if you stripped out half the things that Judd Gregg is "concerned about", you would end up with a bill that was either not deficit-neutral or failed your other requirements.

I'd suggest that everyone read Klein's post before getting too involved with discussion.

Wyden-Bennett also offers the Republicans nice political cover to claim they support it, instead of another bill, because they figure it won't come up for a vote. If it does, I fully expect Republican "support" for the bill to dry up faster than a puddle in the middle of Death Valley.

I could be overly cynical, but given the quotes in the article above, from some of the "co-sponsors", and given the Republican leadership's explicit, public goal of killing any health care reform to try and cripple Obama's presidency, I'm going to veer on the side of cynical here.

It would be nice if there were seven Republican votes sitting ready to sign onto the Healthy Americans Act. That would make it an excellent potential compromise. But having followed this legislation for years now, I've seen no evidence of that fact.

Ezra doesn't even come close to providing evidence in support of his assertion in the linked piece. The closest he comes to finding one Republican who expresses reservations regarding some of the provisions in the bill is Judd Gregg. Yet, Gregg says he's going to support the plan. Sen. Spectre's comment is actually not contrary to Wyden-Bennett, which specifically permits employer-provided health care (although financed differently).

If Ezra has some evidence for his claim, have him present it. But all I see is an obfuscation, a misleading statement, and an evidence-free assertion. Not a great start.

Could it be that Ezra is looking for an excuse to keep his wonky cred but not push Wyden-Bennett .... this whole "Oh, Wyden-Bennett is the best, but we really shouldn't push it because all these Republicans who say they support it are actually lying" strikes me as disingenuous at best. You've got Republicans on record supporting the bill ... if they flip flop, hammer them with it.

"Could it be that Ezra is looking for an excuse to keep his wonky cred but not push Wyden-Bennett"

I don't see how you can say that given how many times Ezra has posted in favor of it, and touting it. I'm not going to go get a count -- one could ask him himself -- but I've seen him tout it dozens and dozens of times, and I don't even read him all that regularly.

*UPDATE: By saying that this claim is "among the articles of faith" circulating in the liberal blogosphere, I mean that all liberals share it.

Well done, sir.

Von, at this point in the process, the onus of proof is on people arguing that Congressional Republicans have a genuine interest in a given health care reform strategy, not on people arguing that said Republicans just want to kill health care reform period. The burden of evidence is tilted that way.

You've got Republicans on record supporting the bill ... if they flip flop, hammer them with it.

Because Wyden-Bennett goes much much farther is severing the link between employment and healthcare, it is extremely risky politically since voters with employer-provided healthcare are extremely nervous about any changes to their current healthcare plans. If Dems turned around and pushed hard for Wyden-Bennet, they might be able to score some points if Republican cosponsors backed off, but they'd take a massive hit themselves by proposing something that affects so many currently happily insured people. They'd give Republicans tons of ammunition to use against them: Republicans could run ads explaining that Dems are now voting for a plan that would make lots of private health insurance disappear in short order while mandating that everyone join a government pool.

What your proposing is a situation in which Democrats have to commit political suicide in order to expose a small number of Republican congressfolk as slightly dishonest. And the mud wouldn't even stick to the Republicans: Wyden-Bennet would have to eventually go to other committees and to the Senate and would get some changes (no bill is perfect) - even if those changes were trivial, they would enable Republicans to say "yeah, I backed Wyden-Bennett but that was before they made trivial change X!". The media wouldn't even cover Republicans backing down since they'd be so busy with the firestorm of Dems pushing a plan that would make lots of private health insurance disappear in short order while mandating that everyone join a government pool.

Bi-Partisan? Harumph.

Name five Republican Senators that will commit to voting for the bill as written. Not even its sponsors, on the GOP side, are willing to commit to that. Several have said that its main provisions are non-starters and that they signed on to signal their interest in bi-partisanship.

"The closest he comes to finding one Republican who expresses reservations regarding some of the provisions in the bill is Judd Gregg."

Moreover, simply as regards the single post you link to, this is simply false. He also cites Arlen Specter (one of the six then-Republican sponsors) and Sen. Bob Corker, and Judd Gregg.

And, frankly, Ezra does actual reporting on Congress, with actual phone calls to actual politicians and aides. I'm more inclined to believe his version than yours unless you can tell me that you yourself know more about what these politicians are actually citing than Ezra does, with some evidence that this is true. I've never seen you, in any of your posts, discuss actual original reporting you've done on contacting members of Congress and their aides, and I've seen Ezra do that many times. So I'm inclined to give him the benefit of any doubt in his claims about where the votes are, in the absence of you having specific evidence to point to to contradict him.

I could double-check on Thomas, but the Wikipedia article you point to links to this piece from The Hill last November listing the following as the sponsors: "Sens. Lamar Alexander (R-Tenn.), Maria Cantwell (D-Wash.), Tom Carper (D-Del.), Norm Coleman (R-Minn.), Bob Corker (R-Tenn.), Mike Crapo (R-Idaho), Judd Gregg (R-N.H.), Daniel Inouye (D-Hawaii), Mary Landrieu (D-La.), Bill Nelson (D-Fla.), Arlen Specter (R-Pa.) and Debbie Stabenow (D-Mich.) also signed the letter to Obama."

And it's perfectly true that it's absolutely commonplace for Senators and Representatives to sign their names as co-sponsors to bills they haven't the slightest interest in actually supporting, for a wide variety of political and parliamentary reasons.

Even assuming they actually will vote for the bill as written, I count above two remaining Republican co-sponsors: Sens. Lamar Alexander (R-Tenn.), Mike Crapo (R-Idaho). (Specter having switched parties, Coleman is out, and Gregg, reports Ezra, would gut the bill, while Corker has dropped his co-sponsorship; and there were only six Republicans to start with.) If you can point to seven, I'd like to know whom the other five are, please. Then we can start talking about all the other Democrats and Republicans who aren't supporting the bill, which I agree would be a fine idea from everything I've read in the past couple of years (not that I'm any kind of expert on health care options, by the Dog).

Thanks muchly.

It's clearly a quantum leap over HR 3200

I don't think that word means what you think it means.

"I don't think that word means what you think it means."

Two word phrase, actually.

*UPDATE: By saying that this claim is "among the articles of faith" circulating in the liberal blogosphere, I mean that all liberals share it.

Whooops. Fixed.

Von, at this point in the process, the onus of proof is on people arguing that Congressional Republicans have a genuine interest in a given health care reform strategy, not on people arguing that said Republicans just want to kill health care reform period. The burden of evidence is tilted that way.

Huh? More than a half-dozen Republicans co-sponser a bill -- not just say that they're going to support it, co-sponser it -- and the "onus of proof" is on those who claim that they are all lying?

In any event, let's assume that Ezra is right that all these Republicans are lying (despite providing zero proof for it). How is that an argument against the ideas in Wyden-Bennett?

I don't think that word means what you think it means.

In the vernacular, quantum leap "has come to mean an abrupt change or 'step change', especially an advance or augmentation." See: http://en.wikipedia.org/wiki/Quantum_leap. Although you might quibble a little bit with my usage, I think it's fair to say that Wyden-Bennett is an abrupt departure from HR3200.

Now, I readily concede that Wyden-Bennett and HR 3200 are not merely the same electron at different energy levels.

It might help the discussion if I could find a more detailed comparison of Wyden-Bennet and HR 3200, but here's my attempt:

-----

House Bill (HB): Would create a federal insurance exchange with a public option.
Wyden's Bill (WB): Would encourage (?) states to form "co-ops".

HB: Strengthens the connection between your job and your health insurance, through measures such as an employer mandate.
WB: Breaks up this connection, through measures such as converting the current tax exclusion for health benefits into a tax deduction for individuals.

WB: CBO says it doesn't add to the deficit.
HB: Working on it...

-----

That's what comes to mind, but right away I'd like to combine HR 3200's exchange (w/ public option) and Wyden's tax conversion -- and I'd wager it's easier to get the tax change done later. So I'm gonna keep my support the House bill (even if I'm more to open to seeing it amended).

Huh? More than a half-dozen Republicans co-sponser a bill -- not just say that they're going to support it, co-sponser it -- and the "onus of proof" is on those who claim that they are all lying?

Given the recent history of Republican efforts to improve health care in America, yes.

How is that an argument against the ideas in Wyden-Bennett?

If Wyden-Bennett can't pass Congress, then it is the worst bill imaginable. If there is no real Republican support for Wyden-Bennett, then it cannot pass Congress because it is political suicide: many Democrats cannot risk giving the GOP such powerful ammunition without having at least some GOP members go along with them. Going on TV and saying "Your dem rep just voted to end your employed-provided health insurance" is incredibly powerful and unless Republicans are willing to take that option off the table by voting in serious numbers for Wyden-Bennett, Democrats cannot vote for it.

Actually I'll come right out and ask:

Would anyone here (von? publius? a random commenter?) be interested in doing a side by side (or point by point, or whatever) comparison of the major aspects of HR 3200 and the Wyden-Bennet bill?

Moreover, simply as regards the single post you link to, this is simply false. He also cites Arlen Specter (one of the six then-Republican sponsors) and Sen. Bob Corker, and Judd Gregg.

Yes, but Arlen Specter's comments are not contrary to Wyden-Bennett. They are consistent with Wyden-Bennett. They don't support Ezra's point.

Corker is irrelevant, because, by Ezra's own concession, he is not a cosponser of the 2009 bill (he was a cosponser of the 2007 bill). Maybe that means he changed his mind and maybe that means that he was lying before .... but it does not mean what Ezra claims that it means, which is that the current, 2009 Republican sponsers of Wyden-Bennett are actually lying. (In fact, it suggests the opposite, which is that Senators don't sponser bills that they secretly oppose.)

Finally, I didn't link that article by Klein -- you did. I linked a different article by Klein that contains actual reporting, rather than unsupported speculation.

von: And the Republican leadership's repeated comments in multiple public places that they intend to try and kill any health care reform and make it Obama's "Waterloo", or to gut his Presidency should be ignored when considering Republicans' attitudes toward any health care bill because...?

Turbulence, I'm genuinely mystified.

How, exactly, does a Senator of any party sponser a bill and then turn around and immediately oppose it without getting hammered on all sides for the flip-flop? That's not being devious; that's being utterly stupid.

Point - Although I won't vouch for it in every particular, the Kaiser Family Foundation has a pretty good general tool for comparing health care plans. It's here: http://www.kff.org/healthreform/sidebyside.cfm

Everyone likes the Wyden plan. So why is the Wyden plan not going anywhere? Some guy from the ****ing Heritage Foundation of all people was on NPR yesterday with Paul Krugman and they more or less agreed that healthcare reform was required and that the Wyden plan was the best approach, but they were concerned it might be "too radical". No-one ever explains what's "too radical" about it. There just seems to be this pervasive sense that passing legislation that might work and solve the obvious problems while not costing anything is a no-no and we must play around passing bills that spend vast amounts of money to probably achieve very little. What the hell is going on?

I smell a rat somewhere. Even if all the republicans who claim to support the bill are lieing, who cares? Last time I checked the democrats controlled both houses of congress. There's some interest group out there that doesn't really want anything effective done. Its not the insurers, since they desperately want an individual mandate passed and will accept anything short of having their CEOs pushed out of an aeroplan door to get it. I don't completely buy that its the unions - many of them are now exposed to their members healthcare costs and thus need to reduce them (can anyone say UAW?) My bet is its the doctors and hospitals, because to my eyes they're the obvious beneficiaries of all-you-can-eat healthcare, which wouldn't last long under the Wyden plan, but I'm also biased.

voters with employer-provided healthcare are extremely nervous about any changes to their current healthcare plans.

This is an article of faith among many pundits and elected officials. But is there any evidence for it? My own employer-provided healthcare has changed repeatedly in recent years, never for the better. Premiums go up, deductibles go up, coverage or network changes in rather arbitrary ways. I hear lots of jokes about that trend, so I assume most people with employer-provided insurance know dern well it's not guaranteed year to year. Why would they resent a government plan to change for the better what is already changing for the worse? Who are these supposed voters?

von: And the Republican leadership's repeated comments in multiple public places that they intend to try and kill any health care reform and make it Obama's "Waterloo", or to gut his Presidency should be ignored when considering Republicans' attitudes toward any health care bill because...?

Jim DeMint said that on a conference call with conservative activists; DeMint is not part of the "Republican leadership" in the Senate (that's McConnell, Kyl, Alexander, Murkowski, and Thune) and he didn't claim to be speaking on behalf of the Republican leadership. (http://blogs.abcnews.com/politicalpunch/2009/07/white-house-plans-to-use-demints-waterloo-quote-to-rally-the-troops.html)

In truth, however, you probably can't get DeMint's vote with any bill ... so why does that affect whether or not you support Wyden-Bennett? Why do you care?

von, it would be nice if you would address the political suicide issue I raised at 2:58 and 3:23. I mean it is fun to talk about policy in the abstract with no regard to winning elections, but it is also kind of stupid and pointless.

How, exactly, does a Senator of any party sponser a bill and then turn around and immediately oppose it without getting hammered on all sides for the flip-flop? That's not being devious; that's being utterly stupid.

Can you point to any such occasions where the media has hammered some Senator? You just pointed to Republican cosponsors that stopped sponsoring the Wyden-Bennett bill. In general, the acts of any one Senator rarely merit much coverage, even when their actions are contradictory. And bills always change, which means that there will always be some justification for dropping support. Even if that justification is completely bogus, no one in the media is going to seriously criticize it: the media lacks the institutional competence to make those determinations. If nothing else, Republicans can always say "well, Dems did X which proves they're not serious about cost control/protecting small business/etc". If they did, you couldn't really fault them: I mean, now that Dems are in the majority, presumably, Republicans have learned things about them they didn't know before. Right?

To put it another way: flip flopping is harmless. What is dangerous is a media firestorm which cements a narrative that you're a flip flopper. Mere flip flopping by itself is rarely sufficient to generate the firestorm or otherwise create the narrative. Kerry probably would never have been branded a flip flopper if he hadn't been running for President.

Thank you, Simon K.

The real opponents of Wyden-Bennett are the unions. Period. That's why the Democratic leadership is not pushing it; not because of hypothetical (but completely unsupported) concerns voice by Klein, but because they don't want to step on what has become the third rail of the Democratic party: organized labor.

Von: Proof? Or should we file that away with the same acceptance you gave the "Republicans aren't actually interested in substantive reform and cosponsor as a way of showboating their bipartisianship?"

"Huh? More than a half-dozen Republicans co-sponser a bill -- not just say that they're going to support it, co-sponser it"

You've got that reversed: actually committing to supporting a bill, and given provisions, in public, however reversible that is, is more meaningful than a cursory co-sponsorship; anyone familiar with how Congress works knows that.

It's amazing how little people remember about the fight over ClintonCare. There were a lot of "bipartisan compromises" - I think one or two that looked like Wyden's bill - floating around then.

They all failed. Quietly. For two reasons. One was that the original sponsors stopped acting in good faith when things got hot. The other is they were all (like Wyden-Bennett) based on sharply regressive taxation and risk-shifting, which few other senators, and nearly no house members, were willing to support.

There is such a thing as bipartisan legislation. There is no such thing as apolitical legislation. That is what Wyden-Bennett aspires to be. That is why the Broderists love it. And that is why it will never go anywhere, just like the Clinton-era compromises never went anywhere.

Turbulence, I have responded to your political points. If this is a trap laid by Republicans, then call them on it. The fallout is not going to look anything like what you're projecting. (How does this go? Democrat Pete: "I join my good friend, [Republican Bob], in supporting Wyden-Bennett." Republican Bob: "Actually, I was lying." You really expect Republican Bob is going to say that?)

In the end, all that counts is the final vote, of course. There are a million procedural ways to oppose a bill that are hard to uncover without incredibly good reporting, or which are even impossible to uncover, save for a final vote. And even that isn't definitive, since often members of Congress will vote for a bill once they know it will fail, while a Senator may switch their vote to against, even though they favor the bill, as that would enable to bring it up again, which couldn't be done if they were on record as voting for it.

Congress works in complicated ways.

"In any event, let's assume that Ezra is right that all these Republicans are lying (despite providing zero proof for it). How is that an argument against the ideas in Wyden-Bennett?"

It's not. But ideas don't mean much when what matters is what can be passed. Ideas are great; getting laws passed is better.

I've got a ton of great ideas for laws, myself.

von: I'm... rather confused, honestly. Mainly because I'm used to being called the naive idealist, but you seem to have infinite faith in the good faith desires of Republicans to work with Democrats and solve problems, despite the last eight years. And this year.

In the House, Roy Blunt, head of the Republican "Health Care Solutions Group" said they're not going to offer a bill, then was contradicted by the head of his party, who said they did, but they're not going to release it yet. Or maybe not. Who knows, they don't seem to know.

This is just like the stimulus debate, when the Republicans claimed they opposed certain things as "wasteful", and said they had another plan (that had no numbers in it) then yet another plan (that was all tax cuts for the rich) and then after a bunch was cut out of the plan, they voted against it ANYWAY.

The Republicans in Congress have NO interest in "bipartisanship" or health care reform. If they had, they could have done whatever they wanted during six of the past eight years, but repeated tax cuts came first, which is part of why your deficit criteria from the previous post is nearly impossible to meet.

There are Republicans who are interested in health care reform, but none of them are in Congress.

"In the vernacular, quantum leap 'has come to mean an abrupt change or 'step change', especially an advance or augmentation.'"

Yes, and people should stop using it that way, he said prescriptively. :-)

"Finally, I didn't link that article by Klein -- you did."

Turbulence did, actually.

von:

I think Turbulence is exactly right on this issue, and it's something you need to address. I think the Wyden bill is widely viewed to be a political dead letter because it's a political dead letter. Once you start messing with the coverage people already have, and lose the ability to say (with a straight face), "if you like what you have, you can keep it," public support will plummet.

Unless I'm understanding it incorrectly, the Wyden bill will require everyone who currently has employer-provided coverage -- that's a whole lot of people -- to make changes (even if those changes are just procedural/tax-related), and that makes it a very tough sale.

Simon K:

See the paragraph above.

"How, exactly, does a Senator of any party sponser a bill and then turn around and immediately oppose it without getting hammered on all sides for the flip-flop?"

Happens constantly. Most people don't look up on Thomas to see who is a co-sponsor, and most reporters don't include full lists. And there are a zillion concealed ways to work against a bill you ostensibly co-sponsor. Again, this is Congress 101 knowledge.

Crafty Trilobyte:
My own employer-provided healthcare has changed repeatedly in recent years, never for the better. Premiums go up, deductibles go up, coverage or network changes in rather arbitrary ways. ... Why would they resent a government plan to change for the better what is already changing for the worse? Who are these supposed voters?

Because even though your employer-provided health care frequently changes, it doesn't change in ways that require YOU to do anything. (The general you, not the specific view.) In the Wyden world, you'd be kissing those pre-tax health care payroll deductions goodbye, and instead writing checks to an insurance company and then having to deal with all the tax work that goes with that. Right now, it's automatic, and you don't even have to think about it at tax time.

Don't get me wrong: Doing away with the employer link would be a Very Good Thing, but it's MUCH easier said than done, because of people's reflexive hostility to changes that impact them personally.

von

That's a great charts on that site -- for comparing the Senate and House bills (seriously, thanks).

But I was hoping for a comparison that included the Wyden plan, so we can better debate which aspects make it the superior bill (and possibly -- possibly -- how the legislation coming out can be made better).

Huh? More than a half-dozen Republicans co-sponser a bill -- not just say that they're going to support it, co-sponser it -- and the "onus of proof" is on those who claim that they are all lying?

Bob Dole backed out of two bills he cosponsored (with Chaffee and then Packwood) in 1994. The issue isn't so much that Republican senators are uniquely deceptive on healthcare or generally, so much as political developments sometimes get ahead of you.

tgirsh, Trilobite - I don't see how changing employer-based coverage instantly makes something a dead-letter. I know its become accepted wisdom that it does, but I don't understand why: most people with employer-provided health insurance are at best luke-warm about it. They moan endlessly about it in fact. If it was clear that people would lose their existing employment-based coverage and that it would be replaced with something that didn't have the problems most employment-based coverage has (which is, as far as I can tell, actually the case), wouldn't that be, y'know, a good thing?

Mickey Kaus is right

Oh, dear.

Simon K:

most people with employer-provided health insurance are at best luke-warm about it. They moan endlessly about it in fact.

I don't know how many more ways I can say it. The general gist is that the only thing people dislike more than the status quo is change. For people with employer-provided plans, health care is something they only have to think about (or do anything about) at most once a year, at enrollment time. I can't imagine how forcing them into a situation where they're effectively on their own in acquiring insurance is going to be well-received, even if the insurance they end up with is ultimately cheaper and better. Nor can I imagine how they're going to be eager to get behind yet another complication on their income taxes every year.

If this sounds excessively cynical, that's because it is. But the bottom line is that people in general aren't very keen when you talk about requiring them to take actions that they aren't currently required to take.

Before we agree that it is dead letter because it makes everyone abandon their employer's health care, can we confirm it really requires that? I thought it just made them portable. Am I wrong?

"tgirsh, Trilobite - I don't see how changing employer-based coverage instantly makes something a dead-letter. I know its become accepted wisdom that it does, but I don't understand why"

Response:

[...] A USA/Today Gallup poll released July 12 found that 43 percent of respondents rated the option to keep their current plan as "very important" while 34 percent regarded it as "extremely important." Only 13 percent rated it as "somewhat important" while 8 percent said it is "not important."

A Quinnipiac University poll conducted in June found that 53 percent of respondents said they would rather purchase health insurance from a private company whereas 28 percent said they would opt for the government program.

It's a Fox News story, so it must be true.

Or we could try Timothy Noah:

[...] Polls tend to show that while a significant majority of Americans favors a more aggressive role for government in controlling health care costs and extending coverage to the uninsured, a majority simultaneously pronounces itself satisfied with its own health insurance, which typically is provided by employers. A March poll conducted by CNN found an overwhelming majority (77 percent to 23 percent) dissatisfied with the health care costs borne by the country as a whole, but also found a narrow majority (52 percent to 48 percent) satisfied with the total cost of its own health care. It's a baffling but not unusual discrepancy.
And there sure are a lot of polls here.

Unless I'm understanding it incorrectly, the Wyden bill will require everyone who currently has employer-provided coverage -- that's a whole lot of people -- to make changes (even if those changes are just procedural/tax-related), and that makes it a very tough sale.

That's a myth. The implementation could be structured as nearly seamless, with the only difference being tax treatment. For example, instead of receiving 5000/year worth of health insurance tax free, the plan would be subject to a tax credit. There may be some headaches in HR, but Wyden-Bennett doesn't require changes in plan or coverage among individual employee. It requires making a choice about a health care plan and executing a new form. I don't know about you, but I've had to make a choice regarding a health care plan and execute a new form every year that I've been employed.

It may be that Wyden-Bennett is a dead letter, but it has nothing to do with any of the reasons identified.
It would be because of the power that unions continue to hold over the Democratic leadership.

Point - KFF does include Wyden-Bennett.

Gary, can you respond to von's 4:44?

I'm pretty much with you on this, but a few points:

1 - I 100% agree that Republicans are more likely using htis as a way to defeat reform. If they want to, thy could say "Here it is, we'll vote for this tomorrow." But that's not the case.

2 - The political obstacles are greater than you think. Wyden is a much sharper break with employer-provided health care. You can blame unions all you want, but this is always what gets demagogued by everyone.

In a world where ending it is impossible, then the NEXT BEST world is a mandate to ensure competitive neutrality.

3 - The HR bill could mor gradually become the Wyden bill by accepting Wyden's new bill, which would open the exchanges up to everyone. That's probably the sweet spot of politics and policy right now.

4 - On your criteria, I think you need to break down "personal" a bit more. I think "sufficiency of benefits" is one concept, and maintaining benefits regardless of employment is another.

But overall, I'm with you. I love me the Wyden. And I think the public option is perfectly compatible with it (there's no structural necessity of the Wyden bill that precludes it)

von

Oops... sorry, didn't notice the search option.* Thanks again.

*if it were a snake, etc., etc., etc.

Turbulence, I have responded to your political points. If this is a trap laid by Republicans, then call them on it.

I've explained why this won't work: it will not seriously damage Republicans but it will seriously damage Democrats. That makes it an ineffective threat. Now, I suspect you disagree, but can you at least explain why?

The fallout is not going to look anything like what you're projecting. (How does this go? Democrat Pete: "I join my good friend, [Republican Bob], in supporting Wyden-Bennett." Republican Bob: "Actually, I was lying." You really expect Republican Bob is going to say that?)

No, I don't expect them to say "I was lying" because they're not stupid. But I do expect them to say "I was all set to vote for it until they changed X" or "I was all set to vote for it until Harry Reid proved to me that he couldn't be trusted and that this whole thing is just a stalking horse for single payer". Again, if a Republican Senator said that, no one in the media would call him on it: I mean, how could you call him on something like that?

Moreover, Slaney has already mentioned the case of Bob Dole backing out of bills he supported. Can you show me any indication that Dole payed a serious political price for doing so? If you can't, why should I assume that Congressfolk are likely to pay a serious political price for this sort of behavior?

I have to say, I'm a little shocked at how naive you appear to be.

they don't want to step on what has become the third rail of the Democratic party: organized labor.

If labor is the third rail of the Dem party, there have been awfully few votes benefiting labor in our Dem controlled Congress, haven't there?

It would be because of the power that unions continue to hold over the Democratic leadership.

You keep saying this but you cite no evidence to justify this belief. I'm sure some unions hate the idea of killing their tax break, but some don't and in any event, I don't see why we should believe that these unions have such perfect control over Democratic leaders. Can you provide any evidence backing up your claim or are you just going to repeat it a few more times?

I don't see how changing employer-based coverage instantly makes something a dead-letter. I know its become accepted wisdom that it does, but I don't understand why: most people with employer-provided health insurance are at best luke-warm about it.

Most people with employer provided healthcare have no idea how much it really costs (they don't pay the full bill).

Before we agree that it is dead letter because it makes everyone abandon their employer's health care, can we confirm it really requires that? I thought it just made them portable. Am I wrong?

AFAICT, employers are still allowed to provide health coverage under W-B. How many would do so is another matter. As I've said before, administering an employee health plan is a task many businesses would prefer to avoid. Given the option of having someone else do that, without leaving employees in the lurch, I suspect many would grab it.

Is the union opposition based on the loss of the tax benefit of expensive union plans?

tgirsh - As Sebastian already suggested, there's nothing in Wyden's bill that puts people "on their own in acquiring insurance". Employers can continue to pay for healthcare for their employees, and employees can continue (within reason) to deduct the cost of health insurance from their taxes. I would assume, since its so obviously in their interest to do so, that most insurers would make it trivially easy for their existing insurees to move from their current plans to equivalent successor HAPI plans (yes, really, they would be called that) and encourage employers to keep their employees with them to whatever extent this remained legal (and I'm sure they'd find some).

But thinking about it, even if that wasn't true, I don't think I buy your cynicism (and believe me - I'm usually very happy to buy cynicism). You're basically saying that people with existing insurance will resist change even if that change is as trivial as having to sign a couple of forms and the horror of the IRS having to add one more line to the 1040EZ (I can actually think of ways they could administer the new credit without even doing that, but this is the IRS). At the cost of having to exercise their handwriting skills for maybe 5 more minutes per year, they get an end to rescision on spurious grounds, guaranteed portability, an end to lifetime/condition limits, and a guarantee that whatever insurnace they buy it will at least cover them and not turn out to be useless. And that's not even accounting for the fact it will probably be cheaper!

I think the bigger problem isn't that the public wouldn't like the deal if they knew what it was, but that our liberal and moderate representatives quake in their boots at the idea of hypocritical attack ads from their conservative counterparts announcing that thanks to them "millions of americans will lose their existing health coverage", and never seem to think to actually tell the public that what they'd get instead would be better.


Doesn't the fact that it doesn't make you abandon your employer's health care take an enormous amount of bite out of Turbulence's critique?

but because they don't want to step on what has become the third rail of the Democratic party: organized labor.

Which explains why card-check was dropped from the Employee Free Choice Act. Because labor is so untouchable.

That's a myth. The implementation could be structured as nearly seamless, with the only difference being tax treatment. For example, instead of receiving 5000/year worth of health insurance tax free, the plan would be subject to a tax credit. There may be some headaches in HR, but Wyden-Bennett doesn't require changes in plan or coverage among individual employee.

I'm confused. Why would any business want to keep offering health care if they could get away with offloading that work. HR folk generally don't work for free after all.

Do you have any health care experts or economists that you can cite explaining your contention above? Because while I'm thrilled that some lawyer who writes on the internet thinks that it would be a trivial implementation detail to ensure that most employer provided healthcare won't disappear over 2-3 years, I'd rather see what the experts are saying.

For example, the CBPP says:

While the Wyden-Bennett plan would give employers the option to continue offering health insurance to their workers as long as the employer plan otherwise met the requirements for health insurance plans offered through the new state-based purchasing pools, the Wyden-Bennett legislation is likely to lead to a substantial reduction in employer-based coverage over time and to the near-elimination of such coverage outside of some large firms (that may opt, at least initially, to continue coverage to avoid disruption and potential complications for their workers).

It seems like we all accept that Wyden-Bennett makes the employer provided health insurance go away (the CBPP report explains why). The only question here seems to be over what time frame this disappearance occurs. If we have reason to believe that this disappearance takes place on a short time frame (say 2-3 years), then it seems like Wyden-Bennett is political suicide for Dems.

Doesn't the fact that it doesn't make you abandon your employer's health care take an enormous amount of bite out of Turbulence's critique?

Possibly. Then again, I don't see any reason why companies would keep spending money on HR to provide their employees with insurance if they don't have a financial incentive to do so, and Wyden-Bennett seems to remove that incentive. Can someone explain this to me?

von/Sebastian/Simon K:

I see Turbulence has beat me to it in responding. But I'd add that even just the tax changes could be enough to defeat Wyden -- it still changes health care from something you think about at most once a year to something you actually need to ACT ON.

And, as Turbulence points out, what makes the Wyden proposal attractive to the wonks here is that it DOES effectively kill employer-based health care. If you think that the "public-option-will-kill-private-health-care" demagoguery has legs, just imagine what vested interests would be able to do with a "you're-going-to-lose-your-insurance-benefit-at-work" line of demagoguery.

It requires making a choice about a health care plan and executing a new form.

No additional schedules and forms at tax time? Premiums continue to be deducted via pre-tax payroll deductions? If either of those is false, then I submit that's a non-trivial change in the eyes of the voting public.

Thanks for your serious and interesting blogging on this issue, von. I may question the good faith of Congressional Republicans, but I have no question about yours.

I do differ in one important respect in the way I see the goals of reform, however. I think your third goal--that the reform not add to the deficit--is both unnecessarily restrictive and off the mark when it comes to the real costs we should be looking at when it comes to healthcare.

Obviously, we need to come up with a way to foot any federal governmental costs. But there are a variety of funding mechanisms available, from cutting bloated and unnecessary federal spending (Defense would be a good place to start) to new forms of taxation (such as the surtax proposed by the House). In short, we can emerge from any reform scheme without increasing the overall federal deficit. We should find the most effective, politically sustainable reform and then figure out how to pay for it.

But another goal of reform has to be overall healthcare cost containment, and that's not a question of the amount the federal government spends on this plan, but of the amount we, as a society, spend on healthcare.

In short, I'm much less interested in keeping the amount the federal government spends on this plan low than I am in getting more bang for our healthcare buck, whether that's federal money or private sector money.

(I suppose I do have a second difference in goals, too. While I wouldn't mind seeing health insurance decoupled from employment, I don't see that as a necessary part of any good bill. There are plenty of excellent health care systems around the world that still have some link between employment and healthcare, e.g. Germany. And I share the sense of others that threatening to make those with insurance change their coverage is a political minefield.)

"The Republicans in Congress have NO interest in "bipartisanship" or health care reform. If they had, they could have done whatever they wanted during six of the past eight years, but repeated tax cuts came first, which is part of why your deficit criteria from the previous post is nearly impossible to meet."

This an absurd statement. There was no more support for bipartisanship from the Democrats during the Bush years. I just love how any disagreement from a Democrat is policy related, but all Republican positions are politically motivated. They have fundamentally differing views on how to solve problems.

"Then again, I don't see any reason why companies would keep spending money on HR to provide their employees with insurance if they don't have a financial incentive to do so, and Wyden-Bennett seems to remove that incentive. Can someone explain this to me?"

They do so now. Why do they do that?

Why would any business want to keep offering health care if they could get away with offloading that work.

Why would any business want to offer health care at all? Nothing forces my employer to pay for my health insurance now, aside from the fact that I'd quit and go elsewhere if they didn't.

They do so now. Why do they do that?

Because it gives them a competitive advantage over companies that don't offer health care. Given an individual mandate, that advantage diminishes somewhat, because everyone will already HAVE insurance coverage of some form or another. Force an employer to deal with multiple insurers, rather than have an exclusive agreement as most currently do, and the administrative costs start to pretty severely outweigh any perceived competitive advantage.

Neither Wyden-Bennett nor HR 3200 seem to address one important part of coverage: finding a doctor or hospital that will accept a person's plan. In urban and suburban areas this is not usually a large problem, since there are numerous doctors and hospitals and chances are good some will accept any given insurance coverage. But in rural areas, this can be a significant problem. For example, here in Colorado, there are rural counties where there are no doctors that are accepting new Medicare patients.

At some point, reform must deal with the problem that an insurance plan that is not accepted where you live is little better than no plan at all.

Turbulence - Employers are not and never have been obliged to offer insurance. They do it for their employees because its tax efficient. There is no direct financial benefit for the employer in offering healthcare as compensation as opposed to a car or housing. Changing the employee's tax break doesn't really change the employer's position, so I don't really see why employers are immediately going to leap over themselves to dump healthcare as compensation unless their employees ask for the cash instead. In the case of company-provided cars, which used to be common in England for tax reasons, for example, employers often continued to provide them even once it stopped being tax efficient - it took quite a long time for the phenomenon to disappear. The employer's position doesn't really change - only the employees. Wyden will kill employer-provided healthcare, but it'll be the employees who make the move, not the employers.

tgirsh - You didn't really answer my point, even though you partially addressed your comment to me. Why on earth would anyone in their right mind prioritise having to fill in an extra line on the 1040EZ over the security of their family's healthcare?

Bah, convenient access to health care wasn't much of a concern when you decided to live in the middle of nucking fowhere, so why worry about it now?

(I kid, I kid! Now I'm off to go eat arugula and sip chardonnay with all the other urban liberal elites.)

[Companies] [provide health insurance] now. Why do they do that?

Because:

1. Just having health insurance available without problems is an enormous benefit for many people. In the current environment individual policies are expensive and often unobtainable.

2. It's cheap compensation. Paying $X/month for an employee's insurance gives the employee $X in after-tax pay (some minor technical quibbles aside). The employer would have to pay [ $X/ (1-T) ] in cash to accomplish the same, where T is the employee's marginal tax rate.

One other thing about employer-paid insurance and taxes. Workers effectively get the deduction even if they do not itemize, as indeed most do not. Substituting an individual deduction won't get it done, unless you change the treatment from the way it is handled now.

Bernard - What Wyden proposes is a refundable tax credit, not a deduction. You don't have to itemise to claim tax credits, just as you don't have to itemise to claim the standard exemptions or the standard deduction. Since this particular credit applies to absolutely everyone, by far the cheapest way for the IRS to implement it is to include it in the standard witholding and the 1040EZ, which is what most people use and much the cheapest form for the IRS to process.

Simon K,

Thanks. I missed that.

Why on earth would anyone in their right mind prioritise having to fill in an extra line on the 1040EZ over the security of their family's healthcare?

Because if they already HAVE health care, they don't view the security of THEIR family's health care as being in jeopardy. It's not entirely rational, but people often behave and believe irrationally.

Also note that currently, employers pay a sizable portion of their employees' premiums, and if I'm not mistaken get a tax break for doing so. My understanding (which admittedly could be wrong) is that Wyden does away with this, effectively shifts the tax burden and the responsibility for paying the full cost of the plan to the employee (because if the employer doesn't get a tax break for paying some of the cost, then why do it?).

I should point out that I actually agree that some modified form of Wyden would probably be preferable; I just doubt it's politically viable, for a myriad of reasons, first and foremost among them the simple fact that people fear change.

"I just doubt it's politically viable, for a myriad of reasons, first and foremost among them the simple fact that people fear change."

You realize that is a great objection to health care reform at all, right?

"Gary, can you respond to von's 4:44?"

I'm not sure what you're looking for. Von's talking about actual implementation ("The implementation could be structured as nearly seamless, with the only difference being tax treatment") and I was supporting tgirsh and Trilobite's points about public perceptions. I suppose perhaps von's argument is that Obama should get out there and try to change public perceptions, but he's already trying to do that with not great success on most points of health reform argument in the first place right now.

What "really" would happen, and what the public thinks would happen are quite separate things, unfortunately. (One might argue that no one should believe in the Birther or Truther stuff, or in UFO abductions, or astrology, or auras, or reincarnation, or that the moon landings are a hoax, or endless numbers of other things that the evidence contradicts, but said evidence doesn't actually convince all these millions of people who believe in these things.)

I just moments ago listened to a piece on the PBS Newshour on how strong majorities of the public believe any change in any plan will lead to them not being able to keep their own doctors, will lead to them having to pay more, etc., and other Dooms. The scare tactics that worked so well in the Eighties are still working well -- or, if you prefer, people's general skepticism of government, and general low-information status, continues to be strong factors.

Point is, what's theoretically possible, and theoretically a great idea, doesn't itself change what's politically possible.

Meanwhile, von keeps arguing it's all the fault, somehow, of the unions: "It would be because of the power that unions continue to hold over the Democratic leadership."

And I'm having trouble believing that the unions have such a lock on what either the public believes, or Congress wants to do. If so, why was card-check dropped? Since when are unions so almighty powerful, in recent decades, in recent American politics, or even the Democratic party?

Mind, I'm not denying that conceivably the unions could be a political factor; I simply amn't in a position to particularly judge; I'd just like more evidence than a claim, if it's so.

Personally I still want single-payer, and lots of people want single-payer, but nobody seems to think that's "politically realistic," either, and I'm unclear if von also blames the unions, even partially, for that, as well, which would seem to logically follow as that would disassociate health insurance from employment as well. Or maybe I'm not following von's arguments well enough. I make no claims, as I said, to know a lot about health care issues.

(History and history of politics, and various other areas of knowledge, are my areas of self-claimed expertise; not health care, or economic issues.)

"I just doubt it's politically viable, for a myriad of reasons, first and foremost among them the simple fact that people fear change."

You realize that is a great objection to health care reform at all, right?

It's certainly a huge political problem, without doubt. Polls all show that people are concerned about the current health care system, and want change, but are skeptical about any specific proposition for change, in short. It's understandable, really: this is very complicated stuff. I like to think I'm not dumb, and I'm damn well more than concerned, and a lot of this stuff, when looked at in detail, makes my eyes start to glaze over.

It takes a lot of time and study of really complicated stuff to even being to understand the issues involved in most of the major proposals and arguments, for the most part; only a little of it can be summed up in short sound bites; Obama is trying his best, but it's a very tough row to hoe.

And I'd say that even if there wasn't a massive investment by various interest groups, and, uh, some politicians, in deliberately putting out confusing claims, and just be oppositional so as to support the status quo.

Oh, and few mainstream journalists do a respectable job of explaining the issues involved, much of the time, as well.

Now that Ezra is at washingtonpost.com, and counts as mainstream, I'd count him as one of the very best.

tgirsch - As gets demonstrated time and again in practise, people "with insurance" are not really safe once their insurer decides they're a bad risk. Everyone, really, knows this, including people who are worried about any change to their insurance. All of the bureaucratic concerns can be dealt with through sensible implementation or amendments to the bill to make the tax and paperwork implications simple and let people keep as much of their existing arrangements as possible. Why the hell don't the politicians who claim to favour reform grow spines and get out there and tell people this instead of settling for a bill that no-one is prepared to defend in public except on the grounds that its the best they could get, when thats at best highly questionable. As I said, I smell a big rat somewhere.

On the question of employer tax exemption for healthcare premiums - its true in the absolute sense that they don't pay tax on money paid for employee's healthcare premiums. But they don't pay tax on any other form of compensation either. Normally the recipient would pay, but with health insurance no-one does.

@ Sebastian: "I just doubt it's politically viable, for a myriad of reasons, first and foremost among them the simple fact that people fear change."

You realize that is a great objection to health care reform at all, right?

---

It is certainly a great *obstacle* but I don't think much of it as an objection; too akin to saying 'no' to medicine because "it tastes yucky"...thin reeds from which to build an improved social contract.

And here's a fascinating addition to the New Yorker story:

McALLEN, Tex. — One of the largest sources of campaign contributions to Senate Democrats during this year’s health care debate is a physician-owned hospital in one of the country’s poorest regions that has sought to soften measures that could choke its rapid growth.

The Democratic Senatorial Campaign Committee collected nearly $500,000 at a reception here on March 30, mostly from physicians and others affiliated with Doctors Hospital at Renaissance, financial disclosure records show.

The event was held at the home of a prominent McAllen developer, Alonzo Cantu, a hospital founder, investor and board member who has raised prodigious sums from the Rio Grande Valley for an array of Democrats.

Another event at Mr. Cantu’s home, in September 2007, brought in at least $800,000 for the committee’s House counterpart, the Democratic Congressional Campaign Committee, according to disclosure reports. The House speaker, Nancy Pelosi, was in attendance and cut a ribbon at the hospital’s new women’s center while in town.

The hospital, which is in Edinburg, adjacent to McAllen, is working both sides of the aisle. Its political action committee, Border Health PAC, split $120,000 last year among House and Senate candidates, including Republicans.

Although Congressional negotiations over health care legislation are continuing, Doctors Hospital seems to be getting much of what it wants. Thus far, physician-owned hospitals have been insulated from some of the most onerous potential restrictions in the health care legislation moving through Congress.

Representative Pete Stark, a California Democrat who wants to clamp down on physician-owned hospitals, said their formidable lobbying had helped eliminate his proposal to limit physician ownership to 40 percent at any hospital.

“Particularly led by these guys in Texas, these guys who have been raising tons of money for contributions,” Mr. Stark said in an interview. “I am sure that some of my colleagues have been willing to hear them out.”

[...]

On at least three occasions in the last two months, delegations from McAllen have made the rounds of Capitol Hill to discuss their concerns, and blunt the effects of the New Yorker article.

[...]

One key provision would limit a hospital’s ownership by doctors to the level in place at the time of enactment. That is a change from previous language in House bills to restrict physician ownership to 40 percent. It would have forced Doctors Hospital, where physicians have an 82-percent stake, to be sold or required some of its owners to divest.

Mr. Stark said the change had been made “at a higher pay grade than mine.” The physician-owned hospitals, he said, “just thought they could buy their way out of it, and it’s a sad commentary on the Congress.”

Speaker Pelosi supported the tougher provisions in previous bills but aides said she was willing to accept a compromise to win the new restrictions.

Aides to Senator Max Baucus. Democrat of Montana, the chairman of the Finance Committee, and to Senator Charles E. Grassley of Iowa, the ranking Republican, said the Senate would never have adopted the 40 percent limit and that it was only fair to allow existing hospitals to maintain their ownership structures.

[...]

Whether or not there is cause and effect, some of the hospital’s beneficiaries have passionately supported its position. In November, the South Texas doctors raised nearly $60,000 for Representative Sheila Jackson Lee, a Democrat from Houston. Last week, Ms. Lee, who has a physician-owned hospital in her district, inserted comments in The Congressional Record against restricting the hospitals’ growth. She did not respond to requests for comment for this article.

Disclosure reports show that about 220 donors from the McAllen area contributed to the Senate Democratic committee for the March event. Receipts totaled at least $425,000, about 2 percent of the group’s collections for the first half of the year.

“We’re not naïve,” said Dr. Ambrosio Hernandez, a pediatric surgeon who gave $5,000. “We understand that politics plays a role in everything.”

There's a bunch more at the article. Read The Rest Scale: 4 out of 5.

@ Marty (Quoting & responding to Nate)

"The Republicans in Congress have NO interest in "bipartisanship" or health care reform. If they had, they could have done whatever they wanted during six of the past eight years, but repeated tax cuts came first, which is part of why your deficit criteria from the previous post is nearly impossible to meet."

This an absurd statement. There was no more support for bipartisanship from the Democrats during the Bush years. I just love how any disagreement from a Democrat is policy related, but all Republican positions are politically motivated. They have fundamentally differing views on how to solve problems.

---

Different views on solving problems? oh, ain't THAT the truth! Especially where health care is concerned. The only solution we've seen out of the Republicans on this front over the last 16 years has been to encourage the increase of costs, and to oppose any measure that might reduce them. The theory seems to be that those who cannot pay the upwardly-spiraling prices will die, freeing up resources for the better-heeled.

Must be why the Republicans swept the last election for the third straight...oh, wait -

"[N]o more support for bipartisanship from the Democrats during the Bush years..."? The Republicans ruled as if the Democrats didn't exist. Bipartisanship wasn't even a theory, much less a possibility - Democrats couldn't even keep the lights on during meetings. The Republicans should be shamefacedly aware that THEY are not being subjected to the same revolting treatment THEY dished out to the minority party. Instead they act like Delay, Armey and Abramoff still run the government. And now a lecture about 'proper bipartisan spirit'? Save it!

You "just love how any disagreement from a Democrat is policy related, but all Republican positions are politically motivated"? Are you unwilling to accept the plain-English statements of Republicans in Congress? Their positions on health care (remember? we were talking about health care before you decided to make it about mean Dems picking on poor, principled 'Pubs?) *ARE* politically motivated. They SAY so. Repeatedly. We voters would be stupid indeed to pretend they don't mean what they say when they speak of their naked purpose.

Nate's comment are cogent, rational, and make sense in context; your statements in response are - well, absurd.

In the case of company-provided cars, which used to be common in England for tax reasons, for example, employers often continued to provide them even once it stopped being tax efficient - it took quite a long time for the phenomenon to disappear.

This is a revealing comment. Of course coverage will not instantly dry up for the sort of people who might, in other countries, be provided with company cars. But what about stockboys and cashiers? What about small employers already on the fence about whether to renew? It makes the biggest difference at the margins. And the margins are not people driving company cars.

"I just doubt it's politically viable, for a myriad of reasons, first and foremost among them the simple fact that people fear change."

You realize that is a great objection to health care reform at all, right?

It is. And other than the "public option", that's why the current plans on offer go out of their way not to rock the boat. Back in '94, only the bluest of the Blue Dogs thought individual mandates were the best way to go. Now it's unquestioned by everyone. And even still, it's a f'ing catastrophe trying to explain it through the freakshow media. Right now they're yelling it'll make Our Respected Seniors be forced commit suicide by ACORN workers. And Chris Matthews is taking it seriously. Imagine how bad it would be if they jerked around with the basic tax principles behind the system as it works now? People'd be in the streets. (Cf. Medicare catastrophic coverage, 1988-1989)

Slaney - and the effect driving away employer-based insurance on the margins is what, exactly? The employers costs don't change - if anything they go down. So for those fortunate stock boys and cashiers who have employer-based insurance (who are in the minority alreay, I might point out), why would it be withdrawn under Wyden's plan?

Sebastian:
You realize that [fear of change] is a great objection to health care reform at all, right?

Yes, I do, which is why reforms have a much better chance of passing the less they change things for people who currently have insurance. The importance of that cannot be overstated. Even with current proposals, there's a lot of demagoguery around "this reform will make you lose your current coverage." I don't think anyone seriously contests the idea that losing one's current coverage under the Wyden plan is substantially more likely than under the current House proposals. (That it would almost certainly be replaced with something better is irrelevant, because people won't believe that until they see it.)

Simon K:
As gets demonstrated time and again in practise, people "with insurance" are not really safe once their insurer decides they're a bad risk. Everyone, really, knows this, including people who are worried about any change to their insurance.

I think you underestimate the power of the "it won't happen to me" mentality. And to the extent that it's a concern, most of the current proposals fix that (by prohibiting rescission) without jeopardizing current coverage (by taking away the employers' and employees' tax benefits). Yes, you're providing a different tax credit, which would (hopefully) offset the lost benefit, but it's something that must be calculated and claimed by the taxpayer rather than something that happens automatically as part of the payroll process. Further, because the payroll benefit is gone, they won't see the tax benefits on a paycheck-by-paycheck basis unless they refigure their exemptions and re-file their W-4, which means less take-home pay and the possibility of error. Thus, even if they get to keep their existing coverage, there's more work for them.

Now, to some extent, these are problems with ANY reform that breaks the employer health care bond, but I think something that does that gradually has a much better chance of getting through than something that does so abruptly.

Once again, if I felt dramatic changes were viable, I'd say go single-payer ("Medicare for everyone") with a simple funding scheme, and completely eliminate the need to figure payroll, exemptions, credits, etc.

Re: "(That's better coverage, bye the by, then even House Democrats claim that HR 3200 would deliver.)"

Pretty sure it's by the bye.

Of far greater import, excellent post, von & informative discussion.

Does this provide for a deduction or a credit? The linked articles are not even internally consistent on this. A $19,000 deduction does little good for a family at poverty wages. That certainly would not provide for 99% coverage.

On the other hand, how on earth could a $19,000 (presumably refundable) tax credit be revenue neutral?

And without some requirements regarding pre-existing conditions and state-wide availability of treatment this plan would only serve to leave workers with less coverage.

It looks like an attempt to shift responsibility to the individual -- which is not in and of itself a bad thing. But this also looks like a way to shift the blame for lack of coverage to those who won't be able to purchase their own coverage, by income, location or pre-existing condition.

Geo:

My understanding is that it would be a refundable tax credit.

"Of course coverage will not instantly dry up for the sort of people who might, in other countries, be provided with company cars. But what about stockboys and cashiers? What about small employers already on the fence about whether to renew? It makes the biggest difference at the margins. And the margins are not people driving company cars."

But stockboys and cashiers get health insurance NOW. And to the extent that they don't from companies 'on the fence about whether to renew', what happens now isn't that they get insurance because there is no other option. What happens is they don't get insurance anywhere because there is no other option.

"I don't think anyone seriously contests the idea that losing one's current coverage under the Wyden plan is substantially more likely than under the current House proposals."

I contest it. I don't think the Wyden plan makes it substantially more likely that you'll lose your current coverage. I in fact don't find it very plausible that you will lose your current coverage. And if it is, because of tax reasons, that is super-easy to fix. Taking away the tax incentive to provide insurance coverage is not a key insight of the bill (in fact I'm not even totally sure it is a part of the bill at all, but if it is, it could be removed without an enormous problem).

So instead of objecting to the plan in toto, why not say something to your Congressman like "I would support this plan if the tax incentive to employers was retained"?

I don't think the Wyden plan makes it substantially more likely that you'll lose your current coverage.

Employers currently get group discounts thanks to exclusivity agreements with insurers. Doesn't the Wyden bill force them off of such exclusivity agreements (thus tanking their discounts) and onto "exchanges" instead? And transferring the tax benefits from the employer to the employee is, as I understand it, one of the key provisions of the plan, which is supposed to be the DRIVER for breaking the employer link.

So instead of objecting to the plan in toto, why not say something to your Congressman like "I would support this plan if the tax incentive to employers was retained"?

"... and it contains a robust public option."

:)

Meanwhile, riddle me this: If expanding Medicare is supposed to be a more politically viable option, then why was making the public option less like Medicare a key provision of the recent compromise with House Blue Dogs?

For what it's worth (perhaps not much), I did email my congresscritter (Joe Courtney) and asked him to take a serious look at the HAA.

My view on why the Medicare for the unemployed option isn't an option is that it doesn't lead easily to the government takeover of health care, and Democrats would prefer a system that could be leveraged into that in the long run.

"Employers currently get group discounts thanks to exclusivity agreements with insurers. Doesn't the Wyden bill force them off of such exclusivity agreements (thus tanking their discounts) and onto "exchanges" instead? And transferring the tax benefits from the employer to the employee is, as I understand it, one of the key provisions of the plan, which is supposed to be the DRIVER for breaking the employer link."

The discounts tend to be based on the size of the pool not because of exclusivity. They tend to be exclusive because no HR department wants to deal with more than one.

The tax benefit should be equally claimable by whomever is paying for the insurance; wheher it is the employee or the employer.

My view on why the Medicare for the unemployed option isn't an option is that it doesn't lead easily to the government takeover of health care, and Democrats would prefer a system that could be leveraged into that in the long run.

That's just silly. The Blue Dogs shifted the public option away from Medicare because they want more government involvement? That doesn't even pass the laugh test.

The discounts tend to be based on the size of the pool not because of exclusivity.

But the size of the pool is what it is precisely because of the exclusivity.

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