Obsidian Wings

Fred Hiatt's Strange Argument

by publius

You'll be shocked to learn that Fred Hiatt opposes the public option.  You'll be further shocked that his argument doesn't make much sense.

Hiatt's main concern is cost control.  He thinks (maybe correctly) that Congress is punting on controlling costs.  Instead, Hiatt wants Congress (1) to impose taxes on employer-provided health care benefits; and (2) to cede their power over Medicare reimbursement rates, etc.  (For the record, the Baucus bill includes the latter -- along with many other promising cost-reducing measures).

Nothing crazy so far.  But Hiatt goes off the rails when he tries to blame these cost problems on the public option itself.  The logic, as I understand it, is that adopting the public option prevents Congress from taking "real" steps on cost controls.

I'm sorry, but this is just gratuitous swiping.  For one, the public option would lower costs, particularly if it were expanded.  Second, precisely zero of Hiatt's cost concerns would be addressed by removing the public option.  All of the problems he cites will exist even if the public option gets scrapped tomorrow. 

Now, maybe that's a reason to criticize Congress, but it's no reason to criticize the public option.  These are just analytically distinct points. Congress is dragging its feet on cost-cutting because cost-cutting is politically treacherous.  The public option has nothing to do with it. 

The real story here is that Hiatt just really dislikes liberals.  His argument, frankly, seems more motivated by animus than by policy concerns (note the swipe against unions).

Of course, DougJ at Balloon Juice says all this more succinctly than I could:

To summarize here’s shorter Hiatt/Samuelson: the public option may not fully address increases in health care costs, so we shouldn’t have one.

That pretty much sums it up.

The Public Option's Most Frustrating Opponent

by publius

Despite its new momentum, the public option has a powerful new opponent -- the White House. 

It's incredibly frustrating.  Although Reid is close to getting 60 votes on cloture, Obama and Rahm (who, for all his bluster, is politically timid) are pushing for the "trigger," which is the same as nothing.

The question, then, is why?

At HuffPo, Sam Stein and Ryan Grim report that the White House's opposition is based on political pragmatism.  The White House feels that Snowe's support is critical to both protect centrist Dems and to ensure their continuing support for the bill. 

My view, though, is that they're being too timid here.  The politics have shifted since the summer -- both in terms of the bill itself and the public option.  The NYT today, for instance, noted how small businesses are suffering from skyrocketing premiums (thus strengthening the policy argument for a public option). 

Frankly, the lack of Republican support is a greater political threat to Republicans than to Democrats.  But it's hard to get some Democrats to see that.

But I think the White House also has some ulterior motives here -- in short, their political self-interest is diverging from the public interest.  The White House, understandably, wants to be re-elected.  Passing health care is critical to that.

I think, though, that the White House also wants to say that they've restored bipartisanship, brought the parties together on big issues, etc.  In short, I'm wondering if the White House's shorter-term political calculations (for themselves) are making them more timid than they should be on this issue.  I'd like to have Snowe's support too, but I don't think it's worth sacrificing an opt-out policy that seems to have wide Democratic support (and would have more if Obama showed some spine).

Of course, this entire post assumes that the politics have fundamentally changed since the summer.  The Dems survived the knockout punch, and reform now seems likely.  The lack of Republican support doesn't pose the same threat that it did in, say, August.  

And of course, the entire debate shows just how undemocratic the filibuster and the 2-Senator rule have become.

Pelosi Goes "All In" On Public Option

By Lindsay Beyerstein

Nancy Pelosi is going all in to support a public option that would hold down costs by setting reimbursement rates at Medicare plus 5%. The CBO's latest cost estimates for various House health care reform options have galvanized Pelosi in favor of a Med+5 public option, Brian Beutler reports. 

Pelosi has always favored some kind of public competition for private health insurers, but she has previously been non-committal about how hard a line a public plan could take to hold down costs.

The House Democrats are in negotiations to combine the various bills that passed their respective committees this summer. Chris Bowers has a good discussion of how Pelosi is using the CBO numbers and the Med+5 proposal to outmaneuver Blue Dog Democrats in the House and Senate. Basically, the stronger the public option the House bill proposes, the bigger the cost savings it will project. Fiscal conservatives will be hard-pressed to vote against a public option that's projected to cost less than the alternatives.

Rep. Raul Grijalva, the co-chair of the House Progressive Caucus, told Bloomberg that the caucus is gravitating towards the Med+5 plan, as opposed to a weaker proposal that would have the government negotiate rates with providers.

It's cheaper for the public to negotiate reimbursement rates for the entire plan because the massive bargaining power of the federal government drives down prices. Whereas, the public invariably gets a worse deal when rates are negotiated piecemeal. There's really no reason not to negotiate in one fell swoop, except as a gimme to vested interests.

Naturally, drug companies and health care providers want piecemeal negotiations. However, Obama has said he won't sign a bill that adds to the deficit and the House is looking for ways to save money. Letting the government drive a hard bargain is an attractive way to cut the costs of health care reform. Piecemeal negotiations would hobble one of the most powerful cost-control features of a public plan.

Get Your "Part E" On

by publius

House Democrats are warming to renaming the public option "Medicare Part E."  The Hill reports:

Say hello to “Medicare Part E” — as in, “Medicare for Everyone.”

House Democrats are looking at re-branding the public health insurance option as Medicare, an established government healthcare program that is better known than the public option.

Frankly, this should have happened a long time ago.  But no time like the present.

Assuming this label catches on, I'm anxious to hear how GOP legislators will distinguish it from the "real" Medicare.  "No, no, no.  Medicare is much different.  We love Medicare.  The public option, however, is a threat.  It will lead to a government-run, single-payer, socialized coverage system.  That's much different than what Medicare does."

In all seriousness, the most valid reason not to call it "Medicare" is that the public option is far less socialized.  Even under the most liberal bills, the public option would only be available to a fraction of the public, and even then would have other restrictions such as artificial floors on reimbursement rates, etc. 

In short, Medicare is much more liberal than the public option.  I doubt, though, that the GOP will adopt this as their main talking point.  Instead, we may see a comeback tour for "Medicare will bankrupt us all."

In any event, the public option is certainly close enough to idea of the Medicare system to justify the label.  So that part doesn't bother me.  Besides, a little gimmickry in the name of good policy is no vice.

What is unfortunate, though, is that the label change is even necessary in the first place.  As virtually everyone agrees, Medicare is a very good program -- it has improved lives and reduced fear in an infinite number of concrete ways.  But it is a public program.  It should, therefore, be a testament to government's ability to help people.

The fact that the term "public option" is tainted in many people's eyes shows that progressives still need to show people that government has been, and can be, a force for good.  We should advertise it more.  It's unfortunate that socialized, single-payer Medicare could be so popular with people who are so ideologically opposed to something called the "public option."

Public Option Politics

by publius

The latest Post/ABC poll shows that Americans continue to favor a public option.  Indeed, the public option is getting more popular -- the poll shows that support has rebounded since the summer, thanks in no small part to committed liberal activists.

The fact that the public option is genuinely popular should make it easier for conservative Democrats to support it (or at least to tolerate it).  But that all depends, of course, on why exactly they've been skeptical in the first place.  Have these Dems been opposing it for "good" reasons or "bad" ones?

The "good" reasons for opposing the public option is simply the fear that voters will punish them.  Polls like this, however, should go a long way is softening this type of skepticism.

The "bad" reasons, however, for opposing the public option is simply to protect rich insurance companies, whose practices over the past 20 years have been morally unacceptable, even if they've been economically rational.  Today's poll won't help with these kind of skeptics, but we can now at least clearly identify who they are.  It's not going to work anymore to say things like "the public option is not politically possible."  Today's poll shows otherwise.

Accordingly, we should assume from this point on that any continued opposition by Democrats is essentially prostitution on behalf of insurance companies.

Reform's "Clarifying Moment"

by publius

We are (knock on wood) tantalizingly close to historic health coverage reform.  In the heat of today's debates, it's easy to forget just how big this is.  If we enact reform, it will instantly be one of the most important legislative actions in American history -- remembered alongside the New Deal and the Civil Rights Acts. 

For this reason, the political debates of '09 will live on for some time to come.  And as we increasingly gain perspective on these debates, the GOP's actions are going to look worse and worse. 

In fact, I predict that the Great Health Care Debates of '09 will be remembered as an intellectual ebb for modern conservatism.  If nothing else, the debates will be a "clarifying moment" that illustrates to future audiences the relative state of the progressive and conservative movements at this point in history.

Health care is arguably the most important policy issue of our generation.  It touches everyone's lives in a uniquely immediate way.  And it has an enormous impact on our national and state budgets, among other things.

But on this most important of issues, the GOP literally -- literally -- had nothing of substance to say.  Instead, they offered 100% opposition (much of it consciously misleading) in a lazy following of the 1994 playbook.  That's not exactly news, but it does reflect some deeper underlying realities.

First, on the legislative side, I think the Democratic legislators and their staffs proved vastly superior to their Republican counterparts in terms of policy expertise.  Despite the in-fighting, the collective sophistication of the Democratic bills far surpassed anything that the GOP proposed (either now, or since 1994).  Indeed, the GOP's policy arms (think tanks, etc.) are so atrophied that I'm not sure they're even capable of producing a credible national reform bill.

On a more strategic level, the institutional GOP was once again tempted by the shiny apple of the short-term news cycle.  They were too fascinated with town halls and Obama's dipping poll numbers to keep focused on the long-term.  In short, winning the news cycle intoxicated them.  But now that the fumes of summer drunkenness have worn off, that position doesn't seem as smart as it once did.  And Obama's long-term focus seems, once again, much more savvy.

This same divide was on display in the blogging and punditry worlds as well.  Personally, I think the progressive policy wonks outshone their conservative counterparts in virtually every way.  The liberal bloggers (Klein, Cohn, Dayen, etc.) were engaged in the political and policy details at a level that simply wasn't matched on the Right.  The conversation on the progressive side was vibrant, informed, and useful for policymakers.

With very few exceptions, I saw nothing on conservative sites remotely comparable to the expertise and engagement shown on these progressive sites.  There was, instead, a lot of heat about Tea Parties and town halls and death panels.  It was generally light on policy and heavy on demogoguery.

In short, the health care debate shows that the American progressive moment is in a much stronger place right now, policy-wise.  It's where the interesting conversations are taking place.  It has the Geist.

To be sure, all this could change quickly.  Conservatives have a strong "farm team" of young smart libertarianish writers.  And events can always turn on a dime.  Indeed, this post will look pretty silly if reform collapses next week. 

But in this debate, at this moment in time, conservatives are simply outmatched at the policy level.  And that will be true even if they ultimately succeed in scaring enough Dems to defeat reform.

A Favorable Wind

by publius

One sign that coverage reform has momentum is that several of the recent attacks from insurers are designed to make the bill more like Democrats want.  Understandably, insurers want more healthy people buying coverage -- and so they want a stricter mandate.  The only way, however, to justify a stricter mandate is to expand subsidies -- another good policy goal.

These are all potentially positive developments.  Indeed, it's always good when the interests of formidable political opponents align with your cause.

Also, as a matter of tactics, the recent insurer attack was clumsy and too late.  If anything, it all but justified a public option by threatening to dramatically raise premiums.  Plus, it gave Democrats license to bash them for a few days, which is always a good PR move.

Not counting chickens yet, but things look good at the moment.

Snowe and the Logic of Defection

by publius

Happy V-F Day -- reform has finally escaped from Finance, with a Republican vote to boot.  And I am quite grateful to Sen. Snowe for doing the right thing in the face of almost certain reprisals.  It's not an easy thing to do, but she did it.

Ironically enough, though, Snowe's vote is a great example of why it's often necessary to enforce party unity through sanctions like committee stripping.  Without it, it would be very difficult to maintain party unity on virtually any high-profile polarized issue.  (See also Benen and Yglesias, who wrote on this yesterday).

Basically, it's a big collective action problem.  On closely divided issues, the Dems would be better off collectively if they all stuck together.  However, any individual Senator would be privately better off by defecting from the group.  Indeed, there's a premium on being the first one to defect.

Snowe illustrates these benefits of defection.  First, by voting "Aye," she's gained enormous influence over the final bill.  She's also amassed an infinite number of chits with the other party (and has attained rights to any Baucus grandchildren). 

Second, she's a media darling.  Because of her vote, she's going to be hailed as a true stateswoman -- someone willing to put partisanship aside for the greater good.  In short, her "yes" vote gets her a lot of power and favorable media coverage. 

Someone like Lindsey Graham could also attain a lot of power and influence if he were actually willing to meet Dems halfway on climate change.  Hell, he could probably draft the legislation if he promised to vote yes. 

But GOP penalties add costs to these otherwise immense benefits.  These sanctions alter the calculus of people like Snowe and Graham.  That's why, I predict, that Graham will ultimately fold on climate change.  He's less structurally free from GOP pressure than Snowe.  Unlike her, he's in a Southern Red state where a primary challenge is a real threat -- and defecting to the Democratic side isn't an option.

All of these same structural dynamics apply to Democratic defections as well.  It's not always that Democrats are chickens, or even that they're more ideologically diverse, it's also that defection (on the Senate side) is all benefits and no costs.  Defection gets you power -- which is probably why Bayh wanted to start his little club earlier this year.

Of course, the objection here is that I'm being hypocritical.  On the one hand, I support party discipline.  But at the same time, I criticize GOP moderates for cowardice.  And to be fair, there's probably something to that critique.  I'll have to think about it.

In my defense, though, I'm not saying that Democrats should maintain perfect party unity.  I just want to raise the costs of defection to ensure that people defect for good reasons. 

If Ben Nelson thinks in his heart of hearts that this is a bad bill that will cost him his seat, then he shouldn't be punished for defecting.  But, we still need the threat of punishment to ensure he's not defecting strictly for the self-serving desire to see himself on Meet the Press, or to squeeze concessions through bad faith blackmail (i.e., Liebermaning).

The Public Option Dialectic

by publius

I'm not sure what the public option's current odds are.  But regardless of the final result, the public option debate itself has been a beneficial and clarifying one for progressives.

Generally speaking, political and intellectual coalitions often benefit from schisms that clarify and strengthen the coalition's ultimate positions.  Sometimes, of course, these divisions can be debilitating.  But to the extent the coalition shares the same broad goals and values, debate is a good thing.

With that in mind, the most interesting "conversation" going on right now in progressive online circles is between two camps I'll broadly call the "wonks" and the "activists."  I recognize that these camps can't be neatly separated, but hopefully most of you have a rough idea of what I'm talking about.

Notably, this divide has nothing to do with "liberal" versus "centrist."  Frankly, I don't think that conservative Democrats have given us much to think about lately.  The "policies" of people like Nelson and Lincoln have more to do with demographic realities and corporate money than intellectual disagreements.

The wonk and activist camps, by contrast, are both pretty liberal.  But they differ in important ways.  Both camps seek to persuade, but the wonks are more focused on explaining, while the activists are more committed to inspiring action. 

The camps also differ in their relative willingness to accept the political realities of the status quo (or in their definition of what those realities actually are).  For this reason, the wonks tend to be more comfortable with legislative compromise, while the activists are (relatively speaking) more resistant.

The public option debate has illustrated some of these intra-progressive divides.  Interestingly, though, I think the debate has strengthened both camps' ultimate positions—and furthered the progressive cause more generally.

In my opinion, the wonks have been less passionate about the public option because they feel that (1) it's not the key to the bill; and (2) it's not politically possible to pass.  The wonks agree that the public option is good policy, but disagree that it's worth going to the mat for.  For what it's worth, this has been my position too.

This worldview, however, rests on certain assumptions about what is politically possible.  The wonks are only right if they are correct about where the boundaries of "the possible" fall.  If they're wrong—if reality is more fluid than they're acknowledging—then they have to rethink some basic positions.

And here is where the collision with the activists has paid off.  The activists have challenged the wonks' notion of where the boundaries of the possible are.  In short, they've blurred these lines in a positive way. 

In doing so, they've helped convinced skeptics like me that I've been far too stingy in imagining what is in fact politically possible.  Indeed, the public option would have been dead a long time ago but for the committed efforts of the activists.  Frankly, I thought it was dead, which is a testament to my lack of vision on this issue.

The wonks, however, have also helped the activists.  Again, this is all personal observation, but my sense is that the wonks have helped clarify the larger stakes.  Reform really does have many important features beyond the public option.  It would therefore be tragic to scuttle the bill solely because it lacked a public option.

But the intra-progressive debate is helping generate the best of all possible worlds.  It's far more likely now that a public option of some kind will be fought for and included.  At the same time, it's more likely that activist liberals will support a bill that ultimately includes a modified public option plan such as an "opt-out," rather than refusing to budge an inch.

Obviously, I'm simplifying things, possibly to a fatal degree.  But that said, I think that the wonk/activist debate has had a beneficial impact on all parties involved—and (hopefully) on the final policy.  Even better, it's the type of ongoing conversation that can be applied in other areas as well.

Stopping the Herd on Coverage Reform

by publius

Brendan Nyhan argues that Obama's health care speech didn't have much effect on public opinion.  He notes that disapproval has now returned to previous levels after a brief bump. 

Numbers-wise, he's correct.  But I think focusing on the numbers alone misses something very important about the speech -- namely, it helped stop the "herd mentality" panic that could have killed reform.

To back up, one of my ongoing frustrations with politics in the digital age is how quickly herd mentality can overcome policy.  The 24-hour cable networks and online media amplify irrelevant stories that shouldn't last more than a day.  As a result, these stories often cascade quickly into much bigger deals. 

Unfortunately, Democratic legislators are particularly susceptible to herd mentality.  GOP legislators and the noise machine, by contrast, are quite good at making the herd start running (see, e.g., Iraq, Schiavo, Glenn Beck).

The way these "cascades of fear" work supports, I think, the Peter Daou "Triangle" theory.  If the Glenn Becks and Malkins of the world can persuade just a couple of gullible MSM reporters to amplify the story (e.g., Halperin), then a few Democrats get scared.  The scared Dems, in turn, then say something unhelpful out of fear, and more MSM reporters jump in.  And on she goes, cascading out of control.

The recent ACORN "controversy" shows both how quickly these idiotic stories can spread simply by pounding the drum hysterically -- and how quickly terrified Democrats will run for the hills.  In response to a complete non-story trumpeted by Glenn Beck (and Jon Stewart), Dems fell over themselves to defund ACORN.

Fear, it seems, is their default setting.  They're like a giant herd of fraidy-cats -- easily scared, and quick to flight.  Say what you will about Rove, but he understood at a deeper level how fleeting these daily outrages are if you simply ignore them.  Dems can't seem to learn the art of ignoring these people.

Turning back to health care, my fear then was that herd mentality would take over during the heat of the town hall protests -- which (while real) were excessively amplified through strategic media promotion.  If a few centrist Dems got spooked and ran, it wouldn't take long for a critical mass to run for the hills.

Fortunately, though, the "flee to the hills" moment has passed -- thanks in part to Obama's speech.  The congressional GOP went for the first-round knockout, but they don't have much left -- certainly no policy to speak of.   The speech, then, helped end the vulnerable period.  Approval may be stable now, but stable is good. 

In short, the GOP threw the best they got, and the Dems -- finally -- held the line.  And with the Baucus bill getting a good CBO score, health coverage reform is looking very good.  Maybe, just maybe, we'll have to get rid of the Dems' fraidy-cat label after all.