Love it, hate it or maybe just sick of hearing about it, this bill will pass today. Obama essentially staked his entire presidency on health care reform this past week, so there’s no shock this thing is going to become a law. Next stop Obama’s desk, and then on to SCOTUS?
Should have taken that $100 bet at Thanksgiving …
Looks like it. Here’s a solid analysis from Jonathan Bernstein guest-blogging at the Daily Dish.
From the link:
Item: Ten House Dems who voted against the bill the first time around are telling the AP (via Jonathan Chait) that they might vote yes this time around. Chait is right about the incentives here as far as public statements are concerned. I’d put it this way: there’s an easily understandable story of going from no, to maybe, to yes…but it makes no sense at all to go from no, to maybe, to no.
I should emphasize here that it is very, very rare for the majority to lose a high-stakes vote on final passage on the House floor. You just don’t bring a bill to the floor unless you know you’re going to win. I can’t imagine a reason that Nancy Pelosi and the White House would bring this to the floor knowing that they were going to lose, for some sort of spin advantage. They either know that they have the votes, or it’s the biggest bluff in who knows how long. Keep watching: does the president really announce the schedule tomorrow that was leaked today? Does the Speaker really keep to that schedule, or do leaks start appearing about pushing it back a few days? I don’t think so, however. I think they have the votes.
It sure seems like it. This is akin to the credit industry going draconian in advance of increased regulation only to prod DC into pushing the date of all that regulation up quite a bit.
Of course, the health insurance industry stands to gain a lot if health care reform with mandatory insurance and no public option is in place. Maybe the move of drastically raising individual health insurance premiums is a ploy to force something close to the current set of bills in Congress through and stifle any new debate on how to fund reform and cover the uninsured. I’m guessing the industry sees its future as something of a complete spin of the roulette wheel with a lot of possible outcomes and just a few that are favorable to its interests. Crazy moves with this bad of PR strike of a desperate attempt to influence that spin.
From the first link:
AP reports that insurance companies in at least four states are raising their premiums for individual insurance policies (those that people have to buy themselves, because they don’t get coverage from an employer) by 15% or more. To give you a sense of what we are talking about if these rates go into effect, a family of four in Maine (which is a relatively poor state) can expect to pay $1,876 a month–about $22,500 a year–for health insurance, starting in July.
And this is just the beginning of what we can expect to see pretty much everywhere:
Premiums are far more volatile for individual policies than for those bought by employers and other large groups, which have bargaining clout and a sizable pool of people among which to spread risk. As more people have lost jobs, many who are healthy have decided to go without health insurance or get a bare-bones, high-deductible policy, reducing the amount of premiums insurers receive.
Cato’s John Samples thinks so. To me the Tea Party movement feels much more nativist/conservative than it does libertarian. For some reason, for years now people seem to love to call themselves libertarian. Several years ago a friend of mine who is a pretty doctrinaire liberal — he once said at a gathering he felt he didn’t pay enough taxes (!!?!!) — considered himself a libertarian. So I think there’s a lot of confusion out there on just what makes one a libertarian. Particularly when separating Republicans from libertarians.
From everything I’ve read, the Tea Partiers talk a pretty good fiscal conservative line, but a great number also talk a very strong social conservative line as well. If that doesn’t define your basic small-tent GOPer, nothing does. And setting the Tea Party rhetoric aside there is quite the disconnect between what the movement purports to believe in, and what it seems to actually support.
The easiest example is government spending on health care: Tea Partiers are vehemently against health care reform, or what has been framed as “Obamacare,” but at the same time want Medicare — quite the “socialist” medical care program by Tea Party definition — left alone. Either you are against government involvement with health care or not. The existing hypocrisy sounds more like Baby Boomer-aged Tea Partiers who are just fine with government subsidized health care as long as they are the recipients of all that government largess.
Needless to say, Samples sees a purity in the Tea Party movement that just isn’t there.
Here’s Samples’ take from the link way up there in the first graf:
It is not Republican; it is not even conservative. It has no interest in debating the merits of No Child Left Behind, abstinence-only sex education or George W. Bush’s rationale for going to Iraq. Replacing a “spend and borrow” Democrat with a “spend and borrow” Republican is not the goal of the Tea Party movement.
This movement is simply saying: “We are fine without you, Washington. Now for the love of God, go attend a reception somewhere, and stop making health care and entrepreneurship more expensive than they already are.”
Machiavelli once said a republic stays healthy by returning to its first principles from time to time. The Tea Party movement is trying to get our nation back to its first principles to prevent our decline. For their trouble, they have been denounced by many in the media and the Obama administration.
But they will continue to fight. They still believe in the promise of America. That faith may spread as Election Day approaches in the second and perhaps final year of what is supposed to be the Age of Obama.
What began as angry town meetings and grew into a political movement may end as a third political party in 2012. Maybe then Washington will finally listen.
Didn’t catch the SOTU (late bit of work), but sounds like a solid, and sober, speech.
Sully and his underbloggers at the Daily Dish put together — as always — a great roundup of opinion from around the blogosphere.
Here’s one from the left:
538:
Obama is making a lot of arguments tonight that the WH should have been making for months now.
One from the neutral sidelines:
Most remarkable: Secretary of Defense Bob Gates applauded Obama’s words [on DADT]. And Americans saw him applauding, thanks to the director’s cut-aways. Which means that, for the most part, the military is on notice: the policy is ending, and ending very soon. Said Obama: “This year, I will work with Congress and our military to finally repeal the law that denies gay Americans the right to serve the country they love because of who they are. Because it’s the right thing to do.” One note: the chairman of the Joint Chiefs of Staff and the chiefs didn’t applauded. But that’s the protocol. They don’t applaud by tradition.
And one from the right:
I have watched many, many State of the Union speeches. This is the most partisan, least presidential of them all. His rhetoric, his glances at the GOP side, and his almost mocking tone at times — not to mention his over-the-top dissembling about the deficit, among other things — will not, I predict, improve his position with the public. Nor should it.
Update 1/28/10 — Here’s a link to the full text of the speech.
(Update — bold emphasis added because it seems it takes a sledgehammer to make a fiscal point right now.)
I’m sure there’s a lot of both going on behind the Democratic Party scenes. There’s a lot of both going on publicly along with plenty of finger pointing, blaming and dissembling among the left blogosphere. The simple fact is health care reform in its current Congressional form has not, and almost certainly will not, pass because of Democratic ham-fisted policy making. But the GOP is behaving shamefully and shamelessly as an opposition party with no alternative ideas and zero compromise on a very necessary evil.
Yes, health care reform is a very necessary evil. Honest libertarians can be excused from the argument, but fiscal conservatives are lying to themselves or everyone else when they deny health care reform must occur at some point in the near future. Health care as a percentage of income is becoming unmanageable and health insurance costs are killing businesses both large and small.
Without reform health care in the United States will continue to bankrupt people at higher and higher levels of income, and cause untold suffering and early death for the uninsured. And at a point in time looming very soon it will simply bankrupt the entire nation. I’m no fan of too much government influence anywhere, but after looking over the arguments (and sorting through the hyperventilated crap from both the left and the right) I am convinced reform at the federal level is now a necessary evil. Any fiscal conservative who looks at the numbers honestly will come to the same conclusion.
Some funny (interesting, not hah hah) facts about the situation on the ground now that Brown has taken over Ted Kennedy’s Senate seat: the oft pointed out irony that Kennedy’s old seat will end his signature legislation; the fact the Massachusetts electorate already has a state run plan along the lines of federal health care reform so scuttling the current reform efforts causes them no significant pain; that the new GOP senator voted for the Massachusetts plan, but has declared opposition to essentially the same plan on the federal level; the heaviest opposition to health care reform is found amongst voters who either are already in, or soon will be, the massive federal subsidy of Medicare or Medicaid and basically fear their benefits being harmed in some way. Talk about wanting to selfishly eat your children. No health care reform equals a potentially very bleak future for everyone middle aged on down.
Not any great surprise to anyone who’s been watching the lead-up to this special election. Scott Brown takes over Ted Kennedy’s Massachusetts Senate seat and deals quite a blow to any flexibility the Democrats have with health care reform. By all accounts, Brown’s opponent, Martha Coakley, ran a positively dreadful campaign and even had the embarrassment of leaking a memo today while voting was still in progress with a weak sauce list of excuses why she failed to keep the Senate at 60 Democratic seats.
Another pretty weak move was to hold a press conference — also while voting was still in progress — claiming “voting irregularities” to try and get a fingernail-hold on any hope of stretching the final verdict out a bit further.
All in all the Defeatocrats got just what they deserve in this election. And given the political reality of Massachusetts Brown will likely be perfunctorily voted out of office in 2012.
From the link on the excuse list (second link), Marc Ambinder’s excellent fisking of the memo (Ambinder’s comments in bold):
Claims about Coakley’s Scant Campaigning and Miscues Were exaggerated
— Because of the failure of national Democrats to support Coakley, she was forced to devote significant time to fundraising in December. She also released a variety of plans in December and had a public event nearly every day.
[Coakley had 19 events after the primary through Sunday; Scott Brown had 66.]
And the form of the reform is taking shape. It’s a major issue in the U.S. and an insanely hot button topic in politics, made even more in modern politics after the defeat of Hillarycare in Clinton’s first term. I’ve stayed largely on the sidelines on heath care reform and have mostly sought as unbiased as possible ideas and opinions. I did think it was a strategic mistake for the GOP to effectively take itself out of the serious sausage-making of the bills and just throwing random poop at the walls to see what resonated as a decent attack line.
I’ve finally read one piece that makes me feel quite a bit better about the legislation that will hit Obama’s desk sometime in the near future, “Testing, Testing” by Atul Gawande in the December 14, 2009, issue of the New Yorker. Gawande is a M.D. and a regular New Yorker contributor and has written on the challenges of receiving and practicing medical care in the current climate. This article is measured, doesn’t really take any of the partisan sides other than to acknowledge something has to be done to change the status quo, and lays out a vision where the current legislation could start an ongoing process of continued improvement in heath care and its administration.
Whichever side of the reform debate you stand on, this article should be a priority read for a glimpse into what could be with the current legislation. It’s not going appease anyone who opposes the bill on either extreme, but it should make anyone who reads the article feel a bit better about the future of medicine in the United States.
In the article Gawande lays out parallels between the agriculture reform efforts of the twentieth century and the current effort at health care reform.
From the link, here’s the concluding graf:
Getting our medical communities, town by town, to improve care and control costs isn’t a task that we’ve asked government to take on before. But we have no choice. At this point, we can’t afford any illusions: the system won’t fix itself, and there’s no piece of legislation that will have all the answers, either. The task will require dedicated and talented people in government agencies and in communities who recognize that the country’s future depends on their sidestepping the ideological battles, encouraging local change, and following the results. But if we’re willing to accept an arduous, messy, and continuous process we can come to grips with a problem even of this immensity. We’ve done it before.
And that thing is an unbiased as possible (I know, I know — that’s probably a pipe dream) breakdown on the business costs for the various plans. Health care reform is a huge and necessarily complicated topic taking into account entire large swaths of the current U.S. economy, and corporate health care benefits are front and center since most Americans currently get health insurance through their employer. So much so that health insurance actually stifles job mobility because some people are afraid to lose their current health benefits and the grandfathered in “preexisting conditions.”
Now the complex topic of heath care reform has become so much more so with the House and Senate muddying the waters through the sausage-making that is legislation. Right now the major national business organizations oppose both the House and the Senate health bills, but how do the bills actually break down and affect businesses of different sizes? I’ve read in many places where small business owners are looking forward to health care reform and see the issue along the lines of, “well, reform couldn’t be any worse than what we have right now.”
With all that in mind in mind, what I’d like to see is a clear auditing of both the House and Senate health care reform bills and how much each costs businesses of different size — size in number of employees and in annual revenue. I have a feeling health care reform would actually be an improvement for businesses that most anyone would consider small, but I don’t know and I’m too lazy (and probably incapable) of doing the policy wonkery number crunching to figure this out. Anyone out there game?
Final tally of 220-215 for the Affordable Health Care for America Act. Now the show is off to the Senate.
And if the GOP is honestly against it I really wonder why the party took itself out of the sausage-making from day one.
From the link:
U.S. House leaders today plan to unveil legislation that would create a government-run health- insurance program, require employers to offer coverage to their workers and impose a new tax on the wealthiest Americans.
The legislation comes after three months of negotiations by House Democrats and represents the most sweeping changes to the nation’s health-care system since the 1965 creation of the federal Medicare program for the elderly. The measure would overhaul the insurance market, encourage greater use of preventive medicine and help Americans buy coverage.
“We think we’ll have the votes,” said California Representative George Miller, who runs the House Education and Labor Committee, after meeting with fellow Democrats yesterday. Formal debate is planned for next week, Miller said.
Lawmakers said House Speaker Nancy Pelosi agreed to a compromise over one of the most divisive issues facing Congress — the establishment of the government insurance program to compete with private insurers try to and drive down costs.
… it’d make sense to do it right.
For better or worse, health care reform is going to pass. The votes are essentially there — and really have been all along. The angry Baby Boomers at town hall meetings over the summer were but a minor distraction in the big play on this issue.
With the knowledge something is going pass regarding health care, I’ve thought it makes the most sense to radically overhaul a much less than perfect system as things currently stand in the U.S., and I agree with Cato’s Michael Tanner that it’s “time to start over.”
The problem is there is no political will, or most likely any political ability, to remake health care. There might have been a shot for that during middle few years of the Bush 43 administration when the GOP held all the reins of power, but we know how successful Republicans were in promoted the stated goals of the party — small government (epic fail), personal responsibility (epic fail) and fiscal conservatism (nuclear fail.)
As appealing as radical health care reform may be for anyone who takes a few hours to drill down into the issue, it’s just not going to happen. The GOP has taken itself out of the process by choice and great forces in the form of the American Medical Association, the pharmaceutical industry and the health insurance industry are lined up t ensure nothing earth-shattering, at least for their fiefdoms, comes to pass.
From the link:
And our current tax laws penalize people who don’t receive insurance through their work, meaning that if you lose your job, you lose your insurance.
The bills now before Congress don’t fix these problems. They simply pile on new mandates, regulations, taxes and subsidies. No amount of tinkering, or budgetary sleight of hand, can make them better.
It’s time for Congress to scrap its current flawed government-centered approach and start over with a focus on creating a consumer-oriented free market in health care.
After all, isn’t it better to get it done right than to just get it done?
… and officially becomes bipartisan with Olympia Snowe’s GOP vote in the Senate Finance Committee.
From the link:
The Senate Finance Committee voted on Tuesday to approve legislation that would reshape the American health care system and provide subsidies to help millions of people buy insurance, as Senator Olympia J. Snowe, Republican of Maine, joined all 13 Democrats on the panel in support of the landmark bill.
The vote was 14 to 9, with all of the other Republicans opposed.
Democrats, including President Obama, had courted Ms. Snowe’s vote, hoping that she would break with theRepublican Party leadership and provide at least a veneer of bipartisanship to the bill, which Mr. Obama has declared his top domestic priority. Ms. Snowe was a main author of the bill but she had never committed to voting for it.
Everyone needs to take this “discussion” down several notches. At least one grumpy old person now really has something to yell about.
From the first link:
California authorities say a clash between opponents and supporters of health care reform ended with one man biting off another man’s finger.
Ventura County Sheriff‘s Capt. Frank O’Hanlon says about 100 people demonstrating in favor of health care reforms rallied Wednesday night on a street corner. One protester walked across the street to confront about 25 counter-demonstrators.
O’Hanlon says the man got into an argument and fist fight, during which he bit off the left pinky of a 65-year-old man who opposed health care reform.
A hospital spokeswoman says the man lost half the finger, but doctors reattached it and he was sent home the same night.
Seems to be the favored option right now. I’m still fairly certain something substantial will pass within two years, and right now it looks as soon as four months.
The health care debate has devolved into posturing on one side and avoidance on the other, but two facts remain: in order to keep the nation solvent, health care — particularly the presently government funded pieces — must be rethought; and by sheer force of will the Democrats can muster the votes to press some type of reform through within the next two years.
The words and actions of the GOP, not the protesters but the elected officials, have gone beyond marginalizing the party to essentially removing the Republican opinion from the sausage-making for whatever bill does hit the floor and pass. Remarks like Senator Chuck Grassley’sreiterating Sarah Palin’s outrageous scare tactics give Democrats the ability to ignore someone who should be a strong advocate for the GOP at the committee level.
The end result is some version of health care reform is very likely to pass before the midterm election in 2010, and that reform bill will contain very few, or more likely zero, Republican fingerprints.
It’s great for an opposition party to oppose the policies from across the aisle. It’s a lot better for the opposition party to challenge and improve those policies.
From the first link:
Given hardening Republican opposition to Congressional health care proposals, Democrats now say they see little chance of the minority’s cooperation in approving any overhaul, and are increasingly focused on drawing support for a final plan from within their own ranks.
Top Democrats said Tuesday that their go-it-alone view was being shaped by what they saw as Republicans’ purposely strident tone against health care legislation during this month’s Congressional recess, as well as remarks by leading Republicans that current proposals were flawed beyond repair.
I think I’ve finally gotten a handle on the crazy, old white people spouting nonsense at the Congressional recess town hall meetings. Throughout their lives the Baby Boomer generation have been a bunch of whiny me-firsters at every stage of development and a lot of this “protesting” is just more of the same. Possibly the last real line of BS the rest of us have to deal with from this bunch. And if you think about it, most of the media figures pushing for this brand of activism are, you guessed it, Baby Boomers.
Maybe it’s too bad the death panels are nothing more than fiction. Looks like the old and cranky are not planning on going quietly into the good night.
Make no mistake about it, the Obama White House will accomplish some measure of health care reform. There are simply too many of the major players sitting at the table and willing to deal for nothing to make it to Congress. The big two health care questions are: how much service and how will the bill get paid?
Looks like in the early go the paying-for-it part is already a little sticky.
From the link:
Sen. Max Baucus, chairman of the Senate Finance Committee, has said repeatedly that health reform would be paid for with a combination of spending cuts and tax increases.
Baucus and others have made some progress through savings in Medicare, Medicaid and other programs.
On Wednesday, for instance, Vice President Biden said hospitals would reduce costs by $155 billion over 10 years. But nothing is final until that deal between the White House and business — and a similar one reached with drugmakers last month — is written into legislation.
And on the revenue side of the equation, there is still no apparent consensus.
This much is certain: Lawmakers must find ways to raise a lot of money.
Here’s two stories on Main Street and the health care debate.
First up is entrepreneurship and opposition to public plan health care:
The so-called “public option,” backed by President Obama and many Congressional Democrats, would set up a government-backed health insurance plan that would compete with private plans. Though details remain fuzzy, the proposal already has critics on both sides of the aisle decrying “government-run health care.” The American Medical Association and private insurers oppose any public option.
Also resisting is the National Federation of Independent Businesses, the nation’s largest and most influential small business group. A fierce critic of the Clinton administration’s health care reform efforts a decade ago, the NFIB now considers universal health care to be one of its top legislative priorities. But it wants to see that care and coverage come from the private sector.
“Our members, who are entrepreneurs and risk takers, really do fundamentally at the end of the day want lower costs and competition, but they are going to be very skeptical of something that has a lot of government involvement,” says Michelle Dimarob, the federation’s legislative policy manager. The NFIB is instead pushing for a reform plan that would provide universal coverage and cut costs by increasing competition among private insurers, likely through the creation of government-mediated insurance pools.
And batting second is a NYT blog post underscoring a range of small biz attitudes toward the debate:
Oddly, the public plan is also one of the battle lines for organizations that claim to represent small business. The National Federation of Independent Business and the U.S. Chamber of Commerce staunchly oppose a public plan; the Small Business Majority appears (pdf) to support it; while the National Small Business Association insists that if there is a public plan, it should be constrained by the same rules as private insurance.
The legislators who will decide the issue are the handful of moderates in both parties. The conventional wisdom is that the House will pass the public plan, and its fate will rest in the hands of maybe 10 senators. But it may prove a battle in the House, too: The conservative Democratic Blue Dog Coalition supports only a drastically curtailed (pdf) government option, and its 49 members could tip the balance. So the question is, how will these moderates vote in the end?
… is coming. Let’s hope it’s a decent system.
And that’s an honest hope. Even as a libertarian I recognize the system as it is has broken. Insurance has become a roadblock to the process of medicine, and to a reasonable allocation of money through the process. I’m no fan of regulation, but some order in this house might just be in order.
From the link:
Former Senator Tom Daschle pledged on Thursday to work with lawmakers of both parties in a grass roots, ideology-free campaign to revamp the nation’s struggling health care system.
“We will be guided by evidence and effectiveness, not by ideology,” Mr. Daschle told the Senate Committee on Health, Education, Labor and Pensions after saying that he wanted “to work with each of you” on ways to improve health care for all Americans.
“When it comes to health care, we really are in it together,” Mr. Daschle said, adding that to do nothing — or too little — about the spiraling costs of health care, the growing legions of the uninsured and substandard medical treatment in some areas is simply unacceptable.
David Kirkpatrick 