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Archive for September, 2009

Public Plan Vote Aftermath: Mostly Dead or Slightly Alive?

On Tuesday the Senate Finance Commitee, the last of the five panels in Congress to consider a health overhaul bill and generally recognized as a proxy to the Senate’s final vote tally, struck down two amendments to include a government health insurance plan (commonly referred to as the “public option”) in its sweeping health bill. 

Although the other four commitee measures currently include a public plan, many commentators identified yesterday’s vote as the key marker of both the fate of a public option and the Democrats’ ability to coalesce around the current proposals to successfully pass a bill.

Philip Klein of the American Spectator predicts a tough road ahead for liberals:

Thus, the whole health care fight may hinge on whether the White House will be able to get liberal lawmakers to drop their demands for a government plan. This is problematic. The reason is that one of the most obvious ways to win over liberals would be to increase the level of subsidies to individuals seeking to purchase health insurance, yet doing so would substantially drive up the cost of legislation. President Obama has boxed himself into a corner on that front by declaring that his plan would cost $900 billion, and by vowing to veto any bill that adds to the deficit.

But some offer a glimmer of hope within the gloom and doom. Katherine Mangu-Ward of Reason tips her hat to The Princess Bride, quoting Miracle Max to illustrate the state of a public option: “It just so happens that your friend here is only MOSTLY dead. There’s a big difference between mostly dead and all dead. Mostly dead is slightly alive.”

The New Republic’s Jonathan Cohn reacts, “This is not the slightest bit surprising. But it’s still frustrating.”  But he sides with the “slightly alive” interpretation of the public plan’s prognosis:

The odds are against enactment, particularly for the Rockefeller amendment. But Schumer’s, which is more or less identical to HELP’s, may be able to get fifty votes. Then it becomes a question of whether moderate Democrats, even those voting against the public option, would break ranks and uphold a filibuster over it–and how much Democratic Party leaders, including the one sitting in the Oval Office, care about the one or two Republican votes they stand to lose over this issue.

The Washington Post’s Ezra Klein thinks moderates compromised too much by voting no on the public option amendment and will need to make other concessions before the bill is finished:

Now the moderate bloc will need to extract something else in an eleventh-hour bargain to show that they applied their centrist convictions to the legislation. Baucus makes it sound as though he’s attempting to ensure a deal. But in reality, he’s just depriving the centrists of the ability to make their deal. That means they’ll have to make a different one, and the bill will get worse twice rather than once.

Heritage’s Matt Spalding responds to Democrat Jay Rockefeller’s assertion that Adam Smith would have supported a public option:

But does Rockefeller seriously think Adam Smith’s principles are consistent with the government-run healthcare?  This view depends on the patently false idea that competition would be enhanced by the addition of a new player – the government – in the insurance market. The problem is that government, by definition, isn’t just another economic player, and will always tend to want to control markets for its political purposes. That threatens economic as well as political liberty. (Hmmm . . . isn’t this why we favor free markets in the first place?)

Hot Air’s Ed Morrissey thinks it’s that the amendments were potentially “offered as distraction” from the possibility that a public plan option will be reinserted in conference:

This won’t be the last attempt to attach a public option to the bill, but the rest will probably have as much success.  It’s far more likely to get added into a conference report when both chambers pass their versions of ObamaCare, and it’s just as likely that Rockefeller and Chuck Schumer offered this as a distraction from that effort.

Wonk Room’s Igor Volsky doesn’t disagree, outlining how a public option could reemerge during conference of the House and Senate bills:

Once in conference, negotiators will have to reconcile the Senate bill with its far more progressive House conterpart (which will include some kind of public plan). Should Reid and Pelosi stack the committee with public option advocates like Rockefeller, Schumer, or Schakowsky, the option will live another day — no Democrat would vote against a health care package simply because it includes a public option that attracts some 10 million enrollees. Conversely, if likely conferees Baucus and Conrad feel ‘constrained’ to vote with Republicans, the option will likely die.

At left-leaning supersite Huffington Post, Mike Lux says the public option remains “very much alive,” and continues, “getting 10 votes on this is promising for those of us who believe a public option is essential.”  Another post by main politics reporter Ryan Grim announcing the outcome of the vote has garnered a whopping 18,000 comments.

And of course, there’s tons of chatter on Twitter.

Wednesday, September 30th, 2009

Public Option Day

Ah, public option day.  That’s what bloggers have deemed today as Democrats Jay Rockefeller and Chuck Schumer plan to make their case for public option during the Senate Finance Committee markup.   By the way — you can watch the action (or lack thereof) on cspan.org, which live-streams video from the Capital.

Reuter’s David Alexander previews: “Senate Finance Committee deliberations have mirrored the broader debate over health care in at least one critical aspect: The tough choices have been saved for later. Later starts now. Tuesday brings votes on the public option — the outcome of which won’t change the final legislation (the Republicans plus the centrists almost certainly have enough votes on the committee to keep a robust public plan out).”

In preparation for the event, Media Matters posted an unexpected defense of the liberal goal: “More Americans believe in UFO’s than oppose a public option.”  That’s definitely a new one…

James Capretta of the New Atlantis takes issue with another new defense of the public option, based on Congressional Budget Office scores of the cost-saving potential of the provision: “The confusion of government price setting with efficiency really goes to the heart of the entire debate. Yes, Medicare does dictate payment rates to hospitals, physicians, and others. On paper, that can, for a time, look cheaper. But hardly anyone believes that is really the solution to our long-term cost problem.”

Perhaps also timed for today’s events, The New Republic published online Jonathan Cohn’s article, “Going Dutch,” on the Dutch health care system, a universal insurance scheme that is comprised of only private companies.  Cohn argues that the Dutch experience indicates a public option is not a “must-have,” but in the absence of more serious regulation, there would remain some differences between the Dutch and U.S. health care systems:

One additional issue, not to be overlooked, is the question of price. Dutch consumers don’t have to worry about paying a lot of money for their health care, even if they are sick, in part because the insurance has very little cost-sharing–and in part because the government continues to play a strong role in setting prices, although it’s been gradually relaxing them. But there’s nothing in the current bills approaching the type of price controls that the Netherlands has.

 And Heritage’s Conn Carroll expands his opposition beyond the public option:

It is unclear at this point if centrist Democrats in Congress are really ready to force this many people out of their existing private care and into government-run health care. But even if the public option is not included, there are still plenty of regressive job killing taxes and invasions of privacy in the Baucus plan that makes it terrible public policy.

Tuesday, September 29th, 2009

The ‘Other Than Max Baucus’ Edition

On the surface, it seems to be a quiet day in the health policy realm. Just as the Senate Finance Committee paused its markup of the health overhaul bill today in observance of the Jewish holiday Yom Kippur, many major news outlets appear focussed on international developments. But it still seems worthwhile to take a look around the blogpshere to see what the health policy types have found to talk about — besides Max Baucus.

Via Andrew Sullivan’s “The View From Your Sickbed” comes an intruiging submission on the month of October at companies around the nation:

I looked to a coworker sitting next to me and said, if this can’t convince people of the need for the public option I don’t know what will. October is the month of Open Enrollment for many corporations across the country.  My company cannot be the only one that is passing through the rising costs to its employees next year. I wonder what the impact of these meetings will be in the coming months.

There’s a new website from The Center for Health Design that focuses on the idea of “evidence-based design,” or the idea that the way a health center is built can have an effect on health outcomes. (Via the Healthcare Economist)

E-medicine points to 10 i-Phone applications that track disease outbreaks, including a “Swine Flu Tracker”. It also has the capacity to track “outbreaks near me” as well as disasters world wide. (Via Insure Blog.)

Health Access blog posts a video of protestors in Oakland who staged a performance at a Whole Foods after CEO John Mackey penned an op-ed on health reform ran in the Wall Street Journal.  The protestors reappropriated 80’s tune “Hey Mickey!” to diss the Whole Foods exec’s views.

Physician Dani Filc guest blogs on the Washington Post’s Short Stack to discuss his book that takes a close look at health care in Israel.

A collection of Catholic clergy has been commenting on the health overhaul push.  Here’s a post from Iowa Bishop R. Walker Nickless.

Andrew Van Dam of AHCJ’S Covering Health provides links to some breakdowns of to the new American Community Survey from the Census Bureau.

Bernard Carroll of Health Care Renewal posts a parody of “Waltzing Matilda” (the “unofficial national anthem of Australia”) to illustrate recent controversy over revelations that some medical journal articles were ghost-written:

Ghosting Matilda, ghosting Matilda,
Who’ll come a-ghosting Matilda with me?
Novartis might sign me up, also AstraZeneca ─
Soon I’ll be famous like that guy at Emory.

Up came an editor, looking for the telltale signs.
Ghost writing’s hard to cover up, you see.
And he found them in the documents: metadata do not lie ─
Bagman just sold his name and passed these off on me.

Monday, September 28th, 2009

Finance Members Keep Baucus’ Frown Upside-down

The Finance Committee remains in the spotlight today as bloggers continue digging into the health reform bill and the politics plaguing its members.

Keith Hennessey, a former Republican staffer, offers a thorough overview of Baucus’ bill, summarizing it, he says, “in a matter similar to what I might have done for my colleagues while working in the White House.” His post is complete with sub-heads such as “substantively meaningless hat-tips for the left and right” and “overlooked political flashpoints.” Hennessey concludes, “I apologize for losing some of my usual objectivity, but I was unable to control myself.  I think this legislation would be disastrous.”

The Washington Post’s Ezra Klein interviews moderate Democratic Senator Kent Conrad, and offers a glimpse of the politics behind his proposal to create nonprofit health insurance cooperatives:

I was also struck when I read the chairman’s mark that the co-op option seemed shackled. It couldn’t sell to large employers. It couldn’t set payment rates. The co-ops are not public. But they were being prevented from competing with insurers on a level playing field. It seemed like private insurers were being protected from competition.

I think there are things I would like to see that would make certain co-ops be given the full ability to compete that others are.

So you would like to see those restrictions lifted.

I would.

Why are they there?

Because that came out of the Group of Six discussions.

Wonk Room’s Igor Volksy previews the committee’s upcoming Tuesday debate of a public option.  While the Senate HELP Committee and all three House committees have included public plans in their reform bills, the landscape on Finance is much thornier, with Conrad pushing for nonprofit co-ops and Republican Olympia Snowe offering a “trigger” mechanism.  In a separate post, Volksy describes Democrats Jay Rockefeller and Chuck Schumer’s conference call with reporters yesterday describing their strategy to insert a public plan into the bill. Volsky even provides a sound clip of the Senators’ tough talk, which is punctuated with a prediction about the final outcome of the public plan battle.

Offering a nice illustration of the interplay at work between Conrad, Rockefeller and Schumer, Politico’s Carrie Budoff Brown described a scene at the Capitol yesterday: “And just as Rockefeller launched a takedown of Sen. Kent Conrad’s co-op proposal — mentioning the senator by name — Conrad himself walked into the otherwise empty room, his hand tucked into his pants pocket and a sly grin on his face. ”

John Thune of the Health Freedom blog says that the committee is “voting down amendments mostly along party lines.”

And Heritage’s Robert Book singles out the way the bill calculates subsidies for purchasing insurance and argues it “would have another, even stranger effect on hiring. Because the subsidy amount is based on family income and family size, not the wages that the employer pays, employers would naturally prefer to hire workers from higher-income families with fewer children. For example, hiring a single parent could incur a substantially higher tax penalty than hiring a worker with a working spouse or parent(s), or a worker who is single and childless.”

Friday, September 25th, 2009

Back and Forth They Go Again, and Again, and Again…

It’s been a week of acrimony as the Senate Finance Committee began marking up its long-awaited bill.  You don’t have to search far to find a classic exchange like this one, as reported today Associated Press reported today:

Republican Sen. Jon Kyl of Arizona indignantly raised his voice after committee Chairman Max Baucus of Montana urged him to hurry up and finish a point. An outwardly irritated Kyl told Baucus he was not delaying, but was instead trying to make an extremely important point about flaws in the legislation. Baucus shot back that while Kyl’s point might be important, he also was holding up the panel’s work. Kyl was speaking in favor of a GOP amendment that could have prevented the government from implementing the bill — even if it’s passed and signed into law.

And plenty more is circulating online as stakeholders and commentators push their agendas across multiple digital platforms. 

There are dueling YouTube videos:

Via Insure Blog, there’s Dick Morris with a five-minute commentary on “Obamacare:” 
 

Not to be outdone, the White House released a four-minute video explaining the “Obama Plan” (via the Health Access Weblog):


 

Or you can watch a tongue-in-cheek PSA (from Funny or Die) featuring several celebrities pleading to “protect insurance company profits.” 

Then there’s David Catron on the American Spectator’s blog lambasting Obama for “[proving] that a politician can be even less trustworthy than Bill Clinton” because of his “reversals” on health reform issues.

Or you could read The Washington Post’s Ezra Klein, who points to a new NBC/WSJ poll that found 21% of Americans approve of Republicans’ handling of health care overhaul and argues that the GOP has undertaken a “sort of kamikaze mission:”

But if it does work, it won’t leave them in a better position to govern. What Republicans — and, when they’re out of power, Democrats — are doing is essentially discrediting the political process. Piece by piece, bill by bill. The argument, essentially, is that politicians are untrustworthy and Congress is corrupt and interest groups are trying to do horrible things to you and problems are not being solved.

Cato’s Michael Cannon presents two sides on whether an individual mandate is a tax, highlighting a debate between himself and MIT economist Jonathan Gruber.  Cannon writes: “It might be inconsistent, however, to suggest that when price controls force you to pay more for something than the market would charge, that is a tax, but when a mandate forces you to purchase something you don’t want at all, that’s not a tax.”   The debate stems from President Obama’s comments that an individual mandate is not a tax during interviews last week.

And Karl Kronebush on the Health Affairs Blog argues that the current crop of Democratic reform bills actually feature “Republican roots.”  According to Kronebush, current GOP opposition “reveals how far today’s Republicans have moved from the policy ideas of the previous generation of Republican officials.”

Thursday, September 24th, 2009

The Tweetest Things

From this morning’s Politico front page: “Revenge is Tweet” — Kenneth Vogel reports on a new study that found almost twice as many Republican lawmakers have Twitter accounts compared to Democrats. Politico takes a closer look at some of the leading “tweeters”: Sen. John McCain, R-Ariz., Sen. Chuck Grassley, R-Iowa and Sen. Jim DeMint, R-S.C.  

Validating Politico’s premise, a look at some tweets from yesterday’s Finance Committee markup: Republican John Cornyn tweeted “That was then, this is now, ” linking to a CBS News piece on “Five Health Care Promises Obama Won’t Keep”.  And Grassley weighed in this morning (during the Finance markup) in his famous disjointed abbreviations: “If u hv time watch Finance Comm during amending process of Health Care. Affects 1/6th economy and evry American. Big lift for Congress.”  The only Democrat who weighed in, Sen. Bob Menedez, just posted pictures of the markup scene.

Quick Hits:

  • CBO chief Douglas Elmendorf doles out the agency’s judgment on the original subsidies to purchase health insurance in the Finance bill. 
  • The Kaiser Family Foundation has a new ’subsidy calculator’ that estimates premiums and government assistance under the various reform proposals. (KHN is a project of the Foundation.)
  • FiveThirtyEight.com’s Nate Silver examines poll numbers and asks if being part of the “Gang of Six” contributes to declining approval ratings. 
  • James Capretta on the New Atlantis proclaims the “Death of Medicare Reform.”
  • The New Republic’s Jonathan Chait wonders if Republicans are committing “a long-term policy blunder” in their opposition to health reform.
  • CyberspacesTV won 2nd place in a video contest from the Galen Institute, which promotes free-market ideas in health policy, that looks at cancer survival rates and wait times in Canada and the United Kingdom.

Wednesday, September 23rd, 2009

Markup Preview: What Would Harry Do?

The Senate Finance Committee has begun its markup of the America’s Healthy Future Act,  a hefty task considering the more than 500 amendments submitted by members so far.  And as the Wall Street Journal’s Jacob Goldstein predicts, “from the looks of things, whatever bill finally emerges from the Senate Finance Committee may not bear much resemblance to what Baucus proposed last week.” 

It could be a long day, what with all those opening statemetns.  The New York Times’ Prescriptions blog advises on which of the 23 committee members making ” full-throated use of their allotted five minutes” to watch.  Prescriptions also has a brief interview with Chairman Max Baucus, D-Mont.

Time’s Karen Tumulty thinks the committee’s markup is “likely to be more revealing then most.”  According to Tumulty, “On public display will be all of the ideological and philosophical fault lines that have for decades stymied every President and every Congress that have tried to do something about this issue.”  And perhaps a glimpse of the internal debates plauging the “gang of six.” In a later post, she notes “Chairman Max Baucus just warned the committee that he is prepared to work all night.” She promises that she and her Swampland colleagues will be closely following the action.

 The New Republic’s Jonathan Cohn corralled a number of experts to rate health overhaul bills on a “Truman scale,” (a nod to the first President to attempt health care reform).  Cohn says he limited his crop of :WWHD (What Would Harry Do) experts to “people who buy into the basic premise of what Obama and his allies are trying to do.”  Among the judges: David Cutler, Jacob Hacker and Sara Rosenbaum.  The Baucus plan, rated below, scored 6.1

 Conservatives aren’t pleased with the bill: James Capretta on Critical Condition argues that while Democrats hope to “create a sense of irresistible political momentum that will feed on itself,” three provisions in the Finance Committee bill “are on very shaky ground politically” — an individual mandate, reimbursement cuts to insurers for Medicare Advantage plans and a tax on high-cost health insurance.  And Conn Carroll of the Heritage Foundation says the bill imposes new taxes and breaks Obama’s pledge not to raise taxes on the middle class.

It’s also probably a good day to check out Finance Committee members’ twitter feeds: @senatorbunning @JohnCornyn @johnensign @chuckgrassley @orrinhatch @johnkerry @senatormenendez @senbillnelson  @chuckschumer @stabenow

Tuesday, September 22nd, 2009

Finance Committee Markup Going on Now

The full Senate Finance Committee is marking up its health overhaul bill now. You can stream it live on http://www.cspan.org.

Tuesday, September 22nd, 2009

Obama To America: Can You Hear Me Now?

Obama blanketed television networks Sunday to ratchet up support for his health overhaul push.  But with mediocre reaction to his media blitz and the Senate Finance Committee set to begin markup tomorrow, could the President’s role in closing the deal be diminishing?

PolitiFact.com reports the President touched on “virtually the same talking points” for each of the five shows on which he made taped appearances. These fact-checkers rated two of Obama’s claims, but only one of them really counts:

He said the average family pays $900 in extra costs every year to pay for the uninsured. There’s some dispute about that number, and we rated it Half True.

His claim that his beloved White Sox could still make the playoffs. Mathematically, that’s at least possible and he earned a True.

Heritage’s Conn Carroll counts speeches and public opinion and concludes: “Mr. President, if you didn’t break through the first 32 times, maybe it is not the message that is the problem. Maybe the problem is that the American people do understand what your health care plan will mean for them, and they just don’t like it.”

Hot Air’s Ed Morrissey thinks Obama is a “mile wide and an inch deep,” and that he isn’t offering any new arguments during his media appearances:

This runs the real risk of exposing Obama as an empty suit.  Most politicians find ways to win debates by adjusting or creating new, compelling arguments for their position.  Obama hasn’t had a new idea in months, really ever since Inauguration Day.  He’s playing a game of gotcha with the broadcasters in demanding all of this time, and showing up with nothing at all original.

The Plum Line’s Greg Sargent thinks the President is “skirting” the debate on the role of government: “It’s hard to avoid the conclusion that he’s still not quite engaging the eternal American debate about government, and could be making a stronger, more affirmative case that government has often been a force for good in people’s lives.”

Ezra Klein counters The Atlantic’s Chris Good, who questioned whether Obama’s TV blitz could “save health reform,” asking, “from what?”

Obama’s weekend blitz wasn’t meant to save health-care reform. It was meant to push it those final 10 yards. He could fail in that effort, but that’s where we sit: incredibly, incredibly close to the finish line. Closer, by far, than we have ever been before.

You can view transcripts and video clips of the interviews at the respective networks: CBS, NBC, ABC, Univision and CNN.

Monday, September 21st, 2009

Baucus Plan: The Gift That Keeps On Giving (At Least To The Bloggers)

Even as we head into the weekend, bloggers are still finding plenty to pick over in the Baucus plan.

For starters, on the State Policy Blog, David Strom raises a provocative issue about the fate of American health care being determined by six people in Congress. His thought: policy debate, especially for “hot button issues” such as health reform, should begin with a commitment to free market principles.

“Over the past few weeks the course of the policy debate in Washington has been plotted by a Senator from Montana seeking to entice a few other Senators from Iowa and Maine. As much as the public has been focused on the storm and strife at the town hall meetings taking place around the country, the fate of the “reform” was being decided in large measure by the negotiations of a “gang of six” Senators. In the end Baucus was unable to secure any Republican support even from the likes of Olympia Snowe, but the bill that was just revealed was largely the product of negotiations between a few members of the Senate Finance committee. Is this how our fates should be determined, by the idiosyncrasies of a few senior members of the Senate?”

Some rambunctious cyber chatter was triggered by tough talk in the opinion columns.

Jonathan Chait chose to take Charles Krauthammer to task in The Treatment for accusing President Obama of misleading the public on health reform. Chait got stirred up by Krauthammer’s column, “Does He Lie,” which appeared in today’s Washington Post:

“[Krauthammer] wants to cast doubt upon Obama’s plan by picking up any available weapon.” He also argues that some of Obama’s proposed cuts in waste, fraud and abuse would “be a total no-brainer consensus issue if the world weren’t filled with Charles Krauthammers trying to kill it off for partisan reasons.”

Meanwhile, Shirley Wang on the the Wall Street Journal’s health blog weighed in on the individual mandate by quoting David Rivkin and Lee Casey, both Justice Department attorneys during two Republican Administrations: “A requirement that all Americans buy insurance is common to all the major health overhaul bills – but it’s not constitutional.”

And on this day three since Baucus officially unveiled his Finance Committee bill, the need to get to the bottom of some of the bill’s moving parts was rampant around the blogosphere.

Rory Cooper, on The Heritage Foundation’s Foundry simply called the bill “The Max Tax,” charging that the measure is “more of the same,” especially with the inclusion of “a public plan disguised as a co-op.” As part of the argument to “hit the reset button,” Cooper also notes the bill’s “seven fatal flaws.”

And Ezra Klein sought to explore both some of the policies and the politics now in play. He offered wide-ranging interviews with Sen. Jay Rockefeller, D- W.Va., and Sen. Ron Wyden, D-Ore., neither of whom have embraced the Baucus bill, as a way to provide this sort of inventory. He also offered his insights about why both senators much matter so much to the White House and the Democratic leadership:

“Rockefeller and Wyden, in other words, aren’t being courted just for their votes. Rather, their votes are needed to ensure other votes for the bill. There’s a certain subset of liberal Democrats who look to Rockefeller for cues, and a certain subset of Democrats who admired Wyden’s Healthy Americans Act and take his opinion very seriously. As neither of them was included in the Gang of Six process, neither is inclined to give the bill a free pass. And Baucus and the administration are now working pretty hard to win their support, which means that there’s a real chance their concerns will be fixed, and their priorities included.”

Friday, September 18th, 2009