Archive for category: Health Policy

When Max Baucus delayed finalizing the Senate Finance Committee’s healthcare bill last August in the name of getting bipartisan support from Olympia Snowe or Chuck Grassley, Republicans and teabaggers spent the month talking about death panels. Allowing the delay in the false hope of bipartisan support was, among a string of poor decisions, probably the worst decision the Obama Administration made.

So why is Obama planning on a bipartisan healthcare summit for later this month?

The move has gotten a lot of people trying to puzzle WTF (?!?!?) Obama intends to achieve. Here are Greg Sargent’s thoughts:

A lot to chew on here. Republicans will spin this as proof that Obama has shelved reform, wants to start again, and will only pursue a bill that GOPers sign onto. Liberals will be dismayed at the apparent suggestion that Obama seems to actually be saying that such common ground could form the basis of anything approaching real reform — and that he’s leaving open the possiblity of doing “compromise” legislation with Republicans.

It’s possible, though, that this is all about laying the groundwork for pursuing a Dem-only reconciliation solution later. Such an effort, should it happen, will inevitably be portrayed as yet another partisan back-room effort to ram reform through. So perhaps the White House hopes a very public gesture of bipartisanship and transparency now will undercut those attacks and allow Dems to argue that they had no choice but to move forward alone.

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Update: Maybe the game plan is to give skittish Congressional Dems cover to support a Dem-only reconciliation (i.e., “back-room” and “partisan”) approach later.

Update: Nancy Pelosi, who’s been much more realistic throughout this process than the White House or the Senate about the likelihood of bipartisan cooperation ever happening, endorses this in a statement:

“I welcome the President’s call for a bipartisan, bicameral discussion in front of the American people on fundamental health insurance reform that will make quality care affordable for all Americans and American businesses. The House and the Senate will continue to work between now and February 25th to find a common approach between the House and the Senate on these solutions.

“The House-passed health insurance reform legislation included a number of Republican amendments – added as the bill worked its way through three committees. In the last Congress, we worked with President Bush in a bipartisan way to pass initial economic recovery legislation, a bill to deal with the financial crisis and historic energy legislation that increased our nation’s fuel efficiency standards for the first time in more than 30 years. We remain hopeful that the Republican leadership will work in a bipartisan fashion on the great challenges the American people face.”

Either this is a coordinated cave, or it’s a coordinated effort to lay the groundwork for a Dem-only solution later.

I think Greg’s thoughts are probably the most likely explanation. Still, I’ve got a nagging suspicion this is an attempt to recuperate the Cadillac tax–or some sort of end to the health insurance tax break.

As Ezra lays out, the Cadillac tax–insofar as it chips away at the tax break for employer-sponsored health care–is a policy that both George Bush and John McCain supported, in even more radical forms.

The solutions the GOP has on its Web site are not solutions at all, because Republicans don’t want to be in the position of offering an alternative bill. But when Republicans are feeling bolder — as they were in Bush’s 2007 State of the Union, or John McCain’s plan — they generally take aim at one of the worst distortions in the health-care market: The tax break for employer-sponsored insurance. Bush capped it. McCain repealed it altogether. Democrats usually reject, and attack, both approaches.Not this year, though. Senate Democrats initially attempted to cap the exclusion, which is what Bush proposed in 2007. There was no Republican support for the move, and Democrats backed off from the proposal. They quickly replaced it, however, with the excise tax, which does virtually the same thing. The excise tax only applies to employer-sponsored insurance above a certain price point, and it essentially erases the preferential tax treatment for every dollar above its threshold.

And of course, the excise tax is probably the biggest sticking point between the House and the Senate.

I can’t help but suspect that Senate claims that they can’t figure out how to pass a fix through reconciliation are, instead, lame excuses mobilized to protect the excise tax that they (and presumably, the Administration, still want). And Pelosi’s response that there simply are not the votes for the healthcare bill in the House is her equally intransigent refusal to pass something that won’t do what it was promised to do and will piss off the unions Democrats need to get elected in November. In other words, the Senate and the House appear to have hit an impasse over the excise tax, one that prevents the most obvious solution to passing health insurance reform.

And all of this has happened at a time when the Administration’s Cadillac tax booster, Jonathan Gruber, has gotten very quiet. At least some of Gruber’s claims (notably that workers would get a raise, but also, probably, that companies would save money, and therefore, possibly even the claims about revenue and cost controls) haven’t survived closer scrutiny. So how can the Administration still argue for a Cadillac tax if it won’t do what they promised it would?

Mind you, even if this speculation is right, I still don’t know WTF (!?!?!?) Obama would intend to accomplish with this summit. Is he just planning on bringing John McCain into a room and saying, “John, I have a great idea! Let’s borrow that idea that you proposed last year that turned out to be such a dud electorally?” Or is he going to try to get the Republicans to commit to the excise tax, since they would welcome an opportunity to screw the unions, regardless of how stupid the underlying policy was?

I do know this. For some time, the White House’s efforts to pass the excise tax barely hid their underlying objective to eliminate tax breaks for employer provided health insurance. So while this is entirely speculative, I do wonder whether Obama is trying to use Republicans to either justify a switch to a different plan, eliminating the tax break, or at the very least, to build pressure for the policy among Democrats.

From the start, let me say I support sidecar reconciliation going forward–the passage of the Senate health care bill, tied to the simultaneous passage through reconciliation of some fairly substantive changes (eliminating most of the excise tax, inclusion of a public option, possibly with Medicare buy-in, elimination of the antitrust exemption, and drug reimportation) that would not only make the Senate bill palatable and much cheaper, but would constitute real reform.

With that out the way, let me just throw a few things out there on which I will base my further discussion.

Rahm’s trial balloon on a stripped down bill

On Wednesday, Rahm proposed a stripped down bill.

RAHM PITCHES STRIP-DOWN, reports Inside Health Policy’s Wilkerson, Coughlin, Pecquet and Lotven: “White House Chief of Staff Rahm Emanuel called House leaders Wednesday to sell a smaller health care reform bill with insurance market reforms and a Medicaid expansion, Democratic and Republican insiders tell Inside CMS. House Speaker Nancy Pelosi (D-CA) so far is not buying it, they say, and one Democratic policy analyst considers Emanuel’s pitch a trial balloon. … Pelosi was scheduled to meet with Blue Dog and progressive coalition members Wednesday (Jan. 20) afternoon and a full Democratic caucus meeting is scheduled for Thursday morning. ‘I would agree she’s not buying it,’ a Democratic policy analyst said, referring to Emanuel’s idea of a smaller bill. ‘We’re hearing that she’s trying to figure it out.’ … In the Senate, Budget Committee Chair Kent Conrad (D-ND) said that while he had opposed using the fast-track process for the health reform legislation ‘writ large,’ he believes reconciliation could be used as a way to make fixes if the House passes the Senate bill.”

Greg Sargent makes it clear that this doesn’t necessarily mean Rahm (or the White House) prefers such an option–he’s just looking into what is possible at this point.

After talking to insiders my sense is that the procedural issues at play are extremely complex, and White House advisers and Dem leaders really want to understand the full range of options before them, as limited as they appear to be, before leaning hard one way or another.

I’m also told that reports that Rahm Emanuel is pushing for a scaled-down bill are false. Rahm is actively involved in sounding out Congressional leaders to determine what’s possible, but hasn’t stated a preference, for the above reasons. This may not amount to a satisfactory explanation for many, but this, as best as I can determine, is what’s happening.

So for the moment, let’s just leave this out there as a trial balloon.

Within hours of Brown’s win, Max Baucus said reconciliation would be part of the solution

After saying for months that reconciliation wouldn’t work, Baucus has spun on a dime and said that reconciliation will be part of the solution.

“Reconciliation, I’m guessing at this point, will be part of the solution,” said Senate Finance Committee Chairman Max Baucus (D-Mont.).

Clearly, this is not the same as having one of the true obstructionists–Lieberman, Nelson, or Landrieu say this–in the Senate. But we don’t need them to pass a bill through reconciliation; we need the still significant majority we have in the Senate.

Note, Baucus’ quick concession that reconciliation would be needed to pass this bill ought to make all those who, before, said, “Reconciliation won’t work, you have to capitulate to Joe Lieberman” think twice about whether their earlier read of the situation was correct, and what Baucus’ quick concession says about the good faith of the hold-outs on the Senate side. If reconciliation is now possible, the only reason it wasn’t possible in the past was the political situation, largely created by the large number of people empowering Lieberman and Ben Nelson by saying “reconciliation won’t work, you have to capitulate to Joe Lieberman.” And that ought to make the same people hesitate before they cry again, “Progressives have to pass the Senate bill as is, without working to fix the bill through reconciliation.”

Votes (particularly through reconciliation) are easier to get in the Senate than the House right now

Here’s a detail many on the left seem to be missing when they call on progressives to just suck it up and pass the Senate bill: the numbers.

Check out the roll call for the passage of the House bill last year. The bill passed 220-215. But that 220 includes Bart Stupak and Joseph Cao, both of whom have said they would not be happy with Nelson’s anti-abortion language–they want Stupak’s own, harsher language (and Stupak says he’s got 10 more Democrats like him). And it also includes Robert Wexler, who has since retired.

In other words, just based on losing those three votes, you don’t have enough votes in the House to just “suck it up” and pass the Senate bill.

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Lanny Davis has wasted no time trying to spin MA voters’ rejection of Obama’s focus on corporations rather than people into an attack on progressives. He starts by ignoring that aspect of the liberal complaint and (as the Administration is doing) blaming all of this on Coakley.

Liberal Democrats might attempt to spin the shocking victory of Republican Scott Brown in Massachusetts by claiming that the loss was a result of a poor campaign by Martha Coakley. Would that it were so.

Then, incredibly, Lanny says something I agree with:

This was a defeat not of the messenger, but of the message—and the sooner progressive Democrats face up to that fact, the better.It’s the substance, stupid!

But from there, Lanny makes several mistakes of analysis you’d expect from someone with a history of selling out real Democratic values.

Lanny says backroom deals sunk Coakley; but then says this is the fault of progressives (Ben Nelson? Hello!!!)

Lanny turns on the insurance industry’s second-biggest champion after President Lieberman, President Nelson, and disowns his smarmy deals.

Then there were the two “deals” that put congressional Democrats in a worse light than the infamous “Bridge to Nowhere”—as impossible as that might have seemed—as an emblem of the special interest politics Barack Obama ran against. We Democrats had to explain to Massachusetts voters and other Americans why non-Nebraskans and nonunion members have to pay more taxes, while Nebraskans and union members get to pay less. Those two deals seem to have alienated most people across the political spectrum.

It is true that voters soured significantly on Coakley after Ben Nelson got his deal. Of course, one big reason for that is that, after MA primary voters picked Coakley partly for her very strong stance defending choice, her election would simply have empowered people like Nelson to gut choice. But somehow Lanny ignores both the demands Nelson made on choice as well as Nelson’s and Lieberman’s insistence that insurance companies not face any competition from Medicare or a public option.

Lanny says a deal that had not yet happened–the excise tax deal–and actually explicitly benefited more than unions was the cause of Coakley’s loss because it painted unions as exceptionalists?

And then there’s Lanny’s attempt to throw the unions–who have been negotiating a deal on the excise tax–in with Ben Nelson. Thing is, that deal, unlike Nelson’s deal, hasn’t happened yet! Not to mention the fact that the deal proposed between the unions and the Administration would have helped all middle class families by exempting dental and vision coverage, making sure older and sicker workers weren’t unfairly punished, and raising the amount at which the excise tax kicked in.

Lanny celebrates getting everyone health insurance–but not care

Then, Lanny makes the mistake that many supporters of the insurance friendly bill make: confusing health insurance with health care.

The Democrats have a simple message on health care that has still not really gotten through: If our bill passes, you never have to worry about getting, or losing, health insurance for the rest of your life.

Thing is, people from Massachusetts know better, because they’ve already got precisely the kind of system that ensures everyone has health insurance even if 21% of those paying lots of money to insurance companies can’t actually afford to use that insurance. MA voters know better than many that having health insurance doesn’t necessarily mean you can get health care.

Lanny mysteriously talks about an Obama plan that didn’t include EITHER a public option OR a mandate–yet there was no time when that was true (and polling still says the PO was the only thing that made this palatable)

Finally, Lanny invents a mythical Barack Obama who at one point supported neither a mandate nor a public option.

The purists on the left of the Democratic Party who demanded the “public option” or no bill at all apparently forgot that candidate Obama’s health-care proposal did not include a public option; nor did it include a government mandate for everyone to either purchase insurance or pay a significant tax approximating the cost of that insurance—the “pay or play provision” in both the Senate and House bills.

Candidate Obama supported a public option with no mandate. President Obama supported a mandate and paid lip service to a public option. But at no point did “his plan” lack both a public option and a mandate. Though I guess Lanny is distinguishing here between the mandate in Obama’s bill (up to 2% of income) and the mandate–like the one in MA’s program!–that is tied to the cost of insurance premiums. I’m not sure why that distinction would be relevant to MA residents though.

And of course, polling still shows that having a mandate is more popular when people can choose not to give their money (20% of which can go to profit and marketing) to private insurance companies.

Now, I don’t blame Lanny for staying up all night to try to spin Coakley’s loss as a call to move to the center. The more logical lesson to draw from it is that Americans are sick of corporatists like Lanny Davis (he rather amusingly adopted the label “liberal” for himself in this piece, though I suspect WSJ may have just stripped the “Neo-” that came before it). Which is precisely what Lanny’s extensive parsing tries to deny.