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Forget Bipartisanship. Democrats Need To Do What is Right on Health-Care Reform.
Senate Majority Leader Harry Reid (D-Nev.) on Tuesday strongly urged Finance Chairman Max Baucus (D-Mont.) to drop a proposal to tax health benefits and stop chasing Republican votes on a massive health care reform bill.
Reid, whose leadership is considered crucial if President Barack Obama is to deliver on his promise of enacting health care reform this year, offered the directive to Baucus through an intermediary after consulting with Senate Democratic leaders during Tuesday morning’s regularly scheduled leadership meeting. Baucus met with Finance ranking member Chuck Grassley (R-Iowa) on Tuesday afternoon to relay the information.
According to Democratic sources, Reid told Baucus that taxing health benefits and failing to include a strong government-run insurance option of some sort in his bill would cost 10 to 15 Democratic votes; Reid told Baucus that several in the Conference had serious concerns and that it wasn’t worth securing the support of Grassley and at best a few additional Republicans.
This is certainly reassuring — not least because it’s coming from Reid, with whom many of the more liberal Democrats have had their problems in the past.
The whole 60-vote thing is being overblown, of course, as it’s unlikely that the Democrats will be able to secure unanimity on something as controversial as health-care reform, but I do think it’s time for the Democrats to stop trying to win over Republican support. The fact is, Republicans aren’t serious about reform, or at least not in the sort of reform that the American people actually need, which is a robust public system, and it boggles the mind why a majority party with 60 votes should need to kowtow before an obstructionist, ideologically rigid minority party that has no interest in real change. Republicans wouldn’t do it, so why should Democrats?
Let the Republicans come out against a public option that would fill the gap to ensure coverage for all Americans. Let them run on that.
It’s time for the Democrats, long past time, to do what needs to be done. Republicans aren’t into bipartisanship — and Democrats should just move on.
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Reid’s push is also reassuring given the ongoing questions surrounding the White House’s commitment to a public option. Rahm Emanuel opened the door the other day to the possibility of dropping it, whereupon Obama may or may not have pushed back the other way.
Open Left’s Adam Green thinks that Emanuel “just went with his natural gut instinct — to be weak, and cave to Republicans,” and that the subsequent comment from Obama was “a great step.”
Actually, though, Emanuel’s comment may have been not so much instinctual as planned, allowing Obama to look like the good guy to pro-reform liberals and progresives. Slate‘s John Dickerson notes that Obama’s rebuttal was vague enough to allow him to go either way on the public option depending on the circumstances down the road. It’s an Obama-Emanuel good-cop-bad-cop routine that we’ve seen before.
While I think that Obama himself would prefer a robust public option, I’m just not sure how committed he is to it, given his pragmatism and apparent lack of unwavering principle. And that’s where the worry comes in: Will Obama compromise to the point where, in order to achieve reform, a reform bill is actually more Republican than Democratic?
Or is this just Obama being Obama, pushing compromise and conciliation (just as he does diplomacy with Iran), only to take a harder line (as he likely will with Iran) when bipartisan outreach fails, turning the other side’s refusal to negotiate or compromise in good faith against it, using that refusal to secure even greater popular support? Here’s hoping.
(Cross-posted from The Reaction.)
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39 Responses to “Forget Bipartisanship. Democrats Need To Do What is Right on Health-Care Reform.”
Flail, Mikey, flail.
Yes. Well, if you don't have all the Democrats and you don't have any Republicans, you don't pass a bill.
Ryan – not following you math, unless you think every bill that passes can only pass if filibuster-proof. Now, it may be true for the health care bill, but not all.
AR – Actually, I do think that, excepting the stuff that can't be filibustered. Before you bring up anything that passed with fewer than 3/5 supporting it, I would point out that a 55-45 vote means that at least 5 senators opposed didn't care about stopping the bill enough to filibuster it. Either they support the bill but don't want to appear so, or they prefer its passage to being labeled an obstructionist, or maybe they're just scrubs. The fact of the matter is that the filibuster is the only card the GOP has left (and now it's even more weakened since they need 1 net defector) and it will be used at every opportunity. In a way, Franken getting seated is a problem for the Senate Dems as they now have Magic Sixty without actually having 60 reliable votes. Maybe Harry needs to ask Ben Nelson how he would feel about caucusing with the GOP for a while. *shrug*
Jay Cost at RCP did some cool math based on Keith Krehbiel's “Pivotal Politics” on Senate legislation and how the filibuster affects how bills are passed…in particular, this health bill.
http://www.realclearpolitics.com/horseraceblog/…
http://www.realclearpolitics.com/horseraceblog/…
“In a way, Franken getting seated is a problem for the Senate Dems as they now have Magic Sixty without actually having 60 reliable votes.”
I'd point out that even discounting Franken's gasket-blowing vulgar in-the-media liberalism, he is probably a reliable (normally lock-step partisan as well as ordinary to leftish) reliable Democratic vote. It's not naive but safe at this time to assume Franken won't be the “defector” in the less-than-sixty-Dem-votes scenarios to envision for the future.
I doubt the “public option” Trojan-Horse-with-klaxons-and-neon-warning-signs will be removed from any compromise legislation, but that more attention will be paid to the more obvious defect in this initiative, the (almost criminal as well as cynical, not merely deceptive) negligence paid to raising taxes to pay for it.
DLS – yes, Franken is probably going to be reliable but some of the conservative Dems are not, and going from 59 to 60 means that “Republicans are blocking us” becomes much less effective since they are no longer capable of doing so by themselves.
“Franken is probably going to be reliable but some of the conservative Dems are not”
Yes — especially in cases where the public is obviously starting to be concerned about spending and fiscal displine or the lack thereof by the Dems, or with not only the cost of any federal health care initiative but the lack to date of progress in planning to pay for it. (The most cynical view is that some Dems are not merely clueless but at their worst, planning to pass the initiatives without any taxes and just keep on adding to the debt, or making it “mandatory” spending without enacting any accompanying new taxes at the same time, the classic deferral, and waiting until after the next elections to levy the needed taxes.)
“going from 59 to 60 means that 'Republicans are blocking us' becomes much less effective “
That never has been the case this year, the GOP isn't anywhere as obstructionist as some would dishonestly portray them, and the Dems have been running rampant and deliberately overrunning any opposition, no matter how reasonable. What concerns me is how many exploitable Dem voters may believe the “blocking” dishonesty nevertheless, in addition to those in and outside the USA who utter it.
The fact is, Republicans aren’t serious about reform, or at least not in the sort of reform that the American people actually need
Exactly. They had 8 long years to address a growing problem, but instead sold out to big insurance and helped preserve the status quo. The health insurance industry wants expensive, inefficient healthcare that maximizes their profits, and they can afford to pump a lot of money into campaigns, lobbying, and bogus PR, but the Dems need to show some backbone here. Trying to appease those who either don't understand or don't care what is in the best interest of the American people ain't the way.
“.. the public is obviously starting to be concerned about spending and fiscal [discipline]…”
I think you're giving the public too much credit. What they want is wonderful government services for free. Being concerned about fiscal discipline is really nice, but just watch what happens when you suggest solutions. (See California for further examples of this. They want the expensive programs, they don't want to pay for them, hence a massive budget gap.)
Nicey nice doesn't do shit with hogs with their snouts in the trough. I learned when I was five, that you had to club the big hogs to get the little hogs food.
Rent a huge sound system with super speakers. Rent a flat bed truck. Wake up every politician that ever even dreamed of voting against single payer every morning with the sound system cranked to 10 and someone with a really irritating voice screaming, “single payer you shithead.”
Nobody drafted these shits. They are whores. Fucking up relations with the neighbors would be much more effective. They move somewhere else, you can buy a cellphone with satellite tracking for less than $100 and since the GSA just proved that getting explosives into Federal buildings is a snap, (I already knew that, the last three times I was in a VA hospital I had a .38 special in an ankle holster) tape it to their vehicle. You can, also, stake out their boyfriend or girlfriends residence with remote video cameras for blackmail.
Fuck nice.
joe – I like my idea better. Boot them from the caucus, kick them off the committees and cut off the DSCC cash. Of course, that may come back to bite you in the ass later. Such is politics.
Ryan — I'm aware of the problem. When you rob for relatively fewer Peters to pay (buy the votes of) so many more Pauls, while we Peters largely complain about the problems, the government(s) will still have the many support of the Pauls. Plus it will have the double-edged support (with demands) of favored interest groups. Yes, as California has long illustrated. I grew up there and am very familiar with that state's “Massachusetts Lite” politics. Yuck. (Dems in Sacramento are really where the power is.)
But much of the public is concerned, in general And as for specific examples in adddition: What do you think is one reason that the fools in Washington trying their incremental moves toward federal health care are avoiding the cost issue, which itself makes them look bad except to the worst something-for-nothing fools? (They want “single-payer” [sic; WHO'S THE PAYER?] health care without paying — for Free [tm].)
“The health insurance industry wants expensive, inefficient healthcare that maximizes their profits”
Again you miss the reality. They're trying at this point to _preserve_ profits for as long as they can retain at least some; they are in a position of an ice climber sliding down ice (toward government control and even direct provision of health care ultimately, by Washington) and using their ice pick or ax not to arrest but merely to brake or retard their descent. They're losing any fight for the status quo, and that's why they're willing to be co-opted by Team Obama and the Congre-Dems and be part of the result for now (a newer, shiner fascist example than Hillary Clinton's in 1993 with the HMO “alliances”) rather than be excluded sooner rather than later. They can buy time by reminding people they are in the private sector, which normally knows better than any government that regulates it from outside, and which is normally superior to an all-public alternative.
The entire health care idiocy we see now is rushed as well as disingenuous and it would have been better for Obama to have simply folded Medicaid into Medicare as a “stimulus” measure (obviating much or all need for additional work and legislation currently begun, as well as finding at least initially some of the money to pay for it) while relieving states of a burden they've longed to discard. Talk about quick good PR as opposed to this health care nonsense we now are getting, which only appeals to the exploitable!
I DO NOT WANT INSURANCE…..I WANT HEALTHCARE!
It is stupid Not to have National Healthcare. We have the most expensive healthcare on the planet and by no means is it the best. Not even close.
Supply and Demand has caused these inhumane costs and NOTHING will bring them down except nationalization of all medical services within the United States. Sorry, but the situation is extreme and extreme measures must be taken.
Cost Cost Cost! NO insurance plan, scheme, coverage, partial coverage, customary coverage, or, imaginary coverage will address the ORIGINAL and ONGOING PROBLEM OF rising Costs. Insurance companies simply raise their premiums to protect their business while fewer and fewer people can afford to pay those premiums.
More and more people in America need healthcare and less and less people can afford it. In light of the fact that every modern nation on earth, (and some not-so-modern), can provide national healthcare for their people, healthcare in the United States is the Laughing Stock of the planet.
Ask not what yer country can do for you…Ask….hey FU!
HOW ABOUT ADDRESSING THE REAL HEALTHCARE PROBLEM PLEASE! I'M FRIGGEN PAYING YOUR SALARY!
Perhaps I don't know all the details, but I suggested a stop-gap solution that would help people get insured and buy time to put together something that actually works.
I know people complain about government running things, but when you look at it objectively, there's plenty of evidence that allowing industry to run things only brings ruin and wrong.
The problem with getting something done is that everyone wants to fix things all at once. I'm willing to see several measures that provide small amounts of improvement. We don't need to do something perfect, but we do need to do something. Provide an automatic sunset and if it doesn't work, it'll go away with a whimper.
Y'all just need to take a deep breath. We're better off than you imagine, and there's no problem so bad we can't make it worse.
Over the weekend my cousin was telling me about his recent European travels, during which he got sick. Scotland has this amazing national health service, and he was treated free (well, at the expense of the Scots). Problem was, the treatment involved just sending him home with antibiotics. After those hadn't helped for two weeks, they said okay, it must be viral, we'll run some tests. Problem was, though they could take blood samples or whatever, they had to send them to Glasgow for analysis, which would take a week or two.
By that time, he'd gotten back home and took his issue to an American doctor. They ran tests and emailed him the results the next day. He had mono. He's better now.
I'm deeply concerned about our health care system. It's too expensive, leaves too many people uncovered, and it needs reform. On the other hand, trading it for a system that controls costs by rationing and compromising in every direction, that takes a month to diagnose mono, strikes me as a horrible mistake.
DLS “When you rob for relatively fewer Peters to pay (buy the votes of) so many more Pauls, while we Peters largely complain about the problems, the government(s) will still have the many support of the Pauls.”
I've always admired in a weird way, your way of framing the public good as “buying votes.” Pandering to the majority, buddy, is called democracy. Who will pay for health care? For crying out loud, we all will, just as we do now. Man, you can't scare us by saying we're going to have to pay for what we're already paying too much for. Besides, those of us who don't have employer-paid, tax exempt, government subsidized insurance have been footing part of the bill for the tiny (about 25%) of those who do have that. Plus those on government plans like military and veterans, medicare and medicaid, Indian health service and all government employees. I don't mind at all if everyone gets to pay into what I've personally subsidized for nearly my entire life.
There are lots of difficult decisions of when and how we need to limit the most expensive procedures. The decision to save 31% (12% excess overhead, 19% overpayment of doctors) is low hanging fruit. We're stupid if we don't take it, and sorry Blue Cross. You suck anyway.
Wait 31 times longer for test results and save 31%? Gee, who wouldn't jump at that deal?
care to document that, J?
I did. I can connect you with my cousin if you'd like.
Dr J: What would have happened to your cousin if he couldn't afford the tests in the US?
Here in San Francisco where he lives, we've got several free clinics, none of which will send anything to Glasgow for tests. If he could swing 72 bucks he can actually get quick diagnosis and treatment from the private market. If he's destitute, he can sign up for Medicaid.
Dr_J, I can't debate this again. Waiting lines and delays are just as much a feature of insurance mediated health care as government insurance mediated health care. Insurance companies do not generally allow quick tests. They have hoops to jump through to see if they can deny it. Most citizens of countries with single payer systems are happier with their systems than most Americans are with ours. This is a red herring issue. My mom's 89. She's been on Medicare for 24 years, with ZERO problems. Her doctors are fine with it, and we have discussed it at length. So anecdotes are well and fine. Every system has its horror stories. But our current system is unfair, expensive and delivers mediocre results for top dollar. I hope the Dems don't cave to the usual Wall St. interests like the GOP surely will. Oh, already has.
I've had years of experience with the so-called conservative viewpoint and consider it classist and elitist, Wall St vs. Main St, corrupt big business running everything for their profit and the GOP lap dogs lapping it up.
To the point about “bipartisanship” I hope the Dems use the reconciliation process so a majority is enough. Screw this “super majority rule”. It's a recipe for stalemate and stagnation. The party of NO will not let anything get done at all because they want Obama to fail, meaning they want him to be unable to deal with any of our pressing issues so he'll appear ineffective. Enough of their obstruction.
So the options are a) pay for it yourself b) charity and c) force the less poor to pay for it. a) doesn't generalize. b) is unreliable. c) sounds an awful lot like socialized medicine. If you are going to set up a system where people can get treated regardless of ability to pay then perhaps it would be better to just do that instead of trying to jam the private insurance peg into that hole.
Ryan, the options strike various tradeoffs between cost and quality, and even the free choices are almost certainly faster than what he got overseas. None of them is perfect. Perfect would have been not being sick to begin with. But the point is he wouldn't be out of luck, he'd have choices–more choices than he had in Scotland.
Choices are valuable. People put different values on money, quality, and time, and a system that's always free but often slow isn't the right answer for everyone all the time. I see a ton of benefit in giving people more than one choice, and in having a system that's free to invent new choices. I don't want to lose these things.
The retail health clinics are an interesting example of companies inventing new ways to give consumers cheaper, simpler, faster choices. The clinics cut into the doctors' 200-bucks-for-10-minutes business, so the AMA is predictably negative on them. They're not a cure-all, but they're a useful option, and one that could never be invented in a socialized system.
one that could never be invented in a socialized system
actually, private clinics and hospitals are available in “socialized systems”. So is private insurance.
The reason you have 'choices' is because some bleeding-heart liberal decided to make someone else pay for your health care. There's no reason to take over the health care providers – they can still exist and earn profit and charge people extra for upgrades, or hell, faster care… but there needs to be a viable last resort option. If you can't afford upgraded service in an otherwise single-payer system, you can still wait for the test, or the procedure, or what have you, and get it. If the system is totally private, then being unable to afford something means you simply don't get it no matter how long you wait, and you have no choice at all.
GD, depends on the system. And the innovation here isn't a private clinic, it's the McDonaldsization of the private clinic–providing a basic product easier, faster and cheaper than a conventional doctor's office.
And since your objection didn't quite speak to my point, let me repeat it. The advantage I don't want to lose is not the clinic but the ability to invent a new kind of clinic. Please show me a socialized system that can do that.
Ryan, I'm not sure I understand your point. Sure, our system isn't completely private today. If it were, you're right, people who were both ill and broke would be SOL. I haven't heard anyone advocating such a system.
The point is that by extending public coverage to everybody you eliminate the can't-afford-healthcare problems across the spectrum, not just for a select few.
What select few are you talking about? People poor enough to qualify for Medicare?
Yes.*
*plus any other similar program, and if needed boosted to make up for shortcomings in the programs.
seems once again that Dr J is claiming there's no problem. Everyone is covered in America. I think most people here know that's not true. As for “prove” that “innovation” works in single payer systems, there are private clinics and testing services all over the world, including the UK, which actually does have a national health service. It also has private labs and clinics. Here are a few:
http://www.google.com/Top/Regional/Europe/Unite…
example The London Radiosurgical Centre – http://www.radiosurgery.co.uk/
Radiotherapy treatment, both NHS and private, for malignant or benign brain tumours, blood vessel abnormalities, acoustic neuroma, trigeminal neuralgia and other brain disorders.
Another:
The entrepreneur who relaunched Pizza Express has been asked to run a chain of NHS cancer clinics. Luke Johnson is in talks with one of Britain's leading cancer specialists to set up a string of “cancer express” centres that will offer patients every aspect of care from initial screening to chemotherapy
and another
On the Waiting List in Malta ? Not Insured ?
No Problem – We will try to help
Day Care Surgery at St. Philip’s Hospital
St Philip’s Hospital will be offering Special Prices for Day Care Surgery whilst obviously maintaining our traditional Quality Surgery in a Safe Environment at less than Day Care Clinic Prices !
Here's a CNBC video on a European conference on health care innovation. http://www.cnbc.com/id/15840232?video=113525383…
Unfortunately, since “socialized medicine” kills innovation, they didn't have anything to talk about. Just kidding of course. How arrogant Americans are to think they are the only innovators because of the profit motive. Open heart surgery, heart transplants, lasik and lots of other cutting edge medical breakthroughs happened not here, because of profit motive, but abroad because just like here, doctors (maybe Dr. J excluded?) are dedicated to advancing the practice of medicine because they happen to like using their brains and skills to advance their field, medicine.
GD, thank you for the pointers, looks like you found some more positive stuff than I expected.
I'm sorry you feel I'm being unreasonable, but here's the honest truth: the notion that government marshals innovation, customer focus, or cost accountability comparable to private industry simply goes against my experience. I'm used to lines at the DMV, security theater from TSA, an absurd tax code, an FAA that will be taking 50 years to upgrade its computer systems, a drug war that has brought decades of failure at the expense of our most disadvantaged citizens but can't be stopped, legislation that reliably sells out the public interest (to the extent such a thing exists) for one interest group or another, a space agency that blows things up, a state government that is now minting its own currency (the IOU), a city government that spends money so foolishly it has to pass bond measures to find the cash to fix potholes, school systems that live at the mercy of teachers' unions and turn out students that can't read…doo dah, doo dah.
I could go on and on, but what frosts me the most is that while companies are held to account by courts, consumers, and ultimately accountants, government is basically not accountable. Books need not balance, policies need not work. Politicians' jobs depend entirely on the sound bites by which voters judge them, not on genuine results.
You're welcome to call this bias, but it feels to me like simple data points. I used to work for the federal government perhaps that was my first mistake. You seem to have a different experience of government; perhaps you're from Canada?
As for the rest of your post, well, I can't help you out. You've managed to interpret “our health care system [is] too expensive, leaves too many people uncovered, and…needs reform” as “Dr J is claiming there's no problem.” And you've brought up insurance yet again, as if I'd said something about it, or as if medical related bankruptcy was caused by insurance bills. Perhaps you're one of those Chinese contortionist chicks I saw in the Cirque du Soleil?
Actually based on your photo, my money is on you being a Scottish golf nut. You're probably peeved that I'm casting aspersions on the Hebrides. Sorry about that.
Dr_J, if in the absence of sound argument all you have left is personal characterizations of someone you don't know, then it might be best if you refrained from running your fingers over the keyboard. It IS optional you know.
Dr J, I agree with all your examples, but disagree that companies are held accountable. They rip off the public, bribe legislators, even screw their stockholders, then laugh all the way to the bank as “the corporate veil” protects their personal asses, er assets, from their misdeeds. Not sure if you've caught my several postings of this link, but I urge you to read it. It's about how Goldman Sachs has engineered, inflated, deflated and profited from every bubble since the Great Depression. I hope it will temper your trust in unfettered corporatism.
However, in the case of health care REIMBURSEMENT (remember, we're not talking about government doctors or hospitals), government already covers more people than any insurance company, or all of them combined. This isn't an experiment; there are decades of data from all over the world that single payer health care for all works, works at least as well as our system and for much lower cost.
Heehee, Scottish golf nut. Love it (I don't golf, but do like Scotch). I don't think I'm off base in characterizing your opposition to a public option as a preference for the current model. You have suggested HSAs as a solution and that patients can bring down costs by negotiating prices with providers, but I consider that unrealistic. Besides, it requires coverage for catastrophic or emergency spending beyond what's in the HSA, which must be provided either by the predatory insurance industry or the government, which choice I would leave to each individual American. As for spending a lot of time finding private health care options in Europe, it took seconds on the Google.
GD, I read your link. The tone was my first clue it might not be an even-handed analysis, and I didn't find it to support your broad assertion that companies are not held accountable. Specifically:
1. The whole thing is about a weird corner of the economy. Goldman Sachs is a speculator, and their customers are speculators. I'm certainly against fraud and market manipulation, but the people who lost money fair and square speculating on dot-com IPOs aren't going to keep me up at night.
2. Even as slanted as the article is, one theme keeps emerging from it: government failure. It loosened commodities regulations, it failed to impose meaningful fines on corporate abuses, it implemented policies to encourage wider homeownership that helped fuel the housing bubble. Absurdly, the author tries to blame Goldman for lobbying for these changes, as if maintaining a balanced regulatory structure were Goldman's job rather than the government's. Congress acted to loosen rules on default swaps trades, but Congress shouldn't be held responsible because the Treasury department lobbied them. But Treasury shouldn't be held responsible because it was run by Robert Rubin, who had come from Goldman Sachs. It's Goldman's fault, you see?
3. In all these examples, within just a few years inflated asset values are corrected, fraud punished and stopped. In the grand scheme of things that's pretty darn quick. How long has the drug war been with us?
4. The millions pocketed by executives of insolvent financial firms makes my blood boil too, and I'd like to see more downward pressure on those bonuses. But I'd rather we optimize the system toward helping the many forward rather than holding the few back, so the few thousand people getting more than they deserve are a distraction from the real question: what best serves the many? A government-heavy system that betrays the interests of the many whenever the few come a-lobbying is the wrong answer.
I can’t imagine anything more important, to any entity’s efforts to solve its problems and improve itself, than having respect for the conflicting views of its constituent members, and being able to incorporate those varying views into an optimal solution or approach. Unfortunately, at least in the current political environment, I am concerned that this principle may not be in operation.