There was a time only a few months ago when it looked like health care reform could actually be easy. Obama's approval rating was sky high. Baucus and Kennedy had gotten all the different industries to the table. A small but noticeable number of Republican senators claimed to be open to reform. Everyone thought the reform train was rolling out, so no one wanted to be left at the station.
Not so long after those first heady months, everything started to unravel. Obama's approval rating started dropping. The Republican meme that killing reform would kill Obama slowly became party doctrine. Baucus and Grassley failed time after time to make their own deadlines. And probably most devastating, the CBO score came back, and it was bad.
It seemed at first there was hope reform could be a big win-win. Doctors gave a little, Phrma gave a little, insurance companies gave a little and there would be enough to pay to get everyone insured. It seems they were hoping several relatively painless changes like more preventative care, payment structure changes, competitive bidding, electronic records, etc. would have their powers combine into huge savings.
If that first CBO report of health care reform came back at only $500 billion it might all have worked. The medical industries would accept some reforms in exchange for a massive new customer base. Liberals would be forced to give up on the public option in exchange for extremely generous subsidies to the poor and middle class. The bill could have been paid for all through savings or only minor, indirect taxes. A decent bipartisan reform bill would have been quickly passed over some progressive objections.
When CBO director Elmendorf refused to score most of the potential savings the grand coalition fell apart. The knives came out and someone (if not everyone) was going to be the loser. What industries would take a huge hit to their profits? Would liberals be forced to accept very small subsides and getting everyone only bad technical insurance? Would Republicans swallow large tax increases?
When reform went from deal making to knife fighting, Obama lost all hope of easy bipartisan reform. His only hope is to rally his base for an arm twisting partisan bill. The only thing which can rally the base is the public option.
The health care activists tend to be the people who were screwed over by insurance companies or had loved ones that were. They aren't going to waste their weekends knocking on doors campaigning to give insurance companies huge checks from the government. They don't want to see the industry be forced to accept some sensible new regulations. They want to be free of them. They want to see these evil companies dismantled.
Some in the media wonder why Obama's progressive volunteers are not turning out in force for health care reform. The answer is simple. He has made it clear he is not committed to their main goal: freedom from the evil insurance companies.
Progressive activists will not rally around slogans like:
“Several new common sense regulations that end some of health insurance's worst practices in exchange for forcing everyone by law to pay thousands for their product.” or “Demand subsidy levels be 9% instead of 11% of income for families making over 300% of the FPL.”
If Obama wants to get the grassroots fighting with him for health care reform he needs to make a firm promise that he is not going to sell them out. Every time he makes a wishy washy statement about the public option, says everything must be on the table, and claims private cooperatives might be just as good, it is a blow to the grassroots' moral. It is Obama telling them he does not need them, does not want them, and will not stand with them.
If Obama wants to rally an army of activists to his cause all he needs to do is publicly say, “I will veto any bill without a real public option.”
Showing posts with label Kennedy. Show all posts
Showing posts with label Kennedy. Show all posts
Health Care Reform in May?
I have reverse-engineered what is possibly the Obama administration's timetable for passing massive health care reform. By piecing together dozens of interviews, news reports, and knowledge about Congress, I've been able to construct what I believe to be Obama's overall strategy. Using all available information, I believe Obama plans to sign a health care bill in late May or early June of 2009.
Step 1. Lay out the budget with $634 billion for health care.
Step 2. Announce both a HHS secretary and a health care czar as a clear indication that Obama is planning to move full-speed ahead. They will now have all the important players in place for the first health care summit on Thursday.
Step 3. Have a group of senators lay out a detailed outline of the bill at the health care summit Thursday. Senator Baucus released a white paper on health care reform right after the election and has been working on it since. Senator Kennedy has also been having secret, closed-door meetings on health care for months now. The optics here are very important. It will be members of Congress and not the Obama team which presents the detailed outline. This way, they can avoid one of the biggest complaints against Clinton's health care plan.
Step 4. Use the detailed outline on health care reform to test the water for support. This will result in one of two possible paths to passing the legislation.
Step 5. Writing and Passing the bill.
A) The bipartisan route: If a substantial number of Republican senators (5 to 11) show support for the bill, they will move quickly to negotiate and write the legislation throughout March. With Republican support, a bipartisan bill should be finished sometime in May. Voting and reconciliation will take a week or two, and the bill will arrive on Obama's desk at the end of May or early June.
B) The partisan route: If Republican senators appear initially united against the outline of the health care reform proposal, the Democrats will choose to play hardball. If there is not strong bipartisan support at the start, it will mean that the Republicans have decided to sink health care to sink Obama. It will be a clear sign they do not plan to negotiate in good faith. The Democrats will use the budget reconciliation rule to pass health care with only 51 votes. They may make it a stand-alone bill or more likely embed it in the new budget (which is also on schedule to be passed in May).
Step 1. Lay out the budget with $634 billion for health care.
Step 2. Announce both a HHS secretary and a health care czar as a clear indication that Obama is planning to move full-speed ahead. They will now have all the important players in place for the first health care summit on Thursday.
Step 3. Have a group of senators lay out a detailed outline of the bill at the health care summit Thursday. Senator Baucus released a white paper on health care reform right after the election and has been working on it since. Senator Kennedy has also been having secret, closed-door meetings on health care for months now. The optics here are very important. It will be members of Congress and not the Obama team which presents the detailed outline. This way, they can avoid one of the biggest complaints against Clinton's health care plan.
Step 4. Use the detailed outline on health care reform to test the water for support. This will result in one of two possible paths to passing the legislation.
Step 5. Writing and Passing the bill.
A) The bipartisan route: If a substantial number of Republican senators (5 to 11) show support for the bill, they will move quickly to negotiate and write the legislation throughout March. With Republican support, a bipartisan bill should be finished sometime in May. Voting and reconciliation will take a week or two, and the bill will arrive on Obama's desk at the end of May or early June.
B) The partisan route: If Republican senators appear initially united against the outline of the health care reform proposal, the Democrats will choose to play hardball. If there is not strong bipartisan support at the start, it will mean that the Republicans have decided to sink health care to sink Obama. It will be a clear sign they do not plan to negotiate in good faith. The Democrats will use the budget reconciliation rule to pass health care with only 51 votes. They may make it a stand-alone bill or more likely embed it in the new budget (which is also on schedule to be passed in May).
Stupid or Playing Dumb?
President Obama's new budget creates a very rough outline of how he plans to make a substantial “down payment” on universal health care. The only details given are that the plan would set aside $634 billion over 10 years for health care reform, and some of that money would come from a change to tax deduction rates for families making over $250,000 a year. Obama's administration is using the estimate that universal health care reform would cost $1 trillion over ten years. (I strongly dispute this often cited figure, but that is a separate article.)
His plan for health care reform in his budget outline appears a first glance, frankly, stupid. Why make a huge “down payment” and just not go for universal reform? Why cover only 36 of the 45 million uninsured? Why link a popular plan to this specific tax increase? The Democrats have the numbers and the momentum to finally achieve a goal they have sought for decades. If they pass the first step now, there is no guarantee they will have the political power to finish the job later. Technically, there is a big difference between $635 billion and $1 trillion, but to the American people, they are both just really big numbers. Not making the health care plan universal will in the long run only make it more expensive.It is possible that the White House is stupid, but its more likely they are a dozen steps ahead. Obama's budget for health care is probably an elaborate rouse. By giving basically no details about what a plan should look like, he can act like he is blameless while Congress is forced to make the tough choices.
The health care reform bill is probably already written by Senator Baucus and/or Senator Kennedy. While it will be changed around the edges, it is likely Obama already knows its basic shape. The bill will be more expensive than planned and probably contains a mandate even though, during the campaign, Obama laid out a health care plan without a mandate. It is even possible the deduction change to pay for it will drop. He will be able to act like he is being forced to compromise instead of breaking campaign promises he doesn't care to keep.
The Importance of Sebelius
Governor Kathleen Sebelius has been named HHS secretary. Her experience makes her an excellent choice for the position. Yet, the big news is not that Gov. Sebelius has been named to the position, but when. On Thursday, Obama is going to have his first health care reform summit.
Government summits are always more about theater than about discussing issues. Summits can serve two possible PR purposes. The first is to make it look like you are working on a problem without really doing anything. The other is to unveil a new policy and make it appear that all players got to be involved in shaping it. I would be shocked if any real work, consensus building, or compromising happens at any of the many summits Obama calls for.
If the Obama administration had its first health care reform summit without a HHS secretary, it would have been a clear indication that it is of the former type of summit. Obama is currently facing several huge issues, and it would not be unusual if he used “summits” as a way to punt the issue down the road without appearing to break campaign promises.
Gov. Sebelius being named HHS secretary days before the first summit does not automatically mean it will be more than a PR move. But it does dramatically increase the probability that the summit on Thursday will be used to launch a major piece of reform legislation. Senator Kennedy has been having secret closed-door meetings about health care for months. It is possible that this first summit will be where Sen. Kennedy and/or Baucus present a detailed and structured “outline” of what the eventual health care reform bill will look like.
Single Payer: Not Going to Happen (Part 1)
Health care reform will be one of the top issues facing the new administration. Many people on the political left have already started pushing hard for a government-run universal single payer system, similar to the systems in Canada or the UK. Some have named the program "Medicare for All." Given the current economic, cultural, and political climate, there is no chance that such a health care system will be adopted in the near future.
The most important problem is the current economic recession. The major short term problems with adopting a single payer system is that it would literally bankrupt some of the country's largest companies overnight. Regardless of how you feel about the health insurance industry, they still employ millions of Americans across the country. It is inconceivable that during these economic times Congress would pass any bill that would put so many people out of work. Ironically, the economic downturn could make it easier to pass universal health care reform but make it almost impossible to adopt a single payer system. Layoffs and rising unemployment is going to create millions of more uninsured Americans. With trillions being used to help struggling corporations, the demand for money to help the nation's struggling working class pay for health care should be strong.
The next problem is cultural. Universal single payer would be a huge government takeover of a large segment of the economy (although through Medicare, Medicaid, the VA, and coverage for federal employees, the government already controls much of the health care sector). The idea of massively increasing the size of the federal government is not a popular one in this country. Groups opposed to health care reform have been very successful at turning single payer health care into a scary bogeyman. When they attack universal health care plans, they almost always go after either Canada's and/or the UK's. Countries with private yet highly regulated systems that ensure universal coverage are never mentioned. So far I haven't heard of anyone in America attacking the health care systems of Japan or the Netherlands.
Finally, there is just no political weight behind the single payer system. Neither Barack Obama nor Hillary Clinton ran on a single payer health care plan. None of the top political players--Senator Baucus, Senator Kennedy, Senator Wyden, Senator Bennett, or Tom Daschle--currently support a single payer system.
The most important problem is the current economic recession. The major short term problems with adopting a single payer system is that it would literally bankrupt some of the country's largest companies overnight. Regardless of how you feel about the health insurance industry, they still employ millions of Americans across the country. It is inconceivable that during these economic times Congress would pass any bill that would put so many people out of work. Ironically, the economic downturn could make it easier to pass universal health care reform but make it almost impossible to adopt a single payer system. Layoffs and rising unemployment is going to create millions of more uninsured Americans. With trillions being used to help struggling corporations, the demand for money to help the nation's struggling working class pay for health care should be strong.
The next problem is cultural. Universal single payer would be a huge government takeover of a large segment of the economy (although through Medicare, Medicaid, the VA, and coverage for federal employees, the government already controls much of the health care sector). The idea of massively increasing the size of the federal government is not a popular one in this country. Groups opposed to health care reform have been very successful at turning single payer health care into a scary bogeyman. When they attack universal health care plans, they almost always go after either Canada's and/or the UK's. Countries with private yet highly regulated systems that ensure universal coverage are never mentioned. So far I haven't heard of anyone in America attacking the health care systems of Japan or the Netherlands.
Finally, there is just no political weight behind the single payer system. Neither Barack Obama nor Hillary Clinton ran on a single payer health care plan. None of the top political players--Senator Baucus, Senator Kennedy, Senator Wyden, Senator Bennett, or Tom Daschle--currently support a single payer system.
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