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Optimistic About Healthcare
So why do I remain fairly optimistic that a decent healthcare reform bill will pass? Sometimes I wonder myself. But here are three reasons. First, Jon Chait, who thinks getting bipartisan support for a bill was always a chimera:
The ultimate endgame entailed getting all the Democrats to pull together and pass something.
Of course, Democrats didn’t want to do this. They wanted bipartisan support, mainly for political cover. Moderate Democrats won’t do this until it becomes clear that the Republican Party is dead set against reform, completely in hoc to its right-wing base, and not negotiating seriously....In that sense, August moved the ball pretty far down the field.
Second, Carl Hulse of the New York Times, reports that conservative Democrats haven't been too fazed by the August freak show:
Even after the tough town-hall-style meetings, unrelenting Republican assaults and a steady stream of questions from anxious voters, interviews with more than a dozen Blue Dogs and their top aides indicate that many of the lawmakers still believe approval of some form of health care plan is achievable and far preferable to not acting at all.
....The political temperature of the Blue Dogs — and their ideological counterparts in the Senate — after the five-week recess is crucial. As representatives of some of the nation’s most conservative territory represented by Democrats, they potentially have the most to lose if a Democratic bill spurs a backlash....One lawmaker in the group, Representative David Scott of Georgia, said his determination to enact a health care overhaul had been increased over the recess because of what he called the spread of misinformation and other unfair tactics engaged in by the opposition.
And third, there's the fact that conventional wisdom places Dems in a very, very deep hole right now:
Some of the most prominent and respected handicappers can now envision an election in which Democrats suffer double-digit losses in the House — not enough to provide the 40 seats necessary to return the GOP to power but enough to put them within striking distance.
Top political analyst Charlie Cook, in a special August 20 update to subscribers, wrote that “the situation this summer has slipped completely out of control for President Obama and congressional Democrats.”
Now, put all this together and look at it from the Democrats' perspective. Republicans have been given every chance and have obviously decided to obstruct rather then work on a bipartisan compromise. So the Blue Dogs and centrist Dems feel like they're covered on that angle. What's more, the townhalls have shown them what they're up against: if they don't pass a bill — if they cave in to the loons and demonstrate that their convictions were weak all along — they're probably doomed next year. Their only hope is to pass a bill and look like winners who get things done.
When you're up against a wall, you do what you have to do. Politically, Dems have to succeed, and at this point they've all had their noses rubbed in the fact that the only way to succeed is to stick together. What's more, Barack Obama has a pretty good knack for coming in after everyone else has talked themselves out and cutting through the haze to remind people of what's fundamentally at stake. If he can do that again, and if he has the entire Democratic caucus supporting him, they can win this battle.
Nearly every Democrat now has a stake in seeing healthcare reform pass. The devil, of course, is in the word "nearly," but at this point even Ben Nelson probably doesn't want to be the guy to sink a deal if he's literally the 60th vote to get something done. It's usually possible to pass a bill when everyone's incentives are aligned, and right now they're about as aligned as they can be. That's why, on most days, I remain optimistic.
UPDATE: A commenter at James Joyner's site describes Obama's style this way: “He operates like a community organizer: let people have their say, let them wear themselves out, then step in and define the consensus.” At his best, I think that gets it about right.
And when is Obama going to do this? Next Wednesday in an address to a joint session of Congress. Nice symbolism there. I hope it works.
What a load of crap.
"Democrats didn’t want to do this. They wanted bipartisan support, mainly for political cover." What a load of crap. There is zero evidence that "bipartisan support" has ever saved anyone's seat in congress. This doesn't even pass the sniff test. The real reason behind the Democrats' failure on health care and everything else is that failing is the easiest option.
It continues to strike me as
tagged as:- solution
It continues to strike me as somewhat dishonest to continually describe the Republicans or anyone that doesn't favor the government option as against health reform. Many of them have said in fact they think health reform is very much needed......the disagreement is in the how and the cost of the how.
I think the American people understand this debate but for some reason (and I think I know why) anyone who doesn't favor the radical approach is against health reform all together. I think that in the end Obama himself is not very wed to this approach either.
So far I think the approach proposed by the house is very antiquated and demonstrates very little creativity and innovation in solving the problem. Lets do a govt plan like everyone else. How unimaginitive is that. Lets push ourselves a bit here. After all we once went to the moon. We can do this if challenged by our leaders.
Of course you realize your
Of course you realize your comment is not grounded in reality. The GOP is not behind any kind of serious reform. In fact, they now say don't touch Medicare. And the Dems are not offering radical reform. It's too tepid for the base.
If you have a more "imaginitive" approach, please let us know about it, but I suspect it's pure moonshine.
Being the obvious
Being the obvious intellectual that you are. I am quite confident that you, in fact, realized your response to the above commenter drove his/her point right across the finish line.
Of course, no other kind of plan would be "imaginative" for you unless it consisted of 100% agreement with all of your points, and a kiss on the hand for good measure. Right?
Useful Idiot much?
No, I'm open to any idea
No, I'm open to any idea that provides universal coverage that also contains costs and maximizes results. Just tell me what that idea is, otherwise you're talking bullshit and wasting my time.
At least the GOP understands
At least the GOP understands that the fight is eternal and you take your wins where you can.
Whistling past the graveyard
Kevin, I'm afraid your analysis has a faulty premise: That Democrats are organized.
That premise should be replaced with: Democrats exist to make the world safe for Republicans.
The change of premise will change your conclusion, I think.
Kevin: I thought Norm
Kevin: I thought Norm Ornstein's piece is WaPo the other day also gives good reason for optimism: http://www.washingtonpost.com/wp-dyn/content/article/2009/08/31/AR200908...
Well, it's not 11
Well, it's not 11 dimensional chess, but it is the well-known power of the counter-attack. It allows you to know your adversaries strengths and weaknesses. For example, we now know all of the Republicans' objections to the bill -- meaning the President know exactly what his target is.
Being on the counter-attack is where any smart strategist wants to be. It's like in a negotiation NOT being the first to name a price -- big advantage.
negotiation
Except Obama named the discount at the outset. By taking single-payer off the table imediately, the GOP was free to work on the public option.
Which Obama seems poised to premptively jettison as well.
When your opponent announces during negotiations that they are not negotiating, will accept no concessions and will oppose anything put forth, it's not time to do anything except walk away from the table.
Obama and Dems haven't done that yet.
I'm not impressed.
Nonsense myth about negotiations
It's only true under some circumstances that you don't want to give the first offer.
If you are the President and otherwise holding the majority of the cards, you do want to make the first offer and set the anchoring points.
Naming first is an advantage
Scholars in negotiation now almost all recommend going first, because it takes advantage of the anchoring effect. Daniel Kahneman got the Nobel prize for his work with Amos Tversky (deceased) on anchoring. Good sources to read on this point are Leigh Thompson's "Heart and Mind" and Bazerman's "Negotiating Rationally."
The exception is when you are completely ignorant about what the market for the good you are negotiating over is.
I suspect that that is true of Obama -- he didn't go first because he is so inexperienced he has little idea of what he wants or can get.
Another way to look at what
Another way to look at what Obama has been doing is to note how widespread now are the cries--not just from Democratic pols but also from pundits and commentators--that "Obama has to step in and take charge of the health care effort!" So when Obama gives his speech next week he will be responding to pleas that he do just that. As opposed to trying to get a word in edgewise when everybody else has stopped listening to him--which is quite possibly what would have happened if he'd been front-and-center on the whole issue since the spring.
Democrats
“[T]he situation this summer has slipped completely out of control for President Obama and congressional Democrats.” Once it slip out of control, I doubt that Democratic Senators, every man a little king, will regain it. Nelson would love to torpedo health care reform. Current polls in Nebraska says "Kill It!" He could care less about the fate of fellow Democrats.
Who does a senator serve?
Some seem to serve their own interests and only give lip service to the public.
Some serve only their home-state electorate or even their activist base.
Some serve larger groups based mostly on ideology.
Some serve the nation and the world.
Some do a little of each of these depending upon the issue.
Since Democrats as a party have worked on this issue for decades and since the previous Dem president (Clinton) won election on the issue and since our current Dem president won largely on this issue it would seem that every Democrat in the country would want to get something done. Turning your back on all other Democrats would be known as leaving the party. Would any Dem senator choose that over serving their party and the country on an issue of this kind (one the president campaigned on)?
This isn't building roads in a Congressional district. This isn't getting a military contract for the local company. This isn't local politics. This is national and it's important to every single American.
When the public polls say they want the public option by over 70% then it's time for every Dem in government to forget themselves and stand with their team and America.
If there is no public option
If there is no public option he will have a whole new problem on his hands. I have yet to see any proposal put forth that would do what it does and thus, no public option means I'd rather see the republicans win.
Yes I am fucking going there.
Yeah, fucking great. Reward
Yeah, fucking great. Reward the GOP for acting like total assholes and the Dems for acting like the commodity-grade politicians that they are. That's the way to make this country better.
OOPS
"slips"
I actually kind of hope
I actually kind of hope Democrats pass this health care bill. It will mean a great year for Republicans next year as they grab back a ton of seats, maybe even enough to retake the house. This healthcare plan is unpopular almost everywhere and a majority of the US is against it in basically ever poll. Voting for this will kill the reelection chances for many Democrats representing conservative areas (I think as of last count it was around 71 representatives). One of the big downsides to that though, are the billions or trillions of dollars that will be wasted on destroying our medical system just so Obama can take credit for something.
I don't see it as much of a
I don't see it as much of a community organizing feat to step in and get the absolute lowest common denominator possible. I agree the Dems may well pass something because they can't afford to fail, but I don't see where that's much credit to Obama's leadership on this.
Its about trust
I dont think it has anything to do with health care, the citizens are becoming convinced you cant trust Obama. He either is just to lazy to get everything right or he is so arrogant he thinks we are too stupid and will buy doctors amputating for pocket change and other nonsense like health insurance companies making a fortune.
YOU CANT TRUST OBAMA SO IT DOSNT MATTER WHAT HE SAYS.
By the way, do you want someone you cant trust talking to your kids?
Documents distributed by Obama as work sheets for his Sept 8th indoctrination.
Words Obama or President used 40 times.
Words country or United States used 5 times.
The man isnt trust worthy which puts the citizens in a precarious position.
I only wish I had more
I only wish I had more confidence that Obama actually understands the nuances of health care policy in a way that allows him to make good choices. I can't even begin to elaborate on the land mines that exist if you make wrong or lopsided choices because you don't understand what loopholes you are creating, I see no evidence that he has any plan to control costs outside the context of a so-called public option, and I see no evidence of the diminution of the lobbying heft of the insurance industry.
I am steeped in details, but in this area, details are actually pretty important.
> UPDATE: A commenter at
> UPDATE: A commenter at James Joyner's site describes Obama's style
> this way: “He operates like a community organizer: let people have their
> say, let them wear themselves out, then step in and define the
> consensus.” At his best, I think that gets it about right.
Community organizers in Chicago don't accomplish very much because the Regular Democratic Party (which these days is the Daley II Machine) controls the city lock stock and barrel. When a Chicago community organizer appears to have accomplished something, it is because (1) they compromised with the regular Democrats (2) the regular Democrats let them because they had something to gain.
Who is the machine in this case, what was the compromise, and what did Obama give up to get it?
Cranky
Mmmmm! Tasty Troll Bait
Barbara @ 1:46 PM is worried about Obama's lack of understanding regarding the nuances of health insurance reform. She's steeped in the details, but neglects to mention any specific examples of the President's ignorance.
Anonymous @ 1:44 PM just doesn't trust anything Obama says. Funny, he doesn't give any examples of Obama misleading anyone. What about his birth certificate!?!?
And then we have the Anonymous @ 1:34 PM who kinda hopes that Democrats pass a health care reform package because it will lead to GOP victories in the 2010 mid-terms. Good luck with that!
Yeah, and thank god we have
Yeah, and thank god we have AK Liberal to police the thread and make sure everyone toes the line.
Did Barbara say much that Paul Krugman didn't say the other day?
No, but regardless, AK Liberal has such an upset tummy about it he/she has to make sure everyone knows that any other disagreement will lead to being named as a troll.
Screw off AK Liberal, why not let a conversation take place?
Oh but I did give an
Oh but I did give an example: I see no evidence of any cost control effort in any of the bills being proffered outside of efforts to shape a public option (as well as Medicare reimbursement) to incorporate certain technical reimbursement goals. If Obama "abandons" the PO, he is also leaving a gaping vacuum insofar as cost control is concerned, at least based on what I can tell from anything concrete he has said. If you have details to the contrary, I'm all ears.
Personally, I think opening up Medicare for private insurance type purchasing by individuals is the way to go. Medicare reimbursement has to be extensively rethought anyway, why complicate things unduly when the program infrastructure is already in place.
There are a lot of other particulars out there that could get really messy as well, but I'm tired of debating at this point until a specific bill is on the table.
Controlling costs
Barbara wrote:
The Exchange brings insurers together (with the public option) and the public can compare. That competition for business should restrain costs.
More money to train primary care physicians could mean more competition which would lower costs if more physicians go into federal health care centers where they receive salaries instead of fee-for-service pay.
More IT could translate into cost savings for everyone.
Preventing insurers from interfering with physicians will mean a lot less time wasted on paperwork and any activities other than serving the patient.
I'm not sure what's in the bills about changing the pay method, but there's been a lot of talk about fee-for-illness rather than fee-for-service and if that's in the final bill then that could control costs.
Gov't research on 'what works' could eliminate a lot of nonsense 'treatment' and tests which don't contribute to the patient getting well.
Getting the industry to help us fill the Medicare Part D donut means less out of pocket for Medicare patients. That's a lot more care for no more money.
The mandate for businesses to insure their employees means more group rates which are cheaper than COBRA or individual rates.
There are ways this reform will hopefully control costs.
Kevin, I suppose you can be
Kevin, I suppose you can be optimistic that something titled "Health Care Reform" will get passed, but whether it's worth the paper it's printed on is not something I'm optimistic about at all.
No public option + a mandate = total failure and a much-deserved ass-kicking in 2010.
Who would like take my bet:
I'm willing to bet that Repubs will walk out on Obama's address to Congress next week.
Community organziing
The comment about community organizing is exactly right, much to my surprise. Obama made this the Dems' fight, not about a conflict about him. So they couldn't walk away from it like they did from Clintoncare. And organizing the Dems has been like herding cats, it's hard to do. But Obama's approach forces the Blue Dogs to practice party loyalty. Sacrifices will have to be made, like keeping the total 10 year bill under 10 trillion dollars, but it's better than nothing and gives the Dems a win. It's well worth it.
There is a lot of wishful
There is a lot of wishful thinking in Kevin's post. If there's no government health care plan, then what's left? Only ordering young people under threat of fine or imprisonment (or maybe merely higher taxes) to buy health insurance. Yeah, that's political gold. People love taking orders from Washington.
60?
The dems don't have 60 right now. at best they have 59.
Don't count out the two
Don't count out the two senators from Maine.
Rope-a-dope
I once described O's approach to combat as rope-a-dope: he likes to let the opponent show his best stuff, his not best stuff, and eventually show his ass.
then, he moves in.
He did this during the campaign. His fans (e.g., me) were absolutely dying at the mostly un-answered attacks he was taking, and so on. he pulled it out, and by a mile.
so i am, with kevin, optimistic--i think he's letting these guys run riot 'cause he knows a. they are not winning new supporters this way, and b. he's hearing all the worst fears and best objections--this tellls him what points he has to be sure to cover in his counter.
of course, this is a risky strategy. It does mean taking a lot of punishment Ali admitted that Foreman hurt him the night he (Ali) invented rope-a-dope. Luckily, none of the Repubs hit as hard as Foreman (but there ARE a lot of them!) so it is no sure thing at all.
but i have confidence he'll make a credible response.
of course, if it includes surrendering on the public option, i might never vote for him again, but, ..........we'll see.
Wall Street bailout
> I once described O's approach to combat as
> rope-a-dope: he likes to let the opponent show
> his best stuff, his not best stuff, and eventually
> show his ass.
> then, he moves in.
So, when do we see the strong regulation and prevention of "too big to fail" moral hazards that was going to be Phase II of the Wall Street Bailout?
Oh right, we won't. Because Wall Street called up and said "no Phase II", leaving the losses socialized, the profits privatized, and the moral hazarded on the taxpayer's back forever. What do you think that portends for the ultimate shape of any heath care bill that does get passed and signed?
Cranky
don't get ahead of yourself
don't get ahead of yourself now.
from the banks that have paid back the government, we've made a profit. sure, not many have paid us back yet (and some might never will, since they'll be out of business). but of those who are in good enough shape to be able to afford it, we're doing pretty well.
yes, they've profited too. but if we both profit, it's not quite the same as shovelling cash into the boiler.
It's not about the public option
A more informed commentor here a couple of weeks ago pointed out that the House bill control premiums and profit margins at private insurers that the makes the public option really not all that relevant. Several European countries, such as Hollland, function fine that way.
Public option should not be make or break, but rewarding recent GOP antics would be a disaster for this country.
A Small Correction
Since 2006, Holland has a healthcare program in which serious illnesses in which long hospital stays are common are covered by the government. Routine healthcare and short hospital stays plus prescription drugs are covered by private insurance companies. In the private coverage, the same premium is charged to everyone, regardless of risk, health condition or age. The government program is funded from taxes withheld from wages as well as other tax sources, employers paying 50% and often 100%. Insurance coverage is mandatory and subsidies are provided to those who can't afford it. Looks like a darn good system to me. Why can't WE have such a sane policy????
http://en.wikipedia.org/wiki/Health_care_in_the_Netherlands
okay, about the public option
Yes. France, too, seems to have a marvelous system that is entirely private. That's why i said "we'll see." up there.
if it's not a public option, there are other ways to get us all insured and simultaneously get us out from insurance-company peonage and cost-increase-penury. (when do we ever get a chance to use those two words in common discussion? well, i hope never again.)
so....maybe. i'm the one who said i'm optimistic.
Health care
If the health care bill passes, the dimwits will loose big in 2010. The public does not want a government-run health care system. THE biggest concern now, according to the polls, is the deficeit, which the Health Care Bill will inflate to unheard of proportions. As far as the federal government, it has proven over and over again, it can't run anything "cost effectively".
Please! Somebody make me pass this bill!
What a party!
We'll see if Obama is going to work the magic you say. According to Ezra Klein's blog, after nearly a year of legislating and 2.5 years of campaigning on the issue, the White House still doesn't know what its position is or what it wishes to see in a bill.
That doesn't bode well for cutting through the haze.
agree
I agree with the comment. The real reason for posting is to express how much easier is to post than before- I had chastised KD on the prior program and felt miffed when I got no response. A general announcement on the matter would be welcome (perhaps it was done and I missed it but I don't think so).
You Liberals are living in La-La-Land
This is just silly shallow nonsense.
The DEmocrats are in trouble with this because it is the antithesis of the American Way. If Democrats were really interested in reform they would get on board with improving the system we now have - make health insurance premiums tax deductible and allow interstate competition. People's premiums would drop overnight, but the Democrats and the clownish, communist administration simply want a single payer system with them in charge. Fuggedaboutit...not going to happen. Besides, this town hall meetings have far more to do with the government in general than simply health care. People are tired of their government infringing upon their rights and sleazing its way into their lives. It's un-American and so are the people who perpetrate socialism, communism and facism.
The funny part of it is that the liberal, facist response has been so predictable - the town halls thugs and obstructionists - and as usual, bufoonish. Keep chanting dickheads, your day is almost done.
Sorry folks, this isn't washing at all with the population and it won't as long as Obama insists he can wiggle a grain of truth out of the biggest lie in American history. The fact is, he won't allow any changes to the Marxist plan, but he will continue to try to find a lie that works for people other than the brain dead drones who would follow him into the abyss. Frankly, I wouldn't follow this clown into a puddle of water.
Three and a hlaf more years and the abamination I mean Obamination is over.
Can you say, "One term Obama?"
La-La-Land in a puddle of bile
What can we say? Maybe that your not spitting enough bile yet, cause it's still affecting your brain functions?
Wow la la land!
According to you, Obama is simultaneously a socialist, a communist, a fascist and a marxist, as well as being liberal. Gee the guy has a lot more talent than I initially thought.
La-La-Land is the Dems best hope
I used to be an independent - open to persuasion by the valid arguements of either party. The thing is the Right has gone off the pier and sunk so low they seem to be in the part of the ocean where the fish don't even need eyes.
I'm now proud to be a Democrat, and every post by someone like La-La just reinforces that. Throwing around worn-out insults like Marxist and Fascist and expecting others to take them seriously speaks volumes about how out of touch they've become.
Barack Hussein Obama, a half-white half-black man, with only one term in any office, and who many thought might actually be a Muslim, was elected by a substantial margin while running against a bona-fide war hero precisely because America has quite rightly lost all faith in and respect for the Republican party and it's supporters.
I voted for him and it's the best thing I ever damn did.
What if Obama/Reid/Pelosi had the votes from the beginning?
And the debate is sorta to convince people we had a debate, not to debate the bill in any meaningful sense?
Or what if the Democrats are trying to fail but blame the Republicans? And what if the Republicans want the bill to pass, but want to stir up as much Right Wing outrage as possible?
Do Republican business owners (outside the financial sector) really want there to be no bill to address cost containment?
I may be somewhat
I may be somewhat pessimistic, but I think not much short of brute force will lower costs. I am actually getting really tired of the debate. I simply look out and see providers with virtually no incentive and no real pressure to accept something less for their services, with insurers as a useful foil because they are even more despised. "Hey, look at him while I pick your pocket" is pretty much the system we have right now, where everyone points fingers at someone else as the real culprit.
The Dutch system sounds good. It sounds like it operates along the same principle as Medicare, with Part A being automatic without premiums, Part B and Part D being priced more like insurance, with subsidies from the government. I think John Kerry had proposed something like this before as well.
I actually think the PO would be good precisely because it would not require the kind of draconian regulation that would otherwise be necessary to police a truly fair insurance market.
And I am getting tired of Obama standing out there like an impotent fool.
Where We Are
You quote/conclude: "'He operates like a community organizer: let people have their say, let them wear themselves out, then step in and define the consensus.' At his best, I think that gets it about right. And when is Obama going to do this? Next Wednesday in an address to a joint session of Congress."
Yours is the best analysis of the situation that I've read recently. I like the "community organizer" image -- and I like the "rope-a-dope" reminder in one of the posts above. The young man has some skills.
Not quite sure speech to Congress is time to "define consensus." I see Obama as focusing attention next week, refining arguments and narrowing guidelines. Why? Because we've got 4, presumably soon to be 5, committee bills as this point. Some options need to be kept open a bit longer. House and Senate have to pull their committee versions together and each has to pass a bill on the floor, with Senate facing filibuster plus vote. At that point, there will still be two separate bills.
Then will be the time to really "define consensus." Depending on how the situation looks at that point, I can see a follow-up speech, not long, maybe from the Oval Office, either when it comes time for the conference committee to reconcile the two bills, or perhaps just before final vote in each chamber.
It's hard to know what to say to the Repubs at this point. Someone above writes, "If the health care bill passes, the dimwits will loose big in 2010. The public does not want a government-run health care system."
Uh, correct -- unless it's Medicare or the VA or even S-Chip. When the Republican Party tries to score points by presenting itself as the great defender of Medicare for the elderly, as it is now doing, then the argument should be over.