HEALTH CARE REFORM ‘ENDGAME’ AFOOT?
Ezra Klein, blogger for the Washington Post, appears to be a conduit for the Obama administration to both Congress and the American people as he apparently has gotten information on what the White House wants us to believe they are thinking regarding how they are going to rescue health care reform.
There are wheels turning within wheels here, so it is as important to note what isn’t being said as much as what message the White House wants Klein to be sending.
According to Klein there are two camps in the White House on what kind of reform package the president will actually put down on paper and highlight in his joint session speech next Wednesday:
The first camp could be called “universal-lite.” They’re focused on preserving the basic shape of the bill. They think a universal plan is necessary for a number of reasons: For one thing, the insurance market regulations don’t work without universality, as you can’t really ask insurers to offer standard prices if the healthy and the young don’t have to enter the system. For another, it will be easier to change subsidies or improve the benefit package down the road if the initial offerings prove inadequate. New numbers are easier than new features. Creating a robust structure is the most important thing. This camp seems to be largely headed by the policy people.
The second camp is not universal at all. This camp believes the bill needs to be scaled back sharply in order to ensure passage. Covering 20 million people isn’t as good as covering 40 million people, but it’s a whole lot better than letting the bill fall apart and covering no one at all. It’s also a success of some sort, and it gives you something to build on. What that sacrifices in terms of structure it gains in terms of political appeal. This camp is largely headed by members of the political team.
Both camps accept that the administration’s proposal will be less generous than what has emerged from either the HELP or House Committees. The question, it seems, is how much less generous.
For the administration to admit that there is a split into two camps probably means that there are not only more than two but that reform is causing the Obama administration to slowly unravel. There seems to be a rift between the far left, and the practical left, with the ideologues more numerous, but lacking the clout of the Rahmbo wing in the administration.
It is also significant that the ideologues are still pushing a strong public option. I referred to the public option as a “Zombie” on my radio show because it’s still walking around, not realizing it has been killed. The numbers are just not adding up in the Senate for any kind of a public option, but it continues to be pressed because the ideological base of the Democratic party refuses to sign off on any reform that doesn’t include it.
The bottom line is that it is a very difficult uphill climb for Obama to achieve any kind of legislative success on health care reform. At the moment, he just can’t get there from here. The practical left realizes that but will have an enormously difficult time convincing the ideologues to drop the public option and go for more modest reforms.
A couple of thing are certain; Obama going before Congress means that the process will not be shut down, that there will be bills emerging from both the House and the Senate, that there will almost certainly be votes on those bills, and that passage in the House of a more liberal bill is almost assured.
The senate process apparently hinges on one lone senator - Republican liberal Olympia Snowe - who has taken it upon herself to negotiate for the entire party:
The answer appears to hinge on Sen. Olympia Snowe. “I’m a Snowe-ite,” joked one official. Her instincts on health care have proven quite a bit more liberal than those of many Democrats. In the Gang of Six meetings, she joined Sen. Jeff Bingaman in focusing on affordability and coverage - putting her, in practice, somewhat to the left of Conrad and Baucus. The problem is that Snowe is scared to be the sole Republican supporting this bill, not to mention the Republican who ensures the passage of this bill. The reprisals within her caucus could be tremendous.
If Snowe drops off the bill, using the budget reconciliation process will probably be a necessity. The bill then goes through Sen. Kent Conrad’s Budget Committee, giving him much more power over the product. The absence of any Republicans repels at least a couple of conservative Democrats. Passage becomes much less certain, which means a scaled-back bill becomes much more likely. This is the irony of the health-care endgame: The bill becomes much more conservative if it loses its final Republican.
I don’t think Snowe will still be a Republican by the end of the year - especially if she is responsible for the passage of the kind of reform being contemplated. Even on judges, she has become an unreliable vote. The question is going to be asked why she didn’t leave sooner.
At this point, it appears the senate will use reconciliation to pass their version of health care - a considerably more “conservative” version than will be passed by the House. At that point, the real headknocking will begin and we’ll see some blood on the floor in the Democratic caucus. I’d say the chances are no better than 60-40 for any kind of bill by the end of the year. I base this on the fact that the president has failed to show leadership on the issue to this point, and expecting him to suddenly acquire the skills to ram this thing through Congress when he has shown no such ability previously is taking a lot on faith.
A couple of other things.
1. Cost “savings” in any White House package will be nothing more than smoke and mirrors. They will try to sell their version of reform as almost revenue neutral through dishonest accounting, hiding some costs in out years of the budget, as well as grossly exaggerating the dollar amounts that would be saved in specific provisions. Any CBO estimates will be ignored. Even in a scaled down version of reform, it will be the only way to fulfill Obama’s promise of not signing a bill that adds to the deficit.
2. The chances of the White House and the Democratic party imploding over reform are fading as Obama becomes more engaged on the issue. Differences will be papered over to the extent that they can because all sides realize the enormous stakes involved. The president’s defenders may dismiss the idea that his administration would be castrated by a failure to vote out a reform bill, but the rest of Obama’s agenda is in deep peril unless he can deliver. He is asking his party to go far, far out on a very thin limb. There are enough vulnerable members who would likely not forget being left to hang if the president can’t get anything done.
Pretty sharp analysis with one exception: the “implosion” of the Democratic Party already has happened as the Far Left and mainstream Democrats have turned on one another. While too early to say how this will impact the 2010 election, it appears an unknown number of moderate Democrats already have been deemed expendable by this Administration.
The decision to sacrifice 20 or considerably more Blue Dog Democrats actually was made when this Administration and the House leadership rammed through Cap and Trade. By the time moderate Democrats realized what had been done to them, Cap and Trade had barely passed.
There simply is no way for Obama to uncouple that ruthless calculation from his push for health care reform, unless…the Senate kills Cap and Trade, which seems more likely with the current legislative carnage.
So the next ruthless Obama calculation will be to deny safe left-wing Democrats both health care with a public option and any substantive type of Cap and Trade, which in my mind is a wonderful turn of events. The left-wingers will bitch and moan yet fall into line, and the Blue Dogs will vote for a very watered down “reform” and hold their collective breath in anticipation of next year’s election. A substantial number are gone already, but this cover will salvage a few others.
You can take the politician out of Chicago…
Comment by jackson1234 — 9/3/2009 @ 8:36 am
I wouldn’t exactly call it an implosion. More like selective bought-and-paid-for influence. A quick review of campaign contributions will pretty much tell you exactly how each Democrat will vote on the issue.
Comment by Chuck Tucson — 9/3/2009 @ 9:18 am
The Obama administration, which doesn’t amount to much to begin with, will almost certainly implode entirely in the next 6-8 weeks. He will then attempt to govern by presidential orders and unvetted Czars, but even the Congress will become unsettled by this and will cut him off at the knees and force the firing of the Czardom!
None of this will matter all that much, since in November 2010, most of the present membership of Congress will be defeated by an untried candidate.The good thing about all of this is that not even George Soros has enough money to buy himself a whole new bunch of Congress-critters!
Our founders never envisioned service in the House or Senate as a full time, lifetime occupation or profession. They always intended that they come to meet for several months each year, do the business needed and then head home to work their farms, or run their factories or whatever it was that was their real occupation.
Comment by Gayle Miller — 9/3/2009 @ 11:23 am
How stupid is Snowe? She voted for the stimulus. Even her left-leaning constituents don’t like it now. But she is going to run into a plane prop over a public option that even, maybe especially, folks Up East find offensive because they remain fiscal cons, like my parents? Freakin’ Christ. Is there a name for suicidal RINOs? Collins won’t do it, give her that one.
Comment by obamathered — 9/3/2009 @ 2:12 pm
Keep your mandates off your prostates.
The Rubicon is not Public Option. It’s the mandates. Any bill that has individual mandates is Unconstitutional.
Comment by Travis Monitor — 9/3/2009 @ 10:15 pm
“The chances of the White House and the Democratic party imploding over reform are fading as Obama becomes more engaged on the issue.”
That increases the implosion factor. Imagine if Bush spent all of 2006 being ‘all Iraq, all the time’… oh wait, no need to imagine.
Comment by Travis Monitor — 9/3/2009 @ 10:16 pm
The minimal November mid-terms take on a bigger role now, especially if nothing’s passed before Nov. 3. There aren’t all that many races up for grabs, but people (especially politicians) remember the Republican wipe-out of the Dems in the ‘93 midterms was a portent for things to come in 1994, and candidate filing time starts in some places just a month after the elections. If you see similar results to ‘93 this time around, it’s hard to picture some of the Democrats in the purple or red areas suddenly becoming emboldened to push forward on health care, especially since the House’s version in likely to be more liberal than what comes out of the Senate.
Comment by John — 9/4/2009 @ 8:06 am
The Democrats and obama had absolutely zero plans to cut care on middle class Americans. The first thing to do would be allow people to purchase care from other states to get better cheaper care. Than you would get rid of the FDA to make it so drug prices go down and we can drug prices down quicker. And there still will be a market for FDA approved drugs if you want them. Yet if you had a choice between paying 50$ less for a drug that has been on the market for two years would you take it. Than through tort reform like loser pays to get rid of the slip and fall lawyers. Also lets just look at it like this another way to cut the price of care would be through insurance companies not making profit through selling the insurance, but by people accessing the insurance. Which lets say you break your arm you pay 50 to a 100 bucks to access the care. And I wouldn’t force any insurance companies to do this, because if one company does this than they all will or else there out of business. Also to get everyone care you would replace medicaid and medicare with private investment accounts in renewable energy such as Nuclear and Geothermal energy. So when you are retired or out of work you can be giving money from these accounts to purchase care. And by giving everybody a thousand dollars at birth and by revenues from that going to purchase more care you would get more stock in the plants so you’ll be able to save taxpayer money and get everybody care, because this sure beats obama’s plan.
Comment by charles — 9/4/2009 @ 8:13 am
Yeah, what they said: it seems to me that by forcing Democrats onto that “thin limb” Obama is courting the very implosion you believe is fading. Also, I really don’t see how legislation can pass, especially in light of today’s unemployment numbers. Americans care about jobs (with health insurance) and not about spending another trillion dollars.
Comment by Eric — 9/4/2009 @ 8:47 am
The endgame is afoot… but it is a feint. Embedding a “trigger” is nothing more than a trojan horse to enable their ultimate implementation. Any Senator that changes their mind because of this subterfuge is either too stupid to hold office or is looking for any excuse to be able to vote for it (and I think a lot of Blue-dogs are both).
Comment by lionheart — 9/4/2009 @ 9:01 am
If you watch cable news at all, you’ve seen the ads for “health care reform”, now being called “health insurance reform”. “It is an interesting subtle switch in language”. Mike Oliphant runs a small Utah health insurance website http://www.dentalinsuranceutah.net whom deals with people day to day struggling to find affordable coverage. “I think it’s important to not understate the huge difference in meaning between “health insurance reform” and “health care reform”. Let’s not lose focus on the need to reform a broken health care system which includes not only health insurance carriers but also billing practices of medical providers. Why isn’t TORT reform part of the national discussion? Studies show that alone could lower costs by 15% for both the medical professionals and health insurance carriers (Humana). Perhaps the federal government should take notice of what Utah has accomplished with first step of health insurance reform and promises for reform in the medical provider arena. Several interesting changes took place with the passage of H.B. 188. House Speaker Clark has championed the need for change while recognizing the experience of the private health insurance sector. To see more about this visit http://www.prweb.com/releases/utah_health_insurance/health_care_reform/prweb2614544.htm
Comment by Mike — 9/4/2009 @ 11:48 am
If a real,100% publicly funded health care system were on the table, things would be different. Compromise is killing the bill. Compromise exposes weakness and the right has been able to take advantage of it. The people would be behind a system were they didn’t have to pay anything for health care.
You’re joking, right? You’re talking 1/6 of the economy just being handed out for “free?” Doctors going to work for “free?” Hospitals treat you for “free?” Drug makers come up with miracle drugs for “free?”
You must be very young - or incredibly stupid. Everybody would pay for that “free health care” in the form of taxes - unsustainably high, economy killing, job destroying, massively unfair taxes.
Get a life, kid. Get a job.
ed.
Comment by Dred Dog — 9/4/2009 @ 4:34 pm
Listen obama tried to do the opposite of Clinton and that was letting Congress write a bill. Now what happened is it became to expensive and there was a serious of other problems. Now pretty much the same thing came with Clinton, but him and Hillary wrote the bill. So the only way this would ever get passed would be if they offered way to much pork in the bill, because they would just say hey hears 500 million dollars so you can build a memorial to Martin Van Buren.
Comment by charles — 9/4/2009 @ 5:46 pm
Just wish that the Republicans would advocate for reforms to occur closer to the people. At least, they could call attention to the fact that the Obama administration is thwarting state plans to insure more people:
http://www.gopideas.com/~gopideas/page/obama-denies-hoosiers-subsidized-health-insuarance
Comment by Paul — 9/5/2009 @ 9:22 pm