PrintEzra Klein explains that scaling back the current health care bill doesn't work -- the whole thing would fall apart. He's right. He then argues that starting from scratch would look different:
If you want to pare back, you need a different approach altogether. You could reduce the cost, the size of the bill, the complexity of the legislation, and the number of regulations by just expanding public programs that helps the most vulnerable groups: Let people over age 50 into Medicare, expand Medicaid to people under 200% of the poverty line, and pay for it through a tax on the rich.
He's right that this would advance some policy goals. But the chances of this, or something remotely like it, passing into law are approximately zero. The Democrats biggest worry right now, I have been reliably informed (Yes -- reporting! I try not to make a habit of it), is that they think health care has just taken too much time. The want to pivot to an economic message. Writing a new, even smaller health care bill takes a lot of time. There are delicate compromises with interest groups who have the power to destroy legislation if they feel threatened. There are negotiations in two chambers. The senate is feeling incredibly skittish right now and probably unwilling to vote for anything stronger than a resolution saying that if anybody dies because they couldn't afford medical treatment it would be a darn shame. (And that resolution would come after months of begging Olympia Snowe to cast the filibuster-breaking vote.)
There are only two options on health care: Something that involves passing the Senate bill through the House, and nothing. There's no fantasy moderate bipartisan alternative. Once Congress gets that through its head, I think -- I don't know but I think -- they'll make the obvious choice.
COMMENTS (14)
They could pass a payroll tax deduction as a stimulus if they want to show how much they care about the economy (I've seen this suggested elsewhere -- it's a tax cut so the GOP can't complain, and it's generally a progressive tax deduction as the payroll tax is regressive) -- immediately after passing the senate bill.
They could pass a payroll tax deduction as a stimulus if they want to show how much they care about the economy (I've seen this suggested elsewhere -- it's a tax cut so the GOP can't complain, and it's generally a progressive tax deduction as the payroll tax is regressive) -- immediately after passing the senate bill.
Or maybe nothing progressive will ever be passed by Congress again: http://blogs.wsj.com/law/2010/01/21/campaign-spending-laws-eased-in-big-...
Or maybe nothing progressive will ever be passed by Congress again: http://blogs.wsj.com/law/2010/01/21/campaign-spending-laws-eased-in-big-...
If they can't pass the Senate bill as-is in the next two weeks, go back and work on something smaller, bi-partisan and less controversial over the next 6 months. But don't make it a priority. If Republicans won't play by July, just pass the sacre thing with Democratic votes and go home and tell the voters how Republicans hate sick people and love insurance companies. It won't accomplish many policy goals, but I bet it will get the Democrats through the 2010 elections without losing control of either chamber.
If they can't pass the Senate bill as-is in the next two weeks, go back and work on something smaller, bi-partisan and less controversial over the next 6 months. But don't make it a priority. If Republicans won't play by July, just pass the sacre thing with Democratic votes and go home and tell the voters how Republicans hate sick people and love insurance companies. It won't accomplish many policy goals, but I bet it will get the Democrats through the 2010 elections without losing control of either chamber.
wildboy, there is no conceivable "smaller," "bi-partisan" or "less controversial" option on healthcare. Doesn't exist for two reasons: First, Republicans will oppose any major Democratic bill. Any bill proposed by Democrats will therefore be exactly as "controversial" and "partisan" as the current bill. Second, any "smaller" bill won't achieve any of the objectives of healthcare reform. No smaller bill can conceivably produce significantly wider coverage, nor prevent insurance abuse of the insured, nor break the cycle of rising costs.
The current bill is the only conceivable model for using a private-insurance model to achieve affordable, universal coverage: individual or employer mandate, p ... view full comment
wildboy, there is no conceivable "smaller," "bi-partisan" or "less controversial" option on healthcare. Doesn't exist for two reasons: First, Republicans will oppose any major Democratic bill. Any bill proposed by Democrats will therefore be exactly as "controversial" and "partisan" as the current bill. Second, any "smaller" bill won't achieve any of the objectives of healthcare reform. No smaller bill can conceivably produce significantly wider coverage, nor prevent insurance abuse of the insured, nor break the cycle of rising costs.
The current bill is the only conceivable model for using a private-insurance model to achieve affordable, universal coverage: individual or employer mandate, plus insurance reform, plus subsidies. There is no other, smaller model that keeps in place an extensive private insurance industry. Pass reform without all three elements, and you'll inevitably make the situation worse, wrecking the market and making insurance more expensive, harder to obtain, and thereby causing even more people to lose their insurance. (Unless you just focus on subsidies without concern for the federal budget: that's a "small" reform that would allow healthcare to be universal and affordable, but it would be even more "controversial" and "partisan" than the current bills.)
After spending a year telling us that only "comprehensive" reform will work, Congress and all the "experts" will get behind more modest but good reform? And give the Republicans a "were you lying to us then or are you lying to us now" kind of opportunity. Don't think so. But it would make great theater.
After spending a year telling us that only "comprehensive" reform will work, Congress and all the "experts" will get behind more modest but good reform? And give the Republicans a "were you lying to us then or are you lying to us now" kind of opportunity. Don't think so. But it would make great theater.
Rhubarbs, I'm with you, Cohn and everyone else on how only comprehensive reform would work in practice. Unfortunately, the ability to pass a comprehensive reform bill just died today and any attempt to revive it now would suck out precious air and political capital from the Democrats. The only thing worse than not passing comprehensive health reform in this Congress is spending another 6 months trying to pass a new comprehensive health reform bill to the exclusion of everything else. If you're a voter who is pissed about the economy and the fact that your elected representatives spent the better part of a year wading around in the weeds of health care subsidies, you won't vote Democrat in ... view full comment
Rhubarbs, I'm with you, Cohn and everyone else on how only comprehensive reform would work in practice. Unfortunately, the ability to pass a comprehensive reform bill just died today and any attempt to revive it now would suck out precious air and political capital from the Democrats. The only thing worse than not passing comprehensive health reform in this Congress is spending another 6 months trying to pass a new comprehensive health reform bill to the exclusion of everything else. If you're a voter who is pissed about the economy and the fact that your elected representatives spent the better part of a year wading around in the weeds of health care subsidies, you won't vote Democrat in November. Period.
My solution here is pure politics, and not policy. Don't walk away from health care like the Dems did in 1994, but it on the back burner for now. Have some more chats with Olympia Snowe or Scott Brown or whoever, so that the average elderly voter who still watches the local news and reads the local papers is happy that people are coming together over something. Then patch together something called "insurance reform" that bans discrimination, increases state Medicare eligibility thresholds and subsidies, creates high-risk pools and throws some kind of tort reform bones to moderate Democrats. Will it potentially screw up health care costs? Yes, but it will get you to 2011 in one piece. I rarely praise bad policy even if it contains good politics, but this is the one time I would make an exception.
No, this is a CHOICE. Bill Clinton forced a less-friendly House to raise taxes in 1993. The result was 1) the Dems lost control of Congress and 2) we had the longest sustained period of prosperity of my lifetime (and the only one where African-Americans closed (slightly) the economic gap). Obama faces a similar choice -- the downside may not be as bad (in 1993 there were still dixiecrat remnants where realignment was probably inevitable, gun rights advocates were more fired-up and Somalia was particularly damaging) but even if it was, would a presidency of health care reform + saving the economy from bottoming-out + readjusting our war strategy be so terrible? And Clinton, even with a GOP ... view full comment
No, this is a CHOICE. Bill Clinton forced a less-friendly House to raise taxes in 1993. The result was 1) the Dems lost control of Congress and 2) we had the longest sustained period of prosperity of my lifetime (and the only one where African-Americans closed (slightly) the economic gap). Obama faces a similar choice -- the downside may not be as bad (in 1993 there were still dixiecrat remnants where realignment was probably inevitable, gun rights advocates were more fired-up and Somalia was particularly damaging) but even if it was, would a presidency of health care reform + saving the economy from bottoming-out + readjusting our war strategy be so terrible? And Clinton, even with a GOP Congress, managed to enact some decent legislation.
The point is that while this mess isn't Obama's fault, he has a choice. Nobody is going to convince me that Obama can't get the senate bill passed by the House by bribery/threat/persuasion -- just like the Clintons did with the 93 budget -- if he wants to. I've frequently criticized Obama for not spending his political capital on anything but his own political ambitions. Here's his golden opportunity to answer history with something other than his election.
wildboy, your approach hands the Republicans a propaganda victory.
"See, we stopped Obama and the government takeover of health care dead in its tracks! Praise God!"
Democrats can't be seen backing down this late in the game. And do you really think that getting a compromise will be easier the closer we get to Election Day?
Congress need to pass, and pass soon, a bill that the President can sign, so the focus can be changed back to the economy. Time is not on our side.
wildboy, your approach hands the Republicans a propaganda victory.
"See, we stopped Obama and the government takeover of health care dead in its tracks! Praise God!"
Democrats can't be seen backing down this late in the game. And do you really think that getting a compromise will be easier the closer we get to Election Day?
Congress need to pass, and pass soon, a bill that the President can sign, so the focus can be changed back to the economy. Time is not on our side.
Zardoz, what I'm suggesting is the real Plan B (or Plan C) if they can't pass the Senate bill as-is. It seems like the consensus now is that Pelosi hasn't given up entirely, but is simply saying that the votes aren't there today. Fine, get the votes by the SOU or the end of next week. But they aren't there by then, then move on. How much of a Republican victory would it be if they spent another 9 months noodling on health care without further results?
Zardoz, what I'm suggesting is the real Plan B (or Plan C) if they can't pass the Senate bill as-is. It seems like the consensus now is that Pelosi hasn't given up entirely, but is simply saying that the votes aren't there today. Fine, get the votes by the SOU or the end of next week. But they aren't there by then, then move on. How much of a Republican victory would it be if they spent another 9 months noodling on health care without further results?
Lymon, Clinton passed some decent legislation BECAUSE he had a GOP Congress. Welfare reform NEVER passes if the Ds are in charge. The same on free trade, generally speaking.
Lymon, Clinton passed some decent legislation BECAUSE he had a GOP Congress. Welfare reform NEVER passes if the Ds are in charge. The same on free trade, generally speaking.
wildboy, I still see that as a distinction without a difference.
Whether Congress spends nine months tinkering with the current bill, or cobbling together a new one, that's nine months not spent on the economic issues that need to be addressed before Election Day.
The longer this process is extended, the likelihood of getting nothing in the end increases.
wildboy, I still see that as a distinction without a difference.
Whether Congress spends nine months tinkering with the current bill, or cobbling together a new one, that's nine months not spent on the economic issues that need to be addressed before Election Day.
The longer this process is extended, the likelihood of getting nothing in the end increases.
And let me repeat that any sign of delay in passing the current bill, or of returning to the drawing board to create the "insurance reform" you mentioned (even if it passes), will be spun by the conservatives as a great defeat for the Democrats.
I can already hear Glenn and Rush cackling if this happens.
And let me repeat that any sign of delay in passing the current bill, or of returning to the drawing board to create the "insurance reform" you mentioned (even if it passes), will be spun by the conservatives as a great defeat for the Democrats.
I can already hear Glenn and Rush cackling if this happens.
butchie makes a good point -- Clinton took on some conservative thinking and made it a Dem objective, so in a sense the GOP had to work with him. But the problem now is that you can't find a single Republican who is prepared to note the fact that the HCR legislation is a centrist as it gets, especially with the public option dead. It's essentially a Romneyite law [note to self: 2012 is going to be really interesting on the GOP side!], and there is no reason whatsoever that moderate Republicans couldn't support it.
Except what's happened to their party.
butchie makes a good point -- Clinton took on some conservative thinking and made it a Dem objective, so in a sense the GOP had to work with him. But the problem now is that you can't find a single Republican who is prepared to note the fact that the HCR legislation is a centrist as it gets, especially with the public option dead. It's essentially a Romneyite law [note to self: 2012 is going to be really interesting on the GOP side!], and there is no reason whatsoever that moderate Republicans couldn't support it.
Except what's happened to their party.
"It's essentially a Romneyite law ... and there is no reason whatsoever that moderate Republicans couldn't support it"
And now we have a new senator from Romney's state, with yet another dubious reason to oppose the plan: "hey, we've got a good thing here; let's not share."
Thanks, GOP. Keep on making America great.
"It's essentially a Romneyite law ... and there is no reason whatsoever that moderate Republicans couldn't support it"
And now we have a new senator from Romney's state, with yet another dubious reason to oppose the plan: "hey, we've got a good thing here; let's not share."
Thanks, GOP. Keep on making America great.