Op-eds by members of Congress, present or former, are rarely worth reading. Today's Washington Post provides one that is. It's about health care reform and its author is Marjorie Margolies.
I agree with Ezra Klein that the House Democrats are foolish to enact health care reform through this "deem and pass" method. And I agree with Ezra, again, that Republicans are being ridiculously hypocritical to attack it as unfair. But that's not why I recommend you read his post. It is, rather, his analysis of why the Republicans are focusing on these attacks:
If the Republicans are going to continue spreading the fiction that Congressional Democrats are playing fast and loose with procedural rules, then D.C. journalists at least have the obligation to fully explain those procedures to their readers and put them in the proper context.
It looks like the coming House vote on health care reform will be the decisive one after all.
Harold Pollack is the Helen Ross Professor of Social Service Administration at the University of Chicago and a Special Correspondent for The Treatment.
More in sorrow than in anger, Washington Times editorialists are concerned that President Obama doesn't do enough to control costs. The Times particularly chides the President for delaying the proposed "Cadillac tax" on costly insurance plans.
A while ago Ezra Klein said he wasn't obsessively following the declarations of every member, in part because everybody would be posturing and he couldn't take their statements at face value. He's got the right idea. It's hard to ignore what members say and, surely, often those statements have actual news value.
The insurance industry is striking back. Attacked by the Democrats, harangued by activists, and reviled by the public, insurers have launched a major public relations campaign designed to make one simple point: It’s not their fault that American health care is so dysfunctional.
There are a lot of thorny issues in American politics that require a great deal of concentrated attention to grasp. The controversy over budget reconciliation and health care is not one of them. It's pretty simple, and can be explained in thirty seconds or so. And yet large chunks of the political class seem unable to grasp it.
Ezra Klein has a big exclusive: He's gotten hold of a consulting firm's report projecting that Wellpoint insurance would be the big winner if health care reform fails to pass. It's not hard to see why, as Ezra explains:
Ezra Klein has a lengthy, thorough response to the arguments that Republican Paul Ryan has made about the Democratic plans for health care reform. According to Ezra, Ryan make a few good points but is mostly wrong. It will shock you, I know, to hear that I agree with Ezra's analysis.
But that's not the reason, or at least the only reason, the article is worth reading. At the end of the article, Ezra reports on an interview he conducted with economist Robert Reischauer:
President Obama says that health care reform will reduce insurance premiums for most people. Senator Lamar Alexander will raise them. Who's right? Obama, although the explanation is a bit complicated. Here's how I explained it back when the Congressional Budget Office first issued its analysis:
Harold Pollack is the Helen Ross Professor of Social Service Administration at the University of Chicago and a Special Correspondent for The Treatment.
A famous political science article describes the legislative battle over a 1956 House bill, HR7535. The bill would have provided federal aid to the states to build schools. Democrats sponsored the bill, which was popular ten years into the baby boom. For familiar pre-election reasons, Republicans wanted HR7535 to die. They got lucky when Harlem Congressman Adam Clayton Powell dropped a hand grenade into the process by proposed an amendment mandating that grants could only be used by states with schools "open to all children without regard to race in conformity with the requirements of the United States Supreme Court decisions."
--Jason Zengerle on Tucker Carlson and The Daily Caller
--Evan Bayh prepares for a career as an evil lobbyist
--Ezra Klein makes a point I was trying to make, but does it much better
Harold Pollack is the Helen Ross Professor of Social Service Administration at the University of Chicago and a Special Correspondent for The Treatment.
Allowing individuals to purchase health insurance policies sold in other states is a key feature of every Republican health care proposal It's also a horrible idea, as Jonathan Chait and Ezra Klein have both explained today. You should read both of their critiques.
Does losing health insurance make you more likely to die? Several years ago, while I was writing my book on health care, I spent a lot of time on that question. I read the two highly publicized reports by the Institute of Medicine (IOM): Care Without Coverage: Too Little, Too Late and Consequences of Unnsurance. I read through the underlying research. And I spoke to as many experts as I could find.
The IOM had concluded that lack of health insurance led to 18,000 deaths a year--a figure that, some experts suggested, was a bit arbitrary. Isolating the effects of uninsurance was just too difficult to arrive at such a specific number. But, plainly, lack of health insurance left people in worse health. Many of them, most likely in the thousands, died every year. The cause-and-effect was certainly consistent with my own observations as a reporter, some of which I'd written about over the years. And so while I didn't make a habit of citing the 18,000 figure, I would (and still do) frequently cite the IOM report, explaining that "thousands" of people die every year because they can't get afford to get recommended medical care.
As you may have heard by now, Megan McArdle has written an article for the Atlantic Monthly questioning that assumption. She's not foreclosing the possibility that uninsurance might make people more likely to die, but she thinks the data hardly support that conclusion. It's not the first time she, or other critics of health care reform, have raised questions about the relationship between health insurance and health outcomes. Since that article's publication, I've been hoping to do what I did a few years ago--sit down with her article, the underlying data, and the compare those with the latest studies on the subject. But I've been too preoccupied with other assignments and tasks.
Ezra Klein, fortunately, has done the due diligence, publishing not one but two lengthy responses to McArdle. He's also posted a guest blog item from the Urban Institute's Stan Dorn, who was the lead researcher on that original IOM study. Austin Frakt has weighed in on this; so has J. Michael McWilliams (guest-posting on Frakt's blog). All of them think McArdle is simply wrong, on the merits. My reading is that they have the better of this argument, by far. But you should read the items, including the rejoinders McArdle posted on her blog, and decide for yourself.
Last year, the Atlantic Monthly's Megan McArdle explained that she opposed comprehensive health care reform because the push to reduce the cost of health care spending would inevitably constrain medical innovation:
Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.
I have before me two tomes. The longer one is a somewhat rushed and tedious product whose guiding ideological vision and fuzzy presentation of crucial details repelled independent voters the last time it was put to an electoral test. The second document is somewhat more succinct and engaging but remains open to criticism for its embarrassingly padded margins and large print that makes it seem so much longer than it actually is. I'll leave you to guess which one is Sarah Palin's memoir and which is the Senate health reform bill.
If you listen to Republicans, they oppose that Senate bill because it is a Rube Goldberg contraption that is just too complicated, too opaque, and fills too many pages. Yesterday, Lamar Alexander gave full voice to this objection speaking with Ezra Klein: "One thing is you can’t be sure what’s in the Senate bill because it's 2,100 pages long. You just know there are surprises in it." He may have good reasons to oppose the Senate bill, but I'm pretty sure that its length and complexity are not his real beef. Congress routinely passes cinder-block-sized tomes that could provide valuable armor plating for tanks headed to Iraq.
Politicians who say that they oppose a bill because it's too long and complicated are generally fibbing. The only mystery becomes: What are they really thinking? In like fashion, a politician who says that she opposes something because it amounts to large-scale social engineering is more likely to believe what she is saying, but she is still telling an untruth. No doubt about it; health reform is ambitious social engineering. So was welfare reform. So were Reagan and Bush (43) tax cuts. So was No Child Left Behind. So was knocking down high-rise public housing here in Chicago. Privatizing Social Security and converting Medicare to vouchers (two favorite Republican ideas) are huge and messy social engineering projects, too.
The idea that Republicans haven’t had a chance to present their ideas on health care reform is a bit mind-boggling. Five separate congressional committees had hearings; each chamber had floor debates. That’s hundreds of hours the GOP had to talk about health care, all of it in public view and televised on C-SPAN. And that’s not even including all of the unofficial channels at the Republicans’ disposal. Generally speaking, the party of Rush Limbaugh and Fox Television doesn’t struggle to get across its message.
President Obama is going to address another Congressional gathering today. The audience will be more friendly this time: It will be the Senate Democratic caucus. But the stakes will be just as high as they were when Obama spoke to Republican House members last week.
Health care is bound to come up at the meeting. I assume Obama will raise it during his prepared remarks; if not, he'll get questions about it. And the big controversy right now is whether the Senate is willing to amend its bill through the budget reconciliation process. It's the only way to make changes to health care at this point, since the Republicans have vowed to filibuster the final vote--and, thanks to the election of Scott Brown in Massachusetts, they have the forty-one votes necessary to sustain it. (In reconciliation, a minority can't block the final vote.) And such changes appear to be necessary, because the House has made clear it won't approve the Senate's bill without some changes.
The problem is that Senate Democrats aren't very happy about taking a reconciliation vote right now. Some worry that the move smacks of partisan politics at a time when the public wants, or says it wants, bipartisanship. Some worry it will seem like trying to bend legislative rules, at a time when voters are clearly angry about the deals Democrats made with special interest groups and some of their own members in order to pass the original bill. And some just want to be done with health care reform, because voters are clearly tired of it and want to hear about jobs instead.
The anxiety is, as you might expect, most pronounced among senators who represent more conservative states and/or are up for re-election this year. Arkansas Senator Blanche Lincoln, who is probably the most vulnerable Democrat running this year, has made clear she'd prefer not to take a reconciliation vote on health care. Her Arkansas colleague, Mark Pryor, has said similar things, as have Indiana Senator Evan Bayh and Louisiana Senator Mary Landrieu. The Democrats can afford up to nine defections and still prevail. But you can conjure up five possible to probable "no" votes pretty quickly--in addition to Bayh, Landrieu, Lincoln, and Pryor you'd include Connecticut's Joe Lieberman.*
The best arguments for moving forward are the ones all of us have been discussing over the last week. All of these senators voted for health care reform already. Republicans will attack them for it no matter what. Their best bet is to pass the bill into law, since that will give them an accomplishment they can tout and clear tangible benefits they show to voters. (As Kevin Drum noted in a must-read analysis, this isn't merely speculative. New polling data suggests Democrats do no worse--and perhaps a little better--politically if they pass a bill. And I'd argue the poll question actually understates the jump, since there's no way for people to know how they'll vote ten months from now.)
Voting for reconciliation will also change the media narrative and clear a path for passing more legislation going forward, even with a "mere" majority of 59 votes.
But there is at least one other reason the Senate ought to go forward with reconciliation.
Since the State of the Union address, especially his back-and-forth with House Republicans, President Obama has focused a great deal of attention on Republican obstructionism. These two posts from Jim Fallows have gotten some attention, including from me. But the topic needs to be considered with a bit more precision.
They're not mine. They're Ezra Klein's. And he nails it. Read both of them. Then read the David Herzenhorn article from the New York Times that Ezra references.
Is health care reform dead? Megan McArdle says so, offering two arguments -- one persuasive, the other not. Her unpersuasive argument is that Democrats are going to walk away from health care reform because it's unpopular:
ince conservatives continue to swoon unashamedly over Paul Ryan and his near-unique ability to ability to discuss health care at some higher level than Fox News talking points -- more examples of the Ryan love-fest can be found 
