Editore"s Note
Tilting at Windmills

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April 24, 2009

RECONCILIATION = HEALTH CARE REFORM.... About a month ago, Sen. John McCain (R-Ariz.) conceded that "Republicans have in the past engaged in using reconciliation to further the party's agenda," and aren't in a position to complain if Democrats choose to do the same. Yesterday, a leading House Republican said something similar.

In an interview with ABC News on Thursday ... Rep. Paul Ryan (R-Wis.) went way off script, acknowledging that the mandate delivered by the election gives Democrats the "right" to push their policy proposals.

"It's their right. They did win the election," said Ryan, a respected member of House Republican leadership. "That's what I tell all my constituents who are worried about this. They won the election. They did run on these ideas. They did run on nationalizing health care."

The GOP repeatedly decried Democratic policies during the campaign as socialist and as wealth distribution. Yet voters chose them anyway.

A faction of congressional Democrats is pushing to use a budget process known as reconciliation to push through health care reform. Reconciliation means that only a simple majority is needed to pass the bill in the Senate, defanging any GOP filibuster threats.

"They have the votes with reconciliation," said Ryan. "They nailed down the process so that they can make sure they have the votes and that they can get this thing through really fast. It is their right. It is what they can do."

This, of course, isn't even close to the usual Republican line. The typical argument is that Dems don't have the "right" to pass key bills under reconciliation; only Republicans have that right.

What about the cost of annoying the congressional minority party by using the same legislative tactics they utilized? Igor Volsky makes a compelling case that it seems the reconciliation process is the only realistic way to get health care reform passed, precisely because the congressional minority has no interest in playing a constructive role in the process.

And Jonathan Cohn did a nice job yesterday explaining the larger dynamic: "It's hard to overstate how radically the reconciliation option would shift the dynamics of debate. It's not just that it would make passage of a bill more likely. It's that it would utterly redefine the conversation."

Steve Benen 11:15 AM Permalink | Trackbacks | Comments (13)

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Plus, using ereconciliation means we can tell Ben "Legend in his own mind" Nelson to go diddle himself. A win-win all around. Need to use this to cut the middleman out of student loans. War Room points out Nelson gets more money from the insurance company than any other source, followed closely by the student loan ripoff industry.

Posted by: TCinLA on April 24, 2009 at 11:17 AM | PERMALINK

It is the right way to go, especially since they can shape the bill anyway they want and won't have to water it down to get support of people that will use it to further their own agenda. If the republicans had in anyway acted in good faith, we might have been able to let them share the credit for something that is going to be very popular. But their constant obstruction of everything, even nominees that they would normally support has earned them being cut out...fuck em.

Posted by: Patrick on April 24, 2009 at 11:24 AM | PERMALINK

"The typical argument is that Dems don't the 'right' to pass key bills under reconciliation; only Republicans have that right."

Please fix the typo; it's the crux of your argument.

Posted by: monocle on April 24, 2009 at 11:27 AM | PERMALINK

From a political-strategy point of view, perhaps it makes more sense for the Republicans to accept reconciliation and prepare to whine about the OMG SOCIALIZED MEDICINE that the Democrats have imposed on the country, than to filibuster and be denounced as obstructionists.

Posted by: Seth Gordon on April 24, 2009 at 11:29 AM | PERMALINK

Actually, we know Republicans do not want a voice in the process and will do anything they can to obstruct. Reconciliation will be used to keep the fate of reform out of the hands of certain Democrats who will do what they can to obstruct as well.

Posted by: Matt on April 24, 2009 at 11:35 AM | PERMALINK

Republican Senators may not support the budget reconciliation pathway, but 95% of the American public does when it comes to health care. The question Senate Republicans need to ask themselves is what will they be doing after their defeat in their next election cycle, be it '10, '12, or '14! -Kevo

Posted by: kevo on April 24, 2009 at 11:38 AM | PERMALINK

And when will there be any pushback on calling anything being proposed as "nationalizing healthcare"? The term "nationalized medicine" is where the national government has DIRECT CONTROL over all healthcare decisions, and is also usually characterized by the doctors being government employees and the consumer pays little or nothing directly (e.g., Veterans Administration healthcare, which scores very high on consumer satisfaction, thank you very much). Even "single payer" doesn't come close to this.

As an aside, why is it that "having the government (which is primarily concerned with effective care) decide what is covered" better than "having a private company (who has a profit motive in not granting coverage) make the decision"?

And to wrap up, calling any sort of reform that's on the table as "nationalized medicine" is the moral equivalent of trying to restrict the sale of Teflon-coated ammunition (i.e., "cop killer" bullets) being equated with gun confiscation...

Posted by: artsmith on April 24, 2009 at 11:43 AM | PERMALINK

wow, golly, thanks Republicans for allowing the winners of the 2006 and 2008 elections to govern by majority rule for one issue.

Posted by: Steve Simitzis on April 24, 2009 at 11:49 AM | PERMALINK

Healthcare Reform: Changing the Incentives and the Rules of the Game.

If you have the financial resources of Bill Gates or Warren Buffett you needn�t pay money to a health plan each month, since if you get sick or injured � even very seriously - you obviously have more than enough money to pay all your medical bills yourself.
But those of us with significantly less financial resources must find some other means of dealing with the thousands or even hundreds of thousands of dollars of medical expenses that we might incur should a serious illness or injury be our fate.
Enter the concept of �health insurance�.
Large numbers of individuals put some of their money each month into one or another big pot called a �health plan�. Those individuals who remain essentially healthy and then suddenly die or leave a particular health plan for some other reason - having put more into the pot than was taken out to pay their medical expenses - wind up helping to pay the medical bills of those who are very seriously acutely ill or injured or become chronically ill and have a lot of medical expenses.
Getting someone else to help pay one�s medical bills seems to have become a very common and socially acceptable expectation for many Americans. Some even think it is a �right� they either do have or should have, simply because they are an American citizen. Some see it as a �right� of all members of the species, Homo sapiens.
In a health plan, the monthly premium money goes into the health plan�s big pot from which �covered� healthcare expenses are paid. But what is also paid out of the pot are all the administrative expenses including big salaries and golden parachutes for CEO�s and other �healthcare executives� � individuals who are paid to find technicalities of one sort or another in the health plan�s agreements so they can somehow deny payments, raise premiums, cancel insurance, or in some other way minimize or exclude �bad risks� from the health plan.
If this system in which large numbers of people pool their money to pay the medical bills of all those in the plan - is going to work, rules must be established as to when and how much money may be taken out of the pot (e.g. �legitimate� doctor and hospital bills and administrative costs) as well as how much money must be flowing into the pot each month in premiums paid by members of the health plan so the pot does not become empty.
But the critically important but underappreciated enemy in all of this that must be overcome, however, is unnecessary illness and injury.
We speak about our �healthcare system� and understand that the continually rising costs we are experiencing are unsustainable. But a lot of illness and many injuries are actually preventable. What we fail to focus on, however, is that other than members of a health plan (or their employers who actually pay the monthly premiums) and the employees of the health plan itself, few participants in what should be more appropriately called our �sickness and injury care system� have any real incentive whatsoever to genuinely promote health and prevent disease and injury.
Much to the contrary. Because of the way they are paid, most participants in our sickness and injury care system have an enormous (if unspoken) incentive for continuing to have massive amounts of disease and injury occur in America - the more of it and the more serious, the better - as long as those who are diseased and injured are �covered� by �good insurance�, i.e. health plans who are reliable bill payers.
That is not to say that there are not some excellent and very dedicated hardworking doctors and other health professionals - who are generally paid to care for illness and injury on a fee for service basis - who nevertheless are attempting to essentially work themselves out of a job by strongly encouraging prevention with their patients. And it also should be recognized that some existing health systems � e.g. Kaiser and Group Health - combine insurance, doctors, and hospitals into a single entity in a way that provides everyone - including all their doctors - a real incentive for prevention as well as early diagnosis and treatment. But unfortunately the above two examples do not apply to most of our sickness and injury care system in America.
Because of the way they are paid, most doctors and other professional providers, acute care hospitals and long term care facilities, pharmaceutical manufactures and pharmacists, medical and surgical equipment manufacturers, personal injury and malpractice attorneys, and others depend mightily on massive amounts of disease and injury occurring in America and would be significantly negatively impacted if a lot of the preventable illnesses and injuries were actually prevented.
Unless the incentives and rules are changed to give as many participants as possible a real stake in prevention, early diagnosis and treatment, and maximizing health and minimizing disease and injury, getting healthcare costs under control will never happen. Changing the incentives and the rules of the game is the real task of �healthcare reform�.
For example, why not financially incentivize individuals? It is well recognized that engaging in regular exercise, abstaining from tobacco, eating a healthy diet, and maintaining a reasonably normal body weight are all significant factors in helping to promote an individual�s health and wellness. These healthy behaviors can all be easily confirmed by simple tests in a doctor�s office. Why shouldn�t those individuals who practice these health promoting behaviors pay significantly less for their health insurance than those who don�t?
To really reform healthcare we must figure out ways � through changes in incentives and the rules of the game - to maximize good health and early diagnosis and treatment, and minimize disease and injury and all associated costs. Every participant needs to have a real stake in prevention, rather than merely giving lip service to prevention while actually thriving only on illnesses and injuries.
Significant changes in the rules of the game in our legal system � tort reform - must also be made so that the gaming of the system by personal injury and malpractice attorneys and their clients is ended.
All this may be a formidable task that has never really been done anywhere else before. But it is a worthy task and now is the time for Americans to step up to the plate and do it.

Posted by: Robert Westafer on April 24, 2009 at 1:56 PM | PERMALINK

Geez...get a web site.

I've been saying this from the git-go. Republicans have announced that they will filibuster ANY health care reform and prevent a public national health care ins program because it would make the dems too popular and they would win elections for years to come. Got it? It has nothing to do with plans or policies or the 'public good'...just stopping dems from being successful.

Therefore the only way ANY health care ins. reform will get passed is by the reconciliation process in the senate. Enter the "Blue Dog Dems" whose only function is to ensure that health care reform does not get through by the reconciliation process. These are the bought and sold DINOs function but hopefully some will come to their senses as the importance of this issue to the American people is so strong that their political careers will be at stake. We'll see...

Posted by: bjobotts on April 24, 2009 at 2:51 PM | PERMALINK

Meanwhile, as various blogs and news outlets cover this news in a sensible way, the New York Times runs a 'news' article by Carl Hulse that calls reconciliation 'obscure' and 'arcane', and reports that the use of reconciliation might "touch off a nasty partisan fight with Republicans."

Remind me, again, about why we need mainstream paper-based media outlets that can avoid the 'unreliable' blogsphere and report in an objective and well-informed way?

Posted by: PQuincy on April 24, 2009 at 3:36 PM | PERMALINK

This recent Republican plan reminds me of the old Soviet Union and how nobody could ever disagree with anything and there was always the question of who would stop applauding herr leader first.

Today's Republicans stand united and say, "No" regularly. It isn't much.

Posted by: MarkH on April 24, 2009 at 5:40 PM | PERMALINK

WHEN are Democrats going to learn that they need to reframe it? Sure technically it's called the reconciliation process, but didn't the Republicans call it something else before?

A simple up or down vote, as I recall.

Why aren't the Democratic talking heads calling it a FAIR up or down vote - the way the Senate is supposed to work.

Don't let Republicans frame the issue again, because as soon as the reform has a glitch, they'll claim Democrats rammed it through congress. When a resolution or law is passed by 50 + x votes, it is legally passed. Do not let Republicans say that the Senate requires 60 votes.

Where is the Democratic Leader of the Senate when you want one?

Posted by: bruno on April 24, 2009 at 11:39 PM | PERMALINK



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