October 21, 2009
LAY OF THE LAND, PART II.... OK, so we talked about how things are going for health care reform in the Senate. Now, let's tackle the House, where there's more movement afoot.
Late yesterday, the Congressional Budget Office delivered some tentatively good news to reformers: the House Democratic plan, which includes a "robust" public option (reimbursing physicians at Medicare rates plus 5%), would cost $871 billion over the next decade -- well below the $900 billion ceiling proposed by the White House. Just as important, the CBO report, which is preliminary and subject to change, also found that the House Democrats' plan reduces the budget deficit.
And with those encouraging preliminary numbers in her pocket, House Speaker Nancy Pelosi reportedly decided last night to move forward on the caucus' ambitious reform plan, whether the Blue Dogs and/or the Senate like it or not.
As Jonathan Cohn explained this morning, it's a strategy with some risks.
Yes, a strong public plan remains a tough sell, particularly with centrists in the Senate. But precisely because the Senate will pull the bill to the right, it's critical that Pelosi pull it to the left while she can. The public option is gaining momentum right now, thanks to strong polling numbers and a realization, among members, that requiring people to get insurance is a bad idea if the available insurance options aren't very good.
It helps, too, that CBO has apparently determined the strong public option -- which would pay at rates pegged to five percent above Medicare -- could save somewhere in the neighborhood of $100 billion. Given what happened during the stimulus debate, when centrists in the Senate successfully pushed to scale back the bill, it'd be foolish of Pelosi not to anticipate that move.
What's more, this way Pelosi can force the Blue Dogs, many of whom oppose the public option, to confront the trade-offs as they exist. If they don't want the public option, she can say, how else will they find the money the public option might save
The fear comes from people who think this move will backfire -- by alienating the Blue Dogs, centrists in the Senate, or both. These people note that we're still not all that far removed from August, a time when reform's very survival seemed very much in doubt.
Things look good now, the argument goes, because of united Democratic consensus around the basic principles of reform. But the consensus is fragile. Senators Kent Conrad and Ben Nelson have offered hints they're open to some sort of compromise, but Pelosi's proposal surely goes too far. And precisely because centrists in the Senate will never go for such a bold public option, the House's Blue Dogs will scream.
During a House Democratic caucus meeting last night, the Speaker conceded that she has not yet lined up the 218 votes she'll need to get the bill passed, though, according to a senior Democratic staffer, Pelosi said, "We are very close and I count tough."
As part of this tough count, the Speaker instructed House Democratic Whip Jim Clyburn (D-S.C.) to start canvassing the caucus, getting firm answers from every member on whether they're prepared to vote for the bill. Going into this week, there are dozens of House Dems who've noncommittal. Today, the leadership expects every Dem in the chamber to get off the fence and pick a side.
The caucus is scheduled to meet again today to see where the party stands.
—Steve Benen 8:35 AM
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Meanwhile on NPR this morning they had a story on health care and part of it was a short snipit from Joe Lieberman saying he would join with the Republican’s and block a vote on health care if he did not like the plan.
Posted by: Napoleon on October 21, 2009 at 8:45 AM | PERMALINK
You know, I've read as much as I've been able to find about the various bills and the "progress" of the debate regarding health-care reform, and one question keeps on coming up: in the end, why would anyone vote against a program that benefits the majority of Americans, helps reduce costs for businesses and -- finally -- puts us on a similar footing with the rest of the civilized world?
I don't admire the way Dems are tackling this at all -- Grayson aside, no one is really stepping up & saying things that need to be said.
Posted by: zhak on October 21, 2009 at 8:48 AM | PERMALINK
znak, the answer is no Dem will, which is exactly why the Democratic leadership should have a strong public option in the bill and just dare any Dem to block it coming to a vote.
Posted by: Napoleon on October 21, 2009 at 8:50 AM | PERMALINK
I dare the White House and their congressional allies to torpedo substantive health care reform in order to placate insurance companies.
The weasel in me hopes they do. I believe the world will be a better place if an irreconcilable schism shatters the democratic party, and a third party emerges from the wreckage.
Posted by: JW on October 21, 2009 at 8:55 AM | PERMALINK
Napoleon, I guess my view is that this is (or should be) a no-brainer. I don't mean that in the Republican sense (ie, no brains) but rather we're the only country whose health insurance is run solely as a profit-making venture & thus, the actual purpose of the companies become perverted. It's no longer about making sure those they insure are properly taken care of, it's all about how much money they can make.
Nobody should count on a vote from Lieberman, btw. Driving through CT, you see huge buildings dedicated to this or that insurance company all over the place. I'd like to think Lieberman has enough humanity to make the proper choice about this, but I do not think this is so.
Posted by: zhak on October 21, 2009 at 8:55 AM | PERMALINK
zhak, are the insurance companies in CT health care insurance companies or life insurance companies. I always thought that CT had a bunch of life insurance companies.
Posted by: Napoleon on October 21, 2009 at 9:00 AM | PERMALINK
The Big Duh has finally landed in the Capitol
Jonathan Cohn: Requiring people to get insurance is a bad idea if the available insurance options aren't very good.
One small correction: It is not just a "bad idea," it is suicidal-nuts.
Posted by: koreyel on October 21, 2009 at 9:20 AM | PERMALINK
The ostensible reason Blue Dogs oppose a public option is because, they say, Medicare+5% would hurt hospitals in their rural districts.
Okay, that may (or may not) be so.
But somebody should ask: How much are those hospitals losing now when they have to provide treatment to uninsured patients. Some of the Blue Dogs represent poor areas, so I'd guess we're talking about a goodly sum.
So: Which is more expensive, Blue Dogs?
Posted by: K in VA on October 21, 2009 at 9:30 AM | PERMALINK
Which is a better scenario? 1) Senate puts a week public option in their bill (perhaps with a trigger, co-op or opt-out). Weak version gets forced into conference report. or 2) Senate leaves public option out, House passes. House version is added to conference report, forcing Senate to vote on a good plan.
I suspect the most important people in this debate are those who participate in the conference reconciliation, and frankly, I'd be more comfortable if the Senate has no public option to choose from.
Posted by: Danp on October 21, 2009 at 9:32 AM | PERMALINK
I love Nancy Pelosi. She's fighting both hard and intelligently for a good bill.
Thank goodness she's Speaker, rather than Steny Hoyer.
Posted by: low-tech cyclist on October 21, 2009 at 9:33 AM | PERMALINK
But, but, but! Lieberman is with us on the important votes! Like renaming Post Office buildings! Why hold against him the fact that he wanders off the reservation on things like war on Iran and letting 45,000 Americans die every year because of no health insurance.
Democratic progressives swallowed hard in the face of the Quest for the Holy Grail of 60 votes. And instead of a Golden Salver overflowing with Social and Economic Justice we got a styrofoam cup full of the warm spit of appeasement of Connecticut based insurance companies.
In a lot of ways Dems were better off with a 55 vote majority. At least back then we were not subjected to individual veto power by Presidents Lieberman, Snowe, Conrad and Lincoln.
55 = strong majority, 65 = overwhelming majority, 60=unlimited possibilities for blackmail. I'd prefer to go 60+ than 60- but Dems need to get off the dime here. Joe needs to be kicked to the curb. I mean when was the last time he was the decisive vote on an actual cloture vote?
Posted by: Bruce Webb on October 21, 2009 at 10:57 AM | PERMALINK
201 for as of last night. 17 needed.
Posted by: MNPundit on October 21, 2009 at 11:31 AM | PERMALINK
Note that we are allowing the differece between a "robust" public option and a weak public option to be defined by what rates they are going to charge. This is not irrelevant, but I would suggest that in either case, the resulting public option would quite possibly be impotent, and unable to compete with private insurance. The real defintion of a strong public option would be one that all members of the American "public" have the "option" to enroll in; as opposed to the one under consideration presently, where only those who don't receive coverage though their employer are eligible, about 10% of the population according to estimates.
The entire public debate, ranging the political spectrum, presupposes that elite interests in the insurance industry, the pharmeceutical industry, and health care providers are protected. Any proposal that would adversely affect these interests is simply off the table.
We should keep this in mind as we argue back and forth over the possibility of establishing a "public option." Even if we win, our victory may turn out to be hollow. In fact, the louder we cheer, the more satisfied we claim we are with the outcome, the more that might be used against us in the future.
Posted by: Jason on October 21, 2009 at 12:13 PM | PERMALINK