January 21, 2010
REFORM DOESN'T WORK PIECEMEAL.... One of the less reasonable health care options raised yesterday by panicky Democratic lawmakers was the notion of breaking the package into pieces. The "incremental" strategy would make it easier to approve some of the more popular elements of the larger legislation.
This is a very bad idea.
For one thing, it would drag out the reform debate for several more months, which isn't exactly what the public is clamoring for. The goal should be to wrap up the process, not make it longer. For another, Republicans won't be any more cooperative when rejecting reform's component parts than they were when rejecting the sum total.
But most importantly, health care reform doesn't actually work that way. The parts are interdependent. Usually, it's conservatives confused about this; House Dems should know better. If, for example, you force insurers to cover those with pre-existing conditions, but you do so with no mandate, insurance companies would pay more without the benefit of a wider risk pool, including healthy people who pay in premiums but do not need treatment. One without the other would make care more expensive for everyone.
President Obama explained this fairly well yesterday to George Stephanopoulos.
"I don't know how we avoid taking on these big problems. Let me just give you a very simple example, just so you get a sense of why these things are so important.
"If you ask the American people about health care, one of the things that drives them crazy is insurance companies denying people coverage because of preexisting conditions. Well, it turns out that if you don't ... make sure that everybody has health insurance, then you ... can't stop insurance companies from discriminating against people because of preexisting conditions. Well, if you're going to give everybody health insurance, you've got to make sure it's affordable. So it turns out that a lot of these things are interconnected.
"Now, I could have said, 'Well, we'll just do what's safe. We'll just take on those things that are completely noncontroversial.' The problem is the things that are noncontroversial end up being the things that don't solve the problem."
Exactly. As Jon Chait explained, "Cantor does say he wants to ban discrimination against people with preexisting conditions, but for reasons I've explained over and over again, you can't do that without an individual mandate, and you can't do that without subsidies for those who can't afford the mandate. So the preexisting condition stuff is just a way of posturing for a popular goal without admitting you oppose the necessary steps to accomplish it."
This can't be done piecemeal -- taking out one major provision causes the other provisions to fail.
Chait also noted that House Dems are tired and frustrated, but added, "If they fail to pull themselves together, future generations will look back at them, note that Congress had passed comprehensive reform in both chambers, had the backing of an eager Democratic president, and could finish the deal by getting 218 of their 256 Democratic members to sign on, and somehow refused. I still find the idea that they'll allow this to happen unfathomable. If they do succumb, it will be because some deep and recurrent character flaw rose to the surface at the worst time, once again."
Kevin Drum added, "It's beyond belief that we could get this close to a century-old goal of liberalism -- we are, literally, just a hair's breadth from the finish line -- and then allow the most significant social legislation of the past 40 years to slip from our grasp just because we're tired and pissed. All we need is one roll call vote in the House. That's how close we are to passing this genuinely historic bill. One vote. Then the next day we can start in on the next 20 years work of improving and finishing what we've begun. We can't allow this to fail now. We can't let the Fox/Drudge/Rush axis win. So call your congressman. Go organize a rally. Write a letter to the editor. Lobby your union president. Do something. Do it now."
Pass the damn bill.
—Steve Benen 8:35 AM
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Sigh. The wonks still don't understand that this "historic" bill is a pile of crap that is and will remain unpopular.
Posted by: Steve LaBonne on January 21, 2010 at 8:38 AM | PERMALINK
Pass the damn bill.
Yeah, good luck with that. The democrats have shown time and time again they are weak and I for one am fed up with it. They will back down against any republican resistance so whatever bill that may pass will be ineffective an be used as a bludgeon against the democrats to prove they are ineffective.
So for that reason I dis-associating myself with democrats and will register as an independent. I will vote only for a candidate that demonstrates they have a spine. I will no longer have my hopes dashed by a political party that has institutionalized cowardice.
This country deserves what it gets by being so goddamned stupid as to vote back into power the same political party that has virtually destroyed this country.
Our political system is a disgrace and a laughing stock and will be the downfall of this once great nation.
Posted by: citizen_pain on January 21, 2010 at 8:41 AM | PERMALINK
John Judis gets it: "Where Obama invited a voter backlash was by letting the burden of reducing health care costs appear to fall on senior citizens and those middle-class workers who had acquired good health insurance through decades of union battles with management, and not on the insurance and drug companies. Obama ceded too much to the policy wonks who were devising intricate schemes to show they could cut the deficit. He took his eye of off the political imperative of keeping middle America in his corner."
Posted by: Steve LaBonne on January 21, 2010 at 8:43 AM | PERMALINK
it is much easier to begin each day with the assumption that everyone in washington, democrat and republican alike, could give a happy god damn about what happens to the poor, the unemployed, the uninsured, the underserved, the desperate and the barely surviving -- except that they are in washington to do jobs and reluctantly must do something for all "those people" or it'll have repercussions on their own agendas...
starting out the day with that perspective "grants me the serenity" to think of the Villagers as just arrogant assholes rather than as monsters.
but as each day grows, they do seem more and more like monsters by the end.
Posted by: neill on January 21, 2010 at 8:44 AM | PERMALINK
Sorry about the link not working.
http://www.tnr.com/article/politics/he-doesnt-feel-your-pain?page=0,2
Posted by: Steve LaBonne on January 21, 2010 at 8:45 AM | PERMALINK
When Mr. Brown gets to Washington, perhaps someone in the press will ask him how he can say his election was a referendum on HCR when he supported the popular Mass. universal care law that is broadly similar? And perhaps why a guy who owns five homes drives around in that beat-up truck?
Posted by: bob h on January 21, 2010 at 8:52 AM | PERMALINK
Armando's comment on the Drums and Benens of the world, in connection with that John Judis post, is also worth pondering: "The Village Dems spent yesterday screaming "it's simple" - pass the Senate bill. This meltdown was revealing, the Village Dems have no connection to political reality. There simply is no doubt that, speaking politically, there is no worse feature in the health bill than the excise tax. It was an unproven policy that was sure to cause a political debacle. Indeed, it is the principal impediment to the House passing the Senate bill stand alone."
http://www.talkleft.com/story/2010/1/21/8270/27113
Posted by: Steve LaBonne on January 21, 2010 at 8:52 AM | PERMALINK
"Sigh. The wonks still don't understand that this "historic" bill is a pile of crap that is and will remain unpopular."
They understand. But they also understand that if they start telling the truth, they'll be out of a job.
-----
Also, why are clueless anti-progressive political hacks like Benen, Klein, Drum, Marshall, Chait, and the rest of the Marty Peretz krew somehow categorized as "wonks"? They don't understand politics or policy. They just understand how to please the folks who sign their checks. That's what makes them "hacks."
Posted by: Petey on January 21, 2010 at 8:53 AM | PERMALINK
Take the time that you spend on one comment post here and communicate your wishes to your legislators. Whine in the right places.
Posted by: lou on January 21, 2010 at 8:54 AM | PERMALINK
Thankfully there is one thing bigger than the Dems weakness and that's the bad Karma that the repubs have reaped over the last 3 decades. And electing a major league d-bag in Mass. won't slow it down. Give all of this at least a couple of days before writing it (and Obama) off.
Posted by: ComradeAnon on January 21, 2010 at 8:56 AM | PERMALINK
This moment could be Obama's epiphany rather than his waterloo. Get on and fight like you did in the campaign President Obama! Go back to your principles! Take care of Americans before you take care of Brutus like Senators & politcians . A happy taxpayer with health insurance that is affordable , controls insurance & pharmaceutical companies is what America wants. Use this as your epiphany to use Medicare extended to All Americans by a simple up and own vote. Simple , easy and douable right now!!!!The Republicans cannot block, filibuister only vote against it. Why can this not be done. Ask Dr. Howard Dean.
Posted by: MlJohnston on January 21, 2010 at 8:58 AM | PERMALINK
The funding sources in the senate bill obviously need some work. The potential revenue sources in both the bills had some major flaws. And no doubt, these would have required some tune ups and add ons over time. But the chance of anything happening now is remote if the Senate bill is not passed. Pass the fucking bill!
Posted by: lou on January 21, 2010 at 9:01 AM | PERMALINK
Pass the fucking bill!
No. There's that lack of connection to political reality again. Want to limit the carnage in November? Pass 50+ Medicare buyin and pivot immediately to J.O.B.S.
Posted by: Steve LaBonne on January 21, 2010 at 9:03 AM | PERMALINK
If the dems can't create their own fucking political reality we are screwed.
Posted by: lou on January 21, 2010 at 9:07 AM | PERMALINK
It's worth pointing out, too (and thanks to others who are taking Benen to task generally) that every salvage proposal is, esentially "piecemeal" under Bene's own terms. Pas the Senate bill in the House... and you have to add legislation to it to correct those "problem areas." Use reconciliation... and you have to pass a supplemental bill to make more changes. Break the bill up into pieces... you have piecemeal.
You don't want piecemeal... do one bill. But it will be a smaller, more focused bill... and it will tunr out that, gosh, you can do "preexisting conditions" without a mandate. And guess what, you can do smaller Medicare reforms and modest reimbursement changes too. You can do a few things. You can do things in pieces. What you cannot do, clearly... is pass the monstrous bill that was wending its way through Congress, which no one really liked and which was probably doomed all along. Take your meal in pieces... Or don't eat. Either one works for me. And, I suspect, for many others.
Posted by: weboy on January 21, 2010 at 9:11 AM | PERMALINK
You make a pretty good case for a limited public option, Steve. The appeasers can't wait to get this out of the way, and yet, we are supposed to believe that over the years(decades? centuries?) they will build upon this foundation of corporate butter, an edifice to shame the world.
Posted by: Michael7843853 on January 21, 2010 at 9:13 AM | PERMALINK
If the dems can't create their own fucking political reality we are screwed.
That.
Posted by: MissMudd on January 21, 2010 at 9:14 AM | PERMALINK
Agree with Steve. Time for you policy wonks to step aside and follow folks with some political sense. The Senate bill is a disaster, policy wise and politically. Just wake up, will ya? Keep it simple and, I know this might be tough to understand, but pass the stuff that the majority of the country already supports (like Medicare/Medicaid expansion & Sanders' health clinics) and make the Republicans filibuster other popular stuff (insurance reform) that can't get over the filibuster hurdle.
Really, you wonkish types have had a year and have mucked this thing up to high heaven. Jesus, the only national Dem who can even talk any sense on this stuff (not to mention having a track record of actually delivering real health care reform while in office) is Howard Dean and he's the one Dem Obama won't listen to.
Posted by: pls on January 21, 2010 at 9:19 AM | PERMALINK
The vicious attacks from the left on "Benen, Klein, Drum, Marshall, Chait" not to mention Obama, has me a little depressed. On the political spectrum, I'm probably close to a socialist. I want to eliminate the power of corporations, I want to restore 95% income tax top rate, I want to guarantee jobs for all who are willing to work, etc. But the reality is that there are huge obstacles in the way of anyone who would make major changes to the way America operates. What is the best approach to making things better, given these obstacles? Opinions differ about whether an incremental approach is the best chance of success, or whether that is just perpetuating the status quo, wasting energy on cosmetic, feel-good changes. But please don't attack your potential allies. Don't make them into enemies, because in a democracy, to get anything done, your allies must outnumber your enemies.
Posted by: Daryl McCullough on January 21, 2010 at 9:19 AM | PERMALINK
Can someone explain something to me? I keep hearing that Obama spent so much time focussing on health care that he has not been able to focus enough on the economy. My question: how the heck is he supposed to focus on the economy when there is no action possible that would not be blocked by a coalition of Republicans and conservative Democrats?
You can talk about the economy until you're blue in the face, but doing something requires government spending - and where is the likelihood that that will be approved?
Posted by: Virginia on January 21, 2010 at 9:20 AM | PERMALINK
Daryl, an incremental "approach" is not an approach at all if it's going in the wrong fucking direction. Just sayin'.
Posted by: Steve LaBonne on January 21, 2010 at 9:21 AM | PERMALINK
If the House Democrats were so easily flustered by the election in Massachusetts to the point that some were saying that the healthcare bill was doomed, why should we believe them when they say that they'll be strong and resolute against passing the Senate version through the House?
Posted by: Mustang Bobby on January 21, 2010 at 9:24 AM | PERMALINK
If the House Democrats were so easily flustered by the election in Massachusetts to the point that some were saying that the healthcare bill was doomed, why should we believe them when they say that they'll be strong and resolute against passing the Senate version through the House?
The progressives will of course fold like a cheap suit as always, but it may not matter, because I don't know if there would even be enough Blue Dog votes to pass the House bill if it were coming up now, let alone to do "plan B". But we'll sure waste a lot of time and energy finding out, instead of passing a slim package of broadly popular measures and moving on. Sigh.
Posted by: Steve LaBonne on January 21, 2010 at 9:29 AM | PERMALINK
Keep it simple and, I know this might be tough to understand, but pass the stuff that the majority of the country already supports (like Medicare/Medicaid expansion & Sanders' health clinics) and make the Republicans filibuster other popular stuff (insurance reform) that can't get over the filibuster hurdle.
What event in the past year has led to your conviction that the GOP will pass anything related to positive HC reform? Anything?
There may be merits to your approach, but "keep it simple" isn't one of them. "Keep it going for months or years as we fight the 60-vote hurdle over and over and over" (unless there's a rules change) is more like it.
Posted by: Tom T. on January 21, 2010 at 9:30 AM | PERMALINK
Why did Scott Brown win? Because he exploited the perception that the current HCR bill was a cozy deal between Congress, the Obama administration and the health care industry, forcing people to buy insurance and financed by a tax on a strapped and scared middle class. Brown ran against the machine in Mass. and against the perceived machine that is Congress. How do you change the perception? Expand Medicare to cover all those in the individual market who can't afford private insurance, offer a Medicare buy-in to those who can and finance it with taxes on derivatives, financial speculation and outrageous bonuses/CEO salaries. 90 per cent of Americans would support this and the Republicans/Blue Dogs would vote against it at their peril.
Posted by: dalloway on January 21, 2010 at 9:33 AM | PERMALINK
If all you commenters like incremental so much, recall how satisfied you were with President Clinton's incremental approach after 1994. And why he had to do that.
Charles
Posted by: charles on January 21, 2010 at 9:36 AM | PERMALINK
"What is the best approach to making things better, given these obstacles?"
We've got 54 Senate votes and 218 House votes for the public option and the Medicare buy-in.
These two provisions can be passed with only 50 Senate votes needed.
These two provisions also happen to be politically popular, which the Baucus Bill most definitely is not.
That is the best approach to making things better, but the Benen, Klein, Drum, Marshall, Chait, Marty Peretz krew have other priorities than making things better.
Posted by: Petey on January 21, 2010 at 9:37 AM | PERMALINK
Leave Steve Benen (and Kevin Drum and Josh Marshall and . . .) alooone! We've been down these namecalling roads before--see the primaries, for example. Steve's pushing a strategy that has as its goal a stronger Dem electoral stand in 2010, and that's not bad, but it is the wrong way to the right goal because the Senate bill is a dead end.
Weboy makes a great point about how the passage is still tied to piecemeal fixes that probably won't happen. Lieberman and Nelson and Baucus (not Steve and co. who criticized the cop outs as they happened) diluted this to the point where it's more a protection for the existing healthcare stakeholders than an expansion of the healthcare consumers' benefits. Passing it as is will finalize the year-long process of doing the GOP's dirty work and then letting them back into office. If 2009 was about reassuring the center then 2010 has to be about winning the next damn election, and as Mass showed, reassuring the center won't win in 2010.
Posted by: angler on January 21, 2010 at 9:44 AM | PERMALINK
If you pass pre-existing conditions and drive insurers out of business you will create one. THAT'S WHAT WE WANT. Into the atmosphere you ram through your leftist public insurance plan and couple that with a mandate. In the panic and suffering it gets passed.
Posted by: MNPundit on January 21, 2010 at 9:51 AM | PERMALINK
Tom T.
You don't need any Repub votes for Medicare/Medicaid expansion. That's the damn point.
Posted by: pls on January 21, 2010 at 9:56 AM | PERMALINK
Steve LaBonne's Judis quote is right on the mark, as are other posters who talked about the lack of spine in the Democratic party.
It's not enough to say "pass the bill". We already see Democrats backing away from the Senate bill as fast as they can scuttle.
What we need know is what we needed before--a president who stands up on his hind legs and says "this is what America needs, it's what I want and it's what you'll deliver." The voters want to see the president fight for them. They want to hear someone not just saying "this is important", but acting like it's important. That's why the base is somewhat disllusioned and why Massachusetts Democrats did not deliver for Coakley. Even if you lose, you must show fight. Or continue to lose both respect and voters.
Posted by: zak822 on January 21, 2010 at 9:59 AM | PERMALINK
Not all HCR related issues need bundling. Introduce a single-issue bill to repeal insurance company's anti-trust pass. Even if it fails, it will serve as an informative voter's guide in the next election.
And speaking of elections, every congress-critter in the house is up for reelection this fall. I trust Pelosi has enough snap to leverage that into a threat to pass the senate version.
Posted by: Chopin on January 21, 2010 at 10:01 AM | PERMALINK
"Leave Steve Benen (and Kevin Drum and Josh Marshall and . . .) alooone!"
I don't see why. They've been lying through their teeth about the state of play on healthcare since June, and they're continuing to do so.
I understand they think that what they're doing is good for their own career paths, but it's not good for the Democratic electoral coalition, or for the American people.
If they stop lying, progressives will stop calling them liars. Deal?
Posted by: Petey on January 21, 2010 at 10:02 AM | PERMALINK
Oooooops. I think I got my election cycle wrong.
Posted by: Chopin on January 21, 2010 at 10:04 AM | PERMALINK
You don't need any Repub votes for Medicare/Medicaid expansion. That's the damn point.
If you're talking about passing it through reconciliation, then say so. Your previous post implies that you actually think you can get it passed through a conventional vote.
Posted by: Tom T. on January 21, 2010 at 10:07 AM | PERMALINK
Oooops. I got it right after all ;-)
It's voter's revenge on congress this fall.
Pass HCR or face my wrath, damn it.
Posted by: Chopin on January 21, 2010 at 10:13 AM | PERMALINK
the Democrats should get vertabra and use ALL the tools they have. The politicians are blocking what is very simple. Extend Medicare to all. It will be more affordable as it won't be subsidizing insurance companies. Have Americans Buy in for the short term and then make it single payer. It is a better affordable plan. Ask the tea baggers They love their Medicare. They don't want to share it 's benefits. Politicans like convolution to confuse and steal money from Taxpayers. Simplicity will cover all with ease and stop all of this nonsense. If B. Obamna really cared he would have this legislation passed in a minute. He prefers corporations and politicans over Americans or this would not have happened.Have an epiphany Mr. Obams follow your principles you campaigned with and take care of the Taxpayer not the politicians.Your life willbe much easier and less confrontational. Is it too much to ask for the taxpayers to have have affordable health care? The corporations be damned.
Posted by: MLJohnston on January 21, 2010 at 10:19 AM | PERMALINK
"Pass 50+ Medicare buyin ..." - Steve LaBonne et all
I don't think congress could get away with that, politically, through reconciliation, which is specifically for taxes and budgetary matters. So that would open up a whole 'nuther can-o'-worms.
The safest bet for HCR is to pass the senate bill, warts and all, then apply fixes through reconciliation.
Posted by: Marko on January 21, 2010 at 10:32 AM | PERMALINK
"Extend Medicare to all..." - MLJohnston
You are not going to reform 20% of the economy and put all the healthcare insurers out of business through reconciliation.
Not. Gonna. Happen.
Posted by: Marko on January 21, 2010 at 10:36 AM | PERMALINK
What I think may be missed here is the severe political advantage of passing no bill.
Health care reform is wildly popular.
Y'all keep bringing this up as a reason to pass it.
I put it to you that this is the perfect reason, in some Democrats' minds to help it fail at the hands of 41 Republicans.
If you can keep this popular cause alive in perpetuity, you have a hammerlock on 15 percent of the population; the uninsured.
If you fix the problem, these 45 million can move on to something they may find more important. This means they may decide to follow a cause more acceptable to and supported by the GOP. This will not help maintain a Democratic majority.
Passing popular legislation leaves Dems with LESS popular legislation to pass. It leaves remaining popular issues to the GOP which would be really bad (flag burning bans, more reckless tax cuts, discredited but still popular deregulation "there'd be plenty of jobs if it weren't for government interference, consarnit!")
What you may be seeing is a Machiavellian game of enlisting the power of suffering to maintain the voting bloc that will keep them in power.
Sick, depraved, diseased, but probably effective.
I credit Rahm Emmanuel, Reid and Pelosi.
Posted by: toowearyforoutrage on January 21, 2010 at 10:58 AM | PERMALINK
There should be no mandate without a public option. The conservatives who gripe about "being forced to buy from private insurers" are the ones that made if necessary to do just that. As for having to pay into coverage: of course it should be a public-funded operation to some extent, since people have the resource of the hospitals and ERs as necessary back-up. We're already paying for it, and ironically "making people buy insurance" is just the sort of case of paying for a service (even if potential, like police protection and forensic investigation etc.) that conservatives say they're for. I think their real problem is the subsidy that pays for lower-income people to have the coverage, not the requirement to pay into per se.
Posted by: Neil B on January 21, 2010 at 11:07 AM | PERMALINK
"Pass the damn bill."
Yes, let's drive even MORE Democrats to stay home in November than stayed home on Tuesday.
Posted by: Joe Friday on January 21, 2010 at 11:32 AM | PERMALINK
Why did Scott Brown win? Because he exploited the perception that the current HCR bill was a cozy deal between Congress, the Obama administration and the health care industry, forcing people to buy insurance and financed by a tax on a strapped and scared middle class. Brown ran against the machine in Mass. and against the perceived machine that is Congress.
Well that and having the good fortune of campaigning against an incompetent nitwit who made one major gaffe after another. I thought Deeds was bad. Coaxley made him look like Reagan on the campaign trail. To be honest I'm surprised it was even this close.
Posted by: woody45 on January 21, 2010 at 2:09 PM | PERMALINK
This can't be done piecemeal -- taking out one major provision causes the other provisions to fail.
You mean like taking out the public option turns the mandate into a draconian nightmare?
Fix. The. Damn. Bill.
Posted by: Dale on January 21, 2010 at 2:28 PM | PERMALINK
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Posted by: Lucy on February 1, 2010 at 12:16 AM | PERMALINK