Whither health care

First off, Josh Marshall wants to know what we're thinking:
Whatever happens [today] in Massachusetts, this is a critical gut-check moment for Health Care Reform and the state of the Obama presidency. There's a lot of irony and painfully unforced errors that went into this current moment. And there's also quite a lot on the line.

Tell me how you're seeing it.

Well, I'm seeing it as a gigantic [obscene phrase for tightly-grouped copulation] of epic proportions, is how I'm seeing it. I'm seeing it as a ringing slap across the face of Democratic complacency.

Now, what happens next? Jonathan Cohn remains cautiously optimistic.
Pelosi is one of the two big reasons I believe health care reform has a decent (not good) shot of passing, even if Scott Brown wins today. The other is President Obama. Both understand that enacting health care reform is in their personal, and their parties', long-term interest. More important, both believe health care reform is the right thing to do--and aren't about to give up on it, this close to success, because their party's majority in the Senate is "only" nine seats instead of ten. The fact that so many Beltway know-it-all's insist surrender is necessary will, I suspect, only stiffen the pair's resolve.

We'll see. One thing I will say for the GOP, they know how to enforce party discipline. No matter how much resolve Pelosi and Obama may have, I question the notion that either will be able to corral their spooked fellows on the Hill if Brown wins. I think Cohn et al have good reasoning behind their speculation, but I don't know how much of a part reason will play in the coming political recalibrations.

I still think the health care bill currently under consideration is the best we're gonna get. [Confidential to GJ -- please feel free to tell me what better plan you would pass, and how you would guarantee passage of said plan with the current make-up of the Senate.] Whether we get it now is anyone's guess.


  1. OK, let this be a reply to the previous post as well.

    First, I'd run a State or a large corporation for at least 4 years so I had some executive experience. Running a government is harder than getting the asbestos out of Altgeld Gardens and harder than being a Senator with no responsibility for executing programs.

    Then, I'd attack the problem with an incrementalist approach. The Big Bang "redo everything all at once" is virtually guaranteed to be a big pile of fail. I'd gain the people's trust by making the smaller reforms successful; I'd take on easier parts first, to gain political acceptance and to prove I actually knew what I was doing.

    No bill would be over 100 pages -- break it up into smaller, simpler reforms if it takes over 100 pages. All negotions would be on CSPAN for real (if CSPAN would take it, and on Youtube if not). No private little closed door sessions allowed.

    A bill would be available online for at least 15 days (or 30, pick something reasonable) in final form, and if opponents were able to tear it to pieces, I'd take that as an indication that we have a bad bill and start over. Similarly, if there were massive public protests about the bill, I'd take that to mean either it is a bad bill (start over).

    I'd make sure to reassure Congressional leadership that if one side or the other went against my promises, I'd look for cold revenge at the earliest possible opportunity, and if everyone played nicely, I'd share all the credit each and every day.

    I have already mentioned several reforms that I think would fit the above, but just to be sure, I'd start by looking to make catastrophic insurance availabel for everyone, thereby capping private insurance risk. No State lockouts. Tort reform. Medicare/Medicaid waste elimination -- let's get that 30% to show the public that government can deliver. I'm sure a reasonably smart person could come up with many other targeted reforms.

  2. John, it's all very well. But for an issue as immensely complicated as health care reform, incrementalism is unlikely to effect any real change. There are myriad industries and players involved, including providers, hospitals, insurers (public and private), drug companies, unions, and the AARP. Something that one desires is sure to be opposed by another, and reform in one area requires reform in another.

    Take, for example, eliminating the ban on people with pre-existing conditions. Insurers could argue that to demand that they insure high-cost patients with expensive conditions, they need a pool of healthy people paying premiums. Which means everyone has to pay in. Which means there have to either be subsidies for people to buy it themselves, or mandatory coverage by employers (and the small businesses will love that), or a public option, or some combination of all of that.

    Catastrophic coverage won't cover things like well child checks. Unless you're going to provide universal coverage for children.

    And you give the public more credit for wonkish understanding of complicated policy than I do. It's all very well to encourage bills to be simple enough for everyone to understand, but that's empty rhetoric. Policy is complicated, and it's far too easy for partisans to spin aspects of policy for their own political ends. (See also: death panels.)

  3. In other words, what Jonathan Chait said.

  4. Yes, much better to do it in secret, make it a huge, incomprehensible bill that leaves plenty of room for each little special interest to insert their fave goodies, and ram it through Congress on a straight party-line vote despite massive public disapproval. Because everyone knows that Harry and Nancy and Barack are just so much smarter than the rest of us that we should just STFU and listen to our betters, just like Jonathan Chait says. What could possibly go wrong?

    That's really working out well for the country, isn't it?

  5. Yes, yes. Harry and Nancy and Barack. Boo!!! Do you feel a whole lot better now? Good.

    Since you've gotten your obligatory digs in about the Democratic leadership, care to address what I had to say in any substantive manner?

    Also, no, I don't necessarily think that Reid and Pelosi and Obama are that much smarter than the rest of us. But their staffers are paid to think about policy all the time. It's what they do. And so they are more likely to have an understanding of the nuances of, say, insurance regulation than your cousin Merle.

  6. of course he can't address the substance of the bill, the elimination of denial for pre-existing conditions, community ratings, mandate so no one can game the system, subsidies so the poor can buy insurance instead of clog waiting rooms, so he just resorts to nyah nyah. About the only thing here that could be done incrementally is subsidies for the poor, but everyone know Republicans loath the uninsured and would sooner see them die then spend a penny in tax dollars.

    Listen schmuck, catastophic insurance is useless. What, you kid gets sick so you should wait until it progresses to pnuemonia so you can utilize your policy. No, wait someone who has to pay 50% for housing costs, living paycheck to paycheck (with Republicans wanting to get rid of the minimum wage) should have $10,000 sitting around to take care of doctors bills. Right. Dude, seriously what is wrong with you? Do you have an ounce of sense?


  7. I'm not sure what to address; after all, we now have an existence proof that Big Bang all-singing-all-dancing healthcare reform, as practiced by Obama and Co., is not going over well at all. The more people learn about ObamaCare, the more they oppose ObamaCare. That can't be casually dismissed.

    OTOH, I'm suggesting that we attack healthcare reform in a series of small steps. Gather the low hanging fruit early, do a competent job, build confidence and trust, and government will allay fears in the electorate. I really think that is a superior method for reforming healthcare.

    And I completely disagree that incrementalism is vulnerable to special interest logrolling. I claim that by separating and isolating the various changes, it will be clear who opposes reform that the public supports. As it stands, with everything done in secret and obfuscated by 2,000 pages of dense, in every sense of the word, prose, all sorts of shenanigans are going on.

    So you can choose between the current steaming pile of fail, or you can try my incrementalist approach, or you can think up another way. But please don't claim that the only way we can do the job is the steaming pile of fail method.

  8. Regarding staffers that think about nothing but healthcare all day and in the shower too, all I can say is that if the current bill is the best they can do, either the leadership needs to find smarter staffers, or the current staffers need to work in a universe with radically different physical, logical, and economic laws.

    And when Barney Frank can read the handwriting on the wall, well, dude. Pelosi may do her best impression of Field Marshal Paulus but I suspect she may have trouble gathering enough cannon fodder to pass the Senate bill. Of course, this is all Bush's fault.

    I recommend the Dems double down; Obama clearly aligns himself with Reid and Pelosi, and guarantees that he will personally campaign for any D officehilder that is worried about voting for ObamaCare. Dems need to make it clear that, as charo believes, the only possible reason anyone could oppose the current bills is that they have a greedy, selfish, black heart and just want to see poor people die. There is no principled opposition to smart staffers who think of nothing but healthcare all day long and the Most. Ethical. Congress. Evah. and Smartest Human to ever hold the Presidency. That should reassure Barney, and ObamaCare would pass, and pink unicorns would come and poop diamonds to balance the Federal budget.

  9. gj, what steps? guaranteed issue, impossible without a mandate that the Republicans say is unconstitutional. subsidies for the poor, impossible (so Republicans say) because of the deficit, increasing medicaid (hell, even Lieberman said no to that). Listen, I don't know if you are evil or just stupid, but the US pays 17% of its GNP on healthcare, Japan 9%, Europe even less. France, Germany, Japan, etc. all have better outcomes at lower costs. It is utter idiocy not to begin to do something about this. This bill is the incremental reform you are talking about. So are you stupid or evil, which is it? Probably both.


  10. gj rebuttal: me no like, me not read bill, me say it bad. Of course gj doesn't lay out how the incremental reforms will pass, or even what they are oh, wait, tort reform (which passed in Texas and made zero difference) or HSA's (which is a tax dodge for the rich) or selling insurance across state lines (so much for states rights, and this would only lead to a race to the bottom vis a vis regulations, companies will buy fly by nighters based in Idaho so they can claim to offer insurance)
    That is about it as far are the sum total of Republican reform to health care.