Wednesday, October 21, 2009

The Day In Health Care

It's been an interesting couple of days for health care reform, and this is where I think we are at the moment:

In the House, Speaker Nancy Pelosi is trying to get the best public option she thinks she can pass. At least, that's what Talking Points Memo is reporting:

It has been an epic tug of war, and at times, the pro-public option side seemed on the verge of being yanked into the mud.

But in recent weeks, as the health insurance industry further disgraced itself by rolling out the big anti-reform guns, and liberal leaders in both the House and Senate made it clear that they view the public option as an essential component of reform--one that serves voters' interests, and saves money--even if the White House isn't willing to put its full weight behind the measure.

It's in that context that Pelosi is running thiis public option endgame.

At last count, she's still eight votes shy of the crucial 218 she needs to pass a robust public option plan, though key players seem to think she has momentum on her side. If she can't whip up those last eight votes she'll likely have to revert and move ahead with a more modest public option--one that negotiates rather than dictates reimbursement rates. That would disappoint reformers and progressives in her caucus. But she (and they) will be able to say she pulled out all the stops.

Speaker Pelosi Throws Down The Gauntlet For The Public Option--Will She Succeed?

I've expressed some pessimism about Rep. Pelosi's abilities in the past. I've expressed rather a lot of it, in fact. At the moment, though, she does seem to be the most progressive of the Democratic leaders on this issue. At the moment, she's the only one who is openly championing a realistic public option.

Let's contrast with President Obama and Senate Majority Leader Harry Reid to see why.

Senator Reid has apparently spent the last few days holed up with Senators Baucus, Dodd, and Snowe, not to mention White House Chief of Staff Rahm Emanuel and Health and Human Services Secretary Kathleen Sebelius. The result so far? We'll get back to you:

With Senate Democratic leaders in intense talks over how to craft a final reform bill, the lukewarm view of the public option by many in the caucus is but one of a slew of differences Senate Majority Leader Harry Reid must try to iron out if he is to win a filibuster-proof 60 votes.

Aside from the public option, lawmakers are worried about the expansion of Medicaid coverage. The proposed expansion would add billions to already strapped state budgets and it has sent governors into a panic. Reid has carved out a five-year exclusion for his home state and other Senators, including moderate Mary Landrieu, D-La., who opposes the public option, are demanding the same treatment, which in the end will increase the cost of the bill by billions of dollars.

Concern Over Details Complicates Health Effort In Senate

It appears that some Senators, like "Jello" Jay Rockefeller, are starting to say that an "opt out" option for states might be a thing they could support. Opt out sounds to me like a way for regressive states to screw their populations, but apparently giving the country even this much help is beyond the people who inhabit our Congress.

As usual, Reid is talking about 60 votes as if he doesn't have sixty Democratic Senators. You'd think there was no such thing as party loyalty on key votes.

You'd think that, at least, if you didn't know that this is, in all likelihood, exactly what the President wants, as Scarecrow points out at FireDogLake. First, he asks why Harry Reid isn't doing very well at leading the Senate on health care reform:

The question many health reform advocates have been asking about the public option debate is “what’s the problem”??? Why isn’t the President demanding it, pushing it, selling it? Well, maybe he doesn’t want it.

Why, given strong Congressional majorities in favor of a public option, continuing strong polling support across the country, and overwhelming support from Democratic voters, is Harry Reid treating the matter as though it were a close call?

To be sure, getting 60 votes for cloture is a challenge, but that is not the same as needing 60 votes for a public option, no matter how many times the media equates the two. Only 5 or 6 Senate Democrats are even opposed in concept. Yet not one of these holdouts has publically declared that he/she would join a filibuster to keep a public option from getting a simple majority-rule vote. Sen. Harkin correctly asks, why should these five be empowered to force over fifty to give in?

Why the White House Probably Doesn’t Want a Public Option

A good question. As you may have noticed, it occured to me, also. Scarecrow then goes beyond what I've achieved, and answers that question:

The Beltway conventional wisdom, steeped in cynicism, is that the White House is being disingenuous when it repeatedly says the President supports a public option. WH officials claim Obama believes it is “the best way” to provide an affordable choice and reduce costs. But then why is he not working to get it adopted in the Senate, and explicitly directing his OFA troops to help that effort? Why has he ducked every opportunity to make even the logical argument that the burden is on detractors to show there’s a better measure? No one has seriously attempted such a case.

In House and Senate leadership efforts to merge their respective bills, it’s curious that no one has noticed that House Speaker Pelosi does not seem to need the White House to tell her how to merge three House bills while improving them. But apparently, Harry Reid is not capable — or cannot be trusted — to merge two Senate bills without having Rahm Emanuel, Peter Orszag and Kathleen Sebelius present every meeting.

There’s nothing wrong with the Senate consulting with the White House about what they’re willing to push and pay for. But the White House told reporters that all the key decisions would be made by Harry Reid. So why are these senior White House people, including the man who sees himself as the center of the universe, there if not to tell Harry Reid what he can and cannot decide.

Why the White House Probably Doesn’t Want a Public Option

That is something that I've mentioned before. I find that I'm in the unaccustomed position of believing in conventional wisdom. By what he's done and what he's said, it's clear that Obama doesn't want a public option. He doesn't want anything that will drive insurers and other big medical lobbies to jump to the Republican side of the fence:

Why should we not also believe that the White House has a deal to shield insurers from competition by preventing the creation of a public option in exchange for the insurers agreeing to reforms on guaranteed issue and limited community ratings (with the flexibility Baucus provided) and to support this framework with tv ads? (Read Ignagni’s WaPo op-ed today; while defending the PwC study, she says they made a deal, but Baucus broke it; she didn’t say the deal’s off.)

The White House isn’t taking up most of the chairs in Harry’s Reid’s meetings just to watch him make decisions on his own. They’re there to make sure Harry Reid doesn’t undo the White House deals and wander off the reservation.

This President has filled the White House with people who have no inclination to pose any major challenge to the economic power of America’s dominant financial industries (GM being an exception). We’ve already seen this in their dealings with Wall Street investment banks and their too-big-to-fail is too-big-to-challenge approach to financial regulation. We’re seeing it now with efforts to shield the major health and insurance industries from any fundamental challenge.

Sure, there are changes being offered, new regulations being proposed, and more people will be insured than before. But there is no framework being laid for a new structure for how health care is delivered and paid for in America. That is the pattern of this White House, and there is little basis to expect otherwise.

Why the White House Probably Doesn’t Want a Public Option

It's well worth reading the rest of Scarecrow's article, and following the links. The proof of what the White House wants is in their actions, not their words. Not that I take much comfort in the President's recent words on the subject. Even they lack any real conviction. If he really wanted a public option, he'd have said he wouldn't sign a bill that didn't have one. He hasn't.

It's not the first time that President Obama has tried to pin the blame for his own pandering to special interests on the Senate. It won't be the last, I'm sure. It won't be the last, because there are still lots of folks who are willing to swallow this nonsense. When they finally figure out what's happening, I have some informative reading for them to consider.

Now, where's my grindstone?

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