Recently in health care Category
Nov 10 2009, 4:09PM
Health Reform "Heavy on Health and Light on Reform"
Democrats are now accusing the White House of tolerating a bill that is all health subsidies and no cost reform. Unfortunately, I think they're right about the bill. But this is strange accusation. The White House isn't writing this legislation. It's setting guidelines. House and Senate Democrats are angry about the failure of bills written by the House and Senate Democrats. It's a bit like having your mother tell you to clean your room, then coming home from school to see your room isn't clean, and accusing your mother of tolerating a dirty room.
I like Rahm Emanuel's line a lot:
I like Rahm Emanuel's line a lot:
Oct 13 2009, 5:18PM
What The Budget Scolds Are Saying
One of the paradoxes of health reform is that you have to spend money to save it. The current system is killing our long-term fiscal outlook, and so it needs reform, but to achieve such reform you have to spend more now in order to save money later. The same logic applied, in a way, to the argument that the stimulus package was fiscally prudent--spend now so the economy doesn't go off a cliff. After the Senate Finance Committee bill passed today, one of the leading budget scold groups--and I use the term affectionately because I think they're more right than wrong--the Committee for a Responsible Federal Budget praised the overall direction of the bill but noted things that could make it even more fiscally prudent. Given that the bill is going to get married to more liberal versions in the House and Senate, I doubt that'll happen, but it's worth noting what they point to:
Oct 7 2009, 2:45PM
Oh, Andrew: A Response To The McCaughey History
I love my former boss and current colleague, Andrew Sullivan. But I think he makes a mistake today in his otherwise thoughtful account of his publishing Betsy McCaughey's 1994 piece on the Clinton health plan. He concludes the piece by saying: "There's one reason the Clinton healthcare bill failed and it isn't Betsy McCaughey. It's Hillary Clinton." But this is reductionist in the extreme. Clinton made mistakes as she's admitted. But the difficulty that President Obama is having passing health care reform under easier circumstances--a bigger Democratic majority, more frustration with the current system--shows that there's a reason presidents since Truman have been taking a shot at this and none has quite managed. One is the sheer size of the undertaking, and second, and more important, is the sheer tenacity of the opposition. Obama's done the opposite of Clinton. Instead of devising a bill in relative secrecy, albeit with consultation from Congress and interested parties, he let Congress figure it out. Instead of specifics, he offered broad principles. Nothing wrong with that. But the end result is that Obama is still fighting for his bill despite having 60--count 'em--Democratic senators and the House that Rahm and Pelosi built. It's tough. Hillary Clinton made plenty of mistakes, and you could argue she deserves the lion's share of blame for the '94 debacle. But to not mention the American Medical Association, Bill Kristol, Bob Dole, Newt Gingrich, Harry and Louise and all the other opposition to the plan is kind of myopic for someone with such good vision.
Oct 5 2009, 2:35PM
Obama Sees It Hillary's Way
Looks like the Senate Finance Committee won't get around to voting on health care for several more days. The Congressional Budget Office has taken longer than expected to tote up what the bill would actually cost. In the grand scheme of things this is no big deal, but it doesn't help matters when there's a delay, given all the forging and compromising and negotiating that needs to be done to try and get a bill through both houses of Congress by the end of the year. Odds are pretty good that the bill passes out of the Finance Committee on a party line vote, but Olympia Snowe, the Republican from Maine, could sign on, and Jay Rockefeller could opt out.
By the way, I don't think enough has been made of Obama's 180 degree turn on mandates since the Democratic primaries. As you may recall, Obama opposed mandates. Hillary favored requiring people to buy insurance. (To be fair, she opposed this back in '94 when the late Sen. John Chaffee proposed them.) This was one of the major issues dividing Obama and Clinton in a campaign that was more about gauzy themes of change and experience instead of real policy differences. Much was made in the elite media about Obama's reliance on the work of Cass Sunstein's book, "Nudge," about encouraging people to do the right thing. Mandates were paleogovernment in Obama's eyes. Now, um, not so much. As policy turnarounds go, this isn't on the order of, say, George W. Bush opposing nation building or Bill Clinton canceling the middle-class tax cut he promised in 1992. But it is a change, and it would probably be a bigger deal if Hillary Clinton were in the Senate instead of at State.
By the way, I don't think enough has been made of Obama's 180 degree turn on mandates since the Democratic primaries. As you may recall, Obama opposed mandates. Hillary favored requiring people to buy insurance. (To be fair, she opposed this back in '94 when the late Sen. John Chaffee proposed them.) This was one of the major issues dividing Obama and Clinton in a campaign that was more about gauzy themes of change and experience instead of real policy differences. Much was made in the elite media about Obama's reliance on the work of Cass Sunstein's book, "Nudge," about encouraging people to do the right thing. Mandates were paleogovernment in Obama's eyes. Now, um, not so much. As policy turnarounds go, this isn't on the order of, say, George W. Bush opposing nation building or Bill Clinton canceling the middle-class tax cut he promised in 1992. But it is a change, and it would probably be a bigger deal if Hillary Clinton were in the Senate instead of at State.
Sep 17 2009, 4:10PM
"Imma Let You Finish But Canada Had Best Health Care"
Is the Baucus bill picking up steam? Eh, not so much. But it showed a little more signs of life today when self-styled moderates including hypercentrist Joe Lieberman and the most courted Senator in Washington, Olympia Snowe were among a group to praise Baucus's efforts. Yesterday, Snowe seemed to criticize them. So today's slight praise of the bill seemed to add to the feeling that there was something that might get built upon. Of course, it's not enough to appease most Democrats who think the bill is a big sell out to insurance interests. Last night, Keith Olbermann was fairly apoplectic over the bill. Since the measure has no public option and is cheaper than other packages, it's considered a big bust. But maybe there's at least the beginning of a conversation to be had here. Meanwhile, the president held a big rally in College Park, Maryland this morning to tout the bill. But the crowd, filled with Democratic supporters of the president and folks shipped in by health care groups, booed Baucus and one sign lampooned Kanye West: "Thanks Obama and Imma let you finish but Canada had the best health care of all time." Such are the pressures from left and right on the president as he tries to hold all Democrats together and peel off a couple of Republicans.
Still betting that nothing passes or a very stripped down bill that makes Baucus look liberal. But we'll see.
Still betting that nothing passes or a very stripped down bill that makes Baucus look liberal. But we'll see.
Sep 10 2009, 10:54AM
Now What? 11 Unanswered Questions About HCR
Last night's presidential speech seemed to mollify liberals and harden conservatives, and the main media narrative -- the narrative of the savvy, if you will -- is that Obama delivered the speech that he ought to have delivered months ago. Health insurance reform is likely to pass (how's THAT for a COTS-like prediction), but there are many enhanced interrogations to be had before "likely" turns into "will."
1. Did the President concede too much last night? By ostensibly liming the cost of the final bill to $900 billion, is he inviting Republicans to find a way to force the costs higher? Is $900 billion enough to provide coverage for all, uh, 30 million Americans who don't have access to it now? (See below.)
2. Why did Obama abandon his preferred pay-for -- a cap on the deductions that high earners can take -- for a more complicated tax on gold-plated or "Cadlilac" insurance plans? One of his main constituents, the unions, oppose this because they've negotiated top-dollar plans already. Will health care come down to a fight about whether unions get an exemption? (Pre-negotiated plans?) In practice, will insurance companies pass the cost of this new tax onto consumers?
Sep 2 2009, 3:54PM
What Obama's Speech Needs To Do
Is Jon Favreau, the chief presidential speechwriter, going to get a break? The White House has announced that the president will address a joint session of Congress on September 9. A primetime, joint session speech is about the biggest thing a president can do rhetorically and so the pressure will be on to come up with something that's at once inspiring and clarifying. I say inspiring in the sense that Obama needs to bring back hope when it comes to health care, the idea that it's possible to have a future in which people with insurance don't worry about losing it and the uninsured can be insured, where bankruptcy need not look as a possibility over every serious illness. The debate so far has all been about problems, not hope and possibility. He also needs to clarify what he wants, what he would not tolerate and what his plan really stands for. It'll be easy enough to shoot down "death panels" and some of the more ludicrous criticisms of the health care plans in play. What will be harder to do is to explain the public option--if he chooses to even continue to defend it--or to explain how universal care could be achieved without it.
Aug 7 2009, 4:40PM
Why The Brawls of August Are Good
There's lots of lamenting on the left about all the teabaggers showing up and town hall meetings on health care being held by returning members. The right's all atwitter about organized labor and the left sending people to these meetings. I'm not sure any of it is really bad. Obviously, death threats, demonization and the like are not good for civil discourse. No one gains from shouting. In a perfect world each town meeting would be a civilized discussion of the merits of different approaches to health care. But that's not the world we live in. The more likely alternative is no interest, sparsely attended meetings or just one side showing up.
Aug 3 2009, 5:09PM
Deadline, What Deadline?
Late on Monday, Sen. Mike Enzi, not exactly a household name but an important figure in the health care debate, said that he didn't feel obligated to meet a September 15 deadline to pass a healthcare bill. The Wyoming Republican is just the latest to balk at the idea of a deadline. Recall that the White House wanted a health care bill before Congress left for its August recess. That got rolled back and the middle of September has been the latest line in the sand. But the truth is that all of these deadlines are pretty useless.
Jun 18 2009, 10:58AM
The Centrist Fallacy
A few things to know about Washington. The press loves centrists. Any self-styled moderate who bucks their party is sure to get good play and generally centrists aren't shy about letting you know it. So it's worth noting the important story by Molly Hooper in the Hill on Wednesday night. All kinds of moderates are having all kinds of meetings over health care. Will it lead to anything? Sometimes they do and sometimes they don't. This time my guess is not.
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