Rational Arguments

I’ve been immersed in this for so long that I thought I’d seen everything.  But this whole process is beyond belief.

Jennifer Rubin on January 27th, in “Is ObamaCare Dead?”:

So it seems that the doubling-down on ObamaCare crowd exists mostly in the punditocracy. Congress wants to move on. Who knows if this is what Obama “wants.” He is, in a sense, a bystander to the wreckage of his own failed first year. The survivors are walking away from the crash, bruised and battered. Whether he acknowledges this failure tonight remains to be seen. But it matters not at all what he says on the subject. The country has spoken, the Congress is finally listening, and the jig is up. ObamaCare is dead.

I still remember being told it was over.  Dead.  People laughed in my face, which led me to write this.

And yet, today, Intrade has passing health care reform at 81%. Nate Silver puts it at greater than 75%.

Once again, I profess that my understanding of politics is way, way inferior to my understanding of policy.  It may be that when I come to work next week, this may have passed the House.

I’m as stunned as you are.

The final bill is reviewed.  I’ll have more when the release the actual analysis:

Comprehensive health care reform will cost the federal government $940 billion over a ten-year period, but will increase revenue and cut other costs by a greater amount, leading to a reduction of $130 billion in the federal deficit over the same period, according to an analysis by the Congressional Budget Office, a Democratic source tells HuffPost. It will cut the deficit by $1.2 trillion over the next ten years.

The source said it also extends Medicare’s solvency by at least 9 years and reduces the rate of its growth by 1.4 percent, while closing the doughnut hole for seniors, meaning there will no longer be a gap in coverage of medication. The CBO also estimated it would extend coverage to 32 million additional people.

Well, it’s more expensive than the other bills, but it also has larger offsets.  That means it’s bringing in more money (taxes) and making more cuts (savings).  These make it deficit reducing.  And, for those of you who still buy into the “more years of taxes than benefits”, it’s WAY more deficit reducing in the second decade, when there are 10 years of taxes and 10 years of benefits.

It’s also going to help trim Medicare (which fiscal conservatives would love in a rational world), close the donut hole (which seniors would love in a rational world), and cover 32 million more people (which liberals would love in a rational world).

Legislation is about compromise.  This isn’t the bill I would write if I were king of the world.  But that’s not the way the world works.  This is better than what we’ve got.

So pass the bill.

From Rep. Kucinich, who declared himself a yes vote for health care reform today:

However after careful discussions with the President Obama, Speaker Pelosi, Elizabeth my wife and close friends, I have decided to cast a vote in favor of the legislation. If my vote is to be counted, let it now count for passage of the bill, hopefully in the direction of comprehensive health care reform. We must include coverage for those excluded from this bill. We must free the states. We must have control over private insurance companies and the cost their very existence imposes on American families…

As this bill passes I will renew my efforts to help those state organizations which are aimed at stirring a single payer movement which eliminates the predatory role of private insurers who make money not providing health care. I have taken a detour through supporting this bill, but I know the destination I will continue to lead, for as long as it takes, whatever it takes to an America where health care will be firmly established as a civil right.

I can’t say that Rep. Kucinich and I always agree (far from it), but in this case I think we do.  It’s not the bill we’d choose, but it’s a necessary step if we want to accomplish anything more significant in the near future.

One of the most frustrating talking points against health care reform is that we don’t want to “rush”.  There’s no crisis.  We should scrap this and start over.   Go small.  Do little.

Then you see something like this:

The number of uninsured adults and children in California swelled by 25 percent between 2007 and 2009, according to a new report by researchers at the University of California, Los Angeles.

One quarter of the state’s population is now uninsured, according to the analysis, and less than half of those with insurance receive it through employers.

The increase, to 8.2 million from 6.4 million, is largely because of job loss during the recession, said Shana Alex Lavarreda, co-author of the study and director of health insurance studies at U.C.L.A.’s Center for Health Policy Research. The figures include all workers in the state regardless of immigration status.

In 2007, even before the economy’s collapse, the number of uninsured adults and children in California had reached more than six million, Dr. Lavarreda added.

One quarter of people.  Remember, everyone over the age of 65 has Medicare.  So the percentage of non-elderly without insurance is even higher.

By the way, the numbers of people also on public insurance also increased over this time.  All the net loss is from the private insurance system.  And insurance rates are going up and up and up.

How high is a crisis?  Does anyone think the economy issues are solved?  Is unemployment going away?

At what point do we say enough?

This also appeared today in the Huffington Post:

Pass the bill. There — I said it.

Before you start screaming at me from the Left, take a deep breath. My bonafides on robust reform are pretty solid. I’ve published research, more than once, on how physicians are pretty receptive to national health insurance. I’ve previously been on the board of Physicians for a National Health Program. I even appeared on the Colbert Report last summer to talk about single-payer health care. I’d rather have that; we’re not going to get it right now.

They should pass this bill.

Before you scream at me from the Right, I know this bill isn’t perfect. I agree that it doesn’t do enough for cost containment (although sometimes I think that I am much more sincere about really containing costs than you are). I agree that there are parts of it that aren’t entirely clear. But most of what you seem to hate about the bill isn’t actually true. So it’s hard to know what to tell you.

They should pass this bill.

Whenever you debate a medical treatment or procedure, you have to weigh the benefits versus the harms. If the harms outweigh the benefits, it’s probably not a good idea. If the opposite is true, it’s a path you likely should consider. And when it comes to this bill, I think that it does more good than harm, if only for the following reasons:

1. Severely increased expansion of Medicaid. Few people know how limited Medicaid coverage is. In most states, you can’t get Medicaid at all if you don’t have kids. And even if you do have kids, some states limits are so low that if you’re part of a couple with two children and make $2500 a year, you make too much to get Medicaid in Alabama. The Senate bill raises the limits for everyone in the country to 133% of the poverty line. That’s a big deal, and would do an amazing amount of good for millions of the least well off among us.
2. Increased regulations on insurance companies. They can’t deny you insurance for pre-existing conditions. They can’t stop paying the bills at some arbitrary limit. They can’t charge you more because you (or your child or your spouse) were unlucky to develop a chronic condition like diabetes, asthma, or cancer. They can’t drop your coverage when you get sick. They can’t spend more than a certain amount on things not actually relevant to health care.
3. Insurance exchanges. People who get their insurance through their jobs have absolutely no idea how difficult and expensive it is to get insurance in the open market. And know this – you’re one layoff from being in that position. Just ask the UAW member, the steel worker, or a local contractor. The exchanges will let everyone, absolutely everyone, be part of a large group to get insurance. I don’t know anyone who opposes this.

And there’s more. There’s money for federal Community Health Centers, which serve over 16 million people and likely more in the future. There’s money for increased training of primary care providers. And – it’s projected to decrease the deficit, unlike Medicare Part D, passed by many of the Republicans and Democrats who’ve now suddenly become averse to spending, which will add about $1 trillion to the deficit over the same time.

Yes, it’s not completely universal. I hate that. It still supports the massively fractured health care system we all seem to loathe. It won’t do much to change our culture of massive over-spending. It won’t do enough to truly rein in costs over time. It’s not as efficient as it could be and still tolerates an enormous amount of waste.

Still. They should pass the bill.

The good it will do is far better than the status quo. It improves the situation for millions of people without insurance. It helps everyone who doesn’t get insurance through their employer. It provides security even for those who do, and might someday join the ranks of those who don’t.

But there is one more reason to pass this bill. It’s an argument I use even when talking to my friends who vehemently oppose it.

If they don’t pass this thing, then no one – NO ONE – is going to attempt to fix this at all in the foreseeable future. And one thing you’re hearing as a scare tactic is true. We are spending almost $2.5 trillion a year on health care. It is 16% of our economy. And it’s growing too fast. If no one touches this, then we’re doomed, fiscally. Costs will continue to rise, politicians will put it off, and we will crash. Then, when we have to fix it, there will be nothing left to fix it with.

We need real cost control, and the only way to do that is to build on this. There needs to be a success to build on. We need to get everyone covered. We need to improve quality. We need to make it even more efficient. And all of those things require some momentum, or something to convince future politicians to act.

Moreover, to truly contain costs, we will need to take more drastic action someday soon. If you think this iteration of reform is unpopular, wait until you see someone honestly try and talk about reining in spending. That will work if – and only if – it applies to everyone equally; it will work only if everyone is covered.

And none of that will happen if they don’t pass the bill.

So pass the bill.

UPDATE: It’s important to note that in this piece I am speaking for myself, as a private citizen, and in no way representing my University or any other organization.

I keep complaining that this bill doesn’t do enough to control costs.  I believe that.  But then I see something like this, and I have to accept that maybe I’m over stating things.  Or, at least, I need to recognize that something is still better than nothing:

If President Nixon’s health reform plans had been enacted in 1975 and slowed the annual rate of spending by 1.5 percentage points a year, today we would be spending 10.7 percent of GDP on health care. In dollar terms, we would spend only $1.6 trillion on health care in 2010, instead of projected health spending of $2.6 trillion. This savings of $1 trillion in 2010 alone would remove much of the financial burden on families, businesses, and government. Even if Nixon reforms had slowed spending growth by “only” 1 percentage point a year, health spending as a percent of GDP would have been $1.9 trillion in 2010, or 12.7 percent of GDP—a savings of 5 percent of GDP.

If cost containment measures slowing spending by 1.5 percentage points a year had been enacted in 1980 under President Carter, the trends would be similar, with spending rising to $1.7 trillion in 2010, or 11.5 percent of GDP. Even if we had acted as late as 1995 under President Clinton, health spending in 2010 would be $2.1 trillion, or 14.2 percent of GDP.

The federal government would have been a major beneficiary of comprehensive health reform under Presidents Nixon, Carter, or Clinton. Instead of consuming 6.2 percent of GDP in 2010, federal health outlays would have been 3.7 percent in 2010 under Nixon reforms that slowed spending growth by 1.5 percentage points, 4.0 percent under Carter, and 5.0 percent under Clinton.

Hard as it is to believe, had President Nixon’s health care reform proposal been enacted – Nixon! – and costs been slowed by as little as 1.5%, our health spending as a percentage of GDP might be 7% lower than it is today.  That’s a massive amount of money.

Maybe incremental reform would do more to contain costs than I thought.

(h/t Ezra Klein)

UPDATE – Language cleaned up to make things more exact.

The top story on memeorandum right now is called, “Ruling Kills an Option for Moving Health Bill.”  There are tons of posts about it.  Here’s the first line:

The Senate Parliamentarian has ruled that President Barack Obama must sign Congress’ original health care reform bill before the Senate can act on a companion reconciliation package, senior GOP sources said Thursday.

HORROR!  Oh no!  What a shocker!

Go to memeorandum now.  Check the news.  See how many stories are talking about how this dims prospects for the passage of health care reform.

Now go back to a post I wrote on March 1:

I’m starting to despair that no one in the media has any idea what they are talking about. I get why Republicans are trying to portray the passage of health care reform as some betrayal of principles or the tyranny of the majority, but it’s not.

Using reconciliation is not “ramming it through”.

Look – the bill has already passed through the Senate.  It got 60 votes.  It’s done.  Was that ramming it through?

Now, let’s say the House of Representatives passes the Senate bill, by a majority.  Is that ramming it through?

And then, the President signs the bill – passed by both houses of Congress.  Is that ramming it through?

No, it’s not.  It’s how laws (that overcome filibusters) are supposed to pass.  And then we would have health care reform.  No reconciliation.  No “ramming it through”.

Today is March 12.  This is news to them?  Really?

You pass the bill.  The President signs it.  Then you do reconciliation.  This isn’t rocket science, people.

Well, so far, it’s not even close.  Only one person so far has emailed me in favor of comments.  Everyone else says no.  I’ll still field votes for a bit, but it doesn’t look like I’ll be changing the policy.

In addition, some of you have asked if I’m on Twitter.  The answer is yes.  I post links to articles I think are interesting there, as well as some less formal thoughts in general.  If you want to follow me, I’m at DSYGAaron.

When I started this blog, I declared that I was not going to have a comments section for posts.  This is mainly because I don’t have time to monitor it closely, and I wanted to avoid partisan sniping or worse.  But many of you have asked for one.

My new fear is that it would just be talking points.  And, you know, this is my blog.  I post people’s emails when they make solid arguments against what I’m saying, or pose good questions, but I’m not looking for anecdotes or talking points as rebuttal.

But I’m willing to reconsider.  Do you feel like I need to have a comments section?  Email me and tell me why.  Maybe I’ll give it a go.

I can’t believe the number of emails I’m getting about if, or how, the Democrats will get the number of votes needed to pass the House.  Evidently, I’m not alone in this.

Stop worrying about it.

There are a number of reasons to do so. The first is – as any good therapist would tell you – your worrying is not going to effect the outcome.  Second, no one who tells you they know how it is going to end is telling you the truth.  Not even this guy.  Nearly everyone who is making a bold prediction is biased or has something to gain by being right.

But the real reason is this.  For Democratic Congresspeople, there will probably be no time in the near future where they can get more press and influence than by appearing to waver on health care reform.  Do you think Rep. Stupak doesn’t know that?  He’s in the paper every day right now.  Do you think other staffers in other representatives’ offices aren’t telling their bosses right now that if they waver, they will get the same publicity?

Want to get a personal phone call from President Obama right now?  Waver.  Want to get a promise for something in your district in the next budget?  Waver.  Want to make sure your pet piece of legislation gets a committee hearing?  Waver.  Want to be on TV?  Waver.

There’s almost no downside.

Look, it’s really out of our hands.  Yes, you can call your representative and tell them what you want.  In fact, that’s always a good idea.  But at some point you have to trust that Speaker Pelosi and President Obama and even Rahm Emmanuel know what they’re doing (or not if you oppose reform).  Either they will get it done or they won’t.  But nothing you will hear on TV or in the paper in the next few days about vote counts will likely predict the outcome.