Rational Arguments

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.

A reader responds:

In your Feb. 1 post, you claim that Rep. Price’s authored bill, H.R. 3400, is “the Republican proposal” for health care reform.  It’s one of several that has been sponsored by Republicans, and most importantly isn’t the one that made headlines this fall from such a “grim” CBO review. That bill was H.R. 4038.  Your post misleads your readers and implies that: there has only been one Republican proposal, and that this is it.  Maybe you made an honest mistake, but words are important and your biases rarely hide themselves. In your words, I look forward to you correcting the record.

First of all, I always love when someone tells me my “biases rarely hide themselves” – as if they’ve caught me trying to hide my preference for a single payer health care system.  Or my disdain for rhetoric.  Or my impatience with politics over policy.

Let me say it for the zillionth time.  It’s not hidden.  I think that the available data and evidence show that such a system would be much more cost-effective.  I think that the media (and others) have done a terrible job of describing the details of proposed policy.  I think that too many people want reform to succeed or fail only because they want Democrats or Republicans to “win” or “lose”.  Even worse, I think that some people want it to succeed or fail merely because of personal feelings for politicians, which is so petty it makes me sad.

If you think I’ve got some other “bias”, please do let me know.  I’ll address it here, in the open.  I’ve got nothing to hide.

As to the idea that HR3400 is not “the Republican proposal”, it’s the one that Rep. Price was talking about when he spoke to President Obama.  It’s the one he said had more co-sponsors than any other health care reform bill in the house.  It still doesn’t.

Although it does have more co-sponsors than HR4038, which has only 23.

But if it makes this reader feel good, then I will say – again – that there has been more than one proposal.  I have talked about them in a number of posts.

None of this changes the fact that the health care reform bill with the largest number of co-sponsors is HR676 – Medicare for all.

Here’s one mistake from last Friday’s Q&A, which has been all-the-rage this last weekend.

Rep. Tom Price said (emphasis mine):

Mr. President, multiple times from your administration there have come statements that Republicans have no ideas and no solutions, in spite of that fact that we’ve offered, as demonstrated today, positive solutions to all of the challenges we face, including energy and the economy and health care. Specifically, in the area of health care, this bill, H.R. 3400, that has more cosponsors than any health care bill in the House.

He’s correct that HR 3400, the Republican proposal for health care reform, has more co-sponsors than the Democrats’ bill.  But he is incorrect that it has more co-sponsors than any health care bill in the House.  Know which health care bill has more?

HR 676.  The United States National Health Care Act or the Expanded and Improved Medicare for All Act.  It’s a bill for single-payer insurance.

It has 87 co-sponsors.

Since the Republicans are obviously proud of their number of co-sponsors, I’m sure they are going to be impressed by this fact.  I’m also going to assume that Rep. Price isn’t lying, and that he just doesn’t know.  I’ll look forward to his correcting the record.  And I’ll look forward to the media reporting any of this to anyone.

Here’s something I pointed out to a friend today:

When the Democrats started the health care reform process a year ago, they held the White House, The House of Representatives by a 78 vote majority, and the Senate by a 58-41 majority.

After the loss in Massachusetts, they hold the White House, the House of Representatives by a 78 vote majority, and the Senate by a 59-41 majority.

That’s a signal to give up?  In what Bizarro universe?

As I watch the Democrats in Congress lose their collective marbles, it’s nice to see one keep his head.  It’s especially nice that it’s one of the oldest and longest-serving members in the House of Representatives, John Dingell:

What are the Democrats’ options going forward?

First, pass the Senate bill. Second, pass the Senate bill and address the deficiencies in a package under reconciliation. Third, address the whole business under reconciliation, with some problems. It’s also possible to break off some of the things we’ve done before and do them. You’ve got the Patient’s Bill of Rights, children’s health, government negotiation of drug pricing. There are loads of things you can do.

The first two options seem easiest. But there’s been real despair on the Democratic side about passing the Senate bill, even with the prospect of modifications. But no one who understands this stuff thinks the difference between the bare Senate bill and the likely compromise measure is bigger than the difference between the Senate bill and the miserable status quo.

I don’t think you’re hearing despair. I think you’re hearing anger. People feel the matter has been badly handled and that a year’s work has been dissipated by the change in the Senate. I’m not satisfied that that is the proper response to this. But I think that when those people have presented to them by the leadership a clear statement of what course will be taken, those people will jump aboard. The fact of the matter is we don’t have time to be angry.

What about those who say we should just wait, that there’s no rush? You’ve been around this issue for a long time. What generally happens when these efforts burn out?

I’m sure the same people will be saying the same thing next year or the year after when we have the same damn problems. I don’t think we’ve been hurt so badly we can’t move forward. We ought to take this bill to conference and stand the Republicans up in the baleful light and oppose this legislation before the public. They’ve been whining that its not been open enough. Let the people see it.

Man’s speaking a lot of sense.  I hope he’s right.

While it’s good to be back from break, today was crazy.  I can’t go to bed, though, without passing along some big developments in the health care reform process.  The biggest news of the day is that the the ping-ponging process that I brought up a few weeks ago seems like it’s going to happen:

According to a pair of senior Capitol Hill staffers, one from each chamber, House and Senate Democrats are “almost certain” to negotiate informally rather than convene a formal conference committee. Doing so would allow Democrats to avoid a series of procedural steps–not least among them, a series of special motions in the Senate, each requiring a vote with full debate–that Republicans could use to stall deliberations, just as they did in November and December.

“There will almost certainly be full negotiations but no formal conference,” the House staffer says. “There are too many procedural hurdles to go the formal conference route in the Senate.”

I can’t help but feel a little pride in thinking this was a good idea back then.

Unfortunately, it’s not very good for conservatives.  It will not allow much room for them to debate the bill at all.  Of course, this was inevitable, since the leadership pretty much said they weren’t interested in negotiationg at all:

One reason Democrats expect Republicans to keep trying procedural delays is that the Republicans have signaled their intent to do so. On Christmas Eve, when the Senate passed its bill, Minority Leader Mitch McConnell memorably vowed in a floor speech that “This fight isn’t over. My colleagues and I will work to stop this bill from becoming law.”

Yes, Republicans are sure to complain that they’re being excluded from deliberations. But given their repeated efforts to block not just reform but even mere votes on reform, it’s not clear why Democrats are obligated to include them in discussions anymore.

The fact that the Senate and the House are discussing this seriously leads me to believe that (1) they must have a plan to get this done and (2) they want to get it done before the State of the Union address.  Things should move fast once Congress is back in session.

I know I’m getting ahead myself here, because the bill hasn’t even passed yet, but I’m amazed at the noise people are making about repealing health care reform.

It’s not going to happen.

That’s not because it will be popular (and I think it will).  That’s not because a lot of people are all of a sudden going to find themselves with nice government subsidies to buy insurance.  That’s not because people on both sides will see it’s not the evil they’ve made it out to be.

It’s because it would be just as difficult to repeal it as it was to pass it.  Repealers would need (1) a majority of the House to vote to repeal it, (2) 60 votes in the Senate to repeal it, and (3) a President willing to sign the bill* to repeal it.

I suppose (1) is possible, if unlikely.  (2) is not going to happen anytime soon.  They’d need to replace at least 20% of the Senate,because NO ONE who voted for the bill will vote to repeal it; there just aren’t that many vulnerable Senators right now. (3) can’t possibly happen until 2013 at the earliest.

This is all theater.  I don’t blame the politicians for being politicians.  I blame the media for covering this seriously.

*Yes, I know that with a 2/3 majority in the house and Senate they could override the veto, but that’s NOT GOING TO HAPPEN.

While checking to see if my latest post at HuffPo was up, I came across this new information over there.

Where we are right now is that the Senate is voting on their own health care reform bill.  If it passes, it obviously isn’t the same bill that the House approved.  So the Senate and the House need to sit down and create a whole new bill from those two individual bills that they believe both the House and the Senate will approve.  This will take some time.

There’s an alternative, however:

There is increased chatter on Capitol Hill about a possible “ping-ponging” of the Senate health care bill: that chamber would pass its health care bill, send it to the House and the House would be asked to pass it with no changes and send it directly to the president.

That limits the options of congressional critics — under the usual procedure, lawmakers dissatisfied with the bill pushed through their chamber can win changes through adroit political maneuvering in conference committee negotiations.

“It’s the only scenario by which we could actually get this whole thing done before the New Year. The House has indicated they’d consider it, depending on what the final bill looks like over here after we finish with the sausage-making,” said a senate Democratic aide involved in the health care fight.

Senate Majority Leader Harry Reid (D-Nev.) is currently negotiating what’s known as a “manager’s amendment.” That amendment includes large and small concerns that senators want worked out before voting to end a filibuster. If Democrats decide to ping-pong the bill, the manager’s amendment becomes, in effect, the only place to work out differences.

If Senator Reid talks to the House beforehand, and can get their concerns into the Manager’s amendment, AND it can be approved by the Senate, then the House could just immediately vote and approve the Senate bill without any more wrangling.

I’m not a political expert, and I don’t know how often this occurs, but it seems like a good idea to me.  One less chance to filibuster as well.

UPDATE: Steve Benen thinks it’s unlikely to happen.

I put this together for a friend, but there’s no reason not to share it here.  He’s a primer on the bill the House just passed:

COVERAGE AND PREMIUM REFORM

1) Medicaid eligibility will be expanded to 150% of the poverty line  (The Senate will likely be 133%).  Those on Medicaid generally do not pay premiums, and co-payments are usually a max of $3 for most services. Medicaid covers a broad range of stuff and does a good job for low-income people, who are more likely than people with higher incomes to be in fair health or worse.

2) Subsidies for premiums.  Those above 150% of the poverty line (the Medicaid limit) but below 400 percent of the poverty line would get help to purchase health insurance in the exchange. An example: a family of three earning $32,000 (175 percent of the poverty line) would have to pay only $1,360 a year (in 2009 costs), compared to $2,013 a year under the Senate Finance Committee bill.*

3) Caps on out of pocket spending.  This is also on a sliding scale up to 400% of the poverty line.  The same family of three earning $32,000 would have to pay only $2000 in co-pays and deductibles; with the Finance Committee bill, the maximum might be twice as high.

*However, a family of four making $88,000 would have to pay up to 12% of its income in premiums, and still face $1,500-per-person copays and total possible costs of $10,000 per year.   That’s a lot (but still better than the Senate).

4) Individual mandate.  You buy insurance or pay a penalty of 2.5 percent of income.  Individuals can get hardship exemptions.  The mandate is actually stronger than the Senate Finance Committee version.

5) Employer mandate.  Employers have to offer coverage meeting certain standards or pay a fine that’s a percentage of their payroll. Most small employers are exempt.  This will result in something like 6 million more people having employer based coverage, so it’s nothing to sneeze at.

MEDICARE REFORM

1) No more extra payments to Medicare Advantage.  We’re overpaying by 14% or $1100 per old person.  No more.

2) We can now let Medicare negotiate drug prices with pharma.  This is huge and goes against the promise the White House made to pharma.  It will be used to close the doughnut hole.

3) Reimbursement reforms.  They’re going to try and implement accountable care organizations and pay for quality not quantity.  I have little faith this will work.

REFORMS TO INSURANCE MARKET

1) Insurers can’t deny coverage for pre-existing conditions.

2) Premiums would have a narrow range.  The most a company could charge for one person compared to another based on age or tobacco use could be only a maximum of twice as much.  In the Senate Finance Committee bill that ratio could be much more.

3) Maximum lifetime out-of-pocket costs and NO maximum lifetime benefit.

4) There will be a minimum package of benefits that will be considered mandatory.  The criteria are tighter than in the Senate Finance Committee bill to prevent cherry picking.

5) These rules apply to all new policies and eventually all employer-sponsored policies as well.

6) The exchange. This is for individuals and to small businesses in every state. States could substitute their own exchanges if they obtain approval from the federal government, comply with all federal requirements, and show that they can do the job adequately. Theoretically, the exchange help people to make informed choices and find a good plan. By year three, it should also apply to businesses with up to 100 workers that wish to use it.  Eventually, everyone might get there.

7) Public Option. It’s national, but restricted in who gets in. And it needs to negotiate with providers.  Maybe we get 6-10 million in it.  It probably won’t get the cost savings many think it will.  The CBO agrees with me.

TAXES

1) A 5.4% surtax on couples making more than $1,000,000 a year and individuals making more than $500,000 a year.  Brings in more money than you’d think.

THE STUPAK AMENDMENT

1) Basically, if you get a subsidy to purchase insurance, that insurance can’t cover abortions.  This will not apply to those with employer based coverage.  This is especially bad, since it means that we will have to hope that insurance companies will offer dual plans in the exchange (with and without abortions) so that those in the exchange not getting subsidies will be able to get insurance coverage for abortions.  Some think insurance companies won’t go to the trouble since most people will be getting subsidies.  Abortions can cost up to about $1000 in the first trimester.

(Helpful source: Center on Budget and Policy Priorities)