issue: Health Care

Another Bite at the Apple

Posted on by The Progressive Policy Institute

The president held a press conference today to announce that yes, indeed, he will press Congress to act on health care reform this month. There’s was nothing immensely new about that development, but it’s interesting that Obama used the occasion to lay out, quite succinctly, the three key points he made in his health care summit with Republicans: why comprehensive reform is essential, why the time for “negotiations” is over, and why there’s nothing that unusual about the use of reconciliation (though he did not use the word, a very unfamiliar term to most people outside Washington) to get the job done. He essentially took another bite at the apple of responding to the most effective Republican lines of attack, and will apparently do so some more in appearances on the road this month.

On the other hand, the presidential press conference may get demoted on the nightly news if a possible scandal involving Rep. Eric Massa (D-NY) continues to develop. Massa, a freshman from a highly marginal district, abruptly let it be known he was retiring. Some sources say he’s suffering from a recurrence of cancer, but Politico is reporting that he was about to come under investigation by the Ethics Committee for allegedly sexually harrassing a male staffer. If the latter story has a basis in reality, it will be big news tonight.

This item is cross-posted at The Democratic Strategist.

President Obama’s Letter: Setting up the Final Push

Posted on by The Progressive Policy Institute

The White House today released a letter from President Obama pointing a way forward for passing health care reform. True to the course that he set at the Blair House summit last week, he stressed the areas of agreement between the two parties, even as he acknowledged some unbridgeable differences.

A considerable portion of the letter — and the part that has gotten everyone’s attention — goes into detail about four GOP ideas that the president said he would like to see in any final package. The president writes:

1. Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.

2. My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.

3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I’m open to exploring ways to address this issue in a fiscally responsible manner.

4. Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers’ use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.

None of those suggestions should surprise anyone who saw the summit or has been paying attention to the president on health care the last few months. Three of the four touch on cost control, which is also not a surprise considering that’s the one area that both sides agree needs to be addressed (although only one party seems to be willing to actually pass legislation to do something about it). As TNR’s Jonathan Cohn rightly points out, the fraud and Medicaid payment proposals should win Democratic support, while the other two might have more trouble.

The key part of the letter, however, comes at the end:

I also believe that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs.

The president, who is scheduled to speak tomorrow to chart his way forward for passing reform, here seems like he’s laying the groundwork for Congress to go down the path everyone has already discussed: passage by the House of the comprehensive bill that the Senate has passed, and a sidecar reconciliation bill to “fix” parts of the bill that House members find objectionable.

What’s important, too, is the language that he uses to justify the continued push. If cost control was the issue on which he could reach out to Republicans, coverage and affordability for ordinary families are the talking points as far as selling reform to the public and to the Democratic caucus. Ending exclusions based on pre-existing conditions, lowering out-of-pocket costs, keeping coverage even after losing your job: these are all hugely popular and marketable ideas. The Democrats have thus far done a poor job of explaining the kitchen-table benefits of reform. But those benefits are real, and they will redound to the benefit of the party who can make reform happen, something Obama seems to understand.

What We Talk About When We Talk About Health Care

Posted on by The Progressive Policy Institute

Regardless of the outcome of the Democratic health reform push, one point is obvious: at every turn, they lost the messaging battle to Republicans and the Tea Party. The latest reminder came this morning, as the umpteenth story on budget reconciliation came on the radio. These days, to talk about health care reform is to talk about process — exactly where the GOP wants the conversation to be.

Over the last few weeks, a new narrative has taken hold in health care news: that of a partisan Democratic Party determined to “ram” a bill through Congress. It’s a frame that the GOP has been relentless and disciplined in perpetuating. Some have even taken to calling it the “nuclear option,” which in its previous political incarnation was the name Trent Lott gave the Republican effort in 2005 to change filibuster rules for judicial nominations.

The “nuclear option” as shorthand for budget reconciliation is not only a misnomer, it’s flat-out misleading. Hardly unprecedented, budget reconciliation has been used 22 times since the process was established in 1974. As Jackie Calmes wrote in the New York Times last week, 16 of those times, it was the Republican Party that used it to “ram legislation through on a one-party vote” (at least that’s how House GOP Leader John Boehner describes its use today).

Moreover, reconciliation has been used several times to pass health care legislation. NPR’s Julie Rovner, who has done superb work on the health care story, pointed out that health care provisions ranging from COBRA (it even says so in the name — COBRA stands for Consolidated Omnibus Budget Reconciliation Act) to the Children’s Health Insurance Program (CHIP) to changes in Medicare and Medicaid have come via reconciliation.

But efforts by reporters like Rovner notwithstanding, the Democrats have already lost this battle as the media have taken the GOP’s cue and fixated on process. The unwarranted magnification of reconciliation is not unlike the media frenzy over Sen. Ben Nelson’s “Cornhusker Kickback,” a bit of horse-trading that was hardly unusual in writing bills, but somehow became the equivalent of a legislative high crime by the time the GOP and the media were done with it.

More than any other piece of legislation in recent memory, health care reform has been debated, negotiated, and written under the unforgiving attention of the 24-hour cycle. This is as close a view as the American public has had to the sausage-making in Washington. They don’t like what they see. Republicans are well aware of this, and continue to point the spotlight on the frequently ugly process.

And so we are now at the current pass. One party has made unprecedented use of the filibuster to prevent anything from being done. The other party is now thinking of using a procedural tactic used nearly two dozen times since 1980, including to pass health care legislation, to break the impasse. While there certainly has been more attention on the abuse of the filibuster of late, that the use of reconciliation is even a story is a problem for Democrats. That Democrats are playing defense on a matter of process speaks volumes about their PR ineptitude, the Republicans’ messaging cohesion, and the media’s ongoing failure to go beyond stenography.

All in on Health Reform

Posted on by The Progressive Policy Institute

There’s something poignant about President Obama’s attempts to reason with congressional Republicans. He keeps hoping that facts, evidence, and logic somehow can penetrate the depleted-uranium armor of conservative ideology. As yesterday’s health summit showed, it hasn’t worked, but a public frustrated with Washington’s tribal politics will probably appreciate the effort anyway.

The summit nonetheless achieved its real purpose, which was not composing differences but illuminating the two parties’ starkly contrasting visions for health care reform so that the voters can make a real comparison. For the past year, Republicans have had the advantage of attacking (often dishonestly) Democrats’ plans without anyone paying much attention to what they have to offer.

The summit put them on the spot, and the clear answer was: not much. Here’s what we learned about what Republicans mean by reform:

First, they don’t much care about health care’s “have nots” – 45 million Americans without coverage. Sure, they favor a modest expansion of coverage to about three million people, but that only begs the question of why the lucky few and not everyone? The answer is that Republicans don’t really believe it’s government’s responsibility to make sure everyone can get access to affordable coverage.

Second, Republicans do care about restraining rising health care costs for those with coverage. But their preferred solutions — medical savings accounts, and allowing people to buy cheaper insurance policies out-of-state — are tilted toward the healthy. The former takes healthy people out of insurance pools, raising premiums for those who remain. The latter allows people to end-run state mandates on the medical services insurance companies must offer. That’s fine for healthy people who can get by with bare-bones coverage, but it doesn’t help the sick. In fact, Republicans generally oppose the insurance market reforms that would prevent companies from cherry-picking healthy customers or dropping people when they get sick.

Third, the GOP has no intention of helping Obama and the Democrats improve their plans, let alone pass them. They feel little pressure to do so, because they think they have the public on their side.

It’s true that polls show majorities are leery of the Democrats’ reform proposals, even if Americans still want Obama to “do something” about health care costs and coverage. Rather than crumble in the face of public skepticism, Obama adroitly used the summit to reframe the health care debate as a choice between action or inaction on one of the nation’s most vexing problems.

The spotlight now shifts to his party. Will liberals torpedo health reform because it doesn’t include the public option? Will moderates play it safe or take a risk for the larger good of their party and their country? Will health care reform be a casualty of that hardy perennial of the culture wars, abortion?

Can congressional Democrats, in short, summon the will and discipline to rise above their own centripetal forces and govern? It should be obvious that failure would reinforce the Republican narrative: the bill was misbegotten in the first place, an overly ambitious, big-government monster that couldn’t even pass muster with Democrats.

Obama has gone all in; now his party needs to follow.

Summit Spectacle

Posted on by The Progressive Policy Institute

Like many of you, I’ve been watching the health care summit, and can’t decide just yet if it’s a spectacle of complex drama, or just one of the longest congressional hearings to be broadcast in a long time. For those unfamiliar with congressional events, the preliminary throat-clearing and personal preening must be excrutiating.

The Republican strategy for this event is pretty clear already: act like the administration is doing something really outrageous by using reconciliation to finalize the health care legislation already passed by both Houses. As I mentioned yesterday, this is factually ludicrous, but repeating talking points does sometimes work.

It’s pretty interesting that tea partiers are protesting the very existence of the event outside Blair House. Appointing themselves representatives of the people, and making unconditional demands on their behalf, has been a hallmark of their movement all along.

Editor’s note: The summit is being webcast live on C-SPAN.

This item is cross-posted at The Democratic Strategist.

Obama’s Multiple Audiences

Posted on by The Progressive Policy Institute

Looking forward to tomorrow’s health care “summit,” Ben Smith of Politico has a pretty good summary of the five distinct audiences the president must think about in handling this event: House Democrats, Senate Democrats, the Public, the Fans of Bipartisanship, and Republicans. But there are obviously priorities in his messaging:

He’ll be making the sale, for the umpteenth time, to an American public that supports aspects of health care legislation but opposes the bill. He’ll be pitching Beltway graybeards obsessed, as always, with bipartisanship. He’ll be appealing to moderate Senate Democrats to back reconciliation.But most important will be his pitch to a handful of conservative Democrats in the House who will have to switch their votes and vote for the Senate health care bill for it to pass into law.

Smith’s right that the most important immediate audience is House Democrats. In the longer run, however, this summit is a very important landmark in his overall positioning of himself and his party for the midterm elections in November. The reality in Washington is that a Republican Party that is becoming more ideologically extreme each day is using every procedural tool and political trick you can imagine to avoid any real action on any significant issue. If that reality becomes more generally known because of the summit, then it will be a success for Obama and Democrats, regardless of how it plays with the Republicans, the pundit class, or Democrats who are wavering on health reform.

This item is cross-posted at The Democratic Strategist.

GOP Complaints on Health Care Process Ring Hollow

Posted on by The Progressive Policy Institute

Republicans are warning of ominous political consequences if the Democrats use budget reconciliation rules to help pass health care reform. It would be “a huge mistake,” averred Sen. Olympia Snowe, the chief object of Senate Democrats’ unconsummated quest for bipartisan cooperation on health reform.

Evidently, for the Democrats to resort to reconciliation would be an intolerable abuse of congressional rules, whereas the Republican habit of filibustering everything in sight is perfectly within bounds. Passing health measures by a simple majority vote, the GOP maintains, would be the political equivalent of nuclear war: It would pulverize what little remains of comity and good will in Washington.

It’s a little late for the GOP to be worrying about that. Nor are Republicans more convincing when they complain that it’s somehow illegitimate for President Obama to start the bidding in tomorrow’s health care summit with a plan derived from bills that have passed both houses of Congress.

“I don’t think the people like this any more than…the approach that came down the pike earlier,” House Republican Whip Eric Cantor said. “People are incredulous. I just think they are wondering, does the White House not get it?” He was referring, of course, to polls showing majority opposition to the main health care proposals before Congress.

Cantor seems to be arguing that shifting public attitudes matter more than election results, and that Congress shouldn’t pass legislation that doesn’t poll well. Does the House minority whip not get representative democracy? (It was a good thing he wasn’t around when Lincoln pushed Congress to enact a draft to win the Civil War.) And if Republicans really are so sure Democrats will self-destruct politically by passing Obamacare, why not lash them on?

One reason might be that the health care summit will highlight the embarrassing fact that Cantor and company offer no serious alternative to the president’s approach. (House Republicans last year labored mightily to produce a mouse of a bill that would cover just three million of America’s 40-plus million uninsured.) The real choice is between the president’s far-from-perfect health care reform, and none at all.

And in a way that’s too bad, because if we had a serious opposition, it might help the president push back against some of the bad ideas coming from his own party. An example: under pressure from labor and liberals, Obama has drastically scaled down and delayed an excise tax on expensive employer-paid health plans. Not only does that reduce revenue needed to pay for health reform, it also barely grazes an open-ended federal tax subsidy that economists believe contributes greatly to medical cost inflation. Rather than insist on limiting that government subsidy, many Republicans claim it’s a violation of Obama’s pledge not to raise taxes on the middle class.

In a similar vein, the Republicans have lambasted Obama’s proposal to cut hundreds of billions from Medicare to defray the expenses of expanding coverage. And so in its blindly partisan attacks on Obama’s push for health reform, the GOP has managed to 1) shred its credibility as a force for fiscal responsibility; 2) thwart efforts to rein in runaway health care costs; and 3) reinforce their well-deserved reputation as a party that measures compassion by the thimble-full.

On health care, the Republicans have hit the trifecta of demagoguery – which is why their complaints about parliamentary foul play ring hollow.

Don’t Tread on My Medicare

Posted on by The Progressive Policy Institute

To continue some thoughts about the growing contradiction between conservative policy predilections and the GOP’s violent anti-spending rhetoric, there’s a specific political factor that’s intensifying the dilemma: the heavy, heavy reliance of Republicans on support from seniors.

Several smart commentators (Chait, Douthat, and Larison) have drawn attention to a new Pew survey on generational political attitudes which shows the exceptionally geriatric nature of the Republican Party’s current base of support. That’s a good thing for Republicans in the very short term, since seniors tend to vote at disproportionately high levels in midterm elections. But it’s not easy to be the Party That Hates Government Spending when your most important constituency is receiving Medicare and Social Security benefits. Here’s how Ross Douthat puts it:

[Y]ou can win an awful lot of elections just by mobilizing the over-65 constituency — they’re well-informed, they turn out to vote, and there are more of them every day. But the easiest way to do it, as the Democrats proved for years and years and years, is to defend Medicare and Social Security like McAuliffe at Bastogne. This means that while the energy of activists may be pushing the Republicans to the right on size-of-government issues, the concerns of their central constituency could end up pulling them inexorably leftward on entitlements….

This wouldn’t be a terrible thing if Social Security and (especially) Medicare accounted for, say, ten percent of the federal budget. But where the size of government — and if we ever want to cut the deficit, the burden of taxation — is concerned, they’ll be the whole ballgame soon enough. And if the Republican Party depends too heavily on over-65 voters for its political viability, we could easily end up with a straightforwardly big-government party in the Democrats, and a G.O.P. that wins election by being “small government” on the small stuff (earmarks, etc.) while refusing to even consider entitlement reform.

Now that’s how it looks if you are simply considering the fiscal numbers. But from a psychological point of view, there’s another problem for conservatives: how to rationalize a posture of maximum defense of Social Security and Medicare with a general hostility to transfer payments. The only obvious way to do that is to treat senior entitlements as benefits earned by virtuous old folks, as opposed to unvirtuous younger folks whose demands for “welfare” are to be resisted and demonized at all costs. You don’t have to hold a negative view of conservative motives to see how this can lead to highly invidious, and perhaps semi-racist, political appeals. Indeed, the current position of Republicans all but demands that they encourage seniors to view public life as a struggle to keep their own public benefits and their own private wealth against rapacious efforts by “elitists” and welfare “looters” to reduce their share of federal spending while increasing their taxes. And that’s a temptation Republican politicians don’t seem inclined to resist, illogical and immoral as it might be.

It’s not clear how long GOPers will continue to maintain this odd mixture of pro-government policies and anti-government rhetoric (a contradiction that extends, of course, to conservatives lust for ever-higher defense spending and foreign policy adventurism). But at present, they might as well emblazon on their Tea Party banners the legend: “Don’t Tread On My Medicare!”

Update: One obvious way around the GOP’s dilemma on entitlements is simply to “grandfather” current beneficiaries and introduce radical changes for younger generations. That’s how Rep. Paul Ryan’s Medicare Voucher proposal — central to the congressional Republican “plans” for both health care and the budget — operates. And that’s explicitly what Tim Pawlenty is talking about doing with both Medicare and Social Security.

It remains to be seen if this approach, which for all the talk about “keeping promises to seniors” sure looks like a cynical effort to buy off a demographic group that favors Republicans at the expense of groups less inclined — will fly with seniors or with anyone else. It does nicely comport with the “I’ve got mine! To hell with the rest of you!” spirit that Republicans are carefully cultivating among older white voters.

This item is cross-posted at The Democratic Strategist.

Photo credit: https://www.flickr.com/photos/roebot/ / CC BY-SA 2.0

The “Obama Plan”

Posted on by The Progressive Policy Institute

So, it’s finally out there: the “President’s Proposal” for health care reform which Obama will explain and defend in the “summit” with bipartisan congressional leaders on Thursday.

It’s unclear to what extent this plan reflects completed House-Senate negotiations on various sticking points between the bills each chamber has already passed. But it certainly addresses many of them. Think Progress has a useful chart comparing House, Senate, and Obama provisions. The biggies in terms of “improvements” to the Senate bill that would be enacted via reconciliation include a significant watering-down of the excise tax on high-cost insurance plans; bigger subsidies for insurance purchases; a sizeable increase in the federal share of costs associated with Medicaid expansion (accompanied by elimination of the special deal for Nebraska that the Senate included to get Ben Nelson on board); and the closing of the so-called “donut hole” in Medicare prescription drug coverage. These do represent the most often cited problems House Democrats have cited in the Senate bill, aside from the more fundamental failure to include a public option.

The two “surprises” in the proposals were that it did not authorize national health insurance exchanges (probably because of fears that such a step could trigger an adverse parliamentary ruling as non-germane to a reconciliation bill), which could be a serious issue for some House members; and a new provision that would enable federal regulators to stop large health insurance premium increases, which was almost certainly motivated by the recent big Anthem premium increases in California.

Republicans, of course, have immediately denounced the proposal as “partisan,” and appear ready for total war at the summit. Interestingly, the only spurned Republican “ideas” specifically mentioned in House Minority Leader John Boehner’s official response to the Obama proposal were interstate insurance sales and a total ban on private abortion coverage for people receiving federal subsidies (the Obama proposal tracks the Senate bill on abortion, which requires separate accounts for supplemental abortion insurance, but doesn’t try to outlaw it outright like the House bill’s Stupak Amendment does).

For those readers most concerned with a late revival of the public option, it should be noted that this possibility remains strictly contingent on progress towards getting 50 Democratic senators signed on. At this point, including it in the Obama proposal would have probably been counter-productive, even among Senate Democrats, while creating a new distraction going into the summit.

So we’re now ready for some serious Kabuki theater on Thursday. Obama’s objective will be three-fold: to rekindle some momentum for final action on health reform; to explode some of the Republican “ideas” like interstate sales; and to force Republicans to show the back of their hands while identifying them with potentially very unpopular proposals like voucherizing Medicare.

This item is cross-posted at The Democratic Strategist.

The World Without Obama

Posted on by The Progressive Policy Institute

If you’ve been watching the cult TV show “Lost,” then you’re familiar with the concept of parallel universes. That is, alternate realities in which history turned out differently, because people made different decisions.

It’s a useful concept when it comes to thinking about President Obama’s current predicament. On a variety of fronts, the Obama administration is suffering from an inability to show Americans the parallel universe in which its past policies were not enacted — and the future that will result if its current proposals bite the dust.

That’s most obviously true with the early, fateful decisions to continue TARP and bail out the auto companies. They arguably averted the collapse of the global financial system, the virtual extinction of consumer and business credit, and 1930s levels of unemployment (especially hard-hit would have been the upper Midwest). Nevertheless, no matter how often the president tells us his actions kept a deep recession from developing into a Great Depression, it remains an abstract proposition for the people who are currently unemployed. The same is true for the 2009 economic stimulus package, which virtually all experts, public and private, credit with saving about two million jobs. The continued job losses reported each month make it hard to claim that one has succeeded by avoiding even greater unemployment.

The problem of “proving a negative” is even more daunting when it comes to prospective policy proposals. Critics savage Obama for a health care plan that doesn’t do enough to limit costs. Obama responds that health care costs are going up anyway, without a plan. But it’s not easy to convince people that the status quo is riskier than a large and complicated series of changes in how Americans obtain health insurance. That’s why the White House has made such a big deal out of Anthem Blue Cross’s gargantuan premium increases for individual policyholders in California. It is, they argue, a sign of where the status quo is headed absent reform. They do not, unfortunately, have such a convenient example that will help them explain the need for climate-change legislation, as conservatives, stupidly but effectively, cite this winter’s heavy snowstorms as disproof for the scientific consensus about global warming trends.

There is one way to deal with Obama’s dilemma. Although it’s difficult to prove that American life under the president’s policies is better than life without them, it should be easier to point to another parallel universe: life under Republican policies. But such an effort requires a basic strategic decision. Should Democrats point back to the reality of life under George W. Bush, which most people remember pretty vividly, and simply say today’s GOP wants to “turn the clock back”? Or should they focus on current Republican proposals, such as they are, which in many respects make Bush policies look pretty responsible? It’s hard to take both tacks simultaneously, since the extremism of contemporary Republican politics is in no small part motivated by a determination to separate the GOP and the conservative movement from association with that incompetent big spender, Bush, who failed because he “betrayed conservative principles.”

It appears the White House is increasingly inclined to take the second, forward-looking approach to highlighting the GOP’s desired alternate reality, rather than the first, backward-looking one. As much as some Democrats wail about the “bipartisanship” rhetoric that surrounds Obama’s outreach to Republicans, which he’s employed while challenging them to direct debate over health reform and economic recovery, the president’s main intention is clear. He wants to force the opposition to help him present voters with a choice between two specific courses of action — or simply admit that their strategy is one of pure gridlock, obstruction, and paralysis (which, as my colleage J.P. Green has pointed out, spells “G.O.P”).

The stake that Obama and the Democrats have in convincing Americans to consider these parallel universes couldn’t be much higher. This November, if voters remain fixated on the current reality, rather than the terrible alternatives, then the midterm elections really will be a referendum on the status quo and its Democratic caretakers. Explaining life as it would be without Obama, and as it could be under Republican management, is not easy. But Democrats must do it or face catastrophe at the polls.

This item is cross-posted at The Democratic Strategist.

The GOP’s Health Farce

Posted on by The Progressive Policy Institute

President Obama hopes his bipartisan health care summit on Feb. 25 won’t degenerate into “political theater.” Too late: the partisan jockeying over health care reform already has turned into a farce worthy of Moliere.

It’s bad enough that Democrats, despite holding the White House and commanding majorities in Congress, can’t pass their top domestic priority. They look as feckless as Moliere’s cuckolded husbands.

But now Republicans are trying to dictate health care policy, despite having been soundly whipped in the last two national elections. As piously as one of Moliere’s hypocrites, they profess their devotion to covering the uninsured and restraining health care costs in a market-friendly way, though somehow they never got around to pushing a serious proposal when they held power.

Republican leaders have warily agreed to attend the summit, for fear that a no-show would cement their image as the party of “no.” But they are telling reporters it will be a waste of time unless Obama agrees to jettison reform bills that have passed both Houses of Congress and start over from scratch.

“Why would they want to keep pushing something that the public is overwhelmingly against?” GOP Senate leader Mitch McConnell asked rhetorically after meeting with Obama this week. “Really, right now, it’s up to the President and Speaker Pelosi to start listening to the American people,” chimed in Eric Cantor, the No. 2 House Republican. “If they don’t, there’s not much to talk about.”

They may be the minority party, but Republicans are effectively claiming a new mandate on health reform – from opinion polls.

True, public opinion has turned against the health reform blueprints that emerged after many months of haggling and horse-trading on Capitol Hill. Obama says Americans were turned off by the “process,” but then, he was the one who decided to offer only the most general reform guidelines and let lawmakers fill in the blanks.

But public opinion is mutable, even fickle. Most Americans were strongly for health reform before they were against it. And it’s highly unlikely they oppose it because they’re intimately familiar with the complex provisions of the House and Senate bills. The way they were put together – basically, by paying off powerful interests and hold-out lawmakers – no doubt was a factor, but polls indicate that worries about the economy and jobs were a bigger one.

Public opinion may yet be turned around by a decisive show of political leadership. That’s why Obama is right to keep pressing for reform, even if in the end he has to settle for less than he wants or the country needs. And the coming summit is shrewdly conceived to give Republicans a chance either to win some substantive points – Obama is already talking about adding tort reform to the mix – or to show their overriding motive is to defeat a Democratic president, not fix health care.

In any case, shifting polls, tea parties and a single U.S. Senate victory in Massachusetts don’t give Republicans the right to speak for the country, much less shape the nation’s health care agenda. That would turn a farce into a tragedy.

Photo credit: https://www.flickr.com/photos/talkradionews/ / CC BY-NC-SA 2.0

Going Along with the GOP Charade

Posted on by The Progressive Policy Institute

Perhaps being snowbound for the third day in a row has left me in an ornery mood, but this 37-second snippet of House Minority Leader John Boehner speaking after yesterday’s jobs bill meeting left me fuming.

Asked to comment on the upcoming bipartisan health care summit that President Obama proposed, here’s what Boehner said:

It’s going to be very difficult to have a bipartisan conversation with regard to a 2,700-page health care bill that a Democrat majority in the House and a Democrat majority in the Senate can’t pass. So why are we going to talk about a bill that can’t pass?

First of all, health care legislation did pass. In both chambers. The House passed its bill. The Senate passed its bill. They were in the process of reconciling their bills when the Senate lost its 60th seat to Scott Brown. Now, because the Republican strategy calls for total obstruction of any major legislation that is not 100 percent Republican, a Democratic majority in the Senate can’t pass whatever emerges from a House-Senate conference even though Dems hold 59 out of a 100 seats. (And Rep. Boehner, it’s “the Democratic majority,” not “Democrat.” But you knew that already.)

But there’s another part to the clip that set me off. It comes in the last few seconds when a reporter outside the frame asks Boehner, “Do you think [Obama’s] sincerely listening to your concerns?” “We’ll see,” Boehner solemnly intones.

Perhaps the most infuriating thing about our discourse today is the pretense among the media and the commentariat that these Republicans are open to discussion — that there actually is a meeting point in the middle, or even right of the middle, where the Republicans finally say, “OK, it’s a deal.” There isn’t. The Republican objective isn’t to shape policy with their own ideas — it’s to make sure policy doesn’t get made at all.

One suspects that many in the media know this. But for some reason, they have to engage in the kabuki theater of pretending that Republicans actually do want to participate in governing, when obstructionism in the pursuit of regaining power is clearly their game plan. Just once I’d like a journalist to ask of Republicans, “You have asked Democrats to drop some of their priorities to achieve compromise. Which of your priorities are you willing to drop?” Or, “If the president accepts your pet provisions for health reform, which of his provisions would you accept?” But in the current media narrative, all the onus to achieve bipartisanship is on Obama and the Democrats. Bipartisanship will be measured by how much they give in to a Republican Party that doesn’t have to budge at all.

Playing Chicken

Posted on by The Progressive Policy Institute

President Obama has now thrown down the gauntlet to Republicans to demonstrate that their alleged willingness to work with him on big national challenges is not just a pose.

On one very high-profile track, Obama has invited congressional Republicans to participate in a public forum on health care reform. After some talk among GOPers of insisting on preconditions like abandonment of the current House and Senate bills, and of any intention of using reconciliation to enact health reform measures in the Senate, it now looks like Republicans will show up. That’s probably in part because a new ABC-Washington Post poll shows Americans blaming the GOP much more than the president for intransigence.

Despite Democratic fears that Obama is going to screw up the highly fragile prospects for final congressional action on health care reform, all he’s publicly said in the way of concessions to the GOP is that he’s willing to take action on medical malpractice insurance reforms if Republicans are willing to get out of opposition to serious action to cover the uninsured. That’s probably not a deal Republicans will seriously consider.

Meanwhile, on another front, the White House is pushing Republicans to make a deal on jobs legislation.

This is a really tricky proposition for Republicans. They’ve spent months attacking any jobs bill as a “second stimulus” bill, which in their vocabulary is a deadly insult. And they’ve certainly boxed themselves into a proposition that any bill significantly increasing budget deficits is a no-go.

But on the other hand, the administration has made it clear that targeted tax cuts for businesses creating new jobs would be the centerpiece of a jobs bill, and it will be difficult for Republicans to reject that in the current environment. At the same time, though, GOPers have consistently argued that across-the-board, not targeted, tax cuts, is what they demand, even though across-the-board cuts benefit big corporations and/or wealthy individuals, and tend to cost a whole lot.

It’s pretty clear the White House is playing chicken with the GOP: offering bipartisan cooperation, but in a way that either exposes Republican self-contradictions and hypocrisy, or makes them finally cooperate on more-or-less the president’s terms. This may represent a revival and intensification by Obama of his controversial “grassroots bipartisanship” strategy, just when most observers in both parties thought it was dead.

The stakes in this game of chicken are very, very big.

Obama Calls a Big Play

Posted on by The Progressive Policy Institute

An onside kick to start the second half may have been the biggest play call of the night, but President Obama’s audacious gambit to jump-start the stalled health care reform effort was not far behind. In an interview with Katie Couric, the president announced that he would like to hold a bipartisan health care summit in front of TV cameras at the end of the month.

Perhaps emboldened by his masterful performance at the televised House GOP caucus retreat — by consensus one of the most compelling pieces of political theater this country has seen — the president goes to the well for the second time in a month.

It’s a brilliant but risky move. The risk comes in putting health care at the forefront of the public agenda when the public would rather fixate on one thing: jobs. That impatience translates into Democratic jitteriness, which could lead to a further decline in legislative support to get something passed. Plus, Obama’s talk of bipartisanship could incense some progressive allies, who at this point are so fed up with Republican obstructionism that they see any attempt to reach out across the aisle as a sign of naivete, even weakness.

But I’m betting that Obama’s play will actually pay off. As Steve Benen notes, it’s a “call-the-bluff moment.” For months now, Republicans have complained that they have been shut out of the process. (False — remember the interminable Senate Finance Committee deliberations? And, let’s be clear, to the extent that they not been included, Republicans themselves closed the door from the outside.) Well, here’s their chance to participate, in as high-profile a setting as they can ask for. Obama’s basically saying, “Fine — you like your ideas so much? Let’s sit down and talk about them for all of the American people to see.”

It has the makings of a no-win situation for the GOP because a) they don’t really have a workable and realistic idea to reform health care and b) it’s much easier to lie about the other side when the other side isn’t there to call you on it. And as Obama demonstrated at the GOP caucus, he has the ability to confront GOP mendacity with equal measures of assuredness, intelligence, and good faith.

You can tell the Republicans are worried — and that they already have the outlines of a strategy. House Minority Leader John Boehner (OH) said in response to the president’s announcement, “The best way to start on real, bipartisan reform would be to scrap those bills and focus on the kind of step-by-step improvements that will lower health care costs and expand access.” But starting over is not an option for Obama. As a White House official said, “We are coming with our plan. They can bring their plan.” And that is how they should continue to frame it.

I wouldn’t put it past the GOP to keep humping the scrap-the-bill note and demand that the only way they can agree to a sit-down with the president is if he starts from scratch. Of course, Obama should call their bluff. Could there be a better image of Republican irresponsibility than a bipartisan summit on health care called by the president, with Democrats and the president exchanging ideas, and all those empty chairs where Republicans should be? Then again, considering how utterly uninterested they are in governing, and how the risk of revealing that fact in a nationally televised forum is too high, not showing up for the game might actually start looking like the less painful option.

The State of Play on Health Care

Posted on by The Progressive Policy Institute

The last week has brought a blizzard of news from the administration: the State of the Union, bank reforms, high-speed rail, 4th-quarter GDP growth, President Obama’s highly lauded appearance at the House GOP retreat, and now his budget and jobs proposals. Conspicuously missing from the headlines has been health care reform. And that’s just how the Democrats like it.

As Jonathan Cohn reported this weekend, there’s more going on behind the scenes on health care than the dismal outlook suggests. The decision to shift the attention to other issues, while viewed skeptically by many progressives as the first step toward dropping the issue altogether, might actually be having a salubrious effect:

Even the decision to focus on jobs, banking, and the economy right now–while letting the “dust settle” on health care reform–may not be quite the sign of retreat it seems at first blush. Many insiders have suggested to me that giving leadership a little breathing space to negotiate, and giving members of Congress more time to adjust to the post-Massachusetts political landscape, will ultimately make a deal more likely. In today’s Los Angeles Times, Rep. Gerald Connolly, president of the House Freshman Democrats says that strategy may be working: “The more they think about it, the more they can appreciate that it may be a viable . . . vehicle for getting healthcare reform done.”

By diverting the attention to jobs, banks, and budgets, the president is betting that he gives Congress the time and room to work out their differences and talk each other off the ledge. Maybe he’s right.

But there’s a legitimate fear that unless the president takes firm control of the process soon — be it behind the scenes or in front of cameras — health reform is in danger of dying of neglect. Cohn reports that the administration is still taking a hands-off approach with Congress, which is giving his supporters heartburn.

Is it enough to tell the Dems to not “run for the hills”? Based on the skittish display congressional Democrats put on in the wake of the Scott Brown win, color me skeptical. It need not happen in full public view, but the president might need to do much more exhorting and hand-holding to get the House to act.

A Close Look at Those Republican Health Care Ideas

Posted on by The Progressive Policy Institute

So lots of Americans, we are told, really wish the president would reach out to the Republican Party and come up with bipartisan solutions for our nation’s problems. This very day, the president is in fact trudging up to Baltimore to attend a retreat of the House Republican Caucus, an organization devoted to his complete political destruction.

But before anyone gets agitated about “bipartisan solutions” or the failure to achieve them, it’s important to take a look at where Republicans actually are on big controversial issues–like, just to pull one example out of the air, health care policy.

At the New Republic today, Washington & Lee University law professor Timothy gives us a refresher course on GOP health care policy, from AHiPs to interstate insurance sales. He concludes their proposals wouldn’t do a whole lot for the uninsured, the insured, or health care costs and federal spending. But the most important conclusion he reaches is that there simply isn’t a lot of “common ground” on which to build any sort of bipartisan compromise.

The two parties presently come at the issue in fundamentally different ways, with Republicans, in particular, being transfixed by the desire to encourage the purchase of individual health insurance policies, if not individual purchases of health care without insurance.

Maybe the president and House Republicans can find plenty to talk about in Baltimore today. But comparing notes on health reform is probably a waste of time.

This item is cross-posted at The Democratic Strategist.