issue: Health Care

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.

Bring On the GOP Health Policies!

Posted on by The Progressive Policy Institute

I’m with Steve Benen on this one: after listening to Republicans say all weekend that the president needs to surrender on health care reform and start embracing theirpolicy ideas, maybe it’s time to draw a lot more public attention to all that fine GOP thinking on the subject.

So where to begin? I guess that would be with the “plan” that drew 176 Republicans votes in the House in a test vote in November of last year, the so-called “Boehner plan.” Dissed by an official Congressional Budget Office analysis that suggested it would cover almost none of the uninsured, while controlling costs far less effectively than the House Democratic proposal, this plan followed the usual conservative template of focusing on tort “reform,” “interstate markets” for private heath insurance (e.g., elimination of state regulations), elimination of the entire employer-based system, and a two-pronged strategy of subsidizing high-deductible individual health plans for healthy people, and state-run risk pools for sick people. It was, as Matt Yglesias put it, an “un-insurance” plan that would take health policy, in some respects, back to the 1950s.

Another example of Republican “thinking” on health care policy is the idea of “voucherizing” Medicare, which was the central health policy element of the official House GOP “alternative budget” offered last April by Rep. Paul Ryan of WI. While “Medicare voucher” proposals vary, they all at the very least aim at transforming Medicare into a system of federal subsidies for purchasing private health insurance, while capping expenditures regardless of the impact on benefits. To put it simply, seniors would march through the streets with torches to protest any such plan if it were taken seriously.

And then there’s the most fully developed Republican health care plan, the one developed and implemented by the front-runner for the 2012 GOP presidential nomination, and recently promoted by the party’s maximum “new star”: the Massachusetts health reform plan. How about allowing a vote on that in Congress? Oh, yeah, sorry, that’s pretty much the plan already passed by the U.S. Senate without a single Republican vote! It’s socialist!

Suffice it to say that while Democrats have been materially hurt by endless scrutiny and confusion about the substance of their ideas on health care, Republicans have massively benefitted from a total lack of accountability for their own ideas. Best I can tell, Republicans would probably be politically destroyed if people truly paid attention to GOP health proposals. So Democrats should find ways to help their GOP colleagues publicize their ideas.

This item is cross-posted at The Democratic Strategist.

Fragile Consensus

Posted on by The Progressive Policy Institute

Everyone should read Matt Yglesias’s post,”How Close Were We, Really?” which makes a point that I’ve been mulling. The fact that health care reform blew up so quickly after the Brown win implies that whatever consensus had been achieved between the Senate and House, it was significantly incomplete, weak, or both. House liberals apparently were not prepared to pass anything coming out of conference that didn’t reverse the problems they have with the Senate bill. But it’s unclear whether moderate senators or representatives would have stayed on board in that event. If the last week shows nothing else it reveals that a whole lot of members of Congress were decidedly un-excited about supporting anything resembling either chamber’s bill.

This seems like a job for Keith Hennessey: knowing what we know now about the uneasiness of moderates and the stubbornness of liberals, what was the likelihood that reform would have passed if Coakley had won? (Keith had the probability of collapse given a narrow Coakley victory at 10 percent — and two percent with a big win — before the election.)

If this interpretation is right, it implies that many progressives haven’t given enough credit to how far out on the plank many moderates actually went (which isn’t that surprising given how many of them misread the polls). Pre-Brown, moderates were betting that antagonism toward reform wasn’t so strong that their job — their chance to work on all of their other legislative priorities — was in mortal danger. The Brown win provided new information that clearly affected the calculus (as did the initial freak-out by Massachusetts’s own Barney Frank).

Perhaps one big reason why the Obama team (and everyone else) was caught flat-footed after the election was that they were unaware of how much moderates already felt they had stuck their necks out.

All this said, I think the consensus that Democrats having second thoughts ought to accept that they have no choice but to vote for the final bill is correct. Actually, I think these Democrats have probably reached that conclusion too. But it’s important to note that that wouldn’t be enough to pass something — if House liberals won’t vote for the Senate bill, it doesn’t matter what moderates do. What progressive bloggers need to do is start working the liberal legislators in the House.

The Living Standards of the Poor — Part I

Posted on by The Progressive Policy Institute

Last week, I spent some time looking at the living standards of the middle class, showing that they have improved notably over time and giving evidence that they are better than or comparable to middle-class lifestyles in other industrialized nations. I will be returning to this issue in a later post in order to address the “two-income trap” argument of Elizabeth Warren, which was raised by Reihan Salam and by Rortybomb.

For now though, I want to talk about the living standards of the poor. It’s important to make the distinction between trends (which I’ll discuss today) and absolute levels of material well-being (which I’ll discuss in a later post) because things can have improved a lot at the same time that they are still not all that great.

Let’s return to the comparison I used in my post on the middle class of “the gold standard” of 1973, when median household income was at its pre-stagflation peak, to 2008. To represent “the poor,” I’ll look at the 20th percentile — the household that is doing better than 20 percent of other households but worse than 80 percent of them. You’ll have to trust me that my research indicates the story would be similar if I were talking about the tenth percentile.

It’s easy to look at only a fairly limited income measure going back to 1973 for the 20th percentile. Doing so indicates that income at the 20th percentile grew from $19,046 to $20,712 (in 2008 dollars, adjusted by the Bureau’s preferred CPI-U-RS). That’s obviously not impressive growth, though it should be noted that the poor are a bit better off today than they were in 1973 (and they look a little better comparing 1973 to 2007, which is a fairer comparison). Using the PCE deflator, which the federal Bureau of Economic Analysis uses (and which I prefer because of the evidence that the CPI-U-RS overstates inflation, particularly among the poor), income increased by about $3,000 after accounting for the cost of living, or 16 percent. That’s about the same as for the middle class using the same measures and methods.

As I noted in the middle-class post, the official income definition is pretty limited. The Census Bureau’s “Definition 14” takes into account taxes, public benefits, and the value of health insurance, and it’s easy to look at going back to 1979 (which was at least as good/bad a year for the poor as 1973 was). By this measure, income at the 20th percentile rose from $17,999 to $24,642 from 1979 to 2008 (using the CPI-U-RS). That’s an increase of over one-third—after adjusting for the cost of living. When the PCE is used to adjust for the cost of living, the increase is almost $8,000—45 percent!

A number of commenters to my post on the middle class didn’t like that the value of health benefits were included in my “comprehensive” income measure. I prefer including them in “income” because employer health care costs have caused earnings growth to be quite a bit lower than it otherwise would have been, and employer- and publicly-provided health insurance contribute to living standards. It is possible that the way the Census Bureau estimates the value of health insurance exaggerates improvements in well-being, but it is not simply the case that rapid health care inflation negates those estimates. Many health economists believe that rising health care costs do reflect corresponding improvements in the quality of care received. At any rate, whether or not you believe I have a dog in this fight, hopefully you believe that the Census Bureau doesn’t.

Nevertheless, we can look at the trend omitting the value of health insurance in 2008. Doing so offers a somewhat conservative estimate of the increase because I can’t omit the value of insurance from 1979. The increase, however, is 21 percent using the CPI-U-RS, and 29 percent using the PCE.

So it seems pretty likely that the living standards of the poor in the U.S. have improved fairly robustly in recent decades. Before leaving behind the question of trends, I should note that there is pretty overwhelming evidence that male workers who don’t get further education beyond high school have seen real wage stagnation (though the story for the median male worker, as I showed in the middle-class posts, is much better). The fact that household incomes at the bottom have grown reflects a decline in taxes paid, an increase in the value of means-tested benefits, and greater work among women (including single women). Computations I have done indicate that confining things to non-elderly households doesn’t affect the story importantly; nor does adjusting incomes for household size.

This issue of greater work among women is one of the last remaining arguments to my case that I feel I need to address more, because it is obviously key to the question of whether higher incomes really reflect improved living standards broadly construed. After all, we could all work more hours and sleep less, which would improve our incomes but not necessarily our quality of life. I’ll take this up in my next couple of posts, but suffice it to say, you can assume my read of the evidence doesn’t overturn the case I’ve been trying to make thus far.

They Don’t Like Each Other

Posted on by The Progressive Policy Institute

A problem that seems to be getting lost in the current confusion over the fate of health reform legislation is something that has little to do with party or ideology, much less with the details of health policy. It’s cameralism.

To put it simply, members of the U.S. House and the U.S. Senate have very different perspectives, mistrust each other’s motives, and rarely communicate. In general, they don’t much like each other. They live and work in two very different institutional cultures, and with the exception of House veterans serving in the Senate, they don’t go to much trouble to find out how the other chamber functions.

Much of the time this “cameralism” is background noise in the legislative process. But when it comes to the kind of highly complex, trust-based maneuvers that health care reformers are talking about this week–you know, House passes Senate bill with assurance that Senate passes bill “fixing” their own bill via budget reconciliation, somewhere down the road–it’s a real problem that can’t just be wished away. And that’s particularly true in an environment requiring almost total agreement among Democrats in both Houses. Maybe that’s one reason the White House is talking about a “cooling off” period on health care reform.

This item is cross-posted at The Democratic Strategist.

Health Reform, Public Opinion, and “Liberal Pundits”

Posted on by The Progressive Policy Institute

In the wake of Tuesday’s Republican victory in Massachusetts, Scott Winship wrote a post here that expressed hope that “liberal pundits” would finally get out of “denial” about the unpopularity of health care reform.

Now as Scott knows, there’s always peril involved in making generalizations about the views of large classes of people. I don’t know which “liberal pundits” he’s thinking about in making the suggestion that there’s a general unwillingness to accept public opinion data on health reform; the links he offers don’t really support the claim. But most of the “liberal pundits” I’ve read in recent months don’t dispute the fact that public support for the particular legislation being discussed in Congress at any given moment has been flagging (though given the very fluid nature of the legislative process, it’s difficult to identify which version the public is reacting to, which is why the variations in the wording of polling questions on health reform so often produce different results).

Scott goes on to mock particular arguments that he views as rationalizations for this alleged unwillingness to accept reality: voters are uninformed, Republicans have misled them, and in any event, a significant part of the opposition to health reform bills is “from the left.”

Are these really just rationalizations? I don’t think so. Poor public information on health reform and Republican lies about “ObamaCare” are germane for the simple reason that public opinion may well change if health reform is enacted, and lo and behold “death panels” aren’t convened, Medicare benefit cuts don’t happen, and “government” does not in fact “take over” health care. And the “opposition from the left” data point is relevant to nervous Democrats in Congress because voters unhappy with the absence of a public option, for example, are not terribly likely to vote for Republican candidates who favor voucherization of Medicare or oppose regulation of health insurers.

Scott also seems to assume that “liberals” who talk about the “will of the majority” being frustrated by the de facto 60-vote requirement in the Senate are talking about public opinion. But all the examples he cites are in fact discussing the “will of the majority” of senators, and the majority of the population they represent. The rules of the Senate, after all, cannot be adjusted daily based on tracking polls of the relative popularity of this or that piece of legislation.

Finally, there’s the apparent motivator of Scott’s post: the Massachusetts results. Should the strong opposition of Scott Brown voters to health care reform (at the federal level, at least) represent an “aha” moment for those with any doubts about public opinion on this issue? Again, I see no atmosphere of denial on the subject; yes, many observers, myself included, have noted that a lot of different things were going on in Massachusetts, and have argued that it was not all just one vast referendum on health reform in Congress. But more to the immediate point, the relevance of the Massachusetts results to public opinion nationally is significantly damaged by its unique status as a state that has already enacted reforms almost identical to those attempted by the pending legislation in Congress. And this, in fact, was Scott Brown’s number one talking point on health care reform: why should Bay State citizens pay taxes to give Nebraska the benefits Massachusetts already enjoys? That’s a pretty compelling argument, on the surface at least, but it’s not one that can be made elsewhere.

Ironically, Scott closes his piece by suggesting that perhaps congressional Democrats should put aside fears about public opinion and enact health reform legislation anyway. In doing so, he reflects the real debate I’ve been hearing among “liberal pundits” for many months now: when given a historic opportunity to achieve a long-held progressive goal which happens to represent an immediate national challenge, should Democrats defer action until public opinion is completely on their side? What’s the point of running for office as a progressive if you aren’t determined to achieve progressive policy goals when you can? Is there any other approach to health reform that might be more popular? Is there any time like the present for action?

These questions don’t automatically answer themselves, but I don’t think it’s fair to suggest that health reform advocates are in denial about the political risks involved in health care reform, particularly at a time when Republicans are absolutely refusing to cooperate, and when much of the beltway commentariat has been telling the president for months that he should abandon all goals other than agitating the air for more jobs and lower deficits.

Progressives need data-driven critics like Scott Winship who are willing to contribute to our debates with sometimes troubling information. But in this case, I suspect, to use an old southern expression, he’s just goosing a ghost.

Health Reform Back From the Dead

Posted on by The Progressive Policy Institute

There was a point yesterday when it sure looked like Scott Brown had managed to kill federal health care reform without setting foot in Washington. Senate Democrats were busily disclaiming any interest in further action on a potential House-Senate conference committee report before Brown could arrive to joyfully join a filibuster and impose the will of the minority. House Democrats were refusing to consider passage of the Senate bill (which could avoid the necessity of a conference committee report and another Senate vote) without iron-clad assurances of future action to change objectionable features (e.g., the “Cadillac tax” which unions hate, and language restricting abortion). Such assurances did not seem to be forthcoming from Senate Democrats. And no one knew where the White House was, though rumors abounded that the president had told a reporter it was time to go back to the drawing board and try to enact something less ambitious.

All this was happening as conservatives in effect snaked-danced through the streets hailing Brown’s victory as the largest political event since, maybe, World War II, and the effective end of the Obama presidency.

The general malaise among health-care-reform-minded progressives was probably best expressed by The New Republic‘s Jonathan Cohn, who has been an eternal optimist about prospects for eventually getting legislation done. He published a piece late yesterday bewailing the White House’s apparent drift, with the bitter title: “Where’s the Obama I voted for?”

As often happens, though, the panic subsided, and things look more hopeful today. Turns out the president’s comments were vague but resolute about pressing forward on health reform. Senate Democrats are not walking away from health reform, and House Democrats have stopped making angry comments about the impossibility of getting acceptable assurances from the Senate about future action in order to facilitate passage of the Senate bill. It still will be complicated to put together a “deal” that both progressives and moderates in both Houses can live with, but it seems to be sinking in that failure to enact anything, after so many Democrats have already cast votes for reform and made themselves targets for conservative attacks, is just not an acceptable outcome.

So the conservative exultation over “the death of ObamaCare” may be a bit premature. We’ll know soon enough.

This item is cross-posted at The Democratic Strategist.