In Praise of Dissenters

Historian Matthew Dallek has a piece in today’s Politico extolling the virtues of dissenting from one’s party. Exhibit A: Sen. Olympia Snowe (ME), whose vote in favor of the Senate Finance Committee’s health bill has proven crucial to giving health reform a much-needed boost in the late innings.

Snowe has drawn fire from the right for her apostasy and from the left for her outsized role in the process (which, one suspects, would not be a problem had she been a strong supporter of the public option). But Dallek suggests that Snowe’s efforts, already crucial in the present context, could prove even more momentous in the long run:

Oftentimes, the consensus within either the Democratic or the Republican Party is a product of ideological blinders or groupthink — and the resulting policies are shortsighted and ultimately deeply flawed.

In recent decades, such voices of protest within a political party have occasionally proved to be far more insightful than anybody at the time cared to acknowledge or even contemplate.

Putting Snowe’s dissent in historical context, Dallek makes an interesting comparison with the creation of the DLC in the mid-1980s. He points out that while the DLC’s attempts to move the Democratic Party closer to the center angered traditional liberals at the time, it ultimately “made the party more competitive in presidential elections and erased the stigma of weakness from some of the party’s future standard-bearers.” The heterodoxy of leaders like then-Arkansas Gov. Bill Clinton and then-Sen. Al Gore (TN) still does not play well in some progressive circles to this day, but the fact is their refusal to march in lockstep with the party ended up revitalizing it.

It’s probably unlikely that Snowe’s departure from the party line on health care — not to mention Sen. Lindsey Graham’s (SC) on climate change — will be similarly transformative. But Dallek’s point is well taken: done in good conscience, thinking outside the party box can often lead to more prudent, sensible ideas — and look good in hindsight to boot.

CO Dems Urge Up-or-Down Vote on Public Option

The prospects for health reform’s passage have certainly brightened over the last few weeks. Yesterday bought a new push in the direction of reform.

A trio of Colorado Democrats — Gov. Bill Ritter, Sen. Michael Bennett, and Sen. Mark Udall — released an open letter to U.S. senators urging them to reject a filibuster and give the public option an up-or-down vote in the Senate:

Even if you oppose a public option, we urge you not to hold it hostage with the threat of the filibuster. Stand up for the people, not the insurance industry, and give the public option the up-or-down vote it deserves.

The call for an up-or-down vote on the public option is something that has been building for a while. (Our own Ed Kilgore made a similar argument in September.) The principle behind it is certainly sound: a senator can vote their conscience and against the public option, as long as they allow the plan to come up for a vote, period. By supporting this tactic, progressives could also avoid the difficulties that come with trying to pass reform through the budget reconciliation process.

Regardless of where one stands on the public option — PPI has always believed that reform was possible with or without one — the idea of letting it stand for an up-or-down vote is something everyone should agree on. Because of their reputation as pragmatic progressives (as opposed to some of the plan’s more ideological supporters), Ritter, Bennett, and Udall’s move certainly makes such a vote a likelier possibility.

Why Baucus May Have Played It Right

From Roll Call today comes the latest episode in the tired series known as The Party of “No”:

Senate Republicans, acknowledging they lack the votes to block a health care reform bill outright, have implemented a comprehensive political strategy to delay, define and derail.

With Democratic leaders and White House officials holed up in Senate Majority Leader Harry Reid’s (D-Nev.) office negotiating a final bill, Republicans are demanding a deceleration of the process and moving to define whatever plan that emerges as a combination of Medicare cuts, tax increases, higher insurance premiums and rising overall costs.

Such legislative nihilism from the GOP isn’t new. What’s striking, however, is how little sting their charges have. When Senate Minority Leader Mitch McConnell (R-KY.) complains that Democrats are trying to rush the bill through without GOP feedback, it rings hollow.

Perhaps the credit for that should go to Sen. Max Baucus (D-MT). Many progressives chafed at Baucus’s insistence on a plodding, methodical process that made a good-faith effort to include moderate and conservative input. The finance committee’s deliberations may have seemed painstakingly slow, but it did yield a Republican supporter — Sen. Olympia Snowe (R-ME) — and a bill that, whatever one thought of it, could not be labeled a rushed and partisan product. In other words, Baucus’s process has, to some extent, inoculated the reform effort from Republican charges that the process hasn’t been deliberative or bipartisan enough.

We’ve seen this before, of course. In the negotiations over the stimulus bill, President Obama came under fire for bending over backwards to reach out to Republicans, as critics pointed out that few, if any, would jump aboard. Obama probably knew this, but also knew that the process, and public perceptions of it, matter. In the end, the administration got the stimulus bill it wanted with some Republican support. Moreover, Obama did it while burnishing his credentials as a pragmatic problem-solver and leaving Republicans looking like unreasonable obstructionists. The health reform debate seems like it’s following the same contours. In retrospect, Baucus may have played this right all along.

Are the States Ready To Undertake Health Care Reform?

As the U.S. Senate prepares for floor action on health care reform, there’s a sudden profusion of schemes that seek a compromise on the key “public option” question by giving states a lot of leeway. Tom Carper is floating a state “opt-in” approach. Others are talking about a state “opt-out” system. The Finance Committee has already adopted Maria Cantwell’s proposal to let states use federal subsidy funds to cover a majority of the uninsured as they see fit. And the original Baucus markup vehicle included Ron Wyden’s proposal to let states do all sorts of “experimentation” with federal funds.

The political value of these approaches is pretty obvious: by giving states flexibility on the key questions surrounding the public option debate, health reform proponents hope to give shaky Democrats and maybe a Republican or two an avenue to get out of the way of health reform while accomodating home-state pressure from health insurers and/or providers.

This makes abundant sense in Washington. But the question must be asked: are the states ready to get into the driver’s seat on the basic design of health care systems, public and private, within their borders?

I raise the question not because of any particular doubts about the competence of states on health care policy. But it’s important to understand that these state-based approaches to national health reform will transfer much of the yelling and screaming and lobbying we’ve seen, along with the complex issues that have to be resolved, right into the center of state politics, just in time for the 2010 elections.

Most of the fears about health reform that state officials have expressedup until now have, understandably enough, focused on the fiscal impact of Medicaid mandates. But governors and legislators, not to mention candidates for state offices, may soon be grappling with the entire range of controversial health care issues. They better get ready, and their representatives in Washington better start talking to them.

This item is cross-posted at The New Republic.

A Republican Starts Making Sense

Maybe Bobby Jindal is a new kind of Republican after all.

Republicans had high hopes for the Louisiana Governor, whose brains, youth and conspicuous ethnicity (his family is from India) marked him as conservatives’ answer to Barack Obama. That’s why they chose Jindal to gave his party’s response to Obama’s first address to Congress last January.

But the nationally televised speech bombed. Jindal served up GOP boilerplate rather than fresh ideas, and his delivery was off-kilter to boot. So much, it seemed, for the GOP’s Great Not-So-White Hope.

But botched speeches aren’t always fatal. Just ask Bill Clinton, whose long-winded keynote address to the 1988 Democratic National Convention was also seen as aborting a promising political career.

And Jindal, a serious wonk who ran Louisiana’s Medicare program while still in his 20s, did something rare for a Republican these days: he started making sense. Specifically, he urged Congressional Republicans to drop their purely obstructionist stance and work with the White House to pass a bipartisan health reform.

“I think now is the perfect time to pivot and say, not only here’s what we’re against, and not only here’s how we’re going to contrast ourselves, but here’s what we’re for,” Jindal told Politico. He also asserted that Republicans offer nothing positive on health reform “to our peril and the nation’s peril.”

That’s an important point. Many Republicans seem to think that carpetbombing “Obamacare” without offering a coherent alternative is politically cost-free. After all, polls show falling support for Obama’s plan to revamp health care, especially among seniors and independents.

Some progressives apparently agree that Republicans can lie outrageously and get away with it. Especially among elites, the plummeting poll numbers confirm an unflattering view of Americans as a bovine mass easily stampeded by right-wing buzzphrases – “socialism,” “death panels,” “the death tax” and the like.

Well, there’s also evidence that many Americans are watching the GOP’s antics, and don’t like what they see. By wide margins, (52-27 in this NYT-CBS poll) the public still thinks Obama has better ideas on health care than Congressional Republicans. According to Democracy Corps, a solid majority believes Republicans “are more interested in partisan politics than solving the country’s problems.”

The GOP’s nattering negativism, in other words, may be undermining public confidence in Obama’s ability to revamp the health care system, but it’s also reinforcing the party’s well-earned reputation as being unfit to govern.

So maybe Jindal is on to something. And progressives ought to have at least as much faith as he seems to in the public’s ability to distinguish serious arguments about health reform from right-wing agitprop and paranoia.

Unreconciled: The Dangers of the Growing Demand for Using Reconciliation To Enact Health Reform

The long-running campaign to make inclusion of a “public option” a progressive litmus test for Democrats on health care reform has entered a new and potentially dangerous phase: growing demands that congressional Democrats use the budget “reconciliation” procedure to avoid a Senate filibuster and lower the effective threshold for enactment of a bill to 50 votes.

As Brian Buetler explains at TalkingPointsMemo, two major new grassroots initiatives–one sponsored by Democracy for America (and headed up by Howard Dean) and another by a new group called CREDO Action–are asserting that reconciliation can easily be used for health reform. The clear implication is that any failure to go this route is proof of Democratic irresolution if not betrayal.

The temptation to insist on the reconciliation route is certainly understandable. Aside from making enactment of a bill by the Senate much easier, reconciliation, if successfully pursued, might make Republicans irrelevant to the process, while vastly reducing the influence of those Democrats who are obdurately opposed to the public option. It could also narrow the gap between House and Senate bills, which currently makes approval in either House of the ultimate conference committee report a difficult challenge.

But unfortunately, use of reconciliation isn’t the no-brainer it’s sometimes made out to be.

There are two major risks to the use of reconciliation which have nothing to do with fear of Republican shrieks about “cramming through a bill” or with fading hopes of bipartisanship.

The first involves an arcane budget provision called “the Byrd Rule,” which creates a point of order in the Senate against material in reconciliation bills that is not germane to budgeting. If the Senate parliamentarian (to whom the chair invariably defers on such matters) rules in favor of such a point of order–and Republicans will raise them constantly–it requires 60 votes to override such a ruling, which eliminates the entire advantage of taking this route to begin with. Nobody seems entirely confident that, say, creation of health care exchanges would be judged as germane.

The second problem is that it’s almost impossible to enact permanent changes in law via reconciliation; provisions can only operate within limited-time “windows.” This problem is best illustrated by the consequences of the GOP decision to enact the big Bush administration tax cuts via reconciliation. The “limited window” requirements of the Budget Act explains why there is still a federal estate tax, even though Congress voted in 2001 to phase it out; and why the remainder of the Bush tax cuts haven’t been made permanent. Creating an elaborate new system for health care on a temporary basis could be more than a little hazardous.

There’s a deeper problem, too, which is reflected in the evolution of the “Byrd Rule,” named after the famously imperious appropriator, the senior senator from West Virginia: non-Budget Committee senators in both parties naturally resist the routinization of reconciliation as a way to bypass the authorizing and appropriating committees. This isn’t a matter of party or ideology, but of institutional prerogatives that are zealously defended even by senators who might favor the kind of health reform legislation that reconciliation would be designed to enact.

It’s entirely possible that the potential payoff of using reconciliation is worth all the risks, particularly if hard-core Republican opposition to health reform makes it the only viable option, and/or if Democratic opponents of a public option refuse to vote for cloture to allow an up-or-down vote. But the key point right now is this: this decision isn’t easy, and the White House and congressional leaders may decide against reconciliation for reasons that should not expose them to angry charges of timidity or subservience to the health care industry.

UPDATE: The indispensible Jonathan Cohn has a post up at The New Republic on reconciliation and health care that makes a similar warning about its perils.

The Dean-Lieberman Fallback Position?

Suzy Khimm’s post at The Treatment about Howard Dean’s latest remarks on health care reform strategy shows the perils of the obsession with the public option on both sides of the barricades. After a fiery demand that progressives refuse to relent on the public option, the good Doctor allowed as how if we can’t get that, he’d be fine with legislation that just regulated health insurance abuses.

Ironically enough, Dean seems to be embracing the same fallback position as his old adversary Joe Lieberman, who’s said regulate-only legislation is all he’d be willing to support if a public option is included in a comprehensive reform bill. The problem, of course, is that absent an individual mandate to bring healthier people into the risk pool, or significant subsidies to lure them in, imposing a national system of community rating or guaranteed access to insurance on behalf of less robust Americans will likely boost private insurance premiums for everybody–not exactly an ideal outcome.

Now it’s likely that Dean is really just engaged in a tactical effort to keep progressives fired up for the public option in order to keep pressure on Senate Democrats and the White House to insist on some competitive mechanism–perhaps a “triggered” public option, perhaps strong national or regional co-ops–that’s significantly stronger than the weak state co-ops in the Baucus bill. And perhaps the reconciliation route means a “robust” public option can still be passed by the Senate. But at some point, when you keep urging people to say “my way or the highway,” you have to look down that highway to see where it leads. And if the end-point is going to be a regulate-only bill, both Dean and Lieberman need to acknowledge that may actually be no better than the status quo, and could possibly be even worse.

This item is cross-posted from The New Republic

Baucus Delivers Finance Bill

After a long and difficult gestation, the Senate Finance Committee has finally given birth to its plan for overhauling the nation’s health care system. Like many newborns, it may not be particularly pretty, but it has potential.

Although it’s the last entry into the health reform sweepstakes, the plan fashioned by Committee Chair Max Baucus is widely seen as the most important. That’s because Baucus, with President Obama’s explicit blessing, tried harder to win Republican backing for comprehensive health care reform. Even if he didn’t immediately succeed, his bill lies nearer the nation’s center of political gravity.

In today’s rancorous climate, that naturally means that Baucus is getting hammered from both ends of the political spectrum. Liberals hate his bill because it embraces (costly) nonprofit health care coops rather than the public option. Senator GOP leader Mitch McConnell wasted no time blasting the bill as partisan and senseless, even though three of his fellow Republicans were part of the “gang of six” who labored with Baucus for months to find common ground.

One of them, Sen. Chuck Grassley, was more circumspect than McConnell. Noting that the “chairman’s mark” is merely the starting point for committee deliberations on the plan, he added, “So if you don’t have the whole thing worked out yet, it would be intellectually dishonest for me to say, you know, I couldn’t vote for it or vote for it. Let’s see what the final package is.”

Whether any Republicans wind up supporting the bill, however, is less important than holding together the coalition of insurance companies and other key players in the health industry who this time around have lined up behind reform. His bill is also calculated to appeal to the moderate Democrats Obama will absolutely have to win in order to pass any reform of consequence.

With a price tag of $856 billion, the Baucus blueprint is cheaper than other Congressional plans. Best of all, it’s paid for — though the particulars will spark fierce debate. The financing package includes $507 billion worth of cuts in public health programs, mainly Medicare and Medicaid. Hospitals will take a big hit, and some providers may stop taking Medicare patients if reimbursements are cut. The bill also envisions $349 billion in new taxes. Most of that would come from taxing the most expensive health insurance policies, though medical device makers would also get nicked.

Complaints about these and other provisions of the bill are piling up thick and fast. Democrats say it doesn’t extend subsidies for buying taxes far enough up the income scale, forcing many families with modest incomes to pay more for coverage or face penalties if they couldn’t. That’s because most people will be required to buy insurance, regardless of how much subsidy they receive.

Republicans don’t like this mandate, or another one on larger businesses that don’t provide their employees with coverage. And with consummate chutzpah, given his party’s ferocious opposition to government-run health care, McConnell has shed crocodile tears over the bill’s Medicare cuts.

The Baucus bill will be, and should be, substantially modified as it runs the gauntlet of the Finance Committee, the full Senate and then a House-Senate conference. But it contains the insurance market changes, subsidies and mandates that are the guts of health reform, and it meets President Obama’s demand that reform seek to restrain health care cost growth while adding nothing to the federal deficit. And conservatives can sleep easy in the knowledge that it contains no death panels, no abortion funding and no insurance for illegal immigrants.

Most important, it moves the arduous legislative process forward, giving critics not only a target to attack, but a mark to beat.