Via Ezra Klein, this heartening news. As Howard Dean said, there's simply no point without a good public option:
According to Congress Daily, the CBO says attaching the public plan to Medicare rates will save even more money than originally thought:
In a bid to wrangle concessions from the Blue Dog Coalition on healthcare reform, House leaders Thursday released CBO estimates for liberals' preferred version of the public option that show $85 billion more in savings than for the version the Blue Dogs prefer.
Rep. Stephanie Herseth Sandlin, D-S.D., a Blue Dog co-chair, said any possible new momentum toward a public option tethered to Medicare rates is, in part, "because of the cost issue" and the updated CBO score.
The original House bill required the public plan to pay providers 5 percent more than Medicare reimbursement rates. But as part of a package of concessions to Blue Dogs, the House Energy and Commerce Committee accepted an amendment that requires the HHS Secretary to negotiate rates with providers. That version of the plan will save only $25 billion.
In total, a public plan based on Medicare rates would save $110 billion over 10 years. That is $20 billion more than earlier estimates, a spokesman for House Speaker Pelosi said.
In other words, the conservatives want to spend $85 billion more than the liberals do. Moreover, the CBO is estimating savings to the government. That is to say, the $85 billion reflects reduced federal spending on subsidies because premiums in the public plan will be lower. Savings to individuals and businesses paying lower premiums will be much larger than $85 billion, and politically, much more important.
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Here's some of the latest on health-care reform. First, Max Baucus released the Senate Finance Committee's version of health-care reform. Such as it is.
Max Baucus will release the Chairman's Mark -- the official first draft of his bill -- later today. But things are not going according to plan. He's got a bill full of the compromises meant to attract Republican support, but no Republican support. Not even Olympia Snowe, at this point, has committed to backing the bill.
Meanwhile, the framework has conceded enough to the GOP that it's also losing Democratic support, including that of Jay Rockefeller, chairman of the Finance Committee's Health Care Subcommittee. And Rockefeller says that four to six Democrats on the committee feel similarly. Baucus is thus caught between a rock and a hard place. The absence of any Republican support makes it hard for him to justify his compromises. And his compromises make it hard for the Democrats on the committee to support his bill.
Nate Silver checks in with objections from the Senate Finance Committee:
Firstly, there's Jay Rockefeller, who opposes the lack of a pubic option.
Ron Wyden doesn't think the subsidies are sufficient.
Then there's Olympia Snowe, who doesn't like the funding mechanism.
John Kerry also has issues with the funding plan -- different issues than Snowe does -- and implies that the bill needs significant changes.
Mike Enzi and Chuck Grassley, who were never really on board in the first place, have a litany of objections.
Kent Conrad now wants the CBO to score the bill with a 20-year time window -- an unorthodox move which could have a variety of motives, but if nothing else introduces another wrench into the works.
These are not just any old random set of Senators opposing Baucus's plan -- these are the thought leaders on health care reform.
Negotiations are funny things. Sometimes the scariest moments come when you're closest to a settlement, as all sides feel emboldened to take the last opportunity to demonstrate resolve. Leverage in a negotiation is not necessarily a zero-sum affair, since nobody has any leverage if there's no hope to reach an agreement. So some of this maneuvering, perhaps, is a reflection of the bill moving closer to passage and not further away.
But let's be clear -- some of this is Baucus's chickens coming home to roost. When you make a unilateral decision to negotiate with only five other people from a 23-person committee and 100-person Senate, and two of those five people have clear electoral disincentives against supporting any plan that you might come up with, the negotiations are liable to end in failure far more often than not. The flurry of on-the-record statements against Baucus's reform plans -- not "leaks", not trial balloons -- points toward a defective process.
And that may suit Democrats just fine. There are at least three other starting points for a final showdown over health care: the House Tri-Committee bill, the Senate HELP bill, and possibly also the White's House's statement of principles, some of which remain vaguely defined. Many of the objections raised to BaucusCare would necessarily apply to one or more of those bills too -- but they'd appear to be starting from no worse a position than Baucus's plan itself.
Ezra Klein talks about what everyone on the Hill knows: that the health-care deal will now get done by making it unaffordable for the people it's supposed to help. Only in D.C. is that considered a "victory." Well, I say it's spinach, and I say to hell with it!
The basic structure of the bill has three main planks working in conjunction with each other: The individual mandate creates a mechanism for a universal, or near-universal, system. A universal, or near-universal, system creates the conditions for insurance market reform. The subsidies make the individual mandate affordable for people to follow.
There are a few ways to destabilize this system. The most likely way is to reduce the subsidies so that the individual mandate isn't really affordable. That seems to be happening even as we speak. At that point, reformers have two options, both of them bad.
The first option is to reduce the value of the minimum insurance policy such that buying something the government considers insurance isn't very expensive. This means policies with high deductibles and co-pays, or policies that don't cover very much. But asking someone with a relatively low income to purchase a policy with a $1,500 deductible and significant co-pays is asking them to purchase something they can't really afford to use. So we're making them spend $7,000 or $8,000 a year on something they don't necessarily want and can't really take advantage of. That's a recipe for a huge backlash.
The second option is to drop the individual mandate altogether. Obama, who didn't have a mandate in his campaign plan, might be amenable to this approach. But here, too, there are problems. The young, healthy risks will hang back from the system while the older, sicker risks will flood in to take advantage of subsidies and new regulations that stop insurers from discriminating against them. The risk pool will reflect that, and health-care insurance will become even more unaffordable for the people who need it. And because it's less affordable because of the presence of the sick, it will become even less attractive to the healthy.
The happy news is that the difference between a plan with decent benefits that's affordable for people and a plan that's not affordable for people and doesn't offer decent benefits is not that large. Optimally, you'd want to spend about $1.3 trillion over 10 years. You could probably do it for $900 billion to $1 trillion. But you can't do it for, say, $700 billion, which is a number I'm hearing fairly frequently.
The difference between doing this right and doing this wrong is, in other words, about $30 billion a year, or $300 billion over 10 years. To put that in perspective, many of the legislators who are balking at the cost of health-care reform voted for the Kyl-Lincoln bill to reform the estate tax at a cost of $75 billion a year, or $750 billion over 10 years. You can make health-care reform work at a price tag that legislators are, in theory, willing to bear, at least when the tag is attached to tax cuts.
Isn't it interesting? Because I never hear them talk quite the same about costs when it comes to war. For example: "We really want to stabilize Afghanistan - but it has to be revenue-neutral" or "Yes, we know we said it was important to stabilize Iraq, but we simply can't afford this anymore."
No, the place where they decide to draw the line is... our health. War is seen as the absolute necessity and health care is seen as optional. That's just crazy.
I hope President Emanuel changes his position on this important issue.
As The American Prospect's Ann Friedman writes, this has to be understood in context. It is the final, decisive act in "an ongoing campaign of intimidation and harassment against someone who was providing completely legal health-care services." That campaign stretched over decades of protests, lawsuits, violence, and, finally, murder. The different elements were not always orchestrated. But the intent remained constant: To counter the absence of a statute that would make Tiller's work illegal with enough intimidation to render it impossible.
This was, in other words, a political act. Tiller was murdered so that those in his line of work would be intimidated. In conversations with folks yesterday, I heard well-meaning variants on the idea that it would be unseemly to push legislation in the emotional aftermath of Tiller's execution. I disagree. Roeder was acting in direct competition with the United States Congress. And it's quite likely that he changed the status quo. Legislative language and judicial rulings had made abortive procedures legal and thus accessible. Yesterday's killing was meant to render abortive procedures unsafe for doctors to conduct and thus inaccessible.
If a woman cannot get an abortion because no nearby providers are willing to assume the risk of performing it, the actual outcome is precisely the same as if the procedure were illegal. Roeder has, in all likelihood, made abortion less accessible. It would be, in my view, a perfectly appropriate response for the Congress to decisively prove his action not only ineffectual, but, in a broad sense, counterproductive.
That's not to suggest fast-tracking legislation that radically transforms the county's uneasy consensus. But there are plenty of remedies that speak to the question of access alone: Bills that make abortion centers safer and help poor women afford treatment, for instance. We can't stop Scott Roeder from killing George Tiller. But we can stop him from having his intended effect on a woman's ability to choose.
Glenn Greenwald points out why the use of unnamed sources is so misleading to the public:
In order to assuage concerns among progressives that the Obama administration intends to follow in the Bush administration's footsteps by trying to cut Social Security benefits, high-level Obama officials have been telling journalists such as The American Prospect's Ezra Klein -- on the condition of anonymity -- that they have no intention of touching Social Security, producing reports which then faithfully communicate that message, such as this one from Klein, two weeks ago:
What people at the White House have told me on Social Security -- and what I wrote in the post she's referencing -- is that there's no intention to touch Social Security in the foreseeable future. It's not a priority and it's not a political winner. . . . The problem, they say, is health care, not Social Security, and that's where the White House is focusing.
Based on those same anonymous conversations, Klein wrote other posts telling progressives who are worried about Obama's intention to cut Social Security that they were worrying about something that doesn't exist.
But in The New York Times today, David Brooks recounted what he described as "conversations with four senior members of the administration." Those unnamed Obama officials all called Brooks in order to refute his column from last week which argued "that the Obama budget is a liberal, big government document that should make moderates nervous." Brooks -- like Klein -- granted anonymity to and then proceeded to quote all four "senior members of the Obama administration" (a) without explaining why he did so, (b) without describing efforts, if any, to persuade them to use their names and (c) without providing any information about who they are or what their motives might be (all flagrant violations of the supposed NYT policy governing the use of anonymity). These paragraphs were the result of the anonymity Brooks gave to the Obama White House (emphasis in original):
Besides, the long-range debt is what matters, and on this subject President Obama is hawkish.
He is extremely committed to entitlement reform and is plotting politically feasible ways to reduce Social Security as well as health spending.
What Klein's anonymous White House sources told him ("there's no intention to touch Social Security in the foreseeable future") is directly contrary to what Brooks' anonymous White House sources, two weeks later, told him (Obama "is extremely committed to entitlement reform and is plotting politically feasible ways to reduce Social Security"). But there's no way to resolve those contradictory White House claims because Klein and Brooks allowed these officials to hide behind anonymity when making these claims. That's what anonymity does -- it allows dubious or even false government claims to be spouted with impunity and without any accountability.
