Friday, December 4, 2009

Keep Checking the FreeStater Blog

I'd like to thank everyone for checking in with the PoliProf blog - for the next few weeks I will focus most of my efforts on the FreeStater Blog for St. Mary's College as we prepare for it's official roll out. So keep checking the FreeStater for news and commentary.

Monday, November 2, 2009

Pre-Election Day Predictions for VA, NJ, and NY-23

Last week I offered my assessment of the key 2009 elections one week out, I return as promised to offer predictions for tomorrow.

Virginia - It's all over but the counting. Tomorrow will be a big night for the GOP as Republican Bob McDonnell reclaims the governorship and the GOP wins all other statewide races (Lt. Governor and Attorney General). I expect the results to be quite lopsided with McDonnell winning by at least 10 points. This will have a down ballot effect and the GOP will probably add about 7 seats to its majority in the legislature. This means that the GOP will have total control of VA during the redistricting that will take place after the 2010 census.

New Jersey - Jersey continues to be a tough race to call, Christie's once commanding lead has gone, but Corzine's numbers have never improved and his approval rating is among the lowest for any governor. Independent candidate Chris Daggett appears to be fading and the late trend suggests a return for Christie. A new Public Policy Polling survey shows Christie up by 6 points. I stand by my prediction that Christie will win by about 2 percentage points, driven mostly by his continued lead among independents.

New York 23 - The most fascinating race of the year. The liberal Republican candidate Dede Scozzafava suspended her campaign on Saturday as it became clear that she could not win. Then on Sunday she endorsed the Democrats Bill Owens. Conservative Party nominee Doug Hoffman appears to have the momentum in the race, but it is unclear what impact Scozzafava's endorsement will have.  This race is getting attention with many seeing it as a microcosm of a coming civil war within the GOP between the conservative base and more moderate voices - but Scozzafava's decision to endorse the Democrat lends credibility to the many Republicans who felt that she simply was not a Republican. Embracing moderates is one thing, by most accounts Scozzafava was not a moderate Republican so much as she was a liberal to moderate Democrat running on the Republican ticket. I expect Hoffman to win by about 5 points.

So yes, I see a tremendous night for Republicans. Democrats will argue that Virginia and New Jersey were decided based on state issues and have nothing to do with the President or his agenda (even as Obama has now declared the NJ race as essential to his agenda). In NY-23 Democrats will argue that it shows that the GOP has no place for moderate or independent voices (a tough argument to make given that moderate and independent voters will be crucial to GOP wins in VA and NJ). If Hoffman wins by more than 5 points (assuming that he wins) in a district carried by President Obama the argument about GOP extremism will be very hard to make.

If there is a GOP sweep tomorrow expect this to seriously undermine key legislative initiatives such as health reform and cap and trade as moderate Democrats become increasingly concerned about 2010.

Stay tuned...

Tuesday, October 27, 2009

Update: Will Virginia and New Jersey be Canaries in the 2010 Coal Mine?

Back in early September I urged you to watch the off year elections in VA and NJ very closely, arguing that two GOP victories would indicate a high level of GOP intensity, Independent willingness to vote GOP, and, most deadly, Democratic apathy. Today marks the one week countdown to Election Day 2009 and I think that it is a good time to revisit the states. There appears to be nothing left to do in VA other than ask how large Republican Bob McDonnell's margin of victory will be.  The three most recent polls show McDonnell crushing Democrat Creigh Deeds by 11, 15, and 17 points. Despite (or perhaps because of) high profile help from Bill Clinton, and other leading Democrats, Deeds is in fee-fall. Now comes word that President Obama will campaign for Deeds today (October 27). This could prove to be embarrassing for the president if Deeds goes on to lose by double digits in a state that is central to Obama's reelection plans. As if the news in VA could not get worse for Democrats, Republicans appear poised to win (reclaim) all statewide posts.

New Jersey is bit more complicated. Back in September Republican Chris Christie appeared to be heading for certain victory over the Democrat John Corzine, the state's unpopular incumbent governor. But things began to shift during late September and early October as Independent candidate Chris Daggett gained traction after Corzine launched a scathing barrage of negative ads seeking to discredit Christie - even making multiple (not so veiled) references to Christie's weight problem. As a result, Christie began to lose support as Daggett's support began to rise. Interestingly, Corzine's support has budged little - stuck around 40%. Normally that would be a death sentence for an incumbent, but the presence of a strong third-party candidate meant that Corzine could win with only 40% support. Although Christie's once clear lead over Corzine has evaporated the most recent polls from NJ suggest that Christie has rebounded (slightly) and that Daggett is losing steam. The last three polls have Christie ahead by 2, 3, and 4 points - certainly too close for comfort, but all show a trend back toward Christie, away from Daggett, and absolutely no momentum for Corzine - despite high profile visits from the President and Vice President and reports that Corzine is outspending Christie by a 3 to 1 margin.

At this point - one week out - I predict with confidence that Republicans will sweep VA setting the stage for a tough battle for Obama in 2012. I also predict that Chris Christie will win a very narrow victory in reliably blue NJ (probably a 2% margin). Democrats will argue that the races have no national implications, Republicans will claim that they represent a repudiation of the Democratic agenda - the truth will be somewhere in between. Expect a clear Republican victory in both states to embolden the party and to further depress Democratic enthusiasm and momentum. A clear Republican victroy in both states will also cause many a Blue Dog Democrat to reconsider their support for a range of issues from health reform to cap and trade as the 2010 midterms begin to take center stage.

The wild card to watch next week is the special election in New York's 23rd Congressional District. A reliably Republican distrcit where the GOP nominated a liberal Republican, Dede Scozzafava, to run against Democrat Bill Owens. Not pleased with the Scozzafava choice the Conservative Party nominated conservative Republican Doug Hoffman. Initial fears within the GOP were that Scozzafava and Hoffman would split the GOP vote and deliver the district to Owens - but two recent polls (each with small sample sizes) show that Hoffman has pulled into the lead. Though the polls showing a Hoffman lead were partisan polls with small sample sizes a review of polls taken since late September show a clear trend in the race. Democrat Owens has been stuck at about 30%, Scozzafava has been losing support, and Hoffman has been rising. If Hoffman wins this race it will show that conservative voters - many of whom sat out the 2008 election - are re-energized. In mid-term and off-year elections few things matter more than an energized base.

See you next Tuesday night...

Monday, October 26, 2009

The Need for Real Health Care Reform

The current reform proposals being considered in the House and the Senate will not solve the systemic problems in the American health care system - in fact they will likely make the problems worse. The current reform proposals maintain our fragmented system and will even add to the fragmentation.... read the rest at the FreeStater Blog.

Friday, October 23, 2009

Gay Marriage: It's a Simple Question of Equality

Perhaps it is appropriate that an 86 year old WWII vet reminds us that equality has always been the American ideal.... in a simple way this is a man standing up for his son, in more profound way it is veteran demanding that his nation live up up to the ideals for he so many have fought and died - freedom, liberty, equality.

Tuesday, October 20, 2009

Deciphering Public Opinion on Health Care Reform

Trying to understand what all of these health reform polls mean? I argue that Democrats are correct when they say that the public supports a public option, and Republicans are correct when they say that the public opposes the health reform proposals currently being considered in Congress... How can both be true? Check out the FreeStater Blog to find out.

Saturday, October 10, 2009

Rationing Health Care: What We Already Do, Done Better

It's a dirty word that no politician dares to utter, but any discussion of health reform, and of cost containment, demands that we talk about rationing. As stated by ethicist Peter Singer argued this past summer "The debate over health reform in the United States should start from the premise that some form of health care rationing is both inescapable and desireable. Then we can ask, What is the best way to do it?" My goal with this post is to better explain rationing, show why it need not be a dirty word, and show how we already engage in health care rationing everyday.

Let's start our discussion in Oregon circa 1987. Oregon's Medicaid program only covered adults with earnings below 60% of the federal poverty level (FPL), but the state wanted to find a way to cover everyone up to 100% FPL - but the state could not spend any additional money. A state commission was formed to determine how to achieve this goal. The commission looked at all services provided by Medicaid and divided them into approximately 700 treatment groups. The groups were then ranked based on medical and cost effectiveness. Treatments that scored well were given a low number, treatments that fared poorly were assigned a high number. Figure 1 shows the treatment groups on the horizontal and the income level of the population on the vertical - the grey area represents treatments that are not covered.

Oregon was providing access to all 700 treatment groups to every Medicaid recipient with earnings below 60% FPL, but nothing was covered for those earning 60% FPL or above (the grey area in figure 1). The Oregon legislature decided that in order to provide health insurance to everyone below 100% FPL they would stop covering the least effective (high numbers in figure 1) treatments. The state stopped covering treatment categories that fell above treatment group 550 (figure 2). This saved enough money that the state was able to provide coverage for treatment groups 1 to 550 for everyone earning below 100% FPL. It was explicit rationing of care, those services deemed to be the least medically or cost effective were dropped, but the state was able to increase the number of people covered by Medicaid by 50%.

So what are the national implications of all of this? Imagine that the 700 treatment groups identified in Oregon were extrapolated to the entire country. Currently, those with good insurance, in Medicare, in Medicaid (other than in Oregon), and those who are wealthy have access to all 700 treatment groups. But access to those treatment groups declines as income (and likely the quality or presence of insurance) drops. Figure 3 shows how health care is already rationed in the United States everyday. The poorest Americans, those lacking adequate health care, have limited access to any of the 700 treatment groups. As income rises so does access to care. This is rationing, but unlike the Oregon experiment, this rationing is driven entirely by one's ability to pay for care. Rather than rationing to ensure that everyone has equal access to a set standard of care it is rationing that provides some unfettered access to care while others can access very little. And it's all based on ability to pay, not on need.

The solution, based on the Oregon example, would be to limit access to the least effective services, and with the money saved, extend equal coverage to everyone (figure 4). In Oregon, the state was dealing with a finite pool of funds for the Medicaid program. Nationally, we would be dealing with a finite pool of funds drawn from the population via taxes to fund universal health care. The inclusion of the entire population in the purchasing pool would likely mean fewer excluded treatments.

In a prior post I argued that the only way to effectively control costs was to implement a single-payer model of health care delivery in the United States. I cited the McKinsey Global Institute's finding that America spends 30% more on health care than we should - largely due to overuse of services. Ending the overuse of services, and therefore saving substantial sums of money from our $2.5 trillion health care economy can only be achieved effectively via single-payer. Achieving those cost savings would require empowering some governmental agency to review service use and determine which treatments are most and least effective, and therefore which services to be covered with our finite resources. It would be explicit rationing, but unlike our current approach to rationing health care, it would be based on providing equal access to the same standard of care – regardless of income.

Special credit goes to Donald Barr and his terrific book “Introduction to U.S. Health Policy” for key information and concepts used to inform this post.

Thursday, October 8, 2009

Public Support for Health Reform: Increasing or Collapsing or Neither?

Interesting data from on health reform - seems clear that support for health reform has not been on the rise as some have suggested.

According to Pew, Obama's approval is down and the public clearly opposes Congressional health reform proposals - and this is from a sample with only 23% Republicans. Gallup puts it at 51% in favor to 41% oppose, the AP puts it at 40% to 40%, and Quinnipiac has it 47% opposed and 40% in favor.

Taken together, the numbers suggest that the public is either opposed or indifferent. The best that could be said by reform proponents is that opposition has leveled off and stopped rising, while support has stopped falling and leveled off.

Public support needs to be higher to bring Republicans on board - even with the urging of former party leaders like Bob Dole.

Tuesday, October 6, 2009

The Economic Case for Single-Payer Health Care Reform

The Center for Budget and Policy Priorities (CBPP) has provided compelling justification for comprehensive health care reform – not the insurance reform that is likely to emerge from the House and Senate, but true health care reform. In their report “Updated Long-Term Fiscal Deficit and Debt Projections,” the CBPP used data from the Congressional Budget Office to estimate long term debt, deficit, and spending trends for the federal budget – the findings show that 1) the U.S. is on an unsustainable spending path and 2) it all comes down to the rising cost of health care.

“The main driver of the long-term fiscal imbalance is the rising per-person cost of health care, which will increase spending and reduce revenues…”

How will it reduce revenues?

“…as health care costs rise, workers are likely to receive more of their compensation in the form of tax-exempt health care benefits and less in the form of taxable wages, so total revenues decline.”

This assumption is confirmed by the fact that employee health care costs have increased by 130% in the past 10 years even as our wages have barely kept pace with inflation. As our wages shrink, so does our taxable income and therefore federal tax revenue.

But it gets worse, because we all buy health care from the same market of providers and facilities the forces driving up private health care costs are also driving up the cost of Medicare and Medicaid. The CBPP estimates that those two programs will grow from their current 5.1% of GDP to 12.8% of GDP by 2050 (Figure 2) – put another way, these programs will more than double in expense in relation to total economic output. Currently, spending on Medicare and Medicaid is equal to 32.7% of all federal revenue ($0.33 of every dollar the government raises via taxes is spent on those two programs), by 2050 that will rise to 67.7% of all federal revenue – meaning that every other federal obligation, including Social Security and national defense, will be fighting for the remaining 32.3% or we’ll have to engage in heavy borrowing or drastic tax increases.

In short, if we are to enjoy a sustainable and healthy economic future, we need to bring down the cost of health care and control its meteoric annual cost increases.

Neither the House, the Senate, nor the President have proposed any such reform.  Rather they have focused on ways to expand coverage while shifting costs around to create the illusion of a decreased federal burden. But the problem with cost shifting is that it does nothing to control costs, nor does it change the ultimate trajectory of rising costs system wide. System wide change is what is needed.

Consider this – in 2007 Canada spent an average of $3,173 per capita on health care, the United Kingdom spent $2,560, and Germany $3,171. The U.S. spent $6,096 – starting to get a sense of the problem? Between 2003 and 2007, US health care spending grew at a rate 22% faster than Germany and Canada and twice as fast as in the UK. As a percent of overall economic output in 2007, health expenditures accounted for 10.1% of GDP in Canada, 10.4% in Germany, and 8.4% in the UK. In the U.S. the figure was 16%.

Finding a New American Way
The U.S. needs to find a way to effectively control costs and reduce per capita health expenditures; our economic health depends upon it.

Canada, the UK, and Germany have all established their own unique approach to health care organization, delivery, and cost containment – but there are many similarities.

Canada employs what is commonly referred to as a single-payer system. Universal health care is funded via taxes paid to the federal and provincial governments. Providers and health care facilities are private, but the government, operating as a monopsony, sets prices. Every province establishes an annual budget for health care; if a provider or hospital exceeds the allotted budget then no additional money is provided. This approach forces coordination of care and the efficient use of resources to ensure that allocated funds last the year. It also means that sometimes elective surgeries and other non-emergency procedures are delayed until the next budget year.

In the UK one will find what is commonly referred to as socialized medicine. Universal coverage is funded via taxation. Hospitals are owned by the National Health Service, specialists are employed by it, and general practitioners accept a negotiated capitated (pre-payment) salary for caring for patients. Health care organization, delivery, and resource allocation are handled by regional health authorities. There is an annual budget for health care. The system is marked by long wait times, and service delivery is often determined based on strict cost/benefit analysis, but everyone is covered, costs are contained, and the World Health Organization ranks the UK health system as 18th in the world (the U.S. is ranked 37th).

In Germany, universal health care is funded via payroll taxes paid by employers and employees. Insurance is provided via non-profit “sickness funds” or insurers. Coverage for kids is funded via general taxes and retirees and the unemployed pay for insurance via deductions from their respective benefits. Germany uses the power of regulation to maintain costs, sickness funds cannot raise premiums at a rate faster that wage growth, and there are limits set on how much hospitals and providers can bill in a year – essentially an annual health budget. If a doctor were to prescribe medication that exceeds the average in his area he would be required to partially cover the cost.

All of these systems share similarities – they all provide universal coverage, they all rely on one system to provide care (unlike the U.S. where we have Medicare, Medicaid, SCHIP, Employer Sponsored Insurance, Large Group, Small Group… need I go on), and they all rely on the government – either as payer or regulator – to handle the distribution of resources. Because each of these nations establish variations of an annual health budget patients are viewed differently as well. In the U.S. every patients and every procedure provided is a source of revenue (provide more services, get more money) – in Canada, the UK, and Germany every service provided represents a depletion of limited funds. This forces hospitals and physicians to prioritize and coordinate care. Do they ration? Certainly, but its rationing based on assessed individual need relative to overall needs and available resources.

We ration in America as well, but it has nothing to do with need. Rather we ration based on an individual’s ability to pay. Forty million lack insurance and millions more have limited access to care due to high deductibles and other out of pocket expenses. There is another important point about these countries; because there is a single source of payment there is no opportunity for cost shifting. In the U.S. if the government cuts Medicare reimbursement hospitals or providers will try to shift the cost onto the privately insured. If an insurer raises prices, an employer will negotiate lower prices by cost shifting to employees in the form of higher co-pays and deductibles. The end result of all of this shifting means that no money is actually saved system wide, it’s just shifted from one payer to another – this cannot happen when you have one payer and a set budget.

The fragmentation of our system and the fact that we spend more than any other nation might be tolerable if we were benefiting in some way. Are we healthier? Do we get extra benefits for all the extra spending? The simple and clear answer is “No.” A recent study by the McKinsey Global Institute (MGI) found that the U.S. spends about 31% more per year on health than would be expected based or our wealth, cost of living, and health. In a $2.5 trillion health care economy that translates into $775 billion in excess spending.  Why do we over spend? We have higher administrative costs owing to the fragmentation in our system, but mostly the problem is the manner in which we pay for services. Since every patient and procedure is a source of revenue providers over-provide. Because our insurance frequently has no limit on the utilization of services, we over-consume. According to the MGI report:

“The higher utilization of care may be attributable to a number of factors such as greater patient convenience and a reduction in risks associated with less-invasive surgery. It also appears likely that this increased usage relates to the fee-for-service nature of outpatient care reimbursement, which creates incentives to providers to render more care... From a supply perspective, outpatient care, particularly for specialist care and diagnostic procedures, is very profitable.”

Why Single-Payer?
What approach should we take? Canadian style single-payer is the only real option as it would preserve our private system of care delivery (hospitals and physicians).  The German model seems appealing at first, but in the end it would be easier to eliminate the health insurance industry than it would be to turn insurers into heavily regulated non-profit entities. So single-payer, like Canada, and like Medicare. Reducing health care costs by 30% would have a dramatic impact on our economic security. Health expenditures would shrink to $4,267 per capita and 11.4% of GDP, we would save over $700 billion in a single year (roughly the size of the American Recovery and Reinvestment Act of 2009). By setting an annual budget we could better control the annual growth in federal health care spending and alter our current unsustainable path. Though we would still be saddled with a need to pay interest on our accumulated debt, we would no long accrue new debt to fund Medicare and Medicaid. States would benefit as well. Medicaid consumes approximately $0.25 of every tax dollar raised by a state.

Replacing Medicaid with a new universal federal program would eliminate that funding need and immediately solve nearly every state budget shortfall. Although we would still need to fund the new program via taxes, we would no longer be paying health insurance premiums and neither would our employers so our wages would rise and no longer be depressed by the rising cost of health care. At the state level, there would no longer be taxes to support Medicaid. At the federal level, there would be no taxes to support Medicare. Instead, a new tax would fund a health care system that costs approximately 30% less than the current system – and everyone would be covered. Sound too good to be true? Tell that to Canada, the UK, or Germany.

So how do we do it? The only way that we can bring health care spending under control, and therefore be able to provide coverage to everyone, is if we move beyond our aversion to government intervention. Only government can effectively allocate our health care resources in a manner the responds to need rather than wealth. Only government can establish an annual health care budget and ensure that facilities and providers abide by the annual limits. Only government can affect our change from a system driven by the perverse incentive to deliver care as a means to generate revenue to a system based on the proper management of care in order to conserve resources. The logical approach would be to restructure Medicare and make it universal. And it must be universal. The only way to get the public on board, and to accept the change, is to have us all in the same system, all guaranteed the same level of care, all sharing the same resources, and the costs. This is what other nations do, and what we must do.

Monday, October 5, 2009

Cost Containment v. Universal Coverage - Part I

The Senate Finance Committee has essentially completed work on the Baucus health reform effort, the committee is waiting for the preliminary CBO score before taking a final vote. That report should come by mid-week. I suspect that it will find somewhat less in savings than did the CBO score of Baucus’ original bill – but will still see the promise of deficit reduction. I also expect that one or two Democrats on the panel will vote "no." Not moderate Democrats opposed to a liberal bill, but rather more liberal Democrats concerned that the bill does not do enough. Ron Wyden (D-OR) and Jay Rockefeller (D-WV) are likely candidates. With 2 defections, Baucus would need one GOP vote and I suspect that he’ll get it from Olympia Snowe (R-ME) – all other Republicans will vote "no." In the end, committee members know that the bill has to be reported out of committee in order to move this process along. The bill will then be placed in the less than capable and uninspiring hands of Harry Reid, a majority leader unlikely to survive the 2010 mid-term election.

Unknown is what any final bill will look like. The LA Times reports that the White House has begun a concerted behind the scenes effort to win support of a public option, but – but as I argued in a post to the FreeStater Blog – not all public options are built the same.

Enter into all of this a new wrinkle. The US insurance industry signaled support for reform at the start of this latest endeavor to reform our health system. They were willing to accept a requirement that they cover all comers, (guarantee issue) with no pre-existing condition limitations, so long as any reform contained employer and individual mandates. Insurers knew that the pre-existing condition folks would be more expensive and increase an insurer’s risk, but that new risk would be more than offset by requiring young, healthy people to purchase insurance and by requiring that employers provide insurance (the employed tend to be healthy). So for insurers the deal with the Obama administration was simple – “we’ll take the bad, but you better send us the good.”

That deal is now starting to sour. The only way that an individual and employer mandate can work is if the penalty for non-compliance is sufficient to compel someone to buy insurance. However, to placate Democratic and Republican concerns over imposing new costs on business and individuals the Finance Committee dramatically reduced the penalty for not obtaining coverage and essentially eliminated the employer mandate. Originally, the bill would have imposed a penalty not to exceed $3,800 for families and $950 for a person for a failure to obtain insurance. These amounts were important as they corresponded to the average employee share of an employer sponsored insurance plan – so a rational person would opt to accept employer sponsored insurance instead of paying the fine.

Those fines have now been reduced to a maximum of $1,500 per family and $750 per person – and the fine would be phased in between 2013 and 2017 (see page 35 of the Finance plan). Taken together, employers would not be compelled to offer insurance and with the reduced penalty for non-compliance individuals would be less likely to purchase what is offered (if anything), even a public option. So insurers will be required to cover high risk folks with pre-existing conditions, but will not get to bring all of those young, healthy folks into the risk pool – suddenly reform looks like a bad deal for the insurance industry – and they are expressing their concern. The insurance industry is a powerful lobbying force that has shaped health policy for more than four decades. If they turn against reform it will mark an entirely new, and from the Obama Administration’s perspective, unwelcome chapter in the reform battle.

In 1993, the leading managed care insurers initially endorsed the Clinton health reform efforts. Then, as now, they were promised individual and employer mandates and a dominant role for managed care. In the end, insurers turned against the plan after President Clinton proposed heavy regulation of the insurers and the creation of National Health Board to regulate the health care market and control costs. Insurers reacted by working, effectively, to defeat reform.

In 1993/1994, as now, the key conflict was between the competing interests of universal coverage and cost containment – this battle has been at the heart of reform battles since President Carter and Senator Kennedy tussled over reform in the late 1970s. So long as we pursue policies that simply seek to provide coverage, without addressing the problem of ever rising costs, cost containment will always win the day and universal coverage will always wait. How we go about controlling costs, and why no politician wants to go down that path, will be the subject of a future post. Stay tuned.

Sunday, October 4, 2009

Saturday Night Live Offers a Funny and Scathing Assessment of the President's Accomplishments.

This is just a scathing bit of "satire" from Saturday Night Live - and it's important. It signifies that the media love affair that has shielded President Obama from scrutiny and criticism (among mainstream media outlets) is ending. Now that SNL has opened the floodgates, expect O'Brien, Letterman, Stewart and others to start bursting through. Until now, most comedians, especially John Stewart made real bad sycophantic jokes… “oh Mr. President your awesomeness is just so funny…” "Your feet must get wet from walking on water..." Something tells me we are about to enter a whole new phase… one that George W. Bush, Jimmy Carter, and Gerald Ford were quite familiar with, we'll have to see how team Obama handles it.

Friday, October 2, 2009

Does Harry Reid Really Plan to Include a Public Option... and Just What Would the Option Be?

Check out the FreeStater blog for my take on Senate Majority Leader Harry Reid's latest expression of support for a "public option."

Wednesday, September 30, 2009

Richard Nixon: Health Reform Visionary

In 1974, President Richard Nixon addressed Congress on the issue of health care. Said Nixon “Without adequate health care, no one can make full use of his or her talents and opportunities. It is thus just as important that economic, racial and social barriers not stand in the way of good health care as it is to eliminate those barriers to a good education and a good job.”

Nixon went on to explain that the rising cost of health care placed too many American families in danger of being wiped out by a catastrophic illness. Our health insurance system was flawed according to Nixon because too many Americans were uninsured and unable to obtain insurance due to low pay, unemployment or pre-existing conditions and still millions more who had coverage lacked “balanced, comprehensive and fully protective” coverage.

To address the problems, Nixon proposed the Comprehensive Health Insurance Program (CHIP). Nixon pledged that CHIP would allow every American to obtain comprehensive insurance, that no American would pay more than he or she could afford, and patients will be free to choose their doctors. According to Nixon, CHIP would build on America’s existing private insurance market, promote effective use of health care resources, and use public funds only when necessary – all without requiring new taxes.

CHIP contained three key elements: Employee Health Insurance, Medicare, and Assisted Health Insurance.
  • Employee Health Insurance – Employers would be required to provide health insurance to their employees, these benefits would need to meet minimum benefit requirements set by the federal government, and employers would be required to cover 75% of the cost of the insurance premium. There would also be a limit placed on annual out of pocket expenses.
  •  Medicare – CHIP would reform Medicare to add coverage for outpatient prescription drugs and it would place an annual limit out-of-pocket expenses. Medicare would also be required to meet the same minimum benefit requirements established for employers.
  •  Assisted Health Insurance – CHIP would have replaced the Medicaid program with a new federal/state program to provide health insurance to everyone not covered by Employee Health Insurance or Medicare. This program would also be available to those with pre-existing conditions who were unable to obtain care from private insurers. Premiums and out-of-pocket expenses would vary depending upon income with low income persons paying nothing. The program would have the same minimum benefit package as Employer Health Insurance.
Nixon argued that CHIP would require no new taxes and would save families money. To better control ever rising health care costs CHIP would rely on Health Maintenance Organizations that would end the days of fee-for-service medicine that incentivize the overuse of service and instead rely on prepaid arrangements with physicians and other providers. CHIP also would create Professional Standard Review Organizations (PRSOs), staffed by physician, an empowered to review best practices and find ways to reduce needless hospitalization.

Every person participating in CHIP would receive a Health-card. Modeled after a credit card, it would offer proof of insurance and provide information on blood type and any medical conditions or drug allergies that may be important to know in an emergency.

The Watergate scandal that ended the Nixon presidency also ended CHIP. Congress had no interest in considering comprehensive reform proposed by a President likely to be impeached.

But good ideas never die. Look to the legislation currently being considered in the House of Representatives or being debated in the Senate Finance Committee and you cannot help but see Nixon’s CHIP. Legislation in the House and Senate rely on employer mandates and establish minimum benefit requirements, the House legislation is likely to include a so called “public option” which is exactly what Assisted Health Insurance under CHIP was, both the House and Senate are proposing to create review bodies to promote efficient and effective resource use, both are likely to prohibit insurers from denying coverage based on pre-existing conditions, and both will rely almost exclusively on the existing private insurance industry to provide coverage.

There are some differences – Nixon wanted CHIP to be voluntary for individuals, no one was required to purchase insurance, but the House and Senate will likely include individual mandates. Neither the House nor the Senate will establish annual caps on out-of-pocket expenses for Medicare beneficiaries and prescription drug coverage was added in 2003 (30 years after CHIP proposed adding it). The House and Senate will also maintain the Medicaid program and in fact expand it. And HMOs have long since fallen out of favor – quite unfairly.

But these differences do nothing to diminish the fact that we are today engaged in a great debate over whether to at long last enact health reform first introduced by President Nixon in 1974. It’s not the first time, or even the second time, that we have considered CHIP – President Clinton’s Health Security Act, introduced in 1993, was essentially Nixon’s CHIP, right down to the health card and reliance on HMOs. Clinton dropped the public option and added an individual mandate, but otherwise it was very much CHIP.

So here we are in 2009 considering a reform first proposed in 1974… at what point does a proposal become too old to be deemed dangerous or radical? Nixon’s Comprehensive Health Insurance Program was a good idea in 1974 and it is a good idea today. We may never see single payer in the US, but we could move closer to the German model via the reforms currently on the table.

Tuesday, September 29, 2009

Is the Senate Really in Play?

Charlie Cook has some eye opening news over at National Journal - the Democrats may not have long to enjoy their 60 vote super-majority.  Cook counts Harry Reid (NV), Blanche Lincoln (AR), Christopher Dodd (CT), and Michael Bennett (CO) as endangered and sees a real chance for Republicans in DE and NY, not to mention the open seat in IL that has been tainted by scandal. That's 7 seats. Now add Arlen Specter (PA) and Barbara Boxer (CA) as each may face serious challenges as well - that totals 9 seats. If Republicans ran the board then Democrats would have a bare majority of 51 to 49 - and one of those seats would belong to Joe Lieberman - so let's say 50 to 49 to 1 - and Lieberman recently hinted that he may join the GOP... Now, this of course assumes that current trends hold and that the GOP does run the board (both are unlikely) - but the fact that such an outcome is even possible just speaks to how far the Democrats have fallen since their high in November of last year... the truth is, if the GOP gains as few as 4 seats President Obama's agenda will need to be drastically altered. Current polling already shows the Republicans within striking distance of recapturing the House.

Public Option's Big Day

See my post at the FreeStater Blog for an update and analysis.

Today will be a decisive day in the health reform battle. Today, the Senate Finance committee will decide whether or not to amend the Baucus bill to add a public option. The Committees 13 Democrats and 10 Republicans will consider no fewer than 4 "public option" options and at this point, no one knows what will happen. Most counts find 9 Democrats in favor of a public option and no Republicans. Max Baucus, not one of the 9, has said he supports a public option but does not believe that it can pass in the Senate (assuming a 60 vote threshold). Blanche Lincoln, Blue Dog Democrat from Arkansas, is an unknown quantity. She is slowly inching toward the endangered senator list - like several Democrats up for re-election in 2010 her seat was once deemed to be safe, until the health care debate changed the 2010 electoral calculus. There is also the issue of Olympia Snowe and her support of a state-based public option trigger - a trigger that would only be pulled if private insurance reforms fail. At least 2 Democrats support Snowe's alternative. If the Senate Finance Committee adds the public option, in form other than Snowe's trigger, then all bets are off with regard to Democrats using reconciliation to pass the bill - they will use reconciliation. Then the battle will shift to the House where leaders will put heavy pressure on select Blue Dogs just to get the simple majority needed there. Today is one of those rare, high drama days in American politics and a day worth closely following.

The Finance committee meeting will begin at 10 AM and will likely be broadcast on C-SPAN.

Sunday, September 27, 2009

Hyper-Partisanship and the Weakening of Democracy

Charlie Cook at National Journal offers some great reasons for redistricting reform. From Cook: "When I first came to Washington in September 1972, Congress abounded with conservative and moderate Democrats, as well as liberal and moderate Republicans. These lawmakers provided the ballast that prevented their parties from going to extremes. They kept the Democrats from driving into the ditch on the left and steered Republicans away from the one on the right."

The lost center in American politics is poisoning our system and weakening our democracy. It turns legislating into a winner take all war rather than the exercise in compromise that our framers intended. When our representatives engage in this brand of politics it discourages moderate voters and emboldens partisan voters - the result being an even more partisan Congress. As Congress becomes so hyper partisan normal rules of procedures are ignored and bypassed. Sarah Binder and Michael Mann at Brookings have a great review of the 110 Congress and show that the use of restrictive rules of debate and amendment in the House, bypassing the normal committee process in the House and Senate, and simply ignoring the Conference process have become the norm. The practices were begun by the Republicans in 1995 and have only gotten worse.

These abuses of process reduce the minority party to a non-entity with little recourse but to serve as an obstructive force. The result is a zero sum game politics where each legislative battle is treated like an all out war. These legislative battles then influence the politics of the voting public. Republican and Democratic voters each view the other as a threat, one that cannot be tolerated, can never be accepted as legitimate. Anger and hate naturally follow. Ends justify the means politics ensue as each side views its policies as superior and noble.

The threat by the Democrats to use reconciliation to pass health care reform is just one more example of our poisoned politics. I have taken serious flak for my support of Max Baucus and his efforts to forge compromise health reform. To be sure, the Baucus plan is flawed and would not bring the fundamental reform we need. So why do I support it? Because Baucus has demonstrated a clear respect for the process of legislating. He has sought compromise and he is seeking a bill that can pass without bypassing the normal procedures of legislating. Baucus represents a Congress of a bygone age... and the best hope of bringing that Congress back. In the process, he may just save our politics. In the end, that is far more important than any one single piece of legislation.

Friday, September 25, 2009

About that New CBS News/NY Times Poll

As all other polls show the president hovering around 50% approval, with little improvement regarding his handling of health care along comes a new poll from CBS News and the NY Times suggesting that the president has a 56% approval rating. It also suggests that he now has a plurality 47% to 45% supporting his handling of health care reform...

So what's the problem? Look to the last page of the poll release and you see that the original sample was 28% Republican, 34% Democrat, and 38% Independent - no too far off from recent surveys of party ID. But then the polling firm weighted the sample such that it was 22% Republican, 37% Democrat, and 41% Independent - from a6% Democrat advantage to a 15% advantage.

What effect did that have? If the pollsters had relied on the original sample (no weighting) the president's approval rating would be 53% and his approval/disapproval on health care would be 44%/48%. That would mean that he gained no ground on health care after his media blitz and that his approval rating fell since August. I guess that neither CBS nor the New York Times felt like reporting that story...

Thursday, September 24, 2009

Is Health Reform Really that Close?

Jay Cost at RealClearPolitics offers an interesting take on where things stand on health care reform - like me, he's trying to figure out just what Nancy Pelosi is trying to accomplish by dissing the Blue Dogs. What I have to ask as well is - how far are Democrats willing to go to pass what is essentially pretty basic reform.

From Cost:
"Some commentators have suggested that the Democrats are pretty close to finalizing a comprehensive bill on health care. But like Mickey Kaus, I am not as certain. Last week, I listed several questions I had about the bill's progress. Here's an update on that post, plus a few extra considerations."

"In other words, the conditions of uncertainty are severe, to say the least. That's why I still have nothing but questions. And as for my prediction for a comprehensive bill about this: I'll put it at 50% with a standard deviation of 25%, for a practical range of 25% to 75%. "

The Democratic party is deeply divided over health reform, it will be difficult to find common ground. Democrats know that they can use reconciliation to pass "Liberal" reform with only 51 votes in the Senate - but can they really get to 218 votes in the House without the Blue Dogs? And, would the Democrats be willing to use reconciliation knowing that it would embolden Republicans and boost GOP chances in the 2010 midterms? The simple fact is, neither the House or Senate have proposed reform so fundamental that it would be worth risking the Democrat's majority status just to pass it. If Democrats really think that they have the votes - they should just swing for the fence and push for single-payer...

Wednesday, September 23, 2009

St. Mary's College to Host Forum on Health Care Reform

The debate over health care reform in the last few months has featured plenty of yelling, a lot of finger-pointing and a shortage of dialogue.

Todd Eberly, an assistant political science professor and coordinator of Public Policy Studies at St. Mary's College of Maryland, hopes to bring some civility to the rancorous issue on Monday, Sept. 28, when three health policy experts offer diverse viewpoints at the school.

The forum, called "Beyond the Shouts: A Discussion of Health Reform in America," came about after Eberly, who spent 10 years as a health policy analyst before coming to St. Mary's, grew frustrated about the lack of conversation at congressional town hall meetings nationwide this summer.

No politicians will be on the college's panel in an effort to foster a productive flow of information and exchange of ideas. The three panelists each have different perspectives on health care reform:
  • Greg Scandlen, founder and director of Consumers for Health Care Choices, opposes President Obama's health care proposal and advocates for individual freedom and a consumer-driven health system.
  • Margaret Flowers, a pediatrician-turned-health activist who is a Congressional Fellow of Physicians for a National Health Care Program, which supports a single-payer national health system that would eliminate private insurers.
  • Karen Davenport, director of health policy for the Center for American Progress, a left-leaning think tank that supports Obama's quest for health care reform.
Each presenter will have 10 minutes to talk about health reform before a question-and-answer session.

Tuesday, September 22, 2009

Baucus is the Only One who can Stop Reconciliation

Word that Speaker Pelosi has reneged on a deal with Blue Dogs and now intends to make a full court press for a Public Option in the House version of health reform offers further evidence that Democrats are leaning toward using reconciliation to pass health reform - a parliamentary trick and clear violation of Senate rules.

Senate Minority Leader Mitch McConnell has warned Democrats that they will "suffer a severe backlash if they used the procedural tactic, which would allow them to pass reform legislation with a bare 51 votes... If you thought the American people were upset in August, you haven’t seen how upset they will be if this device is chosen."

McConnell is right, the voter backlash would be severe. Looking at the 2010 landscape and projections from Stuart Rothenberg, Charlie Cook, and Larry Sabato keep upping the ante for Republican gains in the House - using reconciliation would likely result in a GOP takeover of the House. Most have argued that Senate is out of reach as Democrats enjoy a 10 seat advantage, but look at the 2010 races and you see many Democrats are suddenly in trouble. Majority Leader Harry Reid trails everyone, Chris Dodd is in the fight of his life, the Rod Blagojevich scandal coupled with the Roland Burris scandal puts Illinois in play, Arlen Specter's party switch actually boosts GOP chances in Pennsylvania, Colorado and New York may well be in play as well as the Governors in each state appointed unknown entities to replace Democrats who joined the Obama administration. Throw Arkansas' Blanche Lincoln into that mix and that's seven seats. If 2010 is a repeat of the 1994 wave election then Republicans could run the board -but the don't have to - they need only reduce the Democrat's advantage to 55 seats to effectively stifle the majority and force compromise and a place at the table.

I do not envy the Democrat's situation - after all, what's the point of having a Democratic President and a Democratic majority in the House and Senate if they cannot deliver on universal health care? But the use of reconciliation would not count as "delivering." Rather it would represent a disrepect for the process AND show a failure on the part of Democrats. They will have 60 Democrats by the time the votes are counted - a filibuster-proof majority. Resorting to reconciliation would show that the party could not even compromise with itself - forget about Republicans.

There are a few promising signs that reform will pass without reconciliation - Majority Leader Steny Hoyer has reached out to Republicans to try and build some concensus and the Baucus plan is moving forward and Harry Reid has signaled that with the 60th vote from Massachusetts reconcilliation may not be needed.

During the Bush years, Democrats insisted that 60 votes was an appropriate standard for judicial nominees, if it was good enough for judicial confirmations then it's certainly appropriate for the most sweeping social reform in 45 years.

At least Hoyer and Reid are thinking about the long game... who knows what Pelosi is thinking.

Explaining the Public Option on WTOP Radio

I'll be "appearing" on WTOP radio in DC all week long as part of their Answer Desk segment. I explain just what the Public Option is in health reform. The segments will play all week - usually between 5 and 15 minutes past the top of the hour.

Listen to a clip here.

Saturday, September 19, 2009

Left Wing Hate Killed the Kennedys...

So, according to Eric Boehlert at MediaMatters right wing hate killed John Kennedy - "But I've been thinking about Dallas in 1963 because I've been recalling the history and how that city stood as an outpost for the radical right, which never tried to hide its contempt for the New England Democrat. Now, in this this month's Vanity Fair, Sam Kashner offers up in rich detail the hatred that ran wild in Dallas in 1963. To me, the similarity between Dallas in 1963 and today's unhinged Obama hate is downright chilling.... But the truth is, America's most famous bouts of political violence (i.e. JFK, Oklahoma City, etc.) have always been accompanied by waves of radical, right-wing rhetoric."

I hate stupid people... and this article was written by a very stupid person. JFK was killed by Lee Harvey Oswald, a communist who, according to the Warren Commission despised the "Right." And Oswald considered Kennedy to be a member that hated "Right". RFK was killed by another leftist - a Jordanian nationalist Sirhan Sirhan - because of RFKs support for Israel. Both Kennedy's died at the hands of left-wing hate... not because of right wing hate. Why do we have so many conspiracy theories about the Kennedy assassinations? Because of the deep denial on the Left that they too are capable of hate and violence. They would rather dream up grand conspiracies of a CIA plot and the Military Industrial Complex killing the Kennedys just to protect the war in Vietnam. Claiming tha right wing hate killed either Kennedy is pure delusion.

Rewriting history just to silence President Obama's critics is an insult not only to the lives of JFK and RFK but to their memories and their legacies and the vision of liberalism that they shared and that the contemporary "left" has long forgotten.

Friday, September 18, 2009

Baucus Forecast is Cloudy with a Significant Chance of Snowe...

We have movement on the health care front - Olympia Snowe is sending clear signals that she may yet support the Baucus health reform plan. First, she signed a letter "commending" Baucus for the legislation and now she says that she will decide not based on party, but on policy.

As I argued in a prior post "Baucus needs a Republican - he needs to get to 60 votes. If he can get to 60 votes the pressure on Democrats would be too great, they would need to vote for the bill."

Snowe may once again be the critical vote - the fate of the Baucus plan rests in her hands...

Thursday, September 17, 2009

Fascist! Racist! We Are Spinning Out Of Control

So I have folks on the Left angry that I've criticized Liberals for hurling the racist label around and I have folks on the Right angry at me for making the Sauerbrey "fascism" comments public.

Look - I think that we are on dangerous ground here and I'm not going to play favorites in this debate.

Calling all of the president's critics racist is almost as crazy as calling the president a fascist - but both are dangerous. These labels are powerful and elicit a deep emotional response among people. If one side keeps telling their supporters that America’s future is being threatened by racists and the other side keeps warning that we are seeing the rise of fascism how long will it be until someone, somewhere, resorts to violence? And once that bottle is uncorked it cannot help but spread. When that day comes neither leaders of the Left or the Right will be able to claim clean hands. Which is why they need to stand up now and condemn the dangerous rhetoric coming from their respective camps. Some leading Democrats have stood up to Jimmy Carter... but there is a deafening and unacceptable silence from Republicans.

Former Bush Administration Official Sees Similarities between Obama and Hitler

After I shared this story with Talking Points Memo, they contacted Ellen Sauerbrey and she said "I think that we have a government that is following policies that are socialistic and fascist," she said. "I would not personalize my comments to describe the president. I hope to Heaven he's not. But I think that he's following policies that are taking us rapidly in the wrong direction."

That's so much better...

Original Story

Ellen Sauerbrey, a representative to the United Nations and an Assistant Secretary of State under President George W. Bush and twice a candidate for Maryland governor, told a gathering of Republicans that President Obama was surrounded by cult-like following similar to dictators Adolf Hitler and Juan Peron. Speaking at the annual Lincoln/Reagan dinner in Southern Maryland’s St. Mary’s County, Sauerbrey further stated that she was “afraid for our country” as “our Constitution is indeed being dismantled” by the president as his administration advances “fascist, socialist ideas.” Sauerbrey later denied that she was likening Obama to Hitler – merely that she worried that the bad economy could be used as a justification to undermine our rights – as was done in Nazi Germany.

Here is my take –

Sauerbrey of course denied that she was likening Obama to Hitler, but the implication is clear. Taken collectively, Sauerbrey’s comments were meant to insinuate that Obama had the potential to become another Hitler. Her words were disgusting and incendiary and should not have been spoken by a person so prominent in the Republican party structure in Maryland – they should not be spoken by anyone, but especially not someone with standing.

I have written before and continue to maintain that these hate fueled accusations of Nazism are little different from such accusations hurled at President Bush – even by some prominent Democrats. During the Bush years, no one in the Democratic party was willing to stand up and challenge the Bush = Hitler charges. Now, Obama has inherited this coarsening discourse and the Obama = Hitler charges are flying free. Someone in the Republican party must stand up and denounce Sauerbrey’s thinly veiled insinuation. I can think of few more appropriate than former Maryland Lieutenant Government and current Republican National Committee Chair Michael Steele. Former Maryland Governor and possible future gubernatorial candidate Robert Ehrlich should step up to the plate as well.

This Hitler nonsense must end, the hate that drives it must be challenged, the political parties that capitalize on it – without every endorsing it of course – must take responsibility for the crazies in their midst. At some point, these accusations will incite someone, somewhere, to violence.

Nancy Pelosi has recently expressed concern over rhetoric leading to violence - I would only say to her that it is a two way street and accusing all critics of the president racist could also incite violence.

Thanks to the St. Mary's County Times for providing key material for this post.

Dissent is the Highest Form of Racism?

During the Bush years we were assured that "Dissent is the Highest Form of Patriotism" oh how times have changed...

In the ever escalating battle over whether critics of the President are motivated by racism columnist Mary Mitchell has weighed in to endorse Jimmy Carter's sentiments that indeed yes Obama's critics are simply racists.

From Mitchell: "Say what you will, but former president Jimmy Carter is too old to lie. At 85, he's seen the best and worst of human nature. So, when he says the "You lie!" shouted at President Obama during his address to Congress last week was "based on racism," he is speaking with wisdom... Would Wilson have heckled a Reagan, or a Bush or a Clinton while these white men were delivering a speech before Congress? No matter how bad things were going in this country, Bush was respected as the president of the United States."

I have written to Mitchell to express my problems with her conclusion. Here is the text of my e-mail:

I have so many problems with your column - let me focus on but two:

You write: "No matter how bad things were going in this country, Bush was respected as the president of the United States."

I ask: Where did you live during the 8 years that George Bush was in the White House? In his 2005 State of the Union address President Bush was booed and heckled by Democrats - there was no respect there. Senator Harry Reid called President Bush a "loser" and a "liar" - no respect there. Representative Pete Stark called Bush a liar on the floor of the US House - no respect there.

You write: "These people show up at so-called Tea Parties with racist signs that depict Obama as a Nazi and a witch doctor."

I ask: And what of the multitudes of anti-war protesters who regularly compared George Bush to Hitler? What of Al Gore referring to conservatives on the web as "digital brow shirts"? What of Democratic representative Jerrold Nadler referring to a "whiff of fascism in the air" during the 2000 recount in Florida? What of the multiple posters and representations of Bush dead or being killed proudly displayed by protesters?

Your attempt to portray as racist those who protest President Obama is disgusting. You are using the charge of racism to stifle dissent and intimidate critics into silence. It is a disservice to American political discourse and, frankly, a sign of desperation.

The simple fact is, President Obama is on the receiving end of the same type of hate and vitriol heaped upon George Bush by the left - the difference is you didn't have a problem when people hated and disrespected President Bush.

That's the real double standard. As an educator I am obligated to present a fair and researched presentation of the facts to my students (even when I don't like the facts that I'm sharing) - too bad so few in the media feel a similar obligation.

I'll let you know if she responds.

Ron Wyden Offers Amendment to Expand Access to Insurance Exchanges

Wyden's amendment makes good sense and would preserve our employer based system - but move us more toward the German model that works so well. The Wyden amendment would not add to the cost and should be added to any legislation.

Wyden: "Under the nation’s current employer-based system, most people have little if any choice about where they get their insurance. They just have to accept the plan that comes with their job. That insurance company, in turn, is provided a captive group of customers, so it has no incentive to earn their loyalty.

Empowering Americans to choose from a broad selection of health plans would turn the tables. Those insurers that charged affordable rates and provided good coverage would attract more customers, while those that treated customers badly would be forced to change their ways or go out of business.
I believe there is a way to work with the present employer-based system to guarantee that all Americans have choices, and I am proposing it in an amendment to the latest Senate health care bill. My amendment, called Free Choice, would let everyone choose his health insurance plan.

It would impose only one requirement on employers — that they offer their employees a choice of at least two insurance plans, one of them a low-cost, high-value plan. Employers could meet this requirement by offering their own choices. Or they could let their employees choose either the company plan or a voucher that could be used to buy a plan on the exchange. They could also simply insure all of their employees though the exchange, at a discounted rate."

Wednesday, September 16, 2009

The Baucus Plan Will Cover the Uninsured AND Reduce the Deficit - So Why is it DOA?

What a great and awful day to be Max Baucus. He has delivered his long negotiated health reform bill and even though it represents a tremendous bipartisan effort it was introduced with no Republican support and a great deal of Democratic opposition. Simply put, many Democrats feel that the bill gave away too much and Republicans argue that it costs too much - an argument that lost all credibility today courtesy of the CBO. The CBO's preliminary scoring determined that the Baucus plan would reduce the deficit by $49 billion between 2009 and 2019 - It would REDUCE the deficit. Translation: The bill would pay for itself. Cover everyone AND reduce costs. But the CBO score gets better in the next 10 years, from 2020 to 2030 - over that period the rate of deficit reduction would equal about 0.5% of GDP. In real dollars that translates into an average of $93 billion per year or about $1 trillion between 2020 and 2030. None of the other proposals realize such deficit reductions.

So what's the bad news? With no Republican votes Senate Democrats will likely abandon Baucus and and push for a more (liberal) partisan bill (public option and all) that will only require 51 votes to pass using the reconciliation process (an abuse of process). This will set the stage for a showdown with the Blue Dog Democrats in the House - and with more than 50 members in the Blue Dog caucus they have the votes to block a liberal bill and the political motivation to oppose such a measure. In the end, we could see no reform.

Baucus needs a Republican - he needs to get to 60 votes. If he can get to 60 votes the pressure on Democrats would be too great, they would need to vote for the bill.

Baucus has introduced a bill that covers 94% of the uninsured and reduces the deficit. It also has the distinct honor of being hated by the Left and Right - as a general rule, that usually means that it's a damn good piece of legislation and the best hope we have for meaningful reform.

Tuesday, September 15, 2009

Support for Health Care Plan Falls Back To Pre-Speech Levels

From a new Rasmussen Poll:

Following President Obama’s speech to Congress last week, support for his health care reform plan increased steadily to a peak of 51% yesterday. However, the bounce appears to be over. The latest daily tracking shows that support has fallen all the way back to pre-speech levels.

Forty-five percent (45%) of all voters nationwide now favor the plan while 52% are opposed. A week ago, 44% supported the proposal and 53% were opposed. (see day-by-day numbers).

The latest figures show that 23% Strongly Favor the plan and 41% are Strongly Opposed. In late August, 23% were strongly in favor of the plan and 43% were strongly opposed.

John McCain's Former Chief of Staff on the Politics of Hate

Mark Salter, former Chief of Staff for John McCain, correctly points out that neither side has clean hands in the coarsening of American politics - but you would never know that if you relied on the traditional media outlets. While the hate and vitriol of the Left is ignored by the press, every hint of it from the Right is amplified and explored. Blowhards like Glen Beck and Bill O'Reilly are treated as if they control some vast Right Wing hate machine, while the hot air and hate spewed by Keith Olbermann and posted to the Huffington Post are ignored even as prominent Democrats make regular contributions to both.

Says Salter, "I despair of the coarsening of our politics and our broader culture... But our political discourse won't begin to recover any civility until we get some referees back in the game, who will call bullshit on both sides."

If they neither the Left nor the Right will police the hatemongers within their own ranks, then our only option is to look to the press to hold these folks to account. Sadly, by ignoring the hate coming from the Left, the press only encourages ever more hate from the Right.

With Friends Like These, Who Needs Enemies?

From Jeremy Lott at Politico "Barack Obama’s initial approach to the office of the presidency has been as grandiose as Bush’s was restrained. It’s not hard to recall that he ran as a transformative candidate, promising sweeping, though somewhat fuzzy, “change” during the campaign... So far, he’s failing miserably."

He goes on "What all this means is, barring some unforeseeable world event, Obama’s will probably not be a historic presidency. He will have some successes and a lot of failures. His opposition won’t roll over, and his party will refuse to go along with his more costly, and thus risky, schemes. He won’t coast to reelection. So Obama now has the chance to be the sort of president Bush would have been if the World Trade Center towers had not come down. Here’s hoping he makes the best of it."

Monday, September 14, 2009

Update to "All of this Hitler Nonsense..."

I wanted to add something to my prior post on "All of this Hitler Nonsense..." I want to be clear - there is no acceptable excuse for comparing Barack Obama or George Bush to Hitler - None, period. Though the comparisons mostly originate from within fringe movements, mainstream Conservatives and Liberals must step up and denounce the comparisons. During the Bush years, the mainstream Left ignored these outrageous claims and they grew unchecked. President Obama is now the recipient of an escalation in these reprehensible attacks – and the mainstream Right has remained silent. At some point prominent Republicans must stand up and denounce these folks. If not, it will only escalate further – and god help the next President. Apparently, former Maryland gubernatorial candidate and Bush appointee Ellen Sauerbrey made a veiled comparison to Obama’s agenda and the rise of Nazi Germany during the annual Lincoln/Reagan Dinner in St. Mary’s County, MD. Though Sauerbrey is far from being a mainstream conservative, Republican leaders in the state (especially former Governor Robert Ehrlich and former Lieutenant Governor and current Republican National Committee Chair Michael Steele) should immediately denounce her words and demand that she apologize. This has to stop….

A Health Reform Breakthrough... Could it Be?

According to the Washington Post's Capitol Briefing "Senate Finance Chairman Max Baucus announced Monday that he may unveil his long-awaited health-care bill as soon as Tuesday -- and he predicted that Republicans will find plenty to like about it."

If Baucus manages to report a bill from committee with Republican votes he may earn the title "Senator of the Decade." The question will then be, will the House Progressive Caucus accept bi-partisan reform or will they demand ideological purity...

No "Mo" for Health Care Reform

Last week I argued that the President need a game changer from his speech to re-energize health reform. The first evidence would come from polling done in the days after the speech: "Pre speech the President was at 51% in Gallup and 48% in Rasmussen. Expect a bump - an almost immediate increase to the 55% range should occur by Sunday." Well, it's Monday and Rasmussen has the President at 52% and Gallup has him at 53% - that's a 4 point bump from one and a 2 point bump in the other. This increase is within the range that the President has seen even without grand speeches to Congress; in other words - no game changer. The news from an ABC News/Washington Post Poll confirms this:
  •  Split on Obama's handling of health care: 48-48 (46-50 August 17)
  • Support Obama's health care reforms: 46-48 (45-50 August 17)
  • President Obama's job approval is at 54 (57 August 17)
  • Deficit: 65% think health care reform will make it worse
  • Medicare: 56% of seniors think it will weaken Medicare
  • On the crucial "what's in it for me?" question, twice as many Americans (32-16) think it will make their own care worse, twice as many (40-20) think it will increase their costs, and more than three times as many (37-11) think it will hurt their coverage.
In other words - the President changed no minds. In fact, his post-speech news has been far worse than President Clinton's in 1993. Among other issues, after defending the Public Option in the speech the Administration and leading Democrats have all but abandoned it - especially now that leading Republican moderates Olympia Snowe and Susan Collins have said "No."

Sunday, September 13, 2009

All of this Hitler Nonsense…

On Saturday, estimates are that tens of thousands of Americans descended upon DC to protest President Obama’s domestic agenda – from taxes, to cap and trade, to health care reform – Americans took the time to protest. In a nation more known for its political apathy than activism it, like the anti-war protests that became a hallmark of the latter Bush years, was a moment to celebrate, regardless of whether you agreed with the protesters.

As with all mass protests there was no shortage of extreme elements, no shortage of the uninformed or otherwise unhinged. At this summer’s townhall meetings folks comparing Obama to Hitler received quite a bit of coverage. To be clear – these folks are idiots – and any attempt to portray them as “typical” or “representative” of the average protester is unfair and unsupportable. Many on the Left have seized upon this Obama = Hitler fringe and attempted to paint the entire American Right as racist zealots who carry guns to Obama speeches while chanting “No Nazi Health Care.” This must stop. The American Right is no monolithic group and conservative Americans have every right to protest and, even if you disagree with their beliefs, raise legitimate concerns regarding the power of government and the threat posed to our nation by our current obligations and long term deficit and debt projections.

Many on the Left argue that the protesters are not opposed to policies so much as they are opposed to the President, to Barack Obama. They argue that the opposition is in fact personal, and therefore cause for concern. Where was their concern during the past 8 years? President Bush was on the receiving end of an ever escalating level of personal animus from the Left almost from the moment he was declared the winner of the 2000 election. It was during the 2000 recount in Florida that Democratic Representative Jerrold Nadler said that he “detected a whiff of fascism in the air” following Republican protests of recount methods. The Hitler comparisons did not end there, though few prominent elected officials made the comparison, many in Liberal circles did. Even the prominent Liberal organization MoveOn.Org posted two "homemade" videos that directly compared Bush to Hitler in the 2004 campaign. One place that you could always find the Bush = Hitler folks was amongst the tens of thousands who partook in the frequent protests against the war in Iraq. Click here for a link to an assortment of the Bush = Hitler posters at various protest rallies. Now, did most protesters on the anti-war Left consider Bush to be Hitler? Were the Bush = Hitler fringe representative of the average Liberal? No. Rather, just like today, just like the Obama = Hitler folks, the Bush = Hitler folks were a fringe, a group of, well, idiots.

So what does all of this mean? During the Bush years, Republicans and the American Right sought to de-legitimize opposition to George Bush by linking all Liberals, all protesters, to the Bush=Hitler fringe. In so doing, they convinced themselves that opposition to Bush was of little concern and warranted no response. The 2006 mid-terms and the 2008 Presidential election showed the depth of the Right’s miscalculation. Now, Liberals are attempting to paint all who oppose President Obama’s agenda with the broad brush of Obama = Hitler crazies. They de-legitimize the opposition, and seek to dismiss the possibility of any rational basis for the recent passion seen among the grassroots of the American Right. If the Democrats and the Left continue down that road, they will likely face a big surprise come November of 2010.

Be clear – the Right and the Left have brought us to this sorry state of affairs where any and all opposition is attacked, discredited, and dismissed. Both sides of the spectrum need to realize and accept that both movements, Conservative and Liberal, have valid and reasonable arguments to make. The genius of the American system is that it demands compromise from among competing factions (read Federalist 10 and then 51) for anything meaningful to be accomplished. Zero-sum game politics is a recipe for disaster in our system. At some point we need to stop painting our philosophical opponents as “Right Wing Nuts” or “Anti-American Liberals” and instead recognize the need work together within the system.

We could start by collectively accepting that folks who compare our presidents to Hitler, much like the “Birthers” and the 9/11 “Truthers” do not represent either the mainstream American Right or Left. We can dismiss and condemn the fringe without trying to pretend that they are something more.

Just my take…

Saturday, September 12, 2009

Obama needs to be LBJ to Pass Health Care... but I don't Think that He is.

Eleanor Clift argues that Obama needs to be LBJ in order to get health refrom passed - she's probably right. The problem is - Obama is not LBJ, to be fair few could be such a giant. But Obama's short time in the Senate did not provide him with the skills and insider knowledge that LBJ used to get Civil Rights, Voting Rights, Medicare, and Medicaid.

From Clift "Lyndon Johnson was a master of the legislative arts, having served as Senate majority leader before moving to the White House. Washington lawyer Harry McPherson, who served as counselor to President Johnson, recalls how LBJ used flattery to gain support for a civil-rights bill from Republican leader Everett Dirksen. Johnson reminded Dirksen of the statue of Abraham Lincoln that stood in the town square in his hometown of Pekin, Illinois. Then he'd lean in close and suggest Dirksen's leadership on this historic bill would make it possible for him to be memorialized alongside Lincoln."

Can anyone really see such an approach working for President Obama?

Just Say No to Reconciliation

The Hill is reporting that the President is laying plans to use reconciliation in the Senate to bypass normal rules of procedure and push health care reform without needing to overcome a filibuster-proof majority of 60 votes. I'll post more on this later - but it is a bad, bad, bad, idea. Reform this important and substantial must be viewed as legitimate by the public. Just research the sorry tale of the Medicare Catastrophic Coverage Act of 1988. Parliamentary gimics will only undermine public confidence - and Democrats would pay a steep price in 2010. I keep saying this, but look to the lessons learned in Australia... partisan health reforms caused chaos for decades.

Friday, September 11, 2009

9/11/01: Never Forget

The Big "Mo" for Health Reform?

Did the President's health care speech have an effect?  There are to places to watch - the Rasmussen and the Gallup daily tracking polls. Each is updated by 1PM and today will mark the first day to include polling done after the speech (each poll is a three day rolling average, so today will include 2 days pre-speech and 1 day post speech). Sunday's update will be the first to show 3 days of post speech polling. Pre speech the President was at 51% in Gallup and 48% in Rasmussen. Expect a bump - an almost immediate increase to the 55% range should occur by Sunday. The majesty of a joint address to Congress cannot help but provide a bump. The question is - will it last? Bill Clinton enjoyed a health boost after addressing Congress on health reform in September of 1993 - but it faded within 2 weeks as the "details" of the reform took center stage. Which may be why the White House is hesitant to release details of the President's plan. Democrats are promising that legislation will come by year's end and many commentators are saying that Obama will get reform simply because of the majorities enjoyed by Democrats in the House and Senate - well, we heard that in 1993/94 when they had nearly identical majorities in the House and Senate. There's a reason that comprehensive health reform has been on the agenda for 65 year - because it is nearly impossible to find consensus on the proper reforms. In the House, Nancy Pelosi can only afford to lose 40 votes (assuming no Republicans support the bill). Already about 50 Blue Dog Democrats have said that they will not approve a bill with a public option and better than 100 progressive Democrats have said they will opposed a bill without a public option - who wins that game of chicken? We shall see what happens this time.

Thursday, September 10, 2009

Will VA and NJ be Canaries in the 2010 Coal Mine?

In 1993, gubernatorial elections in VA and NJ served as precursors to the Republican wave in the 1994 mid terms.  In both states, Republican candidates won seats that had been held by Democrats. Now it's 2009 and polls show that the Republicans are leading in each state - and, as with 1993, Democrats currently hold each seat. Republican challenger Chris Christie continues to lead incumbent Democrat Jon Corzine in the race for New Jersey governor. The latest average from puts the lead at 6.5%.  In  the race to become the next governor of VA Republican Robert McDonnell retains a steady lead over Democrat Creigh Deeds - an average lead of 10.2%. A Republican victory in VA would be especially painful to Democrats after President Obama's solid victory there in 2008. It may signal that VA will be less than reliably Blue come 2012.

Watch these two states very closely... two GOP victories would indicate a high level of GOP intensity, Independent willingness to vote GOP, and, most deadly, Democratic apathy.

What's in the Baucus Plan?

Ezra Klien offers a great overview of Max Baucas' plan. The Baucus plan is not perfect - but it is the bill most likely to pass, and in our system the best plan is always the plan that can pass.

From Klein: "Let's begin by stating what isn't in Max Baucus's health-care reform framework : a public plan, serious subsidies between 300 percent and 400 percent of poverty, and a real employer mandate for health-care coverage. Those omissions are disappointing, and will be the focus of a lot of wrangling over the next few days.

But much that's in Baucus's plan is encouraging. The proposal has three primary parts: insurance market reforms, affordability measures and mandates. We'll take each in turn... (continue reading)

Early Signs Point to a GOP Wave in 2010

The evidence continues to mount that 2010 will be a bad year for Democrats. A new congressional ballot survey done for the RNC finds 36% would vote for the Republican candidate for Congress, 36% for the Democratic candidate and 28% are undecided who they would choose. A similar poll in June found Democrats leading 38% to 33%.

The real shocker comes courtesy of Larry Sabato who says "In a preliminary projection, the Crystal Ball predicts the Republican Party will pick up between 20 and 30 seats in that election, a sizeable gain, but insufficient to retake the majority. The Crystal Ball reached this conclusion after intense analysis of all 435 U.S. House districts, rating each race on a scale ranging from Safe Democratic to Safe Republican."

Sabato joins Charlie Cook and Stuart Rothenberg in predicting big gains for the GOP in 2010. Couple that with this tidbit from Gallup - "In August, an average of 45% of Americans identified as Democrats or leaned to the Democratic Party, while 40% identified as Republicans or leaned to the Republican Party. This 5-point advantage represents a decided narrowing of the gap between the parties from the 17-point Democratic advantage in January" - and Democrats should be pretty worried about next November.