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.

Obama's Tactical Retreat is Key to Victory

On September 9, President Obama delivered his second address to a joint session of Congress and his 29th speech on the topic of health care reform. The speech was perhaps one of his best – and I say that as someone who is not a big fan of Obama the orator (I tend to think of him as Obama the teleprompter reader). But this speech was on target – he did an excellent job of explaining why the American health care system is in need of reform. Costs are rising at twice the rate of inflation, insurance premiums have doubled in the last 10 years as our wages have stagnated, the rising costs of Medicare and Medicaid threaten to consume our entire budget – all true.

After a blistering August, Obama needed to reclaim the debate – needed to reframe the debate. To use a tired expression, he needed a game changer. Reactions to the speech have been mixed (John Dickerson, Slate, Janet Hook, Los Angeles Times, James Fallows, The Atlantic, Ezra Klein, Washington Post). That mixed reaction is probably bad news for the President – he needed an undisputed homerun to truly reframe the debate. As for the specifics – the President has clearly retreated from his lofty goals of comprehensive system-wide reform. What he endorsed last night amounted to insurance reform. Needed reforms to be sure – but scaled back from what he had hoped for. In many ways the President endorsed the proposal just released by Senator Max Baucus – leading Blue Dog (details here). Coupling new regulations on insurers with individual and employer mandates, the President, and Baucus, would expand coverage. But lacking any system-wide reform we are unlikely to realize substantial cost savings or improved efficiency and care coordination. Still, by retreating on the call for comprehensive reform, the President will likely win incremental change that takes us a step closer to real reform.

Just my take…

Health Reform's "Red" Herring

As Congress returns from a summer recess of heated town hall protests and even hotter political rhetoric, health reform is on the ropes. An NBC News poll tells the tale – 54% of the public are more concerned that the government will go too far with reform and make quality worse than are concerned that government will not do enough. In April, a quarter of Americans thought that President Obama’s reform plan was a bad idea while one-third considered it to be a good idea. Today, roughly a third still considers it to be a good idea, but fully 42% now think it is a bad idea. According to Gallup, President Obama's approval rating has fallen farther and faster than nearly all presidents since Harry Truman. This is a key measure as studies have demonstrated that a President’s legislative success is more influenced by his standing with the public than by whether his party controls Congress.

President Obama, his surrogates, and Congressional allies attribute this decline in public confidence to “misinformation” and “scare tactics” employed by organized interests intent on derailing reform. Town hall protesters and numerous conservative critics have attacked Congressional reform proposals as “socialism” and even compared them to National Socialism under Nazi Germany. Another protester accused House Majority Leader Steny Hoyer and Speaker Nancy Pelosi of aiding the President in “spiraling us rapidly toward socialism.” When a protester in Massachusetts asked Rep. Barney Frank how he could support “Nazi policies,” Frank simply dismissed her with a joke. But such a line of attack is no joke. Rather than demonstrating a preparedness for such attacks, the White House and Congressional leaders have reacted to these criticisms in a disorganized and poorly coordinated effort and the lack of any coherent response allowed critics to undermine public confidence in reform. As a professor of American politics and a health policy scholar, I cannot help but ask how the White House and Congress were caught so unprepared for this fight.

Look at the lessons of history: When President Franklin Roosevelt was considering the inclusion of national health insurance as part of the New Deal, American Medical Association (AMA) president Dr. Morris Fishbein denounced even plans to promote voluntary private insurance as “socialism and communism.” In 1948, the Federal Security Agency (precursor to the Department of Health and Human Services) issued “The Nation’s Health: A Report to the President” which determined that only national health insurance could effectively organize the American health care system and create a stable financial basis for funding health care. Republican critics in Congress attacked the goals of the report in eerily familiar terms. “Wherever some form of dictatorship prevails in government, there we also find some manifestation of socialized medicine… Communism, Fascism, Nazism, Socialism – all are alike in that they enforce a system of State Medicine.” When President Truman introduced national health insurance legislation in 1948, the AMA hired a public relations firm to derail the plan. The objective - keep public opinion hostile to reform. Clem Whitaker, owner of the firm hired by the AMA, made the strategy clear: “All you have to do is give it [reform] a bad name… America is opposed to socialism so we’re going to name national health insurance “socialized medicine.” The U.S. Chamber of Commerce published a report titled “You and Socialized Medicine” warning that any form of compulsory health insurance served the Democrat’s plan to impose socialism and totalitarianism. Three-quarters of the American public supported national health insurance in 1945; by the end of 1949 less than one-quarter supported such reforms. Truman lamented how critics had “distorted and misrepresented” his proposal. Sound familiar? Truman attempted to salvage his reforms, but the die had been cast.

In the decades since, all significant proposals for health care reform have been met with counter offensives by some combination of interest groups. The players have changed, but their strategy has rarely wavered – any manner of significant health reform is labeled “socialism.”

Even when reformers sought to minimize the government’s role in any reform, the line of attack remained. When President Eisenhower endorsed publicly financed catastrophic insurance, in an effort to protect the private insurance industry, the AMA denounced this modest reform as socialism. So effective has the “socialism” strategy been, that every serious health reform proposal since the 1970s has been premised upon a reliance on the private health insurance market. Even the late Senator Ted Kennedy, one of the nation’s staunchest advocates for universal health insurance, abandoned a single payer, Medicare-like approach, in the late 1970s. From 1979 through to the current debate, Kennedy advocated reform based on the private market. In 1993, President Bill Clinton’s Health Security Act sought to achieve universal coverage via a combination of individual and employer mandates. In a conscious effort to avoid government financed reform it relied almost exclusively on private insurers – yet it was almost immediately denounced as socialism, or "creeping socialism."

Of the current reform proposals being given serious consideration in the House and Senate none advocate socialized medicine. In fact, for good or for ill, all enhance the role of private insurers and our current employer-based approach to insurance delivery. Yet, the socialized medicine and “Nazi policy” critiques have reached a fever pitch. Reform proponents have largely dismissed such protests as the rhetoric of an uninformed fringe movement. But those who dismiss this line of attack ignore a key lesson from past health reform battles – the strategy works and should be taken seriously. Fears of “death panels” or rationing can all be linked to the images of compassionless or dispassionate care evoked by raising the specter of socialism or Nazism

Given its potency, reform proponents must defuse the power of the socialized medicine label. One approach could be pointing out that when it came to ensuring that our veterans receive the high quality care they deserve we opted for socialized medicine in the form of the Veterans’ Health Administration (VHA). The VHA represents socialized medicine in its purest form, government ownership of the facilities and employment of the providers. Proponents might remind voters that to guarantee access to health care for our seniors we adopted quasi-socialized, or single-payer, medicine in the form of Medicare. Seniors receive care from private hospitals and physicians, but they are insured by the federal government. Both programs consistently receive higher customer satisfaction ratings than do private insurers and do a better job of controlling costs while ensuring access to care - hardly indicative of compassionless “socialized medicine.” It’s no coincidence that some of the most vocal town hall protesters are seniors fearful that reform would undermine the Medicare coverage they treasure.

Every major defeat of health care reform has been followed by roughly 15 years of inaction or only minor reforms. That’s 15 years we cannot afford to lose. With 47 million uninsured, millions more under-insured, and with rising health care costs threatening our long term financial security, we must reform our health care system. A recent study by the Commonwealth Fund determined that America trails the UK, Australia, Canada, Germany and New Zealand with regard to quality, access, efficiency, equity and healthy living. If this effort does fail, it will not be because opponents found a new means to stifle reform. It will be because the President and his allies were caught unprepared to counter a line of attack that is now old enough to qualify for Medicare. Historians and political scientists will be left to wonder how they failed to prepare for this fight.