Summited Out: The GOP Wants Capitulation, Not Compromise
Who won? It’s the exact same question people asked in 2008, after each of the presidential debates. I didn’t like it then and I don’t like it now. What’s “winning”–scoring more debate points, making fewer gaffes, or simply appealing to more voters? And aren’t all those judgments pretty subjective anyway?
But if Thursday’s event didn’t produce a winner, it was clarifying.
Health care reform, as I’ve said many times now, is really about achieving three basic goals: Making sure everybody has insurance, making sure coverage is good, and making sure that, over time, medical care will cost less. Thursday’s discussion revealed the stark differences between the two parties–not just over how to pursue these goals but also over whether they are even worth pursuing.
Making sure everybody has insurance is primarily a matter of providing access to policies, regardless of medical status, and then guaranteeing that people can pay for them, no matter what their income. The former requires re-engineering the insurance market–in particular, organizing the non-group market into insurance exchanges, through which insurers will sell regular policies at regular prices even to people with pre-existing conditions. The latter requires providing subsidies, based on people’s incomes, which in turn requires raising some money.
The Republicans made clear on Thursday they rejected both ideas. Re-engineering the insurance market requires too much government, they said, and providing subsidies requires too much money. The best they could offer were “high-risk pools,” which would provide thinner coverage–at higher prices–to people who couldn’t get insurance on their own. This means expanding coverage to only 3 million people, rather than 30 million, but the Republicans hardly seem to care. When Obama asked Wyoming Senator John Barrasso to speak to the problems of the uninsured, Barrasso responded by saying he wanted to talk about … the already insured. Not that Democrats mind talking about the already insured.
Reform’s second goal–making sure everybody’s coverage is good–is primarily for the benefit of people who have insurance today. Many of these people have coverage that won’t meet their needs, although they may not know it yet. Only when they get sick will they discover that their plans have loopholes, allow for exorbitant out-of-pocket costs, and leave them with little recourse if there are disputes over what’s covered. The Democrats propose to fix this by establishing a minimum set of benefits that all plans must cover, limiting the amount of out-of-pocket expenses insurers can pass along, and creating appeals mechanisms for consumers upset about denials.
This approach, too, is one the Republicans rejected on Thursday. Over and over again, Republican representatives and senators said the problem wasn’t insufficient regulation. It was too much regulation. They called for allowing people to purchase insurance across state lines–and allowing small businesses to form associations that would be exempt from existing state regulations. The effect of such changes, as the Congressional Budget Office has noted, would be to erode benefits–to weaken, not strengthen, the protection from medical expenses insurance now provides. Senator Tom Coburn praised this transformation, suggesting the great exposure would turn people into smarter consumers. Well, it might do that. Or it might simply mean people with medical problems face even more onerous financial burdens.
And what about making medical care less expensive? The Democrats’ approach is to try a combination of approaches: Eliminating waste, redirecting Medicare payments so that they reward efficiency, altering the tax treatment of insurance, and so on. They admit it will take time and that they are not sure which approaches will work best. But these efforts get at the root causes of rising medical costs–not just profit or administrative inefficiency, but also the tendency towards unnecessary over-treatment.
Republicans in theory should support many of these ideas, but, as usual, they had nothing good to say about them. Instead, they continued to pound the Democrats for cutting Medicare, even though the Democratic reductions are calibrated to make the program more responsive–and even though the Democratic reductions are far smaller than the ones Republicans have championed over the last 15 years (not to mention the ones Representative Paul Ryan still supports).
Instead, the Republicans’ great hope for reducing cost lay in de-regulation–which, again, succeeds only by shifting medical expenses back onto the people with medical problems–and malpractice reform–another idea that Democrats support but that, according to CBO, doesn’t actually account for that much spending.
The Republicans have their justifications–and, to be fair, if they are convinced government spending and regulation will do more harm than good, then they are right to hold these many views. But it is not as if their alternatives even come close to solving the problems Democrats would. Instead, Republicans seem to believe these problems are fundamentally unsolvable, at least in any manner they would find acceptable.
And this explains the message Republicans delivered over and over again on Thursday: Rip up the bill and start over. That’s not a plea for compromise. That’s a demand for capituation. And it frames the choice for Democrats pretty clearly. Either they will act alone, or they will not act at all.
By: Jonathan Cohn, Senior Editor- The New Republic Feb. 26, 2010
Obama To GOP: It’s Over
Obama listened politely for six hours, with occasional flashes of temper, but in the end, the message was clear: It’s over. We’re moving forward without Republicans.
Whether Obama and Dems will succeed in passing reform on their own is anything but assured, to put it mildly. But there’s virtually no doubt anymore that they are going to try — starting as early as tomorrow.
That was the subtle but unmistakable message of Obama’s closing argument. After hours of hearing Republicans repeat again and again that only an incremental approach to reform is acceptable to them, Obama rejected that out of hand.
Here’s the key bit from Obama:
I’d like Republicans to do a little soul searching to find out if there are some things that you’d be willling to embrace that get to this core problem of 30 million people without health insurance, and dealing seriously with the pre-existing conditions issue. I don’t know frankly whether we can close that gap.
And if we can’t close that gap, then I suspect Mitch McConnell, Harry Reid, Nancy Pelosi and John Boehner are going to have a lot of arguments about procedures in Congress about moving forward.
Unless I’m misreading that, Obama is saying that unless Republicans support comprehensive reform as Obama and Dems have defined it — dealing with the problem of 30 million uninsured and, by extension, seriously tackling the preexisting condition problem — they will almost certainly move forward with reconciliation.
What’s more, Obama also essentially accused Republicans of approaching today’s summit in bad faith — after they had sat there with him for six hours. He said that even after the public option was taken off the table, Republicans continued to use the same “government takeover” slur.
“Even after the public option wasn’t available, we still hear the same rhetoric,” Obama said. “We have a concept of an exchange which previously has been an idea that was embraced by Republicans before I embraced it. Somehow, suddenly it became less of a good idea.”
This accusation, combined with his assertion that Repubicans need to do some “soul-searching” on whether they wanted to join Dems in tackling reform as they have defined it, amount to an unmistakable vow to move foward without them.
Democratic aides are already interpreting Obama’s remarks along these lines. As one senior aide emailed: “We may make one last effort to try to get a Senate Republican.”
In terms of who “won” today’s debate, I tend to think Republicans actually accomplished much of what they needed to do today. It seems likely that some Congressional Dems will be just as skittish tomorrow as they were yesterday about moving forward alone via reconciliation. That means Dems still have an enormously difficult task ahead.
But Obama’s message to Dems and Republicans alike today was that barring some kind of major change on the GOP side, this is exactly what he and Dem leaders are about to attempt.
Update: To clarify, this was a call to Dems, perhaps more than anyone else, that the time has come for them to stiffen their spines and move forward with reconciliation, which Republicans, and even some nonpartisan observers, have repeatedly characterized as akin to marching off a cliff.
Also: This summit was always about laying the groundwork for Dems to go forward alone, barring a major capitulation from Republicans. As noted here repeatedly, Dems will find themselves in exactly the same position tomorrow as they did yesterday: Confronting the enormously difficult task of passing ambitious reform on their own.
Update II: A GOP aide emails the Republican take: “They badly needed a win today and they didn’t get it. Not even close. Republicans were prepared. The President was pedantic and peeved.”
Greg Sargent-The Plum Line Feb 25, 2010
Contrary to Greg’s take on who won today, my take is that the American people won. Delay, deny and obstruct was on full display by the GOP today. That was transparency that even Stevie Wonder could see!
Raemd95
Americans Can Speak for Themselves on Federal Health-Care Reform
Have you voted on any of the Democratic health-care-reform plans? Me neither.
No such vote was ever taken. But with coordination that the Rockettes would envy, Republicans insist that “the American people have spoken” on the matter, and they want the proposals killed.
House Republican Leader John Boehner: “The American people have spoken, loudly and clearly: They do not want Washington Democrats’ government takeover of health care.”
Senate Republican Leader Mitch McConnell: “The American people do not want this bill to pass.”
Republican National Committee Chairman Michael Steele: “The American people have spoken. The White House hasn’t heard their message.”
Quite a coincidence, these guys saying the same thing on the same day. No matter. What they’re saying is nonsense.
All politicians try, but Republicans excel, at creating a fantasy public always marching behind their baton. What the GOP leaders lack in veracity, they make up for in confidence.
They base their public mind-reading on polls showing displeasure with the Democrats’ reform legislation (or what the public thinks is in it). They ignore polls that don’t.
Some Americans are unhappy with the lack of a public option in the Senate bill, others with its inclusion in the House version. Many already have their government-guaranteed health coverage and don’t want to share.
Almost everyone detests the “Cornhusker kickback,” a special deal arranged by Nebraska’s Democratic senator, Ben Nelson.
And how does one count strong opinions by those who don’t have the foggiest idea what’s really in the bills — but who are taking their talking orders from partisan yakkers?
It’s worth noting that President Obama’s proposal, based on the Senate bill, does not include a public option. It eliminates the Cornhusker kickback. It eases up on the controversial tax on so-called Cadillac health plans. And in an appeal to older voters, it does away with the Medicare drug benefit’s “doughnut hole.”
The public option has been the most demagogued item in the entire health-care debate — not because it’s a bad, or even radical, idea but because the deep-pocketed insurance industry opposes it.
Republicans have been portraying it, a government-run insurance plan to compete with private options, as a socialist Satan intent on destroying the American Way. The public option has been burning at their stake for so long, it’s a wonder there’s even an ash left of support for it. But a recent Newsweek poll has 50 percent of Americans still favoring a public option and 48 percent opposed. That the administration refused to strenuously defend a cost-saving device that always enjoyed widespread backing is something I’ll never understand (and may never forgive). Nonetheless, health-care reform must pass, with or without the public option.
The last time “the American people” came close to officially speaking on this subject was in November 2008, when they elected a Democratic president and expanded the Democratic majorities in both the House and the Senate.
It’s mind-boggling that any sophisticated analyst would attribute Republican Scott Brown’s surprise victory in the Massachusetts special senatorial election to public rejection of government-guaranteed health care. As a Massachusetts state senator, Brown voted for a universal coverage plan that’s a lot less conservative than what’s on deck in Washington.
The Newsweek poll also asked for feelings about the job that Obama and Republicans and Democrats in Congress were doing on health care reform. Some 52 percent disapproved of Obama’s performance, 61 percent disapproved of the congressional Democrats’, and 63 percent disapproved of the congressional Republicans’.
No one is walking away from this with an Academy Award, but what’s coming out of Republican leaders’ mouths clearly isn’t what’s coming out of the American people’s. The people will speak definitively on Nov. 2.
By: Froma Harrop-Syndicated Columnist-The Seattle Times-Feb 25, 2010 3:54 pm
When Conservatives Play Make-Believe: Jonathan Cohn
Paul Waldman, today, writing at the American Prospect: The only problem is that there is no tyranny to rebel against. President Barack Obama isn’t rounding up his opponents. He isn’t punishing them for their free speech. He hasn’t even raised anyone’s taxes, save for a boost in the federal cigarette tax (we await the event where the tea partiers dump cartons of Marlboros into the Chesapeake). So what are the outrageous crimes that have driven the right to shout “Enough!” until their faces turn red? In the face of the worst economic crisis since the Great Depression, Obama passed a large stimulus bill. And he might pass health-care reform that could extend coverage to those who don’t have it, all while preserving the private insurance system. He’s also embraced a market-based initiative for reducing greenhouse emissions. Not exactly a program that would that would offend the delegates of the Continental Congress. What has driven conservatives to distraction isn’t tyranny — it’s the oldest political complaint in the book: The other guys won and are attempting to implement their agenda.
Yet when conservatives criticize the administration, today’s playacting revolutionaries imagine themselves heroes of liberty, bravely staring down the forces of oppression. This notion must be called what it is: a puerile fantasy. The tea-party sign-waver is not the man standing in front of the tank in Tiananmen Square. The conservative blogger is not Jacobo Timerman, exposing the barbarity of the Argentine junta only to experience it himself. The activists and operatives and think-tank denizens are not Vaclav Havel, or Ken Saro-Wiwa, or Nelson Mandela.
And they sure aren’t Washington, James Madison, or Thomas Jefferson. Precisely because they live in the country those American visionaries made, the Founding Father fetishists risk nothing by objecting to the current administration, no matter the apocalyptic language they use to clothe those objections in glory. They are participants in public debate in the world’s oldest democracy–nothing more, nothing less. It’s a fine thing to be, but it doesn’t make you a hero. And putting on a tricornered hat won’t make it so.
Jonathan Cohn-Senior Editor: The Treatment-The New Republic- February 23, 2010
A Brief Reconciliation Primer–Jonathan Chait: The New Republic
The health care debate is quickly going to focus on whether its passage entails some immoral act of partisan hardball or merely a common legislative procedure. Unfortunately, it seems that very few people understand the details of it well enough to form an opinion, and this includes reporters who cover it.
Senate Republicans collected quotes from 18 Senate Democrats expressing skepticism about using budget reconciliation to pass health care reform. The Hill reports skeptically on this claim, pointing out that many of the quotes are dated, and the Senators have since expressed openness to using reconciliation. But this response misses the deeper problem here: the Republicans are conflating two extremely different things.
Let me explain. Reconciliation is a legislative procedure for passing changes to the budget — taxes and spending — that only requires a majority in the Senate. Last year some Democrats pondered passing health care reform entirely through reconciliation. Critics pointed out that such a move could result in many of the crucial features of the bill being stricken by the Senate parliamentarian on grounds that they aren’t budget changes. (Say, insurance regulations would probably not be able to pass through reconciliation.) Ultimately, Democrats decided to go through the regular order, and they passed a health care bill through the Senate with 60 votes.
Now that they’ve lost the ability to break a filibuster, Democrats plan to have the House pass the Senate bill, and then use reconciliation to enact changes to the Senate bill demanded by the House. These changes — higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal — mainly involve taxes and spending. In other words, they’re exactly the kinds of policies that are well-suited for reconciliation.
It’s not just The Hill that misses the distinction, but the whole political media. Here’s Sunday’s New York Times:
Many Democrats in Congress said they doubted that it was feasible to pass a major health care bill with a parliamentary tool called reconciliation, which is used to speed adoption of budget and tax legislation. Reconciliation requires only 51 votes for passage in the Senate, but entails procedural and political risks.
Again, using reconciliation to patch up the Senate bill is a totally different thing than using it to pass an entire health care bill. I can understand why Republicans would treat them as identical — they’re spinning for partisan purposes. Reporters covering this issue have no good excuse.
Saturday February 20, 2010 3:04pm
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