This discussion/interview between Ezra Klein and Rep. Paul Ryan is the best thing I’ve seen in the health care debate in months.  Given Ryan’s position as a GOP point man on health care reform, his comments on Wyden-Bennett ought to give hope that maybe it could get enough GOP support to pass if the Dem leadership were willing to push it.  Regardless, the entire back-and-forth is interesting on both sides.  Even if you disagree with Ryan, I think you’ll also find it refreshing to hear a semi-prominent GOP politician speak knowledgeably and seriously about health care reform.

I’ve read more than a few concerned posts about Ryan Avent’s report on projected unemployment rates in the US via the Office of Management and Budget press conference yesterday at Free Exchange. Wrote Avent,

OMB head Peter Orszag is giving a press conference just now with Christina Romer, head of the Council of Economic Advisors, on the president’s Fiscal Year 2011 budget. Ms Romer explained the economic assumptions underlining the budget forecasts. She noted that expected fourth quarter-over-fourth quarter real GDP growth would be 3% in 2010, 4.3% in 2011 and 2012, and would average 3.8% in the five years thereafter. These figures are in line with Fed projections.
She then gave the unemployment forecast. At the end of 2010, the unemployment rate, according to the administration’s forecast, will be 9.8%. At the end of 2011, the rate will be at 8.9%. And at the end of 2012, after the next presidential election, the unemployment rate will be 7.9%.

As Kevin Drum says: good god.

For comparison’s sake, Canadian rates of unemployment, which begn a sharp fall towards the end of 2008 and continued falling, with some minor flucuations, throughout 2009 have already started to improve. And while stagnant through December (no real surprise there), are already at levels that the US isn’t forecasted to reach until the end of 2011.

[Read more →]

“If Obama’s efforts to create a viable regulatory framework in which individuals can buy private health insurance (a) pass congress, and (b) turn out to work well and be popular, then you can imagine a version of Ryan’s plan being put into place. But in the absence of that kind of reform, I just don’t see how you can do this, which is presumably why the implementation is delayed all the way to 2021 which helps Ryan avoid needing to think about implementation details.” ~ Matt Yglesias, writing about Rep. Paul Ryan’s alternative budget

I think Yglesias actually makes a pretty strong point here.  While I’m overall fairly sympathetic to Ryan’s budget – he does, after all, balance it (at least according to the CBO report [pdf]), something virtually no other politician is willing to even propose – I think there is a fundamental flaw with implementing a healthcare voucher program without first fixing the broken, dysfunctional health insurance market.  The exchanges created in Obamacare would be one way to do this. 

What Yglesias does not point out, however, is that Ryan’s budget proposal also puts an end to the tax exemption for employee benefits.  Simply coupling this tax reform with the ability to purchase insurance across state lines creates an entirely new health insurance market.  Suddenly people on the individual market are given the same tax preference as people who receive their insurance from an employer.  Health insurance drifts away from employers and becomes personal and portable.  People wouldn’t lose coverage when they left their jobs.  Meanwhile, insurers would lose their long-held local and state monopolies and be forced to compete nationally, driving down costs both through added competitive pressures and by the better bargaining powers that these large, national firms would have, with their much larger, national cost-sharing pools.

Of course, the hard questions in healthcare will center around two inextricably linked concepts – pre-existing conditions clauses, and individual mandates.  Almost all modern democracies have some form of universal coverage, and the only way that it has been achieved with any semblance of a free market has been by doing away with pre-existing conditions clauses and implementing some sort of individual mandate.  If the former is done without the latter, nobody would buy insurance until they were sick – defeating the purpose (and the viability) of insurance to begin with.

Other alternatives exist, of course.  My personal preference is a model along the lines of Singapore’s healthcare system, which mandates health savings accounts and then picks up the tab on any costs above a certain flat percentage of income.  This puts healthcare directly in the hands of the consumer (cutting out insurance companies altogether) and provides them with catastrophic coverage if something should go wrong.  Furthermore, by placing costs and transactions directly in the consumers hands, it keeps costs from skyrocketing.  The mandated savings would be flat, but the catastrophic coverage functions progressively, covering less and less as income rises.

Either way, before any privatization of Medicare and Medicaid can occur, the private insurance market must be transformed.  Paul Ryan has shown true grit in crafting a budget that is actually balanced, but the possibility of backlash to cuts in entitlements is very real if the systemic problems in our healthcare system aren’t taken care of first.  Both Yglesias and Ezra Klein see this budget as a sort of draconian rationing of benefits for seniors and poorer Americans. If the insurance market could actually be fixed, however, then the system of vouchers which Ryan proposes would be adequate and possibly even better alternatives to the status quo.

From our good friend Joe Lieberman,

“My approach here is we really must do something this year,” said Lieberman, who has been co-sponsoring cap-and-trade bills since 2001. “The two problems of American energy dependence and global warming will only get worse. We’ve just got to do the most we can. I’m not being rigid or ideological about it. So anybody who wants to try to make the problem better, it’s worth considering.”

Says the guy who held health care reform hostage based on his own ill-conceived notions about what the American people wanted. Exit question: did Joe Lieberman’s action on health care reform, and the resultant slouch in Democratic morale, effectively kill any chance he had of passing substantive climate change legislation (let alone cap and trade legislation) any time soon?

The interspheres have been aglow with the leaking of a planned spending freeze proposal by the Obama Administration.  A run down of various opinions can be found in Scott’s post.

Scott writes:

This is politics as usual, painful though it is to level that claim. And though I’m well aware of the danger in making predictions about politics, I think this announcement, more than the Brown victory, may be the moment to which people look back and see the place where the Obama dream died.

And in comment #3 (to that same post), North writes:

A lot of it is hinging on his State of the Union. If he manages to pull something remarkable and hit it out of the park then he may well turn things around. A lot of this will depend on what he decides to do leadership wise; if he tries to turn budget hawk and decides to let his HRC croak completely his base is going to revolt. If he can force HRC through and then starts clamping down on the budget I guess he might be able to thread the needle.

Now, I didn’t quote those passages to call those gentlemen out, just to note their language.  Obama can (has to?) “force health care reform through….” and, of course, “the Obama dream.”

As somewhat of a side note, it might be worth noting the Canadian pedigree of both dudes (it also might not).  As an American living in Canada, this is one aspect of American politics I can never seem to get across to non-Americans (in this case Canadians, but others as well):  that we have a presidential, not a prime ministerial, system.

The President really has no influence on domestic policy.  Presidents at best might be popular figures who become mouthpieces and/or salesmen for a policy that is already bubbling up from below the political ground.  But they rarely dictate policy.  Clinton failed to reform health care by trying to force a proposal through Congress.  Obama has (possibly?) failed to reform health care by letting Congress lead. Or perhaps neither failed, and it’s Congress who stalled out both times, as it’s the legislature’s job to formulate domestic policy, not the President’s.

Sure, presidents get to appoint various department heads at places like the EPA, Justice, etc. and will choose people who they think will bring their style, tenor, outlook and so on to the job.  And it makes some difference, I suppose, but there’s no real gap between appointments from members of the same party.  I mean, if Hillary Clinton were President, I would guess that the Justice Department, The EPA, and Homeland Security would have pretty similar outlooks.

The only real power the executive has in terms of domestic policy is through institutions like The Treasury Department, appointing a Fed Chairman, and the like.  Here Obama I think is definitely in for some well deserved criticism, but either way it’s much less influence and power than we normally assume a president holds.  American presidents have essentially unlimited, near- monarchical power when it comes to foreign policy.  There Obama has done exactly what he said he was going to do.  But I haven’t lost any sense of the Obama Dream, mainly because I never really bought into any dream in the first place.  At least with regard to domestic policy–since Presidents in my book have basically no power in that regard.  Whether they should or not is a different question, but the reality is they don’t.  I voted for Obama solely based on his foreign policy outlook, which – while far from perfect (from my view) – was vastly superior to John McCain’s.

Which leads to what I think is the rather ignorant focus by Democrats on this spending freeze idea.  It’s particularly ignorant because this is occurring in the same week it has become manifestly clear how to pass the most important piece of legislation (from the Democratic point of view) since the 1960s: Namely, have the House pass the Senate HRC bill plus the so-called “sidecar” amendments from the Senate via reconciliation.

In other words, if you are a Democrat (or in favor of health care reofrm), why the hell do you care what Obama is doing or talking about with regard to spending freezes and his State of the Union address?  It doesn’t matter one friggin’ bit.  All the Democrats should worry about now is passing the health care bill.  They should eat, sleep, drink, and think of nothing else except how to pass that bill.   [Read more →]

For those of you observing/participating in the “Pass The Damn Bill” movement there is now a Facebook group you can join that was apparently inspired by Kevin Drum’s posts on the matter — a fact that, after this past Saturday’s rallies here in Canada which were themselves largely initiated by a Facebook group (and about which I’ll blog when I’m not clearing a 48 hour migraine at work), I am much less cynical about posting on.

Health care reform in jeopardy? Super-majority evaporated? Democrats in disarray? There’s only one thing left to do… [Read more →]

Whether you agree with the analysis or not, this is also, straight up, some funny shit: [Read more →]

I understand what Jamelle is trying to say in response to E.D.  I do.  But I think Jamelle is fundamentally misreading the GOP and the nature of what can make something meaningfully ”bi-partisan” (much as that word sends chills down my spine).

Let me start by saying that I mostly agree with Jamelle when he says that”

There is almost nothing in recent political history to suggest that the Republican Party is anything but hostile to health care reform.  And if not hostile, then indifferent.  Republicans had nearly four years of uninterrupted dominance with which to tackle health care reform, and neither President Bush nor congressional Republicans proposed anything. 

I think “hostile” is too strong, but indifferent is probably about right.  Certainly, health care reform is a very low priority for the GOP and to the extent it’s a priority at all, it’s only because it’s so front and center an issue for Dems and liberals. 

Saying something is almost universally a low priority for Republican politicians, however, is not the same as saying that all Republican politicians will be reflexively opposed to any health care reform at all.  It has, for instance, become cliche amongst liberals to say that the McCain health care proposal was worthless and a joke.  Yet the primary difference between that proposal and Wyden-Bennett, which is popular with economists and many movement liberals, solely has to do with the amount of regulation of the individual market – not exactly an irreconcilable chasm. 

My key disagreement with Jamelle comes from this paragraph, however:

Last year, Democrats offered Republicans the chance to make their mark on health care reform.  Yes, it would happen within a liberal framework, but Democrats were more than willing to compromise and scale down if it meant GOP support.  Republicans were repeatedly offered the opportunity to alter the bill to their liking; if Republicans wanted market-friendly reforms, they could have gotten them.  If Republicans wanted something modest and limited, Democrats probably would have delivered.  But they didn’t.  Despite that, Democrats produced and passed a bill that is moderate and bipartisan in everything but name.   

(My emphasis).

The disagreement I have here is that it makes the assumption that altering the scope of a major proposal rather than adjusting its framework is an inherently worthwile effort at bi-partisanship.  In some cases, that may well be true, to be sure.  But it’s not true when the principal objection from the opposing party’s base is the framework itself, which is precisely what the objection has been here almost from Day One.  [Read more →]

I’m not going to pretend to know what the outcome of the special election in Massachusetts last night “meant”, I’ve got too much on my plate trying to organize a rally to keep my own government accountable. But there were two thoughts that occurred to me last night as I finished up the night’s activities that involved me questioning assumptions and beliefs I had previously held.

The first thought arose from reading the following quote by Andrew Sprung, linked to by Andrew Sullivan, about Webb’s comments around health care reform following Scott Brown’s win,

We have one party that has not got the brains to govern. Will we now learn for certain that we have another party that hasn’t got the guts?

It doesn’t strike me as entirely fair to suggest that this failure to recapture Kennedy’s seat and the potential failure of health care reform is due to Democrats being “gutless”. Rather, I think what it points to is the fact that the Democratic Party is a deeply divided institution and those divisions lie along significant fault lines of principle about what it means to be a “liberal” today. [Read more →]

I have seen a lot of pretty good analysis of last night’s elections coming from the “fringes” on both sides, but especially from the far Left.  I have also seen a lot of crappy analysis coming from the establishment types on both sides.  But this piece by Lanny Davis takes the cake.  Essentially, Davis blames hard-core progressives for the loss – not because they failed to support Coakley, but because they’re somehow responsible for the elements of health care reform that have most angered people against health care reform in recent weeks – special interest giveaways to unions and Nebraska, the public option, and individual mandates.  Simultaneously, he seems to attack hard-core progressives for threatening to not support any bill without these provisions. 

Seriously – what world has Davis been living in?  Because so far as I’m aware, those giveaways to special interests were vehemently opposed by progressives and were a big part of the reason why they, along with a lot of independents, started turning against the bill.  So far as I’m aware, the same die-hard progressives Davis is attacking (ie, the Jane Hamsher/Firedoglake set) have also been strongly opposed to the individual mandate.  And, so far as I’m aware, the public option isn’t even included in the Senate bill that was the most proximate impetus for the voter anger for which Davis is blaming die-hard progressives.  Indeed, provisions like the individual mandate, and the various special interest giveaways seem to find their core group of advocates precisely amongst the group of New Democrats that Davis claims progressives should be following.

Others here may well disagree, but I would like to associate myself with every word of James Joyner’s response to Andrew Sullivan’s accusation that a Scott Brown win will signal “a nihilist moment, built from a nihilist strategy in order to regain power.”  The only thing I’d add [Read more →]