Read a wide range of views on whether it’s time for conservatives to embrace universal coverage over at New Majority.

Via Pandagon:

Democrats are choosing to “go it alone” without the country if they opt to pass healthcare reform on a party-lines basis, one Republican congressman accused Thursday.

“If they go it alone without the Republicans, it also sounds like they want to go it alone without the American people,” Rep. Bill Cassidy (R-La.) told a conservative news radio program in an interview.

Rep. Cassidy may not have noticed this, but Barack Obama was elected president, which means – as far as modern presidents are concerned – that he was elected with either a majority or a plurality of the popular vote.  In last year’s case, Barack Obama beat his Republican opponent with a solid 52.9 percent of the vote.  What’s more, if Rep. Cassidy were to look at the results of last year’s congressional elections, he would notice that Democrats represent an even more solid 53.04 percent of the population.  Far from going “alone,” Democrats are accurately representing the stated preferences of a majority of the population, many of whom voted for Democrats so that there would be health care reform.

On a related note, I would pay a lot of money to see a media outlet call bullshit on claims like the one above.  I’ve read a ton of process stories this summer, and few – if any – have taken the time to remind readers that Republicans are both A) a distinct minority and B) deeply unpopular with the majority of voters.  Even after eight years of miserable failure, they are consistently treated as if their ideas (or lack thereof) matter.  With that kind of media attention, it’s no surprise that they are using the opportunity to saturate the dialogue with misinformation and dishonest nonsense.

Charlie Cook, of Cook Political Report fame, is very good at what he does, and when he says that the Democrats are looking at significant losses in next year’s midterm elections, it’s worth paying attention (via the Atlantic’s politics channel):

“….confirm anecdotal evidence, and our own view, that the situation this summer has slipped completely out of control for President Obama and Congressional Democrats. Today, The Cook Political Report’s Congressional election model, based on individual races, is pointing toward a net Democratic loss of between six and 12 seats, but our sense, factoring in macro-political dynamics is that this is far too low.”

My hunch is that it’s still far too early to make any judgments about regarding either party’s success or failure next year.  There is a huge number of things which determine the outcome of any given election cycle, and many of those have yet to play out in full.  At this stage in the game, predictions – or at least confident ones – are almost completely unfounded.  That said, I can’t help but be terrified at the idea of significant Republican gains.

If there was any potential silver lining to the recent explosion of right-wing rage, or the shameless dishonesty on display from Republican leaders, or even the demagogic rantings of right-wing talk show hosts, it’s that it makes the GOP look insane.  Politically, the argument goes, it doesn’t matter if Obama is as successful as he wants to be, since the public recognizes that alternative is orders of magnitude worst.  Granted, that sounds very nice – and extremely comforting – but I’m not sure if it’s actually true.  American politics is, if anything, cyclical.  And there is a definite rhythm to election cycles.  Broadly speaking, party shifts occur when the opposition party is organized enough to capitalize on a significant screw up by the party in power.

If health care reform fails, I guarantee that Republicans will make significant gains next year.  And if Republicans make significant gains, we can look forward to a Republican Party even more unhinged from reality.  In light of a substantial electoral victory, dialing up the crazy wouldn’t seem like a terrible idea, after all, that victory was due – in part – to the near-constant outrage of the previous year.  And, for Republicans at least, it stands to reason that more outrage would prove to be more successful.  A Republican win next year would probably convince a large swath of the party that they have nothing to gain from sensible opposition, and everything to win by pressing forth with alarm-ism, hysteria, and implicit threats of violence.

By way of this post, Matt Yglesias explains why he likes Brad DeLong’s “totally unrealistic health care plan.”  First, to boil down DeLong’s rather long post on the subject, let me lift this excellent summation from Yglesias:

— 1. Taxes on public health hazards (booze, sweeteners, etc.)

— 2. An army of publicly employed doctors and nurses working in clinics and vans and such roaming the country dispensing preventive care and lifestyle advice to all and sundry.

— 3. 15 percent of your income is automatically plunked into a Health Savings Account.

— 4. When you want health care services that aren’t covered by the clinics, you pay out of your HSA.

— 5. If there’s money left in your HSA at the end of the year, it gets plunked into your IRA unless you specifically fill in an opt-out form.

— 6. If you run out of money in your HSA and need more health care, the government pays for it.

— 7. On top of the 15 percent HSA deduction, there’s a 5 percent tax to pay for 6.

I actually think this is a pretty good idea.  I’ve mentioned before I think flat-out single payer might actually be more efficient than the mess we have now, but adding health savings accounts (and thus direct, personal involvement) into the mix is a really good idea at containing costs.  Personal choice also helps avoid some of the problems I’ve bemoaned in regards to monopolization.  I may have not made this clear enough, but I really do think monopoly (not “government”) is at the heart of many economic and social problems.

Consumers responsible for their own health care purchases makes a lot of sense because they have incentive to exercise restraint and because they have options on where that money is spent.  Having insurance (whether single payer or otherwise) for costs above and beyond what goes in their savings account also makes sense. [Read more →]

We’ve all spent a good deal of time here at the League going over the various perspectives of the US health care debate and, indeed, many of us have brought some useful insights to bear on the discussion. However, I thought it might be helpful and interesting to get some thoughts from someone who works directly in and with the health care system on a day-to-day basis.

Luckily, it just so happens that one of the League’s Guest Authors and blogger in his own right (check out: Bleakonomy), Dan Summers, is an MD and was willing to engage in a back and forth with me over email about various facets of the debate. [Read more →]

At the risk of boring everyone with arcane institutional trivia (which I’m sure I did with the reconciliation post), I’m not quite sure what to make of the “two bill” idea being floated around by Senate Democrats.  For those of you who haven’t been paying too much attention, here’s the basic situation: as Ezra Klein explained a few days ago, there actually is a fair amount of consensus surrounding the core provisions of health care reform.  Here he is in his own words:

Here are the things that, broadly speaking, legislators agree about: insurance market reforms, including community rating, guaranteed issue, an end to rescission, an end to discrimination based on preexisting conditions, and an individual mandate. Subsidies for low-income Americans. Delivery system reforms. Health insurance exchanges. An expansion of coverage to about 95 percent of legal residents. Prevention and wellness policies. Retaining and strengthening the employer-based insurance market. Creating some kind of incentive for employers to offer, and keep offering, health benefits. Expanding Medicaid to about 133 percent of poverty.

Of course, this has all been overshadowed by the furor over the public option, and whether or not it will be included in this initial round of reform.  Centrist Democrats have repeatedly spoken against including a public option in the health care package, and because they have a lamentable fair amount of legislative clout (by virtue of their position as the median senators), they also have the power to kill a health reform bill that includes the public option.

The idea then, is that instead of passing a single large bill that includes the not-controversial provisions along with a public plan or health care co-op, Democrats would split the legislation into two pieces.  One piece would include the more controversial elements of the reform package and would be shepherded through the Senate via the reconciliation process.  The other piece would include elements of the health care overhaul – like universal community rating and the health insurance exchange – which have a broad base of support among Democrats and Republicans.  The policy benefits of going this route are pretty clear: by shepherding the entire bill through reconcilliation, you risk those provisions which are valuable, but which have very little to do with the budget/deficit reduction.  If you removed those provisions from the reconciliation bill, you’d be left with a bill that still has a lot of force to it, has a measurable impact on the budget/deficit, and is far less vulnerable to the (informed) whims of the Senate Parliamentarian.

That said, I’m not sure if any of this could actually work, in large part because I’m not sure if centrist Democrats are actually interested in passing any health care reform.  And, unfortunately, they are the most important players in this game.  After all, a Republican filibuster can only hold if your Ben Nelsons or Blanche Lincolns decide to vote against cloture.  If centrist Democrats are genuinely interested in reforming the system and do have honest opposition to a government-run insurance program, then the split bill strategy is a good one, since it holds on to their support for said insurance reforms.  Likewise, the opposite is true.  If our centrist friends opt follow the lead of Republicans and stand against all reform, regardless of content, then splitting the bill simply doesn’t matter.

At the risk of being too optimistic, I don’t think that’s the case.  None of the usual suspects have said anything about opposing the more commonsensical insurance reforms.  What’s more, there is a real political advantage to splitting the legislation; if the less controversial half makes it through the Senate, that gives President Obama a real, substantive victory after a summer of near-deafening right-wing rage.  In turn, that momentum can be directed towards the reconciliation fight, which will be a madhouse, I’m sure of it.

[updated below]

Andrew Biggs crunches some numbers on Medicare over at the AEI blog.   Contra Minnesota Republican Rep. Michele Bachmann and others adopting the new “Obamacare vs. Medicare” talking points, Biggs rightly points out that Medicare is not a program conservatives should be defending.  Conservatives should be looking at ways to reform Medicare, certainly, but defending it without caveats while decrying the government-run-health care bogeyman is ludicrous.  A reformed, solvent entitlement may worth be defending, but the status quo is not.

Biggs explains why the notion that seniors’ have paid for their own benefits is simply not true: [Read more →]

Not surprisingly, this poll from Gallup showing that the extremity of the town hall protests may be succeeding in increasing opposition to health care reform – and certainly have not provoked a backlash – is rightly the story of the day and has the Right celebrating, and the Left a bit bruised, with the proud partisan Big Tent Democrat proudly reasserting his long-held belief that Dems need to be more partisan because they’re never going to succeed in convincing anyone.  Relatedly, the Obama Administration is taking up the argument that the media are failing to refute blatant falsities alleged by many of these protesters.

I take a different view, as usual.  The reason why the health care debate has favored liberals and Democrats in recent years has been their ability to appeal to powerful anecdotes of the uninsured and other actual victims of our current health care system.  What the health care protests have done is to put actual people who sincerely (if very, very wrongly) believe they would be victims of Obamacare front and center, providing reform opponents with easily-relatable appeals to emotion that they’ve never had in the past fifteen years.

That these people have acted in extreme and normally unacceptable ways in making their appeals is largely irrelevant to the observing public, who put themselves in the shoes of someone who sincerely believes that she will die if Obamacare becomes reality.  Of course, if people recognize that you honestly believe a piece of legislation will kill you, then they’re going to be willing to empathize with any manner of nonviolent but otherwise extreme methods of protest. 

I think a lot of proponents of reform recognize this, which is why they point the finger at organizing groups, talk show hosts, and Sarah Palin for spreading misinformation about the proposal, and at the media for failing to rebut that misinformation.  This is an understandable complaint, and is I think an accurate one, though not with respect to the media (more on that in a moment). 

What reformers don’t seem to realize is how the decision to water down health care reform rather than pushing for something more ambitious (like single-payer, on the one had, or Wyden-Bennett, on the other) has hurt them in this debate, perhaps irreparably. 

[Read more →]

Just very briefly – “deregulation” does not mean the stripping away of all rules or the desire to enter into a state of anarchy.  So when I speak of “deregulating” the health care industry, I’m mainly talking about removing rules that prevent competition and create monopoly or that are expensive but provide no real benefit.  So removing restrictions which prevent insurers from competing force insurers to compete is a way to “deregulate.”  Other regulations which keep insurers from ripping people off, or remove barriers which prevent people from even purchasing insurance to begin with make much more sense.  Regulation should increase choice not decrease it, though ironically it is much easier to write rules that limit choice than to write rules that help increase it.

We’re not speaking in black and white here – or at least I’m not.  Some libertarians or anarchists would probably take a very different view than me.

The way I see it, you can follow a guiding philosophy only so far as it is practical to implement.

So you take the concept of market solutions to its practical limit – and this is hemmed in by historical realities, political realities, the electorate, etc – and then you make a compromise that can also be practically implemented. Give consumers choice over who they pick to provide their own health care via the aforementioned deregulation.  Kill the monopolies and create a real competitive market for health insurance.  Then give consumers even more choice by offering means-tested vouchers, whether or not there is a public option, so that all across the board people can make decisions about their own health care.  Spur competition.

Then you have to start making compromises because of all the basic facts that are impeding a real market from taking off (entrenchment of current industry players, high cost of premiums and the distortion created by decades of employer-provided insurance and so forth).  Write smart, simple regulations that prevent insurers from denying coverage.  Offset this by mandating that Americans purchase or acquire health insurance, and set rules for the “basic” plan that all insurers have to offer.  It’s not perfect, but in the real world, no compromise ever will be.  Imperfection is the nature of compromise, and the unintended consequence of imperfection can sometimes be really good results.

In the end this all comes back to the difference between “small” and “limited” government – or the scope of government involvement vs merely its size, and to the ways in which government does intervene into both our lives and, somewhat redundantly, into our economy.

Ezra Klein is worried that our dysfunctional debate over health care reform is symptomatic of broader problems with our democracy:

What we’re seeing here is not merely distrust in the House health-care reform bill. It’s distrust in the political system. A healthy relationship does not require an explicit detailing of the “institutional checks” that will prevent one partner from beating or killing the other. In a healthy relationship, such madness is simply unthinkable. If it was not unthinkable, then no number of institutional checks could repair that relationship. Similarly, the relationship between the protesters and the government is not healthy. The protesters believe the government capable of madness. There is no evidence for that claim, which means that there is no answer for it, either. That claim is not about what is in this bill, or what government has done in Medicare and Medicaid and the VA. It is about what a certain slice of Americans think their government — and by extension, their fellow citizens — capable of.

And Will Wilkinson thinks that Ezra is being deeply – dangerously -  naive:

It requires an amazing kind of selective amnesia to think that there is “no evidence’ that the U.S. government is “capable of madness.” The government of the United States invaded Iraq and its agents have killed many tens of thousands people on the basis of the fact that some Saudis trained in Afganistan flew planes into the World Trade Center, plus some lies. Torture, extraordinary rendition, indefinite detention, etc. I call that madness. Of course, Ezra means the other parts of government concerned with domestic affairs. But not the parts that break into peoples’ houses and destroy their lives for selling contraband herbs, or that subject us constantly to mendacious propaganda about drugs. Our government — and by extension our fellow citizens — is capable of terrible things and proves it every single day. Is it really possible to love government so much, to invest so much hope in its benevolent efficacy, that we grow blind to its evident capacity for evil?

I’m inclined to side with Will here; as he notes, it doesn’t take much more than a quick glance at the past eight years (or the whole of American history, really) to understand that our government, like any other, has immense capacity for evil.  That said, I don’t want to completely dismiss Ezra.  Yes, he’s wrong about the government’s capacity for “madness” but I’m not sure that that actually invalidates his argument.  After all, even by fairly lenient standards, these protesters aren’t very informed: they don’t have a terribly sophisticated knowledge of American political history, and they almost certainly aren’t aware of the “madness” of the past few years.  In fact, if they are aware of the previous administration’s transgressions, I’d be surprised if they were actually bothered by any of them.  In all likelihood, these are the people who were stoked about invading Iraq, and cheered on the administration after Abu Ghraib.

This is all to say that Ezra is, in some sense, completely right.  For the protesters and the teabaggers, there is absolutely nothing in their political ideology which would lead them to believe that the government was capable of madness.  Yes, you could say that these are “small government” conservatives with an inherent distrust of authority, but again, most of these folks sat through – and probably applauded – the massive Bush-era expansions in the size and scope of government.  My guess is that these are folks who have completely lost their faith and trust in the ability of government to represent them in their interest.  But, insofar that they lack trust, I don’t think it’s because they are hyper-aware of the government’s various misdoings and moral failings.  Instead, they no longer believe that America has the moral bearings to choose an adequate leader.  To them, Obama is utterly foreign and it defies belief that a majority of Americans could have elected him.  That they did not only signals that the system is broken, but that they are at its absolute mercy.

It’s that, I think, which is the source of the fear, the rancor and the sheer, unvarnished hatred.

*I’ve been looking for a way to use this song as a post title for weeks.

Last week in the comments, E.D. noted that the more liberal and Canuck of the League’s contributors hasn’t offered much in the way of analysis around the current red hot health care debate. Earlier, I offered my own sense of bafflement over the inability for American health care debaters to have a realistic discussion about reform that actually looks at a single payer system in something approaching sensible terms and noted how many of the tropes involved in that subsection of the debate strike simply incongruous postures vis-a-vis my own life experience.And look, it’s just hard to sit down with the relatively sparse amount of free time that one has at one’s disposal and look through the particulars of the HR3200 v. Wyden-Bennet plans when neither plan’s options will be available to me.

But the broader context of the debate is something I’ve found pretty interesting to follow and in doing so I’ve noted how much the ontology of that context strikes me as largely contrived — and thereby leads to a fairly contrived debate.

Take for example the screaming dissidents of the proposed Obamacare reforms. [Read more →]

Marc Ambinder is right to say that vacuous, unintelligible outrage is kind of a bad strategy as far as trying to stop a popular president’s health care reform package is concerned.  Unfortunately, he can’t seem to make that point without relying on the usual “split-the-difference”/”pox on both houses” calculation: [Read more →]