As much as I appreciate Jamelle’s Darkwing Duck references (though personally, I’ve always preferred TaleSpin), I think he’s being a bit unfair to skeptics of health insurance reform here. Jamelle argues that we can’t have a real, rational debate over health care without agreeing to some shared premises. Well, that’s a bit more difficult than it sounds. The Ruth Marcus column he references, for example, claims that no one other than the very rich are going to see tax increases from the health care bill. What Marcus fails to mention is that everyone who doesn’t comply with the individual insurance mandate faces a pretty hefty fine. Is that equivalent to a new tax? I sure think so. Funnily enough, Marcus goes on to point out that “[p]eople who intentionally evade paying the fine could, in theory, be prosecuted — just like others who cheat on their taxes.” Why, it’s almost as if being fined is just like being taxed!

This is not to suggest that the nut comparing universal health insurance to Dachau at your local tea party rally should be taken seriously. But speaking as a guy who falls somewhere between a largely ignorant public and the inner circle of health care wonkery, I think it’s difficult to agree to shared premises when the contours of reform are subject to so many different variables. I’m all in favor of calling out factually incorrect statements – and Marcus, to her credit, identifies a few whoppers – but concerns about government overreach, spiraling costs, and regulatory capture are serious issues that deserve more than a curt dismissal. It’s a shame that the antics of a few extremists distract attention from the real debate over health insurance, but that doesn’t mean there aren’t substantive arguments out there against the Democrats’ plan.

This Gallup poll has gotten a bunch of attention, and I figure it’s worth posting here:

Yesterday, Ruth Marcus (or rather, whoever writes her subheadline) called the House debate over the health care bill a “GOP blizzard of untrue statements.”  And for good reason. The Republican argument against the bill amounted to a series of incoherent tirades denouncing the health care bill as an apocalyptic threat to everything good and decent about America.  Hell, I half-expected someone in the Republican caucus to describe Speaker Pelosi as the “beast from the sea” and an “abomination of desolation.”

Which is a nice way of segueing into this point: although the formal term for what happened on Saturday is “debate,” you’d be hard-pressed to describe anything that happened on Saturday as an actual debate.  A debate – as far as I understand it – is supposed to involve reasoned arguments and shared facts.  If I were in a debate about Darkwing Duck’s crimefighting ability, for instance, then my opponent and I would have to agree on certain basic facts; that there is indeed a superhero called Darkwing Duck and that he is St. Canard’s resident caped crusader.  If my opponent dismisses those easily verifiable facts, and instead insists that Darkwing Duck is a masked beaver, then well, we can’t really get anywhere.

This is basically where the country has been since the health care “debate” began.  Democrats and liberals have offered proposals and ideas, and Republicans have responded with either outlandish misrepresentations or outright lies.  Contra most of the mainstream pundit world, there hasn’t actually been much of a debate, and consequently the American people really don’t know much about what’s going on.  Which is why I’m skeptical about surveys like the one above; in a rational political culture, where debates were open and constructive, that poll might actually mean something.  As it stands however, that Gallup poll only shows two things: Americans are still anxious about health care reform and Republican demagoguery is depressingly effective.

By Wyeth Ruthven

Forget conference committees, any observer of health care reform needs to add the term “ping-pong” to their legislative vocabulary.

Ping-pong is a little known but increasingly used procedural device to pass legislation. A 2008 report by Walter Oleszek for the Congressional Research Service describes ping-pong as “the exchange of amendments between the houses”

It works like this:

PING: House passes a bill and sends to the Senate.
PONG: Senate amends the bill and sends it back to the House.
PING: House accepts the Senate amendment and sends bill to the President.

Sometimes the ping-pong match goes on for multiple rounds, as the House and Senate exchange amendments back and forth until either one chamber caves or compromise language is reached.

Walter Oleszek’s CRS report noted that pingpongs outnumbered conference committees by a 2-1 ratio in 1994, but went up to a 4-1 ratio by 2008.

Earlier this year, SCHIP legislation signed into law by President Obama (H.R. 2) was handled via the ping-pong method. The House passed a bill, the Senate amended it, the House concurred in the Senate amendment and the bill went to the President. Click here for the legislative play-by-play of the SCHIP ping-pong.

There are 2 procedural advantages of the ping-pong method:

1. No conference committee. Ping pong is a take it or leave it proposition. There is no conference committee, so there is no opportunity for compromises to be struck (or nettlesome provisions removed) by a handful of conferees picked by the leadership.

2. No motion to recommit. Bills can be sent back to the committee of juridiction from whence they came. These bills are recommitted with instructions to make certain substantive changes in the bill. Usually, motions to recommit are efforts by the minority party to attach controversial provisions to a bill, forcing the majority to either kill the bill or force vulnerable lawmakers into taking a difficult vote. Since an amendment does not originate in committee, it cannot be re-committed.

Ping-pong often plays a role in controversial legislation. During the 110th Congress, energy legislation was under consideration that would tax windfall profits on oil companies and use the proceeds to develop renewable energy. Republicans wanted to offer a motion to recommit on the bill to allow offshore oil drilling. Democrats wanted to avoid taking a vote on the issue. So the Senate amended House legislation and sent it back to the lower chamber. After a couple of rounds of ping pong, the House adopted the Senate amendment and the bill was signed into law.

What does this mean for health care?

The two touchiest items in the health care debate are now the public option and the Stupak Amendment. The House bill contains both. It is highly likely that the Senate will take up the House bill (H.R. 3962) and gut it from top to bottom, replacing the entire bill with a massive Baucus amendment containing whatever Senate compromise gets hammered out behind closed doors.

On the Senate floor, there will be amendments to the Baucus amendment – amendments for a robust public option, amendments to add the Stupak language, etc. These amendments will likely be subject to a 60 vote threshold, meaning that they will fail. So the Baucus amendment will remain largely intact when it goes back to the House for an up or down vote. Then it will go to the president.

Russell Arben Fox asks:

How should a distributist or localist or communitarian in America feel about proposals which would attempt to provide the same sort of equalization which Democratic party reformers are squawking about, but do so solely on a state-by-state (or perhaps region-by-region) basis?

Just more of the same? No different from any other kind of centralization? Or different in degree, but not in kind?

First, you have to remember that successfully reorienting our healthcare system requires two things: cost-sharing pools and competition. We need to do two things to achieve this:

1. National sale of insurance so that insurers can scrap together larger cost-sharing pools (which lead to lower premiums) and drive harder bargains with healthcare providers and suppliers.
2. An end to anti-trust exemptions so that health insurance consumers have choices and the industry can’t fix prices. Consumers of healthcare especially need the freedom to exit if they are unhappy with their insurer.

I think many localists and states’ rights advocates miss the larger picture when they advocate for more state control of health insurance. For one thing, many of the problems we currently face are rooted in state-based monopolies in the insurance industry, largely due to the restriction on interstate sale of health insurance and the anti-trust exemption these companies receive. This also leads to overcharging from the supply side and consequently unaffordable healthcare for many Americans.

This is a confusion of scope and scale. Simply because something is able to be sold on a national level does not mean it is in any way more or less “centralized” than if something is sold locally. The problem arises when monopoly or tyranny exist, not simply when something is very large. For instance, a local grocer could very well constitute a monopoly if it were the only grocer in town. It could then wield monopolistic power over the local community, driving up prices and driving down quality of goods and services. The same is true of healthcare. [Read more →]

Note: This was a shitty movie.

So, if Memeorandum is any indication, a few conservative bloggers have taken to mining fourth-rate dialogue from third-rate science fiction movies in order to make an absurd point about how a modest package of insurance reforms amounts to an attack on liberty itself.

I asked something along these lines on Facebook yesterday and in light of the apoplectic conservative reaction to Saturday’s vote, it’s worth posing these questions to the linked bloggers (if they are paying attention, of course).  In what way does the health care bill constitute “socialism” or an attack on our “liberty”?  How does the contents of the bill limit your freedom of action or restrict your ability to pursue your own comprehensive conception of the good?  And, assuming you’re not similarly opposed to Medicare and Social Security, how is the health care bill categorically different from either of those programs?  Finally, I also think it’s worth asking if you have a solution.  If agree that there are serious systemic problems with our health care system, then are there any reforms you think would address – or at least mitigate – the problems of overconsumption, high cost, and inadequate coverage?

If I had to hazard a guess, I’d say that neither blogger has a real answer to any of those questions.  For all of their bleating about how Saturday’s vote dealt a Mortal Kombat-esque fatal blow to “liberty,” I doubt either blogger even has a reasonably well-thought idea of what liberty is.  Indeed, I think it’s entirely fair to say that “liberty” for these folks is anything they really like and tyranny, by contrast, is anything that makes them feel sad and/or knocks them off of their (poorly) self-constructed pedestal.

Also, what John Cole said.

Despite Will’s take on the Washington Post’s “Next Top Pundit” contest, I thought it sounded like a pretty neat way to gain some exposure.  I mean, no matter which way you look at it, for a young writer, being given even the chance to compete for a column is a great way to get a toe or two through the proverbial door.  So I submitted an essay.

And I didn’t win.  As Kevin Drum notes,

By the way, the ten winners include a Nobel Prize winner, a Bush 43 assistant secretary of commerce (guess which one), a senior correspondent for the American Prospect, an analyst at the Council on Foreign Relations, a former researcher at the Kennedy School of Government, an Atlantic Media fellow, and a small-town newspaper editor.  Not exactly a crowd of just plain folks.  It might have been more fun to read the other 4,790 entries.

I guess the odds were against me.  I was under the impression this would be a battle between relative amateurs and unknowns, not Nobel Prize winners and Atlantic Media fellows.  I stand corrected.

Here are the winners.

In any case, here’s what I submitted, in case you’re interested: [Read more →]

Reihan doesn’t think that we should dismiss Republican intransigence as irrational or nihilistic (via Andrew Sullivan):

Among Democrats and liberals, there is a belief that Republican opposition to the various Democratic proposals represents a kind of “nihilism,” and that because Baucuscare resembles proposals offered by liberal and moderate Republicans in the 1990s, today’s opposition is obviously unprincipled if not insane. My sense is that we’ve learned a great deal about health reform over the intervening period, and that, as Christensen, Grossman, and Hwang have argued, it is disruptive competition that promises substantial improvement in the cost and quality of medical services over time. I’m increasingly convinced that the only way to move in this direction is to create a system of universal catastrophic coverage and universal health savings accounts, as proposed by Martin Feldstein and a number of others. The emerging consensus among congressional Democrats moves us in a very different direction, towards a highly centralized, highly regulated system that will give entrepreneurs very little room to dramatically improve care. With that in mind, I don’t think opposition is “nihlistic”; rather, I think it’s responsible.

As I was thinking of a response to this, Nicholas Beaudrot (of Donkeylicious) posted something on the fact that policy making doesn’t occur in a vacuum, and it’s worth quoting here:

Lately I seem to be having conversations with wonkish right-of-center types who have this-or-that idea about how to design a simpler, more efficient, and more effective policy to deal with taxation, climate change, health care, whatever. But it always stops there. No one talks about managing the transition. No one talks about convincing Mitch McConnell to back these ideas. No one talks about sixty votes. No one talks about the interest group dynamics in Washington. No one even talks about working for a decade to elect members of Congress who might be more amenable to these sorts of policies. It’s just policy in a vacuum. Which is an interesting intellectual exercise, but not a legitimate substitute for governance, an ultimately messy endeavor.

And honestly, that’s what I think Reihan’s defense amounts to, an interesting intellectual exercise.  It is true that the ideological commitments of most Democratic legislators lead them in the direction of greater regulation as opposed to greater market intervention.  But it is also true that the emerging congressional Democratic consensus didn’t happen in a vacuum – it didn’t happen in the face of intelligent Republican criticism, and it certainly didn’t happen in the face of decentralized or market-oriented Republican counter-proposals.  Given that Democrats – and Max Baucus specifically – invested a lot of time and political capital into addressing Republican complaints and roping Republican support, it’s not much of a stretch to say that had Republicans been prepared to work constructively, we would have seen a bill that is a bit closer to what Reihan would have preferred.

Indeed (assuming you have a decent imagination or have seen Sliders), you can easily imagine a parallel Earth where everything about the legislative process is exactly the same, and the only difference is that the GOP is a mature, intellectually honest party with a clear interest in governing* and a robust set of conservative policy tools.  In this alternate, wildly unrealistic universe, Republicans responded to Democratic health care proposals with constructive, intelligent criticisms, and Democratic legislators – eager to craft a bipartisan bill – used those conservative insights to craft a more radical bill (it will actually upset the status quo) with a more market-oriented, individual-centered approach.

Of course, here on Earth-Prime, we are stuck with a Republican Party that hears “intelligent criticism” and thinks “death panels” and “Soviet-style gulags.”  What’s more, we’re stuck with a Republican Party that refuses to even acknowledge the necessity of health care reform.  Pace Reihan, this is not responsible behavior.  Indeed, as it stands, if Democrats were to propose a dream package of market-based solutions to various health care related problems, I’m nearly 100 percent certain that they would be attacked and denounced as Orwellian fascists out to impose IngSoc on a nation of fire-breathing freedom lovers.

When Democrats and liberals call Republicans nihilistic, it’s not because we interpret all opposition as inherently nihilistic, it’s because this particular bit of opposition is actually nihilistic.  Republicans have not acknowledged the problem, have not offered any real critiques, and spent a fair amount of time poisoning the well with dangerously inflammatory rhetoric.  And in my book, that is a signal that we shouldn’t take Republicans seriously at all.

I don’t know how, during the long months of this health insurance debate, this quote from Road To Serfdom slipped my mind, but it certainly bears re-emphasis:

“Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance – where, in short, we deal with genuinely insurable risks – the case for the state’s helping to organize a comprehensive system of social insurance is very strong… Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make the provision for the consequences, such communal action should undoubtedly be taken,” – The Road To Serfdom (Chapter 9).

This is why, for all the bluster about “death panels,” and health care reform being an irreversible step on the road to socialism, it is the Randian vision of the world that animating the Right’s position on reform at the expense of the far more rigorous, thoughtful, and classically liberal vision of Hayek.  Were the influence of these visions reversed, we would have a situation where the Right would actually make a good-faith negotiating partner on the issue of health care reform rather than leaving it up to liberals to negotiate reform with spineless and philosophically unmoored centrists. 

The above-referenced quote does not in the least imply that any system of social insurance is acceptable or will work.  An individual-based system supported by tax credits or vouchers? Sure.  A system of nationalized re-insurance?  Quite possibly. Single-payer insurance?  Maybe.  But a byzantine system of employer and individual mandates, public options, increased regulation, etc.?  Absolutely not. 

Yet because the Right is so much more infatuated with the Randian vision rather than the Hayekian vision (even as it so often claims devotion to Hayek), leaving unmoored centrists as the gatekeepers, the reform we will get will be the latter.  This, I would submit, is the worst of all worlds from the supposedly free market perspective held by the movement Right – the reinforcement of existing flaws and regulatory regimes; increased opportunities for regulatory capture; large increases in overall government expenditures and an ever-larger national debt; and only marginal improvements in the delivery of health care to the currently uninsured (at a cost that many of them may be unable to afford).

. . . but I find the idea of banning clove cigarettes or this absurd incident much more offensive to my libertarian-ish sensibilities than universal health care.

Greg Sargent parses some numbers on public opinion and health care today over The Plum Line, noting,

The poll finds that an overwhelming majority of 64% think Republicans are opposing Obama’s health care plans mostly for political reasons. But it also finds that an equally large number, 65%, say Democrats shouldn’t pass a bill without Republicans — even if they think it’s right for the country — and should instead compromise to win over some GOPers.

About which, Sargent concludes,

This shows, I think, that Democrats have convinced the public that the GOP wants Obama and Dems to fail at all costs. But they’ve failed to make the case to the public that GOP obstructionism may leave them no choice but to go it alone in order to realize reform.

Which is right, I guess.

But it leaves this sort of… empty feeling on my pallet. It’s not fair to say that Democrats have no obligation to make their case to the public, nor is it to say that it goes without saying that Democrats should leave Republicans at the door over health care.

But I can’t help thinking that there is a certain gutlessness that has come to pervade much of the political process — an inability to act when acting is the right thing to do that seems to be a kind of runt of the litter progeny of the permanent campaign mentality that is all the more ubiquitous due to it’s impish stature. [Read more →]

“I now put the chances of a substantial health care bill passing at 75%, and the chances of the Democrats losing the house in 2010 at about 66%.” ~ Megan McArdle

Megan’s second estimate is absurd.  The 75% chance of health care legislation passing seems about right.  (By what statistical analysis?  Why – my gut of course!)  But really, does Megan honestly think that the Democrats will lose the House in 2010?  She predicts this will happen at a staggering 66% – based on what exactly?

I think that ramming through the bill on a party line vote makes it very likely that the Democrats will lose the house in 2010; the American public doesn’t like uniparty votes, especially on something this controversial.  A lot of liberals have gotten angry at me for saying this, but it’s not a normative statement; it’s an observation.  IF the Republicans had been willing to push forward on a controversial bill with no Democratic cover, we’d have private social security accounts right now.  But they weren’t, for a reason.

Again, sheer nonsense.  I’m the first to say the current proposals are no good (without major changes), but A) those changes might still happen, and B) the effects of any reform won’t even take place by 2010, at least not in any meaningful way.  So the public backlash over any ill effects won’t occur until at least 2012, and the public is so overwhelmingly anti-GOP right now that I can’t imagine a sudden anti-Democratic backlash because they “rammed it through” without bipartisan consensus. [Read more →]

Yglesias breaks it down: [Read more →]