No doubt following up from this Sunday BMG Thread (“Time for reconciliation on health care”), former DNC head Howard Dean today urged just that approach. HuffPo:
In light of Senate Majority Leader Harry Reid’s decision to give in to Sen. Joe Lieberman (I-Conn.) and agree to scrap a Medicare compromise, and with the public option already off the table, many ardent supporters of health care reform are giving up on the legislation.Former presidential candidate Howard Dean said in a radio interview Tuesday that he agreed.
“This is essentially the collapse of health care reform in the United States Senate,” Dean said. “Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.”
The piece continued: “‘Insurance companies win. Time to kill this monstrosity coming out of the Senate,’ wrote DailyKos founder Markos Moulitas on his Twitter feed Monday night.”
Hear, hear. Now the crucial question: just how far is President Obama prepared to go for health care? Far enough to use reconciliation? What do you think he should do?
Personally, not only do I think he should use reconciliation for health care reform, I think he should also use it for a climate change agreement. But then again, I am a constitutional originalist, and I believe that 50 votes in the Senate, plus the VP, should be enough to enact legislation, just as described in Article II, Section 7.
Discuss
50 Comments . Comments are closed.Reconciliation might get the ball over the goal line...
but does it give Democrats the bill they want?
One interpretation of how it won't work...
.
Does this sound like something the Democrats could use to create a "Public Option"? Doesn't to me.
Lawyers can accomplish anything
Never fear. A good lawyer should be able to get anything from health care reform to designation of Super Bowl Sunday as a national holiday through reconciliation. Everything has a financial consequence. QED.
The next important issue might be the composition of the Supreme Court (if it has to review the legislation), but that's for another day.
you pass what you can
with reconciliation (ie public option, medicare buy-in, etc.), then pass what you can't without it (ban discrimination against preexisting conditions, etc.) The former doesn't have 60 votes, the latter probably does. Simple.
Yes, excellent point.
And worth remembering if anyone tries to hide behind the "can't be reconciled" argument.
Pass the public option as a separate bill, later.
I think the reasonable thing to do is to pass a public option separately and second. If you pass it separately, you can tailor it so that it fits into the Byrd rule better. But passing a public option beforehand could lead to the conservative Democrats and Lieberman refusing to pass rest of the bill unless you kill the public option. Although you'd still want to pass it by the 2010 elections both for political reasons and because if we wait too long it might not happen at all.
Byrd Rule
Is that rule part of the organizing resolution at the beginning of the Senate term, or a law that can be reversed by a 50-vote margin?
They could expand Medicare with the Byrd rule
since it is directly related to the budget, and it's an existing program to boot.
Personally (and I've written about this before) I think lowering the age limit to 55 (or 60) is the wrong approach. I think they ought to instead add a different demographic: women who are pregnant, and mother and child for one year after the child is born. This does two things:
1. It allows the Dems to call out the Pro-life GOP. You really love somebody else's unborn child? Then help make sure it's born healthy, and gets a good start in life. That means medical coverage for the mother-to-be, the baby-to-be-born, and coverage for the baby and baby's source of nourishment, protection, and love.
2. It creates a huge group of people who have been on Medicare as an adult (or had their spouse on Medicare as an adult) and then had it taken away. These will be young adults who will have detailed experience of both Medicare and private insurance. If private insurance is better, there won't be any rumbling for expanded public health options. If, however, Medicare is better, you'll be creating a bigger and bigger voting bloc of people who want expanded public health care options.
3. It removes a major source of variance from the insurance industry, which is a good thing. Pregnancy is expensive, and for the most part insurers have no way to know how many children their female customers will have over the next x years. Removing this variable makes the demand for their coverage more stable, and that's good for them.
4. It has an obvious path for future expansion. Once this has been rolled out and is working, as demand builds, you expand upward. Babies to three years old get covered, then five, etc. Coverage can be expanded incrementally, as there's room in the budget, sufficient additional resources like doctors, nurses, and hospital beds, etc.
5. It also opens the door for other on-then-off patients. Currently, once you're on Medicare, you lose your eligibility upon final retirement. By implementing the 'Medicare for Moms' program, you create the infrastructure where it's normal for people to come on to Medicare, then back off of it onto private insurance. Once you've done this, then you have to ask: why not insure government employees with Medicare instead of BC/BS? Odds are you can get the same coverage at a lower price. Up next, perhaps the VA system. The VA hospitals could be used for their specialties (PT, amputee work, PTSD, etc) by both vets and others on Medicare, and other medical service specialists could serve the VA patients. When a vet needs heart bypass surgery, there's no reason to think the VA Hospital has the best specialists -- nor should they. By allowing vets to go to other specialists with more regularity, and by allowing those who need the skillsets that the VA excels in, both sets of patients get access to better care, more cheaply. There are other redundant insurance and care systems within the government, at the federal, state, and local level. How much more stable would our local budgets be if, instead of 10%+ premium increases each year and the standoff over GIC, our local employees simply were enrolled in Medicare as an employment benefit?
I think this is the best way to improve public health with the system we have now, and it has the side benefits of improving educational outcomes (healthier kids learn better), reduces layers of bureaucracy by streamlining the health care systems of the government, and has a built-in positive feedback system... if it does work, people will want more of it, which is how our government ought behave.
Without reconciliation
we could easily end up with a bill written by Joe Lieberman or Olympia Snowe. This isn't the change I made phone calls for.
I would like to see reconciliation done because it forces the Dems to show what they really support, without the excuse of Lieberman's vote. Even reconciliation might not get us to anything useful. At least we will know who to primary next time around. A vote today on drug importation illustrates what could happen.
I am disappointed in the votes by our two MA senators on a Dorgan amendment regarding re-importation of drugs. Some Republicans voted for it, perhaps to embarrass those Dems who wanted to kill it but didn't want to take responsibility. Here is a brief explanation of the amendment: http://news.firedoglake.com/20... and here is the roll call: http://www.senate.gov/legislat...
A post in another thread noted that getting to reconciliation can be complicated. I have no idea whether it is feasible in this case.
I think Democrats could get Progressives on board if they drop the individual mandate.
Without a public option, the insured and taxpayers have no options other than to pay 23 - 26 cents more per dollar than necessary for their own health insurance and for the health insurance they are underwriting (through their taxes) for Americans who cannot afford their own.
Think about about, for every $4 in taxes for health insurance, $3 pay for actual health services.
That - an individual mandate - along with no public option, no medicare buy-in for folks ages 50-64, no prohibition against annual cap on health insurance reimbursements, no driving down the cost curve is Liebercare and I don;t think I could support it.
Moreover, individual mandate is worth a ton of money to private insurers. Why give it away without getting a public option in return?
I agree
Forcing people to buy crappy private-market insurance (offered by an industry exempt from anti-trust laws and hence not even subject to normal market discipline) is not progressive, even if the government does pay for it for some people.
Wasn't that the MA model?
The individual mandate is necessary
The individual mandate is essential in order for the reforms to work. If you require insurers to ignore preexisting conditions (which the bill does and should) then people will wait until they get sick to insure, which will raise the cost of insurance for those who do have it, defeating the whole purpose of insurance. Instead of spreading out risk, people who get sick would get stuck with big bills while the healthy would pay nothing.
Also, there's other players in this besides the health insurance industry and progressives. Something that makes private insurers happy is not necessarily something that makes Joe Lieberman or Ben Nelson happy. (They do both get a significant amount of support from the insurance industry, but that doesn't mean it's the only thing they care about. Campaign contributions are only a means to an end, after all.) Stripping out the mandate would probably make Ben Nelson happy, since he could tell Nebraska voters that he prevented Big Government from forcing them to buy health insurance.
As a vehicle
for delivering health care reform, this thing has turned into a clown car. As it circles the circus ring of Congress, the clowns Lieberman, Snowe, Nelson, et al. take swats at it, and parts keep falling off. Now they've knocked off the public option and Medicare expansion, the last two things that made it worth doing at all. It's time to tow the thing away and get serious. Push those clowns off to the side and put together a real reform bill. Maybe it will be a high-wire act to do it, but I'd rather see the Democratic majority taking some chances to get something good passed than to have them keep bowing and scraping to the clown brigade.
I disagree
for a couple reasons. First, UserGoogol is correct to point out above that the individual mandate is necessary if we're also going to require insurers to cover those with pre-existing conditions. It also will help reduce costs by spreading risk across a larger portion of the population, which IS a progressive element.
Secondly, the individual mandate will have important long-term implications for health care that will help move it in a more progressive direction. If everyone is forced to get health insurance, the political pressure on insurers to lower costs (and on Congress to get insurers to lower costs) will be greater. People will have a much better sense of the true cost of health care.
profit and overhead unregulated
I do not believe this is true. Once the bill is passed political pressure vanishes until it is taken up again. There are only the requirements under the law.
One thing Rockefeller has proposed in committee and again on the floor is limiting profit, forcing insurers by law to spend 85 or 90 cents of each premium dollar for health services. I could live with this instead of a public option (in Medicare 97 cents of each dollar collected is spent on medical services.)
As it stand, insurers are not regulated in the current bill and on average only .75 cents of each premium dollar is spent on health services, the rest pays for profit and overhead. It is enormously inefficient and therefore irresponsible government to require coverage.
Someone (companies that provide health insurance benefits, individuals who buy their own, taxpayers who underwrite the cost of policies for every American who makes less than 88,000 a year) will be paying way too much for health insurance services.
I'm not buying that last bit
Let's look at who already wants lower insurance costs: * All non-medical corporations with American workers * All federal, state, and local government agencies * All small businesses * All consultants and otherwise self employed
This includes nearly all of the financially and politically powerful in America today, since they would all personally benefit from lower insurance costs, in the form of lower costs to their budgets.
If these groups -- which is a massive group of folks -- can't exert enough pressure, how in the hell would a few extra 20somethings with low wage jobs add to the mix?
Baby, bathwater
Two comments, one on content, one on strategy.
First, a question: Does anyone here really understand what's still in the Senate bill?
Comment on content: I'm no expert on the Senate bill, but it sounds like it has some pretty good stuff in it:
Here's another article that reviews the good parts of the bill.
In short, yeah, a public option or expanded Medicare might've been good, but is what remains good enough? Leading to my second comment, on strategy:
If the Senate bill is indeed an orgy for the insurance industry, then yes, it should be killed. But, on balance, it would have to be pretty horrible to justify the heavy political price of killing it. Doing so may very well give Obama his Waterloo, and frankly I think it worsens D's prospects for 2010. And don't expect a better chance at reform for several years- what's going to happen in the near term that will improve circumstances for reform? Anyone?
For me, what's important in health care reform is improved accessibility, portability, and some attempt to change the basic (fee for service) economics which, in my mind, are the real problems with the way we do healthcare. I don't need a government body to manage payment if the marketplace is structured to promote improvements in both quality of care and cost containment. As it sounds like both the House and Senate bills have elements that move the ball in the right direction, count me in.
Reconciliation is saving the baby, not throwing it out
The idea isn't to abandon health care reform, it is to enact meaningful reform. Reconciliation can accomplish that. A majority of the House favors substantive reform, and at least as many Senators do as favor the current legislation presumably.
In fact, I suggest that enacting a corporate welfare program for the insurance industry as outlined about by Neil is far more likely to be Obama's Waterloo than pushing for reform through reconciliation. If the Senate measure really is nothing more than you outline, it may blow Obama's base as surely as Patrick's three casino plan blew his.
it's not a heavy price to kill it
if there's no public option. A mandate without an option would be an absolute killer for us in 2010. It would quite likely be the biggest tax hike giveaway, for a lousy for-profit, 27%-skimmed-off-the-top product in the history of this country.
I think that is quite right
It feeds into two powerful lines of attack on the Democratic Party: from the right, they crush personal freedom with government mandates; from the left, they are a tool of corporate interests. In this case, both may be uncomfortably close to the mark. The result may be that progressives are left non-plussed and won't work hard, and opponents are energized.
JOhn McCain said last night that neither he or even Dick Durban had even seen the bill yet.
Another article
This is a very well-written article from the New Yorker on a lot of what's in the bill. Not directly, but more by analogy. Very interesting read.
Thanks
Atul Gawande is a must-read on this topic.
I trust Howard Dean and Bob: Reconciliation!
BMG Holiday Party?
This comment's not about health care reform but it's as good a place to ask as any... Does BMG ever hold a holiday season get-together, where we wear name tags and get to meet fellow posters? I'd love to meet some of the amazing people who gather at this virtual water fountain / cafe / salon / courtroom / legislative chamber / cloakroom / smoke-filled backroom.
Even me?
you are considered amazing by some
I'll buy you a drink to break the ice.
We haven't done that, but it is a good idea!
Maybe we can make it happen.
ingredients
our own space at a local watering hole or restaurant; finger food available; name tags
Sending regrets
Given that there is a bunch of taunting behavior going on, I certainly don't want to make myself more of a target by becoming less of an abstract presence.
Have faith
There are more good folks than not on BMG.
yeah, but the bad one in question has threatened kbusch
and me, for that matter.
Obama worse than Lieberman??
It is hard to describe just how duplicitous this new Glenn Greenwald post, "White House as helpless victim on health care," makes Barack Obama look. It's downright depressing if you like and care about Obama. What do BMG'rs think about this?
Deserves a diary
A diary, that is, where someone chases down all Greenwald's links and tries to weigh his thesis against counter-arguments.
Greenwald may or may not be misguided but I cannot imagine him being duplicitous.
please re-read
In case you misinterpreted, I did not say Greenwald's post was duplicitous, I said it made Obama look duplicitous. I agree with you that this subject - Obama's apparent betrayal of progessives on key issues like health care reform, economic recovery and war - deserves its own diary.
Oopsers
Sorry about that, hubspoke.
My feelings
2. If it passes anyway, an amendment requiring a strong public option should be attached to EVERY piece of legislation presented before the Senate.
3. If it fails, a bill calling for government-funded single-payer health care should be submitted in January.
4. No Democrat who advocated against the strong public option should receive a PENNY of Democratic party campaign funding.
I am outraged at this betrayal of my support by my fellow "Democrats".
This kind of back-stabbing will:
1. Bring down the Democratic party. The alternative will not be the GOP. 2. Bring people into the streets. Some of us may be too young to remember the "long hot summer" of riots and mayhem during the sixties. When elected government betrays the public, the public WILL react.
Rioting and mayhem over THIS?
Dream on.
To be fair
He did title the post My feelings.
The progressive Dems should walk if there is no public option
The value of health care reform without the public option is questionable at best. The progressive Dems still hold the trump card. Nothing gets passed until they are on board. They can and should hold out for reconciliation.
To those who feel the Dems should invoke Reconciliation...
I would issue a word of caution. Be careful what you ask for. We all know that nothing is forever and 2010 and 2012 could be years of political reversal. The reconciliation process has not been widely used by the Senate up til this point. The Republicans did use it but not on anything as large or substantial as healthcare. But I do think if it used for Healthcare the flood gates will open for use by future Senates on controversial bills. And remember, all we would need is 51 votes and we could pass anything we wanted (example, with the current mood in the country for limiting abortion funding and the right combination of Senators, abortion could be but back in play). Even though my party could benefit from such a usage of the rules I would not want the Senate being able to use this rule to pass bills which clearly should be passed by a 60+ vote. So while the short term thinkers might think this is good, I would remind them of the great bill the Dems passed a few years ago removing the Governor from naming an interim US Senator in MA... looked like a smart move and then suddenly all hell broke loose.
this is called 'concern trolling'
Is using it once considered using it more "widely" than using it four times?
Under the administration of President George W. Bush, Congress used reconciliation to enact three major tax cuts. These tax cuts were set to lapse after 10 years to satisfy the Byrd Rule. Efforts to use reconciliation to open the Arctic National Wildlife Refuge to oil drilling failed.
You're really something.
Maybe you could give a course in all of the "trolling" techniques.
Please don't insult my intelligence by equating this healthcare reform bill (1/6 of our economy) with tax cuts or drilling in Alaska. They are miles apart although I think Sarah Palin can see it from her porch.
Trying to minimize this as using it "once" reminds me of the expression "Other than that Mrs. Lincoln, how was the play?"
You comment was $quot;concern trolling$quot; which
I notice, you do not contest.
You claim, "The reconciliation process has not been widely used by the Senate up til this point," which is simply not true.
It was used three times to pass the controversial Bush tax cuts and once, unsuccessfully, to pass the controversial drilling for oil in the ANWR (the WR stand for Wildlife and Refuge.)
Until the Senate uses it more than four times you don't have a leg to stand on with this argument.
"I would issue a word of caution." = concern trolling
Don't bother issuing me any $quot;words of caution$quot;. God forbid I need advice from you.
But I will issue you and yours a word of caution on reconciliation. Do it at the risk of future reconciliations which you will despise!
DFTT
SDK
I'm happy to take that risk.
If there are certain categories of things that should require a supermajority, such as confirming judges for example, we should constitutionalize it. Otherwise if the GOP has the majority they too should have the ability to try to pass routine legislation without obstruction, provided rules are in place to allow the minority to offer amendments in good faith and be able to debate such. As for the naming of the US Senator, I have also said that such process should be constitutionalized at the state level to avoid playing politics with something like that.
Does anyone else find $quot;reconciliation$quot; ironic.
In any other context I think of the term as meaning bringing people together in agreement, patching over differences, etc. Here using the process called "reconciliation" is the majority saying to the minority, "We won - go take a hike!" Not that there's anything wrong with that:)
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