THE TREATMENT OCTOBER 26, 2009
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By now you've heard the news: Senate Majority Leader Harry Reid will be including an "opt-out" variation on the public plan in the health care bill he brings to the Senate floor.
It is not a full public option. It will not use reimbursements pegged to Medicare. As Ezra Klein says, it is still a major compromise for liberals. And yet it's also a lot more than liberals seemed likely to get, as recently as a few weeks ago.
Indeed, it is hard to overstate what a turnaround this is--or how quickly it happened. By late summer, passing any reform at all looked like a fifty-fifty proposition at best. And even as the political environment shifted, the public option looked doomed. It was going to take sixty votes to get a public option through the Senate. The votes just weren't there.
To be clear, they still aren't there.
The buzz is that Reid has between fifty-six and fifty-eight votes. And getting those last few won't be easy. Senators Mary Landrieu (Louisana), Blanche Lincoln (Arkansas), and Ben Nelson (Nebraska) haven't ruled out voting for a bill with an opt-out. But they've made very clear it's not anywhere near their first choice.
Maine Republican Olympia Snowe seems even more opposed. And, unlike the centrist Democrats, she's invested a huge amount of time in trying to make her own favored compromise (a public option trigger) work. Getting her on board with an opt-out will be even tougher.
Her vote is obviously not necessary if the Democratic caucus stays united. Word is that all of the wavering Democrats understand the importance of passing reform, which means nothing more than maintaining party unity on the key procedural question of whether to end the inevitable Republican filibuster. Once the filibuster is broken, centrists can vote however they want; Democrats have the simple majority they need to pass a bill. And that's not to mention the myriad ways of dicing the bill--and handing out amendments--in order to give every member a chance to look good for home audiences.
But make no mistake: The centrists have the power to kill the public option. And they may still wield it. Among other things, it's possible that the lobbying against the public plan is about to intensify. Like the rest of Washington, K Street had fallen into a sort of complacency about the public plan. It just didn't seem that likely to happen. You can bet they are paying attention now. And making plans.
Indeed, plenty of observers (and insiders) remain skeptical. The smart aleck take is that Reid is doing primarily to quiet down the left--to prove, to liberal activists and more liberal members of his caucus, that he's listening to them and that they have influence. The same has been said about Speaker Nancy Pelosi, who is busy pushing her caucus to unite behind an even stronger public option.
That seems overstated to me. I think both are pushing for stronger public options because they like the idea, on the merits, and believe they are close to getting the votes to support it. They're not sure they can succeed, but they think it's worth the effort.
In any event, political power in Washington tends is closely correlated with perception. If key members of Congress think it's important to satisfy progressives, then, by definition, it's important to satisfy progressives. That's another way of saying progressives have influence. And if progressives have influence, they may yet prevail on this issue. After all, they've been counted out before.
10 comments
Colorado, Nebraska?
- epnote2
October 26, 2009 at 9:05pm
I *am dreaming,* yes???
- Tgossard
October 26, 2009 at 9:52pm
epnote2- You know, that's the second time I've made that mistake. I'm not sure why. Some weird tic I guess. Anyhow, thanks for pointing it out. It's fixed now.
- Jonathan Cohn
October 26, 2009 at 10:08pm
Jonathan, as a resident of a hard-right red state, I am very concerned about my so-called elected leaders "opting-out" of any public plan, viewing it as a victory for Obama and a push toward socialism. Our Governor and state legislature are tone deaf when it comes to the needs of working-class citizens. Is the "opt-out" a temporary condition or a permanent one? I heard on several news progams last night that the opt-out would only be until 2014, at which time it would be available to all. I can certainly accept that kind of compromise. If the opt-out is permanent, I am very disillusioned because the very people who need it most and would benefit most from the PO will never have a chance to sign up. States like SC, AL, MS, OK, possibly even TX, UT, WY and ID will simply demagogue this issue at the state level and the right wingnuts will prevent the PO from ever seeing the light of day. Does anyone have more info on the opt-out provision?
- desertdog
October 27, 2009 at 10:42am
I, like desertdog, was confused by the morning's "opt-out" explanation. First I thought that it meant that *all* states would be required to have a public option come 2014. I heard a story later that I *think* explains it better: States would have until 2014 to make the decision to opt out, at which point, if they haven't made this decision, they'd be locked in. Does this sound right to others?
- desperjm
October 27, 2009 at 11:52am
After doing a bunch more reading and research today, it looks like the "opt-out" means everybody is in until 2014. At that point, individual states can then decide to get out. I guess that's not quite so bad as I originally feared, but I still think it will make it far too easy for conservative, Ayn Rand types to deny their citizen's meaningful health reform. Perhaps even more significant, it gives the insurance companies that much more time to "work the refs" on the state and local level.
- desertdog
October 27, 2009 at 2:47pm
I believe we can beat the filibuster with a public option in the bill. If we do, I believe we will also get a number of Republicans to switch sides and vote for reform. The trick is beating the filibuster-- that will take discipline. Can Harry Reid pull it off? The opt-out provision sounds worse than it is. I doubt that more than 2 or 3 derelict states will opt-out (the same ones that can't be bothered to educate their citizens). There will be economic consequences from making such a poor choice, and in time they will come around. It is simply too good an idea. Neil
- purcellneil
October 27, 2009 at 2:53pm
Yes, Jonathan, The lay person reading TNR needs an explanation of how the "opt-out" will play out esp given the probable shift of countless more patients into state-run Medicaid. Frankly, I think Sen. Reid's proposal is a cop-out. I suggest a read of David Swanson's Oct. 27 piece in OpEd News, States Permitted to Worsen but not Improve Healthcare? http://www.opednews.com/articles/States-Permitted-to-Worsen-by-David-Swanson-091027-857.html
- hmseil01
October 27, 2009 at 3:24pm
All the more reason to get something on the road as soon as possible.....2011 at the very latest....so the elected leaders in those states will have to go to their voters and say "You've had this for a couple of years , but now we've decided to take the PO away and reduce your choices to private insurance only". Good luck with that argument.
- desertdog
October 27, 2009 at 3:31pm
I have the same question here-for you public option fanatics-misrepresenting how competition will be enhanced and how private insurers will be more honest. You plan is to see the cost structure of the public plan with about a 20% lower cost basis (Medicare plus 5%-as if you've found the Holy Grail)-that's how much less the public plan would pay doctors and hospitals than private insurers. As private insurers pay-out 89% of premiums to providers and to state premium taxes-just 11% covers overhead and profit. If they eliminated that 11%-they'd still be about 9% higher than the public option. How can they compete and how do you make make them honest? It's like starting a college football game, say USC-Notre Dame, and giving Notre Dame 21 points. Yes, there will be a game, yes I guess USC will be honest knowing they will have nearly impossible task to win---that, I guess, is how progressives define competition. If you're serious about competition and honesty-then-once you figure how you'll seed the cost structure of the public option-then-could you hand the same cost structure to the private insurers? If not, why not. The true numbers-as disclosed by the CBO (public option costs 10% less with full Medicare reimbursement rates) and the Center for Medicaid/Medicare Services (public option costs 11% less with Medicare plus 5%)............is............if you give the insurance companies the same cost structure...........they'll charge less than the public option. Is this why you won't support a full and fair competition. Does that make your, and Obama's, attacks on the evil insurance companies look so stupid now? I grow weary of the progressive spin on healthcare. Here's what I'd do: 1. Immediately-and saintly Obama could have done this day 1-let's find the people right now who qualify for Medicaid and get them covered (experts say this is 10 million). 2. Obama cuts $200 billion from his budget which is scheduled to grow to $800 billion by 2019 (and please stop the childish Obama blame game that all of that is due to Bush's policies-after all-it's 10 years from now and you are the man of hope and change) 3. We do full scale tort reform: limit pain/suffering to $250,000, no punitives and a special tort court (where, a panel of 3 independant doctors must certify that theory of plaintiff is founded in medical knowledge) 4. You guys explain to me why: in a low cost country like Japan, 9% of their citizens don't purchase insurance from non-profit insurers, 6% of the federal employees (contributing only 25% to the total premium costs) fail to purchase and 10% of private employees (contributing, again, just 25% of the total premium costs) fail to purchase. My guess, 10 to 15 million Americans prefer their uninsured lifestyle to coverage. Personally, I'm not about to tax anyone-even the hated millionaires, to cover these people 5. I'll give you some subsidies for the near poor-we can work this out Out.
- lobosven
October 27, 2009 at 8:49pm