THE TREATMENT OCTOBER 21, 2009
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Armed with favorable cost estimates from the Congressional Budget Office and emboldened, perhaps, by the self-destructive behavior of the health insurance lobby, House Speaker Nancy Pelosi plans to propose that her caucus unite behind a reform bill with a strong public insurance option. She will do so at a Wednesday meeting of House Democrats, according to The Hill's Mike Soraghan, who was (I think) the first to report the story.
Pelosi's actions have provoked two very different reactions from within the reform community: Glee and fear.
The glee comes from people who think Pelosi is making a smart strategic move. Yes, a strong public plan remains a tough sell, particularly with centrists in the Senate. But precisely because the Senate will pull the bill to the right, it's critical that Pelosi pull it to the left while she can. The public option is gaining momentum right now, thanks to strong polling numbers and a realization, among members, that requiring people to get insurance is a bad idea if the available insurance options aren't very good.
It helps, too, that CBO has apparently determined the strong public option--which would pay at rates pegged to five percent above Medicare--could save somewhere in the neighborhood of $100 billion. Given what happened during the stimulus debate, when centrists in the Senate successfully pushed to scale back the bill, it'd be foolish of Pelosi not to anticipate that move.
What's more, this way Pelosi can force the Blue Dogs, many of whom oppose the public option, to confront the trade-offs as they exist. If they don't want the public option, she can say, how else will they find the money the public option might save?
The fear comes from people who think this move will backfire--by alienating the Blue Dogs, centrists in the Senate, or both. These people note that we're still not all that far removed from August, a time when reform's very survival seemed very much in doubt.
Things look good now, the argument goes, because of united Democratic consensus around the basic principles of reform. But the consensus is fragile. Senators Kent Conrad and Ben Nelson have offered hints they're open to some sort of compromise, but Pelosi's proposal surely goes too far for them. And precisely because centrists in the Senate will never go for such a bold public option, the House's Blue Dogs will scream, particularly if they are forced to commit on this before even seeing what the Senate does.
Meanwhile, the public option threatens almost every special interest group in one way or another. I.e., it's not just the insurers. Fighting all of them, as this argument goes, would be suicidal--even at this late stage of the debate. It's fine to take advantage of the momentum behind the public option. But proposing something this far out, the critics say, could make a workable compromise less likely rather than more.
It's a predictable split, to be sure, although the divide seems to be have as much to do with proximity to negotiations as it does to substantive feelings about the public plan. More often than not, the people celebrating are watching the debate from a distance. The ones sweating it out tend to be the ones in the thick of things, trying to piece together a deal.*
That doesn't mean the latter are correct, by the way. Having an inside view can give you unique insights. Or it can give you tunnel vision.
For what it's worth, I think both arguments have a certain logic to them. This is a judgment call and not an easy one. If anybody tells you they're certain which choice is the right one, they're lying to you. Or maybe themselves.
Of course, it's also possible that Pelosi is doing this primarily to show the left that she tried--and that, at the end of the day, the votes for a strong public plan just are't there. I guess we'll see about that soon enough.
Update: My original item made this seem more black-and-white than it really is. There are certainly plenty of people on the inside who think this makes sense, just as there are plenty on the outside who don't. So I rewrote that sentence, with more appropriate qualifiers.
4 comments
I'm reluctantly on the "Nancy Pelosi, Genius" side of this one. What she's doing is calling the "blue dogs" and "centrists" on their own bullshit. Spend less! Save more! Don't make more changes than the broadest possible public consensus will allow! cry the blue dogs and centrists. Well, in point of fact a strong public option would minimize spending, maximize savings, and satisfy the largest popular majority of any health care reform now being considered. So either the blue dogs and centrists are actually in favor of fiscal restraint and popular consensus, in which case they have talked themselves into supporting a maximally robust public option, or everything they've been saying about healthcare for nine months now has been lie piled on lie with the sole intention of defeating any healthcare reform. Now is the time to find out whether the blue dogs and centrists are all craven bullshitters, or whether Joe Lieberman is an outlier and the rest of them actually mean what they say. Now, when the real work of caucus-whipping needs to start in earnest. If the blue dogs and centrists are all Liebermanian frauds, then Pelosi and her lieutenants have a very different project in the next three weeks than they do if the blue dogs and centrists can be counted on to act on their own alleged principles. And that's not information you want to be surprised with the week before the decisive floor vote; that's information Pelosi needs immediately. The blue dogs and centrists are kind of like the French as allies in war. It's not that you can't beat the other guy if the French are on his side, it's that beating the enemy and the French is a different challenge than beating the enemy with the French on your side. The danger is planning the battle counting on the French as your ally and then discovering at the last minute that the French are fighting for your enemy instead. That's when you're screwed. So the sooner Pelosi knows which side the blue dogs and centrists are really on, the more likely she is to introduce a passable bill.
- rhubarbs
October 21, 2009 at 8:33am
Let's not forget the latest H-bomb waiting in the wings. Congress and the WH got so angry at last week's whinefest and bogus data from the insurers that now they've threatened them with elimination of their decades-old exemption from antitrust laws. What I can't fathom is why they ever had this exemption in the first place? Talk about opening your mouth and exposing your culpability. To quote Shakespeare's Gertrude: "Methinks thou protesteth too loudly".
- desertdog
October 21, 2009 at 10:17am
Democrats in general and progressives in particular should be very fearful and avoid advocating or implementing any non-bipartisan or blue-dog-adverse reform. Rather they should opt for having no public plan to compete with insurance companies and wait for their rewards from voters who pay more for and get less from health care policies they are mandated to purchase. Such an approach to health care is a modern-day-parallel to the peace-in-our-time policies negotiated between two equally reasonable parties that worked so well for both parties concerned many decades ago. We can all relax and look forward to repeating this successful strategy on climate change and bank regulation. It's so comforting to reincarnate Chamberlain as our fearless leader to guide us on a host of critical issues.
- gdbittner
October 21, 2009 at 12:30pm
"requiring people to get insurance is a bad idea if the available insurance options aren't very good." Not necessarily if that's the only way to afford to provide universal insurance without blowing the deficit sky-high. Isn't it a false dichotomy to say individuals either are free not to buy insurance or must buy good insurance (i.e., as Republicans propose, insurance so good every Congressman, staff person, and family must choose it)? Why not force them buy insurance for the kinds of expensive diseases/catastrophes that most people don't get until they hit Medicare age (thus rates will be lower) and let them gamble on whether they break a leg or something that, if they don't self-insure, they'll have to borrow on their credit card or somesuch (go create a student-loan like program for such cases if the credit isn't available).
- Lymon1
October 22, 2009 at 1:40pm