Health Care

It would be nice if members of Congress voting on health care reform thought more about what's good for the country rather than what's good for their re-election prospects. But let's not kid ourselves. Many Democrats are plainly spooked by the prospect of supporting a measure that, according to the polls, a majority of Americans don't support. Some of us have been arguing that the polls are misleading. Among other things, most people don't seem to know what's in the bill.

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David Brooks thinks it. David Gregory thinks it. The Washington Post editorial page thinks it. And, what the heck, I think it. If health care reform passes Congress, the final legislation probably won't cut the cost of medical care as quickly as seems possible on paper. But would the legislation make a good start--as good a start as possible, given political reality? Brooks, Gregory, the Post, and plenty of other critics seem to think the answer is "no." I think they are nuts.

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Stick With Plan A

Harold Pollack is the Helen Ross Professor of Social Service Administration at the University of Chicago and a Special Correspondent for The Treatment. The Washington Post has an editorial this morning that doesn't exactly oppose the President's health reform proposals, but gives the President a rap on the knuckles for not being more aggressive controlling costs. They are particularly aggrieved that the President proposes to delay the implementation of the "Cadillac tax" on high-cost health plans to 2018. Count us among the worriers. The tax is key for two reasons.

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When I was growing up, the filibuster was hardly ever used--except, of course, by the Dixiecrats (southern Democratic senators, racists mostly) and some conservative Republicans. When civil rights legislation was introduced by liberal Democrats, the right wing of the party would mobilize and stage real filibusters, senators often orating for a dozen hours at a time and then leaving the podium only for another recalcitrant. These legislators did not much disguise their intentions in procedural balderdash.

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Passing health care is going to require convincing Representative Bart Stupak, or at least his would-be allies, to vote for the bill despite their concerns that it is tantamount to federal funding of abortion services. Slate's Timothy Noah has come up with a novel argument that might help. It isn't tantamount to federal funding of abortions: A central puzzle of the health reform debate is why Rep. Bart Stupak, D-Mich., keeps saying that the Senate-passed bill allows taxpayer dollars to be spent on abortions. The U.S. Conference of Catholic Bishops says it, too.

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My colleague Jonathan Chait has a terrific summary of the philosophical divide separating Democrats and Republicans on health care: When you consider the differences between Democrats and Republicans on health care, you probably think in terms of scale. Democrats want to enact a big reform, while Republicans favor incremental progress.

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Harold Pollack is the Helen Ross Professor of Social Service Administration at the University of Chicago and a Special Correspondent for The Treatment. There's been more positive attention of-late to the idea of high-risk pools. Some concrete numbers underscore why the idea doesn't deserve it. Most recently, Ross Douthat responded to a nice Treatment piece in which Jonathan Cohn explained why high-risk pools are an infeasible and inhumane response to the lack of health insurance coverage.

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News on health care reform will increasingly be about individual members, as President Obama and House Speaker Nancy Pelosi try to accumulate the 216--er, now 217--votes House Democrats need to pass the Senate bill. The widely held assumption among insiders is that the Democrats can count upon about 200 "yes" votes right now, or maybe a few more. There are, meanwhile, somewhere between 30 and 40 House Democratic votes up for grabs. Thursday brought several developments.

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Ezra Klein has a big exclusive: He's gotten hold of a consulting firm's report projecting that Wellpoint insurance would be the big winner if health care reform fails to pass. It's not hard to see why, as Ezra explains: Wellpoint's business model is uncommonly concentrated in the individual and small-group markets. Those are the exact markets that health-care reform will drastically change. Those are the markets where people get rejected for preexisting conditions, where insurers spend 30 cents of every premium dollar on administration and where rate hikes are volatile and constant.

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The Perfect Storm

Marc Ambinder has a nice analysis of how health care reform came back to life after the Scott Brown election in January. He calls it a "perfect storm": President Obama and the Democratic leaders in Congress made some smart choices, but they also benefited from good fortune, in the form of outside events that helped alter the political landscape. Chief among these was the decision by Anthem Blue Cross in California to announce its huge premium increases. Ambinder's summary is a good way to catch up on the debate if you've been tuned out for the last few weeks.

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