So the House passed a landmark health care bill, and everyone's trying to figure out what it all means. Is passage of a substantial reform now near-inevitable, as the White House seems to be claiming? Or was this the peak, as the Republicans claim?
I don't think you can deny that this adds momentum to the campaign (unless health care reform's favorables, now well below the unfavorables, slip still further). It certainly demonstrates that Nancy Pelosi is a hell of a speaker, whatever you may think of her personality or politics.
I know that Amy Sullivan thinks that she and the leadership committed something close to malpractice by not getting the pro-lifers involved sooner, and thereby setting up the caucus for a deal which banned the use of federal funds to buy any insurance that covers abortions. But I'm not sure that even that charge really sticks. The fact is, on a pooling basis--and that's the level at which the federal government operates--giving someone money to buy insurance that covers abortions is exactly the same thing as directly paying for their abortions. The original compromise, segregating the funds so that the federal subsidy wouldn't pay for the abortion part, was a transparently ineffective gimmick.
How transparently ineffective? If it really was just her money buying the coverage, the rider/segregated funds distinction wouldn't matter. Obviously, the reason it does matter is that funds from some other party--possibly a pro-life party--would be helping to pay for the abortions, either through the fungibility of tax transfers, or premium pooling.
I don't see how anyone ever thought this was going to fly; there are (as we just saw) more pro-life members of the House than pro-choice, and they're not actually total idiots. I knew this was coming two years ago, and not because I'm sort of amazing prognosticator. Medicaid in most places covers abortion only in the cases of rape, incest, and the life of the mother because, well, when the government provides your health care, the procedures that are covered will be determined politically. I had thought that Democratic feminists understood the trade off they were making, and believed that it was worth it. But many of them seem to be genuinely surprised that health care rules will be written with respect to the opinions of the National Right to Life Committee.
I think Pelosi did about the best she could with what she had--maybe a little better, even. The core question now is what happens in the Senate. Every time this project goes through another iteration, its price tag goes up--the cost of buying support from recalcitrant lawmakers. But the mechanisms used to pay for those costs are pulling father apart: excise tax versus income tax, strong public option or no. Normally the senate just trims down the more extreme House provisions, and the price tag. But at this point, every provision is attached to a dug in and very motivated interest group.
Moreover, the reason the House pushed this so fast is that it's getting politically tougher. The favorables on health care are falling, the unfavorables rising, and unless the passage of Saturday's bill reverses this trend, it's just going to get harder to pass anything. I don't know if it's actually true, as I've heard Republicans claiming, that Pelosi scheduled the vote on a Saturday because she didn't want any more Democratic lawmakers going home and talking to upset constituents. But whatever the reason, keeping Congress in town over the weekend to vote on a bill that doesn't take effect until 2013 doesn't signal a really healthy initiative.
The one thing I think we can say definitely is that the gross cost of the bill is going to stay on an upward trend. The problems are being papered over with special gifts to whatever interest groups wavering legislators most favor. That's also going to mean the cost control will be underwhelming.
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Imagine that we were going to have a debate over this bill, and the winner was offered a valuable prize. I offer you the opportunity to support or attack this bill - your choice.
Which do you choose?
Between now and when this bill really engages (if it becomes law), there will be many elections for congress and perhaps even a presidential election. During those cycles, this legislation will be skewered by some of the most talented ad-writers in the business... and there is *plenty* of fodder for that. This bill is a disaster. A mashup of crazy that is already being abandoned by the Senate.
And even if a Compromise Bill is reached, we're still talking about Pelosi and Reid. Megan might think a lot about them for parliamentary reasons, and I might concede some of that, but in the absolute light of an election cycle those two are the best thing to ever happen to the RNC. Any compromise that they come up with will still be pork-laden, poorly focused, and chock full'o fodder for the RNC to attack.
To paraphrase Carville "if the RNC can't win, given this situation, they don't deserve to exist as a party anymore..."
Even if something like this becomes law, don't doubt the possibility of a Republican congress killing it in 2010 or later.
So, are the R's going to override Obama's veto, or are they going to wait until the subsidies kick in in 2012 and then take away the resultant lollipops?
They promised to abolish the Dept. of Ed and repeal the Assault Weapons Ban in 1994, but somehow it never happened.
Dept. of Ed, yes, that never happened.
The Assault Weapons Ban is gone, though. That had to be re-authorized, and it quietly expired. GWB, in one of those Presidential hypocrisies that all Presidents use, promised to sign the bill re-authorizing it if the Congress passed it, knowing that it wouldn't.
"It certainly demostrates that Nancy Pelosi is a hell of a speaker ... "
Don't underestimate the power of being able to selectively distribute $700 billion dollars.
The abortion issue demonstrates the obvious.
Once, government becomes a health insurance provider, all health insurance decisions become political.
This is a bad omen.
A feature, not a bug.
Derek
Once, government becomes a health insurance provider, all health insurance decisions become political. This is a bad omen.
Government became a major league provider of health insurance in the 1960s. It's not an omen -- it's something we've been dealing with for over forty years. Google "Hyde, Henry."
OK.
But the question remains -
Do you want even MORE government control of what is probably the most important aspect of your life - your health?
Kinda pushing the limits of wishful thinking here, Rob. Killing the health reform once passed will be at least as difficult as passing it. Do you really think that Republicans can get a majority in the house and 60 votes in the Senate? And Obama won't use his veto?
Good points, all, and a Republican majority is clearly not going to happen in the Senate - and would be a "barely" in the House, if at all.
Even so, this bloated porker barely passed last night. I'd have to think that a significant shift in the House will lead to all sorts of threats to it. Funding, for one.
Even so, this bloated porker barely passed last night. I'd have to think that a significant shift in the House will lead to all sorts of threats to it. Funding, for one.
I'd have to think you've never seriously looked at how broad-based social insurance programs play out. Hint: voters pretty much never stand for letting them be abolished.
As others have said elsewhere ...
If the plan is so darn good, why does the House bill include 5 years of jail and/or a $250,000 fine unless you participate.
Do you have a cite for that? Because I'd love to read it if you got it.
Here is the link to the letter from Charlie Rangel's committee.
Here is the link to the letter from Charlie Rangel's committee.
http://republicans.waysandmeans.house.gov/UploadedFiles/JCTletter110509.pdf
Even if there were a link to a "letter from Charlie Rangel's committee," I'd want to see some evidence that such a provision was actually in the bill...
The letter is a PDF so I cannot cut and paste, but the first paragraph states:
"This is in response to your request for information relating to enforcement through the Internal Revenue Code ("Code") of the individual mandate of HR 3962 ... you specifically inquired about penalties for a willful failure to comply."
Sorry, spoke to soon.
Those are penalties for tax evasion, generally. Under the bill, if you don't obtain health insurance (subject to a number of broad and important exceptions*), you will be penalized with a tax. And if you fail to pay that tax, you will be subject to the IRS enforcement. So I suppose what you're saying is technically true, but totally misleading.
Ultimately, this comes down to the question of the mandate. If you believe, as I do, that people (who are able) should have to buy health insurance, then it's entirely reasonable to penalize noncompliance with the mandate.
*For instance, the tax doesn't apply if purchasing health insurance would "result in hardship" to the individual. Or for those whose lapses in coverage are de minimis. As far as legalese goes, this is about as broad as it gets...
Please keep in mind that a family of 4 with an income of $55K a year will be required to pay -cash out of pocket- more that $5k a year or pay a penalty (and get no health insurance at all.)
From my way of thinking - forcing a family of very modest means to cough up %10 of their pre-tax income or pay a penalty sounds draconian.
I will leave it for you to decided that (if you are not in that situation) is OK for the common good.
Luckily neither of us have to make that determination. Again, the exceptions written into the enforcement enforcement paragraph cover your scenario. If purchasing health insurance would "result in hardship" to the tax-payer (be it an individual, a small-business, etc.) then they won't have to pay the tax penalty. Again, this is an extremely lenient standard in legal terms.
There's a reason this bill is 2,000+ pages. It's anticipates scenarios like yours. The law will not be enforced when it would draconian to do so. I think this is a pretty sensible way to provide an "out" in a system of mandatory coverage.
GC - "If purchasing health insurance would "result in hardship" to the tax-payer ... then they won't have to pay the tax penalty."
Please note the figures I referenced (actually from the Bacus/Senate bill - I have not poured through the House bill yet)
$55K is above the median AGI of US taxpayers.
I'm not up to date on current US demographics, but I think a family of four is still close to the norm for married households.
So, are you telling me that the IRS is going to show COMPASSION to an average income tax filer who chooses not to pay a tax penalty?
If so, I have GOT to move to Virginia.
The amazing part is who deluded some people are. On another forum, some guy told me he really wants this bill to pass so he can get some surgery he can't currently afford. I didn't have the heart to tell him that the earliest it takes effect is 2013...
The amazing part is who deluded some people are. On another forum, some guy told me he really wants this bill to pass so he can get some surgery he can't currently afford. I didn't have the heart to tell him that the earliest it takes effect is 2013...
Maybe what he means is he can't afford to pay out of pocket -- and he can't get insurance to pay because a preexisting condition means he can't get issued a policy. In which case he's in luck if HCR passes, as provision is made for people with preexisting conditions immediately. Not so amazing, really, when you think about it. Just the common sense type of regulations that denizens of other advanced industrial economies have been enjoying for decades.
It's not common sense to cover expensive people in full when they can't pay even 1% of their costs.
You can't actually save all the million dollar babies, even if the government says you must pay out (and you haven't even cashed a single premium check anyway).
I think Pelosi did about the best she could with what she had--maybe a little better, even.
This sentence doesn't express a rational thought. I am sitting here wondering what sort of mental activity was going on that would generate such a sequence of words.
This sentence doesn't express a rational thought. I am sitting here wondering what sort of mental activity was going on that would generate such a sequence of words.
Simple. It's a very solid piece of legislation. It outlaws the use of recision by insurers, and it also prohibits them from denying coverage based on preexisting coverage. And it sets up a robust subsidy system that gets us to 97% coverage. All while being deficit neutral. It's a shame the eventual legislation making it to Obama's desk is likely to be less progressive, but still, this is progress...
This was the high point. This should be blindingly obvious to all but most deluded people. The bill passed Saturday night was pretty much the only bill that could actually pass in the House- more watered down and cheapened, it would lose votes on the left, and more expensive and government involved, it would lose the small number of Blue Dogs it actually garnered. Even if the Senate Democrats cram a bill through, and I don't think they have snowball's chance in Hell, whatever emerges from conference won't be passable in the House. The divide in the Democrat Party itself is just too deep on this issue, and their plans are just too unpopular.
Saturday was Pelosi washing her hands of the matter. She passed a bill and will let the Senate take the blame for failure. Senate Democrats will now let Republicans filibuster it down so that they don't take the blame either. Viewed from Democrat perspective, this path preserves the maximum amount of political capital from the entire debacle of the last 4 months.
Cap and trade will suffer the same fate (in fact, if the original bill had been voted on today, it would fail in the House)
Pelosi has a 60% majority in the House, the House rules let her rule pretty much with an iron hand, she needed 218 votes, and got all of 219 Democrats (+ 1 Repub), losing I think 39 from her own team.
The Senate looks like it is going to drag this into next year.
Polls are now majority against the plan (44% for, 52% against) and the trend line is "against" rising.
Among the critical "Independents" -- who control the political life and death of Democrats in swing jurisdictions that were held by Republicans not long ago -- opposition to health reform has risen by 15 percentage points to an outright majority of 53%.
The Democrats just saw their team lose big in Virginia and the normally totally Democratic state of New Jersey.
The Senate is going to have great fun passing this bill.
Pelosi has a 60% majority in the House, the House rules let her rule pretty much with an iron hand, she needed 218 votes, and got all of 219 Democrats (+ 1 Repub), losing I think 39 from her own team
Jim: it's been obvious for some time now for anybody reading the tea leaves that Pelosi and Reid both have the votes to get a bill through. Pelosi allowed a bunch of her caucus to join the Republicans because this has been in the bag for a while now. Same thing with Reid: he'll obviously not get the sixty from his caucus on floor votes that he'll get for cloture. But he will get the sixty for cloture. I suspect he'll drop the opt-out public option in favor of the triggered public option, thereby exchanging Jomentum for Snowe. At least that's what I would do.
Indeed, I think passage is in the bag: the only question is whether or not he's able to get a watered down public option or not. I'm guessing in the end not, but I'm also guessing the House manages to keep it in the conference report (perhaps in exchange for a serious watering down of the millionaire's tax, which isn't at all popular in the Senate).
You fellas have been whistling past the grave yard for months now with talk of how HCR can't possibly pass. Well guess what? Democrats have fat majorities in both chambers, and one of their own in the White House, and elections have consequences.
Democrats "have" fat majorities, yes.
But the political trend is such that even the bill doesn't pass, Democrats are going to hemorrhage seats in both chambers even if they don't pass the bill into law. If they do, they run into the buzz-saw of 50%+ public opinion that opposes the bill. ...and how does it influence dynamics that Sen. Reid is one of the most vulnerable?
One thing I agree with you on: there are more votes possible in the House. Speaker Pelosi arranged to help protect some endangered seats by letting them vote "no" once passage of the House bill was assured.
But that merely underscores the problem Democrats face: If they vote for this bill, many will be voted out of office. Ideology is fine and all that, but getting voted out of office is a personal crisis to the person who loses his/her seat.
Rahm created the super majorities by expanding the tent to include conservatives who saw a better chance to win by running against Bush than by running with McCain. Now the problems of maintaining that coalition of disparate views are coming to a head.
Health Care Reform and Cap'n Trade will suffer as a result.
To sum up: Pelosi was protecting Representatives, like you said. It was a political decision because the bill is extremely unpopular. Doing unpopular things gets marginal politicians thrown out of office. Sen. Reid is vulnerable. His Senate coalition cannot get 60 votes on something that will satisfy both moderates and liberals.
Conclusion: election-calculus politics kills the bill. Senators (and/or Representatives, if it makes it to being sent back to the House) will vote their own best long-term interests.
Jasper, if it was so obvious that Pelosi had the votes in the bag for some time, then why did she allow the last-minute up-or-down vote on the Stupak amendment after days of furious negotiating?
"That's also going to mean the cost control will be underwhelming."
Federal government cost control of social programs is underwhelming by definition. The history of Medicare and Medicaid cost controls should be instructive. The federal government has had 45 years to control Medicare/Medicaid costs. Why believe its future efforts would be more efficacious?
Since when did "gross cost" over a 10 year span become an even halfway reasonable way to evaluate legislation? Moreover, what does "gross cost" have to do with cost control? Net cost is what matters for cost control in the short run, and regulatory provisions are what "Bends the curve" in the long run.
Unless you have some reason to believe the compromises to get the bill passed("special gifts") are going to effect long-term cost savings(curve bending) or that they will not be offset, then you are just rechewing Michael Steele's pablum.
In fact you have a reason to believe costs *will* be offset, as Obama has required the bill to be deficit neutral. The 10-year gross cost of the defense bill passed less than one month ago was $6.8 trillion.
You are either completely without a sense of proportion or you don't understand the most basic principles of finance.
I discussed none of the arcana you mention in your comment.
I believe I have a very well developed sense of proportion. I understand finance quite well, thank you. I am also old and experienced; and, I have watched the US federal government over-promise and under-perform for a lot of years. I am a participant in both of its current Ponzi schemes. However, I do appreciate the far greater potential of the proposed new Ponzi scheme.
I do, in fact, believe that some of the costs will be offset, on the backs of Medicare recipients and others, through denial and restriction of service. I am currently "death panel" material; and, I do not feel confident with my future in the hands of Dr. Exekiel Emanuel anymore than I would were it in the hands of Dr. Jack Kervorkian.
I believe I understand full well how the curve would be bent. I hope you do as well, because it will have been bent relatively little by the time it becomes meaningless to me. You, on the other hand, will likely be "bent" far more severely. Enjoy!
Zosima- "The 10-year gross cost of the defense bill passed less than one month ago was $6.8 trillion."
OK, so what.
I can (and do) purchase health insurance for my family.
I cannot buy national defense for my country except through taxation and the defense bill.
(As an aside, the $6.8 trillion dollar defense bill was passed by Nancy Pelosi and Harry Reid.)
Would you prefer the US to reduce our national defense?
Do you know something that Nancy and Harry don't know?
Spoken like a true conservative: national defense spending can be as huge and as wasteful as all get out, but comparatively modest spending on health care? No we can't afford that.
In the meantime, we have spent God knows how much on the unnecessary Iraq war (plus a few thousand lives , but who's counting?)Maybe we can afford universal health insurance if we weren't spending trillions on a useless war, eh?
We have also given away more money to Megan's friends the bankers in ONE year than the health care bill will cost in ten, but that's apparently A-OK.
Bottom line, of course we can afford universal health insurance-just like EVERY OTHER industrialized country does.
Stonetools - "national defense spending can be as huge and as wasteful as all get out..."
As I stated before, Pelosi and Reid passed the defense budget which President Obama signed.
Are you telling me that Pelosi, Reid, and Obama believe in "spending ... as wasteful as all get out..."
I was Hoping for Change That I Could Believe In.
Megan is right about Pelosi . Pelosi got the job done; she led the troops up the hill and won! In this, she has shown she has more cojones than Obama and Reid put together.
Its now up to those two to each grow a pair and finish the job.
The problem is that Pelosi had something they didn't, a workable majority in her chamber. If filibuster were possible in the House, she would be in the same boat Reid is. In other words, it isn't a question of balls.
Not only will health care pass, probably with a public option, but I predict that we will see single payer by 2024, if private health insurance costs keep rising the way they have.There, I said it.
Don't know about 2024, I suspect the US government to be bankrupt by then, but there is absolutely no chance of a bill being signed before 2011.
And we'd still have the contaminated food supply actually giving us the bad health that requires so much 'healthcare'.
most americans live off corn syrup and soy and high-gluten wheat and potatoes fried in corn oil, suffer reduced immune capacity and nutrient deficiencies, leading them to need more doctor visits and hospital care.
it's the government-backed agricultural subsidies leading private health insurance costs to rise, stonetools.