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A Reality Check on Health-Care Reform


My basic experience with Twitter is that you can say a lot in 140 characters. But you can't do a very good job explaining what you just said. For instance, today I tweeted -- and yes, saying that makes me feel like an adorable little songbird -- "Am I the only one not particularly worried about developments with the health-care reform bill? What's surprising here?" A lot of people wanted me to explain that. So here we go.

There is nothing about this moment in the legislative process that was not predictable. Nothing. Zero. Not one statement by one player. Indeed, the single surprising development is that Olympia Snowe is now paying lip service to a public plan. But that's it.

The big news today is that Obama is slipping in the polls. The Washington Post's new poll, for instance, has him slipping all the way down to ... 59 percent? In the Gallup poll, his approval rating has, err, "fallen" from 56 percent to 61 percent. An average in the high-50s and the low-60s isn't necessarily the stratospheric ratings Obama registered in the immediate aftermath of his inauguration. But these are exactly the sort of solid numbers you would have predicted absent any major mistakes.

Congress, similarly, is performing at, or arguably above, expectations. Three separate House committees have agreed on the basic framework of a health-care reform bill. Two of those three have already passed the legislation. In the Senate, the two committees appear to be considering pretty similar bills. The Health Committee has actually passed its legislation already.

What else? It's proving difficult to find consensus on revenues. But that was always going to be true. And if consensus has been elusive, options have been plentiful: There are surtaxes and sin taxes and taxes on health benefits and savings in Medicare and changes to the itemized deduction rules. People can argue about which approach should be preferred. But they cannot argue that no viable approach exists.

The opposition is, as you'd expect, organizing. Republicans are becoming more strident in their criticisms. Industry players are growing nervous and restive. But anyone who didn't expect an eventual fight over the single largest piece of domestic legislation passed in decades was being strangely optimistic. Centrists are making skeptical noises, but their arguments are vague and general. The administration is dangling the IMAC proposal so Blue Dogs and moderates can say they've done something serious on entitlement reform.

Meanwhile, Obama hasn't even showed his hand yet. He hasn't stepped into the process aggressively or given a big speech. He hasn't activated his grassroots network or begun making threats on Capitol Hill. He hasn't pushed. Word is that his involvement begins this week. That is to say, it begins when most of the bills are written, a few of them are passed, and the finish line is in sight. That's quite different from 1994, when Clinton exhausted his political capital long before the legislation was presented to Congress.

Does this mean health-care reform will pass? Or that the final bill will be a glittering accomplishment? Nope! But it is to say that things seem basically on track. They're getting harder in predictable ways. The problems that are arising are problems that everyone knew would have to be solved. The danger was never that we'd get to this place. It was that we wouldn't.

Photo credit: AP Photo/Ron Edmonds.

By Ezra Klein  |  July 20, 2009; 3:24 PM ET
Categories:  Health Reform  
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It is all right for you to compare the journey so far with the failed attempt, considering how important (and rightly) you think 'failed bills' are. But I think real issue here is whether Obama could script it in such a way that it has not become risky endeavor as is now - GOP and most fiscally balance minded are nervous and finding the whole thing hopeless. Read NYT editorial. Why in the world they have to grudgingly accept the fiscal reality and grudgingly say that taxing benefits should be the last resort? The risk which has arisen is 'perception' is percolating that ultimately it is all 'tax and spend' culture of Dems with no concrete results. The avoidable risk has been, lot of pieces of these bills are right (increasing insurance, clipping Congress while setting Medicare fees, choice / availability / transparency etc.); but not the socialism in funding this cost. Dems needed more disciplined about cost, exactly the way they were not about Stimulus Bill. What has transpired is Public has become aware of these dangers. Public does not need GOP / Bohener / Steele to tell that and in any case Public knows credibility of these jokers. Question has been would Obama been more prudent, equitable and specific in these matters. Risk revealed is - he missed that early and it is starting to bite now.

Posted by: umesh409 | July 20, 2009 3:45 PM | Report abuse


The healthcare reform bill released by the House Of Representatives is an excellent bill as I understand it. It's a bill with a strong, robust, government-run public option, and an intelligent, reasonable initial funding plan to cover almost all of the American people. It is carefully written, and thoughtfully constructed, informed, prudent and wise. This bill will save trillions of dollars, and millions of your lives. It is also now supported by the AMA.

This is the type of bill that all Americans can feel good about. And this is the type of bill that has the potential to dramatically improve the quality of healthcare for all Americans. Rich, middle class and poor a like. Democrats, Republicans, Independents, and all other party affiliations. This bill has the potential to dramatically improve the quality of life of every American.

The house healthcare bill should be viewed as the minimum GOLD STANDARD by which all other proposed healthcare legislation should be judged. All supporters of true high quality healthcare reform should now place all your support behind this healthcare reform bill released by the United States House Of Representatives, as the minimum Gold standard for healthcare reform in America.

You should all now support this bill with all your might, and all of your unrelenting tenacity. This healthcare bill is a VERY, VERY GOOD! bill for all of the American people. Fight tooth, and nail for every bit of this bill if you have too. Be aggressive, creative, and relentless for this bill.

From this time forward, go BIGGER and DEEPER with the American people every day until passage of healthcare reform with a robust, government-run public option.

FIGHT!! like your life and the lives of your loved ones depends on it. BECAUSE IT DOES!


Senator Bernie Sanders on healthcare (

God Bless You

Jack Smith — Working Class

Posted by: JackSmith1 | July 20, 2009 3:58 PM | Report abuse

"Republicans are becoming more strident in their criticisms."

You're right that this is predictable, and by no means disclosive. Hell, I think it might be beneficial to HC.

'Cause if I'm Barack Obama, who do I want to be the face of opposition to HC Reform- fellow Democrats, who probably campaigned for me, who I probably raised money for, and who nobody really knows (And thus, have no natural enemies for me to use)? Or do I want the Republicans, who nobody rusts, nobody likes, and are generally understood to oppose everything I do, merit or not?

And what do I want that opposition to say- understandable, though wrong headed concerns about money and timing? Or blatant politicking on the issue on how they can "break" me, sweeping criticisms of the policy followed by "I don't know policy" when actually asked a question, and a general inability to discuss the issue in terms of ordinary Americans?

I mean, I don't know if HC is gonna be a success. But the Chicago Mafia has GOT to be happy that the Republicans opened their traps on the issue.

Posted by: colby1983 | July 20, 2009 4:13 PM | Report abuse

This is another one where I think there's a lot of truth to what Ezra's saying. A lot of what we're reading now is press backlash for the sake of maximizing drama, which is also predictable.

Posted by: tomtildrum | July 20, 2009 5:34 PM | Report abuse

We need real health care reform, unfortunately what came out of the House ain't it. I'd like to see Sen. Wyden's proposal get more attention frankly.

Posted by: usrbinperl | July 20, 2009 8:15 PM | Report abuse

It's good that you post this now. There are some unmistakable negative trends in that polling data. Fewer than half now approve of Obama's handling of healthcare. Yes, still more than those who disapprove, but that gap has tightened a lot, and I seriously doubt it's going to start opening up again.

Strangely, every lib here knows that the longer this takes the less likely it is to happen. Do you suppose that as this drags out you will lose support because healthy debate makes people dumber -- or smarter?

Posted by: whoisjohngaltcom | July 20, 2009 11:39 PM | Report abuse

We can understand why this all looks predicatable and predicted to you. But then you admit, "Does this mean health-care reform will pass? Or that the final bill will be a glittering accomplishment? Nope!" Well, it's good that your expectations were properly adjusted --that's your job! -- but average Americans by the millions voted for there to g*dd*mn well be health reform in Novenmber, and for it not to suck. So I don't think what they actually had in mind was for the smartest (read: most expectation-lowered) political health-reform watchers to in mid-2009 be saying that reform may not pass, and that it may not be a glittering accomplishment. Who knows that to you well-adjusted Beltway dwellers, "not a glittering accomplishment" doesn't mean "Screwed again, Delores."?

Posted by: michaeljamesdrew | July 21, 2009 4:17 AM | Report abuse

While the President hasn't shown his hand as of yet, he has shown you huge portions of it. He's laid down precisely the type of benchmarks that show you where he is headed. Thus far the parties in Congress from both sides of the aisle that have followed these benchmarks have found themselves on the other end of White House criticism in the press.

The center is now pushing for a 70 day delay. The White House says 4 days and vote.

The President's early mistakes are coming back to haunt him in the midst of his most important policy objectives. Rushing never wins in the end. You just cede authority to the opposition.

Prudence wins out. This President is sorely in need of some.

Posted by: snannerb | July 21, 2009 8:08 AM | Report abuse

I worry about a letter to Congress from a group of health providers (Mayo Clinic et al.) Their concerns: the current bills are too much like Medicare, don't address geographic payment disparities, and don't pay for value. It looks as though these outfits lose money on Medicare patients and are further penalized for keeping their costs under control.

Posted by: DaveoftheCoonties | July 21, 2009 10:11 AM | Report abuse

"Normal" for major legislation generally involves negotiating with the minority party. The willingness of the Democrats to exclude the Republicans--fast becoming a hallmark of the Obama administration/111th Congress-- is a new development. Ezra Klein may believe this is a good development, and if so it would be interesting to hear his reasoning. But he is wrong to claim: "There is nothing about this moment in the legislative process that was not predictable."

Posted by: VirginiaIndependent | July 21, 2009 12:49 PM | Report abuse

Dear Mr. Klein ....

"An average in the high-50s and the low-60s isn't necessarily the stratospheric ratings Obama registered in the immediate aftermath of his inauguration. But these are exactly the sort of solid numbers you would have predicted absent any major mistakes."

Actually that ranks him 10th out of the last 12 Presidents.

Yep yep ... he is the 3rd LEAST popular President of the last 50 or so years as of this point in his presidency.

Posted by: chromenhawk | July 21, 2009 4:09 PM | Report abuse

I agree with the expressed perspective that the ideologic posturing which now passes for "health care reform debate" is entirely predictable. What I find more than a little troublesome is equating "reform," which is supposed to mean lower costs, and a >$1 trillion price tag over the next decade. there are a variety of factors that contribute to high health care costs, but among them are the fact that Medicare and Medicaid pay less than cost causing providers to shift those costs to those with insurance. Similarly, the uninsured make use of high price care and those costs are also, to some extent shiffted to the insured. Theoretically, that means that the costs for the insured should go down with universal coverage, or, at the very least, not go up. But I can find no evidencce of this off-setting credit to current private premiums.

Posted by: turntostoneblog | July 22, 2009 8:26 AM | Report abuse

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