Dallas, Tex: So the Baucus bill is a handout to the insurance companies. It seems to be another ineffective (at least for me, employed, have insurance) govt spending program that will not deliver the desired results for the amount of money spent. Seriously, when does it end? The expenditures hit $10K/yr per American. 85% of which are not sick. What has to happen for it to break? We can seriously afford to pay a doctor $200K/yr to service every 20 people in the US. Its pretty obvious Obama will not make the tough choices. Thanks.
Ezra Klein: I'm not sure where you're getting your numbers. 300 million people times $10,000 is a very large number.
Finance Committee: Since there are already 4 bills that have been approved by committees in the Senate, why do need a 5th from the Finance Committee?
Ezra Klein: You need a bill out of the Senate and the House. The House is set. In the Senate, the HELP Committee has passed a bill. But the HELP Committee doesn't have jurisdiction over Medicaid, Medicare, or revenues. So the largest pieces of the bill -- how do you pay? do you expand Medicaid? what happens to Medicare? --are missing in the HELP committee's proposal. To build a complete bill for the floor, you need the Finance Committee, for better or for worse.
Seattle: Ezra, Sens. Baucus and Conrad seem to be taking the amendment process pretty seriously, but I wonder why hasn't Rockfeller or another progressive simply pointed out that the Finance bill is the least progressive thing and it's going to be made more progressive through the next 4-5 rounds of amendments?
Ezra Klein: It's always hard to say how much this stuff will or won't change, so they may not want to be in the position of saying it will trend left and then failing to deliver. But if the bill doesn't end up according to their expectations, I think you'll see more of a direct challenge on the floor, and the expectation is that the floor will be friendlier to progressive amendments.
Atlanta: Just to make sure- there is nothing to prevent someone young and healthy from paying the low individual mandate and then buying into the health-care exchange only if they get in an accident or get sick? Won't insurance companies (including any public option because it funds on premiums) have to jack the prices way up to account for the fact that someone can sign up KNOWING that they will need 100k of health care in the next year? The insurance companies don't get any of the money paid by the individual mandate as I understand it.
Ezra Klein: Not much. The exchanges are allowed to offer cheap catastrophic policies for young enrollees, but presumably this will not be as cheap as going uninsured. That said, I think you can overstate the logic of this. I'm young, and I don't know anybody who wants to be uninsured. The people who are uninsured worry about it, and don't like it, and complain about it. Health care is a big portion of negotiations with their employers. So in a world in which they have more opportunity to buy insurance, I think you'll see young people buying more insurance.
Tempe, Ariz.: Headine from The Onion:
BREAKING: Democrats Hoping To Take Control Of Congress From Republican Minority In 2010
A bit too on the nose?
Ezra Klein: Yep. Though it's really only control of the Senate. And in fact, it's really "Democrats Hoping To Take Control Of Congress From Centrist Democrats In 2010." Republicans would have no power in this debate if Ben Nelson and Evan Bayh and Mary Landrieu stepped out and said we are getting this done, no matter what, and we will vote against any and all attempts to filibuster.
Reston, Va.: Would you discuss how companies self-insuring and using third party administrators to handle processing fits into the health reform debate? I've seen conservatives argue it undermines arguments about lack of competition among insurers?
Ezra Klein: The idea here is that there's considerable competition on the level of the employer: they can choose from among a variety of carriers. But not that many. If a carrier doesn't have a network in your state, then it's not really helpful. And the fact that your employer has choices doesn't mean you do: you can take what they give you or go uninsured. That's a crummy choice, and not the path to a working market.
Federal Worker, DC: I just read that one of the amendments currently being considered in the health legislation would eliminate federal employees health plans.
Are they serious or is this just a political ruse?
Ezra Klein: No one is serious about doing that. It's probably a Republican amendment that will be defeated. What the bill does is open up something exactly like the Federal Employee Health Benefits Program to the whole country: that's what the Exchanges are.
Minneapolis: Hi Ezra -- I have no idea what's going on with health care, but I think it was pretty snarky for one of the other contestants on Top Chef last night to suggest that the winner of the Quick Fire used her past cancer to garner sympathy from the judge. What did you think?
Ezra Klein: Super snarky. Eli did not make himself look good with that one. On the other hand, Robin probably opened herself to resentment by bringing up her cancer in a quick conversation with the judge. On the other other hand, Ron has previously talked about his escape from Haiti, and no one got bent out of shape about it.
Chicago: What's the current status on reconciliation solutions to getting the health care bill through the Senate?
Ezra Klein: People are trying to avoid it, and with 60 Dems plus a real possibility of Snowe, they're likely to succeed.
Los Angeles: If the Senate is forced to use reconciliation, will that poison the well for Dems. to pass other agenda items: banking reform, cap and trade, tax code reform?
Ezra Klein: Yep. Though how much more can the well be poisoned? The Republican threat is they won't vote for anything. They're not voting for anything. The problem with reconciliation has to do with the constraints on the process, which would basically allow the Senate parliamentarian to decide what's in the final bill. It's like trying to pass health-care reform on penalty kicks -- everything gets very random and unpredictable.
Lansing, Mich.: Does the Administration's financial regulatory proposal go far enough?
Ezra Klein: I don't think so.
Ithaca, N.Y.: First the R.N.C. released an ad comparing Nancy Pelosi to Pussy Galore. Now, in N.Y.'s special election, N.R.C.C. has released an ad entitled "From Pelosi With Love"
What is up with Washington Republicans thinking that Nancy Pelosi is a Bond Girl using her feminine wiles to lure men into their deaths?
Ezra Klein: Good question.
Public Option: What's your call on a robust public option amendment as is being proposed in the Finance Committee? Will a good CBO score persuade Lincoln or Conrad, as they've repeatedly stated that they want the title of Budget Hawk?
Ezra Klein: I highly doubt it. But this really will be rubber meets the road time. The line out of Conrad's office, for instance, is that he doesn't oppose a public option, he just knows it doesn't have the votes. So will he vote for it? Argue for it? We'll see.
Austin, Tex.: What's your take on the question of allowing insurance companies to sell across state lines? Some say it would increase competition. Others say that it would cause mass migration of insurance companies to the states with the most lax regulation.
Ezra Klein: The latter. What I want is federal regulation that allows insurers to offer national plans. And the Baucus bill has a provision for that, which I think is one of the least noticed, but potentially most important, slices of the bill.
Negotiate with employers?: As someone who was offered a job at a company that just offered $350 a month towards several (not so great) health-care plans and tried to negotiate a better deal, I was told it was a law that the firm had to offer the same deal to each employee otherwise it wouldn't qualify for tax breaks. Were they lying?
Ezra Klein: Nope. My understanding is that that's in ERISA, or at least the tax code. You can't risk select among your employees.
Washington, DC: I'm thinking of buying Bittman's "How to Cook Everything" since I know how to cook next-to-nothing. Good choice? Or do you have another recommendation that will teach me how to cook everything, or close to it?
Ezra Klein: Every kitchen should have a copy of How to Cook Everything. And of How to Cook Everything Vegetarian. I've bought copies for bunches of friends -- for instance, it was my housewarming present to Yglesias when he moved into his new place. So I put my money where my mouth is on that.
Atlanta: If it's so easy to save $500-600 BILLION on medicare (doesn't Obama say: we can cut payments for medicare by that much?) - then why don't they just pass that bill?
Are they saying there is that much waste in the program? Why are they holding that money hostage? If it's the lowest hanging fruit (they say it is, it must be true) - just pass whatever needs to pass to save that money. Would anyone vote against that bill? Really?
Ezra Klein: Oh yeah. Saving that money isn't the hardest thing in the world, but nor is it the easiest. A lot of politicians are willing to do it if they also get health-care reform out of the deal. But they're not willing to do it if it's not part of a trade.
I've said this again and again, if the Republican Party included real deficit hawks, they could make an incredible bargain here. They could rip up the employer tax deduction and create a powerhouse MedPAC board and much, much more. The fact that they're just crossing their arms and shouting "no" suggests they're not particularly worried about spending, after all.
Washington, D.C.: In watching the Senate Finance committee hearings, it seems like Baucus and Conrad are acting more like Democrats (despite Conrad's talk about the French health care system). Both have refuted Republican Senators' points and have called them out for peddling falsehoods and using dilatory tactics. What do you think accounts for this change in behavior?
Ezra Klein: I'm not sure it's such a change. When the attacks are coming from the left, they seem right-leaning. When they're coming from the right, left-leaning. Baucus and Conrad are moderate for Democrats, but they're still a lot more liberal than Republicans. And both of them do seem to want to pass this bill.
How to cook everything: I've got it, like it, but prefer Jacques Pepin's Technique.
Ezra Klein: Better pictures in Pepin's book, for sure. But it's a bit dated, imo.
re: FEHB: "What the bill does is open up something exactly like the Federal Employee Health Benefits Program to the whole country: that's what the Exchanges are." So why create an exchange? Why not open up FEHB as the exchange and take a "separate but equal" stick out of the Republican's hands? Keeping Congress and federal workers in their own plan just lets opponents hit you for not using the public option open to the public. If it's good enough for Congress, why not open it up as the exchange?
Ezra Klein: Because it's technically impossible. For one thing, insurance is state regulated. So the current FEHBP would be illegal in, say, California. For another, it's paid for by the government, while the exchange has subsidies and individuals and employers. For another, it would be weird to call it the federal employee's benefit program if it wasn't primarily for federal employee's.
What you end up with there is the need to create something on the FEHBP model, but appropriate for the country. hence the Exchanges.
Glendale, Calif.: O.K.: What are these complicated feelings you speak of, regarding last night's Top Chef quickfire?
Ezra Klein: Can you really win a quickfire with an apple crisp and a raw apple and fennel salad? Doesn't imagination count for anything?
DC: Any way we can get you to blog this thoroughly and frequently about cap and trade once health care is out of the way?
Ezra Klein: That's the plan, pretty much.
Ithaca, N.Y.: I honestly did not expect you'd ever use an Alanis Morissette in a post, but I've been proven wrong.
Fun factoid about that song, a bunch of English professors with a bit of time went over the lyrics and found that none of the example given are actually "ironic" yet when you have a song titled "Ironic" without any irony in it, that's ironic.
Ezra Klein: It's meta-ironic!
Boise, Idaho: Are you still standing by ACORN and saying that it is a "transparent and cynical waste of everyone's time" after more video out? What is your standard for when this organization actually has problems that need to be addressed?
Ezra Klein: It is a huge waste of everyone's time. ACORN should reform. Or close down. Or keep going. or whatever. I could care less. The issue isn't that ACORN doesn't have its problems. It's that ACORN is meaningless. It is, as a smart man once said, a "transparent and cynical waste of everyone's time."
Technique: Dated? these are basic techniques used for pretty much anything. The recipes themselves may be dated, but the techniques taught give you a base for trying all sorts of variations.
Ezra Klein: Right. The recipes are what I mean. (This is Re: Pepin's book, for those following along at home.) It's too much classical french stuff for my taste, but that's of course a commentary on my taste more than on Pepin.
Chicago: Why is a Republican like Charles Grassley so popular among the Democrats of Iowa?
Ezra Klein: Hard to say. It's weird to imagine that Harkin and Grassley -- a liberal dem and a conservative Republican -- face the same voters every six years. It is proof positive that Americans really don't understand legislative politics.
la la la la la: I'm sticking my fingers in my ears so I don't hear any spoilers since I haven't watched my Top Chef DVR yet. Wait, since this is online, I guess I should be sticking my fingers in my eyes. . . ouch
Ezra Klein: Please don't sue me. My newspaper is very poor.
Dubious in Downtown: Hey Ezra - What are the prospects for financial sector reform this year? What are the chances we'll get progressive reforms (transaction tax, public or regulated ratings agencies, etc.)? And what about TARP and the bevvy of other bailout instruments - are we going to see people who haven't been completely co-opted by the banks in Treasury? If we think of this from a causal point of view, given that the government saved most of the financial sector, are we ever going to get the fruits of investment - i.e. the returns of most of the financial sector?
Ezra Klein: I think thec prospects are poor. But I interviewed Barney Frank a few days ago -- stay tuned for that -- and he doesn't. So it's hard to say. The transaction tax looks like a total non-starter, and I don't think nearly enough will be done on rating agencies. And no, we're definitely not going to get financial sector profits. But we may get a working financial sector, which is important, too.
Washington, D.C.: Considering how many federal employees there are in Washington, I'm a bit shocked that the body of Federal Census worker found hung from a tree in rural Kentucky with the word "FED" on his chest isn't getting more attention. Before you tell me the media doesn't have all the facts, recalling the run-away bride in Georgia story as just one example, the media has made a circus out of less.
Ezra Klein: Yeah, but I try not to be part of that type of media. I don't know what's going on here. it's very scary, but I want to reserve comment until I know the deal.
Blanca Co: Ezra
Could you recommend a good vegetarian restaurant in Washington, DC for a special occasion?
Ezra Klein: All-veggie restaurants are rarely very good. But Jaleo, Oyamel, and Zaytinya have great veggie options. Two Amy's and Red Rocks have lots of terrific veggie pizzas. Dino has a lot for a vegetarian to eat, as does Cafe Atlantico's incredible Sunday brunch.
Hartwell, Ga.: If Ron Wyden's free choice amendment is added to the Baucus bill, and the cap on the tax exclusion for health care plans is kept, wouldn't this basically be a phase-in of the core principles of Wyden-Bennett?
Ezra Klein: Yep.
Portland: So, have YOU ever actually had bulls testicles, a la Padma? If not, would you??
Second question - why this 2013 start date for reform? That's a llllong time from now.... And do you think if this passes and the Republicans regain control of Congress before 2013 they can just undo it before it even starts?
Ezra Klein: I have not, but certainly would try them.
As for 2013, there are two answers. One is that it can't be implemented till then for technical reasons. I think there's more to this than people are giving it credit for. The second is that it makes hc reform look cheaper in the 10-year window, which helps for budgeting.
Princeton, NJ: Why did you and David Leonhardt reference an old study on defensive medicine in cardiology with a tiny sample group when the CBO (and others) have actually looked at states with tort reform and found no savings, and no difference in frequency of test and treatments with states with no tort reform?
Ezra Klein: Would love you to send me that study.
Los Angeles: Hey Ezra,
Taking a step back from the minutiae of the current health care reform debate, isn't it the case that we no longer are having a debate centered about health care being a right, and that this puts this country on a glide path toward either the collapse of the dollar and whatever national bankruptcy looks like or some model of health care in the future along the lines of what Canadians enjoy today, since we're as a country no longer accepting that having millions of people uninsured is just fine?
Ezra Klein: I think that's basically right. We're not solving the cost problem here. But we will have to solve the cost problem. This delays the day of reckoning a bit, and maybe makes the system a bit better in the meantime, but that's really it.
New York: Dear Ezra, What, if anything, is being done in the current bills to move away from fee for service?
Ezra Klein: A bunch, but it's all stuff that confuses people. Value-based purchasing. Pay-for-performance. Bundling hospital payments. Generating evidence so we know how to pay for value. Etc. We're basically creating the financial incentives and the knowledge infrastructure to move in that direction.
Washington, DC: In your "delivery system day" -- which extended into the next (applause for that), all but one of your experts were from the liberal to very liberal wing of the political spectrum. There are actually quite a number of moderate-to-conservative Republicans who have been talking about this for a number of years. And even though they are the political whipping boy, the insurance industry has actually helped inform this debate with actual data. It's disappointing to see you miss that part, and I wonder whether it's valid to question whether your enthusiasm for liberal Democratic politicians colors your reporting.
Ezra Klein: Actually, I e-mailed a number of conservative experts who didn't contribute anything back. I did publish Stuart Butler from heritage, as he got back to me.
Richmond, Va.: "Ezra Klein: Hard to say. It's weird to imagine that Harkin and Grassley -- a liberal dem and a conservative Republican -- face the same voters every six years. It is proof positive that Americans really don't understand legislative politics."
Or that they understand them too well and want gridlock. Given the performance of one-party government in recent years (on both sides), this appears to be the only way to restrain government spending.
Ezra Klein: Yes. That seems like what your average voter carries with him to the polls: a sophisticated preference for cross-party voting in order to maximize the bias towards inertia embedded in the Senate rulebook.
San Francisco: Hi Ezra,
Thanks for all of the great work. More of a philosophical question: Are you considered an opinion columnist from an WaPo editorial POV? I recall when you were hired, you were touted as a "liberal voice" by the editorial side and by people like Howard Kurtz in an effort to prove that the firing of Dan Froomkin (whom they also considered "liberal") was not part of an pattern to move editorially to the right. In my opinion, you are the best informed and most thorough reporter the WaPo has, at least regarding public policy and I don't find your writing to be particularly ideological. If you are considered a "liberal" by your bosses, do you agree with the label? If so, what makes you a liberal?
Ezra Klein: I don't really know where you remember that from: I was hired months before Dan left. My bosses never ask me about ideology nor ever bother me about the conclusions in my posts. I'm on the opinion side of the spectrum, but I'm in a news section, not on the op-ed page. So the answer is that I'm opinion, but my role is to provide analysis and explanation, not to be the liberal or the conservative.
Richmond, Va.: "Ezra Klein: I think the prospects are poor. But I interviewed Barney Frank a few days ago -- stay tuned for that -- and he doesn't. So it's hard to say. The transaction tax looks like a total non-starter, and I don't think nearly enough will be done on rating agencies. And no, we're definitely not going to get financial sector profits. But we may get a working financial sector, which is important, too."
Did you happen to discuss the bankruptcy cram-down provisions with him?
Ezra Klein: I did! And his answer was really interesting. Stay tuned. The interview will appear on Sunday
September 24, 2009; 1:49 PM ET
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