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Chat Transcript: Health Care, Top Chef and Your Favorite Beatle

Washington, DC: Eazy-E,

I don't get the logic behind the free-rider provision. Is the thought that person A is getting subsidies, so if a company hires them and gives them health insurance, then they can use that subsidy on something else, and hence are getting a free ride? Is it an ACORN-style attempt to keep people on the subsidy books? Why would the government penalize any company for hiring anyone (outside of "undocumented" workers)? Please explain the provision from the point of view of someone who supports it.

Thanks

Ezra Klein: I ... can't. Nor can anyone else I've talked to. My reporting has basically uncovered this much: It seems to be coming from business trade groups, though I don't know exactly which ones. And they seem to have convinced Olympia Snowe. And she seems to have gotten it into the bill.

Also, I like the nickname. I got that one a bunch in high school.

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Chicago: Ezra, I love your blog and read it obsessively. But I have a non-health care related question for you: What do you think of this season of Top Chef, especially considering native DCites being some of top competitors?

Ezra Klein: I'm *loving* this season of Top Chef. The level of cooking is far, far above the last season, and maybe above any past season. The Voltaggio brothers are truly talented. Kevin is among the most intelligent cooks I've ever seen. The jerk from Zaytinya and the awesome blond girl are both great chefs.

More to the point, the type of cooking that's winning out this year is also cooking that's fun to watch. Stephan might have been technically talented, but there was nothing visually interesting about his dishes, or conceptually interesting about his choices. With these cooks, there really is. Following their intellectual process and watching their cooking process is pretty exciting, and helps overcome some of the natural deficiencies of watching people make food you can't taste.

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Washington, DC: Ezra -- I gather Dick Cheney is having elective surgery at GW Hospital today. Does he receive the benefit of his federal insurance policy for the rest of his life as a former VP? Or since he is 68 is he on Medicare? Either way, are the taxpayers paying for his health care?

Ezra Klein: Yep.

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Concord, N.H.: A comment and a question. Comment: You do a great job. Your blog is smart and incisive and is my #1 source for developments on health-care reform. Question: What can Dems and progressives say to seniors who are concerned that cuts to Medicare will impact their care?

Ezra Klein: This is going to be one of the key questions of health-care reform. What they're going to try to say to seniors is that they're fixing the donut hole. Interestingly, that fix goes into place in 2010, so seniors have it before the midterms. But whether seniors will listen ... that's a whole other ball of wax. Remember, this is the most conservative group in the country, and the group with the least to gain from health-care reform. Structurally, their opposition might simply be a given. But since they vote in midterm elections, that's scaring the hell out of Democrats.

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Anonymous: George Harrison-Eric Clapton-Patti Boyd love triangle never gets the attention it deserves since it gave us both "Layla" and "Something."

I first saw you on the Rachel Maddow Show and have become a loyal reader of your Blog since. Any TRMS behind-the-scenes anecdote you cared to share?

Ezra Klein: Rachel Maddow is incredibly knowledgeable about cocktails and liquors. She turned me onto Red Breast Irish whiskey, and would, I think, be glad to see more people brought into the fold on that one. So be like Rachel Maddow: Drink Red Breast.

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Washington: Do any of the bills have proposals to expand the numbers of doctors and nurses? Wouldn't this stimulate competition and reduce high prices? American med schools are anti-competitive and 25% of doctors in U.S. are foreign-trained. They turn out too few GPs. There are many places in this country where there are few, if any, U.S.-trained doctors.

If I were king, I'd triple the number of seats in med schools and nursing schools.

Ezra Klein: If you were king, I'd support you. And I'd ask that you also allow more primary care to be conducted by nurse practitioners and physician's assistants.

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The jerk from Zaytinya : Oh good. I thought I was being hysterical (or that's what he'd say anyway). The worst was when he called the cancer patient "one more OLD lady I have to beat." ack ack

Ezra Klein: Yeah, he's a real charmer. If by "charmer" you mean wild misogynist.

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College Park, Md.: Simply because he's the only one left and might read it (never know), I'll say Paul.

After watching the rectal probe that is a U.S. Senate confirmation hearing and watching ALL the delays that have nothing to do with the specific nominee and everything to do with some pet peeve of a particular jr. senator, is it really such a bad thing that the Obama administration (like so many beforehand) rely on in-house policy advisers (nicknamed czars)?

Ezra Klein: Hear that, McCartney? If you do read this, you're welcome to be a guest on my next live chat. The people, they're clamoring for it.

As for the czars, this gets to a general trend of issues being taken out of the legislative branch because the legislative branch is dysfunctional and can't do anything. Another example was the lead role assumed by the Federal Reserve during the financial crisis. Every filibuster, and every gridlocked bill, makes Congress a little less relevant.

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Ithaca, N.Y.: A popular suggestion for Social Security reform is to raise the retirement age. I don't understand how that's different from just cutting benefits. Right now the "retirement age" is 67, but people can still retire at 62 for less money per year, or at 70 for more money. If we "raised the retirement age" to 70, wouldn't people still be able to retire at 62 or 65 or 67, just for less money than they'd get now? How is that different from a benefit cut?

Ezra Klein: It isn't. It's simply a different kind of benefit cut. And one, incidentally, I oppose. People tend to justify it by saying "we live longer now." Well, yes. We're also richer now. And part of the upside of being richer should be that we get to enjoy more years of retirement if we so choose.

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Chevy Chase, Md.: Any downside to the student loan changes being debated in the House? It seems pretty logical to stop subsidizing the banks in order to save billions.

washingtonpost.com: Bill Would End U.S. Subsidy For Lenders of College Aid (Post, Sept. 17)

Ezra Klein: Not that I know of.

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Los Angeles: Hey Ezra, a non-health care question: Now that I'm dating a non-vegetarian girl, I'm tiptoeing toward making the switch myself. You eat a lot of veggies, where do you get recipes??

Ezra Klein: All over. Chinese, Indian, Thai, and Mexican cuisine all have a huge vegetarian component. The bookstore is thick with vegetarian cookbooks. The farmer's market produce is amazing right now.

As a side note, I much prefer cooking without meat. Long before I was a quasi-vegetarian, I pretty much stopped cooking with meat at home. It was pricey, spoiled too fast, and I didn't enjoy handling it. And I've not had an unvaried or dull cooking life since then.

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Henderson, Nev.: Hi Ezra,

Could you explain something about the Baucus excise tax? It seems to be reported in two different ways. Is the threshold pegged to the total value of benefits, or is it pegged to the premiums paid?

Ezra Klein: Pegged to the total premium cost of the plans. So if yearly premiums would be $25,000, then the tax would be 35 percent of $4,000 ($25,000-$21,000).

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New York: Speaking of czars ... why didn't Obama just bring Daschle onto his White House staff, instead of the unofficial advisory health-care reform role he has now? Thanks.

Ezra Klein: Because he couldn't after he had to withdraw from the process. Bet they wish they had just nominated him for a staff position, though, instead of putting him up for a confirmed position at HHS.

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SW Nebraska: What do you think will happen to SCHIP in any health-reform bill that can pass?

Ezra Klein: It'll be expanded. Baucus's bill, for instance, puts down a floor of 250 percent of poverty, which is a huge increase.

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Only one left?: Did I miss something? What about Ringo? He's still alive!

Ezra Klein: That's a good point. Ringo -- very much alive. he also tours with Colin Hays, who I quite like.

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Bethesda, Md.: Max Baucus is clearly the greatest beetle.

Think about it:

- His thick protective shell has allowed him to survive in the harsh climate of the Senate much longer than should be expected.

- He is generally regarded as a pest by all those he comes into contact with.

- Beetles represent nearly a quarter of all species on earth. Likewise, Max Baucus exercises a greatly disproportionate level of control over United States policy.

Ezra Klein: Spooky.

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Sacramento, Calif.: Hey Ezra -- Care to speculate on what happens next now that we have the Baucus proposal?

Ezra Klein: We got to mark-up in the Finance Committee, where everyone is mad at Baucus. He tells them that the bill can't change much or they'll lose Snowe, who they need. They tell him that his instincts on who will and will not vote for this bill are quite poor. The White House steps in and performs some trickery I can't quite figure out to get it through committee. And we go from there.

Honestly, I think some form of this bill will probably make it through the Finance Committee. But it's very hard for me to see how it will make it through the Finance Committee.

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Georgia: Hi, Ezra,

My question might be irrelevant now or off the table. I am a health insurance agent and for the life of me, I cannot understand the logic of Republicans (and others including the doctor that wrote an article in Outlook a couple weeks ago and the CEO of Whole Foods) supporting "buying insurance across state lines." In Georgia, you would be declined for coverage if you are diabetic. So, if you have diabetes you could get your coverage in Massachusetts. All the diabetics would flock to MA and their insurance pool would go into the tank because only the people with medical conditions would get their coverage in MA. Which means that rates in MA would go through the roof. Or insurance carriers would pull out of the state, like homeowners carriers have pulled out of Florida, providing less and less consumer choice. In theory, the rates in GA would go down, since all we accept are super healthy people. (Yeah, sure. When was the last time anyone got a decrease on their premiums?) How does this help anyone in the long term? And why aren't the States complaining about it? I haven't heard a peep from one single state insurance commissioner on this subject. Am I missing something?

Ezra Klein: Nope. The end result would be all plans clustering in the lowest-regulation state, much like credit card companies do in South Dakota. I'd be interested, though, to hear what you think of the national plan and state compact proposals in the Baucus bill. I explain them briefly here. The national plan ideas seems like a good one to me.

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washingtonpost.com: Stick around for a 1 p.m. chat with David Wessel, Wall Street Journal editor and author of In Fed We Trust, about how Ben Bernanke's Fed has managed the financial crisis.

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Washington, D.C.: What influence do you think you yourself have on the actual writing of the bills? Do you hear from staffers/congresspeople who mention your writing and ideas? Don't be modest.

Ezra Klein: Extremely little. I do hear from staffers, but it's rarely in any sort of advisory or even intellectual capacity. They want to explain their work to me, or bash someone else's work.

To get a better sense of this, pretty much every smart and thoughtful pundit I know made a push for Wyden-Bennett over the last two years. It went nowhere. The op-ed page advocacy meant nothing. Those of us in the chattering class would do well not to overstate our influence.

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Tuckahoe, N.Y.: Poor Mary Travers. This morning NPR does a full one-minute remembrance of the mostly-forgotten Henry Gibson, followed by about 15 seconds on Mary Travers. I'm no great fan of folk music, but this makes no sense to me. And have you ever seen re-runs of Laugh-In? Perhaps the lamest, un-funniest show you'll ever see.

Ezra Klein: I'm putting this comment up because it's so delightfully random.

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Washington, D.C.: What are the chances, do you think, that Democrats on the Finance Committee will amend the bill enough to make it reasonable? I have my doubts. The committee has 13 Democrats and 10 Republicans. Democrats include Baucus, Conrad and Lincoln. You do the math.

Ezra Klein: The math makes no sense to me. Getting Rockefeller and Wyden and others seems to mean losing Snowe and potentially Lincoln.

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Princeton, N.J.: Ezra, I will bet you that less than 1% of the country has the vaguest idea of even the basic principles of Wyden-Bennett.

Ezra Klein: I would bet that you're exactly right.

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Washington, D.C.: I wanted to add one other thought to your discussion in interstate purchase of health insurance. The issue isn't just state regulation that affects benefit levels, guaranteed issue, preventive care, etc. There is also a major capacity problem related to regulating capital reserves, and it seems like no one is talking about that problem. State insurance commissioners have a lot of discretion in this area, and that only works if each market has its own regulator. Even assuming all states are well-meaning, that regulation doesn't make any sense at all if the insurer's market is outside the state.

Ezra Klein: Yep, that's exactly right.

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Anonymous: When are you going to be back on the Rachel Maddow Show?

Ezra Klein: Whenever they next ask me to be on.

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Chevy Chase, Md.: Yesterday you gave 5 ways to improve the Baucus bill. Could you rank them in order of likelihood of happening?

Ezra Klein: 1) Free rider is reformer. 2) subsidies go up. 3) co-op is strengthened, or public plan is added. 4) Wyden's free choice amendment is passed. 5) Baucus gets tough on Republicans.

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Williamsburg, Va.: Has health care (important as it is) taken all the room out of the chamber and now you're not going to see financial reforms or immigration reform or environmental reforms or other big-ticket items any time soon?

Ezra Klein: I think immigration and environmental reforms are basically dead for the year. We'll see about financial regulation. I have concerns.

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Is this true?: A common refrain among reform advocates is the impressive concentration of business between a few insurers in many states, Obama mentioned that in 36 states, five or fewer insurers had 75% or more of the market share. But I just read Alex Tabbarok at Marginal Revolution making the case that it's not really accurate, here.

Is he correct? And if so, what are the implications for competition between insurers?

Ezra Klein: I just read that post. It doesn't make a lot of sense. What Tabarrok is arguing is that many people get health care from large employers, and many large employers self-insure (though they generally contract with a private insurer for administration). That doesn't make the market competitive for most people. They don't get to choose their insurance: they just get what their employer offers. It's not like I can go use the Washington Times's insurance if I don't like the Washington Post's.

There is an argument, I guess, that the market is more competitive if you're the HR department of a large employer. But then, a lot of what health-care reform is doing is trying to give more people the benefits of size, so that it's competitive for them.

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Anaheim, Calif.: Greatest Beatle -- John, because he was the alpha dog and in capitalist countries that always makes you the greatest. (His solo stuff was better too.)

I know the bookies say the Public Option is dead, but assuming for a minute it could be resurrected, how would that most likely play out? In the finance committee? On the floor? In conference?

Ezra Klein: You'd need some signal that it could pass on the Senate floor. So it could either come during the Senate floor vote on HC, or during conference if Reid thought he had the votes. Right now, a critical mass of congressman swear they won't vote for the bill without a public option and crucial senators won't break a filibuster with one. I predict we end up with some kind of trigger.

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Washington, D.C.: Hey Ezra,

I'm from the other end of the political spectrum, but I've always enjoyed your writing. I also have a quick question about your transition from the Prospect to The Post. When you were at TAP, you weren't shy about sounding off on all sorts of things unrelated to domestic policy (torture, Afghanistan and Iraq immediately come to mind). That seems to have changed since you joined The Post. Is it because the domestic front is a lot busier these days? Or is a heavy focus on domestic issues a condition of employment with The Post?

I only ask because I think one of the strengths of blogging is that it provides an outlet for smart non-experts. Big media organizations picking up issue-specific bloggers makes sense, but I miss the more free-wheeling approach of the olden days.

Ezra Klein: I miss it too! It's not The Post's fault. It's simply that my issue has become totally overwhelming. I don't like writing 15 posts a day on health care, and I really don't like being seen as a health-care writer: I look forward to the day when I can stop. But so long as this is actually going on, I feel the best way to serve my readers is to give as much information on this as I possibly can.

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Chicago: How do you envision Cap and Trade getting through the Senate? Might the need to save the planet possibly jump start some reform of our legislative process?

Ezra Klein: At the moment? I'm very pessimistic. Legislators find the "save the planet" rationale oddly uncompelling. If only Captain Planet were real ...

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Plattsburgh, N.Y.: How come I stay in bed, I'm lazy, but when John and Yoko did it, it was revolutionary.

Just curious, what made you think of The Beatles today?

Ezra Klein: Beatles: Rock Band. (The new video game. I saw an ad.)

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Washington, D.C.: Sorry, I'm just joining in so I don't know if you already answered this. Do you know what the deal is on Massachusetts changing their laws to allow for a replacement for Ted Kennedy? This is going to be essential if the Dems can't get Republicans on board for cloture.

Ezra Klein: It's been looking pretty likely in recent days. More so, certainly, than a week ago. I'll also note that I started reading Ted Kennedy's memoir, True Compass, and it's startlingly good.

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Boulder, Colo.: To College Park

Don't feel bad, I actually thought Ringo Starr was dead too. Weird.

Ezra Klein: Poor Ringo.

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Chapel Hill, N.C.: Could this be a possible endgame for health-care legislation? Baucus/Conrad get to keep their tax on high-end insurance plans (er, insurance companies). In exchange, liberals get strengthened subsidies, a public option and a real employer mandate. The conservatives in the Democratic caucus get to crow about bending the cost curve and decreasing the deficit over the long term, and liberals get what they want: greater affordability and public option.

Ezra Klein: That's what I think the end game should look like. Whether we get a replacement for Kennedy is a big deal here. People really want to avoid reconciliation if they can help it.

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Chicago: I think Ringo was basically a very likable and great drummer.

Paul was very good for marketing and adequate for everything else.

George is under-appreciated and probably a better musician than Paul.

I think John was really, over-the-top the best in every category.

Ezra Klein: You know what's funny about me asking the Beatles question? I don't really have an opinion on it. I have an irrational affection for George Harrison, but no particular appreciation of his musical capacity.

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I will bet you that less than 1% of the country has the vaguest idea of even the basic principles of Wyden-Bennett.: Was he the 5th Beatle?

Ezra Klein: If he had been, he'd totally be my favorite Beatle. And with that, I'm done here. Thanks, folks!

By Ezra Klein  |  September 17, 2009; 1:34 PM ET
 
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Comments

Ezra, I got there late, but I wanted to ask if you are aware of any current federal rules prohibiting a state from announcing it would accept health insurance policies that are written for the rules of other states. For instance, could Arizona's legislature pass a law accepting policies (and requisite coverage requirements) from Mississippi? If Republicans want across state-line policy sales, can't they just do it in states where they are running the government?

Posted by: flounder2 | September 17, 2009 1:39 PM | Report abuse

re: raising the age of retirement.

You are just wrong. people can retire whenever the heck they want. It's just wrong to ask the government to pay for it.
We have a program that is running out of money - why should people collect social security when they can work? Why shouldn't YOU be asked to fund your own darn retirement, at least for a few years.

We keep telling ourselves how 'rich' we are. Given the govt changing the rules of the game, you can kiss that idea goodbye. We aren't entrepreneurs anymore. People can't start businesses. The government is the fastest growing industry now, and we owe trillions of dollars to countries overseas. You may think we are rich, but that is going away. Everyone got too greedy (oh, we're rich, we can do that, we're rich we can do this). What's happening in California will happen to the feds soon enough.

Great if you'd like to retire - just stop asking other people to pay for it. We should raise the age because we are living longer. period. When social security was enacted, life expectancy was 65. It is supposed to be for those people who cannot work.

You want to enjoy retirement? Go ahead. No one's stopping you. Just don't think everyone else should pay for it.

Posted by: atlmom1234 | September 17, 2009 2:12 PM | Report abuse

Let's play contrarian and say that George Martin was the greatest Beatle.

Something I always forget, which startles me when I remember: at the time the Beatles broke up, Lennon and Starr were 30, McCartney 28, and Harrison 26.

So by the time George was Ezra's age, he'd written Something and While My Guitar Gently Weeps. (And, for our libertarian visitors, Taxman.)

Posted by: pseudonymousinnc | September 17, 2009 2:22 PM | Report abuse

On Top Chef, while the level of cooking from the contest leaders is better than last year, what's coming from the contestants at the bottom of the pack is shockingly bad. I haven't watched every season, but I'd be surprised if there was ever so clear a line of demarcation between the top 6-8 chefs and the others.

I'm also surprised that the Volt Bros., Kevin, Jen, et al., haven't started coasting a little, since they must know that even if they do something that's not quite up to snuff, Eve, or Prethi, or Ron is going to do something terrible. I'd like to see another elimination quickfire like last week to thin the ranks a bit.

Posted by: JEinATL | September 17, 2009 2:41 PM | Report abuse

I think the Top Chef final four are pretty much set, unless Bryan is carrying his younger brother a bit and somehow that gets teased out by the judges.

Posted by: bmull | September 17, 2009 3:22 PM | Report abuse


you and Rachel need to try the Knappogue Castle '95; like puréed Irish baby angels wafting down your throat as Enya plays in the background.

I got $20 says the Social Security 106K wage base income cap gets the heave-ho before midterms. No need to sweat the retirement age.

Posted by: ThomasEN | September 18, 2009 1:27 AM | Report abuse

Self-insurance does not make the market more competitive, especially when the insurance companies that administer the self-insured plans make most of the crucial decisions, including contracting with network providers, determining reasonable and customary costs for out-of-network costs (typically using the insurance company data base Ingenix), and deciding what is "medically necessary" or "experimental.")

Posted by: ellenfredel | September 18, 2009 12:08 PM | Report abuse

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