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The End of Politics

The New Republic and the American Prospect both had good editorials this month on the underlying realities of our politics that have been exposed by health care. First, from the New Republic:

The Republican reception of Baucus's bill doesn't so much represent a crisis for health care reform as it does a crisis for our system. The GOP is no longer representing interest groups; rather, it has become an interest group itself -- and an implacable one. So that a compromise piece of legislation that achieves a rough consensus among the various factions in the debate fails to get even one vote from one of the two major parties.

And Paul Starr in the American Prospect:

If the long line of GOP reform proposals prior to 1993 truly represented the Republican position today, a bipartisan compromise would be a reasonable prospect. After all, the Democrats have moved toward what once was the Republican position. Their proposals would preserve private, employer-based insurance. For people without employer-based coverage, the proposals don't go as far as Nixon in 1974 and create a federal program -- no, that would be too radical. Instead they create an "insurance exchange" that would enable people to choose among competing private insurers and a public option.

Historically, conservatives objected to Social Security and Medicare on the grounds that those programs should be optional. This year's proposal for a public option is just that -- optional -- but today's Republicans don't like it any better. And it's not as though they are offering to support reform if Democrats will just drop the public option. Rather than searching for common ground, they have tried to arouse a climate of fear about reform, hoping to do to Barack Obama what their party did in 1994 to Clinton -- humiliating a newly elected Democratic president by utterly defeating him on his leading domestic initiative. ...

As Sen. Kennedy lay dying this year, some Republicans said if only he were present in Congress, some compromise might be reached. That was a tribute to him but a convenient fiction for the Republicans. The moderates in their party who might have been negotiating partners are largely gone. Instead, the Democrats are negotiating down reform with themselves, doing bipartisanship in one party. That is what our politics have come to.

By Ezra Klein  |  September 30, 2009; 11:04 AM ET
Categories:  Government  
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Comments

Those are good pieces and thanks for linking to them but I'm not sure if they're revelatory. Haven't we seen this coming for a while now - certainly since Clinton. This is the condition that bred the rallying cry More and Better Democrats.

At bottom this is all about campaign finance reform and it looks like we're moving in the wrong direction there too.

Posted by: eRobin1 | September 30, 2009 11:12 AM | Report abuse

If we get Max Baucus to vote for health care reform, I say we declare it a bipartisan bill.

Posted by: SteveCA1 | September 30, 2009 11:18 AM | Report abuse

The "underlying realities of our politics" seem to include the fact that neither party, as a whole, represents the majority view of the population. Of itself, this is not bad.

It seems to underscore a need for more freedom of speech and more direct, unrestricted, grass-roots financial support for individual campaigns: there might be advantage to eliminating "parties" from the political process and removal of funding restrictions might be a step in the right direction.

Posted by: rmgregory | September 30, 2009 11:19 AM | Report abuse


I think an excellent addition to Ezra's point and the others is the conspicuous absence of Mitt Romney from the debate. The Massachusetts reform and the reform bill post-Baucus mark-up weren't all that different yet only one for Mitt was a triumph of the free market and one was godless socialism. Essentially, he's a fair weather fan of his own ideals.

Posted by: ThomasEN | September 30, 2009 11:20 AM | Report abuse

"The New Republic" and the "American Prospect" are two of the more rabidly left-wing publications out there. And that's Klein's balance.

Posted by: msoja | September 30, 2009 12:03 PM | Report abuse

I would like to add two words for the two economists inside Chuck Grassley's brain:

You Lie!

Also, please, let us not forget that these mega food fights regarding the people's interest are corporate sponsored events.

Posted by: perhapsnot1 | September 30, 2009 12:06 PM | Report abuse

msoja -- Ezra made no claim to be offering "balancing" quotes from editorials. He claimed to be offering quotes from "good" editorials. That is, editorials that said something (similar to one another) that seem to Ezra to represent an approximately accurate assessment of what's happening in the real world. He might well be wrong, but he's not pretending to do anything other than what he is truly doing.

Meantime, if you think TNR and the American Prospect are "two of the more rabidly left-wing publications out there," you really have no clue about the expanse of left politics.

Posted by: JonathanTE | September 30, 2009 12:19 PM | Report abuse

"The "underlying realities of our politics" seem to include the fact that neither party, as a whole, represents the majority view of the population."

THIS is poisonous Broderism-- a pox upon both their houses, just so we're sure we're fair.

The Democrats are pretty freaking mainstream right now-- between the Blue Dog and Progressive camps.

Posted by: adamiani | September 30, 2009 12:20 PM | Report abuse

If we get Max Baucus to vote for health care reform, I say we declare it a bipartisan bill.

LOL

Posted by: eRobin1 | September 30, 2009 12:28 PM | Report abuse

"The New Republic" [is one] of the more rabidly left-wing publications out there. And that's Klein's balance.

Darn! Coffee all over the monitor!

Say what you will about The Left, but at least we understand that US News & World Report is not one of "the more rabidly right-wing publications out there." You don't live in your parent's basement, by chance?

Posted by: antontuffnell | September 30, 2009 12:39 PM | Report abuse

The Republicans are in deep and lasting intellectual trouble.

But if the Democrats are so stupid as to pass a universal mandate without a very strong public option, the Democrats will lose control of the government over the next few elections.

Posted by: Lee_A_Arnold | September 30, 2009 12:45 PM | Report abuse

Republicans haven't signed on because there is nothing in the bill that is conservative and because Senator Baucus was never given the authority by the WH to negotiate a final deal.

Posted by: DavidBerkian | September 30, 2009 1:15 PM | Report abuse

I think Republican opposition to the stimulus bill was a more meaningful indicator of their strategy. One could say their strategy in the health care debate is a mindless repetition of 1994: it worked then so let's do exactly the same thing now. The stimulus bill was different: different subject, different timing (i.e., brand-new President). I think their lockstep rejectionism then, despite the chance to get goodies for their states and districts, is a clear indicator that this is how they will treat *everything.* I think that's a losing strategy for them -- at some point everyone will just ignore them. Maybe even David Broder will give up on them in disgust (o happy day!) But the real effect will be to give one or two Democratic Senators almost unprecedented power to shape legislation as the decisive 60th vote on a number of issues. Just like Sandra Day O'Connor and then Anthony Kennedy became unprecendentedly powerful due to the paralysis of the two Supreme Court factions, so too the Republican withdrawal from bargaining will make that small number of Senators the decisive voice on most issues we care about.

Posted by: robbins2 | September 30, 2009 1:40 PM | Report abuse

The health care mess is so much worse now that the solutions of the 70s, 80s, and 90s will no longer work. That's why Republicans are opposing it. No one wants to be part of a compromised health sham that will be a lemon for the American public and an electoral albatross for years to come. If it was a good bill, Republicans would sign on.

Posted by: bmull | September 30, 2009 2:10 PM | Report abuse

The New Republic is not liberal.

The Am Prospect is, but it's pretty tied in to the Obama administration, so it sort of ignores liberal gripes about the goals in Afghanistan, Patriot Act, working w/ Big Pharma/WellPoint on health care reform, and other issues found in other liberal magazines/blogs.

The Economist is conservative, but has no vested interest in GOP politics. They also support Obama's health care reform:
http://www.economist.com/blogs/democracyinamerica/2009/08/moderate_is_the_new_liberal.cfm

Posted by: Chris_ | September 30, 2009 2:33 PM | Report abuse

remind me again why we should care what it printed in The New Racist, edited as it is by a bigoted racist?

Posted by: johninflorida | September 30, 2009 3:31 PM | Report abuse

i am really sick and tired of people trying to tie the public option to the individual mandate. Maybe you should learn a little bit about risk pools before you speak something you know nothing about.

an end to pre-ex and the mandate are tied together. nothing more, nothing less.

Posted by: visionbrkr | September 30, 2009 3:57 PM | Report abuse

Visionbrkr, No, it goes much further than that. Without a robust public option alongside, the universal mandate means that every person will be compelled by law to buy insurance from a profit-making insurance company.

That is a political disaster for the Democrats. They will lose the support of half of their own voters.

Further: under the universal mandate, people who can't afford to pay for coverage, will be paid for by the taxpayers. Therefore the taxpayers will be subsidizing private insurance companies. Indeed the taxpayers will be paying MORE than necessary, to support those private profits.

That is double the political disaster. Because you can bring everybody who hates government spending on board too. No matter what the Republicans say now, they will hang it around the Democrats' necks. Quite rightly.

Posted by: Lee_A_Arnold | September 30, 2009 4:13 PM | Report abuse

The Republicans are painted into a corner. They won for more than a decade by combining wealthy donors with an authority-seeking popular voting base. Losing power forced much of their funding base to buy policy elsewhere, which left just their base. They're still very adept at energizing their remaining loyal supporters, making the same supernatural appeals they always have. It's actually too effective, because those supporters are so ideologically rigid that Republicans don't have room to expand their message to include anyone else. The recess circus seriously hurt the GOP in the long run, and all but the most extreme Republican lawmakers know this.

A party or group that represents a relatively narrow interest, or merely represents itself, is one of the underlying requirements for violent intervention in government. Parties with broader bases of support and/or the ability to take part in the wider process constructively don't mount coups.

Posted by: extensive_vamping | September 30, 2009 4:34 PM | Report abuse

Lee,

I agree the Dems are in trouble but more by the fact that they're not doing enough to cut costs. Out there in the market today employers are getting 20-50% increases this year similar to what happened in the pre-credit card changes. To me that's idiotic of the insurers to do this because they're giving fan to the flames of those that want their demise. If they were smart they'd hold rates at or near medicare levels, even if they lost money in the short term so they could survive in the long term but alas they're not that bright.

As far as Democrats go they're doomed because they're too fractured. You've got democrats in there that aren't really democrats. They're only democrats because Bush was in office. That to me will paint a picture that's not entirely accurate that even with 60 seat majorities they can't get most of their major initiatives done. That's not fair but ti is reality.

Posted by: visionbrkr | September 30, 2009 4:54 PM | Report abuse

wow. i really should proofread this stuff first.

I meant insurers should keep their renewal increases this year at or near normal inflation of around 3%. They could do that and take losses in the short run but preserve themselves in the long run.

Posted by: visionbrkr | September 30, 2009 4:56 PM | Report abuse

Advising insurers to be clever just shows that there will be more untrustworthy actions to come.

Meanwhile the Dems aren't in trouble -- but they will be, if they don't get a strong public option, and then try to sell a turkey.

It won't even matter if a non-public option plan still controls costs. Costs are going to have to be controlled anyway.

But the Republicans are in deep and long-term trouble, beyond the healthcare issue. They don't see that the whole economic system is getting so complicated that new costs are being incurred by everyone. They don't have any intellectual understanding of this. They think that markets will sort it all out, and the devil can take the hindmost. This is leading them to take untenable political positions on a lot of different policy issues. They have to keep arguing that the Democrats are socialist in principle, but Democrats are happy to do well in markets.

Posted by: Lee_A_Arnold | September 30, 2009 5:21 PM | Report abuse

Lee,

i'm sorry but you've got some seriously over-inflated sense of what I do and what role I have. I don't advise anyone on anything. And in fact THEY'RE NOT DOING WHAT I WOULD ADVISE ANYWAY. It is merely common sense. The same goes to banks who made about $38 BILLION this past year in overdraft charges to consumers. There's talk that may be regulated and capped. If they were smart they'd reduce willingly it to say $25 BILLION in the next year so that they don't get told they can't charge overdrafts at all.

Oh and don't look now but the credit card companies didn't listen to me either (not that I spoke to one). They increased their rates prior to the new laws taking effect regulating them stronger.

Posted by: visionbrkr | September 30, 2009 10:56 PM | Report abuse

Visionbrkr, No, it goes much further than that. Without a robust public option alongside, the universal mandate means that every person will be compelled by law to buy insurance from a profit-making insurance company.

Posted by: Lee_A_Arnold | September 30, 2009 4:13 PM | Report abuse


you also may want to stop listening to talking points (and spewing them) and listen to fact. almost half of the insurers in the US are non-profits currently. Some examples being BCBS and Kaiser. Not to even mention the fact that 50% of polcies are self-insured where the insurer is basically the employer with reinsurance over high caps usually based on the number of employees. Your Aetna's, United's and Cigna's only provide networks to garner discounts and employers pay a fee in those situations. The cost per employee on these plans are very low, in fact with many of them they're lower than Medicare's FAKE numbers of admin cost.

I would simply and humbly ask that you have a clue about that you speak BEFORE you speak.

Posted by: visionbrkr | September 30, 2009 11:15 PM | Report abuse


visionbrkr,

they are holding their rates at/near or even below medicare levels (in some regions), irrespective of how big an increase is getting passed on to employers.

Posted by: ThomasEN | September 30, 2009 11:54 PM | Report abuse

ThomasEN,

I don't necessarily doubt that (although I'd love some proof please). That's why I have always been and am in favor of a national MLR (which by the way isn't in the Baucus bill and I hope and assume it'll get added in committee.) But my state has one at 80% (one of if not the highest in the land) and that does nothing. NJ's MLR statewide in 2007 was 85% with the largest insurer (BCBS with 52% market share) having an 88.2% MLR. I also expect that insurers' actuaries can and do move numbers around from state to state (i'm assuming legally otherwise they'd have been prosecuted for it) so that states with MLR's make those requirements while those without they can make more of a profit in.

At some point we have to get past rates and talk more on utilization because we can pay less per unit but when we're getting too much care and the wrong care, access (if we all had it) wouldn't do us any good.

And I'm all for accountability of insurance companies. Heck put a government employee or employees at each insurance company to make sure no "funny business" happens when calculating MLR's. But again those same employees should also be watching doctors and hospitals to make sure egregious fraud doesn't take place there either because its happening in record numbers and NO ONE TALKS ABOUT IT. No one wants to talk about "their doctor" committing fraud. In the Senate Finance committee meeting either earlier today or this evening (I honestly forget which one) stated that Medicaid fraud was 32.6 Billion PER YEAR. They gave examples too. One doctor in Ohio billed for charges that weren't warranted in the tens of millions of dollars. ONE DOCTOR. Let's not just think that insurers are THE ONLY bad guys here. That's my main point of all my posts since I first came around here months ago. Insurers don't cause any of that fraud and in fact they have departments that go after fraud and abuse, something that the government is just now catching onto. If we totally got rid of it we could easily pay for healthcare for all. (i'm including medicare fraud and private insurance fraud on top of the medicaid number).

Posted by: visionbrkr | October 1, 2009 12:36 AM | Report abuse

thomasen,


oh and in self insured cases (which makes up half the market) even if they are holding reimbursement rates to providers down, employers aren't paying for it, they're saving it. Employers see every dime of claims in a self insured plan and all they have to do is find another carrier willing to give them a better deal on their costs. In fact most of the big insurers (Aetna, Cigna, United, BCBS) all have very similar network discounts when comparing cost.

Posted by: visionbrkr | October 1, 2009 12:44 AM | Report abuse

oh and for those that don't believe me about the MLR in NJ here is the proof from the NJ DOBI website. Note that this is for the 2-50 market of small group.

http://www.state.nj.us/dobi/division_insurance/ihcseh/seh07lossratiorpt.pdf


My numbers were a touch off because I was told them at a meeting but not that far off. I often get asked by people what will NJ get out of reform and individuals in each state really need to look at how their states work and the pluses and minuses of reform for them. NJ will get an individual mandate and exchanges and that's about it. That should help costs a bit in the short run but not for very long. They really need to institute more cost containment features if reform is to have true meaning.

Posted by: visionbrkr | October 1, 2009 8:49 AM | Report abuse

Visionbrkr, you are arguing against my political opinion (in response to Ezra's post about politics) that a healthcare reform without a strong public option will destroy the Democrats at the polls. Because the universal mandate will be used to hammer them into the ground.

If you are responding to my comment, then what is your reasoning for, or against, this estimation of political likelihood?

You give none.

Instead you attack me by cobbling together a lot of statements against the public option.

But the thing is, it looks like your points would argue IN FAVOR of a strong public option -- if you included all the tradeoffs, which you do not:

The fact that insurers' dishonesty is the result of "common sense"?

The fact that there are already non-profit plans?

The implication that Blue Cross has not been trying to turn for-profit?

The implication that self-insuring employers or their management companies are able to control costs better than anyone?

Omitting that two of the largest frauds in U.S. history (until the current financial crisis) were health insurers?

-- In healthcare policy (as opposed to politics,) the first question is how to get everybody covered. That is the first tradeoff. The conversation is hardly advanced by misrepresenting another person's comment and accusing him of not "having a clue" about the facts, while you are "spewing" them yourself rather selectively.

Posted by: Lee_A_Arnold | October 1, 2009 1:20 PM | Report abuse

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