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The State of Health-Care Reform

The research seems pretty convincing that impressive speeches don't do much to transform the dynamics of presidential approval. But then, tonight's speech doesn't need to do much. And it doesn't need to do much because health-care reform is in pretty good shape. Bills have now passed four of the five relevant committees. The outlier committee, the Senate Finance Committee, is circulating its outline and seems likely to pass a bill within the next week or so.

At that point, the bills will go to the floor of the House and Senate, where passage isn't certain but seems pretty likely. And once the bills pass the House and the Senate, final passage of the conference report (the merged bill) is a good bet. And the president's signature is then a sure thing.

That's the context for Obama's speech: It's sort of health-care reform's version of the State of the Union. And the State of the Process is strong: The legislative politics of health care are in considerably better shape than August would have suggested or the ongoing coverage has really articulated (in part because the Finance Committee was gummed up until this week).

Obama's job, then, isn't all that difficult: It's bringing public perceptions of the health reform process closer in line with the underlying reality. And that underlying reality is that the bills are fundamentally pretty similar, there's a fairly high level of consensus, and there are some crucial elements that need to be worked out over the next few weeks, and seem like they will be. The town halls made health-care reform seem chaotic and incomprehensible and disorderly, but at the moment, it's really anything but. In fact, it's closer to agreement than it ever has been before.

By Ezra Klein  |  September 9, 2009; 12:10 PM ET
Categories:  Health Reform  
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"It's bringing public perceptions of the health reform process closer in line with the underlying reality."

I.e., can he persuade the public to accept a reform bill that thus far they've been signaling they're highly skeptical about?

Posted by: tomtildrum | September 9, 2009 12:14 PM | Report abuse

All this chaos of August has done almost nothing to change the status of health-care reform. Congress was in recess, so no negotiations were influenced. And the partisan divide ensured that the two blocks of reform friends and foes remained at almost exact same size. The Republican campaign against health-care was all smoke and mirrors, and now that the air is calming down again, the rumors will die, reality will prevail and health-care reform will be a success.

Posted by: GCReptile | September 9, 2009 12:18 PM | Report abuse

In response to the reference you cite, a comment was made that "(one pushing for change never wants the audience to rely on 'better the devil you know than the one you don’t' as a method for decisionmaking)", which is very true.

One past speaker paraphrased the "bear those ills we have Than fly to others that we know not of" line from Shakespeare's Hamlet by saying "all experience hath shewn that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed".

When that particular rhetoric worked, there wasn't as much agreement as there is today. So, I'm agreeing with your conclusion.

Posted by: rmgregory | September 9, 2009 12:38 PM | Report abuse

>>Obama's job, then, isn't all that difficult: It's bringing public perceptions of the health reform process closer in line with the underlying reality.>>
Bringing public perceptions closer in line with the underlying reality seems a monumental task. We're talking about the US public, aren't we?

Posted by: fuse | September 9, 2009 12:44 PM | Report abuse

Well stated, Ezra,contrary to the hype and sports casting drama amongst your media echo chamber. The health care bill is on track, and the speech will give momentum and help solidify the support it has. One fact has not changed, the political reality that the Dems know they need to pass a bill to survive, and the Rs are banking on 1994 redux. The speech will focus the public's attention for a little while on the issue, which is an opportunity to dissipate the fog machine deceptions that have been pouring out of the right wing. The birthers, deathers, eliminationists, and teabaggers will continue to rattle their cages but their reach is diminishing, not increasing.

Posted by: cmpnwtr | September 9, 2009 12:56 PM | Report abuse

"Passage seems pretty likely" in the Senate? Not unless the bill is pretty severely watered down, like the Baucus draft with inadequate subsidies and no public option.

Under Baucus' plan, a family of four earning $70K gets no subsidies. Without a public option, they could be paying $15K for mandatory insurance, a crushing burden during a recession. There could be backlash leading to a Republican capture of Congress and repeal of the entire bill.

There needs to be generous subsidies AND a strong public option that can use Medicare rates. Without this, the plan just isn't viable *even if it does pass*.

Posted by: tyronen | September 9, 2009 1:10 PM | Report abuse

Speaking of underlying realities, doesn't it occur to anyone in DC that the American people are going to go bananas when they find out what's in the Baucus plan?

-Individual mandate
-Inadequate subsidies
-Uncontrolled costs

I mean what's not to like, right?

Posted by: bmull | September 9, 2009 1:22 PM | Report abuse

bmull, the Baucus plan is almost surely not the plan that will be signed by President Obama. It may be *more* like the Baucus plan than the other plans out there, but the Baucus plan is almost surely the low water mark and the House bill is the high water mark, with the final bill somewhere between the two. Is it disappointing that the high water mark isn't more progressive? Sure, but the low water mark could also be worse.

The bottom line is that none of the bills on the table were ever going to solve our healthcare problems in one fell swoop. This is going to be the first in a line of several pieces of legislation over the next twenty years or so that will have to happen in order to address out systemic problems. As a first step, what's on the table isn't all that I'd hoped for, but it's better than nothing.

Posted by: MosBen | September 9, 2009 2:07 PM | Report abuse

EK seems to have abandoned normative analysis in favor of horse-race discussion. I know something of some sort is likely to be passed. What I come here for is Klein's thoughts on what *ought* to be passed. He seems happy with anything between the (various) House bills and the Senate Finance bills. Even for a centrist, that's pretty damn wishy-washy. Do you real have no thoughts about the mandates? If you really support them, come out and say so; if not, say why not. But being silent on the most controversial component of the Baucus plan suggests that either you're perfectly fine with it, or too cowardly to explicitly endorse forcing middle class families to pay $10,000 a year for insurance.

Posted by: Ulium | September 9, 2009 4:23 PM | Report abuse

"the Baucus plan is almost surely the low water mark and the House bill is the high water mark, with the final bill somewhere between the two."

The problem being that the WellPoint-Baucus plan is the one that has grabbed the rights to the last word in the committee negotiations, unless and until HELP and the House reassert themselves. As long as WellPoint-Baucus remains the headline-grabber, the final bill will be dragged towards it like light towards a black hole.

Posted by: pseudonymousinnc | September 9, 2009 4:26 PM | Report abuse

The Baucus bill is not even on the table. I think Chuck Schumer's scenario is the likely one, with a bill that's done in pieces, some by reconciliation with 51 votes and some that are with 60 votes. He says they can do most of it under reconciliation and doesn't like the "trigger."

Posted by: cmpnwtr | September 9, 2009 4:30 PM | Report abuse

From Ezra: " reform is in pretty good shape."

From Drudge: "At least 44 more moderate Members of the Democrat Caucus have gone on the record in opposition to the current health care bill in the House, a Hill source claims."

Not sure what's more impressive, Klein's predictive powers or his indulgence of denial.

Posted by: wd11 | September 9, 2009 6:03 PM | Report abuse

I've heard it stated in many places that the Dems are motivated to pass a health care bill at all cost for fear that failure to do so would result in a loss of seats comparable to that suffered in the Clinton era. However, it seems worth considering that they might suffer comparable losses if they were to pass unpopular legislation that was seen as a costly diversion from voters' primary and related concerns: the economy and unemployment.

Posted by: tbass1 | September 10, 2009 12:07 AM | Report abuse

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