Austin, Tex.: Hi Ezra - Please help quiet the voice in my head that speaks of conspiracy.
When the insurance industry launched their recent anti-reform media blitz, my first thoughts was "The reform bill must be pretty good, it's clearly going to hit private insurance where it counts - the bottom line."
Then the voice in my head started talking. It almost seemed TOO obvious. ...Is this a reverse-psychology play to help rally Democratic votes in Congress by giving them a reason to vote for the plan, similar to my first reaction? Was this the intention of the conveniently-timed "attack" from the insurance industry?
Or is it just time to cut back on the amount of coffee I'm drinking and up my thorazine?
Ezra Klein: The conspiracy makes perfect sense, though I don't think it's true. I think the insurance industry got caught using a tactic that worked pretty well 10 years ago but doesn't work that well now. That report couldn't stand up to a day of serious scrutiny, and it quickly became a rallying point for progressive cable shows and media outlets and online groups.
But a decade or so ago, it wouldn't have had to stand before scrutiny and there wasn't a progressive movement that could counter-organize against it. I think AHIP was looking for a low-cost way to make a point and scare a couple senators in order to secure a few more goodies, and they were totally unprepared for the backlash.
Grad student: Just a comment - do you watch "Mad Men"? I'm waiting for the show to explain the collective selfishness of the Baby Boomers. If I hear one more old person whine about government involvement in health care and how it's "generational theft" (never mind that my generation of under 30s is largely IN FAVOR of reform and a public option) I think I may scream...
Ezra Klein: I occasionally watch Mad Men. Honestly, I find it a bit more like a moving painting than a television show. It's visually interesting, but doesn't hold my attention very well. Plus, I've been disappointed to see them focusing on weird backstories to their characters: it's a show that was supposed to be about life at a certain time in the country's history, but is increasingly twisting its protagonist into someone who simply can't be mistaken for being representative of anything.
Mental Health Parity or something like it?: I've asked this question a few times but I think I got to it too late in the past. Is there anything in any of the bills that requires mental health coverage in health insurance policies?
Ezra Klein: I'm pretty sure a bill like that passed last year, and so doesn't need to be written into this law. If I remember correctly, the original legislation was written by Paul Wellstone, and it was, weirdly enough, used as a legislative vehicle to pass TARP.
London, England: Hello Mr. Klein,
One of the most appealing aspects of Great Britain's National Health Service is the dedication to transparency. Data on everything from smoking cessation to STD screening rates are available for download online in Excel format. Is there any chance we'll see that in the US sometime in the near future? Better yet, might we be any closer to public availability of outcomes data ala the Society of Thoracic Surgeons?
Ezra Klein: Zero. Private insurers consider all that data proprietary, as its analysis could conceivably give them a competitive advantage. This is one of the quiet but important arguments for a public option: it would give us access to a lot of valuable data that could be used to make life better for a lot of people.
Little Rock: Much optimism has come from Olympia Snowe's vote for the SFC Bill. However, is this optimism a bit misguided given the fact that bills have to be merged and debated and there are so many concerns regarding the bill? Are we getting too excited to soon?
Ezra Klein: That's a very real possibility. There are two major compromises left, neither of which will be easy: there's the compromise between Senate Democrats of different ideological types, and then between the Senate and the House. It's hard to imagine that legislators would allow the project to fail at this point, but crazier things have happened.
Athens, Ohio: You should ask Senator Snowe why she doesn't support an employer mandate.
What I wanted to ask you though is do the bills in the House have a national exchange or state exchanges? Which do you predict will be in the final bill? How important is this?
Ezra Klein: It's a quasi-national exchange that states can run, or something like that. It's a bit opaque to me, still. But having a national exchange is very important, though regulatory issues (states regulate insurers) make it very difficult.
Austin, Tex.: Ask Olympia: "What do you think of the new idea of a national public option plan that individual states can opt out of or opt into?"
Ezra Klein: I think that it's the best compromise proposal I've heard thus far. If an actual public option doesn't have the votes, this should be the compromise that people fight for.
Chicago: I've been wondering recently why unions are so protective of the employer benefits tax exemption. It seems to me they would be much better off if they helped to bring an end to group insurance so that they no longer haggle for it with their employer, have benefits secured through the government, and provided themselves a bargaining position based completely on pay. They'd no longer sacrifice pay to keep benefits, and any problems over regressive tax rates -which I certainly share] could be addressed separately.
Why do you think they have adopted the other position?
Ezra Klein: The common explanation is that they feel they'd be less able to add value if they couldn't deliver health-care benefits fr their members. I don't really buy this. Look at countries with universal systems and they tend to have higher union densities (though obviously there are a lot of factors driving that).
The real reason, I think, is that unions are protecting existing members, not future members. Union memberships, particularly in the AFL-CIO, are largely old, and they have very good benefits, and those benefits would be partially taxed. This is a case where the unions are on the side of their members, but not on the side of progressivism, or a better, fairer, more affordable health-care system tomorrow.
Concord, NH: Amazingly, I've seen some caterwauling from the right that for all the effort on health care reform it will not extend coverage to that many more people. Hypocritical yes, since they have fought tooth and nail against more comprehensive reform. But are there good numbers on how many people will have coverage if the Baucus bill is enacted and how many will not?
Ezra Klein: CBO estimates that 94 percent of legal residents will be covered under the Baucus bill. They estimate 97 percent for the House bill.
Los Angeles: I saw you on Charlie Rose the other night. You're growing into quite the TV talking head. I've always wanted to know, don't need numbers or anything, but do they pay you to appear on these shows?
I've always been curious to know if people are being paid on TV to say some of the things they do.
Ezra Klein: Depends. I didn't get paid for Rose. Mainly, you get paid if you have an exclusive contract with a network, and most people (myself included) don't. The Washington Post has some deal with MSNBC where we get a small sum for appearances there, but that's about it. In general, it's not very lucrative: TV depends on guests wanting the exposure as opposed to actually being paid.
Arlington, Va.: About the exchanges:
My family switched to BC/BS because it is a national plan (only one of 2 I believe) when our son started college in NY. Is there anything in the new legislation that will mandate nationwide coverage? Our 18 yr old daughter traveled to Hawaii during the summer and had to see a doctor unexpectedly. She had to pay out of pocket because the clinic refused to honor her BC/BS card. I am still fighting with BC/BS about reimbursement.
Ezra Klein: There is a provision allowing companies to develop national health insurance plans. I'm not sure how the networks -- which is what you're talking about -- would be run, though.
Virginia Beach, Va.: I'm currently reading your colleague T. R. Reid's book "The Healing of America" and it's an excellent history lesson in health care around the world and extremely readable. He basically traveled the world to see who could cure his frozen shoulder and explains each system along the way. Lots of things are shocking about our country's health situation and other countries but the statistic that stands out to me is the number of bankruptcies in this country due to the very bad luck of getting sick in the richest country and how completely absent that is from the rest of the world. I wish it was mandatory reading for our senators and representatives.
Ezra Klein: A lot of them have read it, including Baucus and Conrad. But Conrad kept quoting it to show that France wasn't a government-run system and progressives should quiet down about the superior efficiencies demonstrated by public structures. That's not really the point of the book, though, and it';s not an accurate description of France. So the book was less useful than I might have hoped.
Alexandria, Va.: Mr. Klein,
All partisanship aside, how accurate do you think the CBO estimate of deficit-reduction effects of the Senate Finance mark is? Doesn't it rely on some pretty big ifs? The bill is deficit neutral if Congress actually implements a cut to Medicare spending, for instance?
Ezra Klein: Well, the sustainable growth rate issues in Medicare are a whole other ball of wax. They're not about health-care reform. As for estimates of the bill's impacts, I think they're trustworthy, but probably underestimating the savings from the legislation and overestimating the revenues from the excise tax. But that's just my read of the data, and there's no good reason to believe me on that rather than CBO. This stuff is hard!
Portland, Ore.: It's obviously a hypothetical, but do you think the health care debate would be any different right now if the President hadn't taken single-payer off the table before negotiations had even begun? Or is this a progressive fantasy, and we'd still be kowtowing to Olympia Snowe to get something close to a public option no matter where we started out?
Ezra Klein: The latter.
St. Paul : Hi Ezra -- Thanks for taking questions today. This is either a really complicated question or a really simple one, but with a Democratic president and Democratic Congress (both houses), why are all eyes on Olympia Snowe? Also, what did you think of Ash's elimination last night? Seemed like a nice guy but he just couldn't get his...utensils? in order.
Ezra Klein: Because Snowe means you can break a filibuster. As I argue on the blog today, if it weren't all about Snowe it would be all about Nelson, and that would be worse.
As for Ash, I predicted he was done this week. He'd really been stinking it up over there, and his kowtowing to other chefs had gotten pathetic. I feel quite bad for Robin, though, who is both doing poorly in the competition and being regularly mocked.
Concord, NH: Question for Olympia: "Why is it important to keep the cost of the bill down? If $1.2T bill could be made deficit-neutral, why should we care about the size of the bill?"
Ezra Klein: This is a good question, I think.
Arlington, Va.: Sorry hoss the gov't cannot mandate that either an individual purchase health insurance or mandate an employer to provide. Despite socialist like you and Comrades Obama and Pelosi we still live in the good ole USA and individual rights are protected.
Any bill passed and signed by the Supreme Idiot will be found unconstitutional by the Supremes. Sorry to burst your socialist do good lets everyone join hands and sing bubble punk.
Ezra Klein: Good points, and eloquently presented. It's a shame no one has informed the United States Congress, or the state of Massachusetts, or the White House, of this.
Brooklyn, N.Y.: Over the summer you stated publicly that you believed that there would be a robust public option in the final legislation. Do you still believe this; and if not, why not?
Ezra Klein: When did I state this?
Washington, DC: Chuck Schumer said the health insurance industry's antitrust exemption "deserves a lot of the blame for the huge rise in premiums that has made health insurance so unaffordable."
Is this thought held by many? If so, wouldn't this be an obvious fix?
Ezra Klein: Not really. My hunch is repealing the exemption wouldn't do much in either direction.
Ezra Klein: The Washington Post building is freezing today. Just wanted you all to know.
Anonymous: So are the death panels dead? Does the legislation still have proposals to have some new Medicare entity vetting which procedures Medicare will pay for, and which it will not?
Ezra Klein: There were never any death panels.
Washington, D.C.: Another questioner asked why the need to control costs if a more expensive bill could be made deficit-neutral. My question is: why does the "cost" always get reported but not the fact that the bills don't add to the deficit or actually save money in the long run?
On CNN, the supposedly middle-of-the-road network, the other night, they had a caption up about the "$829,000,000,000 Health Bill" -- psychologically, that looks like a HUGE number (which it is). And no, it wasn't on Lou Dobbs. Are they TRYING to poison the well?
Ezra Klein: You're asking me if Lou Dobbs is consciously attempting to lower the level of discourse in this country through a potent mix of demagoguery and spin that leaves his listeners terrified of all manner of threats, both real and imagined?
Seattle: Hi Ezra,
From a longtime reader: I'm getting nervous reading the recent arguments that if the HCR bill doesn't provide SOME sort of real benefits to actual voters before 2013, there could be a real backlash in the 2010 and, even, 2012 elections. This seems like a very good point and all too likely. But the suggested solutions (open Medicare to 50-year-olds, etc) seem way too radical in their impact (though great ideas!) to be added to the bill at this late stage.
In your opinion, can anything meaningful that will kick in before 2013 still make it into the bill? Is there a lot of cool stuff that will happen before 2013 in the existing bill(s), that isn't being talked about?
Ezra Klein: There's some stuff: Seniors get some drug rebates, insurers get some new regulations, consumers get an ombudsman for insurance industry complaints, and so forth. But overall, I'm not terribly concerned by this: no fees or taxes will kick in during that period either, so it's not as if people are going to get hit with something new. They'll just go about their lives.
Washington, D.C.: Something I've been missing or am not clear on: is the Baucus bill (or any of the others) both deficit-neutral AND debt-neutral? You hear about the first but not the second.
Ezra Klein: I'm not really sure how the two are distinct (deficit spending gets added to the debt), but yes, it is.
Anonymous: "The Washington Post building is freezing today. Just wanted you all to know. "
That's because you're a socialist.
Ezra Klein: Touche.
Bethesda, Md.: Do you think Lisa Murkowski is willing to negotiate on climate legislation in good faith? Put another way, do you think there is actually any chance she will end up voting for a bill?
Ezra Klein: It's really hard for me to believe that the Republican support being hinted towards on climate change will exist at the end of the day. Health-care reform had a lot more Republican support before there was an actual bill, and before the GOP saw political upside in opposition. The same forces will come into play on cap-and-trade, and it will be closer to an election, and cap-and-trade has less strong support than health-care reform did.
Sterling, Va.: Not a question, but a comment regarding 'death panels': every health insurance policy I've ever seen provided by the almighty Free Market (hallowed be Its name) contained a built-in 'death panel'. It's called a lifetime maximum benefit.
Ezra Klein: Actually, those are repealed: insurers will not be allowed to set maximum caps, at least as I understand the bill.
NJ progressive: Here's a non-health care reform question (albeit a health question): do you grind your own beef? If so, what beef do you purchase? I'm frankly terrified by the article in the NY Times about the woman who ate contaminated ground beef that was impossible to trace back.
Ezra Klein: Nope. I don't eat much meat, though not really due to safety concerns. And honestly, I'm more worried about a major outbreak in something like peanuts than in meat, as meat is fairly easy to track, trace, and warn people away from.
Bethesda, Md.: Do you think Chuck Schumer will make a play for Majority Leader next year? With Reid's re-election campaign off to a bumpy start, and his apparent inability to enforce any discipline whatsoever in his caucus, the timing seems right.
What do you think?
Ezra Klein: I don't think he'll challenge Reid, but if Reid steps down from the position, he'll be one of the main candidates to replace him, alongside Dick Durbin.
Seattle: Former Top Chef contestant Ashley Merriman on the chef everyone loves to hate, Michael Isabella:
"I adore Isabella. He comes across as a complete [expletive], but Michael Isabella is a very talented chef and a very smart man, and I adore him. Knowing the situation and knowing Michael, I didn't take it as anything other than a joke-and in the end, the joke's on him. To me, that's funny."
Sounds like cats and dogs living together! Are you as shocked as I am?
Ezra Klein: Yes. That's incredible.
Durham, NC: Why is Senator Lugar's vote never considered in play on health care given his moderate track record on a number of issues and good relationship with the White House?
Ezra Klein: Because he doesn't put his vote in play. If he did, Democrats would court it.
Washington, DC: This isn't a question on either health care or Wall Street, but I guess an economics chat is the place to ask it. With all the tax credits and taxpayer help being given to homeowners and the like, is there anything being done for people who rent their living quarters? I see that Congress and the White House are thinking of extending the $8,000 tax credit for home sales past the November deadline; the problem is, not everyone who rents can afford to buy, especially in the D.C. area.
Is there anything out there for people who rent? If not, and if there are no plans, is there any particular reason (for instance, they don't think it would help, or they think it would inevitably drive up rents)? I don't begrudge homeowners their aid, but the rest of us are living with increased costs too, and if you're in the "middle class," it's like there's no help coming your way.
Ezra Klein: No. Renters get absolutely shafted in our system, for reasons that strike me as totally indefensible.
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