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Rahm Emanuel makes me very pessimistic about health-care reform

emanuelblackberry.JPG

According to the New York Times, the "White House on Thursday signaled the outlines of its strategy for breaking the partisan logjam holding up President Obama’s agenda." And that outline is the most depressing thing I've read on the chances for health-care reform.

With Mr. Obama’s health care overhaul stalled on Capitol Hill, Rahm Emanuel, the White House chief of staff, said in an interview that Democrats would try to act first on job creation, reducing the deficit and imposing tighter regulation on banks before returning to the health measure, the president’s top priority from last year.

[...] Mr. Emanuel, the chief of staff, said he hoped Congressional Democrats would take up the jobs bill next week. Then, in his view, Congress would move to the president’s plan to impose a fee on banks to help offset losses to the Troubled Asset Relief Program, the fund used to bail out banks and automakers.

Lawmakers would next deal with a financial regulatory overhaul, and then pick up where they left off on health care.

It is very, very, very important to be clear on what the death of health-care reform looks like. It is not a vote that goes against the Democrats. It is not an admission that the White House has moved on from the subject. It is continued statements of commitment from the key players paired with a continued stretching of the timetable. Like everything else in life, policy initiatives grow old and die, even if people still love them.

The timetable Emanuel is laying out makes little sense. The jobs bill will take some time. Financial regulation will take much longer. Let's be conservative and give all this four months. Is Emanuel really suggesting that he expects Congress to return to health-care reform in the summer before the election? Forgetting whether there's political will at that point, there's no personnel: Everyone is home campaigning.

Moreover, there's a time limit on health-care reform. The open reconciliation instructions the Senate could use to modify the bill expire when the next budget is (there's disagreement over the precise rule on this) considered or passed. That is to say, the open reconciliation instructions expire soon. Democrats could build new reconciliation instructions into the next budget, but that's going to be a heavy lift. The longer this takes, the less likely it is to happen. And Emanuel just said that the administration's preference is to let it take longer. If I were a doctor, I'd downgrade health care's prognosis considerably atop this evidence.

Photo credit: By Olivier Douliery/Bloomberg

By Ezra Klein  |  January 29, 2010; 11:41 AM ET
Categories:  Health Reform  
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Comments

So are the progressives who hate Rahm and hate HCR having cognitive dissonance?

Posted by: KathyF | January 29, 2010 11:59 AM | Report abuse

I know you've got a lot invested in this, Ezra, but it is past time to grow up and see the light. It has been clear since Brown looked like he was going to win that the Dems were going to let this die. They'll pass a few meaningless, feel-good things, and nothing will change. (Except the Dems will get crushed in Nov.)

Game, set, and match, Republicans.

Posted by: AZProgressive | January 29, 2010 12:02 PM | Report abuse

Rahm knows this better than you do. He is saying they are going to kill health care reform in a nice way.

Posted by: flounder2 | January 29, 2010 12:03 PM | Report abuse

Can't think of a bigger mistake. Lose any momentum from the sotu. Take the pressure off the senate to get off its collective ass and pass the reconciliation fix. Dems engage in another protracted struggle without a solid win under their belts.

Is Rahmbo actually working for the repiglicans?

Posted by: srw3 | January 29, 2010 12:04 PM | Report abuse

The upside for Democratic Party candidates is that it now looks as if implementation of new taxes and fees embedded in HCR will be delayed past the November elections: if the six month implementation window in the bills begin in late April or early May, the effect of the new taxes & fees will be felt after (not before) the November elections.

There's some electoral logic in the delay.

Posted by: rmgregory | January 29, 2010 12:17 PM | Report abuse

So are the progressives who hate Rahm and hate HCR having cognitive dissonance? No, even a blind squirrel finds a nut once in a while.

Posted by: obrier2 | January 29, 2010 12:24 PM | Report abuse

rmgregory: not nearly enough benefit to counter the loss of momentum from the sotu. Dems will be in a stronger position if they pass their top priority as quickly as possible. We all saw what the delay over the summer and fall did to the popularity of HCR. Delaying it more will just make it worse.

Posted by: srw3 | January 29, 2010 12:25 PM | Report abuse

I understand what they're trying to do: they desparately need some legislative wins on issues that are more popular than the current health care bills, and they obviously think they have enough votes on jobs and bank issues to actually move those bills through. If you also take into consideration what Pelosi has been saying, however, about double-tracking the health care debate, I don't think that what Rahm is saying means that health care will be getting no attention while the other issues progress, but that there will be people working on the issue quietly in the background, simulataneously. Complex bills are often negotiated like this.

I share your concerns about making health care the last major vote before every one heads home to campaign for fall elections, however. However, the content of the compromise may make it more palatable than the current bills are perceived to be. The D's have to do a better job of selling it, however. The recent Kaiser poll shows that there is a lot of support for many of the provisions in the current bills, but that people simply don't know what is actually in the bill, and they become more supportive of the bills once they know certain provisions are in it. http://kff.org/kaiserpolls/8042.cfm

I'm hoping that the addition of Plouffe to start managing the election messaging will mean that the D's will do a better job on communicating with the public this year.

Posted by: reach4astar2 | January 29, 2010 12:26 PM | Report abuse

Of course the Democrats could use that time to craft an actual reform bill...you know, one that would get rid of the employer exemption and provide a path to something that has some chance to reduce cost of *care* in a reasonable time frame.

The bills on the table are the opposite of reform; they are designed to retain the existing dysfunction and add a poverty program to couteract the consequences of that dysfunction. There is little popular support for that.

As far as I'm concerned, Obama's campaign promises have proven unworkable: we can't preserve the existing employer-paid plans and control the cost of care. Congress should just craft a coherent universal system and say "Mr. President, we're sorry but we can't do right by the country and stand with you on keeping the old employer-paid system, the drug deal, and various other concessions"

Conversely, the White House could step in with a real reform plan and say "Congress hasn't been able to come up with real reform so this is what we should do". His initial strategy of leaving it to congress hasn't worked. He should admit that and give them something solid to work with.

Posted by: Athena_news | January 29, 2010 12:27 PM | Report abuse

This is a great opportunity for Republicans. If all goes according to plan and the Democrats refuse to pass even just the Senate bill with their 256-178 majority, the Republicans can then introduce their own health reform legislation. They could propose legislation that is minimally meaningful, e.g. by prohibiting discrimination based on pre-existing conditions, and easily pass it with Democratic help. If Republicans propose meaningful legislation of their own, or even if they just promise to do so in 2011, I would then officially switch and become a Republican. The Democrats have already demonstrated that they won't pass a health bill even with a huge majority. In fact, they are so deeply opposed to the legislation that they'll sacrifice their political future to prevent passage. By contrast, the opposition of the Republicans is probably due to superficail political maneuvering, so there is at least a possibility that they'll come up with a decent proposal once they are in power. I say let's choose the lesser of two evils and give Republicans a chance.

Posted by: opinionpieces | January 29, 2010 12:38 PM | Report abuse

Rahm knows exactly what he's doing. He's the worst thing to happen to progressives in decades.

Posted by: BigTunaTim | January 29, 2010 12:40 PM | Report abuse

"They could propose legislation that is minimally meaningful, e.g. by prohibiting discrimination based on pre-existing conditions, and easily pass it with Democratic help."

Why would they do that? They have no interest in doing that.

The Republicans have no interest whatsoever in moving to the center. They simply want to kill any kind of reform.

Posted by: rick_desper | January 29, 2010 12:41 PM | Report abuse

"They could propose legislation that is minimally meaningful, e.g. by prohibiting discrimination based on pre-existing conditions,..."

Uwe Reinhardt has a column today about that simple-minded proposition.

"...to be implemented, that step has to be accompanied by (1) a mandate to be insured or, at the least, very powerful financial incentives to be insured. And if government imposes such a mandate on citizens, it must be ready (2) to subsidize low-income families in the acquisition of the mandated insurance."

http://economix.blogs.nytimes.com/2010/01/29/no-such-thing-as-simple-health-reform/

Posted by: Athena_news | January 29, 2010 12:54 PM | Report abuse

(1) Rahm can count and he can read polls.

(2) There is an election in November.

(3) Rahm wants to maximize the number of Democrats elected in November.

(4) He wants to do politically popular, not unpopular things, between now and the election.

What kind of progressive is he?!? Throw him out of the party!

Posted by: ostap666 | January 29, 2010 12:55 PM | Report abuse

*the Republicans can then introduce their own health reform legislation.*

If they weren't going to do it between 1995 and 2007, it stands to reason that they aren't going to do it now.

Posted by: constans | January 29, 2010 12:57 PM | Report abuse

Without those two elements, the result would be just what they have in New Jersey now:

"In 1993 the state of New Jersey introduced pure community rating without a mandate to be insured. In a recent analysis of that policy the authors concluded that 'despite positive early evaluations, the [program] appears to be heading for collapse.' It is exactly what economic theory would have predicted."

Posted by: Athena_news | January 29, 2010 12:57 PM | Report abuse

I will never give the Dems a time or an hour of my time again if they don't pass health care. My disgust knows no bounds.

Posted by: mminka | January 29, 2010 12:57 PM | Report abuse

The Dems have lost the argument on this health reform effort - their bills are not only unpopular but twice as many Americans loathe them as love them. Will Dems in close races want to walk the plank in support of an unpopular bill in the run-up to the election? You can be sure that Tea Partiers will be showing up to Democrats' campaign functions. Will that energize or demoralize the Dem. base?

The SOTU was a missed opportunity for Obama. He tried to rally his base and affirm that he's staying the course. In doing so he sounded more like the leader of his own party than the leader of the country. That's been his problem all along. Obama assumed his election was a mandate for the progressive platform when Dems won largely because independents and disaffected Republicans were abandoning the Republicans because the economy had turned sour.

Posted by: tbass1 | January 29, 2010 1:05 PM | Report abuse

I had precisely the same though when I read the piece this morning, Ezra. For a good while now I've thought healthcare reform was in real peril -- if it hadn't been Scott Brown's election, it would have been further mischief from Nelson or Lieberman or Stupak. The administration has been, um, ambivalent in its approach, and this public comment seals the deal. So why did the President even include a call-to-arms in the SOTU? Just to mollify a disgruntled base? Curioser and curioser, as Alice said.

One thing's for sure: this whole debate has been a self-inflicted political disaster of epic proportions. I feel worst for Nancy Pelosi, who at each stage of the game has moved all the heavy furniture like the political superwoman that she is. And for all her grit and determination she'll probably lose her gavel in November, while Lieberman will keep his committee chair.

I really do not get why the President has bought into Rahm's strategy that kicking the base in the face over and over will keep the Independents in the D column. I guess these guys will have to learn the hard way.

Posted by: scarlota | January 29, 2010 1:12 PM | Report abuse

Or, he's trying to get the house to pass the senate bill -- as is.

Most politicians will naturally favor the senate bill, because it is better for the wealthy. And, let's face. They own us now-a-days.

Posted by: rat-raceparent | January 29, 2010 1:14 PM | Report abuse

FDL and other left wing blogs are just as guilty as they're pushing progressives to kill the bill without a public option. They could sign the senate bill with subsidy fixes but choose to hold out for something more progressive including the union fix which is wrong and ending the excise tax for all would destroy the best cost control feature in the bill. I would expect you could get the senate to get 51+ votes if the house just added affordable subsidies but when you add in the union fix, a public option and everything else Ms Nancy wants to make it more like the house bill you get conservadems scared looking at their poll numbers.

Its going to be so sad to see Ms. Pelosi lose her speaker position in the not too distant future because of her caucus' inability to govern.

Posted by: visionbrkr | January 29, 2010 1:32 PM | Report abuse

Athena,

NJ doesn't have PURE community rating (benefit design and family demographic only). We have modified community rating (age and gender as well). But the premise to your post is right. It is going down the tubes because we don't have accountability. Oh and the fact that every doctor in NJ practically owns a surgery center that he now performs at to make GOBS of money from the system using the UCR laws to profit at an alarming rate (Horizon BCBS estimated $52 million over half of last year was paid to outpatient surgery centers). This is causing across the board rate increases that are currently averaging 20-25% annually in a state with an MLR of 80% where actual 2008 figures ran at 85-88% last year.

NJ needs individuals to be accountable (via an individual mandate and subsidies to those that can't afford coverage) and providers that stop profiting as much as they do off the system.

NJ needs what MA has and quickly.

Posted by: visionbrkr | January 29, 2010 1:41 PM | Report abuse

The Dems are simply not behaving like a party that cares about passing this legislation. Full stop.

Of course that raises an interesting question as to how they're going to ask their base to come out and vote for them in a few months. Not a lot of margin for victory if BOTH liberals and independents hate you.

Posted by: NS12345 | January 29, 2010 1:41 PM | Report abuse

*****Rahm can count and he can read polls.*****

I don't know why any of us should be so in awe of Rahm's political acumen, or his ability to count.

It's not solely the White House's fault, but the Coakley loss was a disaster that was eminently avoidable.

I don't mean the loss itself was avoidable as long as Coakley was the nominee. Maybe, maybe not. What I'm saying is:

A) The West Wing has known for some time now that their Senate super-majority was extremely tenuous and
B) They've know it wasn't an IMPOSSIBIILTY that the Democrats could lose Ted Kennedy's seat.

Now, I'm a resident of Massachusetts, and I certainly didn't EXPECT that the seat was going to fall the to GOP. Nobody did, until a week before the election. But I don't do politics for a living. Rahm Emanuel does. Clearly SOMEBODY should have realized a Brown victory had a probability of greater than zero (Republicans win state-wide elections with regularity in Massachusetts, despite the breathless media reporting that this happens about as often as mass extinction events), and that this non-zero probability, should it occur, would very likely kill the bill.

What I'm saying is this: Ted Kennedy passed away over the summer, and from that point on somebody at the White House should have realized there was a danger lurking in the Massachusetts winter that needed to be stopped. Rahm dropped the ball on this bigtime in my view.

Posted by: Jasper99 | January 29, 2010 1:44 PM | Report abuse

Many of these topics will have to be done together anyway. Will Republicans support a tax on the biggest banks to recoup money used for the bailout of the financial sector? Yesterday's vote on PAYGO suggests not, so it is going to have to go into the reconciliation bill. Given Ben Nelson's opposition to higher education loan reform, the only way that can be accomplished is reconcilation.

Posted by: Vadranor | January 29, 2010 1:51 PM | Report abuse

Shorter Rahm: "The only nonnegotiable principle here is failure. Everything else is negotiable."

Posted by: JEinATL | January 29, 2010 1:56 PM | Report abuse

Ah, so Mr. Klein has now blocked those who disagree with his beliefs. Very democratic, Mr. Klein, shutting out opposition voices.

Posted by: octopi213 | January 29, 2010 1:59 PM | Report abuse

"It's dead, Jim."

We can thank Rahm for his horrorific role in this from start to finish as being as much of a negative for healthcare efforts as single person involved.

I scratch my head at where Athena_news thinks any *different* bill is going to get 60 votes in the Senate. There are a number of Dems who, if a vote were taken today, wouldn't vote again for the Senate Bill. People are smoking crack if they think there are 57 Dem + 2 Indy + 1 GOP votes for a *better* bill than the Senate one. It's unlikely that there are even those votes for something even more watered down enough to draw in Collins & Snowe, and that inturn would never pass the House.

I suspect we all know this if we take a step back and think about it.

John

Posted by: toshiaki | January 29, 2010 2:01 PM | Report abuse

It's too late for the Democrats to save themselves. They're going to take a pounding in November regardless. They may as well reconcile the bills and take their lumps. If they think the Republicans are going to cooperate because Mr. Brown is making conciliatory noises, I fear they are sadly mistaken. They have already delayed and quibbled too long. Millions of Americans are depending on them to at least outlaw the worst practices of the insurance industry and continue coverage for their college age children, not to provide subsidies to every Tom, Dick, and Mary. It's now or never, Dems. Do it as cheaply as you can, but do it.

Posted by: FadingFast | January 29, 2010 2:03 PM | Report abuse

Rahm is not the decision maker although he can certainly be the messenger. My secret fantasy about this, Ezra, is that the Dems are quietly putting together a reconciliation package and that when it is ready, they will spring it, with 72 hours to comment, and pass the damn thing. Obama said in a similar article today that he wants the Dems to focus on substance not process. In other words, STFU, do the work and don't talk about it. There is almost nothing to be gained by constant releases to the press about Process, where we are or are not, etc. Much of the reconciliation language has been written. I cannot imagine that it can't move pretty quickly if they want it to.
As for what changes to the Senate bill could be acceptable to the 51, remember it was the 8 or 9 that made it weaker. Many of the 51 wanted the same things the House wanted. So let's see what happens behind the scenes.

Posted by: LindaB1 | January 29, 2010 2:06 PM | Report abuse

*****It's too late for the Democrats to save themselves. They're going to take a pounding in November regardless. They may as well reconcile the bills and take their lumps*****

Well, that's the part that I don't get, either. Q4's GDP numbers were great and all, and I suppose it's possible folks will feel better about the economy nine months from now, but certainly the odds pretty overwhelmingly favor a mid term election coinciding with an unemployment rate between 9-11%. Those kinda numbers ALWAYS mean substantial incumbent losses. I mean, if you're a Democrat in a competitive strict this November and you're afraid to pass healthcare because you've got lots of constituents who hate "ObamaCare," aren't most of them going to vote GOP anyway? Do you REALLY want a whole lot of your base to not come out to the polls?

Posted by: Jasper99 | January 29, 2010 2:21 PM | Report abuse

"So are the progressives who hate Rahm and hate HCR having cognitive dissonance?"

The progressives who hate the HCR bill hate it largely because of the influence of Rahm. So no, in their mind this is more or less more of the same.

Posted by: burndtdan | January 29, 2010 2:26 PM | Report abuse

"My secret fantasy about this, Ezra, is that the Dems are quietly putting together a reconciliation package" - LindaB1

My secret fantasy is that someone, somewhere is putting together a real plan for reform: a coherent plan that can transition us from a dysfunctional patchwork to a sustainable system comparable to what citizens in every other industrialized country enjoy.

Elements of such a plan would include:
* transfer of the health insurance exemption from companies to individuals

*phased transition from employer-selected/paid plans to standard, portable, non-profit plans with individual exemptions for the premiums.

*Replace employer contributions to insurance with a universal payroll tax for healthcare, applicable to all employed persons. That would provide portable coverage for all workers.

*Replace Medicaid with a complementary public program to participate in the same standard, non-profit plans with appropriate subsidy levels.

*Phased transition from government-run Medicare to the same standard plans.

Outcome: universal, non-government run coverage.

Posted by: Athena_news | January 29, 2010 2:27 PM | Report abuse

'scarlota' is right Pelosi is unlikely to be the House Speaker after Nov 2010.

I will not for sure vote for my Dem Rep (Mike Honda) in Nov and like most Americans will hold Congressional Dems responsible for the failure of HCR.

Rahm is right nor wrong. Who cares? After State of Union, it is very clear that President is basically running away from Dem Congress and putting his own survival above Dem infighting and incapability. Rahm to ask for legislative victories first nearly fits in that pattern. HCR - live or dead; Congress will live with the consequences. The idea is 'insulate' White House from HCR disaster. Failing HCR is for sure negative for President, but thinking is he will be able to manage that as his term is long and anyways legacy of President is determined long past the term.

The question Congressional Dems and Pelosi need to ask is - are they so weak that they still have to hang out with Obama or are they going to put their spine here? As things stand, it all seems Congressional Dems would rather prefer to have their 'tails in legs'. If Rahm is doing his famous 'f word' on Congressional Dems; why cry? The Dems in Congress are sucker and will die of their own making.

So sad to see, impeding 'grave digging' by Pelosi. Senate Dems - they may survive. For example, my vote preferences – back Boxer for her Bernanke NO and defeat Feinstein any election she stands for (too much of an establishment candidate). Quite possibly many independents from CA may think along these lines.

It is the House Dems, who are the tragedy here.

Posted by: umesh409 | January 29, 2010 2:45 PM | Report abuse

please stop the whining for Pelosi. She could sign the Senate bill if she was truly worried about the 45,000 that die without coverage every year. Its a sham when you use those political talking points for your own gain but then conveniently forget them when it doesn't suit your agendas. Its like the winning team just scored a touchdown of the last play to win the Super Bowl but they're accepting a penalty to try again when the time has run out. STUPID. Just STUPID. She deserves to lose her gavel for this.

Posted by: visionbrkr | January 29, 2010 2:51 PM | Report abuse

visionbrkr, does your incoherent rant mean anything, or are you just having a bad day, like Judd Gregg did during his recent on-camera hissy fit?

Posted by: constans | January 29, 2010 2:56 PM | Report abuse

Clyburn says House does not trust Senate Dems. That is true and there are valid reasons. I do not intend to say it is the fault of ‘House’ so far. In my earlier post all I wanted to describe was how House Dems are immolating themselves without taking a stand.

The grave injustice in all this politicking is to House (even though I detest their HCR most as it was the worst from cost control point of view). House can think about forcing ways on Senate. As I understand House has the ultimate power on Budget I believe - more than Pres. veto (naturally) and even Senate too. They can take revenge there and meanwhile, don't pass anything what Senate has done. Just s**ew Senate and White House and keep explaining to voters why this is happening - because Senate is broken and WH cannot override 'people's (i.e. House's ) will'. Pelosi is sounding like that when she says 'folks in Congress have to respond to their institutional responsibilities'. She needs to be much more tough and need to get 'ugly' here (these puffy Senators, they only understand the language of ‘rod’ and White House, you have to get Chicago Politics to get something heard).

We have to understand there is something called 'threesome' going on among - WH, Senate and House. We are on the verge of eruption of 'institutional war' (what with President taunting chief justices in STOU).

Neither Obama and Rahm are acting to dose this fire.

Posted by: umesh409 | January 29, 2010 3:01 PM | Report abuse

constans,

i was actually thinking more like Shushter but Gregg will do. No bad day, just tired of knowing that blame deserves to be in a lot of places and the one place it won't be is at Ms. Nancy's feet but it belongs there too.

Posted by: visionbrkr | January 29, 2010 3:06 PM | Report abuse

@tbass1: "Obama assumed his election was a mandate for the progressive platform when Dems won largely because independents and disaffected Republicans were abandoning the Republicans because the economy had turned sour."

Wow, Republican historical revisionism truly knows no bounds. I'd invite you to provide supporting evidence for that assertion, but I already know that no such evidence exists. The 2006 elections - when the economy was doing just fine, at least by typical measures - produced the same dismal results for the GOP. Next insupportable theory please.

Posted by: BigTunaTim | January 29, 2010 3:26 PM | Report abuse

Readers and commenters can use a refresher course of Health Finance 101:

-To ban insurers from refusing to insure pre-existing conditions, you have to require everyone to get insurance. Otherwise people will wait until they're 60 or 70 or 80, and sick, till they get it.

-It is flat out immoral and wrong to require healthy 20 and 30 year olds to buy comprehensive insurance.

The Obama-Pelosi-Reid plans are a step (many steps) in the wrong direction. The country should move, instead, toward more of a free market approach.

It is wonderful news that these monstrous health care bills are, more than likely, dead and gone forever.

Posted by: yourstruly1991 | January 29, 2010 3:27 PM | Report abuse

Klein writes:

"Is Emanuel really suggesting that he expects Congress to return to health-care reform in the summer before the election?"

Klein apparently does not see the irony in his own words. If Congress is reluctant to pass a bill before an election, that's quite persuasive evidence that the bill is unpopular.

Otherwise, members of Congress would be crawling over themselves to pass it before the election.

Progressives talk like they're the only people in the country. In fact, progressives are but a small slice of the American electorate. In ignoring the reality that most Americans oppose their core agenda, progressives sound increasingly disconnected from political and economic reality.

And that just makes them look foolish.

Posted by: SARileyMan | January 29, 2010 3:38 PM | Report abuse

@BigTunaTim

"tbass1" is correct, and the evidence for it is the disjunction between how Obama campaigned and how he has governed.

Independents have indeed turned away from Obama as president, after supporting Obama as a candidate. The polls show this as clearly as they can show anything. To demand evidence of this is to demand that the law of gravity is really true. Just look around.

Obama has spent his presidency governing from the Big Government Left while as a candidate he portrayed himself as a centrist.

Indeed, Obama spent considerable time in 2008 berating Bush for large deficits and irresponsible spending. Yet within weeks of entering the White House, Obama purposefully set the federal government on the all-time biggest spending spree. Obama's deficits, for as far as the eye can see, are several times larger than Bush's.

Independents have been revolted by that, and this accounts for Obama's historic crash in the polls.

So, yes, "tbass1" is correct.

Posted by: SARileyMan | January 29, 2010 3:46 PM | Report abuse

This Bill is an incoherent, corrupt, incompetent mess and it deserves to die a quick but agonizing death.

That's what happens we elect celebrities and career politicians. I know qualifications and an actual record of accomplishment aren't what the cool kids do (they just make speeches and campaign), but the federal government can't function with just smoke and mirror charlatans at the helm.

We have a completely unqualified president, Pelosi has never run anything but her mouth and Reid is a Nevada gaming commission reject. Worthless people every single one of them, that's your problem right there, not Rahm.

Posted by: NoDonkey | January 29, 2010 3:48 PM | Report abuse

"It is very, very, very important to be clear on what the death of health-care reform looks like."

Yes, it is. I took it to be when Obama started making tough noises about bank regulations and the 'spending freeze' after the election. It's called 'lets change the subject'. Face it - he's written it off for the time being.

Posted by: invention13 | January 29, 2010 3:51 PM | Report abuse

"The Republicans have no interest whatsoever in moving to the center. They simply want to kill any kind of reform."

Look they don't want health care reform - instead of constantly bemoaning this, accept it. Instead of trying to merely make something they don't want less bad, offer them something they _do_ want. Throw in serious tort reform as part of the HCR - guaranteed to at least get the interest of a few of the GOP in the senate.

Personally, I think it would be a pretty good trade.

Posted by: invention13 | January 29, 2010 3:57 PM | Report abuse

@invention13

I agree. Obama has written off the "reform" for the time being.

The reason is simple: At this point, the Democratic Party is likely to lose the House and, astonishingly, respected political analysts are starting to wonder if the Dems will hold the Senate.

Plus, Obama's own re-election chances are becoming increasingly doubtful. He's made an awful first impression as president. The KSM trial fiasco alone calls into question his maturity and judgment.

If Obama's first-year agenda had been as popular as the progressives delude themselves it was, this would not be the case.

Right now, the WH is performing triage across a number of policy casualties, and the healthcare "reform" casualty will likely be left to die because the cost of trying to save it would likely cause monumental long-term damage to the party.

Posted by: SARileyMan | January 29, 2010 4:04 PM | Report abuse

Tort reform? Please. This Bill would kill state tort reform that's been very successful in states like Texas, in lowering costs.

The #1 contributor to Democrats however, are trial lawyers so that's off the table, no matter how good of an idea it is.

Trial lawyers own the Democrats and Nancy Pelosi doens't use the restroom without their permission.

Posted by: NoDonkey | January 29, 2010 4:05 PM | Report abuse

@NoDonkey

"Trial lawyers own the Democrats and Nancy Pelosi doens't use the restroom without their permission."

Eloquent, and true. The same is true with respect to the SEIU and the Democrats.

And let's not forget that Wall Street gives 2/3 of its political donations to the Democrats.

Posted by: SARileyMan | January 29, 2010 4:11 PM | Report abuse

*It is flat out immoral and wrong to require healthy 20 and 30 year olds to buy comprehensive insurance.*

If only there were some kind of Republican proposal to allow people to be covered by their parents' insurance up to age 26 that could have been incorporated into the HCR bill.

Posted by: constans | January 29, 2010 4:37 PM | Report abuse

I'm confused: if health care reform is desperately wanted by the public and therefore a political winner, shouldn't the Democrats want to schedule the vote as close to the election as possible (as Bush did with the Iraq war resolution and the Republicans did with the 1996 welfare reform act)?

Posted by: counterfactual | January 29, 2010 4:40 PM | Report abuse

What happened to "We don't quit; I don't quit"? I didn't even watch the damn speech and I heard that. Why, why, why are they doing this?

Posted by: slag | January 29, 2010 4:49 PM | Report abuse

@counterfactual

The Democratic strategy last summer/fall was to ram this through without even giving members or the public a chance to read their incomprehensible, slapdash 2000-page bills.

I suppose they felt the details in these bills were just too popular to reveal to the American people.

Because, you know, the American people were just clamoring in the streets for the government to control their healthcare and create the biggest entitlement bureaucracy in history--not to mention increasing federal spending by trillions and trillions of dollars.

Mr. and Mrs. Taxpayer were writing letters to Obama: "Please take more of my money. I have too much of it and it's stressing me out. And while you're at it, please, sir, place a government clerk between me and my doctor. We just love the efficiency that government bureaucrats bring to everything they touch!"

Yes, healthcare "reform" has been derailed because it's just too darn popular!


Posted by: SARileyMan | January 29, 2010 5:01 PM | Report abuse

All the single payer advocates who are complaining about the individual mandate listen up ... single payer plans REQUIRE individual mandates. They require you to sign up and pay, just like this plan would. You think Medicare is voluntary? It is not. The premiums are taken right out of you SS check for Part B.

Also, the polls do NOT show that people universally oppose health reform. If you ask them a general question like "Do you support or oppose health reform" they are at best split or slightly negative. But if you ask them about individual elements of reform, support goes up to 60 or 70%. The public simply does not know what is in these bills and what it would do for them. Their awareness is quite low. So it's up to those of us who follow this stuff to help the education process. Check out the latest Kaiser Tracking Poll or Nate Silver at fivethirtyeight.com. Both of these sites show tremendous variability in responses to reform questions and much more support for many of the most important pieces of reform.

Posted by: LindaB1 | January 29, 2010 5:11 PM | Report abuse

@slag

"What happened to "We don't quit; I don't quit"? I didn't even watch the damn speech and I heard that. Why, why, why are they doing this?"

After all this, you actually continue to place faith in the word of Barack Obama?

You have not, by now, noticed the Obama pattern:

1. Say something to get favorable headlines in the left-wing press and blog--and to goose fundraising from gullible progressives.

2. Then change his mind when the rest of the American people rise up against it or his own party's more responsible members block it because it's (a) incredible stupid or (b) political suicide to support it.

KSM
Gitmo
Iraq
Afghanistan
National Security surveillance
Cap and Trade
Healthcare reform
"Stimulus"

the list goes on and on, and that's just the first year. Much more to come, believe me.

The closer we get to 2012, the less Barack Obama will care a whit about progressives.

A liberal donating money to Obama in 2010 is as idiotic as a conservative giving the Republicans money in the second Bush term.

Posted by: SARileyMan | January 29, 2010 5:11 PM | Report abuse

@LindaB1:

"The public simply does not know what is in these bills and what it would do for them. Their awareness is quite low. So it's up to those of us who follow this stuff to help the education process."

This reminds us all of the old joke: "I am from the government and I am here to help you."

That's the fundamental and fatal problem with this healthcare "reform." Most Americans do not believe it will improve their lives because most Americans know that the government is a very poor allocator of resources. Selling this "reform" really means convincing most Americans that the government is efficient. Most Americans simply laugh at that idea and at anyone peddling it.

Plus, they know the government is flat broke. Let me repeat that: Flat. Broke. Being broke has consequence. It means we cannot afford more trillion-dollar liberal rainbows.

It does not require "more education" to know that 2+2=4. The Democrats are in dire trouble because they have spent the last year trying to convince the voters that 2+2 = 1. Or, in the immortal words of Nancy Pelosi, that "we will give more care for less money."

The problem is that such a fairy tale situation can only exist in the progressive's mind. Belief in that proposition requires to ignore the least 70 years of big government programs.

It is delusional. It's on the order of preaching that the world is flat.

The American people know better, and they have shot this bad idea down.

And if the Democrats persist in pushing it, the American people will happily shoot them down in November, too.

Posted by: SARileyMan | January 29, 2010 5:26 PM | Report abuse

@LindaB1

You wrote: "You think Medicare is voluntary? It is not. The premiums are taken right out of you SS check for Part B."

This is not correct. Medicare is indeed voluntary. A person can opt out of it if he wants to pay for his own care without Medicare's increasingly tight strictures.

The cost of opting out is, as the rules are currently interpreted, loss of one's Social Security benefits. That administrative rule is receiving judicial review. But a person does not have to receive any benefit from Social Security.

Since you brought up Medicare, I should point out that doctors across the country are leaving it in droves. Actually, it's a stampede. In some states, half of all physicians no longer accept new Medicare patients. I can't blame them. Medicare reimbursements to doctors are reaching microscopic levels in many cases.

If you know anything at all about economics, you would realize that a contraction in supply (number of doctors) coupled with an increase in demand (growing number of recipients) means more and more shortages.

The so-called healthcare "reform" would have made this even worse by cutting reimbursements even more. This would drive more doctors out and lead to massive doctor shortages for seniors.

Simply put, Medicare and Medicaid are financial basket cases that, all by themselves, threaten the financial integrity of the U.S. government in coming years.

Adding the rest of the population to goverment-mandated programs would be truly calamitous.

Posted by: SARileyMan | January 29, 2010 6:11 PM | Report abuse

*It is flat out immoral and wrong to require healthy 20 and 30 year olds to buy comprehensive insurance.*

If only there were some kind of Republican proposal to allow people to be covered by their parents' insurance up to age 26 that could have been incorporated into the HCR bill.

Posted by: constans | January 29, 2010 4:37 PM | Report abuse


Ya becuase that makes it free. RIGHT. no one pays for that then, RIGHT. The cost just DISAPPEARS. Typical Democrat not understanding cost shifting.

Posted by: visionbrkr | January 29, 2010 6:28 PM | Report abuse

"If only there were some kind of Republican proposal to allow people to be covered by their parents' insurance up to age 26 that could have been incorporated into the HCR bill."

Absolutely not. I am 100% committed to *universal* coverage. That doesn't mean looking for every opportunity to get someone else to pay for coverage; it means that everyone is in the same boat.

The House provision regarding *adult* children constitutes an unfunded mandate on insurance companies. There is no reason whatsoever that one able-bodied 25-year old should be given a tax-free ride on his parents policy while another is required to find the (after-tax) funds to pay for his own.

That's another example of the lengths to which Congress will go to avoid doing the hard work of crafting a universal plan. They are too focused on

Posted by: Athena_news | January 29, 2010 7:01 PM | Report abuse

@visionbrkr

The cost doesn't disappear. It is just taken care of by the money tree in Barack Obama's backyard.

I thought everyone knew that. :)

Your point is correct, of course. It's dead on. It's the piece of reality rebar that, in a stroke, sunders the progressive pinata and makes all the uncomfortable truths pour out.

Imagine we were talking green beans instead of healthcare. What would happen if the government paid for everyone's green beans.

In short order:

The quality of the beans would deteriorate because, when the government pays rather than the consumer, the producer loses interest in quality. Why should a producer care what the customer thinks when the customer is not paying?

The quantity of beans would then decline because when the consumer does not pay for something he receives, he will hoard it. Economists call this "free-riding" and it always happens.

People will fill their shopping carts with green beans because, you know, they are "free" and they know other people will hoard them and they will be gone tomorrow.

Eventually, the government will step in and say, "No one gets more than three cans of green beans." Then "no more than two cans of green beans." Then "just one can, but only on odd days." Just like the 1970's gasoline rationing.

This is exactly what is now happening in Medicare.

No wonder Americans decline to go along with the healthcare "reform."

Posted by: SARileyMan | January 29, 2010 7:16 PM | Report abuse

@Athena_news:

"Absolutely not. I am 100% committed to *universal* coverage. That doesn't mean looking for every opportunity to get someone else to pay for coverage; it means that everyone is in the same boat."

If too many people are in the same boat, it sinks. This describes the problem with Medicare and Medicaid, as now constituted.

We should have many different boats. One size does not fit all. The private insurance industry should be liberated from antiquated rules and encouraged to experiment. As it is now, there is no truly free market in private insurance. The government is dictating this and prohibiting that, with all the normal consequences of government interference.

(Indeed, it was the government's tax policy that drove us to the disastrous world of employer-provided health care, which wiped out sensitivity to price and which caused the pre-existing limitations issue to be so acute, not to mention tying people to unsatisifying jobs and stale industries because they did not want to lose their insurance.)

"*Replace employer contributions to insurance with a universal payroll tax for healthcare, applicable to all employed persons. That would provide portable coverage for all workers."

How do you square a "universal tax" with your stated goal of "non-government run coverage"?

If something is paid for through taxes, it is, by definition, government run.

Posted by: SARileyMan | January 29, 2010 7:30 PM | Report abuse

"We should have many different boats..." - SARileyMan

Umm...we have a lot of different boats today and we're sinking while countries with universal care are doing much better. They spend significantly less by any measure (% of GDP, absolute dollars, % of public financing, etc.) and get more for their money

"How do you square a "universal tax" with your stated goal of "non-government run coverage"?

If something is paid for through taxes, it is, by definition, government run"

Not true. Your statement reflects a "uniquely American" fallacy that is illustrative of how much Americans don't know.

There are countries where the entire system is primarily financed through payroll taxes that thare used to fund privately managed and delivered coverage. In those countries, health care is much less dependent on government spending than we are here and more efficiently delivered.

Suppose for instance, that the money employers spend today on health coverage went to a series of separate private carriers. Their total expenditures would be less and individuals could choose which plan they wanted, irrespective of their employer.

That's the way it works in Germany. The government contributes to the same 300+ funds to cover those who aren't covered by employer contributions. The result is a universal system, with portable coverage, that is much more privatized than the US non-system.

Posted by: Athena_news | January 29, 2010 8:10 PM | Report abuse

@Athena_news

The German "sickness funds" takes 13-14 percent of every paycheck.

Please.. I beg you.. convince the Democrats to adopt that as their platform.

Anyway, holding up a German scheme dating back to Bismarck is hardly applicable, let alone persuasive, with respect to the American situation in 2010.

If the best your side can do is "let's be more like the Germans," it's no wonder your side has lost.

The United States is not Germany, France, or Britain, and we can thank the good Lord for that.

Posted by: SARileyMan | January 29, 2010 9:36 PM | Report abuse

"The German "sickness funds" takes 13-14 percent of every paycheck."

In 2008, employers in the US spent an average of $12,680 for family coverage. That was the *average*. Think about it; that represents just over 12% of an income of $100K and more than 17% of $75K. Combine that with the out-of-pocket expenses for individuals and you end up with much more than what anyone else spends. Then think about the fact that 40% of *large* employers aren't even confident that they will be offering health coverage 10 years from now.

FWIW, I don't advocate an abrupt jump to any other system -- whether all-payer, or individual payer like the Netherlands. The first step would be to include employer-paid coverage as compensation and transfer the exemption to the individual so that the full costs of coverage (not care, just coverage) are apparent to everyone.
If the American people knew how much they are already spending, for coverage and care combined, they would be a lot less vulnerable to the anti-tax crowd.

"Anyway, holding up a German scheme dating back to Bismarck is hardly applicable, let alone persuasive, with respect to the American situation in 2010."

And yet it's the scheme in the US, which dates primarily since WWII, that is unsustainable. It's driving the country and its citizens into bankruptcy, while Europeans are free to concentrate on other things. Medical costs are escalating everywhere but other countries are much better positioned to control them.

Posted by: Athena_news | January 29, 2010 10:38 PM | Report abuse

Athena_news wrote:

There are countries where the entire system is primarily financed through payroll taxes that thare used to fund privately managed and delivered coverage. In those countries, health care is much less dependent on government spending than we are here and more efficiently delivered.

Really Athena_news? You want me to pay MORE in taxes? MORE payroll taxes? I live in NJ. If i had to guess i probably spend about 40-50% in taxes when you add up payroll taxes, sales taxes, property taxes, federal income taxes, state income taxes FICA, FUTA, etc etc etc. Now you want me to pay MORE. Please do me a favor and when/if that happens I'll share the number of one or two of my employees YOU'LL need to fire.

Sorry but this money growing tree seems to be on the "fritz".

Here's a little facts about small business before you go asking for universal coverage through payroll taxes. More small businesses are estimated to have failed in 2008 than were started. The "closure to opener rate" of small businesses per year averages around 90%.

http://www.sba.gov/advo/stats/sbfaq.pdf

Posted by: visionbrkr | January 29, 2010 10:41 PM | Report abuse

I believe that Athena_news is proposing to relieve you of the burden of providing healthcare to you employees in return for a payroll tax, visionbrkr, not to levy a payroll tax on top of providing healthcare.

Posted by: bgmma50 | January 29, 2010 11:13 PM | Report abuse

Visionbrkr: How much does insurance for your employees cost you...or how much do they pay? What is the average rate for your clients?

Posted by: Athena_news | January 29, 2010 11:21 PM | Report abuse

bgmma50,


ya i got the idea there and 13-14% is still way too much, especially nowadays. Sorry no deal. I'm not buying her cookie-cutter, one size fits all healthcare plan for 13-14% payroll tax.

My average rate on my healthplan is nowhere near $7000. She needs to find another sap to fund her healthcare plans. What about NO TAXES on small businesses that can't get financing as it is in a recession don't people understand.

Posted by: visionbrkr | January 29, 2010 11:24 PM | Report abuse

"ya i got the idea there and 13-14% is still way too much, especially nowadays"

I didn't specify a rate. The point was that employer-provided insurance is more expensive than the tax rates in coutries that finance universal coverage that way.

"My average rate on my healthplan is nowhere near $7000. "

What is the average employee load for your clients ...in salary percentage?

Posted by: Athena_news | January 29, 2010 11:30 PM | Report abuse

Athena,

my HSA costs me $471 a month for my family. The average rate for my clients is a bit more because I have basically the most catastrophic plan out there and I fund 50% of mine and my employees deductible when necessary. All in all it costs on average about $300-350 a month. If the average salary is $50k per year then 14% of that is $7000. Sorry, no deal. And I honestly don't believe you could do it on 14%. Not with the fraud and horrible negotiated deals in the US based systems (pharma, insurers etc). You'd be looking more like 20% and sorry even moreso no deal. Not unless you want almost every small business to go under.

Posted by: visionbrkr | January 29, 2010 11:32 PM | Report abuse

that $300 to $350 per month that I quote as my "employer portion" is per employee. Two have single coverage, two have husband and wife coverage and i have family.

Sorry I still can't trust the government to spend my money as wisely as i do. Not when they're paying their "government employees" like this:

http://www.usatoday.com/news/washington/2009-12-10-federal-pay-salaries_N.htm


Posted by: visionbrkr | January 29, 2010 11:37 PM | Report abuse

What is the average employee load for your clients ...in salary percentage?

Posted by: Athena_news | January 29, 2010 11:30 PM | Report abuse


probably about 10% of their overall "package" goes to benefits and that's after the average of what I spend in their HSA accounts per year.

alright i'm done, good night.

Posted by: visionbrkr | January 29, 2010 11:40 PM | Report abuse

I agree with Athena_news that the deduction for employer provided healthcare should be eliminated, and with visionbrkr that there should be no mandate or subsidies for cadillac plans with low copays and low deductibles. Those two things are the primary drivers of cost in this country.

Posted by: bgmma50 | January 29, 2010 11:49 PM | Report abuse

According to the 2008 KFF/HRET Employer Insurance Survey, the average employer cost for family coverage was $12,680 ($4,704 for an individual)so you are definitely bringing down the average :).

When it comes to lower income levels, employer-paid coverage is comprises a much a higher percentage of total compensation.

FWIW, the German system has a sliding, income based rate and splits the amount between the employee and employer.

" And I honestly don't believe you could do it on 14%. Not with the fraud and horrible negotiated deals in the US based systems (pharma, insurers etc)."

Obviously, just changing the financing mechanism wouldn't be sufficient to make things more sustainable. As Kaiser's Halvorson told Ezra last month, if all we did was switch to single-payer, we would save a whopping 0.7% ...which is obviously not enough to justify the trauma of change.

Without a universal financing model though, we won't ever get any real control over the costs that everyone pays.

Posted by: Athena_news | January 30, 2010 12:04 AM | Report abuse

This seems like a significant admission from Obama about the socialized medicine bills: http://realclearpolitics.blogs.time.com/2010/01/29/obamas-stunning-admission/

Posted by: mikewkelley | January 30, 2010 1:36 AM | Report abuse

*It is flat out immoral and wrong to require healthy 20 and 30 year olds to buy comprehensive insurance.*

If only there were some kind of Republican proposal to allow people to be covered by their parents' insurance up to age 26 that could have been incorporated into the HCR bill.

Posted by: constans | January 29, 2010 4:37 PM

************************

If only the states had passed laws requiring health insurers to keep "kids" up to age 25/26/27/28/29/30/31 on their parents' health insurance policies. . . . oh yeah, that's right, about 30 states already require this, with more states jumping on the bandwagon every day.

http://www.ncsl.org/issuesresearch/health/healthinsurancedependentstatus/tabid/14497/default.aspx

Posted by: Policywonky | January 30, 2010 11:33 AM | Report abuse

Ezra, your tears are delicious. They taste like win and awesome.

Posted by: EffusingSchadenfreude | January 30, 2010 1:18 PM | Report abuse

"I agree with Athena_news that the deduction for employer provided healthcare should be eliminated, and with visionbrkr that there should be no mandate or subsidies for cadillac plans with low copays and low deductibles. Those two things are the primary drivers of cost in this country." - Bgamma50.

You might be interested in this article:

"It’s often assumed that high-cost health insurance plans—sometimes called "Cadillac" plans—provide rich benefits to plan subscribers. But in this study comparing high- and low-cost employer-based plans, researchers found that benefit design explains only a fraction of the variation in family coverage costs....Only 3.7 percent of variation in the cost of family coverage can be explained by benefit design."

http://www.commonwealthfund.org/~/media/Files/Publications/In%20the%20Literature/2009/Dec/1349_Gabel_taxing_cadillac_hlt_plans_HA_WebFirst_12032009_ITL.pdf

Posted by: PeterH1 | January 30, 2010 2:13 PM | Report abuse

I pretty much believe that those who, in 2008, were skeptical about Obama's transformational nature were correct. He certainly makes good speeches, but being President isn't about making speeches. Still, it's possible that the maneuvers on health care and job creation following Brown's victory in Massachusetts are tactics with timing related to the 2010 elections in mind.
It's probably wise to be very skeptical about that, too, and most likely history's judgment of Obama will be that he was the first African American president and he gave a good speech.

Posted by: -bwg | January 30, 2010 2:43 PM | Report abuse

Policywonky,

in constans defense he doesn't know what he's talking about. How could he? He's not in the sector.

In my state of NJ for example several insurers (in the small group market and everyone in the large group market can "purchase" it) and have it as a rider to allow dependents up to age 25 or 26.

Also there's a law in NJ and NY and probably other states that allows dependents up to the age of 30 or 31 to be covered on the same type of plan as their parents at around 60-65% of the prevailing single rate.

But again how would he know.

Posted by: visionbrkr | January 30, 2010 5:27 PM | Report abuse

Everything we know about economics points to the price increasing nature of plans where consumers are isolated from costs. Please let me use an HSA and benefit from shopping around.

Posted by: staticvars | February 1, 2010 9:35 AM | Report abuse

All this talk about nuts-and-bolts process minutia overlooks the fact that the American people have decisively turned against ObamaCare. It will take a very brave Democrat in a very secure seat to ignore this.

Posted by: Banjo1 | February 1, 2010 10:02 AM | Report abuse

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