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Elections matter

The GOP spent much of yesterday scrambling to answer Barack Obama's invitation to a televised White House health-care summit. They came up with a dodge. "We know there are a number of issues with bipartisan support that we can start with when the 2,700-page bill is put on the shelf," volunteered Mitch McConnell. "The best way to start on real, bipartisan reform would be to scrap those bills," said John Boehner.

Well, the best way to get to write the underlying legislation is to win the previous election, or maybe the election before that. And the second best way to write legislation is to have enough votes to block passage of the legislation the other party writes. But Republicans didn't win those elections and they don't have those votes. They've got the second-smallest minority in the Senate since the 1970s and they're down 40 seats in the House. It's neat how they think positive thoughts all the time, but the situation is what it is: They can write the legislation when the American people say they can.

The Republicans might want to act like they're the majority, but they remain the minority. That's why they're afraid of this summit: They know that the majority can still pass a bill, and it's in the majority's interests to pass a bill, and they want to keep that from happening. But they can't. Only the Democrats can.

By Ezra Klein  |  February 8, 2010; 8:16 AM ET
 
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Comments

LOL. Then just pass it without them. See how easy that is?

Posted by: whoisjohngaltcom | February 8, 2010 8:26 AM | Report abuse

There are too many spooked Democrats who will side with the GOP to kill health reform and then take their chances with their constituents in November. Despite their super-minority status, the Republicans have done pretty well for themselves this year, abetted by a President enthralled with his own "healer" persona.

Posted by: scarlota | February 8, 2010 8:41 AM | Report abuse

The problem isn't that the GOP acts like the majority, it's that the Dems act like the GOP is the majority.

Posted by: Lomillialor | February 8, 2010 8:44 AM | Report abuse

We should also state the obvious: the consequences of elections don't really move the GOP -- the only elections that Republicans deem legitimate are the ones they win. You were probably too young to have followed Whitewater and Ken Starr and impeachment in real time, Ezra, but that was a years-long project to remove a legitimately elected President from office. Something similar happened with the Florida recount in 2000; also Don Seligman in Alabama, other state and local elections that still bear the fingerprints of Rove and Atwater.

This is who they are, and this is why the Obama Presidency is in deep peril. He doesn't understand them at all.

Posted by: scarlota | February 8, 2010 9:02 AM | Report abuse

This is just wrong. The summit itself is a sign of weakness. The Republicans are just pushing further to see if Obama backs down even more. This is a win for Republicans. The bill is on hold for another 2.5 weeks which means more time to kill it and if Obama doesn't "listen" to Republicans in his summit he'll take the heat, not them.

Posted by: endaround | February 8, 2010 9:15 AM | Report abuse

"They can write the legislation when the American people say they can." Pretty big talk, Ezra. Your party had the White House, Congress, and a gail force wind of public support at their backs for much of a year. Elections do matter, and the Dems couldn't finish the job at point blank range. Don't worry, November is coming and the American people will have their say about Obama, his healthcare plan and his entire agenda.

Posted by: superman32 | February 8, 2010 9:18 AM | Report abuse

What endaround said. The optics are beyond terrible, and will further alienate the base.

Posted by: scarlota | February 8, 2010 9:18 AM | Report abuse

@scarlota

Yes. And don't forget Gray Davis in CA. Had he been allowed to be on the post-recall ballot, he would have had enough votes to defeat Arnold and the others.

Posted by: Lomillialor | February 8, 2010 9:21 AM | Report abuse

"Well, the best way to get to write the underlying legislation is to win the previous election, or maybe the election before that."

Dems did win the previous election and the election before that, and they did get to write the underlying legislation. But passing that ghastly mess that they wrote is a whole 'nuther kettle of fish. To do that, they have to write legislation that the public wants passed. Until they write legislation that satisfies a solid majority of the American people, there is no risk to the Republicans in opposing it.

Posted by: bgmma50 | February 8, 2010 9:38 AM | Report abuse

And meanwhile, Iran is building predator drones. But that doesn't matter, all attention must be focused on getting a win for the president. Don't bother him with anything else, okay?

Posted by: truck1 | February 8, 2010 9:44 AM | Report abuse

I agree with the sentiment of most commenters above me here. The President's troubles isnt with the 41 republican senators, its with his own party's 59 who cant somehow find the will to get health care reform out of the Senate because of some inordinate fear of Roberts Rules of Order.

Its weakness and intransigence in a time when the country needs boldness, even aggressive action by the governing majority, and there are few things most Americans hate more than a whiner and a loser, and Democrats have been doing a lot of both.

Posted by: zeppelin003 | February 8, 2010 9:57 AM | Report abuse

Hey Ezra,

Turns out Batman isn't at all happy about this healthcare summit idea!

http://bit.ly/9BQFU9

Thanks for checking it out!
Chas

Posted by: chaslicc | February 8, 2010 9:58 AM | Report abuse

The barrier to passing some sort of health care package is the excise tax on benefits. The ugly deal that exempted unions members from the tax until 2018 died with the MA push back. The vote is so close in the House that two or three members beholden to unions are decisive.

Sadly, the unions would rather see health care die than lose a modest slice of their perk.

Posted by: HuckFinn | February 8, 2010 10:01 AM | Report abuse

It seems to me that the WH is looking to replay President Obama's meeting with the House Republicans. They'll all be on camera talking about various aspects of the bills. President Obama will (hopefully) deftly deflect the Republican talking points, probably scolding a few members for using the more egregious ones. He'll explain some of the more opaque ideas in the bill, like the funding mechanisms or how the CBO score works, and though it will be directed at the Republicans across the table, the real target is the cameras, where hopefully he can turn around some of the public's misperceptions as revealed in recent polls. Towards the end he'll implore the Republicans to support the legislation for the good of the country. When they say "no" he'll then say that with or without Republican support he expects an up or down vote on healthcare to be scheduled in X number of days. Then that feeds into a full court press in the media about how the Republicans won't let Congress vote on the pending bills and they won't allow an up or down vote on his nominees.

I heard the meeting is scheduled to be half a day or something. If I were counseling the Republicans I'd say that they should try to rush the conversation as fast as possible to the point where it's clear that they're at loggerheads. Then stand up and walk out of the meeting in protest of these nasty bills. I still think that gets President Obama his chance to talk a lot to the public about the filibuster, obstructionism, etc., but it's the best bet for Republicans that I see.

Posted by: MosBen | February 8, 2010 10:17 AM | Report abuse

Yeah, pretty much anything the Republican's do this point is not about crafting legislation. Obama could propose tax cuts and the Republicans will resist it. They see future electoral success in completely defeating Obama and the Democrats.

When the Republicans had the Whitehouse, the house, and (barely) the senate, they advanced some of their agenda, but--to their base--they seemed clumsy, incompetent, and too quick and too willing to give up on good ideas, and far too unwilling to go to the mat with the Democrats. The base was discouraged by their poor performance and lack of coherence as the majority party, and (a) quit sending them money and (b) didn't show up to vote.

The Democrats, on the other hand, seemed to have their act together (to the Republican base, at any rate), and were blocking legislation, getting compromises, and otherwise handing the Republican's their posteriors.

Now that the role is reversed, the Republicans are unified and the Democrats--with huge majorities--are discombobulated. The Republicans are competently blocking the Democratic majority, and yet the blame for the lack of progress seems to land squarely on the Democrats.

It seems that each party is much better at resisting the agenda of the other party than in advancing their own.

Posted by: Kevin_Willis | February 8, 2010 10:21 AM | Report abuse

Yes, When president Bush urged both parties and all interest groups to join in a national conversation on Social Security reform, the Democrats responded with many of their own alternatives, came to the bargaining table in a spirit of bipartisan cooperation and declined to use the issue as a campaign tool to bludgeon Republicans in 2006. Except they did the exact opposite. Democrat leaders refused to even discuss the issue unless they could score a quick victory by forcing the Preseident to take SS accounts off the table. They immediatly launched fundraising and issue campaigns using the issue and directly attacked the Republican base in a successful effort to retake both Houses of Congress. What goes around comes around. Democrats deliberately obstructed Social Security reform to gain an electoral advantage. They have no cause to complain if Republicans do the same with their pet projects.

Posted by: WoodbridgeVa1 | February 8, 2010 10:37 AM | Report abuse

@bgmma50: You just gave the best justification I've read so far for the GOP's obstructionism. Even though the Dems have the largest majorities in decades, the individual GOP members of congress do not fear, electorally speaking, standing in the way of health care reform.

But there's a problem here: The reason those GOP members have nothing to fear from opposing the bills is because there's been a very effective disinformation campaign that has persuaded many voters that this bill is something other than it is.

In fact, it's not a "government takeover" of health care; it's a private market-based system that is almost identical to the one proposed by former GOP leaders Bob Dole and Howard Baker, and the one Scott Brown voted for in Massachusetts.

And, when voters are informed specifically about the individual components of the bill, they largely approve.

That said, Ezra's post is a little disingenuous. The GOP hasn't won too many elections in the last few years, but they've won the bare minimum necessary to block action in the Senate. 41 votes is all it takes. And until Obama and the Dems start to make obstructionism an electoral liability, there's not a whole lot that can be done to change that situation.

Posted by: Tractarian | February 8, 2010 11:04 AM | Report abuse

But that's different, Woodbridge. Healthcare Reform is pressing, and it good and wonderful, and, once passed, with shower everybody with lollipops and rainbows by law.

On the other hand, Social Security Reform was evil, and, if passed, would have meant that all old people and poor people would have been shot on sight, while Republicans danced naked in the moonlight and drank the blood of adorable doe-eyed orphans.

Entirely different things. No comparison at all.

Posted by: Kevin_Willis | February 8, 2010 11:04 AM | Report abuse

@WoodbridgeVa1

There's one big difference between the Dems taking advantage of W's push for social security reform, and the GOP's taking advantage of Obama's push for health care reform:

The Dems didn't lie about W's proposals. When people opposed social security reform, it was actually based on facts and reason.

Now, people are opposed to health care reform, but that opposition is based on lies, distortions, and misinformation.

Another big difference is that Dems didn't have to use or threaten a filibuster to scuttle SS reform. Instead, the GOP just realized the votes weren't there and gave up.

Posted by: Tractarian | February 8, 2010 11:21 AM | Report abuse

@ Kevin_Willis

Actually, if you look at federal budget projections, rising health care costs are WAY more of a problem than social security spending.

And, honestly, I haven't heard very many overly-rosy predictions about this health care bill. The best things I've heard even the strongest supporters of the bill (like Ezra) say is that it is better than the status quo, and is a first step toward getting health care costs down and lightening the load on small businesses.

On the other hand, I've heard a lot of hyperbole from opponents of the health care reform bill. I seem to recall a lot of talk about "death panels" and "government takeover" and "destroying the fabric of the nation."

In other words, the GOP has seemed to corner the market on exaggeration and fearmongering. But then, you seem to be more interested in snark than facts....

Posted by: Tractarian | February 8, 2010 11:30 AM | Report abuse

@ Tractarian:

"Actually, if you look at federal budget projections, rising health care costs are WAY more of a problem than social security spending."

Indeed. I never said otherwise. Social Security + COLAs is a fixed expense, the only real variably being how long people live. Healthcare is far more open-ended.

"And, honestly, I haven't heard very many overly-rosy predictions about this health care bill."

I'm pretty sure I was promised lollipops and rainbows. And I'm going to be very upset if I don't get them.

"On the other hand, I've heard a lot of hyperbole from opponents of the health care reform bill. I seem to recall a lot of talk about 'death panels' and 'government takeover' and 'destroying the fabric of the nation.'"

That does sound awfully hyperbolic.

"In other words, the GOP has seemed to corner the market on exaggeration and fearmongering."

I can freely acknowledge the GOP is way over-blowing the likely consequences of HCR, mischaracterizing "end of life counseling" and regulatory changes as death panels and a government takeover of healthcare. Extreme hyperbole, no doubt.

That being said, the Democrats mischaracterized Bush's Social Security proposals, using similar dire warnings and similar hyperbole without ever addressing the relatively modest (at least, compared to the Democrats demagoguery on the issue) language of the actual bill. No doubt, the ends justified the means in that case, but the Democrats took a scorched earth approach to the reform, not a "let's find a bi-partisan compromise" approach. And for those who have said it, it was Bill Clinton who wanted the government to hand over a huge chunk of Social Security over to Goldman-Sachs (the Clinton admin's trial balloon on a potential Social Security bill), while it was George Bush who wanted to give individual tax payers the *option* to invest a small *percentage* of their Social Security taxes into private individual accounts that could have been government bonds, for pity's sake. And still would have almost certainly gotten a better return on that fractional amount. For the folks who exercised their option to opt in. Which they didn't have to. And nothing, at all, was going to change for current recipients of Social Security.

And it's not snark, it's satire. It's actually double-ironic meta-satire, because I understand the Republicans are using some dirty tactics, and I enjoy both lollipops and rainbows.

Posted by: Kevin_Willis | February 8, 2010 11:47 AM | Report abuse

Ezra: "Well, the best way to get to write the underlying legislation is to win the previous election, or maybe the election before that."

The "underlying legislation" is deeply unpopular with the American people. That is the best argument for scrapping it and starting over.

Ezra: "The Republicans might want to act like they're the majority, but they remain the minority."

Or they might want to just bide their time because the next election promises to strengthen their hand.

The Republicans have ample cause to view Obama's offer warily. Only after being stymied are the Dems reaching out to them in more than a perfunctory manner - and, like as not, only as an election strategem, to paint them as obstructionists.

Posted by: tbass1 | February 8, 2010 11:53 AM | Report abuse

"The reason those GOP members have nothing to fear from opposing the bills is because there's been a very effective disinformation campaign that has persuaded many voters that this bill is something other than it is."

I would say that there has been disinformation coming from every side about these bills, but despite it all, the voters have figured out exactly what it is.

From my perspective, the core of the problem with the Democrat's approach is that they have failed to produce a truly affordable option. From that central failure flows most of the rest of their problems. The uninsured young adults who comprise a majority of uninsured citizens rationally reject spending their own money to purchase coverage they don't need. Thus, the highly unpopular mandate and massive subsidies intended to make the package affordable to the individual. But those same subsidies make the whol plan unaffordable to society and result in all sorts of headaches in trying to finance the thing.

If, instead of extending the model of expensive employer based and taxpayer subsidized gold plated insurance to everybody, the Democrats went back to square one and concentrated on something affordable, the other dominoes won't keep falling on them.

Posted by: bgmma50 | February 8, 2010 11:58 AM | Report abuse

tbass1, I've seen the argument that the Dems haven't involved the Repubs in the process before, but I haven't seen a good answer to the question, "What about Baucus' Gang of Six' approach that spent months negotiating with Republican Senators?" That process delayed the Senate bill and pissed the hell out of liberals. Please explain how this counts as perfuctory and what level of Republican involvement would suffice.

Posted by: MosBen | February 8, 2010 12:02 PM | Report abuse

MosBen,

I view it as an effort to pick off the one or two liberalmost Republicans to create a patina of "bipartisanship".

Posted by: tbass1 | February 8, 2010 12:07 PM | Report abuse

Liberal commenters here seem not to understand how the Republicans and their base are thinking about health care. I don't think anyone is claiming that the health care system is fine.

What's happened is that Republicans have actually convinced themselves that the current bill is worse than nothing. I think it started to some degree with the political convenience of criticizing the bill. But then, when you hang out all day with people who will say the same things back to you, people back themselves into broadly thinking of the bill as bad.

The other key observation is that Republicans do actually feel left out of governance. I was struck from Obama's meeting with the Republican caucus by how genuinely hurt the Republicans seemed by the characterization that they're just a party of "no", and by how genuinely they seemed to feel that their voices were not being heard.

Like any group of politicians, Republicans are composed partially of people who are just interested in getting elected and partially of people who are dedicated to making the world a better place. The latter group really appreciates the opportunity to participate in crafting legislation. And, if you create the public perception that the Republicans own legislation too, then the former won't go in and muck up the gears -- or at least, not nearly as much.

I really think it's a terrific move by Obama to sit down and talk it out with Republican leadership. Once people sit down and talk it through, I think there's a lot of common ground on policy, as Ezra has repeatedly pointed out. If Obama does it right, Republicans will feel like they've been listened to too. And, once again, if Obama does it right, the television cameras will force the public perception that the legislation is now being crafted with everyone's input.

I couldn't be happier.

Posted by: jeffwacker | February 8, 2010 1:33 PM | Report abuse

@ jeffwacker:

It's hard to know (unless you're there) whether or not there's been a sincere effort to negotiate by EITHER party. Is it:

a). Repubs were included at the table/in the committee, but all their suggestions were summarily rejected? (Bernie Sanders and others have said that the Bill contains 127 Republican amendments) Or ...

b.) Repubs only pretended to be involved (delay tactic - Gang of 6) and walked away when it was time to vote? Or ...

c.) Repubs participated long enough to see that their ideas weren't being incorporated (due to legitimate ideological differences) and walked out?

Ezra, do you have inside information that would clarify this?

Posted by: onewing1 | February 8, 2010 2:30 PM | Report abuse

What a shame we have no leaders left in our country. The weakness they show is sick. Republican, Democrat, makes no difference. They do not know how to get along, and refuse to listen to their constituents who seem to know more about what should be done than our leaders. We are paying obscene salaries, health care,pensions etc. etc. for their high maintenance way of life while our whole country is going down.. This is not the America I grew up in. Our leaders refuse to work for us. Who pray tell are they all listening to? It is not the Legal Citizen's of America.
Put the Health Care Scam Issue on T.V. for all of us to see how corrupt they all are. We can see for ourselves who says what without back room corruption. It is time for the public to see what is going on. See how honest and brave they can be with everyone watching..It is time...........

Posted by: peggydlhk | February 8, 2010 3:47 PM | Report abuse

tbass01, well, the Gang of 6 included more than just the one or two most liberal Republicans in the Senate. Moreover, as onewing1 points out, Republicans sit on every committee and can offer ideas/ammendments to legislation. Do you have any information as to how they were shut out from the process?

I'd be happy to be corrected on this, but the feeling that I've gotten from the Republican leadership is basically that "involving them in the process" means taking out everything they don't like about the bill. That's not reasonable compromise, and saying "We have nothing to add other than scrap the bill completely" is waiving your participation.

Posted by: MosBen | February 8, 2010 4:03 PM | Report abuse

MosBen,

The Dems consulted with a handful of Republican moderates in the Senate but made it clear that they would have been happy to pick off just one or two of them and that they were prepared to move ahead regardless. I don't think such window dressing is what most people think of as bipartisanship.

The Republican leadership was not in the room when the key compromises were struck (i.e., when Obama was cutting deals with the insurers and big pharma and when Pelosi and Reid were crafting sweetheart deals for the unions and Democratic moderates).

Essentially the Democrats were trying to pass the most progressive bill they possibly could and only diluting their vision as much as necessary to secure the votes for passage. That's not the type of compromise that Republicans were ever likely to find appealing. And for months Obama was suggesting that people who opposed the various bills were shills for special interests and worse. Such a posture doesn't convey good faith.

That's my take anyway.

Posted by: tbass1 | February 8, 2010 4:37 PM | Report abuse

@ bgmma50

"I would say that there has been disinformation coming from every side about these bills, but despite it all, the voters have figured out exactly what it is."

And you'd be wrong.

And you'd go ahead and prove it in your very next sentence ("the core of the problem with the Democrat's approach is that they have failed to produce a truly affordable option"-- huh?)

That said, I do like your advice for Democrats. "go back to square one and concentrate on something affordable"! Brilliant! Why hadn't I thought of that!??!

You, sir/madam, are a perfect example of GOP concern-trolling. Pretend to acknowledge that there's a problem, argue that the Dems' plan is fundamentally flawed, argue to start over and somehow a magical "affordable option" will arise without the necessity of an individual mandate or subsidies (or single-payer, for that matter).

The fact is, you are an enemy of health care reform, period. And, given that, your overriding objective is to deny Obama and the Dems any meaningful achievement they can run on in November and 2012.

Posted by: Tractarian | February 8, 2010 4:59 PM | Report abuse

Tractarian, $5000 per year cost for coverage for a healthy young adult who can get coverage that serves their needs for $1200 per year (and yet they still opt out in favor of their iphone plan) is not affordable.

Posted by: bgmma50 | February 8, 2010 6:26 PM | Report abuse

"Pretend to acknowledge that there's a problem, argue that the Dems' plan is fundamentally flawed, argue to start over and somehow a magical "affordable option" will arise without the necessity of an individual mandate or subsidies (or single-payer, for that matter)".

The basic coverage should consist of high deductible major medical coverage. Finance subsidies by capping the employer exclusion. In fact, make the cap on the employer exclusion the same amount as the cost of the basic plan. You'll probably generate revenue. Instead of a mandate, give all adult Americans two years to sign up, after which they are subject to waiting limits, catch up payments, or preexisting condition limitations if they opt out.

Bet it could be done in a lot less than 2000 pages, too.

Posted by: bgmma50 | February 8, 2010 6:32 PM | Report abuse

"Tractarian, $5000 per year cost for coverage for a healthy young adult who can get coverage that serves their needs for $1200 per year (and yet they still opt out in favor of their iphone plan) is not affordable."

The way that every insurance pool works, and the only way to hold down costs, is to make the pool as large as possible including relatively low risk enrollees.

The reason your auto insurer can cover repair and medical expenses when you have an accident, is that on any given day there are countless other people in the pool who are not having accidents.

Furthermore, while a young person is at relatively low risk, the key word is there is relative. Some of them will experience catastrophic illnesses, and keeping them in the pool and out of social services and the bankruptcy courts is not only good for them as individuals, it is good public policy for us all.

Finally, you may be young and healthy, but one day you will be old, and your medical needs are likely to increase substantially. Does it make sense to kick you off insurance, or make your contribution sky high, simply because you are now a higher risk for the rest of us to carry on our backs?

Spreading the costs with as big and diverse a pool as possible is the only way to reduce cost in any insurance system, public or privately run, and it makes no sense to say you want to solve a national problem by reducing cost, and yet say at the same time you want to slice and dice the population. Get everyone in, make the biggest pools you can, and everyone has a lower (and more predictable) investment in the system over their lifetimes.

Posted by: Patrick_M | February 8, 2010 9:44 PM | Report abuse

"The uninsured young adults who comprise a majority of uninsured citizens rationally reject spending their own money to purchase coverage they don't need."

Rational (sort of) for them, but bad for evryone when you widen the lens and look at the national cost of our health care.

My home has never caught on fire and it is very unlikely that it ever will. Sometimes I feel like I don't "need" fire insurance. But I understand that the only reason my insurance company can cover my losses if my home does burn down, is because countless other people who don't have a house on fire are paying their premiums. Spreading the risk is the only reason it works.

I have a son in college. He is still on our health plan. That's a good thing, because this past summer he had a freak accident, broke his left foot. Long story short: Emergency room, x-rays, surgery to insert a screw, followed by a cast, prescriptions, monthly follow- up visits to an orthopedist and x-rays (still going on) and some work with a physical therapist. Many thousands of dollars in expenses, most of which are thankfully covered because he is insured with us.

Young people may be low risk, but that doesn't mean that they are risk free, and that they don't benefit from something more comprehensive than bare bones catastrophic coverage.

Young or old, perfect health or otherwise, none of us know what tomorrow will bring, so none of us can ever know what kind of insurance we actually "need" and that's why they call it insurance.

Posted by: Patrick_M | February 8, 2010 10:11 PM | Report abuse

"Sometimes I feel like I don't "need" fire insurance. But I understand that the only reason my insurance company can cover my losses if my home does burn down, is because countless other people who don't have a house on fire are paying their premiums. Spreading the risk is the only reason it works."

My home is at very low risk also, not least of which because it is well maintained and I and my family take proper precautions. I also carry very high deductibles. So, my insurance is cheap. Ditto with my auto insurance.

"Furthermore, while a young person is at relatively low risk, the key word is there is relative. Some of them will experience catastrophic illnesses, and keeping them in the pool and out of social services and the bankruptcy courts is not only good for them as individuals, it is good public policy for us all."

Ummm, I believe I said I supported subsidizing catastrophic insurance. And if I had a college age son, I'd also be sure I had medical coverage through my automobile policy, automobile accidents being a known risk among young males.

"Finally, you may be young and healthy, but one day you will be old, and your medical needs are likely to increase substantially"

Uh huh. I'm pretty sure that's why we have Medicare.

I don't know about your son, but I fully expect that a lot of these Millenials will realize, have indeed already realized, that they are among the host animals being prepared by the Democrats for the application of a great big leech.

"Spreading the costs with as big and diverse a pool as possible is the only way to reduce cost in any insurance system etc. etc. etc."

No, it isn't, as a matter of fact. Although I do favor creating a system that makes us a national pool of health care consumers for obvious reasons. I did not advocate slicing and dicing the pool, I advocated reducing costs by only guaranteeing and subsidizing catastrophic care. You see, one of the other ways of reducing costs is by offering less benefits. Which gets us back to the original point I made, and on which Tractarian challenged me, which is that the Democrats have not produced a low cost alternative. I expect that for Tractarian, and for you, and definitely for such as Nancy Pelosi, nothing will do but to guarantee to everyone and to subsidize a package of benefits that includes low copays, low deductibles, no caps on annual and lifetime benefits, prescription drug plan and all of the trappings that employer provided and taxpayer subsidized plans have conditioned you to think is the birthright of every American. And that is precisely why your bills have run into trouble.

Posted by: bgmma50 | February 9, 2010 12:05 AM | Report abuse

"Uh huh. I'm pretty sure that's why we have Medicare."

...which (in the 1960's) people excatly like yourself also argued against using exactly this same logic:

"these Millenials will realize, have indeed already realized, that they are among the host animals being prepared by the Democrats for the application of a great big leech."

Leechapocalypse!!!

Such overheated imagery used against Medicare now sounds more than a bit silly in retrospect, and in the future your language will seem even more absurd in connection with the very moderate HCR legislation to expand privately provided coverage and lower costs.

And as for:

"My home is at very low risk also, not least of which because it is well maintained and I and my family take proper precautions. I also carry very high deductibles. So, my insurance is cheap. Ditto with my auto insurance."

Yes, high deductibles, sensible maintenance, and "proper precautions" get you a rather small discount, but the primary reason your insurance is affordable at all is because the pool is large, so the ratio of claims to subscribers is low and easily predicted by actuarial methodology.

If your fire insurance provider only had ten subscribers, even if all ten subscribers had high deductibles and took "precautions" - that insurance provider would not be able to conduct business, because a single claim for loss would immediately make it insolvent. Insurance works (and becomes cheaper) with a big pool.

It is just actuarial math, not a socialist plot by Obama to turn young adults into "host animals."

Posted by: Patrick_M | February 9, 2010 12:53 AM | Report abuse

"I expect that for Tractarian, and for you, and definitely for such as Nancy Pelosi, nothing will do but to guarantee to everyone and to subsidize a package of benefits that includes low copays, low deductibles, no caps on annual and lifetime benefits, prescription drug plan and all of the trappings that employer provided and taxpayer subsidized plans have conditioned you to think is the birthright of every American."

Um, well maybe, although not really. If you can presume those things, then I could presume you would be very happy if you paid zero taxes and if there were no publicly funded social services or tax subsidies for anything at all.

But here on Earth, the debate is not about what you or I might fear that each other might consider optimal (fear of the unknown, aka xenophobia), it is about the actual content of the legislation.

If you want to argue against the specific provisions in the bill passed in the House, or against the specific provisions of the bill passed in the Senate, please do. But what you describe above bears no resemblance whatsoever to the content of either bill.

Posted by: Patrick_M | February 9, 2010 1:22 AM | Report abuse

"...which (in the 1960's) people excatly like yourself also argued against using exactly this same logic:"

You mean the logic that Medicare would become unsustainably expensive? Gosh, you think maybe they had a crystal ball?

"Such overheated imagery used against Medicare now sounds more than a bit silly in retrospect,"

You should Google "the future of Medicare" sometime.

"and in the future your language will seem even more absurd in connection with the very moderate HCR legislation to expand privately provided coverage and lower costs."

The HCR legislation that lowers costs so much that you have to collect revenue for 10 years to pay for 6 years of benefits AND raid Medicare to the tune of $500 billion to "pay" for it?

"Yes, high deductibles, sensible maintenance, and "proper precautions" get you a rather small discount, but the primary reason your insurance is affordable at all is because the pool is large, so the ratio of claims to subscribers is low and easily predicted by actuarial methodology. "

You seem rather proud of your ability to state and restate the obvious regarding insurance pools, but I'm a little unclear as to why you continue to belabor the point as I already told you that I favor creating a national pool of health insurance consumers.

"If you want to argue against the specific provisions in the bill passed in the House, or against the specific provisions of the bill passed in the Senate, please do."

Did Ezra die and make you the guy who determines what I get to argue about and what I don't?

Posted by: bgmma50 | February 9, 2010 2:00 AM | Report abuse

"Did Ezra die and make you the guy who determines what I get to argue about and what I don't?"

No, and if you prefer to argue about things that you just make up (as you do throughout these latest posts), by all means, do that, but don't be overly surprised when another of Ezra Klein's readers calls you out after it happens.

"...the logic that Medicare would become unsustainably expensive... / ...raid Medicare to the tune of $500 billion to "pay" for it"

Now should we support savings in Medicare if we can achieve them or not? Seriously, these days it is getting hard to tell whether Republicans want to abolish Medicare or pretend that they are its primary protector. It appears that they want to do both.

"I already told you that I favor creating a national pool of health insurance consumers."

Me too. But once again, you also suppose that:

"for you, and definitely for such as Nancy Pelosi, nothing will do but to guarantee to everyone and to subsidize a package of benefits that includes low copays, low deductibles, no caps on annual and lifetime benefits, prescription drug plan and all of the trappings that employer provided and taxpayer subsidized plans have conditioned you to think is the birthright of every American."

...all of which you know full well is not in either bill, and which is therefore merely a fear-mongering rant disconnected from the actual legislation, like the "government takeover with rationing death panels that pull the plug on Grandma," yada yada yada.

You may argue that passage of a modest package of reforms to the private health insurance system will end gravity on Earth too. But like the phantasmagorical...

"guarantee to everyone and to subsidize a package of benefits that includes low copays, low deductibles, no caps on annual and lifetime benefits, prescription drug plan and all of the trappings that employer provided and taxpayer subsidized plans have conditioned you to think is the birthright of every American"

...zero gravity would also not be a consequence of the either bill, or of any imaginable final reconciled form of the bills, as people who read Ezra Klein's writing (and who understand the actual content of the final legislation) are fully aware.

Posted by: Patrick_M | February 9, 2010 3:24 AM | Report abuse

"I advocated reducing costs by only guaranteeing and subsidizing catastrophic care. "

...and you say immediately thereafter...

"You see, one of the other ways of reducing costs is by offering less benefits."

Yes, if there are no benefits extended, there will be no costs. I completely agree with that. But the fact is that Americans will still need the health care that they need, and it will have to paid for in some way.

The question is how to deliver heath care to everyone who needs it at the lowest possible cost, and decelerate the extremely out-of-control annual inflation now taking place within the laissez-faire private insurance-controlled system.

Many of us Democrats (myself included) have wondered why the Republicans have never offered such a basic universal catastrophic plan, such as you suggest, while they were in control.

Part of the explanation lies in your additional stated disdain for even the suggestion of the notion of "no caps on annual and lifetime benefits."

How is anyone truly "covered" for a "catastrophic" medical condition, when the insurer can drop all coverage after some arbitrary cap, during a single year or during a lifetime? This is why increasing numbers of your fellow working citizens, with "good insurance," end up filing bankruptcy every year due to medical expenses caused by a major illness within the family. As it stands today, that eventuality can happen to virtually anyone.

The Democratic reforms are not "gold-plated" and they don't create any "birthright" for unlimited free medical care for anyone.

Instead, the bills expand coverage to most of the uninsured, eliminate existing insurance traps like denial of coverage based upon pre-existing conditions, end the present ability of insurers to cancel policies after chronic conditions develop, and end the ability to deny claims above lifetime existing caps.

Just a set of modest and sensible changes, that will help millions of people, reduce costs, and lower the deficit. Simple common sense changes that leave the private insurance and medical provider system completely intact, and with lots of new subscribers coming through the doors.

No wonder the Republicans have from the very beginning resorted to the "government takeover via backroom deals with rationing death panels that pull the plug on Grandma" demagoguery. No wonder they are now balking about participating at all in the televised open and bipartsan negotiations that President Obama has scheduled in advance of final passage of the comprehensive HCR bills that have already cleared both chambers of Congress.

Posted by: Patrick_M | February 9, 2010 5:57 AM | Report abuse

LOL. Ezra is such a dummy. Why don't the Dems just pass the bill now if they have the votes?

Can't believe this clown writes for the Washington Post.

Posted by: mitchflorida | February 9, 2010 7:16 AM | Report abuse

Except they do have the numbers in the Senate now to block Obamacare because as you say elections matter and the Republicans won an election in Massachusetts. Also, come November the Republicans have a good chance of winning back one or both branches of Congress running on the publics overwhelming opposition to Obamacare. Why would they give ground? Do you think the Democrats would if the positions were reversed and the Republicans were trying to pass a priority of theirs like Social Security reform? After the 2004 elections the Republicans had huge marjorities in both the House and Senate and still couldn't pass Social Security reform because of Democratic obstructionism.

Posted by: RobT1 | February 9, 2010 8:17 AM | Report abuse

"...all of which you know full well is not in either bill, and which is therefore merely a fear-mongering rant disconnected from the actual legislation, like the "government takeover with rationing death panels that pull the plug on Grandma," yada yada yada. "

What I know full well is that the CBO estimates the cost of the basic plan at $5000 per year per individual, and double that for a family. With a national purchasing pool, that amount of money had better deliver on Nancy Pelosi's promises, which include "No Co-pays for Preventive and Wellness Care -- No Excessive Out-of-Pocket Expenses, Deductibles or Co-Pays -- Yearly Caps on What You Pay -- No Yearly or Lifetime Cost Caps on What Insurance Companies...", or you guys are going to be really screwed.

Do the bills spell all of this out? No they do not. (Which is in and of itself rather odd. How a party can devote thousands of pages to health care legislation without ever spelling out what voters are getting for their money and expect people to support it is beyond me) But as I said, if you plan to charge people $5000 per year for insurance coverage, you'd better plan on delivering all of the things I spelled out or you're going to be in a heap of trouble.

"Instead, the bills expand coverage to most of the uninsured, eliminate existing insurance traps like denial of coverage based upon pre-existing conditions, end the present ability of insurers to cancel policies after chronic conditions develop, and end the ability to deny claims above lifetime existing caps."

And if that's all they did, they would have passed by now.


Posted by: bgmma50 | February 9, 2010 11:23 AM | Report abuse

"Do the bills spell all of this out? No they do not. (Which is in and of itself rather odd. How a party can devote thousands of pages to health care legislation without ever spelling out what voters are getting for their money and expect people to support it is beyond me) But as I said, if you plan to charge people $5000 per year for insurance coverage, you'd better plan on delivering all of the things I spelled out or you're going to be in a heap of trouble."

You seem to be arguing against consumer choice and against having insurance companies compete against each other for the business (a "Republican idea"). You seem to argue in favor of a "government takeover" with strictly defined benefits for everyone, ala Medicare.

The legislation provides certain blanket new rules for all health insurance, some of which I already mentioned (no denial for pre-existing condtions, etc.). Beyond that new framework, the idea of the exchanges is to allow insurers to woo new customers with a variety of packages, and the insured will then be able to pick the policy from among competing alternatives that best meets his or her needs.

Most of the elements in the Pelosi quote that you use (with no context) are either already part of the new regulations (like capping total out-of-pocket costs and eliminating lifetime coverage caps) and others doubtlessly will be offered even if not required, because they are in the insurer's interest.

An example of this is having no co-pays for preventative care ... insurers have offered this for years because (as an example) they would rather pay for a middle-aged person's $20 annual flu shot than finance a hospital stay if that person were to contract influenza and see it progress to a more serious illness, like bacterial pneumonia.

The content of the legislation is not a mystery, despite the smoke and mirrors being used to mischaracterize it by the wingnut crowd.

Posted by: Patrick_M | February 9, 2010 1:21 PM | Report abuse

"You seem to be arguing against consumer choice and against having insurance companies compete against each other for the business (a "Republican idea"). You seem to argue in favor of a "government takeover" with strictly defined benefits for everyone, ala Medicare."

I have never been opposed to a public option. I have no problem with eliminating or capping the exclusion to provide funds to guarantee and subsidize a modest and limited benefits package for all Americans. I think that all Americans ought to be able to upgrade that package with all the bells and whistles they want, provided they pay for it and I don't have to subsidize it.

Posted by: bgmma50 | February 9, 2010 2:19 PM | Report abuse

A government run entitlement program for every American, financed by raising taxes on big business...your plan is to the left of Speaker Pelosi.

Posted by: Patrick_M | February 9, 2010 3:28 PM | Report abuse

"A government run entitlement program for every American, financed by raising taxes on big business...your plan is to the left of Speaker Pelosi."

Yes, but it's much cheaper.

Actually, if I could wave a magic wand and say "Democrats, you can devise any plan you want and I'll support it, as long as the funding is limited to revenues you generate from eliminating or reducing the exclusion", I'd be a happy camper.

Posted by: bgmma50 | February 9, 2010 6:10 PM | Report abuse

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