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Will a more moderate bill attract more moderate votes?

Yesterday, Rep. Bart Gordon's office sent out a press release saying the congressman believed "the additional cost reduction measures in the President’s new health care proposal are moving in the right direction." This was notable because Gordon was one of the higher-profile Democratic defections the first time around. But if you think policy matters, it shouldn't be surprising. As Neera Tanden (formerly of the administration, but now working for the Center for American Progress and writing for the New Republic) explains, the bill the House is considering now is much more moderate and fiscally cautious than the bill the House passed last year.

In fact, the Senate bill, even after the president’s proposed modifications, addresses almost all of the major concerns that the Blue Dogs have raised. As a matter of policy, the Senate bill is a moderate Democrat's dream. House moderates have to ask themselves, apart from political considerations, how can they now vote against a bill that senators Lincoln, Lieberman, Landrieu and Bayh have all voted for?

Let’s go issue by issue. The Blue Dogs opposed the public plan that featured so prominently in the House bill. Well, the Senate scrapped that a long time ago. Blue Dogs wanted more cost-containment policies. Well, the Senate bill is not just stronger, but substantially so. It features a robust Independent Payment Advisory Board with authority to lower Medicare payment rates. The House bill doesn’t even have such a commission. The Senate bill also has stronger provisions to push payment reform through a new “innovation center” that will reward quality of care, rather than the volume of care that doctors provide. These are important moves away from the fee-for-service system.

Some House moderates criticized the House bill for taxing the rich. Lucky for them, that’s barely in the Senate bill. While the House bill used the millionaire’s tax to raise $460 billion in revenues, the Senate bill has a Medicare tax that raises only $87 billion from high-income folks.

What about deficit reduction? Both the House and Senate bills would reduce the deficit by upwards of $100 billion over the next decade, but the Congressional Budget Office gives the Senate bill better marks over the next decade on longer-term savings. The CBO says the Senate bill “would reduce federal budget deficits over the decade after 2019 relative to those projected under current law—with a total effect during that decade that is in a broad range between one-quarter percent and one-half percent of GDP.” Furthermore, they should be suffering from significantly less sticker shock. The Senate bill costs nearly $200 billion less over ten years. Not a trivial difference.

One of the big questions in this process was whether a more moderate bill will attract more moderate votes. The statements of Gordon and some others suggest that maybe, just maybe, it will.

By Ezra Klein  |  March 5, 2010; 8:59 AM ET
 
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Comments

Another example of how the media doesn't get it, and inadvertantly misleads the public - a CNN anchor last evening played a soundbite from Obama during the campaign, saying that HCR couldn't be done by a simple majority, then a recent soundbite of him calling for a majority vote (reconciliation) - the anchor implied this was a contradiction. But of course the Senate did pass HCR with 60 votes, and now reconciliation is being used to make particular changes. So CNN viewers got a different, misleading message. ARRGH!

Posted by: jduptonma | March 5, 2010 9:28 AM | Report abuse

Regarding what constitutes moderate policy - 2 branches of conservatism are giving conflicting criticisms of HCR. Branch 1: there's not enough cost containment, so this will break the bank. Branch 2: there's too much cost containment, so this is potential rationing. Double AARGH!

Posted by: jduptonma | March 5, 2010 9:31 AM | Report abuse

Haven't many Democrats in Congress been arguing against the revolving door policy which allows political staffers -- such as Neera Tanden -- to leave their taxpayer funded jobs in favor of position with political action lobby firms like Center For American Progress Foundation? Sure, it's a pay raise (in Tanden's case, a significant pay raise), but is it ethical?

Some of these operatives even take documents with them. One large concern with health care reform is that Federal staffers will now have access to electronic medical records, making the medical records of political enemies prime targets for unethical (and illegal) use in smear campaigns. Already, many unethical lobby groups steal business records and illegally republish them as part of smear campaigns -- there's nothing to stop Tanden and those like her from using medical records in similar smear campaigns.

Posted by: rmgregory | March 5, 2010 9:38 AM | Report abuse

Obama must be given credit for playing a good polka hand by calling for an unproductive summit (where he was obviously going through the motions) and then calling for a "up or down" vote. I won't pretend to understand the procedural maze that will be used, but if this bill gets out of the House, it will be signed. I just wonder if the incumbent Dems really care about the mood of the country's taxpayers. The level of distrust among voters and anger over the process will be a huge factor in November. Personally, I am against the overall bill as presented; but want reform of the system on a smaller, more paced schedule. But it is going to be very interesting to watch this process over the next month or so. There is great peril for all incumbents. And, this is not a Republican vs. Democrat issue. If it was truly partisan, the Dems, who control the House and Senate, would have passed this bill months ago! Can the Dems get together? I hope not...but, I think they will!

visit: http://eclecticramblings.wordpress.com

Posted by: my4653 | March 5, 2010 9:40 AM | Report abuse

jduptonma - These are not contradicting criticisms.

Without reducing costs, the government will be forced to ration care. Effectivly the middle class will be pushed into a new privately outsourced form of Medicaid, and when the government runs out of subsidies to pay for the escalating costs of their care (and the care of the poor) the government will have no other choices but to start limiting coverage.

This will be no surprise to Obama who ALREADY understands and acknowledges that rationing will have to happen:

http://www.bloomberg.com/apps/news?pid=20601070&sid=aGrKbfWkzTqc

Posted by: FastEddieO007 | March 5, 2010 9:41 AM | Report abuse

The ultimate result of Obamacare is that middle class families will pay more money, receive less care at a lower quality and the USA Government will be permanently fiscally damaged by mounting structural deficits that cannot be supported by the tax base.

Democrats have extrapolated the Union mentality of recklessly insisting on demands with audacious disregard of the sustainability of those demands. We all know what the ultimate result of that mentality is....simply look at what that Union mentality has done to the city of Detroit.


Government cannot protect us from reality. It can only "fake it" for a few years, and then it will collapse on top of us.

Posted by: FastEddieO007 | March 5, 2010 9:46 AM | Report abuse

@jduptonma: " So CNN viewers got a different, misleading message. ARRGH!"

Too bad more people can be super smart like you, and thus able to figure that out on their own.

It must be so very hard, being so high above the great unwashed masses. CNN will fool them all. Because only really smart folks, like you, can figure out the truth. Or do any kind of critical thinking on their own.

Frankly, given that you were one of the seven people watching CNN, I wouldn't worry that much.

Posted by: Kevin_Willis | March 5, 2010 9:48 AM | Report abuse

Kevin

Do you ever actually contribute anything thoughtful or factual here? Or is your only purpose here to ridicule, whether or not it is deserved? Your behavior is very typical of Republicans (you seem to never actually address the issues/points being discussed). At least that's what I've seen here.

Posted by: Lomillialor | March 5, 2010 9:53 AM | Report abuse

Piecemeal implementation of "reform" as the Republicans and some Democratic moderates have called for simply means no reform at all.

Every one of the "baby steps" they've suggested could have been dealt with long ago -- if they were actually intent on making some reform.

Liberal ideologues aren't happy that the bill doesn't go far enough. But it does go much farther than "no where."

So with a reasonable moderate bill, moderates who oppose it are... what... just posing for the cameras?

On another point, folks need to stop confusing the passage of a bill which in both chambers is done with a simple majority and the Senate's procedural hurdles -- invoking cloture, stopping a filibuster, etc. -- which require, at present, a 60 votes to clear the hurdle but only 51 votes to pass the measure. Two very different things that have been conflated.

Posted by: jade_7243 | March 5, 2010 9:53 AM | Report abuse

Worth noting that Gordon is retiring.

Posted by: Art27 | March 5, 2010 9:54 AM | Report abuse

Back in the fall, it was routine for people to argue that Pelosi and the committee chairmen might have been pushing too hard on the public option -- that without the "government-run" component, gathering the necessary votes among Democrats for health reform would be easy. I think we're going to find out that dropping the public option doesn't get you as many votes as we might have thought at the time (although 5 or 10 may be all you need).

Posted by: vvf2 | March 5, 2010 10:09 AM | Report abuse

Rather than using the Massachusetts plan, which is causing costs to rapidly increase, why don't we use the Indiana plan as a model? Giving people their own money to spend encourages good decisions and takes insurance companies out of the equation for most health care. Combine this with forcing providers to publish their prices so they can't rip off people that aren't backed by a big plan or Medicare, and you have a system where the market will push prices to their natural level.

http://online.wsj.com/article/SB10001424052748704231304575091600470293066.html

Posted by: staticvars | March 5, 2010 10:24 AM | Report abuse

@Lomillialor: "Do you ever actually contribute anything thoughtful or factual here?"

My apologies. The whole "I saw this last night on the TV, and everybody is fooled except me, cuz I'm so smart!" thing is a personal bugaboo of mine not directly related to what Ezra posted. My apologies.

"Or is your only purpose here to ridicule, whether or not it is deserved?"

Clearly a very selective reading of my comments. You may disagree.

"Your behavior is very typical of Republicans (you seem to never actually address the issues/points being discussed). At least that's what I've seen here."

That's just not the case. Most of the time, I stick to the issues and points being discussed. I just have a few personal irritants, and the implicit self-congratulations of statements saying, "I saw these lies on TV, and only I am (and maybe a few of you are) smart enough to know they are lies to see through the deception.

Did not mean to offend you, or stray too far off topic. I will endeavor to do better in the future.

"Typical of Republicans". I'm also an entertainment geek. Is my behavior typical of entertainment geeks? I also work for the county government. Is my behavior typical of employees of municipal governments? I also have dark hair. Maybe my behavior is typical of all those other dark-haired folks you know.

Sheesh.

Posted by: Kevin_Willis | March 5, 2010 11:11 AM | Report abuse

staticvars,

Getting rid of insurance companies would be a great idea, but that's even more radical than single payer. The flip side is that no matter what policy we pursue, improved price transparency would be a good thing.

Posted by: etdean1 | March 5, 2010 11:39 AM | Report abuse

Isn't the Medicare Commission hampered by all sorts of conditions and rules that make its ability to cut provider reimbursements difficult.

Posted by: nathanpunwani | March 5, 2010 12:08 PM | Report abuse

nathanpunwani,

MedPAC doesn't actually cut reimbursements. It makes recommendations to Congress, and then Congress votes to institute those recommendations. It can't actually do anything itself.

Posted by: etdean1 | March 5, 2010 12:23 PM | Report abuse

@etdean1

I didn't mean get rid of insurance companies, I just meant limiting them to catastrophic situations. It's really much less radical than assuming a Marxist theory of pricing can apply to health cost containment. Using HSAs offer a proven method of saving money and giving control to consumers, and they are in use by large corporations and state governments. It's also coincident in theory behind the very successful plan in Singapore.

If we follow that more moderate approach, many new value based innovations in health care will emerge.

Posted by: staticvars | March 5, 2010 2:28 PM | Report abuse

@ etdean1,

I know that. I'm talking about the Medicare Commission under the Senate bill. I heard that its still really weak.

Posted by: nathanpunwani | March 5, 2010 5:48 PM | Report abuse

Lomillialor,

I am a proud liberal, and I think Kevin_Willis is among the very few voices on the right regularly posting here who continually makes substantive thoughtful and articulate points.

Kevin's views will always be welcome, at least by me. If we lose voices like Kevin, this blog may turn into FastEddie 24/7. You wouldn't want that, would you? Please stay, Kevin.

Posted by: Patrick_M | March 5, 2010 8:37 PM | Report abuse

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