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Posted at 10:27 AM ET, 02/10/2011

Let's talk about us

By Ezra Klein

The name "Mitch Daniels" does not appear in Kathleen Sebelius's op-ed this morning. But the whole piece is a response to Daniels's op-ed in the Wall Street Journal demanding that states get more flexibility to set the standards governing the insurance products that'll be offered in their exchanges. Here's the key bit from Sebelius's rejoinder:

What these critics miss is that the law already gives states most of the resources and flexibility they're asking for.

States have discretion, for example, to offer a wide variety of plans through their exchanges, including those that feature health savings accounts. Utah and Massachusetts already operate exchanges but take very different approaches: Utah allows all insurers to participate; Massachusetts has stricter standards. Under the law, both approaches could work.

States also have the flexibility to decide what benefits plans must offer. They can choose to require basic protections, based on the typical benefits people get through their jobs, or set higher standards.

I hope and assume that someone in the Department of Health and Human Services has placed a call to someone in Indiana's Family and Social Services Administration. Two op-eds containing a variety of unsubstantiated assertions -- why does no one link to bill text? -- about what the law does and doesn't allow aren't worth much here. But if Sebelius's point is that the administration believes in giving states lots of flexibility and Daniels's point is that the states should have lots of flexibility and he's got some concerns, it seems like something could be worked out, at least if everyone involved is actually interested in working something out.

By Ezra Klein  | February 10, 2011; 10:27 AM ET
Categories:  Health Reform  
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Comments

An astute reader mentioned recently -- and as Bureaucrat Sebelius herself notes today -- the Governors of Sovereign States DO have the upper hand. If a Governor so desires, he can veto state legislation implementing the PPACA, thereby forcing federal bureaucrats to go to Congress to request the true amount of cash necessary to implement the burdensome requirements of the PPACA.

Sebelius is making a wise step -- but what real choice does she have? Foolishly, Congressional Democrats enacted a statute which dares The People to resist... and thereafter engaged in a campaign having the theme "Resistance is Futile!" To that attitude, The People responded in the style of David Farragut (he was around prior to the Borg named Hugh).

It "seems like something could be worked out, at least if everyone involved is actually interested in working something out." True! Why not simply repeal the PPACA, then gather around a table to discuss a real, meaningful, and Constitutional solution to the health care cost issues resulting from Johnson's Medicaid program?

Why won't obstructionists in the Senate come to the table and listen to the will of The People? Will these same obstructionists be willing to PAY for the PPACA cost overruns -- thereby admitting their original "error" in cost estimates?

Posted by: rmgregory | February 10, 2011 10:47 AM | Report abuse

OK Mubarak is stepping down. Now that the Saudis are involved, I have a great deal more confidence in the situation.


I have ZERO confidence in Obama.


GEESHHH Did it really take a stern, firm telephone call from the King of Saudi Arabia to get Obama to listen to people ???


Meaning, it sures appears as though Obama was ignoring all the Middle East experts.


JUST like Obama was ignoring all the Generals on the Afghan War as outlined in Woodward's book. Did it really take a telephone call from the King of Saudi Arabia to straighten out Obama??? Unbelievable.


.

__________________________


Sure seems like Obama had NOTHING to do with Mubarak stepping down.

It is a plan worked out by other people.


Obama is practically a non-entity in terms of influence in the Middle East. Our allies in the region are waiting for Obama's term to be over so they can deal with the next American President.


.

Posted by: RainForestRising | February 10, 2011 10:53 AM | Report abuse

" it seems like something could be worked out, at least if everyone involved is actually interested in working something out."

Ah, but there's the rub. Most Republican governors just want the ACA to go away. They have zero interest in "working something out."

Posted by: jp1954 | February 10, 2011 10:57 AM | Report abuse

Ezra

WHAT you do not understand - is any social legislation in the US MUST have bipartisan support, or it will not stand.

Obama's health care bill will not stand, and is unconstitutional as we speak.

The Republicans will soon be in control of Congress and the Presidency - they will write the next health care bill - trashing Obama's ridiculous ideas from A to Z.

Obviously Obama could have done things differently


IF Obama had supported a GENUINE BIPARTISAN BILL - DRAFTED BY BOTH PARTIES - this bill would probably not be headed for the trashheap of history right now. That was the ARROGANCE AND EGO OF OBAMA AND THE LIBERALS. You choose this road.


.

Posted by: RainForestRising | February 10, 2011 10:58 AM | Report abuse

As you say, Ezra, coming to resolution of common concerns depends on whether "everyone involved is actually interested in working something out." Arguably, Mitch Daniels proposal is one of the better-faith GOP pitches out there, but it's not at all clear what his goal is. Is he serious about addressing his concerns or is he just looking to "seem" serious a la Paul Ryan? No one in any position of GOP Congressional leadership wants there to be any successful "resolution." Only obfuscation.

Until someone calls out Mitch Daniels and puts him on the spot -- i.e. put your money where your mouth is, Mitch Daniels -- this is nothing more than two op-eds talking past each other. Someone like, say, Obama or Harry Reid gesturing out to Mitch Daniels to "put him on the spot" or inviting him to tea or whatever could yield some progess. It could also nip this in the bud and score major points for the Dems. if something positive came out of it. I'm not holding my breath. Obama likes to wait until the 11th hour to get involved in things, and it seems as if the rest of the Dems. are just waiting out the health care re-debate presuming nothing's going to happen.

Posted by: pbasso_khan | February 10, 2011 11:00 AM | Report abuse

Wow, you read the comments attached to the Sebelius article and you can see the stupidity and obfuscation by right wing.

Sadly, it pays off for way too many citizens; an alarming number of who buy into the right wing idiocy.

Why tell a difficult truth when an easy lie gets you just as far?

Posted by: JkR- | February 10, 2011 11:12 AM | Report abuse

"Two op-eds containing a variety of unsubstantiated assertions -- why does no one link to bill text? -- about what the law does and doesn't allow aren't worth much here."

You mean somebody is being disingenuous about what is in the PPACA? Mark me down as incredulous.

Posted by: willows1 | February 10, 2011 11:22 AM | Report abuse

RainForestRising. Were you out of the country for the last two years? The original health care reform debate dragged out for over a year *because* Obama and the Dems. kept trying (in vain) to get a "bipartisan" health care bill. Remember Baucus's Gang of 6? Remember the overtures to get Olympia Snowe? Remember the "summit" at the White House? And, what could have been more "GENUINE" as a bipartisan bill than using Bob Dole and Mitt Romney's health care plan, but changing the names and the dates? You are entitled to your own opinion, but not your own facts.

And where on Earth do you get the statment, "any social legislation in the US MUST havebipartisan support, or it will not stand"? Do you have any example from history that you're thinking of?

Unforunately, "ARROGANCE AND EGO" are not partisan traits. I think we might just find some of that on the GOP side as well.

Posted by: pbasso_khan | February 10, 2011 11:48 AM | Report abuse

pbasso_khan has it exactly right. Sen. Baucus tried desperately to get GOP buy-in. They simply wouldn't take yes for an answer.

Posted by: steveh46 | February 10, 2011 12:01 PM | Report abuse

Ezra,

but at some point I would suspect HHS is going to set the baseline for coverage in the exchange and that's I expect what Daniels has a problem with. What works in NJ may not work in IN or in CA. If the baseline for example requires coverage for example for autism treatment like is the law in NJ here where its prevalence is higher than in other states then that is a cost that IN may not want its citizens to have to bear if its not as prevalent there. If the baseline does not cover it then those of us in NJ who utilize that benefit will lose coverage in effect because of PPACA (another promise that should never have been made broken).

Posted by: visionbrkr | February 10, 2011 12:07 PM | Report abuse

rmgregory, what gets obscured in your whole spiel about how the health care law "dares The People to resist ... The People responded in the style of David Farragut" is who "The People" are?

Look, "the People" (as in, the American people) are fickle. They were clamoring for health care reform leading up to the 2008 elections, not so much in 2010 after the process got ugly. But, please don't try to make it sound like "The People" = "All the People." In fact, most current polls suggest "The People" don't want a complete repeal of health care reform (true, depending on how the poll is conducted and what question is asked). Moreover, a large segment of "The People" feel very passionately *in favor* of the health care law and a larger segment still think the health care law didn't go far enough.

So really what it comes down to is "SOME" People seem to believe the health care law is some tyrannical government something or other and Secretary Sebelius gets to be insulted as "Bureaucrat Sebelius," but "SOME" People do not speak for "ALL" People.

And are you really referencing Star Trek: The Next Generation? Borg named Hugh?

Posted by: pbasso_khan | February 10, 2011 12:43 PM | Report abuse

If we add the people in support of ACA to the people who don't support it because they want it to be MORE LIBERAL, we are up to 55-56% of the population, without breaking a sweat. The People want a single payer.

Posted by: Lee_A_Arnold | February 10, 2011 1:11 PM | Report abuse

You overlooked the 800 lb gorilla. Namely, that Mitch Daniels is a (willfully) ignorant partisan wishing to cause a Democratic President problems. I honestly don't believe Mr Daniels is stupid. I feel it's far more likely he is comfortable lying to curry favor with his Fox News set, which by reports out in today's media indicate that lying about your opponents is the rule, not the exception.

Posted by: kindness1 | February 10, 2011 1:12 PM | Report abuse

pbasso_khan - I think we'll get there because of this law. We had to start somewhere. I think the real action will be when the states begin to implement their own versions of PPACA. I wouldn't be surprised if at least a few states went STRONG public option or single-payer and we find out that this is what works the best (duh!). Personally, I'm open to almost any solution, but I just don't think the Ryan austerity plan gets us there. This whole thing is likely to be re-litigated within the next ten years with a lot of new information gleaned from the state-level experiments.

Posted by: willows1 | February 10, 2011 1:37 PM | Report abuse

Lee A Arnold -

I think we'll get there (to single payer or something resembling single payer) because of this law. We had to start somewhere. I think the real action will be when the states begin to implement their own versions of PPACA. I wouldn't be surprised if at least a few states went STRONG public option or single-payer and we find out that this is what works the best (duh!). Personally, I'm open to almost any solution, but I just don't think the Ryan austerity plan gets us there. This whole thing is likely to be re-litigated within the next ten years with a lot of new information gleaned from the state-level experiments.

Posted by: willows1 | February 10, 2011 1:38 PM | Report abuse

I remember way back in the 70s when the Republican party health care platform was based on taking away individual state flexibility so that insurance could be sold across state lines...

Wait, that was their platform 2 years ago?

http://online.wsj.com/article/SB122282743245193057.html

What a joke of a party.

Posted by: eggnogfool | February 10, 2011 2:17 PM | Report abuse

Mitch is not interested in working out anything. he's a repug presidential contender and wants his name in the news ala Palin.

Posted by: bayroad22 | February 10, 2011 3:40 PM | Report abuse

Quite a simple solution, really.

Give the states the cash and let them decide whether to use it for providing healthcare to some chumps or to attract jobs and grow business.

Posted by: krazen1211 | February 10, 2011 8:23 PM | Report abuse

krazen1211, that's really terrible: "healthcare to some chumps"? C'mon now. You know a lot of those "chumps" are children and seniors, who wouldn't otherwise be able to afford the high cost of health care. My parents got government support for end of life care, and they both worked damn hard for over 50 years a piece.

Posted by: pbasso_khan | February 10, 2011 9:19 PM | Report abuse

"krazen1211, that's really terrible: "healthcare to some chumps"? C'mon now. You know a lot of those "chumps" are children and seniors, who wouldn't otherwise be able to afford the high cost of health care"

If you truly believed in the merits of the providing health care to unproductive people you would have no problems with this type of program.

Posted by: krazen1211 | February 11, 2011 9:29 AM | Report abuse

krazen1211: Health care isn't a salary or wage replacement or a reward. It shouldn't matter how "productive" you are to warrant medical treatment. Providing health care to a child helps him or her to grow into a healthy (and productive) adult. In the case of the elderly, they've alredy lived a "productive" adulthood and are now eligible to retire. Basic health care is not a privilege.

Posted by: pbasso_khan | February 11, 2011 10:59 AM | Report abuse

"krazen1211: Health care isn't a salary or wage replacement or a reward. It shouldn't matter how "productive" you are to warrant medical treatment. Providing health care to a child helps him or her to grow into a healthy (and productive) adult. In the case of the elderly, they've alredy lived a "productive" adulthood and are now eligible to retire. Basic health care is not a privilege"

According to what, exactly? This is a position based on the wishes of ideologues, not the path to a growing economy.

In any case, Obamacare is about giving money from productive adults to unproductive adults. Children and the elderly are already covered and bankrupting our nation under Johnsoncare.

Posted by: krazen1211 | February 11, 2011 2:34 PM | Report abuse

Here's the key bit from Sebelius's rejoinder:
"What these critics miss is that the law already gives states MOST of the resources and flexibility they're asking for." ------ This is a dumb statement. Everyone knows junk gets thrown in any law - all it takes is one sentence to negate (or provide a loophole in) 90% of a proposal - often we hear about great laws/ideas "that have no teeth". I'd like to know more, but sounds like Sebelius is writing an opinion that could be missing key information.

Posted by: chris76543 | February 12, 2011 10:24 AM | Report abuse

Only a couple politicians have talked about Medicare fraud that's estimated at $60 BILLION per year. Until someone comes up with a way to stop this, any national plan (one supporting 10 times more people) could have 10 times as much fraud.

Posted by: chris76543 | February 12, 2011 10:26 AM | Report abuse

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