Tuesday, August 18, 2009

Are the wheels coming off...

the reform train? I don't think so, not yet. Nothing passing is still certainly a possibility, but I think the looming Medicare financing problems as the baby boomers retire make doing nothing not so good. If nothing passes this year, we will have to be back sometime in the next few years to address the fact that Medicare Hospital Insurance trust fund is going to be broke by 2019 or so.

The President's approval polls on health care are not so good....but they have been not so good for about a month. The didn't really get any worse during the last couple of weeks, even with all the town halls, etc. And the basic math has been somewhat clear for awhile: the house is going to pass some bill with a public option of some sort; the Senate will not. And the primary action will occur in a conference bill that produces a compromise between the two houses that must then be passed by both the House and the Senate to go to the President's desk. I think in a conference, bills typically move right, not left.

This is a very reasonable discussion of public option, I think. Not a panacea, nor a disaster. Need to keep moving ahead and try and address cost inflation, especially in Medicare, and increase health insurance coverage. I would prefer single payer (Medicare for all) with high deductibles for those less than age 65 (say $10,000 individual/$15,000 family) and a robust insurance market for the gap.

Here is some interesting discussion of the reconciliation process, with the key issue being whether the Senate Dems will need 60 votes (filibuster proof) or whether they would try and pass it via reconciliation rules with 51. I suspect they will have to do it with 60, which will also move any conference bill right.

While the wheels aren't off, they are wobbling. The President is either a Jedi and about 8 steps ahead of everyone, or has really lost control of the messaging (I suspect the second). However, I think the 'left revolt' is actually helpful to the President, in part because the discussion by single payer advocates is typically quite clear, and also shows the President to be toward the middle of between 65-90 members of the House of Representatives. Their basic argument is that health care is different, it is not a commodity and that for profit administration of it is inappropriate.

For the House folks wanting single payer, public option is already a fall back, and that is going, going if not gone.

The Co-ops are a political solution mostly, and it is not clear what they are or how they would work. They don't seem worth it to me, and they won't attract Republicans. The Republicans seem to be consistently opposing everything as it comes about, including now saying the co-ops are also 'government takeover.' So, every Republican in the Senate save MAYBE 1 or 2 in the Senate are going to vote against any bill, no matter what, so the Dems need to focus on what can get 60 votes in the senate and 218 in the House. There is enough work to do within the Democratic party.

I guess in analyzing any bill that actually comes out of a conference, everyone has to figure out what they think doing nothing holds for the future; and then decide whether proposals that emerge are better than that, or not.

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