Does Bart Stupak Want A Bill?
Congressman Bart Stupak (D-Michigan) leads a group of about a dozen Democratic representatives who demanded that restrictions on public funding for abortion services be included in the House health reform bill last fall. He is now insisting that he and his group will not vote for the Senate bill, currently before the House, unless some way is found to tighten the Senate bill’s restrictions on abortion. However, because the Senate no longer has the 60 votes needed to overcome Republican filibusters, the only way for the House to amend the bill is through a parallel “sidecar” budget bill that would be passed in the Senate via budget reconciliation rules. Abortion is not a budget issue so Stupak’s concerns probably cannot be addressed in the sidecar bill.
Is Stupak trying to kill health reform? He says he isn’t and he is continuing to negotiate with House leaders. Stupak’s statements closely parallel those coming from the US Conference of Catholic Bishops, which strongly supports the larger reform but insists on tighter abortion restrictions. The question for Stupak and the bishops is: Are you willing to risk losing your preferred abortion language to ensure passage of health reform? If so, the abortion issue could be split off into a third bill that would get a vote on its own. Such a deal would probably guarantee success for health reform. So far, Stupak and the bishops have not embraced this approach. Instead, they are demanding that their language be included in the sidecar bill. The bishops would then work to get 60 votes in the Senate to overrule the Parliamentarian and allow the abortion provision to pass via reconciliation. I don’t see how pro-choice Democrats and anti-reform Republicans could be convinced to vote with the bishops, so this strategy doesn’t appear to lead anywhere.
With victory on abortion unattainable for the bishops, the question remains: Do they want a bill? If so, face-saving votes can be arranged that demonstrate their commitment without killing the bill. If not, they will kill the bill. My personal guess is that they want a bill, but we probably won’t know for sure for about two weeks.
The Sound of One Man Compromising
More on unilateral bipartisanship from Ezra Klein:
The White House just released a letter (pdf) pledging to move forward with health-care reform and include some of the Republican proposals offered at the Blair House Summit.
… [I]f we were dealing with an actual negotiation in which both sides agreed that we should have a bill ensuring near-universal coverage at no cost to the deficit, it might be enough. But that’s not the negotiation we’re in. Instead, as Lamar Alexander said, Republicans have “come to the conclusion that we don’t do comprehensive well.” And the president is compromising on that point.
And for this the president can count on exactly how many more Republican votes than he’d get without compromise?
For the record, Obama is being characteristically true to himself (as we’ve come to learn). His brand of post-partisan, community organizing jujitsu may deliver health reform. Any other rewards it promises likely won’t be delivered in this political life. It takes a special discipline to compromise with yourself. Isn’t it hard to know when to stop?
The Art of Thought Experiments
Ezra Klein cooked up a good one.
Imagine that John McCain had won the 2008 election [and] … decided to co-opt a longtime Democratic priority and reform the health-care system.
… How many Republicans would support the bill if it were their party that looked likely to benefit? How many House Democrats would stick with the plan if it was taxing some benefits and had no public option and a Republican president had his name on it? And if you think that the differences in vote composition would be dramatic — and I do — then what does that say about the usefulness of evaluating legislative fights on grounds of policy disagreements?
Maybe it isn’t so much that Congress is the graveyard for good ideas but that it isn’t even about ideas. They can only get through the iron gate by coincidentally being politically viable (for which the party affiliation of the president matters). I think I’ve just about said that before.
How The Health Summit Helps Pass Reform
I’ve been reading commentary about the President’s health summit last night and this morning and there seems to be confusion about what this was meant to achieve. Most everyone knows that bipartisanship was not going to suddenly break out yesterday, so what was the point? It seems clear to me that the summit was designed to help corral Democratic votes, first in the House for the Senate bill and then in the Senate for amendments through reconciliation.
Did it succeed? The biggest problem was that House Democrats from swing districts were too frightened by Republican opposition to vote. The summit did two things for them. First it redefined the debate from Democratic leadership against moderate Democrats to all Democrats against all Republicans. This appeals to moderate Democratic partisanship and helps motivate the Democratic base. Second it role played the Democratic-Republican issue debate at length, so individual members could see how it’s done. The President didn’t have to decisively win the debate, he just had to demonstrate that the issue is not a loser for Democrats. Given that no Republican votes are needed, that’s probably going to be enough to pass the bill.
Summetric Equilibrium
What do you call a negotiation game when neither side has any intention to negotiate?
Obama’s New Democratic Populism
There is something new going on in the Democratic Party. The President’s top domestic priority, health reform, ran into determined and increasingly effective Republican obstruction and misinformation. Opinion polls registered growing public opposition built on the foundation of Republican attacks. The Democrats lost a special election in a normally safe seat. Democratic Senators and Representatives panicked and loudly expressed their desire to seek compromise with Republicans and/or abandon the issue. How did the President react?
He could have moved rightward, adopting a Republican issue (tort reform?) as his own and intentionally antagonizing Democratic liberals. Bill Clinton was notorious among Democrats for maneuvers like this (remember “triangulation”?). He could have fired his cabinet, making a clean break with an unsuccessful team. That move helped seal Jimmy Carter’s fate in 1980. Instead, Obama stuck to his original plan, carefully designed from the beginning to reach for major policy goals while maximizing interest group support. He tweaked his position to add popular cosmetic elements (insurance company rate review) and eliminate unpopular ones (cornhusker kickback). Then he stage-managed a confrontation with Republicans to emphasize the shallowness of their appeals to bipartisanship. When he calls the question, chances are he’ll have the votes.
Two things are striking about this response: its confidence and its populism. Barack Obama trained as a community organizer in Chicago. He spent years training community leaders to use the power of populist confrontations to win concrete, lasting policy achievements. That’s how community organizations are built. He also knows that most of his supporters are motivated by symbolic issues with an easily identifiable villain (like ending the anti-trust exemption for insurance companies), so he should campaign on those instead of on the policy elements that will actually have the biggest impact (exchanges and subsidies). Furthermore, he apparently understands that Independents want to see an open process with bipartisan intent, but, again, the policy specifics don’t matter as much to them. So the recipe for success is clear: build an interest group coalition around concrete, winnable issues, emphasize populist components in the campaign, make highly visible overtures to Republicans, and then set up confrontations with entrenched opponents on your terms.
As a candidate Barack Obama promised to change politics. Few thought this was what he meant, but as a former organizer myself this is definitely change I can believe in.
The Health Reform Vampire
The seemingly endless debate among Democrats about whether or not to include a public plan in health care reform finally ended in December with the exclusion of a public plan from the Senate’s bill. Now, unfortunately, it seems that the public plan may be coming back from the dead. Twenty-two senators have signed a letter urging Majority Leader Reid to include a public plan in the Democrats’ health reform legislation, expected to pass the Senate via reconciliation if 50 votes can be found to support it.
Ezra Klein discusses the political advantages and disadvantages of adding a public plan to the bill. Very briefly, it could make the bill more popular, especially with the Democratic base, but it could confuse and slow down a process that has already taken way too long. Jonathan Cohn provides more detailed reporting here and draws essentially the same conclusion with more emphasis on the worry side. These political reads seem mostly right, but they both express ambivalence because they say a public plan would improve the bill on policy grounds while reducing the chances of success in the end. However, while the political benefits may be real, the policy value of a public plan is likely to be an illusion.
As I wrote in a column last May with Bryan Dowd and Roger Feldman, the real-world implementation of a public plan is unlikely to deliver the lower costs and improved efficiency imagined by its proponents. Drawing on years of experience with Medicare policy, we observed that public plans (like Medicare) are too subject to political meddling from Congress to be effective purchasers of services from well organized groups like doctors, hospitals, and equipment manufacturers. These providers, enthusiastically enabled by members of Congress, routinely overturn or block efforts by Medicare administrators to use sensible acquisition procedures like competitive bidding. There is no reason to think a new public plan would be any more successful against these forces than the old one has been. This is the most important reason why the Congressional Budget Office estimated almost no budget impact for the public plan included in the House bill.
As we begin the make or break push to pass health reform, resistance will be strong and the degree of difficulty is high. The public plan divides the Democratic caucus and alienates important interest groups including hospitals and physicians. It sucks the life out of the reform effort without holding any realistic prospect of worthwhile policy change. It may look attractive to some at first glance, but relationships with the undead never work out well in the end.
Clean Up
Apparently there were some technical difficulties with Michael McWilliams’ post that reviews the literature on the health consequences of lack of insurance. They may have only been experienced by Internet Explorer users (seriously, give Firefox a try; it really is better). In any case, the problems should be fixed now. So try again if you couldn’t read the full post earlier.
See also Ezra Klein’s latest on the topic. He’s providing a level of synthesis you won’t find here because it’s not my thing.
I don’t want to be too harsh, and I don’t want to imply that anyone is sitting around twirling their mustache thinking up ways to hurt poor people. But opposition to health-care reform (which is different than opposition to the people who would be helped by health-care reform) is leading to some very strange arguments about the worth of health-care insurance — arguments that don’t fit with previous opinions, revealed preferences, or even the evidence the skeptics are citing.
… Saying that the protective effect of health-care insurance is hard to measure is very different than saying it is “too small to measure,” particularly when the comment is coming from someone who pays for health-care insurance, and is being made in context of whether the uninsured should get insurance rather than whether the insured should let go of theirs. There’s a methodological question here, and then there are political agendas here, and the two are getting mixed up
The hypothesis that some individuals in this debate are motivated by political agendas strikes me as far more plausible than the hypothesis that there is little proven connection between insurance and health and mortality. Though, that bar is pretty low.
Later: See also Kevin Drum who puts up a nice chart from McWilliams’ 2009 Milbank Quarterly paper that summarizes the research. Worth a look.
Watch This Story. It Could Be Obama’s Legacy.
The foundation of one component of Obama’s legacy may be established with his planned health care summit. We saw a preview two weeks ago in his appearance at the GOP retreat. For lack of a better description it’s a form of unilateral bipartisanship. And it is poorly understood. Jon Chait gets it.
This apparent paradox is one reason Obama’s political identity has eluded easy definition. On the one hand, you have a disciple of the radical community organizer Saul Alinsky turned ruthless Chicago politician. On the other hand, there is the conciliatory post-partisan idealist. The mistake here is in thinking of these two notions as opposing poles. In reality it’s all the same thing. Obama’s defining political trait is the belief that conciliatory rhetoric is a ruthless strategy.
Chait was writing about foreign policy. In a must read post today he notes the same elements at work with health reform. There, Obama has already adopted many of the opposition’s ideas. If they accept that fact and walk with him, he’s won a bipartisan victory. If they walk away in plain view, their disingenuous inconsistency is revealed.
At the moment, Obama’s outstretched hand exists in a quantum superposition-like state, simultaneously an olive branch and cudgel. Republicans’ response will determine which is realized. Unless Republicans find a way to rewrite the narrative Obama ends up looking good either way. Chait calls this The Obama Method.
I’m not saying this is some kind of genius maneuver. I’m not even saying it will work. (I wouldn’t bet against it, though.) I’m just saying that this — not starting over, and not pleading for bipartisan cover — is what Obama is trying to accomplish.
If it works I expect it will be identified as a quintessential element of Obama’s legacy. Unilateral bipartisanship may be, logically, semantically, an oxymoron, but it is exactly the marrying of those two ideas that Obama offers as a third way of governing. Though it may also end up as productive as one hand clapping.
A Pass the Damn Bill Fund?
Something I’ve been pondering: if a voter becomes disenchanted with Democrats for failing to pass health reform and is disappointed with Republicans for opposing it what should he do with whatever energy and money he’d devote to issues or political campaigns?
Yesterday, a reader read my mind and e-mailed an idea:
If the Democrats don’t get it together to pass the bill I’m not going to feel like supporting them, but how can I demonstrate that to them before the fact? Why doesn’t someone organize a “Pass The Damn Bill Fund” that people could contribute to instead of contributing to their usual candidates and party committees? If they pass the bill, the fund disburses it’s balance to the party committees. If they don’t pass the bill, the money goes to charity care.
That sounds sensible to me. If political contributions are free speech then passing the hat for passing the bill is the American way.
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