Riddle Me This, Batman.

Democratic Plan A: pass a really good bill with either a strong Public Option or a Medicare Buy in.

Democratic Plan B: fuck up and pass nothing.

Why is there no Democratic Plan B: pass the shortened, Lieberman approved bill and then ram a separate "Public Option" through under the budget--a Public Option that would start immiediatly because it was really some form of "Medicare for all." I understand that under the Byrd Rule it would have to lower the deficit--but I think the various CBO scorings show that it can or does sufficiently to pass that bar. And I understand that the Democrats don't want to do it as part of the Budget because it will all have to be reauthorized at some future time. But if you had already passed the bulk of the health care reforms under the regular system you'd have all those goodies and structural changes to back you up with the voters. And if the Public Option you forced through reconciliation started on day one and enrolled a ton of people in every state you'd have a built in voting base that would fight tooth and nail not to be thrown back into the private market. You could then go ahead and argue for the next two election cycles that we must have more and better Democrats in the Senate in order to permanently pass the Public Option.

Can someone explain to me why this can't be done?

aimai

Our Stupid Discourse:


Look, there's something wrong with this thoughtful analysis, can you spot it?

To begin with, a public option would attract only a few million people, the Congressional Budget Office predicts. Those people would probably be sicker than the general population. For that reason, and because their numbers would be relatively small, their premiums would be higher than for private insurance.

A) The Public Option wouldn't "only attract a few million people" it would, as currently drafted, only *permit* a few million people to be eligible.

B) Those people wouldn't "probably be sicker than the general population"--they would definitely be sicker because the Option, at the moment, is limited to people who have essentially been uninsurable for quite some time, or are uninsurable because they have pre-existing conditions, or are poor and have the risk factors of poverty and low status employment.

C) "For that reason..." their premiums would be higher than for private insurance *which they can't get, and won't get, under any circumstances.* There is no "private insurance" system that is taking these people. They have been priced out, or forced out by reason of pre-existing conditions--from the private insurance market. There is no comparison between those premiums and Public Option premiums because the two markets don't simultaneously exist.

People need Health Care, Health Insurance is simply the means we use to deliver the most health care, the most efficiently, to the largest number of people when they need it. If it doesn't deliver health care, if it doesn't do it efficiently, if it leaves a large number of people uncovered or uncared for, if it doesn't offer health care when they need it--the system is a failure. You can create an insurance system that does all these things but it is never going to be successfully "for profit" if it does. You can create an insurance system that does all these things but as long as it can cherry pick its clients, or force the sickest onto someone else's books, it is never going to do all these things efficiently, or humanely, or cost effectively.

Why at this late date are the reformers allowing this fundamental fact of reality to be obscured? Why do we continue having incoherent surface discussions of "what the Public thinks" when there is no clear or honest information being offered about what the various plans do, for various kinds of families, over the course of the lifetime of those families? In addition, why are pundits and pollsters insisting on talking about a generic "Public Option" when no such Option really exists or, indeed, of "Private Insurance" when no such option realistically is offered, or works, for Americans. I'm sick and tired of having pundits explain to me that the "Public Option" ain't all its cracked up to be when they refuse to admit that the Private Option is nothing like its supposed to be.

The simple fact is that even Americans with Employer Based Health Insurance are only temporarily insured. Medicare and Medicaid are already serving as a way that private insurance (and Employers) dump the sickest among us onto the Public Rolls. But the public doesn't know that, because the Administration doesn't know how to talk clearly about the hidden costs of our Health Care crisis. If the Government, at least, would talk honestly about our Health Care needs from cradle to nursing home the public would have a better idea of just how bad the system is, and where reform will make the most sense. The public would also have a better idea of who to thank when the problems were solved. As it is, the goodies in the bill for the average person are not well understood now and never will be. Most people only grasped how bad private insurance was when they got forced out of the system, or tried to buy in. To the extent that the Obama bill will ameliorate some of those things the citizenry will simply never know--anymore than they think about the regulations that give them pure tap water.

aimai

aimai

Is Lieberman In, or Out?

Today in Politico:

Sen. Joe Lieberman (I-Conn.) said Tuesday that he’d back a GOP filibuster of Senate Majority Leader Harry Reid’s health care reform bill.

Lieberman, who caucuses with Democrats and is positioning himself as a fiscal hawk on the issue, said he opposes any health care bill that includes a government-run insurance program — even if it includes a provision allowing states to opt out of the program, as Reid’s has said the Senate bill will.

"We're trying to do too much at once," Lieberman said. “To put this government-created insurance company on top of everything else is just asking for trouble for the taxpayers, for the premium payers and for the national debt. I don’t think we need it now."

Digby is hearing that he won't filibuster and is hopeful that Blanche can be threatened with losing her Ag Chairmanship. But if the Dems were actually playing hardball with the Senate Caucus on anything we wouldn't be hearing this kind of outright hostility from Lieberman.

Its not over, not by a long shot.

aimai

Which Way Will the Snowe Fall?

Apparently I was half right--Snowe was "Homer" in my example below. She waited just that fraction of a second too long to turn a profit on the sale of her bipartisanship. But now the question for us cognoscenti is--which way will she go when she actually has to pick a side, first for cloture and then for the historic vote on HRC in the Senate? Steve Benen (one of the hardest working Steves in blog commentary) and Brian Beutler try to figure it out:

Not surprisingly, Maine's senior senator was not pleased. Snowe's statement yesterday afternoon read:

"I am deeply disappointed with the Majority Leader's decision to include a public option as the focus of the legislation. I still believe that a fallback, safety net plan, to be triggered and available immediately in states where insurance companies fail to offer plans that meet the standards of affordability, could have been the road toward achieving a broader bipartisan consensus in the Senate."

Brian Beutler sees glimmers of hope in this: "How explicit a statement is that, though? I could be over-parsing here, but it sounds to me as if she's leaving a door pretty wide open to supporting this bill down the line. Note, she doesn't say she's withdrawing her support."

Perhaps, but I suspect Snowe's "deep disappointment" is her way of distancing herself from the bill. Indeed, just four days before Reid's announcement, Snowe said, "I'm against a public option." Asked if she'd join a GOP filibuster on this, Snowe said, "Yes, it would be difficult" to support letting the bill come to the floor for a vote.

In other words, I suspect the key question is no longer, "How do we keep Olympia Snowe happy?" Rather, it's, "How do we convince Ben Nelson, Blanche Lincoln, and Mary Landrieu to let the Senate vote on health care reform?"

I think they are both right--Beutler's right that Snowe is still in play and still trying to be a player. Benen's right that the Dems have, for the moment, moved on and are not trying to negotiate with her to get her vote. But I think they will get her vote anyway. Waaay back in the mesozoic age, two weeks ago or so, Snowe voted for the passage of the horrible Senate Finance Bill with the absurdly self important and rhetorically ugly statement "When history calls..." as though history imposed itself on us like an urgent need to pee. That's the real Snowe--someone who wants to be on the right side of history, however foolishly and narrowly she conceives that to be. She won't vote with the rest of the Republican pack dogs against Cloture and against the final bill. I can't figure out which Snowe will come to the ascendant at which point in the process--much seems to depend on how much attention, credit, or blame she will get, in her own mind, for each vote separately. I can see her voting against cloture if she thought she had enough "centrist" Dems to give her cover. I can see her voting for cloture if she sees the partisan breakdown as irremediable and she decides that "history is calling" her once again to pretend to be a swing vote. But I actually think, one way or another, she will end up voting for the bill on the floor, whatever it is, once its clear that passage is inevitable. There are ideologues, and true believers, and partisans, and obstreperous people who don't mind being hated and love the limelight whether it shines on them warmly or with hellish heat. Snowe isn't one of those. She's a woman of ego and self interest who loves the spotlight as long as its comfortable. Like Baucus, when the bill seems inevitable, she'll rush to put her signature on it and pretend it was all her idea all along.