The last staff post on public option alternatives percolating in the Senate really got me thinking: are the senators or health reform advocates kicking around state-based approaches to the public option really thinking through the political implications of taking this route? Or are they just focused on their own legislative problems?
The one thing that’s clear about these approaches is that they would considerably ramp up the importance of health reform in state politics going into an already crazy 2010 election cycle. I’ve got a post up at The New Republic raising this issue, and wondering if state politicians in either party are quite ready for this challenge. In effect, letting the states make the most fundamental decisions about how to design a health care system–not just for the Medicaid or SCHIP participants they currently deal with, but for pretty much everybody–would simply shift all the many controversies we’ve seen in Congress this year to state capitals.
It’s hard to say how this would all play out. Chris Bowers suspects Republican-controlled states (including some where a public option is most needed) would kill any sort of public option immediately. Others may be more sanguine given the general popularity of the public option nationally. All I’m saying is that senators and health reform advocates need to think and talk about this political reality at some depth, and not simply seize on state-based approaches as a clever way out of their own dilemmas.
It’s reassuring that one of the proponents of a state-based approach, Tom Carper, is a former Governor, who presumably understands the political implications at the state level. And it’s encouraging that two others, Maria Cantwell and Ron Wyden, are trying to enable the states to adopt reforms more radical than any we would see in a one-size-fits-all national reform template. But a 2010 state political cycle dominated by a raucous health care debate is a tricky proposition, particularly given the potential impact of health industry dollars on legislators and candidates alike.
Look before you leap, senators.
Democratic Strategist
Quite a few progressives have taken the position that only a “robust public option” (typically defined as a government-sponsored insurance plan linked to Medicare payment rates) can make a hybrid, private-insurance-based health reform system worthwhile. Otherwise, they argue, any initiative that includes individual and employer mandates will simply give private health insurers more customers and profits, without constraining costs or improving quality.
But barring the use of budget reconciliation procedures or a semi-miraculous act of party discipline on a cloture vote, a “robust public option” is unlikely to be enacted by the Senate, and could even encounter trouble on the floor of the House. So public option supporters (and opponents) have been mulling over a growing number of alternatives being floated by Senate Democrats (and one Republican, Olympia Snowe).
Tim Noah at Slate offers a good rundown of these “half-loaf” measures, including two he considers unacceptable: Conrad’s nonprofit cooperative approach, and Snowe’s public option “trigger.”
Tom Carper has suggested a “opt-in” state public option that would also allow states choosing to go in that direction to form regional public plans. And without a lot of fanfare, the Finance Committee has already adopted a proposal by Maria Cantwell that would allow states to use federal subsidy funds to directly make insurance available to a large category of the uninsured, up to and including creating state single-payer plans.
Sam Stein of HuffPo reports today on another wrinkle that’s being discussed: an “opt-out” variation on Carper’s state public option plan, which would have the advantage of creating a strong national public option that states could take or leave.
All these state-based approaches to the public option have the obvious goal of enabling key centrist Democrats to get out of the way of a public option while preserving the right of their own states to go in a different direction. This might be especially appealing to senators getting a lot of pressure from insurance companies and/or health care providers in their own states to oppose a public option affecting them.
It’s unclear which if any of these alternatives will emerge as the go-to plan, but without a doubt, a crucial factor will be the extent to which “robust public option” advocates, particularly in the House, decide to expand their own definition of an acceptable public option. Remember that many public option fans actually favor a single-payer system, and are disinclined to support any alternative that strengthens the hand of private health insurers. A lot may depend on whether they are reasonably sure their own states, and most states, will take advantage of opportunities to create the kind of public option they favor.
Meanwhile, state-level politicians will soon come to the realization that national health care reform may actually place them in the driver’s seat, and make the basic design of health care an even more dominant issue in their own political lives, perhaps beginning in 2010.
The much-awaited Congressional Budget Office analysis of the Senate Finance Committee’s version of health reform legislation is in, and the initial reports are reasonably positive. CBO says the amended Baucus bill would actually reduce federal budget deficits by a cool $81 billion over the next decade, and far more in later years. It would also cover 94 percent of legal non-elderly Americans. Since the Senate Finance bill is generally considered the most conservative contributor to the ultimate reform legislation, that’s not bad.
But as Ezra Klein ponts out, the Finance Bill reinforces a focus on the uninsured that sells genuine health care reform short:
This bill will change the insurance situation for 37 million legal residents, 29 million of whom would otherwise be uninsured. That’s a big step in the right direction. But most people will never notice it. When I got an early glimpse of the Senate Finance Committee’s bill back in June, I called it “comprehensive incrementalism,” and I stick by that label. It makes a lot of things a bit better, but it’s not root-and-branch reform.
The Obama administration’s decision to avoid disruption of existing health insurance arrangements, reinforced massively by Republican claims that reform would denude seniors of existing coverage, made this outcome unavoidable. Health care reform will be just that: a reform, but not a revolution in the U.S. heath care system.
One of the favorite conservative talking points over this last year has been the argument that Barack Obama has been trying to move the United States towards “European-style socialism” even as Europe repudiated it. Never mind that Obama’s policy positions are a lot closer to those of Europe’s center-right parties than are the policy positions of the GOP. But in any event, the death of Euro-socialism has once again been greatly exaggerated, just as it was in the era of Margaret Thatcher.
A couple of weeks ago Portugal’s Socialist Party held onto power in parliamentary elections, albeit with reduced margins. And now comes the news that Greece’s center-left Pasok Party has won a resounding electoral victory, turning out the government of Costas Karamanlis and his center-right New Democracy Party. Pasok’s leader, George Papandreou, sure to be the next Greek prime minister, also happens to be president of the Socialist International.
Truth is that internal factors typically have more to do with specific electoral results than various theorists of Left or Right supremacy tend to admit. Regional trends also tend to be cyclical. Moreover, virtually every European government, regardless of its party configuration, remains “socialist” by American conservative standards.
So take away the Inevitable March of History from the factors that are supposed to re-deliver the U.S. to conservative rule in 2010 or 2012.
Most of the media buzz about bipartisanship, or rather the lack thereof, has focused on criticizing the Democrats for not reaching out to their adversaries, while giving the Republicans a free ride regarding their intransigence. Yet, during the last decade or so, a tally of votes in congress would almost certainly show that a lot more Democrats have voted for legislation sponsored by Republicans than vice-versa.
Grudgingly, you have to give the Republicans an “A” for party discipline, which is another way of saying the modern GOP has become a party of mostly inflexible ideologues. But there are some signs that, maybe, just maybe, the ranks are begining to break a bit, at least on the issue of health care reform. In today’s WaPo, for example, Michael D. Shear and Ceci Connolly have an article, “Reform Gets Conditional GOP Support,” noting
And in the past two days, former Senate Republican leader Bill Frist; George W. Bush health and human services secretary Tommy G. Thompson and Medicare chief Mark McClellan; California Gov. Arnold Schwarzenegger; and New York Mayor Michael R. Bloomberg — a Republican turned independent — have all spoken favorably of overhauling the nation’s health-care system, if couched with plenty of caveats regarding the details.
The White House lobbying campaign was aimed, in part, at the one Republican who has indicated she may vote for reform legislation, Sen. Olympia J. Snowe (Maine), and she said Tuesday that she hopes the comments from her GOP colleagues will resonate.
Give a listen to Bill Frist, who is a surgeon, pretty much endorsing a triggered public option with ‘local control’ in this CNN clip. Even at (gasp) Fox News, there are stirrings of sanity towards health care reform, as anchor Shep Smith steps up to shred Republican Senator John Barrasso (WY) for his knee-jerk opposition to the public option in this surprising clip at TPM.
In her article at Daily Kos, “Not All Republicans Are on the Train to Crazy Town,” McJoan adds former Republican Majority Leader Howard Baker and former GOP presidential nominee Bob Dole to the pro-reform list, wondering if,
Maybe it’s their message to their folks on the Hill that, while there may be short term gain with keeping the base riled up for 2010, ending up on the wrong side of history on this debate could have really damaging long term consequences….There’s nothing radical about healthcare reform, and I’d take it a step further to say there’s nothing radical about a robust public option. We’ve already got one, in the form of Medicare. Hell, we’ve already got the most “radical” form of healtcare–single payer–in America in the form of the VA system. That “radical” policy position was rejected before the debate even began, and the robust public option has been the reasonable compromise from the get-go in this debate.
Healthcare reform: the new mainstream.
Granted this is small ‘taters, considering that only Snowe has an actual vote to cast on health care reform legislation. But could it be that Republicans are starting to hear from their health care industry supporters, who are begining to think that a triggered public option may actually be their best hope for delaying the dreaded single payer system?
If you follow public opinion research on health care reform, you probably know that recent polls have generally shown a modest but definite trend towards support for reform efforts. The latest Gallup poll, for example, shows a plurality of respondents favoring reform legislation for the first time in a while. A new AP/GfK survey shows the support/oppose ratio on health reform has changed from 34/49 in September to 40/40 now.
There’s one quite jarring exception to this trend: Fox News, which released a poll this week showing that only 33% of Americans support health reform legislation, while 53% oppose it.
Since this is Fox we are talking about, could the results simply be a matter of systemic bias? You might think so, but as Nate Silver points out in a careful deconstruction of the poll at fivethirtyeight.com, the same survey puts the president’s job approval rate at 58%, a relatively high number.
How can you square the high approval rate with the exceptionally low assessments of the president’s top domestic priority? Look at where the questions appear in the poll, says Silver. The job approval question is first, while the health reform questions comes after a long series of heavily loaded questions about the president that are pretty close to Republican talking points. This is a texbook case of what is called “question order bias,” whereby poll questions that seem unobjectionable in isolation elicit very different responses when placed after “pushy” questions that predispose the respondent in one direction or another. And this is an old habit with Fox, helping to explain why its “horse-race” numbers during the last campaign–based on questions asked at the beginning of their surveys–were pretty much like everyone else’s, but its “issue” numbers tend to skew very, very conservative. As Silver concludes:
[T]hese question order effects can arise even when pollsters have the best of intentions, and even when they are asking unbiased questions. If, for instance, back during the Presidential campaign, you had asked a series of perfectly neutrally-worded questions on the economy before asking about the horse race, they could easily have tipped the numbers slightly in Obama’s direction, since the economy was perceived to be the Democrats’ strength….
But when you ask a series of biased questions before taking the voters’ temperature on health care or the horse race, you have much less excuse. Going forward, Fox News should put its health care questions closer to the top of their survey or break them out into a separate poll; take their numbers with a grain of salt until they do.
Make that a shaker of salt, Nate.
This item was cross-posted at The New Republic.
Today Michael Crowley expresses shock over a new Pew poll finding that 61% of Americans would favor military action to prevent Iranian development of nuclear weapons if other options fail.
I’m less shocked. In the run-up to the Iraq War, the belief that Saddam Hussein had developed or was rapidly developing WMD, including nuclear weapons, was a pretty important factor in the robust majorities that favored military action. And the discovery that he actually didn’t have WMD helped turn Americans against the war once his regime had been toppled. Since evidence of an Iranian nuclear program is far better established, it’s not that shocking that Americans would react now as they did in 2002 and 2003.
But the other big thing that obviously turned Americans against the Iraq War was the immense cost and difficulty of consolidating the initial military victory. In the Pew poll, respondents are asked if they favor “military action.” It’s entirely possible that many of those answering “yes” are thinking in terms of some “surgical strike” that will destroy the nuclear program without a wider war. Should negotiations and/or sanctions fail and we are actually contemplating military conflict with Iran, it will more than likely become apparent that eliminating Iran’s nuclear program will require an actual ground war aimed at regime change. It’s at that point when the lessons of Iraq will truly begin to sink in, and support for “military action” will go down. But we haven’t had that debate yet.
What the Pew poll does show is that Americans don’t seem to buy the argument that a nuclear Iran is deterrable (by the United States or by Israel), just as the regimes of Stalin and Mao–and for that matter, Hitler, who had stockpiles of chemical weapons he didn’t dare to use–were deterrable. Perhaps that means that Americans, like many Israelis, view the current Iranian regime as uniquely dangerous, or at least frighteningly irrational, and capable of inviting unimaginable casualities in a nuclear exchange with Israel or the U.S. Or perhaps they simply think a nuclear Iran would permanently destabilize the world’s most fragile region. But deterrance is inevitably a matter of calculated risks. Had it been possible during the Cold War to “take out” the Soviet Union’s or China’s nuclear capacity without a calamitous war, a majority of Americans would have supported doing just that. Once the costs and risks of war with Iran are fully aired and debated, some Americans now favoring “military action” may decide that Iran is deterrable after all.
The fact remains that we haven’t yet had the full debate that will ultimately shape U.S. policy towards Iran. In the meantime, it’s fine by me if Tehran reads about this Pew poll and reconsiders its current drive for nukes.
UPCATEGORY: Democratic Strategist
Most people outside New York have probably never heard of Betsy McCaughey, and even New Yorkers would mainly remember her bizarre one-term stint as Lieutenant Governor of the Empire State in the 1990s, characterized by constant friction with her supposed boss and running-mate, Gov. George Pataki.
But in the world of policy wonks, McCaughey is notorious for a studious-sounding 1994 piece published by The New Republic that is frequently blamed for undermining support for the Clinton health plan at a crucial moment, via fundamental mistatements of its impact on people who already had health insurance. Indeed, her role in derailing universal health coverage led directly to her short career in Republican politics.
Current TNR editor Franklin Foer apologized for the magazine’s publication of McCaughey’s piece in his first signed editorial. Now that she is back on the same scene spreading disinformation about the current health reform effort, that apology has undoubtedly been made manifest in Michelle Cottle’s definitive smackdown of McCaughey in an article with the same title–“No Exit”–as the 1994 essay.
After listing a variety of highly negative characterizations of McCaughey’s veracity as a policy thinker by other wonks, including many conservatives, Cottle makes this provocative judgment:
What kind of person drives normally staid wonks, including her own ideological teammates, to such stinging public reproof? Part of it is obviously the nature of her commentary. But beyond that, there is something about McCaughey herself that drives her critics wild–and has throughout much of her career. Friends posit it’s her disconcerting blend of brains, beauty, and confidence. Detractors chalk it up to her rank dishonesty, narcissism, and lack of shame. Whatever the cause, the passion McCaughey inflames is familiar. Looking over the sweep of McCaughey’s life, from her swift political rise (and fall) to her humble roots, from her straight-talking persona, fierce will, and blinding confidence to her gift for self-dramatization, head-turning looks, and embrace of the gender card, one sees precursors of a more recent conservative phenom. Replace the East Coast researcher’s political-outsider, stats-wielding, pointy-head shtick with a political-outsider, gun-toting, populist one, and a striking parallel emerges: Betsy McCaughey is, in essence, the blue-state Sarah Palin.
The comparison to Palin is inevitable, since it was McCaughey’s “research” on current Democratic health reform efforts that inspired Palin’s infamous claim that they would lead to government “death panels” withholding health care from seniors and people with disabilities. The big difference between McCaughey’s destructive role on health reform in 1994 and now is, of course, the rise of hyper-ideological media eager to take her think tank credentials at face value and give her a big and continuous platform for her views.
But as Cottle argues, there’s a more direct parallel between McCaughey and Palin: an uncanny knack for turning any and all criticism into an indictment of the alleged biases of critics, a tactic that perpetually evades basic questions of fact and fiction:
[McCaughey] has proved devastatingly adept at manipulating charts and stats to suit her ideological (and personal) ambitions. It is this proud piety concerning her own straight-shooting integrity combined with her willingness to peddle outrageous fictions–and her complete inability to recognize, much less be shamed by, this behavior–that makes McCaughey so infuriating. In this way, perhaps most of all, she resembles the tell-it-like-it-is good ol’ girl Palin, whose scorching self-regard and ostentatious disdain for politics-as-usual infuse even her most self-serving fabulisms. Palin, of course, hawks homespun wisdom, faith, and common sense, in contrast to McCaughey’s figures and footnotes. But both women have an uncanny ability to shovel their toxic nonsense with nary a blink, tremor, or break in those dazzling smiles. People of goodwill and honest counsel don’t stand a chance.
You have to guess that Michelle Cottle will soon experience McCaughey’s tactics first-hand.
It is often suggested that the struggling economy is a giant millstone around the neck of the Democratic donkey, which can’t do much about it because widespread fears of rising federal budget deficits have taken most remedial options off the table.
But a new survey from Hart Research Associates, asking some well-framed questions, paints a different picture of public opinion on the economy. Americans are still more worried about unemployment than budget deficits, still blame George W. Bush more than Barack Obama for current conditions, and are open to further action by the federal government.
Even self-identified Republicans rate unemplomyent as a bigger concern than deficits by a margin of 51%-42%, and overall, only 27% of Americans consider deficits as among the one or two most important economic problems facing the country. Even so, Americans blame the Bush administration as opposed to the Obama administration for current budget deficits by a 52%-27% margin (45%-27% among self-identified independents).
Meanwhile, 83% of Americans consider unemployment to be either a “very big problem” or a “fairly big problem.” A remarkable 68% of people in rural areas rate unemployment as a “very big problem,” which is a reminder that some parts of the country have been struggling economically for a long while, and don’t necessarily view the recession as having suddenly emerged last year.
Moreover, the recession is a very personal thing to vast numbers of Americans, with 44% claimiing that someone in their own household has either been laid off or has had hours or pay cut in the last year. This number rises to 54% among Hispanics.
Perceptions of this year’s stimulus package are more positive than you might expect, though not very strong; 53% said it had helped the economy a little, and 12% a lot, while only 16% bought the conservative argument that it had hurt the economy. Unsurprisingly, voters oppose the now-common Republican idea of freezing further stimulus spending by a 55%-39% margin. And in a parallel finding, Americans favor the economy strategy of “creating jobs and investing” over one of “shrinking government spending” by a 61%-36% margin.
At a time when sweeping generalizations about public opinion on the economy are far too prevelant, this new research from Hart is well worth reading and pondering.
TDS Co-Editor William Galston earns a quote of the day designation for a quote included in an Eliza Carney piece for National Journal on the possible use of budget reconcilation procedures for health care reform:
Resorting to reconciliation would amount to “bridge burning, not bridge building,” acknowledged William A. Galston, a senior fellow at the Brookings Institution who was a policy adviser to President Clinton. “On the other hand, as I look at Congress right now, I don’t see a lot of bridges that haven’t been bombed out already. It’s sort of like Europe in 1944.”
