At the end of this important week on the health care front, one thing clear is that the differences between what the House and Senate are likely to vote on are not as large as everyone expected a few weeks ago. Harry Reid’s advancing a public option bill with (it appears) a state opt-out, and the House is going with a public option that will negotiate rates instead of pegging payments to Medicare. Had the Senate gone with a weak trigger or something like co-ops, or the House had insisted on the Medicare peg, it could have caused some very serious problems down the road.
However you happen to feel about the substance of these nuances, anything that steadily narrows the gaps between Senate and House Democrats is a step towards enactment of health reform this year. Or at least that’s how it looks to me from an internet cafe a very long way from Washington.

Veteran congressional staffer Bill Goold is doing some creative strategic thinking over at the HuffPo, where today he shares “Building Progressive Staying Power,” proposing the establishment of “a progressive legislative exchange” for shaping and refining ideas into legislative reforms. As Goold rolls it out:

The resurgent progressive movement needs to think more long-term, come together quickly, and systematically build a Progressive Legislative Exchange to share and hone a steady, perpetual stream of the best, actionable ideas that progressives and liberals, near and far, have to offer for public and private sector problem-solving. This is a very egalitarian, 21st century idea whose time has come and is all the more attainable because of the Internet and other far-flung communication capabilities. Progressive leaders and activists have it within our grasp to organize and create a permanent incubator and clearinghouse for conceptualizing and refining progressive legislation to serve the public interest and address myriad problems confronting our nation and our world that will connect and empower imaginative thinkers inside and outside of Congress as never before.
…Imagine an organized intersection on-line and otherwise through which progressives can exchange, funnel, and refine ideas and proposals for possible legislation that interested Members of Congress and their dedicated hard-working, over-stretched staff can easily survey and pick and choose for possible further development, introduction, and advancement in the House and Senate. Conversely, this Progressive Legislative Exchange could also make it possible for Members of Congress and their staff to efficiently post or otherwise make available any pieces of legislation they have conceived and want to further refine before the bill(s) and/or amendment(s) are formally introduced, subjected to hearings, and voted upon.

Among Goold’s interesting examples of ideas that can be shaped into legislation:

Provide a tax credit and other financial incentives to enable all taxpayers to invest more reliably in socially and environmentally responsible companies that employ Americans;

and,

Establish enforceable worker rights (e.g. freedom of association, prohibition against job discrimination) and environmental safeguards as cornerstones for all future U.S. trade agreements;

Goold cites a compelling need to “capitalize more fully upon this rare window of opportunity when lasting, historic change is attainable because of last year’s elections.” He see’s the exchanges as a unique way Dems can leverage “our existing comparative strengths,” including “a stronger hand in the free-wheeling intellectual marketplace of ideas” and faith in government, in glaring contrast to “the pinched, narrower marketplace of commercial ideas and self-interested, short-term profit-making” of the GOP.

Please, all moderate, centrist and conservative Democrats, take a few minutes to read Paul Krugman’s op-ed. “The Defining Moment ” in The New York Times, and then take a few more minutes for honest self-reflection. History is calling, and there may not be another chance to do so much to help so many people, whose very lives are at stake for a long long time. As Krugman explains:

…Everyone in the political class — by which I mean politicians, people in the news media, and so on, basically whoever is in a position to influence the final stage of this legislative marathon — now has to make a choice. The seemingly impossible dream of fundamental health reform is just a few steps away from becoming reality, and each player has to decide whether he or she is going to help it across the finish line or stand in its way.
…The people who really have to make up their minds, then, are those in between, the self-proclaimed centrists….Senator Joseph Lieberman of Connecticut says, “I want to be able to vote for a health bill, but my top concern is the deficit.” That would be a serious objection to the proposals currently on the table if they would, in fact, increase the deficit. But they wouldn’t, at least according to the Congressional Budget Office, which estimates that the House bill, in particular, would actually reduce the deficit by $100 billion over the next decade.
…I won’t try to psychoanalyze the “naysayers,”…I’d just urge them to take a good hard look in the mirror. If they really want to align themselves with the hard-line conservatives, if they just want to kill health reform, so be it. But they shouldn’t hide behind claims that they really, truly would support health care reform if only it were better designed.
For this is the moment of truth. The political environment is as favorable for reform as it’s likely to get. The legislation on the table isn’t perfect, but it’s as good as anyone could reasonably have expected. History is about to be made — and everyone has to decide which side they’re on.

Health care reform legislation, because of its complexity, will never be perfect for anyone. But nothing will pass if moderates insist on having their way about every single aspect of health reform. Legislation to improve on the consensus bill can be passed later on, when problems become evident. It’s a work in progress. History is calling. Who will answer the call?

TDS Co-Editor William Galston has a post up at The New Republic, “Is the Public Ready for Bold Action?,” which makes an opinion data-based case that President Obama doesn’t have a lot of leeway remaining for audacious reforms regarding health care and other progressive initiatives. As Galston explains:

…Trust in government now stands at 23 percent—the lowest level in at least twelve years. A stunning 76 percent of Americans believe that the government in Washington will do the right thing only some of the time, or never. These statistics confirm the findings from a recent CBS/New York Times poll, and they suggest that proponents of government action must overcome deep skepticism….fully 53 percent of the respondents expressed the fear that if government gets more heavily involved in health care, it will just make matters worse. Similarly, the NBC/WSJ survey found 51 percent more concerned that government will end up “going too far and making the health care system worse than it now is in terms of quality of care and choice of doctor” versus only 44 percent concerned that the government will not do enough to lower costs and cover the uninsured.

Galston continues, limning the statistical decline in public confidence in the leadership of the President, congress and the political parties. He concludes “This bad news does not warrant the conclusion that the president’s program has been misguided. It does suggest, however, that the bold actions he has undertaken have taken a toll in public confidence and support.”

Ezra Klein makes an important point.
Under the way the Senate bill is currently structured, the opt-out debate will be pushed back until 2014, when many of the health care reforms would take effect.
By then, he believes, the public option won’t be controversial:

By 2014, we’ll be arguing over all manner of things, but a public insurance option for the small sliver of the population with access to the health insurance exchanges will be one of those things. In that scenario, where there’s very little controversy over the public option, I don’t believe that state legislatures and governors are going to go to the trouble of rejecting it, and I don’t believe that anyone will manage to reinvigorate the controversy around it. The controversy around the public option is an expression of the controversy around Barack Obama’s presidency in general, and health-care reform in particular. Once those issues are essentially settled, the underlying policy isn’t going to hold people’s attention.

Another reason why Republicans in Utah probably ought to hold off on introducing their opt-out bill in January.

Here’s what leading mid-east expert Cole says”

When Obama came into office in January, 142,000 U.S. troops were in Iraq, conducting regular patrols of the major cities. His Republican rivals were dead set against U.S. withdrawal on a strict timetable. He faced something close to an insurrection from some of his commanders in the field, such as Gen. Ray Odierno, who opposed a quick departure from Iraq. Moreover, Obama assumed the presidency at a time when Iran and the U.S. were virtually on a war footing and there had been no direct talks between the two countries on most of the major issues dividing them. In February, the government of Pakistan virtually ceded the Swat Valley and the Malakand Division to the Pakistani Taliban of Maulvi Fazlullah, allowing the imposition of the latter’s fundamentalist version of Islamic law on residents, and Islamabad had no stomach for taking on the increasingly bold extremists.
Eight months later, it is a different world. While it is still early in his presidency, and there is too much work unfinished to give him an overall grade, it’s already apparent he’s outperforming his predecessor.

Read the rest here

In her article, “Disorganized: What Happened to Obama’s Massive Network of Grassroots Activists?” at The New Republic, Lydia DePillis reveals one of the key reasons for the post-election floundering of the activist coalition that was instrumental in electing America’s first African American President. In a nut graph, Depillis explains:

…The biggest problem was built into OFA’s very structure–the structure that Plouffe had wanted and Hildebrand had warned against. Obama’s people had created something both entirely new and entirely old: an Internet version of the top-down political machines built by Richard Daley in Chicago or Boss Tweed in New York. The difference (other than technology) was that this new machine would rely on ideological loyalty, not patronage. And that was a big difference. The old machines survived as top-down organizations because they gave people on the bottom something tangible in return for their participation. By contrast, successful organizations built mainly on shared philosophy tend to be driven by their memberships. Marshall Ganz, the legendary United Farm Workers organizer-turned-Harvard-professor and godfather of the Obama field strategy–he helped orchestrate Camp Obama, a grassroots training program for staff and volunteers–sees the command-and-control nature of OFA as a crucial flaw. “It’s much more an instrument of mobilizing the bottom to serve the top than organizing the bottom to participate in shaping the direction of the top,” he told me.

DePillis adds “…Being part of the DNC has neutered Organizing for America when it comes to pressuring moderate Democrats.” With regard to the battle for health care reform in particular, she cites the examples of ‘outside groups,’ including the Progressive Change Campaign Committee, MoveOn, and Health Care for America Now, which are “running hard-hitting ads that target foot-dragging congressmen,” while OFA’s ads “were gauzy and positive, mentioning no one by name.” As DePillis explains, “The White House couldn’t deal with Max Baucus in good faith if its ground operation was hammering him in Montana.”
DePillis is undoubtedly correct that there are built-in limitations that come with OFA operating as a DNC entity, particularly with an issue that has many complex facets, like health care reform. Activist networks work best with a simple idea, such as electing a particular candidate, or legislation that does one major thing. Perhaps the best test for OFA’s effectiveness will come when all of the Democratic reforms are reconciled into a single bill.
Multi-faceted legislation like the current health care reform packages being proposed, are more likely to experience fragmentation of activist energy. It’s easier to mobilize citizen lobbying around a simple idea, like no disqualifying coverage for prior conditions, than it is to get activists excited about a complex package that includes numerous provisions. It doesn’t mean that big package strategy for health care reform is wrong; It may be the right way to go at this political moment. But it’s reasonable to expect some dilution of grass-roots energy as the complexity of a reform increases.

Behind the high drama of the debate over health care reform, other progressive reforms are gaining momentum, despite being bounced to the back pages. In his latest ‘Public Opinion Snapshot‘ at the Center for American Progress web pages, TDS Co-Editor Ruy Teixeira has good news for supporters of legislative reforms to address climate change — new data from the Pew Research Center indicates that “public is ready to move forward in this area.” Says Teixeira:

First, the public rejects the idea that the United States should go alone in addressing climate change. By 56-32, they say that the United States “should join other countries in setting standards to address global climate change” rather than “set its own standards to address global climate change.”
Second, the public gives 50-39 support to “setting limits on carbon dioxide emissions and making companies pay for their emissions, even if it may mean higher energy prices” (emphasis added).

Teixeira concludes that “legislators should not rest on their laurels even if they succeed in passing health care reform. The public appetite for change is clearly broader than that.”

We now know that the health care bill that reaches the Senate floor will contain a public option with an opt-out provision. That said, if the bill passes, we don’t know how the opt-out will work in practice.
Matt Ygelsias appears to have the answer to one of my biggest questions about the process:

To opt out you need a bill based by both houses of the state legislature and signed by the governor.

And while Yglesias is the only source I’ve seen reporting this, those kind of mechanics certainly make sense. If those are the conditions for opting-out in the final bill, that probably sets up a scenario in which most states actually do join the program.
It’s important to remember that opting-out, as a policy mechanism, is not a new idea.
Medicaid, for instance, is an opt-out program, but no state has ever chosen to take that step.
Federal highways are also an opt-out program, but we all follow the same speed limits.
At worst, we should expect about as much resistance as we saw with the federal recovery package earlier this year. Despite a lot of hand-wringing from conservatives, ultimately, most states took most of the money.
That doesn’t mean we won’t have to listen to Republicans who are determined to grand stand on the issue. In Utah, they’re already considering legislation to keep their citizens from having access to a public option:

Utah House Speaker Dave Clark (R) told the (Salt Lake City) Deseret News that “we already have a health-care system in Utah that is bottom three in cost for the nation. As I understand the latest version (of health care legislation) — always subject to numerous changes — I would recommend Utah opt out.”
Utah Senate Majority Leader Sheldon Killpack (R) also expressed skepticism; another Republican state representative, Carl Wimmer, said he will introduce a bill in January “that will get us out.”

While most state policymakers will probably wait to see the final content of the bill before they start drafting laws, these statements from the Utah legislators highlight an important point.
The debate in Washington is about to go on the road — every state lawmaker in the country is going to get asked what they think about a public option.
Update: There are, of course, plenty of exceptions to speed limits. But states still do what is required of them to receive money from the Highway Trust Fund.

I’ll just share three interesting revelations scattered among the fallout from Senate Majority Leader Harry Reid’s announcement yesterday of the compromise Senate health reform package.
First, in his op-ed in today’s WaPo, “Health Reform’s Chevy Tax,” Harold Meyerson sheds fresh light on the numbers involved in the tax on the so-called ‘Cadillac benefits”:

The Senate’s tax would initially apply to all individual policies costing more than $8,000 a year, or $21,000 for a family. Those thresholds are to be indexed to the overall consumer price index (CPI) plus 1 percent. Problem is, medical costs and health insurance premiums increase a good deal more than the overall CPI. Since 2000, they have risen three to four times faster — which means, more policies will be subject to the tax with each passing year. The congressional Joint Committee on Taxation has calculated that in 2013, when the reforms kick in, the tax will apply to 19 percent of individual plans and 14 percent of family plans, but that by 2019 it will sock 34 percent of individual plans and 31 percent of family plans.
Last time I looked, a third of American motorists were not driving Cadillacs…Unfortunately, that excise tax targets a lot of Chevy plans as well.

Meyerson adds that the assumption that workers will get higher wages to help pay for the taxes is not warranted by recent experience, and he supports the surtax on incomes over $500,000 funding proposal championed by House Speaker Nancy Pelosi and others as a more credible progressive alternative.
I do hope Andrew Sullivan is right in his ‘The Daily Dish’ post “The Lethal Politics Of The Opt-Out Public Option” in The Atlantic Online. Sullivan writes:

…Imagine for a moment that the opt-out public option passes and becomes law (I give it a 65 percent chance at this point). Then what happens? Well, there has to be a debate in every state in which Republicans, where they hold a majority or the governorship, will presumably decide to deny their own voters the option to get a cheaper health insurance plan. When others in other states can get such a plan, will there not be pressure on the GOP to help their own base? Won’t Bill O’Reilly’s gaffe – when he said what he believed rather than what Roger Ailes wants him to say – be salient? Won’t many people – many Republican voters – actually ask: why can’t I have what they’re having?
This is why this is lethal. The argument against new entitlements requires a macro-level perspective. You have to argue that…you just need to rely on the wonderful private sector to deliver the goods in a more market-friendly way. This is always a tough sell because it requires voters to put abstract concerns over practical short-term gains. It’s why conservatism always has a tough time in welfare state democracies…Imagine Republicans in state legislatures having to argue and posture against an affordable health insurance plan for the folks, as O’Reilly calls them, while evil liberals provide it elsewhere…I can see a public option becoming the equivalent of Medicare in the public psyche if it works as it should. Try running against Medicare…it has the potential to make “liberalism’ popular again; it has easily demonized opponents – the health insurance industry; and it forces Republicans not to rail against socialism in the abstract but to oppose actual benefits for the working poor in reality.

If Sullivan is right, the opt-out concession to win moderates could end up being more of a problem for Republicans than an unadulterated ‘robust’ public option.
Lastly, anyone seeking a convincing explanation for Sen. Lieberman’s opposition to the public option for health care reform, despite strong support for it in recent polls, need not look much further than Charles Lemos’s MyDD post “The Worries of Joe Lieberman ,” in which he explains:

“I want to be able to vote for a health bill, but my top concern is the deficit.” So says Senator Joe Lieberman of Connecticut, a state that is home to 72 insurance headquarters, the largest concentration of that industry in the nation. Connecticut has three times the US average of insurance jobs as a percent of total state employment. In 2004, the insurance industry in Connecticut was a $12.2 billion dollar industry. Two years later, it hit $14.6 billion. That’s a CAGR of 9.4 percent.
Sixteen of those 72 insurance companies provide health or medical service insurance. Those 16 insurance companies employ over 22,000 employees and have annual payroll of over $2.3 billion. The total annual state insurance industry payroll exceeds $6 billion. 5.5 percent of the state’s gross domestic product comes from the insurance industry. But no Joe Lieberman isn’t worried about their profits, he’s worried about adding to the deficit.

Lemos goes on to add that Lieberman’s crocky tears about the deficit are somewhat belied by his blank check support for war ops in Afghanistan, now over $230 billion over the last 8 years, coupled with the fact that the CBO projects more than $100 billion in savings as a result of the publlic option over the next 10 years. As Lemos puts it “I can see a return on investment in healthcare, it’s harder to see one on Afghanistan.”