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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Month: August 2009

Truth and Consequences

There’s very little question that two basic decisions by the Obama administration on health care reform have significantly complicated efforts to mobilize public support for actual legislation. The first, which was actually made during the early stages of the 2008 presidential campaign, was to adopt a relatively complicated approach to reform that involved competing public and private plans, health insurance “exchanges,” and subsidies, among other technical-sounding features. The second, after the election, was to promote reform generally through the congressional committee system, without issuing a detailed blueprint the President would insist that Congress follow.
There were very good substantive and political reasons for both these decisions, but inevitably, they have made it harder for Americans who only vaguely want health care reform to embrace Obama’s approach, and easier for reform opponents to cherry-pick provisions in various bills that can be blown out of proportion or demonized, and to simply lie about features that are difficult to explain.
This has created a gap in public opinion between what people might support if they understood it, and what they support in the absence of any understanding. In a new post at The Atlantic on recent polling, Ron Brownstein takes a closer look at that gap:

The NBC/Wall Street Journal national survey also released this week…found that just 31 percent of independents now approve of Obama’s handling of health care, while 54 percent disapprove, according to crosstabs from the poll provided by Public Opinion Strategies, one of the pollsters. Asked their view of Obama’s health care plan, just 28 percent of independents said they consider it a good idea, while 43 percent described it as a bad idea, and the rest said they didn’t know.
Yet when the pollsters read a description of the Obama proposal to respondents, the attitude among independents sharply shifted. Opposition among them remained roughly the same at 44 percent. But support jumped to a 52 percent majority. The gap between potential and actual support for Obama’s plan among independents suggests two things: that the White House is losing the struggle to define the plan so far, and that they may have room to increase their support if they can regain the initiative.
Obama faces a formidable gap between potential and actual support even among Democrats in the NBC/WSJ poll. Just 62 percent of Democrats described his plan as a good idea; but after hearing the explanation, 78 percent of them said they would support it. (Even among Republicans, support jumped from just 9 percent to 23 percent when they were provided a description of the plan.)

So voters need to hear this explanation, from the President and every available ally, the moment the White House decides on a reasonably clear vision of what can be ultimately wrested from Congress. There won’t be a lot of time for this to happen, and in the end, some congressional Democrats from competitive districts or states will need to vote for reform in hopes that constituents will like the results even if they are doubtful about what they understand to be the plan. After all, most of the fears being fed by reform opponents will not actually materialize if a bill is enacted; the seniors who are so negative about reform will discover that little or nothing has changed in Medicare; death panels will not be convened; doctors will not lose their right to control treatments.
Reality ought to count for something in the health reform debate; reform proponents need to explain what they can, and also count on the consequences of the legislation to make its enactment a political plus.


Can Co-Ops Be a Public Option?

This item by J.P. Green was originally published on August 18, 2009.
Sorting out the pros and cons of the co-op option vs. the public option is the challenge of the hour for progressives who want real health care reform, and it will certainly be hotly debated. Most just-published articles and blogs equate ‘public option’ with a government plan. But it seems important to ask, is there any way that a co-op can be a public option? There is no shortage of opinions on the topic:
The New York Times has “Alternate Plan as Health Option Muddies Debate,” a probing article by by Robert Pear and Gardiner Harris. The authors spotlight some key problems with the co-op approach:

As the debate rages, lawmakers are learning that creating cooperatives — loosely defined as private, nonprofit, consumer-owned providers of health care, much like the co-ops that offer telephone, electric and other utility service in rural areas — will not be easy.
The history of health insurance in the United States is full of largely unsuccessful efforts to introduce new models of insurance that would lower costs. And the health insurance markets of many states suggest that any new entrant would face many difficulties in getting established.

More specifically:

The government would offer start-up money, perhaps $6 billion, in loans and grants to help doctors, hospitals, businesses and other groups form nonprofit cooperative networks to provide health care and coverage.
The co-ops could be formed at the national, state or local level. Proponents say that a health co-op might need 25,000 members to be financially viable, and at least 500,000 members to negotiate effectively with health care providers…they would need time to buy sophisticated information technology and to negotiate contracts with doctors, hospitals and other health care providers.
…In the 1990s, Iowa adopted a law to encourage the development of health care co-ops. One was created, and it died within two years. Although the law is still on the books, the state does not have a co-op now, said Susan E. Voss, the Iowa insurance commissioner.

Not a very promising prospect, according to ‘the newspaper of record.’ Worse, $6 billion is about what we spend occupying Iraq in one month. Iraq and Afghanistan are the ignored elephants in rooms where health care reform is being debated. Few would doubt that half of what we spend on these two wars annually could go a long way toward bringing real health security to America.
Columnist Bob Herbert is even more dismissive in his NYT op-ed, “Forget about the nonprofit cooperatives. That’s like sending peewee footballers up against the Super Bowl champs.”
In his Alternet post “It’s Now or Never for a Public Option: Why We Need to Take a Stand Against the Insurance Industry’s Greed” Joshua Holland explains,

In 2000, the Government Accountability Office conducted a study of the impact similar purchasing schemes had had to date. “Despite efforts to negotiate lower premiums,” the GAO concluded, “cooperatives have only been able to offer premiums that are comparable to those in the general small-group market. The cooperatives we reviewed typically did not obtain overall premium reductions because: 1) their market share provided insufficient leverage; 2) they could not produce administrative savings for insurers.”
The Commonwealth Fund did an analysis of the impacts nonprofit co-ops would have as well (PDF), and its findings were similar. Researchers found that, “with very few exceptions,” premiums offered through co-ops “have not been lower than those available to small employers elsewhere” because they “have not been able to reduce administrative costs … they have not had enough market share to bargain for discounts.”
Because of their inherent limitations, former Vermont Gov. Howard Dean told me in an interview last month that the co-op scheme is a “fake public option,” and “really not [a] serious health reform.” He predicted that if they were created, they would “be crushed just like Blue Cross was crushed. Most Blue Cross chapters are now for-profit. They’ve been taken over by the insurance industry. Any reasonable-sized insurance company can crush a not-for-profit co-op.”

And, in The Nation, Katha Pollit writes of co-ops,

…They’re untested, small, unregulated, that they exist in twenty states and that Senator Kent Conrad of North Dakota really likes them–but I didn’t discover what they actually are. I understand “public option,” and “public” has a good, strong ring to it–it says, Healthcare is a right, part of the common good, something everyone should have, and if you can’t afford it in the marketplace, the government will provide it. “Insurance co-op” speaks a whole other language, of commerce and complexity and exclusivity

Writing in the Washington Post, David S. Hilzenrath and Alec MacGillis explain:

“It’s very difficult to start up a new insurance company and break into markets where insurers are very established,” said Paul B. Ginsburg, president of the Center for Studying Health System Change. “I don’t see how they’re going to obtain a large enough market share . . . to make a difference.”
Karen Davis, president of the Commonwealth Fund, a foundation focused on health care and social policy research, said co-ops may not enroll enough people to negotiate favorable rates with health-care providers.
…Co-ops would lack perhaps the main advantage of the public option: reimbursement rates for doctors and hospitals set by federal law, like those paid by Medicare, the program for older Americans. Federally determined reimbursement rates were central to the cost-saving promise of a government-run health plan and a potentially powerful competitive advantage. They were also a lightning rod for intense opposition from health-care providers and private insurers, who denounced the public option as a threat to their financial survival…Co-ops would lack the ability to piggyback onto existing government institutions, like the ones that help administer Medicare.

On the other hand, Co-ops have some advantages and “could serve a useful purpose in health care — just as credit unions compete effectively with banks, prompting them to offer higher interest rates on deposits and lower rates on loans,” explain Pear and Harris, summarizing the views of Ann Hoyt, a University of Wisconsin economist who has written extensively about co-ops.

…Professor Hoyt said she had been a member of the Group Health Cooperative of South Central Wisconsin since 1985, and she reported that “the care is excellent.”…Larry J. Zanoni, executive director of the Wisconsin plan, said: “We are a testament to the success of a health care cooperative. But it took us over 30 years to get where we are today.”


Another 2012 Sounding

It’s a long, long way to 2012, but Public Policy Polling has a new set of data out that measures the favorability of four possible Republican candidates (Palin, Huckabee, Gingrich and Romney) and also matches them against President Obama.
Obama leads all four, but the somewhat surprising thing is that Mike Huckabee comes the closest, trailing the President 47-44. When you look a little deeper, you see that Huck is rated favorably by 24% of self-identified liberals, 40% of moderates, and 61% of conservatives. It’s pretty clear that we’re talking here about the genial and funny Kevin Spacey Lookalike and bass player of 2008, who lashed Wall Street and didn’t talk that much about his history of theocratic views. Since he’s spent a good part of this year participating in the echo chamber of Fox, rebonding with the more exotic precincts of the Christian Right, and comparing Obama’s agenda to that of Lenin and Stalin, it’s reasonable to assume that his standing among non-conservatives is destined to decline. It’s less clear whether he can repair his frayed relationship with economic conservatives, who pretty much decided in 2008 that he was prone to taking Gospel pronouncements about helping the poor a mite too literally.
Meanwhile, the probable front-runner for 2012 at this point, one Mitt Romney, has Huckabee Lite numbers, with favorable ratings from 22% of self-identified liberals, 34% of moderates, and only 49% of conservatives.
The solid winner in favorability among the self-identified conservatives who dominate the Republican nominating process is clearly Sarah Palin, at 68%. And she, unlike Huck or Mitt, has no need to reposition herself to appeal to the Republican base. That’s where she lives, whether it’s in Alaska or some place warmer.
UPCATEGORY: Democratic Strategist

On Monday, a radical cleric issued a statement rejecting a two-state solution for Israel-Palestine, suggesting that one of the two parties involved in the conflict should be made to find a homeland “elsewhere.”

The “radical cleric,” needless to say, was the Rev. Huck.


Don’t Sweat It

This item is cross-posted from The New Republic.
As the Dog Days of August descended upon us, there developed across the progressive chattering classes a deep sense of malaise bordering on depression, if not panic–much of it driven by fears about the leadership skills of Barack Obama. The polling numbers seemed to weaken every day, and Democratic unease was matched by growing glee on the airwaves of Fox and in Republican circles everywhere.
Within ten weeks, however, Obama was elected president and joy returned to the land.
Yes, dear reader, I am suggesting that this August’s sense of progressive despair feels remarkably similar to last August’s. This week last year, the Gallup Tracking Poll had McCain and Obama in a statistical tie. The candidates were fresh from a joint appearance at Rick Warren’s Saddleback Church, which was widely viewed by progressives as a strategic error by Obama. More generally, Democratic confidence, so high earlier in the year, was sagging. “Liberals have been in a dither for several weeks now over Barack Obama’s supposedly listless campaign performance following his return from Europe,” influential blogger Kevin Drum summed up sentiments at that time, “and as near as I can tell this turned into something close to panic.”
These doldrums dissipated by the time of the Democratic convention later in the month, but reemerged in September, when McCain actually moved ahead in some polls. And the diagnosis of the problem was typically that Obama was too passive, and wasn’t articulating a clear enough message. This should sound familiar to connoisseurs of contemporary progressive concerns about Obama.
Now, this deja vu sensation I’m having obviously doesn’t guarantee that the current struggles over health care reform and climate change will have as happy an ending as the presidential contest. But it may well provide a plausible argument for giving the president the benefit of the doubt today as we should have done a year ago.
Part of the psychological problem now may be a matter of unrealistic expectations. Much of the trouble Obama has encountered in promoting his agenda has been entirely predictable. His approval ratings are gradually converging with the 2008 election results. Health care reform is a complicated challenge that threatens a lot of powerful interests and unsettles people happy with their current coverage. Major environmental initiatives lose steam in a deep recession. A new administration gradually begins to assume blame for bad conditions in the country. Republicans, adopting a faux populist tone, are fighting Obama tooth and nail. Democratic activists are frustrated by compromises and sick of having to put up with the Blue Dogs. The Senate is still the Senate, a monument to inertia, pettiness, and strutting egos.
Progressives are waiting for Barack Obama and his team to work the kind of political magic they seemed to work in 2008–except when they didn’t. Cutting through all the mythologizing of the Obama campaign, the real keys to his stretch-run success last year were his legendary calm (“No Drama Obama”); his confidence in his own long-range strategy; his ability to choose competent lieutenants and delegate to them abundantly; and his grasp of the fundamentals of public opinion and persuasion. There was zero sense of panic in the Obama campaign itself late last summer, because they stuck with their strategy and organization and didn’t let the polls or news cycles force them off the path they had chosen.
The administration’s demure approach should thus not be terribly surprising, nor a sign that it has lost its heart or its mind. Obama has not, presumably, lost the qualities he showed in the tougher moments of the 2008 campaign. As it planned its legislative agenda for 2009, Team Obama knew health care reform was going to be challenging, and also knew they could probably get away with blaming the economic emergency for paring it back or slowing it down. They decided this was the right time to act, and it’s far too soon to assume they were wrong.
This particular moment might be more endurable if, as it used to be, August was a political and legislative dead zone. We’d all get a breather, maybe calm down and look ahead to the real deal going down in the fall. But the “August Doesn’t Matter” era has ended–perhaps dating back to the grand jury testimony in the Clinton/Lewinsky scandal in August 1998, if not earlier. (It arguably began to fade when Washington got air-conditioning.) Now, even if nothing substantive is actually happening this month, the absence of action is itself painful, and feels like defeat.
While I certainly don’t know if the Obama game plan for the next couple of months is going to be successful, I’m reasonably sure a game plan exists. On the issue most on everyone’s mind, I certainly don’t know how to reconcile the sharply contrasting demands of House Democrats and Senate “centrists” on sticking points like the public option. But the odds remain good that the House will pass a bill, the Senate will pass a bill, and then we will find out if the White House and the Democratic congressional leadership have the skill to make something happen that we will be able to recognize as “change,” and perhaps even a victory for progressives. Until then, it’s probably a good idea to drink a tall glass of cold water and wait out the August political heat.


Health Care Reform: ‘Low-Hanging Fruit’ Strategy Takes Shape

Jonathan Singer’s MyDD post, “WSJ: Dems Could Split Bill, Use Reconciliation,” flags an interesting ‘trial balloon’ being floated to move health care reform forward in Congress. Singer cites a Wall St. Journal report by Jonathan Weisman and Naftali Bendavid that Democratic leaders are considering “a strategy shift that would break the legislation into two parts and pass the most expensive provisions solely with Democratic votes.” Singer says,

…There is a better than even chance that Senate Majority Leader Harry Reid, working in consultation with the Obama administration, will move forward in this regard — passing the easier parts of healthcare reform in normal order, and passing the more difficult parts using the budget process. In such a case, the Democrats could afford to lose as many as 10 votes in the Senate (including that of Ted Kennedy, who has not been seen in the Senate for months) while still enacting the more contentious portions of reform, namely a public option.

Bendavid and Weisman report that “Privately, those involved in the talks now say there is a 60% chance the split-bill tactic will be used.”
The idea here is to cull the ‘low-hanging fruit’ provisions of the health care reform package, such as requiring insurers to cover those with pre-existing illnesses and pass these measures with a few Republican supporters, allowing President Obama to keep his campaign promise about earnestly seeking bipartisan support for reforms. The more hard-to-pass elements, like as ‘the public option; would be voted on afterward through the reconciliation process, which requires only 51 Senate votes.
One upside of the strategy is that it guarantees The President and Congressional Democrats a significant victory before they fight the most bruising battle. It could build support for the more difficult to pass health care reforms, since voters would likely be impressed that the Administration passed needed reforms, sort of a confidence-builder. Momentum can be a ‘force multiplier,’ as was clearly demonstrated by Obama’s election victory (I was one of the clueless who didn’t think Iowa would be all that important in the nominating process).
If there is a downside, it might splinter Democratic supporters into “I like this, but not that so much” camps, diluting support for the more controversial measures. It might also give some members of Congress cover: “I voted for package ‘A,’ because it made sense, but not package ‘B’ because it was too expensive.”
No one really knows how this would play out. An important health care win could build support for another victory, narrow the focus and sharpen the debate. Better if they had broken the bill down into strategically-sequenced components from the get-go, gaining momentum with each new victory, instead of betting the ranch on one huge bill. That’s how single-payer systems were achieved in most democracies that have it.
That said, if the decision is to stick with the big package after all, I’m for it. The provisions seem solid, and glitches can be corrected later by amendments and new legislation. Whatever strategy President Obama and Democratic congressional leaders chose, none who call themselves Democrats should sit this one out.


Big Stakes, Big Risk

At 538.com, Tom Schaller points out a reasonably obvious but oft-forgotten reason for the steady erosion of President Obama’s approval ratings over the last few months: he’s trying to do a lot, and trying to do a lot depletes political capital more rapidly than trying to do very little:

Big change is costly, and not just in actual dollars from the Treasury, but in terms of how much of his capital reserves a president is willing to spend to get what he wants. Obama is not plugging for school uniforms, folks. He’s re-regulating Wall Street, trying to stimulate the economy by pumping nearly $1 trillion into it, and attempting to tackle the policy problem too many of his predecessors never could: reforming our messy, complicated health care system. Accordingly, he’s paying the price for even trying.

To put it another way, what would you prefer if you are a Democrat: that the President keep his approval ratings above 60 without working to implement the agenda he campaigned on, or lose some points and mybe get something done that won’t have to be done later or left undone entirely?
No gain without pain, folks.


The Public Option and Its Passionate Defenders

If you’re wondering why the so-called “public option” in proposed health reform plans is such a line-in-the-sand non-negotiable requirement for so many progressives, you should definitely read Mark Schmitt’s brief item for The American Prospect explaining the history of this concept.
It all started, Schmitt explains, among single-payer advocates who had been convinced by pollster Celinda Lake that their approach just didn’t have enough popular support to carry the day:

One key player was Roger Hickey of the Campaign for America’s Future. Hickey took UC Berkley health care expert Jacob Hacker’s idea for “a new public insurance pool modeled after Medicare” and went around to the community of single-payer advocates, making the case that this limited “public option” was the best they could hope for. Ideally, it would someday magically turn into single-payer. And then Hickey went to all the presidential candidates, acknowledging that politically, they couldn’t support single-payer, but that the “public option” would attract a real progressive constituency.

John Edwards signed on, and then Obama and Clinton, and a hybrid proposal that added the public option to the prevailing concept of a competitive system of private insurance plans became the standard Democratic approach.
But baked into the cake was a subtle but important difference in perspective between single-payer fans who viewed the public option as the sine qua non, and other progressives who viewed it as just one of many moving parts in a comprehensive system.
That division continues today. Here’s how Schmitt describes the passion of single-payer advocates for a “robust” public option, as many House Democrats call their demand:

So now this energetic, well-funded group of progressives is fired up to defend something fairly complex and not necessarily essential to health reform. (Or, put another way, there are plenty of bad versions of a public plan.) The symbolic intensity is hard for others to understand. But the intensity is understandable if you recognize that this is what they gave up single-payer for, so they want to win at least that much.

So hard-line defense of the public option is about substance, but it’s also about emotion, and about people who think they’ve already compromised enough by accepting a system built around private health insurance. This is all worth remembering when the final deals get cut in Congress on health reform.


Democrats: In objecting to people who bring guns to town halls, don’t insult the large numbers of Americans who carry weapons for legitimate reasons. The majority are considerate of others and do not bring guns into settings where they do not belong.

The report in TPM today that two of the men seen carrying guns at the recent town halls are linked to right-wing extremist groups is an extremely disturbing development.
But, in responding, it is important for Democrats to remember that most of the Americans who carry weapons do so for legitimate reasons – security guards, night watchmen, private detectives, parole officers, and businessmen who have to carry large quantities of cash.
These normal, law-abiding Americans would never dream of wearing their gun at a wedding, or a PTA meeting, or a decent restaurant. They would leave their weapon in the glove compartment of their car instead. (one friend of mine, a lanky Vietnam vet named Pete, always leaves his sidearm in his car before going into Waffle House to sit around and joke with the waitresses. “It wouldn’t be polite” he explains).
What the “pistol-packers” showing up at the town halls are doing on the other hand is the exact opposite – they are being intentionally provocative and deliberately seeking to offend. Their behavior has absolutely nothing to do with the second amendment or gun control. The “pistol-packers” know perfectly well that they are deliberately violating the norms and values of their communities and the code of behavior followed by the vast majority of responsible gun owners. Their second amendment rhetoric has no purpose other than to obscure this basic fact.
Dems should not let the pistol-packers hide behind legitimate gun owners. The simple fact is that normal law abiding citizens do not carry their weapons into settings where their presence is inappropriate. The pistol-packers are making a point of it.
Don’t confuse the two.


Can Co-Ops Be a Public Option?

Sorting out the pros and cons of the co-op option vs. the public option is the challenge of the hour for progressives who want real health care reform, and it will certainly be hotly debated. Most just-published articles and blogs equate ‘public option’ with a government plan. But it seems important to ask, is there any way that a co-op can be a public option? There is no shortage of opinions on the topic:
The New York Times has “Alternate Plan as Health Option Muddies Debate,” a probing article by by Robert Pear and Gardiner Harris. The authors spotlight some key problems with the co-op approach:

As the debate rages, lawmakers are learning that creating cooperatives — loosely defined as private, nonprofit, consumer-owned providers of health care, much like the co-ops that offer telephone, electric and other utility service in rural areas — will not be easy.
The history of health insurance in the United States is full of largely unsuccessful efforts to introduce new models of insurance that would lower costs. And the health insurance markets of many states suggest that any new entrant would face many difficulties in getting established.

More specifically,

The government would offer start-up money, perhaps $6 billion, in loans and grants to help doctors, hospitals, businesses and other groups form nonprofit cooperative networks to provide health care and coverage.
The co-ops could be formed at the national, state or local level. Proponents say that a health co-op might need 25,000 members to be financially viable, and at least 500,000 members to negotiate effectively with health care providers…they would need time to buy sophisticated information technology and to negotiate contracts with doctors, hospitals and other health care providers.
…In the 1990s, Iowa adopted a law to encourage the development of health care co-ops. One was created, and it died within two years. Although the law is still on the books, the state does not have a co-op now, said Susan E. Voss, the Iowa insurance commissioner.

Not a very promising prospect, according to ‘the newspaper of record.’ Worse, $6 billion is about what we spend occupying Iraq in one month. Iraq and Afghanistan are the ignored elephants in rooms where health care reform is being debated. Few would doubt that half of what we spend on these two wars annually could go a long way toward bringing real health security to America.
Columnist Bob Herbert is even more dismissive in his NYT op-ed, “Forget about the nonprofit cooperatives. That’s like sending peewee footballers up against the Super Bowl champs.”
In his Alternet post “It’s Now or Never for a Public Option: Why We Need to Take a Stand Against the Insurance Industry’s Greed” Joshua Holland explains,

In 2000, the Government Accountability Office conducted a study of the impact similar purchasing schemes had had to date. “Despite efforts to negotiate lower premiums,” the GAO concluded, “cooperatives have only been able to offer premiums that are comparable to those in the general small-group market. The cooperatives we reviewed typically did not obtain overall premium reductions because: 1) their market share provided insufficient leverage; 2) they could not produce administrative savings for insurers.”
The Commonwealth Fund did an analysis of the impacts nonprofit co-ops would have as well (PDF), and its findings were similar. Researchers found that, “with very few exceptions,” premiums offered through co-ops “have not been lower than those available to small employers elsewhere” because they “have not been able to reduce administrative costs … they have not had enough market share to bargain for discounts.”
Because of their inherent limitations, former Vermont Gov. Howard Dean told me in an interview last month that the co-op scheme is a “fake public option,” and “really not [a] serious health reform.” He predicted that if they were created, they would “be crushed just like Blue Cross was crushed. Most Blue Cross chapters are now for-profit. They’ve been taken over by the insurance industry. Any reasonable-sized insurance company can crush a not-for-profit co-op.”

And, in The Nation, Katha Pollit writes of co-ops,

…They’re untested, small, unregulated, that they exist in twenty states and that Senator Kent Conrad of North Dakota really likes them–but I didn’t discover what they actually are. I understand “public option,” and “public” has a good, strong ring to it–it says, Healthcare is a right, part of the common good, something everyone should have, and if you can’t afford it in the marketplace, the government will provide it. “Insurance co-op” speaks a whole other language, of commerce and complexity and exclusivity

Writing in the Washington Post, David S. Hilzenrath and Alec MacGillis explain:

“It’s very difficult to start up a new insurance company and break into markets where insurers are very established,” said Paul B. Ginsburg, president of the Center for Studying Health System Change. “I don’t see how they’re going to obtain a large enough market share . . . to make a difference.”
Karen Davis, president of the Commonwealth Fund, a foundation focused on health care and social policy research, said co-ops may not enroll enough people to negotiate favorable rates with health-care providers.
…Co-ops would lack perhaps the main advantage of the public option: reimbursement rates for doctors and hospitals set by federal law, like those paid by Medicare, the program for older Americans. Federally determined reimbursement rates were central to the cost-saving promise of a government-run health plan and a potentially powerful competitive advantage. They were also a lightning rod for intense opposition from health-care providers and private insurers, who denounced the public option as a threat to their financial survival…Co-ops would lack the ability to piggyback onto existing government institutions, like the ones that help administer Medicare.

On the other hand, Co-ops have some advantages and “could serve a useful purpose in health care — just as credit unions compete effectively with banks, prompting them to offer higher interest rates on deposits and lower rates on loans,” explain Pear and Harris, summarizing the views of Ann Hoyt, a University of Wisconsin economist who has written extensively about co-ops.

…Professor Hoyt said she had been a member of the Group Health Cooperative of South Central Wisconsin since 1985, and she reported that “the care is excellent.”…Larry J. Zanoni, executive director of the Wisconsin plan, said: “We are a testament to the success of a health care cooperative. But it took us over 30 years to get where we are today.”
Representative Earl Pomeroy, Democrat of North Dakota, said the proposal for cooperatives was “a very worthy idea.”…“The market here is uncompetitive,” said Mr. Pomeroy, a former state insurance commissioner. “A cooperative could provide an alternative source of insurance and some interesting competition for premium dollars. A co-op could operate at lower costs, in part because it would not need to pay its executives so generously as the local Blue Cross Blue Shield plan.”

There are plenty of co-ops already operating, note Harris and Pear:

…In a study published in March and financed in part by the federal government, Professor Hoyt and other researchers at the University of Wisconsin identified nearly 30,000 cooperatives with revenues of more than $650 billion a year. They include farm co-ops, retail food co-ops, rural telephone and electric co-ops and credit unions — entities as diverse as Ace Hardware, The Associated Press, Blue Diamond Growers (almonds), Carpet One, Land O’Lakes (dairy products), Ocean Spray (cranberries) and Sun-Maid Growers (raisins).

If co-ops are going to do any good, they must be adequately capitalized, particularly since guaranteeing coverage of pre-existing conditions is a cornerstone of Obama’s and Progressive concepts of health care reform. Also, there are more well-established ethics and accountability rules and regulations in government. And it is a fair question to ask if co-op employees would have enough of a commitment to public service, as well as the competence and resources to protect the health security of Americans. Also, how do you level the playing field, so giants like Blue Cross-Blue Shield don’t have such a potent edge over new start-ups?
Can co-ops actually be a sort of public option, performing a very similar role as does government? As Republican Sen. Orrin Hatch, quoted in The Times article, says “You can call it a co-op, which is another way of saying a government plan.” And, noting that Democratic Majority Leader Harry Reid called co-ops “some type of public option,” Chris Good adds at The Atlantic ‘Politics’ blog:

The RNC forwarded a press release/research memo to reporters today claiming that a “‘public option’ by any other name is still government health care.”…The idea is that co-ops (whether it’s one national co-op, state co-ops, or a national co-op with state affiliates) would serve the same function as government-administered health insurance, in that they’d operate as non-profits and perhaps utilize some added bargaining power or lower payment rates, thus forcing for-profit insurance companies to drive their own costs down, out of sheer economic necessity, once they had to compete with a non-profit that had some consumer cost advantages.

According to Rep. Anthony Weiner, as many as 100 members of the House of Representatives may see a bill with no ‘public option’ as a deal-breaker. In the Senate, however, Nate Silver guestimates only 41 solid votes for a ‘public option,’ compared to Chris Bowers’ 43. It’s hard to define the congressional consensus on the ‘public option’ between the House and Senate.
Is it ‘either/or’, or ‘both/and’? Might some kind of hybrid, that taps some of the advantages of both co-ops and government be possible? Much depends on whether co-op advocates can provide credible answers to these and other questions.


RIP Robert Novak

Robert Novak, who died today of brain cancer at the age of 78, had such a long and varied journalistic career that different people probably remember him in different ways. Some younger readers may completely associate him with the Plame saga, or with his career as a conservative gabber on cable. Others may recall the many years in which his syndicated newspaper column was (as David Stockman once put it) a “bulletin board” for movement conservatives who wanted to make their views known to members of the Washington establishment–or sometimes, vice versa. And a few of us oldsters will remember his earlier days, when he was actually a Democrat and an old-fashioned shoe-leather muckraking reporter, in association with his Odd Couple co-columnist (and co-participant in his pioneering cable television show) Rowland Evans.
The book Evans and Novak wrote about LBJ, Lyndon Johnson: The Exercise of Power, remains one of the best political biographies around, particularly if you are interested in the arcane operations of either the U.S. Senate or the White House. I haven’t read his recent autobiography (entitled, in a reference to his longtime nickname in Washington, The Prince of Darkness) but through other obituaries I am hearing that it’s a fascinating book even if you deplore the author’s politics, and intend to go out and buy it directly.
I only met Novak once, just a few years ago, when I had the strange experience of being on a political panel seated between the Prince and another right-wing legend, Paul Weyrich. I found Novak to be smart, cynical, and appropriately scary. By then he had undergone a late-life conversion to Catholicism, reportedly via the agency of the mysterious conservative organization Opus Dei. That, too, was fitting, given his long association with the Cultural Right. I gather his final illness was characterized by excrutiating pain. Much as I dislike large elements of the man’s journalistic and political legacy, I hope his faith gave him comfort, and may he rest in peace.