This item is cross-posted from The New Republic.
Naturally, the attention of health care reform observers (and who isn’t one these days?) is focused on the action in the Senate Finance Committee right now. But an equally important drama is playing out in the House Democratic Caucus.
As Ryan Grim explains at HuffPo today, the Caucus is due to meet tomorrow to assess the views of Members before the House formally acts on the “tri-committee” proposal that’s been cleared for the floor. And the big issue is the relative strength of those within the Congressional Progressive Caucus who have vowed to oppose any bill at any stage of the process that doesn’t include a “robust public option,” and those in the Blue Dog Coalition who don’t much like the public option. Both groups are whipping their members, reports Grim:

The fate of the public option in the House will be largely determined by the parallel whip efforts — and how aggressive each bloc is in pushing for its priorities. In other words, it comes down to which pack wants it more, the Blue Dogs or the progressives.

This isn’t, it’s important to understand, primarily about votes on the initial House legislation, particularly when it comes to the Progressive Caucus members. It’s about what happens after the Senate finally enacts its own version of health reform. If Progressive Caucus members continue to stand behind the pledge that 60 of them have made to torpedo any conference committee report that junks a strong (or possibly, any) public option, that will have an effect not just on House conferees, but on the Senate Democratic strategy (i.e., whether to pursue the risky budget reconciliation approach to produce a more “liberal” bill). At the same time, it’s clear that some Blue Dogs will vote for a House bill they don’t like in anticipation that the conference commitee report will produce a weaker version of the public option, or some different mechanism like co-ops or a public option “trigger.” If that’s no longer a lively prospect, more of them could be lost on the initial vote.
With House Republicans almost certain to oppose any legislation en masse, it’s all about what 218 House Democrats can be mustered to support now and later. So even among senators, what happens in the House tomorrow will be fateful.

Talk to a conservative about health care reform, and nine times out of ten he or she will quickly get around to a rap on medical malpractice insurance, tort reform, and the evil, evil trial lawyers that are responsible for high health care costs and that have bought political protection from the Democratic Party. Having heard this a million times, most progressives simply close their ears when the very subject comes up.
Via Ezra Klein, there’s a very good fact-based summary piece on this subject from David Leonhardt of the New York Times.
Here’s an excerpt:

The direct costs of malpractice lawsuits — jury awards, settlements and the like — are such a minuscule part of health spending that they barely merit discussion, economists say. But that doesn’t mean the malpractice system is working.
The fear of lawsuits among doctors does seem to lead to a noticeable amount of wasteful treatment. Amitabh Chandra — a Harvard economist whose research is cited by both the American Medical Association and the trial lawyers’ association — says $60 billion a year, or about 3 percent of overall medical spending, is a reasonable upper-end estimate. If a new policy could eliminate close to that much waste without causing other problems, it would be a no-brainer.
At the same time, though, the current system appears to treat actual malpractice too lightly. Trials may get a lot of attention, but they are the exception. Far more common are errors that never lead to any action.
After reviewing thousands of patient records, medical researchers have estimated that only 2 to 3 percent of cases of medical negligence lead to a malpractice claim.

The usual GOP method for dealing with this issue is, of course, simply capping damage awards for malpractice suits, which might somewhat reduce “defensive medicine,” but at a hard-to-estimate cost in even greater medical errors. The other issue, of course, is that other elements of the health care system encourage unnecessary tests and procedures as much as fear of lawsuits. As Leonhardt notes:

The problem is that just about every incentive in our medical system is to do more. Most patients have no idea how much their care costs. Doctors are generally paid more when they do more. And, indeed, extra tests and procedures can help protect them from lawsuits.
So the most promising fixes are the ones that don’t treat the malpractice system as an isolated issue.
Imagine if the government paid for more research into which treatments really do make people healthier — a step many doctors don’t like. Such evidence-based medicine could then get the benefit of the doubt in court. The research would also make it easier to set up “health courts,” with expedited case schedules and expert judges, which many doctors advocate.

In other words, medical malpractice reform is not a substitute for health care reform, and in fact, the best way to deal with “defensive medicine” may be through health care reform.
That’s a better answer than the usual Kabuki Theater back and forth on this issue.

You often hear conservatives say that if alternative energy sources were feasible, they’d be cheaper. And many conservatives favor an approach of subsidizing every energy source through tax breaks, as opposed to making a conscious choice to limit or at least boost the price of the fossil fuels that contribute so much to climate change while perpetuating our dependence on unstable global oil markets.
That’s why it’s important to understand that producers of fossil fuels current benefit from a large variety of federal subsidies that are much more extensive than anything offered on behalf of clean and/or renewable energy sources. Via Grist’s David Roberts, there’s a new study by the Environmental Law Institute and the Woodrow Wilson International Center for Scholars that puts a price tag on U.S. subsidies for various energy sources during the years 2002-2008.
It’s a pretty bad picture. Over this period, fossil fuels received $79 billion in federal subsidies, while renewable fuels received $29 billion. And among the renewables, over half the subsidies actually went to just one politically connected source, corn ethanol, which is controversial because of its impact on agriculture, and because its production typically requires extensive use of fossil fuels.
As Roberts notes, the figures for fossil fuels subsidies are conservative:

It did not include any number of things that could be considered indirect or implicit subsidies. It didn’t include military spending to defend oil in the Middle East, spending on the electricity grid, or transportation spending. Those things don’t go exclusively to fossil fuels, but if there was a way of including the share that goes to fossil fuels, the fossil subsidy number would go way, way up. Infrastructure spending has more or less exclusively supported fossil fuels for decades now.

Just yesterday, President Obama told the United Nations that subsidies for fossil fuels around the world need to come to an end. That’s certainly a goal that needs to be embraced by the United States.

Mike Lux is a very pragmatic and unity-minded member of the self-conscious progressive wing of the Democratic Party. So it certainly got my attention when he published a post at OpenLeft today threatening that adoption by Senate Democrats of Sen. Olympia Snowe’s “public option trigger” would create a “Democratic Civil War.”
Mike’s primary substantive argument is that Snowe’s “trigger” involves a Catch-22 mechanism whereby the “affordability” of private health insurance that would avoid a public option in any given state is judged according to prices that include federal subsidies defined as making coverage “affordable.” Thus, he reasons, there will be no public option anywhere private insurance is offered. I doubt that’s right, but not having seen any actual legislative language for the Snowe “trigger,” I can’t say with certainty it’s wrong, either. This may be a case where perception matters as much as reality, particularly if progressives suspect they are being sold a pig in a poke.
The general “insider” view on the end-game for health care reform has been that in the end, public option advocates would unhappily accept a “trigger” as far preferable to the co-op structure embedded in the Baucus bill. Indeed, the main appeal of the “trigger” idea, as Ezra Klein has explained, is that it accomodates the wildly different empirical assumptions that supporters and opponents of a public option hold about what would happen to the price and availability of private health insurance in a competitive system. If progressives are right that effective competition would not occur–one of the main arguments for a public option in the first place–then a public option would arise, at least in theory.
Now Mike is saying that’s all a sham, and you’d have to expect that many public option opponents would say the same thing from the opposite perspective, arguing that the “trigger” will always be pulled. As Ezra Klein also noted in his piece on the “trigger,” there’s not much of a constituency for compromise on this issue. And that’s why offers of a legislative “fix” for the flaw that Mike is focusing on won’t be very warmly welcomed.
But here’s the realiity: As a practical matter, if Senate Democratic leaders reject both co-ops and a “triggered” public option, then they probably have to move health care reform legislation via the budget reconciliation route. It’s not just a matter of giving up the pursuit of Olympia Snowe (and perhaps the one or two Republicans she might be able to bring with her); enough “centrist” Democrats have heartburn over a “robust” public option, over a purely partisan bill, or over what will eventually emerge from a conference committee, to all but guarantee that Democrats will fall short of the 60 votes necessary to kill a filibuster, even now that Massachussets is supplying Democrats with a 60th senator.
As I noted earlier this week, there are legitimate concerns about how the use of reconciliation would play out. Maybe that really is the way to go, and maybe it will produce a 50-plus-one vote margin for a bill that not only has a strong public option, but that’s pretty close to what the House is likely to pass, which simplifies this whole process considerably.
But in cases like this, a Plan B would be advisable, and public option supporters might want to give some serious thought as to whether there is a version of the “trigger”–in which “affordability” is better defined, and a larger scale for competion is provided than the state-by-state approach Snowe is promoting–that might be acceptable if push comes to shove. This really isn’t a great time for a “Democratic civil war.”

So what’s going on with the House Republican leadership, the hard-core conservative base probably wants to know. Are they going soft and moderate?
First we learn that House Republican Whip Eric Cantor of VA participated in a very civil discussion of health care policy with Democratic Rep. Bobby Scott, sponsored by the Richmond Times-Dispatch. According to Dana Milbank’s account of the event in the Washington Post today, it was a very tepid affair:

No talk of death panels. No complaints about illegal immigrants. Nothing about killing Grandma, no mention of socialism, nobody calling anybody a Nazi. And at no point during the 90-minute forum on health care did Cantor, or anybody else, call President Obama a liar.
The Richmond area lawmaker wouldn’t have had any trouble riling up the people in the audience, many of whom wore “Tea Party” or “9-12 Project” T-shirts. But “what use is that?” he said after the session. In fact, he came away with some advice for his colleagues: “Stop the revival stuff and let’s talk.”

I was wondering what Glenn Beck would say about that when I got an email from Richard Viguerie, the legendary hard-right organizer and scourge of all things moderate, with the subject line: “Are you kidding? Boehner says Obama Not a Socialist!” Seems that on Meet the Press Sunday, David Gregory specifically asked if the House Republican Leader thought the President was a socialist, and he finally allowed as how he didn’t think so. Boehner has in the past called Obama’s agenda “a socialist experiment,” but never mind.
As you can imagine, Viguerie’s pretty upset at this backsliding, so he’s put out a poll of his internet readership to find out whether they think Obama is a socialist, or maybe a Marxist, a traditional liberal, or even a “centrist.” He promises to pass the results on to Boehner and others when they are in. I figure it will be “Marxist” in a landslide.
Ah, can’t trust these weasely Washington Republicans. It’s probably time for another Tea Party to stiffen their spines.

This item is cross-posted from the Progressive Policy Institute site.
The long-running campaign to make inclusion of a “public option” a progressive litmus test for Democrats on health care reform has entered a new and potentially dangerous phase: growing demands that congressional Democrats use the budget “reconciliation” procedure to avoid a Senate filibuster and lower the effective threshold for enactment of a bill to 50 votes.
As Brian Buetler explains at TalkingPointsMemo, two major new grassroots initiatives–one sponsored by Democracy for America (and headed up by Howard Dean) and another by a new group called CREDO Action–are asserting that reconciliation can easily be used for health reform. The clear implication is that any failure to go this route is proof of Democratic irresolution if not betrayal.
The temptation to insist on the reconciliation route is certainly understandable. Aside from making enactment of a bill by the Senate much easier, reconciliation, if successfully pursued, might make Republicans irrelevant to the process, while vastly reducing the influence of those Democrats who are obdurately opposed to the public option. It could also narrow the gap between House and Senate bills, which currently makes approval in either House of the ultimate conference committee report a difficult challenge.
But unfortunately, use of reconciliation isn’t the no-brainer it’s sometimes made out to be.
There are two major risks to the use of reconciliation which have nothing to do with fear of Republican shrieks about “cramming through a bill” or with fading hopes of bipartisanship.
The first involves the arcane budget provision called “the Byrd Rule,” which creates a point of order in the Senate against material in reconciliation bills that is not germane to budgeting. If the Senate parliamentarian (to whom the chair invariably defers on such matters) rules in favor of such a point of order–and Republicans will raise them constantly–it requires 60 votes to override such a ruling, which eliminates the entire advantage of taking this route to begin with. Nobody seems entirely confident that, say, creation of health care exchanges would be judged as germane.
The second problem is that it’s almost impossible to enact permanent changes in law via reconciliation; provisions can only operate within limited-time “windows.” This problem is best illustrated by the consequences of the GOP decision to enact the big Bush administration tax cuts via reconciliation. The “limited window” requirements of the Budget Act explains why there is still a federal estate tax, even though Congress voted in 2001 to phase it out; and why the remainder of the Bush tax cuts haven’t been made permanent. Creating an elaborate new system for health care on a temporary basis could be more than a little hazardous.
There’s a deeper problem, too, which is reflected in the evolution of the “Byrd Rule,” named after the famously imperious appropriator, the senior senator from West Virginia: non-Budget Committee senators in both parties naturally resist the routinization of reconciliation as a way to bypass the authorizing and appropriating committees. This isn’t a matter of party or ideology, but of institutional prerogatives that are zealously defended even by senators who might favor the kind of health reform legislation that reconciliation would be designed to enact.
It’s entirely possible that the potential payoff of using reconciliation is worth all the risks, particularly if hard-core Republican opposition to health reform makes it the only viable option, and/or if Democratic opponents of a public option refuse to vote for cloture to allow an up-or-down vote. But the key point right now is this: the decision isn’t easy, and the White House and congressional leaders may decide against reconciliation for reasons that should not expose them to angry charges of timidity or subservience to the health care industry.
UPDATE: The indispensible Jonathan Cohn has a post up at The New Republic on reconciliation and health care that makes a similar warning about its perils.

If you are confused about the state of public opinion on health care reform, check out an exhaustive post at pollster.com by the respected nonpartisan observer Charles Franklin. Looking at every poll from virtually every available perspective, here’s what he concludes about recent trends:

[T[he big picture is that opposition ramped up significantly through June or July but has recently slowed or stopped. Support fell less precipitously but has been working back up for a month (despite or perhaps because of the circus coverage in August.) We could pick a chart to fight over the details, but we shouldn’t. It is the big picture of public opinion that is important here. Within a couple of points, opinion is evenly divided. The White House has gained a bit of momentum, but will be challenged to lower the opposition numbers, not just raise the support numbers.

All the data that Franklin analyzes was gathered before the President latest media blitz. It will take a while to assess its effectiveness, particularly since it is ongoing. But it does not look like the administration or congressional Democrats are bucking an adverse trend any longer. And it also appears the townhall meetings and the associated conservative hysteria may not have changed much of anything, and might have even backfired a bit.

It’s been a big week for anti-anti-racism. Virtually the entire conservative world has waxed indignant about Jimmy Carter’s suggestion that racism is responsible for the unusual virulence of anti-Obama sentiment.
Listening to it all, you’d think the so-called “race card” was a much bigger problem in American society than racism itself, and that does seem to be what a lot of conservatives think. But it’s getting to the point where the argument seems to be that if anti-Obama protesters have any non-racial motives for their behavior, then mentioning race as any sort of factor (hard to avoid given the revival of screaming about “welfare” and the preoccupation with the marginal organzing group ACORN) is a terrible insult.
Witness David Brooks’ unintentionally hilarious column in the New York Times today. David jogged through last Saturday’s Tea Party demonstration on The Mall, and can assure us all that there were no racists there:

[A]s I got to where the Smithsonian museums start, I came across another rally, the Black Family Reunion Celebration. Several thousand people had gathered to celebrate African-American culture. I noticed that the mostly white tea party protesters were mingling in with the mostly black family reunion celebrants. The tea party people were buying lunch from the family reunion food stands. They had joined the audience of a rap concert.

Now David is a Yankee, so perhaps he can be forgiven for believing that mingling with black folks, listening to their music, and allowing them to prepare one’s food are things no racist could possibly do. If that’s the case, of course, there’s never been any racism in the Deep South, and neo-Confederate sentiments really are and were just about abstractions like “states’ rights.”
Unfortunately, the Brooks column never much rises above this sort of superficial argument that if there’s any evidence of non-racism among Obama opponents, then even mentioning racism is an outrage.
His main contention is that the Tea Party movement reflects an authentic all-American populist tradition dating back to Jefferson that is “ill mannered, conspiratorial and over the top — since these movements always are, whether they were led by Huey Long, Father Coughlin or anybody else.” So it’s “not race,” says Brooks. “It’s another type of conflict, equally deep and old,” and it’s mainly about Obama’s “elitism” and a “producerist” revolt against redistributionist policies. Nothing to see here, folks, it’s just good old-fashioned American populism.
You’d think maybe his own reference to Father Coughlin as an example of right-wing populism would alert Brooks to the folly of his argument. Was Coughlin solely motivated by anti-semitism? No, almost certainly not. Does that mean the anti-semitism he stimulated wasn’t real and dangerous, leading eventually to his suppression by his own bishop? Absolutely not.
Lord have mercy, David, think about it: the Ku Klux Klan wasn’t just “about race;” it was about hostility to immigrants and to some extent to capitalism; early twentieth-century Kluxers, in alliance with William Jennings Bryan, thought of themselves as “progressives.” That was rather cold comfort to the people they tormented and threatened.
No, I am not comparing the Tea Party folks to Klansman; I am simply noting that every racially tinged political movement in American history has, of course, had other, non-racial motivations, so simply citing such motivations doesn’t address the possibility of racial motivations.
It makes you wonder: what if Jimmy Carter had simply said that Obama’s angry opponents were “ill mannered, conspiratorial and over the top.” I suspect the overall conservative reaction would have been just about as wounded and self-pitying, but I doubt David Brooks would have agreed with him.
Indeed, this column concludes with the signature Brooks assertion of the equivalency of right-wing craziness and the reaction to it:

What we’re seeing is the latest iteration of that populist tendency and the militant progressive reaction to it. We now have a populist news media that exaggerates the importance of the Van Jones and Acorn stories to prove the elites are decadent and un-American, and we have a progressive news media that exaggerates stories like the Joe Wilson shout and the opposition to the Obama schools speech to show that small-town folks are dumb wackos.

So if you object to Glenn Becks’s ravings, you’re as guilty as he is of extremism, and moreover, you think small-town folks are dumb wackos.
That charge is at least as offensive as any over-attribution of racial motives to Obama-haters.