Brian Beutler of Talking Points Memo has a short, but informative post “The Final Four: Who’s Standing In Reid’s Way, And Can They Be Won Over?” discussing the motives of four senators now stalling enactment of a decent health care reform bill. Beutler dishes on what’s driving Sens. Lieberman, Lincoln, Nelson and Landrieu.
Lieberman, he says is most likely driven by the insurance industry’s formidable clout in his home state, and Beutler also wonders if Lieberman is consciously giving some “cover to his centrist friends,” who would like a more bipartisan final vote to end debate. This last notion seems a little calculated, but it may be part of his gambit. However, there’s no denying the influence of the insurance industry in CT.
Beutler cites Sen. Lincoln’s waffling on the public option — her website and recently-stated postions re the public option are at odds — as symptomatic of her tough re-election campaign. Lincoln, says Beutler, “would like to present her conservative constituents with a scalp to prove she didn’t roll over for the liberals in her party.” Sounds about right. She may also be enjoying the unprecedented media attention, if not the heat.
Sen. Nelson “always prefers the option that liberals in the party don’t…” He feels his cred with constituents depends on his being the maverick Dem on most issues. He wants to show them that his leadership made the reform bill more responsiblle in terms of cost-containment.
Beutler puzzles a bit over Landrieu, who isn’t up for re-election until ’14. She is dealing with a trickier constituency, since the flight of too many Dems from Louisiana since Katrina. I’m thinking she is leveraging her position to get more much-needed aid for her state, as she did on the vote-to-debate. Pretty clever, actually.
Beutler makes mention of Sens. Carper and Snowe, both advocates of a ‘trigger mechanism,’ but he doesn’t say much about exactly what can be done to win the support of any of the six senators in question. Poor Harry Reid is playing a very difficult game of three-dimensional chess, in which concessions to any of the six have to be precisely measured, then weighed against worst and best-case scenarios.
Since Lieberman is out of the picture for any kind of public option, the logic of the political moment points to some kind of trigger-like amendment, or perhaps a private/public hybrid. As a Baltimore Sun editorial puts it, “If the public option survives, it will be watered down like a discount cocktail at a low-rent nightclub.”
If progressive Dems have to eat a weak public option, a much more substantial broadening of eligibility for access to the ‘insurance exchanges,’ as Sen. Wyden has been advocating could sweeten the bitter pill. What is unacceptable is that four, or even six senators be allowed to gut the public option supported by a majority of both houses of congress, with no quid pro quo reflected in the final bill.

Nate Silver has a perceptive ‘where do we go from, here’-themed post, entitled “Is The Public Option Un-Un-Dead?” up at his FiveThirtyEight.com blog. Among Silver’s insightful observations, is this one that offers some comfort to public option advocates:

The fundamentals of the public option are, in some sense, still fairly strong. It polls well. Perhaps more importantly, the CBO seems to think that it would save money. For this reason, I don’t think we can completely rule out the possibility that Lincoln, Nelson, et. al. could be persuaded about its merits. Also, importantly, the bill that will be reported to the Senate floor will contain a public option, which leaves it with a certain amount of inertial momentum.

As for a strategy to save the public option, Silver takes a strong position favoring ‘persuasion’ over ‘strong arm tactics’:

The two strong-arm tactics that people seem to be excited about are reconciliation — a procedural maneuver to pass the bill through a majority-rules environment — and a “progressive block” strategy in which progressives threaten to vote down the health care bill unless a reasonable public option is included. I don’t think either of these are liable to have their desired effect.
What’s wrong with the progressive block strategy? For one thing, it’s not clear that the threat is credible. Technically speaking, the bill that the House passed did not contain what had initially been defined as a “robust” public option — meaning one pegged to Medicare rates. But only one or two progressives wound up voting against it for this reason, even though many had threatened to do so.
But suppose that the threat were credible — that Bernie Sanders and Roland Burris, say, were prepared to carry it out. And suppose that you’re Blanche Lincoln. Don’t you now have something close to the best — or perhaps the least bad — of both worlds? Now you can vote against a bill which is unpopular in your state and dodge some of the blame for doing so, insisting that it was those no good socialists lib’ruls who were responsible for torpedoing the bill’s chances.

Read more…

A number of political commentators have expressed concern about the timetable for implementing health care reforms, particularly as it relates to Democratic prospects in the upcoming midterm elections. So far, Politico‘s Carrie Budoff Brown has the best summary of the timetable for the proposed Senate compromise health care reform bill. Here’s a much-abbreviated summary of Brown’s rundown on “immediate benefits” of ‘The Patient Protection and Affordable Care Act,’ which kick in the first year after enactment:

Access to Affordable Coverage for the Uninsured with Pre-existing Conditions…
Closing the Coverage Gap in the Medicare (Part D) Drug Benefit… reduce the size of the “donut hole” by raising the ceiling on the initial coverage period by $500 in 2010…also guarantee 50 percent price discounts on brand-name drugs and biologics purchased by low and middle-income beneficiaries in the coverage gap.
Small Business Tax Credits…Tax credits of up to 50 percent of premiums will be available to firms that choose to offer coverage.
Extension of Dependent Coverage for Young Adults…until age 26.
Free Prevention Benefits…exempt these benefits from deductibles and other cost-sharing requirements in public and private insurance coverage.
No Arbitrary Limits on Coverage…prohibit insurers from imposing lifetime limits on benefits and will restrict the use of annual limits.
Protection from Rescissions of Existing Coverage
Prohibits Discrimination Based on Salary
Health Insurance Consumer Information…provide assistance to States…to assist individuals with the filing of complaints and appeals, enrollment in a health plan…
Clear Summaries, Without the Fine Print

It’s encouraging that the key element of no denying coverage for prior conditions kicks in during the first year. That alone is a significant selling point. The problematic Senators (Lieberman, Nelson, Landrieau and Snowe) will have to think twice about the costs of casting a vote that may kill that important reform for consumers. The other measures are gravy, thin gravy in some cases, but selling points nonetheless.
Now for the tough sell, according to Brown:

The Senate bill pushes back implementation of major parts of the reform to 2014 — a change from 2013 under the Finance Committee bill…This is bad news for lawmakers who will need to explain to constituents why the elements that have attracted the most attention — the public plan, the Medicaid expansion and the insurance exchanges — won’t be available for four years.

Presumably, the timetable for these these delayed reforms is negotiable in myriad combinations with other proposed modifications to come in horse-trading during the weeks ahead. The challenge is to devise face-saving options for Nelson, Lieberman and/or Snowe, and maybe Landrieu — which don’t significantly undermine the substance of Reid’s proposals. Quite a hat trick, that.

All good Dems have gotta love this CNN headline, especially considering the author of the article: “Republicans heading for a spectacular bloodbath in Florida.” If you had to pick just one state for Republican wingnuts to drink the political Kool-aid en masse, it would be the Sunshine State, and according to the author, former Bush speechwriter David Frum, they are obliging with gusto:

The Republican fratricide in the November 3 special election in upstate New York may prove just an opening round of an even more spectacular bloodbath in Florida in 2010…In New York, Republican feuding lost the party a seat in the House of Representatives. At stake in Florida is not only a senatorship — but very possibly Republican hopes for 2012 as well.

Almost too good to be true, from a Democratic point of view. Frum speaks of the Senate race between moderate Republican Gov. Charlie Crist and former Speaker of the Florida House Marco Rubio, who is the darling du jour of GOP wingnuts.
Even Republicans are embracing the political suicide metaphors in describing the FL Senate race. As Kate Zernike reports in the Sunday New York Times,

“Florida is a hill to die on for conservatives,” said Erick Erickson, editor of the conservative blog RedState.com, which leads a daily drumbeat against Mr. Crist. “This is the clearest example we have of these two competing concepts.”

Wingnuts are still livid, it seems, because Crist, a moderate on several issues, like cap and trade to check global warming and restoring voting rights to ex-felons, not only endorsed the Obama stimulus, but campaigned for it as well. Even conservative luminaries, like George Will who should know better have climbed on the Rubio bandwagon. Frum points out that every GOP Governor eventually accepted stimulus aide, despite the grumbling. The funds were urgently-needed in FL, as Frum explains:

The final Obama plan granted Florida more than $15 billion over three years. That money averted radical cuts to schools and Medicaid. It saved the state from furloughing employees and raising taxes even higher. It has paid for emergency employment on roads and water projects. It has extended unemployment benefits for 700,000 Floridians and put an extra $25 per week in their relief packets.

While most sane Floridians are grateful for the much-needed aid, Rubio has instead attacked Crist for accepting the funds as a “terrible threat to a fragile economy.” As a result, Frum notes, Rubio “trails Crist badly in all demographic categories. Rubio even trails Crist by 10 points among Hispanics, despite his Cuban ancestry and fluent Spanish.”
Frum is very worried about his party, and asks a good question, “Are vague bromides about big government anything like an adequate response to the worst economic crisis experienced by any American under age 80?…If all we conservatives have to offer is oppositionism, then opposition is the job we’ll be assigned to fill.”
If Frum is correct about the fallout of the Crist-Rubio fight, Florida Dems may soon be drinking a toast of their own — no, not Kool-aid, but champagne.

Dems who opposed the health care reform bill passed last week blundered badly for a number of reasons — ten to be exact, according to TDS Contributor Robert Creamer’s post in today’s edition of HuffPo. In addition to the principle reason cited by Creamer and other pundits — that the bill’s key provisions, including the publlic option, were supported by majorities in their districts — Creamer adds some interesting contentions among the ten, including these nuggets:

2). Once the bill is passed it will become even more popular. Social Security, Medicare, and child labor laws were all controversial when they were first passed. Now they are all revered features of the American landscape. The same will be true of the health insurance reform that makes health care a right for all Americans.

and,

4). If Democrats are successful at passing their agenda and nationalizing the Mid-terms – which would otherwise be terrific news for the most vulnerable Members – the Members who voted no on the health care bill will look like skunks at the garden party.

and,

6). News flash to Democrats who voted against the health bill: not one of the “tea party” gang is going to support you in 2010. Whether you voted yes or no, they are all going to work their hearts out for your opponent. The “tea party” gang you saw at your town meeting in August does not represent swing voters in the district – they are the hardcore base of the Republican Party.

and,

8). Voters like fighters…On the whole, swing voters – and certainly mobilizable voters – like fighters. They like candidates who have strong beliefs, and stick by their guns. That quality is an independent variable in deciding how persuadable voters cast their ballots.

Actually, all of Creamer’s points are both plausible and interesting. He concludes saying that all is not lost, even for those who voted against the legislation on the first lap, noting “each of the 39 Democrats – and all but one Republican — who voted against the health care bill have one more chance to redeem themselves. When the bill comes back from the House-Senate Conference there will be one more up or down vote on health care reform.”
To the average voter, the candidate who rides the tide of historic change that gives millions of American families a stronger sense of security looks a lot better than the one getting rolled by it.

At The Plumline, Greg Sargent flags a new Pew poll, (conducted 10/28-11/8), indicating “some potentially ominous signs for Dems, finding that anti-incumbent sentiment is running at levels comparable to the worst in two decades.” Worse, Sargent adds, “Those planning to back a Republican next year are more enthusiastic than those backing Dems — by double digits.”
The outlook for Independent voters is also worrisome, according to the Pew poll overview:

Support for congressional incumbents is particularly low among political independents. Only 42% of independent voters want to see their own representative re-elected and just 25% would like to see most members of Congress re-elected. Both measures are near all-time lows in Pew Research surveys.

Before we go all chicken little over these numbers, consider that they could quickly change when we pass a health care bill, which should give the Obama administration and congressional Democrats a boost in their competence cred. The danger is that the Republicans, smelling Dem blood as a result of recent polls, will harden their opposition. It’s not hard to imagine Olympia Snowe, for example, concluding that a few less Democratic senators in ’10 would increase her personal bargaining leverage considerably.
Among the more encouraging findings of the Pew poll:

Despite the public’s grim mood, overall opinion of Barack Obama has not soured – his job approval rating of 51% is largely unchanged since July, although his approval rating on Afghanistan has declined….Currently, 47% of registered voters say they would vote for the Democratic candidate in their district or lean Democratic, while 42% would vote for the Republican or lean toward the GOP candidate. In August, 45% favored the Democrat in their district and 44% favored the Republican.

But the poll also provides additional cause for concern regarding increasing U.S. troops in Afghanistan:

…40% say the number of troops in Afghanistan should be decreased, 32% say the number should be increased, and 19% favor keeping troop levels as they are now. These numbers are virtually unchanged from January. However, more Republicans now favor increasing the number of troops than did so in January (48% now, 38% then). The proportion of Democrats favoring a troop increase has fallen from 29% to 21% over the same period.

This may account for President Obama’s reconsideration of sending in more troops.
With respect to health care reform, the Pew poll indicates Dems face a daunting challenge in winning the confidence of voters:

While support for the health care bills before Congress ticked up slightly from last month, more Americans continue to oppose than support the overall package by a 47% to 38% margin. And strong opposition continues to outweigh strong support buy a 34% to 24% margin.
Currently, 38% support the health care bills in Congress, up slightly from 34% last month. The shift reflects a rebound in support for health care legislation among independents, particularly independents who lean toward the Democratic Party…Overall, 33% of independents favor the health care legislation being discussed in Congress, up from 26% in October. This is driven by a 16-point rebound in support (from 42% to 58%) among the subset of independents who say they lean Democratic. But overall, just over half of independents (51%) remain opposed to health care overhaul.

The study also notes a strong edge in the enthusiasm of opponents of Democratic health reform proposals, as well as deep and wide pessimism about the economy.
Polls are important. But they are almost always tempered by event. Health care reform is very much alive, there are signs that the economy is beginning to recover and victory in Afghanistan may turn on how the Administration refocuses the definition of the mission. Few Presidents have faced as many overwhelming challenges so early into their presidencies. It may be that in a year from now, even most skeptical voters will have to concede, “President Obama inherited an awful mess, but he came out of it OK.”

Lieberman looks like a lost cause, as far as the public option is concerned. But ActBlue is setting an impressive example of citizen lobbying, via TV ads, to persuade Senator Blanche Lincoln to not filibuster against an up or down vote on the public option.
BlueAmerica’s latest Lincoln ad is very tough, and graphically amusing, depicting Senator Lincoln all gussied up like a NASCAR driver, only the ads pasted all over her jumpsuit are for her many health care contributors. Slide the right-side bar at the link down and view three more ‘Harry and Louise’ style ads depicting a couple at the kitchen table wondering why Sen. Lincoln is so concerned about health insurers, when they can hardly pay their bills. The idea here is to build constituent awareness about her foot-dragging and get them to call her and urge her to get on the side of consumers, who need a public option to have any leverage with private insurers.
Some I guess would argue that these ads may do more harm than good if they alienate Lincoln from her progressive supporters. If she is that petty, however, she would probably vote wrong anyway. So I say it’s time for the full-court press. The ads are honest, both in the facts presented and in depicting the utter bewilderment many of her constituents — especially those Democrats who voted for her — are feeling at her reluctance to even allow a vote on a measure that would let maybe 10 percent of Americans chose government health insurance over private insurance. Will Lincoln be a corporate lackey or champion of the people? Maddow puts the campaign to win Lincoln’s support in perspective right here.
Meanwhile a facebook group has raised over $200,000 in pledges to support Lieberman’s opponent if he votes against allowing an up or down vote on the public option.
(Thanks to commenter pjcamp for correction)

James Oliphant’s Sunday L.A. Times article, “Healthcare Reform Bill Wouldn’t End Higher Premiums Based on Age” raises a touchy issue, which may entail significant political costs for Dems in the mid-terms and ’12, if some adjustment is not made. Oliphant, discussing current health care reform proposals, explains it thusly:

…The far-reaching clampdown on insurers leaves one highly controversial element untouched: the issue of charging higher premiums to older policyholders than to younger, presumably healthier consumers who are less likely to file costly claims…Under the provisions of the bill passed by the House on Saturday, as well as in the probable Senate version, insurers will be able to charge middle-aged consumers at least twice as much as they do younger customers.
…Experts use the arcane-sounding term “age rating,” and they discuss it in terms of ratios — as in a 2-1 formula or a 4-1 formula. Behind the jargon, the issue has huge financial and other implications for millions of Americans and the insurance industry.
For example, according to a recent Urban Institute study, if the age-rating ratio were set at 2 to 1, a typical 58-year-old policyholder would pay about $5,900 a year for health insurance. If the age rating were 4 to 1, the premium could jump to $8,650…Conversely, a 24-year-old would pay about $2,965 under a 2-1 rating system, but the premium could fall to $1,880 if the 4-1 ratio were used.
Advocates for older Americans argue that age rating amounts to discrimination, gives insurers a back-door way to deny coverage to those who need it most, and imposes serious hardship on many middle-aged people who are years away from being eligible for Medicare.
“Age is an immutable characteristic. I can’t make myself younger,” said Natale Zimmer, policy director for OWL, an advocacy group for middle-aged and older women. “To charge someone more simply based on age really amounts to discrimination.”
…Meanwhile, depending on the ratings, older people could have both higher costs and higher out-of-pocket expenses because they are more in need of services.

It’s a difficult challenge, determining fairness in health care premiums. Today’s older health care consumers were told when they were young that they paid relatively high premiums so their costs would be less when they got older. Now they are being told they have to pay more because they are older. Can’t blame them for feeling a little scammed.
The political implications are no less problematic. The importance of young voters in Obama’s election, underscored by the effect of their absence at the polls last Tuesday complicates the political trade-off between making younger voters happy vs. pleasing the older demographic, which turns out on election day at higher rates.
Add to this the fact that older voters are more likely to suffer the ravages of last year’s economic meltdown, in which approximately one-third of pension assets disappeared for most workers who had significant pension holdings. Younger workers will have more time to re-accumulate the missing third, while older workers are more likely to get stuck with the loss. This will not make for happy campers in the older-aged demographic, and unless something is done, incumbents will likely pay the price.
Thus far, Democrats have not been culpable in the rip-off of older workers. It’s been mostly a Republican thing. But if health ‘reform’ that increases costs to older voters is enacted, all bets are off. Conversely, Democrats need a much higher profile as champions of pension reform and moderating health care out-of-pocket costs and premiums paid by older consumers. Assuming they will not react politically to a triple-screwing is wishful thinking, bordering on political suicide.

The announcement of double-digit unemployment is usually an automatic meme-generator for the out-of-office party, so we can expect a lot of Fox News and wingnut jabber about how it’s all President Obama’s fault. It probably won’t matter much to them that most thoughtful voters will connect it to the Bush meltdown.
Alert Dems will respond that this is the 22nd consecutive month of job loss in America, so the trend started at the end of ’07, when the ‘mission accomplished’-‘heckuva job Brownie’ guy was running things. Dems will also remind the commentators that it’s amazing the rate isn’t worse considering we are only a year from the worst economic meltdown since the crash of ’29. More to the point, it would be worse, if not for the Obama/Democratic stimulus, and it would be a lot better, if not for the GOP-led opposition to the stronger stimulus most dems wanted.
As Paul Krugman argues in his New York Times column:

…early this year, President Obama came into office with a strong mandate and proclaimed the need to take bold action on the economy. His actual actions, however, were cautious rather than bold. They were enough to pull the economy back from the brink, but not enough to bring unemployment down.
Thus the stimulus bill fell far short of what many economists — including some in the administration itself — considered appropriate. According to The New Yorker, Christina Romer, the chairwoman of the president’s Council of Economic Advisers, estimated that a package of more than $1.2 trillion was justified.

Krugman is pessimistic about the president’s prospects for securing a significant cut in unemployment before the mid-terms, a point of view shared by former Secretary of Labor Robert Reich in his Salon.com post earlier this week:

If Obama and the Democrats lose one or both houses of Congress in the midterms, it will be because the president learned only the most superficial lesson of the Clinton years. Healthcare reform is critically important. But when one out of six Americans is unemployed or underemployed, getting the nation back to work is more so.

In today’s L.A. Times, Reich is quoted saying of the jobless rate announcement,

It’s an important political threshold…the 10% is going to give Republicans more ammunition to criticize the [Obama] administration and force the hand of the administration to at least appear to be taking additional steps to remedy the situation.

The one encouraging sign in the unemployment report is that hires of temp workers are up, usuallly a harbinger of hiring for more stable jobs.
Fed Chairman Ben Bernanke, declared the “recession is very likely over” in September. If he’s got any leverage left to help make good on his pronouncement, now would be a good time to deploy it.