As Ed Kilgore has noted on several occasions, the Senate is towing with a variety of opt-in or opt-out schemes for a health reform public option that would effectively shift major decisions (and perhaps hard-to-calculate costs) to the states. Said states have already been worrying about their share of the costs involved in expanding Medicaid coverage, which is a piece of the health reform puzzle in every version of the legislation.
Now, as Suzy Khimm of The New Republic reports, one draft version of the House bill (the one with a “negotiated rate” approach to the public option) boosts Medicaid eligibility significantly more than past versions (to 150% of the poverty rate). Although House leaders say states will be “held harmless” in the short run for the elibility increase, it´s not clear how that will be achieved, and where the state funds will come from for a much larger Medicaid population in the long run. So state leaders really do have a complicated task in ensuring they are prepared, fiscally and politically, to potential changes in the federal-state health care “partnership,” which could be just over the horizon.

Just wanted to let readers know that I will only be posting sporadically for the next month, when I will be travelling. But other TDS regulars–J.P. Green, James Vega and Matt Compton–along with guests, will be filling in. And I”ll be back on a regular schedule before you know it.

1. Can anyone find a single serious military analyst who believes that the Taliban can actually take over Afghanistan as long as the current 66,000 US troops remain in the county?
If not, why do almost all the commentaries that advocate a major troop increase over and above the current 66,000 end up describing the negative consequences if the Taliban completely takes over the county as a major argument in favor of such an increase?
2. Can anyone find a single serious definition of the term “news organization” that includes the phrase “organizing and promoting anti-administration street demonstrations” as a normal aspect of such an organization’s operation?
If not, why do so many commentators describe the administration’s criticism of FOX as attacks on a “news organization”?

In all the swirl of developments and speculation surrounding the treatment of the public option in the House and Senate (Jon Cohn has a good current summary here), one bit of commentary today stands out. The originator of the public option, Yale professor Jacob Hacker, has a New Republic piece on the ¨trigger¨approach that pretty much condemns the whole idea.
Hacker offers a fairly long and complex critique of trigger proposals that merits a full reading, but he basically makes three key points: (1) “affordability” provisions in all the trigger proposals vastly undershoot the actual affordability of total health care costs, and fail to take future medical inflation into account; (2) any “triggered” public option that doesn´t rely on the Medicare infrastructure probably won´t work, particularly if it´s phased in slowly; and (3) “triggers” are, in the Senate at least, typically linked to regulatory structures that give states too much leeway in letting private insurers off the hook for offering affordable universal coverage.
His conclusion is pretty categorical:

Added to the Senate bills, a trigger would represent a backdoor way of killing the public health insurance option that a majority of Americans (and U.S. Senators) support. It is way past time to trigger real competition for private plans that have failed to ensure affordability or cost restraint for decades.

The practical effect of Hacker´s likely-to-be-influential critique is two-fold: it could stiffen the resolve of public option advocates in the House to insist on a “robust” public option with no trigger and national rules, and could also make the “state opt-out” approach the only acceptable compromise for these advocates, on the theory that creation of a strong national public option is the key objective, even if fighting to keep it in place in the states over time proves to be a struggle (as I personally think it would be).

NYT‘s ‘Bloggingheads’ has a short, but interesting discussion between Proffs Mark Kleiman of UCLA and Steven Teles of Johns Hopkins about how Democrats should “frame the 2010 election.” Teles takes up most of the time, but Kleiman makes a salient point in arguing the Democrats had better ‘front-load’ the regulatory benefits (“no pre-existing conditions, no recisions” etc) as opposed to expenditures of the health reform package to get any creds from voters next year. Teles urges Dems to not run “defensively” and he emphasizes the importance of creating a sense of “delivery” to constituents and the problematic “traceability” (to Dems) aspect of the stimulus.

The following commentary by Chris Bowers, originally published on Open Left on 10/21, is an important contribution to the ongoing discussion of Democratic strategy:
New polling on the 2009 Virginia Governor’s election is horrendous for Democratic nominee Creigh Deeds. Of the five polls where the majority of interviews were conducted over the last ten days (that is, since October 11th), Deeds trails by an average of 12.0%. The margin is the same whether you are looking at the median or the simple mean. With only 13 days until the election, it is highly unlikely that Deeds is going to make up such a large deficit.
Perhaps the most important factor in Deeds’ impending defeat will be the lack of turnout among Obama voters. In 2008, President Obama won Virginia by a margin of 52.6%-46.3%. However, two recent polls, Survey USA (by 1%) and PPP (by 6%), show McCain voters outnumbering Obama voters within the 2009 Virginia electorate.
In both the Survey USA and PPP polls, Deeds scores 80% of Virginians who voted for Obama in 2008, and 5% of Virginians who voted for McCain. McConnell has 12% of Obama voters in PPP, and 19% in Survey USA. The Republican nominee also has the support of 88% of McCain voters in PPP, and 95% according to Survey USA.
As such, if the 2009 Virginia electorate had the same 52.6%–46.3% proportion of Obama and McCain voters as it did last year, Creigh Deeds would be 9% closer in both the Survey USA and PPP polls:
Survey USA (2008 turnout model in parenthesis)
McDonnell (R): 59% (54%)
Deeds (D): 40% (44%)
PPP (2008 turnout model in parenthesis)
McDonnell (R): 52% (47%)
Deeds (D): 40% (44%)
If the Obama-voting Democratic base was an excited in 2009 as it was a year ago, Deeds would still be losing, but he would be within striking distance. Instead, he is about to get wiped out, and decided to rev up the base with statements like this from last night :

At the final debate of race last night, Virginia Democratic gubernatorial nominee Creigh Deeds said he “shared the broad goals” of health care reform, but would “certainly consider opting out” of a public option “if that were available to Virginia.”
“I’m not afraid of going against my fellow Democrats when they’re wrong,” Deeds said. “A public option isn’t required in my view.”

Deeds has since backpedaled from this statement, but a campaign clarification at a press gaggle doesn’t cancel out a televised debate. The damage is done: Deeds isn’t afraid to go against Democrats when they are wrong. Fine. If that is the way he thinks, then I hope enjoys getting wiped out at the polls because Democrats don’t turn out for him. At least, as the Democratic nominee, he ran on a campaign he could believe in: attacking Democrats.
Many Democrats still take it as obvious that moving to the right is the best way to win elections, because the Democratic and liberal vote is static and doesn’t change. Deeds’ predicament is a perfect example of why that thinking is stupid and self-defeating. Currently, he trails by 12%, but he would be 9% closer if Democrats in Virginia were as excited about his candidacy as they were about Obama’s.
The liberal and Democratic vote is not static. It can vary both as a percentage of the total electorate, and in its support for Democratic nominees. For example, in the 2008 election, liberals were actually a slightly larger swing vote for President Obama than either moderates or conservatives. Also, in 2006, Democrats improved their share of the national House vote more from self-identified Democrats than from Republicans and Independents combined.
I am not arguing here that exciting the liberal and Democratic base is the most important aspect of a campaign for Democratic nominees. Rather, I simply wish to point something out that should be obvious to Democratic politicians and campaign operatives: both turnout levels and partisan preference for self-identified liberals and self-identified Democrats vary from election to election. Those variations will have an impact on the outcome of any given election, and are largely determined by the behavior of the Democratic nominee. As such, ignore–or even actively distance yourself from–the liberal and Democratic base at your own peril.

This item was cross-posted at The New Republic.
It´s too early to write off the gubernatorial aspirations of Creigh Deeds in Virginia, but if he doesn´t overcome a consistent lead by Republican Bob McDonnell in the next twelve days, you can be sure many pundits will attribute his defeat to Barack Obama.
There´s only one problem with this hypothesis: despite his extraordinary unpopularity in other parts of the South, the President remains relatively popular in the Old Dominion. According to pollster.com, Obama´s average approval/disapproval ratio in recent Virginia polls is 51/46. Even Rasmussen has him in positive territory at 53/47, and the latest Washington Post poll had him at 53/46. This is precisely the same margin by which Obama carried the Commonwealth last November.
Nor does general disdain for the Democratic Party appear to be the culprit. The current governor of Virginia, Tim Kaine, is chairman of the Democratic National Committee. His average approval ratio at pollster.com currently stands at 53/39.
It´s always tempting to interpret state electoral contests as bellwethers for national political trends, particular in odd years like this one. But it´s usually wrong.

Open Left‘s AdamGreen flags Nate Silver’s FiveThirtyEight.com post, “Why The (Impure) Public Option is (Probably) Gaining Momentum,” which provides an insightful 10-point explanation of why this pivotal health care reform is finding new traction. Silver’s #1 should be a source of encouragement (despite the zinger) for progressive bloggers:

1. The tireless, and occasionally tiresome, advocacy on behalf of liberal bloggers and interest groups for the public option. Whatever you think of their tactics — I haven’t always agreed with them — the sheer amount of focus and energy expended on their behalf has been very important, keeping the issue alive in the public debate.

Among Silver’s other factors:

2. The fact that the CBO thinks it will save money.
5. The “innovation” of the opt-in/opt-out family of compromises, which have more liberal “street cred” than co-ops or triggers and are potentially also much more politically advantageous.
6. The fading from memory of the tea party protests and the “government takeover” meme.
7. Polls in myriad swing states and swing districts showing the public option is reasonably popular in these regions.

And, in addition to points 1 and 6, Silver’s point #9 should be of particular interest to activists concerned about media strategy for health care reform:

9. The insurance industry’s “senior moment”: forgetting that this isn’t 1993 and that the shelf life of a misleading study would be measured in hours (rather than days or weeks) and would damage its credibility in the process.

Green’s post also includes a video clip, in which Rachel Maddow (who else?) conducts a substantive interview of Green, co-chair of the Progressive Change Campaign Committee. Green presents a compelling argument explaining why Senate Majority Leader Harry Reid’s most important legacy as a public servant would be providing strong leadership for the public option — and may be his best shot at saving his own bacon (54 percent of Nevadans want it).

Anyone familiar with sentiment in the region is aware that Barack Obama isn´t very popular among white voters in the Deep South. The Obama-Biden ticket did worse than Kerry-Edwards `04 among white voters in much of that area, despite the Democratic breakthroughs in nearby North Carolina and Virginia.
But the scope of the continuing unpopularity of Obama and Democrats in the South is graphically demonstrated in recent analysis from DKos-R2K. Obama´s overall national favorable/unfavorable ratio in its October poll was 55/37. In the South, it was 27/68. The Republican Party´s rating nationally was 21/67. In the South, it was 48/37. The Democratic Party´s national rating was 41/51. In the South, it was 21/72. And on the congressional ¨generic ballot,“ Democrats led nationally 35/29; GOPers led in the South 47/21.
These are regional averages which almost certainly overstate Democrats´ problems in Florida, NC, and Virginia, but may also understate the problem in the Deep South.
Such numbers will undoubtedly reinforce already strong tendencies by non-southern Democrats to “write off“ the region as intractably reactionary if not incurably racist. That would be a major mistake. Most of the congressional districts held by southern Democrats are far friendlier to Obama than the regional averages indicate, and we need to hold as many of them as possible (the same is true of many statewide offices, and in the state legislative contests that will determine control of redistricting). And as the 2008 results in FL, NC and VA showed, there are demographic trends in the region that give Democrats considerable future hope wherever sufficient concentrations of minority voters, upscale professionals, and academic/research centers co-exist.
What the current numbers probably reflect more than anything is the exceptional unhappiness of southerners with the economy, which has reversed decades of sunbelt growth. If high southern unemployment rates begin to turn around by 2010 or 2012, the South´s outlier status may moderate as well.

Admirers of Rep Alan Grayson have a post to read at The Nation, where John Nichols reports on the congressman’s new project:

The Florida Democrat who drew national attention last month when he declared on the House floor that the Republican plan for uninsured Americans was “don’t get sick, and if you do get sick, die quickly,” was back on the House floor this week to announce the creation of a website to honor the victims of the current system.
Grayson, who has taken the lead in highlighting a Harvard study that shows 44,000 Americans die annually because they have no health insurance, told the House and the nation: “I think it dishonors all those Americans who have lost their lives because they had no health coverage, by ignoring them, by not paying attention to them, and by doing nothing to change the situation that led them to lose their live.”
With that in mind, he announced the launch of a Names of the Dead website.

Nichols quotes from Rep. Grayson’s welcoming message at his website:

Every year, more than 44,000 Americans die simply because have no health insurance…I have created this project in their memory. I hope that honoring them will help us end this senseless loss of American lives. If you have lost a loved one, please share the story of that loved one with us. Help us ensure that their legacy is a more just America, where every life that can be saved will be saved.

Naturally, the Republicans are going ballistic about Grayson’s latest project. But it’s a wonderful idea and a highly creative use of the internet to promote awareness of the brutality of the current ‘system’ and the urgent need for comprehensive, affordable health care reform. Rep. Grayson is providing either a courageous template for Democrats running in moderate to conservative districts or a cautionary example of political harakiri. Either way, in my book, he merits consideration for the JFK Library’s Profile in Courage Award (make your nomination here).