I´ve been something of a skeptic, perhaps even an alarmist, about the idea of dumping decisions on how to design the health care system on the states via some sort of state opt-in or opt-out of the public option, in part because of the likely impact on the 2010 campaign in states across the country, and the impact of the campaign on health care decisions.
Turns out we may be getting a preview of the latter dynamic:

At the final debate of the 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.”

This could become a pretty common line in 2010 if states are indeed asked to figure out the public option and the many related decisions about health care.

As the economy continues to struggle, it´s increasingly obvious that some sort of federal job tax credit may be the only ´´second stimulus package´´ that could gain traction in Congress.
The idea has long attracted conservative support, but lately progressives, including former Labor Secretary Robert Reich and the Economic Policy Institute, have been out in front. It´s popular among some Democrats and economists in part because its costs are dependent on its success (unlike across-the-board tax cuts), and in part because it´s viewed as a way to counteract offshoring of jobs.
EPI has a new job tax credit proposal out, and it´s very focused on designing a credit that is large enough to have an immediate impact, temporary enough to keep its cost relatively low, and efficient enough to avoid corporate freeloading.
If there´s another idea that can serve as the centerpiece of a follow-up to the stimulus legislation, I don´t know what it would be. Waiting for a cyclical economic recovery seems irresponsible, and certainly dangerous to the party controlling the White House and Congress.

One of the most important current conservative political memes is to make George W. Bush a very distant memory, even though he was still Commander in Chief just ten months ago. There are two reasons for this, of course: conservatives want to blame Barack Obama for the policies and conditions he inherited, and they also want to pretend the 43d president’s ideology and policies had nothing to do with what his successors on the Right are promoting today.
Since it it rather difficult to argue on any rational basis that the domestic and international state of the nation was shaped far more by the man who was in the White House for the last eight years than the man who’s barely unpacked, a twist on the “blame card” meme is to suggest that Obama and Democrats are, well, being impolite and cowardly by failiing to suck it up and take responsibility for what they walked into on January 20. A good example is a new column by National Review’s Rich Lowry:

When Obama first burst on the scene, he seemed to respect the other side. That refreshing Obama is long gone. Now, he impugns his immediate predecessor with classless regularity, and attributes the worst of motives – pure partisanship and unrestrained greed – to those who oppose him. Their assigned role is to get the hell out of his way.
The acid test of the White House inevitably exposes a president’s character flaws: Nixon’s corrosive paranoia, Clinton’s self-destructive indiscipline, Bush’s stubborn defensiveness. Obama in the crucible is exhibiting an oddly self-pitying arrogance. It’s unbecoming in anyone, let alone the most powerful man on the planet.

So forget about facts; forget about actual responsibility; forget about justifying a different policy course at home and abroad by explaining why the Bush approach failed so dismally. Obama isn’t a mensch unless he shoulders Bush’s blame, and he must “respect” his opponents by absolving them of responsibility for their own deeds and for the policies of the man they so recently lionized as a world-historical colossus.
There’s little doubt that history will judge the Bush administration as a batch of gambles–from the invasion of Iraq, to the abandonment of ailliances, to the demonization of “enemies” overseas and domestic, to giant regressive tax cuts, to an effort to gut the New Deal legacy, and to a systematic attempt to govern in the most partisan manner possible–that failed. It’s simply wrong to forget all that, even for a moment.

There have obviously been a lot of lies told about health care reform this year, including lies about its provisions, costs and benefits, But as William Galston notes today in The New Republic, there’s a growing temptation among reform advocates to prevaricate a bit too, particularly via the sorts of accounting gimmicks that made the Bush administration notorious. The real problem, says Galston, is the risk of self-deception about the true costs of health reform:

This may strike some readers as a detail, or worse, as a diversion. I don’t think so. We’re already facing an unsustainable fiscal future. The least we can do is to honor the political version of the Hippocratic oath and do no harm. That’s what President Obama has promised. Serious legislators shouldn’t use accounting tricks—such as pushing deficits outside CBO’s scoring windows–to sidestep this pledge.

Yeah, we’ve had enough of that from the bad guys.

Here’s the summary of the report from D-Corps:
The self-identifying conservative Republicans who make up the base of the Republican Party stand a world apart from the rest of America, according to focus groups conducted by Democracy Corps. These base Republican voters dislike Barak Obama to be sure – which is not very surprising as base Democrats had few positive things to say about George Bush – but these voters identify themselves as part of a ‘mocked’ minority with a set of shared beliefs and knowledge, and commitment to oppose Obama that sets them apart from the majority in the country. They believe Obama is ruthlessly advancing a ‘secret agenda’ to bankrupt the United States and dramatically expand government control to an extent nothing short of socialism. They overwhelmingly view a successful Obama presidency as the destruction of this country’s founding principles and are committed to seeing the president fail.
Key Findings
Instead of focusing on these intense ideological divisions, the press and elites continue to look for a racial element that drives these voters’ beliefs – but they need to get over it. Conducted on the heels of Joe Wilson’s incendiary comments at the president’s joint session address, we gave these groups of older, white Republican base voters in Georgia full opportunity to bring race into their discussion – but it did not ever become a central element, and indeed, was almost beside the point.
First and foremost, these conservative Republican voters believe Obama is deliberately and ruthlessly advancing a ‘secret agenda’ to bankrupt our country and dramatically expand government control over all aspects of our daily lives. They view this effort in sweeping terms, and cast a successful Obama presidency as the destruction of the United States as it was conceived by our founders and developed over the past 200 years. This concern combines with a profound sense of collective identity. They readily identify themselves as a minority in this country – a minority whose values are mocked and attacked by a liberal media and class of elites. They also believe they possess a level of knowledge and understanding when it comes to politics and current events, one gained from a rejection of the mainstream media and an embrace of conservative media and pundits such as Glenn Beck and Rush Limbaugh, which sets them apart even more.
Looking at the current political debate, it was evident in our focus group discussions that the divide between conservative Republicans and even the most conservative-leaning independents remains very, very wide. Independents harbor doubts about Obama’s health care reform but are desperate to see some version of health care reform pass this year; the conservative Republicans view any health care reform as a victory for Obama and are militantly opposed. The language they use further reflects this divide. Conservative Republicans fully embrace the ‘socialism’ attacks on Obama and believe it is the best, most accurate way to describe him and his agenda. Independents largely dismiss these attacks as partisan rhetoric detracting from a legitimate debate about what many of them do see as excessive government control and spending

A just-out WaPo-ABC News poll reveals that the ‘public option’ for health care reform now wins a “clear majority” (57 percent) of the public, according to a report in today’s Post by Dan Balz and Jon Cohen. However, the poll also brings signs of trouble for the proposal to tax the so-called ‘Cadillac’ health care benefits, as Chen and Balz report:

But if there is clear majority support for the public option and the mandate, there is broad opposition to one of the major mechanisms proposed to pay for the bill. The Senate Finance Committee suggested taxing the most costly private insurance plans to help offset the costs of extending coverage to millions more people. Sixty-one percent oppose the idea, while 35 percent favor it.

If Democratic lawmakers needed another reason to be skeptical about taxing health care benefits, unions are fiercely opposed to the idea. As Jeff Crosby put it in his AFL-CIO blog:

Vincent Panvani of the Sheet Metal Workers (SMWIA) warns:If any of these Democratic Senators vote for this, they’ll be out in 2010, and it will be used against Obama….[Y]ou’re taxing the middle class. Teamsters President James Hoffa calls taxing health care benefits “the poison pill that will kill reform.” The Laborers have attack ads at the ready…We have to say, right now, that we will kill any effort to tax our benefits as yet another transfer from our pockets to the health care profiteers.

Perhaps there is a income line that can be drawn to protect union workers from having their hard-won health benefits being taxed, while making those at higher income levels pay their fair share. Democratic leaders need to be very clear and unified that union benefits be exempted and only the wealthy, if anyone, will have their health benefits taxed. This ought to be doable, and most of the revenue shortfall should be made up with tax hikes on unhealthy substances like tobacco, liquor and soft drinks.

A couple weeks ago I expressed skepticism about a Pew survey suggesting that a majority of Americans were feeling pretty bullish about military action towards Iran to stop its nuclear program, in no small part because the poll didn’t distinguish between different types of military action.
Now there’s a Washington Post/ABC poll finding that’s a bit more nuanced. 42% of respondents favor an air attack on Iranian facilities to prevent acquisition of nuclear weapons, while 54% oppose that step; and 33% favor an invasion of Iran to topple the government, while 62% are opposed.
The Post write-up on the poll notes that partisan differences on these questions aren’t as large as you might expect, though ideological splits are more noticeable (liberals oppose bombing Iran 74/24, while conservatives favor it 56/38, and moderates are positioned exactly half-way between the two). Even Republicans (57/40) and conservatives (51/44) oppose a ground invasion aimed at regime change, perhaps remembering how that went in Iraq.
This poll doesn’t make support for military action contingent on the failure of other options; Americans support direct talks with Iran by 82/18, and international economic sanctions by 78/18.

The crucial nature of the individual mandate for health care reform has drawn some helpful attention to the fact that universal coverage isn’t just a charity measure for the uninsured, but a way of creating a risk pool broad enough to lower costs generally, while also avoiding over-utilization of high-cost care options like emergency rooms. In fact, private insurance companies are among the most avid supporters of the individual mandate because it guarantees them new customers.
But as Peter Harbage explains at The New Republic today, a penalty-based coverage mandate isn’t the only way, or even the best way, to get more people insured:

[F]or all of the attention we’re paying to mandates, we’re not giving nearly enough attention to automatic enrollment and other innovations that can get people insured, rather than penalize them if they’re not. Ideally, we’ll get to a “culture of coverage” where everyone assumes they are supposed to have health insurance, much as everybody now assumes they are supposed to get primary education. The situation is quite similar, actually: We have truancy penalties, but most parents send their kids to school because the education system is affordable to families, easy to access, and social pressure says it is the right thing to do.

Automatic enrollment could not only make sure people are insured, but can also help steer them to the plan best designed for their medical and economic circumstances. They would be free to change coverage, but wouldn’t be forced to navigate the current highly complex system to get covered in the first place. It’s worth thinking about as we near the end-game of the health reform debate.

Polls three years in advance of a presidential contest aren’t worth a lot generally, but they do give you a sense of the sentiments of hard-core, high-attention “base” voters who have a disproportionate impact on the nominating process. The latest offering from Rasmussen on the possible Republican field shows Sarah Palin fading a bit (her new insta-book is probably coming out just in time), and Tim Pawlenty continuing to arouse mysteriously high levels of disdain.
The “who-do-you-favor-for-2012” poll has Mike Huckabee ahead at 29%, Mitt Romney at 24%, Palin at 18%, Newt Gingrich at 14%, and Pawlenty at 4%. More interestingly, the “who-do-you-least-favor” question puts TimPaw at 28%, Palin at 21%, Gingrich at 20%, Romney at 9%, and Huckabee at 8%. Usually little-known candidates don’t arouse much hostility, but in the current GOP atmosphere, it’s possible that a goodly number of conservative base voters don’t like any potential nominee who hasn’t spent sufficient time howling at the moon about socialism and the destruction of the Constitution. Indeed, it’s worth noting that one candidate who has distinguished himself in this respect, Mike Huckabee, seems to represent the center of the party right now, being most popular and least disliked.
The poll also asks GOPers how likely they think a win over the President is in 2012. 50% say victory is “very likely,” and another 31% “somewhat likely.” That could change, but primary voters who are very confident about a win tend to favor the most ideologically pure candidate available. This would not be Tim Pawlenty, who continues to be a fine candidate only on paper.

The moral case for the public option in health care reform has been well-made by numerous Democratic leaders, activists and writers, and some have also made a persuasive case that it’s good political strategy. Robert Parry’s Consortium News post, via Alternet, takes the argument a step further; that the public option is not only politically-wise; it should be implemented on a faster track — or the Democrats could be risking “electoral disaster.” As Parry explains:

Indeed, if the Democrats abandon the public option for the sake of passing a bill like the one that came out of the Senate Finance Committee, they may be courting electoral disaster once voters grasp that they will have to wait years for the law to be implemented and then that it could lead to higher costs for much the same unpopular private insurance plans.
…As the legislation stands now, many of the key features that hold some promise of helping consumers – such as the “exchange” where individuals and small business would shop for the best product – won’t even take effect until 2013. That means that Americans now facing the crisis of no health insurance won’t get much help for another four years, if then.
…By contrast to the four-year phase-in for these relatively modest reforms, the Medicare single-payer program for senior citizens was signed into law by President Lyndon Johnson on July 30, 1965, and was up and running less than a year later.
..The implementing delays mean that in both 2010 and 2012, Republicans will be free to make the truthful case that the Democrats – despite their promises – had accomplished little to help the American people on health care. Already, Republican senators are using the talking point that the four-year delay is part of a budgetary trick to make the bill appear cheaper over 10 years than it would be if its key features took effect quickly.

Parry believes the implementation delays of both the insurance exchanges and public option ‘trigger’ could work against each other to an even more deleterious effect:

…But the insurance exchanges won’t open until 2013, so it may take years before any trigger would be pulled. At minimum, the industry would have earned a lengthy reprieve.
And by the time, the exchanges have a chance to be tested, Congress and the White House could be in Republican hands. If that’s the case, the Republicans might well undo even the triggered public option. Unlike the Democrats, the Republicans would surely not worry about ramming their preferred policy through the Congress.

Conversely, Parry sees a huge upside to a bolder implementation strategy:

On the other hand, if Congress enacts a public option now, it presumably could be implemented at least as fast as Medicare, especially if it were piggybacked onto the existing Medicare bureaucracy. That would enable Democrats to show they had accomplished something beneficial for the public before voters go to the polls in November 2010.
By 2012, if the CBO predictions of substantial savings prove true, Obama could campaign for reelection on the basis that he had improved the welfare of the American people — and the budget outlooks for government and business.

It would be bitterly ironic if Democrats enacted a strong health care reform bill, with a solid public option, but then suffered political damage because it was implemented too late to do us some good. Parry makes a compelling case that putting implementation of both a public option and health exchanges on a faster track is wise strategy.