E.J. Dionne, Jr.’ “Harry and Louise Have Changed” in today’s WaPo explores the strategic implications of the fact that comprehensive health coverage for all Americans means “fifty million new customers” to the industry. It is an important point, and one which gives significant leverage to the reform movement. Not that the insurance companies won’t fight the public option, forced coverage for pre-existing conditions and other specific reforms with a multimillion dollar ad campaign. However, as Dionne explains:

Many have expressed amazement that the interest groups historically opposed to fixing the health system seem ready to work with the reformers. Their public-spiritedness reflects enlightened self-interest: The health system is so unstable that even the drug industry and the insurance companies are worried that it will crash on top of them.
Health-care reform could bail out these interests by adding the currently uninsured — fast approaching 50 million people — to their customer base and by preventing more individuals and employers from dropping insurance altogether…Leaders of the health industry know that unless more government money flows into the system, they will suffer along with everyone else.

It’s a survival issue, and they know they need government help to stay afloat. They will fight the public option, but they know that some form of expanded government health coverage is inevitable. Still every health insurance company, hopes to get a share of the 50 million new customers. Dionne says the real fight in congress will be about cost containment, and he concludes “So by all means, let’s welcome the drug and insurance companies to the health-care bargaining table. But let’s also remember that they are sitting at that table as a matter of urgent necessity.”
Lisa Girion riffed on the same topic in the Sunday L.A. Times, explaining that

The customer base for private insurance has slipped since 2000, when soaring premiums began driving people out. The recession has accelerated the problem. But even after the economy recovers, the downward spiral is expected to continue for years as baby boomers become eligible for Medicare — and stop buying private insurance.
…The industry’s real trouble begins in 2011, when 79 million baby boomers begin turning 65. Health insurers stand to lose a huge slice of their commercially insured enrollment (estimated at 162 million to 172 million people) over the next two decades to Medicare, the government-funded health insurance program for seniors

Meanwhile John Harwood reports in The New York Times “The Caucus” that a new “sense of inevitability” about health care reform has taken root, as key political leaders and interest groups begin an earnest search for consensus. Regarding funding for reforms, Harwood adds:

No one has spelled out how to finance the roughly $1 trillion over 10 years for an overhaul that would provide care to the uninsured. But two recent Obama White House shifts have made that easier.
First, Mr. Obama vowed to find another $200 billion to $300 billion in savings from Medicare and Medicaid, beyond the $300 billion or so already proposed. That would leave lawmakers needing about $500 billion in higher taxes.
Second, Mr. Obama signaled that he could support acquiring part of that money from limiting the existing tax exclusion for employer-provided health benefits — a concept he criticized Senator John McCain, Republican of Arizona, for proposing in the 2008 presidential campaign. Taxing only the most lavish 10 percent of benefit plans would raise an additional $336 billion in income taxes, according to the nonpartisan Tax Policy Center.

Via Consortium News, Alternet leads today with an article by Robert Parry, “119 Million Americans Want a Public Health Option — Why Aren’t Politicians Listening?” Parry discusses Republican Sen. Chuck Grassley’s assertion at Politico that,

“As many as 119 million Americans would shift from private coverage to the government plan,” Grassley wrote in a column for Politico.com. That migration, Grassley said, would “put America on the path toward a completely government-run health care system. … Eventually, the government plan would overtake the entire market.”
Grassley’s logic is that so many Americans would prefer a government-run plan that the private health insurance industry would collapse or become a shadow of its current self. That, in turn, would lead even more Americans entering the government plan, making private insurance even less viable.

Wait a minute. Polls indicate millions are happy with their current insurance, so where does the 119 million figure come from? Are they so happy with their current plan that they would be willing to switch to a public plan just for kicks? Perhaps Grassley’s argument is based on some other factor. In one of the more revealing graphs, Parry also notes,

…Grassley’s various political action committees have collected nearly $1.3 million in donations from the industries related to the health insurance debate, according to OpenSecrets.org. Grassley’s top four donor groups were Health ($411,956); Insurance ($307,348); Pharmaceuticals ($233,850); and Hospitals ($197,137). Eighth on Grassley’s donor list were HMOs at $130,684.

Today’s Wall St. Journal ‘Review and Outlook’ section has a more thougthful critique, “Obama’s Health Cost Illusion,” which notes:

Now the White House — especially budget chief Peter Orszag — claims there is new cause for hope. The magic key is the dramatic variations in per patient health spending among U.S. regions. Often there is no relationship between spending and the quality of care, according to a vast body of academic research, most of it coming out of Dartmouth College. If the highest spending areas could be sanded down to the lowest spending areas, about 30% in “waste,” or $700 billion each year, would be saved. More than enough to pay for ObamaCare. Or so the theory goes.
But — how? Mr. Orszag’s ideas include more health information technology; emphasizing prevention and healthy living; rejiggering reimbursement policies so doctors and hospitals are paid more for quality care; and funding federal research that compares the effectiveness of medical treatments. These are the lovable bromides of all politicians, and some of them may or may not improve health overall. But there’s scant evidence that any of them will ever save real money.

Most worrisome of all, former Secretary of Labor Robert Reich writes in Salon today that “Big Pharma and Big Insurance go on the attack: Lobbyists are working behind the scenes to kill the public option in the healthcare bill. And they’re succeeding.” Says Reich:

So they’re pulling out all the stops — pushing Democrats and a handful of so-called moderate Republicans who say they’re in favor of a public option to support legislation that would include it in name only. One of their proposals is to break up the public option into small pieces under multiple regional third-party administrators that would have little or no bargaining leverage. A second is to give the public option to states where Big Pharma and Big Insurance can easily buy off legislators and officials, as they’ve been doing for years. A third is to bind the public plan to the same rules that private insurers have already wangled, thereby making it impossible for the public plan to put competitive pressure on the insurers.

Reich’s challenge ought to send reform advocates to the barracades:

This is it, folks. The concrete is being mixed and about to be poured. And after it’s poured and hardens, universal healthcare will be with us for years to come in whatever form it now takes. Let your representative and senators know you want a public option without conditions or triggers — one that gives the public insurer bargaining leverage over drug companies and that pushes insurers to do what they’ve promised to do. Don’t wait until the concrete hardens and we’ve lost this battle.

Yesterday when trolling regional newspaper websites, I ran across an article in the Atlanta Journal-Constitution with this depressingly familiar intro:

State government incentives offered to lure technology company NCR to Georgia are worth at least $96 million, according to an Atlanta Journal-Constitution analysis. That is $36 million more than the state estimated when the deal was announced last week.
The $96 million tally does not include another part of the incentive package, a state grant. Officials confirmed late last week that Georgia has offered the grant but refused to say how much money is involved.

Everything about those two graphs is typical of the game of mega-project competition among the states, where taxpayer subsidies of corporations always seem to creep ever upward as time goes by, and with state officials happy to boast about the payoff (in this case, 2,120 jobs split between two locations) for their pinstriped safaris, but less forthcoming about the costs.
The NCR deal was significant because it was the first big Georgia corporate giveaway under a new law designed to cut special deals for big projects–the famous “mega-deals” that get headlines and provide rich press conference opportunities for pols (usually a trifecta of investment announcements, ground-breakings and ribbon-cuttings where the same relative handful of jobs gets feted repeatedly). As the AJC story noted::

Georgia offered the incentives at a time when the state is desperately in need of cash as the recession depresses tax revenues. But economic development experts said it would have been virtually impossible to attract a major employer without a lucrative package of incentives.

Anyone familiar with this issue knows, of course, that the kind of “economic development experts” who perpetually justify big corporate subsidies are often the very people who are paid to put them together, working for elected officials who don’t much think corporations should have to pay taxes in the first place.
The sad thing is that Georgia used to be very proud of refusing to engage in race-to-the-bottom competitions to thrown public money at high-visibility corporate relocation projects. When I was working there in the 1980s, state officials scoffed at our neighbors in Alabama, Tennessee and South Carolina for trading years and years of revenues for foreign-owned auto plants whose owners demanded massive concessions in multi-state negotiations. Indeed, the state’s tradition of resisting special-interest tax breaks was symbolized by a sales tax exemption for purchases of crab bait by commercial fishermen–which was famous because it was the only such exemption that had ever gotten through the state fiscal watchdogs in the General Assembly.
Those days are long gone. The NCR deal almost looks efficient compared to the $410 million package put together by Georgia in 2006 to get a 2,500-job plant built along the Alabama border (and probably employing many Alabama taxpayers) by Kia.
Worse yet, you get the sense that economic-development-via-corporate-subsidies–a practice so ancient and notorious in the South that opposing it was a primary impetus for the original Populist movement–is getting less controversial, even, or perhaps especially, at a time when state government officials are cutting essential services to balance their books.
A separate AJC article yesterday on the NCR deal ought to come with a Raiders of the Lost Ark sound-track to illustrate its tale of swashbuckling GA bureaucrats outpandering those in Ohio, NCR’s previous home. Wonder how it would all come across if the actual costs had to be reflected: “Yessir, we’ll ante up 5,000 kids losing health insurance, and raise you a freeze in school construction. And have we mentioned we don’t like unions around here?”
Check out this 2007 article by John Sugg in the libertarian magazine Reason for a good if intermittently nauseating account of the use of corporate subsidies as a development tool in the South. He managed to find a number of “economic development experts” who don’t think these giveaways pay for themselves, or are actually necessary for development, or are really much more than an especially perverse form of public financing for the campaigns of the politicians who sign the deals and take the credit.

There’s a new Democracy Corps poll out that focuses on the relative success or failure of recent Republican efforts to rough up President Obama. The rough-stuff is going over well with conservative Republicans, but not with much of anybody else:

[T]wo of the most high-profile debates in Washington could damage the GOP further by isolating the party from the vast middle of the electorate as Obama’s nomination of Sonia Sotomayor to the Supreme Court receives better than two-to-one backing, even after the initial onslaught of Republican attacks against the nominee, and former Vice President Dick Cheney’s popularity falls to an all-time low….
Cheney is a deeply divisive figure, popular only with the conservative base of the Republican Party but unpopular with everyone else, including independents (among whom he has net -26 favorability rating) and moderate Republicans. In fact, President Obama (+5) is more popular with moderate Republicans than Cheney (-9). Moreover, by a three-to-one margin (66 to 23 percent) likely voters reject Cheney’s recent statement that he would prefer to see Rush Limbaugh, rather than Colin Powell, set the direction of the GOP. Again, only conservative Republicans side with Cheney, while Democrats, independents and moderate Republicans all strongly prefer Powell….
Sotomayor’s nomination has created a similar dynamic. By a more than two-to-one margin (56 to 27 percent) likely voters approve of the nomination. This level of support is similar to that enjoyed by John Roberts, and exceeds those held by Harriet Miers and Samuel Alito, when they were nominated to the Court in 2005. More important, once again the base of the Republican Party finds itself at odds with the rest of the electorate. While conservative Republicans strongly disapprove of her nomination, Sotomayor earns at least plurality support from moderate Republicans, independents and Democrats.

If you look at the crosstabs for the poll, which break out moderate/conservative Democrats and moderate/liberal Republicans, the risk of self-isolation by conservative Republicans becomes even more apparent. Democrats are largely sticking together with Obama, and the more the GOP adopts attack-dog ideological and personal attacks on the President (and on “RINOs” like Colin Powell), the less Republicans stick together in opposition.

It’s hard to find anyone inside the D.C. beltway who actually believes single payer health care reform can be achieved in this session of congress. The majority of progressives seem to have settled for the “public option,” which can be seen as a step toward achieving a single-payer system down the road, make that way down the road.
The public option does seem to be the most promising proposal for achieving a progressive consensus for this session of congress. But I do hope the single payer warriors will keep the heat on as the ‘scary left’ that makes the publlic option seem like a moderate alternative.
I applaud incremental reform as generally a more practicable approach than “big package” reform. By providing a smaller target and a simpler policy, precisely defined incremental reforms have a certain edge in winning hearts and minds. Incremental reforms have less baggage than “big package” reforms and they reduce the opposition’s ability to use red herrings to distract voters. Republicans, for example, had an easier time of it trashing ‘Hillarycare’ than they would in fighting a bill that forces insurance companies to do one simple thing — cover pre-existing conditions.
The oft-cited advantage of big package reform is that you can build a broader coalition. Well, that’s true. But it gives a well-organized opponent plenty of targets for mobilizing opposition. The right is very good at distracting voters with specific objections to proposals that offer otherwise beneficial reforms. See our staff post yesterday on William Galston’s New Republic article to get a sense of how complicated are public attitudes toward various health care reforms.
Incremental reforms are often portrayed as a ‘sell-out’ of progressive principles because they invariably leave some constituency out. The pre-existing coverage requirement, for example, still leaves millions without coverage. But if there is an understanding that other specific reforms to broaden coverage will be strongly advocated shortly after pre-existing coverage is enacted as part of a coalition commitment, then it could become possible to achieve something resembling universal coverage in fairly short order. Voting on highly specific health care reforms one by one in rapid succession may be a quicker way of getting to universal, comprehensive reform than having a grand battle over a highly complicated health care reform bill with many moving parts that have to work together in synch.
Incremental reform is not a new idea. Governor Howard Dean proposed insuring all children first, which is a good example of a politically-attractive initial reform. I like the idea of first guaranteeing catastrophic coverage to everyone — codifying the principle that no one loses their home or retirement assets because of an illness. It would be politically-popular by providing a huge sense of relief to millions of voters and it could be financed through a single-payer mechanism, sort of a partial single-payer reform. Let the private insurer reforms and the public option address other coverage issues — for now. A comment by Daniel Bliss in response to an Ezra Klein post on health care reform at The American Prospect made the argument nicely:

The key thing, as I see it, is that a final plan will not be successful in the long run unless it has a single payer component. Note the qualifying word, “component.” It merely has to share the risk and streamline the core of the system, but does not have to be single-payer in its entirety, and indeed probably shouldn’t if we want the best possible system. There is after all a great deal of difference in how applicable a market is to something that people simply won’t do without (e.g. accident and emergency) compared to something that is relatively more discretionary (non-urgent care administered in relatively small and affordable increments, such as chiropractic treatment). It’s worth noting that the top-rated health care systems in the world, according to the World Health Organization, tend to embody this concept of mating single payer for catastrophic coverage with supplemental insurance taking care of more discretionary parts of health care. France is the outstanding example.

If the Obama Administration can say 3 years from now, “We eradicated the fear of ruinous health care costs for all American families,” that’s a hell of an impressive achievement to run on on 2012.
Given the complexity of attitudes toward health care proposals, I’d prefer to see a series of specific health care reforms debated, voted and enacted in succession, each piece standing on its own merits, rather than having them all linked together and inter-dependent on each other. It would bring more clarity — and simplicty — to the debate over health care reform, and my hunch is consumers/voters would welcome it.

In a post yesterday, I noted in passing that one recent analysis suggested that Florida has been the state hit hardest by the recession. That was based on a chart from the Wall Street Journal showing that the state was in the bottom five in terms of changes in GDP, jobs and housing prices during 2008.
But that’s just one measurement, obviously, and the impact of hard times also can various enormously within a single state. So I thought it was worth mentioning today that a look (also from the WSJ) at current (as of April, at least) unemployment rates for the nation’s metro areas shows some startling variations and concentrations.
On the latter front, thirteen MSAs have unemployment rates over 15%. Nine are in California, mostly in central CA. On the other end of the spectrum, of six MSAs located entirely within Iowa, five have unemployment rates under 5%. Getting back to Florida, of its twenty MSAs, exactly half have unemployment rates over 10%, and half don’t.
The chart’s worth staring at for a while as background for political developments. We are definitely in a national recession. But at least in terms of unemployment, the pain has not been spread equally.

Anyone who thinks that public opinion about health care reform is any less complicated than our health care system should give TDS Co-editor William Galston’s article on the topic in The New Republic a slow read. On policy-holders self interest:

I take as my point of departure a survey Kaiser conducted in October of 2008, on the threshold of the presidential election. It shows that twice as many voters cared about making health care and health insurance more affordable as about expanding coverage for the uninsured, and that only one in ten gave high priority to improving the quality of care and reducing medical errors. Not surprisingly, voters were very concerned about increases in their health insurance premiums and other out-of-pocket costs–indeed, more concerned about this than about increasing employer, government, and national spending combined. It is hard to avoid the conclusion that in evaluating proposed health reform legislation, voters will be looking first and foremost at its impact on their own pocketbooks, with broader issues trailing well behind.

On funding:

…58 percent believed that “if policymakers made the right changes, they could reform the health care system without spending more money to do it.” If the people mean what they say, they are likely to regard requests for additional funds as evidence that Congress has made the wrong changes–that is, unless President Obama and congressional leaders explain why health reform cannot succeed without substantial upfront investments.
…As for financing options, majorities support increasing taxes on cigarettes, alcohol, and “unhealthy snack foods” but not soda and soft drinks, which experts regard as major contributors to the rising tide of obesity. (When those who favored this approach heard the argument that so-called “sin taxes” would hit low-income people the hardest, however, six in ten changed their minds and opposed it.) As for taxing employer-provided benefits, a solid majority are opposed, even when they are told that only the “most generous” benefits would be affected.

On health care as a national priority:

This brings me to the April tracking survey. It showed that respondents think reforming health care is only the fourth most important priority (on a list of eight), behind improving the economy, stabilizing Medicare and Social Security, and reducing the federal budget deficit. It is hardly surprising that partisans divide sharply: Democrats rank health reform second from the top, Republicans second from the bottom. Independents, whose ranks have swelled since the election, place it fifth.

Galston has an interesting section on the experts opinions vs. public opinion, with this nugget about the proposed compulsory purchase of health insurance:

Consider, finally, the proposition that all individuals, including those who are young and healthy, should be required to purchase health insurance. Most experts and policymakers agree that without this “individual mandate,” insurance companies will continue to screen out prospective beneficiaries with preexisting conditions and other discouraging health profiles, and the linchpin of current reform proposals will snap. Unfortunately, the people don’t agree: A Rasmussen survey published in late May indicates that only 31 percent of Americans favor requiring everyone–including young adults and those in good health–to purchase insurance. And when they were asked what should happen when those who choose not to buy insurance end up in emergency rooms, three quarters say they should receive treatment even if they can’t pay.

Galston concludes with a warning to political leaders to level with the American people about “the choices they face if we are finally to achieve universal health insurance with meaningful cost containment.” He urges bringing the public into the discussion to help avert “another catastrophic failure.” Such a buy-in can increase public confidence in the reforms that are enacted — and help strengthen the Obama Administration and congressional Democrats.

Last month TDS featured a lot of analysis (here, here, here, here and here) on the whole question of whether new polls from Pew and Gallup showed some sort of major shift in public opinion towards opposition to legalized abortion. The polls got a lot of hype from conservatives in the context of the President’s speech at Notre Dame, and the Sotomayor nomination.
Our last post on the subject was from Emory University’s Alan Abramowitz, who addressed the specific question of whether Democrats could successfully appeal to voters with anti-abortion sentiments (doesn’t much look like it, he concluded).
Now Abramowitz has another post up at pollster.com factoring in a new poll from AP, and summarizing the overwhelming evidence that public opinion is stable on abortion, and continues to lean towards the pro-choice position. Check it out.

The midterm elections of 2010 are still seventeen months away, but in many states, the cycle’s starting early, in part, no doubt, because everyone is expecting a difficult environment for fundraising.
In my home state of Georgia, the 2010 gubernatorial contest has been actively underway for months, and has been enlivened by two big events that have significantly changed the field. Lt. Governor Casey Cagle, the early frontrunner on the GOP side, suddenly withdrew from the governor’s race in April, citing health issues (he is, however, running for re-election). That decision lured U.S. Rep. Nathan Deal, who shares a geographical base with Cagle, into the GOP field, which already featured two statewide elected officials, Secretary of State Karen Handel (a protege of term-limited incumbent Gov. Sonny Perdue) and Insurance Commissioner John Oxendine.
Then just yesterday, former Gov. Roy Barnes, who lost to Perdue in 2002 in a major upset, jumped into the race on the Democratic side. The field already includes Attorney General Thurbert Baker, former Secretary of State and Adjutant General David Poythress, and state House Democratic leader Dubose Porter. Barnes is the Big Dog of Georgia Democratic politics, and was immediately regarded as the front-runner, even getting a big shout-out from the Democratic Governors Association as though he were the putative nominee. It wouldn’t be a big surprise if one or more of Barnes’ rivals decides to give the contest a pass. Early polling by DKos/R2K in April showed Barnes running ahead of Handel and just behind Oxendine.
Though Georgia has leaned decisively Republican in recent cycles, the recession (which has hit the state very hard), infighting among Republicans, and significant cutbacks in state services and investments, have all given Democrats hope that they can stage a comeback in 2010. Indeed, Georgia may become one of many states where there will be an interesting test about which party gets the blame for bad times: the governing party in Washington, or the incumbent party closer to home.
The same could be true of Florida, which at least one recent analysis called the hardest-hit of all the states, thanks to a massive decline in home prices. Though Obama carried the state last year, Republicans have been regularly winning most other elections of late; gubernatorial candidate Alex Sink, the state CFO, is the only Democratic statewide elected official other than U.S. Sen. Bill Nelson, and Republicans control both state legislative chambers.
Sink enjoys a cleared field for the gubernatorial nomination, and Florida Democrats are enthusiastic about her candidacy (it doesn’t hurt that her husband is 2002 gubernatorial nominee Bill McBride, a wealthy trial lawyer). Her almost certain opponent, Attorney General Bill McCollum, has lost two Senate bids since 2000, and he will also have to deal with possible fallout from a bitter, ideologically-driven Senate primary between Gov. Charlie Crist and former FL House Speaker Marco Rubio. Crist will likely win that primary, but hard-core conservatives could decide to sit on their hands on General Election Day. And since Republicans now control state government, the perennial state budget crisis will probably be held to their account by many voters.
Georgia and Florida are two states where Democrats often express optimism early in cycles, only to experience the hard realities of minority status when voting draws near. This is one cycle where Democrats have more realistic grounds for an optimism that could extend right through to election day.

People all over the world are watching replays and coverage of President Obama’s big speech in Cairo. Conservatives, of course, are already attacking it, sometimes without bothering to read or listen to it.
TDS Co-Editor William Galston has an interesting take on the speech at TNR today. Comparing the President’s words to those of Ronald Reagan, he suggests that Obama, like Reagan, believes his presidency coincides with a transformative moment in national and world history–you know, sort of like his campaign represented one of those moments in American politics:

Barack Obama is president today because he understood the moment better than anyone else and had the imagination and courage to seize it. He is conducting his presidency on the same basis as he did his campaign, and he may be right again. Whatever happens, it will be one heck of a ride.

For those political folk who aren’t satisfied with off-year elections, or even with midterm elections, yes, there’s already talk going on about the 2012 presidential race, and the emerging field of Republicans. The Daily Beast has not one but two articles up on the subject, one by long-time GOP strategist Mark McKinnon, and one by Benjy Sarlin
McKinnon makes this interesting observation about the current political climate:
I’m surprised by how many people I talk to in the media and politics, including many Republicans, already presume Obama will be a two-term president.
Nonetheless, there’s plenty of Republicans who are at least flirting with the idea of running against him. In his own handicapping, McKinnon ranks Romney and Pawlenty at the top of his list, mentions John Thune prominently, and
suggests that new Ambassador to China Jon Huntsman could “solve an early crisis and come home” to torment Obama.
Sarlin focuses on the evenness of the field, and offers brief profiles of ten potentential candidates–interestingly, not the same ten on McKinnon’s handicapping list!