Jane Hamsher and John Cole are in a shouting match, and that’s fine. I don’t care. One bone of contention between them is rather important, though. Hamsher claims that 53 Democratic senators were on the record at one point or another as being in favor of a public option. Cole, on the other hand, claims that there were never enough votes to pass a public option. As it happens, they are both correct (or nearly so, as Hamsher links to an article that documents that 51 Democrats were in favor of a public option).
How can they both be correct and still be arguing with each other? Well, Hamsher points out correctly that the Senate Dems eventually had to resort to the Budget Reconciliation process to finish off the bill. And the Budget Reconciliation process only requires 50 votes (plus the vice-president’s tie-breaker). So, if there were 51 votes for a public option, it could have been included in reconciliation.
Cole counters that it required 60 votes to pass the main bill, and that there were never really even 50 votes for a public option because some of the Democrats were lying about their willingness to support one.
While Cole’s argument involves more conjecture, he’s nonetheless right.
What was needed was a different question from the one Hamsher was asking. Instead of asking whether senators supported a public option in the abstract, they needed to be asked if they supported using the Budget Reconciliation process to get one. On that question, there were never 50 senators voting in the affirmative. What it amounted to was that there were a few senators who expressed support for a public option, but not for “ramming it down the throat” of the Republicans with the reconciliation process. And, since that argument doesn’t make a whole lot of sense, it’s probably safe to agree with Cole that they were basically lying about their support for a public option. They told the base what it wanted to hear, but they hid behind procedure. Although, I admit, there were technical problems with fitting a public option into the reconciliation process that were valid concerns.
But this goes all the way back to the first months of the Obama administration. It was clear in the spring that the Senate Finance Committee didn’t have the votes to pass a public option. And Kent Conrad, who is a member of that committee, as well as the chairman of the Budget Committee, was telling anyone who would listen that he didn’t support using the Budget Reconciliation process for the health care bill.
It’s hard to move a process that involves getting the chairman of the Budget Committee to do something he says he absolutely will not do.
The administration’s strategy took account of the aversion of many Senate Democrats for using reconciliation. In the end, the loss of Teddy Kennedy’s seat gave them no alternative, and they made Conrad walk the plank. But that doesn’t mean that they ever had 51 votes for including a public option in the reconciliation process.
Where Hamsher is on strong footing is that it should have been possible to pass a public option using reconciliation if the Democrats who said they supported a public option were actually willing to vote for one when the time came. They weren’t.
The end result of the health care debate wasn’t inevitable. The rise of the Tea Partiers and unexpected loss of Kennedy’s seat dramatically weakened the final product. Max Baucus could have moved his bill faster through the Finance Committee so that it could have been melded with the HELP bill before the August recess. The president could have fought harder than he did for the worthy provisions that ultimately were defeated. But, it simply isn’t the case that the votes were ever there for passing a public option through the reconciliation process. And I don’t place a whole lot of blame for that on the administration. They knew that to be the case at the outset, and conditions did not improve.
Another point Hamsher refuses to acknowledge is that there were two kinds of public options being floated. One was along the lines pf paying physicians at current medicare rates, a proposal which was roundly opposed by the AMA, small state senators, many rural doctors. It had absolutely no chance getting through the Finance committee.
The second public option which was set at some payment point above the medicare rate was poorly scored by the CBO. The CBO projections was that this public option plan would end up attracting the sickest patients into the government plan from private insurers, and about five million or so uninsured people would end up using this plan. The cost-benefit analysis wasn’t great for this second option.
The individual mandate plan was the only viable plan which stood a chance of getting through the senate; it covers far more people at an efficient cost scale.
I think there is a myopic public option or nothing false argument which fails to look at the whole picture. For the folks who are saying Obama should have rammed the bill through in August ’09, could you imagine the outcry from the media against the president? They would accuse him of not seeking Republican support or some compromise. It was never an easy endeavor pushing a massive bill like health care reform through this Congress. Many presidents have tried and failed.
At the time, Hamsher did acknowledge those two different public options and was whipping Congress, especially the progressives in Congress to hold firm for the stronger public option. And when she found out that progressive members of Congress were not being straight with her about the situation is when she went on the warpath and sought for progressives to stop the bill. The logic being that a bad bill was worse than no bill at all.
As for ramming it through in August. A lot of those expectations were set by members of Congress and the leadership. Kent Conrad sticks out as the exception and essentially was read that Conrad himself would torpedo the public option. Instead, Lieberman and Lincoln did the job.
And intensifying the emotions was the fact that for the first time folks paid attention to what was going on in the markup sessions. The sessions for the Recovery Act actually showed Congress working, with Republicans advocating changes to benefit their districts. Thereafter, once it became known that people were watching, even mark-up sessions became competitive showboating.
The stronger public option didn’t make it through the House. It had absolutely no chance in the senate. The second public option was poorly scored by the CBO, and after that even the so called progressive senators starting to have cold feet. Eventually, they went for the individual mandate which ended by scoring far better than the second public option plan in terming of covering more people and being cost effective over the long term.
Seventy percent of an excellent bill is better than a no bill. A lot of folks don’t have the luxury of waiting on the sidelines getting sicker and even dying all in the name of punting to get a supposedly stronger health care bill in the future.
I’m not clear on what you’re saying. The individual mandate was going to be in any bill that forced insurance corporations to insure sick people (preexisting conditions) but had no relationship to the public option, regardless of what form it took.
The alternative to a public option turned out to be lowering the age of Medicare eligibility, and Joe Lieberman spiked it because Anthony Weiner liked it.
“the individual mandate was going to be in any bill that forced insurance corporations to insure sick people (preexisting conditions) but had no relationship to the public option, regardless of what form it took.”
I’m not sure that’s correct. The second public option as scored by the CBO would have ended up being a net negative for the government, as only five million people would take advantage of it, but it would have attracted the sickest patients.
What I said is correct regardless of the CBO scores for various public options.
The strong public option tied to Medicare rates would have saved $85 billion. The lesser plan would have saved only $25 billion. Neither of them would have cost money.
The lesser public option plan would have saved less than the individual mandate plan.
I don’t know what you mean by the “individual mandate plan.”
This is a fairly simple concept, but I”ll explain it anyway.
You don’t insure someone’s car after it crashes or someone’s home after it has been flooded, and you don’t insure someone’s health after they become sick. You sell insurance to hopefully make a profit, not to take a sure loss. So, there is no reason for a health insurance company to give an affordable policy to someone who has had cancer or who suffers from diabetes. The way to make it economically possible for someone with diabetes to get affordable insurance is to make all the healthy people who are skating without insurance go buy coverage from these insurers. They’ll pay in, but mostly they will not cost anything. They are collectively so profitable to the insurers that they make up for the astronomical cost of paying for those uninsured people who have preexisting conditions.
Thus, the individual mandate is an absolutely necessary component of any plan that forces insurers to cover those who are already sick. This is true no matter what public option you choose or even if you choose no public option at all (as is the case with the bill that passed). There is no logical connection between the mandate and the public option. They are not in competition with each other. The mandate costs money because it requires the government to come up with enormous subsidies for people who can’t afford insurance. But there are benefits that are hard to measure in having our underclass and our self-employed getting access to health care.
any chance that lowering medicare eligibility age may be revisited any time soon?
Not unless we win these Senate elections.
Hamsher has a second point about the 51-53 Senators who formally or informally claimed to support the public option. Some of them were lying to their constituents.
But Cole was right about the reality of the situation. The problem is that no Senator came out and said it outright. Progressive Senators led the progressive part of the base on. Tom Harkin on TV guaranteed a public option by Christmas 2009.
Hamsher’s broader point is that neither Congress, nor the administration, nor the advocacy groups were leveling with their constituents and small donors.
It was a stealth legislative effort, not an honest compromise honestly arrived at. And the public senses that. And that is why the public has been so distrustful of what is in the bill. And the worst part of it was Baucus’s Gang of Six.
“Politics is the art of the possible.” Otto von Bismarck, remark to Meyer von Waldeck, 11 August 1867.
So I read this and had to sit back. Wow.
Al Giordano gets points for intensity but Booman, you…. you make this look uncommonly like art.
I think Harry Reid killed it by getting the “public option” in the base bill. That guaranteed it wouldn’t get reconciled and would specifically be removed in the house/senate conference committee.
That was done to fire up supporters and to allow it to die. There never was enough senate support for it on its own. The only way it could have been supported in the senate is if Obama had really pushed his ex colleagues hard and somehow compensated via campaign donations against the health lobby.