Wednesday, August 19, 2009

Cramdown on the Hill? 

I can understand the frustration of liberal legislators in the Democratic Party regarding the current health care reform debate. The Party controls the White House, has 60 seats in the Senate, and a 256-178 advantage in the House. The planets are aligned for the Progressive Caucus to pass a bill that would significantly change the status quo, and ultimately pave the way for Single Payer down the road. They are (or were) so close that they can taste it, and all that is standing in their way are a handful of moderate members of their own Party, and the illness of two of their Senators. Republicans are largely irrelevant in the actual mechanics of getting a bill passed and signed.

Here is a list of the House Democratic Leadership -- and note the actual overlap from the CPC list linked above (Becerra, Miller, Pastor, Schakowsky, Waters), in addition to Speaker Pelosi's announced views. Why wouldn't they attempt a cramdown this fall? Pass a bill that includes a public option, and bribe Blue Dogs if you have to with promises of private sector consulting jobs if they get booted out in 2010. The Senate is not likely to filibuster the bill -- Ben Nelson might vote against the bill, but would he actually vote to filibuster? It might mean that Ted Kennedy might have to resign and that the Massachusetts Legislature selects a reliable temporary U.S. Senator (recall that the Governor was stripped of that power in 2004, because it was feared Romney might select a Republican to replace Kerry, had Kerry won the Presidency), and also West Virginia Governor Munchin picks a replacement for Byrd, if Byrd cannot show up to vote against a possible filibuster attempt, all so that the Democrats can get to 60 votes. Also, there is always the Nuclear Option.

Regardless of the backlash in 2010, it would be worth going for it if you are a True Believer in the CPC or House Leadership. The legislation is massive and "sticky" -- once it is passed, it is difficult to undo completely without a tectonic shift in legislative (and executive) power.

Of course, if the Democratic Party leadership (including Senators Reid and Durbin) are pragmatic and not ideological, they might read Steven Pearlstein's interesting column in today's WaPo, or yesterday's editorial in the Wall Street Journal, both of which observe the death of the public option, but see that the "fight is a long way from over" for health care reform legislation. Indeed, liberals should be happy about how far they have advanced the ball in the last 16 years (since the attempt and then crash and burn of HillaryCare) -- even conservative Republicans such as Paul Ryan (R-WI) want universal access to health insurance.

Prediction: a bill gets passed this year without a public option, but with provisions addressing portability, individual mandates, and pre-existing conditions. The White House has simply used too much political capital to walk away with nothing. Should President Obama win a second term, he might revisit it (the public option as a means for ultimately getting to Single Payer) in 2013.


By Anonymous Anonymous, at Wed Aug 19, 02:29:00 PM:

Are you suggesting you like the Coop idea? Pearlstein is. Are you thinking along the same lines as Ezra Klein, and advocating stealth nationalization, via expansion of existing programs? Or, is this a muse, a sort of "where we are now" piece?  

By Blogger Escort81, at Wed Aug 19, 02:51:00 PM:

Yes to the last question, Anon 2:29. Just trying to read the lay of the land.

I am actually surprised by how many Democrats are open about their desires regarding "stealth" (or not so stealthy) nationalization. Rep. Anthony Weiner (D-NY) was on MSNBC twice this week basically touting Medicare for Everybody. I guess it it a case of UK envy, speaking of which, reading the NYT piece on Sunday in the Week in Review section, it must have been reassuring to those with means that even under Single Payer, they can jump the queue:

A little over one in 10 Britons have some sort of private supplemental insurance; others pick and choose when to use the N.H.S. and when to pay out of pocket for the top specialists or speedier care.

Told my husband needed a sophisticated blood test from a particular doctor, I telephoned her office, only to be told there was a four-month wait.

“But I’m a private patient,” I said.

“Then we can see you tomorrow,” the secretary said.

Now there's a business opportunity -- private supplemental insurance. It's a great lab for economists to test their ideas about Queueing Theory. How much would you pay for the privilege of gaining access to a medical test that might save your life? Some of what I learned about queues was from Prof. Uwe Reinhardt, an expert in health care economics, who had a piece yesterday on the CNN website, and is pretty much pro-reform, but also has been a mentor to former Senator Bill Frist on the subject.  

By Anonymous Anonymous, at Wed Aug 19, 02:55:00 PM:

I predict that the Dems lose the Senior voting block for this should it pass, just like the GOP lost Blacks after running Goldwater (who voted against Civil Rights).  

By Anonymous Anonymous, at Wed Aug 19, 03:16:00 PM:

Well, we already have a Death Panel. Zeke Emmanual got it into the Porkulous without anyone noticing.  

By Anonymous Anonymous, at Wed Aug 19, 05:20:00 PM:

From Link,

I fear that the Democrats will Rahm through a health care bill for its own sake -- and as a platform for "stealth" initiatives. Lord knows what we'll get -- I wouldn't totally count out the public option yet.

John Mackey -- CEO of Whole Foods -- caused a ruckus by voicing his views on health care reform in the Wall Street Journal. He's actually reasonable and straightforward. The whole thing is here: http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html

Mackey starts by pointing out that our federal deficits are already unsustainable. His main points are that health care reform needs to allow for more personal responsibility (e.g. deductibles) and to allow more freedom in how we pick and pay for our insurance plans. Also tort reform ... how you can have "health care reform" without mention of "tort reform" is beyond me. Mackey's proposals have the benefit of mostly removing existing laws that are barriers to reform, rather than just adding more bureaucracy. His approach is so straightforward and sensible, it's a pity it's been dismissed by progressives out of hand.

One of the Catholic charitable hospitals expressly uses the motto "no margin, no mission." As Maggie Thatcher famously said: "The problem with socialism is that eventually you run of other people's money." In effect, we've already reached that point: you could raise tax rates to 100% on income over $200,000 and not close the structural deficit gap we already have. Even totalitarian states can go broke -- just ask Gorbachev.  

By Anonymous Blacque Jacques Shellacque, at Wed Aug 19, 05:46:00 PM:

Zeke Emmanual got it into the Porkulous without anyone noticing.

Of course nobody noticed. No one's going to know exactly what's in a piece of legislation if they can't be bothered to read it first before voting on it....  

By Blogger Roy Lofquist, at Wed Aug 19, 07:33:00 PM:

They can't do a cramdown even if the had 80 Democratic Senators. There are two ways to freeze the Senate - deny Unanimous Consent and require each bill to be read in the well.

"This legislation declares Rhubarb Pie Month - I move for unanimous consent."

"Object, Please have the clerk read the bill"

Blah, blah blah...

"I move for unanimous consent"


Full roll call vote.  

By Anonymous Anonymous, at Thu Aug 20, 02:39:00 PM:

The VA already has moved ahead on Death Counseling, seeking to sell elderly veterans on ending their lives. The Vets are specifically referred to the Hemlock Society as a resource for them to consider.

"Well, the VA has instructed its physicians to deliver this end-of-life counseling to all of its patients. In effect, the US government is telling every veteran it treats that they may want to die for their country"  

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