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Is it time for progressives to push the reset button yet? The strategy of supporting the Public Option idea in hopes that Republicans, Conservatives, Blue Dogs, and the health insurance industry would be more friendly to it than they would be to a Medicare for All Government Health Insurance Plan has certainly failed. The opposition to the PO is every bit as hysterical and intense as we might have imagined it would be for Medicare for All. However, in supporting it, progressives have certainly sacrificed the clarity of their ideas and legislative proposals and also the enthusiasm of supporters of health insurance reform who still believe in Medicare for All. So, now entering the days of climactic conflict over health insurance, when Democrats must rely on the progressive base of the Party to pressure Congress into voting for a worthwhile health insurance industry reform bill, that base is hanging back, reluctant to enter the fight.
The problem is that the Administration, the Party, and various progressive organizations working with them, want the progressive rank-and-file to go to the mat for weak bills that they don’t believe in and are not excited about. The public option may have been the compromise that progressive organizations such as HCAN, DFA, and Move-on agreed to months ago, but the POs in the Senate HELP bill and HR 3200 are absolutely not what anyone originally had in mind when the PO was first proposed By Jacob Hacker, and when the progressives agreed to support a bill with the PO as its central feature.
Both those bills will be operational and political disasters, if only because even the inadequate and constrained in eligibility PO and exchange proposed in both won’t be available until 2013. To follow a new strategy that has a much better chance of success, progressives must reset the conversation. They must forget about the PO and go back to supporting Medicare for All and only that in Town halls, demonstrations, meetings with Congress, articles and blogs, social networking communications, and any other promotional settings. Maximum effort must be made to pressure Congress to get HR 676 through. The Progressives ought to compromise with the President and the blue dogs only after HR 676 is defeated, and only on a minimalist strategy implementing three separate bills with the following content and in the following sequence:
1) Establish a public component to compete with private insurance, and put it into operation within a year of passage of the bill. This can be done by extending both Medicare and Medicaid eligibility to everyone under reconciliation, and balancing off the cost by having people under 65 buy into it, and by raising taxes on those with incomes over 250,000. This will take 50 votes + 1 VP vote in the Senate to pass. The need for 50 + 1, rather than 60, will make it much easier to get this, than it is to get a comprehensive bill. Nevertheless, it will still be very difficult to pass this, and I think the only way to do it is for progressives to make clear that no other health insurance reform bill will pass because they will block it, and that without a reform bill, the chances are very good that many blue dogs, their health insurance industry and Pharma contributions notwithstanding, will be defeated in 2010, but not many progressives, because the latter will be voting for what constituents in their relatively safe districts want.
2) Eliminate the worst insurance company abuses, such as denial of coverage based on preconditions, raising insurance prices for those who have become ill, and rescissions. This will take 60 Senate votes in a separate bill, but would be hard for any Democrat and even a few Republicans (Snowe, Collins, Voinovich, Lugar) to vote against. It’s hard to see how this one could fail, if it were brought to an up or down vote.
3) Create an exchange, providing subsidies for individuals and implementing mandates for them, but not for businesses. This will also take 60 votes, but it is the piece the insurance companies will really want, especially if 1) and 2) have been passed first. On the other hand, progressives in both houses will be much less interested in this than they are in the first two. They’ll be interested in the subsidy part, but not really in the other two. The middle course for the blue dogs is to vote for 1) in return for progressive support on 3). Once 1) and 2) are in the tank, the insurance industry will throw its weight behind 3) so it should get a lot more than the 60 votes needed.
The operative effect of these three bills will be to produce a robust PO along lines of the original PO proposal. This will not be as desirable for progressives as Medicare for All, because private insurance companies will still exist, and will still be driving up national expenditures on health insurance. However, it will still produce a path toward Medicare for All and also the ability to “bend the cost curve” since private insurance companies will have to compete for customers against a public insurance system that will be charging Medicare rates and will be using Medicare’s private network. This will either make the companies compete by lowering their rates, or offering much superior services. They can also, of course withdraw from the business of providing insurance for basic health care services. Which alternative they select is up to them. It will be a matter of “free enterprise” acting in its own interest.
(Also posted at the Alllifeisproblemsolving blog where there may be more comments)
16 Comments
Until the House progressives announce clearly what they want, I think we are still on track for the sellout that HR3200 promises to be.
Hugh, I certainly agree. We’ll have to wait and see; probably not for very long.
thanks letsgetitdone.
who knows, hr 676 may have more votes than we think.
Hi selise, I hope so. The more votes we can get for it, the better. In any event, we need to do as much as we can to get as many votes as we can. And we should not be discussing any compromises unless and until HR 676 or S 703 or both are voted down.
Even then, we should not compromise on anything else that gives the insurance companies something for nothing.
So, no mandates without subsidies, and neither mandates nor subsidies until pre-existing conditions, rescissions, and other abuses of this sort are made illegal, and access to Medicare and Medicaid are available. We can do this if we insist that the mandates come last.
If they defeat the extension of Medicare and Medicaid as a free standing bill, we can then pass a regulatory bill ending abuses. I don’t think they’ll dare to vote against that, and I also think we can get 60 votes. If nothing else can move, then fine, next year they’ll be jacking up prices something awful to maintain their stock prices and profits.
When they do, we try, in 2010, to pass universal access to Medicare and Medicaid again, this time with more public support due to the rising anger against the companies. If we still fail at it, then pass price controls on the insurance companies as an alternative in order to stop insurance cost inflation. Businesses and individuals will support that, I’m sure. And the Democrats can run on that, if necessary in 2010. Once they experience price controls, I’m sure these companies will drop their opposition to universal access to Medicare and Medicaid, and try to figure out how they can compete with a public insurance choice. Then we can move on to mandates, subsidies, and exchanges as a final stage.
Over the longer run, say 5 years, things should evolve into a Medicare for All situation where most or all of a package of standard basic care will be funded by Medicare and Medicaid and the insurance companies will get out of the business or provide funding for boutique-like services for very rich people.
86 cosponsors..
http://thomas.loc.gov/cgi-bin/…..00676:@@@N
Thanks. You said it exactly right. Except I would not phrase it as “after HR676 is defeated” — sounds defeatist. Maybe more something like “if HR676 doesn’t make it this session, here is a backup plan.” As you know, in politics nothing is ever final.
Support Anthony Weiner’s Single Payer — Medicare for All — Amendment.
http://salsa.democracyinaction….._KEY=27743
Forget about Obama. He’s not necessary and he’s on the wrong side. The power is with the people.
Hi Evelyn, Thanks for your kind reaction and explicit statement about HR 676.
Of course, the whole premise of the three-step plan is the contingency that both HR 676 and S 703 (Bernie Sanders’ bill) have been defeated despite our best efforts to pass them. There’s no need for the three-step strategy unless they pass.
I think that for the longer run, we need to build the movement again, since Obama has weakened it. Here’s a recent post from the Dog about that.
I don’t see how the 3-step plan is an improvement on the best effort to reform the health insurance racket submitted by Congress, so far. Each step added just introduces more imponderables. Any alternative to HR 676 should be just as simple and plainly layed out so nothing is left to the imagination and it satisfies everyone except the racketeers.
Hi alank, Thanks for your comment. I think the three-step plan isn’t better than HR 676, of course, but I think it’s better than HR 3200. Why?
Because the expansion of Medicare and Medicare to allow any individual to select it in 1), provides more opportunity for individuals to select a public insurance alternative than we find in HR 3200 or Senate Help. Also, we could make this choice effective inside of a year, rather than waiting until 2013.
On the politics of it, it’s easier to advocate for it, because it is Medicare and people understand that. All we have to say, is if the insurance companies drop you, or won’t insure you, or start charging too much, or you just prefer it, you can choose to get into Medicare. It will be cheaper than private insurance, and will give you more choice of providers. Also, this can be passed under reconciliation and requires only 51 votes.
Moving on to 2), if we pass 1) first, we have a problem, namely that the insurance companies will be able to cherry-pick healthy patients and dump everyone who is sick onto the the new Medicare. This problem introduces pressure to solve it by closing the regulatory loopholes in private insurance coverage. That will take 60 votes in the Senate. But how can any Democrat, Blue Dog or not, vote against such “fairness” regulations? How can Susan Collins and Olympia Snowe, or Dick Lugar vote against it? A stripped down bill with this alone in it will surely get 60 votes.
With the first two bills done, we have a true Medicare/Medicaid option for everyone and also insurance regulatory reform. We also have pressures on the insurance companies since they’re now forced to insure costly patients and also to compete with the Medicare option. At this point I think they’ll do anything to get mandates and subsidies, even agree to setting up a good exchange that will give the Medicare option plenty of exposure. But if they don’t agree to a good exchange then, we can just refuse to pass that third bill, and let everyone move to the Medicare option as time goes on. As time goes on, I’m sure we’ll be able to pass subsidies without mandates under reconciliation, further growing Medicare and making things even tougher for the insurance companies.
So what I’m saying is that the three-step strategy may not be HR 676, but it would produce a result that is as good as Jacob Hacker’s original idea, now off the table.
Make no mistake about the three-step bill. It is tough politics. It is intended to increase the pressure on the insurance companies incrementally and to put them in a corner, without giving them targets such as public plans no one can understand, or very long pieces of legislation that no one can read and understand and that people can therefore easily mistrust.
The strategy also gives something to the public in each of the first two steps without giving away much of anything to the insurance companies. So, it builds trust, and by the time step 3 arrives there’s more trust than there is now to draw on in legislating the subsidies, mandates, and the exchange. But if there’s not enough trust by then to get the mandates, we can just pass the subsidies under reconciliation, and wait for a fourth step to get the mandates.
Of course, if we can pass HR 676 straight off that’s the best thing to do and that’s what we should be working for until we know for sure that it has not been passed and cannot be in this Congress.
letsgetitdone – here’s a quote for you, from ian welsh:
and another bit:
probably should read the whole thread, hopefully these bits will tempt you.
selise, thanks will do. I like Ian’s stuff very much.
me too wrt to ian.
we’ve been told so many times that “there aren’t the votes” (or similar), i was encouraged to see there is at least one person with an insider’s pov willing to say it’s not the votes in the house that aren’t there, it’s the leadership.
That doesn’t surprise me at all. I think the problem in the Senate is lack of leadership too. Can you imagine Lyndon Johnson acting the way Harry Reid does? That guy needs firing in the worst way.
There is only one way to win real healthcare reform; make companies instruct their lobbyists to stand down from pressuring politicians on their vote. In the 1960’s, activists pressured politicians because they controlled legislation. Today, it’s lobbyists that control Washington, and the legislation it produces.
Obama will sign any bill that reaches his desk. He is relying on the pressure from lobbyists, and their money, to produce the final bill that will please corporate interests.
Companies are not concerned with voters/consumers because we aim our efforts at each other; not at the power behind the curtain. Redirect our peaceful energy at companies, or more precisely, their income, and they will begin to listen to voters/consumers.
The proposition to companies by activists is simple: Stop blocking real healthcare reform or we will take away your incurious, mindless, controllable consumers, that respond to marketing like Pavlovian lab experiments, and replace them with calculating consumers with an agenda.
TPAZ, why make that deal. If we can really do that with consumers, why not just do it and end the political power of the corporations by getting them out of politics?