Friday, December 11, 2009

The Sort of Health Care Deal, Dirty Tricks and Bad Government, The Closely Divided Nation, A Tale of Two Tales

Democrats Strike a "Broad Agreement"

You have to give Senator Reid this...he is trying like hell to keep his caucus united behind health care reform. The announcement this week of a "broad agreement" between liberal and moderate Democrats on the public option potentially paves the way for passage of a health care bill from the Senate this year...maybe. Assuming Sen's Lieberman, Webb, Landrieu, Lincoln and Nelson are all on board with the agreement (Lieberman and Nelson being by far the most staunch critic of the public option, Webb and Nelson being the two Senators who have mostly voted with the GOP on recommit motions thus far and Senator Lincoln being among the most vulnerable to attack from the right on this issue in 2010), it settles one of the two key issues that has divided the Democratic caucus.

The agreement, in essence, would dissolve the public option in its present form and replace it with a hybrid system, whereby those 55 to 64 would be able to buy into the Medicare system (in essence, creating a "public option" for them, complete with the accompanying cost controls), while those 54 and under would be able to buy into a program that is managed by the government but provided by a private provider or private providers, similar to the government employees insurance program. It gives the public option liberals the 55 to 64 year old population on the public rolls and gives public option opponents the fact that no new government-run program is created.

The compromise is actually better in my eyes than the original legislation. The public option as originally designed in the Senate bill did little to curb costs as it would only allow the government to negotiate with providers, the same as any insurance company and would likely include only a pool of high-risk individuals, those who couldn't find a deal in the private market. The Medicare compromise allows the government to leverage its power to legislate compensation levels for people in the program and is a much more powerful carrier, since the program already contains basically everyone 65 and up. Providers could, as always refuse to treat people on Medicare, but rejecting providing care for all seniors is worlds different from rejecting providing care for a relatively smaller group of high-risk individuals. As has been the case with Medicare so far, I would guess most providers would play ball, which would mean favorable pricing and therefore cost containment. None of this helps the 54 and under crowd, but I'll take something over nothing.

But, the public option is not the only source of division in the Democratic caucus. The Senate also rejected the amendment offered by Senator Nelson this week that would have strengthened the prohibition of the inclusion of abortion coverage in the health care bill.

The bill, as presently written, prohibits use of government subsidies to pay for abortion coverage, but allows for abortion to be in the overall coverage schemes provided by private insurers, provided the portion of the coverage that covers abortion is funded through the out-of-pocket portion of the premium. In other words, if there is a $500/month health policy and the individual pays $100/month of that premium with the government picking up the rest of the tab, the policy could provide abortion coverage as long as the cost of that coverage is not more than $100/month. Nelson and other anti-abortion advocates (as well as some that favor abortion rights but are wary of funding abortions with federal dollars) object to the provision as currently written, since virtually all policies would have an individual contribution sufficient to fund abortion coverage, meaning that virtually all federally subsidized policies would be free to offer coverage for abortion services.

Senator Nelson's amendment would have expressly prohibited providing abortion coverage for subsidized policies. Essentially, it would require someone wanting abortion coverage to pay for a separate policy to insure abortions, although that could, theoretically come from the same company. It is very similar in language to the House amendment that Bart Stupak successfully pushed through in the House version of the bill. The senate rejected the amendment 54-45, with Republican Senators Susan Collins and Olympia Snowe joining the majority of Democrats to defeat the amendment, which won the support of the remaining Republicans plus 7 Democrats.

Senator Nelson has said that he will not support the final bill with the abortion amendment, so assuming that Reid has agreement with all the Democrats on the public option, he will still need to win over either Nelson or one Republican (presumably Olympia Snowe) to carry the day and get his 60 votes.

Victory is in sight for Reid, but is still not assured. The Democrats would be wise to give ground on the abortion is unlikely that the bill could get back through the House without the provision anyway.

Which brings me to one more point...if the Democrats do get a bill through the Senate, why not vote on that bill in the House unamended and skip the conference committee process? Let me explain...ordinarily when the House and Senate pass differing versions of legislation, a conference committee from the two bodies melds the two bills into a final bill that is then revoted on by both houses. But that is not how it HAS to work. Given that any final bill would have to look essentially the same as the Senate bill, if one passes, why not just have the House adopt the Senate bill as is? It would shorten the process, dodge another tough fight in the Senate and get a bill to the President by year's end (assuming the Senate is able to move something by then, which is far from assured.)

The Senate is taking a break from health care for a few days while the CBO scores the Reid compromise. In the meantime, they are going to take up a truly awful example of:

Bad Government, Plain and Simple

I've written extensively on how fouled up the appropriations process has been this year and ever year in recent memory. It is the middle of December and the majority of agencies still don't have a budget for the fiscal year that started in October, but rather, have been operating on a series of continuing resolutions, which provide short-term extensions of last years budget into this year. So, basically, the departments have been operating tactically, unsure of what longer term projects will be approved and which will not. Not a great practice.

Enter the Minibus. A bill was shoved through the House this week by a 221-202 vote (all Republicans voting "no", joined by 28 Democrats) that would cover appropriations for the Departments of Transportation, Housing and Urban Development, Commerce, Justice, Labor, Health and Human Services, Veterans Affairs and State in one fell swoop, leaving only the Department of Defense budget to be dealt with at a later date. The Senate will likely vote next week, before the present continuing resolution expires on December 18th.

So shouldn't I be happy that Congress is finally moving the ball on appropriations? Hell no! This massive bill was shoved through with almost no debate, with some of the departments not even having an initial bill that was debated in both houses of congress with an opportunity for amendment. The bill was voted on less than 24 hours after it was printed, leaving zero time for public examination of the legislation, which probably contains poor provisions and irresponsible earmarks that we may never even hear about until after it is law.

Yes, finally passing a budget is good. Doing it in the dark rather than in the sunlight is not. There are plenty of working days for congress to do its job before the fiscal year starts. This type of mess happens when they fail to show any type of discipline with the calendar. And one has to wonder if some members don't like it better this way....rammed through bills are easier to cram in pet provisions.

Democrats should be ashamed. Unfortunately, this issue is complex and mundane enough that it will likely garner little coverage or public outcry, as the whole budgeting process as failed to do, just like every year.

On the President, a Closely Divided Nation

It's obvious that they love President Obama in Europe still. The latest Nobel Peace Prize winner (nope, not going to rehash that debate) is a rock star overseas. He used to be a rockstar here. Now he seems all too human. On the question of whether the President is doing well, Americans are sharply divided, and getting closer and closer to even.

President Obama's aggregate approve minus disapprove numbers have tracked below his 7.2% November vote margin every day since November 29th, his first days below this benchmark threshold. This means that his coalition has shrunk since November. He has yet to have a day where his disapproves exceed his approves yet, but judging by the pattern, if he doesn't start getting some good news, it may be just a matter of time.

His monthly averages, with smooth out the bumps, show a decline of almost 4% from his November numbers to December, which would put him on track to have his worst month since August, when angry town halls and tea party protests dominated the news.

The Rest Is Still Unwritten...

The President's declining poll numbers bring me to my central thought about the Obama Presidency thus far...the road has not yet forked. What I mean by that is I can clearly imagine two distinct narratives being told at the mid-terms in November 2010. Here they are:

"A brutal night for the Democrats as the drag of unpopular President Barack Obama leads the Republicans to retake the House of Representatives and make significant inroads into the Democratic majority in the Senate. The President, who has been plagued by persistent double digit unemployment following his failed stimulus package as well as attacks on his ineffectiveness as a leader as he failed to get either health care reform or environmental legislation passed. His foreign policy is seen as an extension of the policy failures of the Bush administration as casualties mount in Afghanistan and Iraq slips back into civil unrest. Many Democrats are now wondering aloud how they elected a man of such little executive experience and what this will all mean for the future of the party."


"A discouraging night for Republicans as they not only fail to make inroads in the House, but lose key seats in the Senate with Democratic wins in Ohio and Missouri. Buoyed by a dropping unemployment rate and a victory on health care, the Democrats now hold the seats to pass legislation virtually at will. President Obama's popularity, at its height, is bolstered by the sense that he is the among the most accomplished first year Presidents in history, having passed not only the most sweeping Health Care reform policy since Lyndon Johnson, but having pulled the country out of the worst economic conditions since the Great Depression, as unemployment falls below 8%. President Obama is also bolstered by strong international support for his policies, which have ended the Iraq war while stabilizing Afghanistan and driving the Taliban into hiding."

Which narrative will we tell? Probably somewhere in between. The point is, we don't really know yet whether the President will get his way on key legislation or whether what he has done on the economy and in the foreign policy arena will work. But the stakes for the performance of the economy, the success of the President's Afghanistan strategy and the fate of Health Care legislation are immense. And not just for the Democrats.

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