Health care reform: see how you're affected

Input your insurance status, income, and marital status, and this handy tool will tell you how the new legislation affects you.

We're effed

Well: health care reform is dead. Coakley's loss means that the Democrats have one vote short of a filibuster-proof majority, which is giving centrist Democrats an excuse to run for cover. Democratic support for the bill is caving as speak, as Jim Webb volunteers that there will be no more votes on heath care until Scott Brown is seated, and no less a Massachusettes liberal than Barney Frank rules out this possibility as well. Senator Evan Bayh is already acknowledging the election as a rebuke to the Democratic agenda.

But this whole experience proves something more than a failed attempt by Democrats to reform health care insurance: it shows that the United States government is incapable of passing major legislation that will solve our biggest problems. Health care needs to be reformed, one way or another: its costs are spiraling out of control, and the ranks of the uninsured keep growing. If costs continue growing apace, the federal government will go broke paying for Medicare in the next fifty years.

Of course, broadening health care insurance isn't the only way to solve the looming budget problem; you could go the Republican route, and cut entitlements. The problem is: no Republicans are seriously advocating this. Scott Brown ran on a platform of not reducing a penny of Medicare spending, and he supports Massachusettes' own universal health care program. Indeed, the fact that the Dem's reform package would have resulted in Medicare spending cuts was used by Republicans as a talking point against the legislation. And of course, it was a Republican President and Congress that last decade passed Medicare Part D, the largest expansion of entitlements since the passage of Medicare itself--all of it funded with deficit spending (which is to say, none of it was funded at all).

Now, ultimately this failure is attributable to the rules of the Senate--specifically, the recently adopted practice of requiring a 60 vote supermajority to pass any legislation whatsoever. If a simple majority was all that was needed to get something through, the legislation would have passed in the middle of last year. But so long as this supermajority requirement remains, it will be impossible for either party to pass any legislation that is capable of solving our nation's biggest problems. I think it would behoove the leadership in both parties to agree to abolish the filibuster in a set period of time from now (6 years, say, when it is unknown which party will be in power). Otherwise crucial legislation--whether it is coming from the left or the right--will continue to crash on the shoals of arcane procedural votes in the Senate.

The public option: tastes like water!

Ezra Klein has a must-read post that succinctly describes the current state of the public option, as well as how it got to be the watered-down non-factor that it is.

Did you know that even if it passes and is implemented, it will only even be available to 10% of Americans--and that it would draw all its revenue from customer fees, and not the public coffers? A pretty far cry from a government takeover of the health insurance industry, and yet that is what the opposition's rhetoric would have you believe.

The federal budget as a reflection of America's character

The amount of defense spending in the federal budget is truly mind-boggling, and, I think, pretty sickening too. This year alone we will be spending $680 billion on defense--not including the wars in Iraq or Afghanistan. Meanwhile we are busy haggling over a health reform bill that will cost a mere $90 billion per year ($900 billion over a 10 year time frame).

I wonder if some day we will have a political culture that is capable of saying "no" to military spending.

Back

Well, I'm back from The Burning The Man. I was a little bit in suspense coming back, since I hadn't had access to any media whatsoever, and lots of crazy stuff can happen in a week (for example, Katrina happened during Burning Man--so when my friends got back from it, there was this whole crazy "Um, New Orleans was destroyed while you were gone" talk). But alas, things seemed to have been churning on like normal.

About the speech tonight, I will say that I side with Matt Yglesias with regards to the heckling issue:

Personally, I sort of liked Rep Joe Wilson’s idea of introducing British-style heckling to the halls of congress; totally disrespectful and out of step with American tradition, true, but their tradition is better. Unfortunately, Wilson was also lying about the point at issue and will thereby set back the cause of heckling by decades.

I would add that I think there probably used to be a fair bit of heckling back in the old days, when Congress behaved more or less like a country bumpkin version of the Drones Club.

Also, I think this wins for best description of what went down as the heckling was going on:

All eyes turned in the South Carolina Republican's direction -- including Obama's, House Speaker Nancy Pelosi's and Vice President Joe Biden's.

Wilson, looking agitated, leaned forward and began tapping away at his BlackBerry, as if he were Googling up proof that the president had, in fact, lied.

"Shame on you!" shouted someone from the Democratic side. "Throw him out!" shouted someone else. First Lady Michelle Obama, seated behind and above Wilson, seemed to mouth a drawn-out "damn" at the scene unfolding before her.

That's pretty good.

Throw down the gauntlet, draw a line in the sand, etc.

Remember how, during the Presidential primary and general election, many of us were moved by a profound sense of urgency to do things like donate money and make phone calls to get Obama elected? Well, this would probably be a good time to get into that mentality again, because health care reform lies in the balance.

The Obama administration has signaled that it is willing to use the public option as a bargaining chip to get health care legislation passed, which has touched off a bit of a revolt on the progressive left. Even though I think that Obama is basically right substantively when he says that the public option is just one part of the overall reform and that it doesn't make sense for the legislation to live or die by the public option, it is also true that the left needs to--at some point--assert itself and take a hard stand if it is to have any influence on the final legislative product. The public option is just as good a rally-point for this as any other.

An organization called ActBlue is targeting specific Democratic House members and 1) getting them to pledge to vote 'No' on any bill that does not contain a public option, and 2) rewarding this behavior with donations. The idea is that if we get a large enough block of Congress to believably commit to this, then it will become a "political reality" that no bill can pass without the public option, and Rahm will have to factor this into his calculus the next time he goes to deal with the centrists and the Blue Dogs. Anyway, today I donated some money to their cause; you can do the same here.

The problem with Peter Suderman's argument

Libertarian Peter Suderman deploys a familiar kind of argument:

No, I don't think this is a failure of leadership so much as a feature of democratic politics -- and a reminder of how unpleasant and unsatisfying to nearly everyone the business of politics can be.

Democratic politics is a messy business. It's disorganized and frantic and unpredictable and frustrating. Politics is a matter of shouting, and dissent, and deal-making, and strategy, and slippery rhetoric, and compromise....

...

Given my libertarian streak, I'd also add a final thought: The way to avoid the maddening convulsions of politics isn't to change them, or rise above them, or move past them, or transform them, or whatever the trendy term of art is on any given day. It's to avoid them -- and reduce their power to hold sway over how we live. And the more decisions about our lives and welfare we put in the hands of politicians, the harder that will be to do.

It's kind of a sly move that you get from many small-government types, that goes something like this:

1. Politics--the collective activity of everyone in the country deciding laws--sucks, and ends in sucky results.
2. It is better to have less of a sucky thing.
   
3. Therefore there should be "less" politics. (1, 2)
   
4. We should support policies that make government--and therefore, the sphere of politics--"smaller". (3)

There are a couple of problems with this argument. In the first place, (2) is not necessarily true--you may not want less of a sucky thing, if the alternatives are even suckier. There is ample empirical evidence that health care systems that feature more government involvement than ours are more efficient and lead to better results than our system. This doesn't mean that such a system wouldn't suck: it's just that it would suck significantly less than the status quo. To turn Suderman's invocation of Churchill on its head: single-payer is the worst health care system, except for all the others.

Second, if you delve a little further into (1), it becomes apparent that it doesn't make sense to use this claim about the activity of politics in general (which Suderman identifies as the "matter of shouting, and dissent, and deal-making, and strategy, and slippery rhetoric, and compromise" that accompanies law making) as a stepping stone to a claim about preferring a specific, first-order set of policies (i.e., libertarian ones). The reason is that, after a moment's reflection, we see that what is actually maddening about politics isn't the process itself, so much as the dismal first-order results it produces. If we lived in a world in which the shouting was every bit as loud, the dissent every bit as pitched, the deal-making, strategy, slippery rhetoric, and compromise every bit as unsavory--but political success, for all that, could actually be achieved--then it wouldn't be very maddening at all. The source of the frustration isn't that mean people on TV yell--it's that, despite sweeping Democratic majorities, meaningful health care reform still goes down in flames. Given all this, it hardly solves any problems to say that, hey, we should adopt a libertarian agenda since that will get this unsavory politics business out of our lives--because that's just coextensive with saying that we should abandon the (non-libertarian) first-order policies that I prefer, the very non-enactment of which is causing my resentment of politics in the first place.

So, nice try libertarians. But if you want to make your case for a specific set of policies, it's going to have to be a substantive one made on the merits, not this "hey-ain't-politics-a-drag-I-know-let's-abolish-entitlements-then-there-won't-be-so-much-politics" mumbo-jumbo.

Politifact.com

More Politifact: someone made a chart tracking the veracity of claims made by Democrats and Republicans in the health care debate.

Actual information about health care reform

Phil (dig the Hawaiian-Punch-esque design of the Percolator website, btw) writes in:

With everybody on the news going apeshit about the Health Care Reform Bills, it's easy to get confused. Crazed town-hall meetings, bizarre terms like "Government Death Panels" being coined, how all this is affecting Obama's approval ratings, for fuck's sake; it's obnoxious. It seems like the story is about all the different kinds of reaction to the bills, but I haven't really come across a clear explanation of what's supposed to actually be in these bills. It's frustrating. So for those of us still confused as to what's actually in the Health Care Reform Bills, I came across this today:
http://www.politifact.com/truth-o-meter/article/2009/aug/13/health-care-reform-simple-explanation/

So far, this seems like the clearest, simplest explanation of what's supposedly in these health care reform bills and some of its major controversies. This is by no means a complete explanation -- one glaring ommission: a description of exactly how the government-run public option intends to make its coverage decisions. But I'm at least happy to see this very basic explanation after all this freaking time.

One little note about a point in the actual article: It says that conservatives "argue that employers, motivated by cost, will drop their coverage and send their employees to the public option. Some believe it's a stalking horse for an eventual single-payer system; others believe it's simply unfair competition for private providers." Well, whatever happened to the unyielding conservative faith in the free market? If private providers were so worried about losing business to the public option, wouldn't they just lower their costs or provide much better coverage to stay competitive? Or is there some sort of basic economic principal that I just don't know and am not applying to this situation? I just don't buy this argument.

Also, is Politifact worth a damn? I'm not a news junkie or anything, but I'm always a little wary when my news comes from sites I know almost nothing about. Well, I'm always a little wary regardless.

Thanks for the link; it looks like a pretty useful summary of the key aspects of the proposals currently circulating in Congress. As far as Politifact, I haven't heard of it either, but on the face of it seems to be a pretty legit fact-checking outfit.

I think you're right about the conservatives' arguments against the public option not adding up: they want to have it both ways. On the one hand, they like to say that government-run insurance would be a disaster: it will be run as poorly as the DMV and the Post Office! they say. On the other hand, they claim that a public option will put the private insurance companies out of business by out-competing them. Presumably they think that the government-backed plan will be tax-payer funded and so be able to charge below-market-rates, thus crowding out the private insurers--but this isn't true, according to the Politifact article, which says

Congress is negotiating now to put safeguards in place so the public option competes on even footing with private insurers. Those include requiring the public option to finance itself through customer premiums (i.e., no taxpayer subsidies) and to make it negotiate like any other insurance company on what it pays doctors and health-care providers.

So long as the public option is implemented with these constraints, I don't see how it could be that it will have an unfair advantage in the marketplace.

(A brief aside: it didn't look like this was mentioned explicitly in the article, but it seems that the public option will only be an option within the exchange that is set up for people who don't have employer-based insurance. So if you have employer-based insurance, you won't even be able to access the public option. That said, it could very well be that once the exchange is set up, employers will abandon health insurance benefits en masse, letting their employees partake in the exchange instead.)

In any case, in my opinion the go-to source for intellectually honest health care blogging from a progressive perspective is Ezra Klein's blog. It's quite good about actually explaining the various health care proposals, rather than people's reactions to them.

PS: I should mention that Carlos and Harinder know boatloads about all this stuff. Maybe it'd be kind of fun to do some informal interviews with them and share their opinions... at the very least, it'd be the rare instance of actual domain knowledge exhibited here on the blog.

(Photo by a.drien)