To be stuck inside of DC with the health care debate again...
Paul Krugman exhorts House Democrats to ignore the voters of Massachusetts, ignore the national Gallup poll showing a majority wants a pause in the process, and just jump off a cliff by passing the Senate bill for Obama's signature. Whether swing seat House Dems are that keen to rejoin the private sector in the current tough job market is untested.
I also score this from Krugman as "Maybe":
The fact is that the Senate bill is a centrist document, which moderate
Republicans should find entirely acceptable. In fact, it’s very similar
to the plan Mitt Romney introduced in Massachusetts just a few years
ago. Yet it has faced lock-step opposition from the G.O.P., which is
determined to prevent Democrats from achieving any successes. Why would
this change now that Republicans think they’re on a roll?
I suppose a lot of things look centrist from the far left. Be that as it may, the Republicans can't be the Party Of No forever. In 1994 Newt Gingrich offered the Contract with America as the Republican agenda; presumably Republican "leaders" (are there any?) will follow that example in 2010.
I can easily imagine Republicans proposing some modest package - a down payment on reform - that could pick up 70 votes in the Senate and 300 in the House. It won't satisfy the vast scope of Dem aspirations, but if the Democrats refuse, well, who is obstructionist and unrealistic now? The Times describes such an approach here:
Lawmakers, Congressional aides and health policy experts said the package might plausibly include these elements:
¶Insurers could not deny coverage to children under the age of 19 on account of pre-existing medical conditions.
¶Insurers would have to offer policyholders an opportunity to continue coverage for children through age 25 or 26.
¶The federal government would offer financial incentives to states to expand Medicaid to cover childless adults and parents.
¶The federal government would offer grants to states to establish
regulated markets known as insurance exchanges, where consumers and
small businesses could buy coverage.
¶The federal government would offer tax credits to small businesses
to help them defray the cost of providing health benefits to workers.
¶If a health plan provided care through a network of doctors and hospitals,
it could not charge patients more for going outside the network in an
emergency. Co-payments for emergency care would have to be the same,
regardless of whether a hospital was in the insurer’s network of
preferred providers.
The package could also include changes in Medicare,
to reduce the growth in payments to doctors and hospitals while
rewarding providers of high-quality, lower-cost care. To help older
Americans, it could narrow a gap in Medicare coverage of prescription
drugs, sometimes known as a doughnut hole.
Sara Rosenbaum, a professor of health law and policy at George Washington University, said the proposals were “totally doable” and could help perhaps 15 million people.
“Medicaid already covers poor children through age 18 and could be
expanded to cover all nonelderly poor people, regardless of age,” Ms.
Rosenbaum said. This proposal does not go as far as the House or Senate
bill, but she said, “It’s an idea that has been supported in the past
by health policy experts across the political spectrum.”
Those proposals don't raise my blood pressure - readers?
David Brooks identifies four grim paths forward for Obama, one of which is to ignore the voters and press on:
The Democrats now have four bad options. The first is what you might
call the Heedless and Arrogant Approach. A clear majority of Americans
are against the Congressional health care reform plan. Democrats could
say: We know this is unpopular, but we think it is good policy and we
are going to ram it through and you voters can judge us by the results.
My major, screaming-out-loud objection to that analysis is that there won't be any results until 2014, unless Democrats think a few early tax hikes will count as popular "results". If Democrats pass this as is, they will spend the next ten months defending it instead of moving on to jobs.
Josh Marshall thinks there is a small and fading chance that Democrats will realize that there is no other road forward and that sometimes nothing is a really uncool hand.
Ezra Klein can't imagine a world with a pared back bill, but I bet he isn't trying. Instead, he is locked up on the same argument that Obama utterly rejected during the campaign - if there is a ban on exclusions based on pre-existing conditions then there must be mandates, from which it follows that there must be subsidies. Hillary backed that logic during the campaign, Obama opposed it (irrationally, IMHO, but I am not smart enough to be a Democrat), and the voters spoke. OK, Obama then flip-flopped back to reality and supported mandates, but voter support for the mandate notion has been tailgate tested and tailgate-rejected.
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