Bill's Big Diamond Blog

CBO Estimate Favors Public Option in Budget, Deficit Reduction

New CBO estimate sees public option as reducing deficit and coming in under Blue Dog proposal in budget impact. See CNN article.

Healthcare Debate— A New Option for the Public Option

As you no doubt know already, the public option as an essential element of healthcare reform has been under sustained attack.  Not only did the town hall Astroturf commandos decry the public option as part of a “government takeover” of healthcare, but soon afterward, the insider oddsmakers in Washington declared the public option dead-on-arrival, even as a substantial majority of the House of Representatives supported it, along with most Americans polled on the subject.

 While the public option would provide competition the private health insurance market currently lacks, it’s become clear that passage of it will be a monumental task in the Senate.  One way to do it would be by the same method President George W. Bush got both of his huge tax cuts for the super rich: by using “reconciliation,” a parliamentary procedure that bypasses the promised filibuster by the Republican minority.  While the reconciliation process has been used by both Democrats and Republicans, the current Senate majority and the President are reluctant to push through a monumental healthcare bill without any Republican support.

Other options to pass healthcare with either no public option or a severely hobbled version of it are viewed as a cop-out on the promise to truly reform the system.  With all the momentum gathered to pass a healthcare bill this year, it would leave tremendous disenchantment among supporters to end up with a bill that didn’t actually make the health insurance market more competitive and affordable for most Americans.  It would be particularly hard to explain to those who now lack affordable insurance and the easier access to care it provides.

There are those who argue that any substantial reform that includes the nationwide elimination of “pre-existing conditions” and moves towards full participation will eventually lead to a better system… over time.  They posit that what isn’t passed now will be easier to obtain once healthcare is viewed as a right by most Americans and the reform process continues over the coming years.  This position doesn’t address all those whose health is endangered today by a lack of healthcare or by poverty produced by a bankrupting experience with illness.

Now, there appears to be another option to pass a reform bill with a public option, but without the highest level of conflict— a public option with a state-by-state opt-out provision.  Nate Silver at fivethirtyeight.com has posted some reasons to consider a public option with an opt-out for states that choose not to offer the choice to their citizens.  I’ll be honest, I haven’t explored comments on the proposal outside of Silver’s on the subject, but at first glance, it sounds like the best compromise short of a “clean” public option bill.  It has the beauty of leaving the workings of the public option alone (not hobbling it as other compromises would do) yet making it more politically palatable to Senators who fear voting for its inclusion universally.

As Silver notes, making the public option the ‘default choice’ would be a powerful way to encourage most states to remain opted-in.  The presence of the public option in most areas would encourage even conservative states to offer this alternative that would be available to residents of nearby states.  And the power of the public option where is would actually be in effect would be undiluted.  No hobbled plan to make the insurance companies happy.  The main attraction of the public option—the negotiating power to offer care at low rates— would remain.  

Perhaps this is the “magic bullet” necessary to pass a true reform bill.  Maybe not.  But meanwhile, outspoken progressive support for the public option remains the only bulwark between the insurance lobby and a Senate cave-in to their demands.

(Bill cross-posts at Buck Naked Politics.)

Florida Sunshine in the Healthcare Debate

Two of my colleagues at the other place I post, Buck Naked Politics, are based in Florida, the home of the dimpled chad.  For a decade, we’ve all been cringing when we hear they have an election down there.  Will they elect another member of the Bush family, or someone like Kathleen Harris, unable to discern the difference between serving the Bushes and performing her responsibility to voters?  Perhaps they’d send us another a moral-majority type like Mark Foley, leading one (creepy) life for himself and espousing another very conservative set of rules for the rest of us?  Who would Floridians send to Washington next?

 Well, thanks to Damozel and Deb, I’ve noticed that they’ve now served up a refreshing Florida surprise down there in Congressman Alan Grayson, a freshman Democrat from the Orlando area.  Perhaps the Sunshine State has spawned some real cultural changes over the last decade— and we may all be better off for it.  While most of the country is still sending timid negotiators or know-nothing naysayers to the floor of the Congress, Florida has delivered us a legislator who wants to focus attention on some basic realities about the battle for progressive change.

When confronted with a Republican chorus of “start over,” “no government in my healthcare,” and “let’s not rush into change,” Grayson decided after eight months in Washington to fight fire with fire.  He stood up in the well of the House and called Republicans on the content of their healthcare plans… or rather the total lack of any plan in their obstructionism.  He described the Republican plan in three parts:

 1- Don’t Get Sick

 2- If You DO Get Sick…

 3- …Die Quickly

Many media pundits quickly criticized Grayson for incivility and several Republicans took him literally, demanding hilariously to know when he had heard any of them actually asking particular people to die.  But, in truth, Grayson exposed the incredible double-standard that’s been at play in the healthcare debate, in which the Right simply calls the President names— and then twists reform into descriptions of ‘death panels’ and a looming Big Brother, while Democrats (with a few notable exceptions) turn around and defensively parry these outrageous statements with gentle rejoinders, charts, and graphs.  The effect of this dynamic is to make healthcare reform look unpopular and ultimately doomed, despite continued grassroots support for a public option and for real change.

One thing I’ve learned living in New York: when the people you’re fighting with stop fighting fair, you better take off the gloves too, or you’re gonna be lying in the gutter soon, wishing you had.  Grayson has spent the last week responding to calls about his attention-grabbing parody by citing just how dangerous it is to do nothing about our broken healthcare system.  It’s actually fatal to 4,400 people every year.  That’s right, people die in this country all the time because they have no insurance.  If we’re planning on waiting till every Republican is happy with a compromise plan, many more Americans will die for lack of health insurance—and that’s simply unacceptable, Grayson says.

Until now, the healthcare debate has featured passion on the Right and mostly compromise, vacillation, and gentle persuasion by reform proponents.  Congressman Grayson has just pointed out that in order to make change, it might be necessary to some people go away mad, so the rest of us can move forward and make a better America.  It’s way past time for us be disengaged while the reactionaries and talk radio celebrities grab headlines with pitchforks, placards, and shouldered shotguns.  If we want change, we better realize, as Grayson has, that it’s not gonna come easy, or gently, but only with resolve and a willingness to fight ignorance with truth— and backbone.

UPDATE— In the same vein as the post above, Paul Krugman writes today (Monday) in the NYTimes about the new position of the Republican Party:  attack anything that might look like success for the other side, no matter what ideological inconsistency might be necessary.  Scorched Earth.  The new black.   

(Bill also cross-posts at Buck Naked Politics.)