I”ve been a skeptic all along, but I don’t think the issue this
time is really interest groups, except maybe by anticipation. The anticipation
part being that some Democratic leaders do not want to be frank about cost
control because of fear of alienating the providers. The issue is simply a
bunch of legislators who, as David says, are unlikely to go for more big change
with a big price tag. But the numbers are close enough that nobody should be
sure how it will turn out. I count about 20 swing Senators. If the major
changes are done on Reconciliation, the Dems can lose 9. Will they lose more
than nine? Maybe. But maybe not. There are 52 Blue Dogs. The majority will
definitely vote against decent reform. But if the Dems lose only 2/3 of these
votes in the House, and only a couple of others, they still have a majority.
So I agree with Tim that there’s a very good chance the Dems can
do more than David thinks. While thinking David is right about the deficit
sucking the air out of the room.
Best,
About a quarter of a cheer,
Joe
From: Anglo-American
Health Policy Network [mailto:[log in to unmask]] On Behalf Of Jost,
Timothy
Sent: Friday, September 11, 2009 10:01 AM
To: [log in to unmask]
Subject: Re: The Speech
David.
I am not sure the President can get everything he wants but he can get a lot
more than this. These things would do nothing for the vast majority of the
uninsured and interstate sale of insurance without national regulation would
make the nongroup market much worse. I think a lot of americans are angry and
fearful but the majority are still ready for real change. Tim
Timothy Stoltzfus Jost
Robert Willett Family Professor
Washington and Lee University
From my Blackberry
From: Anglo-American
Health Policy Network <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Sent: Fri Sep 11 09:12:05 2009
Subject: Re: The Speech
Hi Ken and others
For the sake of the discussion, I want to register my disagreement with Ken’s
analysis in point 2 below.
First, I do not think that the institutions or public
opinion are particularly open to non-incremental health reform now AFTER having
gone through non-incremental de facto nationalization of the banking industry,
nationalization of the world’s largest insurance company, and nationalization
of half the country’s automotive industry.
In a flat diffuse structure, which is the American
politial system, non-incremental is hard to come by under any circumstances.
The chance for something BIG in health care was blown away long ago when
all the oxygen was sucked out of the room by the financial crisis, the
bail-outs and the faux stimulus package.
I just do not think that one can overestimate the
fatigue of the institutions, the fatigue of the players and the fatigue of
public opinion at this point.
In that regard, Joe Wilson’s outburst – calling the
president a liar from the floor, an unbelievable breach - is analytically
interesting, even if socially and protocol-unacceptable:
I know Joe Wilson; he also represents the district
where I grew up in South Carolina, whether I ever voted for him or not.
He is not an outburst kind of guy. Never, ever has been.
He’s also not a drunk, so you can’t blame it on alcohol.
Why did he suddenly lose it?
The depth and breadth in certain parts of the country
of deep suspicion, even paranoia, about government in the US now suddenly
becoming an uncontrollable behemoth, this has re-surged to the fore.
Remember, America was founded on a “keep the government out of our
lives” moral philosophy. You might argue that the original incubators of
the Cato Institute were in fact the Founding Fathers.
However the bumps of public opinion may read just after
the Speech, over the longer term (weeks and months), there is no public opinion
consensus on the specifics of anything that has to be done to reform health
care, or even that there is any dire-ness to the problem.
Recall that we all thought the situation equally dire
in 1993/94. Ted Kennedy himself thought the situation dire in 1971, when
he nearly came to a bargain with President Nixon over the issue.
Still, today: Nothing.
Alas, it doesn’t haunt Republicans at all that they
“have no solution.” It doesn’t haunt independents either. It may
haunt Democrats, but they, going it alone, cannot non-incremental reform
achieve – reconcilation procedure or not.
More disturbing to me right now is that the focus of
the president on big reform in this very thorny area, when no oxygen is left in
the room, has distracted him and everyone else from the discrete do-able:
Pass a law making insurance portable from one employer to another
and across state lines. Pass one ensuring that employer-based
insurance is kept for 12 months after the employer lets you go and you still haven’t
found a new job. Pass another law banning pre-existing condition
exclusions.
Three “small” things right there would begin to the
change the game for many individuals in the US now. That’s the way you
start stuff rolling in a flat diffuse porous political system that is
structurally hostile to big change.
Yours
David
On 9/10/09 9:49 AM, "Thompson, Ken (SAMHSA/CMHS)" <[log in to unmask]">[log in to unmask]> wrote:
Tim et al..
I agree with your sentiments- with two other observations..
1)
I am hopeful that Obama made some
headway in defining the American ethos- and moving it away from the rape and
pillage individualism of the right. What is to be the character of
America?? This game is more then about health care…
2)
If he does not win health care
reform, how does the game play out? I strongly object to the notions that
he will have lost the day- he is cooking the pot, and the pressure is building.
The argument that this is the only chance for reform only holds if the
need for health care reform was not dire. But it is dire- that is why we
have any movement at all. So if Congress does not move forward, all that
happens is that the situation worsens- probably dramatically as the health care
industry tries to maximize its gains before Congress is once again forced to
act. And we are right back here- except worse off. And the
republicans hold the whole blame. They cant really want this end game.
They have no solution to the problem- it haunts them.
Ken
From: Anglo-American
Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Jost, Timothy
Sent: Thursday, September 10, 2009 8:48 AM
To: [log in to unmask]">[log in to unmask]
Subject: Re: The Speech
I am
more optimistic. This is the first time that many Americans have actually
heard what is contained in the legislation being considered by Congress.
A CNN flash poll showed that support for the plan jumped dramatically
immediately after the speech. This is consisent, however, with what other polls
have shown: people say they oppose "Obamacare" but when told
what the plan actually is, support grows considerably.
The
media have done a terrible job of covering health care reform. It is no
wonder that the public is confused. Americans have received virtually no
real information from the media, which has been totally preoccupied with
controversy and political machinations. Again this morning, the only news
is about Congressman Wilson having yelled "you lie" and about the
President having effectively called ex-governor Palin a liar. But last
night, Obama went over the heads of the media and told the American people what
he is in fact proposing. They liked it.
More
importantly, perhaps, Senator Baucus has finally said Senate Finance is moving
forward, and once they are done, both the Senate and the House can vote on a
bill. The bills will be rather different, but what comes out of conference will
probably be better than the Senate bill. I really believe we will get
something by the end of the year.
Then
comes the real problem. If in fact, nothing happens until 2013, as in the
House bill, two congressional elections and one presidential election from now,
the odds of actual implementation are, to my mind, very low. Opponents
will have three years to snipe at the bill while Americans see nothing concrete
coming from it, as their fears build. I realize that the delay is
necessary to make the budget numbers add up, but something needs to happen in
the meantime, or we will never get health care reform, and Obama is likely a one-termer.
The President hinted last night at an interim program for the
uninsurable. We need more than this. We at least need some Medicaid
expansions, some kind of help for those who cannot afford insurance, and
possibly opening up Medicare at cost to people over 55. But we cannot
expect the American people to hold their breath and trust the President for 3
years.
Tim
Jost
Timothy
Stoltzfus Jost
Robert
L. Willett Professor
Washington
and Lee University School of Law
(540)
458 8510
fax
(540) 458 8488
[log in to unmask]">[log in to unmask]
From: Anglo-American
Health Policy Network [[log in to unmask]">[log in to unmask]]
On Behalf Of David Wilsford [[log in to unmask]">[log in to unmask]]
Sent: Thursday, September 10, 2009 8:16 AM
To: [log in to unmask]">[log in to unmask]
Subject: The Speech
At first blush of the morning after, a rhetorically strong speech (which we
know to expect from him), which changed no minds within the Congress, although
it temporarily has re-energized the Democratic liberal base.
Did it change any minds in the country? We won’t
know until the weekend. My guess is that within a couple weeks, public
opinion will have settled back into its muddle.
There is also still the irreconcilable difference
between House Democrats who say they insist on the so-called public option and
key Democratic senators from the center, like Baucus, who say the public plan
will NOT be in any Senate bill. Then, there is Jay Rockefeller who
disdains the whole idea of coops. (He’s right, too.)
And there is still the matter of clashing goals
in the same reform effort, which end up sooner or later muddling the debate:
extend coverage ≠ controlling costs.
The president’s figures on this from the Speech are not
at all convincing and lawmakers from the opposition are bound to return to
these very large inconsistencies.
Voilà, my first take on it.
D
--
David
Wilsford Ph D
Professor
of Political Science, George Mason University (Fairfax Virginia USA) and
Visiting Fellow, London School of Economics (UK)
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