Health Care: Obama Engages More Deeply
Is Barack Obama finally channeling LBJ to save his health reform initiative? As we've noted before, the President until now has stayed away from the nitty-gritty of the negotiations on Capitol Hill, largely because he wants to avoid the mistakes that the Clintons made in 1993, when they tried to dictate to Congress precisely how to transform the health system. His role, as he saw it, was to make the case on the outside, with the public, to convince Americans that health reform is needed--and needed now.
But that kind of hands-off approach to the legislative process hasn't been working so well lately. The Democratic committee chairmen in Congress seem to be losing sight of one of Obama's major goals, which is to bring long-term health care costs down. As a result, the whole effort is coming under growing criticism from such diverse and credible quarters as the Congressional Budget Office and the Mayo Clinic. As recently as last night, Obama was telling liberal bloggers that this wasn't a real problem, and that any defects in the legislation could be fixed after it passes the House and Senate, when it reaches a conference committee.
With Congress looking less and less likely to make Obama's deadline for House and Senate passage by the August recess, however, there are signs that he is shifting into a different gear. One close Obama ally predicted to me: "He's going to become increasingly specific--and increasingly persistent--about the things he does and doesn't want" in the health care bill. This afternoon found the President knee-deep in negotations with the conservative Democrats known as "Blue Dogs," who have been slowing down Energy and Commerce Committee Chairman Henry Waxman's efforts to get a bill through his panel. And as a result, the President and the conservative Democrats are making common cause on one cost-containment measure that both would like to see added to the House bill.
In a conference call with a group of reporters after the session, Obama Budget Director Peter Orszag said that the White House and the Blue Dogs agree that the "biggest missing piece" of the House bill is a proposal--similar to one championed in the Senate by Democrat Jay Rockefeller--to take the job of setting Medicare reimbursement rates out of the hands of Congress, and turn it over to an independent agency that presumably would have more expertise--and more insulation from political pressure. (You can read our earlier discussion of it--and Orszag's argument for it-- here.) The idea has also won words of praise from the Mayo Clinic on the very blog where it criticized the House bill yesterday. And Obama's engagement may be bringing the Blue Dogs aboard.
As the Obama adviser told me, there is simply no one else who can close the deal the way a President can. "There is something about the President of the United States calling you as a member and asking you to do something, and not just calling once, but twice and three time," he said. "It is awfully hard to say no to a President of your own party."
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1
It may be looking at things that aren't there, but I think the lobbying success over the F-22 funding has emboldened our President and made it clear that the hands-off approach isn't going to work with this herd of cats. It's time to get in the trenches and get something that's workable and doable.
Fantasy moment: what if Obama finally decides the only solution is singly payer? (Walks self back from cliff slowly...)
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1.1
If only!
Arrgh!
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1.2
Exactly! It's about time that the Dems, blue-dogs and all, realized that their success depends upon the President being successful.
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1.3
An' it be time th' President were realizin' tha' 'IS success d'pends upon passin' real, fundamental, health care reform - no' th' smoke an' mirrors health insurance give-away masqueradin' fer reform tha' be under consideration now!
Arrgh!
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2
Two different bills are going to pass the House and Senate. Details like the shift of the Medicare rate setting to IMAC need only be in one of the bills to get included in the final bill.
Bush Dogs whining about this is nothing more than their typical preening for the camera. -
3
Didn't Obama just admit that he doesn't even know what's in the House bill?
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3.1
No.
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4
It's getting interesting isn't it? Thanks again for the window, KT.
I guess it won't surprise you to learn that I no longer consider The Mayo Clinic a "credible quarter", especially related to Medicare policy. Like nearly everyone else, they have a dog in this hunt and we've already heard them make an unqualified statement of fact about what will happen to both quality and cost in the future should the currently proposed legislation be enacted. That's political BS, pure and simple.
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5
From Time's Q&A with Howard Dean:
"The last thing I want to say is I don't see this as a vote between the Democrats and the Republicans and the liberals and conservatives. This is about whether you're going to vote for the insurance companies or whether you're going to vote for what your constituents want. And we'll be watching."
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6
It's about time the President got more directly involved. The longer this gets dragged out the chances lessen of serious reform taking place. He needs to twist some arms and make a few thinly veiled threats. The 2010 elections are going to be here before we know it and there's always the chance the republicans will pick up enough seats to throw a serious monkey wrench in the works.
He's been placing too much faith in the members of his own party putting aside their petty bickering and working for the people they serve. I hope he finally realizes that relying on their own "good intentuions" is wishful thinking. They need a swift kick in the ass to get them moving.
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7
More wisdom from Howard "the scream" Dean . . . .
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(And yes I know how deeply unfair the coverage of the scream really was . . . ., and no, I don't care).
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And if they turn over the rate setting to an independent agency, how are they going to keep costs down?
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Here's another question--will the contribution by people on public plan be solely income based? What about assets? -
8
And how is Massachusetts doing under its healthcare system? That seems relevant here too. Right?
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8.1
Better than Idaho.
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8.2
Massachusetts was only about expanded coverage, it did not address cost containment. That was a flaw we don't intend to repeat.
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9
Sacred, by "the people they serve" you mean their corp sponsors, then I'm in full agreement.... The real question for the health care experts (and I'm not one of 'em) is whether Obama is putting muscle behind a deeply flawed bill, mindful primarily of "victory" over substance. Thoughts--P-luk, SZ?
Here's a blog post by The Krug that I missed the other day. Interesting that he makes the pt. that progressive economic pts of view are unwelcome in the Obama admin. And we all just thought it was the MSM that shunned us.
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9.1
I might be overly optimistic when I say the people they serve are the average voters and not their corporate masters. It's hell being an optimist. Confusing too.
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9.2
I be sayin' th' answer be AYE! Vict'ry o'er substance!
YARR!
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10
"if by"
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11
KT-So its his health reform initiative. This will have impact on no one else but Obama? I'm just asking because when you phrase it like that. People tend to think that's the way it is. Prior reporting would suggest that this is not really Obama's health care initiative, but one he can get behind. Is there a difference?
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11.1
Gunny: It is indeed his health reform initiative. If it suceeds, it will be viewed as the biggest achievement of his presidency. He chose to take this on, when even some of his own advisers urged him not to. So, yes, it's his.
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12
"The Democratic committee chairmen in Congress seem to be losing sight of one of Obama's major goals, which is to bring long-term health care costs down."
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Three choices, efficiency, rationing or squeezing suppliers.
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You won't get more efficiency without nuking a lot of the tort lawsuits--good luck with that one, guys. Don't you remember who runs the Democratic party? Rationing? So what's up with that "counseling provision" where you tell the elderly about end-of-life decisions (hey, I thought libs were against mandatory counseling--remember, abortions?) And squeezing suppliers--well, that would never happen, would it? (And if suppliers get squeezed, they will pass along costs to private insurers, which will drive up those costs and hurt those people, but hey, they only work for a living, so f 'em.)-
12.1
Tort lawsuits are the cause of less than two percent of the cost of hea;th care in America. The real driver for our high-cost low-performance health care (the quality of our health care is rated 37th in the world, between Costa Rica and Slovenia) is the for-profit nature of our profiteering health-insurance and pharmaceutical companies, combined with the fee-for-service approach to paying physicians.
Doctors should be paid high salaries by not-for-profit organizations who emply them , as is done at our best hospitals, like the Mayo Clinic and the Cleveland Clinic. This will prevent patients being subjected to unnecessary and expensive procedures that can actually do more harm than good, just because it profits hospitals and physicians to perform them.
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13
"Interesting that he makes the pt. that progressive economic pts of view are unwelcome in the Obama admin."
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Yeah, funny how the adults shun the dormroom Marxists.-
13.1
"dormroom Marxists" = Nobel prize-winning economists.
I'm going to go out on a limb and guess that spob has been spotted passing a hat around the dorm for another keg more recently than Joseph Stiglitz.
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14
well, Jimmy, beware of signs that say hidden driveways.
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15
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15.1
That's a neat trick. Very existential thinking. It reminds me of a painting I once saw titled "White Cow in a Snowstorm". Being loaded at the time...all I saw was a blank canvas.
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15.2
The Tao that can be spoken is not the Tao.
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15.3
You've captured the mind of spob perfectly. Rabidly white, totally empty.
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15.4
Is that a deafening silence Gunny? No seriously how did you pull that trick off?
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16
KT -- can I rephrase gunny's question for you? Well, I will and I think you're uniquely qualified to answer this -- it's not "is it Obama's bill?" in the sense of "will its passage of failure be part of his legacy?" It's, "Is this the kind of reform he campaigned on?" Did his reticence to get involved early leave him with a congressional bill that's kind of like what we thought we were getting when we voted for him or is it something else?
How about -- is this a bill for Obama supporters?
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16.1
Whether this is a bill for Obama supporters is something that Obama supporters will have to decide.
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16.2
You may as well just tell him that this is a political blog, not a healthcare blog, KT.
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17
Here's Rep. Kucinich on Democracy Now:
Well, it's not close to the idea of single payer. It's mandating that people buy insurance. And it's telling insurance companies they have to sell insurance. Well, you know who wins in that deal.
The fact of the matter is, this debate is all skewed right now. You know, there are—both political parties are in trouble on the issue of healthcare. Our political system is failing the American people, and it's a bipartisan affair. So, what we have right now is a mishmash, which is being offered up as reform. Well, no wonder it's in trouble from all sides.
I mean, if people were offered a clear choice of a single-payer plan or not and told what the advantages are of having the government paying the bills, eliminating the overhead, enabling all Americans to have not just basic coverage with doctor of choice, but vision care, dental care, mental healthcare, prescription drugs, long-term care, all covered, if people knew that was the choice they could have, there wouldn't even—there wouldn't be much of a debate at all.
But we're falling back on old ideological arguments, when the fact of the matter is the insurance companies are running Washington and we have to break their hold. And that's why the single-payer amendment that I offer that gives states an option is a small step in the direction of trying to give states the ability to be able to determine their own destiny, and then hopefully America will be able to see in these laboratories of states that we can have a single-payer plan that can save people money and protect people's economic security and their health. Healthcare is a basic right. We still don't hear of that talked about in the major debate here in Washington about the bill that is being presented.
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17.1
It be ri' strange tha' jcapan be findin' Kucinich talkin' 'bout single-payer, bu' th' MSM don't even be knowin' th' option exists!
Arrgh!
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18
And KT, if WaPo can say it...
"Baucus's fundraising prowess underscores the enduring political strength of the health-care lobby, which led all other sectors in donations to federal candidates during the last election cycle and has shifted its giving to Democrats as the party has tightened its control of Congress.
The sector gave nearly $170 million to federal lawmakers in 2007 and 2008, with 54 percent going to Democrats, according to data compiled by the Center for Responsive Politics, which tracks money in politics. The shift in parties was even more pronounced during the first three months of this year, when Democrats collected 60 percent of the $5.4 million donated by health-care companies and their employees, the data show."
Again, folks, the enemy of true reform right now are wearing big f'ing D's on their chest.
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19
I think this reader over at TPM answers the "is it all about Obama" (or even politics) question pretty eloquently:
Just to mention something that is obvious, but hopefully not overlooked, i.e., if this country cannot pass a bill which insures that every citizen has access to medical care, which every developed country has managed to do (and got done many many years ago), there is something very fundamentally and structurally wrong with this country.
Such an event, in my mind, would confirm that we live with a completely corrupt and dysfunctional form of government. Forty nine states, each with bicameral legislative bodies, some of which have distinguished themselves recently with unabashed levels of incompetency and cluelessness. Then, graft a federal government over that, which is also bicameral, the non-representative portion of it being filled with officials who are certifiable morons and/or who are bought and sold like whores by wealthy contributors.
Talk about a Waterloo.
This is a defining moment in our history. Do we fulfill our supposed status as a "shining city on a hill" or continue our long slow decline into a second rate oligarchy?
I am not one prone to hyperbole.
I believe this to the depths of my soul.
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19.1
"This is a defining moment in our history. Do we fulfill our supposed status as a "shining city on a hill" or continue our long slow decline into a second rate oligarchy?"
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Yeah. Absolutely. I've seen this coming for a while and I truly believe we are at the crossroads of history now. Not a recession, a blip, or a cycle but a fundamental fork in the road. Climate change, dwindling water supplies, over population, drought, a failing economic system, but perhaps the greatest hurdle we face is our own stupidity.
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I really hope the Mayans were right about December 21, 2012, because this must all end.
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20
Thanks for that Shep. It'd be awesome if it weren't so spot-on & depressing. Again, everyone should be looking to CA--it vividly foreshadows the American future writ large.
“We will have to repent in this generation not only for the vitriolic words and actions of the bad people, but for the appalling silence of the good people.”
Dr. Martin Luther King, Jr., Letter from a Birmingham Jail
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21
Hmm KT, guess I phrased it badly. What I was asking you is a question of fact that you would probably be able to answer. Is this bill consistent with what Obama campaigned on or not? I'm not trying to get you to say yes or no, I really don't know the answer and I think you do.
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21.1
Sorry. Didn't mean to blow that off. This bill is consistent on one level with what Obama promised. It dramatically expands coverage. However, what we have seen thus far does not dramatically transform the health care system. That's why you are hearing critics from the CBO to Mayo Clinic and Orszag. There are "pilot projects," but no real teeth in anything that would change the incentives for health care providers and health care consumers to continue to spend money on health care that is ineffective and inefficient.
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22
It was beyond time for Obama to personally take control of the health care debate and dialogue.
And Jim DeMint is a real folk hero for Dems...
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23
Here's Digby commenting on progressive groups attempting to target Baucus in MT:
http://digbysblog.blogspot.com/2009/07/mad-max-by-digby-meet-winner.html
Here's the ad they hope to run, if they get enough $
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23.1
They REALLY need to simplify how you get to the donor page there JC-san! Otherwise yes the pressure needs to be laid on and thick. This ain't gonna happen until people start screaming to the high heavens for it. That means pressure, pressure, and more pressure.
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24
As we've noted before, the President until now has stayed away from the nitty-gritty of the negotiations on Capitol Hill, largely because he wants to avoid the mistakes that the Clintons made in 1993, when they tried to dictate to Congress precisely how to transform the health system.
I don't appreciate that frame, K.T.
This country made an enormous mistake back in 1993-1994. And we're still paying for it.
Bill Kristol and company hope we make the same mistake again.
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24.1
Its not an inaccurate frame insofar as it describes what went wrong legislatively.
The problem with it is that it is an incomplete frame -- it ignores the mechanism that lead to the legislative failure, i.e. the vast sums of money spent by the health care parasites to defeat the Clinton plan.
The 'Obama' plan is going to be an even bigger failure, because its being written by the same parasites who killed the Clinton effort. So instead of a good plan that isn't passed (leaving us with the option to try again), we're getting a completely horrible and ridiculously expensive plan that is merely a form of corporate welfare for the insurance and Pharma industries masquerading as accomplished reform.
Its inevitable failure will set back any effort toward true reform for decades....
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25
Hi,
I'm reading this from Australia, a country where we have Universal health care for our citizens - which is free to those who cannot afford to pay for health care. It is funded centrally by the federal government so is effectively paid for by the taxpayers, and is not really free for people like myself who work and pay tax.
The debate that goes on in America has always been an interesting one for us, as we take our own system for granted. Like Canada's system, our's is based on the premise that those who can afford it, subsidise those who cannot. I know this is sometimes viewed as a little too 'socialist' for the US, but when you see a system like our's working, and compare it to the plight of the uninsured in the US, I don't see how any argument against it can stand up to scrutiny.
Our system is not perfect, and many choose to pay for private health insurance (as I do), but I simply couldn't imagine being one of the uninsured in the US.
Mick
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25.1
The problem, Mick, is that there are rabid RW nuts over here who are terrified that someone might get something they don't "deserve". Combine this with the massive amounts of money that pharm companies can and do spend, and you have a recipe for howling yahoos as soon as a serious attempt at actually covering our uninsured is made.
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25.2
It's so difficult to explain to Europeans/Australians/Canadians what exactly American conservatism is like. It's the most extreme right-wing reactionary party you have there. Now go even further right than that. That's where American conservatives are right now.
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25.3
Don't blame our problems on "conservatives".
The real impediment is that when Democrats are given the opportunity to lead the country in the right direction, they are more concerned with keeping power than improving the country.
Real change always entails a political cost. LBJ changed this country for the better, and the Democrats suffered mightily for it. Reagan and Bush II also changed the country (but for the worse), and the GOP is now suffering the consequences.
But the corrupt and weak leadership of the Democratic Party in Washington has sold out the American people to the Wall Street bankers and the health care parasites. We had an "once in a generation" opportunity handed to us this year to effect real change, and Obama, Rahm, Axelrod, Reid, Pelosi, Hoyer, Baucus, etc have chosen to line their pockets in an effort to perpetuate their own power rather than actually reform our economy and health care systems.
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