Should Obama NOT Do More On Health Care?

So says Ezra Klein. Yesterday I worried that Obama needed to get out there and make the case to Senators and the American public about the necessity of reform and a public option, but Ezra thinks this type of argument is misguided:

For now, the White House should have as little to do as possible with the various legislative products. Let the committees absorb the blows of the bad weeks. Let the early coalitions present themselves. Let the Republicans show their strategy in the mark-up sessions. Let the CBO score all the different options. Let the legislature familiarize itself with different revenue options. Wait. Wait and wait and wait. Wait until Congress has pushed this as far upfield as it’s able.

Then open up the White House. Then have Obama on TV. Then have Rahm on the phone with legislators. Then take Olympia Snowe for a ride on Marine One. The White House can exert explosive force on a piece of legislation, but it can only do so effectively for a short period of time. That was the mistake Clinton White House made in 1994. By the time their legislation was near reality, administration officials were so deeply involved that they couldn’t add external momentum. It is not a mistake that Rahm Emmanuel, who watched it all happen firsthand, means to repeat.

That’s a reasonable argument, but I’m not entirely convinced. Though the mistakes of 1994 aren’t being repeated, I worry that the administration may be so jittery about Clinton’s failure at reform that they are making the inverse of Clinton’s errors. Whereas Clinton tried to push a very specific package and froze out many Democrats and the entire Republican caucus, I fear Obama will leave all specifics to congress and yield too much to an obstinate and deeply unpopular Republican caucus. And if the legislature comes to a consensus for a weak and toothless health care package, it may not matter how hard Obama drums support for deeper reforms. Once enough Senators come out on the record against a public plan, it will be an excruciatingly difficult task to force them to back down. And that’s a very real possibility.

This isn’t to say that the administration shouldn’t save a trump card or two for the end, but it would be reassuring if the White House was doing and saying more now.

Obama, the Public Plan and the Bully Pulpit

Sweeping health care reform looks to be faltering. The public option, a government-run insurance plan that competes with private insurance, may be nixed in the final bill altogether. This would ostensibly be the time for Barack Obama to champion the public option as he makes his way across the country touting the necessity of health care reform. He could forcefully make the case for a public plan and ask the crowd (and TV viewers) to call their senators and demand action. But he isn’t doing that. As Paul Krugman notes, “centrist” Democratic Senators like Blanche Lincoln from small states where “one or at most two private insurers dominate the market” have been wary of the public plan. And this makes sense since powerful insurance companies can raise lots of money for a  candidate. But you know who else can raise a lot of money? Barack Obama. Obama and Joe Biden could spend a couple hours calling major bundlers for each of these Democrats and, I suspect, raise as much or more than the insurance companies would. That, along with a public crusade for a public option could conceivably go a long way. But neither seems to be occuring.

Obama is a clear-cut pragmatist, sometimes to a frustrating degree. Some liberals are starting to wish there was more truth to the “socialist” and “leftwinger” labels that conservatives have been hurling at the president. But there’s never been any real reason to believe that Obama harbors any radical impulses. Even the fake reasons, like Jeremiah Wright, are probably just twisted evidence that Obama has always been as cautious and pragmatic as he is today. He had a radical black reverend when he was a state senator from a heavily black district in Chicago. When he was running for president in what’s still a heavily white country, he severed ties with Wright.

The conventional wisdom is that Obama has been dismissive of gay rights and willing to bend to conservative framing on matters like deficit reduction because he was stocking up on the political capital to ram through the big issues. But this is the big issue! And Obama is staying almost entirely out of the specifics of reform. That may change, or maybe his cautious approach has some justification I am missing. We will look back years from now and truly reflect on the wisdom (or lackthereof) of that strategy. But right now, it’s very worrying.

Is Howard Dean Relevant?

Howard Dean has been an important player in understanding how Democrats ended up with majorities in both chambers of congress and even to Obama’s landslide victory in November. Dean’s tenure as DNC chairman saw the Democrats take back the House and Senate in 2006 and comfortably pad their majorities in 2008. His “50-state-strategy” laid the theoretical and material groundwork for Obama to compete in traditionally red states like Indiana, North Carolina, and Montana. Dean’s innovative online outreach and fundraising operations were an inspiration for Obama’s own internet success.

But since Obama’s victory, the White House’s relationship with Dean has been unambiguously icy. This was perhaps most visible when Dean’s successor at the DNC, Tim Kaine, was publicly selected for the job in a press conference with the president while Dean was on vacation.

Now the good doctor fights for political relevance by injecting himself in the ongoing health care debate. Dean is releasing a new book on health care which will forcefully argue for a “public option” as an element of reform — a policy that both the VP and HHS Secretary Sebelius seemed alarmingly uncommitted to in their media appearances over the weekend. Dean has also soundly rejected Sen. Kent Conrad’s compromise proposal of health care “co-ops” as an alternative to the public option, by quipping that “insurance companies will be licking their lips.”

It will be interesting to see how much political power Dean still holds. He can’t command the spotlight the way he could when the Democratic Party lacked an annointed leader. The young and liberal voters who were Dean’s base are now solid Obama supporters, and even Dean’s grassroots organization Democracy for America has larginally been supplanted by Obama’s Organize for America. Dean is right about health care but I’m skeptical that he will matter much at all when everything is said and done.

Get Gov’t Away From Health Care and Leave My Medicare Alone!

It’s almost certain that we are going to get some form of health care reform this year. The Obama budget triggers health care reform to automatically move to the reconciliation process if it doesn’t get passed by summer. So if the Republicans and centrist Democrats filibuster or squash health care reform, the budget reconciliation process allows legislation to get passed with only 50 votes (rather than the 60 necessary to end a filibuster).

Of course insurance companies, BigPharma, free marketers, and just about anyone with entrenched interest in the current broken health care system will mobilize to water down reform as much as they can. One of the first steps will be to try to turn public attitudes against “government intervention” into care. You know, stopping big government from interfering with the “doctor-patient relationship” and making sure that “hospitals aren’t being run like DMV.” Considering that the American health care system is very badly broken and knowing that popular president Barack Obama won a landslide election campaigning (in part) on fixing health care, you’d think the public would be in pretty fervent agreement with the president’s positions. Right?

Not exactly. According to Pew’s recent survey, public opinion about health care reform is decidedly mixed. While 86% of people told researchers they thought “the government needs to do more to make health care affordable and accessible,” 46% answered (see the table on the right) that they were “concerned that the government is becoming too involved in health care.” In other words, a significant number of people really have no clue what they think.

What’s pretty striking is, when broken down by age, the only segment of the population in which a majority fears the government is becoming too involved in health care is the over 65 crowd. This hit me as pretty weird since most of these old people are on Medicare and old people love their Medicare! Or so I thought. But maybe these folks have to deal with government-sponsored health care and know first hand of the evils that a governmental insurance plan holds. So I looked up the numbers and decided to bake up this delicious pie chart:

Medicare Satisfaction Chart

As you can see, old people really do like their Medicare. So where are their worries coming from? Are they scared this will somehow negatively impact their Medicare? Do they just not want others to have the wonderful services they do? Are they confused?

If anyone has any ideas, fill me in, because this doesn’t make any sense.

Conservatives Criticize Kennedy Health Care Plan For Being A Health Care Plan

I recently stumbled on Keith Hennessey’s blog. He’s a conservative policy wonk and was an economic policy coordinator in the Bush White House. Today he wrote up a summary of Ted Kennedy’s health care bill, which is a pretty straight forward overview and commentary from the Republican side of things. His post gives me the opportunity to address this point, which we are sure to hear more about soon:

Health insurance plans could not charge higher premiums for risky behaviors:  “Such rate shall not vary by health status-related factors, … or any other factor not described in paragraph (1).”  Smokers, drinkers, drug users, and those in terrible physical shape would all have their premiums subsidized by the healthy.

In the coming months conservatives are sure to raise hell over healthy people subsidizing sick people’s health care. But this isn’t some malevolent consequence of a universal health insurance system — this is a consequence of health insurance! That’s what a risk pool is — the healthy pay into the pool, subsidizing the sick, with the knowledge that eventually when they need care, it too will be subsidized by those who are healthy. That’s how Hennessey’s health care worked when it was bankrolled by the government while he worked in the White House. That’s how his care works now that he is (presumably) insured on the private market. When Hennessey retires, that’s how his Medicare will work too.

Anyway, if you are interested you can download the draft of Kennedy’s legislation here.

The Invisible Hand in Health Care

From CQ, Jane Norman writes about the palpable discouragement of free market types with regard to coming health care reform:

“I have never seen the free-market proponents in a debate as discouraged as they are over health care,” Greg Scandlen, a health expert at the Heartland Institute, wrote on the group’s Web site. The bleak mood, he said, was compounded by the fact that “there was no unity. Everyone has his or her own pet peeve in health care and is uninterested in unifying around a theme.”

Interviewed later, Scandlen had few kind words for Republicans in Congress, who would seem to be natural allies. While they are often criticized for being too ideological, he said, they have displayed no ideology on health care, and not even much real interest. “They are virtually useless,” Scandlen said. “There are a few bright lights, but not many.”

This really shouldn’t surprise anyone. The American public wants health care reform and politicians are accountable to these people. Reducing moral hazard among the insured so that patients feel more financial risk isn’t going to deliver any votes.

What is surprising (or at least pretty stupid) is that these conservative groups really want to push Republicans to beat the free market drum. Imagine the repercussions if you increased the US health care system’s susceptibility to market pressures. Cuts to S-CHIP mean less care for kids. Eliminating preexisting condition clauses allow insurance companies to deny care to a greater number of sick people. Eliminating the employer tax exclusion for health insurance would lead a lot of employees to seek insurance on their own where they would feel the true brunt of health care costs. This is what free market health care looks like. And where does it lead? To a lot of people even angrier than they are now, in more precarious circumstances. Pretty soon these people will have had enough, and they will be demanding reform. If this ever happens you can bet we’d get reforms a whole lot more sweeping than what the Democrats are proposing now.