SELECT YOUR VOTE

David Orentlicher: The public option compromise likely will do little to achieve the option’s main purpose–the containment of health care costs–but its real value lies in its ability to ensure that there are 60 votes for the Senate bill. If the compromise paves the way for passage, it achieves a great deal.

As the compromise indicates, the health care legislation continues to evolve into an approach of expanding access now and addressing costs later. This strategy may ultimately unravel, as has happened with a number of state health care reforms that expanded access without curtailing costs. Moreover, the legislation’s sustainability is made more difficult since the main provisions to expand access will not kick in until 2013 or 2014. It’s much easier to preserve a program when voters are already benefiting from it. All in all, there are real risks with the current proposals. But the greater risk lies in doing nothing.

Tevi Troy: Harry Reid clearly has an unfortunate tendency to make inappropriate comments. His comparison of legitimate questions about the health care legislation to support for slavery or opposition to civil rights call his rhetorical judgment into question, but we should not lose sight of the problems with his policy judgment as well. Contrary to a host of promises from President Obama and other Democratic leaders, the Senate health bill will not bend down the health care cost curve, will raise taxes, and uses unrealistic assumptions to paint itself as budget neutral. The latest “compromise” ideas will make the bill even more expensive and further threaten Medicare’s already questionable fiscal sustainability.

Steve Steckler: On Health Care: Obama recently exhorted Democrats to make history by adding a fourth entitlement program at a time when the first three are bankrupting the country. There is an Enron quality to his call, as though Kenneth Lay was still telling Andy Fastow to keep betting other people’s money on deals already in the tank.
Perhaps we need a Sarbanes-Oxley for Congress instead of Arthur Andersen as chair of the Senate Finance Committee. It might be excusable — and even historic — if this were really a reform bill that addressed Medicare’s fiscal problems and America’s health care cost dynamic, but instead it merely compounds them by expanding the reach of the culpable systems. And like Enron, it is built with fictitious accounting (starting with nearly $500 billion in Medicare cuts) and the salvationist ego of its progenitors. There has never been a better time for cooler heads to prevail since the Cuban missile crisis.The latest wrinkle in this ongoing pretense is the "compromise" public option, a mere watering down of fiscal cyanide whose sole purpose is to find an additional and less obvious means of inflating federal health care spending. It’s good to know that all those previously-unemployed Enron accountants now have jobs as committee staff. Moreover, the revised option sits astride newly-increased regulation of private insurers that actually reduces competition among them, both by fixing a benefits package for any federally-assisted purchase and by continuing to block insurance companies from offering a non-subsidized benefits plan available in one state to citizens in another. History says it’s time for a fast re-write.

Julian E. Zelizer: Senator Reid’s statement might energize some health care proponents who are frustrated with dynamics of the Senate. However, those kinds of statements do little to advance negotiations at this stage and only serve to strain relations with the Democratic moderates who hold all the power right now. These kinds of statements also just dominate media discussions on the wrong kinds of issues.

Karen Finney: As an African American woman I find the GOP’s very fake "outrage" over Senator Reid’s comments insulting. This is so obviously yet one more- in a long string of attempts to distort the truth in order to distract from the business of passing real healthcare reform. Republican members of Congress have spent the vast majority of their time over the past months whining, complaining and attempting to obstruct progress,at times resorting to flat out lies in a blatant effort to protect the status quo and insurance company profits.

Senator Reid was clearly making the comparison to other watershed moments in American history when the possibility of significant change and progress was met with lies, excuses and obstructionism.
Members of Congress hold in their hands the power to enact legislation that will have an impact on every American. If that doesn’t count as a landmark moment in history like the civil rights act or granting women the right to vote than what does?

Given their cowardice and obsession with partisanship, its not surprising that GOP members of Congress don’t want to acknowledge the significance of this moment when each member has the chance to put people ahead of politics and summon the courage to do the right thing.

Timothy Stoltzfus Jost: I lost much of my interest in the public plan once the House and Senate required the public plan to pay negotiated rates. A public plan paying Medicare + 5 would have offered Americans a real choice, a real alternative to private insurance. It would also have driven down health care costs and could have "bent the curve", particularly when coupled with new approaches to cost control in Medicare. It could have introduced real competition into our monopolistic or oligopolistic insurance markets.

Negotiated rates put the public plan at a disadvantage compared to dominant private insurers and give it little space to reduce costs. It is ironic that "libertarians" on the right who always talk about choice seem so bent on denying Americans a choice that most Americans want, and that Republicans and conservative Democrats, who complain loudly that the reform legislation contains no cost control, seem so intent on stripping the bill of all of the cost control measures it contains. The House public plan is still worth something, but it is a pale imitation of the real thing.

It is difficult to say whether the public option compromises discussed today achieve anything because it is difficult to know what the compromises are. As I noted in my post on Sunday open-mic, using the OPM to bargain with nonprofit plans gets us nowhere. Half of Americans are now insured through non-profit plans and they don’t know it because most nonprofits behave just like for profit plans. Also, although the OPM does negotiate with plans in the FEHBP, it is not a tough negotiator and would add little value to the little that the exchanges might already accomplish. This is not a compromise, it is barely a fig leaf.On the other hand, raising the Medicaid eligibility level to 150% of poverty and opening up Medicare at cost to people over 55 could be helpful. The House already raised Medicaid to 150% because it realized this would cost less than providing insurance premium credits to this population. (It also raised payments to primary care physicians in Medicaid to 100% of Medicare, which would be essential if the new Medicaid enrollees are to find medical care). Opening up Medicare to early retirees and others over 55 is an idea that has been around for a long time and makes sense. It should not affect the financial viability of Medicare, since these people would be paying full cost.

I would at this point be willing to give up the public plan for movement on what I view as the two most important issues in health care reform. First, Congress needs to move up implementation. It is to me inconceivable that the bill will ever be implemented in 2014, the Senate date, in anything like its current form. At least 2013, the House date, would allow the President and Democrats in Congress to run in 2012 promising immediate implementation if they are reelected. 2014 is a joke. I realize that budget constraints drive the delay in implementation, but there is greater political danger, and danger to the bill, in delaying 4 years than in coming up with a few hundred billion dollars. Remember the repeal of Medicare Catastrophic, and that was only after a year. I can’t imagine why Democrats in the Senate want to go through two more elections before the health reform promise is realized.

Second, it is vital that Congress adopt the House rather than the Senate version of implementation and enforcement. The House bill would be implemented uniformly throughout the country by the federal government. The Senate bill depends on the states to implement the bill as an unfunded mandate. A number of states have already made it clear they will actively oppose implementation on their soil. The Senate approach promises nothing but headaches and is likely to result in failed implementation.

As to Reid’s remarks, they may lack tact, but the resistance health care reform is meeting is eerily similar to that which met the civil rights movement in the 1950s and 1960s, although then, of course, conservative Democrats then led the charge. Parliamentary stalling tactics, filibusters, demagogues whipping up hysteria among the populace, states passing constitutional amendments opposing the federal law, and a concerted attempt to deny those who are losing out in our society a chance at equality–the parallels are remarkable. The most important parallel, however, is that opponents are again on the wrong side of history, as we will all eventually realize. I believe that a half century from now, opposition to health care reform will feel equally unsettling to Americans as opposition to civil rights a half century ago feels now.

Fred Barbash: On the EPA’s announcement yesterday on regulation of greenhouse gasses

>>John Kerry: Get moving
This is a clear message to Copenhagen of the Obama Administration’s commitment to address global climate change and a clear signal to Congress of the importance of passing comprehensive climate and energy legislation. The EPA has acted on the Supreme Court’s decision and made it clear that greenhouse gas emissions are a threat to public health in the United States and can be addressed under the Clean Air Act.
The message to Congress is crystal clear: get moving. If Congress does not pass legislation dealing with climate change, the administration is more than justified to use the EPA to impose new regulations. Imposed regulations by definition will not include the job protections and investment incentives we are proposing in the Senate today. Given the potential for agency regulation, those who now aim to grind the legislative process to a halt would later come running to Congress to secure the kinds of incentives we can pass today. Industry needs the certainty that comes with Congressional action on this vital issue.

Rory Cooper: At The Heritage Foundation, we have long called for expanded coverage options for America to be modeled after the actual Federal Employee Health Benefits Program (FEHB). During the past year of debate, many liberals have contended that the FEHB includes a public option, which it simply does not. It is heartening to know that we are finally reaching an area of debate based in reality. The FEHB is an exchange of private insurance options, period. However, and this is a big however, that does not mean that this will be acceptable if the ‘compromise’ includes expanded Medicare to persons 55 years old, or expanded Medicaid (i.e. health welfare) to those who can afford to not be on it. This is simply the old Hillary Clinton trick of sliding the scales to catch everyone into a government program.

The reason we are debating this right now is because the left is finally catching up with American public opinion, and killing a public option that would not be effective, costly or prudent. Trying to sneak everyone into a government plan through the back door, i.e. expanding current government programs that are bankrupt and full of fraud, is a bad idea and would be catastrophic spending in the face of our ever-expanding deficit. So if the left on the Hill wants to finally kill the “public option,” I say hoorah. But if the alternative is using smart conservative ideas as a smokescreen for the largest unpaid-for expansion of Medicare and Medicaid ever, I will be equally as dismayed.At least we are finally seeing the results of what thoughtful and deliberative debate can achieve. This is why conservatives have been asking to be included in this debate from the beginning. Harry Reid has shut them out of a hyper-partisan process, even yesterday unbelievably comparing his colleagues on the right to pro-slavery advocates and admonishing them for wanting to participate. Well America, slowing down is the best public ‘option’ yet. The longer we have to expose bad policy and promote good consensus, the closer we can all come to solving our health care woes. Add on to the current plans the ability to take insurance with you from job to job, or allowing companies to sell across state lines and you have the makings of real conservative health care reform. Hoorah.

Bradley A. Blakeman: Reid’s comments are hateful, hurtful, and have no relevance what so ever to the health care debate. If "Mr. Congeniality" thinks this type of rhetoric will get him support for his plan, he is sorely mistaken. Call it what they will, between the public option, abortion funding and the high cost of Reid’s health care plan, there is enough not to like to kill health care reform. The death will not come at the hands of Republicans it will be by "Democide".

Victor Kamber: Passage of a Democratic Health Care Plan with or without the bells and whistles allows to base to feel progress has been made and a beginning of health reform has finally been achieved. Will all be happy on the left…NO,but they will have time to regroup and deal with the real enemy the Republicans. 2010 is close but there is plenty of time to still recruit, raise money and organize if the Democrats achieve something with health reform legislatively. -

Fred Barbash: I also asked Arena contributors for their views on President Obama’s job-creation proposals.

>>Darrell M. West: President Obama is expected to come to Brookings today and announce a new jobs program involving help for small businesses, infrastructure development, and home retro-fitting. The political tug of war will concern how much of the unused stimulus money will go to job creation versus deficit reduction. Republicans want more for the latter, while Democrats will push to devote more resources for job creation. The president is expected to say he will set aside some stimulus money to cut the deficit, but not as much as the GOP would prefer. Whatever he announces, look for Congress to fast-track it!

>>Darrell M. West: President Obama is expected to come to Brookings today and announce a new jobs program involving help for small businesses, infrastructure development, and home retro-fitting. The political tug of war will concern how much of the unused stimulus money will go to job creation versus deficit reduction. Republicans want more for the latter, while Democrats will push to devote more resources for job creation. The president is expected to say he will set aside some stimulus money to cut the deficit, but not as much as the GOP would prefer. Whatever he announces, look for Congress to fast-track it!

>>Dean Baker: If the advanced reports of President Obama’s new economic package are accurate, then it is a real disappointment. The country has 15 million people out of work. They did not do anything wrong. They are out of work because people like Alan Greenspan, Ben Bernanke, and Henry Paulson messed up horrendously in their management of the economy.
We know how to get these people back to work — they have done it Germany, and Germans surely are not that much smarter than Americans. If President Obama can’t find a way to sell the spending programs that are needed to expand the economy, then he can give incentives to firms to share work — shorten hours — instead of laying people off. Firms dismiss close to 2 million workers every month. If we can get this number down by 10 percent, it has the same effect on employment as creating 200,000 jobs a month. It would be very disappointing if President Obama were satisfied to make small symbolic gestures that will have little impact on employment. Hopefully, the advance reports on his plan are inaccurate.