House Renews Health Care Talks As August Battle Brews
Reformers and obstructionists gear up for August battle. Politico: "A White House official said the administration is still in the process of making plans for the recess, but labor leaders and other administration allies [are] gearing up to spend millions on television advertisements and grass-roots organizing. And, judging by spending already reported by some of these groups, they are off to an impressive start ... Kaine’s counterparts at the main Republican campaign committees, as at range of conservative groups, are making their own plans [to] focus primarily on the cost of health care reform and focus on vulnerable members like Virginia Rep. Tom Perriello and Colorado Rep. Betsy Markey. Key Republican Senate targets include Majority Leader Harry Reid, while Democrats say they hope to exact a price from North Carolina’s Richard Burr, among others, from opposing health care legislation.
Speaker Pelosi confident bill will pass House. W. Post: "[Pelosi] raised the stakes by planning to restart talks Monday among bickering Democrats on the Energy and Commerce Committee, one of three House panels with jurisdiction over health care and where the bill stalled last week. Democratic leaders are newly confident that these differences can be resolved, possibly in time to bring a House bill to the floor before lawmakers depart Friday for the August recess, although Pelosi did not commit to a timetable."
WH open to tax on insurers offering high-priced plans. NYT: "David Axelrod, senior adviser to President Obama, cited the Goldman [Sachs] program as an example of the expensive benefits the administration might consider taxing to help pay for its health care program."
Baucus bipartisan compromise may short-change middle-class. NYT: "The Senate Finance Committee is considering proposals to limit eligibility for subsidies, a move favored by some fiscally conservative Democrats in the House Blue Dog Coalition. One proposal would bar subsidies for people with incomes over 300 percent of the poverty level ($66,150 for a family of four.) Richard J. Kirsch, the national campaign manager of Health Care for America Now, a consumer group, expressed concern. 'If Congress sets the limit at 300 percent of the poverty level,' Mr. Kirsch said, 'millions of middle-income families would not be able to buy insurance because they could not afford the premiums on their own.'"
The Health Care Blog's Matthew Holt's reports possible softness in support for public plan option among liberal congresspeople: "[Top drug lobbyist Billy] Tauzin said explicitly that several liberal members of Congress demonstrated by a show of hands at a dinner last week that they thought the Public Option was going to be traded away. They also all agreed that the Blue Dogs in the House wanted the weaker Senate bill to be voted on first, so that they weren’t forced to defend a vote on a more liberal House bill that would be converted to a much more moderate bill in Conference. So the expect a Baucus-lite compromise."
Krugman latest to slap Blue Dogs for being incoherent: "even as they complain about the plan’s cost, the Blue Dogs are making demands that would greatly increase that cost."
FireDogLake's slinkerwink praises Blue Dog rebel: "Gabrielle Giffords, a Blue Dog Democrat, wrote an editorial in the Arizona Daily Star, about the need for health care reform that includes a strong public option that lowers everybody's costs and competes with private insurers ... the Blue Dog Democrats aren't united as a caucus against the public option."
The Plum Line on new ad challenging GOP: "This new ad being launched by White House allies, which blasts Republicans in Congress for blocking reform, is probably the most direct effort yet to link current GOP obstructionism to the successful scuttling of reform in the early nineties."
Counterspinning CBO Cost Estimates
Dems plans to push back on consevative spin from CBO cost estimates. The Hill: "Democratic leaders in Congress likely will make the case this week that the healthcare reform plan has multiple benefits and cost savings that cannot be scored by independent congressional accountants ... White House budget director Peter Orszag on Saturday criticized the CBO and suggested he was puzzled by the methodology the CBO used to estimate cost savings from a proposed Independent Medicare Advisory Council (IMAC) ... Columnist Paul Krugman said on ABC’s 'This Week' that healthcare economists were surprised at [CBO's] assessments. 'Most of the healthcare economists I talk to think that the MedPac [IMAC] reform…would actually be quite important, especially if you go into the long run. So they were really kind of surprised,' Krugman said Sunday."
Ezra Klein: "The potential savings from IMAC aren't something you can plug into a formula. After all, the point of IMAC is not that it would implement the best ideas we have in 2009, but that it will give a body of experts the ability to implement the best ideas they have in 2022, and 2034, and 2019, and every other year. CBO can't guess at what those ideas will be any more than I can. We don't have the data they'll be using, we don't know the technology they'll be able to employ, and it's impossible to estimate the political climate. May as well ask what the top-rated NBC show will be in 2029. Which makes it a bit strange that the CBO attached any numbers to its long-term predictions at all."
GoozNews says you can't judge proposals in isolation: "This latest CBO statement probably reflects the same caveat attached to its recommendations from last December. It is being evaluated in isolation from other proposed reforms. Yet its true power is only in conjunction with those other reforms."
Change.org's Tim Foley says CBO buried the lede: "CBO determined there may well be substantial long-term savings, but marginal short-term savings. However, given the furor of last week, it’s striking that part of the reason why Elmendorf and his staff don’t believe IMAC will yield much short-term savings is because their recommendations will likely overlap with provisions in HR3200 that will already be reducing costs."
The Treatment's Jonathan Cohn lays out the options following the latest CBO report:
One is to follow the CBO instructions to the letter--to revise the reform plan further so that it includes either a stronger IMAC, some form of an exclusion cap, or some combination of the two. If a bill includes these measures, CBO is likely to certify--as it has not yet--that reform will indeed reduce the cost of medical care over the long run.
This is the approach Obama and his allies seem to favor--and this is, in many ways, to their great credit. After all, the previous president and his allies rarely took the projections of government actuaries so seriously. And there is far more grounds now than there was then for questioning the projections. Plenty of experts believe that CBO has been too pessimistic in its outlook about reform--and too definitive in its pronouncements.
A second option would be to ignore the CBO, given the inherent uncertainty in these projections, and to push ahead with the reform plans as they already written. Remember, these plans more or less pay for themselves in the first ten years of the federal budget window. (The House plan has a problem paying for itself after the tenth year, although--as I wrote earlier--it’s not clear how big that problem really is.) And they do include some payment reforms that should make medical care more efficient.
Quite possibly, that will be enough to make health care less expensive over time. And if not, well, then we’ll still have made health insurance available to almost every American--a huge accomplishment that will spare millions of people financial and physical hardship. It would be, again, the single biggest accomplishment in domestic policy since the Great Society. We wouldn't have solved our long-term fiscal problems. But we wouldn't have made them appreciably worse, either.
A third option would be to give up on reform altogether--that is, to do nothing. Medical care would keep getting more expensive, health insurance would keep getting more inaccessible.
CBO concludes reform with public plan would increase number with private insurance, debunking conservative talking point. NYT: "The Congressional Budget Office, answering questions by Republican critics of the health care legislation proposed by House Democrats, said on Sunday that the bill would drive 9 million people off of employer-provided insurance plans but that 12 million people who do not have such coverage now would get it — a net increase of 3 million people insured through their employers."
Walker Report also notes: "A new report from the Congressional Budget Office shows that a strong public plan would increase the federal government's tax revenue and wages for some workers."
