Wait, who did we just screw over?

Health care reform passed on Sunday night.  On Monday, health care stocks soared – including shares of insurance companies.  It might seem counter-intuitive – after all, the talk of Washington has been that the health care overhaul would put patients ahead of “special interests.”

As with any Washington, DC mystery, the rhetoric is pointless and the real answers stem from who has their hands in the cookie jar.

Yesterday, passing healthcare seemed so far away

On Friday, Barack Obama was a one-term President.  The Democrats were swimming upstream against the political current, weighed down by an unpopular health care bill.  Scott Brown’s election meant that the Republicans would sweep the fall elections.

Today, the details of the health care bill are quite inconsequential: despite the fact that many Americans are saying they’d support a candidate who pledged to repeal the deal, Obamacare is now the law of the land.

If you can get past the needless potshots at conservative talk radio and other efforts to prove he’s really one of the cool kids, David Frum’s piece on CNN makes a few tidy points about how hard a straight repeal is:

Some Republicans talk of repealing the whole bill. That’s not very realistic… Will they vote to reopen the “doughnut” hole for prescription drugs for seniors? To allow health insurers to deny coverage to people with pre-existing conditions? To kick millions of people off Medicaid?

Kudos to Frum for the correct spelling of the word “doughnut” – and for laying several policy proposals to fix the bill that was passed last night.

He gets some of the policies wrong, but he gets the big point right: that the one-word campaign of “Repeal!” just won’t cut it.  Republicans will need to have a plan in place to do things Obama promised to do with his health plan – especially reducing cost and expanding access.

Obamacare’s opponents can no longer arguing against an unpopular proposal; they now must argue against an existing entitlement.  Polls may show that many voters opposed the health care overhaul last week, but those who would change the policy must now fight a different battle altogether.

3 Unfortunate Predictions about Health Care

Sunday looks like D-Day for President Obama’s push to overhaul health care.  There is plenty of speculation flying around about votes in the coming days and what those mean for votes in November.

How will health care affect the political environment over the coming eight months?  Some humble predictions:

1. Health care will only be a short-term political liability for Democrats if it doesn’t pass – if it does, it will be a short-term benefit.

The bitter battle over health care is one reason that voters are souring on everybody in Washington.  The sooner that debate is over, the sooner Democrats can focus on things like regulatory reform and passing out money like Jack Nicholson’s Joker in Batman ’89 while asking, “Who do you trust?” – both of which are much easier to craft messages for.

But there’s more than that.  The opposition to Obamacare (both official and unofficial) has highlighted long-term effects for the American health care system and federal budget – unfavorable comparisons to British and Canadian health care systems, excessive cost, and even shortages of care and care givers.  These won’t take effect by November 2010 or even 2012.

If the health care overhaul passes – and the expected state challenges are quick and quiet – Democrats will trumpet their progress for the next three years while accusing Republicans of lies and scare tactics.  Obama is right to link the passage of health care and his party’s political fortunes.

2. It’s probably going to pass, and it doesn’t matter how.

As Dan Flynn opines, the reason there hasn’t been a vote already is because there aren’t enough votes.  Until Nancy Pelosi can amass 216 Democrats to support whatever parliamentary gymnastics she has to do to get a bill through the House, there will not be a vote.  When the vote comes up, bet the house – it’s getting through.

3.  The “Repeal Obamacare” movement will get less traction than one might expect.

Entitlements are the gifts that keep on giving.  They don’t actually help end poverty, they don’t give people a comfortable retirement, and they don’t help people who have lost their jobs find new ones.  They do provide platforms for politicians to promise even more entitlements.  When entitlements fail to fix the problem they were meant to solve (or make it worse), the answer is generally to dump more funding into the failed program.

Even failed programs can be elevated to third-rail status.  Remember the left-wing backlash against President George W. Bush’s Social Security reform?  You can expect a similar reaction to future attempts to roll back Obamacare.

Like Social Security reform, real health care reform – that involves doing more than just getting more people into a broken system – will require a long-term, sustained effort that changes how our culture views our government.

Bonus prediction: By the way, whatever the outcome of the vote on Sunday, people with money will always get the health care they need and want.

Where are the Massholes on health care?

Democrats like to throw it back in Scott Brown’s face that he voted for the Massachusetts health bill back in 2006.  Mitt Romney gets it thrown back in his face a lot, too.  That bill was the Mogwai to the current Gremlin of a proposal that Congress is trying to pass-without-passing.

Those critics don’t like to mention the problems Massachusetts is having now.  And Romney and Brown aren’t about to issue the mea culpa the country needs to hear now.

As Bay State native Dan Flynn chronicles, the Massachusetts plan has increased coverage but also insurance costs.  State treasurer Tim Cahill, a Democrat turned Independent, railed against the plan.

“This has been tried, and it failed,” Romney or Brown could plead of the current incarnation.  “In Massachusetts, we tried this.  It cost the state more, it cost patients more, and though there were more people insured they got less care for their money.”  They might even quote Franklin Roosevelt: “It is common sense to take a method and try it: If it fails, admit it frankly and try another.”

Who ya gonna call?

The Washington Post’s Ezra Klein revealed yesterday that Harry Reid and others feel like the filibuster has been “abused” because it takes days for the Senate to enact cloture votes.  (It sparked an interesting discussion in the Post’s message boards, as well.)

“I file cloture” — the motion to end a filibuster — “to move to discuss the bill on Monday,” Reid explained. “That takes two days to ripen. We don’t have a vote till Wednesday. Once that’s done, Republicans have 30 hours to do nothing. After the 30 hours is up, you’re on the bill. If there’s no amendment offered” — remember, amendments can be filibustered, too — “you file cloture to move to the vote. It takes two days and then another 30 hours. So that’s 60 hours plus four days to vote on the bill. That happened 67 times last year.” You do the math.

One way to make the lawmaking process more efficient would be to reduce the number of people in the legislature, or to merge lawmaking authority with the executive branch.  Cuba, Venezuela, Iraq, North Korea, Germany, France, and others enacted similar systems at various times in history… though it hasn’t gone well.

Otherwise, we all may have to accept that our legislature’s inefficiency is by design.  That’s not necessarily a bad thing, of course.

The filibuster exists to maintain the Senate’s deliberative nature, so the best reform might be to force actual filibusters.  Senators who want to extend debate should actually have to talk.

When Republicans made the same grumblings years ago, they missed an opportunity to demonstrate Democratic obstructionism on judicial nominees. The GOP could have made political hay out of CSPAN clips of Democrats talking endlessly or reading the phone book to keep debate going.  Republican parties in the home states of the filibuster-ers could have organized “Save the Judicial Branch” rallies to protest their talkative Senators.

The problem for Democrats now is that the filibuster is blocking an unpopular piece of legislation.  If I were a Senate Republican, I would welcome the chance to speak on national TV about the future of health care, about federal spending, about the risks of government running anything, and the bribes Democrats are using to win support.  And even the bill’s passage may be a losing proposition.

At the very least, we should all agree that the filibuster should be maintained so that the eventual remake of Mr. Smith Goes to Washington makes sense.  All in favor… say die:

A tale of one health care plan

Indiana Governor Mitch Daniels – one of the potential GOP contenders for 2012 – made a case for consumer-driven health care reform in today’s Wall Street Journal.  Daniels calls for the incorporation of Health Savings Accounts, or HSAs, into health care reform efforts.  So does Michael Tanner, a senior fellow at the Cato Institute.  Though both are ostensibly arguing for the same thing, check out the subtle differences in how they do so.

(This is, by the way, a new and different type of call for health care reform than we have seen from most voices from either party in the past few years, and it’s a positive development.)

Daniels talks about his experience implementing an HSA-based health care program for his “co-workers” employed by the state of Indiana.  Recognizing public concern not only over health coverage but also cost, Daniels points out savings to employees as well as the state.  But the thrust of his argument is the benefit to the patient:

State employees enrolled in the consumer-driven plan will save more than $8 million in 2010 compared to their coworkers in the old-fashioned preferred provider organization (PPO) alternative. In the second straight year in which we’ve been forced to skip salary increases, workers switching to the HSA are adding thousands of dollars to their take-home pay. (Even if an employee had health issues and incurred the maximum out-of-pocket expenses, he would still be hundreds of dollars ahead.) HSA customers seem highly satisfied; only 3% have opted to switch back to the PPO.

Buried towards the end of Daniels’s piece is the argument that patients are more frugal when face with spending their own money – which is true, but not the strongest argument on behalf of HSAs.  Tanner, however, makes that a central part of his case.

If everyone were to receive a CT brain scan every year as part of their annual physical, we would undoubtedly discover a small number of brain cancers much earlier than we otherwise would, perhaps early enough to save the patient’s life.

But given the cost of such a scan, adding it to everyone’s annual physical would quickly bankrupt the nation. But, if they are spending their own money, consumers will make their own rationing decisions based on price and value. That CT scan that looked so desirable when someone else was paying, may not be so desirable if you have to pay for it yourself. The consumer himself becomes the one who says no.

Tanner’s point is strong an irrefutable, but it’s an academic argument rather than a political argument.  It’s as callous as it is true – saying, essentially, “Pay for your own doctor, Chet.”  When was the last time logic won a political debate?

Daniels’ vision of consumer health care isn’t a shift in burden, but about trusting the patient to steer their own course – without government or, for that matter, the vilified insurance companies.

It may not be an idea the American public is ready to accept quite yet, but the more people make the case as Daniels has, the more palatable patient-driven health care will become.

More about the health care-waves

TechPresident has an intriguing behind-the-scenes look at technology behind “On the Air,” the DNC/Organizing for America talk radio call-in project.  OFA compiled the data the site needed (dial-in information for all those shows) from volunteers thanks to a program that emerged from their Innovation Labs division.  The program itself is impressive enough, but the idea of a creative division spitballing ideas is a bold step.

Organizations funded by other people’s donations have to be able to show results, or else the gravy train stops.  A labs division, which may produce one tangible product for every 25 they conceive, seems like a poor investment.  Considering the usefulness of that 4% yield, it’s usually worth the investment.

To use OFA’s example, they now have a database of talk radio programs across the country.  In addition to national programs like the Glenn Becks and Rush Limbaughs, they also have good, current information for regional and local shows.  And don’t forget, OFA still has a massive list of email addresses and – especially important – mobile numbers, which they can filter for voters in a certain state or Congressional district.  So if you live in a district with a competitive House race in September, you could easily get a text message asking you to dial in to your local talk radio show, with the number included.

On the Air is a good innovation, but the underlying technology could have even great applications down the road.  For DNC/OFA donors, this should prove the labs experiment is a successful one.

On the air for government health care

With Congressional Republicans and President Obama putting on a meeting that could make Bill Lumbergh ask you to go ahead and drop hemlock in his coffee, Organizing for America is pushing its supporters to talk radio to advocate the expanded government control of health care.

OFA’s radio site gives users everything they need to be good soldiers  the government health care army.   The site provides a link so advocates can listen into various programs and phone numbers to call in.  If they are having trouble getting through, the advocates can click through to another show’s information quickly.  A “Calling Tips” section prepares them for what to expect and how to deal with hosts that challenge their views; and a clear list of talking points helps them stay on message.

The site – and the tactic of calling in to radio shows – will likely not change a single person’s mind about government health care.  After all, most of the folks  listening to Glenn Beck, Rush Limbaugh, or even news radio probably have their mind made up.  But there are two important possible results that could come of this:

  1. It’s important for any side in a political debate to have voices that come from outside of Washington.  If Harry Reid, Nancy Pelosi, and Barack Obama are the voices of government health care, it is hard for the average voter to identify with their side.  It’s much easier to identify with someone who calls into a news show; for government health care advocates, injecting their views into the debate through the grassroots is vital.
  2. Making the case for personal ownership of health care is not hard, but it’s much more difficult to make that case to someone who has a personal story to tell.  Further, a bombastic conservative talk radio host – with no electorate to answer to in pursuing the goal of entertaining radio – may slip up and insult an opposing caller.  Whether a conservative host is flummoxed by a personal testimonial or overly aggressive, it’s a clip of a voice from the right sounding stupid on health care.  Enough of those clips can indeed change people’s minds.

The key to the site’s success is the “Report your Call” function – something which allows OFA to at once track progress and people.  Remember, the next campaign is just around the corner.

The Year in Google

Google has released their 2009 Zeitgeist report – a summary of popular search trends along various topics.  Lists like this are usually predictable – the most-searched-for baseball team was the Yankees; the alphabet soup of AIG, GM, and TARP led bailout-related searches.

But search results can also give a good concept of popular thinking on key news topics.  For instance, the top term used in healthcare-related searches is “Obama.”  That seems to indicate that, for better or worse, people are closely identifying the President with the health care reform issue.  Also interesting is that the Heritage Foundation was the #5 search term in this category – which could mean that Americans are open to hearing alternatives to what has been circulating on Capitol Hill.

Google also looks at localized search topics for several major cities.  Movie theaters and school websites dominated the results, especially colleges.  In DC, the top term was “fcps blackboard” – the portal for the Fairfax County public school system.  This actually says a lot about the Washington, DC workforce and commuting patterns.  (I knew I had company on my daily commutes into and out of Your Nation’s Capital from Merrifield, but had no idea it was enough to alter search results; Metro clearly needs more trains.)

That education websites are so popular also notes another trend.  Around the Thanksgiving table this year, my soon-to-be brother and sister in law commented that they hadn’t seen their daughter’s recent report card, despite the marking period having ended.  They explained that they just check her grades online.

Pollsters can call voters, ask questions, track answers, and get a pretty good idea of what folks are thinking.  Still, there’s an element of the Heisenberg Uncertainty Principle in that method – that the very act of measuring could affect the responses to poll questions.  Internet searches are somewhat anonymous.

As the old saying goes, you are who you are when no one is watching.