Big news broke over the weekend: Evidently, the president lit a fire under Max Baucus (D-Mont) and the Senate Finance Committee by unexpectedly announcing last week that he'd be laying out his own vision for health care reform this Wednesday. Just weeks ago, committee member Kent Conrad (D-ND) predicted the Finance Committee wouldn't have a bill until November. But Baucus circulated a legislative framework over the weekend.
Baucus's bottom line: There will be no public option. Instead, the government will spend hundreds of billions of dollars to subsidize the same old expensive, inadequate private insurance system that health care reform was supposed to reform. The insurance companies get 46 million new customers, and in return, they will pay higher taxes to offset the cost of the subsidies -- a kickback to Uncle Sam.
Last week Brian Beutler of Talking Points Memo and I sat down to discuss some burning questions in health care reform: What's the president's thinking on the public option? What leverage does he have over the progressives in the House who demand single payer and/or the Blue Dogs in the senate who reject it? Why is Sen. Olympia Snowe (R-Maine) the last best hope for bipartisanship? (The transcript of our discussion has been edited for brevity and clarity.)
You said the [week of September 1] really stood out from the last month in terms of the health care debate. How so?
Maybe the last two days just stood out from the previous month....Obama's approval [rating] slid and popular support for the idea of healthcare reform slid. And August came to an end and the President's vacation is winding down, and suddenly the administration realizes that Congress is coming back and they are going to have to do something. And so, it seems they start leaking to a bunch of high profile reporters that they are going to perhaps ditch the public option as part of a grander move to regain control of the debate.
Are the anonymous leakers saying in so many words that they want to ditch the public option?
Well, it's unclear what they are actually going to do. The Public Option would die with dignity. [If] that is accomplished, the President could maybe win over some Republicans, grab the debate and spell out in clearer terms what he wanted [beyond] the public option. He could do this all in a big speech for Congress which is scheduled to happen Wednesday.
Isn't this just a repeat of what we saw during the week of August 20, when the White House seemed to be doing a good cop/bad cop routine where an anonymous aide would leak "to hell with the liberals and the public option" and then another adviser would say on the record how much the president loves the public option?
It could just be a replay. Once those stories came out, the picture sort of fogged up. [There were] secondary reports that the President was courting Olympia Snowe (R-Maine) again -- as if maybe one Senate Republican would vote with him on health care reform. Snowe's idea [includes a] public option, but you attach it to a trigger mechanism so that it is only enacted if the rest of healthcare reform is unsuccessful at bringing down prices and expanding coverage. And that's sort of been unacceptable to reformers and progressives, but...that might be the pound of flesh that she yields from the bill. It fits in with the picture that the leakers painted...that the public option was no longer going to be one of the key features of the bill.
You wrote about how budget reconciliation could be used to get around the filibuster. How would that work?
The greater problem is the structure in the Senate, where legislation can pass with a majority vote -- but only after Senators have debated the bill for as long as they want. As long as 60 Democrats aren't there to shut the minority up, debate can go on and on and on. [ED note: AKA filibustering.] And for every major piece of legislation you see, this happens....
There's this de facto 60-vote rule on most legislation, at least in this Congress and the previous Congress since the Democrats took it over. It's extremely difficult to pass a bill through just the regular procedure without either having to concede a bunch of substantive provisions...or just give up on the bill entirely. [There are] 59 members of the Democratic caucus right now, and maybe 10 of them are mushy on the more progressive part of the President's agenda. Even if all of them are on board, you're still one vote short of what you need to end debate. And that is why Olympia Snowe matters right now.
So the House would pass the bill and the Senate would pass a bill with budget reconciliation?
They could in theory. Budget reconciliation is sort of like a magic bullet. Every year, the Congress can pass what is known as a budget reconciliation bill. It sets new taxes, or moves money around within the federal budget to basically do what the Congress's budget lays out. It...was made exempt from the filibuster because Congress [has to] set a budget....They need to make sure that money is there and can't have Senators filibustering it just because they're in a fit of peak. So that bill can't be filibustered, but at the same time, the legislation that can be passed in it has to be relevant to the budget, it has to move money around in some way.
So you can pass a lot of elements of healthcare reform in theory -- you can pass subsidies to poor people and middle-income people. And you can pass Medicaid expansion, and you might even be able to pass the public option because the public option may need subsidies of its own and could drive down other costs and be a big moneysaver.
How might the president pressure progressives into accepting the bill?
My sense is that the President [will pressure] progressives to back off on the public option. But that could change. Trying to figure out what is going to happen is kind of like trying to move 23,000 moves ahead in a game of 17 dimensional chess....
[What Obama can] say is that what he's planning will, while not perfect, help a lot of people make the healthcare system more progressive than it was ...But it would really harm the democratic party and his presidency if the whole project failed and nothing passed. Obama doesn't have a tremendous amount of leverage. [Many] progressive members of Congress are progressive because they don't have viable challenges. They come from progressive districts, with constituents like them, approval ratings in the 60s, 70s, and they aren't going to lose to a member of the opposite party. So in that sense, they can do what they want.
How can Blue Dogs say that progressives should suck it up and vote for every bill when they are never prepared to do the same thing?
... It would at least be a good experiment, for the party and the country, for the [Blue Dogs] to be put on the spot. They believe that their jobs are on the line if they vote for controversial legislation. I don't know how those conversations go when political members of the administration confront these guys and say 'You got into politics to make the world a better place, not to just have a tenure job on Capital Hill. So you're going to vote yes on this and if you lose your jobs as a result, then you did the right thing and we'll make sure that the Democratic party infrastructure is there for you....But that's not the way the party thinks. [It's a] game of building an unstoppably large coalition, and that becomes the goal in the end. And at some point you lose sight of why you are amassing this giant congressional majority and you're never willing to say, well we built this 70 whatever majority so that we could sacrifice some of these seats and do something really impressive and progressive for the good of the country.
This post features links to the best independent, progressive reporting about health care and is free to reprint. Visit Healthcare.newsladder.net for a complete list of articles on health care affordability, health care laws, and health care controversy. For the best progressive reporting on the Economy, and Immigration, check out Economy.Newsladder.net and Immigration.Newsladder.net. This is a project of The Media Consortium, a network of 50 leading independent media outlets, and created by NewsLadder.