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Cover 40 million? 20 million? Individual mandate? No mandate? Can the White House really be this uncertain about their strategy at this point? They schedule a big speech without having a clear idea of what they are going to say? ... P.S.: At least they aren't giving off an air of semi-desperation by leaking quotes like, "It's so important to get a deal ... He will do almost anything it takes to get one." ... Oh. ....[via RCP] 1:49 P.M.
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1) U.K. Telegraph: Not a death panel but a death pathway. ...
2) The obvious weak spot in Dick Morris and Eileen McGann's argument that Obama has "no good options" on health care is this:
If Obama waters down his proposals to attract moderate support, he'd lose votes on the left -- perhaps more than he'd gain, at this point.
Left-Dems are going to kill a watered-down health bill? I don't believe it. Do you? ...
3) Still, the best evidence that Obama's health reform might be sliding down the Liverpool Care Pathway is his decision to address a joint session of Congress next week. Obama can give one more of these stunt speeches, maybe, before their effectiveness is radically diminished. Why do it now? Especially when he doesn't seem to have anything new to say. ... And when his last attempts mainly proved that what Politico calls "the most gifted explainer of anyone to occupy the Oval office since Reagan or Roosevelt" (please) was stunningly ineffective as a salesman--especially when it came to reassuring seniors worried about rationing. ... When even if Obama is atypically persuasive the best that will happen, in the ensuing days, is that the bill will get out of a Senate committee, leaving a long slog ahead. ...
It's possible that White House aides are deluded about Obama's persuasive powers. It's possible that they're deluded about the impact of invoking Senator Kennedy's legacy two weeks after his death.
It's also possible that they aren't deluded, and they know that despite all the optimistic stories planted in the MSM, they are in big trouble--that public support has fallen dangerously low. ... The speech itself seems a sign of weakness. ... Update: Implausible but inventive alternate theory.
4) Two new things Obama should do in his speech that he probably won't: a) Offer a strong assurance of no rationing, under some reasonable and simple definition--strong enough assurance that it could be used as a weapon against future attempts at NHS-style cost-cutting. Suggested line: "Every treatment that I, as President, would get, you will be able to get under Medicare."** b) Answer the demands for hope by describing the world of wondrous medical cures that science will make available under his health plan (rather than implying that scientific progress is kind of annoying because it might cost the government money). ...
P.S.: Gloria Borger says
.. it's curious that the White House allowed the public plan to become such a centerpiece of the debate when it actually isn't.
No it's not curious. Not if the idea has always been that the White House can dramatically throw it overboard and seem moderate. Duh.. ...
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**--A repeat recommendation. Based on a line from Michael Kinsley. ... I can't help but feel that the reason the President doesn't effectively rebut the "rationing" argument is that he kind of believes we have to move toward rationing. But couldn't he fake it? ... 12:38 A.M.
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Jon Alter's latest column--calling for health care to be treated as a "civil right"--brings up an underdiscussed question: In a single payer plan, would health care be treated as a constitutional entitlement that couldn't be taken away without "due process" under the Warren Court's so-called "New Property" doctrine? My Con Law knowledge is a few decades out of date--but the doctrine covered welfare benefits, guaranteeing a hearing to individuals before they could be denied. Why not health benefits? ...
Isn't it possible, then, that rules produced by Orszag's cost-cutting IMAC board preferring some treatments over others, or some patients over others, would be hamstrung by constitutional proceduralism? Maybe sick patients who want disfavored Treatment X would sue and demand an individualized hearing before their "right" to that treatment could be denied.
And if the "New Property" operated to constitutionalize treatment rights in a single payer system, would the same doctrine apply to a so-called "public option" plan that competed with private plans in a health insurance "exchange"? If not, maybe a government-run "public option" would have an efficiency advantage over government-run single-payer. It wouldn't have to worry about all those hearings.
In fact, the more I think about the "public option" idea, the more it appeals to me--not because it's the "thin end of a wedge that will move the system" towards single payer, as Clive Crook summarizes it, but because it seems superior, in some respects, to single-payer.
1) Obama sells the "public option" as a way to "keep the private insurers honest." But the converse effect might be more important: the private insurers in the "exchange" would keep the "public" plan honest. Sure, in this marketplace the government plan will probably get the lion's share of customers. It will offer more security, for one thing. But if it starts to provide lousy service, or excludes too many treatments, the private plans might start to lure some of those customers away. Private insurers would provide an escape valve--an "exit"--unavailable in single-payer government monopoly. The obvious analogy is to private "charter" schools competing with public schools.
2) Likewise, if the public insurers managed succumbed to cost-bloat--if all the people who washed the laundry in hospitals became unionized, for example, and politicized government plans blithely passed the giant resulting bill on to their customers (not wanting to anger the SEIU and other good Dem supporters)-- the private sector might underbid the public plan and 'bend the cost curve' down! Again, that's something that probably wouldn't happen in a single payer scheme; and
3) As discussed, "public option" might help avoid having every "we won't pay for this treatment" decision become a constitutional issue in a way a universal, single-payer entitlement couldn't.
I'm not saying all the differences between the two sorts of plans would cut against single payer--some days it seems completely appropriate to handle treatment decisions as a constitutional matter, since lives are at stake. If a single payer plan is, as a result, less able to deny treatments, that could be a feature, not a bug.
I'm just saying the differences between the two forms of "government" plan have been blurred (mainly by the right), that some of those differences may favor the "public option," and that Obama may be missing a bet in failing to defend the "public option" by pushing off against government-run single payer plans of the left rather than by pushing off against the greedy, evil private insurance companies.
Triangulation--something that lets Obama seem a centrist--helps at this point, right? Or are voters worried that he's insufficiently fond of unchecked government dominance? ... 3:18 A.M.
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kf Gets to Yes! I tend to favor a public option--at least it seems worth trying. Meanwhile, private insurance companies think it will put them out of business. But why is this fight not susceptible to a tradtional hack form of compromise: let half the states** try a public option, if they want, the rest stick with the private sector or co-ops? Then liberals are happy and the insurance companies are happy. The issue can be revisited in a few years when we see what happens. ... You're welcome. ... Now we can move on to the more presssing problem--getting Orszag's disturbing treatment-denying "game changers" out of the bill so public support doesn't collapse so completely that passage of anything becomes impossible. ..
**--or states representing half the population. 5:59 P.M.
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