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THE CONSENSUS-DRIVEN LIFE.
The two health care scoops I've had in the last week -- that the Obama administration expects the legislation they sign to cap or otherwise reform the employer deduction and to pursue universality through an individual mandate -- have both, to my frustration, been understood as gotchas. The Obama campaign said one thing -- though in both cases, they hedged during the campaign -- and the Obama administration will end up doing another. But the larger story here is not what Obama said in the campaign. It's what he's signaling to Congress.
In 1994, Bill Clinton built himself a brand new health care plan. It wasn't similar to anything proposed in Congress. It didn't look like George Mitchell's health care plan or Jim Cooper's legislation. (It was like something John Garamendi had proposed in California, but few knew about that.) Managed care amidst managed competition was a new theory. A smart theory, maybe, but a new one. Every Congressman had to understand, and then be convinced of, an idea they weren't previously committed to. That meant the process required more time and began with fewer allies.
Conversely, Obama is moving into alignment with the preexisting center of the health care reform debate. The individual mandate has conquered the Senate. It is in Ron Wyden's bipartisan Healthy Americans Act. It is in Max Baucus's White Paper. Today, CBO director Doug Elmendorf testified that "near-universal coverage" -- the CBO is more careful than politicians -- "would require mechanisms for pooling risks, subsidies to make health insurance less expensive, and an enforceable mandate." (Read his prepared remarks, which go into much more detail, here).
Similarly, reforming the employer tax exemption is widely understood to be not only a crucial source of new money for health reform but an important step forward in rationalizing the health system as a whole. It is, again, in Ron Wyden's bipartisan Healthy Americans Act. It is, again, in Max Baucus's White Paper. And it was, again, mentioned by Doug Elmendorf in his testimony this morning. In fact, it was mentioned by Wyden and Elmendorf at once. "Wouldn't it be possible," Wyden asked, "to generate additional revenue that would be progressive in nature and also serve as a disincentive to inefficient spending by reforming the federal health tax laws?" Elmendorf's reply was one word: "Yes," he said.
Obama is signaling support for the congressional consensus. The skeletal health plan outlined in tomorrow's budget has been built to fit the work Congress is already doing on health care reform. As such, it will being with committed allies. It will not lose time defining new concepts to skeptical committee chairs. It will respect and support the existing legislative coalitions It is a strategy aimed at ensuring votes. At passing legislation. At achieving consensus, or as close to it as the Senate can come.
COMMENTS (8)
His opposition to a mandate during the primary did seem to me to be -- in part anyway -- driven by his desire to stand out from the crowd (both Clinton and Edwards incorporated mandates into their plans.) And he got to do his favorite thing: come at a progressive issue ("universal health care") from a conservative direction ("government shouldn't be in the business of forcing us to get coverage...")
Posted by: Todd | February 25, 2009 3:24 PM
So you have a de facto tax increase on the rich to pay for expanded coverage. When exactly do these efficiency provisions kick in? And I thought health reform was about fiscal responsibility. There is nothing fiscally irresponsible with expanding the size of government but there is nothing responsible about it either.
Posted by: gordon gekko | February 25, 2009 3:33 PM
I'd say the frustrating thing about this pot - and with the speech last night - is the considerable lack of detail: it's meaningless to say "the plan will include a universal mandate" or "the plan will set limits on the employer tax benefit" absent the context of a full plan, never mind that "increased efficiencies" is all but useless at defining anything. There's differences between embracing Baucus or Wyden, and there's still plenty of questions if you go with either, ones that I think are probably being avoided, for now, by shrouding everything in as little content as possible. On their own, I don't know if one can say "I'm opposed to a mandate" or to limiting the tax exemption; in the context of what else is planned... well, that's the catch. I'm in favor of a "reform agenda", and I think probably all one can do for now is wait... but I think it's concerning that what we are getting is beyond vague, and really, so far, doesn't provide much to make sense of; I remain concerned that because we deal in vague generalities of "the health care crisis" we leave people plenty of reason to object later when the details become clearer and the overall context is more plain. Understanding health care - indeed understanding why "health care" and "health insurance" are not the same issues and one does not solve the other - I think cries out for specifics, for details, for clear explanations. Progressives are really not laying that groundwork... nor, really, did that speech do a lot of the heavy lifting last night. And this matters, especially since it appears, as much as anything can right now, that this is going to be a big, full-on shift. People shouldn't have to (and shouldn't be expected to) decide whether to like such major change absent a good understanding of what and why.
Posted by: weboy | February 25, 2009 4:11 PM
Ezra,
This is a little too much "have your cake and eat it too." Its one thing to have stated a policy position durign the campaign and now support a new one. Its another to actively campaign against a policy idea within the last year and now be supporting it. This was Obama being a politician looking to win, and that's OK. But its also OK to call him out on it.
Your "hedged" point is the key one-- its likely that he actually supported both ideas at the time, privately, but chose the alternative path to have a more politically advantageous position. Again, that's OK, but so is pointing that out down the road. Its a pretty fair "gotcha" to me.
Posted by: wisewon | February 25, 2009 4:14 PM
President Obama falsely conflated the need for cost control and his proposal for health care reform. Unfortunately rhetoric aside, the mainstream inside-the-Beltway allowable proposals, including Obama/Baucus and Wyden, etc do NOT control costs. They actually explode costs. Nor do they get to 100% universality in coverage, and they are very bad in terms of comprhensiveness or quality of coverage.
Furthermore Wyden, and other plans that "reform" (aka: reduce) the tax credit while pushing to buy more private health insurance, just shift the total cost increase from the Federal Government back to States, employers and individuals. CBO and GAO may call it budget neutral or beneficial, but that is only to the Federal Governement purse. Since total costs go up, those costs are even more dumped on everybody else.
It may seem strange to some who don't follow this closely, but the "single payer" and "medicare for all" proposals such as from Rep. Peter Stark and John Conyers are actually the economically sensible, fiscally conservative proposals, that really do control costs.
Don't take my word for it. That is according to Commonwealth Fund and the Lewin Group, which do not support single payer/Medicare for All (they push their so-called Building Blocks proposal which is essentially the same as Obama/Baucus).
See:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=777197
See also:
http://www.dailykos.com/story/2009/2/25/85211/4019/280/701460
Peace & Health
Posted by: steve | February 25, 2009 4:24 PM
It is very hack-ish of you, Ezra, to write about this and not once mention Hillary Clinton. Who can forget the famous "Shame on You!" Hillary speech when Obama released anti-mandate mailers in Ohio?
Mr. Obama should apologize to Mrs. Clinton. And you should stop making excuses for his flip-flops and broken promises.
Posted by: D.K. Jamal | February 26, 2009 11:52 AM
On the money as usual Ezra. The stars have moved into alignment on healthcare and Obama is going to ride the wave to victory. Even the Republicans know it. And all the gophers waffling on about apologies to Clinton and similar bs lift your eyes off the tree and take a look at the forest for godsake.
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