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BREAKFAST AT PELOSI'S.
Just returned from a small breakfast the Maria Leavey Memorial series put on with House Speaker Nancy Pelosi. This much, I think, was clear: Pelosi is focused on energy legislation She named energy policy as this Congress's "flagship" priority. Cap and trade, she promised, would come to the floor this year, in a bill that she hoped would include not only carbon pricing but heavy investment in renewables and a reform of the energy grid. "I'd like to see it as one bill," she said. "That would show the integrity of it: How each piece relates to the other."
There was less evident interest in health care reform. Pelosi pointedly did not say that a bill would pass this year. "Cap and trade," she predicted, "will be out of committee by May. Health care is bigger ticket."
Asked about the lessons Congress has learned from 1994, she gave a long answer that said rather more about the way she thinks about health care than her strategy for passing it. "It's a whole different world that we live in," she replied. "There's no question that the urgency of health care is felt very strongly by the American people. But the appeal that we will have with this is not to say that 46 or 48 million people don't have health care. That's important to us -- and to those 46 million -- but what's important to the population is their health care." This echoes comments that administration officials have made to me: 95 percent of Obama's voters had health coverage. The margin isn't likely to be different for congressional candidates. The Democratic Party relies on the favor of insured voters, and it doesn't mean to forget that.
Pelosi echoes the Orszag analysis tracing the connections between health care and entitlement spending. "The biggest issue for our budget and for entitlements is that health care increases faster than any other cost," she agreed. "Health care reform is entitlement reform. This is central to our economy."
She also emphasized the need for universal coverage. "Everyone's health care is better if everyone has health care. And that has to be our guiding principle. The wealthiest person in America's health care is better if the poorest person has health coverage."
She admitted that her answer "didn't define how health care is paid for. That's what the President is putting forward." But that's only half true. The budget outline puts up $634 billion in financing over 10 years. That's around half the total that experts expect the bill will need. Congress will have to come up with the rest.
Pelosi was clear on another facet of Obama's role, however. "Outside mobilization, whether grassroots or message is what produces the positive results here." Working the Congress became much easier, she said, when Obama began working the country. She brought this up in context of health care, energy, and general Republican opposition. "It's not about persuading Republicans in Congress. It's about persuading their constituents."
The full transcript will soon appear here.
COMMENTS (26)
How could an internet foodie blogger not tell us what was for breakfast?
I wouldn't place too much weight on the relative priority of energy/environment vs health care from what Nancy said. She's good at listening to both the administration and her caucas, and she'll respond to that emphasis.
I suspect that she's trying to get energy/environment back to equal par with healthcare legislatively since Obama's team emphasizes healthcare and really hasn't put any cards on the table on energy/environment yet.
I'd bet healthcare comes first, because that's Obama/Orszag's push. And for good reason: that issues cuts in the voters more today than any other big issue, and there's momentum from interest groups to push it real soon now.
Posted by: JimPortlandOR | March 3, 2009 11:55 AM
Oh, and NO ONE in the Dem. party wants healthcare to be still in the air for the 2010 elections. That's the key way to hurt the GOP and irresolution would play to the divisions the GOP likes to exploit.
Also, energy/environment will impact the economy somewhat negatively in the short run (2010-2012) because it requires lots of investment with little short run return. I think Obama wants the recovery underway before he tackles that problem, whereas healthcare can be positioned as part of the recovery measures.
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Posted by: JimPortlandOR | March 3, 2009 12:01 PM
"Everyone's health care is better if everyone has health care. And that has to be our guiding principle. The wealthiest person in America's health care is better if the poorest person has health coverage."
Unless I'm missing something, I don't think that's true. The traditional argument for universal health care is the adverse-selection argument: the smaller the risk pool, the riskier the average customer in that pool. In a certain sense, then, Pelosi is right: the more insured people you have, the better off everyone is.
But wealthy people *don't need* insurance. If they get sick, they just pay 100% out of pocket. So I don't think it's right to say that the wealthy are better off when the poor are better off; I think it's correct to say that the wealthy *insured* are better off when the poor *insured* are better off. ... Even then, I'd want to add some qualifiers.
For that reason, I think it'll be hard to convince the wealthy to support health-insurance reform out of self-interest.
In "The Great Risk Shift," Hacker noted that income variability in a given person's lifetime is quite high, as measured by the probability that a randomly selected person would experience a large percentage (say, 25% or 50%) swing in annual income during his lifetime. If this is the case for wealthy people, then they'd support income stabilization out of pure self-interest. (This is just Rawls: support maximin because it could happen to you.) To the extent that the wealthy *don't* experience big income shocks, they'll be less likely to support a stronger welfare state.
That's the story I'm running with for now, anyway.
Posted by: Steve Laniel | March 3, 2009 12:08 PM
She's "focused on energy" Why, you blithering fucktard. She's focused on the highlights in her hair, her botox, and her dental veneers. There's not much time or energy for a seventy year old to do much beyond that.
Posted by: Anonymous | March 3, 2009 12:20 PM
Her focus on energy may just be a sage division of labor. The Senate has, collectively, been pretty clear that it is going to run things on the Health Care side. So Pelosi decides that the House will just go along with whatever compromise the Senate reaches.
That frees up Waxman to put his time into climate change, an issue on which the Senate is so sluggish that Lieberman is considered a visionary. The House's hope is that the Senate, seeing that the House is putting more resources into climate change than it could possibly hope to, will sense the urgency and treat the House's climate change bill as an anchor, rather than as something to be watered down and fiddled with.
It'll be interesting to see if it plays out like this.
Posted by: tom veil | March 3, 2009 1:05 PM
Its totally false to imagine that the "wealthiest persons" health is separate from the "poorest uninsured person"--the main health issues for people aren't spontaneously generated or merely genetic but often relate to epidemics, pandemics, socially transmitted diseases which freely cross class barriers. In addition wealthy people benefit enormously from advances in medical science and technology which are tested on the poor and desperate. No mass trials of drugs and technology no new approvals and no high cost life saving surgeries. The wealthy need teaching hospitals but there is no way that the wealthy alone can pay for them.
In addition, and this is an important point that NYCeve has made over and over again at dkos, even the insured are really underinsured. You often don't know it until you need something covered and you find out that its not. And of course the insured don't have the freedom to move between insurers so there is no rectifying the original choice, generally made by your employer, when you discover that your insurance doesn't cover you.
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Posted by: aimai | March 3, 2009 1:23 PM
I sort of agree with you Steve, but your argument falls apart when you factor in the ER. 14% of the people in front of your wealthy patient are there for a chronic condition that could've been treated with better case management in a medical home (Health Affairs, 28, no. 1 (2009): 26-35). Another 12% in front of you are on Medicare and Medicaid (under-insured, as opposed to un-insured) and there for a chronic condition which, again, could've been treated with better case management in a medical home. That's more than 1-in-4 of the people in front of the wealthy patient being in the ER as an preventable admission, slowing down service and care. If those people had better insurance coverage, your wealthy patient would get in the door that much faster.
I know that's sort of an esoteric argument to try to sell to the people up in Greenwich, but very real.
Posted by: ThomasEN | March 3, 2009 2:01 PM
Pelosi is much, much smarter than CW gives her credit for, and cap-and-trade (or a carbon tax) is gonna be a virtuous revenue source (like tax on cigarettes) to answer the long-term budget deficit, so staging it before the health care debate is a good idea.
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