White House to Abandon Public Option?

[Dominus Atheos]

The stupidity is staggering:

"I don't understand why the left of the left has decided that this is their Waterloo," said a senior White House adviser, who spoke on the condition of anonymity. "We've gotten to this point where health care on the left is determined by the breadth of the public option. I don't understand how that has become the measure of whether what we achieve is health-care reform."

"It's a mystifying thing," he added. "We're forgetting why we are in this."

Another top aide expressed chagrin that a single element in the president's sprawling health-care initiative has become a litmus test for whether the administration is serious about the issue.

That's because without the public option there is no "reform" since you aren't making any actual changes to the system, you're just forcing people to buy private insurance regardless of the cost!

I for one would rather have the current proposals fail, since at least with the current system if the insurance costs too much I can just refuse to buy it.

[Darth Wong]

I'm looking forward to MKSheppard's evidence for his assertion that adopting a British style healthcare system would increase costs on the government.

He's just bring a rightard. Did you notice that all of his proposals for improvement involve making life easier for the corporations which currently provide these services? None of them involve guaranteeing anything for the people.

[Stark]

It almost sounds like the 'staffers' and 'aides' are the same on both sides.

[MKSheppard]

He's just bring a rightard. Did you notice that all of his proposals for improvement involve making life easier for the corporations which currently provide these services?

Of my ideas, only #1 and #5 would make life easier for corporations (tort reform + reform of insurance regulations)/

#2 and #4 don't directly affect corporations; since those are aimed at increasing the supply of trained medical personnel through various means; though I have to admit I did not know about there already being nurse practicioners who can perform light surgery, etc - thanks for that, Pablo.

While #3 would be bitterly hated by the corporations -- putting restrictions on how many hours an intern can be on duty? What? You mean we can't overwork our interns to save money? THE WORLD IS COMING TO AN END!

[Vympel]

Glenn Greenwald weighs in on the healthcare debate in his usual insightful manner, after the insipid White House anonymous comments referred to above

Why the health care debate is so important regardless of one's view of the "public option"

The New York Times today has a discussion from several contributors, including me, of the politics of the health care debate. My contribution, which focuses on the role the White House has played and the ample evidence that they have been quite active in shaping the course of events, can be read here. I want to elaborate on a couple of points I referenced in passing.

Over the past decade, the Democratic Party has specialized in offering up one excuse after the next for its collective failures. During the early Bush years, the excuse was that they endorsed Bush policies because his popularity and post-9/11 hysteria made it politically unwise to oppose him. In later Bush years when his popularity plummeted, the excuse was that Democrats were in the minority and could do nothing. After 2006 when they won a Congressional majority, the excuse was that Bush still controlled the White House and had veto power. After 2008 when a Democrat won the White House, the excuse was that Republicans could filibuster.

Now that they have a filibuster-proof majority, a huge margin in the House and the White House, the excuses continue unabated, as Democrats are now on the verge of jettisoning one of the most significant attractions for progressives to the Obama campaign -- active government involvement in the health insurance market. The excuses for "compromising" are cascading more rapidly than ever: We need Republican support to ensure it's bipartisan. The Blue Dogs won't go along with what we want. Centrist Senators will filibuster. There are similar excuses being made to defend Obama from accusations that he deserves some of the blame for the failure of the "public option." Matt Yglesias makes the typical case for shielding Obama from any responsibility:

I think there’s something perverse in the very strong desire I see among liberals to make problems in congress be about anything other than congress. It’s just not in the power of Barack Obama to make the senate anything other than what it is.

I'm really surprised that there's anyone, especially Matt, who actually believes this -- that the Obama White House is merely an impotent, passive observer of what the Democrats in Congress do and can't be expected to do anything to secure votes for approval of the health care bill it favors. As the leader of his party, the President commands a vast infrastructure on which incumbent members of Congress rely for re-election. His popularity among Democrats vests him numerous options to punish non-compliant Democrats. And Rahm Emanuel built his career on controlling the machinations within Congress. The very idea that Obama, Emanuel and company are just sitting back, helplessly watching as Max Baucus, Kent Conrad and the Blue Dogs (Rahm's creation) destroy their health care legislation, is absurd on its face.

When it comes to defiant progressive members of Congress -- as opposed to supposedly defiant Blue Dogs and "centrists" -- the Obama White House has proven itself extremely adept at compelling compliance with the President's agenda. Consider what happened when progressive House members dared to oppose the war supplemental bill which Obama wanted passed:

The White House is playing hardball with Democrats who intend to vote against the supplemental war spending bill, threatening freshmen who oppose it that they won't get help with reelection and will be cut off from the White House, Rep. Lynn Woolsey (D-Calif.) said Friday.

"We're not going to help you. You'll never hear from us again," Woolsey said the White House is telling freshmen

When progressives refuse to toe the White House line, they get threatened. Contrast that with what the White House does with Blue Dogs and "centrists" who are allegedly uncooperative on health care -- they protect them:

The Politico’s Jonathan Martin reported this morning that Rahm Emanuel warned leaders of liberal groups in a private meeting this week that it was time to stop running ads attacking Blue Dog and "centrist" Dems on health care.

I'm told, however, that Emanuel went quite a bit further than this.

Sources at the meeting tell me that Emanuel really teed off on the Dem-versus-Dem attacks, calling them "f–king stupid." This was a direct attack on some of the attendees in the room, who are running ads against Dems right now.

What does that vast disparity reveal? If anything, Blue Dogs -- virtually all of whom represent more conservative districts -- are more vulnerable and thus more dependent for re-election on the White House and Democratic Party infrastructure than progressives are. If health care fails and the Obama presidency weakens, they will bear the brunt of the voters' desire to punish Democrats. The White House would have at least as much leverage to exercise against Blue Dogs and centrists. They just aren't doing so. In fact, they're doing the opposite: they're protecting them even as they supposedly impede what the White House wants on one of Obama's signature issues.

This isn't to say that Obama can single-handedly control what Congress does. It's possible that even with maximum leverage exerted, a President can still lose. But there isn't any leverage being exerted against anti-public-option "centrists" and Blue Dogs. There's just no effort being made. The White House seems perfectly content with what the centrists and Blue Dogs have done thus far; the only anger they have shown, as usual, is towards progressives who are demanding robust reform.

* * * * *

A related (and in my view equally unpersuasive) excuse was offered by The Washington Monthly's Steve Benen, who seems to take seriously the claim that Democrats have been compromising so much because they wanted to attract substantial GOP support for health care. Steve correctly points out why such an expectation is ludicrous: "Senate Minority Whip Jon Kyl (R-Ariz.) announced that Republicans will reject reform no matter what's in the bill. . . . Negotiating health care reform with politicians who oppose health care reform doesn't make sense. Negotiating reform with politicians who've vowed to vote against reform under any circumstances is insane."

That's obviously true. In fact, it's so obviously true that no matter how dumb one might think Democrats are, they're certainly not so dumb that they failed to realize that the GOP was highly unlikely to help Obama pass health care reform no matter what the bill contained. From the start, it's been obvious to everyone -- the Obama White House and Senate Democrats included -- that the GOP would not help Obama pass health care reform. Why would the GOP want to help Obama achieve one of his most important and politically profitable goals? Of course they were going to try to sabotage the entire project and would oppose health care reform no matter what form it took. Everyone knew that from the start for exactly the reason that it was so obvious to Benen.

The attempt to attract GOP support was the pretext which Democrats used to compromise continuously and water down the bill. But -- given the impossibility of achieving that goal -- isn't it fairly obvious that a desire for GOP support wasn't really the reason the Democrats were constantly watering down their own bill? Given the White House's central role in negotiating a secret deal with the pharmaceutical industry, its betrayal of Obama's clear promise to conduct negotiations out in the open (on C-SPAN no less), Rahm's protection of Blue Dogs and accompanying attacks on progressives, and the complete lack of any pressure exerted on allegedly obstructionists "centrists," it seems rather clear that the bill has been watered down, and the "public option" jettisoned, because that's the bill they want -- this was the plan all along.

The Obama White House isn't sitting impotently by while Democratic Senators shove a bad bill down its throat. This is the bill because this is the bill which Democratic leaders are happy to have. It's the bill they believe in. As important, by giving the insurance and pharmaceutical industries most everything they want, it ensures that the GOP doesn't become the repository for the largesse of those industries (and, converesly, that the Democratic Party retains that status).

This is how things always work. The industry interests which own and control our government always get their way. When is the last time they didn't? The "public option" was something that was designed to excite and placate progressives (who gave up from the start on a single-payer approach) -- and the vast, vast majority of progressives (all but the most loyal Obama supporters) who are invested in this issue have been emphatic about how central a public option is to their support for health care reform. But it seems clear that the White House and key Democrats were always planning on negotiating it away in exchange for industry support. Isn't that how it always works in Washington? No matter how many Democrats are elected, no matter which party controls the levers of government, the same set of narrow monied interests and right-wing values dictate outcomes, even if it means running roughshod over the interests of ordinary citizens (securing lower costs and expanding coverage) and/or what large majorities want.

* * * * *

That's why this debate has now taken on such importance -- regardless of whether you think a public option is important or even if you think it's a good idea. Thanks in large part to the months-long efforts of Jane Hamsher and her FDL team -- who spent enormous amounts of time and resources getting large numbers of progressive House members to emphatically commit on video to opposing any health care bill that lacks a robust public option -- there's actually a chance this time that the outcome could be different. If those progressive House members actually adhere to their pledge, they can and will block any health care bill that lacks a public option. They can actually thwart industry demands and the dictate of Beltway leaders; can empower a new faction in Washington (themselves) beholden to different interests (ordinary citizens); and can vest some actual significance in the outcome of the 2006 and 2008 election.

Along with several other blogs, Jane and FDL are sponsoring a fundraiser to reward, and embolden, those progressive members who have made that pledge, and it raised an extraordinary sum of close to $150,000 in just a couple of days. Those interested can donate here. Rachel Maddow's lead segment last night was a discussion with Jane regarding the political significance of the health care debate and the possibility that progressives could actually prevail on something of significance for once.

The Washington Post today quotes an "anonymous White House official" excoriating what he condescendingly calls "the left of the left" for petulantly demanding a "public option." That article notes that the Obama White House is surprised by the intensity of progressives' insistence that the bill include a "public option," and who can blame them for being surprised? Ordinarily, progressives are told that they cannot have what they want because Blue Dogs and Republicans (on behalf of the industries that own them) must get what they want, and progressives meekly accept that because it's "better than nothing" (don't let the Perfect be the Enemy of the Good, they are lectured). More than anything else, it's vital that this dynamic change. Such a change -- a shift in Beltway power dynamics -- would be far more consequential even than the specific health care policy issues at stake in this debate.

In other words, the White House never gave a fuck about single-payer (which was written off immediately) or public option. They're not stupid, they just always intended to suck industry cock.

[Stark]

But does that make any sense politically? What would they lose by actually doing something decisive with their power?

[Vympel]

But does that make any sense politically? What would they lose by actually doing something decisive with their power?

The health insurance industry, I imagine.

[Stark]

So you figure they're just massively corrupt, and that a US government with a majority would never seriously attempt to do anything about this?

I say we have to invade and bring democracy to America.

[Darth Raptor]

I wonder if they're just so out of touch with actual poor people that they think the issue isn't that health insurance tends to either be unaffordable or basically useless (sometimes both!), but that people just aren't buying it because they're irresponsible. Only in that universe does making it mandatory ala car insurance make sense.

Or, you know, they're just industry pod people.

[Elfdart]

So you figure they're just massively corrupt, and that a US government with a majority would never seriously attempt to do anything about this?

I say we have to invade and bring democracy to America.

Please do.

Matt Taibbi nails it:

Now, obviously (and this is will be explored in more detail in the forthcoming piece, which will be out this week), the public option was not a cure-all. In fact, the Democrats had in reality already managed to kill the public option by watering it down to the point of near-meaninglessness. But the notion that our president not only does not have any use anymore for a public option, but in fact “will be satisfied” if there is merely “choice and competition” in the market is, well, disgusting.

I’ll say this for George Bush: you’d never have caught him frantically negotiating against himself to take the meat out of a signature legislative initiative just because his approval ratings had a bad summer. Can you imagine Bush and Karl Rove allowing themselves to be paraded through Washington on a leash by some dimwit Republican Senator of a state with six people in it the way the Obama White House this summer is allowing Max Baucus (favorite son of the mighty state of Montana) to frog-march them to a one-term presidency?

To quote Method Man’s Calvin “Cheese” Wagstaff character from The Wire, “This is some shameless shit right here.”

Ed Schultz and Dennis Kucinich also get it:



What we have is a weak, half-hearted effort on behalf of weak, half-hearted reform.

[Vympel]

Perversely, some are noting that the White House trying to throw the public option under the bus was just what health reform needed - because it has pissed the the left the fuck off and all of a sudden the story is not about the rabid town hall assholes, but about pissed off progressives (i.e. the liberal base of the Democratic party) - and not in a dismissive "oh well they shouldn't govern from the left" Villager bullshit way - you know, what progressives have been putting up with since Clinton. There's some genuine fear of the progressive wing. Fuckin good.

Digby

Digby 2

[SirNitram]

[Obama Fanatic]See! He's just THAT GOOD he knew how to put the fear of LIBERALISM into people![Fanatic]

[bobalot]

Hey MKSheppard, I'm still waiting. Are you going to provide some evidence that a British style system would cost the U.S government more or are you going to keep avoiding the question?

[MKSheppard]

If we assume that a government run health care would cost about $2,952 per capita (average of all your stuff on that list bobalot); then that means that providing health care to 300 million americans would cost about $885 billion.

Now; we can safely assume that this would replace government outlays in Medicare, Health, and the VA that are already existing.

Problem is......

Link to Census Bureau's Statistical Abstract of the US
Table 455

Medicare is $375.4 billion
Health spending directly linked to health care for people is $233.9 billion
Hospital and medical care for veterans is $32.3 billion

That's $641 billion we can hack off the price of the FHS (Federal Health System/Service), leaving us with a net shortfall of $244 billion.

Where is that money gonna come from?

If you look at Table 455 above; you'll see there are only two categories which can be reduced:

Social Security: $586 billion
National Defense: $552.6 billion.

Both are politically uncuttable; at least as long as there's a war in Afghanistan to be won; and who wants to hear from their constitutents that Granpa's SSI check was cut by half?

Well, you could increase taxes; but that's political suicide, especially in today's GRIMDARK ECONOMIC TIMES.

Added to this is the fact that we're about to be flooded with a tidal wave of baby boomers which will strain Social Security, and drive the outlays for it up big time.



Plus as we all know, old people are goddamn expensive relatively speaking, to keep healthy compared to a younger person; so this will place even more strain on the FHS.

So yeah, FHS is definitely not a good thing.

PS Bobalot, you can suck my dick.

[Uraniun235]

Well, you could increase taxes; but that's political suicide, especially in today's GRIMDARK ECONOMIC TIMES.

That's what should really happen anyway. I'm not sure what the best system would be for that (i.e., as a withholding from paycheck? as a tax on employers only, the idea being that the money that would have gone to private is instead going to public? I don't know) but if the federal government is going to spend more (on a permanent basis) then it should (try to) increase tax revenue to match.

[Darth Wong]

He's just bring a rightard. Did you notice that all of his proposals for improvement involve making life easier for the corporations which currently provide these services?

Of my ideas, only #1 and #5 would make life easier for corporations (tort reform + reform of insurance regulations)/

#2 and #4 don't directly affect corporations; since those are aimed at increasing the supply of trained medical personnel through various means; though I have to admit I did not know about there already being nurse practicioners who can perform light surgery, etc - thanks for that, Pablo.

While #3 would be bitterly hated by the corporations -- putting restrictions on how many hours an intern can be on duty? What? You mean we can't overwork our interns to save money? THE WORLD IS COMING TO AN END!

Increasing the supply of medical practitioners would make life easier for the corporations supplying these services. Setting limits on intern overwork is the only thing you suggested which is neutral, and as I said before, NONE of these things involve GUARANTEEING ANYTHING FOR THE PEOPLE, which is the part of my post that you conspicuously snipped out when you quoted me in your reply.

[PeZook]

Shep, all national health care systems provide a public insurer. For example, in Poland every employed person pays a premium automatically deducted from their checkque, according to earnings. In order to raise the 244 billion you need, you'd need to offer premiums worth 1572 bucks (on average). Quite a bit for a McWorker with 12 000 a year, but that's why you weigh it towards the high earners.

That doesn't factor in the efficiency saving from merging all the various fucked up funding systems into a single payer.

[Darth Wong]

Where is that money gonna come from?

If the US government adopted a single-payer system, increased taxes would be a perfectly reasonable giveback for the fact that private corporations' operating overhead will be greatly reduced by the elimination of the need to pay for all the health care of their employees.

Well, you could increase taxes; but that's political suicide, especially in today's GRIMDARK ECONOMIC TIMES.

The socio-political stupidity of the average American citizen is a problem, yes. But let's not mistake it for anything other than what it is: stupidity.

[Lusankya]

If we assume that a government run health care would cost about $2,952 per capita (average of all your stuff on that list bobalot); then that means that providing health care to 300 million americans would cost about $885 billion.

The US already spends $2,728 per capita on public financing of healthcare anyway. In fact, the only OECD countries that spend more public money on healthcare are Norway, Iceland and Luxembourg (Iceland is only barely more than the US).
(A PDF with my information in it)

Anyway, even if we assume that we need to use your $2,952 per capita number (though I really don't know why, since that would be more than the total per capita healthcare spending of over half of the OECD), that would mean that you'd have to find $200 per person to spend on healthcare. $200x300 million = $60 billion dollar shortfall, which is only a quarter of your estimate.

[PeZook]

Lusankya, except only 155 million Americans or so are workers, the rest are either dependents of their families or the state.

[KlavoHunter]

Plus as we all know, old people are goddamn expensive relatively speaking, to keep healthy compared to a younger person; so this will place even more strain on the FHS.

So yeah, FHS is definitely not a good thing.

I asked you on AIM and you went silent; Why NOT bring the rest of the relatively cheaper, younger, healthier population onboard? Their costs should be far, far less than old people with their failing bodies.

[aerius]

Shep's missing a big piece of the puzzle here, Americans are currently spending $5700 per person per year on healthcare, and that money is being sucked up, offshored, paid into executive bonuses, and blown in the stock market to chase better "returns" for the insurers' assets. A lot of it ain't getting taxed and most of it isn't doing anything productive, it's a drain on the economy & productivity much like the banking industry is these days.

So let's say we go with a public option that costs $3000 a person, that'll free up $810 billion to circulate around in the economy, which means the government gets to tax it and collect money off it. I'd be shocked if the government can't get an additional $200-300 billion in revenues off it.

[bobalot]

If we assume that a government run health care would cost about $2,952 per capita (average of all your stuff on that list bobalot); then that means that providing health care to 300 million americans would cost about $885 billion.

Now; we can safely assume that this would replace government outlays in Medicare, Health, and the VA that are already existing.

Problem is......

Link to Census Bureau's Statistical Abstract of the US
Table 455

Medicare is $375.4 billion
Health spending directly linked to health care for people is $233.9 billion
Hospital and medical care for veterans is $32.3 billion

That's $641 billion we can hack off the price of the FHS (Federal Health System/Service), leaving us with a net shortfall of $244 billion.

Where is that money gonna come from?

If you look at Table 455 above; you'll see there are only two categories which can be reduced:

<snip>

PS Bobalot, you can suck my dick.

It's funny, I simply ask you to back up your statements, and you ask me to suck your dick. Is this macho internet tough guy shit supposed to impress people?

As well as obviously compensating for something, you are dishonest as well. You have posted $641 Billion in Federal costs, you fail to mention how much the states spend. You may argue that I was only arguing in terms of federal costs, but that would make you a evasive shit, because the main thrust of this entire debate over UHS is it will cost the country less (it's government, State & Federal). You are quite well aware of that.

Using Table 124 of the same source you posted here.

It estimates:
Total federal costs = 753 Billion
Total state costs = 286 Billion

For a total of $1039 Billion in government costs. Which is greater than that figure of $885 Billion. You lose.

Take into mind, this doesn't even cover everybody which the UK system does (another point you avoided). The U.S system also transfers a lot costs into large private costs for the individual.

That per capita cost from my graph is private and public spending. You are comparing a overall Per Capita cost including private and public spending against U.S Federal spending, excluding State and private costs. I admit it was my mistake, I should have titled both of those graphs. But it should have been obvious.

The graph I provided points out that that total per Capita spending = $5711
Your calculated federal spending = $641 Billion, assuming 300 million people that's about $2136 per capita. Even a cursory glance should have warned you the maths don't add up.

Table 127 makes the case that the per Capita health costs (Public + Private) is even greater than the figure I posted.

[Lusankya]

Lusankya, except only 155 million Americans or so are workers, the rest are either dependents of their families or the state.

What's that got to do with anything?

[Mr Bean]

Lusankya, except only 155 million Americans or so are workers, the rest are either dependents of their families or the state.

What's that got to do with anything?

I'm going to take a guess and say the other 135 million don't pay taxes yet still count towards those covered by universal heath care.