Meetings On Endless War

The President abruptly summoned Congressional leaders in both parties to the White House for a meeting tomorrow about Afghanistan. This is the first bipartisan White House meeting in months, and considering that Republicans support the war far more strongly than Democrats, that stands to reason.

The White House does want everyone to know that they're not leaving, however.

Obama may take weeks to decide whether to add more troops, but the idea of pulling out isn't on the table as a way to deal with a war nearing its ninth year, White House press secretary Robert Gibbs said.

"I don't think we have the option to leave. That's quite clear," Gibbs said.

Of course we can't leave. We can't seem to leave anywhere. US troops still live in Germany and Japan and Korea. America is the house guest that overstays its welcome by 50-60 years.

Maybe instead of the Congresscritters, Obama could invite Peter Galbraith to the meeting. He was the UN official who witnessed the fraudulent Afghan election and got fired for having the temerity to want to address the situation realistically instead of handing the country to Hamid Karzai. Maybe lawmakers could benefit from his experience in the country. He certainly has some settled views:

GALBRAITH: In the absence of having a credible Afghan partner…it makes no sense to ramp up. On the other hand we cannot afford to pull out. … At this point, no surge. … [W]e also don’t have unlimited resources and unless those troops can secure an area in a way that then Afghan partners, the government, the Afghan army, the Afghan police can come in and fill in after them, we’re going to be there as an occupying force for a very long time and that to me doesn’t make sense [...]

Unfortunately, there is no analogy between what happened in Iraq and what’s going on in Afghanistan. In Iraq in the Sunni areas of the country, the al Qaeda element, the fundamentalists, moved from attacking the Shiites to attacking the tribal sheiks themselves so this was a matter of their self-defense.

In Afghanistan the tribal elders, many of them are supporting the Taliban, they are the Taliban or and this is the more common situation, they are neutral. They see no reason to choose a government which they experience as inexperienced, corrupted and abusing power.

Galbraith isn't advocating an immediate withdrawal, but his logic inevitably leads you to the conclusion that we cannot have an open-ended commitment to fight a war where we have no partner to defend.

Rep. Barbara Lee has introduced a bill to block the escalation. It's HR 3699. There's one problem, however:

However, something she told me at the meeting yesterday put me on DefCon-5 alert. The House has already passed (with Lee in opposition of course)-- and the Senate is considering-- a bill that will exempt Department of Defense from coming under the budgetary pay-go strictures. Let me explain why that is so dangerous for those eager to end the deadly and catastrophic U.S. occupation of Afghanistan.

Bush funded his wars with supplemental budgets which meant he just printed money-- trillions of dollars-- to pay for them without having to worry about raising taxes (on current voters) or about cutting services directly. One result has been the worst economic disaster since the Great Depression. Obama campaigned on a promise not use supplemental budgets but to ask Congress for money through established budgetary procedures. That would kick in pay-go and a member of Congress voting for funds to escalate expensive occupations of other countries would have to agree to either raise taxes on his or her constituents-- what do you think Boehner, Cantor, Pence, Ryan and other leading GOP warmongers will think of that?-- or cut back on social programs, a prospect none too attractive to many of the conservative and moderate Democrats who have gone along with Bush's outrageous supplemental budgeting and are thereby complicit in the economic disaster that has ensued.

I really thought "pay-go" was our ace-in-the-hole to stop the war in Afghanistan. Not even a political thug like Rahm Emanuel could bully and bribe enough Democrats and Republicans to go for this, especially not at a point when the war is as increasingly unpopular as it is. If the Senate doesn't kill the legislation that the House passed, it is, in effect, a vote for a war that will last until Obama is voted out of office.

It's not surprising that Congress would willingly constrain itself when it comes to helping provide health care to all or strengthen the social safety net for the needy, but has no problem waiving those constraints when it comes to permanent war and occupation. This is just dangerous. The money will inevitably flow to war as a kind of stimulus package. It's got to be stopped.

Socialized Medicine In America!

If anyone in the Congress called for every American to have a personal attending physician in their place of business, paid for by the government and available to provide primary care at any time of day, offering everything from everyday physicals to X-rays to prescription drugs to physical therapy, they would be laughed out of the chamber. But frequently, politicians all the way up to the President say that Americans should have the opportunity to get the same services that their member of Congress gets.

Well, that is what they get.

This fall while members of Congress toil in the U.S. Capitol, working to decide how or even whether to reform the country's health care system, one floor below them an elaborate Navy medical clinic -- described by those who have seen it as something akin to a modern community hospital -- will be standing by, on-call and ready to provide Congress with some of the country's best and most efficient government-run health care.

Formally called the Office of the Attending Physician, the clinic -- and at least six satellite offices -- bills its mission as one of emergency preparedness and public health. Each day, it stands ready to handle medical emergencies, biological attacks and the occasional fainting tourist visiting Capitol Hill.

Officially, the office acknowledges these types of services, including providing physicals to Capitol police officers and offering flu shots to congressional staffers. But what is rarely discussed outside the halls of Congress is the office's other role -- providing a wealth of primary care medical services to senators, representatives and Supreme Court justices.

Through interviews with former employees and members of Congress, as well as extensive document searches, ABC News has learned new details about the services offered by the Office of Attending Physician to members of Congress over the past few years, from regular visits by a consulting chiropractor to on-site physical therapy.

"A member walked in and was generally walked right back into a physician's office. They get good care. They are not rushed. They are examined thoroughly," said Eduardo Balbona, an internist in Jacksonville, Fa., who worked as a staff physician in the OAP from 1993 to 1995.

This costs a member of Congress a bit over $40 a month.

Now, I'm going to pull back slightly, but only slightly, from my criticism. Members of Congress live all over the country, their primary care doctors are scattered everywhere, and if they have an illness or nagging injury requiring care, they actually need something in Washington on which they can rely.

But the price for this peace of mind hasn't risen in decades. And many of the same people who rail against government-run health care have no problem visiting a government hospital with government-funded doctors for their primary and even specialist care.

By contrast, those who don't have access to such a setup frequently have to turn to something like this:

Over the weekend, thousands of Texans attended what is being called the “largest free clinic ever held in the United States” to get health care they otherwise could not afford. ABC-13, a local Houston station, reported that the event showed that there is an “epidemic” of people without proper health coverage in Texas:

It’s an epidemic here in Texas and Harris County — people without health insurance. On Saturday, the uninsured lined up to get their needs met.

More than 2,000 people came to Reliant Center to see doctors for free. Many of the people we talked to can’t afford health insurance, especially in the rough economy. Some say it shows the need for health care reform.

They either wait for years for a free clinic of that scale to come around to their part of the country, or, fearing the cost of health care, they try to walk off an illness or injury, and they die.

It's quite a contrast...

Not Leaving It Alone

Chris Dodd and some colleagues have announced a bill to repeal retroactive immunity from the FISA law:

Senators Chris Dodd (D-CT), Patrick Leahy (D-VT), Russ Feingold (D-WI), and Jeff Merkley (D-OR) announced today that they will introduce the Retroactive Immunity Repeal Act, which eliminates retroactive immunity for telecommunications companies that allegedly participated in President Bush’s warrantless wiretapping program.

“I believe we best defend America when we also defend its founding principles,” said Dodd. “We make our nation safer when we eliminate the false choice between liberty and security. But by granting retroactive immunity to the telecommunications companies who may have participated in warrantless wiretapping of American citizens, the Congress violated the protection of our citizen’s privacy and due process right and we must not allow that to stand.”

Senator Leahy, Chairman of the Senate Judiciary Committee said, “Last year, I opposed legislation that stripped Americans of their right to seek accountability for the Bush administration’s decision to illegally wiretap American citizens without a warrant. Today, I am pleased to join Senator Dodd to introduce the Retroactive Immunity Repeal Act. We can strengthen national security while protecting Americans’ privacy and civil liberties. Restoring Americans’ access to the courts is the first step toward bringing some measure of accountability for the Bush-Cheney administration’s decision to conduct warrantless surveillance in violation of our laws.”

Let's make it clear up front: This isn't going to pass. Even if you could get 60 votes for it, which you can't, you have an occupant in the White House who voted for immunity, opening the possibility of a veto if it miraculously got through the Congress.

What this does signify is that some members of Congress will not be content to let the past remain in the past, especially if a great wrong was committed. Maybe they get 30 votes for immunity this year. Maybe 35 next year. And so on. But they keep offering it up, because they don't see the justice in allowing companies immunity for perpetrating a great error by aiding and abetting the government in illegal activities that violated the constitution. So they'll continue to push this at the legislative level. Meanwhile, at the judicial level, EFF and other groups continue to sue the government for real civil penalties to this lawbreaking.

It seems to me that, to succeed in politics, you have to be relentless. Introducing bills like this year after year is one example.

The People's House

One of the more persistent problems with our democracy is the distance between politicians and the people. This is exacerbated by the gradual increase of the constituency, since the House of Representatives has not been expanded in almost 100 years. In the Senate it's far worse, as equal protection laws are violated on a daily basis, with my representation in California equaling the representation of Wyoming, despite this state having 74 times as many people in it. This problem of unequal representation exists in the House as well, and a group of lawyers have organized a challenge to the status quo, calling for an expansion of the House to address these inequities.

The most populous district in America right now, according to the latest Census data, is Nevada’s 3rd District, where 960,000 people are represented in the House by just one member. All of Montana’s 958,000 people likewise have just one vote in the House. By contrast, 523,000 in Wyoming get the same voting power, as do the 527,000 in one of Rhode Island’s two districts and the 531,000 in the other.

That 400,000-person disparity between top and bottom has generated a federal court challenge that is set to be filed Thursday in Mississippi, charging that the system effectively disenfranchises people in certain states. The lawsuit asks the courts to order the House to fix the problem by increasing its size from 435 seats to at least 932, or perhaps as many as 1,761. That way, the plaintiffs argue, every state can have districts that are close to parity.

“When you look at the data, those are pretty wide disparities,” said Scott Scharpen, a former health care financial consultant from California who has organized the court challenge. “As an American looking at it objectively, how can we continue with a system where certain voters’ voting power is substantially smaller than others’?”

No incumbent will really want to change a system that dilutes their own power. They won't even sign off on giving DC voting rights in the House and expanding the body to 437 (there's an extra member for Utah in that compromise measure). But for decades, this was standard practice, with the House expanding from 65 members to 435. Other countries have governing bodies of up to 600 members despite having smaller countries. Our Congressional districts hold 700,000 people on average, which is just incredibly unwieldy. This would also rejigger the Electoral College in Presidential elections, as each state gets electoral votes based on their number of Representatives. Adding seats to shrink Congressional districts would dilute the inequity of the Senate in those elections and move us closer to a one-person, one-vote standard there.

Really we should have a unicameral legislature and a national popular vote for President, but those are a way off. The Supreme Court has never weighed in on mandating additional House members, and given the current makeup, not much good may come of that either. But it's time to build a political coalition for these changes. The bigger a Congressional district gets, the further removed that member of Congress gets from the people. It leads to Blue Dogs who don't vote their districts but can fake it using campaign contributions from corporate interests. It makes it harder for challengers to raise their profile. If you want to spark something TRULY populist, contra the teabaggers, it would be to expand the House of Representatives.

Why We Need Hearings On Insurance Industry Practices

Some weak-kneed Democrats aren't so keen on seeing Henry Waxman grill the insurance industry over their immoral policies of denying care. They probably don't want to jeopardize their campaign contributions. But Waxman and others aren't listening to them, and will move forward.

“It’s completely fair to talk about profits and reserves and compensation and how they make their decisions,” said Rep. Jan Schakowsky (D-Ill.), a leader of the Progressive Caucus. “Let them come and make their case.” [...]

Regardless, Waxman and the House Energy and Commerce Committee appear to be heading forward.

Rep. Bart Stupak (D-Mich.), chairman of the Investigations subcommittee, said Tuesday that most of the nation’s 52 largest insurance companies met Monday’s deadline to submit documents on their profits and compensation to executives and board members. He also said a hearing is being put together.

“We will be doing hearings on different aspects of the insurance industry, including this,” Stupak said. “I hope that by the end of this week we’ll have a schedule set … I’d like to do another one of these, at least one or two, this month.” [...] “Blue Cross Blue Shield, which is the insurer of last resort in Michigan, they’re raising their rates 22 to 40 percent,” Stupak said. “How do you justify that when inflation is basically zero? Where is the money going? Is it going for healthcare? Or executive compensation?”

“I think it’s part of the mix, in that our committee needs to look at it,” said Rep. Gene Green (D-Texas). “I remember a quote from Sen. [Charles] Schumer [D-N.Y.] sometime this year … he said that some of those healthcare CEOs’ packages would even make Exxon-Mobil blush.”

Just so it's clear, here are the types of policies that Blue Dog Dems would rather not have discussed publicly in Congress in the middle of a debate over health insurance reform:

• The South Carolina Supreme Court ordered Assurant to pay 10 million dollars for rescinding the policy of a 17 year-old after he tested positive for HIV.

• Several insurance companies in the individual market consider pregnancy optional and don't cover maternity care. What's more, others refuse to cover any woman who has had a Caesarian section, considering it a "pre-existing condition".

That's really the tip of the iceberg. The stories of runaway profits, lavish lifestyles for CEOs and denials of care causing suffering and death have been chronicled over and over at Sick For Profit. The public ought to know about them, at least as much as they think they do about death panels, and if Congress can find a way to raise attention, all the better.

They Can't Even Muster A Decent Hissy Fit

The House is taking up a "resolution of disapproval" for Joe Wilson today, carefully writing it so nobody thinks they actually disapprove - just a technical rules violation is all - and the Republicans are cleaning their clocks with it on the House floor.

In a clear sign that Republicans intend to turn the disapproval vote against Joe Wilson into a rallying cry for their own base, far more Republicans than Democrats have been speaking during the floor debate on the resolution.

The subject of their talk: That the American people are done with this and don't want to talk about it anymore. The message here is that the Dems are wasting time with the proceeding, and abusing their power to persecute Wilson.

"There is definitely a sense that House Republicans aren't dealing with the same hot potato they were dealing with on Thursday morning after the president's speech," a GOP leadership aide just told me. "The president's acceptance of Joe Wilson's apology has left the Democrats looking petty and possibly on the verge of overreach. The fact that White House has now adopted some of Wilson's policy proposals is evidence that this is no longer the political loser Democrats once thought it would be just a few days ago."

The highlighted portion above took any teeth completely out of the hissy fit, and partisan Republicans used it as a rallying cry. The resolution passed 240-179, BTW, with a whopping seven Republicans crossing the aisle to vote yes (12 Democrats voted no and 5 "present").

The point is not whether or not Wilson's outburst represented some violation. The point is that Democrats gradually made a decision to try and beat up Republicans over a universally despised high-profile action, and they managed to blow it. And get the policy wrong by tailoring it to the universally despised person. Who's also a serial liar (Just throwing that in because I think it's funny. You can literally say anything as a Republican and never get called on it).

If you can't even pull off the hissy fit, about the easiest two-step in politics, particularly in this day and age when the cable news channels might as well rename themselves "Umbrage 1," "Umbrage 2" and "Republican Umbrage 3", then really, it's time to get a new batch of consultants.

An Affront

NBC's First Read, which has replaced The Note as a Village weathervane, is just awful depressed about the whole Joe Wilson saga coming up in the House today.

A Democratic House leadership aide confirmed to First Read that a resolution reprimanding South Carolina GOP Rep. Joe Wilson -- who shouted, “You lie” at President Obama during last week’s joint address to Congress -- will likely come this afternoon. NBC’s Kelly O’Donnell adds the official language of the resolution is expected to be "short, direct, non-partisan," and it will address the "breach of decorum." Yet after House GOP leaders reportedly urged Wilson to apologize on the House floor, Minority Leader John Boehner said he would oppose the resolution, the New York Times says, adding: “Democrats are likely to paint the [GOP] stance as evidence of a lack of Republican respect for the House as an institution and an outgrowth of the unruly and uncivil atmosphere that marked town hall meetings in August.” Folks, it could be a very ugly day on Capitol Hill -- one of those days that explains why Americans, no matter their ideology, have a negative view of Congress.

I don't remember this rending of garments when MoveOn.org was censured in Congress for using the words "General Betray-Us." There were probably some high fives among the Village elders for putting the hippies in their place. But now, when a Republican breaks a House rule and Democrats try to mildly take note of that fact, not with censure but a "resolution of disapproval," it's just sad and shows why all Americans should hate Congress.

Seems like a double standard at work.

The Progressive Revolt And Its Implications

House liberals will not go quietly, Mr. Emanuel.

In a letter delivered to the White House moments ago, the two leaders of the bloc of House progressives bluntly told President Obama that they will not support any health care plan without a public option in it — and demanded a meeting to inform him face to face.

The not-yet-released letter — the first joint statement from progressives since news emerged that Obama might not address the public option in next week’s speech — is their sharpest challenge yet to the president, given the extraordinary sensitivity of this political moment. The letter urges him to mention the public option in his speech.

“Any bill that does not provide, at a minimum, a public option built on the Medicare provider system and with reimbursement based on Mediare rates — not negotiated rates — is unacceptable,” reads the letter, which was sent over by a source. It was signed by Reps. Lynn Woolsey and Raul Grijalva, the two leaders of the Congressional Progressive Caucus.

They're buttressed by the Speaker of the House, quoted again as saying that a bill without a public option cannot pass the House and that its elimination would be a major victory for insurance companies. Not much room to climb down from those remarks.

Some chin-scratchers are wondering why the public option, a so-called "sliver" of the legislation but not its entirety, has taken on such prominent significance. I think this gets at part of it.

To help understand, I think it’s useful to read past the sarcastic opening to this Chris Bowers post and read him lay out the strategic thinking in detail. I think what you’ll see is that while the movement on behalf of the public option certainly wants a public option and believes the public option is important, the larger goal is to “to try and make the federal government more responsive to progressives in the long-term” by engaging in a form of inside-outside organizing and legislative brinksmanship that’s aimed at enhancing the level of clout small-p progressives in general and the big-p Progressive Caucus in particular enjoy on Capitol Hill.

That requires, arguably, some tactical extremism. If you become known as the guys who are always willing to be reasonable and fold while the Blue Dogs are the guys who are happy to let the world burn unless someone kisses your ring, then in the short-term your reasonableness will let some things get done but over the long-term you’ll get squeezed out. And it also requires you to pick winnable fights, which may mean blowing the specific stakes in the fight a bit out of proportion in the service of the larger goal.

There's more to it than that, however. First of all, whatever the state of the public option on offer - and I don't think it's sufficient - can be improved upon if it just gets past the post and into circulation. I cannot believe that Ezra Klein would think that something like a public option could be introduced as an add-on later, as long as the "basic structure" of universality gets enacted now. A government-administered insurance plan is not a minor fix; getting one for Medicare or Medicaid took a number of years and tough battles, and we still leave out everyone under 65 who isn't impoverished. Adding it later would not be a "relatively simple matter," as he says. We get a crack at this now, or we create a forced market through an individual mandate that makes it a crime not to buy private health insurance. Given our crack regulatory structure in the US of A, that won't hold, the insurance companies won't live up to their end of the bargain, and costs will continue to soar. If the subsidies are too low, this wouldn't even get out of the gate - both parties would be clamoring to repeal it. Adding the public option offers far more opportunities to improve upon the system, rather than not having that option and having to do a supreme lift to get it. I agree that the coverage subsidies and the design of the exchanges are important, but the public option stands with those as a pillar of the plan.

And I know that because none other than Max Baucus told me so in his original white paper on the subject.

Tell me how this sounds for a health care reform plan.

• A national health care exchange
• Buy-in to Medicare at age 55
• No discrimination against those with pre-existing conditions
• No waiting period for Medicare for disabled
• CHIP covers up to 250% of poverty level
• Credits for small businesses and individuals to make health care affordable

Oh, and don't forget this bit:

• A public option

Now, it may surprise you to learn this. But the architect of this program is none other than Max Baucus--the guy who has been pushing against a public option since the insurers were allowed to drive this debate. Here's the language from his white paper--dated November 12, 2008--on the public option:

The Exchange would also include a new public plan option, similar to Medicare. This option would abide by the same rules as private insurance plans participating in the Exchange (e.g., offer the same levels of benefits and set the premiums the same way). Rates paid to health care providers by this option would be determined by balancing the goals of increasing competition and ensuring access for patients to high-quality health care.

There was a time when conservative Democrats knew how to best deliver a quality health care bill, and us dumb-as-a-stick bloggers and activists went ahead and looked at the proposals and actually agreed with them. Silly us!

The other reason why progressives are drawing a line in the sand over a public option is that they voted for one, and voted for a President and a Congress to deliver it. Clearly conservatives were going to freak out on the President as a mad socialist no matter how much he trimmed his sails, so it would be appropriate to at least deliver on a promise or two. Give them something to talk about and all that.

And contrary to popular opinion, Blue Dogs actually need health care reform far more than progressives. Sure, they want to do it in such a way that preserves corporate profits. But progressives can see the desire to pass something and exploit that for their own ends, which is approximately how politics works, basically.

The reason I disagree with Klein is fairly simple: if no health care legislation passes, and Democrats lose seats as a result, Blue Dogs are the people who will lose the seats, not Progressives. Even if Klein is correct and Democrats lose a bunch of seats because Progressives blocked it, Blue Dogs are actually the ones who will bear the brunt of those losses. As such, Blue Dogs have more to lose if health care fails to pass than Progressives [...]

If we feel that we have to protect Blue Dogs at all costs, then of course it will be impossible for Progressives to have as much leverage as Blue Dogs. However, as soon as we make it clear that we don't feel much of a need to protect Blue Dogs, then they are the ones who have a lot more reason to cave into our demands. If another Republican wave really is coming, Blue Dogs will be the first Democrats to lose.

I see nothing wrong with a maximalist strategy, which also corresponds to the stated goal of cutting costs and helping people get health care coverage. It does have an importance for future fights. But it also has an importance for right now. A health care reform that forces people to buy private insurance will destroy the party that builds it. And because of the emphasis placed on the public option, which is really out of the control of Washington at this point, a failure to incorporate it into the final legislation will dispirit the base and lead to a slaughter in 2010. In addition to being smart politics, the progressive revolt is a self-preservation strategy for the Democratic Party.

CA-10: A Quick Post-Mortem

Just a couple random thoughts from last night's victory for John Garamendi:

• Survey USA has been maligned by some for its robo-polling techniques, but they consistently overperformed other pollsters throughout the 2008 primaries, and they basically nailed the polling in CA-10. The final numbers track almost precisely with the final vote tally. Well done.

• These special elections largely come down to name ID, and there's not a whole lot you can do about that. The challengers certainly tried - Joan Buchanan spent $850,000 of her own money and got a whopping 12% of the vote. But Garamendi really cruised to victory in this one.

• Katie Merrill, last seen yelling at the netroots for daring to consider a primary of Ellen Tauscher, became Mark DeSaulnier's campaign manager, where she devised the craptacular strategy of focusing on Garamendi's residency requirement, which approximately nobody cares about, instead of building a campaign infrastructure outside of Contra Costa County. Despite having a minority of residents, in Solano, Alameda and Sacramento counties, Garamendi picked up over 6,000 votes on DeSaulnier, who finished well back in all those regions. There was no way he could have ever won that back in CoCo, where he lost as well by 2,300 votes. Maybe introducing yourself to people outside your base would have worked better than the "neener-neener, here's this technical non-violation" nonsense that is a proven loser.

• Lisa Vorderbrueggen still doesn't get it.

6. I thought Anthony Woods might break into double-digits. Instead, he ended up with 8.5 percent of the vote. He is a strong candidate who was probably too liberal for the moderate 10th District but he kept the elected officials on their toes. I suspect we will see Woods on a ballot again one of these days.

This "moderate district" thing really has to get flushed down a toilet somewhere. John Garamendi was endorsed by the California Nurses Association, the most progressive organization maybe in America. He's a single-payer advocate. He's strongly liberal and far to the left of Ellen Tauscher. And he won. Woods' difficulty was simply a product of name ID and a quick-strike primary. He didn't have labor ground troops and that was that.

• Just to reiterate, there will now be a general election between Garamendi and David Harmer on November 3. Garamendi will be strongly favored.

CA-10: Garamendi Poised For Victory, Only Woods Has Momentum

As John Garamendi touts in a diary here, the most recent SurveyUSA poll shows the Lt. Governor with a comfortable lead in the CA-10 primary set for Tuesday. I am surprised that another candidate hasn't talked it up as well, however, because the only candidate showing movement from the previous SurveyUSA poll is Anthony Woods.

In fact, this new poll, from 8/26-8/27, has Garamendi at 25%, Sen. Mark DeSaulnier at 16%, Asm. Joan Buchanan at 12% and Anthony Woods at 9%, with 5% undecided. The last poll, from 8/10-8/11 was Garamendi 26%, DeSaulnier 15%, Buchanan 12% and Woods 5%. I don't think there are enough undecided voters to push Woods much further, but he's running the only race drawing undecided voters, if the polls can be believed.

Among those who have already voted, the numbers are similar: Garamendi 27%, DeSaulnier 18%, Buchanan 13% and Woods 10%.

Certainly, Garamendi looks very strong for victory, and there aren't likely to be enough voters Tuesday to favor a late riser, but Anthony Woods is running the only race moving from no built-in support to a credible challenge. As for the relative flatness of the two state legislators, I'd say the choice by Sen. DeSaulnier to decide on a monomaniac focus on Garamendi's residency issue, which simply has not moved voters in numerous other instances, instead of giving voters a reason to support him, would offer some answer. Buchanan has run a self-funded campaign focused mainly on finding female support, but not necessarily a larger message. In an environment with three safe or fairly lackluster campaigns, the expected form is holding. Only Woods appears to be taking in new support, but his uphill battle was perhaps too high to climb.

Public Option On The March

Turns out that the polls still show the same robust support for a public option, as long as the question is asked consistently.

More than three out of every four Americans feel it is important to have a "choice" between a government-run health care insurance option and private coverage, according to a public opinion poll released on Thursday.

A new study by SurveyUSA puts support for a public option at a robust 77 percent, one percentage point higher than where it stood in June [...]

Earlier in the week, after pollsters for NBC dropped the word "choice" from their question on a public option, they found that only 43 percent of the public were in favor of "creating a public health care plan administered by the federal government that would compete directly with private health insurance companies."

Opponents of the president's agenda jumped on the findings as evidence that backing for the public option was dropping. Proponents responded by arguing that NBC's tinkering with the language of the question (which it had also done in its July survey) had contributed to the drop in favorability for a public plan.

SurveyUSA's poll, which was commissioned by the progressive group MoveOn.org, a proponent of the public plan, gives credence to those critiques. While arguments about what type of language best describe the public option persist --"choice" is considered a trigger word that everyone naturally supports -- it seems clear that the framing of the provision goes a long way toward determining its popularity.

"Choice" may be a trigger word, but it also accurately describes the policy - under the plan individuals seeking insurance would have a choice of a range of options in the insurance exchange, including a public plan. And people like that. A lot.

Jacob Hacker, the progenitor of the structure of the public plan, is out today with a study showing that the types of plans in the initial House bill, the ones that progressives are fighting for, are the only ones likely to work (I'd personally like to see the firewall removed and allow individuals the same choice as well, but baby steps).

Progressives have raised $264,000 and counting for the 64 lawmakers who have said they will vote for nothing unless it contains a public plan. Nancy Pelosi is saying no plan will pass the House without that element included.

"There is no way I can pass a bill in the House of Representatives without a public option," she said to a crowd in California, noting that regional health care co-ops won't get the job done. "If they want to have [co-ops] for their state, perhaps that could be included in the legislation. But it is not a substitute for a public option."

And we're up to 45 Senators willing to support it as well, with the final five directly in the sights of activists. If 50 go definitively for a public option in the Senate, given the option of reconciliation for the more contentious bits there's absolutely no reason to leave it on the table.

Heck, when you have Terry McAuliffe vowing to hold a fundraiser in Virginia for the first lawmaker to pledge to support a public option (yes you read that right, Terry McAuliffe), something has shifted.

Terry McAuliffe thinks it is time to "insist" on the public option. We couldn't agree more. Terry's agreed to host a fundraiser with Virginia and national bloggers who are insisting on a public option for the first Virginia Congressman who will take our pledge! This will be an awesome event to highlight and honor any Virginia Congressman who shows leadership on this issue [...]

Will the fundraiser be for Bobby Scott? Jim Moran? Gerry Connolly? Tom Perriello? Any of them can get a night with national and local bloggers honoring them featuring T-Mac... but first they have to do the right thing.

All the energy and excitement on the Democratic side is around this element of reform. If it's bargained away, all the energy goes away. And so does any chance at a health care bill.

Figure it out, Rahm.

Waxman: Show Me The Money

(I have been hired as a blog fellow for Brave New Films and their Sick For Profit campaign, exposing billionaire health insurance CEOs and their profiting off of denying care. Join the campaign on Facebook)

It's a little shocking that the story of health insurance CEO largesse hasn't been told, by and large, by the Congress in the debate over health care reform. The debate has covered public options and "death panels" and Nazi comparisons and cost curves without addressing the fact that for-profit health insurance companies add almost nothing of value to access or quality of care and exist only to skim off the top and keep as much of their premiums as possible. And they rake in giant profits at the same time. Now Henry Waxman, no stranger to Congressional investigations, wants to put a dollar sign on those profits, specifically what money goes where.

Two powerful House Democrats have sent a letter to insurance companies asking them to provide detailed information about their conferences and retreats, executive pay, and other business practices [...]

The Waxman-Stupak letter asks companies to provide, by mid-September, the compensation packages of any employee or officer who made more than $500,000 in any year from 2003 to 2008. It also asks the companies to list all their board members and their compensation.

The congressmen also want information "listing all conferences, retreats or other events held outside company facilities from January 1, 2007, to the present."

In addition, the letter demands more basic information, such as the companies' total revenues, net income, and total dividend payments, as well as premium revenue, sales expenses and profits.

It seems like, especially considering the prominence of the subject of health care over the past few months, this should be public information. Here's the full letter.

We already have a pretty good understanding of the profits of the insurance companies, as well as the rewards of their CEOs, in salary, options, and additional perks. That was the subject of Sick For Profit, which in the first installment exposed Steven Helmsley, the CEO of United Health Group, and his $13.2 million in compensation in 2007, his $6 million dollar home in Minnesota, and his $744 million in unexercised stock options ($127 million of which he exercised in 2009). But Waxman asking for this information puts it into an investigation. And that gives it a different feel. He can use subpoena power. He can haul the CEOs before the committee. He is in the best position to contrast the 47 million people without health insurance, and the 40 million who are underinsured, with these obscene profits.

This could get interesting.

They Should Be Thrilled

Anonymous wankers in the White House expressed surprise in the WaPo this morning about the intensity of feeling about the public option in the health care debate.

President Obama's advisers acknowledged Tuesday that they were unprepared for the intraparty rift that occurred over the fate of a proposed public health insurance program, a firestorm that has left the White House searching for a way to reclaim the initiative on the president's top legislative priority [...]

"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."

If the public option gravitated to the center of the debate and the White House never wanted it there, it's their own damn fault for talking like CPAs about "cost curves" and "risk adjustment" and arguments that could be plotted on a graph for six months without being specific about the moral case of covering millions of people who have no choice and no hope, and beating back the unrivaled greed of the insurance industry. The only element of health care reform as set out by the White House with a beating pulse has been the public option, and humans being emotional creatures as well as rational ones, that's where progressives gathered.

But I want to focus in on this element of "surprise," which is silly, since the public option was the compromise down from the policy with the most intensity on the left in the health care debate, single payer. Beyond this anonymous staffer being clueless for his surprise, he's not even understanding that the revolt on the left is the only thing saving health care reform at this point.

When town hall crazies and conservative misinformation dominated the debate, health care was on a losing trajectory, if not dead in the water. Since Kathleen Sebelius' statement on Sunday on CNN, the nature of the debate has shifted so much away from that and toward actual policy you'd think it was intentional on the part of the White House. Noam Scheiber captures this at TNR.

Around the conference table at TNR, we’ve been saying for weeks that what Obama really needed was a group of equally vocal, equally zealous critics on the left, pulling the debate’s center of gravity in the other direction. And, wouldn’t you know, that’s exactly what’s happened over the last 48 hours. We’ve now got a pole on the left to match the intensity of the pole on the right. (Don’t get me wrong: I’m not suggesting a moral equivalence between the two. As far as I’m concerned, the critics on the left are basically right and the critics on the right are either insane or deeply cynical.) From a sheer tactical perspective, I think the White House and the Democratic leadership in Congress have dramatically improved their position.

You now have 64 House Dems who have raised over $100,000 and counting from over 1,600 Democrats in 24 hours since they took the pledge of not voting for any bill without a public option. You have House Democrats strongly behind the public option in their weekly caucus meeting, with everyone in support of it because their constituents had pressed them on it. You have labor warning Democrats that they'll sit out specific elections if any members oppose a public plan. There's a vital energy to the debate now that was simply missing when Obama was offering vague principles and playing an inside game trying to frame health care reform as entitlement reform. And it's actually doing more to get a health care bill passed than anything the White House has done all year.

Elites who reflexively kick the left will retreat to the familiar ground of the Washington Post editorial page to demand that liberals "give up on the public option". And they can make their case for that on the policy - the currently administered public option on offer, by firewalling those who get insurance through employers, will struggle to survive because it cannot capture enough of the market to force competition on price and quality of care (though historically, governments build on what gets enshrined into law gradually over time, so the policy of the moment matters less than what can be done with it eventually, and having nothing, or weak co-ops that experts have shown cannot work at all, would be disastrous). On the politics, liberal elites are dead wrong. They will lose health care completely if they alienate the base. And the base wants competition against for-profit insurance CEOs with a public option, at the very least. Because they understand that a properly administered version of this competition would save people and the government money, with more savings the more popular it is. That's only something to fear if you want to protect insurance company profits.

As Chris Bowers says:

However, the current fight over the public option is a perfect demonstration of why such left-wing criticism is absolutely essential to any attempts to pass progressive legislation by the Democratic leadership and the Obama administration. If there had been no left-wing revolt to Sebelius's statements on Sunday, it would be far more difficult for the Democratic Congressional leadership and the Obama administration to justify not giving into right-wing demands. Lacking any Progressive Block demanding more progressive legislation, the Democratic leadership and administration would be practically forced to offer up even less progressive legislation than even the compromises they were floating over the weekend [...]

It is understandable that some progressives who worked very hard to elect President Obama get irked by left-wing criticism. Not all Democrats are on the left, not everyone buys into the same strategies as me, and criticism toward someone you personally identify with is irritating [...]

No matter these objections, in order to pass progressive legislation, both prominent left-wing criticism and powerful, Congressional Progressive opposition to a Democratic trifecta is absolutely necessary. In the current health care fight, the lack of such criticism and the lack of such a block would mean that the public option was dead in the water right now. Not everyone is going to like it, and some party higher ups like Rahm Emanuel may call it "f*ckng stupid," but any progressive ecosystem lacking such criticism and left-wing organizing is only a short time away from suffering a mass extinction.

I would go further, and say that without progressive organizing around the public option, there wouldn't be any health care reform legislation. Period. The band of hippies is saving the Democrats from themselves.

Please thank those who have stood up for their efforts. Let's get to $200,000 today.

Co-Op'd

If you're going to create a substitute for the public option, it would be a good idea to know what it actually does before presenting it to the nation as the substitute.

The White House has indicated that it could accept a nonprofit health care cooperative as an alternative to a new government insurance plan, originally favored by President Obama. But the co-op idea is so ill defined that no one knows exactly what it would look like or how effectively it would compete with commercial insurers [...]

As the debate rages, lawmakers are learning that creating cooperatives — loosely defined as private, nonprofit, consumer-owned providers of health care, much like the co-ops that offer telephone, electric and other utility service in rural areas — will not be easy.

The history of health insurance in the United States is full of largely unsuccessful efforts to introduce new models of insurance that would lower costs. And the health insurance markets of many states suggest that any new entrant would face many difficulties in getting established.

Here's some more good news: Kent Conrad, the brainchild of this idea, admitted today that co-ops won't bring down the cost of premiums for individuals, unlike the public option. Which would be the point.

ROBERTS: What would they do to reduce costs? Because that is one of the central issues of health care reform.

CONRAD: Well, the important thing is they’d provide more competition. … Beyond that, I think it’s very important not to over-promise here. [...]

ROBERTS: So nothing really in driving down the costs of service then?

CONRAD: Uhhh, no. If you believe competition helps drive down costs, then they would certainly contribute to holding down costs.

A note on how these would affect "competition" - in Conrad's home state of North Dakota, Blue Cross Blue Shield emcompasses almost 90% of the health insurance market. And they're a non-profit that thinks they can qualify as a co-op, under Conrad's rules, making them eligible for some of the $6 billion in seed money, I presume. Amazing that Conrad's plan and the dominant insurer in his state match up almost perfectly, ain't it?

The co-op model should be seen for what it is, protection of the insurance industry. Which makes sense, considering how many Senators are in bed with those interests, in some cases quite literally. And given that the industry and their Republican representatives in Congress will STILL oppose co-ops, learning from the lesson that making a ruckus will cause Democrats like Kent Conrad to give up whatever benefit to the people can be managed in exchange for nothing, you can pretty easily see an outcome where even the weak co-ops are given no ability to come into existence, the way it happened in Iowa:

In the 1990s, Iowa adopted a law to encourage the development of health care co-ops. One was created, and it died within two years. Although the law is still on the books, the state does not have a co-op now, said Susan E. Voss, the Iowa insurance commissioner.

Wellmark Blue Cross and Blue Shield collects about 70 percent of the premiums paid in the private insurance market in Iowa and South Dakota.

Conrad keeps saying that there aren't the votes for anything but his favored idea, but no Senator has come out and said they would join a Republican filibuster of health care reform under any circumstances. Until we reach that point, 60 votes - and maybe some combination of the Maine two - remain in play. Sounds like a better scenario to me than one where 60 House progressives have already said they won't vote for anything without a public option. Mr. Emanuel, are you paying attention? Are you doing the math? Or are you reading the LA Times?

...By the way, here's a GAO report saying that co-ops wouldn't lower costs. And here are several experts saying how difficult it would be to start them up. And here's my favorite headline of the day:

Co-Ops Are the Single Dumbest Idea I Have Heard in the Health Care Debate in Twenty Years

OK, let’s start with the notion that a co-op can do a better job of negotiating prices and protocols. But wait, on day one how many members does the co-op have? Well it has no members on day one. So, the co-op's provider relations guy goes to the doctor and hospital administrator and demands better prices and protocols. My guess is the provider’s response would go something like this, “So you are here because your stated objective is to screw my reimbursement down more than it is, you have no members now, and if I give you the rates to take members away from the existing health plans you are going to make life even more difficult for me than those existing health plans have?" My guess is that when the provider stops laughing…

A Chip They Should Not Bargain

Everyone's freaking out about Kathleen Sebelius' statements about the public option on CNN over the weekend. I'm actually quite pleased that the conversation is moving back toward this, rather than the media obsessing over old conservatives shouting or people holding signs that confirm their ignorance. At least we're back to the policy. And talking about a health care reform with or without a public option in some way presumes a health care reform law. So maybe the teabagger protests have outlived their theatrical usefulness and everyone's ready to move on.

As to the specifics: Sebelius said that the public option was "not the essential element" in any reform. Which is of course true, based on the legislation they crafted. A bill where the public option would be an essential element would be a single payer bill. The bill that the White House and Congress put together relies far more on mandates and regulation, with a weak, walled-off public option that can only attract customers from the individual market and select small businesses thrown in to allow for "choice and competition," in their parlance. It's MassCare, which, depending on who you talk to, doesn't constrain costs enough or works pretty well. And MassCare does not have a public option. That part of reform was pretty much always designed as a bargaining chip, in the context of this legislation. And the White House has been bargaining with it consistently over a number of months.

As far as I can tell, there's been no change in the administration's position. It has always supported a public plan option. It has never claimed it essential, or the only path to competition in the insurance market. The one deviation came in July, when Obama said the words "must include" in a sentence that also had the words "public option." But it's not clear whether he was talking about the health insurance exchange or the public option. And that only happened, to my knowledge, once. That statement, not this one, was the deviation.

Try as we might to pin them down, the White House will never, ever, ever view a public insurance option as essential to passing a bill. Or anything else, for that matter, other than abstractions about "controlling costs" and "providing affordability." They want something to pass. Something they can call health care reform and tout as a victory after 40 years of defeats. If they think the best path to getting that through Congress is dropping the public option, they'll enthusiastically endorse such an approach. If they think it's not dispensable because 64 liberals in the House won't pass a bill without it, they'll have to keep it. The space in between, where the House doesn't compromise any further below a public option and the Senate doesn't allow anything beyond co-ops, is what Matt Yglesias describes as the legislative dead zone. This is basically the question House progressives must ask themselves:

If it comes right down to it and the senate is prepared to pass a bill that:

(a) subjects insurance companies to tough new restrictions,
(b) taxes employers who don’t provide decent health insurance to their employees,
(c) creates a new regulated marketplace in which individuals and small business employees can buy quality health insurance,
(d) expands Medicaid eligibility, and
(e) offers subsidies to ensure the affordability of insurance for middle class families

I have a hard time believing that House liberals will really kill the bill. But maybe they will.

This is where Mr. Krugman comes in today, comparing the plan on offer to what is occurring in Switzerland, where everyone must buy insurance, lower-income residents get subsidies, and the insurance companies have very strict regulations by which they must abide.

So where does Obamacare fit into all this? Basically, it’s a plan to Swissify America, using regulation and subsidies to ensure universal coverage.

If we were starting from scratch we probably wouldn’t have chosen this route. True “socialized medicine” would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system. That’s why I and others believe that a true public option competing with private insurers is extremely important: otherwise, rising costs could all too easily undermine the whole effort.

But a Swiss-style system of universal coverage would be a vast improvement on what we have now. And we already know that such systems work.

(One thing nobody who endorses this type of plan talks about is the fact that we have no national regulatory framework for health insurance companies, and the regulatory vigor in the states, where they are now regulated, varies widely from one to the other, so the plan on offer would either have to create a large new bureaucracy to accompany that regulation of insurers, or rely on the balkanized state approach. Neither is ideal.)

The public option could be an element of a Swiss-style system, but not the essential one. In essence, there's very little daylight between what Krugman says and what Sebelius said yesterday. So, what is one to think?

Those trying to minimize the importance of a public option are only looking at the one currently up for discussion, which is not available to anyone who gets coverage through an employer. That's not really a big enough market to change insurance company behavior anyway, which is why I favor the kind of plan offered by Ron Wyden, where employees can opt out of their coverage and buy into the insurance exchange. In fact, we have historically seen a government program like the public option refined and tweaked once it came into existence, from Social Security to Medicare. So we should not view it as static.

Which is why it's important to include it now. Sure, the public option could be added in future years as a deficit reduction element, much as MassCare is considering going to fee-for-service medicine after getting their universal system in place. But we're having the conversation now, and including a government-managed element in isolation down the road would allow everyone to train their guns very directly. This will not be the last health care reform bill in the history of America, but it's certainly the one with the most potential to codify something like a public option into law. And all the action for doing that is in the Senate - the White House will go along with whatever can pass.

...also, too: this is bigger than health care reform, it's about the progressive wing of the party being credible on standing their ground. That has implications on a host of issues.

Membership Has Its Privileges

The LA Times has an article out about Congressional health benefits that fails to delineate between the recipients of those benefits. Congressional staffers work long hours and a great majority of them make next to nothing. These benefits are excellent, but they'd probably be happy to give them up in exchange for a bump in salary.

The lawmakers themselves have less of an excuse. Their salaries are fixed but the great majority of them are rich beyond belief. If you means-tested health benefits for members of Congress at, say, $1 million dollars net worth, you'd capture close to every member of the Senate and a good bit of the House.

Really only one Congressman, Steve Kagen (D-WI), can speak with any authority about this issue:

The Wisconsin Democrat has refused to accept federal healthcare benefits, making him the only member of Congress to do without. He will continue, he said in an interview, until every American can enjoy the same coverage as federal lawmakers.

Kagen recently had knee surgery, writing checks for more than $4,500 after bargaining for a reduced-rate MRI and a 50% discount on the operation. (He is still dickering over the hospital bill.)

"If every member of Congress put their heads on their pillow every night like I do . . . knowing this could be the night I lose my house, we'd fix healthcare in a week," said Kagen, who spent decades as a doctor in the Green Bay area before winning office in 2006.

Kagen said his wife and three of his four children have health coverage. But not his oldest daughter, 28, who can't afford insurance.

She's a nurse in Miami.

I don't think a guy who practiced medicine for decades before landing a job with a comfortable six-figure salary is actually in danger of losing his house (and how did he bargain for a discount surgery? Can I do that?), his point is fairly obvious. And the punch line, about the daughter who can't afford health insurance while a practicing nurse, is devastating.

Meanwhile, morons like Jim DeMint feel comfortable opening their yap every day about health care, not only while having done nothing for the American people in all the years Republicans were in power, but while accepting generous subsidies from the taxpayer for their own health insurance.

Still Lots Of Pork In The Defense Bill

I still consider it a big victory for Obama and those who want to eventually see the military-industrial complex neutered to see additional funding for the F-22 fighter struck from the defense appropriations bill. I'm glad the Pentagon took a stand. But the final House version of the bill still includes numerous weapons systems that the White House never called for.

The House approved a $636 billion defense spending bill Thursday after voting to strip money for the controversial F-22 fighter. However, it left funding in place for several other military programs that the Obama administration said it does not want [...]

The White House also hinted that a veto might occur if the bill included funding for the VH-71 presidential helicopter and for an alternative engine program for the F-35 Joint Strike Fighter. But money for both programs remained, as did funding for other items the Pentagon does not want -- extra C-17 transport planes and F-18 jets, as well as the Kinetic Energy Interceptor, a missile defense program.

(Good for the House, by the way, getting all of their appropriations bills done by the end of July. Majoritarian government is efficient government!)

This unwanted equipment totals almost $7 billion dollars at a time when we need to beg and scrape for $2 billion more for the wildly successful cash for clunkers program (just a side note on that, this Economist writer is relying on theory of the program offering little environmental benefit, and not the practice that fuel efficiency has shot up 69% in the cars traded in, saving consumers $187 million in gasoline and reducing carbon emissions by 655,000 metric tons).

Congress will be Congress, as they say. It's just difficult to get things out of the system once they become entrenched. And for every F-22 victory, there are billions of dollars in lesser-known projects that are just as useless and constrain our budgets. We still have a long way to go.

Stories Of Government Working

After a minor stumble, the House today passed the Food Safety Enhancement Act, which would bolster the Food and Drug Administration's efforts to ensure food that's not contaminated and vomit-inducing. La Vida Locavore has more. Basically, the bill would properly fund the FDA to carry out their mission, paid for by the food producers, and would enact stringent performance standards for food producers, with mandatory trace-back systems and frequent inspections of facilities. And it would apply the standards for domestic food safety to imported food as well.

Given how pretty much almost everyone in America eats food, and given the high profile of food outbreaks during the age of e.coli conservatism, if this gets through the Senate I would hope that somebody would let the public know. It ain't health care reform, but it's an important measure with a tangible effect on people's lives. I'll give you a couple others. The stimulus package provided $100 million dollars for the nation's food banks to make sure the truly needy could find food this year during these economic struggles. Food assistance is up about 30% this year over last year, and so providing some stimulus funds to feed people has a real human benefit, in addition to allowing the hungry some breathing space to get back on their feet. And the House pumped in some more money for highway and unemployment funds, so that people who are jobless can continue to access benefits and construction projects in the states can continue.

We have a problem with the conservative demonization of government, mainly because too few people are out there telling the story of government when it works. It makes it easier to lift the heavy policy objects when you restore a little bit of trust that when government is properly organized and managed it can actually help people.

This is another failure that liberals would be wise to counteract.

UPDATE: The roll call. The food safety bill passed 283-142. A few House liberals voted against it, I'd be interested to hear their thoughts.

UPDATE: The President:

"Today the House of Representatives passed H.R. 2749, the Food Safety Enhancement Act of 2009, legislation that will raise food safety standards, allow the FDA to issue mandatory recalls of harmful products, and enhance our oversight of imported food.

This action represents a major step forward in modernizing our food safety system and protecting Americans from foodborne illness. Those are the goals of the Food Safety Working Group I convened in March and charged with making recommendations to improve our food safety system. And that is why we announced a new rule to control Salmonella contamination in eggs and are working to reduce the presence of harmful pathogens such as E. coli in meat and produce; strengthen our capacity to trace the source of outbreaks; and update our emergency operations procedures.

I commend the House of Representatives for its action today and look forward to working with the Senate to enact critical food safety legislation."

This stuff matters too.

We're Here, We're Progressive, Get Used To It

House progressives have really tried to throw their weight around on the deal put together between Henry Waxman and the Blue Dogs. They probably should get the full list of co-signers before releasing it, but still, this represents a rare step for the Progressive Caucus in taking a stand against compromise after compromise with the conservative wing of the party. I hear they got 53 members to add their names to this:

We write to voice our opposition to the negotiated health care reform agreement under consideration in the Energy and Commerce Committee.

We regard the agreement reached by Chairman Waxman and several Blue Dog members of the Committee as fundamentally unacceptable. This agreement is not a step forward toward a good health care bill, but a large step backwards. Any bill that does not provide, at a minimum, for a public option with reimbursement rates based on Medicare rates - not negotiated rates - is unacceptable. It would ensure higher costs for the public plan, and would do nothing to achieve the goal of "keeping insurance companies honest," and their rates down.

To offset the increased costs incurred by adopting the provisions advocated by the Blue Dog members of the Committee, the agreement would reduce subsidies to low- and middle-income families, requiring them to pay a larger portion of their income for insurance premiums, and would impose an unfunded mandate on the states to pay for what were to have been Federal costs.

In short, this agreement will result in the public, both as insurance purchasers and as taxpayers, paying ever higher rates to insurance companies.

We simply cannot vote for such a proposal.

At issue seems to be the reimbursement rates for the public option, which seems odd to me, because the Medicare +5% rates in the House Tri-Committee bill only exist for the first three years, and the negotiated rates from the Health and Human Services Secretary will presumably be improved over that of private industry. I agree about the lower coverage subsidies, but again, we're talking about 1% on those between 300 and 400% of the federal poverty level, which is not determinative. Finally, looping back to the public option, I agree that bargaining rates are important, but even if they are restored, the fact that relatively few people can access it because it's firewalled for people who get health insurance from their employers seems to be a MUCH bigger problem.

If you're interested in covering people, the primary questions are the subsidies, the employer mandate and the individual mandate. If you're interested in reforming the system, the primary question is the strength of the Health Insurance Exchanges. And if you're interested in the public plan? It's the Health Insurance Exchanges. Again.

In all the bills we've seen, the public option is on the exchange. It is only available to those who are able to buy into the exchange. But most Americans can't buy into the exchange. They're not allowed. To make this very clear, imagine that the House and the Senate both pass Henry Waxman's proposal tomorrow. Liberals would celebrate. That's got a good, strong public plan. And I can't use it. Not even if I want to pay for it out-of-pocket. I work at a large employer and thus I am not allowed to buy into the exchange.

A strong public plan on a weak exchange will fail because it won't attain sufficient market share. It's as simple as that. Conversely, even a weak public plan on a strong exchange could thrive, because it would have access to a lot of customers. Focusing on the public plan and ignoring the rules of the exchange is like focusing on engine power but ignoring whether people can buy the car.

And the one remedy for this problem, the Free Choice Act, which would give employees the choice to take employer coverage or use that money on the insurance exchange, is being pushed by Ron Wyden but virtually nobody else, certainly not House progressives or the larger progressive activist community.

(Now, I will say that Matt Yglesias' contention that the exchanges aren't the most important part of reform, but the insurance regulations are, when things like rescission and pre-existing conditions don't apply to the employer market either, is a little weird. An exchange that has all of those consumer protections on the insurance industry AND is available to anyone who wants to buy in would be a game-changer, particularly with a public plan providing competition inside the exchange.)

So, if progressives are vowing not to vote for deals that don't even contain the kinds of reforms they'd want, what's going on here? I think Ezra Klein has it right.

House liberals are afraid of the dynamic in which good bills face Blue Dog opposition in the final mile and are aggressively watered down. Senate liberals are afraid of the same. And throwing this final compromise with the Blue Dogs into doubt is a show of strength. After all, House liberals feel they've already compromised plenty: Coming down from single-payer is a compromise. Cordoning the public plan off on the Health Insurance Exchange is a compromise. The whole bill is one big compromise, and every subsequent iteration is a compromise stacked atop a compromise placed upon a compromise. At some point, the compromises have to stop. Or, better yet, they have to go in the other direction.

Yep. This is not about the specifics of the bill as much as it is about changing the general dynamic. It shows me that progressive lawmakers are learning from the mood of the grassroots, who have been demanding this for a while. Furthermore, they can add that, if health care goes down, the people on the front lines will be the ones who wouldn't deliver what the people wanted and are in the kind of districts most likely to flip to Republicans. I'm sure that progressives are mindful that a half a loaf bill will open them up to challenges from the left, too.

The Real Problem With Obama's Poll Numbers

My big takeaway today is supposed to be that Barack Obama is fading in selling his health care plan, as eroding poll numbers, both on health care and his job approval rating, threaten legislation in the coming year. As references to "Obamacare" rise, some blame the President for a poor sales job with health care legislation. I fault the President, but for different reasons.

Right now Obama is simply a captive to Congressional process. That process is messy, it's easy to view it as negative, and people are in general reacting to the ups and downs that wound the possibility of passing a bill. The President has no bill to go out and hawk because the Congress is deep into negotiations, so he's selling nothing, a difficult task for anyone. You could say that Obama should have just stepped in and laid down the law, but not only has that proven to fail in the 1993-94 Clinton health care plan, but I don't necessarily want executive dictates to trump Congressional process. I think there's a lot of unnecessary bottlenecks in Congressional process, like the undemocratic filibuster and the seniority system for Committee chairs (particularly in the Senate) and the anti-majoritarian nature of the Senate itself. But in general, we don't elect emperors, and checks and balances are by and large healthy, and I'm OK with Congress performing their task of coming up with legislation and the President performing his task of executing it. Obviously he has some input, but I don't want an executive dominating the process. The paradox of this is that, since people generally believe that a President can just walk in and magically implement his policies, his personal approval is getting dragged down by the slog of health care bills in Congress.

The other wall that Obama is running into has been described for years as the Two Santa Claus theory. For 30 years and more, the American people have been sold on the idea that they can have unlimited services and endlessly low taxes. Somehow the lower taxes generate enough revenue to cover all the services they desire. This was part of a Republican ideological project begun by Reagan aides to basically force Democrats into wearing the black hats, and it has turned into doctrine from then on.

By 1974, Jude Wanniski had had enough. The Democrats got to play Santa Claus when they passed out Social Security and Unemployment checks – both programs of the New Deal – as well as when their "big government" projects like roads, bridges, and highways were built giving a healthy union paycheck to construction workers. They kept raising taxes on businesses and rich people to pay for things, which didn't seem to have much effect at all on working people (wages were steadily going up, in fact), and that made them seem like a party of Robin Hoods, taking from the rich to fund programs for the poor and the working class. Americans loved it. And every time Republicans railed against these programs, they lost elections [...]

Wanniski decided to turn the classical world of economics – which had operated on this simple demand-driven equation for seven thousand years – on its head. In 1974 he invented a new phrase – "supply side economics" – and suggested that the reason economies grew wasn't because people had money and wanted to buy things with it but, instead, because things were available for sale, thus tantalizing people to part with their money. The more things there were, the faster the economy would grow.

At the same time, Arthur Laffer was taking that equation a step further. Not only was supply-side a rational concept, Laffer suggested, but as taxes went down, revenue to the government would go up!

Neither concept made any sense – and time has proven both to be colossal idiocies – but together they offered the Republican Party a way out of the wilderness [...]

Democrats, (Wanniski) said, had been able to be "Santa Clauses" by giving people things from the largesse of the federal government. Republicans could do that, too – spending could actually increase. Plus, Republicans could be double Santa Clauses by cutting people's taxes! For working people it would only be a small token – a few hundred dollars a year on average – but would be heavily marketed. And for the rich it would amount to hundreds of billions of dollars in tax cuts. The rich, in turn, would use that money to import or build more stuff to market, thus increasing supply and stimulating the economy. And that growth in the economy would mean that the people still paying taxes would pay more because they were earning more.

There was no way, Wanniski said, that the Democrats could ever win again. They'd have to be anti-Santas by raising taxes, or anti-Santas by cutting spending. Either one would lose them elections.

The most important numbers in these collections of polls this week are this. People generally still want health care reform and they believe the system is broken. But they also believe that Congress should cut the deficit without raising taxes or cutting spending. With the caveat that we're talking about aggregate data and cannot make specific conclusions about individual beliefs on the deficit, taxes, and spending, this is not the result of one poll but pretty much the standard poll result over many decades, particularly when Democrats are in power and the deficit-industrial complex ramps up their rhetoric. Simply put, Republican fantasy projections have given the country an out to refuse to accept the normal choices that must be made to deal with reality.

If you don't have the time or inclination to obsessively pay attention to issues, I don't see why you wouldn't decide that we should just pay down the deficit but get good services like comprehensive health care reform but do it without raising taxes. It's very untroubling and simple, and if I'm working two jobs or busy with other things in my life it sure sounds like a good deal to me.

I agree that the President needs to do better in selling his plans to the public. A speech in prime-time, not a press conference but an actual speech, complete with Ross Perot graphs if necessary, as Nate Silver advocates, sounds like a good idea. But his problem is more about American political ideology than the ins and outs of this bill. America elected a Democrat because they didn't like George Bush. But they didn't elect a liberal ideology, even if they may agree with it on many points, because a liberal ideology wasn't on offer. Nobody in the Democratic Party has pushed back against the Two Santa Claus theory, or offered up a competing theory of their own, in the thirty-plus years since it was invented. Obama spent the first few months, when he had a honeymoon and his approval ratings were high, assuring everyone that 95% of Americans will see a tax cut, that he was pragmatic and will only go with "what works," and so on. And so when you get to an issue like health care, which does have moral overtones, which does speak to the fundamental rights of a society to ensure care for their sick and bleeding, there's no ideological foundation to fall back upon, no belief that America is worth paying for and those who use the commons to a disproportionate degree need to give a little bit to maintain the societal fabric. So we have an overhaul of health reform to expand coverage to everyone who needs it couched in the terms of cost curves and long term budget projections and constrained by the obsessive desire of deficit neutrality. This does not inspire activists and partisans to action. It does not force any thinking from those susceptible to attacks on "government-run health care" from the other side. And it does not break the underlying principles of the Two Santa Claus Theory. Nobody has fought the dominant wisdom, inside the Beltway and even in the country, and stated plainly that conservatives have lied to the country about economic issues for 30-plus years. The epic collapse of the economy under the Bush Administration provided an opportunity that nobody took.

Unless and until we start challenging conservative ideology and not conservative candidates, we will always have trouble making major changes because the public has swallowed a notion of government that makes no logical or coherent sense.