Healthcare Reform Thread II

[Drake Tungsten]

What's "sleazy" about it?

The so-called “Slaughter solution” for enacting health care reform without a conventional House vote on an identically worded Senate bill would be vulnerable to credible constitutional challenge, experts say.

No lawyer interviewed by POLITICO thought the constitutionality of the “deem and pass” approach being considered by House Democrats was an open-and-shut case either way. But most agreed that it could raise constitutional issues sufficiently credible that the Supreme Court might get interested, as it has in the past.

“If I were advising somebody," on whether deem and pass would run into constitutional trouble, "I would say to them, ‘Don’t do it,’” said Alan Morrison, a professor at the George Washington University Law School who has litigated similar issues before the Supreme Court on behalf of the watchdog organization Public Citizen. “What does ‘deem’ mean? In class I always say it means ‘let's pretend.’ 'Deems' means it's not true.”

Any challenge likely would be based on two Supreme Court rulings, one in 1983 and the other in 1998, in which the court held that there is only one way to enact a law under the Constitution: it must be passed by both houses of Congress and signed by the president.

In the more recent of the two rulings, a 1998 decision striking down the line-item veto, the court specifically said that the bills approved by both houses must contain the “the same text.” Rep. Louise Slaughter (D-N.Y.), for whom the procedure under consideration by House Democrats is now named, and Speaker Nancy Pelosi (D-Calif.) filed amicus briefs arguing for the result the court reached in the line-item veto case.

In the case of health care reform, the “Slaughter solution” would employ a “deem and pass” or “self-executing” procedure whereby the House would craft a rule deeming the Senate bill enacted, without a direct vote, for which members could pay a steep political price.

The Senate bill and its text would not come before the House in the ordinary way for an up-or-down vote but would be passed indirectly. While this procedure has been used before, the Supreme Court has said in past cases that repetition of an unconstitutional process does not make it constitutional.

“You run the risk that it could be declared unconstitutional. ... If both houses vote on the substance of everything, then I'm not troubled. But if it looks like the House is never going to vote on the Senate bill, that’s very troubling. I wouldn’t want to stake the entire bill on that,” said Morrison, who authored the brief challenging the line-item veto signed by Slaughter and Pelosi.

http://www.politico.com/news/stories/0310/34508.html#ixzz0iNwygLkG

[Drake Tungsten]

On the contrary, the Dems only hope is to pass the bill despite current public opinion.

See? Even normally reasonable Dems like Guy have bought into the insane idea that it's better to pass an unpopular bill than to not pass it.

The GOP is going to hammer them either way

Yes, but if you vote against the healthcare bill this time you can go home and tell your constituents "hey, I made a mistake and voted for healthcare the first time, but I listened to your concerns and came around in time to vote no on the second try." There's an opportunity for forgiveness there that doesn't exist if you vote for the bill a second time when it's pretty clear that your constituents don't want you to.

[DinoDoc]

On the contrary, the Dems only hope is to pass the bill despite current public opinion. The GOP is going to hammer them either way; either they do nothing, and health care continues to suck, or they pass it, and health either continues to suck, or sucks in a different way, or actually improves for some people (ie, no preexisting condition bull****, etc). The odds aren't great, but a 1-in-10 chance is better than zero.

It's looking as if even rigged CBO scores show it to be likely to increase the cost of healthcare if reports are to be believed.

[DinoDoc]

On the contrary, the Dems only hope is to pass the bill despite current public opinion.

See? Even normally reasonable Dems like Guy have bought into this insane theory.

I'm scared.

[Guynemer]

Yes, but if you vote against the healthcare bill this time you can go home and tell your constituents "hey, I made a mistake and voted for healthcare the first time, but I listened to your concerns and came around in time to vote no on the second try." There's an opportunity for forgiveness there that doesn't exist if you vote for the bill a second time when it's pretty clear that your constituents don't want you to.

Then the GOP will just pull out the "he voted for it, before he voted against it" meme. Basically, the Dems (as usual) have ****ed themselves five ways from Sunday with their inate incompetence. Their odds of success are remote with passing the bill, but nonexistent without passage.

Now, please understand, I'm not saying that passing the bill would be good for the country. I'm saying that it is the only option that could be good for the Dems.





Also:

Dems like Guy

Take that back.

[Drake Tungsten]

Then the GOP will just pull out the "he voted for it, before he voted against it" meme.

That's a hell of a lot better than "He voted for it, you let him know you didn't want it, and then he voted for it again! He doesn't care what you think!" The public doesn't like flip-floppers, but they really ****ing hate unanswerable politicians.

Take that back.

My bad. "Liberal-leaning types like Guy"...

[DaShi]

I agree with Guy. Politically, the Dems are better off passing the bill than not passing it. They can play up the benefits and the drawbacks can be spun through obfuscation. Not passing it is a big failure on their heads that they won't be able to hide from.

[Drake Tungsten]

They can play up the benefits and the drawbacks can be spun through obfuscation.

What benefits? The Dems had to delay the bulk of the benefits for four years (while starting the tax increases right away) in order to make the bill appear to reduce the deficit and receive a positive CBO score. All they're going to have to point to in November and again in 2012 is plenty of pain and few benefits. And all they had to do to deliver this crap sandwich to an unenthusiastic public is bribe numerous Senators and House members, use reconciliation in the Senate to avoid a filibuster and potentially engage in unconstitutional behavior in the House in order to "deem" the bill passed. To think the public is going to be happier about this than the fact that a bill they dislike didn't pass is utterly insane...

[DinoDoc]

Can you explain this poll result, Guy?

Health Reform and Primary Care Physicians
• 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

http://www.nejmjobs.org/rpt/physician-survey-health-reform-impact.aspx

[Guynemer]

Not even remotely. Best I can tell, the proposed reform won't have much effect at all on me; if anything, it may "harm" specialists.

That said, I'm pediatrics, not family medicine or internal medicine. As it stands, I already see everyone, since all children are covered one way or other. (At least, in theory.)

[Hauldren Collider]

There's absolutely no way that passing this bill will be better for Democrats than not passing it. The reason that many consider it "dead" if it doesn't past before recess is that the congressmen will go home and talk to constituents. The last time they did that, we had those infamous town hall meetings where the Democrats wrote off the massive opposition as essentially conservative conspiracy. But with the midterm and special elections of Bob McDonnell, Scott Brown and that other governor I can't remember may have convinced them that perhaps their constituents are actually pissed.

The idea that it will be worse for them if it fails originated during Clinton's presidency. They took the wrong lesson--Democratic strategists determined, in my opinion incorrectly, that the reason Republicans took control of Congress was that the public was unhappy with how dramatically the bill failed. I think it's more likely that most Americans just don't like the idea of healthcare reform.

[DaShi]

Not even remotely. Best I can tell, the proposed reform won't have much effect at all on me; if anything, it may "harm" specialists.

That said, I'm pediatrics, not family medicine or internal medicine. As it stands, I already see everyone, since all children are covered one way or other. (At least, in theory.)

Be glad it's not my plan. I would replace you with PAs and RNs.

[MrFun]

It's looking as if even rigged CBO scores show it to be likely to increase the cost of healthcare if reports are to be believed.

I hate to agree with DD, but . . .

By RICARDO ALONSO-ZALDIVAR, Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer – 2 hrs 37 mins ago
WASHINGTON – Buyers, beware: President Barack Obama says his health care overhaul will lower premiums by double digits, but check the fine print.

Premiums are likely to keep going up even if the health care bill passes, experts say. If cost controls work as advertised, annual increases would level off with time. But don't look for a rollback. Instead, the main reason premiums would be more affordable is that new government tax credits would help cover the cost for millions of people.

Listening to Obama pitch his plan, you might not realize that's how it works.

Visiting a Cleveland suburb this week, the president described how individuals and small businesses will be able to buy coverage in a new kind of health insurance marketplace, gaining the same strength in numbers that federal employees have.

"You'll be able to buy in, or a small business will be able to buy into this pool," Obama said. "And that will lower rates, it's estimated, by up to 14 to 20 percent over what you're currently getting. That's money out of pocket."

And that's not all.

Obama asked his audience for a show of hands from people with employer-provided coverage, what most Americans have.

"Your employer, it's estimated, would see premiums fall by as much as 3,000 percent," said the president, "which means they could give you a raise."

A White House press spokesman later said the president misspoke; he had meant to say annual premiums would drop by $3,000.

It could be a long wait.

"There's no question premiums are still going to keep going up," said Larry Levitt of the Kaiser Family Foundation, a research clearinghouse on the health care system. "There are pieces of reform that will hopefully keep them from going up as fast. But it would be miraculous if premiums actually went down relative to where they are today."

The statistics Obama based his claims on come from two sources. In both cases, the caveats got left out.

A report for the Business Roundtable, an association of big company CEOs, was the source for the claim that employers could save $3,000 per worker on health care costs, the White House said.

Issued in November, the report looked generally at proposals that Democrats were considering to curb health care costs, concluding they had the potential to significantly reduce future increases.

But the analysis didn't consider specific legislation, much less the final language being tweaked this week. It's unclear to what degree the bill that the House is expected to vote on within days would reduce costs for employers.

An analysis by the Congressional Budget Office of earlier Senate legislation suggested savings could be fairly modest.

It found that large employers would see premium savings of at most 3 percent compared with what their costs would have been without the legislation. That would be more like a few hundred dollars instead of several thousand.

The claim that people buying coverage individually would save 14 percent to 20 percent comes from the same budget office report, prepared in November for Sen. Evan Bayh, D-Ind. But the presidential sound bite fails to convey the full picture.

The budget office concluded that premiums for people buying their own coverage would go up by an average of 10 percent to 13 percent, compared with the levels they'd reach without the legislation. That's mainly because policies in the individual insurance market would provide more comprehensive benefits than they do today.

For most households, those added costs would be more than offset by the tax credits provided under the bill, and they would pay significantly less than they have to now.

The premium reduction of 14 percent to 20 percent that Obama cites would apply only to a portion of the people buying coverage on their own — those who decide they want to keep the skimpier kinds of policies available today.

Their costs would go down because more young people would be joining the risk pool and because insurance company overhead costs would be lower in the more efficient system Obama wants to create.

The president usually alludes to that distinction in his health care stump speech, saying the savings would accrue to those people who continue to buy "comparable" coverage to what they have today.

But many of his listeners may not pick up on it.

"People are likely to not buy the same low-value policies they are buying now," said health economist Len Nichols of George Mason University. "If they did buy the same value plans ... the premium would be lower than it is now. This makes the White House statement true. But is it possibly misleading for some people? Sure."

Premiums Could Rise Under Obama's Plan

[DanS]

See? Even normally reasonable Dems like Guy have bought into the insane idea that it's better to pass an unpopular bill than to not pass it.

I agree that this idea is insane. There was an op-ed a few days ago by a couple of Dem pollsters that took the insanity head on. However, the greater insanity might be that we think we can know how it will play out. We do much better with our weather forecasts than our political forecasts.

[Ramo]

The Dems had to delay the bulk of the benefits for four years (while starting the tax increases right away) in order to make the bill appear to reduce the deficit and receive a positive CBO score.

I know Republicans love this talking point, but it's not true. If you bothered to look at the CBO score, you would see that the first year when you get a significant increase in revenues is 2013 (which itself is small relative to a couple years later). You see a very large decrease in the deficit from 2010-2014, but that's because expenditures go down, not because revenues go up. As for the "appearance" of deficit reduction, in the second decade the growth in revenues is significantly faster than the growth in expenditures, due to the excise tax.

n.b. Some of this is subject to change depending on the reconciliation fixes.