Tuesday, December 22, 2009

Democratic Congressman to Switch Parties - Join the GOP

Could this be a bit of the politcal price that Democrats will pay for passing health care reform in the most partisan of manners? According to Politico Rep. Parker Griffith, a doctor and freshman Democrat from Alabama, will announce this afternoon that he's switching parties to become a Republican. According to the NRCC, the seat has not been held by a Republican since 1866. Add this to the 4 Democratic House members that have announced their retirements and the evidence continues to mount that 2010 will be a wave election - and that the Democrats need to be worried.

Saturday, December 19, 2009

Health Reform Secures 60 Votes in the Senate! Will the House Play Ball?

After weeks of false starts it appears that Senate Democrats have united behind a health reform bill - my read of Harry Reid's changes - the so-called Manager's Amendment - convinces me that this is a good bill and one that will substantially improve the American health care system. It is also, with minor exceptions, essentially the bill that Max Baucus reported from his Senate Finance Committee months ago. The key sticking points came down to federal funding for abortion and the creation of a so-called public option - both are gone. No federal funds will be used to cover or even subsidize insurance that covers abortion and states will have the option of excluding abortion coverage within the newly created health insurance exchanges. The Medicare expansion is gone as well, but the federal Office of Personnel Management will oversee a new national non-profit plan that people can buy in to.

Significant Elements:
  • Insurers in the large group market will be required to spend at least 85% of all premiums on medical care (that leaves 15% for administration, marketing, profit), in the small group market the standard will be 80%.
  • Individuals and families under 400% of the federal poverty line who receive employer-sponsored coverage and spend 8-9.8% of their income on premiums, could “convert their tax-free employer health subsidies into vouchers that they can use to choose a health insurance plan in the new health insurance exchanges. This would allow folks more choices in selecting coverage and force insurers to compete with the exchange.
  • Medicaid eligibility would be extended to everyone earning less than 133% of the federal poverty level and as a protection for states the federal government will pay for 100% of the cost until 2017 - typically a state pays nearly half the cost of Medicaid.
Why should Ben Nelson and Joe Lieberman - the hold outs who forced so many concessions - be celebrated and not derided?
  • Lieberman - Had it not been for Lieberman's efforts to strip away the public option the bill never would have received 60 votes. Lieberman has provided political cover for vulnerable Democrats like Mary Landrieu (D-LA) and Blanche Lincoln (D-AR) as well as dozens of House Democrats from conservative districts.
  • Nelson - The abortion concessions won by Nelson will also  provide coverage for House Blue Dogs, but Nelson's greatest contribution was his insistence that the full cost of the Medicaid expansion in Nebraska be covered by the federal government forever - while the expansion in all other states is covered for only 5 years. Seem unfair? Sen. Tom Harkin (D-IA) summed it up well "In 2017... when we have to start phasing back from 100 percent, ... they are going to say, 'Wait, there is one state that stays at 100?' And every governor in the country is going to say, 'Why doesn’t our state stay there?'" In other words, Nelson win for Nebraska is likely a win for every state.
According to the Congressional Budget Office, the new proposal would reduce the deficit by $132 billion over 10 years and by $1.3 trillion over 20 years and it would extend insurance to 31 million individuals, covering approximately 94% of legal residents by 2019. This bill is a step in the right direction. It deserves the support of conservatives and liberals alike. To those on the left who argue that it is better to have no bill at all than to accept a bill that limits abortion coverage and contains no public option - I urge you to get your priorities straight. This bill is about extending health insurance, not about imposing ideological rigidity. To those on the right who lament the lack of malpractice reform or the fact that you were essentially shut out of the process – get over it. This is a common sense bill that deserves bipartisan support.

If Harry Reid truly has the 60 votes necessary for cloture then the stage would be set for a vote by December 24th. After that it goes to conference committee where Nancy Pelosi will need to win major concessions from House liberals in order to avoid having this deal fall apart early in the new year. Of course, early word is that House Democrat conservatives may not be willing to accept the abortion compromise...

Thursday, December 17, 2009

Welcome Baltimore Sun Readers

The FreeStater Blog welcomes those of you visiting us via the Op-Ed in the Baltimore Sun. Click here for a detailed analysis of the 2010 gubernatorial race and Bob Ehrlich's chances.

Breaking Waves of Dealignment

Realignment: the coming to power of a new coalition, replacing an old dominant coalition of the other party (or replacing a stalemate, as in the United States in 1896 or 1932). The concept of realignment or a critical election was first put to paper by political scientist V. O. Key in a 1955 article titled "A Theory of Critical Elections." According to Key and subsequent realignment adherents political parties, voter loyalty, and policymaking routinely shift in swift, dramatic sweeps - or critical elections. Realignment literally means that voters, en masse, switch allegiances from one party to another. In contrast, a dealignment is said to occur when voters abandon party loyalty to become independents or nonvoters.

Many believed that the one-two punch of the 2006 mid-terms and the 2008 presidential election was heralding a realignment in America with voters moving to the Democratic party. Indeed, the party reclaimed Congress and the White House and enjoyed a clear advantage in voter expressed party preference for the first time in 20 years. It appears that such realignment predictions were made in haste. Democrats no longer enjoy an advantage in voter preference and according to the latest NBC News/WSJ Poll only 38 percent of voters said their representative should be re-elected, while nearly half (49 percent) believe it’s time to give a new person a chance. According to Politico “That’s the lowest net re-elect number for Congress since November 2005 – and even worse than the polls taken right before the landslide election of 2006 that swept Democrats in control of Congress (39 re-elect/45 new person), and worse than those taken before the Republican revolution of 1994 (39/49).”

Translation? 2010 is shaping up to be another wave election – a term that non-political scientists and media commentators often use to describe a critical mid-term election. This presents a problem – critical elections were thought to usher in generational shifts in loyalty. But we have now had two wave elections in 12 years – 1994 and 2006 and may have a third on the way - only 4 short years after the last wave. All of this suggests that we have in fact dealigned in America. Voters are no longer loyal to any party, as such they willingly and easily switch allegiances from one election to the next. Writing for Politico back in August, Eamon Javers referred to this new generation of voters as “Fickle Kids” who change voting preference as often as they do cell phones. If this is true, if we have dealigned, if voters no longer have a true connection to either party, America is likely to enter a very unstable era in which party control of government will be very unpredictable and likely short-lived. It remains to be seen how the parties will react to this change.

Wednesday, December 16, 2009

Turkish Delight Has Turned Sour for Some Washington Insiders

Turkey has been lately undergoing major transformations, domestically and internationally. The Turkish economy has been growing steadily, save the expected ramifications of the global recession. The political influence of the military is dramatically reduced. Turkey is now debating a comprehensive reform package aimed to integrate a free and fair representation of the Kurdish identity in the political system. Turkey has also made a significant progress toward normalizing relations with long-time foes such as, Armenia and Syria. Turkey is now an active and dynamic regional player, engaging diplomatic wrangling in an area ranging from the Balkans to the Caucasus, to the Levant, and to the Caspian Sea. Albeit these developments, which delight most Turkish citizens, for some among the foreign policy circles in Washington, Turkish delight has certainly turned sour.

For these analysts, Turkey’s recent ambitious domestic and international overtures are bound to doom for one overarching reason: Turkey is ruled by an “Islamist” party—Justice and Development Party (known as AKP)—and, because of its ideological identity, whatever initiative the government would advance will only help further Islamize the Turkish nation, undermine the secular political structure, and distance Turkey from the West. I believe that this outlook is not only reckless in assessing Turkey’s position, but also a reminiscent of Cold War mentality of bipolar world. Accordingly, the world is divided into West and the “Rest” (and the “other”, i.e. the Muslim World) and Turkey needs to make a decision about which side it truly belongs.

One recent and—one of the most representative—example of this view was illustrated by David Schenker (The Wall Street Journal, November 5, 2009). The title of his essay says a lot: “A NATO Without Turkey?” According to Schenker, the Turkish government “is increasingly pursuing illiberal policies at home…while aligning itself with militant, anti-western Middle East regimes abroad”. Accordingly, this wrong choice of policy by Turkey certainly warrants reconsideration of Turkey’s membership to NATO. Another example is a recent essay published by Morton Abramowitz and Henri J. Barkey (“Turkey’s Transformers”, Foreign Affairs, November/December 2009). In this piece, the authors, although they could not resist praising some recent initiative by the AKP government as radical and transformative in a positive sense, felt the need to close their essay with a dire warning for Turkey’s ambitious policy makers: “Turkey’s leaders, for their part, must not think that they can expand the country’s influence without first having a firm footing in the West”.

Both these views are part of a misguided approach based on the erroneous—or imprudent—reading of Turkey and its government. Calling AKP as “Islamist” and seeing it as a catalyst of Islamization in Turkey is just plain wrong. AKP is not an Islamist party in both sociological and practical senses. The fact that the leadership of the party had a history of political Islam does not conceal the fact that only after a democratic epiphany the party leaders such as Recep Tayyip Erdogan (currently the prime minister) and Abdullah Gul (currently the president) were able to appeal to mainstream majority, which lies at the center-right of the political spectrum. Second, it is outlandish to argue that AKP Islamizes the Turkish society when 90 percent of the population identifies themselves as Muslim, 70 percent would like to see elimination of headscarf ban in public institutions, 50 percent claims to practice their religion on a daily basis. These statistics were not affected by AKP; rather, AKP’s popularity is greatly enhanced by its skilful incorporation of the values dearly held by an overwhelming majority of the Turkish people and its integration of the demands of the new conservative middle class emerged as result of liberalization policies launched in mid-1980s. AKP, at best, is a Muslim Democrat party. In this respect, and contrary to some observations, religiosity in Turkey is not increasing; rather, the restrictions imposed on religiosity are decreasing as part of the further democratization of the system and normalization of civil-military relations.

Some assessments of the recent assertiveness of the Turkish foreign policy also suffer from similar one-sided and misguided reading of the events. Seeing AKP as an Islamist party with an arguably hidden Islamic agenda can provide emotional satisfaction for some. But this view is seriously missing the point. Turkey neighbors not only EU member countries such as Bulgaria and Greece, but also Russia, Georgia, Armenia, Syria, Iraq, and Iran. A policy that seeks “zero problems with neighbors” as advocated by Ahmet Davutoglu, Turkey’s highly esteemed minister of foreign affairs, would certainly seek zero problems with the last three of those neighbors which happen to be Muslim-majority countries. Turkey engages with Russia, and Bulgaria, as much as it does with Iran, Iraq, and Syria. Turkey’s “strategic depth” entails engaging beyond the immediate neighbors. In this respect, Pristina, Grozny, Jerusalem, and Baghdad are all located at about the same distance to Turkey’s borders and would require similar level of attention. Consequently, the West-and-the-Rest dichotomy just does not work from Turkey’s vantage point.

To conclude, reading Turkey’s domestic and international policies and achievements through Islamism is either inaccurate representation or manipulation of the facts on the ground. Turkey’s attempts to achieve peace and harmony at home and abroad is a win-win situation both for Turkey and the region and ought not to be considered as part of a civilizational clash that does not really exist. And for all those who seek similar goals, Turkey appears to be the best partner in the region.

Tuesday, December 15, 2009

Health Reform Will Pass.... Probably

Update - There's a reason why I tend to practice cautious optimism - Susan Collins appears to be a solid "No" and Ben Nelson continues to say "No" as well. And the Democratic Left may be unwilling to accept the watered down bill.

Last month I took to this page to argue that health reform would fail to pass. In my original post and one subsequent follow-up I theorized that disagreements within the Democratic Party and between the House and Senate over funding, mandates, taxes, and abortion would ultimately sink health reform - and they almost did. But it is now increasingly likely that health reform will pass and all credit goes to two Senators - Max Baucus (D-MT) and Joe Lieberman (I-CT). Lieberman has become public enemy number one among the Left this week since stating that he would filibuster any bill with a Public Option AND any bill that allowed for a Medicare buy-in. Baucus enjoyed a similar bit of infamy back in September when his Senate Finance Committee drafted health reform legislation that did not include a public option and had watered done the individual and employer mandates. Baucus argued that his goal was to write a bill that could receive 60 votes.

Senate Majority Leader Harry Reid (D-NV) took Baucus' bill and added a public option and has spent the better part of a month trying to reach 60 votes. It seems that Reid has now surrendered. Word out of Washington is that the Senate will strip away the public option, will strip away the recently proposed Medicare expansion and will essentially consider the legislation originally reported by Baucus' committee back in October. Liberal Senate Democrats such as Tom Harkin (D-IA) have stated that they will accept scaled back legislation and the White House has urged Reid to make what ever concessions are necessary to get the bill passed.

Perhaps most significant is the increased likelihood that the scaled back Baucus inspired bill may receive 2 Republican votes – Olympia Snowe and Susan Collins, both from Maine. Snowe supported the Baucus bill in committee and Collins recently praised Lieberman’s efforts to strip away objectionable elements in the bill. So there you have it – the bill that Baucus originally produced has now become the savior of the Democrats' health reform effort and because of the efforts of Joe Lieberman it is likely to pass complete with a Republican vote or two.

If you are wondering why Harry Reid opted to not introduce the Baucus bill in the beginning it is because of the politics of the House of Representatives and the powerful progressive caucus there. Reid needed to prove that a public option could not survive in the Senate, he needed to prove that the Baucus bill was the only acceptable legislation. The last month has made that clear. Given that the House has passed a health care bill the normal process would be for a House/Senate Conference Committee to reconcile differences between the chambers and return a compromise bill for final votes in each. I do not expect that to happen – rather I suspect that whatever passes in the Senate will be introduced in the House and approved unamended, thereby negating the need for a conference. Any other approach would introduce more delay and uncertainty. The White House and Democratic Leaders will exert tremendous pressure on progressive House members to grit their teeth and simply vote for the Senate bill, or risk getting no reform at all.

I would add that abortion remains a hurdle – but I suspect that it is one that will be overcome.

Monday, December 14, 2009

Will 2010 be a Repeat of 1994? Yes and No.

Last week I argued that the political forecast for Democrats looked pretty bleak. Less than a week later I would argue that the forecast has worsened. That said, several prominent bloggers took to the web this weekend to argue that 2010 will not present a repeat of 1994 when Republicans netted 54 seats in the House and 8 seats in the Senate to claim a majority in both houses of Congress. Writing for his Talking Points Memo Josh Marshall argues that the 1994 rout by Republicans was largely the result of the Southern realignment coupled with redistricting efforts in 1990-92 and a spate of Democratic retirements. Marshall argues "2010 is fundamentally different. The key problem for Dems isn't unpopularity. It's a highly apathetic Democratic electorate facing an extremely energized Tea Party GOP."  Marshall does not dismiss the possiblity that Democrats may lose the House or Senate, he simply veiws the comparisons to 1994 as being inappropriate. I do not disagree, but when it comes to elections, any election, comparisons to prior elections are largely inappropriate. Each election cycle takes on its own dynamic and unique set of issues and circumstances.

Asking if 2010 will be like 1994 is not the same as asking if the the same dynamics that shaped 1994 will shape 2010. In all but two midterm election cycles in the past since FDR the party in the White House has lost seats in the midterm - what made 1994 unique was the size of the loss in the House and the Senate. In the past 50 years there have been 12 midterm elections, in 10 of those races the party in the White House lost seats. In 5 of the 12 the losses in the Houses amounted to 15 or fewer seats, in 2 of the 12 the losses ranged from 26 to 30 seats (1982 and 2006), in only 3 of the 12 did the losses top 40 seats -1966 (47 seats), 1974 (49 seats), and 1994 (52 seats). In 1998 and 2002 the party in power gained seats. So the real question for 2010 is whether the Democrats will suffer losses in line with historical norms - about 15 seats - or will the party suffer the more extraordinary losses registered in 1966, 1974, and 1994?

Current political conditions suggest that 2010 will not follow the historical norm model of 15 or so seats. The latest edition of the Cook Politcal Report finds that of the 258 House seats held by Democrats 218 are considered to be safe - that is the exact number needed to maintain their majority status. Cook rates 39 Democratic seats as competitive and only 11 Republican seats. The generic Congressional ballot from multiple pollsters favors the Republicans and 4 Democratic House members have announced plans to retire. Add to all of this a president with an approval rating below 50% and you have the makings for an election year that will not be good for the Democrats. At the moment the most likely scenario is a midterm that follows the 1982 and 2006 model of 25 to 30 losses. In the Senate, the Democrats face challenges in AR, CO, CT, DE, NV, NY, OH, and PA while Republicans are fighting to keep KY, MO, and NH - a net Republican gain of 4 or 5 seems likely at this point.

So will 2010 be like 1994? The dynamics of the race will be different - but such is true of all races. With regard to shifting control of Congress 2010 also is unlikely to be like 1994.  But make no mistake, if Republicans gain 30 seats in the House and 5 seats in the Senate the 2010 election will be like 1994 in that it will fundamentally alter the political dynamic in Washington. The midterm vote will be viewed as a harsh assessment of the president and the Democratic majority and will result in an altered agenda leading into 2012. It will also give the GOP tremendous influence over that agenda as they reclaim the ability to filibuster in the Senate.

Friday, December 11, 2009

Could Only Obama Could Go to Oslo?

President Obama’s Nobel Peace Prize acceptance speech yesterday drew praise from both the left and right. The praise from the left is hardly surprising, but accolades from both the Wall Street Journal editorial board and Sarah Palin are noteworthy. The strong response from conservatives tended to focus on the section of the speech were Obama meditates on the notion of “just war” and the meaning of a President fighting two wars receiving the Peace Prize.

But as a head of state sworn to protect and defend my nation ... I face the world as it is, and cannot stand idle in the face of threats to the American people. For make no mistake: Evil does exist in the world. A non-violent movement could not have halted Hitler's armies. Negotiations cannot convince al Qaeda's leaders to lay down their arms. To say that force may sometimes be necessary is not a call to cynicism -- it is a recognition of history; the imperfections of man and the limits of reason.”

This portion of the speech, arguing both that war may be justified and using the word “evil”, led other commentators to argue that Obama was simply using his flowery rhetoric to say the same things put more bluntly by his predecessor. Historian Walter Russell Mead from the Council on Foreign Relations argues that Obama is simply better than Bush at selling the same policies. He argues,

“Barack Obama's acceptance speech for the Nobel Peace Prize was a carefully reasoned defense of a foreign policy that differs very little from George Bush's... If Bush had said these things the world would be filled with violent denunciations. When Obama says them, people purr.”

Similar sentiments have been echoed elsewhere on the right. The only problem is that President Bush would have never given a speech like this. Let’s call it the “Only Obama Could Go To Oslo” phenomenon. Obama accepts the prize for peace and makes the case for the necessity of war. However, the greatest differences between Bush and Obama were not in what Obama said, but in those things left unsaid. There was no discussion of Iraq, other than the oblique reference to a war that “is winding down.” No discussion of the need to use U.S. power to spread American ideals. And while Obama did mention evil in the world, there is no talk of good versus evil.

In fact, while Obama front-loads the discussion of just war, the speech ranged over a number of topics that draw upon a broad array of international relations theories. The clear-eyed discussion of war reflects political realism, while the call for the United States to adhere to global standards reflects idealism. The significance of international institutions in maintaining the post-war order mixes in neoliberal institutionalism, while arguing that, “America alone cannot secure the peace,” draws in traditional foreign policy liberals. For good measure, Obama includes a discussion on democratic peace (“America has never fought a war against a democracy”), just war (“philosophers and clerics and statesmen seek to regulate the destructive power of war”), classical realism (“War, in one form or another, appeared with the first man.”), and clash of civilizations-type arguments (“the cultural leveling of modernity… people fear the loss of what they cherish in their particular identities”).

If anything, the Oslo speech seems to undergird Obama’s emphasis on addressing the complexity of the problems confronting the United States and the administration’s emphasis on “smart power.” While the meaning of “smart power” remains broad enough to be frustratingly elusive, the general emphasis of Obama’s speech seemed to be that it is critical to find the proper diplomatic tool to fit the job. Thus, to Nobel speech can draw praise from across the American political spectrum, because it acknowledges a simple point: the Obama’s foreign policy will draw on a broad array of international relations theories. While this may frustrate those who seek clear and simple guiding principles in U.S. foreign policy, it offers hope to those that believe context is critical.

Wednesday, December 9, 2009

Democrats Facing an Ever More Bleak Political Forecast

Hyperbole is all too common in political commentary, but it’s increasingly difficult to overstate just how the political landscape has shifted under the feet of the Democratic Party. Last year they had reclaimed the White House, added to their majority in the House and were well on their way to attaining a 60 vote super-majority in the Senate. More important, the American public was on their side. In an Ipsos-McClatchy poll taken last November the Democrats enjoyed almost unimaginable levels of public support. On issue after issue the public preferred Democrats over Republicans. Handling the economy? A 58% to 37% advantage for Democrats. Taxes? 52% to 35%. Dealing with the deficit? 56% to 26%. Reforming the health care system? 62% to 23%. Jump ahead one year and the most recent Ipsos poll shows those Democratic advantages are gone. The Economy? A 40% to 39% tie. Taxes? Democrats now trail the GOP by 2 points. Dealing with the deficit? Now a 41% to 34% advantage for the GOP. Reforming health care? The Democrats 39 point advantage has dwindled to 4 points. And on the all important question of which party would be better for economic growth the Democrats have gone from a 30 point lead to a 3 point deficit. The poll also finds President Obama falling to a new approval rating low of 49%. Among the all important Independents fully 55% disapprove of the job he is doing.

As negotiations on health reform continue a new Quinnipiac poll shows the public opposes reform by a 52% to 38% margin. The polls also found a nearly equal level of disapproval of Obama's handling of health reform and the 20 point advantage that he enjoyed over Republicans on the issue back in July has now shrunk to 7 points. As for the 2010 midterms - the list of Democratic incumbents who plan to retire has now grown to 3 and Charlie Cook counts 39 potentially vulnerable Democratic House seats and only 11 Republican seats (and the number of vulnerable Democrats grows each week). In the ever important swing state of Ohio (crucial to any Republican White House quest) the Democratic incumbent Ted Strickland now trails challenger John Kasich by 9 points. It's hard to find any cause for optimism among Democrats other than the news that the national unemployment rate dropped from 10.2% to 10% last month. So far the political trajectory of 2009 is looking a lot like 1993 - Democrats desperately need a course correction to keep 2010 from ending up like 1994.

As Progress is Made on Health Reform, Public Opposition Solidifies

Update II: Senate Democrats have reached an agreement and the Public Option is gone. This clears one hurdle, but another has popped up. The Senate rejected Ben Nelson's abortion funding amendment making the math of 60 votes still a difficult equation.

Update: Late word indicates that GOP moderate Olympia Snowe is not a fan of the new compromise that would expand Medicare and Medicaid, this could make it very hard for Democrats to reach 60 votes. Especially if they lose Ben Nelson over the issue of abortion coverage.

News today suggests that significant progress is being made in the Senate on compromise health care reform as Democratic Party leaders seek a path to 60 votes. It is increasingly clear that the Public Option that Majority Leader Harry Reid had included in the bill will be dropped - but progressive members of the Democratic caucus have not simply surrendered, rather they are using the elimination of the Public Option to bargain for new and potentially far reaching concessions. Multiple sources are reporting that the Public Option would be replaced with a new nationwide nonprofit health plan to be administered by the federal Office of Personnel Management (the same agency that administered the federal employee health benefit system). The new national plan would be offered by a private insurance company. Party leaders hope that progressives will find this to be an acceptable alternative to a Public Option run by the government. In exchange for dropping their demands for the Public Option, progressives have pursued amendments to the current legislation in the form a significant expansion of the Medicare program – the nation’s health insurance system for those over the age of 65. Under the proposal currently being discussed, the Medicare program would be opened to Americans over the age of 55. This is a population that can face great difficulty obtaining affordable coverage – especially if they suffer a job loss. Also being pursued is a proposal to open the new national health insurance exchange to more Americans. As originally proposed, the exchange would have been limited to a select few small employers and uninsured Americans, perhaps as few as 15-30 million. Adoption of these compromises would have a far more significant impact on health reform and coverage expansion than would the limited Public Option and progressives would be wise to pursue them.

Interestingly, or perhaps distressingly for Democrats, just as progress is being made on reform public opposition is on the rise and public support is collapsing. According to the latest tallies from Pollster.Com a majority of the country now opposes reform and less than 40% is in support. As heated debates remain over touchy issues such as abortion and funding – to say nothing of a needed reconciliation with the House – Democrats in tough re-election fights need the cover of public support - at the moment they do not have it. Only time will tell if that changes as details of these new negotiations emerge.

Friday, December 4, 2009

A Comeback for the Political Center in Maryland's 4th District?

At the moment all of the mid-term Congressional drama in Maryland has been focused on the 1st Congressional district and the tough re--election battle that Democrat Frank Kratovil is likely to face in a rematch with Andy Harris. I urge everyone to consider another race as well. Prince George's County State's Attorney Glenn Ivey is expected to mount a primary challenge against Democratic Rep. Donna Edwards for Maryland's 4th District Congressional seat. In 2008, Edwards defeated incumbent Rep. Al Wynn in the primary to claim the safe Democratic seat. Wynn was a moderate Democrat and his defeat in the primary by the unabashedly liberal Edwards struck a blow to the already dwindling number of political moderates in Congress. Ivey has a reputation as a moderate political voice and his victory in the September primary could signal an anti-incumbent and potentially anti-liberal preference among voters. The September primary in Maryland could serve as a barometer for things to come in the general election 2 months later.

Monday, November 16, 2009

Chinese Take Out

President Obama’s trip to China has been accompanied by the usual concerns about human rights abuses and the value of the Yuan that have troubled Sino-American relations for the past two decades. This trip has also raised a relatively new concern about China: that it is not pulling its weight on international problems. Stephanie Kleine-Ahlbrandt of the International Crisis Group writes that China is a “global free-rider,” for failing to help the U.S. take action against Iran and North Korea. Over at the New York Times, China is similarly charged with needing to “play an even stronger international role,” including assisting the U.S. with the remaining two-thirds of the axis of evil.

The objection that China is free-riding is silly and myopic. To free ride is to fail to contribute to a public good that you enjoy. In order for China to free-ride on the proliferation issues in North Korea and Iran, China has to believe that a change in the status quo would significantly damage their national interests, which is not at all clear. On Iran, the Times notes, China “seems more concerned about its own voracious energy needs, and Iran’s ability to satisfy them.” So China is looking out for its own national interests, perhaps to the detriment of other states in the international system? Would other states dare to do this?

When Nixon made the bold opening with China nearly three decades ago, he hoped that the Chinese would exert pressure on the North Vietnamese to help bring an end to the war in Vietnam that would benefit the United States. The Chinese, with little to gain from an end to the war, did not fulfill Nixon’s wishes. The premise of free-rider arguments is that China and the United States want the same things in their foreign policies, when, in fact, they do not. Thus, there is no free-riding. [Climate change is a different issue, but unfortunately, the United States is not much better.]

The underlying concept here is soft power and the United States general inability to use it effectively with the Chinese. The Obama administration needs to get China to “want what we want.” This moves outside the realm of international bargaining (and discussions of American’s limited leverage over the Chinese) to focus on how China should perceive the international system. Increasing Chinese significance in the international system will change Chinese interests, but not necessarily cause them to align with the United States. Unfortunately, over the medium term it seems unlikely that China’s interests will mirror those of the United States due to economic, domestic political, cultural, and geo-strategic reasons.

Thursday, November 12, 2009

Why Aren't the Democrats Smiling?

It was a monumental accomplishment - on Saturday, November 7th the U.S. House of Representatives became the first house of Congress to endorse a plan for universal health coverage in America. Nancy Pelosi and the House leadership cut deals, made promises, and were able to scrap together 219 Democrats and 1 Republican to gain a 220 to 215 vote margin of victory. So why aren't the Democrats smiling? Because one of the deals struck to ensure passage of the bill threatens to consume the Democratic Party in a civil war over the issue of abortion. To win the votes of conservative and pro-life Democrats Nancy Pelosi allowed a floor vote on an amendment that would bar the use of any public funds to subsidize private insurance plans that covered abortion. The amendment, offered by Rep. Bart Stupak (D-MI), passed by a vote of 240 to 194 - of all the votes cast on the health care bill, it was the most bipartisan.

The Stupak amendments was crucial to passing the bill, but it has opened a deep wound in Democratic Party unity and may well derail final passage of health reform. Pro-choice Democrats are threatening to oppose any final bill that maintains the Stupak language and Senate moderates are demanding that the language remain. All of this points to growing threat to the Democrat's majority status.

Democrats regained the majority in the House and Senate by recruiting conservative candidates to run in moderate and conservative districts - the strategy worked, but the consequence is a more diverse party caucus. Democrats now face the real possibility of a push by the party's liberal base to purge moderate and conservative members. All at a time when election results in Virginia and New Jersey, coupled with recent polling data from Gallup, show that moderate and independent voters are flocking to the GOP. According to Gallup, Independents prefer Republicans on the generic congressional ballot by a 52 to 30 margin. In fact, Gallup says that the GOP has not polled this well since 1994 and 2002 - two mid-term election cycles that were very good for Republicans.

And it gets worse for Democrats. How has the public reacted to the historic vote on Saturday? By increasing their level of opposition to the health reform bill. According to Pollster.Com, public opposition to health reform legislation has risen. In fact, the most recent poll by Pew shows that the public opposes the reform by a 9 point margin.

The Senate will begin debate on health reform next week, expect a bitter battle over abortion, the public option, and immigration. And don't expect any quick or easy resolutions. So worried is the White House that they are now openly hinting at the possibility of passing the bill via reconciliation, a risky parliamentary trick that would certainly enflame public opinion.

Monday, November 9, 2009

Why Health Reform Will Fail (To Pass) - Part Two

I wanted to provide an update to my prior post in which I explained why I think health reform will ultimately fail to pass. This weekend, in an historic vote, the House passed health care reform by a very narrow 220-215 vote. Never before has any house of Congress passed legislation for universal health care in America. So does this alter my prediction? Hardly - in fact I am more convinced than ever that no bill will reach the President's desk. And the seeds of its destruction were sown in the deals made to reach 220 votes in the House. To win the votes of pro-life Democrats Speaker Pelosi allowed a vote on an amendment offered by Rep. Bart Stupak (D-Mich.) that would prevent the use of federal subsidies to pay for insurance that covers elective abortion. The amendment was adopted with the votes of 64 Democrats. Pro-choice Democrats were angry, but they knew that the bill could not pass without the votes of pro-life Democrats, so they accepted the amendment. Now the bill has moved to the Senate, where moderate Democrats have made it clear that they too will demand a bill that bars any federal funds for abortion. So, the Senate is unlikely to pass a bill if it does not include the Stupak language. Problem is 40 pro-choice Democrats in the House have now signed a letter pledging to vote against any House/Senate compromise bill that includes the Stupak amendment. If the Conference Committee agrees to a bill with the Stupak language it will lose the 40 pro-choice votes in the House and fail.  If, on the other hand, the Conference strips the Stupak language then it would lose the votes of pro-life Democrats in the House and the Senate and fail to pass. What must be remembered is that in the Senate, Conference Reports can be filibustered - it's rare, but allowed. So now add abortion to the list of reasons why health reform will fail - and later, expect me to add immigration policy to the growing list.

Original Post
There has been much news this week about the momentum for health reform. House Speaker Nancy Pelosi has just introduced a 1,990 page bill representing the House version of reform, complete with a public option that would allow the government to negotiate payment rates with providers. On the Senate side, Majority Leader Harry Reid made news earlier this week when he announced that the Senate bill would include a public option with an allowance for states to “opt-out” of the program.

Given these developments there is now a sense of inevitability that health reform will pass and be signed into law by President Obama either this year or early next year. I’m not so certain. In fact, I am increasingly convinced that no reform legislation will make it to the president’s desk.

Allow me to explain why…

The Public Option
For too long the press has been obsessed over the question of the public option, as if it were the only point of contention between the House and the Senate. The truth of the matter is that the debate over the public option was as much about disagreements within the House and within the Senate as it was about a disagreement between the two bodies. In the House, Democrats can be divided into three camps 1) those who demanded a public option that paid doctors a fee linked to Medicare reimbursement rates, 2) those who supported a public option but wanted negotiated reimbursement rates (mostly rural state members where Medicare rates are low), and 3) those who simply oppose creation of a public option (mostly Blue Dogs who hail from conservative districts). There are 256 Democrats in the House and it takes 218 votes to pass any legislation – so Democratic leadership had to find a compromise. In the end, Pelosi went with group 2 (negotiated reimbursement) based on the assumption that many in group 1 and perhaps a few from group 3 would come on board. At last count, Pelosi is still short of the 218 votes; so passage in the House is still an open question.

In the Senate, disagreement over the public option and the form it should take is a bit more complicated, but Senators can also be grouped. There are 1) those who support a public option but would allow states to “opt-out”, 2) those who favor the creation of a trigger that would create a public option if other reforms efforts fail, 3) those who support allowing states to create their own public option, and 4) those who oppose the creation of a public option. Harry Reid has decided to go with group 1 and the opt-out provision in hopes that it would represent an acceptable compromise. The problem that Reid faces is that any bill requires 60 votes given the likelihood of a filibuster. There are only 60 Democrats in the Senate and only 1 potential GOP vote – Maine’s Olympia Snowe – so Reid cannot afford to lose anyone. So far Snowe has said that she opposes the opt-out approach and Joe Lieberman (CT) (and Independent who caucuses with the Democrats) has said the he to will seek to block such an approach as well. By most counts Reid is about 5 votes shy of the 60 he needs. Trouble is, if the opt-out provision comes to the floor as part of the bill any effort to strip it out via amendment would also need to overcome the 60 vote hurdle – and there may be 41 Democrats who want to keep it. So Reid finds himself lacking the votes to pass legislation with the public option opt-out and possibly lacking the votes to remove the opt-out from the bill. As such, reform could easily die in the Senate.

But let’s assume that the House and Senate do pass their bills. Then a conference committee will be convened for the purpose of reconciling the differences. With regard to the public option there are key differences between the House and Senate. The House bill would not allow for an opt-out and it is doubtful that House liberals would accept such a provision; likewise, the Senate could not muster enough votes to pass a public option without an opt-out. The greater threat to compromise between the House and Senate would be the elimination of the public option in the Senate version. It is unlikely that Pelosi could wrangle the 218 votes needed for compromise legislation with no public option, even with the provision for a trigger. So the public option could derail passage in the House, in the Senate, and especially in the final stage of compromise between the two bodies.

But the public option is just one point of disagreement. The House and Senate also differ on how to pay for reform and how to achieve universal coverage. The differences are significant and philosophical and raise serious questions about whether compromise can be attained.

Employer provided insurance is the principle source of health insurance for Americans under the age of 65 (99% of those over 65 have Medicare). About 60% of the non-elderly population receives health insurance through an employer (or a parent/spouse/guardian’s employer). As health care costs have increased more and more employers are opting to no longer provide insurance. But 83% of the uninsured live in a family headed by at least one employed person. As such, many support requiring employers to provide insurance as a way to expand coverage. To that end, the House legislation requires that employers provide insurance coverage to their employees or face a penalty equal to 8% of total payroll. The Senate legislation does not require employers to provide insurance, but is expected to contain a provision stipulating that if an employer has any uninsured employees who receive a federal subsidy to purchase insurance that employer would face a fine of $750 multiplied by its total workforce. It is an odd provision to be certain, but well short of a mandate. Given that individual insurance costs approximately $5,000 per year, and that most employers pick up the tab for 75% of that cost, a $750 fine per employee may seem like a bargain compared to providing health insurance. It is unlikely that a strict employer mandate could pass in the Senate and equally questionable whether progressive members of the House would accept any compromise that eliminated the employer mandate. The House bill also contains an individual mandate to purchase health insurance, those who fail to do so face a fine equal to 2.5% of their adjusted gross income. In the Senate the individual mandate has been all but eliminated with individuals who fail to purchase insurance facing a maximum fine of $750 per year, and that fine is phased-in slowly over the next 7 years. Given that individual insurance costs about $5,000 per year, the $750 fine may not motivate many to purchase insurance. House Democrats view the mandates as essential to maximizing coverage, many Senate Democrats view mandates as being too burdensome and punitive.

Concern over rapidly rising deficits and President Obama’s pledge that he will not sign any bill that exceeds $900 billion over the next ten years or that “added one dime” to the national debt has forced the House and Senate to find ways to pay for health care reform. Not surprisingly each found its own way. The House would fund a substantial portion of its reform via a proposed 5.4% surtax on individuals earning more than $500,000 per year and couples earning more than $1 million. In the Senate income tax increases are a non-starter, instead the Senate has proposed a 40% excise tax on extravagant health plans – so-called Cadillac plans – defined as those that cost more than $8,000 a year for individuals and $21,000 for families. The argument being that this would keep the source of new revenue within the existing health care system and it could discourage such extravagant plans in the future, plans that encourage the overuse of services. The tax on these insurance plans will go nowhere in the House given that many of these Cadillac are in fact the result of years of bargaining on the part of organized labor. Labor is a key constituent of the Democratic Party, labor opposes the Senate tax, and it would never survive the House. The House and Senate taxes are essential to paying for the bills, yet it is hard to see how the House and Senate can come to any compromise on this key funding issue.

In the end, I simply find too many substantive differences between the House and Senate proposal to see how a conference committee could reach consensus that would then be acceptable to each chamber. Months of negotiation, deals, and concessions in each chamber have resulted in legislation that would be acceptable to the barest majority needed to pass a bill in each house of Congress. The conference committee negotiations would necessarily unravel those deals and the fragile coalitions they created within each body. So the House has introduced a bill that currently lacks the 218 votes it needs to pass the bill, the next couple of weeks will be dedicated to finding those votes. In the Senate, Harry Reid is preparing to introduce legislation that is at least 5 votes shy of the 60 votes it needs. The next month (at least) will be spent trying to find those 60 votes. But even if the House and Senate clear the considerable hurdles that remain within their own chambers the far greater, and perhaps insurmountable, challenge will be reconciling the two bills. But the differences between the House and Senate on key provisions – the public option, mandates, and taxes – are considerable and represent deep philosophical and political differences that may prove impossible mediate.

Many expect that once the House and Senate have passed their respective bills President Obama will wade into the negotiations and hammer out a deal – those expectations may not be realistic. Progressive Democrats in the House and the Senate see this as a limited window of opportunity to enact substantive reform and have expressed little willingness to compromise. They know that whatever passes will be policy for years if not decades; after all, it took 15 years just to put health reform back on the agenda after the Clinton failure in 1994. But progressives lack the votes to pass anything without the votes of moderate Democrats, and they are far less willing to embrace substantive change.

(Of course, if I'm wrong I reserve the right to delete this post and pretend that I never wrote it...)

Monday, November 2, 2009

Election Preview for NJ, VA, and NY-23 at the PoliProf Blog

Last week I offered my assessment of the key 2009 elections one week out, I return as promised to offer predictions for tomorrow. A full write-up is available via the PoliProf

In short, I see a tremendous night for Republicans with wins in VA, NJ and NY-23. Democrats will argue that Virginia and New Jersey were decided based on state issues and have nothing to do with the President or his agenda. In NY-23 Democrats will argue that it shows that the GOP has no place for moderate or independent voices.

If there is a GOP sweep tomorrow expect this to seriously undermine key legislative initiatives such as health reform and cap and trade as moderate Democrats become increasingly concerned about 2010.

Thursday, October 29, 2009

Beyond the Shouts: A Discussion of Health Reform in America

Everyone - from Congress to drug and insurance companies to providers and patients - has an opinion on health care reform. On September 28, 2009 St. Mary's College of Maryland brought together a panel of policy experts to offer their take on the heated debate and answer community questions about this complicated issue.

Participants in the panel included health care financing expert Greg Scandlen, pediatrician Margaret Flowers, and Karen Davenport, director of the Center for American Progress. Todd Eberly, Assistant Professor of Political Science and Coordinator of Public Policy Studies served as moderator.

Watch the forum here (please note that the volume is quite low):

Tuesday, October 27, 2009

Preview of the Virginia and New Jersey Elections

I have a preview of the high profile races in New Jersey and Virgina over at the PoliProf Blog. Back in early September I urged you to watch the off year elections in VA and NJ very closely, arguing that two GOP victories would indicate a high level of GOP intensity, Independent willingness to vote GOP, and, most deadly, Democratic apathy. Today marks the one week countdown to Election Day 2009 and I think that it is a good time to revisit the states.

Monday, October 26, 2009

The Need for Real Health Care Reform

A few weeks ago on the PoliProf Blog I cited a study by the McKinsey Global Institute (MGI) which found that the U.S. spends about 31% more per year on health care than would be expected based or our wealth, cost of living, and health. In a $2.5 trillion health care economy that translates into $775 billion in excess spending. Why do we over spend? We have higher administrative costs owing to the fragmentation in our system, but mostly the problem is the manner in which we pay for services. Since every patient and procedure is a source of revenue providers over-provide. Because our insurance frequently has no limit on the utilization of services, we over-consume. My argument then was that only system-wide reform could realize the substantial savings implied by the study.

The findings from the MGI study have just been confirmed by a new study conducted by Thomson Reuters. That study found that the American health care system wastes an estimated $700 billion a year, roughly one-third of the nation's healthcare bill. Among the key findings:
  • Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.
  • Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
  • Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.
According to a Reuters news account of the study "All this could help explain why Americans spend more per capita and the highest percentage of GDP on healthcare than any other OECD country, yet has an unhealthier population with more diabetes, obesity and heart disease and higher rates of neonatal deaths than other developed nations."

The Reuters story concludes with this "Democratic Senator Charles Schumer said on Sunday that Senate Democratic leaders are close to securing enough votes to pass legislation to start reform of the country's $2.5 trillion healthcare system."

The implication from that final line about Schumer and Democratic leaders being close to a deal on reform is that the reform may actually address the problems highlighted in the Thomson Reuters study - unfortunately, that is simply not the case. The current reform proposals being considered in the House and the Senate will not solve the systemic problems in the American health care system - in fact they will likely make the problems worse. The current reform proposals maintain our fragmented system and will even add to the fragmentation. The expansion of Medicaid and the creation of a public insurance option will only add to the plethora of insurance providers with which doctors and hospitals must contend. The reforms will do nothing to address the care-linkage deficiencies that result in the poor management of patients with chronic conditions (asthma, diabetes, heart disease) who consume 70% of our health care dollars. The reforms will not change the fact that our fee for service system makes every patient and every procedure a source of revenue - and therefore encourages overuse. The reforms will not alter our malpractice policies and the defensive medicine that results. Rather the proposed reforms will extend coverage to about 30 million Americans (a good thing), but it will accomplish this by dropping them into an inefficient, expensive, and broken system - the simple result will be even greater costs (a very bad thing).

In his recent book The Healing of America, T.R. Reid writes "Any proposal for reform that continues to rely on our fragmented structure of overlapping and often conflicting payment systems... will not reduce the cost or the complexity of American health care. Any proposal that sticks with our current dependence on for profit health insurers... will not be sustainable." Unfortunately our elected leaders have spent the past few months hammering out deals that will do those very things. While our press and our politics have been obsessed with whether or not reform would have a public health insurance option the real question should have been "will these reforms actually improve the American health care system?" Perhaps no one wanted to ask the question because the answer is so clearly "No."

President Obama has said repeatedly that he would like to be the last president to take on the challenge of health care reform... if he signs into law any reforms similar to the legislation being debated in the House and Senate he will fall well short of that goal.

Wednesday, October 21, 2009

Mo' voting, mo' problems?

The news yesterday that Afghan President Hamid Karzai has accepted the findings of the Electoral Complaint Commission (ECC) and hold a run-off election between himself and Dr. Abdullah Abdullah on November 7 was greeted positively in many corners. By all accounts, Karzai received the “Johnson treatment” from a host of Western politicians, including John Kerry, Hillary Clinton, and Gordon Brown. So, a run-off is good for Afghanistan, and by extension the United States and its allies, right?

There appear to be four possible outcomes to this decision. The best-case scenario for the United States is Karzai winning the run-off in a clean election that increases his legitimacy and allows the U.S. to continue to prosecute the war in Afghanistan with an ally or at least known commodity. The second best outcome is Abdullah winning a clean election, which would give him legitimacy, but offers a more uncertain outlook for U.S.-Afghan cooperation in fighting insurgents. Those are the two good outcomes, now we get the two far less desirable results. First, Karzai could win another election marred by fraud, leaving him in power as a weak, illegitimate leader at a time the U.S. needs a strong partner to assist in its strategy change under General McChrystal. Finally, in the worst-case scenario, Abdullah wins a tainted election and the U.S. stands at square minus-one. You could debate my rank ordering here, perhaps arguing that Abdullah is not a bad option for the U.S., but clearly the bright line exists between a free and fair election and one that is tainted.

The key probability for U.S. policymakers is the likelihood that the Afghans’ second try at an election will come off better than the first. There are a number of reasons to doubt this will be the case. First, the Afghans will have to scramble to prepare the country to vote in just over two weeks, and hope that the weather cooperates. Of course, considering turnout in round one was merely 30%, wintry conditions are only likely to keep more voters away from the polls. So, the first problem facing the second election is that low voter turnout might sabotage even a free and fair outcome.

The second problem is that telling Karzai, “This time, don’t cheat!” may not have much of an impact. Despite losing one million votes, Karzai still held a commanding lead over Abdullah. This raises the question, if Karzai believed he could win fairly, why would he organize fraud on such a massive scale? The answer is that, like many things in Afghanistan, Karzai may not have complete control, even over his own supporters who stuffed ballot boxes because they believed it would help their candidate. Fraud committed out of loyalty or to curry favor is likely to turn up in the second round, even if Karzai does not orchestrate it. Of course, it may be that all the fraud committed in the first round was sanctioned and organized by Karzai, but if that is the case, we might consider whether he is a good ally.

The final problem involves the images from the press conference yesterday where Karzai announced the run-off election. Succumbing to outside pressure is unlikely to increase Karzai’s bona fides as a nationalist. Even if he wins the election, Karzai may feel the need to exert his independence after this experience or he may be viewed by an increasingly large swath of the population as little more a Western puppet.

The take away point from all of this is that the outcome of a second election is highly uncertain and may be just as bad, or worse, than where we stand today. We are now far beyond Colin Powell’s “Pottery Barn Theory of International Relations” that we now have to “buy” Afghanistan because we broke it. Instead, the situation the U.S. finds itself in is more akin to working at the corporate offices and dealing with a difficult local manager. You have a certain vision for how things should be handled, but the manager has his own interests that may occasionally clash with yours or bring embarrassment on the company (country). Yes, this is the “David Wallace Theory of International Relations,” and it is much trickier than repairing overpriced dinnerware.

Tuesday, October 20, 2009

Deciphering Public Opinion on Health Care Reform

As Harry Reid (D-NV), Chris Dodd (D-CT), Max Baucus (D-MT), Rahm Emanuel, and Olympia Snowe (R-ME) continue to hammer out the Health Reform compromise between the Senate's HELP and Finance Committees there is a picture emerging with regard to public opinion toward health reform – and at first glance it makes little sense. The most recent data from Pollster.Com (see chart below) show that public support has begun to drop (after a mini-rally last week) and opposition is on the rise. A recent ABC News survey found that 48% opposed “the proposed changes to the health care system being developed by Congress and the Obama administration,” while 45% supported such changes. A Fox News survey found that 54% opposed “the health care reform legislation being considered right now,” and only 34% supported it. According to Rasmussen Reports 54% opposed “the health care reform plan proposed by President Obama and the congressional Democrats,” and 42% supported.

Taken together these polls suggest considerable opposition – but beyond these topline questions the picture becomes murkier. When ABC News asked “Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans” an overwhelming 57% indicated support – odd given that such a proposal is being considered as part of the changes being developed by Congress – the same changes that only 42% of respondents supported. When Fox News asked whether respondents would prefer “the current health care system or the health care plan proposed by the Democrats in Congress” the current system was favored by a 51% to 34% margin. The Rasmussen survey found that a majority of respondents believed that health care costs would increase and quality decrease if the current reforms were enacted.

So what can we make of this? There appears to be clear opposition to the health reform plans in general, support for maintaining the current system, a lack of faith in the ability of the proposed reforms to control costs or maintain quality, but also clear support for the creation of a public option. I see two possible explanations – one being that many Americans don’t know what the “public option” is and therefore their response to questions regarding support or opposition must be taken with a grain of salt. A recent post by Mark Blumenthal at Pollster.Com gives credence to the theory that the public does not understand the term. As he points out, a recent PEW study found that 56% of the public correctly linked the term “public option” to health, meaning that 44% of the populace does not recognize the term. He also points to a randomized internet survey where only 37% of the adult population could correctly identify the public option when presented with three choices (by random chance you would get 33%). So perhaps the public simply does not get it. There is one other possibility that gives the public a bit more credit. When Fox News asked respondents whether they supported reforming “the entire health care system” or reforms to provide “health insurance to those who don't have it,” covering the uninsured was preferred by a 50% to 27% margin. With that answer, current public opinion makes much more sense.

The current proposals in Congress would represent system-wide changes, though largely incremental in nature, they are more akin to the “Comprehensive Incrementalism” defined by the Washington Post's Ezra Klein. It would appear that most Americans are opposed to the proposed comprehensive incrementalism, but support efforts to cover the uninsured – such as a public, or government-sponsored health insurance option. So when ABC News asked whether respondents would support “a plan that includes some form of government sponsored health insurance for people who can't get affordable private insurance, but is approved without support from Republicans in Congress; or a plan that is approved with support from Republicans in Congress, but does not include any form of government-sponsored health insurance for people who can't get affordable private insurance?” it should not be surprising that “government sponsored health insurance for people who can't get affordable private insurance” was preferred over bipartisanship by a 51% to 37% margin. This is roughly the margin that preferred covering the uninsured over system-wide reform in the Fox poll. By no means does it suggest that the public would prefer Democrats to “go it alone” on overall health care reform, nor does it suggest public support for current proposals would be higher if those proposals contained a public option. It does tell us that Democrats are correct when they say that the public supports a public option, and Republicans are correct when they say that the public opposes the health reform proposals currently being considered in Congress.

Friday, October 16, 2009

Let it Snowe, Let it Snowe, Let it Snowe...

On Tuesday, Olympia Snowe (R-ME) became the only Republican member of the Senate Finance Committee to vote in favor of the so-called “Baucus Bill” for health reform. Though threatened with repercussions by Republican leadership Snowe simply stated that “when history calls, history calls.” Snowe also prefaced her vote by saying that her vote today did not forecast what her vote would be when final legislation came to the floor of the Senate. With that one vote, Snowe has catapulted herself in to the final negotiations over health reform legislation. In fact, Ezra Klein reports today that Snowe now has a seat at the table along with Senate HELP chairman Chris Dodd (D-CT), Finance chairman Max Baucus (D-MT), and White House representatives Rahm Emanuel and Nancy-Ann Min Deparle. This has incensed liberal Democrats in the House and Senate. They are angry that in an effort to create the veneer of bipartisanship one GOP senator has been granted tremendous influence on the final product. Make no mistake, Snowe’s involvement will influence the final product, it will likely ensure that the Senate bill contains no strong public option (if anything), and it will likely mean that the weakened individual mandates (see prior post) will remain. One thing is certain, with that one "Yes" vote, Snowe demonstrated that she is a very shrewd politician.

Monday, October 12, 2009

Shooting from the AHIP... or 1993 All Over Again?

Last week on the PoliProf Blog I warned that the decison by the Senate Finance committee to water down the individual mandates in the health reform legislation risked raising the ire of the insurance industry. Consider their ire raised... After initially signaling support for reform efforts the industry's chief lobbyist issued a report today that projects that the legislation, as currently proposed, would add $1,700 a year to the cost of family coverage in 2013. When asked, Karen Ignagni, president of America's Health Insurance Plans (AHIP), would not rule out attack ads on TV featuring the study.

In 1993, AHIP was responsible for the highly effective Harry and Louise ads which featured a middle-aged, middle-class couple, expressing deep concern over the bureaucratic nature of Clinton's proposed reform. One can only assume that AHIP is dangling a similar threat now to extract as many concessions as possible at this make or break point. Democrats and the White House have reacted harshly to this apparent broadside from AHIP, but they had to know that it was coming after weakening the individual mandate. As it stands now, insurers will be required to cover high risk folks with pre-existing conditions, but will not get to bring all of those young, healthy folks into the risk pool because the mandates have been so weakened – suddenly reform looks like a bad deal for the insurance industry - and they are expressing their displeasure. Given the power of the insurance industry, Democrats should be worried.

Friday, October 9, 2009

All Eyes on the Prize

The quite surprising news out of Oslo today that President Obama will receive the Nobel Peace prize is likely to raise eyebrows even among the President’s supporters. The debate in the United States will likely provide a rehash of last year’s election campaign, with the President’s critics arguing that his thin resume does not justify the honor. However, the real question surrounding the award is whether Obama is a Willy Brandt or a Woodrow Wilson, two prominent leaders who received the award at different stages of their political careers. The Nobel committee clearly hopes that Obama’s award signals the potential of things to come, just as Brandt’s Ostpolitik had not yet born fruit when he received the prize in 1971. For Wilson, the Nobel award is the tale of promise unfulfilled, as his efforts to build an enduring peace following World War I failed when the Senate failed to ratify the Versailles Treaty and thereby beginning the slow death of the League of Nations. The general problem with the Peace prize is that unlike the Literature prize, winning the award does not appear to help your career. Since the award is normally given for past service – hence Jimmy Carter’s win in 2002 – it does not lend itself to furthering one’s goals. The exception to this might be when the award is given to lesser known human rights or environmental campaigners such as Jodi Williams or Wangari Maathai, who can parley the award into greater recognition for their causes. The larger point is that despite the prestige of winning the Nobel, Obama will be hard pressed to use it to support his foreign policy goals. The large number of Democratic winners over the past decade (3) is likely to lead Republicans to view the award as a left-wing coronation rather than a distinguished prize. On the other hand, the award will raise Obama’s esteem in the international community where he already enjoys broad popular support. However, the award occurs in the same week as the release of a report by an American Political Science Association task force investigating anti-Americanism. The report argues that while Obama does enjoy widespread popularity around the world and is partially responsible for the improved views of the U.S., there remains widespread discontent with many U.S. foreign policies. The awarding of the Peace prize could contribute to the opposite effect of what occurred during the Bush presidency, with Obama enjoying more positive ratings than the country as a whole. In the end, as with Woodrow Wilson, the question remains as to whether the goals that Obama has set for U.S. foreign policy will be matched by results.

Thursday, October 8, 2009

Health Reform's Comprehensive Incrementalism

Ezra Klein offers a pretty fair assessment of the Senate Finance Committee's health reform legislation post Congressional Budget Office analysis "this bill will change the insurance situation for 37 million legal residents, 29 million of whom would otherwise be uninsured. That's a big step in the right direction. But most people will never notice it."
Klein coins a great new term "comprehensive incrementalism" and correctly notes that the bill would produce some good change, but is by no means represents system-wide reform. So even if it becomes law, Barack Obama will not be the last president to take on health reform.
There is a larger political point though, according to the CBO the Senate Finance bill would cover 94% of the population and with cost offsets and new revenue would reduce the deficit - the bill is paid for. So Republicans have a choice to make; will they simply be the party of "No" or will they follow the advice of former Majority Leader and presidential candidate Bob Dole and support the reform effort? The bill offers the promise of expanding coverage while maintaining the basic structure of our current system (unfortunately), so what is there for the GOP to oppose?

Wednesday, October 7, 2009

Lessons in disastrous analogies

There has been some buzz this week over Gordon M. Goldstein's Lessons in Disaster, which documents key decision-making moments during the Vietnam War from McGeorge Bundy’s perspective. According to George Stephanopolous, the book has become a must-read for Obama administration officials. Of course, since this is a book about Vietnam, you can guess that the message administration officials are going to take away is unlikely to be that escalation is the answer to American problems in Afghanistan. Putting the debate about the correct path forward in Afghanistan aside for the moment, the selection of Goldstein’s book raises a larger question about how policymakers form their opinions on international issues. While Goldstein’s book is undoubtedly a fine history of the difficult decisions surrounding the Vietnam War, merely raising the specter of Vietnam means that the lessons likely to be set out before the spine is cracked. It seems unlikely that Vietnam will ever be invoked by a politician as a successful case of U.S. military operations.

The greater problem is how history is being used here. Obama is certainly not the first President to employ this tactic. George W. Bush read Hugh Thomas' The Spanish Civil War, which leads to the argument that if fascism were stopped in Spain, further horrors could have been avoided. If we simply treat history as a grab bag, from which we draw examples to affirm our pre-existing beliefs, the true value of history is lost. While on health care Obama assigned an article with social-scientific underpinnings (Atul Gawande’s “The Cost Conundrum”), on foreign policy issues there seem to be only a small number of examples from which we can draw lessons (Munich, Yalta, the Cuban Missile Crisis and Vietnam) and these tend to be very poor approximations to most modern problems faced by the United States. As Yuen Foong Khong has pointed out, such analogies tend to generate more heat than light: we read into them the message that we want to see.

Admittedly, finding good data on success against insurgencies is difficult, although the Enterline and Magagnoli dataset mentioned in an earlier post is a good start. Perhaps the fact that Presidents repeatedly select histories for guidance on foreign policy is more a comment on the shortcomings of international relations scholarship: unreadable prose, limited policy applicability, and a focus on theoretical debates. Still, I’ll dream of the day that I see the White House book club is reading an IR scholar’s book. Then I can criticize them for reading the wrong scholar…

Tuesday, October 6, 2009

The Economic Case for Single-Payer Health Care Reform

I make the case for single-payer health reform over at the PoliProf Blog:
"The only way that we can bring health care spending under control, and therefore be able to provide coverage to everyone, is if we move beyond our aversion to government intervention. Only government can effectively allocate our health care resources in a manner the responds to need rather than wealth. Only government can establish an annual health care budget and ensure that facilities and providers abide by the annual limits. Only government can effect our transition from a system driven by the perverse incentive to deliver care as a means to generate revenue to a system based on the proper management of care in order to conserve resources. The logical approach would be to restructure Medicare and make it universal. And it must be universal. The only way to get the public on board, and to accept the change, is to have us all in the same system, all guaranteed the same level of care, all sharing the same resources. This is what other nations do, and what we must do."

Friday, October 2, 2009

There's a Public Option and Then There's a Public Option...

The Senate Finance Committee defeated two efforts to add a public option to Baucus authored health reform bill, but proponents have note ceded defeat. In fact, many are being heartened by recent statements from Harry Reid that “We are going to have a public option before this bill goes to the president's desk.”

What does this mean? Will Reid ensure that the public option is retained when the Senate Finance and Senate Health, Education, Labor, and Pension committee bills are merged? Does it mean that he will ensure that the public option survives the House/Senate conference process? Does it mean that he plans to use reconciliation to pass the bill and has sufficiently prepared for all of the challenges that would present?

Or does it mean that Reid is choosing his words wisely? Moments after his initial comments were made public his office offered a follow-up: “Sen. Reid believes that health insurance reform must include a mechanism to keep insurers honest, create competition and keep costs down… the public option is the best way to do that… we don't know exactly what that option will look like.”

I’d suggest that it won’t look like a federal public option, rather it is more likely to come in the form of the amendment drafted by Tom Carper (D-DE). Carper’s amendment would:

give states the authority to increase competition in health insurance markets by implementing one of the following mechanisms listed below. This would allow a state to offer a state public option; however, both the executive and state legislature would have to agree.
The state would have the option of implementing one of the following mechanisms:
1. Participate as grantees in the CO-OP program and apply for seed funding.
2. Open up that state’s employee benefits plan.
3. Create a state administered health insurance plan with the option of banding together with other states to create a regional insurance compact.

So states could participate in the co-ops created in the Baucus bill as a substitue for a national public option, open the state's insurance plans, or create a state based public option... This is hardly a significant change and arguably "allows" states to do things that they can already do.  So I would advise tempering any excitement over Reid’s comments.