When protesters marched on washington a few weeks ago, one of the most common rallying cries was that congress was disconnected from the opinions of the American people.  They argued that Americans were outraged that congress was (among other things) shoving a healthcare bill down American’s throats that they don’t want.  I found this to be a curious charge, considering the bipartisan calls for healthcare reform that have grown louder over the last few decades.  But maybe the protesters had something there.  Perhaps it’s true that congress has become disconnected from what mainstream Americans want out of all this healthcare reform talk.  Fortunately, a few polls have been released recently which give us some insight into how the public feels about the public option , perhaps the most famous, most misunderstood, and most contentious element of the healthcare plans proposed thus far.

First up is an ABC news poll released Sept 14th, shortly after the president’s healthcare address.  The entire poll is interesting (found here) but in regards to the public plan the numbers were close but clear:

“On specifics in the health care plan, 55 percent support a so-called public option, with 42 percent opposed – slightly less opposition than in last month’s 52-46 percent division, but still shy of the initial reaction in June, 62-33 percent support.”

Notice the reference to numbers from earlier in the summer, when support for the public option started out strong, and then dipped significantly in popularity through July and August.  Clearly the townhall protests, the “death panels”, the abortion furor, and the numerous other healthcare reform myths had taken their toll.  So was the slightly aleviated opposition after Obama’s speech a blip on the radar or a sign of a turning tide?

If the recently released NYT/CBS poll is to be believed then the tide has turned indeed.  Here are their numbers on the public plan:

What surprises me most is that they threw “like medicare” into the language of the question which, in my opinion, makes the public option seem more socialistic than it actually is, and still the result was dramatic.  Perhaps some of this increase in support can be explained by a bloomberg poll, released in between the two afformentioned polls, which asked those surveyed to rate the validity of various claims they’ve heard about healthcare reform.  Here are the results:

While these wild charges were certainly making headway at first, it seems that the fact-checkers have caught up and most Americans have, by now, recognized them as non-issues.

While not representative of America as a whole, another poll released a couple weeks back asked America’s physicians what they thought of the public plan:

“When given a three-way choice among private plans that use tax credits or subsidies to help the poor buy private insurance; a new public health insurance plan such as Medicare; or a mix of the two; 63 percent of doctors supported a mix, 27 percent said they only wanted private options, and just 10 percent said they exclusively wanted public options.”

To clarify, the “mix” option refers to the public plan which would compete with private insurers, and the “new public health insurance plan such as medicare” refers to single-payer healthcare ala Canada.  This means that a full 73% of doctors support either a public option or something far stronger.  This is not surprising to me having come recently from a CMA conference in LA where I heard republican physician after republican physician extol the benefits of healthcare reform and lament the lack of competition in the private insurance industry.

So lest my tentative support of the Baucus bill confuse anyone, I count myself among the 65% of Americans who would support a public plan.  The co-ops of the Baucus Bill, while better than nothing, aren’t shaping up to be strong enough to have the negotiating power necessary to substantially lower premiums or lower long-term costs as efficiently as a public option.  While I’m nearly always in favor of political pragmatism, and I believe compromise is superior to partisanship even when one has the power to make their ideals law, I feel it should be noted that the public option was a proposal that came pre-compromised.  It was, in itself, an attempt to bridge the gap between the liberal and conservative theories of healthcare reform.  And as recent polls have shown us, it remains a mainstream, moderate choice.  And if these polls weren’t evidence enough, Bill O’Rielly came out in support of the public plan recently.  I’m not kidding! And when both Keith Olberman and Bill O’Rielly agree on a policy proposal, maybe that’s a sign we have found a reasonable compromise.

So perhaps the tea-party protesters were right in a way.  Maybe congress isn’t listening to the public on this one.  How else could we, with a democratically controlled congress, and a democratic president now be laying our hopes on a healthcare reform plan that does not include a public option, and thus lies to the right of the feelings of most Americans and the large majority of doctors?

Honestly I think it was a strategic issue more than anything else.  Had Obama come in pushing a more liberal plan we might be happily settling on a public option right now.  But, as he has on bills past, Obama attempted to bridge the gap first, then present the plan.  But I think we’ve learned that no amount of concessions prior to coming to the negotiating table will placate those who simply don’t want Obama’s presidency to succeed.  One of the things I liked about Obama during the election was that he consistently expressed a calm faith in the ability of Americans and congress to overcome partisanship.  Perhaps he gave us too much credit?  I hope not.  At the very least we’ve learned that acting as if we’re living in a post-partisan America, isn’t enough to make it so.

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Today the Senate Finance Committe (made up of both republicans and democrats) released their long-awaited “compromise” healthcare bill.  Since Obama’s healthcare speech last week (Read or watch the speech here) this seems to be the bill everyone’s been looking to as the hope for the future.  Some of that may be warrented but there’s still a long road ahead.  I’ve provided details and links after the jump

Links

For the full text of the bill (which seems to be formatted in an odd paragraph format) see here:

http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf

For a brief but thorough official 18 page summary see here:

http://finance.senate.gov/press/Bpress/2009press/prb091609.pdf

For the Congressional Budget Office’s always excellent and always non-partisan analysis see here:

http://www.cbo.gov/ftpdocs/105xx/doc10572/09-16-Proposal_SFC_Chairman.pdf

For a summary of the CBO analysis, from their blog see here:

http://cboblog.cbo.gov/?p=354

And for CNN’s description of the bill, which seemed to me to be the most balenced and informative of the major news outlets articles see here:

http://www.cnn.com/2009/POLITICS/09/16/health.care/index.html

Summary

So what does it contain?  Well it’s similar to many of the bills completed in the last few months in that it contains subsidies for those who can’t afford insurance, a mandate for individuals to purchase insurance, new regulations preventing insurance companies from dropping patients mid coverage or denying them insurance due to pre-existing conditions, mechanisms for eliminating waste from medicaid, and it creates a health insurance exchange.  But it’s also clearly designed to appeal to republicans and thus has some important differences from previous bills, specifically:

-It does away with the “public plan” (read more about the public plan) and replaces it with a series of co-ops (read more about healthcare co-ops)

-It includes more detailed provisions against providing funding for illegal immigration, adding stronger enforcement mechanisms

-It discusses abortion explicitly, reinforcing the old capp’s amendment, making clear that no tax dollars would be used to pay for abortions, except in cases of rape, incest, or immediate threat to the life of the mother, as it has always been in medicare and medicaid.  It also allows all state abortion regulations to stay in place

-Encourages tort reform, the details of which are to be decided by individual states

It’s also important to note that the CBO analysis was also released today and on the two big statistics everyone’s looking for the bill does decently well.  Ten years out the CBO predicts that the projected number of uninsured will be reduced from 54 million, to 25 million (pg 16), and the federal deficit will be REDUCED by 49 billion (pg 3)! That second number is significant because while Obama has always maintained that he would not sign a bill that wasn’t at least deficit neutral, this is the first completed bill I’m aware of that actually is.

Reception

The bill was received with optimism by the president, and by democratic leaders of the senate, but some democrats there have expressed concerns, namely Jay Rockefeller, who has come out in open opposition to it, and fellow finance committee member Ron Wyden.  In fact, as of right now, nobody on the Senate Finance committee aside from Baucus has endorsed the bill, and no republicans are committed to support it.  Not even the moderate Republican Olympia Snow who the white house has been working with extensively.  But the markup process will proceed for the next several weeks and it’s quite likely that a few republicans will be on board by that time.  Acquiring the support of at least a few senate republicans is a necessity since democrats do not have the majority necessary there to pass the bill on their own.  But moderating the bill wasn’t motivated purely by a desire to attract republicans, several moderate democrats were also somewhat uncomfortable with some of the provisions of the house bill and their support should also be more reliable with the Baucus Bill.

Unfortunately, widespread republican support on this, or any bill, cannot be expected.  Upon the Senate Finance Committee Bill’s release today, Mitch McConnel (R-Kentucky) released a statement saying “This partisan proposal cuts Medicare by nearly a half-trillion dollars and puts massive new tax burdens on families and small businesses to create yet another thousand-page, trillion-dollar government program.”  With all due respect to Mr McConnell, the first concern about cuts to medicare has already been widely debunked, there are new taxes for very few Americans but I think anyone looking at the numbers would say massive is a gross overstatement, the bill is not a thousand pages but is only 223 pages (almost half of which is just describing existing policies) and the CBO clearly predicts a gross cost of a bit over 800 billion dollars over ten years and a net cost of -49 billion.

But this kind of response was to be expected.  I tend to agree with Obama’s assessment in his speech last week that there are

“those who have made the calculation that it’s better politics to kill this plan than improve it”.

Back in July, Sen. Jim DeMint (R-SC) said in a conference call, “If we’re able to stop Obama on this it will be his Waterloo. It will break him”.  And since that time, I think, many republicans have committed themselves firmly to the idea that killing reform in the hopes that it will destroy Obama and get them more congressional power in 2010 is the best course of action.  The fact that republicans have yet to submit a proposal that is even halfway serious seems to support this theory.  Not that this is new behavior for congress.  It’s unfortunately common for one party to oppose good, moderate proposals simply for strategical reasons, especially when that party is the party out of power.  But I guess I had just hoped that with a healthcare crisis immediately looming, and with this being a subject that deals with the very life and death of American citizens, everyone would be putting forth a good-faith effort.

Anyway, this is important because it means that Democrats can really only hope to pick off a handful of republicans to support this bill, and they risk losing a corresponding number of liberals at the same time.  It’s a difficult task to balance.  And it’s beginning to upset liberals, Like Rockefeller and Wyden, who feel that Democrats “are being asked to support a bipartisan bill that doesn’t have bipartisan support.”  The compromise without the cover.  This same concern was present back in Stimulus days when extensive bipartisan talks resulted in a strikingly conservative final bill (with the final product being 42% tax cuts and 58% spending, nearly equaling Rush Limbaugh’s stimulus proposal in the WSJ of 48% tax cuts and 52% spending), but it still passed on a nearly party-line vote.

In the end will liberals say, “enough is enough” and push through a bill using a public plan with no republican support?  Will they use the controversial budget reconciliation method to do it?  Or will they stay on board with a compromise bill as it continues to be modified to meet republican needs to draw those precious few to their side?  Time will tell.  Personally, as much as I think a public plan would be a better choice, I think budget reconciliation is the wrong way to go at this point.  I think Americans prefer a bi-partisan bill, even if that bi-partisanship amounts to 57 democrats and 3 republicans.  And while I’ll reserve my final judgement for when mark-ups are finished, I think baucus’s bill looks decent so far.  Frankly, if it weren’t for the possibility of securing something “better” I think democrats would be thrilled with it.  I hope the liberal democrats realize that it would be silly if we took 0 steps forward because people were upset about taking 3 steps forward instead of 4.

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