TheWorldPolitics

Did progressive organizations and members of Congress get completely rolled in the health reform negotiations?  Nope.

By comparing the current state of health reform legislation to the most conservative proposals that were passed out of Congressional committee, a healthy list of concessions progressives forced out of the right-wing of the party becomes visible.  If there were no alterations from the most conservative health reform proposals that were passed out of Congressional committees in 2009, then the current state of health reform legislation would have:

1. $125 billion less for Medicaid, CHIP and exchange subsidies (total across all three programs);
2. Numerous exceptions to Medicaid eligibility even for people below 133% of the federal poverty level (FPL from here on out);
3. No minimum medical loss ratio for health insurance plans, instead of an 85% minimum medical loss ratio;
4. The Stupak amendment, instead of the Stupak state opt-out that is in the Senate bill;
5. No extra money for federally funded Community Health Centers, instead of increased funding to provide primary care to 16.2 million patients annually;
6. An excise tax on high end insurance plans would start in 2013 (giving most unions no time to renegotiate contracts), and a lower threshold (making it less progressive);
7. No 2.9% tax increase on unearned income, making the funding mechanism for the overall bill less progressive;
8. A stronger individual mandate and fewer responsibilities for employers;
9. No national exchange, instead of what appears to be both a state-based and a national exchange in the proposal form the White House.

Does this list of concessions mean that progressive health reform activists have won resounding victories up to this point?  Certainly not–the current state of health reform legislation is far from ideal, and much closer to the right-wing proposals that passed Congressional committees in 2009 than the left-wing proposals that passed out of committee.

(Even the best proposals that passed out of committee are a far cry from what many progressives wanted.  Then again, there are some conservative Democrats who want no reform at all.  As such, I am only looking at proposals that passed committee, since those were the only viable proposals on either side.)

Still, it is an impressive list that should make any progressive activist who participated in the health reform fight proud, even if dissatisfied.  You really did improve the bill, and have the opportunity to keep improving it.

In the extended entry, I provide extensive justification for this list of progressive improvements to the health care bill.  I do so by comparing the most progressive, and least progressive, proposals to be passed either out of a Congressional committee, or by the full House or Senate in 2009, to the current state of health reform legislation.  This analysis looks at ten key fights legislative fights over health reform that have occurred over the past year:

1. The public option;
   
2. Repealing the health insurance industry’s anti-trust exemption;
   
3. Instituting a minimum medical loss ratio for insurance policies;
   
4. Expanding primary care in low-income areas through Community Health Centers;
   
5. Medicaid expansion;
   
6. Exchange subsidy levels;
   
7. Tax structure for funding the bill;
   
8. Insurance exchange structure;
   
9. Reproductive rights;
   
10. Mandate

It is a lengthy post, but in order to develop a comprehensive list of ways that progressives had improved such a large piece of legislation requires a lot of detail.  I have no doubt that there are some areas where my analysis could be cleaned up quite a bit, but at the very least I hope this is a good starting point in an important discussion.  So many people who poured their guts into this effort need to know what they achieved, because if this bill passes they achieved quite a bit.

More in the extended entry.
1. Public Option–Total Conservadem victory

Progressive proposal (Passed by House Ways and Means committee, PDF page 6): Public option tied to Medicare rates, available to everyone on the new health insurance exchange.  Estimated to cover 10 million people by 2019.

Conservadem proposal: No public option

Result: No public option

How did it happen? (You know this story) After House Progressives were unable to find the votes for the Ways and Means proposal, the House ended up passing a weaker public option that would have covered 6 million.  That proposal was further weakened in the bill sent to the floor of the Senate, which was a level-playing field opt-out that would have covered 3-4 million.  When even that was dumped at the behest of Blanche Lincoln, Mary Landrieu, Joe Lieberman and Ben Nelson, a Medicare buy-in compromise that would have covered around 1.5 million was adopted.  And then, that was dumped because Joe Lieberman backstabbed everyone, and the Obama administration backed Lieberman.

****

2. Anti-trust exemption–Current Conservadem victory, but pending

Progressive proposal (included in House bill): Repeal anti-trust exemption for health insurance companies

Conservatdem proposal (Senate Finance committee bill): Don’t repeal it.

Result (Senate bill): No repeal of anti-trust exemption, although the House passed it as stand-alone legislation. Might still have a chance of passing.

How did it happen?: Concession to Ben Nelson.

****

3. Medical Loss Ratio–Mostly Progressive victory

Progressive proposal (In the early December Medicare buy-in agreement): Require a minimum medical loss ratio of 90%.

Conservadem proposal (In Senate Finance Committee bill): No minimum medical loss ratio.

Result (In the February White House proposal): Minimum medical loss ratio of 85%.

How did it happen? The 90% loss ratio was originally included in the early December Senate deal on the public option as a concession to public option supporters. It was nixed by CBO when it declared such a provision would make all private insurance a government program.

****

4. Community health centers–Mostly Progressive victory

Progressive proposal (In the House bill): Increase funding for Bureau of Primary Health Care within the Health Resources and Service administration (aka, the federal Community Health Center program) by $14 billion total over next five years.  At current rates of service–$2.5 billion (PDF page 6) for 20.27 million primary care patients in fiscal year 2011– this would expand community health center patient base by 22.7 million.

Conservative proposal (in the Senate Finance Committee bill): No increase.

Result (in the Senate bill): Increased funding of $10 billion total over next five years.  At current rates of service, Community Health Centers will provide primary care to 16.2 million additional patients.

How did it happen?. Bernie Sanders got this result in exchange for his vote in the Senate.  Also, while some have doubted the ability of the Community Health Centers to provide primary care for so many patients at such low cost, the simple fact is that they do.  Kaiser has more information on Community Health Centers.

****

5. Medicaid–Even wash

Progressive proposal (House bill): 150% FPL eligibility with no exceptions; $425 billion in outlays; 15 million people covered

Conservadem proposal (Senate Finance Committee): !33% FPL eligibility with numerous exceptions; $345 billion in outlays; 11 million people covered.

Result (White House proposal). 133% FPL eligibility with no exceptions, over $400 billion in outlays, between 12 million and 14 million covered.

How did it happen? By an odd circumlocution, Nelson actually did something good for the bill.

Congress was looking to expand Medicaid in the bill, but red-state Governors didn’t want to come up with additional revenue.  So, as the bill progressed through the Senate, the federal government kept picking up more and more of the tab for states–including famous deals like the one Ben Nelson scored for Nebraska.   Eventually, by the time the White House released its proposal, the federal government is paying for virtually of the expansion.  Just about every state gets Ben Nelson’s deal for Nebraska, now.  The proposed outlays from the White House might exceed those in the House bill.

****

6. Exchange subsidies–Mostly Conservadem victory

Progressive proposal (House tri-committee): $773 billion in subsidies

Conservadem proposal (Senate bill): $436 billion in subsidies

Result (White House proposal): “slightly higher on average in the White House bill than in the Senate bill.” In total, the White House is proposing $75 billion more in Medicaid and exchange subsidy spending then the Senate bill.

How did it happen? In September, President Obama demanded the bills cost less than $900 billion over ten years, probably because the administration was afraid of the word “trillion” in the messaging wars.  So, one of the two main expenses in the various proposals–exchange subsidies, or Medicaid / CHIP outlays–had to be reduced.  Since Congress kept increasing the amount it was spending on Medicaid in the bill, the subsidies ended up on the chopping block.

****

7. Tax Structure–Mostly Conservadem victory

Progressive proposal (House proposal): Surtax on high-income households,; no excise tax on high-end health insurance plans

Conservadem proposal (Senate Finance committee): Payroll tax, excise tax on high-end health insurance plans

Result (White house proposal): No surtax on high income households; delayed and weakened excise tax on high-end insurance plans; tax on unearned income

How did it happen? Labor negotiated a delay and weakening of the excise tax, which the White House then expanded to the entire country to avoid appearance of special interest deal.  White house largely adopted Conservadem approach otherwise, and closed funding gap with tax on unearned income.

****

8. Exchange Structure–Unclear

Progressive Proposal (Mainly the House bill): National exchange that would quickly open up to entire country.  The House bill had a national exchange, but from there it gets decidedly mixed.  The Senate bill allows more businesses to be eligible at the exchange, and the House bill opens up the exchange to the whole country one year faster than the Senate bill.

Conservadem proposal (Mainly Senate bill): State based exchanges with the reverse of the mixed bag listed above

Result (White House proposal): A state based exchange and a national exchange; no word on starting eligibility or expansion rate.

How did it happen? Kind seems like this one is still happening.  Not sure how it will end.

****

9. Reproductive Rights–Mostly Conservadem victory

Progressive proposal (Several bills at the committee level): No change from existing law.

Conservadem proposal (House bill): Stupak amendment that would prevent any insurance plan on the exchange from covering abortion procedures.

Result (Senate bill): Stupak amendment, but on an opt-out basis.

How did it happen?: Democrats apparently elected an anti-choice House of Representatives. Bad candidate recruitment will likely result in backward movement for reproductive rights under a Democratic government.  That makes this mainly a Conservadem vistory.

****

10. Mandate–Mostly Conservadem victory

Progressive proposal (Mainly House bill): Strong employer mandate, minimal penalty for individuals who choose not to purchase

Conservadem proposal: (Senate bill): Basically no employer mandate; moderately stiff individual mandate (exemption if insurance costs more than 8% of income, fee of $750 for refusal)

Result (White House proposal): Some concessions (for example, refusal fee reduced to $695 or 2.5% of income, whichever is lower), but still closer to Conservadem proposal.

****

There are many more Conservadem victories than Progressive victories.  Still, in every case except for the public option and the repeal of the anti-trust exemption, progressives wrung at least some concessions out of Conservadems and the White House.  And Progs might yet still win a concession on the public option, and pass the anti-trust exemption.

Progressives really did make the bill better in substantial ways.

News from the UK election campaign remains personality driven, with little new thinking as to what either of the big parties may actually do to turn around the British economy (other than some phantom level of expenditures cutting where Labour cuts = X and Tory cuts = X +2).

Gordon Brown spent a relatively quiet Friday at the Chilcot Inquiry and made few waves. Quite confident, yet sufficiently apologetic for the loss of life that has accompanied the Iraq conflict, Brown’s performance received a grudging nod from most of the UK media. He is not likely to have won any new supporters, however, by simply holding the line for the New Labour hawks of the early 2000s.

At the same time, David Cameron and the Tories were knocked a bit on their heels by news that their biggest donor and Conservative deputy party chairman Lord Ashcroft was a so-called “non-dom” who does not pay UK taxes on his billionaire’s wealth. With dual citizenship in the former South American British territory Belize, Ashcroft promised to end his non-domiciled status in 2000 in order take up his peerage in the House of Lords. The main critique has been that in the last week, Cameron’s responses have been weak and equivical. Basically, he hoped the whole thing would blow over — and certainly it will — but with it likely goes some portion of the Conservatives waning momentum.

Saturday oestensibly marked the two month mark ahead of the UK vote. Here at FiveThirtyEight we will now be kicking our coverage of the election into high gear, launching about nine weeks of regular coverage.

One new feature will be a set of background posts from myself and two newly added FiveThirtyEight research assistants. The goal is to provide some useful descriptive detail on the UK electoral system, campaign styles, key players and articles of controversy for our US-based and international audience.

The descriptive backgrounders will support a series of analytic pieces that will be more in line with the FiveThirtyEight ‘examine-and-project’ style.

The next few topics to be discussed in the next 8 weeks:

1. Boundary systems in the UK and US: Similarities, differences and why it matters in this elections.

2. Independent voters in the UK election: Whichever party wins this year’s UK general elections will likely have swing voters to thank for it. As Nate pointed out last fall, though, this is a tautology: whichever party wins an election has by definition captured the swing vote. In the 2010 UK General, how do these voters break down?

3. The “Built-In Labour Bias”: Boundary commissions, tactical voting, or mythology? We will pick apart which elements are relevant and which political rhetoric in a 2010 context.

4. Projecting the outcome of the election: With reputable pollsters and smart poll aggregators, why is there so much question about the outcome of the election? We will examine what is needed to effectively project individual constituencies, along with the national party share numbers.

We have tackled a few issues already, for those who have not been following the series closely.

1. A Hung Parliament (From the Gallows, Perhaps?): Basic electoral information and history from the past 25 years.

2. Instant Run-Off Proposed by Brown: Considerations of the Alternative Vote proposal, and how it might play in this election.

3. For UK Conservatives, It’s the MP Ratio that Matters: Translating national horse race numbers into shares of the final allocationo of MPs is always a challenge in the UK. This article looks at why it matters.

—
Renard Sexton is FiveThirtyEight’s international affairs columnist and is based in Geneva, Switzerland. He can be contacted at sexton538@gmail.com

Monday opinion: The Hurt Locker wins big.

NY Times TV Watch:

The hosts, Steve Martin and Alec Baldwin, did an updated Catskills routine, but were at their best when snubbing George Clooney and mocking the most distinguished nominees. “Oh look, there’s that damn Helen Mirren,” Mr. Martin said, pointing at the audience. “That’s Dame Helen Mirren,” Mr. Baldwin explained.

Best was pointing to a few young actors and then themselves: “this is you in 5 years.”

Paul Krugman:

Everyone has a theory about the financial crisis. These theories range from the absurd to the plausible — from claims that liberal Democrats somehow forced banks to lend to the undeserving poor (even though Republicans controlled Congress) to the belief that exotic financial instruments fostered confusion and fraud. But what do we really know?

What do we know? Whatever happens, the banksters get their bonuses. That’s what we know.

EJ Dionne:

In a city where the phrase “bipartisan initiative” is becoming an oxymoron, the urgency of containing the damage the Supreme Court could do to our electoral system creates an opportunity for a rare convergence of interest and principle.

In a city where Democrats offer olive branches, and Republican burn the branches for fuel, the parties are equally blamed, except by the public (they blame Republicans 2:1 for non-cooperation in the polls). But Republicans are the party that appointed the SCOTUS that screwed American voters in favor of corporate money.

Mark Penn offers health reform advice you didn’t request, and won’t be interested in after you read it.

Drew Westen:

To his credit, the president pushed through a stimulus bill that prevented us from falling off the cliff. But he refused, as FDR had done, to brand the crisis that had occurred as the direct result of Republican ideology and governance. He refused to explain to the American people why deficit spending in times of a crashing downward spiral is a virtue and not a vice. And he refused to call out — let alone even answer — Republican politicians attacking him from his first days of office for deficit spending, although they had just created as much debt in 8 years as in the previous 200-plus with enormous tax breaks for the wealthy and a trillion dollar war “off the books,” neither of which they even considered paying for. As a result, he got little credit for having prevented another Great Depression, and now there are two competing narratives, that the stimulus saved us and that it was a waste of taxpayers’ money.

FDR didn’t contend with political foes with their own cable network and credulous he said, she said stenographers.

Joan Walsh:

I predicted Wednesday that Republicans and the mainstream media would soon have a new but typically simplistic partisan line: that recent scandals involving Democratic Reps. Eric Massa and Charlie Rangel and New York Gov. David Paterson would make 2010 what 2006 was for Republicans — the year voters punished the party for its corruption. Throw in oldies but goodies like former Illinois Gov. Rod Blagojevich and former New York Gov. Eliot Spitzer, both Democrats, and I foresaw an avalanche of 2006-2010 comparisons. And I was right.

Before I attack that false equivalence, let me make clear: I’m not defending these Democrats.

Just setting the record straight.

At the end of a discussion of Haiti on HBO’s Real Time with Bill Maher, actor Sean Penn went on a rant in defense of Venezuelan strongman Hugo Chavez, suggesting prison time for American journalists: "every day, this elected leader is called a dictator here, and we just accept it! And accept it. And this is mainstream media, who should – truly, there should be a bar by which one goes to prison for these kinds of lies."

This is a little strange, since a study by our Business and Media Institute of Chavez coverage from 1998 to 2006 found Chavez’s much-criticized human rights record was mentioned in only ten percent of stories, and he was described as a leftist in only 12 percent of stories. Maher shifted to Chavez and the end of the Haiti interview, asking Penn to make a case for his man Chavez:

MAHER: His image in the media is just a buffoon. You have been there. You know him. You’ve talked to him. That’s all I really know about Hugo Chavez, is what I read in the media. A dictator, took over a lot of the branches of government, wants to be president for life. What do you know that I don’t know, that I should not have such a harsh feeling about this guy?

PENN: I think that if you’re more happy with 20 percent of a population having the access to dreams, access to the feeling they have an identity and a voice. If it’s okay with the 20 percent, versus the 80 percent he gave it to, then you can criticize Hugo Chavez. You know, there are a lot of complicated issues that comes simply out of perspective. We in the United States have a difficult time putting ourselves in the shoes of what has been the history of Venezuela, the history of Latin America, and many other places.We’re very monocultural. And then we are hypnotized by the media. For example, Hugo Chavez. Who do you know here who’s gone through fourteen of the most transparent elections on the globe, and has been elected democratically, as Hugo Chavez?

Stay with the transcript here, because Penn’s talk gets very fuzzy and inarticulate, but his primary point is that Venezuela and Cuba helped him provide assistance to Haiti, when he knew next to nothing about how to help, so he is frustrated that anyone would speak negatively about them:

PENN: Hugo Chavez, who when I went to Venezuela, when I went to Haiti, because when I, starting up an NGO [non-governmental organization, in U.N.-speak], how do I , an actor in Hollywood, order bulk narcotics? [Laughter] But meanwhile –

MAHER: Oh, I know you do know how.

PENN: But on a serious note, you know, this is where amputations, reamputations after gangrene sets in – it was Venezuela, Cuba, were – supplied us with those to be able to get them to hospitals. And then later when I – it wasn’t because the Americans weren’t, it was because I didn’t know how – It seemed I didn’t know the same people that I know to be able to do it.

Penn wrapped up the segment by insisting that he’s a little sympathetic to anti-American conspiracy theories about occupation, because this is the kind of gunk that gets thrown at his hero Hugo, and it should be punished by jail time:

PENN: The collaborative opportunity in Haiti, when you talk about Hugo Chavez, and some of the other people who are demonized [think Castro], and you know, when some of these countries accuse us of an occupation — where I believe this was strictly a humanitarian action by the United States military, and an incredible one – I’m a little sympathetic. Because every day, this elected leader is called a dictator here, and we just accept it! And accept it. And this is mainstream media, who should – truly, there should be a bar by which one goes to prison for these kinds of lies.

Penn did not offer praise for the network news reporters who spoke well of Chavez, as BMI reported:

Jessica Yellin of ABC’s Good Morning America" portrayed him as the "wildly popular Venezuelan President Hugo Chavez" and added "it’s clear the real star in these parts is Mr. Chavez, the protest leader" in her Nov. 5, 2005, broadcast.

Ironically, an Aug. 16, 2004, "NBC Nightly News," report actually noted concern had Chavez lost the election. Anchor Tom Brokaw expressed that sentiment: "There had been concerns that a Chavez defeat could further disrupt oil supplies."

Chavez and Penn do seem to agree on George W. Bush, as BMI noted:

A Feb. 5, 2006, Reuters report quoted him [Chavez] saying: "The imperialist, genocidal, fascist attitude of the U.S. president has no limits. I think Hitler would be like a suckling baby next to George W. Bush."

So Penn doesn’t think Chavez isn’t more of a demonizer than a demonizee?

During the final years of the Soviet Union many political dissidents weren’t sent to slave labor camps as happened in the bad old Stalin era if they weren’t outright liquidated. Instead, their divergence from the official party line was viewed as some sort of mental disorder that must be treated, usually with forced confinement in mental institutions which were little more than prisons. And now we have a Marxist blogger for Psychology Today who proposes that Tea Party participants suffer from a mental disorder. The funniest thing is that when one reads the rantings of Michael Bader, he appears like Captain Queeg on the witness stand. The more he writes, the less rational he sounds. Take a look at just the first sentence of Bader’s extended rant and guess who comes off as sanity challenged. BTW, the word "f—ers" in his primal scream article is fully spelled out:

These tea-party folks seem to most liberals-well, to most of us who live in the "reality community," or, as I like to call it, "reality"-like crazy f—ers.

Bader doesn’t hide his outright hate for the tea party folks:

I hate these folks but I also understand them. And, well, uh, I also empathize with them. They share the same psychology as the paranoid patients I treat every day. The only difference is that the paranoid beliefs of the tea-party movement are political while those in my consulting room are of a more personal nature.

So it’s all just a mental disorder, just like what the Soviet dissidents suffered from. Bader then proposes to "understand" the tea partiers…so as to fight them:

I have come to have empathy for the tea-party’ers, even as I despise their influence and work hard to defeat their ideology. It’s crucial that progressives do likewise because if we don’t understand the ways that decent, god-fearing, and victimized people can come to espouse such a dangerous ideology, we won’t be able to fight them effectively.

And now a paranoid theory about tea parties put forward by one Michael Bader:

For new tea-party members, however, the drift toward paranoia is facilitated by the right-wing media machine that offers several ready-made narratives perfectly designed to help its consumers clear up their confusion, understand their helplessness, absolve them of any blame, and offer a way out. The conspiratorial alliance of business and government, a growing tyranny intended to disenfranchise, disarm, and exploit ordinary citizens, secret pacts to overthrow the constitution, etc. all currently led by an un-American, godless, colored, elitist, contemptuous, foreigner–Barack Hussein Obama. A grim and frightening picture of the world to be sure.

Yeah, a "right-wing media machine." Now who is being paranoid, Mr. Bader?

A few final swings with the butterfly net by Bader:

The "problem" is that tea-party activists move from legitimate feelings and normal longings to paranoid political positions that are dangerous and cruel. But because these positions serve an important psychological function, because they resolve an emotional dilemma, they can’t be changed by rational argument. 

…Perhaps the progressive movement shouldn’t waste its time dealing with the tea-party movement except as a spur to get our own house-and movement-in order. A legitimate argument can be made that these people are, simply, the enemy and that our challenge is to build progressive majorities immune to their sabotage and interference. But I would argue that to the extent we want to reach people who are drawn to tea-party, patriot, libertarian, and other right wing movements but are not yet hard-line ideologues, or prevent others from becoming so, we have to begin with empathy. We have to get inside their heads, figure out how their choices are reasonable from their point of view.

As for the claim by your humble correspondent that Bader is a Marxist,  is that some sort of scurrilous "McCarthyite" charge? Nope. The person who claims that Michael Bader is a Marxist is…Michael Bader as you can read in his biography:

I was always a lefty. My father was the only liberal in a family and community of racist republicans.  My older brother went to U.C. Santa Barbara in 1967 and gave an adoring younger brother regular reports from “the front.’  And I went to Berkeley from 1970 to 1976.  ‘Nuff said.

At first, politics for me was all about the New Left, Marxism, and political economy.  I was “out-there,” active in various extremist groups, and fully engaged at the same time with the counter-culture.  Eventually, with the decline of the New Left, I gave up being active in the public political world and chose a profession—psychology.  I never gave up my sentiments or beliefs, but couldn’t figure out how to blend them with my work, since I don’t believe that good therapy should have a political agenda in any way.

Got that? Bader still clings the the stale economic beliefs of a discredited 19th century deadbeat who never held a regular job and spent his days jotting down impractical rantings in a London library reading room while hitting up his friends for money. And yet Bader, who claims to be based in reality, continues to cling to those same beliefs as subscribed to by the likes of Lenin, Stalin, Castro, and Hugo Chavez.

For further proof of Bader’s complete divorce from reality, check out his Why We Should Stop Demonizing John Edwards.