Reviewing the checklist from the President’s speech
9 September
Let’s compare my checklist with what the President said tonight.
- Deadline – No deadline. Update: AP reports VP Biden as saying, “I believe we will have a bill before Thanksgiving.” That’s a prediction but not a deadline.
- “Must” and its variants – I found one bright line, and one fuzzy line claiming to be bright:
- “But I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice.”
- “I will not sign a plan that adds one dime to our deficits – either now or in the future. Period. And to prove that I’m serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don’t materialize.”
- Any new numbers – The President surprised me by proposing a specific number for “his plan”: “around $900 billion over ten years.” While this is less than the $1+ trillion in the House bills, it’s still an enormous amount of money.
- Public option language – He spent the bulk of this part of the speech explaining why he favors a public option. But he was weaker in support of the public option than I anticipated, and he talked more about legislative packaging than I anticipated:
- “But an additional step we can take …” (Rather than “we should take” or “we must take”)
- “But its impact shouldn’t be exaggerated – by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles.”
- “The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal.”
- And then he explicitly references Senator Snowe’s trigger idea and Senator Conrad’s co-op idea as “constructive ideas worth exploring.”
- Does he think the problem is substance or communications? – Communications: “Instead of honest debate, we have seen scare tactics.”
- How does he characterize the opposition? – He went after them hard. He called out “radio and cable talk show hosts,” “prominent politicians” (I assume he means Gov. Palin), and “special interests.”
- What did he learn from the August town halls? – Apparently nothing? He never referenced the August town halls. This surprised me.
- Does he explicitly reject bills developed in July to give nervous Democrats cover? – No.
- Medical liability / malpractice / tort reform – He committed to begin medial liability demonstration projects through administrative action. I assume he believes this obviates the need for the subject to be addressed in legislation.
- What is the priority: helping the insured or insuring the uninsured? – Both, as expected. He puts the insured first, but doesn’t strongly prioritize one over the other.
- “Universal” what? – OK, this one is fascinating. Nowhere in the speech does he promise universal health insurance, or universal health care. His only specific universal statement is “It’s time to give every American the same opportunity [to buy health insurance through an exchange] that we’ve given ourselves.” This is a fallback, allowing him to declare victory if expanded coverage falls far short of universality. You have to look carefully to see this. (I had to word search for “universal” and “every.”)
- Tax increases – He proposes the Kerry policy: “This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money – an idea which has the support of Democratic and Republican experts.” This is inaccurate. D and R experts have endorsed repealing or capping the current-law tax exclusion for individuals who buy expensive employer-sponsored insurance plans. Experts on both sides of the aisle have criticized the Kerry variant as inefficient and silly/stupid.
- Lines designed to highlight the partisan split. – He made the Kennedy linkage. To my ear the speech sounded extremely partisan.
- Falsely claiming that opponents have no alternative. – As best I can tell, he avoided the direct accusation.
- Straw men vs. valid substantive critiques – He again highlighted the straw men. He tried to address the deficit point. I’ll address this more tomorrow.
- What does his speech signal about his strategic legislative choices? – I’m not changing my projections this evening, but expect I will update them before the weekend. I need to see at least a day of public and Member reaction.
- Cut a bipartisan deal on a comprehensive bill with 3 Senate Republicans, leading to a law this year; (5% chance)
- Pass a partisan comprehensive bill through the regular Senate process with 59 Senate Democrats + one Republican, leading to a law this year; (25% chance)
- Pass a partisan comprehensive bill through the reconciliation process with 50 of 59 Senate Democrats, leading to a law this year; (25% chance)
- Fall back to a much more limited bill that becomes law this year; (40% chance)
- No bill becomes law this year. (5% chance)
The deficit language is the most interesting. He tries to be definitive:
I will not sign a plan that adds one dime to our deficits – either now or in the future. Period.
He immediately follows this with language that is written as if it strengthens this commitment. I think instead it undermines the commitment.
And to prove that I’m serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don’t materialize.
I think he’s anticipating that the Congressional Budget Office will continue to score legislation as increasing long-term budget deficits by an increasing amount each year. The President and his Budget Director will, I think, continue to assert that their “game changers” will reduce long-term budget deficits, despite providing no quantitative evidence to support this claim. This new Presidential language suggests that they will include additional language that requires actual spending cuts if (when) the game changers don’t work.
If I’m right, it’s a transparent gimmick designed to try to get CBO to say the bills don’t increase the long-term budget deficit, without actually making any of the hard choices needed to do so. If you care about the deficit, keep a close eye on this element of the President’s proposal. I will help you do so.
Finally, the President characterized his proposal as a “new plan.” We’ll see if he backs that plan up with anything more on paper.
Related Posts
(best matches are listed first)- A checklist for the President’s health care speech
- The text of the President’s health care speech
- Updated legislative scenarios for health reform
- Updating the legislative scenarios (already)
- Apparently $634 B is only the down payment for health care reform
- President Bush’s speech on financial markets and the world economy
- Incorrect conventional wisdom about health care reform
- The legislative landscape for health care after House passage
They will pass something as vague as possible and then go to court to define it.
So the Great and Powerful Ob has spoken and his principal message was "PAY NO ATTENTION to that public plan behind the curtain".
Appreciate your analysis above and look forward to your comments tomorrow.
Great analysis. I find Obama increasingly an embarrassment to the nation. I am tired of these daily Obama lies.
Keith,
Thanks again for the great analysis, and also a framework for scoring what the president says. To my ear, it didn't sound like anything new was said tonight. Rather, I might summarize it as "You people obviously don't understand what a great idea this is, so I'm going to explain it again, only slower." As I've heard others note, the problem [for him] is not that we don't understand what is being proposed, but that we do.
While we're here, I have another question that would require a fair bit of analysis or background information, which seems to be a Hennessey specialty: Is it possible to break down where my insurance dollars go? As an example, let's say that my family insurance policy costs $15,000/yr. That is, do we know what percentage of insurance payments cover: doctor's fees, support staff, regular medical office overhead, hospital overhead, hospital rooms, prescription drugs, medical devices, long-term nursing care, medical malpractice insurance, costs shifted from other government programs, etc? Politicians regularly like to pin blame on various of these cost components, but it's not obvious which ones are really driving costs.
KBH: thanks for the first pass analysis. I look forward to follow up posts.
Did I miss something in the Presidents speech? Was this a game changer or just one more speech in a litany of speeches? Light on detail, heavy on oratory, the President apparrently believes if he speaks the waters will part.
"Experts on both sides of the aisle have criticized the Kerry variant as inefficient and silly/stupid. "
But, in fairness, some experts have said that it might be politically the closest thing in practice that could get passed.
You're correct. It's a dumb but potentially passable implementation of a good idea that is unlikely to pass drafted as a good idea.
Yeah, I guess Obama doesn't like "special interests." Too bad for him that he can't, or won't, understand that the American public is the biggest "special interest" of all.
He specifically said that in addition to Medicare/aid waste and fraud paying for this new plan it would ALSO pay for the presecription drug program (increasing unsustainably — if that's a word).
Just my opinion, but I think in the end Obama and the Dems may give a fair amount in order to get bills out of both the House and Senate, and they will then keep the Blue Dogs off the Conference Committee and totally rewrite everything in Conference, jamming the Conference Republicans as much as necessary, and roll it out for a final vote in each House the last day before a big recess, and just twist off anyone's (Dem) arm who doesn't go along. If Pelosi and Reid can enforce party discipline they have 60 in the Senate and votes to burn in the House.
That's pretty much the way we do things in Illinois and that's where Obama and Emanuel and Jarrett and a bunch of the rest of them learned how.
Maybe someone more familiar with House and Senate rules can tell me if there's a flaw in that logic?
It's sound logic. The only question is how many arms, and how effective might such arm-twisting be?
I hoped there was a procedural rule to prevent that.
Rahm will tell Dems that if they worry a Yea will hurt them in 2010, they should also worry about primary challenges and no Party or union support if they DON'T vote Yea. If you vote the right way and lose in 2010, we'll take care of you. We only need 60 or 218 and if you're not in the first 60/218, we owe you nothing. I can hear Rahm telling a nervous, wavering Member how little it means to be 61st or 219th!
That's how it's played in Illinois, and it can be very effective. My guess is a lot of Members aren't ready for that.
3 or 4 squishy GOP in the Senate, maybe a dozen in the House (tho maybe not, House GOP held on ARRA), this strategy would have a good chance. I don't like most of this proposal, so I hope that if it gets to a Conference, the GOP conferees would include a few willing to fight and leak hard, so there is some warning… but if the Dem majority just has staff go write a report, I suppose it could get jammed through Conference at 9 a.m. and be voted on in both Houses by 1 p.m. or next day?
Understand how Washington works, but I believe the American people are tired of the games. Fifty minutes of the same old tired talking points for the past 4-5 months. You are probably right on the 40% chance on a limited bill with the opportunity to sneak thru the rest over a period of time in appropriation bills.
Re: long term deficits
In other words, what he is saying is:
"We promise spending cuts. "
"If we don't achieve those spending cuts….
we will promise more spending cuts".
Do I have that about right?
—————————————————————————————-
I saw an interesting item on the WaPo Q&A after the speech:
Question:
What will be the extent of the "bureaucracy" to administer the program and are those costs inherent in the program costs?
Robert G. Kaiser:
No big new bureaucracy is envisioned by any of the bills passed by committees so far, and I wouldn't expect that to change.
IS THAT TRUE? As I read the bill, I wrote down every new agency, task force, etc. I came up with 42. Some think tank counted 53. (I didn't count state/local bureaucracies.)
I don't understand who Obama thought he was addressing with all the tough talk in this speech. When he was stamping his feet and saying "now is the time" and "stop bickering," who the heck was he supposed to be talking to? If it was to the recalcitrant Democrats, why excoriate them publicly instead of arm-twisting behind closed doors?
I suspect he was really addressing the American public. If that's the case, he just made a very costly mistake. Nobody is going to be swayed by, "Here's my bill again. Now stop being such a pain and accept it."
Dear Keith,
Is it true that the genesis of employer provided health care insurance is connected to federal government wage controls imposed during WWII? Found this link online which claims that: http://healthinsurance.about.com/od/jobbasedcover...
If this is an historical fact, then why aren't Republicans making hay out of this? Seems to me the experiment has proven to be a total failure…and that it's about time to simply have the employer turn that money over to the employee as an increase to his wages so that the employee can purchase his/her own health care coverage.
Yes, that's correct. The government tried to control wages in WWII. In addition, the IRS made a ruling that employer-sponsored insurance was not taxable. Much of our current health insurance structure is a result of historical accident.
MaidMarion:
It's true; employer-provided health plans (it's more than just "insurance") were a way to give workers more than the authorized wage without paying them more cash.
Why aren't Republicans making hay about this? John McCain tried. He proposed taxing health benefits as income, paired with a tax credit for purchasing insurance. You'll notice that John McCain is not the president. The guy who won raked McCain over the coals for proposing to RAISE PEOPLE'S TAXES, even through the net effect would be no tax increase. That's why Republicans don't pipe up. It's one of the easiest issues to demagogue.
This is the first post of yours that I've read where I think you're off the mark and being hyper-critical.
"must and variants" – There were several other variants of must in the speech. It just happens that they are issues on which both sides agree, e.g. pre-existing conditions, no rescission for insurance companies. These are non-negotiable components to any plan.
"Public option language" – Personally, I thought this was one of the stronger points of his speech. He speaks to both sides of the debate and asks everyone to consider other options. You think the extreme left is going to love that Obama told them to chill out with the public plan? The real question lies in the response. Which side, left or right, will actually listen to that basic concept? Will Liberals ease up on the public option? Will the Conservatives even give the public option a chance? As Obama put it "And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have." (I must mention that the Republican response implied a government takeover. "Replacing your family's current health care with government-run health care is not the answer").
Which leads to "Opponents" and "substance or communication" – I can't speak for what is being said in private, but when Grassley says "there is reason to worry" and the GOP has taken such a strong, unwavering stance against a public option because it's a "government takeover". Well… That's not exactly substance. That's over-inflated rhetoric. So, communication seems to be a main problem. I have yet to see a switch in the debate since July (this site excluded). Death panels, government takeovers and slashing Medicare benefits are the dominating issues. However, I'll also add that he does give respect to ideas that are different than his own (about which you appear skeptical in your first checklist post). He says a number of times that he's willing to listen to other ideas. But are they willing to do the same?
"universal" – He mentioned that everyone would be required to have insurance like we are required to have car insurance. How is that not universal? Suggesting he is hedging his bets just because he didn't over-use the word is a thin argument. (Although, politically, he's certainly hedging his bets).
"Partisan split" – Well of course he was going to use Kennedy. He made a career talking about health care. And of course they will use it to a political advantage. Republicans would do/did the same thing (2004 RNC Reagan = Bush love-fest) . Even Kennedy himself would expect no less. I agree with your advice to Repubs, stand and honor the man, disagree later. I was listening on radio so didn't see if they stood or not. I see this kind of thing as rote. Certainly not a sinister Machiavellian type thing.
"Opponents have no alternative" – Again, he acknowledged many ideas from his opponents and continued to encourage open talks. I can see that he could have used more examples.
"Strawmen vs substantive critiques" – I agree with you here. But my 'spin' on it is that he was talking more directly to 'the people' rather than policy wonks. Addressing the strawmen is what he HAS to do. And be honest. Republicans float those strawmen arguments in order to detract from actual substance and keep the discussion on gut reactions. (Democrats do the same thing). If he started listing off numbers and budget deficits and whatnot, he'll lose most of the audience and be criticized for trying to confuse everybody, i.e. elitist. Addressing death panels are proof that this type of strategy works. (And I think it sucks).
I always enjoy reading your take on it.
You should have read Mr. Hennessey's checklist. It would have helped with your perspective on this post. It is clear the president learned nothing over the August break. He sharpened his rhetoric, but last night proved to me, once again that Mr. Obama talks out of both sides of his mouth when it comes to special interests, demagoguery, false statements, size of government, and deficits. All of Mr Hennessey's checklist points gave Mr. Obama an opportunity to prove that he was different and to frame a substantive argument. He is not and he did not.
Keith, thank you for the checklist an insight. I can see why people can be taken in by rhetorical wizardry.
I did read his checklist. I just disagree with many of Keith's (and your) statements.
The Lewin Group would suggest your casual dismissal of the "public option" is flawed – I have seen numbers in the area of 100M lives losing their private insurance within X years – and not some thing like 2030. A public option is a government takeover of the remaining 50% of the health care market they don't already control.
The Lewin Group's publication is based on numbers that aren't valid anymore. For example, they assume that the public option will use the same Medicare reimbursement rate. The numbers I've read are about 20-30% higher. This would greatly effect the number of people that would go to the plan. Another issue is with the Americans that are eligible to buy in to the plan. Is it open to everyone or just open to small businesses and individuals? This greatly effects enrollment.
My point here is that there are ways to ensure there is no government takeover of health care. It's possible to make the public option work but Republicans have shown that they are unwilling to discuss ways to do this by screaming 'government takeover' every chance they get.
I will have to say, even though I kind of applaud the Congressman from South Carolina for speaking out during the speech, to let the American people know Obama is a liar….on the point illegals getting helath care, we need more information…right now, there are illegal aliens, right now, these illegal aliens get free health care every single time they enter the emergency room…BUT, the next BIG thing on President Obama's "list of things to do" is Immigration reform, which means, in a nut shell, he wants to make ALL those folks that are "illegal" NOW, LEGAL, with a swipe of his pen….so, IF Health Care reform is Passed….and EVERY "LEGAL" person is covered, then the next logical step is making IL LEGALS, LEGAL….so while he might have been telling the truth in the speech….he's going to change the rules down the line….watch out. And, watch out, when Immigration reform comes, because IF THAT passes…the borders will be over run like ants….