Do Democrats Face “Unmitigated Disaster” at the Polls if They Pass Reform?

Republicans continue to warn Democrats that if they pass health care reform, they will lose their seats in November.

For what it’s worth, I believe that a fair number of incumbents (Republicans as well as Democrats) will lose their jobs in November because unemployment will remain high. In good times, Americans vote for the person they like: charisma carries the day. In bad times, they vote their pocketbooks. Health care reform will not be the issue that decides elections in November.

I also remain confident that Democrats will manage to pass this legislation, probably using the strategy that Ezra Klein outlines here. It may sound complicated, but according to congressional scholar Thomas Mann of the Brookings Institution, Pelosi’s “deem and pass strategy is not unusual.”

Also, consider the fixes to the Senate bill that Klein describes: “the elimination of the Nebraska and Florida deals, the delay of the excise tax, more affordability and oversight provisions and more funding of community health centers.”  They’re all good, and they should please both the House—and the public.   

Will Democrats Who Vote For Reform Be Punished in November?

If you’re a Democrat who is worried about losing in November, it strikes me that you might want to be remembered as someone who voted for the public good—legislation that would cover millions of uninsured Americans.

Unless, of course, you’re a Democrat who agrees with the Republicans…Earlier today Pelosi summed up the Republican’s point of view; “The same forces that are aligned against Medicare are against this bill. This is what they believe. I’ll give them credit for staying true to their beliefs – they don’t believe in health care for all Americans and a government role in that. The budget that they have  [Rep. Paul Ryan’s budget] privatizes social security, offers vouchers instead of Medicare, and gives block grants to states instead of Medicaid. That is what they believe.” 

Pelosi added: “If we don’t pass this bill, how do we explain that to Americans?"         

Democrats Have More to Lose If They Don’t Pass Legislation

There, I think, she gets to the crux of the matter. If her party fails to pass a bill that it has described as the most important piece of legislation that this country has seen in decades, Democrats will seem not only impotent, but totally incompetent. Why would you vote for any of them again?

It is not as if there is an alternative to this legislation that the pubic might like better. The only alternative is the status quo:  the cost of care will continue to spiral, and more and more Americans will find themselves priced out of the health care market.

On the other hand, as Joseph White, a professor of politics at Case Western Reserve University, pointed out this week-end in The Fiscal Times: if Democrats pass reform  they will be able to  point to something and say: “This is what we did, this is the truth about it, this is how it would help you.”  (Thanks to Merriill Goozner for calling attention to White’s column over at GoozNews on Health.)  

Moreover, White noted, if we have a bill, the press may begin to focus “more on the actual provision of the bill as opposed to GOP charges.”  Keep in mind: polls show that the more Americans learn about what is actually in the legislation, the better they like it.

White concludes: “The Democrats also have to remember that the ‘losers who can’t deliver’ consideration will be far more prominent in November if they pass nothing now. In short, the battle over interpretation of the health care reform effort has only begun. We do not know how it will turn out in November, but there are good reasons to believe the Democrats are better off  fighting it with a new law in hand.”

Finally, keep in mind, voters will see some of the benefits of reform immediately: As the Brookings’ Institution pointed out in a piece published today:  “contrary to conventional wisdom, will not simply frontload the costs and backload the benefits. The plan will move quickly to erase the unpopular 'doughnut hole' that results in a costly jolt for many seniors buying prescription drugs, to end discrimination based on preexisting conditions for children, to ease the insurance burden on those losing or leaving their jobs, and to enable parents to carry children up to the age of 26 on their family policies.”

How many Americans know that all of these provisions are part of the legislation and that they won’t have to wait until 2014 to see the effect? Today, I would say, “not many.”  However, if we pass legislation, by November the public will be better informed.

23 thoughts on “Do Democrats Face “Unmitigated Disaster” at the Polls if They Pass Reform?

  1. I’m confused. If passage of this bill will really trigger “unmitigated disaster” for Democrats, why are Republicans so interested in warning them? Seems like they spend every waking moment hoping for an “unmitigated disaster” for the Democratic party.

  2. John–
    Indeed.
    But this is part of conservative fear-mongering–in this case aimed at moderate Democrats.
    It’s also meant to make the public feel that most voters don’t want hc reform and that reformers are arrogantly ignoring what the public wants.
    Since many Americans just aren’t sure what’s in the reform legislation–or how they feel about it- these
    very confident statements by conservatives can make some people think: “I guess these reformers really don’t care how I feel. And they’re just fools that they’re committing political suicide by passing this thing.”

  3. If health insurance rates go up then by 2012 I predict the democratic party will dissolve or evolve.

  4. If there is no “simple up or down vote” and if the house tries to pass a law by not actually voting for it, it is easy to see very big enthusiasm gap come November. None of you have obviously played sports because the talk of “unmitigated disaster” is nothing more than just talking smack and reinforcing their narrative. November is going to be all about enthusiasm. Passing a law by not actually voting for it is going to do nothing but turn the dial up to 11. No wonder most Americans think the Democrats are nothing but a bunch of effete pushovers.

  5. med shop online, Jenga, Mike,
    med shop online–
    Please see my reply to John below.
    Jenga– The procedure that you call “Passing a law by not actually voting for it” is called “deeming.” (See my link to Ezra where he explains it)
    This is not unusual, and has been used by both parties. “Deeming” as used 36 times in 2005 and 2006, when the GOP was in charge & 49 times in 2007 and 2008, after Dems had taken control.
    More importantly, most Americans are not interested in Congressional procedure. How the bill is passed is of little interest to them.
    What is in the bill is of mroe interest–particularly if it provides benefits for them.
    The change in the donut hole will please a great many seniors; 20-something and their parents will be pleased that 20-somethings can stay on their insurance; and any parent of a child with a pre-existing condition will be very, very happy to know that he or she can no longer be refused insurance.
    Once the bill is passed, there will be many stories in the news about these concrete and immediate changes.
    The November election will be all about the economy and jobs.. And, for the Dems, it will be all about getting out the vote that got Obama elected in the first place: African-Americans, Latinos, young well-educated liberals, etc.
    Mike C– It strikes me as unlikely that they would try to vote on drug re-importation right after passing HCR. Republicans would almost certainly vote against it, as would some Dems.
    I also think it would be less messy to simply let Medicare negotiate for discounts on drugs (as every other govt’ in the developed world does.) Private insurers will then begin asking for similar prices . . .
    I think that will happen sometime before 2014.
    Ed– You can be sure that health insurance rates will continue to go up unless hospitals and doctors begin doing fewer tests, surgeries, etc., and/or lower their fees.
    The amount that insurers have been paying out to doctors, hospitals and patients has been going up 8% a year, on average, for the last 8 years.
    As long as that continues, insurers will have to raise premiums.
    I’m hopeful that we will succeed in reining in health care inflation but it’s not going to drop from 8% to 0 in one or two years.
    If insurers cannot pass along increases in reimbursements in the form of higher premiums, they’ll simply go out of business.

  6. It may be that Democrats will face large losses in November if they pass health care reform, although there are good arguments that failing to pass health care reform after devoting so much time and energy to it would actually be worse for them.
    When John Kennedy wrote “Profiles in Courage,” he celebrated politicians who took important actions even though it hurt or ended their political careers.
    The health care vote is that type of situation. If you are a Democrat, what is the point of being elected if you can’t vote for the most important health bill in our history, and the beginning of the fulfillment of eighty years of Democratic campaigns for health care?
    If it means you lose your seat, then you lose your seat, but you have the consolation of playing a critical role in a reform as important as the original passage of Social Security, and what will undoubtedly be seen historically as a major step forward to a better and more just society.
    In fact, as one observer stated, if Democrats can’t support this bill, then we may as well start voting for Republicans, since at least then we would pay less taxes.

  7. At this point in the Healthcare issues, I am prepared to vote against my Democratic Representative if he does not vote for the Bill. I have never been a one-issue voter, but this is the case where I will be. There is no excuse for the past year of Democratic inaction. They are now faced with paying the price for their poor judgement to date. But pay it they must….now, or at the polls.
    On another note, the Republicans are frantically pulling out all stops to oppose the bills, despite recent comments that they want it to pass so the Democrats can be targeted in the Fall. Yet, I wonder if the Republican opposition isn’t posturing to be able to give their large contributors their “moneys worth” for their lobbying efforts against the bills. Looked at this way, fierce opposition by Republicans makes sense.
    This way, if the Bills pass, the Republicans can tell their lobbiests that they fought the good fight, and keep the money coming.

  8. Pat S. writes: “When John Kennedy wrote “Profiles in Courage,” he celebrated politicians who took important actions even though it hurt or ended their political careers.”
    And Pat, to paraphrase a Kennedy critic, with this Congress, we need a lot less profile and a lot more courage.

  9. Maggie, WHen health insurance rates go up don’t you think the Dems will be blamed? Do you think the voter will buy the logic that rates have to go up before they come down? The Dems have put themselves into a catch 22 when they abandoned single payor and its cousin the public option.
    Dissolve or evolve they will have to do because the Democratic Party as it is will never be trusted again. I’m not saying lots of folks want to do they right thing, but this isn’t the right thing, its the creation of a hog trough.

  10. The Democratic party will be safe either way.
    Passage fails, blame it on the Republicans and especially on the Dems who voted against it, replace Dems with better Dems in the next primary and replace Republicans all together.
    Passage happens, celebrate a victory and elect more Dems in the fall by pointing fingers at the monsters who don’t want people to have access to health care.
    Too simple? Perhaps but then many people still think Obama is a Muslim and the reform bill includes death panels.
    Remember, “Fear leads to anger, anger leads to hate and hate is the path to the dark side.”
    – Darth Cheney

  11. Mike, Ed, Pat S.
    Mike — I like your attitude!
    Ed– Rates would still go up with single payer or a public option.
    Rates don’t come down unless doctors and hospitals start charging less or doing less–it’s that simple. (Also the prices of drugs and devices will have to level off, and we’ll have to stop over-medicating.)
    Medicare reimbursements to docs and hospitals have been going up 6% a year for the past 10 years. The same thing would happen under single-payer or a public option. (Insurers’ administrative costs don’t drive inflation; they have remained relatively stable. It’s the underlying cost of care that keeps spiraling, pushing the nation’s health care bill higher and higher.)
    This can change if Medicare begins refusing to pay for waste, over-treatment, unncessary tests etc.–and if Medicare refuses to over-pay for procedures, drugs and devices that are no better than the older treatments they are trying to replace.
    If Medicare does that, private insurers will follow suit. (They, too, would like to pay less, but they are not gong to lead the revolution.)
    Unfortunately, many patients will fear that they are not getting the care they need: they will have a hard time accepting the fact that, in the past, they have been getting many unnecessary tests and treatments.
    And some hospitals and doctors will be unhappy.
    There will be a period of adjustment for everyone, and it won’t be easy.
    But the alternative is to watch the cost of your health care double over the next 9 years. Few people can afford that.
    Meanwhile, over the next 2 or 3 years, I suspect that the administration will give insurers a very hard time about raising premiums, and I suspect that some for-profit insurers will just fold their tents and get out of the business.
    This is not necessarily a bad thing. I would rather see the insurance business dominated by non-profits because they don’t labor under the same conflict of interest (torn between satisfying shareholders and satisfying customers.)
    Non-profits don’t have shareholders. But they, too, have to raise premiums as reimbursements go up. All of the non-profits have had to charge more in recent years, and that will continue.
    This won’t change until we address the basic problem: we’re paying too much for many products and services and we’re receiving too much unnecessary care.
    Tom– Yes, I agree, Politicians need to be less concerned about their “face” or profile (how they look) more concerned about spine.
    I also am not a one-issue voter. But I cannot think of a Democrat who is opposed to the hc legislation who I would vote for–this includes liberals.
    Anyone willing to be a “spoiler” on this issue (Dennis K.) is, to my mind, simply grand-standing, with no concern for the millions of people who need hc insurance to relieve needless suffering.
    Regarding conservatives: I don’t think their opposition is just about wanting the money from lobbyists. (Though that’s true.)
    As Pelosi said today, you have to give them credit for being consistent.
    They honestly don’t believe that we as a society have a responsibility to make sure that everyone has access to care, or that gov’t should be involved.
    They believe that it’s up to everyone to take responsibility for himself and his family. And if that means that some children don’t have the care they need . . “I’m not my brother’s keeper.”
    We’re really looking at a very basic difference in values.
    Of course, in the end, it all comes down to money: conservatives don’t want to pay for health care for low-income people, and they don’t want to share the nation’s medical resources with others.
    Pat S.
    Yes, as Pelosi has said, leglsators aren’t elected simply so that they can be re-elected.
    They are expected to do something, following their conscience to advance the public good.
    But let’s not get carried away. We definitely don’t want to elect Republicans who will cut taxes.
    At that point, we want to move to Vancouver. Or, perhaps, Paris? Start a commune for aging ex-pats?

  12. Maggie,
    How is that Medicare payments to doctors is going up 6% a year? Each time i look at my bill it seems what they are paying my doctor is less overtime for the same procedure?

  13. Suan–
    Medicare payments to most doctors have remained fairly flat in recent years–
    But in order to make up for flat fees, many doctors are “doing more”– buying or leasing diagnostic testing equipment so that they can do more tests in their offices. (Research shows that docs who buy or lease the equipment recommend twice as many tests), seeing more patients in a shorter period of time, etc.
    Specialists are doing more procedures and surgeries.
    They’re seeing patients more often.
    Most of this is largely unconscious. Very, very few docs consciously over-treat patients. But the doctors’ costs are rising, and they are trying to keep their income level or up.
    Of course, there is the question: even with costs rising, do doctors who earn somewhere between $450,000 and , say $1.5 million a year really need to keep their income at the same level?
    (Most specialists are in this bracket by the middle of their career, if not earlier.)
    Inevitably these doctors feel that they do need to earn $450,000 to $1.5 million. Or, at the very least, that they deserve it.
    Whatever a person earns seems, to most well-paid people, the amount that they must earn, the amount that they need.
    People create a life-style based on their salary, and a result, a very high salary seems necessary to maintain that life-style.

  14. To be a “Profile in Courage”, I would think you would actually have to have an opinion on a subject. Deem and pass, looks like the move of a coward. I would think as much time has been spent they would want to risk this on something that will be challenged with instantaneous lawsuits and has the aura of illegitimacy. Think Birthers on Steroids and that’s what will happen. Americans like courage, they hate cowards.

  15. Jenga – the folks moving to use deem and pass are not the cowards. The cowards are those (Dems) who are running from the issue for fear of voter backlash.

  16. Fear to hold “a simple up or down vote” because you might lose is cowardice. Loads of mental gymnastics and intellectual dishonesty going on. I don’t agree with Kucinich on many things, but at least he now has a position. If you support deem and pass you are aiding cowardly behavior.

  17. Jenga —
    It is important not to get caught up in Fox News and Tea Party talking points.
    It is the Republican opponents of health care reform who are refusing an up or down vote and trying to thwart the rule of democracy: using the filibuster to block progress in the senate, promising to issue ammendment after ammendment in the House in order to bog down congress and prevent passage.
    In a straight up or down vote, health care reform would have passed before Christmas. A straight up or down vote would have also passed the public option.
    Deem and pass has been used repeatedly by Republicans when they have controlled the House. Deem and pass does hold a specific vote on the health care program. That is why the Republicans will vote in a bloc against it.
    What it does differently is to tie that up or down vote on the Senate bill to a set of modifications passed by the House as part of the same bill, forcing the Senate to consider the modifications. The only reason the modifications are not being passed first is that the Senate parlimentarian, who is a Republican appointee by the way, has indicated that the modifications cannot be passed ahead of the bill. The deem and pass approach ties the two together, addressing the concerns of the House about the Senate bill at the same time as it passes the Senate bill.
    Everyone knows that this is in fact an up or down vote on health care. The prattle about it not being that are just talking points of opponents who oppose universal health care on principle, and would oppose any universal health care proposal. That is all just spin.

  18. Maggie,
    I guess i don’t think 450,000/yr is too much for a doctor. A million is a little off the hook, but then again we as a society pay many people who contribute much less, much, much more.
    Susan

  19. It is important to not get caught up parroting the views of the Daily Kos, MSNBC and Ezra Klein. Just because Republicans usd a procedure does not make it correct. It seems like a lot to risk to have instant questions of illegitimacy. No one can question the legitimacy if the Senate Bill is passed first. Blaming Republicans is nothing more than a tired Liberal talking point. The Democrats had more concentrated power this year than any party has ever had. Democrats only can pass this into law with zero questions of legitimacy, yet they still haven’t. This is Black and White. Call it for what it is Cowardice.

  20. @Mike – I have never heard something so outrageous. We will see in just a few months.
    Mind you, I am in favor of health care reform.
    @Maggie – You don’t actually believe that this bill will help to control costs better than single payor or its stepwise cousin the public option?

  21. Pat S., Jenga, Mike
    Pat S. Yes, opposition to deem and pass is simply spin which is intended to confuse people.
    Jenga– I’m afraid Pat S. is right. Your mind has been muddled by Fox/Tea Party “talking points”– hollow phrases that have no real meaning.
    Mike C–
    Single payer or the public option would save administrative costs. There is no guarantee that either would rein in the over-treatment and over-charging that drives health care inflation.
    The Commonwealth Fund estimated that under a public option, the administrative savings would shave about $2,000 from the cost of a family plan. So it would cost $11,500 (in today’s dollars) rather than $13,500.
    But that’s a one time savings.
    After that one-time savings ,, the cost of the family plan would continue to rise roughly 8% a year (as it has for the past 10 years) unless the government decided to cap fees to doctors and hospitals or change the way we pay them in ways that would discourage over-treatment adn encourage greater efficiency.
    To rein in costs, the government also would have to crack down on the cost of drugs and devices, refusing to buy those that are over-priced.
    Just two countires in the developed world have single payer– the U.K. and Candada, and they have cracked down on over-treatment.
    In Canada, for example, an eye surgeon is allowed to do only a certain number of surgeries a year. In the UK the government has to decide that a drug is cost-effective before agreeing to pay for it. (Since there is only one payer, the drug won’t be on the market unless the govt agrees to pay for it.)
    But it’s not clear that a single-payer system in the U.S. would rein in spending in this way– particularly if the decisions had to go through Congress.
    It might be easier for a public option to make tough decisions that rein in costs because people would have alternatives– private insurers. if they felt the public option was too stingy–too Draconian–some could choose private insurance instead (assuming they could afford it.)
    This is how things work in Germany. There is a public health plan that most people like. But there are no frills–you don’t get a private room in a hospital unless it’s medical necessary. There are waiting lines for some procedures, etc.
    Under the more expensive private plan, you get the frills, and it’s more expensive.
    IN Germany the public plan is good enough that most people choose it. Most people feel that it includes everything that is medically necessary On the other hand, as Uwe Reinhardt (who is German) points out, Americans are accustomed to frills, and so might not be satisfied.
    Under the current legislation, we won’t have the one-time administrative savings.
    But I think it is very likely that we will rein in
    spending –and that Medicare will lead the way.
    The legislation lets Medicare change what it pays for and how it pays for it. The legislation also lets Medicare cut fees for various procedures that it thinks are over-priced or that provide little benefit to the patient.
    Congress can object to these decisions, but it has only a limited amount of time to object– and then Medicare’s decisions automatically go into effect.
    Moreover, if Congress objects, it has to find another way to achieve equal savings within Medicare.
    That’s tough. So probably Congress will just look the other way and let Medicare’s panel of doctors and health care experts rein in costs. (The alternative is that the Medicare fund that pays for hospital care will be insolvent in 7 years.)
    Once Medicare begins squeezing out waste, private insuers are likely to follow. (Today, they follow Medicare’s fee schedule, just paying roughly 5% to 15% more than Medicare for each item. In other words, if Medicare pays a cardiologist 6 times more for 15 minutes of his time than it pays a primary care doc, insurers also pay 6 times more. If Medicare cuts the cardiologist’s fee and raises the primary care docs fee so that it is paying the cardiologist only 4 times more, chances are insurers would follow suit. (This is only a crude and hypothetical example.)
    So, if Medicare reins in spending, this is likely to have a ripple effect throughout the entire health care system.
    In this way, Medicare could
    function like a public option. LIke a public option, it doesn’t have to worry about Wall Street or profits for shareholders. Like a public option it can focus on doing what is best for patients– protecting them from over-treatment, and rewarding high quality care.
    IN that way Medicare, like a public option, can set an example for the marketplace.
    I would still prefer to have a public option competing directly with private insurers. And I think there is a fair chance that we will ultimately add a public option to the system.
    But as I said, there is no guarantee that a public option would save money–particularly if its decisions had to go through Congress.
    I’m not as enthusiastic about single-payer because I like many of the excellent non-profit insurers that we have in this country– much like the combination of non-profit insurers and government that you see throughout most of Europe.
    Ultimately, I would like to
    see our insurance system become largely non-profit.