Put Obamacare On The Table!

Kevin Drum notes that Republicans insist on something called “entitlement reform,” but have no actual ideas about what this reform might mean  (aside from getting rid of Medicare).  So now they are insisting that President Obama make the first offer, which is a laughable position.  The also insist on “putting Obamacare on the table”, which the White House immediately rejected.

But maybe it shouldn’t.  If we’re talking about reducing entitlement payments, wouldn’t it be great if we could find something that could save, say, $500 billion over ten years, but not reduce access to coverage and actually make the health care system more efficient?

Oh wait: we do!  Remember the public option?  That’s what it would do, according to the Lewin Group and the Urban Institute.   Both studies estimated a public option at saving the federal budget $50 billion a year.  And if anything, those estimates are conservative, because they do not assume that Medicare providers would be mandated to accept public option patients (as they should be), and they also assume large “cost shifts,” i.e. increases in private insurance costs, which have no empirical basis.  So I say put Obamacare on the table and put in a strong public option.

What’s that you say? That such an action would reform entitlements and save money, but that the Republicans would never go for it?  Gosh, it’s almost as if the GOP doesn’t really care about saving money and really only wants to cut people off of health insurance.  I can’t imagine why anyone would think that.

Author: Jonathan Zasloff

Jonathan Zasloff teaches Torts, Land Use, Environmental Law, Comparative Urban Planning Law, Legal History, and Public Policy Clinic - Land Use, the Environment and Local Government. He grew up and still lives in the San Fernando Valley, about which he remains immensely proud (to the mystification of his friends and colleagues). After graduating from Yale Law School, and while clerking for a federal appeals court judge in Boston, he decided to return to Los Angeles shortly after the January 1994 Northridge earthquake, reasoning that he would gladly risk tremors in order to avoid the average New England wind chill temperature of negative 55 degrees. Professor Zasloff has a keen interest in world politics; he holds a PhD in the history of American foreign policy from Harvard and an M.Phil. in International Relations from Cambridge University. Much of his recent work concerns the influence of lawyers and legalism in US external relations, and has published articles on these subjects in the New York University Law Review and the Yale Law Journal. More generally, his recent interests focus on the response of public institutions to social problems, and the role of ideology in framing policy responses. Professor Zasloff has long been active in state and local politics and policy. He recently co-authored an article discussing the relationship of Proposition 13 (California's landmark tax limitation initiative) and school finance reform, and served for several years as a senior policy advisor to the Speaker of California Assembly. His practice background reflects these interests: for two years, he represented welfare recipients attempting to obtain child care benefits and microbusinesses in low income areas. He then practiced for two more years at one of Los Angeles' leading public interest environmental and land use firms, challenging poorly planned development and working to expand the network of the city's urban park system. He currently serves as a member of the boards of the Santa Monica Mountains Conservancy (a state agency charged with purchasing and protecting open space), the Los Angeles Center for Law and Justice (the leading legal service firm for low-income clients in east Los Angeles), and Friends of Israel's Environment. Professor Zasloff's other major activity consists in explaining the Triangle Offense to his very patient wife, Kathy.

26 thoughts on “Put Obamacare On The Table!”

  1. I too would like to see Pres. Obama table the public option but I am not blind to his unrelenting hostility towards it. He has refused even to use it as a “bargaining chip” and went out of his way head off even the slightest possibility that the public option would even be the tiniest part of the health care reform debate.

    I think you need to be realistic about Obama’s second term agenda which will almost certainly continue to be coextensive with the agenda of the DLC. To borrow from Donald Rumsfeld, we reelected the incumbent Democratic president we had, not the president we might want or wish to have in a less toxic political environment. I will consider the country fortunate if anything remains of the New Deal when Obama leaves office.

  2. This is nice hardball, 95 mph right at their heads. Hit the dirt or get creamed, our red feathered friends – the only kind of response that will actually make them think. It’s pretty simple, I think – modern American conservatism has become, functionally, “red in tooth and claw.” Anyone who’s trained large dogs knows what I mean – at this point the political right will respond only to force, dominance and submission. Nothing more, nothing less. I think Benghazi, post election, is proof beyond doubt. It’s going to be a process of containment and extinction – containment by using every means available to force the right onto its collective knees and keep them there; extinction by time and erosion, by making the prospects of foot soldiering for plutocracy untenable Forcing the right to publicly manage hardball proposals like this one would be a step in the right direction.

    1. You might want to consider your comment after reflecting upon the traditional recipe for hobo stew.

    2. When I used to pitch, I’d just do chin music – never at the head – then often it was the biggest curveball I could throw, starting at the head.

      The out came from the rest of the at-bat being inside heat. This is how you pitch to this red-jerseyed stiff as well, who stands there waving the bat menacingly and talking about how hard he is going to hit your stuff, but the holes in his swing you can drive a (bailed-out) car company through. One hopes Obama walks around the mound, gathers his thoughts, and sticks to the plan. Bring it.

      1. I suppose hope springs eternal. I just don’t see Obama jeopardizing his “former presidency” and his children’s futures by playing hardball on behalf of the poor and middle classes. He has been pursuing his “grand bargain” the way that Capt. Ahab pursued Moby Dick.

  3. I’m puzzled: Why shouldn’t Obama have to make the first move? Didn’t he just win the election? Surely this must bring SOME responsibilities to go with the perks.

    “Fine, you won. Let’s hear your plan.”

    1. Obama has already put a plan forward. What the House Republicans mean by “offer” is “concession”.

    2. Brett, because the GOP Congress kicked the can down the road, hoping for a GOP preisident in 2013.

      They lost that bet.

      Besides, Mr. Constitution – all spending bills must originate in the House 🙂

      1. Ummm. No, actually, “All bills for raising Revenue must originate in the House of Representatives; but the Senate may propose or concur with Amendments as on other Bills.”

        Article I, Section 7, Clause 1.

        Spending bills can start in either house, taxation must begin in the House of Representatives.

    3. Bret, it seems from this comment that you may not have the same concept of “negotiate” as most of us.

      President O’Bama pledged to negotiate in good faith, to “put entitlements on the table along with taxes.” In the terminology of negotiation, “on the table” doesn’t mean I’ll make a proposal, it means we can entertain your proposals on the subject.

      As an illustration of that definition, the Republicans have said categorically that tax rates are *off the table,* although they have stipulated that we can consider tax revenues, presumably by some legerdemain under which we will raise revenue while lowering everybody’s taxes some more. Put aside the idiocy of the position, and just consider the definition of “negotiation.” The Republican position is that they have conceded to entertain some proposals on the subject of taxes.

      In return, however, the mirror would be the Democrats would concede to entertain some proposals from the Republicans on the subject of entitlements.

      That would be my idea of “negotiation.” But it seems like you believe it’s just the Democrats job to propose the Republicans’ position for them, at which time the Republicans can choose what to accept, then blame it all on the Democrats.

      1. mr. rhodes, the list of terms which mean different things to mr. bellmore than they do to most human beings is relatively long and surprising. we’ll see if he can pass a turing test here but experience suggests that holding one’s breath would be ill-advised.

    4. Obama and the Democrats have no need to make the first move and can afford to be very choosy because they needn’t fear the “fiscal cliff”. There is immense waste and corruption in defense spending and the Democrats can simply propose to reinstate any cuts to domestic priorities in the new Congress and let the Republicans oppose restoring these very popular programs. In fact, I think Obama should just run out the clock and start fresh in January when the Bush tax cuts will be gone, the debt ceiling won’t be reached and there will be more and better Democrats in the new Congress.

      It’s up to the losers to make the first move and to make the vast bulk of the concessions. As Dick Cheney said, elections have consequences.

    5. Also, Obama has made the first move. He’s made an offer.

      also, Republicans have been talking for years about how much they want to cut entitlements — and all of a sudden they can’t come up with specifics about what they want to cut? Anyone who believes that, I’ve got a nice shiny bridge in Brooklyn to sell you.

    6. Republicans: Entitlements! Entitlements! Entitlements! We must cut entitlements!

      Obama: OK, let’s hear your ideas. What entitlements should we cut?

  4. Another easy money-saver would be allowing Medicare to negotiate prices on Part D. Of course, the Republicans would never go for that either. (As Brett might point out if he were feeling partisan-but-constructive, neither would the Democrats–ACA was drafted to make the world safe for insurers and pharma.)

    1. Don’t forget, though, that ACA was drafted by the Dems, with no cooperation from the Reps, to be passed by Congress. Consequently, blaming the Dems for leaving out some good ideas has to be understood in the context of feasibility. Having a better plan in a document on a bookshelf, instead of the law of the land, would be a Ralph Nader victory, but not a success for most of us.

      1. I agree with what you said, but I think that the Dems also understood that ACA represented a deal with incumbents, in which no economic interest (except perhaps hospitals) would significantly suffer. Politicians tend to keep their word, which is why their rhetoric is often so weaselly.
        I think that the preservation of Part D without competitive bidding was part of the deal. I don’t think that this was true of the public option, which insurers didn’t like but could live with. The public option fits your model very nicely: it died in the interest of the 60th Democratic vote. I don’t think that a practical Democratic politician would view adoption of the public option as reneging on any deal.

        1. Very true re public option; but also true with negotiating on Medicare Part D. As I understand it, Obama agreed to not make price negotiation part of the ACA originally. But he pointedly did NOT agree never to bring it up again. It was a timing issue, not a Norquistian lifetime pledge. Of course timing is crucial but this is still on the table for Dems — as it should be.

          1. I like this idea. I can’t see it working — I think the GOP would do anything rather than see a public option — they would probably rather keep the state exchanges, and maybe even promise to make them required in each state, before doing something so sensible — but, I’d have fun watching.

            And I hope that McDermott bill — the guy who wants to facilitate state level single payer — gets passed somehow in all this. Cali is all ready to go, imho. Our state health people seem to be hauling a**. If we are really supposed to be labs, let’s try an experiment.

        2. Not a problem. I do not see any contracts made by our elected officials with insurance companies and their ilk to binding because they do not seem to have been signed with blood of the party to be charged. This is a longstanding precedent established by my colleague Daniel Webster in a case he famously argued in the colonial era. Consequently, I believe we are entitled to again table the proposal.

  5. Yes yes a thousand times yes. Also let the CMS bargain over pharmaceutical prices. Also a carbon tax. Also military spending cuts. The fact is that Republicans don’t give a damn about the deficit so one bluff a day can be called for months.

    I want to comment on the earlier post on why Republicans hate Obamacare. I think the root of their anger is that it is Obamacare. Notably Romney had no problem with Romneycare. An analogy. You’ve watched football games no? Why does one team have such a passionate desire to move the ball towards a goal line (say the one to the East). Why do they change their aim every 15 minutes of clock time and struggle just as hard to get it to go the other way ? They aren’t social easterngoalinists who suddenly change their minds and become fundamentalist westerngoalinists. They want their team to win.

  6. In one debate, Mr. Obama actually informed the viewing audience (undecided naifs) that one of his accomplishments was removing the leeches (I believe he used the word “middlemen”) between government student loans and the students. Good for him. That promulgation was a long time coming…

    The public option is basically the same idea. If we can save 500 billion (or 50 billion or 5 billion) by removing the corporate “health care taxes” we pay that feed these leeches than why not?
    Because I’ve got to give a good goddamn about something called Capitalism (that benefits a few and the expense of the many)?

    Please. For 500 billion dollars in savings I’d shit on Capitalism’s soul, stomp it into a mudhole, douse it with gas, torch it, and then piss on it to hear the sizzling sound…
    Of course that’s just pragmatic me. I realize I live in a country of jackasses straight-jacketed by their idolization of the marketplace.
    Thus Obamacare…. And thus we give the American marketplace another 10-20 years to show beyond a shadow of a doubt it simply can’t scale healthcare…

  7. I’m pretty sure that when the Republicans said Obamacare should be on the table, they weren’t open to replacing it with something even more left-wing. 🙂 Too bad.

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