Monday, August 17, 2009

Lone Ranger and the Hole in the Wall Gang of 6

President Obama has been very skillfully navigating the tricky waters of healthcare reform to this point. He has allowed Congress to take the ball thus far, and even though everyone keeps talking about Obama's Health Reform Plan, it is important to note that the President has not proposed a plan yet! Notice the difference between the way that this administration and the Clinton administration have approached reform - President Obama is allowing Congress to make all the initial mistakes, and he will come riding in after the dust settles to save the day. As Paul Krugman pointed out back in February there are big differences in Obama's approach to reform and Clinton's, and most of these are due to political realities.

There are now various plans, at various stages in both the House and the Senate, of which various aspects of each are being vigorously debated. The only plan that appears able to actually pass is still being worked out in the Senate Finance Committee by the so-called Gang of Six (three Democrats and three Republicans). These six hold the key to the President's plans for reform. They are:

Chairman Max Baucus (D-MT) has repeatedly stated that he will work on a bipartisan compromise. He agreed to keep negotiating with the rest of the gang through September despite pressure from the White House to vote on a health reform measure before the August recess. In the Great Falls Tribune, Baucus said "There's no bill yet because I haven't written it. There's just a lot of ... stuff out there. Health reform is not dead or dying; there's just a lot of misinformation out there." Baucus says he is committed to eliminating the current pay-per-procedure system and replacing it with one focused on quality outcomes. He has put healthcare cooperatives and a national insurance pool at the top of the list of reforms for health insurance.

Chuck Grassley (R-IA), a 28-year Senate veteran, faces a possible primary challenge in next year's election so he is being very careful. At a town hall meeting, a constituent told Grassley that if he helped get this bill passed he would lose the election. Grassley seems to have a real desire to reform healthcare, and has offered preliminary support for the health care co-op idea advanced by Kent Conrad (D-ND). Grassley has said, "Not all Democrats think the same and there's some that are like me, who do not want any more government interference in health care." If Grassley leaves the Gang, there is a big hole in the wall for any bipartisan compromise.

Kent Conrad (D-ND) is responsible for the healthcare cooperatives idea, which is now seen as the only path to a bipartisan compromise. Under the Conrad plan, cooperatives would be national in scope, and would receive startup money from the federal government. In the Wall Street Journal he said, "It is the only plan that has bipartisan support in the Senate." He also claimed, "It's quite clear the public option does not have the votes." Conrad was elected with 69% of the vote in 2006, but has recently been accused of receiving favorable terms on a loan on his second home issued by Countrywide Financial (since absorbed by Bank of America during the financial meltdown).

Olympia Snowe (R-ME) has been involved with healthcare issues since she was first elected in 1994. During the run-up to the health care reform debate, Snowe sponsored (along with Democrat Dick Durbin of Illinois) a bill establishing the Small Business Health Options Program (SHOP), which would enable small companies and the self employed to form state or nationwide health insurance purchasing pools. She holds one of the safest seats in the country, having won 74% of the vote in 2006, and is widely viewed as a moderate Republican.

Jeff Bingaman (D-NM), was elected to his seventh term in a 2006 landslide. Like Conrad, Bingaman is from a more conservative and rural western state. He opposes the public insurance option proposed by the House. He has been open to the idea of health care cooperatives as a way to help the uninsured. According to Politico, Bingaman favors a series of "benchmarks" to gauge the success of the health plan as it unfolds. Bingaman says, "I think that makes sense. You could make an evaluation and midcourse corrections if needed. I think that's the prudent thing to do."

Mike Enzi (R-WY) is the most conservative member of the Gang. The New York Times says, "An accountant and former computer programmer, he is the shrewd numbers man with a common sense outlook." He is considered to be in a safe seat. On healthcare reform, Enzi says, "We're past due for doing it, and the American people want it," but also says, "I don't think they like what they see so far." Enzi favors the co-op idea and has also sponsored legislation similar to Snowe's that offers small businesses and individuals the right to buy insurance from a national pool. Senator Enzi is firmly opposed to abortion and illegal immigration, so expect that these views will be reflected in legislation that comes out of Senate Finance.

The Gang of Six faces a difficult climb to work out the deatils of reform. Enter the Lone Ranger, President Barack Obama! He has been watching carefully and whether you agree with his ideas or not you have to admit he is maneuvering brilliantly. When the Whitehouse makes their reform proposal it will be with broad support that is guaranteed to pass. It won't have everything he or his supporters want in it, but such is the nature of the political process and compromise.


  1. Interesting post, Brian. I've been avoiding politics but I'm gettin' ready to pop

  2. It's amazing how the media collectively haven't noticed his most obvious strategic move, which is to let Congress take the darts. He'll still get the credit. Maybe next time, they won't hyperventilate as much every time a legislator makes a press statement.

  3. Thoughtful post, Brian.

    The trouble is, this could not have been their plan. Approval ratings of the President on health care are in steep decline, led by his handling of this issue. It's reminiscent of how Bush supporters used to say he was a brilliant poker player as a way of explaining his own periodic bouts of unexplained passivity.

    Sometimes, what you see is just someone who has handled something poorly, and it's not some clever ruse meant to make you think that's what they meant to do.

    Anyway, thanks for the post, keep up the good blogging!

    Evan Falchuk

  4. Sorry to burst your bubble, Brian, but Obama has turned off the general public so badly that he could present a gold plated plan that would make, rather than cost us money and we would all be suspicious. At some point we're just done, and I do believe that the combination of the unstimulating stimulus plan, over 80 bank failures this year, astronomical unemployment, playing the race card, then playing the religion card, bringing crooked and communist cronies into his administration - we'll regurgitate whatever he tries to feed us at this point.

    True healthcare reform would start in small steps, one bill at a time, tort reform, expanding community-public health centers for the uninsured, dramatically expanding medical school slots for U.S. students plus medical school tuition assistance, insurance industry regulation, earned income credit refunds for medical insurance premiums or out of pocket medical expenses, expanded health savings accounts, ending Medicare cuts while reforming DME procedures to cut billions in waste, ending all Medicaid for non-citizen immigrants (along with the public health clinic expansion), repeal of 99% of the Stark rules and similar restrictions placed upon physicians so they can actually practice medicine, and strict price controls on the pharmaceutical industry that would require them to sell drugs in the U.S. for no more than the lowest price for which they sell them outside the U.S. - stop the U.S. consumer from paying all the R&D costs for the rest of the world.

    That's just for starters. Obama won't begin to embrace any of those suggestions because he is in bed with the trial lawyers, insurance companies and drug companies and the corruption runs far too deep.

    Physicians and consumer-patients should be in charge of health reform. No matter what it costs to deliver good medicine, the value in productivity and human lives is worth it. Unfortunately, Obama's proposals all ration care to the most vulnerable and place an economic burden upon the American taxpayer that will cause the United States to become a third world country.

    It's time to stop believing that Obama is the Lone Ranger or the Messiah. He is simply a community organizer who rose above his own abilities and is in deep trouble because he began to believe his own PR.