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Patrick H. Caddell and Douglas E. Schoen have an editorial in today’s Washington Post that carries a warning for Democrats. And while the message is one that has been around a while, the messengers this time are different.

Caddell has been a thorn in Democrat’s side since 1988, with sharp criticism for the party’s direction. But his resume is impressive; he worked for national candidates and Presidents like George McGovern, Jimmy Carter, Gary Hart, Joe Biden and Jerry Brown. Schoen was one of Bill Clinton’s pollsters, but is no stranger to controversy himself: his 2008 book Declaring Independence: The Beginning of the End of the Two-Party System angered partisans on both sides of the aisle.

Like David Frum in the GOP, the voices of those unhappy with their party are often much more important than the cheer-leading done by those toeing the party line.

Pundits tell us that some Democrats no longer speak of the benefits of reform, but only what will happen to their jobs if they don’t pass something, even if it won’t work. In other words, the American people will reward them for at least acting, even if they don’t like the act. Caddell and Schoen address that issue:

First, the battle for public opinion has been lost. Comprehensive health care has been lost. If it fails, as appears possible, Democrats will face the brunt of the electorate’s reaction. If it passes, however, Democrats will face a far greater calamitous reaction at the polls. Wishing, praying or pretending will not change these outcomes.

Nothing has been more disconcerting than to watch Democratic politicians and their media supporters deceive themselves into believing that the public favors the Democrats’ current health-care plan. Yes, most Americans believe, as we do, that real health-care reform is needed. And yes, certain proposals in the plan are supported by the public.

However, a solid majority of Americans opposes the massive health-reform plan. Four-fifths of those who oppose the plan strongly oppose it, according to Rasmussen polling this week, while only half of those who support the plan do so strongly. Many more Americans believe the legislation will worsen their health care, cost them more personally and add significantly to the national deficit. Never in our experience as pollsters can we recall such self-deluding misconstruction of survey data.

They point out that recent polling shows even the dreaded health insurance companies have higher favorability ratings than the government:

Scott Rasmussen asked last month whose decisions people feared more in health care: that of the federal government or of insurance companies. By 51 percent to 39 percent, respondents feared the decisions of federal government more. This is astounding given the generally negative perception of insurance companies.

The authors reject the Republican idea of “starting over”, favoring instead a change of focus to individual measures that will win at least some bi-partisan support and gain success for some legislative attempts that will address the voter’s concerns. The crisis of confidence the Democrats are experiencing will otherwise lead to an electoral blood bath in November.

Cross posted to Donkelphant

Politics Doug Schoen, health care reform, Patrick Caddell

While health care reform remains near the bottom of the list of the public’s concerns, with recent polling averaging at 53% opposed to the Democrat’s plans, policymakers realize the impact of future medical and Medicare costs still matter. They exert direct influence one of the biggest concerns Americans have: the ballooning deficit and burgeoning public debt.

The filibuster proof Democratic caucus failed to secure the left’s preferred vision of health care reform over the course of the last year. Now, President Obama is reaching out to Congressional members, even those on the Republican side of the aisle.

Ditching the straw man argument that the GOP wants to “do nothing”, the President has confirmed that some proposals have merit. Rep. Paul Ryan (R-WI) was engaged by the President regarding Ryan’s proposed Roadmap for America’s Future Act for 2010 at the February 1st Republican conference:

President Obama: I think Paul [Ryan], for example, the head of the Budget Committee, has looked at the budget and has made a serious proposal. I’ve read it. I can tell you what’s in it. And there’s some ideas in there that I would agree with but there’s some ideas we should have a healthy debate about because I don’t agree with them.” The major driver of our long-term liabilities, everybody here knows, is Medicare and Medicaid and our health care spending. Nothing comes close. That’s going to be what our children have to worry about. Now, Paul’s approach, and I want to be careful not to simplify this, I know you’ve got a lot of detail in your plan, but, if I understand it correctly, would say, we’re going to provide vouchers of some sort for current Medicare recipients at the current level – No?

Congressman Ryan: No – we protect the program for Americans 55 and above [those in and near retirement]…

Obama: I understand – there’s a grandfathering in….That’s why I said I wanted to make sure that I’m not being unfair to your proposal. I just want to point out that I’ve read it, and the basic idea would be that, at some point, we hold Medicare cost per recipient constant as a way of making sure that that doesn’t go way out of whack, and I’m sure there some details…

Ryan: We increase the Medicare payments with a blend of inflation and health inflation. The point of our plan is, because Medicare as you know is a $38 trillion unfunded liability.

Obama: Right.

Ryan: It has to be reformed for younger generations because it won’t exist. It’s going bankrupt. The premise of our idea is look, why not give people the same kind of health care plan we here have in Congress? That’s the kind of reform we’re proposing for Medicare. [applause]

The CBO scored Ryan’s proposal with some favorable findings:

The Roadmap, in the form that CBO analyzed, would result in less federal spending for Medicare and Medicaid as well as lower tax revenues than projected under CBO’s “alternative fiscal scenario” described in CBO’s June 2009 publication The Long-Term Budget Outlook. Federal spending for Social Security would be slightly higher than under CBO’s alternative fiscal scenario for much of the projection period, but the system would become sustainable as revenues increase and traditional benefits decline. The budget deficit would peak at 5 percent of GDP in 2034 and then decline. By 2080, the Roadmap would generate a budget surplus of about 5 percent of GDP. Under the Roadmap, the ratio of government debt held by the public to economic output (the ratio of debt to GDP) would be lower than that under the alternative fiscal scenario in every year. In particular, debt is projected to peak at 100 percent of GDP in 2043 and to decline thereafter, reaching zero by 2080. (Debt held by the public was about 53 percent of GDP at the end of fiscal year 2009.) The federal government would accumulate net financial assets equal to 17 percent of GDP by 2083. In contrast, under the alternative fiscal scenario, debt is projected to skyrocket over the next several decades.

The Roadmap accomplishes this by implementing notable reforms to Social Security and Medicare that should find bi-partisan agreement.

The Heritage Foundation analyzed the bill for its impact on non-seniors, and concluded:

The Ryan bill outlines clear, sound principles to reform entitlement spending and health care. The Roadmap’s health care provisions would bend the cost curve in health spending, make insurance more affordable and accessible, and create a consumer-driven, highly-competitive system.

The Roadmap addresses health insurance coverage for non-seniors in three ways. First, changing the tax treatment of health care insurance enables a transition from an employer-based tax exemption to individual tax credits to put the consumer back in the driver’s seat, a key component of reducing health care insurance costs. You pay more attention when you know the cost will impact you and your personal insurance rates (people are often more careful about filing a claim with their auto insurance company than they are with their employer’s health insurance policy).

Secondly, state based exchanges and reforms are encouraged through a Federal-state partnership, allowing our states, the “laboratories of democracy”, to find new and innovative ways to cover the uninsured.

Finally, allowing interstate purchases of insurance allows a wider national pool of consumers to be built by the insurers, lowering costs by spreading risks in an actuarilly sound manner.

Rep. Ryan is a thoughtful, smart guy who moves beyond rigid partisanship to find solutions worthy of consideration. It remains to be seen if the highly partisan atmosphere in Washington DC can accommodate his ideas.

Cross posted to Donklephant

Politics health care reform, Rep. Paul Ryan, Republican health care proposals

It’s been a bad week for Democrats. Republican Scott Brown won the special election for the Senate seat formerly held by Sen. Ted Kennedy, leading to predictions that the House and Senate will not be able to cram through their strictly partisan health care reform bill. To add to the nervousness already felt by the Dems, the Supreme Court struck down components of campaign finance reform that favors incumbents and Democrats specifically.

But the GOP shouldn’t sit back and gloat. There is a unique opportunity to actually work with the Democratic leadership and get some things done that remain popular with the American people. And failure to act on them may expose the GOP to the same anti-incumbent mood that swept them from the majority in 2006. USA Today reports:

A 55% majority of Americans say President Obama and congressional Democrats should suspend work on the health care bill that has been on the verge of passage and consider alternatives that would draw more Republican support, a USA TODAY/Gallup Poll finds.

. . .

An overwhelming 72% of those surveyed Wednesday say Brown’s victory “reflects frustrations shared by many Americans, and the president and members of Congress should pay attention to it.” Just 18% say it “reflects political conditions in Massachusetts and doesn’t have a larger meaning for national politics.”

What kind of reforms should the GOP put forward? There are a number of blocked proposals the Dem leadership should now allow on the floor for debate. From the GOP.gov website:

For more information about some of the other common-sense health care reforms proposed by Republicans, please visit the links below:

• Empowering Patients First Act  (Republican Study Committee  Health Care Reform Bill, introduced July 30, 2009)
• Improving Health Care for All Americans Act (Shadegg Health Care Reform Bill, introduced July 14, 2009)
• Medical Rights & Reform Act   (Kirk-Dent Health Care  Reform Bill, introduced June 16, 2009)
• Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act   (Gingrey medical liability reform bill, introduced June 6, 2009)  
• Small Business Health Fairness Act of 2009   (Johnson small business health plans bill, introduced May 21, 2009)
• Promoting Health and Preventing Chronic Disease through  Prevention and Wellness Programs for Employees, Communities, and Individuals Act of 2009   (Castle Wellness & Prevention Bill, introduced July 31, 2009)
• Improved Employee Access to Health Insurance Act of 2009  (Deal auto-enrollment bill, introduced October 15, 2009)
• Health Insurance Access for Young Workers and College Students Act of 2009  (Blunt bill to improve health insurance coverage of dependents, introduced October 21, 2009)

The Heritage Foundation, a leading conservative think tank, explains these bills further, and points to several “guiding principles” that Republicans can support in other proposals:

Tax Equity: Today, if an individual purchases health insurance through their employer, they receive unlimited tax breaks on the value of their insurance. But if you purchase your insurance on your own, you receive no such benefit. This is inequitable and regressive. Ideally, Congress could replace the current tax exclusion with a system of universal tax credits. But at the very least, Congress should provide tax relief for those who purchase coverage on their own, and redirect other health care spending to help low-income individuals and families purchase private health insurance coverage.

State-Based Reform: Every state is different when it comes to health care challenges. Some states face high rates of uninsured citizens while others face spiraling costs. Instead of a federal one-size-fits-all approach, Congress should embrace federal-state partnerships that preserve diversity in the states. The states could devise their own way to achieve reform, like a mechanism for portability (i.e. take your insurance from job to job). Individuals should also have the freedom to purchase insurance from any trusted source and not be restricted by where they live (i.e. buying insurance across state lines).

Entitlement Reform: Not only are Medicare and Medicaid increasingly costly, they’re not delivering value to American taxpayers. If health providers could compete directly for the business of seniors and the poor, the cost-curve would truly be bent and private innovation would flourish. Right now, the tsunami of entitlement spending is on an automatic course for disaster, with locked-in spending, and more to come. Long-term costs of entitlement programs must be built into the annual budget process so Congress can no longer ignore the crisis that is continually pushed off on future generations. Americans can no longer blindly pay into an entitlements system that offers little incentives to providers to offer better value to the consumer and the funding taxpayer.

There is a difference between saying “no” to a bad plan, and just saying “no”. The task for the GOP will be to come up with common sense alternatives that people can support.

Cross posted to Donklephant

Politics GOP health care proposals, health care reform

Congressional leaders are planning to hold “secret” meetings instead of the traditional public conference committee hearings to reconcile the Senate and House versions of the health care insurance reform bills.

While the GOP has reacted with expected outrage, the proposed “new system” of “private meetings” is generating some concern from the traditional media, as ABC News reports:

The C-SPAN television network is calling on congressional leaders to open health care talks to cameras — something President Barack Obama promised as a candidate.

Instead the most critical negotiations on Obama’s health plan have taken place behind closed doors, as Republicans repeatedly point out. In a Dec. 30 letter to House and Senate leaders released Tuesday, C-SPAN chief executive Brian Lamb asked for negotiations on a compromise bill to be opened up for public viewing, as Democrats work to reconcile differences between legislation passed by the two chambers.

The C-SPAN letter (pdf file) is a pretty straight forward request. It makes you wonder, what are the Democrats trying to hide?

As ABC News sums up:

Obama pledged during a presidential debate in January 2008 that he would be “bringing all parties together, and broadcasting those negotiations on C-SPAN so that the American people can see what the choices are.”

Will the Democrats live up to their promises for openness, or will they continue to draft legislation in the back room?

Cross-posted to Donklephant

Politics C-SPAN, health care reform, transparency

One of the proposed changes in the health care insurance reform bills is the “employer mandate”, a requirement that employers of a certain size either provide health insurance to their employees or pay a fine. If the employer provides insurance, it can be provided before taxes in most cases, providing a tax benefit (or, subsidy) to help the employee afford the share of premium. If the employer doesn’t provide the insurance and pays the fine, the employees can then use the “insurance exchange” to buy their own coverage. To help people afford it, subsidies would be given to the employee based on their income.

Either way, the employee is being subsidized for his health insurance premium, either by his employer or by the rest of us.

In an examination of this scheme in the New England Journal of Medicine, the point is made that the House legislation penalizes people based not on their individual income level, but on the average wages at their company.

The graph shows the pattern of subsidies under the Affordable Health Care for America Act passed by the House of Representatives in November. We consider a hypothetical low-wage company that chooses the “pay” option and is subject to the 2% payroll assessment applicable to companies with a payroll of $500,000 to $585,000 (e.g., a 20-person company with average wages of $27,500). An 8% assessment would be applied to companies with a payroll of more than $750,000. The “pay” option’s pattern of subsidies, which decrease with income, would be similar under the Senate’s Patient Protection and Affordable Care Act, although the Senate bill uses a $750 penalty per worker on companies with more than 50 workers, rather than a percentage of total payroll. We also consider a hypothetical high-wage company that chooses the “play” option.

A low wage earner would be treated differently, and receive different subsidies, based on what his employer did and where he worked. High wage companies would probably provide health insurance, netting the $22,000 per year employee a tax benefit of about $1,887 a year. The same wage earner in a company with total payroll under $585,000 would probably see the company cancel its group plan and pay the small fine. In that case, the low wage earner would go to the insurance exchange and receive a subsidy of $3,574. The low wage worker in a company that provides health insurance is out of luck, receiving less of a benefit than a comparable paying job at a smaller company:

The $1,687 difference represents about 32% of the premium and 8% of the worker’s income. For low-wage workers who are currently uninsured, such a difference might have a substantial effect on compliance with a mandate to obtain insurance.

Well, we can always throw the bums in jail if they don’t buy insurance. The IRS is good at dealing with those who flout the rules.

The authors don’t simply point out the problems and walk away. They propose a solution that, if you are going to subsidize health insurance, seems to avoid the (possibly) unconstitutional unequal treatment:

Ideally, the subsidy for private insurance should depend explicitly on total family income. Such a program would be described as one in which workers (not employers) pay for coverage, but the employer might arrange for group insurance and collect wage-related taxes and premiums. The current inequitable tax subsidy would be replaced, and the concept of a penalty for companies not offering coverage would be abandoned. The proposed subsidy would instead be inversely related to income, and people would receive the same size subsidy for the same coverage regardless of whether they obtained their insurance through an exchange or their employer. For people with employment-arranged insurance, the premium’s value would become taxable income, but the additional tax cost borne by workers would be offset by a progressive income-related subsidy toward the premium, administered as a tax credit either directly to employees or indirectly through employers and exchanges.

Or, we could call the whole massive-all-in-one Frankenbill off, start over with some realistic goals that would actually solve the problems, and pass some bi-partisan solutions to improve the system.

Cross posted to Donklephant.com

Politics Employer Mandate, health care reform, insurance exchange, Pay or Play