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Via Ace of Spades, I found this essay on Obamacare at The Federalist. Clear, concise, nicely balanced.
Read the whole thing but here’s an appetizer:
Three years after enactment of the law, CMS decided to finally ask the question: just who are these poor wretched uninsured people and what are they looking for? One might think they would have inquired about this before enacting a remedy, but there you have it.
The truth is that it is natural, as well as necessary, for every man to be a vagabond occasionally. - Samuel H Hammond
I’ve been feeling rather bitter because my liberal friends - who support Obamacare - get their health insurance through their employers while I buy mine individually. I believed that this meant I would have to give the IRS information about my income and health insurance while they would not. It looks like I was wrong. According to Avik Roy at The Corner (and do read the longer post at Forbes):
To enforce the individual mandate, the IRS needs to know whether or not you have purchased insurance this year. It will also need to know the specific insurance policy you have, in order to ensure that it meets Obamacare’s “minimum essential coverage” requirement.
To enforce the employer mandate, the IRS needs the same information from employers in terms of the specific policies employers purchase for their workers, and also the hours worked by every part-time employee. In addition, your employer will need to know what your household income is, in order to ensure that the coverage it offers you is “affordable” to you by the law’s definition.
This makes me feel less bitter about my friends (it’s probably a sign of a serious moral failing that I rejoice to know they, too, will fall under the watchful eye of the IRS). However, it also made me realize something I had known but not fully understood before: The individual mandate means no one has the right to be left alone any longer.
Let’s say I work until I’m 50 and save my money. I then decide to retire and become a vagabond. I convert my savings to cash and keep it in a no-interest checking account. I live off the cash, never earning a salary or interest or capital gains. I have no reason to interact with the Federal government since I owe no taxes. I do not maintain a residence which means I have no reason to interact with State or local government. I can, if I want, legally step outside the grid.
Under Obamacare, that will change. I now must interact with the IRS. I have to tell them how much money I make and what health insurance I purchase. If I do not purchase health insurance, they will fine me. I can no longer legally step outside the grid.
That seems to me to be a terrible loss. I know that very few people want to take that step but I believe we have lost something precious by making it impossible for people to do so without breaking the law. How did we end up in a situation where my life is now subject to my government’s beck and call?
A post at The Corner about unintended consequences of Obamacare got me thinking about health insurance again. The post is worth reading (although it’s bad news for people like me with significant health problems) but that’s not what I’m thinking about. I’m thinking about this from Megan McArdle:
Certainly, this [the Oregon Medicaid study] bolsters my belief that health insurance should provide financial protection from catastrophic events, not wrap-around first-dollar coverage. Those who used to read me on The Atlantic may recall that the McArdle Plan for Healthcare involved the government picking up the tab for any medical expenses above 15-20% of income: simple, progressive, and aimed at the actual problem we know health insurance can fix. Unfortunaely, Obamacare made that sort of coverage functionally illegal.
That kind of plan tied to income would be great but it’s unlikely to happen while Obama is President.* What might be possible, though, is to modify Obamacare to permit true catastrophic health insurance. You know, the kind Secretary Sibelius is so clueless about. Perhaps the Republicans could agree to pass something the Democrats and Obama want if and only if the bill to do so includes a modification that adds catastrophic insurance policies as one of the options under Obamacare. Ideally, I’d like to see these with a range of deductibles: $1,000; $5,000; $10,000; $15,000; and so on. That way they would be available to people with a range of incomes.
Presumably the cost for a catastrophic plan would be less than for those that cover doctor’s visits for annual exams, flu shots, dropping a pot lid on your toe (don’t ask), and kids with colds. That might encourage people to purchase catastrophic plans which would increase our sensitivity to the cost of medical care and that, in turn, might actually decrease spending on health care a little.**
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Notes:
* I haven’t found a lot of specifics on the “McArdle Plan for Healthcare” but my impression is that she would set a single percentage to be spent on health care before government coverage kicks in. If I were going to take a serious look at this kind of policy, I’d considered percentage brackets, with those who have less money having to spend a lower percentage of their income before the government steps in - much like the brackets we now have for income tax rates.
** Under this modification to Obamacare, as opposed to the McArdle Plan, the insurance companies would still insulate people from true health care costs. When I get a medical procedure, my insurance company decides how much my provider will be paid. So long as insurance companies continue to do so, the insured will continue to pay less than the true cost - and the uninsured will continue to pay more.
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Reading:
These were the Atlantic posts I found that talk about the “McArdle Plan for Healthcare”. They date from February of 2010.
The Benefits of Health Benefits - This began as a response to an Ezra Klein post. The Klein post has links to a number of other McArdle posts, all of which are interesting.
The Limited Benefits of First Dollar Health Care Coverage- Follow up to previous post.
Mitt Romney on health care, paragraph seven, emphasis mine:
The reforms that I propose, which are based on the same philosophical tenets as the reforms I offered during my last presidential campaign in 2008, return power to the states, improve access by slowing health care cost increases, and make health insurance portable and flexible for today's economy.
Mitt Romney on health care, paragraph ten, emphasis mine:
Step 3: Focus federal regulation of health care on making markets work. This means both correcting common failures in insurance markets as well as eliminating counterproductive federal rules. For example, individuals who are continuously covered for a specified period of time may not be denied access to insurance because of pre-existing conditions. And individuals should be allowed to purchase insurance across state lines, free from costly state benefit requirements. Finally, individuals and small businesses should be allowed to form purchasing pools to lower insurance costs and improve choice.
[Another post written a while ago, although it’s not really ancient - it was originally written within the last few months.]
Math is hard
A letter from MoveOn.org to its members says in part:
Imagine if someone told you in 2008 that Barack Obama was actually thinking about signing legislation to extend the Bush tax giveaways for the rich. I wouldn’t have believed it.
Now more than ever, we need the Barack Obama we elected in 2008—the smart, tough, hopeful progressive champion who inspired millions of us—to stand up and say “no” to a millionaire bailout.
I’ve seen and heard this particular bait-and-switch before, where $250,000 suddenly becomes $1,000,000. Two-hundred fifty thousand dollars is a lot of money - but it’s not a million. If there are those who think we should raise taxes on millionaires then they should argue for just that: letting the Bush tax cuts expire for those making over $1,000,000 a year. I’ll be a lot more likely to believe someone has the right solutions for our economic woes if he first convinces me he knows his numbers.
Shoulda looked Left
(Because there’s nothing like a dead skunk in the middle of the road.)
In discussing Max Baucus’ rather sad polling number, Jennifer Rubin quotes a poll that says:
At this point pretty much all of his support from Republicans has evaporated with only 13% approving of him and although his numbers with Democrats aren’t bad at 70/21, they’re not nearly as strong as Jon Tester’s which are 87/6.
Baucus’ plight is similar to that of a number of other Senators who tried to have it both ways on health care, watering down the bill but still voting for it in the end.
Rubin’s interpretation of this is:
That is a nice way of saying that while they posed as “moderate” Democrats, they voted like liberals.
Nope. This is a nice way of saying that they refused to fish or cut bait and we ended up with the worst of all possible worlds: no fish and rotten bait. Just as people on the Right believed we needed government to restrict its role in health care to figuring out how to make the free market work better, people on the Left believed we needed government to step up and step in rather than just shoveling business to the insurance companies. ObamaCare did neither. It’s a “compromise” which furthers the worst of both approaches.
Whether you’re a Tea Partier or a Move.Oner, you don’t have to be a genius to figure out that when Big Government gets in bed with Big Business bad things happen to the little people. It’s just that you’ll see different solutions: The Tea Partier’s solution is for government to get out of the way and let business do it; the Move.Oner's solution is for government to just do it. So, no, Democrats aren’t unhappy with Max Baucus because he voted like a liberal; they’re unhappy with him because he didn’t.
Trifles show character
One of the things that helped move me from leaning Left to leaning Right was hearing about George W. Bush from bloggers who didn’t hate him, especially The Anchoress. I discovered that his speeches were often remarkable* which was quite a surprise to me since I found his delivery of them so off-putting I never listened to what he said. And I discovered PEPFAR: the President’s Emergency Plan for Aids Relief. This program was started by President Bush in 2003 to provide funding from the United States to fight AIDS and related conditions, primarily in Africa. It was a source of amazement to me then that I had heard - as far as I could remember - absolutely nothing about this program from bloggers on the Left.
It was PEPFAR as much as anything that made me step back and take another look at Bush. Why would a man who was a racist, homophobic, stupid, war-mongering, isolationist, cowboy even know AIDS relief in Africa was necessary, much less set out to provide it - and in increasing amounts? Hercule Poirot teaches us that if we have constructed a theory and we find a piece of evidence that doesn’t fit, we cannot find the truth by doing what most people do: throw out the evidence that doesn’t fit our theory. Instead, we must develop a new theory that accounts for the new evidence. When George Packer treats Bush’s championing of PEPFAR as simply a weird aberration he does so at his own intellectual peril.
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Footnote:
* I found Bush’s May 2008 speech to the Knesset very powerful; you can read it at The Anchoress. Bush’s Sharm El Sheikh speech won my heart by talking about women in the Muslim countries; you can download a pdf of that speech here.
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Reading:
I ran across the John Derbyshire/Peter Wehner discussion (to put it politely) regarding PEPFAR while writing this post. It simply confirmed my distaste for Derbyshire. Here’s Wehner; I’m not linking to anything from Derbyshire.
[I wrote this in March of 2010. I was going to junk it - I’m cleaning up my computer files - but part of it still resonates so here it is with a nice new footnote.]
Movin’ Meat has up a post in which he cites the case of Anthem Blue Cross Blue Shield paying claims late and says:
Actually, that's pretty much SOP for most insurers: deny and delay at will, and dare providers/consumers/regulators to punish them. Fines (when there are any) just go back to the insureds as increased premiums, and any time the providers/consumers are fatigued out of demanding the insurers actually pay, that's pure profit for the insurance company.
Pass. The. Damn. Bill.
As I said in the comments there, I don’t see how any of the three (perhaps soon to be four) health care reform bills that might be passed would eliminate this issue. The bills don’t get rid of insurance companies so the business models for the companies won’t change and bad insurance companies won’t suddenly become good ones. I suppose supporters can argue that Federal law will be better at regulation than State law but in rebuttal I would simply mention the Great Financial Crisis of Twenty-Aught-Eight. Whoever was at fault in that Crisis, no one can argue that having the Federal government regulating the financial industry made companies behave in a saintly manner. Incentives are incentives even for the best companies in any industry and every industry has some bad apples. All the Federal law in the world won’t change that.
What intrigues me about this is that it’s representative of a firm belief in some quarters: passing Obamacare will make all the problems with our health care and our health insurance magically disappear. Movin’ Meat believes Obamacare will make insurance companies stop delaying claim payments. Yet Obamacare doesn’t get rid of health insurance companies. Similarly, at the health care summit, Representative Louise Slaughter said:
I have a constituent that you won’t believe and I know you won’t, but her sister died, this poor woman had no dentures. She wore her dead sister’s teeth which of course were uncomfortable and did not fit. Do you believe that in America that’s where we would be?
Yet according to The New Republic:
The Senate and House health reform bills are relatively silent about dentistry. (The word "dentist" appeared once in the 1,502-page Senate Finance committee draft bill.) Child coverage has been expanded. Provisions are included to strengthen the dental work force and to address other infrastructure concerns. Yet these bills do relatively little to ensure adult access or to apply a careful delivery reform lens to dental services. (The status of stand-alone dental plans within proposed insurance exchanges raises delicate concerns, for example.)
Based on that analysis, I don’t know why Slaughter would think Obamacare would magically produce dentures for her constituent.
A week ago, Movin’ Meat was claiming that we had to pass the health care bills in order to eliminate rescission. Yet the House health care bill still allows for rescission in the case of “clear and convincing evidence of fraud” subject to third-party review. The Senate bill is even more gentle, allowing for rescission in the case of fraud or intentional misrepresentation; this is not an improvement over most State regulations and existing Federal regulations. When the Exchanges are up and running in 2014, everyone will have to buy health insurance so there will presumably be no conditions under which rescission can happen. But until then passing Obamacare will not eliminate rescission.
This is really just another version of what puzzles me so terribly about the Left’s support of Federal government health care reform. The Left believes the Federal government constantly and chronically fails in its regulatory, moral, and fairness obligations: the financial crisis; the environment; the Wars; Guantanamo; enhanced interrogation; restricting campaign financing; hate crimes; education; lifting people out of poverty; protecting the rights of women and minorities; and on through the endless list. Yet the complaints that our national government is failing us at every turn are always accompanied by demands that the Federal government do more. How does this make sense? If the Federal government is doing things so badly, why will increased action on their part make things better?
My belief is that if the Federal government is doing something badly then either this is not a task that the government should be attempting or that imperfection is the best we can hope for. In the former category, I put education: the Federal government has no business in education. In the latter category, I put Guantanamo: it’s the best of a whole armful of lousy options. Sadly, my belief does not appear to be widely shared.*
My impression is that a lot of people never even consider that doing something badly means either that the Federal government shouldn’t be doing that thing or that doing it badly is sometimes the best we can do. Instead they cling to the conviction that if government is doing something badly then either it isn’t trying hard enough or it isn’t run by the right people. They seem to believe the government can do anything and do it very well, perhaps perfectly. All that is required to turn the government’s poor performance into perfection is more money, more effort, more laws, more regulation; the right people running things (this is crucial); and a way to make everyone else do what they’re supposed to. Reality-based, my foot.
If Obamacare passes, it will be interesting to see what happens to all the stories about people who suffer from denied claims, delayed claims, lack of dental care, and being dropped by their insurers because they left something off their applications. I don’t believe the problems will magically cease. I do believe it will no longer be those on the Left who are talking about them.
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Afterword
Except for polishing my concluding language, I wrote this post yesterday. This morning I read a letter from the Red Queen to President Obama (Via Blue Lyon). The whole letter is worth reading (language warning) but what struck me was the contradiction I see between the first and last sentences in this fragment:
Thank you, President Obama, for destroying any hope (or should I say delusion) that I had about our government's efficacy.
Thanks for giving me the change (and by change I mean the spare change I'm going to start asking for on street corners) I can believe in.
I am just one little person in a sea of millions of little people all drowning in this financial crisis. I do not have the clout that say a few "savvy" banksters do. I'm just a mom, with no income, no health insurance and a kid who has a toothache and can't go to the dentist.
And what I need from my government is for it to work for me.
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Footnote:
* In the year since I’ve written this, it’s been interesting to watch the Left’s position on Guantanamo now that it’s Barack Obama’ baby. They seem to either be ignoring it (no links, obviously) or still criticizing it (Glenn Greenwald is the obvious link here). Now, I can see that Greenwald’s continuing criticism of Guantanamo could be a sign of admirably steadfast principle. But I do wonder why no one on the Left is looking at the similarities between what the George W. Bush Administration did in the Global War on Terror and what the Obama Administration is doing in that same conflict, and saying to themselves:
Hmm. If two Presidents with such dissimilar world views are both doing the same things, maybe it’s the best we can manage to do.
Cardinalpark is pushing for Medicare and Medicaid to become defined contribution plans rather than defined benefit plans, citing the success his company has had in doing that with its own health insurance. This is a sort of variation on the types of plans I discuss here and, obviously, I think it’s a great idea.
However, what really caught my attention was this idea from one of the commenters:
I think HSA for medicare would be a great way to go. In addition we should do away with the current estate tax and replace it with an end of life health care bill. So that the heirs receive a bill for a % of the medical cost for the last three years of life up to a % of the estate. Combining these two would go a long way to reduce health care costs as families ration their own care. Dr visits & MRI's with HSA's and massive end of life care with the estate bill.
I really like this. It lets the person who is at the end of his life decide whether he wants to spend his money on extreme measures or would prefer to leave a larger estate to his heirs.
We would need to build in safeguards of course; we don’t want a greedy heir to be able to take control of his infirm grandmother’s finances and decide to preserve his inheritance by consigning Grandma to the tender mercies of Shady Farms CutRate Hovel for the Aged. In a mild bit of irony the best safegaurd would be detailed end of life instructions like, oh, I don’t know, maybe an expansion on the basic Order for Life Sustaining Treatment?
Once the Obamacare Exchanges get going in 2014, everyone not in Medicare or Medicaid is going to have to either buy acceptable private health insurance as defined by the Federal government (with some exemptions for various things) or pay a penalty. The penalty is going to start at 1% of a person’s income in 2014 and rise to 2.5% of a person’s income by 2016.
Let’s take a best case scenario (also known as a fantasy) and assume I can buy health insurance for $100 per month, $1200 per year. I would have to be making $120,000 per year in 2014 in order for the penalty to be more expensive than the health insurance. If I make less than $120,000 then so long as I’m reasonably healthy it’s not in my best interest to buy health insurance. I know I can purchase insurance whenever I need or want it so the smart thing for me to do is to pay the penalty and put the difference between the penalty and the insurance premium into a savings account. I can use the money in savings to pay for ordinary medical costs like checkups and even dental care (which is not covered under Obamacare). If I become seriously ill, I can simply purchase insurance then - the insurance companies aren’t allowed to turn me down just because I’m already sick.
This plan works fine if the future illness is slow-moving. If I’m diagnosed with cancer, for example, I’ll almost certainly be well enough and have time enough to arrange for health insurance before I start incurring huge medical bills. Ditto for major degenerative diseases like multiple sclerosis. But what happens if I’m suddenly, catastrophically ill?
Let’s say I have a massive heart attack and am unconscious for days while the doctors struggle to save me. My medical bills mount to the rafters. I can’t apply for health insurance; I’m unconscious. My family could and I certainly think anyone who elects to wait for an illness before purchasing health insurance should make sure his family has a limited power of attorney that enables them to purchase health insurance on his behalf. But what if I have no family or by the time my family is contacted by the hospital and collects itself together enough to do the paperwork, I’ve already run up huge medical bills? That’s easy to do in the case of heart attack or stroke or being hit by a bus. Here’s where there’s a business opportunity waiting to be seized: Catastrophic Bridge Insurance.
Catastrophic Bridge Insurance (CBI) would offer a very limited form of health insurance, contracting only to pay whatever expenses are incurred before I could sign up for traditional health insurance. I would not buy traditional health insurance; I would pay the penalty to the government; and I would also pay a premium to my CBI carrier. In addition, I would provide that carrier with a limited power of attorney enabling it to apply for health insurance for me. I would get a card for my wallet - just like my current health insurance card - which would let medical personnel know who to contact about the bills even if I couldn’t contact the carrier myself. That contact would trigger my CBI carrier to apply for traditional health insurance for me.
Obviously customers will only buy CBI if the penalty for not having traditional health insurance plus the CBI premium is still less than the premium for traditional health insurance. I would think the premiums for Catastrophic Bridge Insurance would be fairly modest. The insurance only kicks in when catastrophe strikes so carriers wouldn’t have to charge enough to cover anticipated costs for the kinds of illnesses that drag on and on. No type of therapy would ever be covered; no long-term drug treatments; no follow-up visits and tests; none of the unending medical costs that mount up and up and up. Theoretically the most the carrier would be on the hook for would be 72 hours of emergency treatment if I’m inconsiderate enough to suffer a catastrophe on a weekend; in most cases it would be less than 24 hours of treatment. That treatment can be very expensive but it is limited in time and - most important - presumably occurs relatively infrequently.
Perhaps, in hopes of not being put out of business by the unsustainable setup* of Obamacare, the traditional insurance companies could start offering Catastrophic Bridge Insurance themselves. It would be a way for them to, in effect, bring healthy people back into their customer pool. If I have CBI coverage through, say, Blue Cross Blue Shield then if catastrophe strikes they just sign me up for their traditional health insurance.
Even better, the insurance companies might be able to backdate applications for traditional health insurance so that their CBI customers who fall ill would be signed up for traditional insurance prior to the date of their catastrophe. The insured would owe some number of previous month’s premiums (maybe customers would have to put up that amount as part of their contract) and their coverage would be considered to have commenced that many months prior to the catastrophic illness. Between the premiums from their customers who stay healthy and the ex post facto premiums from those who don’t, insurance companies might be able to stay afloat.
Although, I gotta say: this is starting to sound kind of like the system we have now.
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* Why is Obamacare an unsustainable setup for insurance companies? I live in New Jersey, where I’d be lucky to get health insurance for $3000 a year, never mind $1200 a year. If I make $50,000, my penalty will be $500 in 2014. I’ll save $2500 by paying the penalty instead of buying health insurance. Why on earth would I buy health insurance before I need it? Even without Catastrophic Bridge Insurance I’m far better off banking the thousands of dollars of difference between my premiums and my penalty, giving my husband a power of attorney to buy health insurance for me if I need it, and taking my chances. And if the enforcement mechanism for collecting the penalty is as weak as it seems to be, I save even more by choosing to forego health insurance.
Even if we assume that Congress decides to put some real teeth into collecting the penalty and everyone who chooses to forego health insurance ends up having to pay the penalty, it’s still going to be cheaper for most people to pay the penalty and the insurance companies will still go out of business. You see, the real joker in the deck for the health insurance companies is that the penalties don’t go to them. If they did, the companies might survive since they would effectively be subsidized for being forced to insure people with pre-existing conditions; that is, they would be collecting income without having to provide a product so long as the penalty-payers stay healthy.
Instead the penalties will go into the Federal coffers and the insurance companies will collect income only when they will have to pay out. Premiums will have to rise since this is no longer insurance but simply a pass-through from insured to health care providers. The Federal government (no matter which party is in control) will have a cow over the high rates and insist that “greedy” insurance companies lower their rates. The insurance companies will either stop doing business voluntarily or go broke trying to comply.
The House passed the Senate’s Christmas Eve health care reform bill. Here are three afterwords I recommend: FDL because it’s a interesting (although lopsided) summary; McArdle because I share her fear (and - in my case and I think hers - anger) about process; and Douthat because he’s writing about possible outcomes. As terrifying as this bill and the process used to pass it are, it’s not everyone who gets to be alive and paying attention at the beginning of an undertaking that’s going dominate the political (and probably economic and possibly social) landscape for years to come. It will be fascinating to watch this unfold.
On what the bill does and doesn’t do: FireDogLake - Fact Sheet: The Truth About the Health Care Bill
On the politics: Megan McArdle - The Future After Health Care
On outcomes: Ross Douthat - Show Time for Health Care
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On process, I strongly recommend a couple of posts from Deafening Silence, one written before and one written after passage of the bill:
You Just Lost Me, Mr. President. For Good. - Written before
Morning in the Brave New World - Written after
I also recommend Megan McArdle’s chat from yesterday.
Just in case anyone is thinking that health care reform can be repealed after the 2010 elections if the Republicans are successful enough:
The Republicans currently have 41 votes in the Senate.
The Democrats currently have 57 votes in the Senate.
There are 2 Independents in the Senate who caucus with the Democrats.
There are 10 Republican Senators up for re-election in 2010.
There are 21 Democratic Senators up for re-election in 2010.
The 2 Independents who caucus with the Democrats are up for re-election in 2010.
Let’s assume the Republicans hold all 10 of their contested Senate seats.
Let’s assume the Republicans win all 21 of the Democrats’ contested Senate seats.
Let’s assume that either the Republicans win both of the Independents’ contested Senate seats OR the Independents begin caucusing with the Republicans after the 2010 elections.
The Republicans will then control 64 votes in the Senate.
However, assuming all seats in the Senate are occupied and all members are present, it requires 67 votes in the Senate to override a Presidential veto.
Unless 3 Senate Democrats break ranks, it will not be possible to repeal health care reform after the 2010 elections even under the rosiest possible scenario for Republican gains in that election.
(Thanks to Texan99 whose comment inspired me to finally sit down and do the math.)
This is why I don’t really have anything else to say about the Democrat’s health reform bill. Movin’ Meat is complaining about his company’s insurance company imposing a $500 fee on emergency room use by two of their insureds. I am perfectly willing to stipulate that the trips to the emergency room were reasonable and should have been covered without question and that the insurance company is behaving badly by attempting to impose the fee.
Movin’ Meat was puzzled by the fee because it should have been prevented by his State’s insurance regulations. When he investigated, he discovered that his State’s insurance regulations did not apply; his company’s contract is controlled by ERISA. ERISA is Federal law and does not outlaw this type of behavior on the part of insurance companies.
Movin’ Meat is a strong supporter of the Democrat’s health insurance plan which will place control of insurance companies completely in the hands of the Federal government.
A. You just can’t make this stuff up.
B. Reality-based, my foot.
C. What logical argument could I possibly make that would have any impact on someone like Movin’ Meat?
I wrote earlier about the process by which Congress could relatively simply pass a version of Obamacare. First, the House passes the Senate’s already passed health care bill as is. The House and Senate then pass a second bill (the sidecar bill) which amends the first bill as desired by the House. To get this through the Senate, the reconciliation process is used. This means the second bill only requires 50 votes to pass the Senate; it also means the second bill can only cover matters that can somewhat reasonably be considered financial matters. Using the sidecar bill to amend the first bill’s abortion funding provisions will probably not be possible under the reconciliation process.
This probable inability to make the more restrictive House language on abortion part of health care reform is giving hope to those who would prefer such reform not be passed. They were made even more hopeful by Representative Bart Stupak earlier today. Stupak, whose name is attached to the House’s more restrictive language on abortion funding, said that:
he and 11 other Democrats will vote against the overhaul unless a provision subsidizing abortion is removed.
Since the House will probably need those twelve votes to pass the Senate bill and since abortion funding can probably not be changed via the sidecar bill, does this mean passing health care reform is virtually impossible? I don’t think so.
If I were trying to get this done, I would simply create a third bill - the Stupak bill - that does nothing except amend how the first bill funds abortion. The Stupak bill would replicate the extremely restrictive abortion funding language from the House bill and would therefore be a bill which prohibits the Federal government from funding abortions in any way through health care reform. It would be an anti-abortion bill pure and simple and that would put Republicans in a bind.
How could 41 Republicans in the Senate refuse to pass the Stupak bill? If they did so, they would be leaving in place the more liberal funding for abortion. Even if Republicans claimed now that they would oppose such a Stupak bill in the future, I don’t see how they could actually do so if the House in fact passed the Senate bill. Once that happens, filibustering the Stupak bill would mean leaving more liberal abortion funding in place and I don’t think Republicans could do that and explain themselves to their anti-abortion supporters in a believable way.
Of course, that’s what I think. What really counts is whether the Stupak Twelve can be convinced that getting a Stupak bill through both houses of Congress would be a cakewalk once the Senate bill is passed. I wonder, though, if it’s possible to pass a Stupak bill now. That is, can Congress legally pass a prospective bill, one which says:
In the event the Senate health care bill is passed by the House and signed into law, it will be amended in the following way...
I have no idea if that is legally possible but if it is, it might be a way for the Democrats to convince the Stupak Twelve to vote for the Senate bill. Even if it’s not, I wouldn’t bet against the Twelve coming to realize that the Republicans would be hard pressed to oppose a Stupak bill once the Senate bill is signed into law. If the Twelve do come to such a realization, they will also realize they can vote for the more liberal Senate language secure in the knowledge that it will be tightened up immediately.
Assuming of course they believe they can get enough Democrats to vote for the Stupak bill once health care reform is a done deal. Hmm. If I were the Stupak Twelve I might insist on the anticipatory version of the Stupak bill after all.
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Reading:
Writers at The Corner are talking about the House vote on the already-passed Senate bill being the one that matters. Ramesh Ponnuru is counting votes in the House.
Back in the “I’m so confused” world, The Gormogons are describing a process that doesn’t really make sense to me. They seem to think a conference committee (House and Senate) can work out the differences between the two versions and that the vote on a conference committee report cannot be filibustered. I’m not sure they’re correct on that (emphasis mine):
Conference reports themselves, unlike measures on initial consideration, are not subject to a double filibuster, because they are privileged matters, so that motions to proceed to their consideration are not debatable. Inasmuch as conference reports themselves are debatable, however, it may be found necessary to move for cloture on a conference report.
In other words, Senators cannot filibuster a motion to consider a conference report but they can filibuster a vote on the report itself. (If The Gormogons are right about conference reports not being subject to the filibuster, then why do they think a sidecar bill would still be necessary? Everything could be worked out in conference.)
I was looking for something else when I found this speech by Senator Russ Feingold in May of 2000, decrying the overuse of cloture:
[The Senate] rules honor the sentiments of committed minorities. They give dedicated groups of Senators substantial power. And they give any group of 41 Senators the absolute right to kill a bill.
The Senate Rules thereby force consensus. When these rules are honored, no major change in our government’s laws may come about without the concurrence of a three-fifths majority. When these rules are honored, policy changes are likely to be more moderate and more incremental.
As Nobel Prize-winning economist James Buchanan has argued, societal efficiency may be served by a Congress that has a hard time enacting laws. Under such circumstances, laws change less often - less frequently disrupting peoples’ lives, less often intruding into them. If you agree with Thoreau that the best government is that which governs least, then the most efficient government for society is the one with the most checks and balances. [snip]
But the character of the Senate has been unmistakably altered. The majority’s actions are transforming the Senate into a much more majoritarian institution. And that is not how the Founders wanted it.
Recall that the Constitution itself manifests a belief in supermajorities. Supermajority requirements are evident in the veto power, in the ratification of treaties, in the Constitutional amendment process, and in a number of other places.
Recall, as well, that the Founders who created this Senate also expressed a healthy distrust of simple majority rule.
Feingold is, of course, a Democratic and when he made his impassioned speech he was decrying the tactics of a Republican-controlled Senate. To his credit, he repeated his concerns about reconciliation even after the Democrats took both houses of Congress and the Presidency. In the Spring of 2009 the Democrats inserted a “reconciliation instruction” into the Conference Report on the Concurrent Resolution On The Budget For Fiscal Year 2010. As Keith Hennessey told us in August of last year, the instruction was inserted:
for just this purpose, as a backup plan in case Democrats could not broker a deal with Senate Republicans, and in case they couldn’t hold all of their own caucus together.
This year’s reconciliation instruction orders two committees, Senate HELP (Kennedy/Dodd) and Senate Finance (Baucus) to report legislation to the Senate Budget Committee by October 15th. Each committee’s bill must reduce the deficit (through either spending cuts, tax increases, or a combination) by a net of at least $1 billion over the period 2009-2014.
Hold on. $1 billion?!? I thought this was supposed to be a budget bill? I thought these were trillion+ dollar bills?
You can see that Senator Reid created this instruction not to create a fast-track legislative vehicle for deficit reduction, but instead to create such a process for a bill that is basically deficit neutral.
In April of 2009, Feingold said he would support the conference report that contained the reconciliation instruction but reiterated his reservations about the abuse of reconciliation.
However, there are some features of this resolution with which I take exception, most notably the use of reconciliation as a tool to expedite health care reform. The arguments over the use of reconciliation are familiar to this body. Sadly, a tool intended to streamline the painful process of deficit reduction has been used to clear a path for major policy changes that have, at best, only a passing relationship to reducing the budget deficit. [snip]
I had hoped that with a new President in the White House and Democrats in control of both Chambers we could restore a respect for the proper use of budget procedures. But while the budget we pass today is a huge improvement over those submitted by the previous administration, both with respect to honest budgeting and the fiscal path it embraces, its misuse of reconciliation to advance policy priorities is regrettable.
I opposed using reconciliation when it was abused by the other party to enact fiscally reckless tax cuts and when it was attempted to be used to open up the Arctic National Wildlife Refuge for oil drilling. I opposed it earlier in this debate as a way to expedite climate change legislation, and I oppose it now as a vehicle to fast-track health care reform.
Congressional leadership indicate they may not need to use reconciliation to enact health care reform, that it will be used only as a last option to ensure Congress acts on that vitally important issue. That may be, and I certainly hope this body will pass a health care reform measure under regular procedures. Health care reform is long overdue, and I look forward to the Senate finally acting on an issue that is so important to my constituents. But let's not kid ourselves. It is no more appropriate to use reconciliation as a hammer to push through health care reform under regular procedures than it is to use it directly to enact those reforms. Both are abuses. Both undermine its original intent. Both invite even greater abuses in the future.
Sadly, it now appears - although I have seen only one small story about it and he is not on TPM’s running list - that Feingold has decided to support the use of reconciliation with regard to health care reform if that’s what it takes to get a public option enacted into law. I hope not. It would be nice if at least someone in the United States Senate thought that process was more important than outcome.
Movin’ Meat has up a post in which he cites the case of Anthem Blue Cross Blue Shield paying claims late and says:
Actually, that's pretty much SOP for most insurers: deny and delay at will, and dare providers/consumers/regulators to punish them. Fines (when there are any) just go back to the insureds as increased premiums, and any time the providers/consumers are fatigued out of demanding the insurers actually pay, that's pure profit for the insurance company.
Pass. The. Damn. Bill.
As I said in the comments there, I don’t see how any of the three (perhaps soon to be four) health care reform bills that might be passed would eliminate this issue. The bills don’t get rid of insurance companies so the business models for the companies won’t change and bad insurance companies won’t suddenly become good ones. I suppose supporters can argue that Federal law will be better at regulation than State law but in rebuttal I would simply mention the Great Financial Crisis of Twenty-Aught-Eight. Whoever was at fault in that Crisis, no one can argue that having the Federal government regulating the financial industry made companies behave in a saintly manner. Incentives are incentives even for the best companies in any industry and every industry has some bad apples. All the Federal law in the world won’t change that.
What intrigues me about this is that it’s representative of a firm belief in some quarters: passing Obamacare will make all the problems with our health care and our health insurance magically disappear. Movin’ Meat believes Obamacare will make insurance companies stop delaying claim payments. Yet Obamacare doesn’t get rid of health insurance companies. Similarly, at the health care summit, Representative Louise Slaughter said:
I have a constituent that you won’t believe and I know you won’t, but her sister died, this poor woman had no dentures. She wore her dead sister’s teeth which of course were uncomfortable and did not fit. Do you believe that in America that’s where we would be?
Yet according to The New Republic:
The Senate and House health reform bills are relatively silent about dentistry. (The word "dentist" appeared once in the 1,502-page Senate Finance committee draft bill.) Child coverage has been expanded. Provisions are included to strengthen the dental work force and to address other infrastructure concerns. Yet these bills do relatively little to ensure adult access or to apply a careful delivery reform lens to dental services. (The status of stand-alone dental plans within proposed insurance exchanges raises delicate concerns, for example.)
Based on that analysis, I don’t know why Slaughter would think Obamacare would magically produce dentures for her constituent.
A week ago, Movin’ Meat was claiming that we had to pass the health care bills in order to eliminate rescission. Yet the House health care bill still allows for rescission in the case of “clear and convincing evidence of fraud” subject to third-party review. The Senate bill is even more gentle, allowing for rescission in the case of fraud or intentional misrepresentation; this is not an improvement over most State regulations and existing Federal regulations. When the Exchanges are up and running in 2014, everyone will have to buy health insurance so there will presumably be no conditions under which rescission can happen. But until then passing Obamacare will not eliminate rescission.
If Obamacare passes, it will be interesting to see what happens to all the stories about people who suffer from denied claims, delayed claims, lack of dental care, and being dropped by their insurers because they left something off their applications. I don’t believe the problems will magically cease. I do believe those on the Left will magically stop talking about them.
My understanding of the current state of the heath care reform bills was that the House had passed one and the Senate had passed a different one. That is, both bodies had already passed a version of Obamacare. With the election of Scott Brown, it is almost impossible to imagine the Senate being able to pass another health care reform bill since the Democrats no longer have the 60 votes necessary to shut down a Republican filibuster. Therefore, the most likely scenario for getting a health care reform bill out of Congress and onto President Obama’s desk was for the House to scrap their already passed bill and pass the exact bill the Senate has already passed. The House and Senate could then pass a completely different second bill which made changes to the just-passed Obamacare bill to incorporate some of the features that are in the House-passed bill but not in the Senate-passed bill - and possibly to incorporate some of the ideas President Obama introduced a week ago. Since the Senate would still not be able to muster 60 votes, the follow-up bill would have to be passed via the 50-votes-needed reconciliation process designed to handle budgetary matters. Thus the follow-up bill could only address matters that could at least semi-reasonably be construed as having to do with the budgetary matters for which reconciliation was intended. Voila! Obamacare becomes law in two bills.
Then on Sunday I read this post by John Podhoretz and became hopelessly confused. Podhoretz is arguing that there are no good option for the Democrats when it comes to passing Obamacare and outlines the four bad options he sees. In the course of that outline he totally confused me with statements like:
The bill that has been voted out of the Senate committee for consideration of the full Senate... Republicans have enough votes to filibuster this bill. [snip]
The way to muscle this legislation into law is for the House to give up its bill, bring the Senate bill (after it’s passed with 51 votes) up for a vote, pass it, and have Obama sign it. [snip]
Even if the Senate does pass the bill through the 51-vote reconciliation process ...
I kept re-reading this and thinking that I must have missed something: Podhoretz seems unaware that the Senate has already passed a bill but surely that can’t be true. I finally decided that either Podhoretz was talking about some other Senate health care bill I was unaware of or there was some legal - not political - reason the House could not just pass the already-passed Senate bill.
Then (thanks to Neo-neocon) I read Keith Hennessey and my confusion subsided. My understanding of the strategy is correct. You can read his detailed and useful explanation of the process here. It is pretty much as I understood although I had not really thought about - and love - his description of the “Byrd bath” necessary to avoid the Republicans raising points of order in order to derail the passage of the follow-up bill via reconciliation.
Thank you, Mr. Hennessey, for reassuring me I had not wandered into some alternate reality. Now if I could just figure out what I missed in Podhoretz’ post, all would be well.
Some references for discussion of health care reform:
H.R. 3962 - This is the version of health care reform passed by the House on November 7, 2009. This bill is 2016 pages long. Cite this bill as ‘‘Affordable Health Care for America Act’’. From the link, you can download a pdf of the bill or read a hyperlinked version on THOMAS.
H.R. 3590 - Despite the HR designation, this is the version of health care reform passed by the Senate on December 24, 2009. This bill is 2409 pages long. Cite this bill as “Patient Protection and Affordable Care Act”. From the link, you can download a pdf of the bill or read a hyperlinked version on THOMAS.
President Obama’s Health Care Proposal - This is a little confusing. You can download the pdf of “the President’s key improvements” but there is also a list of items headed “Summaries of Key Elements of the President’s Proposal” which doesn’t really match up with the pdf.
A transcript of the February 25, 2010, Health Care Summit from the Washington Post - I like the fact that this is indexed by speaker.
It is easy to be brave from a safe distance. - Aesop
Today on This Week, host Elizabeth Vargas and House Speaker Nancy Pelosi had the following exchange about passing health care reform:
VARGAS: ... What do you say to your members, when it does come to the House to vote on this, who are in real fear of losing their seats in November if they support you now?
PELOSI: Well first of all our members -- every one of them -- wants health care. I think everybody wants affordable health care for all Americans. They know that this will take courage. It took courage to pass Social Security. It took courage to pass Medicare. And many of the same forces that were at work decades ago are at work again against this bill.
But the American people need it, why are we here? We're not here just to self perpetuate our service in Congress. We're here to do the job for the American people. To get them results that gives them not only health security, but economic security, because the health issue is an economic issue for -- for America's families.
I think Pelosi has a good point. Ideally members of Congress should be about more than just getting themselves re-elected. The problem is that it’s very easy for Pelosi to say this: she has been in the House since 1987 and took 71.9% of the vote in the 2008 elections. So I wonder if she’d be willing to take the same stand if there was any chance she’d lose re-election this November, if it was her service in Congress that was in danger of not being perpetuated.
Here’s my proposal: Nancy Pelosi should tell her fellow House Democrats that if the House passes a health reform bill and the Democrats lose their majority in the House, she’ll resign. From the House.
From JustOneMinute, quoting the Wall Street Journal (emphasis mine):
President Barack Obama will use a bipartisan summit Thursday to push for sweeping health-care legislation, but if that fails to generate enough support the White House has prepared the outlines of a more modest plan.
His leading alternate approach would provide health insurance to perhaps 15 million Americans, about half what the comprehensive bill would cover, according to two people familiar with the planning.
Half? I simply do not understand how we ended up in this position with a Democratic Congress and a Democratic President. Surely the priority for Democratic health care reform would be - should be - to make sure people who don’t have health insurance get health insurance. Sure they went off-track a little and instead of a ten-page bill that made sure people without health insurance could get health insurance, they ended up with a bill that has an additional 1,990 pages that do who knows what. Now they’ve realized they may not be able to pass their 2,000 page bill. So do they eliminate the 1,990 pages of dreck and keep the ten pages that actually get everyone health insurance? Of course not. They eliminate the coverage for half the uninsured and keep, well, I have no idea what they’re keeping.
I’m sorry to repeat myself but this just makes me nuts. If President Obama, Harry Reid, and Nancy Pelosi had any sense between the three of them then on January 21, 2009, they would have proposed a bill that made sure people without health insurance could buy it if they wanted to. Let everyone who wants to buy into the Federal Employees Health Benefits Plan or buy into Medicaid or buy whatever insurance they want and subsidize those who cannot afford to do so. That should have been their priority and it would have been politically feasible. Even all those people who are very happy with their existing health insurance worry about what would happen if they lost their jobs or their premiums skyrocketed. As for paying for it, they could have used some of the money that went into the stimulus bill. Heck, David Plouffe himself said that health care is a jobs creator.
Insuring the uninsured would have solved the most urgent of our health care problems and bought the country time to figure out how to lower health care costs. And since the Democrats would have successfully accomplished the task of protecting everyone’s health insurance they would have had political capital to help push through the rest of their health care reform.
Instead, Obama and the Democrats ceded not only the best political ground but also the best moral ground and committed themselves primarily to lowering health care costs. They acted as if extending coverage was a sort of dessert they'd promise not consider unless they managed the Brussel sprouts of cost control. That's a strange approach for Democrats and particularly Democrats in control of the Federal government.
Clive Crook believes that Obama’s closing statement at the health care summit:
did crystallise the key point of difference between the two sides. Democrats mainly want to expand coverage, and promise to contain costs in order to pay for it. Republicans have the opposite priorities: first contain costs, which they say would make insurance more affordable.
I don’t see it that clearly in the transcript but even if Crook is right, he goes on to acknowledge that:
Up to now [Obama] has emphasized cost control first, broader coverage second--because that is where most voters seem to be. Relatively little effort has been spent on making the case for wider coverage, and on persuading the country that this is worth paying for. Making the switch now comes a little late.
In other words, what could have been - should have been - a golden opportunity to accomplish what I always assumed was a key Democratic goal of insuring the uninsured has been frittered away. We’ve spent a year on a health care reform bill that probably won’t pass; we’ve spent a year with the uninsured staying uninsured; we’ve reduced the chance of any bill that covers the uninsured getting through Congress; we’ve done nothing to address health care costs; and while we were failing to accomplish all that we also weren’t paying much attention to stuff like improving the economy and getting people back to work. (Although if the health care reform process is any example, the economy and the unemployed might be better off if Congress and the Administration don’t try to help them.)
What the heck happened?
In a good explanation of the health insurance premium rate review provision in President Obama’s proposed health care bill, Wonk Room says:
Since conservatives will surely claim that rate review is some kind of government take over of private industry or a burdensome new federal requirement for insurers, it’s important to note that states that have instituted rate review house profitable insurance companies and maintain competitive and vibrant markets.
Um, no. I hope that conservatives are intelligent enough to claim that rate review is best handled by States, especially since the Wonk Room post itself says (emphasis mine):
According to the New York Times the Health Insurance Rate Authority, “made up of health industry experts that would issue an annual report setting the parameters for reasonable rate increases based on conditions in the market.” What’s ‘reasonable’ will vary from state to state.
Although Wonk Room talks about the success some States have had in beating back health insurance premium rate hikes they considered unreasonable, it also claims that “state governments often lack the resources or political will to keep insurers in check.” Perhaps, but why is that my problem? My State of New Jersey regulates its health insurance companies within an inch of their lives and I’m sure some of my State tax dollars go to pay for that regulation. I don’t see why I should also pay for the Federal government to "take care" of States whose voters aren’t willing to do the job themselves. Or who even - heretical as it no doubt seems to Obama - don't think the job needs to be done at all.
(Via Legal Insurrection via Neo-neocon)
A few days ago, I said I wanted climate change scientists to provide the world with:
Raw temperatures for all land measurements for as long as we have them broken out into individual measurement stations. ... The next column in the spreadsheet should contain the adjusted temperatures. The next column in the spreadsheet should explain how the adjustment was calculated.
Prompted by a Times (UK) article headlined, “World may not be warming, say scientists”, TigerHawk is calling for the climate science community to:
hit the reset button on the whole project. Post all the raw data, then post all the adjustments with the explanations therefore. Do it in bloggy form, allowing for comment fields. Post the software used in the models, and use change control (which requires ex ante justification for any change), just as one would require for any mission-critical software. Use open-source programmers, when appropriate, who might well produce better code for a given routine. Harness the distributed power of the web, act in the open, and see what the data look like and the models predict then. Do all of that, and many more people will believe the result.
The additional step of posting and improving the model software is valuable but before we even start considering what the models predict for the future, we need to know for sure what the data are telling us about the past and the present. Thus I believe posting the data is the first step and should be done immediately rather than making it part of a package deal with the software - which could take forever to get up.
This seems even more urgent given the recent surprising interview with Professor Phil Jones. According to the Daily Mail (Via Watts Up With That), Professor Jones:
agreed that there had been two periods which experienced similar warming, from 1910 to 1940 and from 1975 to 1998, but said these could be explained by natural phenomena whereas more recent warming could not. [snip]
admitted that in the last 15 years there had been no ‘statistically significant’ warming, although he argued this was a blip rather than the long-term trend. [snip]
said that the debate over whether the world could have been even warmer than now during the medieval period, when there is evidence of high temperatures in northern countries, was far from settled.
If the report of the interview is accurate, this all seems like kind of a big deal and even more reason to make the data available.
On a completely unrelated topic, Megan McArdle has given sort of a throw-away endorsement of the idea of government-provided catastrophic health insurance:
The problem with both sets of plans [Republican and Democrat] is that the [Republican] voucher cap would never withstand the assault from angry and frightened seniors, while the [Democratic] provider caps and treatment disallowals would never withstand the pressure of various other interest groups. That's why I want to turn the Federal government into an income-based catastrophic insurer, for expenses that exceed 15-20% of AGI. I don't think there's much hope of controlling cancer treatments or heart surgery. But I think we could eliminate a hell of a lot of unnecessary day to day expenses--the ER visits of convenience and CYA tests for diseases there's no indication the patient has. But the only way we'll do that is by making the consumer responsible for those costs. Short of that, we're just rearranging the deck chairs on the Titanic.
I don’t remember her writing about this before although it’s possible I just missed it or she wrote about it before I began reading her regularly. If I could figure out a way to search just the text of her posts and not the comments, I’d try looking for earlier posts by her on the topic. Unfortunately, a Google search turns up 252 hits; I checked out the first few and all the references to catastrophic insurance are the comments. It would be interesting to see if she’s fleshed out her thoughts, taken a look at the costs, and so on.
The Corner has up a post with the text of a letter from House GOP Leader John Boehner and Whip Eric Cantor (R., Va.) responding to President Obama’s invitation to a bipartisan health-care summit. This letter is seriously ugly.
Let’s leave aside the fact that I think the letter is very poorly put together, with ideas jumbled together, logical flow choppy or non-existent, and paragraph breaks seemingly occurring based on word count rather than by key points. That may be a matter of style (theirs stinks) and personal opinion (I’m right). The real problem is that this is not the letter of a political party that wants to lead; this is the letter of a political party that wants to sit back and make political hay by taking potshots at those in power.
First, the stench of political point making arises from the pixels like noxious fumes from a, well, a fever swamp. The letter begins by pointing out that the GOP asked for a bipartisan discussions way back in May but would Obama listen? No, of course not, so now he’s getting his comeuppance. The snarky “assuming the President is sincere” (twice!) is just bush-league - and a mistake I doubt either the elder or the younger George Bush would make. The references to the “job-killing bills” is unnecessary and frankly stupid if the GOP really wants to get something done; it assumes facts not agreed on by both sides and is deliberately provocative. Then there’s the stuff that sounds like something a fifteen-year-old girl would scream at her mother before slamming the door to her bedroom. For example: “‘Bipartisanship’ is not writing proposals of your own behind closed doors, then unveiling them and demanding Republican support.” And, of course, there’s this laugher:
The President says Republicans are ‘sitting on the sidelines’ just days after holding up our health care alternative and reading from it word for word. The President has every right to use his bully pulpit as he sees fit, but this is the kind of credibility gap that has the American people so fed up with business as usual in Washington.
Right. As opposed to this letter which is concerned solely with policy and with getting something done for the American people.
Even worse than the political posturing, though, are the questions. A party that wants to lead doesn’t ask questions about what the President will do; a party that wants to lead sets its own agenda. There are 979 words in the body of the letter; 295 of those words are contained in questions: Will the President give up the idea of reconciliation; will he make legislative proposals available at least 72 hours before voting; will he include these guys and those guys and opponents and people from the States and these experts and those experts and special interest groups? The Republicans sound like an over-anxious mother grilling her kid about who’s going to be at Barack’s house. Worst of all is this question: will Republicans be permitted to invite health care experts to participate? Permitted? Now the GOP sounds like a nine-year-old asking if he can invite friends over for dinner.
Don’t ask. Tell. The President has invited the GOP to sit down and discuss health care reform. The GOP shouldn’t use its response to score political points - or, more accurately, try to score political points since I don’t think they’ll succeed with this approach. Nor should the GOP hand all the power over to the President by asking him what he’s going to do about this, that, and the other. Rather the GOP response should set out - clearly, calmly, and without nastiness - the conditions under which the GOP will agree to such a meeting. Somebody has to be the grown-ups here. How about if the GOP gives it a try?
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