The Blue Dog Lament

by dday

As you may know by now, 40 members of the Blue Dog Caucus sent out a letter vowing to withhold their support for health care reform without what they call “significant changes.” What’s interesting about the letter is how insignificant the changes actually are. Among other things, they want:

• a deficit-neutral policy, which is what every single proposal for this bill has included;
• aggressive solutions to bending the cost curve, which also is a goal of pretty much everyone;
• protecting small businesses, which every iteration of the plan has, including the employer mandate proposals that exempt certain small businesses and make them eligible for purchasing health care through the insurance exchange;
• rural health equity, a pretty small point;
• a public option that doesn’t use Medicare bargaining rates, which isn’t different from what, for example, Chuck Schumer has called for, although I find that to be a toothless public option, which I’ll explain later;
• time to read the bill, which I support;
• bipartisanship, which is the most ridiculous of these demands, but which actually does exist in the bill on the Senate side, where dozens of Republican amendments have been included in the HELP Committee markup.

So what’s the problem here? Well, dig a bit deeper and you’ll see. In short, the Blue Dogs want to reform the health care system without implementing things that would reform the health care system. They want to bend the cost curve and find savings from within the current system, yet they also want “rural health equity,” which actually means spending more on rural health. That would INCREASE costs. Similarly, a separate letter signed by many Blue Dogs ask Henry Waxman to cancel plans to reinstate price controls on prescription drugs to help seniors. The entire point of Waxman’s proposal is to plow savings from the current exorbitant prices paid to drug-makers back into the system. And finally, there’s the matter of the public option. Here’s the language in the letter:

We also wish to reiterate our support for the recommendations previously made by our coalition regarding how to appropriately structure a public option. In order to establish a level playing field, providers must be fairly reimbursed at negotiated rates and their participation must be voluntary. A “Medicare-like” public option would negatively impact hospitals, doctors and patients. Medicare reimbursement is on the average 20 to 30 percent lower than private plans and this inequity is even greater in some parts of the country. Using Medicare’s below-market rates would seriously weaken the financial stability of our local hospitals and doctors.

So, they don’t want a public option using Medicare reimbursement rates because they’re 20-30% lower than private plans. Which means they want to spend 20-30% MORE on provider rates, while… controlling costs, somehow. The entire point of a public option would be to lower overall costs to individuals and government; a plan on a “level playing field” is just another non-profit with little leverage to change the overall dynamic. The Blue Dogs are just being incoherent.

You don’t save money by magic. You save money by spending less money. You can do that by just letting a large and growing number of people go without adequate health care. Or else you can do that by spending less money on overpayments, inefficient processes, and unnecessary treatments. But you can’t do that without taking a bite out of someone’s bottom line. The Blue Dogs seem to be looking for a free lunch, or else just grasping at straws for reasons to object to the bill.

I think it’s the latter. Like with the effort in 1993, the Blue Dogs are inventing reasons to resist a health care overhaul. It’s obvious from the contradictions in their argument.

But lurking behind all of these complaints, according to several sources I consulted Thursday evening, is a general wariness of taking a political plunge on health care. Like their counterparts in the Senate, House members don’t like taking hard votes. Raising taxes, cutting spending, anything that takes money ouf of people’s pockets–these are not things they want to do, even in the service of a greater, more popular cause.

And now they’re getting nervous. They’re seeing the president’s popularity dipping, however incrementally. They’re watching the Senate chase its tail over the same controversies. And having just taken what were–for many of them–similarly tough votes on an energy bill, they’re not exactly thrilled about “walking the plank” again.

Never mind the literally clueless arguments from conservatives, or the complete hash from contrarians over health care – in the end, Democrats hold the fate of this bill in their hands. And lots of them don’t want to face up to the fact that their concerns about costs are solved in this case by MORE progressive reforms, not less. It hurts their wittle feelings. And maybe they’ll just use their go-to lament about bipartisanship, when the minority on this issue exists to prevent anything from being signed into law.

Fortunately, some Blue Dogs have spoken out on this issue in an intellectually coherent way. But unless more of them come around, this is how an overhaul will either be whittled down to nothing or just plain die – because so-called fiscal conservatives want to stick their fingers in their ears rather than face up to the facts.

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