For the moment, Senate Democratic leaders are taking an aggressive approach, defying Republicans and brushing aside the objections of moderate Democrats who are apprehensive about a public plan. “All the national polls show a wide majority of Americans support the public option,” Mr. Reid said.But Mr. Reid’s decision will not be the last word. The Senate will probably spend weeks on the health care bill and could vote on dozens of amendments, including several to alter or eliminate his version of a public plan. At any stage, 60 votes could be required.... NYT
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Nate Silver has a characteristically intelligent and honest assessment of health care reform legislation -- as of today -- and of his own earlier predictions about where we'd be at this point. It's his analysis of the surprise elements -- what he didn't expect -- that's particularly interesting.
The first surprise is that Reid is showing some backbone. I don't think this move is quite as risky as it looks, because Reid has some wiggle room before he passes the point of no return. But Harry Reid does not generally have a reputation as a risk-taker, even in small doses. A nontrivial factor is that he's literally gone overnight from being a goat to a hero in the progressive blogger/activist community, something that could pay dividends when he's seeking cash and volunteers for what will be a very tough re-election campaign. Save perhaps for Alex Rodriguez, nobody has done more in the last month to resuscitate their image with their fan base.
The second surprise is that this happened without much explicit support from the White House.
The third surprise is the way that Democrats regrouped after the turmoil of August. The President's speech on September 9th was a major and -- in my opinion -- still somewhat underrated factor in this. But also: the tea party/town hall movement that dominated the headlines in August is at this stage somewhat immature, with a lot of sound and fury but not so much focus -- sort of where liberals were at in 2002/03 before the failures of the Bush administration became more manifest. Whereas liberal activists have been focused on a laser like the public option, conservative activists have been distracted by ACORN, Van Jones, the NFL's conspiracy against Rush Limbaugh, and who-knows-what. Usually it's liberals who have amorphous, omnibus critiques of the government, and conservatives who bear down on specific policies; the polarity seems somewhat to have reversed.
The fourth surprise, less important than the first three, is that the usually very footsure insurance lobby undermined its credibility by putting out the wrong study at the wrong time, giving a gift to Democrats by making it easier for centrist Senators to distance themselves from them.The fifth surprise is that the usually very prepared Olympia Snowe didn't do her homework on triggers, failing to flesh out the proposal to the point where it was ready for a floor vote, much less had gained credibility with the Democratic caucus. If Snowe had done more legwork on the trigger -- at least theoretically, there are manifestations of it that ought to have been relatively acceptable to progressives -- then we'd almost certainly be talking about a "hard" trigger versus a "soft" trigger, instead of opt-ins versus opt-outs. [emphases added]
I don't think Silver can be bested in his dissection of the past several weeks' activities. I'm less surprised by the turnaround in Harry Reid's strategy than I am by Obama losing his focus and his followers recovering their ability to focus. In the same way, the sight of the insurance industry shooting itself in the foot was a surprise -- to the extent that it almost seemed intentional.
Nate Silver also looks at what we've wound up with: "Firstly, states will have the right to "opt out" of it (not that big a deal, IMO). Secondly, it will be limited to negotiating its rates in the market, rather than charging Medicare rates (a very big deal). Thirdly, it will be open only to the relatively small handful of people who are eligible for the health insurance exchanges, rather than the whole country (ditto)."
As it happens, I've had some experience of the health care "industry" during the past several weeks and am stunned at how very, very bad administration and information coordination are among doctors' offices, hospitals, and insurance companies. It's as though the various components of our current health care system live on different planets and are determined to keep it that way. What's problematical is that -- even if reform legislation takes this into account -- it will take years and years to break through the bureaucratic turf-guarding as we try to build a new and more responsive system on top of the present system.
In other words, the battle will just begin with the passage of a health care reform bill.
