Numbers Game: Is Health Care Reform Still Worth the (Lower) Costs?

By Gorman Gorman

Nov 19, 2009 8:18am

ABC News’ Rick Klein reports: Maybe the finish line is so close they can see it from their houses. Maybe you can see it from the House. But the view is still different from the Senate.

Sixty senators get to be the 60th senator. Few of them really love — or still, as of Thursday morning, really know — what’s being produced. Fewer still believe the numbers are realistic.

And the Senate will be voting on something that won’t take effect until the midterm election year — the next one, as in, the one that comes in 2014.

Democrats have yet to align the political gains with the political risks over health care reform. Blown deadlines are bad enough — but lawmakers might like to think they’ve missed them for a reason. Lower costs don’t necessarily mean a bill that’s worth it. (And there are several ways to measure costs.)

What are we in this for, again? “Most of Washington seems to think a low [Congressional Budget Office] score is automatically a good CBO score. But a low CBO score means a bill that doesn’t involve a lot of federal outlays. And without a lot of federal outlays, you can’t insure as many people or provide them with as much protection,” The New Republic’s Jonathan Cohn writes.

As we’ve watched the ambitions of spring turn into the clamor of summer and the exasperation of fall, where have we gotten? Is it possible that by trying to do too much — expanding health insurance, for example, while simultaneously purporting to cut the deficit — that the bill winds up doing too little?  (Cost controls, anyone?)

“Health-care reform is increasingly hostage to numbers that are disconnected from the reality of the bill and its purpose,” Ezra Klein writes at his Washington Post blog. “Compromising beneath $900 billion might be necessary, but it’s nothing to celebrate. It’s a concession, not an accomplishment.”

Health care is looking like a story of “missed connections,” Andrew Gelman, Nate Silver, and Daniel Lee write in a New York Times op-ed: “On the one hand, there is a disconnect between Mr. Obama and the electorate: the president — who had popularity ratings in the 60s when the health care debate began — has generally stayed in the background during health care negotiations, leaving the unpopular Congress to be the public face of the bill. On the other hand, there is a disconnect between the electorate and the 535 members of Congress, who seem to be so fixated on Mr. Obama’s standing in their states that they’ve paid little attention to what their constituents might want — or need.”

The big procedural picture: “Democrats in the Senate — the House is not the problem — need to have a long chat with themselves and decide whether they want to engage in an act of collective suicide,” E.J. Dionne Jr. writes in his column. “But it’s also time to start paying attention to how Republicans, with Machiavellian brilliance, have hit upon what might be called the Beltway-at-Rush-Hour Strategy, aimed at snarling legislative traffic to a standstill so Democrats have no hope of reaching the next exit.”

It’s big: “The battle over health care reform has entered one of its final — and most difficult — phases,” ABC’s Jonathan Karl reported on “Good Morning America” Thursday. “This is a massive bill — 2,074 pages — one of the biggest and most expensive bills ever to come before the Congress.”

Jubilant late Wednesday — and can that feeling last into the weekend? “Tonight begins the last leg of this journey we have been on for some time,” said Senate Majority Leader Harry Reid, D-Nev., per ABC’s Z. Byron Wolf and Huma Khan. “The finish line really is in sight.”

Or: “It’s going to be a holy war,” said Sen. Orrin Hatch, R- Utah.

Reid’s gambit, in pressing for a procedural vote Saturday: “The move quickly turned up the pressure on the last few wavering moderates to support the plan, which includes a sizable chunk of deficit cutting,” Politico’s Carrie Budoff Brown reports. “One holdout appeared to be Sen. Blanche Lincoln of Arkansas, who faces a tough reelection fight next fall. On her way in to the briefing with Reid, Lincoln was asked how she will vote on the motion to proceed: ‘We’ll wait and see,’ she said.”

“The handful of moderate senators who will decide the question seemed likely to support opening the debate,” The Boston Globe’s Lisa Wangsness and Susan Milligan report. “But, in a testament to the tremendous political difficulty ahead for the president’s top domestic policy initiative, Reid spent more than an hour yesterday giving three moderate Democrat fence-sitters a special closed-door briefing on the bill, and administration officials, including Vice President Joe Biden, met separately with senators to sell it.”

Sounding like a yes, on Saturday, if not beyond that: “It is a motion to start debate on a bill and to try to improve it,” said Sen. Ben Nelson, D-Neb., per ABC’s Z. Byron Wolf.

Big guns: “Senate Majority Leader Harry Reid has recruited an all-star team of former senators — Vice President Joe Biden, Tom Daschle and Ken Salazar — to push healthcare reform over the finish line,” The Hill’s Alexander Bolton reports.

 ”Democratic leaders were jubilant that the nonpartisan Congressional Budget Office determined that the Senate bill would cut federal deficits by $130 billion over the next decade,” Shailagh Murray and Lori Montgomery report in The Washington Post. “Those projected reductions could prove critical in winning the support of three wavering moderate Democrats whose votes Reid (D-Nev.) must secure to bring the legislation to the floor before the Senate breaks for Thanksgiving. But Reid also stacked the bill with provisions sought by liberals, including a public insurance option, albeit a version with an opt-out clause for states.”

Meet the “botax”: “Senator Harry Reid’s health care bill included an array of new provisions that are being scrutinized on Wednesday night, but one particular tax proposal in particular already has attracted a buzz — a 5 percent levy on elective cosmetic procedures that was quickly dubbed the ‘botax,’ ” David M. Herszenhorn reports in The New York Time.s

Keith Hennessey: “It would apply to surgery performed beginning in 2010, so get your work done before the new year.” 

Getting to the real finish line: “The two bills have differences on taxes, abortion coverage and a public-insurance plan and would require considerable work to reconcile if Congress hopes to pass some form of health care overhaul — the centerpiece of President Barack Obama’s domestic agenda,” Greg Hitt and Janet Adamy report in The Wall Street Journal. “The $848 billion cost is below the $1.05 trillion cost of the health overhaul passed by the House this month, and the prospect of additional deficit reduction may raise chances fiscally conservative Democrats will back the package.”

President Obama is headed back to Washington — with just one storyline following him home.

ABC’s Jake Tapper lists the disappointments: “President Obama has spent a week in Asia, with high level meetings across four countries. But critics argue all that time and jet fuel has not been well-spent. The President leaves South Korea today with arguably little show for it.”

Said David Axelrod: “This not an immediate gratification business. I understand that Washington’s in the immediate gratification business.”

The New York Times’ Helene Cooper and Marvin Fackler: “With the novelty of a visit as America’s first black president having given way to the reality of having to plow through intractable issues like monetary policy (China), trade (Singapore, China, South Korea), security (Japan) and the 800-pound gorilla on the continent (China), Mr. Obama’s Asia trip has been, in many ways, a long, uphill slog. … Mr. Obama quickly discovered that popularity on the Asian streets did not necessarily translate into policy successes behind closed doors in the Kantei, the Japanese White House, let alone in the Great Hall of the People in Beijing.”

“The Seoul stop was the last on a trip that has notably lacked concrete achievements but has seen Obama’s personal narrative on full display,” Anne E. Kornblut reports in The Washington Post. “But is his biography-as-diplomacy approach beginning to show its limits?”

Time’s Michael Scherer: “As Obama’s foreign policy ambitions move beyond the introductory phase, harder questions are coming to the fore: When does politeness lapse into passivity? When does seeking common ground erode the soil that anchors American priorities?”

In Afghanistan — Hamid Karzai has been sworn, possibly eliciting a more complicated reaction from Secretary of State Hillary Rodham Clinton than that other inauguration she attended in 2009.

ABC’s Martha Raddatz, from Kabul, on “GMA” Thursday: “President Karzai defended his government, calling corruption a ‘dangerous enemy’ that we will tackle seriously. But in a 90-minute session with Karzai last night, Secretary of State Hillary Clinton had to do some serious arm-twisting, telling the Afghan president he must show measurable results.”

The AP’s Deb Riechmann: “U.S. Secretary of State Hillary Rodham Clinton said Thursday that the international community will support the embattled Afghan government, but expects it to build up the country’s defense forces, boost security and improve the lives of its impoverished people.”

“On the eve of Karzai’s inauguration, the mood in Afghanistan’s capital could hardly have been less celebratory. Fearing violence, most people hurried home early from work or school Wednesday,” the Los Angeles Times’ Laura King reports.

War strategy: “President Barack Obama and British Prime Minister Gordon Brown have turned the focus of Afghan war planning toward an exit strategy, publicly declaring that the U.S. and its allies can’t send additional troops without a plan for getting them out,” The Wall Street Journal’s Peter Spiegel and Yochi J. Dreazen report. “The shift has unnerved some U.S. and foreign officials, who say that planning a pullout now — with or without a specific timetable — encourages the Taliban to wait out foreign forces and exacerbates fears in the region that the U.S. isn’t fully committed to their security.”

Jobs data gets a Capitol Hill airing Thursday, in front of the House Oversight and Government Reform Committee.

Opening the day: “More than 50,000 jobs, or one out of every 10 jobs the White House says were ‘saved or created’ by their economic stimulus plan, came from projects that reported spending no money yet, according to a government report obtained by ABC News,” Jonathan Karl and Matthew Jaffe report.

“The report by the Government Accountability Office analyzes the administration’s October 2009 report on jobs saved or created by the $787 billion stimulus program and finds a ‘range of significant reporting and processing problems that need to be addressed.’ ”

Jay Carney, Vice President Joe Biden’s spokesman: “Never before in history has a federal government program been this transparent and accountable. … Never. Not even close.”

Ed O’Keefe, of The Washington Post: “The Government Accountability Office found that almost 4,000 designated recipients who have not yet received stimulus funding reported creating or saving more than 58,000 jobs. Another 9,200 recipients reported no job creation, despite receiving a total of $965 million.”

From the opening statement of the committee’s ranking member, Rep. Darrell Issa, R-Calif.: “This Administration continues to misread the economy, misunderstand the nature of economic growth, mislead the American people with faulty job claims, and miss the steps this country needs to take to get our economy back on track.”

A White House official, to Politico’s Mike Allen: “Time is on our side: as late reports coming in, new data will shows the jobs total climbing, and the numbers getting more reliable. In the end, the data debate is frustrating, but a side show: the American people care a lot more about our success in creating jobs than our precision in counting them.”

More fun with stimulus dollars: “There’s $1.5 million to fix a remote lighthouse on uninhabited Monomoy Island, off Cape Cod. Security measures to protect the Spirit of Boston party cruise ship from terrorist attacks will cost about $123,000. And the University of Massachusetts at Boston received nearly $95,000 to study pollen samples from the Viking era in Iceland,” The Boston Globe’s Jenn Abelson writes. “Massachusetts school districts … bought window blinds, photocopiers, and a cafeteria dishwasher, and the Patrick administration recently came under fire for proposing to use $9 million to build a pedestrian bridge connecting parking lots near Gillette Stadium in Foxborough.”

OK, so Sarah Palin can still draw a crowd: “Fans of the former Alaska governor started lining up at 9 p.m. [Tuesday] night and slept out all night long in sleeping bags and snow gear outside the Barnes and Noble store at Woodland Mall, which is the first stop on Palin’s book tour,” ABC’s Kate Snow reports. “At 7 a.m. [Wednesday] morning, bookstore staff began handing out orange wristbands to those who would be allowed to meet and greet Palin. Barnes and Noble staff tell ABC News they distributed all of their 1,000 wristbands for tonight’s event.”

Between 450 and 500 people were already in line in Fort Wayne, Ind., by 7 am ET Thursday, Snow reports. “If these first stops are any indication, Sarah Palin is still pretty popular,” she said on “GMA.”

Dave Murray, in the Grand Rapids Press: “Pulling away in a motorcoach emblazoned like the cover of her best-selling memoir ‘Going Rogue: An American Life,’ Palin capped a whirlwind tour-kickoff day that found about 1,000 people waiting hours to have their books signed. Nearly all arrived at the mall before the sun rose to obtain a wristband that entitled them stand on another hours-long line for a signature, a photo and a moment with a women who stirs deep passions on both sides of the aisle.”

“If Sarah Palin were running for president, this is where she’d come,” Politico’s Ben Smith writes. “And if she were running for president, she’d be doing about what she did Wednesday, under the watchful eyes a half-dozen capable advance hands, veterans of the White House and the McCain campaign, who herded the press and the public into even lines. She had a VIP list for key local conservatives, shuttling them discreetly to the front of the line. She had a few talking points, tailored for the local area, to deliver after she stepped down with a big smile from her big bus, handing baby Trig off to an aide after her four-inch heels hit the sidewalk outside a shopping mall Barnes & Nobles, where she held her first book signing.”

And @SarahPalinUSA got its first Tweet: “Michigan-thx 4 Going Rogue! Perfect tour kickoff w/Kid Rock tune praising Northern MI humming in backgrnd @ Barnes/Noble. Above expectations.”

Sen. John McCain breaks what’s been his (for the most part) silence on the book’s juicier tidbits: “There’s been a lot of dust flying around in the last few days and I just wanted to mention that I have the highest regard for Steve Schmidt and Nicolle Wallace and the rest of the team … and I appreciated all the hard work and everything they did to help the campaign,” he told Reuters’ Steve Holland. “I think it’s just time to move on.”

The Washington Post indexed Palin’s book.

And so did, with a little more snark, (Sample entry: “diet: forced by Steve Schmidt to go on, 284; Steve Schmidt needs to go on , 285.”)

Next up in the DNC’s “call ‘em out series”: Senate Minority Leader Mitch McConnell, R-Ky. “Our nation has been talking about comprehensive health insurance reform for nearly a century. And this time around, Congress has been debating it for almost 10 months. But Senate Republican leader Mitch McConnell said the whole process is going too fast, and he’s trying to bury reform under endless delays and distortions.”

Also from the annals of Democratic pushback: “Nearly half of the 30 organizations participating in a job fair [House Minority Whip Eric] Cantor is holding Monday in Culpeper were recipients of the stimulus,” Anita Kumar reports for The Washington Post. “The list includes a slew of government agencies and schools that have directly benefited from the package and may be using stimulus money to hire people (as the money was originally designed to do), including the Orange County public schools, the Transportation Security Administration and Virginia Department of Labor, and some companies that may have indirectly benefited such as Comcast and Terremark.”

Dick Morris, in Little Rock Thursday. From the press release, for the event coming from the 60 Plus Association: “Arkansans are rallying to express their strong concerns that they were represented poorly by their Congressmen and that they do not want the bill to pass in the Senate. The ‘Hands Off My Healthcare’ bus will be at each rally, and Dick Morris, political author and commentator, will be speaking at all Thursday, November 19 events.” 

The Kicker:

“I like Michigan and it worked out demographically.” — Sarah Palin, on why she started her book tour in Grand Rapids.

“You’re never going to find the ‘evil empire’ on a map of the world.” — Sarah Palin, to ABC’s Barbara Walters, explaining how her use of the term “death panels” is similar to Ronald Reagan’s cold war use of the term “evil empire.”

For up-to-the-minute political updates check out The Note’s blog . . . all day every day:

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