Washington Post Business Blogger
Thursday, September 3, 2009 12:00 PM
Ezra Klein writes a Post blog about economic and domestic policy, and he was online Thursday, Sept. 3 at Noon ET to take your questions about collapsing banks, cap and trade, health-care reform and pretty much anything else you can attach a chart to.
A transcript follows.
Ezra Klein: Morning folks. Let's talk about fun, interesting, light topics -- like international health-care spending!
Manassas, Va.: A number of pundits, columnists, and congresspersons keep talking about a government mandate for individuals to purchase health insurance as if there were no serious Constitutional issues associated with that feature of health-care reform. I read the piece in the Post by Alice Rivlin which seemed to lay out a fairly well documented case against an individual mandate on Constitutional grounds. Can the Post run a column that lays out why this mandate would not be unconstitutional?
Ezra Klein: A number of people have looked into this and concluded it passes legal muster. States do it with car insurance. Massachusetts does it with health-care insurance. There doesn't look to be any particular problem here, though I haven't read the Rivlin piece you cite.
Anaheim, Calif.: Ezra, would you list your minimum requirements for a health-care reform bill that is worth doing?
Ezra Klein: Sure: Helps people at a reasonable cost. That seems a bit flip, but I think people get a bit tied up in details when talking about health care and forget why we're focusing on this. It's to help people, not to make private insurers cry or even to bend the cost curve.
Now, there are a lot of bills that I might think are better than nothing, but as for a bill I'd be happy with? Subsidies to at least 300 percent of poverty, and probably 400 percent. Serious insurance market reform. Health insurance exchanges that either start out strong, or are expected to grow. Medicaid expansion to at least 133 percent of poverty. Sufficient subsidies so that an individual mandate -- which is to say, a universal system -- is possible. A decent minimum benefit package. Delivery system reforms.
There's a lot more I'd like to see in a bill, including a public plan. But I am, at base, a structuralist: I think the most important thing is putting together the basic structure for a decent universal health care system. Then we can build on it. We can improve the subsidies, add a public plan, increase the benefit package. But if we don't have the basic structure, it's a lot harder to build.
SE Washington, D.C.: David Brooks keeps pushing Wyden-Bennett. What are the odds of that bill going anywhere? Why?
Ezra Klein: Pretty near zero. It has little real Republican support. It's disliked by a lot of liberal Democrats because its subsidies don't grow as quickly as health-care costs, and by unions because it eliminates the employer tax deduction for health care. Its support is primarily intellectual elites who think the bill makes sense -- I'm one of those people -- not folks who vote for these things, or work for them, or spend money passing them.
Buffalo, N.Y.: Hi Ezra, I'm a huge supporter of health-care reform and think that it is a moral imperative. However, there is one concern expressed by a lot of people I know that I haven't been able to adequately address. How will the health care system handle the sudden and large influx of 35 to 40 million new regular customers (not just ER patients). Will we have enough physicians, enough hospitals to meet the demand? Even if parts of the bill don't take effect until 2013, that still only leaves 3-4 years to train new doctors and build new infrastructure to accommodate the increased demand.
Ezra Klein: A few things. First, the new folks don't come in all at once. They come in over 10 years. Second, most of these people are getting care right now, although somewhat less than they will be. Third, a lot of these folks are young, and won't need much. And fourth, we've done this before, with Medicare and Medicaid. New demand creates new supply. I could imagine disruptions for a few years, but they'd resolve themselves fairly quickly, and could even have some good impacts, like creating more of a role for physician's assistants and nurse practitioners in primary care.
My overall take on the doctor's thing is that it's a very good problem to worry about and prepare for, but it's no reason to oppose the bill.
New York: Hey Ezra,
What is with the WaPo's new TV interview backdrop? It seems as if the collective energies of the internets are growing dissatisfied with the Purple People Corner! Also, sometimes we can see the edge.
Ezra Klein: Interesting story! The Post is ripping out its entire fifth floor -- the huge newsroom -- to redo wiring, lighting, etc. A lot of reporters are working from home. The rest of us are stacked atop each other elsewhere in the building. The fifth floor also, sadly, had the tv studio. So the studio is now in the tiny, closet-sized room where we used to do radio. It's a sad little camera in front of a tiny backdrop. It looks like a corner because, well, it's actually in a corner. Somewhat less dignified, but hey, you take what you can get.
Chicago: What are the chances that Harry Reid will force the reform opposition to mount an actual, in- person, ad infinitum, pants-wetting filibuster, rather than simply conceding a 60-vote Senate? If this isn't being considered, why?
Ezra Klein: Seems to be low. There are a couple reasons you hear for this. One is that the filibuster is much harder on the majority than the minority: you basically need the whole majority there to call votes and beat back points of order and only three or four members of the minority. Another is that health reforms poll numbers aren't great, so it's not clear if it would be terrific politics to just give the minority endless tv time to talk about death panels. Another is that Democrats are afraid of losing that fight and really having their back broken.
That, at least, is what I'm told. Honestly though? I don't know why no one ever calls bluff. Sometimes you have to gamble.
Philadelphia: Having a very minimal understanding of Senate history, I always thought that LBJ famously did away with the seniority system in the Senate and that move paved the way for civil rights legislation to finally pass. Did that never happen? And moreover, why are Democrats still stuck on the seniority system when it seems to be hurting them so much?
Ezra Klein: Nope. The big change that allowed civil rights was the expansion of the House Rules Committee, so liberals held a majority. Seniority took its hits, if I'm not misremembering, in the post-Watergate Congress, and also, among Republicans, in 1994.
As for why Democrats are stuck on the system, what you have, I think, are congressmen stuck on the system because they believe it helps them, or it's the way it's always been, or something. Democrats -- and Republicans -- generally have no idea the system exists.
Arlington, Va.: Last night I was catching up with some Daily Shows that I had recorded before they went on vacation, and I finally saw the interview with Betsy McCaughey regarding her concerns on the House's health care bill. She's very worried that people will be forced to have a living will. This made me wonder: why is this a bad thing? Isn't it possible to have a living will that says, yes, I want everything possible to keep me alive no matter what, I want to be on a ventilator and I want to be fed through tubes, etc. if it is necessary to keep my heart beating? I never thought that a living will always meant DNR, but that seemed to be what she was implying.
Ezra Klein: That's because she's a liar. A living will can say that I want heaven and earth moved to save my life. Indeed, one thing about the living will is that it can also work towards more treatment: you might want doctors to do everything, but your children, not knowing that, might make the decision to take you out of your agony earlier. The only thing a living will does is allow you to choose.
Betsy McCaughey is really just a horrible, evil, awful, lying person who wants to make the world worse for people because that's her ticket to increased TV time. There's no other way to put it.
Capitol Hill: Hey Ezra,
I noticed you took a "reasonable" line on the McDonnell thesis--in fact I think you started edging towards Broderish territory on that one. After all, the guy was 34, specifically went to (now) Regent University to come to terms with his religious and political beliefs, wrote a political--not academic--manifesto, and then went into politics afterwards. I admit he -probably- has changed his mind on women in the workplace, but I say put his feet to the fire and make him explain it, and I don't think it is particularly partisan to think so. Mushy moderates wouldn't like the positions in the thesis any more than Democrats.
Ezra Klein: I don't think making him explain it is particularly partisan, or even arguable. I think some of his explanations hold water and some don't. In particular, I think he's still a Neanderthal on marriage and gay rights but has gotten a lot better on women in the workplace. But yes! Make the guy explain it till his throat is hoarse. He owes Virginia nothing less.
Boston: You recently revealed that you're not quite 25 years old. But you don't seem not quite 25. Your posts reveal a level of understanding of politics, government, health care, and so forth that few 40-year-olds possess.
Can you say something that is more indicative of a 25-year-old? Otherwise I won't believe you.
Ezra Klein: It should be said that I am fully 25-years-old, not slightly less than 25-years-old. The proof is in the lunch breaks: there's much too much indie rock for anyone but a 25-year-old still too insecure to fully buck Pitchfork.
Baltimore: Have you seen any polling covering the number of people who are "staying in their job for the health care". I've always wondered how many more would consider consulting or starting a small business if we didn't have our big employer favoring system.
Ezra Klein: I looked into this at one point and the literature doesn't seem to find a large, measurable effect of "job lock." That said, it could be the case that fairly few people stay in a job they don't want because of health care, but many more would leave to do something they really did want to do if health care wasn't a factor.
Re: Juicebox Mafia Comment: Most of the rest of the juice box mafia has given a comment to Marvel being bought by Disney. Can you add to the amusing snark-fest, bub?
Ezra Klein: The real pity is that they didn't merge with Dreamworks. Shrek vs. Hulk would be a serious moneymaker. As would a Shrek and Thing movie, in which the two gentle giants talk about their hopes, their dreams, and the hardships of concealing a sensitive interior beneath a grotesque exterior.
Betsy McCaughey is really just a horrible, evil, awful, lying person who wants to make the world worse for people because that's her ticket to increased TV time. : Come on Ezra. Don't hold back. Tell us what you really think.
Ezra Klein: I can't. This is a family paper.
Washington, D.C.: What's the answer to the "What's in it for me" argument against climate change legislation? Is there any way Dems can convince us that's the wrong question to ask?
Ezra Klein: The answer, which you're not really allowed to say, is "not being a horrible person." Climate change is primarily the product of this particular era in this particular country, but it will largely affect other, poorer, countries in the future. That's not an argument that polls well, however, so people make a lot of bankshot arguments about hurricanes and green jobs.
Washington, D.C.: Hi Ezra, Your link this morning to Pearlstein's article on the Mulligan Club makes me think of the religious- like trust we put in the financial sector and investment bankers. Despite being disastrously wrong about many things lately, many people still put their faith in the wisdom of investment bankers. What is your take on this phenomenon? And what do you think leads to this sort of amnesia? Is it due to our willingness to put our trust in people who claim to understand things that we do not? Thanks!
Ezra Klein: I think it's primarily trust in the experts. There was this poisonous argument during the meltdown in which we were told that these people had pretty much destroyed the world, but they were the only ones who understood their doomsday machine well enough to save us, and so they needed to be treated gingerly, and paid handsomely, and kept at the table. And the worst part is that that argument probably wasn't even wrong. But good lord was it galling and intuitively objectionable.
Laurel, Md.: The car insurance analogy is false. No one is required to drive.
My other question is: why is the bill one thousand pages long, when the government already has good models for providing health care or insurance; like Medicare and -caid, Veterans Administration and federal civilian and postal employee plans; that could simply be expanded?
Ezra Klein: Spoken like a Iowa of a metropolitan area. If you live in rural California and work 40 miles away, driving isn't much of a choice.
Man, I never get to play the heartland card!
New York: Hey Ezra, I've been trying to wrap my head around the public option "trigger" that might be required to get Olympia Snowe on board. It seems to me that in evaluating this proposal, the devil really is in the details of what the trigger event would be. If the trigger event is that the insurance companies have to reach a level of cost savings 7 years from now that is extremely unlikely to occur, than isn't the trigger really just a public option that phases in 7 years from now? That sounds like something that the Progressive Block should be able to live with. Do you think there are opportunities for a deal around the trigger idea?
Ezra Klein: I basically agree with that. Also, you'd want the trigger to create a national public option, not just an Iowa public option. So the devil is in the details, though I'd suggest that the fact that this is being used by people who don't really support the public option implies that the details won't be that great.
Atlanta: Great work - I love your food columns. Have you done any analysis/commentary on the moral dilemma of sending our more technologically advanced (read: genetically engineered) foods as part of aid packages to developing countries?
Ezra Klein: I haven't. Though I'm not sure it's such a moral dilemma: if the seeds work for them, they work for them. Now, if there are more specific harms involved with specific seeds or foods, that might be different. In general, though, I'm not terribly worried about GMOs as a broad category, though there are certainly specific areas that merit concern.
Washington, DC: If you, Ezra Klein, were a member of Congress, would you have signed the Progressive Caucus pledge not to vote for a bill that doesn't contain a public option?
How bad would a compromise bill have to be for you to vote no?
Ezra Klein: Hard to say. If I had signed that card, and my vote ended up being needed for a bill that would really help people but would not include a good public option, I'd break the promise. So I guess I wouldn't sign the card. But I think it's good that people are pushing the issue hard, just so long as they keep perspective in the final negotiations.
I don't know. I'm glad I don't have to make those decisions.
As for how bad a compromise bill would have to be, I've not seen the compromise yet that I wouldn't vote for if it was the last thing on the table. But the question isn't what you'd do in the case of a watered down bill. It's what you do to make sure the final bill isn't that watered down.
St. Louis, Mo.: Hi Ezra, from my understanding, some aspects of any health care bill signed this fall would not be fully up and running until 2013 (i.e. the public option). What would be stopping President Romney and a new Republican majority passing a new bill to eliminate the fall 2009 health bill? Could major losses in 2012 be as big a potential threat to the public option as Snowe, Nelson, Bayh are now?
Ezra Klein: If Obama gets beat in 2012 and Republicans take over and the public hates health-care reform, then nothing, save maybe the filibuster. That's democracy, or the form of it that we have.
FEHBP: Why didn't reformers propose to open the FEHBP to everyone instead of creating these new exchanges? Wouldn't that have been simpler and easier to explain?
Ezra Klein: You couldn't really have done it, as the new thing wouldn't be FEHBP. What we're doing is basically the closest thing, and it certainly should have been explained in those terms.
Re: Filibuster: Given that no one admits to liking the filibuster but no Senator admits to wanting to get rid of it, how would a group outside the Senate go about getting rid of it?
Ezra Klein: Hard to say. I guess it's like any other long-term campaign to build support for a particular policy objective. That said, one thing that may do it sneakily is encouraging majorities to use tactics like reconciliation. The more that the Senate abandons the filibuster in practice, the likelier it gets that it eventually recognizes the new reality and reforms itself to get rid of the filibuster in writing.
Health Reform costs: Ezra, what is the most cost-efficient (read cheapest) alternative: 1) doing nothing and maintaining the status quo on health care 2) single-payer plan 3) public option or 4) one of the "Blue Dog" type compromises?
Ezra Klein: To rank them:
2, 3, 4, 1.
Austin, Tex.: If I can sneak in one last follow-up to your answer on health care being eliminated if Republicans re-take control in 2012, is that really feasible? Wouldn't inertia of the recent changes prevent it from just being switched back off?
Ezra Klein: That's my sense. There are examples of policies being rolled back, like Medicare Catastrophic in 1989. But look, if Obama passes a bill that will cover 40 million people and end insurance market discrimination and can't sell that in an election, then he doesn't deserve to win.
Houston, Tex.: Ezra, Care to comment on the Joe Klein/Greenwald JournoList spat? According to Greenwald you are the owner of that mailing list. Are the kind of emails Klein sent representative? What's the purpose of the mail list? DC Gossip? Gang of 500 mind-meld?
Ezra Klein: The purpose of the list is policy and political discussion. Even that thread was about policy: It was about health care, and that's how people began arguing about Jim Cooper and whether he should face a primary challenge. In it, someone echoed Glenn's argument, and then Joe took some shots at Glenn, as they've both done to each other in public many times, and the thread got sent to Glenn, and here we are.
That side of it is regrettable, but no, it's not indicative of what goes on on the list. Rather, it's discussions of much the sort you'd expect if you got a bunch of bloggers and journalists and wonks in a room. Usually, those discussions are useful. Sometimes, they're snarky. Sometimes, people complain about writers they don't like. That gets folks in trouble, and I wish they'd stop doing it. But I think anyone who's read Joe and Glenn over the years knows you don't need secret e-mail lists to get them to snipe at each other.
Athens, Ga.: Do you believe that broad-based prevention will save the health care system (and the federal budget) significant money over the long-term, or is CBO right that it's actually a net cost?
Ezra Klein: I think it will improve value in that it will make people healthier at a lower cost. But I'm not sure it'll save money. You spend a lot on preventive care because you try and reach a lot of people. But only a few of those people would ever have contracted the condition anyway. And that's okay: the health system is supposed to spend money to make people healthier. If it did more of that, and spent less money that didn't make people healthier, we'd be in better shape.
FEHBP: The reason its not open to everyone is because Feds like me would openly revolt and overthrow Congress and execute our leader at the WH! No mincing words there would be open revolt and a strike. Let the country try to function w/o us!
Ezra Klein: Huh.
Bethesda, Md.: What does Olympia Snowe really want for health care reform and how would she pay for it?
Ezra Klein: From what I hear, that last part is the part that no one knows. Also, I think she'd like other Republicans on the bill. But aside from maybe Collins, that doesn't look likely.
Ezra Klein: Thanks, folks!
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