Economy Department with Ezra Klein: The Stupak amendment, the Fed as systemic regulator and how health-care reform is deficit neutral

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Ezra Klein
Washington Post Business Blogger
Thursday, November 12, 2009; 12:00 PM

Trying to understand health-care reform, but getting lost in the weeds? Don't worry, Washington Post blogger Ezra Klein can help. From individual mandates to health care exchanges, Klein explains it all. He was online Thursday, Nov. 12 to take your questions on health-care reform, economic and domestic policy, the latest episodes of Top Chef and pretty much anything you can attach a chart to.

A transcript follows.


Ezra Klein: I spent the morning locked out of my house. But at least I made it into the chat room!


Ezra Klein: Don't know if you guys aren't submitting questions or I'm not seeing them, but I've not got much to answer here!


Chapel Hill, N.C.: Once the House and Senate health insurance bills (assuming the Senate passes one) are combined in conference committee, can the conference bill be filibustered under current Senate rules?

Ezra Klein: Yes. It's somewhat rarer, but yes.

The thing about filibustering a conference report, however, is that a conference report cannot be changed. A vote to filibuster is a vote to kill. That's very different than how some of the conservative Democrats prefer to work. They say that they want changes made to the bill, and if they don't get them, they can't vote for cloture. That's a vote, effectively, for changes, not against the bill. But if they filibuster after conference, that's a vote to kill the bill, and it opens them to a whole lot more in the way of political reprisal.


Raleigh, N.C.: I read your post on better care not always translating into better profits for hospitals, and it made me wonder whether any insurance companies own health care organizations? If the two sectors were merged, profit motives would be better aligned with positive health outcomes.

Ezra Klein: Yep! Kaiser Permanente is an example of this, as is the Veteran's Health Administration. Mayo is a bit more complicated, but not altogether different. If I could rebuild the system, I would never, ever allow financing to be a different industry from care delivery. It's mania.


Washington, DC: Ezra,

I know that Saturday was a historic victory for health reform, but I'm having trouble getting excited about the bill in its current form (or the prospect of what the Senate will do to it).

Aside from the immediate consumer protection improvements, Medicaid expansion, etc., what about this bill are you optimistic about? What provisions do you think will do the most to affect the structural problems of our health system or give legislators the backing to come back and address cost control later?

Ezra Klein: Spending $900 billion to help people afford something they need. Delivery system reforms. Exchanges. Out of pocket caps. A structure that commits the government to a universal care system, or something close to it.

The process by which we pass health-care reform is going to be annoying, upsetting, and slow. By the end, fairly few people will be excited about the product. But it will nevertheless be the greatest social policy advance in a generation.

As analogy, I just moved houses. I was very excited before the move. Then the move was, as moves are, a giant pain in the neck, and I became much less excited. But now I'm in the new house and I love it. That, I think, is a pretty good analogy for the legislative process.


Mountain View, CA: What's the likelihood that HCR will pass in the Senate via reconciliation as opposed to some further watered-down compromise like triggered co-ops?

Ezra Klein: Extremely low.


Culver City, Calif.: It is becoming conventional wisdom in liberal circles that the White House undercuts itself by starting negotiations with the Hill at too low a level and that they just end up compromising on their initial compromise. You hear this a lot in regards to the stimulus bill. What is your opinion on this? I don't buy it simply cause I think Rahm & Peter Rouse would have a better understanding of Congressional politics than most bloggers but maybe I am wrong here.

Ezra Klein: I don't buy it, either. A lot of my friends have a mental model of legislation as a negotiation in which both sides want to get to "yes." In that scenario, it makes sense to start high and then bargain lower. But this is not that negotiation. One side wants to get to "no." In that scenario, the issue isn't how high you start, it's whether you can hold the votes together. And that means beginning with legislation that people are basically comfortable with.


Providence, R.I.: Happy Thursday to you. How are you feeling about the Dems' political prospects right now, in light of last week's election results and the jobs situation/outlook?

I know you made the valid point that there's little to extrapolate from two gubernatorial races and one weird upstate contest, but I'd still be interested to hear whether this concerns you in terms of whether or not things will get accomplished legislatively over the next year.

Ezra Klein: I don't think much about it, honestly. I'm not an elections guy. I don't believe campaigns matter very much. I don't believe savvy strategizing will let Democrats hang onto this majority forever. Insofar as I have any opinion on this at all, it's that the Democrats are best served by passing good legislation that they can brag about in the midterm elections. Other than that, I'm interested in how they use their majority. That's something I think they have control over. Whether they keep it is, in my view, not in their control.


Laramie, Wyo.: Are you planning on reading ex-Governor Palin's memoirs "Going Rogue"?

Ezra Klein: Nope!


Tysons, VA: What is the logic behind the idea that if the health care doesn't have a public option, it will hurt the democrats? The people who demand the public option are generally the more liberal and there is little chance they are going to switch parties. Also in a close election, there is probably little chance that they stay home since they often are not big fans of republicans. I would think they would hold their nose and just vote anyways.

Ezra Klein: If you believe that the public option is the key to cost control, then it's the key to the bill in the sense that cost control will be the determinant of success. I don't believe that the public option under consideration will do much to control costs, so I don't buy that argument. My sense is that the public option, even if it passes, will not be a very big deal five years from now. Keeping it in will make the bill somewhat better and taking it out will make it somewhat worse, but if the option isn't attached to Medicare, it's not decisive either way.


Reston, Va.: After the Stupak amendment victory, can we expect the Pro-life community to attach amendments to the Defense budget saying that no public funds can be used to kill people?

Ezra Klein: Oh, definitely. I hear they're organizing on that right now.


Cumberland, Md.: The US Congress does NOT do "Comprehensive" well at all, in fact they do it very badly, why didn't they start small with just a few things and build on that? Wouldn't that have been a lot smarter in the long run?

Ezra Klein: Nope! One way to think about this: Modern medicine isn't perfect, and it treats simple diseases better than it treats complex ones. But if someone comes in with a tumor, you don't get to treat it as a cold just because that would be easier for you.

Our health-care system has huge, systemic problems that directly kill thousands and will eventually bankrupt the nation. Compared to that, Congress's fix is small and insufficient. Making it smaller and more insufficient does not make any sense. At some point, we, as a country, need to be able to solve the problems that confront us.


Capitol Hill: Am I naive to think it is a good idea to leave the systemic regulator function with the Fed? Or are there benefits to Dodd's proposal of a new super-regulator that I am not seeing?

Ezra Klein: I don't like leaving responsibilities shared among many different regulators. That's just not a good way to run the system. So in that sense, I'm with Dodd. The Federal Reserve is also, due to its bank-oriented structure, not necessarily the best source for tough regulation of banks. William Greider has written some good stuff on this if you want to search it out.


New York City: What is the likelihood of a constitutional challenge to mandatory coverage.

Ezra Klein: High, I imagine. As for it succeeding? Very, very low.


Arlington, Va.: Ezra,

I remember reading somewhere a while back that John Dingell's single-payer bill would be getting a CBO score as a nod to his long-standing leadership on health care. What ever happened with that? Did the analysis come in and I missed it?

Top Chef side note -- isn't it crazy that the one time Robyn actually shouldn't have been voted out, she was!? Eli's dish looked disgusting so I can't imagine how it tasted...

Ezra Klein: It was the Conyers bill through Anthony Weiner's amendment. But Weiner gave up the vote when moderates said it would be too much for them. It was one of the many compromises that got made in the few days before the vote. But I, too, would have loved to see the CBO score.

As for Top Chef, word. I thought Eli was going home.


Dallas, TX: Can you help explain to me how HCR is revenue neutral? I keep saying it to my friends, but even as I'm speaking the words out loud it sounds counterintuitive to me.

Laymans terms: HCR is revenue neutral because _____.

Ezra Klein: Deficit neutral, number one. But it's deficit neutral because it raises, saves, or cuts more money than it spends. Think of it this way: I want to buy a new TV for $800. So I write a freelance piece for $600, and I cut $200 from my food budget by bringing lunch for two months. It's not that the TV didn't cost money. But I paid for it without going into more debt. That's the case for HCR, to..

_______________________ That's all folks, thanks.


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