Economy Department with Ezra Klein: Senate debate over health-care reform bill grinds on

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, Dec. 17 to take your questions on health-care reform, economic and domestic policy and pretty much anything you can attach a chart to.

A transcript follows.

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Ezra Klein: Hey folks, I'm going to have to cut this chat at 12:45 or so today, so let's get this started!

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Reconciliation: Howard Dean and others on the left are saying that a better health care bill can still pass through reconciliation. What is your take on this?

Ezra Klein: I think there's no chance of it. First, the bill would likely lose the insurance regulations, much of the delivery system reforms, the exchanges, possibly the mandate, and more. In return, you'd get...what? A weak public option? Medicare buy-in? You're talking about bulldozing the infrastructure of the bill so we can put back in some of the interior furniture.

But putting that aside, the politics of it are baffling. You go back to the drawing board. You're closer to the election. You seem like you've suffered a massive defeat. Poll numbers continue to drop. There's more industry opposition. Vulnerable Democrats want to move to jobs. There's huge controversy over whether reconciliation is legitimate. The final bill will have parts that we can't predict stripped from the legislation.

And aside from all that, if you think we can get these pieces in reconciliation, why not pass the bill and then go back and get these pieces in reconciliation? If reconciliation is a good strategy, it's a good "and" strategy, not a good "or" strategy.

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Brooklyn: Looking back, how much of the backlash right now is attributable to having framed private insurance as the biggest bogeyman? Was there an option? Should Pharma have been brought out in front as well?

Ezra Klein: It's hard to say, but inside the process, people worked hard to keep Pharma on-board because they have so much more money than any other interest group. The thinking was that insurers don't really have enough to launch a lethal attack. Pharma does, and did. So I'm skeptical that picking a direct fight with them would have been appealing.

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19th and R: Did you see the DailyKos post making the comparison between those on the left who supported the Iraq war and who now support the healthcare bill? As someone who supports the bill, your thoughts?

Ezra Klein: I didn't see it. But it's hard to think of a comparison of two more unlike things.

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Paju-Si, South Korea: Matt Yglesias asserted the other day that "moralistic language works." But I like you, and Matt, because of your technocratic standpoint. Do you agree with Matt, here? And doesn't the brouhaha surrounding what you said about Lieberman demonstrate the tangibly negative effects of deploying moralistic language (i.e. backlash)?

Ezra Klein: There's backlash in part because it works. As I said in that debate, the issue for me wasn't the efficacy of the language. It was the clarity of it. And I thought, and think, we've moved to a level of abstraction in this debate that has obscured the human cost of losing this bill and the real benefit of passing it.

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Palookaville, Pa.: I'm a moderate who has supported health care reform from the beginning. I am now very concerned that the current state of the bill delivers all the uninsured into the arms of a very content insurance industry, while not only failing to rein in costs but failing to in any way address the fundamental causes of the current crisis. Liberals, with whom I was in agreement until this past week's development now accuse me of being emotional and irrational because I don't want to create an even greater burden for the poor, which I believe the bill, in its current form, does. Please tell me, is it not reasonable to be worried that this bill exacerbates the current crisis? What would you see as reasonable opposition from those who want reform, but don't want it to be a boon to insurance companies?

Ezra Klein: I don't believe it is. I want to be very clear on this: I think this bill will do more to help the poor and underserved than anything since the Great Society. I think it will do more to control costs, and create an infrastructure to control costs and a politics able to control costs, than anything we've ever done, full stop.

I'm not alone in this. Writers like Jon Cohn. Advocates like the Center for Budget and Policy Priorities and Families USA. Senators like Jay Rockefeller. Among the people who have really been on the trenches on this for years, there's near unanimity that losing this bill will be, and will come to be understood, as one of the most tragic and unnecessary failures in recent legislative history.

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Lexington, Ky.: If there is no public option, what is the primary mechanism in the bill that will promote competition, thus presumably driving rates down? If insurers continue to be exempt from anti-trust rules and there is no public option, do you believe there will be a significant increase in real competition?

Ezra Klein: The public option contained in the House bill, which is a public option that Dean and others would accept, would not have controlled costs. CBO estimates, in fact, that its premiums would be slightly higher than comparable private plans (though they also said the public option would have delivered slightly better services).

I don't know another way to say this than to say it clearly: The idea that the exchange-limited, non-Medicare public option was the central cost control mechanism in this bill was never credible. It was good policy, and I would have liked to see it in the bill. But the effort to secure it by pretending that it was somehow transformative ended up misinforming a lot of people about the nature of both the option and the larger bill.

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Potomac, Md: Ezra, thanks for explaining everything so clearly. I understand that insurance companies can't exclude people for pre-existing conditions, but can they charge higher premiums, which could have the effect of excluding them?

Ezra Klein: Nope.

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Bennington, Vt.: I read various different accounts about your relationship to Howard Dean so I was hoping you could explain in your words what exactly your professional and personal relationship is with Howard Dean presently and in the past?

Ezra Klein: I have no personal or professional relationship with Howard Dean. I don't believe I've ever spoken to him. I did volunteer for his campaign for about two months in late-2003. As someone who was attracted by his pragmatism at that time, I am disappointed in his dogmatism at this time.

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Washington: My friend and I have been arguing since last night about this. I'm worried that this Liberal backlash is the gravest current threat to health care reform. When this bill goes back to the house (where it didn't pass by much last time), I'm worried it'll be tough for Democrats to vote for. My friend thinks the bill will make it through the Senate in roughly its current form, and that the momentum will be too great at that point for any House Dems to cause trouble. Who's right?

Ezra Klein: We'll find out soon enough, I guess.

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Washington, DC: Normally, I'm wary of any legislative strategy suggested by Daily Kos, but this sounds pretty good: Introduce an amendment to strip the individual insurance mandate out of the health care bill. If Republican senators vote for it, they're making the bill better. If they vote against it, they're culpable in whatever gets passed. What do you think?

Ezra Klein: Do you honestly believe that Republicans will be culpable for this bill because they voted for, or against, an amendment? Mike Enzi got 41 amendments passed into the legislation. But this is not considered Mike Enzi's bill.

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Morris, MN: Hey Ezra,

I keep seeing complaints about the mandate is a problem in the absence of a public option because there will be no competition--is there a strong argument that the exchanges won't work (to produce competition)?

Ezra Klein: Not an argument that is somehow solved by the inclusion of the weak public option. Also, the new attack on the mandate is really disturbing: There's an almost ironclad argument that the bill itself, much less the exchanges, won't work in the absence of the mandate, as I argued in yesterday's post 'the importance of the individual mandate.'

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Columbia, SC: Hello Ezra, I've read your post on the individual mandate and understand the desire to cover an additional 30 million Americans. I agree that we need HCR and those folks should be covered. However, the problem I see with this mandate is the lack of any sort of cost controls on insurance companies, other than our hope that they will cooperate. What's your take on this?

Ezra Klein: I don't know what cost controls people want exactly. If insurance is not affordable under the mandate, the mandate will be revoked or stronger cost controls will be added. But here's one cost control in the bill: if an insurer jacks up his rates, he can be decertified from the exchange. That is to say, an insurer who raises prices beyond what's reasonable would lose access to the market. That's a strong cost control than anything we have now. So too is the excise tax, which slaps a 40 percent tax if insurers let their costs rise above a certain level, and that levels grows more slowly than cost increases do.

This is what cost control looks like. And it's better than anything we currently have.

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East Hampton, CT: Now that Keith Olbermann has joined the "Kill the Bill" crowd, and with his tendency to book guests that support his take on things, do you anticipate returning to "Countdown" anytime soon?

Ezra Klein: It's up to them, as it's always been.

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Raleigh, NC: Can you be more specific on what provisions in the current bill - minus the public option and minus a medicare buy-in - help to control costs and provide a mediating benefit to the poor who will face a mandate for health insurance?

The difficulty in the debate for citizens is not really knowing what is in the bill. We hear what pundits and wonks "say" is in it. Please be specific.

Ezra Klein: Keep an eye on my blog today. I will write a longer post responding, okay?

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The Proper Comparison to Make: Sen. Klobuchar just made a great point on MSNBC- using the logic of those wanting to kill the bill because it isn't good enough, we would never have passed the Civil Rights Act of 1960 because it didn't have the reforms of 1964, 68, and 91 included. (via John Cole)

Ezra Klein: Yep. And Social Security excluded African-Americans originally. As, come to think of it, did America.

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New York, NY: Ezra, as originally announced, the "gang of ten" compromise consisted of (1) Medicare buy-in; (2) a triggered public option; and (3) OPM's authority to create national nonprofit insurers. (Hope I've got that close to correct.) (1) and (2), as we know, are now gone to get Lieberman's vote, but is (3) still in the plan?

Ezra Klein: I believe so. There's also a package of stronger regulations on insurers that may still be viable. But we haven't see language on any of this.

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Cincinnati, Ohio: With all of the health care debate, I have heard very little of the Healthy Families Act as of late. I know in the past you've said you don't think it will pass. Why?

Ezra Klein: You know how health-care reform is within one or so votes of breaking a filibuster? The HAA probably needs 55 more.

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Boston: Would you write your blog about Lieberman the same way today as you did originally after you've had time to reflect on what you were saying and the reaction to it?

Ezra Klein: Yes. There are people, I think, who believe being called uncivil is the worst of political slurs. I'm not one of them. I'm much more afraid of growing callous.

The chaos of the past day or so? This is Lieberman's fault. There was a compromise on the table. A compromise that he had supported as recently as three months ago. A compromise he has never given a single coherent reason for opposing.

The critique of Lieberman does not apply to Nelson, or Snowe, or any of the other senators who, though I may disagree with them, have been constructive participants in a long process and are doing their best to weigh long-held policy beliefs against an important bill that will help countless people. As I have argued at length, I do not believe Lieberman fits into that category. And in single-handedly reducing the chances this bill passes, he has a lot to answer for. But this town works in such a way that he'll probably never have to.

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New York, NY: I was hoping you could talk about how killing the Senate health care bill could undermine progressive politics because of its impact on electoral politics. I hate to use the failure of 1993 as example, because I think we're in a different moment with different complexities, but there's something there. This, to me, has not garnered enough attention in discussions among liberal/progressive activists and wonks.

Ezra Klein: I think some of the bill's critics would argue that Democrats will suffer from passing this bill because it won't work. I don't agree, obviously, but I'd also note that there's a fair amount of time between now and 2014/15 to change the bill. Kill the thing, however, and you've just stabbed the Democratic majority through the heart. I get why Republicans want to do this, but not why liberals want to do it.

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Chicago: We've been hearing so much about Ben Nelson and Joe Lieberman, what's up with Olympia Snowe? Is her vote still in play?

Ezra Klein: Yep.

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19th and R: Following up, the point of the DailyKos post was that it was the same people in the left blogosphere that supported both and that perhaps this showed the wonks on the left were more willing to give in to bad policy while the activists were less compromising.

Ezra Klein: Paul Krugman opposed the Iraq War. He supports passing the bill. Again, this line of reasoning is nonsensical. It's a way for people to congratulate themselves. What I think is legitimately unsettling about it is that it reads like an effort to relive the righteous glories of opposition even while these folks are, broadly speaking, in the majority now.

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Chicago IL: If everything goes well going forward, when is the earliest that Obama could sign a bill?

Ezra Klein: Mid-January, I'd guess?

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San Francisco: This whole process makes me yearn for the system of most European countries, where civil servants write the details of most legislation, which then gets an up-or-down vote by the rubber-stamps in Parliament. There's less democratic control, but it's also less annoying than the diva-ism of the Senate.

Ezra Klein: Yep.

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Cedar Rapids, IA: What are the mechanisms in the bill to deal with insurance companies if they are charging too much for premiums or raise rates too much and how would "too much" be determined?

Ezra Klein: They could be kicked out of the exchanges.

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Ezra Klein: Gotta run a bit early today. Thanks, folks!

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