Ezra Klein: The latest on health-care reform

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Ezra Klein
Washington Post Business Blogger
Thursday, February 18, 2010; 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 took 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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El Paso, Texas: Is it not true that in order to have private insurance carriers cover those with preexisting conditions and those who are older and have more health ailments, a mandate to have all obtain health coverage is necessary in order for the private carriers to be able to provide insurance to all?

This is necessary in order to not have a public option and let the private insurance carriers continue to carry the ball in trying to insure all that cannot afford now or those who cannot obtain due to health conditions.

Ezra Klein: Yep, you need a mandate to get to universality. The public option is of no help here: If you have a public option and no mandate, the public option is as likely -- or maybe even more likely -- to end up with sick people rather than healthy people, and high premiums that few can afford.

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College Park MD: How is it that small-business jobs are the key to national job growth? Do they really add up? And what constitutes as a small-business job anyway?

Ezra Klein: Steve Pearlstein wrote a good article on this awhile back. I'lll quote from it here.

"This is not the time or place for a long statistical explanation. Suffice it to say that, in terms of new job creation, the data show that most of it happens in a small number of very fast-growing companies that are no longer what most of us would consider small. There are lots of reasons for the success of these fast-growing firms, among them the ingenuity and hard work of their founders, the availability of capital and a culture that celebrates risk-taking.

But the dirty little secret is that a lot of small-business job growth has also been driven by the decision of big businesses to outsource many tasks that they used to do in-house. In an economic sense, jobs haven't been so much "destroyed" and "created" as they have been shifted from one company to another."

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Princeton, NJ: Do you think the comission on debt will have any real economists like Paul Krugman and Greg Mankiw on it?

Ezra Klein: If they are included, they won't be listened to. For a look at how an economist would balance the budget, see these 10 suggestions from Harvard's Jeff Frankel. Economists scare politicians, at least when they're speaking honestly.

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New York, NY: Senator Bennet's public option letter has been gaining signatures at a pretty fast pace. Do you think that including the public option in the likely reconciliation bill might help improve chances of health reform being passed? It could add an additional selling point to the public (i.e. we're doing reconciliation to scrap the backroom deals and provide you a public option) and that could motivate Senators to pass the bill. Is anyone in Washington thinking that way?

Ezra Klein: Right after Brown was elected, I made the argument that the Democrats might retrench to a simple, populist bill: Medicare buy-in, Medicaid expansion, maybe a public option, and funding through a tax on the rich. The political theory for that was that the Brown election had shown that Democrats had lost control of perceptions of the legislation, and they needed to reel that back.

But that wasn't what Democrats did. Instead, they took the position that it was important to regain control of the perceptions of the process, and that meant being more bipartisan, and being more open, and making fewer deals.

My judgment, for now, is that this public option letter is a red herring. It's very good organizing work on the part of the PCCC, but nothing in my talks with Democrats has convinced me that there's an appetite to cut a reconciliation deal restoring the most politically controversial and polarizing element of the bill. Maybe there is, or there will be within a week. But it's so far from the preferences Democrats have recently expressed that I'd caution people to keep hold of their skepticism.

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Germantown, MD: I have to disagree with your comment about a mandate being necessary if insurers are to be required to cover pre-existing conditions. I work for the federal government; as far as I know, our health insurance covers pre-existing conditions and yet we are not required to buy health insurance. Our system seems to work pretty well. What am I missing?

Ezra Klein: Your employer provides it to you, so pretty much everyone takes it because they're being massively subsidized. If we had subsidies in the individual market that were paying 70+% of the cost, we wouldn't need a mandate.

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Davis, CA: Jonathan Gold recently wrote that Los Angeles is the best food city in the world. Have you explored LA's restaurants, and what do you think about Gold's assertion?

Ezra Klein: I lived in LA for a time and grew up in the area, so count me with Gold. I can still taste the Daikokuya ramen from my most recent visit.

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Sen. Udall's Filibuster proposal: Ezra, What are the chances of Reid and Biden playing along with Sen Udall (no, the other one) and his proposal to change the filibuster at the start of the next Congress?

Ezra Klein: Reid has already said he won't, and he believes any rule changes require not just 60, but 67, votes.

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Arlington, VA: Ezra, When it comes to the punditization of the news, and people like Bayh retiring, I feel you are one of the people to blame. Just like Rush Limbaugh complained good riddance as the RINO's were summarily beat last election, you are beginning to do with the centrist democrats. Then you complain that politics is getting increasingly partisan, which is the natural result of two sides have more hardline members as their moderates get picked off. We should all be concerned about the moderates on both sides stepping away, instead of hoping for some pure-breed political candidate.

Ezra Klein: I don't hope for pure-breed politicians, and I haven't said good riddance to Bayh. I certainly never wrote a post encouraging his retirement. Instead, I've attempted to offer an accurate assessment of Bayh's political career. That's not necessarily been the sort of coverage Bayh wants, but it is my job.

Relatedly, I don't complain that American politics is getting more partisan. I think that's actually a neutral development. I observe that it's happening and argue that we need to change the system's rules thus that it can function effectively given the realities around it.

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Red Oak, IA: I am confused about the potential healthcare compromise that is supposed to be unveiled at the White House healthcare summit. Is it the reconciliation fix that we have been hearing about and will the House still need to pass the Senate bill?

Ezra Klein: Pretty much, and yes.

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Washington, DC: Ezra,

Do you think Progressives are setting them up again for another huge let down with the current signature drive going on in the Senate?

Isn't this just kabuki and red meat for the base? Is there even a 1% chance the public option could be introduced? I am a huge public option proponent, but I am unwilling to be Charlie Brown to the Senate's Lucy anymore.

Thanks

Ezra Klein: Yeah, that's basically my view. It makes me feel bad, because I want a public option. But I think this whole thing is a bad idea. Health-care reform's survival is even-odds right now. The odds if we end up in another giant public option argument? Significantly less.

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Leesburg, VA: Ezra,

When I listen to the GOP tell me what they think the solutions for Health Care Reform should be, I really only get two things: Buying insurance across state lines and tort reform.

My issue is with the ideological inconsistency of these two proposals. I was always under the impression that the GOP was in favor of States' Rights. However, their two primary solutions for HCR are to remove a States' Right to determine the minimum coverage required to do business in their state, and the maximum damage awarded by State Courts.

Sorry, that wasn't a question as much as it was an observation.

Ezra Klein: Yeah, but it's accurate.

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Seattle, WA: Given that Republicans seem to think they're going to take back the Senate in November, why wouldn't they be the ones leading the charge to end the filibuster?

Ezra Klein: It's a good question. But I think they don't know if they'll take over the Senate in November.

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San Francisco, CA: Hi Ezra-- Passing the Public option by reconciliation would kill two birds with one stone. It would provide evidence that Dems can move legislation and it could demonstrate to Republicans that there are worse things than bipartisanship.

Ezra Klein: There's truth to that, too. The question is whether they can do it. It's worth noting, though, that the Democrats gave up the public option as a concession to other Democrats, not to Republicans, so they never got even an ounce of bipartisan credit for what was really a huge substantive concession. That was badly handled, I'd say.

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Inside the Beltway: Hi Ezra,

So your former colleague Matt Yglesias asked the Administration why they are leaving two of the seven seats at the Fed vacant, and they declined to commment. Do you care to speculate on their motives? Does the chairman really weild outsized influence, or are Fed decisions decided by a simple majority vote?

Thanks.

Ezra Klein: This is part of the broader trend that the administration is slow to make nominations and unwilling to make recess appointments in the face of Senate intransigence and sluggishness. I'm baffled by it.

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Rochester, NY: Is it true that you will only take questions in the forum that match your radical ideological bent?

Ezra Klein: Ah, I like it when people call me a radical. It makes me feel young again.

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Washington, DC: It seems to me that the filibuster is now used so commonly that it has become an accepted practice, and as a result it is widely understood and accepted that 60 votes are required to pass any bill in the Senate. This wasn't the case as recently as 20-30 years ago however. Back then, employing the filibuster for literally every bill would have been considered something like an egregious abuse of power. Do you think a similar evolution is possible with the so-called "nuclear option"-which seems like the only way to eliminate the filibuster permanently? Right now, using the "nuclear option" would be considered an egregious abuse of power and it seems that will be the case right up until the moment one of the parties decides to go for it. Then it will be considered a normal, accepted practice. Do you agree?

Ezra Klein: No. The nuclear option is a single event, not a gradual transformation. I do think it's possible with the reconciliation process, and that it in fact happened during the Bush administration. Bush used reconciliation for tax cuts, which had never been dome before, as reconciliation was considered a way to reduce the deficit and ensure more responsible budgeting.

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Princeton, NJ: When are you going to release an app for the site/blog?!

Ezra Klein: When someone makes one for me!

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New York, NY: Any chance we'll ever see Treasury Secretary Elizabeth Warren?

Ezra Klein: Doesn't seem very likely, if for no other reason than the Senate confirmation fight. I'd love to see White House advisor Elizabeth Warren, though.

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Margaret, Phoenix AZ: Are Senator Shelby's holds still in effect? If so, why aren't Democrats using every opportunity to talk about that?

Ezra Klein: No, he lifted them on all but three nominees.

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Princeton, NJ: When you took the question, "Is it true that you will only take questions in the forum that match your radical ideological bent?", did that answer it automactically?

And have you stopped beating your wife, dog, editor, etc.?

Ezra Klein: Nope. Editors are still subject to regular beatings.

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Ezra Klein: Thanks, folks!

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