Who'll go to the mat for the individual mandate?

I fear that the trio of Republican senators who killed "skinny repeal" in late July (Collins, Murkowski, McCain) are going to have a hard time rejecting the tax cut bill in the name of the individual mandate.

Skinny repeal was linked to a (somewhat uncertain) presumption that the bill would be merged in conference with the House bill, which included repeal of enhanced federal funding for the Medicaid expansion and imposition of per-capita caps on federal Medicaid spending. Defense of Medicaid was the heart and soul of the Resistance, as it should have been.

Now, we may well get a partial birth abortion of the ACA - - mandate now, massive cuts to Medicaid (including expansion repeal) later. As Andy Slavitt has warned, that splits the "23 million uninsured" baby.

The individual mandate has always been unpopular -- and frankly, after years of both self-inflicted wounds and sabotage of the ACA marketplace, it has cause to be.  Health economists say that the mandate penalty was too small and too lightly enforced to be fully effective. The counterpoint is that a stricter mandate requires stronger subsidies - e.g., a cap on insurance premiums as a percent of income for all buyers, perhaps one that that matches the "affordability" threshold (currently 9.56% of income for employer-sponsored insurance and 8.05% of income for an ACA-compliant bronze plan).

For many who don't qualify for marketplace subsidies but must look to the individual market for coverage, the mandate is already effectively dead - -and so is the market.  To cite just a couple of cases I've had cause to look up lately:

John McCain is Obama's Sal Maglie

Back in February, John McCain told Anderson Cooper he would support "some sort of exchange" for Bowe Bendahl -- at a time when it was public knowledge, explained by Cooper on the same show, that the exchange being negotiated was for the five Taliban detainees who later were in fact exchanged.  Now McCain says that the done deal is  "ill-founded," that it is "putting the lives of American servicemen and women at risk," and  that the five traded detainees are "the hardest and toughest of all" and "wanted war criminals."

I am reminded of the sage advice offered by Seattle Pilots pitching coach Sal Maglie in Jim Bouton's 1969 memoir Ball Four:

In the clubhouse meeting yesterday on the Oakland Athletics Sal Maglie said about Reggie Jackson, “Once in a while you can jam him.” I could just see the situation. Reggie Jackson up. Pitcher throws one high and inside, perfect jam pitch. Jackson leans back, swings and puts it into the right-field bleachers. And Sal screams from the bench, “Not now, goddammit, not now!” (Kindle locations 4403-4406).

It's not necessarily inconsistent to have been in favor of negotiating but now to balk at the terms of the actual deal struck. McCain did leave himself some wiggle room in his February exchange with Anderson Cooper: 

COOPER: Would you oppose the idea of some form of negotiations or prisoner exchange? I know back in 2012 you called the idea of even negotiating with the Taliban bizarre, highly questionable.
SEN. JOHN MCCAIN (R), ARIZONA: Well, at that time the proposal was that they would release -- Taliban, some of them really hard-core, particularly five really hard-core Taliban leaders, as a confidence- building measure. Now this idea is for an exchange of prisoners for our American fighting man. I would be inclined to support such a thing depending on a lot of the details.

Did Nancy Pelosi (and Kerry) read Max Fisher?

Kind of looks like it:

Ms. Pelosi said..that she was hopeful the American people “will be persuaded of” military action. 

“President Obama did not write the red line,” she said. “History wrote the red line decades ago.”

[UPDATE: guess that's the party line: Kerry echoed it in his testimony this afternoon:

Now, some have tried to suggest that the debate we're having today is about President Obama's red line. I could not more forcefully state that is just plain and simply wrong. This debate is about the world's red line. It's about humanity's red line. And it's a red line that anyone with a conscience ought to draw. ][9/5: Obama said the same in Sweden.]

Compare Fisher:

The U.S. decision to move toward possible strikes appears, rightly or wrongly, wisely or unwisely, to be all about reinforcing international norms. It’s not about us; it’s not about “because Obama said so.” It’s about “because international norms say so.”

Obama girds for nuclear budget war, cont.

So Obama has repackaged and linked two old proposals -- revenue-neutral corporate tax reform and a package of jobs stimulus measures. The tax reform would be revenue neutral over the long term, cutting rates and reducing loopholes, but would yield a one-shot revenue boost as the loopholes are closed, paying for teh short-term jobs measures.

This mini "grand bargain" is part of Obama's announced series of economic speeches and proposals.  The purpose, as I see it, is twofold. First, to shift the national agenda in the upcoming budget battles from deficit reduction to jobs (short-term stimulus and long-term investments). Second, to present Republicans with a series of manifestly reasonable programs and compromises to reject. That way, when they shut down the government or threaten national default because Obama won't agree to obscenely large spending cuts, he can say, "I offered to compromise six ways to Friday, but my opponents won't agree to anything but more spending cuts and more tax cuts." 

Why is McCain suddenly John So-New-New?

I have no insight into the latest cut-back in the double reverse that is John McCain's long career. I just want naming rights.

Update: Dana Milbank interviewed McCain 4.0.  The reborn maverick's explanations for his serial transformations make no sense, but as long as this is the final somersault, Democrats won't complain.

Political science consensus judgment of the day

The U.S. District Court of political commentary, xpostfactoid division, affirms in part and vacates in part Peter Beinart's remediation order* for the GOP [n.b. note update at bottom for second appeal ruling] :

...to seriously challenge for the presidency, a Republican will have to pointedly distance himself from Jeb’s older brother... It won’t be enough for a candidate merely to keep his or her distance from W. John McCain and Mitt Romney tried that, and they failed because the Obama campaign hung Bush around their neck every chance it got. To seriously compete, the next Republican candidate for president will have to preempt that Democratic line of attack by repudiating key aspects of Bush’s legacy. Jeb Bush would find that excruciatingly hard even if he wanted to. And as his interviews Sunday make clear, he doesn’t event want to try.

Upheld:  it would be a good idea for the next GOP presidential candidate, and probably all GOP candidates for the foreseeable future, to distance themselves from W.  David Frum saw the writing on the wall back in February 2008:

GOP Demonization Index soars again

Speaking at a New York fundraiser heavy with basketball stars on Wednesday, Obama ventured a snapshot of how far the GOP has moved to the right during his presidency:

This is probably the most consequential election of my lifetime, and in a lot of ways, it’s more consequential than the one in 2008.... back in 2008, we were running against a Republican candidate who believed in some basic things that I believe in -- believed that money shouldn’t dominate politics; believed in immigration reform, that we should give every young person who’s here a chance to become an American and contribute to this country; somebody who believed in climate change and believed in science.

GOP leaders: GOP is unfit to govern

Let's step back and let the obvious sink in. Think about this internecine GOP spat for a moment:

BRIAN KILMEADE: Now, Sen. McCain, I want you to hear a sound bite from one of the Sunday shows. Dick Cheney sits down, talks about your selection of vice presidential candidate Governor Palin. Listen.

DICK CHENEY: I like Governor Palin. I’ve met her. I know her. She – attractive candidate. But based on her background, she’d only been governor for, what, two years? I don’t think she passed that test…of being ready to take over. And I think that was a mistake.

BRIAN KILMEADE: You agree? Disagree?

SEN. JOHN McCAIN: Well, I’m always glad to get comments four years later. Look, I respect the vice president. He and I had strong disagreements as to whether we should torture people or not. I don’t think we should have. But the fact is I’m proud of Sarah Palin. I’m proud of the job she did. I’m proud of the job she continues to do. Everybody has their own views and I respect those views. But I’m proud of what we did.

The presidential campaign in story and song

Of a certain worthy KNYGHT, the first of Chaucer's pilgrims to get a bio in the prologue to the Canterbury Tales, we are told

At mortal batailles hadde he been fiftene,
And foughten for oure feith at Traniyssene
In lystes thries, and ay slayn his foe. 

In 2007-08, Barack Obama did the knyght a few better, debating Hillary Clinton et al twenty six times, and most definitely slaying McCain thrice in their general election contests.  No wonder he's nostalgic today, with the armies of the unemployed looming on the election horizon, for those mortal batailles of old.

The presidential campaign in story and song

Of a certain worthy KNYGHT, the first of Chaucer's pilgrims to get a bio in the prologue to the Canterbury Tales, we are told

At mortal batailles hadde he been fiftene,
And foughten for oure feith at Traniyssene
In lystes thries, and ay slayn his foe. 

In 2007-08, Barack Obama did the knyght a few better, debating Hillary Clinton et al twenty six times, and most definitely slaying McCain thrice in their general election contests.  No wonder he's nostalgic today, with the armies of the unemployed looming on the election horizon, for those mortal batailles of old.

A false choice between hope and fear

Media coverage of political strategy is often about framing false choices. Or rather, about framing either/or choices where a delicate balance is required.

For the Obama campaign, the either/or de jour is hope vs. fear.  A couple of days ago, I put forward my own plea that the Obama campaign quite legitimately scare us by spelling out the consequences of the tax cuts and budget cuts Romney has promised.  Seems I needn't have worried -- at least as regards the degree of aggression, if not its focus: I think it should be mainly economic, as Romney's polling lead as the candidate better able to manage the economy is the chief danger sign for the Obama campaign right now.  But John Heilemann has taken a deep dive into the Obama campaign's thinking, and he reports on plans for a full-scale multi-front attack in the offing:

McCain hearts Palin as victim-in-chief

John McCain's purported graciousness is disingenuous.

In an op-ed in today's Washington Post, McCain praises Obama's speech in Tucson -- then twists it to second Sarah Palin's depraved implication that she is the nation's chief victim of overheated political rhetoric.

According to McCain, "The president appropriately disputed the injurious suggestion that some participants in our political debates were responsible for a depraved man's inhumanity."  That's true, insofar as Obama suggested that we don't know "what thoughts lurked in the dark recesses of a violent mind." It's also true that  Obama upheld the value of "debating what might be done to prevent such tragedies in the future" and recommended that we "challenge old assumptions in order to lessen the prospects of violence in the future," but McCain's pullout is accurate as far as it goes.

McCain moves on to inveigh against character assassination and affirm his own belief in the President's patriotism and fitness to govern. He admits that he has been part of the problem in the past (remember: "he'd rather lose a war than a campaign"?). Then comes the sleight of hand:

"Robin" Medvedev gets red-breasted over missile defense

Is it unduly speculative to infer that Medvedev's newfound tough-guy demeanor is early fallout from the WikiLeaks cable dump? From The New York Times online:

MOSCOW — President Dmitri A. Medvedev, expressing continued wariness over the prospect of military cooperation with his country’s former cold war adversaries, warned on Tuesday that a failure by Russia and the West to reach an agreement on missile defense could provoke a new arms race. [snip]

The following alternatives await us in the next 10 years,” Mr. Medvedev told an audience of Russia’s top leaders gathered at the Kremlin. “Either we reach an agreement on missile defense and create a joint mechanism for cooperation or, if we do not succeed in entering into a constructive understanding, there will begin a new arms race.”

In the absence of cooperation, he said, Russia would be prepared to deploy “new means of attack.”

"Enemy Belligerent" lawmakers: McCain and Lieberman

The Enemy Belligerent Interrogation, Detention and Prosecution Act of 2010, a legislative monstrosity produced by John McCain and Joe Lieberman, goes further than any Bush-era legislation in abrogating the core principle of Anglo-American justice: that a suspect is innocent until proven guilty. While the bill is deplorable in every detail -- it denies terrorist suspects their Miranda rights and codifies indefinite detention without trial -- one particular provision effectively ends the presumption of innocence for all of us. That provision codifies the President's right to define any criteria he chooses to deliver any individual into the legal Twilight Zone defined by the bill.

The bill authorizes the President to establish an "interagency team" to make a "preliminary determination of the status" of an individual "suspected of engaging in hostilities against the United States or its coalition partners through an act of terrorism, or by other means in violation of the laws of war, or of purposely and materially supporting such hostilities."  That team will determine whether the suspect shall be accorded a preliminary designation as a "high value detainee" (a.k.a. "unprivileged enemy belligerent" -- the bill makes no coherent distinction between these terms).  A final status determination is to be made by the Attorney General and Secretary of Defense; the President can only weigh in if these two disagree.  Incredibly, the entire procedure from capture to final status determination is to be completed within 48 hours. 

The provision that removes all discretionary limits to this secret determination of status is in the Criteria for Designation of Individuals as High-Value Detainees. That section creates an initial impression that such "determinations" are subject to the rule of law by laying out specific criteria, beginning with "(A) The potential threat the individual poses for an attack on civilians..." (B) the potential threat the individual poses to United States military personnel..." etc. But the final criterion (E) zooms to infinity: it is simply "Such other matters as the President considers appropriate. " 

The contortions of Brooke Buchanan

I would not like to be John McCain's spokesperson Brooke Buchanan these days.  Between her boss's disregard for facts and his complete reversals of past positions, the poor woman's got a lot of 'splainin' to do.

Here's Brooke (via TPM) after McCain insisted on TV last night that Christmas bomber Umar Abdulmutallab bought a one-way ticket to Detroit -- two weeks after being corrected on air for making the same mistake:

McCain spokesperson Brooke Buchanan tells us that the senator is "aware now" that Abdulmutallab was not on a one-way ticket.

"The initial reports are where Senator McCain was taking the information was from," she says. "He's actually focused on bigger things, like making sure this doesn't happen again."

 That is, he's too focused on the problem to bother with facts.

Brooke also had to go into action after McCain declared himself "disappointed" that Secretary of Defense Robert Gates and Joint Chiefs Chairman Mike Mullen both stated unequivocally that they supported repeal of the military's "Don't Ask Don't Tell" policy for gays in the military.

Paging John McCain

Quick question, though I'll confess to not yet looking at the fallout from the Supreme Court strike-down of McCain-Feingold in any depth: where does McCain stand on McCain-Feingold II?  Not to mention on Obama's proposed "Volcker rule," a lighter version of McCain's proposed Glass-Steagall II.

Historical accident would seem to have put McCain on the Dems' side of the ledger on two key fronts just as the Democrats have lost their 60-vote supermajority.

Will the worm in John McCain's soul turn once more and turn him left? I wouldn't bet on it. But still.

UPDATE 1/23: The WSJ has this reaction to Obama's bank reform proposals from McCain:

But in a political environment decidedly hostile to big banks, Democrats might need only a few Republican votes to enact a variant of what Mr. Obama called "the Volcker rule." Sen. John McCain, the Arizona Republican, said the White House appears to be moving closer to a proposal he is co-sponsoring that would reinstate restrictions on banks that were repealed in the late 1990s. "It seems to me that a number of the proposals [Mr. Obama] has move in that direction," Sen. McCain said, "but I haven't had a chance to examine the details."

Most recent post: Frank Rich wrote his column too early this week

Quote of the Day

“Paul Volcker, a top economist in the Obama Administration and former Federal Reserve Chairman, wants the nation’s banks to be prohibited from owning and trading risky securities, the very practice that got the biggest ones into deep trouble in 2008.  And the administration is saying no, it will not separate commercial banking from investment operations.  Mr. Volcker argues that regulation by itself will not work.  Sooner or later, the giants, in pursuit of profits, will get into trouble.  The Administration should accept this and shield commercial banking from Wall Street’s wild ways..."

John McCain, Dec. 17, 2009
On the Banking Integrity Act of 2009

Quote of the Day II

When banks benefit from the safety net that taxpayers provide, which includes lower-cost capital, it is not appropriate for them to turn around and use that cheap money to trade for profit. And that is especially true when this kind of trading often puts banks in direct conflict with their customers’ interests.

The fact is, these kinds of trading operations can create enormous and costly risks, endangering the entire bank if things go wrong.

We simply cannot accept a system in which hedge funds or private- equity firms inside banks can place huge, risky bets that are subsidized by taxpayers and that could pose a conflict of interest. And we cannot accept a system in which shareholders make money on these operations if a bank wins, but taxpayers foot the bill if a bank loses.

Barack Obama, Jan. 21, 2010
On Additional Reforms to the Financial System (e.g., "The Volcker rule")

McCain's bill calls for a complete ban on investment banking activities by deposit-taking banks; Obama proposes simply to ban proprietary trading and internal hedge funds. So what excuse will McCain find to oppose the milder separation of bank functions?

When Obama stole a line from Cheney

One of the defining moments of the 2008 campaign came in the wake of the Lehman Brothers collapse, when John McCain announced that he was suspending his campaign and called on Obama to postpone their upcoming debate while al hands were called on deck to deal with Treasury Secretary Hank Paulson's request for $700 billion to bail out the megabanks. Obama's response - a President has to be able to do more than one thing at a time -- exposed McCain for the shallow showboating bully that he is.

Who noticed at the time that Obama was quoting his distant cousin, Dick Cheney?  I just stumbled on this exchange in a Tim Russert interview with Cheney on March 16, 2003, days before the U.S. attacked  Iraq:

MR. RUSSERT: In order to pay for this war, would the president consider suspending his proposed tax cut?

VICE PRES. CHENEY: We don’t believe that’s the right course of action, Tim. This is one of those times when as important as the war on terror is and as important as the problem of Iraq is, we’ve also got a lot of other balls in the air. And an American president these days doesn’t have the choice of focusing on only one thing. We’ve also got to deal with the Middle East peace process, with Israelis and Palestinians which we did this week. We’ve got to deal with the domestic economy. It’s very important to get the economy growing again. And one of the reasons we’ve had a fall-off in revenue, obviously, is a slow economy and we need to get growth started again....

I imagine that in one form or another, the observation that a President has to focus on many issues simultaneously is a truism going back many decades, if not a couple of centuries.

BTW, a look back at the Russert interview highlights what we lost with his untimely death.  He asked Cheney every question he should have -- whether he disagreed with the International Atomic Energy Agency's assessment that Iraq had no nuclear program, whether the U.S. was alienating allies, whether the invasion would stimulate anti-American feeling and terrorism among Muslim populations, whether we would need hundreds of thousands of troops on the ground to secure the country after invasion, whether the war mightn't cost $100 billion, whether Brent Scowcroft's vocal criticism of the rush to war gave him pause -- and, per above, whether war might require scaling back tax cuts..   You can't accuse Cheney of being unwilling to engage these questions, either -- though you may marvel how wrong he was about everything.

Boehner gives the game away on missile shield in Eastern Europe

John Boehner's denunciation of Obama's cancellation of the missile shield deployments in Poland and the Czech Republic shows what the plan was always really about:

“Scrapping the U.S. missile defense system in Poland and the Czech Republic does little more than empower Russia and Iran at the expense of our allies in Europe,” said Representative John A. Boehner of Ohio, the House Republican leader. “It shows a willful determination to continue ignoring the threat posed by some of the most dangerous regimes in the world.”

Note the sequencing of threats in this knee-jerk reaction. What does that say about Bush's repeated protestations that the shield had nothing to do with Russia?

And don't expect any subtlety from John McCain, enabler-in-chief of that Georgian fool's Saakashvili's furnishing of a pretext for Russian intervention in 2008:

“I fear the administration’s decision will do just that [undercut allies],” Senator John McCain, Mr. Obama’s Republican rival in last year’s presidential election, said Thursday, adding that the decision came “at a time when Eastern European nations are increasingly wary of renewed Russian adventurism.”

The Poles and Czechs, meanwhile, seem to have been concerned mainly to get American boots on their soil, whatever the pretext. They're about as worried about Iran as we are over incoming meteoroids.

The decision's possible downside -- raising Polish and Czech anxieties, perhaps emboldening Russia with an unforced 'concession' over a program that allegedly had nothing to do with them--does highlight what may be the signature challenge of the Obama Administration: unraveling bad policies that entail real commitments to various parties.

MedPAC: Obama's rudder for the healthcare battleship

In an interview focused on healthcare, Washington Post editorial page editor Fred Hiatt asked Obama why he's set against capping businesses' tax exemption for money spent on health benefits.

It's widely assumed that this would be an effective tool for reducing healthcare inflation, since businesses would have an incentive to keep their healthcare spending per employee below the cap. It's also generally assumed that Obama is resisting this measure because it was a central plank in McCain's healthcare "plan" (such as it was), which Obama campaigned against.

But Obama's answer to Hiatt's question is interesting, and compelling:

Now, this is something that I think economists find appealing partly because it's -- although it's a blunter instrument, it's more measurable than some of the delivery system changes -- although I actually think the delivery system changes are more long-lasting. And you could have a situation in which you cap the exclusion or eliminated the exclusion and, yes, that would drive health care inflation down, but it also could drive quality of health care down because you're not doing anything to change a perverse system in which we pay for more medical care as opposed to medical care that actually makes us healthier.

In other words, as long as a healthcare plan is still indiscriminately reimbursing doctors and hospitals on a fee-for-service basis, the only way it can cut costs is to cut coverage -- and Americans' health plans are already riddled with holes, rising copays, uncovered treatments, lifetime benefit caps. Obama is saying that he does not want to mandate private sector benefit cuts until those cuts will be directed at unnecessary care -- MRIs for every muscle strain, Caesarians for every slow birth, unnecessary prostate cancer operations, proton radiation, the whole panoply of wasteful testing, operating, medicating that Americans have been trained to expect -- rather than against necessary preventive and catastrophic care, which so many plans today cover inadequately.

Obama did tell Hiatt that he'd be open to a cap on the healthcare tax exemption set above today's top spending levels. Obama's thinking/political framing of this issue is structurally similar to his approach to corporate taxation: he is open in principle to reducing the corporate tax rate if and when Congress closes the huge array of loopholes that make the effective corporate tax rate so much lower than the nominal rate. In both instances he is seeking to avoid change with unintended consequences -- or perhaps with stealthily intended consequences -- by insisting that structural change precede a reform that will misfire without it.

In the Hiatt interview, after pivoting away from the tax exemption cap, Obama placed his cost curve-bending chips on "MedPac on steroids," a commission empowered to set reimbursement rates and treatment emphases for Medicare and Medicaid. He cast MedPac as perhaps the chief vehicle for tackling the real fundamental task-- moving the healthcare payment system away from fee-for-service and towards some kind of global payment system, where doctors and hospitals are paid per patient, with performance incentives.

At this point, I am confident that both the House and the Senate bills will contain what we've been calling MedPAC on steroids, the idea that you continually present new ideas to change incentives, change the delivery system, understanding that because this is such a complex system we're not always going to get it exactly right the first time, and that there have to be a series of modifications over the course of a series of years, and we have to take that out of politics and make sure that an independent board of medical experts and health economists are providing packages that are continually improving the system. So I think there's general consensus that that is one of two very powerful levers to bend the cost curve.

The role that Obama envisions for MedPAC is a window on the way he conceives of systemic change generally. He's what you might call a radical incrementalist. Recognizing that the fundamental task in tackling healthcare inflation is to change incentives -- end fee-for-service -- he also recognizes that the payment system cannot be changed by fiat, that the task needs to be done in stages, experimentally, on the basis of what is shown to work. To empower MedPAC in Obama's view is to create a "powerful lever" to "move this big battleship a few degrees in a different direction" and set the stage for a long series of subsequent reforms.