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Pelosi Aims to Squeeze Skeptics on Public Option With Cheaper Bill Than Senate

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Rep. Nancy Pelosi (D-CA) with Sen. Harry Reid (D-NV)

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The House health care bill is getting cheaper, but Democrats aren't boasting just yet. Because when they ultimately break silence the hope is to present conservative Democrats in both chambers with a bill that will walk the walk of fiscal responsibility--including a public option, which is projected to save the government billions.

As always, the legislative process is unpredictable, and the Senate is operating in isolation from the House. But with the public option potentially in the balance, Speaker Pelosi's goal is this: present conservative Democrats in both chambers with a Hobson's choice between a public option bill and a potentially more expensive Senate bill that may have no public option at all.

On Friday, the Washington Post ran with leaked CBO numbers, showing that House health care leaders have reduced the price tag of their bill by at least $100 billion. The numbers were preliminary--not reflective of the current state of the legislation, which is changing constantly--but they showed a definite downward trajectory in the overall cost of its reform plan.

Still, leadership was not pleased.

"These numbers are outdated and are by no means final as we will send new policy specifications to CBO," said Brendan Daly, spokesman for House Speaker Nancy Pelosi. "But they do confirm, as the Speaker has said, that the coverage provisions of the House bill will be under $900 billion and we will have a public option. No final policy decisions have been made on how to proceed."

Why the long face when the news is ostensibly quite good? Because the hope, politically speaking, is to make the news better.

The Senate Finance Committee bill clocks in at about $829 billion in new spending--an extremely low number for a project so ambitious--and it has the added bonus, in a legislature that fetishizes fiscal responsibility, of being a deficit reducer. But even if the House can't get it's final health care package below that mark, it may still be able to make quite a splash when official CBO numbers are released in the weeks ahead. The ideal scenario is a House bill that's cheaper in absolute terms than the final Senate bill, without gutting subsidies. But at the very least the House bill will cover more people than the Senate bill, at a comparable price, providing the government more bang for its health care buck.

How would that work? Crucially, the Senate Finance Committee bill isn't the bill that's coming to the Senate floor. It still has to be merged with the more expensive Senate HELP Committee package, and when some of the HELP proposal's pay-fors are incorporated into the final Senate bill, the price tag could be higher than the stand-alone Finance package. Inasmuch as the House and Senate bills are viewed as competitors, it's the bills that come to the floor that ultimately count. The House bill will almost certainly cover more people, and the hope (though it may not be possible) is to do so while matching, or perhaps besting, the Senate bill's bottom line. And that could put conservative Democrats in a bit of a pickle: What if the progressive House bill, complete with a public option, is actually cheaper--or, at least, cheaper per consumer--than its counterpart in the Senate?

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18 comments

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October 19, 2009 1:01 PM   

It seems PElosi is playing a good game. Good on her.

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October 19, 2009 1:23 PM   

I hope that when the final House bill emerges, and it's cheap and has a strong public option, that people start giving Nancy Pelosi her due as a strong, progressive, House Speaker.

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October 19, 2009 5:17 PM    in reply to El Puerco

Amen to that. This woman is fantastic. I don't get the haters of this woman.

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October 19, 2009 1:26 PM   

If the public option makes HCR cheaper, wouldn't providing HCR with a public option a year earlier make it cheaper still, if they just delayed the outlays (subsidies for lower middle class families and increases in MediCare coverage) until the third year as the current legislation plans?

Set up the exchanges a year early in 2012 with the public option, and tell states that they can start offering the subsidies for their citizens in 2012 until the federal subsidies kick in for 2013.

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October 19, 2009 2:12 PM   

The expression is "Hobson's Choice", not "Hobbesian Choice". (Though the situation described isn't a Hobson's Choice, which is a choice to take or leave a single option.)

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October 19, 2009 3:00 PM    in reply to simsby

Morton's Fork?

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October 19, 2009 3:11 PM    in reply to simsby

Learn something new everyday. #philosophyfail

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October 19, 2009 3:48 PM    in reply to simsby

Careful. When I took someone to task for sayin "take another tact" instead of "take another tack," some dude on some whole other blog went off on me for it.

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October 19, 2009 5:21 PM    in reply to The Commenter Formerly Known as NCSteve

Ain't that the truth. It's happened to me too. I had the audacity to spell secede wrong and I was accused of everything under the sun by a touchy Texan no less

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October 19, 2009 2:52 PM   

The best part of this is that which should have been obvious for so long may finally, actually become obvious - The more robust the health care reform, via public option or other methods, the cheaper it will be per consumer. "Moderates" who have objected under the cover of cost containment will have nowhere to hide. They will either have to support it, quietly get out of the way, or try to come up with another lie to justify their opposition. The Republican's dilemma will be even more fun to watch. Once the curtain is drawn back, they may have to double down on their worn-out Reagan mantra, that government is still the problem, even if it can provide the consumer better and cheaper health care. Good luck with that.

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October 19, 2009 3:07 PM   

Except, Brian, the House bill will never be as fiscally responsible as the Senate's bill simply because the Senate finances their bill entirely through the health care system while the House bill, through the millionaire tax, does not. The millionaire tax may be deficit neutral over the first 10 years, but it leaves a $1 trillion hole in the deficit over the next 10 years simply because health care costs grow so much faster than wages. The only thing that grows as fast as health care costs is, as Dan Quayle would put it, health care costs. The Senate Finance Committee bill, by reducing the tax subsidy for employer-provided health insurance instead of using the millionaire tax, is deficit-saving for the next 20 years.

I'm not so sure Nancy Pelosi wants to ask President Obama to sign a bill raising taxes for people earning above $1,000,000/yr. by 9-15 percent, and still leave a $1 trillion hole in the deficit from 2020-2029. But that is what Nancy Pelosi is doing with her millionaire tax. Taxing employer-provided health benefits above a certain level seems like a much better idea than this sloppy millionaire tax.

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October 19, 2009 7:17 PM    in reply to jimbomoron

What a surprise -- if you start with the assumption that reform won't reduce health care inflation (i.e., that it will fail at one of its primary goals), then you can "conclude" that it will be very expensive.

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October 19, 2009 3:11 PM   

Also, the $900 billion price tag comes with significant costs -- the subsidies are being reduced. In other words, the lower the price tag, the higher the deductibles, co-pays, co-insurance, and out-of-pocket caps. That's not good, nor is it good policy.

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October 19, 2009 6:49 PM    in reply to jimbomoron

I see your spreading your BS here too, jim bow.

Subsidies will provide more bang for the buck if they are directed towards a PO than towards private insurance, because the PO itself will be cheaper. You know this, so you clearly aren't a "moron" as your name states, you're just full of shit.

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October 19, 2009 6:12 PM   

Pelosi........I love you. She is playing a damn good game here, I was wondering why those CBO numbers weren't headline news.......that's because they were old news. This is only going to get better folks.

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October 19, 2009 7:11 PM   

How about a millionaire tax and taxing employer-provided health benefits? Both, not either/or! Millionaires have too much of a good thing. And we really need to start decoupling health care and employment. We're the only country that does it that way and it's stupid.

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October 19, 2009 7:53 PM    in reply to Tanjaoui

There really are a surfeit of good ideas in health care reform. There are more ways to curb health care inflation and raise funds than simply taxing employer benefits. But taxing employer benefits is still a pretty good idea! Likewise, why not create co-ops and a public option? A thousand flowers!

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October 23, 2009 10:48 AM   

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