The Buie Knife

Why Chief Justice John Roberts Voted for Obamacare

Jeffrey Rosen interviewed Supreme Court Chief Justice John Roberts at the end of his first term way back in 2006. Recalling that interview in a New Republic article, Rosen offers this analysis of why a conservative like Roberts would vote in favor of Obamacare:

Roberts returned repeatedly to one theme: his desire to restore the bipartisan legitimacy of the Supreme Court. In Roberts’ view, the Court was losing respect with the public because it issued too many rulings along partisan lines. “I do think the rule of law is threatened by a steady term-after-term focus on five–four decisions,” he said. “I think the Court is also ripe for a similar refocus on functioning as an institution,” he told me, “because if it doesn’t, it’s going to lose its credibility.”

Roberts said he had been inspired by the example of his greatest predecessor, John Marshall. “He could easily have got on the Court and said, ‘I’m the last hope of the Federalists: We’re out of Congress, we’re out of the White House, and I’m going to pursue that agenda here,’” he said. “But instead he said, ‘No, this is my home now, this is the Court, and we’re going to operate as a Court, and that’s important to me.’”

As we talked, it became clear that Roberts saw the promotion of consensus in service of the Court’s long-term interests as the greatest test of a successful chief justice. “I think judicial temperament is a willingness to step back from your own committed views of the correct jurisprudential approach and evaluate those views in terms of your role as a judge,” Roberts explained. “A justice is not like a law professor, who might say ‘This is my theory of this, and this is what I’m going to be faithful to and consistent with, and in twenty years we’ll look back and say, I had a consistent theory of the First Amendment as applied to a particular area,’” he said. “Coherence in the Court’s jurisprudence is more important than coherence in each individual justice’s jurisprudence.” He added, in a remark that now seems prescient, “I would like to think, looking back, that my opinions show a concern about the legitimacy of what we’re doing is an important part of the inquiry in each case.” The fact that Roberts was willing to defend the Court’s institutional legitimacy in the health care case confirms that he meant what he said."

 Read the New Republic article.

Senior Citizens Voted Against Dems Because They Perceived Health Care Reform As Medicare Cut

Senior citizens shifted dramatically from support of Democrats to Republicans in the mid-term elections, largely because they believe health care reform will be achieved by taking benefits away from them. Analysis in The New Yorker.

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• Senior Citizens May Be Crucial to Health Reform's Perceived Success or Failure

Obama's Health Reform Is Actually More Moderate Than GOP Proposals

Jonathan Chait, New Republic: "Obama's plan closely mirrors three proposals that have attracted the support of Republicans who reside within their party's mainstream: The first is the 1993 Senate Republican health plan, which is compared with Obama's plan here, with the similarity endorsed by former Republican Senator Dave Durenberger here. The second is the Bipartisan Policy Center plan, endorsed by Bob Dole, Howard Baker, George Mitchell and Tom Daschle, which is compared to Obama's plan here. And the third, of course, is Mitt Romney's Massachusetts plan, which was crafted by the same economist who helped create Obama's plan, and which is rhetorically indistinguishable from Obama's. (The main difference are that Obama's plan cuts Medicare and imposes numerous other cost-saving measures -- which is to say, attempting to craft a national version of Romney's plan would result in something substantially more liberal than Obama's proposal.)"

Be sure to read the comments as well: "the Republicans have moved so far from the center that the bill they offered 16 years ago is now an unconstitutional assault on our way of life." 

Senior Citizens May Be Crucial to Health Reform's Perceived Success or Failure

Senior citizens are a politically powerful interest group -- they vote in very large numbers, even in off-year elections. They also tend to vote Democratic, so their support for health care reform may be crucial to the party's prospects in the 2010 and 2012 elections. But "Seniors Are Wary of Health Overhaul's Impact on Medicare," AP reports, in an article posted on the AARP website. 

The new health care law cuts "waste" in Medicare Advantage programs, but some seniors are anxious that they'll face higher premiums for lower services. In 2010, many seniors experienced $40 to $70 a month increases in Medicare Advantage premiums.

But three-fourths of seniors are covered by traditional Medicare, and stand to gain from the law's investments in preventive care and improved payments to frontline primary care physicians and nurses. The law also eliminates the gap in prescription drug benefits, but that doesn't fully phase in until 2020.

Health Reform Moves to the States

Will states lose or gain money from the feds as they are required to expand Medicaid to cover the uninsured? Most states will gain, according to this graphic, but Southern states may lose and could be strapped with new federal mandates without the financial means to cover more of the uninsured. See "Why the Fate of Health Reform Lies in States' Hands." States are free to develop innovative ways to cover more of the uninsured. See also, "The State-based Single-Payer Strategy."

Will Public Support for Health Care Legislation Rise Above 50 Percent?

CBS News poll illuminates the public relations challenge facing President Obama and the Democrats this year. Asked whether they approved of the health care legislation, just 42 percent say they do. However, this was up from 37 percent support before Congress passed the legislation. To preserve the Democrats' congressional majority, the percentage of people supporting the legislation probably needs to rise above 50 percent.
 
http://www.cbsnews.com/8301-503544_162-20001117-503544.html

Nate Silver of FiveThirty Eight.com pointed out in a December analysis that 12 percent of the opposition to the health care reform legislation came from the left, while 31% of voters said the bill was about right. If the left unites behind the legislation, that would put support at 43%. About 20% of voters then were undecided or unsure, while 35%, the Republican base, said it went too far. So the challenge for both parties is persuading the undecideds.

If the 20% of undecideds split evenly, that puts support for health care reform at 53%, approximately the percentage by which Obama won the presidency and won his 60-seat majority in the Senate. So the challenge for Obama and the Democrats is to shore up and keep the support they received in the 2008 election.That's a special challenge in an off-year election where people are less engaged and tend not to vote than in presidential years. Historically, the people who are most motivated to vote in off-year elections are angry opponents of the president, whoever he is.

Newsweek's Howard Fineman interprets Rasmussen and Gallup Polls on health care reform as bad news for Obama and the Democrats, though they essentially track the same as the other polls. Perhaps Obama, the Democrats, public relations and political advertising firms will work together to reassure undecided voters, neutralize the opposition and allay fears. A significant plurality or majority of Americans are afraid the new health care law will: 

harm the U.S. economy (44–34 percent).  

harm the overall quality of health care in the U.S. (55–29 percent), 

harm the federal balance sheet (61–23 percent). This is addressed in "How Health Care Reform Reduces the Deficit in 5 Not-so-easy Steps."

Health care reform, many people fear, will adversely affect

"the health-care coverage you and your family receive" (34–24 percent); 

"the quality of health care you and your family receive" (35–21 percent); and 

the "costs you and your family pay for health care" (50–21 percent).

It will be interesting to see if, with concerted effort, these negative numbers can move before the November, 2010 midterm elections. The 35 percent (Republican base) who are vehemently opposed to the legislation will never be persuaded. But some strategically placed messages on how the health care legislation 

• helps the U.S. economy;
• improves the overall quality of health care in the U.S.;
• reduces the federal balance sheet;
• improves the health care coverage you and your family receive;
• positively affects the quality of health care you and your family receive; and 
• either reduces or doesn't affect the cost of health care for you and your family 

can probably neutralize some of the opposition.

Relief Rather Than Joy That Health Reform Finally Passed; Huge Improvement Over Status Quo

My friend Bruce Johnson offers his reaction to the passage of health care reform legislation:  

"The wonder I feel is easy, yet ease is a cause for wonder," T. S. Eliot wrote in "Little Gidding," the last of his "Four Quartets." I don't know if that exactly expresses it, or if it's more that I was disappointed so many times before I still can't quite believe it happened . . . In any event my feelings are more of relief than of the joy that I might have anticipated.

Finally. After given up for dead so many times. The dream that was the central goal of progressives for almost half a century has become a reality. The racial slurs yelled at John Lewis, the spitting on another black congressman, the gay slurs at Barney Frank, even the incomprehensible shout of "baby killer!" to staunchly pro-life Bart Stupak, the hero of both getting the bill passed AND ensuring that it will continue to protect unborn life, yelled out by a fellow congressman - none of that can change the fact, the legislation PASSED.

Like you, I too grew very weary of the posturing. There was one point where I almost gave up on Democrats --  when some of them would admit they were putting up a bill with no chance of being passed in the hopes of scoring points in the next election. Of course, the posturing from the GOP over the past year has been amazing.

I agree with you that the bill isn't perfect but it is a HUGE improvement. And I think Axelrod has it right. If the Republicans want to run on repeal, "we welcome that battle." 

About the only provision that kicks in IMMEDIATELY is that kids with pre-existing conditions can't be denied medical coverage. I'd love to see some guy say he wants THAT repealed. Personally, I agree with the President - I think once people see it in practice, they'll see that all the Chicken Little types like Glenn Beck and Rush Limbaugh and Sarah Palin who've gone around screaming "the sky is falling, the Commies are coming!" are going to be seen as having been just ridiculous. The sky isn't going to fall, America won't go communist, and people will see at least some improvements.

Check out David Brooks' piece, "The Dems Rejoice" in The NY Times.  It was anti-Dem but in as thoughtful a way as you could imagine - a guy who grew up "with a poster of Hubert Humphrey over my bed" writing how watching the Dems in the health care debate felt like watching his family reunion, but why he doesn't feel he fits in the family any more. But he had a half-way wistful, regretful way of saying it, and he admitted he still admires Democratic idealism and passion for fairness and social justice.

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• Between Now and 2020: Great Time to be a Reporter Covering Health Care Policy
  

Between Now and 2020: Great Time to Be A Reporter Covering Health Care Policy

I reported on health care policy for 12 years -- including the 1993-1994 Clinton health care reform plan -- but got frustrated by all the partisan posturing, windbaggery and lack of action to correct obvious flaws in the system. I could have built a huge bonfire from the reams of proposals and counter-proposals I collected that never went anywhere.

But the next 10 years, until 2020, are going to be very interesting times to be a health care reporter. There will be so much to report on as the health care system adapts (or doesn't adapt) to the historic legislation passed by the 111th Congress and signed into law by President Obama. 

Republicans are mounting a massive public relations campaign to inflame voters and portray the legislation as disastrous. Their hope is to win back control of Congress in the 2010 midterm elections. But even if they do, chances of repealing the most popular provisions of the law are highly unlikely. Especially if Democrats mount a counter-campaign that persuades a majority of the public that the legislation passed represents real progress, and an increase in their personal security.

Of course few things in life are absolutely certain, and the legislation is far from perfect. Whether proponents' best hopes about the new law are realized remains to be seen. Opponents have a lot of complaints, which they will be pursuing in the courts, at the ballot box and in future Congresses. But for now, it's good to celebrate the triumph of action over inaction, after 100 years of proposals that went nowhere.

Here are some of the provisions of the new law, as proponents see it: 

Health Policy Experts, Insurance Industry Still Pushing Congress to Pass Reform

Hope for health care reform is not lost: 47 health care policy experts, including Jonathan Oberlander of the University of North Carolina, Paul Starr of Princeton University, James Tulsky of Duke University, and Henry Aaron of Brookings petition the House of Representatives to accept the Senate version of the bill and then work to improve the legislation through the Budget Reconciliation process (which doesn't require 60 votes in the Senate, which revising the legislation in the Senate does require). And some leaders of the health insurance industry, noting that rising premiums are too costly for many consumers, now realize their companies would be more profitable if Congress passes reform. Legislation requiring everyone to have insurance and subsidizing consumers who can't afford it would actually be a boon to the private health care industry.

Jeff Goldsmith on The Health Care Blog offers a cogent analysis of the mistakes and progress made in 2009, and proposes a scaled-back bill: "Unlike Clinton, Obama does not seem driven by the compulsive drive to have everyone love him. Some cold calculations about who you can afford to piss off is the key to making the right choices," he writes.

U.S. House Passes Comprehensive Health Care Reform

I haven't yet studied the details of the health care reform legislation passed by the U.S. House, and the devil is always in the details. But on the surface, it's difficult to understand how anyone but insurance company profiteers could disagree with these provisions of the legislation. "Private insurers could no longer deny anyone coverage based on preexisting conditions, place lifetime limits on coverage or abandon people when they become ill. Insurers would be required to disclose and justify proposed premium increases to regulators, and could not remove adult children younger than 27 from their parents' family policies...Businesses with payrolls exceeding $500,000 would (in 2013) be required to offer their workers insurance or pay a fine of as much as 8 percent of payroll. Individuals would be required to obtain insurance or pay a fine of as much as 2.5 percent of income."

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• At Least 7 Important Questions Remain About the "Public Option" in Health Care