Liberal Values Defending Liberty and Enlightened Thought

The White House has been responding to yesterday’s attacks on the watered-down Senate health care reform bill from the left which I also discussed here. David Axelrod appeared on MSNBC:

Axelrod, responding on MSNBC, said: “I have a lot of respect for Governor Dean but he got on the phone with Nancy-Ann DeParle, our point person on the health care issue, went through point by point. She explained why he was wrong. And he simply didn’t want to hear that critique. I saw his piece in The Post this morning, and it is predicated on a bunch of erroneous conclusions.”

Asked his response to progressives who say “kill this bill now,” Axelrod replied: “I think that would be a tragic, tragic outcome. … I guess if you’re hale and hearty and have insurance, it’s fine to say, ‘Kill this bill.'”

Peggy Noonan, the columnist and former Reagan speechwriter, told Axelrod: “On the issue of health care, you are losing the left, you are losing the right, you are losing the center. That looks to me like a political disaster.”

“When you describe what’s in the bill, there’s strong support for it,” Axelrod replied. “We don’t think of the world in terms of left, right and center. We think of the world in terms of small business people, … senior citizens, … Americans who are looking for help on a problem that we’ve been trying to solve for a century.”

The White House Blog has been busy responding, starting with White House Communication Director Dan Pfeiffer:

Recently, a somewhat perplexing new line of argument has emerged about health insurance reform, with some folks suggesting the Senate bill is a “dream” for insurance companies.

If that’s the case, though, it must be news to them. The insurance industry has been leveraging its considerable resources in a ferocious effort to defeat this bill, including producing a report the day before the Senate Finance Committee vote that was so misleading the firm behind it had to walk away from it. And that’s not surprising, because this bill will finally wrest power away from the insurance industry and put it in the hands of American consumers.

• Among the many provisions to end insurer abuses, lower premiums, and hold insurance companies accountable:
• Insurance market reforms will prohibit abuses such as denying coverage for pre-existing conditions, charging exorbitant premiums based on gender, age, or health status, dropping coverage when people are sick, and imposing lifetime limits on benefits.
• Consumer rights will be enhanced by requiring all insurers to provide effective appeals procedures including outside, independent review of appeals
• New insurance exchanges will reduce premium increases by lowering administrative costs and increasing the leverage of individuals and small businesses in this insurance market.
• Competition will also be enhanced by providing consumers comparative information on available insurance options giving them the tools to make more informed decisions and drive competition based on value and service.
• Insurers will be held accountable for excessive overhead costs fueled by unreasonable executive compensation and profits.
• Insurers will also be required to compete against cost-effective national plans selected by the federal Office of Personnel Management.
• Wasteful taxpayer overpayments to insurance companies through private Medicare Advantage plans will be eliminated.

Jason Furman, Deputy Director of the National Economic Council, added:

As we move into the final stage of the historic push for health reform, opponents of reform are testing the age old adage that if you only say something enough times you can somehow make it true.  Yesterday, we heard a new version of the old, tired refrain that the health reform bills in Congress would raise taxes on the middle class.

So let’s set the record straight:

• First, the health insurance reform bill being considered in the Senate does not raise taxes on families making less than $250,000 – in fact it is a substantial net tax cut for American families. The bill being considered represents a substantial net tax cut for middle income families. According to the independent Joint Committee on Taxation, the bill will provide nearly $450 billion in individual income tax cuts over the next 10 years.
• Second, the excise tax levied on insurance companies for high-premium plans, the so-called “Cadillac tax,” will affect only a small portion of the very highest cost health plans – a total of 3% of premiums in 2013. The vast majority of health plans fall below the thresholds set in the Senate plan and would be completely unaffected by the provision. And those that are above the threshold would only face an excise tax on the generally small portion of the plan that exceeds the threshold. As a result, based on analyses by the Joint Committee on Taxation, only about 3% of premiums will be affected by this provision in 2013. In addition, the Senate plan provides special protections to plans held by workers in high-risk professions – like police and firefighters – as well as by those over 55.
• Third, for the small sub-set of plans that are affected, the primary impact of this provision will be to increase workers’ wages. Getting a pay raise is not what most people would call a tax increase. Economists agree by taxing the highest cost plans this provision will lead insurance companies to be more efficient and provide quality care to consumers at lower prices (see this endorsement in a letter from a group of prominent economists – including three Nobel laureates and previous members of both Democratic and Republican administrations and this analysis by CBO 2009). Even a report commissioned by the insurance industry’s trade association acknowledged that: “[w]e expect employers to respond to the tax by restructuring their benefits to avoid it.” [PWC, 2009].  As a result, employers will be in a position to increase workers’ take home pay.

Nancy-Ann DeParle, Director of the Office of Health Reform, described the benefits of the measure and the blog also quoted Bill Clinton:

At last, we are close to making real health insurance reform a reality.  We face one critical, final choice, between action and inaction.  We know where the path of inaction leads to: more uninsured Americans, more families struggling to keep up with skyrocketing premiums, higher federal budget deficits, and health costs so much higher than any other country’s they will cripple us economically.  Our only responsible choice is the path of action.

Does this bill read exactly how I would write it? No. Does it contain everything everyone wants?  Of course not. But America can’t afford to let the perfect be the enemy of the good.  And this is a good bill: it increases the security of those who already have insurance and gives every American access to affordable coverage, and contains comprehensive efforts to control costs and improve quality, with more information on best practices, and comparative costs and results. The bill will shift the power away from the insurance companies and into the hands of consumers.

Take it from someone who knows: these chances don’t come around every day.  Allowing this effort to fall short now would be a colossal blunder — both politically for our party and, far more important, for the physical, fiscal, and economic health of our country.”

Ezra Klein also disagrees with Howard Dean’s evaluation of the Senate bill:

What’s so strange about Dean’s objection is that the exchanges in the Senate bill (pdf) do act as “prudent purchasers,” that is to say, they set limits on the plans that can enter in the exchange to ensure that people are getting good choices. The relevant section begins on page 131 of the Senate bill. “The Secretary shall, by regulation, establish criteria for the certification of health plans as qualified health plans.” A couple of pages of relevant criteria follow, including marketing requirements (plans can be disqualified for focusing their marketing in outlets that would bring them uncommonly healthy enrollees), broad provider networks, coverage of options used by low-income folks (community health centers, say), quality measures, quality improvement strategies, consumer ratings, standardized benefit packages, etc.

And then, a couple of pages later, the language gets stronger. On page 143, the exchanges are given power to certify insurance plans based on whether “the Exchange determines that making available such health plan through such Exchange is in the interests of qualified individuals and qualified employers in the State.” On 144, premiums, and premium increases, enter explicitly into the discussion. Any insurance plan that wants to increase premiums has to submit a written justification for their decision. It will have to post that information on its Web site. And if the exchange is not convinced, it can decertify the plan.

Don’t believe me? In his op-ed, Dean names John Kerry as the senator who has been working hardest on this question. This morning, I spoke to Kerry’s staff, who got me a statement from Kerry himself. “The prudent purchasing provisions in the Senate health bill will lower costs and increase affordable options for consumers,” Kerry says. “It’s strong language that will allow the exchange to deliver competitive prices and offer high quality care, and I’m thrilled to see national reform honor the best innovations already succeeding in Massachusetts.”

John Podesta has also made a case similar to the arguments above.

Update: Richard Eskow disagrees with some of the claims from the White House.