The House passed a trillion dollar bill that will force Americans to buy health insurance, force even small businesses to provide health coverage, and require insurance companies to cover pre-existing conditions.  (The last, as I have previously argued, makes it something other than “insurance.”)

Lori Montgomery and Shailagh Murray for WaPo:

Hours after President Obama exhorted Democratic lawmakers to “answer the call of history,” the House hit an unprecedented milestone on the path to health-care reform, approving a trillion-dollar package late Saturday that seeks to overhaul private insurance practices and guarantee comprehensive and affordable coverage to almost every American.

After months of acrimonious partisanship, Democrats closed ranks on a 220-215 vote that included 39 defections, mostly from the party’s conservative ranks. But the bill attracted a surprise Republican convert: Rep. Anh “Joseph” Cao of Louisiana, who represents the Democratic-leaning district of New Orleans and had been the target of a last-minute White House lobbying campaign. GOP House leaders had predicted their members would unanimously oppose the bill.

Democrats have sought for decades to provide universal health care, but not since the 1965 passage of Medicare and Medicaid has a chamber of Congress approved such a vast expansion of coverage. Action now shifts to the Senate, which could spend the rest of the year debating its version of the health-care overhaul. Majority Leader Harry M. Reid (D-Nev.) hopes to bring a measure to the floor before Thanksgiving, but legislation may not reach Obama’s desk before the new year.

[...]

The House legislation would for the first time require every individual to obtain insurance, and would require all but the smallest employers to provide coverage to their workers. It would vastly expand Medicaid and create a new marketplace where people could obtain federal subsidies to buy insurance from private companies or from a new government-run insurance plan.

Though some people would receive no benefits — including about 6 million illegal immigrants, according to congressional estimates — the bill would virtually close the coverage gap for people who do not have access to health-care coverage through their jobs.

Carl Hulse and Robert Pear for NYT:

Handing President Obama a hard-fought victory, the House narrowly approved a sweeping overhaul of the nation’s health care system on Saturday night, advancing legislation that Democrats said could stand as their defining social policy achievement.

[...]

Democrats were forced to make major concessions on insurance coverage for abortions to attract the final votes to secure passage, a wrenching compromise for the numerous abortion-rights advocates in their ranks.

Many of them hope to make changes to the amendment during negotiations with the Senate, which will now become the main battleground in the health care fight as Democrats there ready their own bill for what is likely to be extensive floor debate.

Democrats say the House measure — paid for through new fees and taxes, along with cuts in Medicare — would extend coverage to 36 million people now without insurance while creating a government health insurance program. It would end insurance company practices like not covering pre-existing conditions or dropping people when they become ill.

[...]

Some Democrats said they voted for the legislation so they could seek improvements in it. “This bill will get better in the Senate,” said Representative Jim Cooper, a Tennessee Democrat who has been outspoken in his criticism of some provisions of the bill but decided to support it. “If we kill it here, it won’t have a chance to get better.”

[...]

The House legislation, running almost 2,000 pages, would require most Americans to obtain health insurance or face penalties — an approach Republicans compared to government oppression.  Most employers would have to provide coverage or pay a tax penalty of up to 8 percent of their payroll. The bill would significantly expand Medicaid and would offer subsidies to help moderate-income people buy insurance from private companies or from a government insurance plan. It would also set up a national insurance exchange where people could shop for coverage.

This measure barely passed the House, where Democrats enjoy a solid majority in which most Members are Gerrymandered into uncompetitive seats.  And there are many Jim Coopers among the Yeas: People who would have voted Nay if they were not so confident the Senate would produce a much less radical bill, ensuring any measure that reaches the president’s desk will be less mild.  I’m pretty sure they’re right.

Still, this is a rather staggering measure passed by the House.  If this became law, the poor would be significantly poorer and small businesses would be even less competitive with the big box stores.  During a very weak economy with an unemployment at ten percent, no less.  Oh, and insurance rates will go up for the rest of us, too, as companies amortize the cost of absorbing people who have costly illnesses — who will by definition be a net drain on the pool from Day 1 — by passing it on to the rest of us.

Presumably, the rationale behind these moves is to wreck the current system entirely, making a government system the only alternative.  Certainly, it’s not a good faith measure to improve the current system.

I get that the status quo is far from perfect.  Young, healthy people often can’t afford health insurance.  (I went without during my graduate school days, for example, unable to justify spending $250 a month out of a $750 stipend to cover the incredibly unlikely event of getting seriously sick.)  The poor clog up our emergency rooms.  People are stuck at their job because they’d lose coverage at an otherwise preferable job.  Dealing with insurance companies can be a nightmare.

This bill helps address some of those problems, at least at the margins.  But it exacerbates others.

Moreover, this plan does nothing to address the fundamental problem with the status quo:  The unsustainable skyrocketing in health care costs.    If the Senate were to somehow pass the identical bill, we’d cover more people — a good thing in and of itself — but at a higher per unit cost.  That means an even greater share of GDP would go to health care from the beginning with no additional constraints on the escalation of costs.

The loss of a Republican seat in NY-23 under highly unusual circumstances notwithstanding, yesterday was a good day for Republicans. After crushing defeats in successive elections, they won back the Virginia governor’s office in a blowout and knocked off a billionaire incumbent governor in New Jersey despite having their vote split between two candidates.

I would, however, resist the temptation to see these contests as a referendum on Barack Obama’s presidency and the Democratic Party, much less a harbinger for 2010 and beyond.

Glenn Reynolds has an op-e in the NY Post titled “The Obama Magic has Faded.”

All politics is local, they say, and Tuesday’s off-off-year elections certainly had their local angles. Jon Corzine has been a terrible governor even by the undemanding standards of terribly governed New Jersey. Creigh Deeds, though he looked good to Democratic Party recruiters not long ago, turned out to be an undistinguished campaigner, more driven by the concerns of Washington Post editorialists than of Virginia voters. And NY-23 Republican nomineee Dede Scozzafava was a bizarre choice, bizarre enough to inspire a seemingly quixotic third-party run by Doug Hoffman.

But these local angles weren’t enough to keep the Obama administration out of the races. President Obama barnstormed Virginia and New Jersey — and pumped money and Joe Biden into NY-23 in support of Democratic candidate Bill Owens. (One suspects Owens would have preferred more money and less Biden.)

And — until it started looking as if they might lose — the Obama people were suggesting that these races would seal their mandate and encourage congressional wafflers to toe the line on health-care reform. Not so much, as it turns out.

Now, this is right, so far as it goes.  Exit poll analyses by both ABC and CBS show Obama remains personally popular but that people are extremely worried about the economy and the direction of the country.  The reality has set in that Obama’s a politician, not a messiah.  While many retain high hopes, most of the irrational exuberance has faded.  And, clearly, he doesn’t have coattails when he’s not on the ballot.  Then again, neither did Ronald Reagan.   Recall that Republicans lost 27 House seats in 1982.

A stronger case is made by Dan Balz in an “analysis” piece at WaPo titled “Contests serve as warning to Democrats: It’s not 2008 anymore.”

Neither gubernatorial election amounted to a referendum on the president, but the changing shape of the electorates in both states and the shifts among key constituencies revealed cracks in the Obama 2008 coalition and demonstrated that, at this point, Republicans have the more energized constituency heading into next year’s midterm elections.

The most significant change came among independent voters, who solidly backed Democrats in 2006 and 2008 but moved decisively to the Republicans on Tuesday, according to exit polls. In Virginia, independents strongly supported Republican Robert F. McDonnell in his victory over Democrat R. Creigh Deeds, while in New Jersey, they supported Republican Chris Christie in his win over Democratic Gov. Jon S. Corzine.

For months, polls have shown that independents were increasingly disaffected with some of Obama’s domestic policies. They have expressed reservations about the president’s health-care efforts and have shown concerns about the growth in government spending and the federal deficit under his leadership.

Tuesday’s elections provided the first tangible evidence that Republicans can win their support with the right kind of candidates and the right messages. That is an ominous development for Democrats if it continues unabated into next year. But Republicans could squander that opportunity if they demand candidates who are too conservative to appeal to the middle.

This is exactly right.  Independents, by their very nature, are fickle.  When thing are going well, they’ll stick with the party in power and when they’re not, they’ll vote for change.

So, if unemployment is still high and we’re still mired in a mess in Afghanistan a year from now, the Republicans will have an opening to make major gains in the House and Senate.  But they’ll need candidates who won’t alienate independents.

I followed the Virginia race with some interest given that I live in the Commonwealth.  It wasn’t a race about Obama or national issues at all.  Deeds was the surprise winner of the Democratic primary, with the well-financed and well-known Terry McAuliffe and Brian Moran killing each other off and leaving Deeds standing.   He was a moderate Democrat with appeal to rural Virginians who had narrowly lost to McConnell four years earlier when the latter got 323 more votes for attorney general.  But when the Washington Post went on attack against McDonnell for an old master’s thesis and some rather unprogressive statements about women and homosexuals, Deeds decided to run a nasty campaign hammering at those points.  It backfired, as McConnell turned the other cheek and came across as a decent, reasonable man.  (As an aside, I should note that Republicans easily won the lieutenant governor and attorney general races in landslides, too. )

In New Jersey, Corzine is personally unpopular and his state is in bad shape.  I posited on last night’s OTB Radio that it was all downhill after the motorcade incident, which was the first time I realized what a jackass Corzine was, but I don’t follow Garden State politics closely enough to know for sure.   At any rate, Chris Christie was perceived as a reasonable alternative even in a Democrat-leaning state.  Corzine’s genius advisers decided their best course was to double down on the jerk factor, campaigning on the theme that Christie was too fat to be governor.  Oddly, it didn’t do the trick.

Regardless, these races demonstrate that Republicans can win — even with all the damage to the brand suffered in recent years — given both an opening and a solid candidate.

In a much discussed post, Ezra Klein produced a series of graphs showing that Americans pay more for office visits, scans and imaging, drugs, and other aspects of health care — often, far more — than is the case in Canada or Western Europe.

There is a simple explanation for why American health care costs so much more than health care in any other country: because we pay so much more for each unit of care. As Halvorson explained, and academics and consultancies have repeatedly confirmed, if you leave everything else the same — the volume of procedures, the days we spend in the hospital, the number of surgeries we need — but plug in the prices Canadians pay, our health-care spending falls by about 50 percent.

In other countries, governments set the rates that will be paid for different treatments and drugs, even when private insurers are doing the actual purchasing. In our country, the government doesn’t set those rates for private insurers, which is why the prices paid by Medicare, as you’ll see on some of these graphs, are much lower than those paid by private insurers. You’ll also notice that the bit showing American prices is separated into blue and yellow: That shows the spread between the average price (the top of the blue) and the 90th percentile (the top of the yellow). Other countries don’t have nearly that much variation, again because their pricing is standard.

Bernard Finel, recalling a series of posts and comment threads from a while back, observes,

James Joyner has argued that in order to reduce health care expenditures we need to make a choice — we can’t have it be better, faster, and cheaper.  Yes, we can.  The reason we can is that the choice isn’t simply between better, faster, and cheaper, it is between better, faster, cheaper, and more profitable.  If you cut profits — for medical insurance providers, for medical malpractice insurance providers, for med-mal attorneys, for doctors, for hospitals, and for drug companies — you can have better, faster, and cheaper.  The problem is that our system is essential optimized for profits — our goal is not to make people healthy but to make people wealthy.

That’s true up to a point, although some of this is simply the Find The Umbrella phenomenon combined with arbitrary itemizing of costs.  (Maybe the scans are $900 because they can bill that much for it while something that they’d otherwise bill more for is capped because the insurance companies won’t reimburse above a certain rate.)

Beyond that, as Dave Schuler points out, there’s no good reason to think OUR government is going to hold down costs in the same way the social democracies have.

I see no reason to believe that even if we went to a single-payer system that the federal government would be willing to lower healthcare prices so that we’re spending what France, Germany, or the Netherlands is. Despite the legislative mandate to do so that’s been around for about ten years they haven’t lowered Medicare reimbursement rates. Every year they postpone that painful choice and, indeed, they’re preparing to do so again.

And, indeed, as Kevin Drum acknowledges, nothing in the bills before Congress will do anything at all to reduce costs.

The special election to fill New York’s 23rd Congressional District seat vacated by the appointment of Republican John McHugh as Secretary of the Army has taken yet another bizarre twist.  Republican nominee Dede Scozzafava dropped out over the weekend, causing great celebration on the part of Republicans like Michelle Malkin, who termed her “radical leftist GOP candidate Dede Scozzafava” and chortled “don’t let the door hit you on the way out!”  Earlier, Malkin had explained why, in her view, “the GOP should be ‘purged’ of left-wing saboteurs.”

Well, now Scozzafava has endorsed Democrat Bill Owens over Conservative Doug Hoffman in a press release.

I am supporting Bill Owens for Congress and urge you to do the same.

It’s not in the cards for me to be your representative, but I strongly believe Bill is the only candidate who can build upon John McHugh’s lasting legacy in the U.S. Congress. John and I worked together on the expansion of Fort Drum and I know how important that base is to the economy of this region. I am confident that Bill will be able to provide the leadership and continuity of support to Drum Country just as John did during his tenure in Congress.

In Bill Owens, I see a sense of duty and integrity that will guide him beyond political partisanship. He will be an independent voice devoted to doing what is right for New York. Bill understands this district and its people, and when he represents us in Congress he will put our interests first.

Hoffman’s campaign dubbed her a “turncoat” and said “This afternoon Dede Scozzafava betrayed the GOP.”   But, um, Hoffman split from the GOP and was running against its candidate!

Malkin, happy a day earlier to purge the likes of the radical leftist Scozzafava from the GOP thinks she’s being ungrateful.

Hey, how did that six-figure RNC donation to the NRCC plus $85,000 to the New York GOP plus nearly half-million-dollar investment in advertising and other independent expenditures on behalf of radical leftist Dede Scozzafava work out?

She repaid the GOP by endorsing Democrat candidate Bill Owens. Some gratitude, eh?

But why should she be grateful for the humiliation of having out-of-state Republicans calling her names and openly campaigning for a third party candidate against the duly nominated candidate of their own party?

While I’m a Big Tent guy who thinks the Republican Party needs to accept the fact that winning seats in the Northeast will require backing candidates who would be considered “liberal” in Mississippi, I fully understand the thinking of people like Malkin who prefer an ideological party.  At some point, having an “R” after a candidate’s name doesn’t mean much if they’re going to work against your leadership.   But you can’t have it both ways.  Either the GOP accepts people like Scozzafava as candidates in liberal districts or it runs them off to become Democrats.

Nate Silver calls the race “nearly impossible to forecast.”

Special elections, with their low turnout, are intrinsically pretty difficult to predict. So are multi-candidate races. And certainly, races where there are substantial late-breaking developments — such as the Republican candidate dropping out four days before the election and endorsing her Democratic rival — present especial difficulties for forecasters. Here, you have all three of those circumstances, producing a perfect storm of uncertainty. Not only will I not be surprised if either Democrat Bill Owens or Conservative Doug Hoffman wins on Tuesday — I will not be surprised if one of them wins by a substantial, possibly even double-digit margin.

His gut says that it helps Owens (but then his heart is pulling for Owens).

Owens is probably in a better position than he was 48 hours ago. Endorsements don’t usually matter very much, but with Scozzafava’s exit from the race, you suddenly have as much as 30 percent of the electorate up for grabs and undoubtedly feeling very, very confused. Plus, the endorsement was unexpected (although perhaps it shouldn’t have been, since Scozzafava is much closer ideologically to Owens than to Hoffman), which might make it more impactful.

At least one poll — which Silver “respects” because of its good showing in recent races — shows Hoffman with “a commanding lead.”

In a three way contest with Democrat Bill Owens and Republican Dede Scozzafava Hoffman leads with 51% to 34% for Owens and 13% for Scozzafava. In a head to head contest with Owens Hoffman holds a 54-38 advantage.

Polling the race was a little haphazard in a weekend with many twists and turns but Hoffman showed a similar lead at all junctures. In interviews conducted before Scozzafava announced the suspension of her campaign Hoffman led Owens 49-31 with 17% going to Scozzafava. Poll respondents Saturday afternoon/evening and early Sunday afternoon were informed that Scozzafava had dropped out but that her name would still be on the ballot. During that period of time Hoffman led Owens 51-34 with Scozzafava’s share going down to 12%. After Scozzafava announced she was endorsing Owens the remaining Sunday respondents were informed of that and the race showed a little tightening with Hoffman up 52-38 on Owens and Scozzafava’s share dropping to 7%.

If Hoffman was at 51% with Scozzafava running, he’ll almost certainly win.  I’d guess almost all of those supporting the Republican candidate will wind up voting Conservative or staying home.  And I’d guess that, in a race where turnout will be extraordinarily low, Hoffman’s True Believers will be far more likely to actually show up.

But, as Silver says, with so many late-breaking developments, prediction is “nearly impossible.”

UPDATE:  Not shockingly, perhaps, but the WSJ editorial board sums up my thoughts exactly:

The voter revolt ought to be a lesson to the GOP’s backroom boys, especially in New York state, where the old Al D’Amato insider club has led the party to irrelevance. GOP state chairman Joe Mondello, now thankfully retired, and Beltway bigs misjudged public dismay against the Democratic agenda in Washington. Nominating a candidate who “can win” in the Northeast does not have to mean someone whose voting record is more liberal on taxes and unions than that of most Blue Dog Democrats.

But that lesson will be for naught if conservatives conclude that their victory is reason to challenge any candidate who doesn’t agree with them on every issue. The truth is that some conservatives are as bloody-minded and intolerant of all dissent as the hard left is at the Daily Kos. A majority political party requires a far more diverse coalition than the audience for your average right-wing blogger or talk show host. Some of those voices prefer having Democrats in power because it drives up their own ratings.

Democrats did themselves no favors by driving Joe Lieberman out of their party, and conservatives will do their cause no good by forcing GOP candidates in Illinois, California and Connecticut to sound like Tom DeLay. If conservatives now revolt against every GOP candidate who disagrees with them on trade, immigration or abortion, Nancy Pelosi and Harry Reid will keep their majorities for a very long time.

Striking that balance isn’t easy.  But it’s essential.

Ron Rotunda and Peter Pham argue in today’s WaPo that it would violate the Constitution for President Obama to accept the Nobel Peace Prize while in office.

Article I, Section 9, of the Constitution, the emolument clause, clearly stipulates: “And no Person holding any Office of Profit or Trust under them, shall, without the Consent of the Congress, accept of any present, Emolument, Office, or Title, of any kind whatever, from any King, Prince or foreign State.”

The award of the peace prize to a sitting president is not unprecedented. But Theodore Roosevelt and Woodrow Wilson received the honor for their past actions: Roosevelt’s efforts to end the Russo-Japanese War, and Wilson’s work in establishing the League of Nations. Obama’s award is different. It is intended to affect future action. As a member of the Nobel Committee explained, the prize should encourage Obama to meet his goal of nuclear disarmament. It raises important legal questions for the second time in less than 10 months — questions not discussed, much less adequately addressed anywhere else.

[...]

An opinion of the U.S. attorney general advised, in 1902, that “a simple remembrance,” even “if merely a photograph, falls under the inclusion of ‘any present of any kind whatever.’ ” President Clinton’s Office of Legal Counsel, in 1993, reaffirmed the 1902 opinion, and explained that the text of the clause does not limit “its application solely to foreign governments acting as sovereigns.” This opinion went on to say that the emolument clause applies even when the foreign government acts through instrumentalities. Thus the Nobel Prize is an emolument, and a foreign one to boot.

Adam Blickstein argues that this contention is absurd, noting that General H. Norman Schwarzkoft, Fed Chairman Alan Greenspan, and others have accepted knightships and other awards whilst holding offices of trust with no complaint.  But that’s not much of a counter: Maybe nobody noticed before.

More to the point, though, he points to an old Newsmax article reporting Greenspan was in fact challenged on these grounds by Rep. Howard Phillips and wrote back with a note from the Fed’s chief attorney to wit:

Congress gave its consent to the acceptance of certain gifts and decorations in the Foreign Gifts and Decorations Act (originally enacted in 1966). The Act provides as follows:

The Congress consents to the accepting, retaining, and wearing by an employee of a decoration tendered in recognition of active field service in time of combat operations or awarded for other outstanding or unusually meritorious performance, subject to the approval of the employing agency of such employee.

The Act defines “decoration” to include “an order, device, medal, badge, insignia, emblem or award.” The Department of Justice has ruled that an honorary knighthood is an “order” as permitted by the Foreign Gifts and Decorations Act.

Rotunda and Pham do not make their argument out of pique; they quite charitably say Congress should provide their consent.  It turns out, they did so when Obama was five.

A NYT/CBS poll finds that President Obama’s approval remains strong but support for his handling of key policy issues is dipping. The Republicans are not, however, gaining much ground.

At 56 percent, his approval rating is down from earlier in the year but still reasonably strong at this point compared with recent presidents.

More Americans are starting to credit his stimulus package with having helped to revive the economy. And Mr. Obama retains a decided advantage with the American public over Republicans on prominent issues, starting with health care.

The poll found that an intense campaign by Mr. Obama to rally support behind his health care plan — including an address to Congress, a run of television interviews and rallies across the country — appears to have done little to allay concerns. Majorities of respondents said that they were confused about the health care argument and that Mr. Obama had not done a good job in explaining what he was trying to accomplish. [...] But the poll suggests that Mr. Obama is in a decidedly more commanding position than Republicans on this issue as Congressional negotiations move into final stages. Most Americans trust Mr. Obama more than Republicans to make the right decisions on the issue; 76 percent said Republicans had not even laid out a clear health care plan. And by a lopsided margin, respondents said that Mr. Obama and not Republicans had made an effort to cross party lines and strike a deal that has the support of both parties. Two-thirds of respondents said they wanted Congress to come up with a bill supported by both sides.

At the same time, there has been a slip in confidence in Mr. Obama’s handling of the war in Afghanistan. There is tepid support for maintaining troop strength there, much less increasing it, as his top commander in Afghanistan prepares to submit a request for additional forces. A majority of Americans do not want troops there for more than two years.

[...]

The percentage of people who approve of the way he has dealt with Afghanistan has dropped to 44 percent from 56 percent in April. The percentage of Americans who approve of his handling of the economy, at 50 percent, has dropped from 61 percent since April. In April, Mr. Obama had a 43-point advantage over Republicans in terms of who would make the right decisions on the economy; that has dropped to a 26-point advantage. Americans think the economy is on the mend, and there has been a 15-point increase, to 36 percent, in the percentage of Americans who said Mr. Obama’s stimulus package has improved the economy.

Congressional Republicans have an overall favorable rating of 30 percent, within the margin of error of where it has been all year (32, 29, and 28 in the previous surveys) in this poll. Congressional Democrats at at 47 percent which, again, is within the margin of error of where it has been all year (48, 50, and 47 in the previous surveys). So, the decline in Obama’s approval numbers (which are quite consistent with other recent presidents at this point in their first term) isn’t redounding to the benefit of the opposition party.

Republicans are making modest gains on issue areas but are still leagues behind the president. Again, though, that’s pretty typical: A president has to be doing a lousy job, indeed, to fall behind Congress in these things. Congress tends to be viewed with an esteem on par with used car salesmen.

Interestingly, those of us who think Obama is overexposed, making too many public appearances, are in a decided minority (35 percent) with 58 percent saying he’s making “the right number.” Only 4 percent think he’s making too few. (Interestingly, the Obama overexposed and Obama fatigue memes have been around since last summer’s campaign.)

Sam Stein reports that “Democrats are bracing themselves for a new line of conservative attack against a provision in the health care legislation once considered so non-controversial that it was endorsed by several major Republican officials.”  What is it, you might ask, that these dastardly Republicans are opposing out of their racist hatred of Barack Obama?

On Tuesday, Sen. Jon Kyl (R-Ariz.) described the health care legislation being considered by the Senate Finance Committee as a “stunning assault on liberty” due to a provision that would require individuals to buy insurance.  Earlier in the week, the individual mandate also came under attack when Tim Phillips, who heads Americans for Prosperity, described it as an assault on individual liberty. “When you have health care, that’s a choice that impacts yourself,” Phillips told MSNBC’s Hardball. “Drivers’ insurance impacts other drivers you may have accidents with.”

The attacks have confounded Democrats in and out of government, who noted quickly that mandating coverage was, until recently, a relative given when it came to health care reform.  “It’s f–ing ludicrous,” said one health care reform activist, who noted that when Finance Committee Chairman Max Baucus (D-Mont.) asked committee members to air their disagreements with an individual mandate during a meeting on May 5, no one chimed in.

Indeed, for months it was presumed that a relatively ironclad deal was in place: in exchange for the government mandating coverage, private insurance companies would agree to cover individuals with pre-existing conditions. The arrangement was all but blessed by prominent figures from within the GOP ranks. In mid-August, the ranking member of the finance committee, Sen. Chuck Grassley (R-Iowa), announced that the way to get universal coverage is “through an individual mandate.” “That’s individual responsibility,” the senator told Nightly Business Report. “And even Republicans believe in individual responsibility.”

So, Chuck Grassley and at least six other Republicans currently in the Senate support — or at least are willing to sign off on –  a law forcing Americans to buy health insurance.  But that hardly renders it “non-controversial.”

Indeed, this provision was incredibly controversial during last year’s Democratic presidential primaries.   Indeed, only John Edwards and Hillary Clinton supported mandates.  Among those opposing?  Barack Obama and Joe Biden who, as some will recall, went on to win the presidential and vice-presidential nominations, respectively, of the Democratic Party and go on to win election to those offices.

John Judis for The New Republic in June 2007:

Obama’s health care plan, which he announced last week, has been widely criticized by liberals for not making health insurance mandatory. Challenged by Edwards, Obama explained why a mandate is not a cure-all. “If you look at auto insurance, in California there’s mandatory auto insurance,” Obama explained. “Twenty-five percent of the folks don’t have it. The reason is because they can’t afford it. So John and I, we’re not that different in this sense; that I’m committed to starting the process. Everybody who wants it can buy it and it’s affordable. If we have some gaps remaining, we will work on that. You take it from the opposite direction, but you’re still going to have some folks who aren’t insured under your plan, John, because some of them will simply not be able to afford to buy the coverage they’re offered.”

Ron Chusid summarizes the intra-liberal debate on the subject in Liberal Values, February 2008

Paul Krugman continues his vendetta against Barack Obama’s health care plan due to its lack of mandates. The consequence of lacking mandates is unclear as nobody knows for sure how many people would still go without insurance if it was affordable but voluntary, and nobody really knows for sure how many people would remain uninsured despite mandates. It does seem reasonable to assume that achieving near one hundred percent compliance with a mandate would require yet another new bureaucracy and the expenditure of funds which might better be used for actual health care.

There are a variety of views as to whose plan would really insure more people. Robert Reich has argued that more people would wind up being covered under Obama’s plan than Clinton’s.

[...]

Using mandates to achieve universal coverage seems like quite a cop out to me. Regardless of whether the plan is good or the plan stinks, universal coverage is achieved because the government forces you to join up. In contrast Obama takes on the challenge of offering a plan so good that virtually everyone will want to participate to receive health coverage. There is also a clear philosophical difference here in that Obama isn’t obsessed with having every single person sign up. In contrast, a self-proclaimed government junkie like Hillary Clinton just can not live with the fact that somewhere, someone decides they do not want her help. Clinton will help them whether they want her to or not.

I know Clinton supporters will scream that I’m using right wing frames here, but again I must point out that freedom and choice should be considered virtues, not right wing frames. Liberty is what liberalism is ultimately all about, which explains whey Clinton prefers to label herself a progressive and not a liberal.

Some on the far left claim that Democrats lose when these alleged right wing frames about freedom are employed. They got it all wrong. Democrats lose when they concede traditional liberal values such as liberty to the right. If an election is framed so that one side is allowed to be defined as the party of freedom, that party will win virtually every time. Democrats have lost so many elections not because of using right wing frames, but because of conceding values such as freedom to conservatives, even though conservatives talk about freedom without really supporting it.

Ryan Lizza explains why Biden agreed to be Obama’s running mate for The New Yorker in October 2008:

Biden was impressed that Obama’s proposals seemed to be written with an eye toward passage in Congress. (For instance, the lack of a mandate in Obama’s health-care proposal could make the idea more palatable to Republicans.) During the primaries, Biden often played the role of policy grownup, the candidate who liked to chide the unrealistic plans of his rivals.

On July 17th, PoliFact’s Truth-o-Meter awards Obama a full-on flip flop on the issue:

Walk back with us through the mists of time to early 2008, and you might remember then-candidate Barack Obama defending the rights of hard-working people so they would not be forced to buy health insurance.

Obama’s position was different from his two nearest rivals, Hillary Clinton and John Edwards, who included mandates for individuals to buy health insurance in their plans for reform. It was an issue that got downright contentious on the campaign trail.

At a debate in South Carolina, Edwards said Obama’s plan really wasn’t universal health care, since it didn’t have a mandate to ensure everyone was covered.

Obama replied that his plan was universal (a claim we rated Barely True ) and explained why he was against a mandate: “A mandate means that in some fashion, everybody will be forced to buy health insurance. … But I believe the problem is not that folks are trying to avoid getting health care. The problem is they can’t afford it. And that’s why my plan emphasizes lowering costs.”

Obama said at the time it was possible some people would refuse to buy health care under his plan.

“It’s true that some people could game the system by just waiting till they get sick and then they show up,” Obama said. “But keep in mind that my plan also says children will be able to stay on their parents’ plan up until the age of 25. And so I don’t believe that there are a whole bunch of folks out there that will not get coverage. And John, both you and Hillary have a hardship exemption where, if people can’t afford to buy health care, you exempt them so that you sort of don’t count them.”

Now, I don’t much care about the flip-flop.  The debate has moved over the past two years, as has the political make-up of the Congress.  Obama may well have been legitimately persuaded that his best chance of getting what he wants it to accede to a mandate.

But let’s not rewrite history, either.  Forcing Americans to buy health insurance regardless of whether they want it or can afford it is extremely controversial, with not only Republicans but most of the Democratic contenders for the presidency in 2008 opposing it.

UPDATE: Headline of the Day honors go to Bill Quick for “Mandating Change Without Hope.”

Taking a page out of Soloman’s playbook, Congressional Democrats have a brand new plan for passing health care reform.

The White House and Senate Democratic leaders, seeing little chance of bipartisan support for their health-care overhaul, are considering a strategy shift that would break the legislation into two parts and pass the most expensive provisions solely with Democratic votes.

The idea is the latest effort by Democrats to escape the morass caused by delays in Congress, as well as voter discontent crystallized in angry town-hall meetings. Polls suggest the overhaul plans are losing public support, giving Republicans less incentive to go along.

Democrats hope a split-the-bill plan would speed up a vote and help President Barack Obama meet his goal of getting a final measure by year’s end.

Senators on the Finance Committee are pushing ahead with talks on a bipartisan bill. Democratic leaders say they hope those talks succeed but increasingly are preparing for the possibility that they do not.

Now . . . waitaminute.   If the Democrats have the votes to pass the more controversial parts of the bill on their own, why would they take the heat for doing it and then give the Republicans a free pass by allowing them to vote for a pain-free bipartisan bill?

Most legislation in the Senate requires 60 votes to overcome a filibuster, but certain budget-related measures can pass with 51 votes through a parliamentary maneuver called reconciliation.

In recent days, Democratic leaders have concluded they can pack more of their health overhaul plans under this procedure, congressional aides said. They might even be able to include a public insurance plan to compete with private insurers, a key demand of the party’s liberal wing, but that remains uncertain.

Okay, but — again — if they can get these things through via a workaround, why not just keep the bill intact?

Apparently, even people in Barney Frank’s ultra-liberal Massachussets district are afraid and/or angry about ObamaCare. Frank, who has survived revelations of a gay escort service run out of his apartment, is rather confident he’ll be re-elected:

Most Congress members conducting town hall meetings this month have chosen a noncombative posture to deal with angry participants who disrupt the proceedings. Not Rep. Barney Frank.

At a lively two-hour meeting Tuesday night in Dartmouth, Massachusetts, Frank gave as good as he got in confronting opponents of overhauling the nation’s health care system.

The crowded hall had both supporters and detractors, but the opposing side was much louder and more raucous, booing the Massachusetts Democrat from the moment he was introduced and shouting questions and challenges at him throughout.

“You want me to talk about it or do you want to yell?” he asked over and over when interrupted while trying to answer. Continued shouting brought a sterner rebuke. “Disruption never helps your cause,” he said more than once. “It just looks like you’re afraid to have rational discussion.”

While Frank attempted to respond to all questions, he gave up when one woman compared health care proposals favored by Frank and President Obama to policies of Nazi Germany. “When you ask me that question, I’m going to revert to my ethnic heritage and ask you a question: On what planet do you spend most of your time?” Frank asked.

From Larry King:

The folks at FOX can’t understand why Frank was so rude:

A slightly different take from Fox:

Like Will, I’m not among Barney Frank’s biggest fans. And I disagree with him vehemently on the direction we should take our health care system. But the refusal to take obnoxious lunatics seriously is fine by me.

WaPo fashion critic Robin Givhan has irked some conservative bloggers by going after the town hall protesters for being a mite casual in their choice of couture.

By and large, the shouters are dressed in a way that underscores their Average Guy — or Gal — bona fides. They are wearing T-shirts, baseball caps, promotional polo shirts and sundresses with bra straps sliding down their arm. They wear fuchsia bandannas and American-flag hankies wrapped around their skulls like sweatbands. A lot of them look as though they could be attending a sporting event and, as it turns out, the congressman is the opposing player they have decided to heckle. If not for the prohibition on signs and banners inside these meetings, one could well expect to see some of these volatile worker bees wearing face paint and foam fingers, albeit the highlighted digit would be one expressing foul displeasure rather than competitive rank or skill level.

[...]

The common man, in his T-shirt and jeans, is shouting passionately at “the suit.” In the videos from these meetings, audio is unnecessary. It’s clear who’s in charge and who is shouting into the wind.

What would happen if all those unhappy townspeople showed up for these meetings in suit jackets, like high school debaters prepared to take on their opponents with facts and nimble intellect rather than histrionics? Would they garner more respect? Would they compel more lawmakers to rethink their positions rather than merely repeat, again and again — in a voice that has the tone of an impatient kindergarten teacher — the same core points?

[...]

Washington’s power brokers have suited up to underscore their authority and the seriousness of the subject matter. And bully for them. But their attire also says: I am the boss of you. All those howling citizens — in their T-shirts and ball caps and baggy shorts — are saying: No, you’re not.

Glenn Reynolds thinks Givhan is “underscoring the press’s identification with the rulers rather than with the ruled” and observes, “There was a time when journalists were badly-dressed working stiffs, rather than upper-middle-class strivers putting on airs.”

Ann Althouse thinks Givhan is obsessed with men’s suits and wonders why she didn’t write a column about the Beer Summit, where men sat awkwardly in suits drinking beer in the sweltering sun.

Pundette says “Givhan reveals so much contempt for the poorly dressed masses that one wonders whether her chief motive in writing this is to run them down.”  P.J. Gladnick chimes in with “dripping with disdain.” And Fausta Wertz thinks Givhan’s missing the real story behind the protests.

Steve Gilbert points out, “The angry mob just can’t win. One day they are mocked for dressing like Brooks Brothers. And the next we have this.”

And Don Surber notes that Democrats wear t-shirts, too!

Now, I’m far from Robin Givhan’s biggest fan.  She first came to my attention in January 2005 for her post on Dick Cheney’s Auschwitz outfit.  She followed up with commentaries on Condi Rice’s commanding clothes, John Bolton’s hair,  John Roberts’s 1950s family, and Hillary Clinton’s cleavage.  Let’s just say the New Yorker hasn’t come clamoring for her services.  (Although, in fairness, she won a Pulitzer for this stuff!)

But doesn’t she have something of a point here?

Sure, our elected representatives work for us. Accordingly, they wear suits when meeting with us as a sign of respect for their bosses and to demonstrate that they’re serious people worthy of our continued trust.

But we each represent ourselves. How we dress sends signals about sort of people we are.

And this isn’t about social class.  Attorneys and executives are going to dress differently on the job than truck drivers and farmers. Most likely, they’re going to own nicer, more expensive clothes, too.  But just as attorneys shouldn’t wear $1500 suits to a picnic, truck drivers shouldn’t wear sweaty overalls when they’re dining out with their families.

People going to a town hall meeting with their Congressman should dress in a way that shows respect for the occasion, their fellow citizens, and themselves. T-shirts and flip flops are great for sitting around watching TV or grilling burgers in the backyard.  But I change into better attire than that for a trip to the supermarket.

It’s true that reporters were, once upon a time, on the same financial and educational level as cops and teachers and firefighters.   Most likely, their clothes were shabbier in those days.  But I bet they all showed up in suits when they went to City Hall.

Yesterday’s Gallup poll finding that the town hall protests are having the desired effects of gaining sympathy for the protestors and increasing doubts about health care reform efforts is getting a lot of attention.  Those results don’t surprise me, however.  (They do surprise Mickey Kaus.)

What is interesting is this:

Frank Newport:

There is a fair degree of consensus among Democrats, independents, and Republicans about the “shouting down” behavior as described in the survey, with a clear majority of each partisan group saying that this represents an abuse of democracy.

Opinions are more divided on the other two behaviors. For both the “angry attacks” and “booing” behaviors, a majority of Democrats say they are abuses, while a majority of Republicans say they are democracy in action. In both instances, independents are more likely to side with the Republican than with the Democratic position.

The consensus strikes me as exactly right:  shouting down supporters is an abuse of democracy whereas booing politicians is democracy in action.   I’m actually stunned that an overwhelming majority of Democrats think booing a Congressman is an abuse of democracy!  Expressing disapproval of one’s elected representatives is the very essence of the First Amendment.

Bill Maher has a piece at HuffPo arguing that Americans are a bunch of idiots who should just shut up and let people who know what they’re talking about make decisions on tough issues like health care reform.

[T]ake the health care debate we’re presently having: members of Congress have recessed now so they can go home and “listen to their constituents.” An urge they should resist because their constituents don’t know anything. At a recent town-hall meeting in South Carolina, a man stood up and told his Congressman to “keep your government hands off my Medicare,” which is kind of like driving cross country to protest highways.

I’m the bad guy for saying it’s a stupid country, yet polls show that a majority of Americans cannot name a single branch of government, or explain what the Bill of Rights is. 24% could not name the country America fought in the Revolutionary War. More than two-thirds of Americans don’t know what’s in Roe v. Wade. Two-thirds don’t know what the Food and Drug Administration does. Some of this stuff you should be able to pick up simply by being alive. You know, like the way the Slumdog kid knew about cricket.

Not here. Nearly half of Americans don’t know that states have two senators and more than half can’t name their congressman. And among Republican governors, only 30% got their wife’s name right on the first try.

Sarah Palin says she would never apologize for America. Even though a Gallup poll says 18% of Americans think the sun revolves around the earth. No, they’re not stupid. They’re interplanetary mavericks. A third of Republicans believe Obama is not a citizen, and a third of Democrats believe that George Bush had prior knowledge of the 9/11 attacks, which is an absurd sentence because it contains the words “Bush” and “knowledge.”

People bitch and moan about taxes and spending, but they have no idea what their government spends money on. The average voter thinks foreign aid consumes 24% of our federal budget. It’s actually less than 1%. And don’t even ask about cabinet members: seven in ten think Napolitano is a kind of three-flavored ice cream. And last election, a full one-third of voters forgot why they were in the booth, handed out their pants, and asked, “Do you have these in a relaxed-fit?”

And I haven’t even brought up America’s religious beliefs. But here’s one fun fact you can take away: did you know only about half of Americans are aware that Judaism is an older religion than Christianity? That’s right, half of America looks at books called the Old Testament and the New Testament and cannot figure out which one came first.

And these are the idiots we want to weigh in on the minutia of health care policy? Please, this country is like a college chick after two Long Island Iced Teas: we can be talked into anything, like wars, and we can be talked out of anything, like health care. We should forget town halls, and replace them with study halls. There’s a lot of populist anger directed towards Washington, but you know who concerned citizens should be most angry at? Their fellow citizens. “Inside the beltway” thinking may be wrong, but at least it’s thinking, which is more than you can say for what’s going on outside the beltway.

And if you want to call me an elitist for this, I say thank you. Yes, I want decisions made by an elite group of people who know what they’re talking about. That means Obama budget director Peter Orszag, not Sarah Palin.

This rant is so powerful it’s united Dennis the Peasant (aka Kenton E. Kelly, CPA) and Roger L. Simon!

Kelly snarks, “Just ask any progressive. They love ‘the people’. They want to help ‘the people’. They want equality, fraternity, mutual respective and constructive dialog.”

And the meme’s spreading. Greg Sargent reports that Obama chief of staff Rahm Emanuel says Democrats attacking other Democrats are “f-king stupid.”  And president Obama wants people who disagree with him to shut up.

What’s interesting here is that Maher’s largely right on the facts.  We’ve known for decades that people are wildly ignorant about basic facts.  Some of it’s explainable by getting caught off guard or not quite understanding the question.  But anyone who has taught college freshmen knows that even fairly bright folks can be astonishingly ignorant.

It doesn’t follow, however, that people are too stupid to make judgments on issues. People may not be able to answer the question “Name the branches of the U.S. Government” but they probably know that we have a president, a Congress, and courts and have some vague sense that there are checks and balances.  They may not know how much of our budget is spent on foreign aid but they know that they’d rather spend their money at home.  They know that abortion is legal and controversial even if they don’t know the name of the case that made it so or even understand that the Supreme Court is responsible.

The nature of representative democracy is that the people make judgments on broad policy directions and elect people to govern them accordingly.  The details are left to the elected representatives and, increasingly, to unelected bureaucrats with actual subject matter expertise.

To the extent that the public’s misunderstanding of the issues makes it difficult to make changes that presidents and congressmen think are necessary, it is incumbent on these leaders to explain themselves better.  Obama is a fine orator and gets more television time that “Seinfeld” reruns.   If he can’t persuade people to buy what he’s selling, he might need a new product.

Matt Yglesias cites a 15-year-old essay by Hendrick Hertzberg arguing that the filibuster is unconstitutional:

It’s true that the framers did not specify that the Senate would do its normal business by simple majority vote, but that’s because it didn’t occur to them that they had to specify it, any more than it occurred to them to specify that senators should not dunk each other’s powdered wigs in the inkwells. For, as the Supreme Court noted in 1892, “the general rule of all parliamentary bodies” that “when a majority is present, the act of a majority of the quorum is the act of the body…has been the rule for all time.”…. Unfortunately, the Court, which is extremely shy of challenging the internal workings of Congress, is not about to outlaw filibusters.

Matt tends to agree but 1) thinks it’s a good thing that the courts are reluctant to weigh in here; 2)the Senate could fix this if it’s Members wanted to; and 3) it’s members don’t want to because “most senators care more about their personal power and prerogatives than they do about the welfare of the country or the world.”

While I think the widespread use of the filibuster and other supermajority requirements like the Byrd Rule are extraconstitutional, they’re rather clearly not unconstitutional. Why?  Because Article I, Section 5, Clause 2 specifies that “Each House may determine the rules of its proceedings.”  So long as the rules don’t violate other provisions on the Constitution, then, the Senate can run itself however it damn well pleases.  And it does!

UPDATE: Commenter TG Chicago writes, “I’d also be interested to know what you think of the good of the filibuster rather than just the legality of it.”  I’ve written pretty extensively on the topic in the past but most people reading this post likely haven’t read those old posts.

Short answer: I think it’s a good thing if used for truly huge legislation that will have a major impact on the way we govern ourselves and a bad thing if it’s used routinely on even basic legislation.  So, for example, filibustering a total overhaul of the health care system or a $1.3 trillion bailout is fair game but filibustering, say, Cash for Clunkers is not.

Additionally, I disagree with the use of the filibuster on presidential prerogatives, such as judicial and cabinet appointments, where the Senate’s intended role is merely advisory.  With legislation, Congress is the lead actor with a presidential signature as an institutional check.  For appointments, the president is the lead actor with the Senate there to prevent clearly unqualified nominees from getting through.

This map resulting from a Gallup poll on party identification is making the rounds:

The lede from Jeffrey Jone’s write-up:

An analysis of Gallup Poll Daily tracking data from the first six months of 2009 finds Massachusetts to be the most Democratic state in the nation, along with the District of Columbia. Utah and Wyoming are the most Republican states, as they were in 2008. Only four states show a sizeable Republican advantage in party identification, the same number as in 2008. That compares to 29 states plus the District of Columbia with sizeable Democratic advantages, also unchanged from last year.

So, Texas and Mississippi are competitive states?  Alabama is just a smidgen Republican?  And North Carolina and Virginia have gone from competitive Red States to Solid Blue in a matter of months? Does this strike any of you as even remotely plausible?

Jones offers this as a preemptive rebuttal:

Since Obama was inaugurated, not much has changed in the political party landscape at the state level — the Democratic Party continues to hold a solid advantage in party identification in most states and in the nation as a whole. While the size of the Democratic advantage at the national level shrunk in recent months, this has been due to an increase in independent identification rather than an increase in Republican support. That finding is echoed here given that the total number of solid and leaning Republican states remains unchanged from last year. While the Republican Party is still able to compete in elections if they enjoy greater turnout from their supporters or greater support for its candidates from independent voters, the deck is clearly stacked in the Democratic Party’s favor for now.

Now, I don’t doubt for a moment that the last sentence is true.  Democrats have shed their image as a radical Left party and the Republicans are at modern lows after the debacle of the Bush presidency and twelve years in the Congressional majority.   But does anyone really think Mississippi is equally likely to go for Obama as for the Republican nominee in 2012?

I’m not suggesting Gallup is cooking the books here, merely that their questions would seem to be a poor proxy for what we’re trying to capture when we as about party identification.

Ezra Klein and Steve Benen are recirculating this somewhat interesting chart on political polarization in America by political scientists Nolan McCarty, Keith T. Poole, and Howard Rosenthal.

Ezra argues that “this level of polarization makes it virtually impossible to govern in a system that is designed to foil majorities and require a constant three-fifths consensus. It’s not good if the country is virtually impossible to govern.”  Steve says this is especially true when, pace Harold Meyerson, the opposition party “is dominated by Southern neo-Dixiecrats.”

Given this situation, Ezra observes, “Problems don’t stop mounting while we try and figure things out. We could respond to this by making it easier for the majority party to govern and thus less likely that we have some sort of massive crisis that totally realigns our politics.”  He’s not talking about amending the Constitution but rather implementing unspecified rules changes in Congress that would strip power from the minority to get in the way.

Newt Gingrich made a bunch of changes in 1994. Democrats made a bunch of changes in 1975. John F. Kennedy made some big changes in the early 1960s. FDR changed the way Congress worked, and so too did Woodrow Wilson. This isn’t something invented by a bunch of bloggers in the early 21st century.

My recollection of both the Gingrich and post-Watergate reforms is that they were aimed at breaking down the power that came with seniority and to deal with public perception that Members were unduly influenced by outside interests rather than the ability of the opposition party to shape or block legislation.   And I’ve got no idea whatever of what Kennedy did to reform Congress; indeed, I’m not sure how he would have done that from the White House. In the cases of FDR and Wilson, they simply seized power for the presidency during extreme national crises with the acquiescence of Congress.

Regardless, as Thomas Mann and Norman Ornstein document, there have been numerous and nearly-continuous efforts to reform Congressional rules over the years.  And I’d be quite happy, for example, to do away with or seriously limit the use of the filibuster, secret holds, and various other measures which make it easy for the minority to block even relatively minor legislation.  Those are extra-constitutional at best and are not supposed to be used routinely as they now are.

At the same time, however, I disagree with the underlying premise of Ezra and Steve’s complaint.  The fact that we’re more polarized on politics as a nation than we have been in decades, by definition, means that there’s little national consensus.  That’s simply not a time for radical policy changes.  Ramming through unpopular programs in a very polarized nation is a recipe for more polarization.

George W. Bush was re-elected in 2004 along with Republican majorities in both Houses of Congress.  Among the signature programs he ran on was a radical overhaul of the Social Security retirement system that included a private option.   Once we got to the legislative phase, however, and the public saw the actual program rather than an abstract notion, it became decidedly less popular.  And the Democratic minority in Congress was able to block it.   We may well be on the road to the exact same thing happening on health care reform, with the public option failing to catch on for now.

That is how our system is supposed to work.  It’s precisely designed not to allow big change based on a small majority.

Furthermore, the Democrats have a reasonably comfortable margin in both the House and the Senate.  To the extent that they’re failing to get things done, it’s not because “Southern neo-Dixiecrats” in the minority party are using dastardly tricks to foil the popular will but because of fissures within the Democratic coalition.   Which, incidentally, the Republicans faced, too, back when they had the majority.

The nature of putting together a governing coalition in a politically polarized country is that getting over the top requires winning seats in states and districts that are either closely divided or are usually won by the other party.  “Blue dog” Democrats are no more in line with the Progressive wing of their party than the Northeastern Republicans of yore were with the Southern Conservative wing of theirs.