Wednesday, February 17, 2010


Greg Sargent reports that House and Senate (and presumably White House) Dems are getting close to an agreement on a single health care bill, although details are scarce and what's there seems, to me at least, problematic (could they really use reconciliation to expand the exchanges the House-friendly national version?).

Regardless, I have one piece of advice to the Democrats as they close in on a final bill: fully close the donut hole, effective ASAP.  Don't worry if it pushes the cost over whatever arbitrary limit that you've been working with, or if it hurts the deficit projection, or if it means that you have to tweak taxes a little bit higher in order to do it, or even whether it's good policy or not.  This is a just an enormous political opportunity.  Seniors vote, and fully closing the donut hole will give them skin in the game, immediately.  Seniors have been the most skeptical group of health care reform (at least of those groups that could possibly support it -- that is, excluding serious conservatives and partisan Republicans), and I'm pretty convinced that this one provision alone would make a significant difference in their views on the issue, which in turn would have a real effect on overall polling on health care reform.  And my sense on this one is that to get the effect, the Dems should go in whole hog; halfway measures won't do the job, politically. 

Yes, there are other measures that take effect immediately, but many of them are either obscure, or limited in who they help.  For example, ending rescissions  is substantively a big deal and politically a great issue to bring up if your goal is to demonize insurance companies and convince people of the need for reform...but no one is going to vote for Democrats this year because they think that if only the health care bill hadn't passed, their insurance company might have found some excuse to not pay up had they encountered a serious medical problem sometime after the bill became law.

No, in the short term, the biggest bang in the largest swing population of voters is the donut hole.  If Democrats are smart, that's where they'll go.

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