The big political problem with health care, I think, is that on the one hand pushing for major cost-savings is a more “moderate” policy goal than is just expanding coverage. But on the other hand, pushing for less reform is also more “moderate” than pushing for more reform. But the nature of the current health care system in the United States is that you achieve more savings by pushing more reform; by becoming less moderate and more radical. Thus, as Steven Pearlstein writes in today’s Washington Post if the Blue Dogs are really concerned that the draft House legislation doesn’t do enough to control cost growth they ought to be pushing for more outside-the-box ideas, not just carping around the margins:

A better vehicle would be the new government-run insurance option that has become a political must-have for House leaders and President Obama. In return for dropping their opposition to such a “public option,” the Blue Dogs could have insisted that it not be structured as a fee-for-service plan along the lines of Medicare but rather offer services through a network of high-quality, lower-cost hospitals and clinics that use teams of salaried doctors to provide coordinated care, along the lines of the Mayo and Cleveland clinics that Obama is always touting. In a competitive market, the success of such a government-run plan would force other insurers to follow suit.

That’s a good idea! Pearlstein concludes:

The problem with the Blue Dogs is that they tend to confuse centrism with splitting the difference between the warring camps, or making policy by choosing one from Column A and one from Column B. The more effective centrists use their political leverage to create a Column C.

Maybe that’s the problem, or maybe the problem is that the Blue Dogs are busy raking in health care, financial services, and energy sector corporate cash. After all, in addition to difference-splitting or column-grabbing, one thing you can do with your pivotal position in a legislature is block reform in exchange for money from interested parties. You hear a lot about Blue Dogs coming from “conservative rural districts” but it’s not as if major financial services firms are wildly popular among rural conservative voters.

Fun with congressional procedure as House Republicans find a way to bring legislative action to a halt in order to clear room in the schedule for Representative John Boehner (R-OH) to make it to a “beach party” fundraiser at Cantina Marina down by the Southwest Waterfront:

C-SPAN viewers who tuned in to watch the late-running House votes at around 6:30 p.m. were treated to an odd sight. Rep. Darrell Issa (R-Calif.) insisted that the clerk read an unusually long 55-page motion to recommit aloud — a process that took an excruciating 40 minutes, halting House business.

Squirmy Democrats began wondering what was going on. Soon an aide pulled up a blog post reporting that Minority Leader John Boehner (R-Ohio) had scheduled a 6 p.m. “Beach Party” fundraiser — at $250-$5,000 a head — at DC’s waterfront Cantina Marina.

Boehner’s spokesman denies that the scheduling of a massive procedural delay at the exact same time as the fundraiser had anything to do with the fundraiser. Rather, “We forced the reading of the MTR to protest the un-democratic rules the Democratic Leadership is insisting on for the appropriations process, which do not allow Republicans the opportunity to step in the way of their out-of-control spending spree.” But protest or no, the fact remains that they could have organized this stunt at all kinds of different times, but instead they scheduled the protest to coincide with the fundraiser.

The Sunlight Foundation’s Political Party Time website is a pretty neat resource. You can read about how the fact that the House Energy and Commerce Committee’s “Blue Dog” Democrats insisted on slowing down the markup process didn’t just make it more likely that tens of millions of Americans will lack adequate health insurance for years to come, it also prevented Blue Dog members from needing to work nights this week thus freeing up valuable opportunities to rake in special interest cash at fundraising parties.

One thing that’s clear from reading today’s news is that Representative Mike Ross (D-AR) is very upset about the House health care bill and is planning to lead a bloc of Blue Dog Dems on the Energy & Commerce Committee to vote against it unless major changes happen. It’s also clear that said bloc is in fact large enough to join with the Republicans and kill reform. What’s not at all clear is what exactly Ross’ objections are. CNN’s report says Ross “didn’t give details on changes the Blue Dogs want.” Politico’s report, likewise, has no information about what Ross actually wants to see happen. He just says there should be “drastic changes.”

Fortunately, thanks to the internet I can sit here in DC and read Arkansas News’ coverage where they have more actual information about Rep Ross’s moment in the sun. Apparently these are the key bullets:

— The cost of health care reform, both for the explosion in the deficit they fear and the dearth of real savings for consumers they also fear.

— Whether to have a public plan and if so, how to design it. The Blue Dogs prefer it as a trigger if cost-reduction targets aren’t met and they do not want a reimbursement schedule like Medicare’s, which is less for rural areas. Actually, they want to change the Medicare schedule. The bill as written gives them a study commission, probably a mere brush-off. Is there a contradiction in the Blue Dogs, worrying about costs and then trying to jack up Medicare? Sure.

— Employer mandates, either to provide health care to employees or pay a fee. The Blue Dogs like the exemption for small businesses. But they don’t think it goes high enough in terms of payroll and employees. They want to expand it.

— And there’s the whole respect thing, with the Blue Dogs tired of being forced left by Pelosi while the Senate goes a more moderate way.

In other words, they’re concerned that the bill (a) costs too much overall and (b) will increase the deficit. And their proposed solutions to this are to (a) increase the cost of the bill by neutering the public plan and (b) decrease the quantity of revenue by fiddling with the employer mandate. Under the circumstances, it’s no wonder that Ross didn’t want to go into detail with CNN about how he’d propose changing the bill. Maybe Harry Potter knows a spell that could untie this mess of contradictions.

The health reform debate would be a lot simpler if the kind of center-of-center politicians inclined to worry about spending too much money were also inclined to support the kind of government intervention into the health care system that’s likely to reduce health care costs. But instead, the left finds itself needing to argue both sides of the issue against forces of the status quo who both object to the cost of giving people health care and object to cost-saving measures like a robust public plan. And the House Blue Dog Caucus is no exception judging by their latest letter on health reform. As Igor Volsky explains “the letter contains an inherent contradiction”

[T]he Blue Dogs want to find more savings within the system — they’re asking for Delivery System Reforms and “maximizing the value of our health care dollar” — but they’re also asking the bill to spend more on rural health and physician reimbursement. And, they are reluctant to support any legislation that moves us towards that goal, causes providers to lose revenue or regulates the system to improve efficiency.

Consider their objection to a “Medicare-like” public option that reimburses providers 5 to 10 percent above Medicare rates. According to MedPAC, Medicare rates are adequate and consistent with the efficient delivery of services. In fact, over-payments by private insurers to health-care providers drives up overall costs. “Hospitals which didn’t rely on high payment rates from private insurers ‘are able, in fact, to control their costs and reduce their costs when they need to’ and ‘combine low costs with quality,’” Glenn Hackbarth, the chairman of MedPAC, said during recent testimony in front of the House Ways and Means Committee. Moreover, if the public plan pays bloated market rates, it will fail to offer lower premiums within the Exchange, and would cause the government to spend more money on subsidies.

You don’t save money by magic. You save money by spending less money. You can do that by just letting a large and growing number of people go without adequate health care. Or else you can do that by spending less money on overpayments, inefficient processes, and unnecessary treatments. But you can’t do that without taking a bite out of someone’s bottom line. The Blue Dogs seem to be looking for a free lunch, or else just grasping at straws for reasons to object to the bill.

To her credit, I saw Lorretta Sanchez (D-CA) talking about this on MSNBC earlier. She’s a Blue Dog but she explained that she didn’t sign the letter specifically because she sees the public option that the letter objects to as a big part of the solution to the cost issues. That’s a correct and coherent stance, the rest of the caucus might want to listen to her.

Yesterday, the House Blue Dog bloc came out with a statement on the idea of a public option in health care reform. It’s supportive but not really, as per these bullet points from Igor Volsky:

— The plan would not disrupt the ability of families to keep their health care coverage and see their doctor.

- Medicare payment rates should not be used as the basis for reimbursement.

- The public health care option would be financially stable, and that it be employed only in the absence of adequate competition and cost containment.

So the first point here is basically a red herring, but the Blue Dogs are welcome to this “concession” since nobody’s proposing anything different. The third point actually contains two different points. The point about financial stability, if I understand it, is a solid fiscal conservative argument that the public option should need to be able to float on its own bottom and finance itself out of the same premiums and subsidies that private plans work with, rather than tapping extra tax dollars. The second half of point three is this trigger business.

But it’s really point two that’s sort of at the core here. A big part of the appeal of the public plan is precisely that it would use Medicare payment rates or else Medicare-esque rates. The idea is that this would produce a plan that’s cheaper. At that point, in order to stay in business private insurance companies would either need to find ways to get costs down to Medicare-esque levels or else find ways to deliver a demonstrably higher level of quality. Now insurance companies don’t like this idea. Not, I should say, because they’re possessed by evil spirits. But because a big part of what businessmen do in the political arena is try to get the government to shelter them from competition. What progressives are pushing for in this case is for the government to create additional competition. Insurance firms don’t want that. And what the Blue Dogs are talking about here is a way to cripple the public plan’s ability to compete effectively.

There are some arguments out there for doing this on the merits. But it’s important to keep in mind that those most certainly aren’t fiscal conservative argument. If you want to expand access to affordable health care, but you’re also concerned about deficits, then clearly the best way to expand access is to ensure the existence of a low-cost public option using Medicare reimbursement rates. Both the trigger mechanism and the prohibition on using Medicare rates are “moderate” ideas, but they’re not ideas that promote the coal of fiscal austerity. They do the reverse. Which is fine. Politicians don’t need to make austerity priority number one at all times. But this reality ought to be an important part of the context as this debate plays out. Blue Dogs are basically saying they want to put aside one of our best available tools for cost control, while progressive members are fighting for measures that will keep total outlays in check.