Super-wonk Keith Hennessy has released a new outlook for health care reform. Read it!

Here's a sample:

It is highly likely the legislative process will continue at least into January.

I am still projecting a 60% chance that a comprehensive bill becomes law this year, but I have shifted some of that 60% from the regular order path to the reconciliation path. By itself I’d never expect the Senate to shift to a reconciliation path after failing to get 60 – Senate-only logic says heck no, and the strain on Reid’s caucus would be too great. But if Democratic leaders are forced to shift away from regular order on a comprehensive bill, I would guess that Speaker Pelosi would push hard for the Senate to use reconciliation to produce a bill more compatible with the House-passed bill rather than dialing back expectations. This puts me at 40% regular order success, 20% reconciliation success, 20% fall back to a narrower bill, and a 20% chance the whole thing implodes. It’s the slow pace and the two intervening recesses that give me hope.

More where that came from here.

Dr. Eric Novak, a spokesman for "Patients First," a grassroots group opposed to Obamacare, rips the Obama administration on H1N1 and Gitmo.

“Vaccinating Guantanamo Detainees ahead of millions of at-risk Americans should serve as a serious warning about the federal government’s ability to follow through on its health care reform promises,” said Novack. “The government has had more than 6 months to prepare for the H1N1 pandemic, and it’s still completely unprepared to effectively manage this public health crisis. The Obama Administration promised up to 120 million vaccine doses by mid-October, and now there are only 16.5 million available in November. With results like these, why should we trust Washington to take over our entire health care system?”

Last week, President Obama declared a national emergency because of the H1N1 virus. What had been a matter of concern, was elevated, in the minds of many, to something that is cause for panic. Citizens across the country have spent hours trying to schedule an appointment for a vaccination. Others have waited in long lines in order to get a shot.

Parents of "at risk" children have been tying up the phone lines of their pediatricians trying to find out who has the vaccine and where they might go to get their kids a shot. Parents in a Milwaukee suburb spent hours in the rain waiting for a shot. A group of concerned mothers from Maryland will be waking their children before dawn Saturday and driving nearly an hour to wait in line for who knows how long -- all in the hopes of scoring one of 800 vaccinations available in a neighboring county. Pediatricians are waking up in the middle of the night after nightmares about a vaccine shortage.

Frustration and anger have been building but there had not been an obvious target for those feelings. That may have changed late Friday afternoon with the news that the Pentagon has offered to give swine flu shots to detainees and Guantanamo Bay, Cuba.

Major Diana Haynie, a spokesman for the Joint Task Force at Gitmo, explained the decision this way.
"Detainees at JTF Guantanamo are considered to be at higher risk and therefore they will be offered the H1N1 vaccination."

Really? Higher risk than who? Pregnant women are six times more likely than others to have a fatal bout of swine flu -- and yet some of them have been unable to get a shot. The shortage is so severe that state and local health officials have been forced to cancel and reschedule vaccination clinics, and to adjust their strategies about who gets a shot and when. According to this article:

The Centers for Disease Control and Prevention lists those at greatest risk of serious illness from swine flu as: pregnant women; healthcare and emergency medical staff who have direct contact with patients; people who live with or provide care for children under 6 months old; children ages 6 months to 4 years; and children 5 to 18 with chronic medical conditions such as asthma and diseases of the heart and liver.

The CDC forgot to list Gitmo detainees. "JTF Guantanamo conducts safe, humane, legal and transparent care and custody of detainees. As such, we must provide detainees the medical care necessary to maintain their health," said the Gitmo spokesman.

So Khalid Sheikh Mohamed, the man who conceived the 9/11 attacks that killed nearly 3000 Americans, is eligible for a swine flu vaccination. But Kristin Bencik, a pediatrician working overtime to treat kids suspected of having swine flu, has chosen to forego a shot so that she is not taking one away from one of her vulnerable patients. And she is really a "higher risk" case -- she's pregnant.

It's worth wondering what effect all of this will have on efforts by Democrats to pass a $1 trillion overhaul of the US health care system.

As Bill Kristol notes:

we're seeing a big government health care program in operation right now--the Obama administration's effort to deal with the swine flu problem. No, come to think of it, it's now the swine flu emergency. Last week, President Obama so legally designated it. How's that test case in government-run emergency care going?

Turn on your local news to find out. You'll see false reassurances, broken promises, rationing which doesn't provide the promised rations, queues lengthening while supplies run out, and lots of bureaucrats explaining just why things aren't working quite as their centrally planned plans had planned.

The swine flu emergency is a foretaste of life under the Pelosi Plan. Surely this spectacle, happening in real time before us, will give even more Democrats pause. Do they really want to be known as the Swine Flu Democrats?

It's a good question. And he asked it before word leaked that the terrorists in Gitmo are eligible to receive those coveted shots while thousands upon thousands of normal American taxpayers cannot get one.

If you thought people were angry in August...

Speaker Nancy Pelosi unveiled the House Democrats' merged health-care bill today. It weighs in at 1,990 pages--you can read them all here. Tevi Troy has compiled a good list of who will be unhappy with the bill here.

The bill purportedly costs just under $900 billion over ten years (though the Democrats haven't released the CBO's "preliminary" score yet; UPDATE: Here's the CBO score; the bill would actually cost over $1 trillion). It will be paid for with a 5.4% surtax on individuals making more than $500,000, a 2.5% tax on medical device manufacturers, up to an 8% payroll tax on businesses with more than $500,000 in payroll that don't provide employees health insurance, "between $125 billion and $150 billion" in cuts for pharmaceutical companies -- "almost twice the $80 billion they agreed to under the White House deal" -- and a $2,500 limit on contributions to tax-exempt health flexible spending accounts.

The bill is also paid for through Medicare "savings" (read: "cuts"). The Democrats claim that the bill would reduce the deficit by $30 billion over 10 years (after that, things look iffy). The problem is that the Democrats assume that Medicare reimbursement rates will be slashed by 20 percent. But House Democrats introduced separate legislation today to eliminate the scheduled Medicare cuts--the so-called "doc fix" bill. So, if you add that bill with the health-care bill, the health-care bill would add more than $200 billion to the deficit, rather than cut $30 billion, over 10 years.

And what do we get in return? A government-run insurance plan or "public option," an expansion of Medicaid to those making 150% of the poverty line, subsidies or "affordability credits" for those making between 150% and 400% of the poverty line, and a raft of coverage restrictions for insurance companies. Best of all, the Washington Post notes that the "insurance industry would face new coverage restrictions," and the bill would "require health plans to allow young adults to remain on their parents' insurance policies until their 27th birthdays." (I'm pleased to know that the Democrats want to extend Ezra Klein's childhood for two more years.)

And, of course, the bill provides coverage for elective abortions for those on the public plan as well as for those who purchase federally subsidized plans. The bill includes the language of the Energy and Commerce committee's Capps amendment.

President Obama said during his health-care address to Congress that "under our plan, no federal dollars will be used to fund abortions." The (false) talking point from the White House is that the Hyde amendment prevents federal-funding of abortions, but in fact that amendment would not apply to the health-care bill.

Pelosi-care is a mess. No wonder the public remains opposed to health care reform.

Donald B. Marron writes: "If Congress enacts a $245 billion doctor fix without paying for it, why should anyone believe it would ultimately allow the payment cuts and tax increases included in the health bills?"

That's just a taste of Marron's excellent blog entry on the "Medicare Doctor Fix" over at E21.

You see, Medicare's payment rates are set to decline by more than 20 percent in 2011, and there's no way Congress is about to let that happen. The various House health care reforms restore the cuts completely at a price tag of $245 billion over ten years. The Baucus bill, according to Marron, has a one-year "patch" for $11 billion. But there's a separate Senate bill, sponsored by Debbie Stabenow, which includes a full restoration at a cost of $247 billion.

As Marron points out, while the White House is adamant that health care reform is "paid for," Stabenow's fix is not. "All $245 billion would thus flow straight into our deficits," he writes.

All of which is reason to be skeptical that the Medicare cuts promised under Sen. Baucus's White-House-approved version of health care reform, along with a health bill that actually "bends the cost curve" of Medicare spending, will ever come to pass.

Side Note: E21 is a great clearing-house for research and commentary related to the economic crisis and the future of American economic policy.

Jeffrey H. Anderson looks at the Census tables and comes up with a surprising figure:

The Census is the source for the much-cited figure of 46 million uninsured. Yet the very same table plainly indicates that 9 million of those are not US citizens. That leaves 37 million uninsured who are Americans.

But there's more. In the same document, the Census also plainly states that "health-insurance coverage is underreported" in its survey. When it cross-checked its survey results with the official Medicaid rolls, it found that 16.9 percent of those on Medicaid had claimed on their Census forms that they were uninsured. That 16.9 percent amounts to 9 million people.

So the actual tally, according to the most authoritative source we have, is just 28 million uninsured citizens (46 million minus 9 million non-citizens, minus 9 million on Medicaid who were falsely recorded as uninsured).

To be more exact, it leaves 28,157,000 uninsured out of a total of 280,209,000. That leaves us with 90 percent of American citizens covered by insurance, according to the Census.

Anderson's "small bill" alternative to Obamacare, which Ross Douthat linked to in his column today, can be found here.

Obamacare will jump over another hurdle today when the Senate Finance Committee passes the Baucus bill with the support (for now) of Republican senator Olympia "When History Calls" Snowe.

But health care reform is still far from a certainty. Baucus's health bill needs to be merged with the Senate HELP Committee's much more liberal version; this new bill needs to pass the Senate; House Speaker Nancy Pelosi needs to merge the three House bills; her new bill needs to pass the House; and, assuming all this happens, the House and Senate bills need to be merged and the final, mutant monster bill must pass both chambers before going to the president. Who knows if -- and when -- that will happen.

CATO's Michael Cannon, for one, doesn't think it will happen at all. The rub, Cannon writes, is that "universal coverage is so expensive that Congress can’t get there without taxing Democrats." New taxes will spur special interest opposition, and "once the shooting starts, industry opposition will sway even Democratic members, because there are physicians and hospitals and employers and insurance-industry employees in every state and congressional district."

Megan McArdle is skeptical:

I think it is more likely is that this thing passes, and fails spectacularly. There are too many moving parts, and if any of them breaks, the whole thing rapidly starts to spin out of control and eat a gigantic hole in the deficit. If it does break, I think that Democrats keep control of Congress just long enough to explain why they keep having to enact whopping new tax increases every few years. Republicans don't need to improve their message. They just have to wait for Democrats to recover their reputation as tax and spend politicians who woefully underpredict the cost of everything they propose.

The old adage from British politics is that "oppositions don't win elections; governments lose elections." And signing legislation that raises taxes on the middle class, that will -- if history is any guide -- raise the price of individual policies, and that the public opposes is certainly one way to lose an election.

AEI's Kevin Hassett looks at the Joint Committee on Taxation's analysis of the "America's Healthy Future Act of 2009" and concludes:

Ostensibly the excise tax is a tax on insurers. But as with other excise taxes (gasoline, cigarettes), the cost would undoubtedly be passed on to the consumer, in the form of more expensive insurance. Or firms might stop offering generous plans and increase wages commensurately, which would also increase tax revenue.

The analysis by the Joint Committee on Taxation concluded that tax payments would indeed rise. And it found that the middle class would be stuck with the tab.

The report projected that the excise tax would raise about $52 billion in 2019. Of that, about $8.9 billion would come from taxpayers with incomes of less than $50,000; about $19.4 billion from taxpayers with incomes between $50,000 and $100,000; and about $17.4 billion from taxpayers with incomes between $100,000 and $200,000.

Add those up, and you see that about 87 percent of the revenue in the original Baucus proposal to finance Obamacare would come from individuals with incomes of less than $200,000.

The funny thing about tax hikes on "the rich" is that the higher such taxes go, the lower the threshold at which one becomes "rich" falls.

More on the tax hikes included in "health care reform" here.

JCT report here.

Change you can believe in?

In his speech to Congress last night, Barack Obama threw a bone to Republicans on tort reform.

Many in this chamber – particularly on the Republican side of the aisle – have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush Administration considered authorizing demonstration projects in individual states to test these issues. It’s a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today.

There are credible estimates that serious tort reform could save the country between $100 and $200 billion annually in wasteful spending, as doctors practice defensive medicine to preempt lawsuits. Trial lawyers are adamantly opposed to any caps on damages and have made fighting tort reform their top priority for years. So tort reform was excluded from Obama's version of health care reform because the trial lawyers would have bitterly opposed it. Here's how former DNC chairman and medical doctor Howard Dean put it in a town hall two weeks ago. "Here’s why tort reform is not in the bill. When you go to pass a really enormous bill like that, the more stuff you put in it, the more enemies you make, right? And the reason that tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers in addition to everyone else they were taking on. And that is the plain and simple truth."

Now Obama says he's going to study the issue. "I am directing my Secretary of Health and Human Services to move forward on this initiative today," he said.

That would be Secretary of Health and Human Services, Kathleen Sebelius, whose resume includes eight years as director of the Kansas Trial Lawyers Association.

So Obama has chosen a former industry lobbyist to run tort reform.

Why are people cynical about health care reform?

David Brooks is absolutely right to recommend that the president (and New York Times readers) check out David Goldhill's essay in the Atlantic on American health care.

Thing is, if the president were to read Goldhill's piece, he'd find it contains substantive, compelling criticisms of the Democrats' approach to health care. The liberal health care consensus "simply do[es] not address the root causes of poor quality and runaway costs," Goldhill writes. Moreover:

The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.

Makes sense to me! Goldhill quotes approvingly from Harvard Business School professor Regina Herzlinger, who also backs a consumer-driven approach and who writes occasionally for National Review.

Then again, since Goldhill and Herzlinger are skeptical about his current plan, Obama may think these reasonable, good-faith critics are just a couple of writers who "use fear to block change."

News that the president will address a joint session of Congress on September 9 brought to mind Fred Barnes's recent piece on Obama-as-salesman:

Between July 20 and July 30, President Obama was a busy man, barely out of the public eye while campaigning furiously for his health care initiative. He did four town hall events, spoke at two hospitals, delivered a radio address, was interviewed on two network TV news shows, and held a prime time press conference--all devoted to promoting his health care plan. On this issue as on no other, Obama personally took his case to the people.

Something else occurred during that time frame. The president's job approval rating fell 9 points, from 61 percent to 52 percent in the Gallup Poll. This was an unusually precipitous decline from which Obama hasn't recovered. In mid-August, after more weeks of barnstorming for his health care program, his approval rating remained in the low 50s. Only Bill Clinton among recent presidents had a lower approval after seven months in office.

For Obama, there's still worse news. Not only has he lost ground, but public support for his health care proposal has collapsed to the point that a majority of Americans prefer no reform at all to his plan. And the more he stumps for it, the less support it attracts. Rather than a peripheral phenomenon, the noisy opposition in congressional town hall meetings turns out to be a reflection of the deep national suspicion of Obamacare.

Read the whole thing, as they say.

Exit question: Is there any reason to think Obama's September 9 speech will stop the trend that Barnes identifies?

Jonathan Cohn has a piece in the new issue of TNR that makes a rather serious allegation. Specifically, Cohn accuses PhRMA (the drug industry group that happened to buy the ad space on the back page of TNR this week) of extortion:

It's the kind of quid pro quo that generally raises eyebrows, as more than one conservative was quick to note: "The press and congressional Dems would have gone nuts if we had tried anything remotely like this," said Tevi Troy, who was a health care official in the Bush administration. And, in fact, a few congressional Democrats have gone nuts. "We have all been focused on the debate in Congress, but perhaps the deal has already been cut," Representative Raul Grijalva, co-chairman of the Congressional Progressive Caucus, told The New York Times, which first broke the story. Beyond Capitol Hill, the reaction from liberals was even harsher. "When an industry gets secret concessions out of the White House in return for a promise to lend the industry's support to a key piece of legislation, we're in big trouble," former Labor Secretary Robert Reich wrote on his blog. "That's called extortion."

Extortion is a harsh word, but not an inaccurate one. By almost any reckoning, the drug industry demanded--and got--a sweetheart deal in exchange for its support.

Did PhRMA extort the President of the United States, or did the President of the United States extort PhRMA? I think Cohn has it backwards. Wikipedia has a pretty good definition of extortion: "'Extortion', outwresting, or exaction is a criminal offense which occurs when a person unlawfully obtains either money, property or services from a person, entity, or institution, through coercion."

So who obtained money, property, or services in this deal? The White House did. Obama obtained $80 billion in savings that he could herald as a major breakthrough in the still struggling effort to keep health care reform deficit neutral. He also obtained financial support for his reforms in the form of advertising to be paid for by PhRMA (and to be produced by Axelrod's own firm). And PhRMA agreed to provide services, too, in the form of lobbying support for the president's efforts.

Extortion is usually associated with organized crime -- mobsters shake down local business in exchange for protection. Obama doesn't wear a fedora, but he does have the power of coercion and he did get the better end of this deal. Indeed, Cohn goes on to say that the government might come back for more money and concessions from PhRMA: "Besides, it's not as if the administration and its allies can't seek more concessions from PhRMA later on--a possibility the White House itself seemed to encourage, after the August Times report, by pointing out that the deal was only about health care reform legislation and not future acts of Congress." So the White House is going to go back to PhRMA to get extorted again? No, of course not. The White House will be going back to squeeze a little more out of an industry that already paid for protection.

When swimming pools opened around Memorial Day, according to the Gallup daily track, President Obama's approval rating stood at 64 percent. Now, as we approach Labor Day and the lifeguards get ready to go off to college, Obama's approval in the Gallup track is 52 percent.

Meanwhile, while Congress in the abstract is never too popular, the Pew poll has congressional favorability at a 24-year-low.

Why the drop-off in support? Sure, Obama's numbers were bound to return to earth at some point; we live in an evenly divided country. Yes, the unemployment rate and the price of gasoline have both risen since Obama took office. And approval ratings are inversely correlated with these numbers.

But the truth is that the president and Congress have spent the entire summer trying to convince the country that (a) a major overhaul of the country's health care system is necessary, and (b) the way to achieve such an overhaul is to increase federal mandates, regulations, and fees while buttressing the insurance-dominated system we have today. Other approaches to the issue have been ignored, and grass-roots opposition to the Democrats' plans has been demonized. Here's how Fouad Ajami put it last week:

... [T]here is joylessness in Mr. Obama. He is a scold, the "Yes we can!" mantra is shallow, and at any rate, it is about the coming to power of a man, and a political class, invested in its own sense of smarts and wisdom, and its right to alter the social contract of the land. In this view, the country had lost its way and the new leader and the political class arrayed around him will bring it back to the right path.

Thus the moment of crisis would become an opportunity to push through a political economy of redistribution and a foreign policy of American penance. The independent voters were the first to break ranks. They hadn't underwritten this fundamental change in the American polity when they cast their votes for Mr. Obama.

Word comes today that Obama may try to hit the reset button. Rather than shift course, however, and focus on jobs and the deficit, it looks like Obama is going to double-down, put forward a health-care plan of his own (one that lacks, according to Mike Allen, a public option), and attempt to strong-arm it through Congress. "I’d be lying to you if I told you I don’t look at polls," White House adviser David Axelrod tells Politico. He may not want to look at the polls at all if Obama continues down this treacherous course.

The House Republican Conference is out with a new document today on the deal between the White House and drug industry group PhRMA announced in June. Though the terms of the deal remain murky, the lobbying association agreed to cut millions in drug costs for seniors in exchange for ... well, a bunch of things, including Obama's promise that he wouldn't use the government to buy drugs directly and thereby bid down the price. PhRMA also agreed to pay for millions of dollars in television advertising in support of Obamacare. Some of the money went to David Axelrod's old firm. Here's the House GOP's thesis:

Even as he campaigned on a platform of change and transparency, an examination of Barack Obama’s
comments during the election—and his actions since taking office—indicates that on both politics and
policy, the President has changed his tune on numerous issues of relevance to the pharmaceutical
industry—perhaps as a result of up to $150 million in drug industry-funded advertisements supporting his government takeover of health care[.]

The whole arrangement gives off the strong odor of cronyism and inside-dealing. No one but the White House and PhRMA seems satisfied with it. You can read left-wing criticism of the deal here and here. The White House spin is here.

We've spent the summer arguing over the big questions about Obamacare: the cost, how much additional government intervention the people are willing to tolerate in the health care sector, who ought to make decisions regarding denial of treatment and end-of-life care, and so on. If the GOP Conference document is any indication, though, it's likely that when Congress returns the Republicans will also train their fire on the method by which Obamacare has been constructed and strong-armed through the Congress. It hasn't been pretty.

Obama yesterday:

"Last year, just about this time, you will recall that the Republicans had just nominated their vice presidential candidate, and everybody was - you know, the media was obsessed with it, and cable was 24 hours a day, and 'Obama's lost his mojo,' and ... You remember that? There's something about August going into September where everybody in Washington gets all we-we-ed up."

NBC's First Read blog today: "The hand-wringing, doubts, and skepticism of August 2008, however, later turned into Obama's decisive seven-point victory in November."

As NBC blogger Mark Murray goes on to note, however, "campaigning - especially when the outgoing president and his party were incredibly unpopular - is much different than governing." You don't say.

The Wall Street Journal editorial board zeroes in on Obama's health care non sequiturs:

So the health-care status quo needs top-to-bottom reform, except for the parts that "you" happen to like. Government won't interfere with patients and their physicians, considering that the new panel of experts who will make decisions intended to reduce tests and treatments doesn't count as government. But Medicare shows that government involvement isn't so bad, aside from the fact that spending is out of control -- and that program needs top-to-bottom reform too.

Read the whole thing, as they say.

I don't know whether Joe Klein believes Rep. Paul Ryan of Wisconsin is a "nihilist" and a "hypocrite" engaged in a "disinformation jihad" aimed at persuading the "tight, white, extremist bubble" that is the GOP to defeat ObamaCare. Still, it might have been a good idea for Klein to have read Ryan's health care reform plan, or the Republican Study Committee proposal, or Michele Bachmann's Health Care Freedom of Choice Act, or the many ideas included in Yuval Levin's latest editorial in THE WEEKLY STANDARD, before he wrote in his new column that "There is no Republican health-care alternative in 2009."

George Stephanopoulos: "Administration officials are thinking about how to use the former First Couple [the Clintons] on the subject they know so much about: health care."

Mark Murray writes at MSNBC.com that yesterday's NBC News / Wall Street Journal poll found that "Americans remain skeptical about White House plans to overhaul the nation's health system." It sure did!

But the poll also finds that "myths endure" concerning pending health care legislation, according to the Journal's Washington Wire. Among these "myths," Susan Davis writes, is the idea that "the overhaul will lead to a 'complete' government takeover of the health care system." Writes Davis: "[T]here is also no actual proposal for that."

Of course there isn't. (Unless you count, you know, John Conyer's HR 676, which imposes "Medicare for all"-style government health care and has 93 cosponsors.)

But the NBC / Journal poll question didn't ask whether respondents thought the bill "was a government takeover of health care." It asked whether the bill "will lead to a government takeover of the health system [my emphasis]." That's a subjective prediction, not a statement of fact.

Some opponents of health care reform believe that the plan - the "public option" in particular - may result in unanticipated outcomes and subsequent government interventions that could crowd out the private insurance market and lead to a system of national health care. This is not an outlandish position. Even Barney Frank has said that the "public option" (which he supports) is "the only way" that "we're going to get to single payer [i.e., government health care]." By the Journal's reasoning, then, Frank is also propagating a "myth," as the House bill does not currently contain provisions for a single-payer system.

The rhetoric of "fact-checking" has allowed journalists to show that a politician's claims or an individual's perceptions may not be true. Which is good. But it has also allowed a lot of journalists to betray partisan biases under the cloak of "truth-telling." Which is not so good.

As the Times and Politico report today, the White House is now backing a unilateral approach to health care reform. How did we reach this impasse? Carl Hulse and Jeff Zeleny report:

Top Democrats said Tuesday that their go-it-alone view was being shaped by what they saw as Republicans’ purposely strident tone against health care legislation during this month’s Congressional recess, as well as remarks by leading Republicans that current proposals were flawed beyond repair.

Translation: It's all the GOP's fault.

But not just the GOP! Here's today's Post story on the intra-Democratic debate on the public option:

"I don't understand why the left of the left has decided that this is their Waterloo," said a senior White House adviser, who spoke on the condition of anonymity. "We've gotten to this point where health care on the left is determined by the breadth of the public option. I don't understand how that has become the measure of whether what we achieve is health-care reform."

"It's a mystifying thing," he added. "We're forgetting why we are in this."

Translation: The left is to blame, too.

Is the White House ever responsible for its political miscalculations?

What Would Rove Do? James Carville took a shot Sunday:

“What about this?,” Carville said Sunday on CNN’s State of the Union, “Suppose they pass a House bill that can get 56 Senate Democrats.” Then, Carville suggested, instead of using reconciliation, a special budgetary maneuver in Senate procedure that frustrate GOP attempts to mount a filibuster, Democrats should call for a vote. “And make [Republicans] filibuster it. But the old kinda way is that they filibuster it and make’em go three weeks and all night and [Democrats] will be there the whole time.

“Then, you say, ‘They’re the people that stopped it. We had a majority of Democrats. We had a good bill. They stopped it.’"

The Democratic strategist also rejected any comparison between the Clinton administration’s failed efforts at health care reform in 1994 and the Obama administration’s efforts now.

Democrats “pulled the plug,” Carville said, on health care reform in August of 1994, just months before the mid-term election where Republicans took control of the House. Now, “this is August of the year before the election,” Carville said.

“Make’em filibuster it and then run against a do-nothing Congress [in 2010],” the former aide to Bill Clinton and longtime ally of both Clintons told CNN’s John King.

That strikes me as ludicrous -- even if Democrats are able to paint Republicans as obstructionist, they still can't explain how Democrats could be so incompetent as to allow the Republicans to obstruct them despite their huge majorities in both chambers. You got outmanuevered by Jim DeMint and that's what you're going to run on? In any case, cynic that I am, I personally have a pretty good idea of a strategy Republicans could pursue over the next four years assuming the Democrats do pass some health care package, which still seems pretty likely despite all the confusion in Washington.

1. Scare the hell out of the American people and run against the health care reform in 2010 and 2012.

2. See above.

That's my whole plan, but I think it could work. Liberals seem to be under the impression that health care reform will be like a new entititlement, and that Republicans will run against it at their own peril -- as was the case with Social Security reform in 2005. And they may be right, but not until this monstrous bill actually goes into effect some time in 2013. Which means that for the next four years, Republicans will be able to say whatever they want about the health care reforms that were passed but won't come into effect for years. Republicans will be able to come up with another "death panel" every week.

The bottom line is that people don't understand Obamacare because it's really complicated (it's now pretty clear that Barack Obama and the Democrats in Congress don't understand their own proposals either, though the CBO keeps sending them helpful notes explaining things). That confusion has helped Republicans over the past few months as they fight to kill the bill, but if Democrats do pass something, people will still be confused. It would be political malpractice if Republicans didn't exploit that confusion and use it to find their way out of the wilderness.

Let's play Count the Clichés! Today's subject is Democratic strategist Bruce Reed, who writes in Slate that "[h]ealth care reform remains a good bet."

Why? Well, because (a) Ezra Klein says so, and (b) "virtually all Democrats in Congress want to get health care reform done." If only it were that easy.

The real reason to read the post, however, is to try to spot all the clichés, partisan boilerplate, silly phrasing, and mixed metaphors contained therein. Here are the ones I found. If you spot some more, send them in!

(1) "Recess is war by other means."

(2) "As grass-roots armies have marched into battle at town meetings and shopping malls across the country, fake troops sometimes get in the way of real ones."

(3) "Health care has always been the Middle East of domestic policy, and after the lulling calm of six months of relative ceasefire, all this renewed fighting has left some proponents a little shell-shocked."

(4) "If health reform were a baseball team, it would be the Chicago Cubs—coming up short so many times that even its most devoted fans assume every bad bounce is the beginning of another season-ending swoon."

(5) "[T]he political hay-making in town halls and the legislative sausage-making that preceded it obscure a deeper consensus."

(6) "Down the stretch, Democrats still need to close the deal on health care—and the president was right to hit the stump and recognize that the cacophony in Congress can't win the debate for him." (This one is my personal favorite.)

(7) "Obama's strategy has been not to draw lines in the sand or make the perfect the enemy of the good."

(8) "Health care reform will survive the recess to end all recesses—and in a long war that has claimed as many casualties as health care, that's a victory in itself."

For what it's worth, I'm increasingly in agreement with Rich Lowry, who writes today that "[i]t’s not inconceivable that the entire effort [i.e., health care reform] could collapse." Barring that, we are more likely to see Obama sign a bill imposing federal regulations on insurance companies and increasing subsidies for lower-middle-class families than we are to see him sign a drastic reconfiguration of the American health insurance system that includes a massive new entitlement in the form of a "public option."

Politico reports that liberals are in "full revolt" against White House signals that the so-called "public option" is negotiable. Bob Herbert - yes, Bob Herbert - has an angry column in today's Times in which he writes that the White House has been "rolled" and that the emerging Obama health reform leaves the "public interest ... behind." In the Post, Eugene Robinson - yes, Eugene Robinson - writes that "we didn't elect Obama to be an expedient president. We elected him to be a great one." (Speak for yourself, Gene.) Unbelievably, Jon Stewart is also mad at the president.

The public option controversy exposes a flaw in the liberal agenda. Liberals viewed the 2008 election as an affirmation of their program rather than a repudiation of Bush's (and by extension McCain's). In order for liberals to implement their program, however, they require the support of people who do not attend Netroots Nation or read The Nation. But most Americans, as today's Robert Wood Johnson Foundation poll reveals, are satisfied with the health care they receive from America's hybrid public-private system, and do not support a major government overhaul of such. Indeed, as Arthur Brooks argues in today's Journal, "There is no evidence that more than a minority of Americans accept the idea that a $17 trillion national debt, greater reliance on government for jobs and health, and hyper-progressive taxation offer the hope they deserve for themselves and their children."

The flaw is that, as some liberal policy leaders -- i.e., the Democrats who represent more than gerry-mandered Congressional Districts or one-party Democratic states such as New York -- bend to satisfy what Brooks calls the "independent, optimistic" culture of "most Americans," most liberal opinion leaders become increasingly dissatisfied and subject to revolt. For the very reason that they mistakenly believe that on November 4, 2008, the public embraced the "progressive agenda" hammered out every year at the Take Back America conference, those thought leaders have an outsized confidence about the strength of their position. An excessive pride. The type of thing, in other words, that goeth before the fall.

The primary Democratic response to criticism of ObamaCare has been to attack the motives, intelligence, and good faith of the people making the criticism. One of the most common tactics is to highlight those instances when a voter seemingly betrays his or her ignorance of the fact that Medicare is a government program. Here's Obama on July 28:

And I got a letter the other day from a woman; she said, I don't want government-run health care, I don't want socialized medicine, and don't touch my Medicare. [Laughter.] And I wanted to say, well, I mean, that's what Medicare is, is it's a government-run health care plan that people are very happy with. But I think that we've been so accustomed to hearing those phrases that sometimes we can't sort out the myth from the reality.

Here's GOP Rep. Robert Inglis of South Carolina in the Washington Post that same day:

The reaction to Democratic proposals has been strong, too. At a recent town-hall meeting in suburban Simpsonville, a man stood up and told Rep. Robert Inglis (R-S.C.) to 'keep your government hands off my Medicare.'

'I had to politely explain that, "Actually, sir, your health care is being provided by the government,"' Inglis recalled. 'But he wasn't having any of it.'

And so it goes. Paul Krugman: "Medicare is highly popular, as evidenced by the tendency of town-hall protesters to demand that the government keep its hands off the program."

As Bill Kristol noted when Obama first brought up his correspondent's letter, "This may once have really happened, but it’s been recycled endlessly in recent years as a liberal talking point about the ignorance of the American people and their silliness in resisting new big government health care schemes." We first started hearing these stories during the fight over Clinton's health care bill in 1993.

It's certainly true that plenty of Americans know things that are not so - 53 percent of the electorate voted for Obama, after all - and that many of them may believe incorrectly that Medicare is not a government program.

But is it actually that silly to tell your elected representatives to "keep their government hands off" Medicare? Precisely because Medicare is a government program, it is subject solely to the "hands" of politicians, who can wreak a lot of havoc - by cutting benefits or not covering certain treatments, say - as well as do good (occasionally). When people make this argument - and they probably don't make it as often as is commonly accepted - they really are saying that they are comfortable with existing arrangements, and don't want Washington messing around with things. Not a bad instinct to have. And one that has led to ObamaCare's current impasse.

P.S. Ramesh Ponnuru made similar arguments a while back in this post

Last week, an article in the New York Times laid out the background details of the deal between the White House and the pharmaceutical industry -- or at least its representative in Washington, former congressman Billy Tauzin. In short, the drug companies promised $80 billion in "savings" and the White House promised not to go after more. (And, as a bonus, or maybe just a lucky coincidence, the pharmaceutical industry plans to run $150 million in ads supporting of health care reform and has not actively fought the "public option" desired by the White House.)

Pressed by industry lobbyists, White House officials on Wednesday assured drug makers that the administration stood by a behind-the-scenes deal to block any Congressional effort to extract cost savings from them beyond an agreed-upon $80 billion...

“We were assured: ‘We need somebody to come in first. If you come in first, you will have a rock-solid deal,’ ” Billy Tauzin, the former Republican House member from Louisiana who now leads the pharmaceutical trade group, said Wednesday. “Who is ever going to go into a deal with the White House again if they don’t keep their word? You are just going to duke it out instead.”

So, is it a "rock-solid deal?" Here is what President Obama said yesterday in New Hampshire:

Now, in terms of savings for you as a Medicare recipient, the biggest one is on prescription drugs, because the prescription drug companies have already said that they would be willing to put up $80 billion in rebates for prescription drugs as part of a health care reform package.

Now, we may be able to get even more than that. But think about it. When the prescription drug plan was passed, Medicare Part D, they decided they weren't going to negotiate with the drug companies for the cheapest available price on drugs. And as a consequence, seniors are way over-paying -- there's that big doughnut hole that forces them to go out of pocket. You say you take a lot of medications; that means that doughnut hole is always something that's looming out there for you. If we can cut that doughnut hole in half, that's money directly out of your pocket. And that's one of the reasons that AARP is so supportive, because they see this as a way of potentially saving seniors a lot of money on prescription drugs.

Maybe not so "rock-solid?"

UPDATE: Jake Tapper looked at the same issue this morning, before I did. He comes to the same conclusion and adds that a PHRMA spokesman says Obama's language "clearly it creates a little teeth-gnashing" among their members. (H/T Rich Lowry).

The Heritage Foundation's Nina Owcharenko looks at the details of the Senate HELP Committee's work on health care legislation. She reports that the committee voted on a party-line basis to defeat an amendment offered by Senator Tom Coburn that would have ensured health care money went to health care.

She writes:

The legislation offers only broad guidelines as to where the money can go and does not limit the size of the grant. Sen. Tom Coburn (R., Okla.) offered an amendment that would prohibit the use of grant money to build and maintain sidewalks, parks, bike paths, or street lights. Other federal programs already direct money toward these projects. Dollars designated for improving the health-care system, Coburn argued, could be spent on far more constructive areas, such as increasing access to health care. Remarkably, Coburn’s amendment failed on a straight party-line vote, meaning taxpayers’ hard-earned dollars can wastefully go towards projects that are already funded by the federal government.

It wasn't Iraq. It's not Afghanistan - at least for an increasing number of them. And the Global War on Terror doesn't exist anymore.

There's a new enemy: You. At least if you oppose government-run health care and speak up at town hall meetings.

"The war's on," Representative Baron Hill (D-IN) told the Indianapolis Star. And his opponents are "political terrorists."

Hill is not holding town hall meetings. Why? “I’m trying to control the event,” Hill said. “What I don’t want to do is create an opportunity for the people who are political terrorists to blow up the meeting and not try to answer thoughtful questions.”

Hill is not alone. Steny Hoyer and Nancy Pelosi believe that "drowning out opposing views is simply un-American." Just like Democrats argued when they condemned unruly Iraq War protesters.