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The Next Step



One of the things a president can do in her final months is to try to get items put on a party’s ongoing agenda. Like this:

President Obama is calling on Congress to “revisit” a public option for Obamacare, citing the lack of health insurance options in some of the law’s marketplaces.

“Based on experience with the [Affordable Care Act], I think Congress should revisit a public plan to compete alongside private insurers in areas of the country where competition is limited,” Obama wrote in an article for the Journal of the American Medical Association published Monday.

 The article marks the first time a sitting president has written for the medical journal, which is considered one of the country’s most prestigious.

The public option push is part of a larger suite of changes that Obama is suggesting legislators and health advocates pursue during his final months in office. And it is one Democrats have increasingly gravitated toward heading into the election. Over the weekend, Hillary Clinton promised to push for a public option if elected — a position that Sen. Bernie Sanders enthusiastically endorsed.


Now he’s mapping out a course that not this Congress, and possibly not the one after that, but one later down the line might follow. As he prepares to leave office, he’s leaving behind both a legacy and a plan to improve it.

Moving the American system towards a more equitable and efficient one comparable to those in other liberal democracies will require action on a number of fronts: expanding Medicare and Medicaid, increasing the regulation and subsidization of private markets, and a public option. The latter is a good one to focus on: it already has substantial support in the Democratic caucus, many of its strongest opponents in the caucus are out of office, and passing it will help with the other issues. It’s not viable in the short term, but it should be right on the radar the next time there’s unified Democratic government.

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  • In other words, another reason to vote for Jill Stein and her VP candidate, Narcissism.

    • Scott Lemieux

      If we want the public option now, we need to throw the election to Trump.

    • Warren Terra

      I believe her VP candidate will be Illjay Einstay. She’ll have a lock on the Pig Latino vote.

  • Craigo

    What committee chairmanship is Zombie Ben Nelson in line for in the next Congress? We have to start planning now.

    • tonycpsu

      Depends on whether Evan Bayh retains his seniority when he returns, dunnit?

      • Craigo

        Remember back when he thought he had a chance of being President?

  • Colin Day

    One of the things a president can do in her final months

    Her? Am I missing something here?

    • Linnaeus

      Yes. Gender-inclusive language.

    • tonycpsu

      We’re in the awkward in-between years between when we realized that using masculine pronouns to represent unspecified gender was sexist and when we become enlightened enough that the singular they is widely acceptable.

      • mikeSchilling

        I knew she was a Kenyan Muslim, but her gender is unspecified too?

        • UserGoogol

          The sentence says “a president,” the current one is obviously the focus of the thread, but the sentence is about presidents in general.

          But yeah singular they.

          • I used “gender neutral” ‘her’ for a long time. I like it in a lot of ways, but you run the risk of misgendering a person who has worked very hard to get away from that pronoun (for example).

            So, I much prefer singular they! Scans nicely, historically rooted, and actually neutral so doesn’t privilege or misgender.

        • sharculese


          I deserve a mention, here.

          • tootmyhorn

            Yeah… You’re the short dude with the really long hair-like a girl, right ;)
            You, the polar bear and the zombie are neck and neck for most frequent self-reference of avatar or handle. So winning! Jenny reference in 3-2-1.

            • Pseudonym

              I feel like you’re unfairly leaving out Twiggy.

          • mds

            There’s a difference between “Gender unspecified” and “GENDERFRAUD.” Blamed if I know what it is, though.

      • demit

        Avoidable in this case by rewording the sentence to “One of the things presidents can do in their final months is…”

  • AMK

    Some of the bigger blue states might have the scale and the resources to fool around with public options to supplement their exchanges in the meantime. No reasons for people in those states to wait on troglodyte America to improve their healthcare….and it would serve as Romneycare-style proof of concept.

    • mds

      Some of the bigger blue states might have the scale and the resources to fool around with public options to supplement their exchanges in the meantime.

      Eh, it might require taxes to go up, even if it reduced total health insurance spending. And this is why even big blue states frequently can’t have nice things.

      Granted, part of the problem with Governer Shumlin’s shot at single-payer was that Vermont isn’t a big blue state. But it still illustrated the phenomenon. “But my taxes will go up!” “Yes, but you and your employer wouldn’t have to pay for health insurance any more, and future costs would be better controlled.” “But … my taxes will go up!” Meanwhile, Connecticut has moved from budgetary crunch to budgetary crunch, essential services keep being cut, but modifying the last tax increase to be actually progressive on rich people as well as everyone else is “off the table.” Can’t have all those Gold Coast fund managers job creators decamping to Shithole, South Carolina, after all.

  • Murc

    One of the things a president can do in her final months is to try to get items put on a party’s ongoing agenda.

    If we’re talking about what Obama is or should be doing in his final months… dude needs to fire up his pardon pen.

    The number of pardons he has issued has been shockingly low for a two-termer. In fact, as of right now only five Presidents have issued fewer pardons than he has, and two of those are William Henry Harrison and James Garfield, who had goose eggs owing to dying early in office. He’s issued less so far than Bush the Elder, and Bush the Elder served only the one term.

    That would be good if our criminal justice system had evolved such that we don’t either wrongly or unjustly convict people anymore, but it hasn’t. It really, seriously hasn’t. Obama isn’t running for anything ever again. Between November and January he should sack up and empty some fucking prisons, is what he should do. Non-violent drug offenders, people who have been horrifically abused by the prison system, etc. He should shoot for five figures, break some goddamn records.

    • CrunchyFrog

      I’d go for a blanket pardon for anything H. Clinton might have done. Yeah, I know, it would be bad optics, etc. etc. So what. No one but us lefties still remembers that GHWB did the same for Reagan’s cabinet, and no one but us lefties is still made about the Ford-Nixon pardon. The benefit is that it heads off all of the House investigations you know they’ll be running with even before her inauguration. And by November 2018 no one except fire-breathing wingnuts will care about it anymore.

      • Murc

        I know this is legal, but it absolutely shouldn’t be. A pardon should require an actual, you know, conviction, not a blanket “anything you might, or might not have done, is totes okay now.”

        Also, frankly, if I were Clinton I would refuse it, because a pardon implies you’ve done something that needs pardoning. She has not.

        It also wouldn’t have any practical effect, I don’t think. The wingers have nothing legal on Clinton, and in the case of potential impeachments, an impeachment isn’t a court of law; “high crimes and misdemeanors” are whatever Congress decides they are.

        The wingers have also smartened up in this regard. I was sure Obama would be impeached, like, dead certain of it. Only they never did.

        • CrunchyFrog

          On your first point, a lot of people made the same comment at the time. That the pardon of Nixon wasn’t valid because it didn’t reference the crimes he was guilty of. However, all charges were dropped, the press accepted it, and now the precedent is established.

          On the second, it would be good optics for Clinton to say she doesn’t accept it, but it would still hold legally.

          The third point I hadn’t thought of, and yes, technically a pardon doesn’t prevent impeachment processes. But this was just a random thought anyway – it’s not like it would happen.

      • witlesschum

        I was born in 1978 and I’m still pissed at that asshole Gerald Ford. But I’m a weirdo.

        • CrunchyFrog

          Like I said, only us lefties. Most of the mainstream now has been co-opted to think it was good idea because it spared the country the turmoil of a trial or something. Similar to how most of the mainstream thinks Bush v Gore was fine because “someone had to decide” or something.

    • bender

      I agree. I hope he has several people drawing up the list right now, and that they know how to keep their mouths shut. Go out with a bang.

      I wonder whether Obama could make a deal with Raul Castro to take all the men languishing in Gitmo because they are ready for release but no country will accept them.

      • LosGatosCA

        I also agree. He could have an extensive list of folks currently serving disproportionate minority drug sentences and commute their sentences to the shorter, ‘fairer’ length.

    • Warren Terra

      The obvious goal for Obama’s use of his pardon power on the way out is not Clinton (terrible idea!) but Manning and Snowden; both have suffered for years, both presumably have no further ability to leak sensitive information (or at least none prevented by keeping them in their current situations), both intended to make us a better country and didn’t intend to hurt anyone. It would be the ultimate Cool President move, and it would spare Clinton the headache of dealing with their situations.

      • GeorgeBurnsWasRight

        The purpose of the Snowden and Manning prosecutions is to be so draconian that other people are afraid to leak classified info. A pardon would be less draconian, so IMO is unlikely to happen.

      • Halloween Jack

        it would spare Clinton the headache of dealing with their situations.

        I’m not seeing that either one of them is really a headache for Obama right now, Oliver Stone’s forthcoming movie notwithstanding. I’d split the difference and urge a pardon for Chelsea Manning.

    • Lurking Canadian

      I am in the middle of a book called The New Jim Crow, that focuses on the phenomenon of mass incarceration. I had the same thought as you. I don’t know if it is within his power, but the ideal NMFTG shot to fire on the way out of Washington would be a blanket pardon (and thus restoration of voting rights) to anyone with a non-violent drug conviction.

      He probably couldn’t do it before the election, lest he ruin Clinton’s chances due to law&border hysteria, but in January…

    • Not necessarily pardons (which he has few) but commutations (which he has many but still not enough) Obama should sign a blanket commutation for 10s of thousands of non-violent drug offenders. It doesn’t have to be a pardon because they are guilty of the crimes they are charged with but many were sentenced to unjustly long sentences. Give them time served and let them out.

  • CrunchyFrog

    In his last two years Obama has sounded like the President a lot of his supporters thought they were getting in 2008. And lest you think that statement is just a whine from an overidealistic dreamer who didn’t understand the realities of politics, well, let me remind you of Velma Hart and her question to Obama in this video:


    It’s clear Obama has learned on the job. I don’t think you’ll ever see him again open negotiations having already conceded major points to the opposition. Or see him make the mistake again of seeing the GOP as “partners”. He’s become a much stronger president, with each 2-year term period being better than the last in terms of his personal performance, and seems to be doing all of the right things to pass on his legacy to Clinton to carry forward. That last point is extremely unusual in US presidential history. It’s more common to see antipathy between a president and his same party successor (whether nominated or actually elected), as we did with Clinton-Gore, Reagan-Bush, Nixon-Ford, LBJ-Humphrey, and Eisenhower-Nixon.

    However, if Obama signs the TPP during the the lame duck session against the clear wishes of his party he – and any Democratic Senator who doesn’t participate in the filibuster – will forever stain his legacy beyond repair.

    • LosGatosCA

      Don’t think there was much antipathy between Nixon-Ford. Nixon had to be pretty grateful for the pardon.

      And ‘stain beyond repair?’ Definite a strike against him, like his educational policy, appointing Repubkicans to the daddy jobs it would be highly disappointing.

      I could see a Garland confirmation for TPP swap which would be a mistake, but politicians (normal ones) like to make deals.

      • CrunchyFrog

        My recollection is that Ford wasn’t taking advice from Nixon and was doing everything he could to distance himself. Similar to what Gore was doing with Clinton. That is, the lack of cooperation came from the successor, as opposed to the predecessor as was the case with Reagan-Bush.

  • Porkman

    Sarah Kliff is usually really good on healthcare stuff but she drops the ball in this article.

    She writes

    In the public option’s place, the health law included “community operated and oriented plans” program. This co-op program gave nonprofits loans to launch new, local health insurance plans. It was often described as “public option lite.”

    In Obamacare’s first year, many of the co-ops offered consumers especially cheap premiums — a seeming sign of success that these new options could bring more affordability to the law’s marketplace.

    But three years later, it’s clear that the co-ops were priced much too low, and many have been unable to cover their members’ pricey medical bills. Half of the co-op plans have gone out of business since they launched in 2014. Just this week, Connecticut’s health marketplace announced its local co-op, HealthyCT, is going out of business.

    The federal government is still working to recoup $1.2 billion in unpaid loans to the co-ops.

    This makes it sound as if the co ops were just poorly run and they died because of their own bad decisions.

    But that’s not the case, they were killed. From Charles Gaba at ACAsignups. http://acasignups.net/15/10/08/my-half-assed-attempt-explain-risk-corridor-brouhaha

    The Affordable Care Act was designed to let early payments out exceed payments in if necessary, the idea being that the government would get to keep any excess payments in but would have to eat the loss on any excess payments out.

    The “Cromnibus” bill, as you may recall, was passed at the last minute in December 2014 as a way of keeping the federal government open for awhile. One of the ugly parts included, insisted upon by the House Republicans, was a provision specific to the ACA’s risk corridor program which prevented the federal government from covering the difference if “winners” came up short. Instead, they were reduced to crossing theif fingers and hoping that payments in would be higher, making it a moot point.

    Unfortunately, that didn’t happen. They only had $362 million come in, but owe $2.87 billion. The U.S. federal government is basically having to dole out “I.O.U.” cards for the $2.5 billion difference, promising to pay the balance next year or the year after…if 2015 and/or 2016 end up resulting in net “profits” for the program.

    Most coops weren’t doing so hot that getting 12 cents on the dollar was something they could weather. So half have folded.

    Now this was great Republican play. They killed the “public option lite” but did it in a sneaky way that disparages the whole idea of a public option and leaves neutral reporters in the dark.

  • Peterr

    To look at the actual JAMA article . . .

    First, by publishing in JAMA Obama is speaking to the medical community on their own turf, on an issue of great importance to them, in their own language. Like just about everything else in JAMA, every claim is footnoted for those inclined to chase down the claims, which you don’t see in the general media. Readers may still disagree with the claims, but like other JAMA authors, Obama is showing his work for peer review.

    Second, he goes right after the GOP. In the “Lessons for Future Policymakers” section at the end, he starts like this:

    While historians will draw their own conclusions about the broader implications of the ACA, I have my own. These lessons learned are not just for posterity: I have put them into practice in both health care policy and other areas of public policy throughout my presidency.

    The first lesson is that any change is difficult, but it is especially difficult in the face of hyperpartisanship. Republicans reversed course and rejected their own ideas once they appeared in the text of a bill that I supported. For example, they supported a fully funded risk-corridor program and a public plan fallback in the Medicare drug benefit in 2003 but opposed them in the ACA. They supported the individual mandate in Massachusetts in 2006 but opposed it in the ACA. They supported the employer mandate in California in 2007 but opposed it in the ACA — and then opposed the administration’s decision to delay it. Moreover, through inadequate funding, opposition to routine technical corrections, excessive oversight, and relentless litigation, Republicans undermined ACA implementation efforts. We could have covered more ground more quickly with cooperation rather than obstruction. It is not obvious that this strategy has paid political dividends for Republicans, but it has clearly come at a cost for the country, most notably for the estimated 4 million Americans left uninsured because they live in GOP-led states that have yet to expand Medicaid. [65]

    Lots to chew on here, but it is clear that Obama is trying to outflank the GOP by his choice of publications and has no problem in laying a lot of the blame for problems on their doorstep.

    I’ll be curious to hear from the docs of my acquaintance how they receive this.

    • Warren Terra

      It’s obvious that Obama’s main plan in publishing in JAMA was to improve his Erdos number, but then he screwed it up by publishing as a monograph instead of with co-authors.

    • CrunchyFrog

      That really is a terrific summary of what happened.

      As far as appealing to doctors, my experience is that doctors are a lot like the population in general. They have a certain number of wingnuts who believe Obama is Satan Hitler and just ignore any facts to the contrary. After that they cover a variety of political views but in general are on board for the need for a better insurance system than the free market insurance-based one that we’ve suffered under and which cost doctors excessive amounts of clerical costs to administer.

  • It’s not viable in the short term, but it should be right on the radar the next time there’s unified Democratic government.

    It’s not viable as long as the Republicans control either side of Congress, that much is true.

    • Warren Terra

      In theory the Public Option could be a small profit maker for the Government and so fiscal hawks should love it!

      … yeah, I don’t think that’ll sway any Republicans, either

      • A fiscal hawk is someone who wants larger military expenditures paid for with huge tax cuts on the wealthy so your example is inapplicable.

  • Lurking Canadian

    Is there anything that can be done at the statutory level to fix the Medicare expansion thing, or is the only hope re-litigation at the SC?

    • mds

      Doing anything at the statutory level would require, well, statutes. So you’d need that unified Democratic Congress. But yes, if Democrats had the power to pass a public option, they would also have the power to fix the Sebelius decision, by abolishing Medicaid and replacing it with an otherwise-identical program that mandated the expansion in exchange for any federal funds.

  • Halloween Jack

    I like the credentials listed in the JAMA article:

    Barack Obama, JD1
    [-] Author Affiliations
    1President of the United States, Washington, DC

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