If the fight over health care reform has proven anything, it's just how broken our system has become -- from the crippling influence of money on our politics to the way the modern misuse of the filibuster has taken away the power of the duly elected majority and handed it to a handful of bought-and-paid-for senators (yes, I'm talking about you Joe Lieberman).
This disturbing and destructive state of affairs has created a country that is, in the words of Tom Friedman, "only able to produce 'suboptimal' responses to its biggest problems."
And that's where we find ourselves on health care as we head towards the legislative end game. The big optimal solutions have all been gutted -- and we are left to pick through the patchwork of suboptimal ones.
What makes this exercise harder is that the details seem to change form more frequently than the characters in Twilight. At the moment, and while we are waiting for the latest CBO score, "the whole town," as Mike Allen puts it, "is talking about a proposal that few have seen, and none understand."
One by one, Congressional leaders who said they would not support a bill without a public option have come to the conclusion that, on second (or third or fourth) thought, they actually will. Leaving aside what this does to the already tattered trust the public has in their representatives, is a progressively watered-down public option preferable to a Medicare expansion combined with a national non-profit insurance plan similar to the one offered to federal employees, regulated by the Office of Personnel Management?
Bernie Sanders, one of the leading advocates of the public option, is now arguing that these proposals combined "may be stronger than the very weak public options that both the House and the Senate have already passed."
Jacob Hacker, the godfather of the original public option concept, also approves of the proposed expansion of Medicare, calling it an "enormous positive development."
Of course, expanding Medicare by allowing those 55 to 64 to buy into the program won't be subsidized for the first three years and therefore may end up being prohibitively expensive, especially if it ends up being an expansion of Medicare not tied to Medicare rates.
Amidst the tea leaf reading and jockeying for political position (at least among Democrats; Republicans are united in their commitment to kill reform) it's important not to lose track of the things that absolutely have to be included in any health care bill for it to deliver reform in more than name only.
It has to expand access to include as many of the 46 million uninsured Americans as possible. Both the House version and the current incarnation of the Senate bill go a long way to meeting this goal.
It has to create competition and reduce costs. In the end, it doesn't matter if this is accomplished by creating a government-run non-profit insurance provider (the so-called "public option") or by adopting a national privately run system that is heavily regulated by the federal government, and allowing those 55 to 64 the "option" of buying into the Medicare program. It's not the label we give these that matters, it's the end result: competition and cost reduction. The current bill mandates that most Americans get insurance coverage, creating 30 million new customers for the insurance industry. These new customers have to have options -- especially less expensive options -- or this will be a massive windfall for insurance companies.
The best way to provide more choices for consumers is through the latest incarnation of Sen. Ron Wyden's Free Choice Act, which he is offering as an amendment to the health care bill. The provision would give employees the ability to choose their own insurance plans within the insurance exchange -- instead of having to accept the plan chosen by their employer, as is the case in the bill Harry Reid brought to the floor of the Senate.
To qualify as real reform, the bill also needs to give Congress the ability to negotiate with the drug companies over Medicare prescription drug prices. The White House cut a deal with PhRMA taking away this ability to negotiate. That agreement is still part of the Senate bill but not part of the House bill -- and should not survive the conference process.
And, knowing how quickly things can get slipped into bills, or carved out of bills, in the dark of night, we have to ensure that the positive elements of the current bill don't suddenly vanish -- especially the provisions that keep insurance companies from denying people coverage on the basis of pre-existing conditions or dropping customers when they actually become sick.
If the final bill contains all these elements, it will be a suboptimal solution worth supporting.
Then we can move on to the business of fixing our broken system, so we can get back to being a country able to produce optimal responses to our biggest problems.
December 11, 2009
November 25, 2009
Sorting Blinks From Winks In The Copenhagen End Game
In the world of military intelligence, much time is spent trying to distinguish "blinks" -- unpremeditated random actions -- from "winks" -- deliberate moves designed to communicate intent and draw out a response. The climate change negotiations have now entered a phase where a team of tame "spooks" is needed by anybody trying to make sense of the myriad messages emerging from the hectic schedule of pre-Copenhagen meetings.
The APEC Summit saw confident headlines that the US and China had agreed to a Danish proposal to make the Copenhagen outcome non-legally binding. On closer examination these reports came from a US press conference following an informal Heads breakfast. Meanwhile the real US-China Summit two days later agreed that both countries are "striving for final legal agreement" at Copenhagen, and the Chinese confirmed they are still "studying" the Danish proposal. A "Pre-COP" Ministerial meeting held in parallel in Copenhagen showed a range of conflicting messages from countries; with Saudi Arabia defending the Kyoto Protocol, some developing countries backing a new single negotiating process but a strong push from Brazil and others to maintain a legally binding Copenhagen outcome.
Even the US seems unclear what it wants: on the one hand, Obama is promoting an agreement at Copenhagen which has "immediate operational effect", but his lead negotiator is discussing a mid-year deadline for completing a treaty. Of course, these outcomes need not be mutually exclusive, but in the fevered atmosphere of the end game confusion is predictably interpreted as conspiracy.
This is damaging to the negotiations. The APEC story drowned out the positive announcements of new mitigation commitments by Brazil and South Korea. It also markedly increased the already high level of distrust between countries. Conversations in the negotiating corridors increasingly circle round what these events imply about the motivations of the main players. Is the US Administration acting in good faith but hamstrung by a hostile Congress? Or is there a subtle strategy to neuter the international regime and avoid pressure to increase US commitments? Will China align with its traditional allies in the G77? And if so, can it support the proposals from the industrialized countries? Will India stick with its oft-quoted red lines, or are these merely negotiating chips to be relinquished in return for new finance? The inability to sort blinks from winks - and conspiracy from confusion - makes countries fearful of making the bold diplomatic moves needed to make Copenhagen a success. It also fuels an increasingly pessimistic media cycle and undermines public faith in the effectiveness of the international negotiations.
This is the wrong way to approach the climate change process. We are not back in the Cold War trying to determine the aggressive intent of a declared and secretive enemy. Copenhagen is a multi-polar negotiation between highly interdependent countries who are aiming to preserve their mutual climate security. It is not a game any one nation can win, but it is one we can all lose.
Stripping away the confusion the underlying dynamics of the Copenhagen end-game are rather more straightforward:
There is no credible alternative to a legally binding international agreement to limit global climate change below 2°C; any "bottom-up" system of country pledges will always fail to drive the necessary scale and pace of reductions as it does not help countries take on domestic interest lobbies.
The US will not accept a binding target unless China and India also agree to be bound to commitments that are internationally verifiable.
But China will not commit to decarbonise its economy unless the US accepts a binding and ambitious emissions reduction target.
The majority of developing countries will not agree to any new framework unless it binds developed nations and contains significant new medium term public finance for adaptation, forestry and clean energy.
Europe and Japan - who have met their reduction commitments under the binding Kyoto Protocol - can only accept the weak US commitments which are on the table if a new agreement is at least as binding as Kyoto, and the US commits to comparable emission reductions by 2030 at the latest.
This is the inexorable logic of the multilateral negotiations and leaves a clear set of decisions for the US. The Obama administration will struggle to convince the US Senate to pass a domestic Climate Bill if it cannot show that this is part of a wider international effort that delivers climate security for America. A binding international agreement that commits China and India to real emission reductions would show the value of US leadership. To achieve this, the US will have to agree to be bound itself and to put its 2030 mitigation target and some commitment to medium term finance on the table.
None of this need breach the wise position of the US negotiators that they are not prepared to sign up to an international agreement unless they are confident they can pass the domestic legislation needed to implement it. The administration has a good story to tell of how committing to US legislation has catalysed serious emission reduction commitments from all major economies.
The US has more room for manoeuvre than it currently thinks. If President Obama wants to make real the leadership he has proclaimed so eloquently in his speeches, now is the time to send a clear, unified and unambiguous message to the other Parties. We want a 2°C agreement; we will put forward what is needed to secure this; we expect others to agree to be bound by their promises - as we agree to be bound by ours; this will require a legally binding treaty. We may need more time to agree final details, but we are ready to make substantial and lasting commitments in Copenhagen.
All of this leads to a simple conclusion: if political leaders are unable to reach a binding international agreement in Copenhagen in December they must come up with a credible plan for concluding that agreement no later than June 2010, before US Congressional mid-term elections. Allowing the process to drag on beyond June 2010 risks a repeat of the Doha WTO negotiations, which have limped along without resolution for over a decade. Reaching agreement by June 2010 is challenging but achievable if Copenhagen provides the necessary political impetus.
Specifically, Copenhagen needs to do three things:
Give a clear political mandate to negotiators to reach agreement on all key issues by at the latest June 2010 and to enshrine this agreement in a legal instrument or instruments.
Set out in as much detail as possible the content of the eventual legal instrument(s), including emissions reduction targets for developed countries, nationally appropriate mitigation actions for developing countries, the long-term financing architecture, and the international framework for measurement, reporting and verification of commitments.
Maintain momentum through commitments to immediate action before 2012, including quick-start funding for adaptation, tackling deforestation and low carbon growth plans.
There are no fundamental obstacles of interest to such an agreement, but it will require great diplomatic skill and significant trust between countries to deliver; neither of which is yet apparent in the current negotiations. There are still some countries trying to block any substantive deal, but they are now a vanishing minority. In contrast, the impetus to agreement is supported by an unprecedented range of global business, finance, labour, faith and civil society coalitions who are aligned around the common elements of a Copenhagen deal.
In the final weeks towards Copenhagen it will be easy to be caught up in the day-to-day turmoil of events, but while fascinating as a spectator sport, this chatter is not what will determine the final outcome. The world is close to an ambitious deal; what is missing is the trust needed to cement the process through to a legal conclusion. Trust will be built through plain speaking not hints, spin and clever tactics. That is why Obama must go to Copenhagen along with other leaders. Only a personal face-to-face commitment will generate the trust needed to seal the deal.
The APEC Summit saw confident headlines that the US and China had agreed to a Danish proposal to make the Copenhagen outcome non-legally binding. On closer examination these reports came from a US press conference following an informal Heads breakfast. Meanwhile the real US-China Summit two days later agreed that both countries are "striving for final legal agreement" at Copenhagen, and the Chinese confirmed they are still "studying" the Danish proposal. A "Pre-COP" Ministerial meeting held in parallel in Copenhagen showed a range of conflicting messages from countries; with Saudi Arabia defending the Kyoto Protocol, some developing countries backing a new single negotiating process but a strong push from Brazil and others to maintain a legally binding Copenhagen outcome.
Even the US seems unclear what it wants: on the one hand, Obama is promoting an agreement at Copenhagen which has "immediate operational effect", but his lead negotiator is discussing a mid-year deadline for completing a treaty. Of course, these outcomes need not be mutually exclusive, but in the fevered atmosphere of the end game confusion is predictably interpreted as conspiracy.
This is damaging to the negotiations. The APEC story drowned out the positive announcements of new mitigation commitments by Brazil and South Korea. It also markedly increased the already high level of distrust between countries. Conversations in the negotiating corridors increasingly circle round what these events imply about the motivations of the main players. Is the US Administration acting in good faith but hamstrung by a hostile Congress? Or is there a subtle strategy to neuter the international regime and avoid pressure to increase US commitments? Will China align with its traditional allies in the G77? And if so, can it support the proposals from the industrialized countries? Will India stick with its oft-quoted red lines, or are these merely negotiating chips to be relinquished in return for new finance? The inability to sort blinks from winks - and conspiracy from confusion - makes countries fearful of making the bold diplomatic moves needed to make Copenhagen a success. It also fuels an increasingly pessimistic media cycle and undermines public faith in the effectiveness of the international negotiations.
This is the wrong way to approach the climate change process. We are not back in the Cold War trying to determine the aggressive intent of a declared and secretive enemy. Copenhagen is a multi-polar negotiation between highly interdependent countries who are aiming to preserve their mutual climate security. It is not a game any one nation can win, but it is one we can all lose.
Stripping away the confusion the underlying dynamics of the Copenhagen end-game are rather more straightforward:
There is no credible alternative to a legally binding international agreement to limit global climate change below 2°C; any "bottom-up" system of country pledges will always fail to drive the necessary scale and pace of reductions as it does not help countries take on domestic interest lobbies.
The US will not accept a binding target unless China and India also agree to be bound to commitments that are internationally verifiable.
But China will not commit to decarbonise its economy unless the US accepts a binding and ambitious emissions reduction target.
The majority of developing countries will not agree to any new framework unless it binds developed nations and contains significant new medium term public finance for adaptation, forestry and clean energy.
Europe and Japan - who have met their reduction commitments under the binding Kyoto Protocol - can only accept the weak US commitments which are on the table if a new agreement is at least as binding as Kyoto, and the US commits to comparable emission reductions by 2030 at the latest.
This is the inexorable logic of the multilateral negotiations and leaves a clear set of decisions for the US. The Obama administration will struggle to convince the US Senate to pass a domestic Climate Bill if it cannot show that this is part of a wider international effort that delivers climate security for America. A binding international agreement that commits China and India to real emission reductions would show the value of US leadership. To achieve this, the US will have to agree to be bound itself and to put its 2030 mitigation target and some commitment to medium term finance on the table.
None of this need breach the wise position of the US negotiators that they are not prepared to sign up to an international agreement unless they are confident they can pass the domestic legislation needed to implement it. The administration has a good story to tell of how committing to US legislation has catalysed serious emission reduction commitments from all major economies.
The US has more room for manoeuvre than it currently thinks. If President Obama wants to make real the leadership he has proclaimed so eloquently in his speeches, now is the time to send a clear, unified and unambiguous message to the other Parties. We want a 2°C agreement; we will put forward what is needed to secure this; we expect others to agree to be bound by their promises - as we agree to be bound by ours; this will require a legally binding treaty. We may need more time to agree final details, but we are ready to make substantial and lasting commitments in Copenhagen.
All of this leads to a simple conclusion: if political leaders are unable to reach a binding international agreement in Copenhagen in December they must come up with a credible plan for concluding that agreement no later than June 2010, before US Congressional mid-term elections. Allowing the process to drag on beyond June 2010 risks a repeat of the Doha WTO negotiations, which have limped along without resolution for over a decade. Reaching agreement by June 2010 is challenging but achievable if Copenhagen provides the necessary political impetus.
Specifically, Copenhagen needs to do three things:
Give a clear political mandate to negotiators to reach agreement on all key issues by at the latest June 2010 and to enshrine this agreement in a legal instrument or instruments.
Set out in as much detail as possible the content of the eventual legal instrument(s), including emissions reduction targets for developed countries, nationally appropriate mitigation actions for developing countries, the long-term financing architecture, and the international framework for measurement, reporting and verification of commitments.
Maintain momentum through commitments to immediate action before 2012, including quick-start funding for adaptation, tackling deforestation and low carbon growth plans.
There are no fundamental obstacles of interest to such an agreement, but it will require great diplomatic skill and significant trust between countries to deliver; neither of which is yet apparent in the current negotiations. There are still some countries trying to block any substantive deal, but they are now a vanishing minority. In contrast, the impetus to agreement is supported by an unprecedented range of global business, finance, labour, faith and civil society coalitions who are aligned around the common elements of a Copenhagen deal.
In the final weeks towards Copenhagen it will be easy to be caught up in the day-to-day turmoil of events, but while fascinating as a spectator sport, this chatter is not what will determine the final outcome. The world is close to an ambitious deal; what is missing is the trust needed to cement the process through to a legal conclusion. Trust will be built through plain speaking not hints, spin and clever tactics. That is why Obama must go to Copenhagen along with other leaders. Only a personal face-to-face commitment will generate the trust needed to seal the deal.