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20 Questions, 20 Responses

I’m happy that this debate seems to be evolving into something a little more civilized on all sides. This is my response to Markos Moulitsas (DK) at Daily Kos and Jon Walker (JW) at FireDogLake who were kind enough to respond to the 20 questions I posed earlier. This is a lot of text, so I apologize in advance for any typographical or readability issues.

1. Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people?

MM: The assumption here is that this bill is the only option on the table. The House still has a say in the matter. And really, the point of reform isn’t to shovel taxpayer dollars to the insurance companies, it’s to expand care and lower costs. I’m not willing to surrender on costs.

JW: Killing the current deal does not preclude passing the good parts of health reform through reconciliation. When they are forced to face passage of some of these reforms with reconciliation, or the threat of reconciliation, it is not impossible to envision Lieberman, Nelson, and Lincoln backing down on their threat of joining a filibuster.

Certainly, one of my fundamental assumptions is that a bill with a decent public option cannot be passed through regular order. I’ll tackle Jon’s arguments about reconciliation down below — for now let’s consider regular order.

One of the fundamental rules of political forecasting is never say never — miracles, or at least things that seem like miracles beforehand — can happen occasionally. But it would probably take a miracle to get any sort of marginally robust public option into the bill. At least 2-4 senators have stipulated outright that they’d vote to filibuster such an effort, have been saying so for months, progressives have no obvious leverage over them. Blanche Lincoln will not be unhappy if liberals block the bill; she’ll be thrilled that she doesn’t have to make a no-win vote and can blame Bernie Sanders or Roland Burris or the SEIU for her troubles. I don’t know how many times you can bang your head against the wall before this sinks in. It’s not like liberals haven’t tried everything in the playbook to get a public option into the bill; they’ve been both dogged and creative in their pursuit of one. It hasn’t worked.

Perhaps there’s some chance of reviving the Olympia Snowe trigger, which to my knowledge only Joe Lieberman is firmly opposed to. Indeed, this is probably a more plausible path than the Medicare buy-in provision, where the opposition has more unequivocal and the support less robust. But the Snowe trigger has not been considered an acceptable solution by most liberals — and understandably so, because it’s a fairly poor excuse for a public option.

At some point, though, the assertion that a halfway-decent public option can still be passed via regular order begins to smack of the First Stage of Grief. At the very least, I would suggest that Kill-Billers spend some time engaged in the thought experiment of how they might feel about the bill if it really were this way or the highway.

2. Would a bill that contained $50 billion in additional subsidies for people making less than 250% of poverty be acceptable?

MM: This betrays a simplistic view of liberals, as if our answer is to merely shovel money at a problem. What we’re looking for is good policy, which in this case, would also be good politics. So no, throwing money at the insurance companies doesn’t change a thing. The insurance industry would simply absorb the new subsidies just like universities have raised tuition to shovel up any increases in financial aid.

JW: That money will help a few people in the short term, but, in the long run, our system built on private insurance companies is unsustainable, and will ruin our entire economy. I have zero confidence that the subsidies promised today will remain the same in the future. They might be increased by future Democrats or reduced in 2016 by a Republican Congress. Without cost controls, that money will quickly be eaten up by the ever-growing cost of health care. This reform is about trying to fix the system, not patch it with more money.

Here’s one of the bits that I find disingenuous. “That money will help a few people in the short term”? That framing doesn’t seem proportionate to the good that this bill would do. As I wrote earlier tonight the bill is and always was “a big bleeping social welfare program”. Indeed, it’s almost without doubt the biggest bleeping social welfare program that liberals have had an opportunity to pass in a generation. I don’t know how you can just brush off providing $900 billion in subsidies, or helping 30 million people to become insured. That’s not some side effect of the bill; it’s the whole point of the bill.

Markos’ point that this represents a “simplistic view of liberals” is intriguing — certainly, it is interesting to me how some of the liberal and conservative critiques against the bill have started to coalesce — but we’ll address this at another time.

3. Where is the evidence that the plan, as constructed, would substantially increase insurance industry profit margins, particularly when it is funded in part via a tax on insurers?

MM: Where is the evidence that insurance companies would rig the system to extract record profits? I don’t know. Perhaps the last decade or two might provide the answer.

JW: The fact that the price of private, for-profit insurance stocks have gone up dramatically with each day of bad news for the public option. More importantly, the bill doesn’t need to increase profit margins to make the insurance companies more profitable. It will increase overall profits by expanding their customer base, which has be shrinking for years.

The Record Profits Myth strikes again — I don’t like the insurance companies either; I’d gladly get rid of them and replace them with single payer. But the industry’s profits are low: only about 3.3%.

And the evidence that the insurance industry would benefit from this bill on balance — on either a marginal or an aggregate basis — is almost completely lacking. Jon’s point that “insurance stocks have gone up dramatically with each day of bad news for the public option” [emphasis mine] is absolutely correct — I have observed this as well. But my question is how insurance company profits would respond to a public-option-less bill versus the status quo.

4. Why are some of the same people who are criticizing the bill’s lack of cost control also criticizing the inclusion of the excise tax, which is one of the few cost control mechanisms to have survived the process?

MM: Because it is a measure that would disproportionately affect blue collar workers in high-risk jobs, or workers that have given concessions on wages to preserve good benefits packages. Limit that provision to people making over X amount (say, $100K/year), and I wouldn’t have a problem with it.

JW: The excise tax is designed horribly. It’s a very weak cost control that will only reduce NHE by $100 billion by 2019. That is a 0.3% reduction. And it will only do that by encouraging employers to provide their employees with worse quality insurance policies that cover fewer procedures and have higher co-pays and deductible. Let’s say that again: the Senate bill achieves cost control by making the health insurance you already have through your employer worse so you will have fewer procedures. I support cost control mechanisms that do not hurt the quality of health insurance. The excise does not meet this important criteria. The people who told you it is a magical cost control mechanism sold you magic beans. Drug re-important alone would do a better job of bring down NHE.

This is another area in which liberals have tended to quote some questionable data. It’s simply not true that the excise tax would “disproportionately affect blue collar workers in high-risk jobs”.

If you look at the aggregate amount passed on to middle class people under the excise tax, it would exceed the aggregate amount passed on to upper-class people. But that’s only because there are a lot more middle class people in the country than upper class people. On a per-person basis, the tax is quite progressive up to about $200,000 (at which point it becomes somewhat regressive). Also, as the CBPP study notes, most of the reduction in premiums that the excise tax would facilitate would be passed back to the workers in the form of higher wages.

There is also a debate about how much cost savings the excise tax would generate; the CMS study that Jon cites says “only” $100 billion total through 2019, whereas the CBPPstudy says $74 billion per year by 2019. I honestly don’t know where the difference in assumptions lies, but the tentative consensus among economists is probably closer to the CBPP estimate.

This is not to say, by the way, that the excise tax can’t be designed better — possibly including a carve-out for deals negotiated under collective bargaining. But this does need to be a tax applied to insurance, and not merely to income, if it’s going to have any “curve-bending” effects.

5. Why are some of the same people who are criticizing the bill’s lack of cost control also criticizing the inclusion of the individual mandate, which is key to controlling premiums in the individual market?

MM: Because without premium caps or a public-run competitive option, there is no incentive for them to lower their premiums. They have a monopoly, and monopolies aren’t in the business of unilaterally reducing their prices. There are two ways to force them to do so — government regulation or market competition. The former is out, and the latter is inadequate.

JW: The individual mandate only works if you have a strong social contract between people on the government. The government must promise to provide everyone with access to quality affordable health insurance, and then the people agree to an individual mandate to buy insurance. This bill fails to guaranty either quality or affordable health insurance. There is no ban on annual limits, meaning the insurance companies can now put a cap on how much they will pay out. They will still be allowed to drop their sick customers and deny claims if they decide their customers need an “unreasonable” amount of health care. And the maximum out-of-pocket limit is far too high. It will not stop medical bankruptcy if you get really sick, which makes a mockery of the whole idea of insurance.

The goal of reform is to hold down overall health care spending, not premiums. An individual mandate only holds down premiums if the premium money is used to pay for care to spread the risk. There is nothing stopping the insurance companies from just pocketing that extra money or using it to bribe providers with higher reimbursement rates to lock out competitors.

I don’t know how people can still be arguing that the individual mandate isn’t necessary. If you don’t have a mandate but require insurers to cover people with pre-existing conditions, you get extreme adverse selection and possibly even a death spiral.

Indeed, this why it’s so hard to do incremental health care reform. If you want to cover people with pre-existing conditions, you need an individual mandate or everyone will be furious that their premiums have gone up. But if you have an individual mandate, you had better have subsidies to help poor people to afford the coverage. The nexus of the individual mandate and the magnitude of the subsidies is really what needs to be explored here.

Of course, if you have some kind of forced choice, you want it to be as appetizing a choice as possible. The bill on the floor fact does create a somewhat more competitive insurance market — through the exchanges. It’s not what I’d like to see, but given that profit margins for private insurance companies are not high, I’m not sure that competition per se is quite the problem that it’s been made out to be. The high profit margins in the industry, rather, come at the provider level — not the insurer level. The reason, for instance, that a public option benchmarked to Medicare rates would have been so powerful is because Medicare squeezes the providers.

6. Would concerns about the political downside to the individual mandate in fact substantially be altered if a public plan were included among the choices? Might not the Republican talking point become: “forcing you to buy government-run insurance?”

MM: If you start worrying about Republican talking points, you’ve lost the game. They’re accusing Democrats of trying to kill grandma. They’re not going to back off because a talking point isn’t 100 percent accurate. 2010 will be the year of the “commie socialist Democrats”, no matter what health care reform bill is passed.

In any case, Republicans have tried to destroy socialist programs such as Medicare and Social Security for years. If people like a program, there’s nothing the GOP can do about it.

JW: The Republicans will say what they want anyway, but if there is a choice between public and private insurance it would not be true. And with a public option, at least you would not be forcing some people to give their money to the extremely unpopular health insurance companies — which is probably why the overwhelming majority of Americans support having that choice. Of course I’m more concerned about policy than politics when it comes to the individual mandate.

By no means am I dismissive of the perspective that the mandate has some potentially damaging political effects. I just think it’s liable to have more to do with the extent to which insurance is perceived as affordable, rather than who you’re buying it from — someone who gets deeply subsidized insurance from Aetna is not likely to complain, whereas someone who gets “unaffordable” insurance from the government probably will. (And for what it’s worth, the CBO has estimated that premiums for the public option would actually be higher than those for private plans, although in exchange for much better coverage.)

7. Roughly how many people would in fact meet ALL of the following criteria: (i) in the individual insurance market, and not eligible for Medicaid or Medicare; (ii) consider the insurance to be a bad deal, even after substantial government subsidies; (iii) are not knowingly gaming the system by waiting to buy insurance until they become sick; (iv) are not exempt from the individual mandate penalty because of low income status or other exemptions carved out by the bill?

MM: Is this argument that the mandate doesn’t matter because too few people will be subject to it? If so, then strip it out. It shouldn’t matter.

JW: If people are “exempt” from the individual mandate because the private insurance companies made insurance too expensive for them to buy (which thanks to the 1:3 age rating would be the older sicker people most in need of insurance) what is the point of the individual mandate? This sounds like a recipe to price out the old (nonprofitable) and force only the young (profitable) to buy insurance. The individual mandate should only be used for an “everyone in” system. This is “everyone in” except those whom the private insurance companies price out of the market.

Certainly, the mandate penalty needs to be designed carefully so as not to pervert incentives. The point is that not that very many people will fall into the category of feeling like they’re “forced” to buy insurance because most of them will continue to get policies through their employers, or will think they’re getting a pretty good deal.

8. How many years is it likely to be before Democrats again have (i) at least as many non-Blue Dog seats in the Congress as they do now, and (ii) a President in the White House who would not veto an ambitious health care bill?

MM: I’m not sure how the future composition of Congress has anything to do with a battle in our current congress. This battle isn’t over. But if anything, this argues for pushing for the most progressive bill possible.

In any case, most of the endangered Democrats next year are of the Blue Dog variety, while most of our (relatively meager) pickup opportunities are in Democratic-leaning districts. In other words, while our majorities will likely be smaller, it will be a more intellectually cohesive caucus. That’s why all of the outright House retirements thus far have been Blue Dogs — they’re not interested in having to defend themselves in a caucus that is trending leftward.

JW: Zero more years, because if they can’t get this Senate bill passed they will use reconciliation. Obama has decided he must pass health care reform, and if reconciliation is his only option he will use it.

The notion that only Blue Dog seats are endangered is flat wrong. There’s almost no way that Democrats will end up with more votes for a public option at any point in the near future — keep in mind that the House passed its bill, which had only a mediocre public option, by just about the bare minimum of votes.

9. If the idea is to wait for a complete meltdown of the health care system, how likely is it that our country will respond to such a crisis in a rational fashion? How have we tended to respond to such crises in the past?

MM: No, the idea is to get the best possible legislation today. We may not be able to get something with reconciliation before Obama’s State of the Union Address, but I don’t think something this important should be beholden to something as trivial as a speech, even one as important as the SOTU.

JW: That is not the idea at all, and completely irrelevant. The Senate bill will fail to stop the rapidly approaching meltdown of our health care system, and anyone is a fool for thinking otherwise. The CMS predicted that even if the bill passed, the cost of an average premium for a family of four will still increase roughly $1,000 a year. The meltdown is coming either way. This Senate bill is at best a very expensive band aid, and at worst a way to quicken the meltdown.

This is one of my less pertinent questions — I certainly haven’t seen this argument raised by either MM or JW although I have seen it in places. For the record, I think it goes without saying that politics are very dynamic and unpredictable in crisis situations. If you examine the collective response to recent cataclysms such as 9/11, the financial meltdown, and global warming, it has been a little scary for progressives.

10. Where is the evidence that the public option is particularly important to base voters and/or swing voters (rather than activists), as compared with other aspects of health care reform?

MM: Given that the current bill only has 32 percent support, I don’t think this turd of a bill in the Senate has much support of anyone, much less party activists. And the voter intensity numbers are clear — base Democratic voters are planning to sit out 2010. And I doubt 18-29 year olds — a key part of the Democratic base — are going to be thrilled with a mandate. In fact, it may be the single least popular item in the bill.

JW: Once again this is about policy for me, but there are many polls showing stronger support for the public option than the President’s health care bill. The few polls done on the matter have also shown that without a public option the individual mandate is extremely unpopular. If Democrats in Washington did not think the people cared about the public option they would have killed it a long time ago.

There’s no doubt that the public option is popular, especially with the base — as we have been reminding people over here for months. But polls also show that it’s considered one of the less important aspects of health care reform, especially for swing voters. We need to remember that the “activist left” and “the base” are two different and distinct things, although obviously there is some overlap especially in the Internet age.

11. Would base voters be less likely to turn out in 2010 if no health care plan is passed at all, rather than a reasonable plan without a public option?

MM: Nope, if Democrats gave it a serious shot, and then built campaigns around the obstructionists. Caving in to Lieberman, Republicans, and corporate interests, on the other hand, sends the message that the Democratic super majorities are irrelevant, and all the hard work from the last four years in electing them was a wasted effort.

JW: My goal has always been reconciliation, the use of the nuclear option, or the White House using its influence to back down conservative Democrats — something that hasn’t happened yet. I think this question is misleading because that is not the actual choice on the table. It is bad bill with regular order, a better bill with 50 votes in the Senate, or no bill.

I’m actually coming around to the view that Democrats are about equally screwed either way, in large part because of the vehemently negative reaction that we’ve seen from the left over the past 72 hours. The left is fracturing over this issue in ways that are nothing like what I’ve experienced since I began covering politics for a living — which granted, was only two years ago.

12. What is the approximate likelihood that a plan passed through reconciliation would be better, on balance, from a policy perspective, than a bill passed through regular order but without a public option?

MM: Likelier. Seems self-evident. And really, Medicare and the VA health system shows that the government is quite capable of handling health care.

JW: Extremely high. If I did not believe a much better bill could be passed using reconciliation I would not have been advocating for it for months. It is a pure myth that a good bill cannot be passed using reconciliation.

I don’t understand the confidence here, and it smacks to me of wishful thinking. I’m not a process wonk, but the overwhelming opinion among people who are is that, although the public option might survive the reconciliation process, things like the ban on denying coverage for people with pre-existing conditions, the additional regulations on insurers, and the creation of the health insurance exchanges would almost certainly not. Plus, the bill would have to be deficit neutral over five years and would be subject to renewal every five years.

If your lone objective were to end up with something that you could call a public option, then yes — reconciliation offers some possibility of that. But I don’t see how you’re likely, on balance, to wind up with a better bill — losing the guaranteed issue provision alone would probably outweigh the inclusion of a public option.

There’s also the idea, which Jon has advanced, of using the reconciliation process for some parts of the bill but not for others. It’s a creative idea, but I don’t see how it works, since it’s not like you can keep this a secret from people. If you plan to pass certain provisions under reconciliation so as to circumvent Ben Nelson, it seems to me nearly certain that Ben Nelson would counter-circumvent you by filibustering the parts of the bill that you attempted to pass under regular order. So you’d still end up with half a loaf — although maybe a different half than you might have otherwise.

Now, I certainly do think the Democrats would have some chance of passing portions of the bill under reconciliation in 2011; in that case you wouldn’t have this transparent bait-and-switch with the moderates and could claim that you’d received a new mandate from the public.

13. What is the likely extent of political fallout that might result from an attempt to use the reconciliation process?

MM: Fallout with the DC press corps? They didn’t mind when Republicans used it to pass their tax cuts under Bush, but that’s a different time. I’m sure they’ll hyperventilate about it now. The voters? I’ve seen no data that suggests they care about process. Just results. Democrats would cheer, Republicans would bitch, but those guys will bitch anyway.

JW: I think it will be very small. People care more about results than process. If reconciliation results in this early Medicare buy-in starting in 2010, I think it would be a huge net political gain for Democrats by showing that reform is working.

Was there a political fallout from Bush’s tax cuts because they where done through reconciliation? I do think there was.

More wishful thinking, IMO. The Bush tax cuts were popular; health care is not. Moreover, the filibuster actually polls well, so use of the procedure itself would be unpopular. If you intersect an unpopular policy with an unpopular process, I don’t know what you’re going to get, but the downside risk would seem to be fairly profound — as in, I’d take even money at that point that the Democrats would lose the House.

Also, tax cuts are a relatively straightforward application of the reconciliation process — health care is not, and the resulting procedural debate would last weeks if not months, giving the public plenty of time to stew over it.

14. How certain is it that a plan passed through reconciliation would in fact receive 51 votes (when some Democrats would might have objections to the use of the process)?

MM: It’d be nice to find out.

JW: First you only need 50 votes plus the vice president to break the tie. Second, are you really asking progressive to not stand up for better policy because there are possibly 11 Democrats who will bring down the reconciliation bill to protect their absurd Senate clubhouse feel?

The Democrats in the Senate seem were willing to give Joe Lieberman anything he wanted to get a bill labeled “health care reform” passed. If they will swallow their pride for Lieberman, they will do it for reconciliation if that is the only way the can get the “win.”

Hey, if this were the only risk I’d say “go for it”. But it is another contributing factor on the downside. For starters, you’re going to lose any senator who is already looking for an excuse to vote against health care reform — meaning Lincoln, Lieberman, Nelson, Landrieu. You’re going to lose a couple of process hawks — Byrd, probably Conrad, probably Bayh, maybe Feingold. There are far short of 50 enthusiastic votes for the public option — there are closer to about 43, and that includes a couple of the process hawks. The odds of getting to 50 votes under reconciliation would seem to be about 60/40 at best.

15. Are there any compromises or concessions not having to do with the provision of publicly-run health programs that could still be achieved through progressive pressure?

MM: Expand medicaid, add a national exchange instead of the state one, get rid of mandate, etc.

I’m curious … how many concessions has the other side made? Maybe it’s time for a “compromise” that actually includes a compromise.

JW: No. If progressive pressure cannot protect the extremely popular public option, I don’t see a single thing progressives can win on.

Progressive have zero power in Washington if they can not draw a line in the sand and say enough is a enough. Only by being willing to bring down a bad bill will they force those in power to listen to them instead of Joe Lieberman. Unless progressive are willing to play hardball, all the power will remain with Joe Lieberman (who has announced his intention to rewrite the climate change bill).

There are a lot of ways that progressives might be directing their focus — arguing for more generous subsides, for instance.

The point is, at this point I don’t think they’ve been directing their focus in ways that optimize the progressive-ness of the health care bill. But, as both Markos and Jon imply, that might not be the point. Rather, progressives are fighting a sort of proxy war over the public option — as a way to exert their influence and authority. This is where I’ve always parted ways with the strategy — I think health care is too important an issue to use as a demonstration of one’s authority. What might be better? Financial reform would be one answer. But obviously, the cat is way out of the bag now on the public option and people have become vested in their positions.

16. What are the chances that improvements can be made around the margins of the plan — possibly including a public option — between 2011 and the bill’s implementation in 2014?

MM: I’m actually a little more optimistic about this. But here’s the thing — everyone surrenders now, the impetus for such tinkering will be gone. If people are angry and campaign on these key issues, then political pressure will be maintained for further action. The “surrender now” crowd actually makes further tinkering less likely, not more.

JW: If Obama does not feel a need to listen to progressive on the issue of health care reform at this moment, I don’t see how that will change between now and 2014. If anything, when people are not looking the lobbyists will go to work slowly crippling all the new regulations this bill will add. As long as we have this 60 vote myth controlling everything in Congress, all the power is with Joe Lieberman.

I’m not sure that there’s a fundamental disagreement here — my point, as made under #12 above — is that I think the proper application of the split-the-bill strategy is to split it between the current Congress and the next one that convenes in 2011.

I don’t agree with Jon’s pessimism that the bill will be “crippled” — because of loss aversion, it’s much harder to take something away from someone than to give it to them in the first place. And so long as the filibuster is in place, it will protect the status quo — in this case, a new status quo in which poor and sick people get more help from the government.

17. What are the potential upsides and downsides to using the 2010 midterms as a referendum on the public option, with the goal of achieving a ‘mandate’ for a public option that could be inserted via reconciliation?

MM: The public option remains popular, despite the year-long demonization process by insurance interests, Republicans, teabaggers, and even some Democrats. Popular enough to base a “referendum” around it? Beats me, I’d have to see more data. But if 2010 is a referendum on that current Senate bill, we’re in deep trouble.

And in any case, I don’t think we have much of a choice in the matter. 2010 will be all about Democratic “socialists”, and HCR will be Exhibit A in the wingnut playbook.

JW: I don’t know and I don’t plan to find out. We can get the public option now using reconciliation and that is what progressive should demand. It does not matter if we “win” the referendum on the public option in 2010, we already “won” the referendum on health care reform in 2008 when Barack Obama campaigned on it. If we can’t hold our elected representatives to account now it is foolish to think we will in two years.

This is largely addressed under #16 above. I simply wanted to point out that the fight over the public option, to the extent that people regard it as a gratifying organizing exercise, will not end just because a bill has been adopted that doesn’t include one.

18. Was the public option ever an attainable near-term political goal?

MM: Yes. But even if it wasn’t, perhaps we would’ve been better off starting with a Medicare For All approach, or at least an expansion (back when Lieberman was for it). I’m sure someone will write a book about all the tactical mistakes made during this battle. There’s no doubt the Democrats blew it big time, but that’s not the same as saying a desired policy outcome was not attainable.

JW: Yes. If Reid had used reconciliation months ago we would already have a bill passed with a public option.

My answer is probably not; this is addressed at length in my article from Monday. Progressives asked for this fight, and actually made a lot of progress — but it was always going to be a profoundly uphill battle. To use it as a litmus test for progressive efficacy was rather risky, in the same way that it’s risky to declare your training regime a failure because you collapsed on the last stage of the Ironman Triathalon.

19. How many of the arguments that you might be making against the bill would you still be making if a public option were included (but in fact have little to do with the public option)?

MM: Depends on the details of that public option.

JW: I don’t know about others but I have always argued against the excise tax. I have always said the individual mandate is only acceptable if the government provide everyone with access to decent cost effective health insurance.

This is obviously something of a rhetorical question, so we won’t dwell on it. Certainly, some of the points about the individual mandate have been in play for months now. What I tend to find more disingenuous are the people who have suddenly decided that the bill was really about cost control after all, and that the coverage aspects of the bill are merely incidental. It’s (mostly) a coverage bill and always has been; a bill that was primarily targeted at cost control would have looked much different from the get-go.

20. How many of the arguments that you might be making against the bill are being made out of anger, frustration, or a desire to ring Joe Lieberman by his scruffy, no-good, backstabbing neck?

MM: Max Baucus caused more damage to this process than Lieberman, by slowing things to a crawl pretending that Enzi (from Wyoming!) was ever a good-faith negotiator, giving Republicans and teabaggers a chance to ramp up the hysteria and slowing whatever initial momentum the administration and congressional Democrats ever had on the issue.

I don’t give a shit about Lieberman’s opposition. He’s just confirming everything we ever said about him. In fact, it’s kind of nice seeing the Beltway and congressional Democrats start to finally understand who the real Lieberman is. But I never expected anything less from him, so pretending that this is some weird grudge match minimizes what are serious policy disagreements. Lieberman may be petty about this, but I’m not. I settle those grudges on the electoral battlefield, not the policy one.

And it’s clear, we’ve been fighting this fight long before Lieberman decided to shine the spotlight on himself.

JW: My arguments against the current bill were all made long before Joe Lieberman was empowered by Harry Reid to remove the public option. Now that the public option has been removed, the regulations have been weakened and the excise tax remains, I think the bill will do more long term harm than good when it comes to health care reform. FDL drew the line in the sand on the public option close to 6 months ago. This is not anger — this is long-term planning.

I know Markos and consider him a friend; I don’t know Jon but always find him level-headed. So, this is not meant to implicate them. Nor am I going to go about trying to illustrate for you exactly which arguments against the bill were or weren’t made out of spite.

But I’ve never seen things get quite so personal — I’ve gotten as many nasty comments and e-mails from Democrats on this issue as I have in the past six months from conservatives (on all issues). That emotion is a factor in this debate seems self-evident to me. I do somewhat regret egging things on with a deliberately provocative headline on Tuesday. But I would urge everyone to take a deep, deep breath, to the extent possible.

Nate Silver founded and was the editor in chief of FiveThirtyEight.