Right now HCR has been pushed to the back burner by discussions of just how clueless the Democrats are on the issue of terrorism pushback--not pushback against actual Muslim terrorists but pushback against Republican terrorists. Over at Balloon Juice yesterday there was a good discussion of just how flawed the Democratic response has been to the flurry of right wing hysteria over the crotch bomber. But, as usual, it also degenerated into a discussion of whether Obama bore some, all, or none of the "blame" for failing to get the Public Option. The situation is madly complicated by the fact that by the time push came to shove the "Public Option" we were being offered by either the House or the Senate was a shadow of itself. In addition, as Chris Bowers argues at Open Left there are many pieces of the current bill (s) that amount to an expansion of public option (s) that are not insignificant. That Obama didn't throw his prestige and power, such as it is, publicly behind the gutted capital "P" Public Option at the last minute doesn't mean that he isn't, in fact, going to get some good small "p" public options out of it.
Nevertheless unless Obama and Rahm change their style of governance we are going to see a lot more public triangulating and hedging because that seems to be the way they think they can best get things done. There's a value in just getting things done, of course--and sometimes small structural changes can produce great social and philosophical changes while great philosophical pushes, absent real plans, produce nothing in the way of forward motion. In the case of this health care reform bill its quite possibly the case that, as defenders have argued, just putting the government's hand down on Health Insurance, nationally speaking, is such a moment--like opening the floodgates. I actually agree with that.
One of the biggest complaints on the left is that the stupid "Cadillac tax" is, well, incredibly dumb and, because its not indexed to inflation, will soon hit a huge proportion of the middle class. Does that sound like anything else the government has ever done? How about the AMT? Hideously bad idea, not indexed, leading to bracket creep, punishes middle class/blue state taxpayers with children. Well, in reality, what happens?
For years, Congress has passed one-year patches aimed at minimizing the impact of the tax. For the 2007 tax year, a patch was passed on 12/20/2007, but only after the IRS had already designed its forms for 2007. The IRS had to reprogram its forms to accommodate the law change.Or how about the Medicare Doc Fix. That's the bizarre and stupid problem that absent annual Congressional intervention the amount that Medicare pays its doctors is cut, not raised. Every year, apparently, Congress has funded that on a "patch" basis rather than trying to pay for it all at once, or repeal the ridiculous law and try for a more sensible solution to the problem of rising costs. This year, of course, the Democrats actually tried to fix the fix and were shot down by an alliance of the centrist dems and the republicans.
Sane outsiders would think that passing the best legislation possible is the only sensible option. But its pretty clear that quite bad legislation gets passed all the time and never repealed but always fixed when it is politically unpopular to allow the true harm of the legislation to be felt. Looked at one way--Obama and the Dems know that a bad tax is incredibly hard to repeal--but not to fix or ameliorate. Looked at another way, Obama and the Dems know that a bad tax can be fixed with a "patch" periodically and most people will never have the faintest idea what is going on. That's by way of saying that, ultimately, I think Obama and the Dems--if they get the Health Care Bill at all--will have put the Democrats in as good a position as exists in the real world to try to tinker around the margins and get us most of the way towards the promised land of certain, cost effective, health care for all. That's because the new regulations shifts the focus of people's anger from themselves (I'm too poor to afford Health Insurance) and from the insurance companies (those bastards *&^%) to the government itself. Citizens who are forced to buy Health Insurance are citizens with a vested interest in making sure that they get subidies and or the premiums are lowered. They are not actually citizens who have a vested interest in returning to the current status quo. This means that the bill brings into being millions more potentially angry and activist citizens demanding government intervention in Health Care--a government agency devoted to policing the Insurance Companies? Calls to your AG demanding he investigate your denial of service? Calls to your congressman demanding that your subsidies be raised? These are all way more likely than calls to repeal the entire act. And each of them are more likely to be acted upon, because they are piecemeal "fixes" than just the repeal of the mandate--which is the only objectionable part of the bill from a consumer point of view.
That being said I'm still disappointed in the way the run up to the Bill was handled, and at the limp way the Public Option was sold away so publicly. The rest of this post is a reprint of a comment I posted over at Balloon Juice on a thread about Democratic Disorganization and Public Response:
I hate to enter back into a discussion that is becoming more rarefied and bizarre by the moment—how much blame does Obama get in a tripartite system of government? 1/3, 1/6th? none, all? But I think something that the “excuse Obama/blame Harry Reid” people keep not understanding is this simple, obvious, issue:
Politics is theater. I don’t care how mature and manly and shy and retiring Obama is as a President, or how he thinks of his role as leader—its theater. His voters expected him to act like he cared about the things they cared about—and they expected him to look like he cared enough to fight for those issues. Chief among those issues was some way of bending the cost curve by creating necessary competition with the private insurance industry*. He campaigned on it. It was one of the chief differences between him and Hillary. It was also very good policy.
It was obvious very early on that Obama and his team had decided not to risk any imaginary political capital by pushing too hard for any specifics that they might not be able to get. Obama started getting very vague and leaving things rather up in the air very early. That made sense from a “hoard your capital” point of view. If he believed that he’d never get the public option and that his voters would be more embarrassed by a public failure than a default on his reform promises that was a smart move. But, as it turns out, sometimes its not true that your supporters would rather you save yourself a humiliating public rejection. Sometimes they want to see that you are willing to go to the mat for something. I’m not saying its right or wrong—its a fact of political life and political organizing. And its one the democrats are well aware of since Obama and his team are starting the process of walking back the Public Option and talking up the reforms in order to heal the wounds left by his unwillingness to fight for it publicly.
I think it would have been wiser, politically speaking, for Obama to have fought harder, and uglier, and more publicly for the public option because I think since he didn’t he and the dems have a harder hill to climb convincing voters that they at least did the best job they could under the circumstances. They have to do that because they have to sell the bill emotionally in advance of rolling out its actual benefits.
I think the whole discussion of whether Obama is at fault or not is misplaced—who cares? Its also not a difference between Obama being a mature political actor and a hysterical leftist political actor. All choices were political. All were made with the same goals in mind: get some kind of health care reform, pass some kind of bill, run again on the bill holding his base and getting more center votes.
He had the chance to stride the stage like a colossus and that came with the danger that he’d end up in a pratfall. He chose to be more cautious and retiring and to try to shift the fight and the blame onto Reid and the Democrats in the Senate but without ever demonizing or attacking the most difficult dems. That was as political a choice as fighting harder and maybe getting slapped back publicly. Its all politics. Its all theater.