This Bears Repeating--Because I Feel Like It

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.^[15]

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.

aimai

Before the Devil Knows You're Dead:


Sign the Senate Version of the Health Care Bill into a law before Joe Lieberman, Chair of Homeland Security, finds it incumbent upon himself to kill it at the next Cloture vote.

Before the final Senate Vote there was some talk of "ping ponging" the bill--that is, eliminating the House/Senate Conference and just sending the Senate Bill straight to Obama's desk to sign. There were some problems with that approach, because it required the House to cede its prerogatives as a co-equal law making body to the much more dysfunctional Senate. It also required the Progressives to take another body blow, since the House Bill was, in some ways, more progressive than the Senate Bill. It also would be another example of House progressives and voters being told that "their concerns would be addressed in conference/on the floor/in an amendment" and then being told that for reasons of policy that moment will never come. (See, e.g. Weiner's Single Payer Amendment, Stupak-Pitts, the entire Public Option). On the good side taking the Senate Bill and rushing it through to signature prevents one more massive cloture vote fight during which, for example, Byrd could die or Lieberman defect.

So, what are the odds of Lieberman, or any other wobbling Senators, defecting if the House and Senate Bills are merged in conference? The problem with figuring this out is that we don't know what the White House and Reid think they know about Lieberman and the other Senators. So far we've all just been forced to watch from the outside and guess at the internal struggles and compromises. Nevertheless, looking at Lieberman's history of disappointing his friends and joining with our enemies, we can be sure that Lieberman will not let this last chance to fuck Health Care Over go without a struggle. There's a some Probability that Lieberman will insist on either being part of the negotiations in the House/Senate conference or will appoint himself a "shadow member" and simply let it be known, from the sidelines, that any and all changes to the bill for the better will be opposed with a final vote against Cloture.

I can't put a number on the odds of Lieberman actually carrying through on the anti Cloture vote but I think the betting must be very heavily in favor of his using the threat to fatally deform the House/Senate conference itself. That's been the real trick to it all along, hasn't it? The killer cloture vote was used to force the progressives and the real Democrats to cede ground on the bill before it came to votes--this was clearly the case, for example, even when the bill was in the House and the threat of "not getting to sixty in the Senate" was used to keep the House progressives in line. It was doubly true in the Senate where Lieberman and Nelson both forced the progressives, like Boxer, to do their bidding. (That this was done to weaken the bill and the Democrats as a whole is clearly the case regardless of your feelings about the minimal Public Option and Medicare buy in. Its clear that Lieberman's goal is to cripple both negotiations and the bill). What that means is that the more good things get put into the Conference Bill the more Lieberman will fight to have them taken out--I'm thinking of things that will specifically be pleasing to the base such as moving up the timing of some of the goodies.

But Lieberman himself is a shifting set of spites. Now that we've had our first Terrorist attack of the Obama years and Lieberman will be leaping to the fore in his role as Committee Chair for Homeland Security I see vast new arenas opening for Lieberman to exercise his bitter hatreds. Whatever he promised Obama and the Dems before the last cloture vote about the next Cloture Vote is now null and void. All bets are off. Lieberman is going to do something dreadful with the double power he now has as the "sixtieth vote" on everything. Before the Senate Bill was finalized I suggested that Obama and Reid should have made explicit "linkages" between parts of the bill that they really wanted (if, for example, they really wanted the Public Option) and goodies that the Senators wanted outside the bill. In Lieberman's case I suggested things having to do with Israel, or offering him an Ambassadorship to a desirable country, or both. I don't think Obama and Reid ever did anything quite that direct, although they were certainly willing to buy off Nelson with a quid pro quo when that was offered. Whatever went on in those negotiations I think Lieberman has proven himself a master at getting what he wants in and out of negotiations--look at the way he double crossed the Democrats on the Public Option/Medicare Buy in Swap--and he is now going to be making "linkages" between his Health Care Vote and his role in Homeland Security. That's just the way he does things.

Previously, even a day ago, I was opposed to the ping ponging of the bill. I hoped that a conference report might, with the good wind at its back, materially improve the bill and still squeak through the Senate's sixty vote bottleneck. Now I'm sure that Lieberman is going to step up and screw us if he can, when he can. Just imagine his puffed up self hectoring us about how irresponsible it is to spend money on health care when there are terrorists attacking us in our valued cities, like Detroit?

I recommend that Obama, Reid, and Pelosi take what they can get--push the Senate version of the bill through as is and then fix every bit of it they can as it relates to the budget through Reconciliation. Do it fast and without warning. And make the terrorist attack your excuse, if you want. Say "the country has been through enough and we need to get on with things. We believe this bill is very good and we can fix the parts that need fixing through reconciliation in a timely manner." And then just do it. Lieberman will be left with his mouth hanging open and the majority of the bill will be irrevocable. But promise the progressives that they will absolutely be able to get the rest of their initiatives through the reconciliation process and hew to that promise. It will be the best of all possible worlds.

Edited to add the link to "wobbling Senators" up above.

You've Got To Dance With the Ones That Brung You


Meteor Blades says what I've been thinking about this whole "who killed the bill" discussion. The people who are now being excoriated for not supporting the bill, such as it is, were not part of the strategy to get the bill in the first place. Obama's actual supporters were not polled about what they wanted in the bill. The Left, whoever she be, wasn't asked what should be in the bill. And the actual progressives in the House and the Senate were, at every turn, told to sit down and shut up and take a back seat to negotiations with the all important moderates and reactionaries. I imagine this happening daily in the halls of Congress:

Philip Henslowe: Mr. Fennyman, allow me to explain about the theatre business. The natural condition is one of insurmountable obstacles on the road to imminent disaster.
Hugh Fennyman: So what do we do?
Philip Henslowe: Nothing. Strangely enough, it all turns out well.
Hugh Fennyman: How?
Philip Henslowe: I don't know. It's a mystery.

That attitude towards your voters works fine if you can deliver, in the end, what they want--and if they can see that you delivered. It won't work if you deliver something whose benefits are far less than you promised, if the benefits aren't evident, if the benefits are too long delayed, or if you look like you didn't fight. Its this last point that really seems, to me, to be important. Fighting hard, or fighting ugly, isn't Obama's style. And I certainly never expected it to be. People were ticked that Lieberman was invited to the White House Channukah party? I wasn't. I expect Obama to always be gracious and civil--I'd expect it would also be a good time for Rahm and some of Obama's more liberal Jewish guests to take Lieberman into a back room and piss on his shoes and stick his head in the toilet. (And if you think they wouldn't I have some enraged senior Jewish Democratic Donors I could introduce you to). That's the essence of good cop/bad cop--if u r doin' it rite.

This attitude towards your voters works less well when you fail to give them some respect: you don't include them in your discussions, you don't ask them for their help with the parts of the bill they care about, you strip out the parts of the bill you promised, you act like its no big deal to sacrifice key constituents (women) to placate obviously deranged and dishonest Senators (no links, anyone who's been watching knows who I mean, and why). That's ok too--you didn't think you needed your voters during the run up to the bill and you think you won't need them again until 2010. Perhaps they'll come back around by then.

But all of a sudden, in the last crunch hours before the Senate does whatever the Senate needs to do to please Nelson, Lieberman, or Snowe the cry goes up--"Its the fault of the left that we couldn't get this great/not great/disasterous/totally necessary bill all the way through?" I know defeat is an orphan and all that but this feels more like defeat is a parricide, to me. This bill is so crucial, such a once in a multi generational shot that the Democrats went into it with no clear blueprint to success--no guarantee from their own membership that all cloture votes would be pro-forma? No serious attempt to take down the cloture rule? No one ever took Nelson into a backroom with a coathanger and a copy of the constitution and choked him on the necessity of keeping local Nebraska religious politics out of other women's medical care?

There's been a lot of talk about "candidate Obama" vs. "president Obama" and I think there are lots of differences, of course, between those two styles of leadership. To my mind the most important difference isn't the difference between someone who promises vs. someone who has to govern, or someone who can be irresponsible vs. someone who is responsible (which are the various ways this has been conceived) but between someone who grasps that he is only going to get over if he really seems to want what his base wants, and is seen as fighting for it and someone who starts to act like the base were just some crazy fans who, once they've bought their tickets, have no right to say whether they like the show or not. I know I'm mixing my metaphors, here, but just one wouldn't do.

Read the Plouffe interview and see that the amorphous but passionate movement of Obama voters and supporters--people who were encouraged to get together, share their stories, build their own networks, pursue money, votes, support, local initiatives, political office--was not only entirely shut down but that Plouffe thinks this is a good thing. The weak, watery, politics of the post election Obama campaign has produced a weak, watery, confused, popular response to this tragedy of a bill. There's really nothing surprising about it. Where the campaign Obama asked people to commit to getting something specific done: deciding on Obama, contacting voters, contacting legislators, fighting for the election the President Obama has told everyone to sit back and let the grownups handle things. They asked us to be disengaged--they told the left not to have opinions about Senators or Congressmen who were going to vote against the bill. They told us not to mix in by running ads. They asked us not to advocate for policies we wanted but to accept the compromises that their right wing counterparties demanded.

This is the exact opposite tack from the campaign Obama ran in which, famously, ordinary people unleashed a ton of creative energy just reworking the logo, or making their own youtube videos and songs, or contacting their neighbors, or holding fundraisers. Well, if you run in the opposite direction from your base you have to expect that, in the end, you will get a very different response from them. Either they will accept your dicta and remain passive and disengaged, or their passion and engagement are going to go in other directions. This is what has happened. Instead of being able to draw on passionate support, Obama is fighting a headwind of apathy, disappointment, and general distrust. That's not because he is losing the battle for the bill against Lieberman and Nelson--its because he has refused to include his supporters in his strategy to get the bill in the first place. Because people were told explicitly that their contributions were not wanted they are uninvolved and uninvested. If they had been involved, and invested, as the bill started to go south they would have still felt some ownership of it, and still felt some trust that Obama and the Senate would deliver something pretty good. But months of ham handed negotiations, closed door agreements, shaving and mutilation, and contemptuous lectures have really killed people's trust in the process and its architects. In many ways Obama would have been better off if he had explained at the start that this was such an uphill battle against entrenched and corrupt interests that we had very little hope of getting anything good.

To get people to invest in the bill you have to either write the bill they want to see, pass a pretty good bill, or have a really good fall guy when the bill fails. Obama's people, if not Obama (of course), have decided that the fall guy is going to be "the left" or the "voters" for failing to appreciate all that was going to be done for them. But just as we were not involved in the writing or the negotiating for this bill we are not to blame. Frankly, I think the concept of blame is absurd. Obama and his team wanted to pursue the bill a certain way, and they did exactly what they wanted to do. They refused all offers of outside help, or criticism, or suggestion. They own this bill and they own the mechanisms that allowed Lieberman, Nelson, and Snowe to hold it up and, perhaps, to kill it. Just as they chose to exclude the base from the construction of this bill, however, they now seem determined to conclude that somehow its the base's lack of faith that is preventing the bill from being passed. Nothing could be further from the truth, and nothing could be more dangerous for the Democratic party. If this bill goes down I hope Obama and the Dems wise up and grasp that the fall guy had better not be "the base" for its lack of faith--the fall guy has to be Lieberman, Nelson, Snowe and the entire Republican party. Because you can't run against your own voters in 2010 and hope to win.

This is what I'm talking about:

MSNBC paired Howard Dean with Mary Landrieu on a health care segment last night on Hardball, which had the curious effect of forcing Landrieu -- a red state Dem who's been a hard sell on reform -- to be a staunch advocate of the Senate bill, which Dean wants to see killed for being insufficiently progressive. It made for a very interesting dynamic and compelling TV as a sitting Democratic senator and the previous chair of the DNC hashed it out.

SteveM and I were having this argument somewhere, but I can't find it, about when and how Obama could have used the left to get a better bill. Its not that I thought that Howard Dean was all that, or had any armies or followers, but that the very presence of a strong voice on (as it now turns out, the left) pulls the discussion away from the purely rightist dialogue. It makes a difference whether you have Democrats like Landrieu being forced to fight for the bill against the aggressive left, or whether you have Democrats like Landrieu being courted by the far right. In any event, we know now they didn't use the left to pull the debate left and make Obama's health care reform the "mid point" between socialism and capitalism because they didn't want health care reform to get even that close to a good bill. They preferred to have the battle be between the center and the far right.

I've given up the woulda/shoulda/coulda debate. I think its very, very, very, clear at this point that, as Jane Hamsher argued, we couldn't have gotten a better bill because Obama and Rahm didn't want a better bill. They wanted the Senate Finance Bill, more or less, and they threw the fight and blew the opportunities they did have, such as they were, to get it. The anger that arises from this realization isn't, as Talking Points Memo's letter would have it "primal" as in "emotional" or somehow not rational--the anger is foundational, embedded in very good understanding of just how terrible this capitulation by our President is for us as a country and as a party and as a people.

For the really depressed among us, go read thereisnospoon, and then come back. Did you read it? Because it basically lays it out--from now on it has to be war to the knife with Obama and the corporatist Dems. I'm not recommending leaving the party. And I'm not recommending not voting. We have to do both. But we have to go back to Dean's fifty state strategy--his "get yourself elected dogcatcher" and "member of the school board" strategy. Because there isn't going to be any hero riding in on a wave of popular enthusiasm and actually doing anything for the people. I think Obama has made that abundantly clear. Either he can't, or he won't. Either way the big discussion about who or what Obama really is has to stop--what matters going forward is what we can force him, the Senate, and the House to do for us. And that begins, as thereisnospoon argues, with creating parallel organizations, voices, and propaganda outlets to push our policies until they become inevitable.*

*Steve and I and others have had ongoing discussions about whether "the Democrats" as in the entire party could have done more to shift the public dialogue to make a good public option, or medicare for all, an unstoppable part of this bill. I really believe they could have--they just didn't bother because they didn't want to. Things that they should have done, and could have done for very little money (really, very little all things considered) would be to have sponsored *all through the summer and august* free health clinics around the country, filmed them, passed out voter registration cards, collected names, and put together a pressure group of people without insurance, or with fragile insurance to fight for the bill publicly with their local representatives.

Negotiation 101.

Its too late to say this, but it bears repeating: we are where we are on Health Care Reform because the White House doesn't understand how negotiations work. They wanted the backing of Pharma and of the Insurance Companies during the next election cycle. They wanted that money, in other words, to run Democratic candidates and they didn't want that money going to Republican candidates. In addition, they wanted some of that corporate money to go into advertising to actually support the bill as it came time to get the votes. So Obama and Rahm thought they could use Corporate money to do the work that the grassroots could have done, and would have done, for free.

That wasn't a stupid decision. In fact, it might have been quite clever. But in order to get the deal they wound up losing their political shirts because they worked backwards. As far as we know they agreed to use Congress and the Bill Making process as a bargaining chip to be bargained *away* instead of as a threat to induce compliance. What I mean is that they offered to squelch real reform--drug reimportation, the public option, etc...etc...etc... in return for a promise of funds to be disbursed later instead of pushing for the most drastically radical bill they could get and then backing off it. Similarly, Obama and Rahm preferred to keep the grassroots quiet as a gift to the deal making process, instead of using populism as a tool to force the best bargain. Instead of activating their own voters and pressuring Pharmaetc with popular rage and populist demands O and R told the most progressive members of the coalition--MoveOn for example and the Unions, to keep their mouths shut.


This violated what I'm sure are well known rules of bargaining--I myself only know what I picked up bargaining for rugs in a Nepali bazaar.* If I'd been Rahm and Obama I would have done things in exactly the opposite fashion: whip up popular anger, create a groundswell for major progressive reform, and *then* go to individual Senators and the Pharmaetc... and say:

"I don't think we can restrain the House and the Senate from going all out and demanding Single Payer and a cap on Drug prices. Its going to happen unless you back a very strong but slightly less perfectly liberal bill. And I mean back it. To the hilt. All your bought and paid for Senators are going to have to toe the party line on this or its going to be much, much, much worse than you can imagine."

And then, instead of putting all those things off the table, as Obama did, and squelching progressive amendments and moves in the House, as Rahm did, Obama and Rahm should have gone to the Blue Dogs and insisted on party loyalty on the best, most progressive, health care bill imaginable. At that point they could have gone back to Pharmaetc and offered to shave off a little here or there.

The same is true for the way the White House handled individual Senators. If the Manager's Bill that Reid put forward had been ten times stronger when Lieberman and Nelson kicked up their hissy fits there would have been tons of fat to trim. As it is the Bill doesn't contain enough liberal goodies for any shaving of the edges to be less than harmful.

Enter Howard Dean, Reconciliation, and the Public Option/Medicare Buy In. In an ideal world the White House would recognize that having Howard Dean out there demanding the bill be killed is good for negotiations with Lieberman and Nelson. Why? Because Lieberman and Nelson either want to kill the bill (in which case they will do it anyway, regardless of Dean) or they want to vote for the bill after gutting it and represent themselves as saviors--in which case every time Dean and the House act like they are the deciders and not Lieberman or Nelson L and N will move closer to an accommodation. This is why Progressives begged Reid not to take Reconciliation off the table at the start. Reconciliation, which removes Lieberman's pivotal position, should always have been kept as the stick to render Lieberman's filibuster meaningless. So when Howard Dean and the Progressives say they won't support the bill you don't say "they are irrelevant"--you say "Oh, this is terrible! We won't be able to restrain our wild eyed left wing flank. What can you, Lieberman and Pharma and the Insurance Companies do to buy them off and make them accept this bill with its mandates and 30 million new customers?"

I have no objection to Obama running against us DFH's, in Digby's felicitious term. That's what he would do if he wanted to get to a seriously progressive Health Care Reform Act. Because only when he can say to Pharmaetc, also known as Joe Lieberman's masters, that Obamacare is the only bulwark between them and the pitchforks can he get a good bill. Needless to say the same went double for the bailouts--I have no problem bailing out the banks but it ought always to have been done with the understanding that regulation would be the price the bankers would have to pay for not being strung up by their guts on the nearest lamp post.

Here endeth the lesson.

aimai

*For instance, if you want a small blue rug go into the shop and ask to see all the red rugs with green backgrounds, in large size. After they've shown you fifty of those rugs, each of which is not perfect, let them start showing you others until they get down to the one that is farthest in style and color from where you started, and they are completely demoralized and desperate to make the sale. During this time the price will have been dropping, and they will have become more and more invested in selling you something. Finally, just before you walk out, as a gesture of pity, allow them to sell you the rug you wanted in the first place, at the lowest price. It will be the lowest price because, as you will have pointed out to them, its not what you really wanted, its the wrong size and color, and you feel bad about wasting their time otherwise.

Jed Lewison has an important piece up at Kos arguing that it would be good politics, as well as good policy, for Obama to get out ahead of his own Health Care Bill and admit its flaws. Its a brilliant essay and should be read in its entirety. But although Obama has been smart enough, and elegant enough, to do essentially that with his own Peace Prize, he won't do it with his Health Care Bill. Lewison's argument is that the bill itself is highly compromised, as are the key players in the Senate. He suggests Obama admit this up front, at the signing, and promise to work hard to fix the errors and omissions in the Bill as well as the structural problems in the Senate that forced the progressive Democrats (and Obama) to compromise with the most reactionary and corrupt members of their own party in order to get the damaged bill through.

I agree with Lewison that this is both good politics--putting Obama back on the side of his own supporters--and good policy (since it puts Obama and the Dems on the side of continuing improvement of the Bill and of our health care system. But the very notion of "continuing improvement" cuts against being able to campaign on "getting something done" and "getting a bill passed." Rahm and Obama have acted, so far, as if the Democrats can campaign on "well, we got something signed! yay us" in 2010. They have another think coming, but apparently it will still be something of a surprise. It has been grassroots Democrats and the progressives who have been pointing out, very late in the game, that the benefits of the Bill as currently envisioned (such as they are) won't even kick in until 2011 and that meanwhile people are forced to pay massive sums to an indifferent and corrupt insurance business for junk insurance. Its very, very, very, clear to those watching the negotiations that aside from the intransigence and ill will of the reactionary Democrats and Lieberman, Snowe, and Collins that the biggest flaw in the bill from a political point of view was that the Democratic leadership was not willing to fight for big, splashy, popular changes up front. There are lots of reasons why they failed to fight for big things fast. But for whatever reason, their strategy is to pass something--anything-- and then brag about it.

More to the point, Obama isn't going to campaign against his own Bill, and against the "centrist" Senators. He will never admit that the bill that reaches his desk is fatally flawed because of the truly bad acts of some truly contemptible Senators. Its not his style. I'm sure he will be polite, and gracious, and humble about the Bill and its good effects. He's not much of a braggart, our President. But he is not going to rhetorically undercut the Bill and the work of the Senators who worked out whatever ghastly compromise they've worked out--because one of the compromises was, doubtless, that no one would be punished for their public heckling and their private backstabbing of the Bill. Its going to be Lieberman and Lamont all over again. Neither Lincoln, Landrieu, Nelson, Conrad nor Carper will be taken to task by the Democratic Party--that's not the way the Democrats do things.

There is another and even more important point: Obama will never admit publicly that there was one, or at most two, ways to bend the cost curve (god, I hate that stupid phrase), insure everyone, pay for what we need, put the system on a good footing--and that was some form of Single Payer or a wholly regulated not for profit insurance model. Atrios put his finger on it the other day in a post I can't find--none of the decisions left in the bill make any sense until you realize that the first principle was "don't scare the insurance companies and their flacks" not "insure everyone, fairly, without gaps, from cradle to nursing home." So the flaws in this current bill will remain unenunciated and unadmitted because the flaws are grounded in a reality we can't be brought to face: capitalist, free market, approaches to health care are doomed to failure--if success is measured by the number of people happily and healthily served by the system.

A delicate, jury rigged, legislative approach to ameliorating the flaws of a for profit, employer based, health insurance system is like trying to get rid of cannibalism by partially regulating the meal times of a cannibal society. You can measure the pots and pans, you can specify how long the meal should take, you can even order people to add a few more vegetable sides to the main dish--but you will never stop cannibalism through small legislative fixes. The problem is that you have a need--food, or health care--and you simply have to find a way to replace one source with another.

But to admit that up front would be, in essence, for Obama to run against capitalism and the free market (as ideas) and also against two of the biggest industries around (Insurance and Pharma) as well as against the reactionary members of his own party. How likely is that? It would be great politics, of course. He could assume the mantle of populist leader running against Washington and that would be a great platform for him in 2012. But it is very, very, dangerous for the lower level Democrats in 2010 and it goes against Obama's general tendency to underplay himself and his agenda as revolutionary agents. So don't expect Obama to ever do more than murmur, politely, that this Health Care Bill is a great start.

Our Stupid Discourse:


Look, there's something wrong with this thoughtful analysis, can you spot it?

To begin with, a public option would attract only a few million people, the Congressional Budget Office predicts. Those people would probably be sicker than the general population. For that reason, and because their numbers would be relatively small, their premiums would be higher than for private insurance.

A) The Public Option wouldn't "only attract a few million people" it would, as currently drafted, only *permit* a few million people to be eligible.

B) Those people wouldn't "probably be sicker than the general population"--they would definitely be sicker because the Option, at the moment, is limited to people who have essentially been uninsurable for quite some time, or are uninsurable because they have pre-existing conditions, or are poor and have the risk factors of poverty and low status employment.

C) "For that reason..." their premiums would be higher than for private insurance *which they can't get, and won't get, under any circumstances.* There is no "private insurance" system that is taking these people. They have been priced out, or forced out by reason of pre-existing conditions--from the private insurance market. There is no comparison between those premiums and Public Option premiums because the two markets don't simultaneously exist.

People need Health Care, Health Insurance is simply the means we use to deliver the most health care, the most efficiently, to the largest number of people when they need it. If it doesn't deliver health care, if it doesn't do it efficiently, if it leaves a large number of people uncovered or uncared for, if it doesn't offer health care when they need it--the system is a failure. You can create an insurance system that does all these things but it is never going to be successfully "for profit" if it does. You can create an insurance system that does all these things but as long as it can cherry pick its clients, or force the sickest onto someone else's books, it is never going to do all these things efficiently, or humanely, or cost effectively.

Why at this late date are the reformers allowing this fundamental fact of reality to be obscured? Why do we continue having incoherent surface discussions of "what the Public thinks" when there is no clear or honest information being offered about what the various plans do, for various kinds of families, over the course of the lifetime of those families? In addition, why are pundits and pollsters insisting on talking about a generic "Public Option" when no such Option really exists or, indeed, of "Private Insurance" when no such option realistically is offered, or works, for Americans. I'm sick and tired of having pundits explain to me that the "Public Option" ain't all its cracked up to be when they refuse to admit that the Private Option is nothing like its supposed to be.

The simple fact is that even Americans with Employer Based Health Insurance are only temporarily insured. Medicare and Medicaid are already serving as a way that private insurance (and Employers) dump the sickest among us onto the Public Rolls. But the public doesn't know that, because the Administration doesn't know how to talk clearly about the hidden costs of our Health Care crisis. If the Government, at least, would talk honestly about our Health Care needs from cradle to nursing home the public would have a better idea of just how bad the system is, and where reform will make the most sense. The public would also have a better idea of who to thank when the problems were solved. As it is, the goodies in the bill for the average person are not well understood now and never will be. Most people only grasped how bad private insurance was when they got forced out of the system, or tried to buy in. To the extent that the Obama bill will ameliorate some of those things the citizenry will simply never know--anymore than they think about the regulations that give them pure tap water.

aimai

aimai