President Obama will address a Joint Session of Congress a week from today on health care reform. George Stephanapoulos has a blog post up at ABCNews.com called The 5 key Strategy Questions the White House is Considering on Health Care 09/02/09. He doesn't cite particular sources, so it's not clear whether he's passing on White House suggestions or reciting Beltway Village conventional wisdom. Here are his first two conditions:
1 - What is “death with dignity” for the public option? Is it better for the president to sacrifice it himself? Or convince Democratic leaders behind closed doors to come to him? Some will argue for taking the public option issue to the floor, passing it through the House and sacrificing it in conference - but once you’ve gone that far, it may be impossible for House Democrats to back down. So, giving it up on the front end in some fashion is likely the preferred option.
2 – How do you get the price tag down, likely down to about $700 billion? At that cost the most unpopular tax increases will not be necessary. And moderates in both the House and the Senate have already signaled that they can live with it at that level.
It may not be so easy for the Obama administration to flush the public option down the toilet as it looks from inside Pundit District 9.
Labor leaders drew a line in the sand today, saying a health care reform bill must include three specific elements -- including a government-sponsored health insurance plan, or "public option" -- in order to win their support. ...
Every day people are drowning from the cost of health care," AFL-CIO President John Sweeney said.
Richard Trumka, who will replace Sweeney as president in a couple of weeks, said there are "three absolute musts" for health care: the public option, an employer mandate, and no taxes on employer-provided health care.
"That means we won't support the bill if it doesn't have the public option in it," Trumka said.
He alluded to his earlier assertion that lawmakers will pay a political price if they do not support the public option.
"We're going to tell our members the truth, who stood with them," he said. [my emphasis]
Without the public option, there is little prospects of bringing America's very excessive per capita expenses on health care down closer to the dramatically lower levels of other OECD (wealthy) countries. And without an effective individual mandate to buy insurance, neither the goals of universal coverage nor adequate cost reduction will likely be achieved. David points out that without the public option, the only way to cut the costs of the plan significantly would be to slash the proposed subsidies for lower-income individuals buying health insurance:
Reducing the cost of the bill either keeps more people off Medicaid or reduces the subsidies, making forced insurance under an individual mandate unaffordable. You would have to pull back from subsidies at 400% of the federal poverty level to something like 200%, and probably not expand Medicaid at all (the House bills call for expansion to 133% FPL, the Senate HELP bill ups it to 150%). There’s this notion that bloggers and progressive groups don’t care about the poor, but we’re not writing the bill, and kowtowing to the lunatic moderates who put a price tag above morality except when talking about war. I have understood from the start that the coverage expansion elements of the bill were crucially important, and the same thinking that artificially lowered the stimulus cost to the detriment of state budgets and public investment would doom the coverage expansion elements.
Furthermore, insurance companies have sought to reduce the percentage of premiums they would have to spend on health care, and how much of that cost they would push off to customers (Insurers would have to pick up at least 76% of care in the House bills, but 65% in the Senate Finance draft, according to reports). While the public option remains crucial, these coverage expansion policies and insurance regulation also must be demanded as the minimum requirement for liberal support of the bill. [my emphasis]
I don't see David's position as liberal purism at all. This is not a continuing resolution to keep existing programs going. This is an strategic, historic revision of the way we provide health insurance in the United States. And doing it without the basic elements that will make it work really would be worse than not doing it at all. As David puts it:
Stephanopoulos is very plugged in, and so this could very well be the discussion at the White House. Who apparently have yet to figure out that forcing millions of Americans into buying crappy insurance that can only come from private industry will be so massively unpopular that, if Republicans don’t repeal it, Democrats will be forced to themselves. That would be the quickest and easiest way possible to squander the majority, which at times I think is the Washington Democratic establishment’s metier. [my emphasis]
The health care battle has made it clear that there is a major difference on domestic policy between the corporate wing of the Democratic Party and what we could call the blue-green wing (organized labor and blue collar workers) and greens (environmentalists, antiwar Dems, civil rights and civil liberties supporters). The late Paul Wellstone used to call the blue-green part of the Party, "the Democratic wing of the Democratic Party", a slogan Howard Dean adopted for his antiwar Presidential campaign in 2003-4. The Democratic Party has generally been following the Republican-lite strategy of the corporate wing for 20 or 30 years before Obama got elected in 2008 on essentially a blue-green platform. Fully embracing the corporate-Dem approach by caving on health-care reform could squander not just this opportunity, but the chance for three or four decades of progressive political ascendancy in the United States.
I hope that in a couple of weeks we won't be looking at a political landscape in which the activist base is having to face up to the fact of an essentially conservative, corporate-oriented leadership completely determining the direction of the Democratic Party. I don't see a viable third party developing unless the Republican Party completely tanks in 2010 and 2012, leaving it as little more than a rump Southern regional party. But the idea of a two-party system in which the choices are between a conservative party and a reactionary party isn't a pleasant thing to think about. And if the Dems fail on health care, either by failing to pass comprehensive reform at all or passing one so neutered that it quickly becomes unpopular, I see very little prospect on the horizon of the Republicans completely tanking in the next two election cycles.