Thursday, January 14, 2010

Sectarianism by progressives and real existing health care reform possibilities

Aimai at No More Mister Nice Blog (Splinter Group! 01/14/09) argues that the folks at FireDogLake and some of her own commenters are going overboard in their polemics on the health care reform. I wouldn't put it the way she does. But I do share what I take to be her suspicion of the passion to be pure in politics:

Now that I've typed that I see that there is another almost natural religious trope lurking in the wings: the truly manichean perspective posits a good god, and an evil god, warring for control of us. I acquit most Obama voters of having been truly in love with Obama--I know I wasn't--or having any illusions at all about him. But the rage that has been directed at him and at Rahm (his mini satanic alter ego) smacks of the rage of the disappointed lover and the apostate. Its not just authoritarian Americans who love the idea of the attentive, harsh, dominating daddy--I think the longing for this all powerful fantasy figure underlies a lot of leftist rage at Obama as much as it underlies a Maureen Dowd column. Its not that I think people are making the transition all the way from "O-Bot" to Anti-Democrat but I think people had a lot of unexamined illusions about the way things might go once we got "one of ours" finally into the White House. Well, things haven't gone as hoped and planned--and someone and something has to take the fall for disappointing the kiddies when the bicycle isn't under the tree.

I'm not a child and I don't need a fall guy or a personalized explanation for why a top heavy, heavily monetized, highly divided and corporatist political system with a Senatorial bottleneck and a supermajoritiarian filibuster might have a hard time totally rebuilding a decayed health care system from the ground up in a matter of months. Its not even a question. It just can't be done right now, using stone knives, bearskins and sheer logic. What we are getting is probably the best we can get under the circs. [my emphasis]
I've described my own particular reasons for being disappointed at Obama's capitulations to the Blue Dogs on the public option. And while "the best we can get under the [circumstances]" may describe the prospects for health care reform right now, we certainly can't ignore that Obama and the Democratic leadership shaped these particular circumstances in specific ways.

I would prefer to see the House Progressive Caucus insist on having a public option included and force Obama to either fight for it in the Senate or join Joe Lieberman and Ben Nelson in taking the blame for a popular health care reform going down. That's my own reading of this particular political moment.

And part of that reading is based on thinking that the individual mandate without a robust public option is a bad outcome. And I believe the likelihood is that such an arrangement will fail in practice to meet two essentials of meaningful health care reform: access and cost control. It sounds good to say that 30 or 35 million of the currently uninsured will be insured under the Obama-Lieberman plan.

But if they have to pay up to 8% of their income to private insurers and are stuck with deductibles up to $12 thousand per year - which is my understanding of the current Senate (Obama-Lieberman) version - then for most of those 30-35 million, they get the worst of both worlds. They have to pay out the wazoo to private insurers. But for most of the health care services that they actually use in a year, they will still have to pay for all of it out of pocket. Which means they will will have the same financial pressure as now - or even worse,considering the amount they'll be paying out for their junk health insurance policies - to delay going to the doctor when they are sick. It's been a common observation of health care reformers for decades that these delays are a major factor in running up costs. Because when people neglect early treatment, some of them wind up having to have more expensive treatment, either in emergency rooms or by winding up with a more serious condition that could have been treated less expensively with earlier intervention. And the Obama-Lieberman version wouldn't put much of a constraint on insurance policy costs, either.

There are good features in the bill. Junk insurance policies like those I've described would at least provide catastrophic coverage for major illnesses or injuries requiring long hospital stays or repeated major surgeries. The Senate bill also includes expansions of existing community health services, which may be the single most beneficial aspect of the bills. So now the White House is putting the kind of pressure on health care reformers that it steadfastly refused to put on the Blue Dogs and saying, do you want to be responsible for the good parts of the bill going down?

That involves negotiating strategy that is in a very particular stage right now. And as a former boss of mine put it crudely in describing negotiating, "you've got to have balls to go bowling". Joe Lieberman and other Senators who are so friendly to the insurance lobbyists are obviously willing to use their willingness to walk away from the table and let the whole thing go down to get the changes they want. Why shouldn't progressives in Congress be willing to do the same thing? Especially on an issue so critical to the general public and to the Democratic Party?

I also don't like being played for a schmuck. The Senate can do away with the filibuster rule with a simple majority vote. We saw in the "Gang of 14" show back in 2005 that the Republicans were prepared to do away with the filibuster to get what they wanted. At the risk of being repetitive, why shouldn't the Senate Democrats be willing to do the same thing? Especially on an issue so critical to the general public and to the Democratic Party?

The Senate Democrats could have passed this without Joe Lieberman's vote. And I just don't buy the notion that the White House came down hard in December against the public option and in support of Lieberman's position because they thought they had to have 60 votes. They didn't, and they knew they didn't. And there were even other approaches like the reconciliation process to avoid the cloture vote. And, hell, can't the White House get something from some of these war-worshipping Republicans for agreeing to escalate the Afghanistan War? Like, for instance, a vote for cloture on health care reform?

One way to preserve the beneficial parts of the health care bill would be to take out the individual mandate. That's the main part of this that the insurance industry really wants. If we're taking the public option off the table, why not also take the insurance industry's favorite part of the table, too? Then the Democrats would have a real incentive to offer the industry in later efforts to improve the bill - as the leadership is assuring the base they want to do just as soon as this bill gets passed, honest to goodness they want to improve it some more!

Again, Aimai is making a good point about sectarian-type thinking. And obviously we won't know what the final product looks like until the deal is done.

But Aimai may also be underestimating what a psychological shock it was for Democratic activists in December to see the White House come down hard in favor of tossing out the public option, which they had assured us all year they supported.

At the very minimum, after everything we saw with how the Obama administration approached their general business this past year, and the health care reform in particular, it's hard to see how we can avoid the conclusion that Obama has much more respect for those like Joe Lieberman who oppose Obama's stated positions than for those who support them.

I expect to continue to say so when I see Obama's policies moving in the right direction. Today's announcement by the Bulletin of the Atomic Scientists that they judge the danger of nuclear war to have decreased somewhat during Obama's first year in office is great news. For all the scary projections of the effects of global warming, nuclear war is still the biggest menace to the human race. Reducing that risk is an important achievement.

A final point for this already lengthy post. A great deal of what has been encouraging for liberals and for not only the Democratic base but also the general public has been Obama's eloquent expressions of popular hopes and aspirations. But I find myself unable to get excited by Obama's rhetorical declarations any more. On an issue like escalating the Afghanistan War which the Republicans support, his actions have been consisted with his 2008 campaign rhetoric. And in a substantive way. But on health care, labor rights, civil liberties, immigration reform - so far we've mostly gotten pretty words.

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