Health care reform and progressive politics

In my previous post, I focused on policy concerns with the health care bill just evaluated by the Congressional Budget Office (CBO). As I mentioned there, the public option isn't dead yet, as of this writing, but it looks like it's all over for the public option but the funeral. But there are obviously big political stakes, as well.

There's general agreement among pundits and real analysts that passing health care reform will be understood as a victory for Obama and the Democrats and a defeat for the Republicans. The conventional wisdom is that defeat of the bill would help Republicans. Now that it looks like it's going to pass, the punditocracy will probably be soon telling us that that result is also Good For The Republicans.

It's not clear to me, though, that passing health care reform will necessarily help the Democrats. The Republican base is mobilized against it and energized. The Democratic base, by contrast, is de-mobilized - not least by the Party's uninspiring behavior during this health care reform effort. Unemployment is still bad and there's no dramatic relief in sight. The Afghanistan War is unpopular, especially among the Democratic base. This is not a good configuration for the Democrats for the fall elections. Their main hope is that Republican extremism has been so off the tracks that people will be turned off by it.

In the current squabble among Democrats, I would have preferred to see the Progressive Caucus hang tough and demand that a public option be included. More on this below.

These are some major themes that stand out for me right now:

Quid pro quo contributions

Maybe this sounds like some goo-goo (good government) truism. But one thing that has been bothering me the last few days is seeing such blunt quid-pro-quo-sounding deals like Ryan Grim mentioned in the quote in the previous post: "The pharmaceutical lobby has signed off on the increased commitment and will be running ads in Democratic districts in support of reform."

Congressman Dennis Kucinich has also said he would give back donations he took from anti-reform groups because he agreed with President Obama that he would vote in support of the reform bill: Ryan Grim, Dennis Kucinich Flips On Health Care Reform: Will Support The Bill Huffington Post 03/17/10. He reports:

Other liberal activists were not nearly as pleased with the congressman's change of heart. Minutes after Kucinich's announcement on Wednesday, a prominent progressive who has petitioned liberals to defeat the bill called on him to return the money he had raised from kill-the-bill supporters.

"Dennis Kucinich signed a pledge to vote against any bill that does not have a public option," FireDogLake's Jane Hamsher emailed the Huffington Post. "Online supporters donated over $17,000 to him over the past two days as a direct response to his reiteration of that promise this week. It would be deceitful of him to keep that money now, as well as the $8,000 raised after he signed that pledge in July." ...

A Kucinich spokesman tells HuffPost that Kucinich will return any money donated to him under the assumption that he would oppose the health care bill for not including a public option, confirming this post. The amount is between $15,000 and $20,000.

Pretty much everyone realizes that the American system of lobbyists and campaign contributions is largely a legal form of bribery. But a straight quid pro quo is not allowed. I'm not saying that I think Kucinich or the pharmaceutical companies broke the law in these instances; I assume that what they are doing is legal. I am saying that what I quoted above makes these sounds uncomfortably like straight-up quid pro quo arrangements.

Individual mandate with no public option

The link in Grim's post is to this one by Firedoglake's Jane Hamsher, Dennis Kucinich Will Return Money to Donors 03/17/10, who has taken a very vocal hard line on killing the bill if there is no public option included. She lays out how some of the policy problems in the bill could turn into political problems for Democrats.

The biggest political problem in reform would be if we get the individual mandate without a public option. Even if the enforcement of the new consumer protections is effective, the individual mandate requires that millions of people not currently buying insurance will have to start buying it, resulting in healthy new profits for insurance companies and hospitals. But in terms of future horse-trading, giving them the individual mandate now without a public option makes it more likely that they would opposed adding the public option in the future.

The individual mandate is also inevitably going to cause some grumbling among healthy and younger voters, who will be more option to Republican anti-tax rhetoric as a result. That political effect would largely be offset if a robust public option is concluded, based on the positive effects on the cost and accessibility the public option would be expected to provide. Especially if insurance companies rig the new system with expensive premiums and/or high deductibles, millions of people could wind up experiencing the individual mandate when it begins in 2014 as the government requiring them to hand over money to insurance companies with little or nothing in return. And that perception may well be accurate.

For the Democrats, that is a real political problem for the future.

And Democratic political problems over health care reform will also become problems in fixing policy problems.

What the health care reform fight has shown us about Obama

Obama made a closed-door deal early on to oppose the public option. Miles Mogulescu, NY Times Reporter Confirms Obama Made Deal to Kill Public Option Huffington Post 03/16/10.

Despite what the troubled Maureen Dowd may think about Obama's girly-man tendencies, he showed in this fight that he is willing to come down hard on Democrats to get what he wants. The problem in this case is that he came down hard against the supporters of the public option. We saw a dramatic example this week with his successful arm-twisting of Dennie Kucinich. He never applied pressure remotely like this to get the public option passed when he he favored it. Whether he could have gotten the public option passed by pushing for it will almost certainly remain a "what-if" scenario. But there's little doubt in my mind that if he had wanted the public option, pushed for it hard in public, and lobbied the Blue Dogs over it the way he lobbied Kucinich, that it could have passed.

Obama's approach to the financial bailout and to the health care reform leave little doubt that he's inclined to govern as a corporate Democrat. Don't get me wrong: a corporate Democrat is better for the country than a Predator State Republican - and I'm not sure we have any other kind of Republicans right now.

But it does mean that Obama is oriented toward the neoliberal policies that should have been permanently discredited by the financial crisis and the severity of this recession. The neoliberal approach has fundamental problems. We shouldn't forget that Obama has given definite signs that he is willing to go down the road of reducing Social Security and Medicare ("entitlement reform"). The fact that he's not as bad as the Republicans doesn't mean that some of his ideas aren't bad ones.

Progressives in Congress

Another thing that has happened in the extended debate over health care reform is that the progressives in the Democratic Party turned out to not have nearly the practical clout that a small bunch of Blue Dog Democrats did. Like their close Republican kin, the Blue Dogs are willing to go to the mat for their conservative sticking points. The progressives in Congress weren't.

Jane Hamsher may be expressing it in a particularly pessimistic way. But it's hard to argue that the experience of health care reform has to make even the most optimistic progressives Democrats how much fortitude and clout the House Progressive Caucus and Senate progressives really have (Yes, Rahm is Totally Vindicated Firedoglake 03/18/10):

Nobody will take progressives in congress seriously, nor should they. Their threats are idle and they won’t fight for anything they believe in. In the end, they’ll just take turns shaking their fists in futility and alternately sucking so no serious liberal challenge ever emerges to anything.

Whatever Barack Obama wants to do will be the farthest left any piece of legislation gets, and if anyone should try to challenge from the left, the unions and the liberal organizations and party blogs would rise up to condemn them and whip them into line — even if it means completely reversing themselves and devolving into total incoherence. And they’ll be rewarded with carve-outs and corporate money and expensive advertising and personal sinecures for playing their role in facilitating the corporate cash pipeline. Because that’s the job of the ever-expanding veal pen: cover Obama’s left flank and shut down progressive opposition.

Gleen Greenwald weighs in with Has Rahm's assumption about progressives been vindicated? Salon 03/18/10:

For almost a full year, scores of progressive House members vowed -- publicly and unequivocally -- that they would never support a health care bill without a robust public option. They collectively accepted hundreds of thousands of dollars based on this pledge. Up until a few weeks ago, many progressive opinion leaders -- such as Moulitsas, Howard Dean, Keith Olbermann and many others -- were insisting that the Senate bill was worse than the status quo and should be defeated. But now? All of those progressives House members are doing exactly what they swore they would never do -- vote for a health care bill with no public option -- and virtually every progressive opinion leader is not only now supportive of the bill, but vehemently so. In other words, exactly what Rahm said would happen -- ignore the progressives, we don't need to give them anything because they'll get into line -- is exactly what happened. How is that not vindication? ...

If you were in Washington negotiating a bill, would you take seriously the threats of progressive House members in the future that they will withhold support for a Party-endorsed bill if their demands for improvements are not met? Of course not. No rational person would. [emphasis in original]

Glenn goes on provides some useful, practical discussion of negotiating strategy in these situations. But he and Jane are right on the point: if the public option is left out - as it almost certainly will be - the health care reform bill represents a major smackdown for the Democratic wing of the Democratic Party. Unless the progressive Dems are willing to negotiate as hard as the Blue Dogs are, they will continue to lose these fights. Unless pro-choice Dems are willing to negotiate as hard and the antiabortionists, they will continue to lose in these fights.

I don't think that progressive expectations are just going to fade away into resigned acceptance of more neoliberal policies that inject unnecessary risk into the economy and that continue to increase the maldistribution of wealth and income and continue to export American jobs. One very promising form of progressive political resistance (is that too strong a word?) is the newfound popularity of primary challenges to corporate Democrats. There are bound to be others, maybe some of them very surprising. Robert Reich observes in Principles Before Heroes Democracy Spring 2010:

In 2010, the American public will continue to experience housing foreclosures, job losses, lower earnings, less economic security, widening inequality, soaring pay on Wall Street and in executive suites. But without the articulation of a larger narrative that ties these phenomena together and explains what needs to be done, the nation will be unable to mobilize politically to demand and support large-scale change. The public will also be more susceptible to dangerous right-wing arguments that its problems were founded in "big government" and excessive taxes, and to simplistic arguments on the left that its problems all stem from greedy corporations and global trade and investment.

But Obama and the Congressional Democrats did not use the financial crisis and the health care reform fight to encourage a broad democratic movement against plutocracy. Seriously squandered opportunities. Reich continues:

A "double dip" [recession] might itself create political demands for large-scale reform, but an economy that's merely bad is more likely to unleash a political backlash – as, over time, more Americans grow skeptical that established institutions will respond to their needs, and convinced that the game is rigged against them. Stirrings of such backlash can already be found in the increasing shrillness of American politics, the coarsening of public debate, and the public’s deepening cynicism about every large institution – big business, Wall Street, and government. And it can be seen in the public’s increasing isolationism on foreign policy, weakening support for international trade, growing aversion to immigrants, and escalating hostility toward elites of all kinds – whether business leaders or politicians, the denizens of Wall Street or lobbyists, ivory-towered intellectuals, or people with great wealth. [my emphasis]

Tags: health care reform