"Business Week" hearts mandates

Peter Coy has an interesting piece on the practical reality of mandates in insurance, The Case for Way More Mandates Bloomberg Businessweek 07/05/2012:

Insurance mandates, far from being unique to Obamacare, are all around us. States require drivers to carry liability insurance. Your state government also provides you with—and charges you for—insurance against losing your job. The federal government mandates flood insurance for anyone living in a flood plain who has a federally insured mortgage. Social Security is mandatory insurance against a penniless old age, and the premiums are deducted from your paycheck, whether you like it or not. “This is part of our fabric,” says Ann O’Leary, director of the Children and Families Program at the Center for the Next Generation, a San Francisco think tank.

The logic of getting everyone to jump into the risk pool is powerful: Left to their own devices, many people will choose to go uncovered against fire, flood, car crashes, and cancer. Then, if something bad happens, they throw themselves on the mercy of society. The cruel solution would be to let them live (or die) on the streets. To our societal credit, we are unwilling to do this. A coverage mandate at least ensures that people who create the risks will bear the costs, on average, over time.

People who choose to skip insurance are often more shortsighted than devious. Most Californians who took out earthquake insurance after the 1994 Northridge earthquake have let it lapse, says Howard Kunreuther, a professor at the University of Pennsylvania’s Wharton School. "The biggest challenge we have faced is to convince a person, anyone, that the best return on an insurance policy is no return at all." The point of a mandate isn’t only to protect people from the consequences of going unprotected; it's also to prevent the rest of us from having to pick up the tab. [my emphasis]

A single-payer system, "Medicare for all", for example, would be preferable to the ACA system ("Obamacare").

But my problem with the individual mandates in the ACA is not that they exist. If we're going to have a private-insurance based system, having mandates to make sure people are covered - along with penalties/taxes to make sure wanna-be free riders pay their fair share - we need a public option, a buy-into-Medicare option to provide price and quality competition for the private insurers. If the private options provide better value and service, they will continue to win customers. But if the public option provides better service and value, that's great. If the insurance companies lose business because they can't compete with a public option, it will be because the public option proves itself to be the best way to provide health insurance.

Another thing I like about Coy's article is that he calls Social Security what Social Security supporters should call it all the time, insurance. Social Security is a social insurance system. It's not an investment vehicle or even a retirement system proper, although the severe deterioration of private pensions - another major value of the private sector in the US - has made Social Security the primary source of retirement for many.

Enemies of Social Security have worked hard to re-brand Social Security as an "entitlement" (which in RepublicanSpeak means "something black people use") and to make phony comparisons of potential "returns" on Social Security to returns on an investment account. The latter comparisons become less frequent in times of stock market alarms. But in good times are bad, it's a plainly false comparison. Social Security is insurance, not an investment.

Tags: health care reform

Health care reform and its problems

The Supreme Court's review of what even the President is now calling "Obamacare" reminds me again of the policy and practical political problems with the ACA (Affordable Care Act).

Obamacare is the main domestic achievement of this Administration. And the public has more of a negative than a positive impression of it.

Cenk Uygur of The Young Turks is no doubt right in assuming that the Administration's indifferent defense of the ACA in face of non-stop Republican attacks over the last two years has ceded the active opinion-making on the subject to the program's enemies.

The lack of a public option is a huge problem. The public option would have been a major factor to force private insurers to keep their rates restrained. It would also have led in the direction of a single-payer system.

The individual mandate combined with the absence of the public option is seriously problematic. The mandate is necessary. Unless everyone participates, the important goal of restraining health care costs and health insurance cost is undermined. If people are mandated to buy private insurance, without a public option available, and without a low ceiling on deductibles, the insurance companies could wind up selling what for most people would be "junk" insurance, i.e., insurance with such high deductibles that it wouldn't cover most of the costs those covered would use in any given year.

This would damage the effectiveness of the program, because part of the reason for coverage is so that people will go to the doctor early in the stage of being sick, when treatment is more successful and cheaper. If people are stuck with a $5,000 deductible, the program won't provide that incentive. And people who are forced by law to pay several thousand dollars a year without being able to get their actual health expenses in a year covered with understandably be upset and the mandate.

Exemption of undocumented immigrants is also big hole in the ACA, both in basic fairness and in the universality of coverage, which again is a major factor in restraining costs and promoting good health. This is not a hard concept. If parents are afraid to take their kids to the doctor for fear of running afoul of immigration authorities, their kids are more likely to come to schools with contagious ailments, and the parents more likely to go to work with them.

For that same reason and others, it was also foolishness to postpone the implementation of the main part of the ACA until after the 2012 Presidential election. There are lots of people without insurance in this depression and they need access sooner rather than later. The reason was delaying was largely mindless "free market" dogmatism. Postponing the start meant that the 10-year deficit projections sounded lower. Which might have been a political benefit to the Democrats if anyone actually gave a flying flip about the deficit besides our political and media elites.

Instead, the Administration got better deficit projection, which is highly unlikely to drive any votes to the Democrats. And most people won't see the full benefits of the law until after the Presidential election. And if Obama loses, a real possibility, then Republicans will have a good shot at repealing it before it even goes into effect.

So, going into the 2012 election, Obama and the Democrats gets four years of Republicans blasting the ACA. Most of the benefits are postponed. The very popular public option provision was left out. And the Administration has failed to aggressively defend the program, although Obama has started to do so lately. Maybe he at least will continue to do that now that it's an election year.

Progressive Democrats also need to remember that the omission of the public option was a specific defeat for the Congressional Progressive Caucus and one that largely deprived it of effectiveness during Obama's first term up until now. They made inclusion of a public option a red line minimum for them to support the ACA. Dozens of Representatives signed a statement saying they wouldn't support it without a public option. In the end, they did. They also ate the increased abortion restrictions the Blue Dogs and Republicans inserted into it. Yes, Progressive Caucus got far more pressure from the Democratic establishment than the Blue Dogs did. But it still showed the White House that they could be rolled.

Until the Obama Administration has to worry more about opposition from the Progressive Caucus than he does about opposition from Blue Dogs, his Administration will continue to promote neoliberal economics and pre-compromise its proposals for conservative appeal and then compromise them some more.

I haven't followed the legal arguments closely enough to even guess how the Supreme Court decision on the individual mandate might go. Although if the Roberts Court strikes it down, it will be another heavily political decision.

Jonathan Cohn notes in Obamacare on Trial: What the Right Already Won The New Republic 03/26/2012 how the Republicans have used the fight over health care to push their preferred framing, a process facilitated by Obama's continual compulsion to define his own proposals and principles in terms friendly to the Republican framing:

As recently as three years ago, the idea of an individual mandate (the requirement that most people get insurance or pay a penalty) was largely uncontroversial, not only within the Democratic Party but within the Republican Party as well. As late as the spring of 2009, prominent Republican lawmakers like Charles Grassley, ranking minority member of the Senate Finance Committee, publicly embraced the idea of the mandate as part of health care reform. If he or any other leaders of the GOP thought the mandate was an unholy violation of liberty, they kept it to themselves.

The mandate also has a lengthy, bipartisan resume: Among its original architects were researchers at the Heritage Foundation. Among its early supporters were the three top Republicans running for president: then-Senator Rick Santorum of Pennsylvania, then-Speaker Newt Gingrich and then-Governor Mitt Romney of Massachusetts. Romney, of course, enthusiastically promoted the mandate as a way of enforcing individual responsibility—because, as he liked to say, people who can pay for their health care share shouldn’t pass their bills onto others.

But now they changed:

The mandate is health care reform’s least popular element. By focusing on it, rather than more popular elements of the law, Republicans have a useful tool for attacking President Obama—potentially undermining his most significant domestic policy achievement and ending his tenure in office at one term.

I would like to believe that a Court decision striking down the individual mandate would create an incentive for Obama and the Democrats to make a new push for the public option and event to make a more explicit political issue out of the Court's reactionary tilt. But the last three years offer little hope that Obama and the corporate Democrats would respond that way.

One very odd part of Cohn's article is that he mentions Laurence Silberman as one of the group of "well-respected conservative judges". Respected by whom? Silberman is the Republican hack who overturned Oliver North conviction for perjuring himself before Congress and was a big player in the Whitewater witchhunt during the Clinton Administration. This hack accused President Clinton of "declaring war on the United States" because some White House aides had criticized Special Counsel Kenneth Starr, one of the slimiest characters in American history. (See his profile at Right Wing Watch 04/18/2007) I ask again, respected by whom?

Tags: health care reform, laurence silberman

Money, politics and policy: health care edition

Matthew DoBias, Health Groups Do Balancing Act With Donations National Journal 10/09/2010

Overall, contributions from trade associations representing doctors, hospitals, and drug manufacturers are all leaning heavily toward Democrats. Yet, while avoiding direct confrontations with their Democratic allies in the health care fight, the groups are tilting toward Republicans in open-seat Senate contests -- signaling that they might be preparing for a post-midterm world in which Republicans will control more of the agenda.

The clear tilt of donations toward incumbent Democrats represents an extension of the handshake deal that the hospital, physician, and pharmaceutical lobbies made with Obama to support his approach to health care reform.

In July 2009, three of the nation's most influential hospital groups, including the American Hospital Association and the Federation of American Hospitals, trumpeted a deal to accept more than $155 billion in Medicare and Medicaid cuts to help finance the reform effort. In return, they agreed to back the Democratic-led effort to reshape the health care industry. That commitment remains apparent -- to a point -- in the way they are distributing their campaign dollars this year.

The wording isn't clear there. It sounds like the industry made a concession, and then out of gratitude for being allowed to make the concession, made another one. It doesn't explain the role of the individual mandate and the public option.

But for each of these groups, this cycle's pattern marks a shift from their traditional approach. [The pharmaceutical lobby] PhRMA has been closely identified with Republicans over the past decade; until earlier this year, it was led by former Rep. Billy Tauzin, R-La. From 2000 through 2006, while Republicans controlled both Congress and the White House, PhRMA directed about three-fourths of its congressional contributions toward Republicans. The Federation of American Hospitals also had leaned strongly to the right, directing nearly two-thirds of its giving toward the GOP. So did the AMA: In each election from 2002 through 2006, it directed at least three-fifths of its contributions to Republicans.

Almost without exception, the groups this year have avoided contributions to Republicans challenging incumbent Democrats who voted for reform. The AMA PAC, for instance, hasn't contributed to any such challenger except Eric Wargotz, a Republican physician who hasn't displayed a pulse in his race against Sen. Barbara Mikulsk of Maryland. And AMA has contributed to her campaign as well.

AHA and PhRMA have also shied away from contributing to Republicans challenging incumbents who voted for the legislation. The four PACs have contributed to a long list of embattled Democratic supporters of the bill, from Sens. Michael Bennet of Colorado and Harry Reid of Nevada to Blanche Lincoln of Arkansas, who held up her vote until the 11th hour before ultimately supporting the package. [my emphasis]

But now that the industry has the individual mandate and the public option is out, it seems pretty clear what the answer to the question posed at the end of the following passage will be:

The broadest measure of health industry support sends a similar message of qualified allegiance. Individual contributors who identify themselves as part of the health care sector have donated close to $321 million to congressional campaigns, according to an analysis by the Center for Responsive Politics. And they have split their donations almost exactly in half between Democrats and Republicans.

For Democrats, this bifurcated pattern of support for incumbents and a tilt to open-seat Republican challengers leaves the largest question unanswered: If a new GOP majority tries to repeal or block the law in 2011, will the industry defend the law or join in the campaign to raze it?

Tags: 2010 elections, health care reform

Obama and the public option

Tom Daschle's new book includes another reminder that the key reason that health care reform doesn't have a public option is because the Obama White House bargained it away early on in the process in secret meetings with "the hospital association, with the insurance (AHIP), and others," as Daschle put it in an interview with Think Progress. This is a major problem, a weakness that is likely to deprive the health care reform of much of its effectiveness, undermine public support for it, and give the Republicans and opportunity to reverse the parts of the reform beneficial to consumers.

Glenn Greenwald has a good report on the Daschle item, Truth about the public option momentarily emerges, quickly scampers back into hiding Salon 10/05/2010. See also Igor Volsky, Daschle: Public Option 'Taken Off The Table' In July [2009] Due To 'Understanding People Had With Hospitals' Think Progress 10/05/2010; David Dayen, The Deal with the Hospital Industry to Kill the Public Option 10/05/2010.

As Greenwald puts it:

What Daschle said here -- in his interview with Volsky and, apparently, in his new book -- is crystal clear, and is consistent with what has long been clear: despite its stream of public statements to the contrary, the Obama White House made no efforts to have a public option in the bill because their secret, early agreement with "stakeholders" was that no public option (and thus no real mechanism of competition with private industry) would be created.

And he's correct in saying, "one cannot argue that the White House did push for it, or even that they wanted it, since it was part of their deal with industry and its lobbyists from the start that it would not be in the final bill."

I would note that one very public indication of such a deal with the stunning admission by White House advisor Valerie Jarrett at her appearance at Netroots Nation in August 2009 that the White House had no intention of bringing any kind of pressure on the Blue Dog Democrats to get them to support the health care plan, which at that time still included the public option, which the administration was still claiming to back.

Her response was stunning. The question was posed to her by comedian Baratunde Thurston, who generally did a poor job of conducting the interview with her, which was the format of her appearance. He asked a reasonable question that was put in a melodramatic form, which gave Jarrett the chance to duck the actual question. Although she actually answered the real question about whether the President was going to pressure the Blue Dogs to get in line. This is from the transcript, though I've done some clean-up on capitalization, spacing, punctuation and paragraph breaks:

[Baratunde:] This question is from Facebook from Martha Elizabeth. Is the President going to call all the Blue Dogs in his office and give each a piece of paper with the amount of stimulus money and say, "I want your vote on healthcare? If you're a Democrat get in line. Otherwise any time you want money in juror [your?] district you can ask Jim De Mint for it?" Wow. Mary Elizabeth!

[Jarrett:] Mary Elizabeth. She has a fan club.

I was going to say. I'm jealous. I haven't got that kind of applause yet. my goodness. The fact of the matter is I know obviously that's hit a note here, and I know that there is a lot of frustration here and around the country, and I'm telling you, I am convinced this president has it right and he is going to continue to go along the way he's going.

He is not one to punish or do any of the kinds of things that perhaps you might want to do in a moment of span [?] the mayty [martyr] or anger but he'll count on the American people to put the pressure on their elected representatives because that's way the system works the best. it doesn't work for him to punish from the Oval [Office].

Since the most prominent target of criticism from Blue Dogs in the health care reform at this point and into 2010 was the public option, this was a very clear signal that the White House was not seriously committed to the public option. Baratunde had blundered his way into evoking a newsworthy answer from Jarrett. But he was apparently too clueless to realize it or follow up on it.

In fact, her response was so silly it was downright insulting. Even a high-school civics teacher wouldn't pretend that the President doesn't bring pressure on recalcitrant Members of Congress to get his bills passed. And we saw in 2010 when Obama started fighting against inclusion of the public option, he was certainly willing to bring pressure on House progressives to get them to support his position against the public option.

Jarrett followed up immediately with this, sounding like she was giving a pep talk to a group of Party functionaries:

When you guys get out there - and it's hard work but when you organize and when you, and not just form letters but when you call and - I met a person right as I came in going and having 60 meetings on the hill in the next few weeks with they're elected representatives. Meet them in the district. Go to the town hall meetings and make phone calls and organize your block and audiences and bloggers and put the pressure on them that way. That's how we'll get healthcare done this year. Not quite as much applause, but trust me. It will work. [my emphasis]

For the public option, it would have worked, if the White House hadn't already made a deal with the health insurance companies to oppose the public option.

Bill Clinton signaled the same thing in a less crass but more direct manner during his own keynote address at that event, making a point of telling the crowd that if the public option doesn't get into the final bill, don't do what "the left" supposedly did to him and criticize Obama for that result.

Recalling this is far more substantive than sour grapes from the Democratic base. It also means that it's unlikely in the extreme that the Obama administration has any intention at this point of pushing for a public option as an addition to the reform. And that's a substantive problem, both for the quality of health care reform and for the politics of preserving it from Republican attacks.

Tags: health care reform, obama administration

Health insurers exploit the absence of a public option

Susie Madrak in Health Insurers Up The Ante Over Pre-existing Conditions Rule By Denying Coverage To Children. What Next? Crooks and Liars 09/21/2010 comments on the decision by some major health insurers to drop their child-only policies because the new health care reform prohibits them from denying coverage for pre-existing conditions.

This already displays in practice the likely-fatal weakness of the Obama health care reform: the absence of a robust public option. Big insurers can and will exploit the loopholes in the regulations in the law. They can and will use the harm caused by their own self-interested actions to attack the health care reform and whittle it down, piece by piece.

Having a robust public option, such as the option for people to buy into Medicare, would change their whole competitive calculus. With a viable public option, actions like this would immediately drive some of their current customers to the public option. And once they insurance companies had demonstrated their unreliability in providing a particular kind of insurance, they would have a hard time ever winning it back.

More broadly, once the public option proved to be not only reliable but cheaper than private options, it would drive private insurers to boost their own service quality and their prices more attractive.

But Obama followed the neoliberal script and gave private insurers the major prize they wanted - the individual mandate forcing individuals to buy insurance while giving the insurers big loopholes such as high deductibles - without getting the critical element that would make such a private-based system work adequately - the public option.

Obama sneered at voters who were concerned about the absence of the public option to wealthy donors in Connecticut recently. But the public option passed the House and had 59 votes in the Senate. But Obama and Harry Reid used Joe Lieberman's opposition to hide behind their self-imposed 60-vote standard to eliminate the public option. Because that was the deal the administration made with the insurance lobby. But the problem is real.

Tags: health care reform, obama administration

Bring a chicken/To the doctor

It's got a catchy beat.



Tags: health care reform, radical right

The Democrats' health-care win

Karoli at Crooks and Liars has provided a handy list of Ten immediate benefits of HCR [health care reform] 03/21/10.

I don't know of anyone who consistently reflects the press corps conventional wisdom, for better or (usually) worse, than the San Francisco Chronicle's Carolyn Lochhead. So I was glad to see her headlining article, Houses passes health care bill 219-212 03/22/10, because I know of no more reliable source for the press CW on national issues.

It's good to see her mentioning the racist protesters from Saturday:

Before the final debate, House Speaker Nancy Pelosi of San Francisco locked arms with her Democratic lieutenants, including civil rights veteran John Lewis, D-Ga., to enter the Capitol through a phalanx of angry protesters. It was an emphatic show of solidarity after several ugly incidents on Saturday when demonstrators hurled racial slurs at several African American members of Congress and anti-gay insults at Rep. Barney Frank, the gay Massachusetts Democrat.

But there's plenty of Republican spin rolled in there as well, in this case at least a reference to the Republican slogan about "one-sixth of the economy":

When fully implemented in four years, the landmark legislation will reshape one-sixth of the U.S. economy and expand health insurance coverage to nearly all U.S. citizens, including an estimated 8 million uninsured Californians. [my emphasis]

This is also worded in a way that highlights several dubious Republican talking points:

Costing $940 billion for the next decade - about the price of the Iraq and Afghanistan wars so far - the bill is paid for with a combination of spending cuts and tax increases. It will require future Congresses to make tough decisions to ensure that its promise of $1.3 trillion in deficit reduction materializes over the next two decades.

In four years, it will require all Americans to carry insurance or pay a $700 fine. It will create a new federal entitlement of subsidies to help people shoulder the cost. Most people earning less than $200,000 a year are likely to see clear benefits, while those earning more than that will pay higher taxes. Small businesses will get a 35 percent tax credit to cover employees, and those employing fewer than 50 full-time workers will not be required to provide coverage. Larger employers, however, will pay fines up to $2,000 per worker if they do not provide coverage.

Republican-enacted Medicare Advantage plans that offer a range of extra benefits to the elderly beyond standard Medicare will be greatly cut back to help expand coverage to the uninsured.

If that last comment is even technically accurate in any sense, it's a very contorted way to state it. Is this her way of describing what's called "the closing of the donut-hole" in the Medicare Advantage plan, whose actual result will be to make medication more affordable for Medicare recipients. Weirdly, she later returns to it in discussing the original passage of the program and says, "Democrats battled that bill to its final moments, but on Sunday expanded it by closing a coverage gap in drug benefits to seniors." I suppose it could theoretically be true that the current health care reform both expands and greatly cuts back Medicare Advantage. But I can't say that her reporting on that is even close to clear.

She does eventually get around to saying:

Broadly speaking, the bill is modeled on an overhaul implemented in Massachusetts in 2006, and will generally align the U.S. health care system more closely with those in several European countries, such as Switzerland and the Netherlands that provide universal coverage mostly through private insurers.

Peter Nicholas offers the following analysis for the Los Angeles Times, Healthcare fight was Obama's proving ground 03/22/10. He telegraphs what is likely to be the script followed by some of our Pod Pundits in the next few weeks:

On Sunday night, the president who was criticized for winning a Nobel Prize without much of a record finally won a signature achievement -- victory on the kind of massive healthcare overhaul that Democrats had sought and failed to achieve for nearly half a century.

In the months ahead, Obama will face the question of whether his healthcare victory is a high-water mark for a now-exhausted administration, or instead becomes the leaping-off point for victories on other big issues, such as energy, immigration and financial regulation. [my emphasis]

A "now-exhausted administration"? After 14 months in office?

Bob Kuttner in Defining Moment Huffington Post 03/21/10 is hopeful that the course of the health care fight will make Obama more willing to fight openly for progressive goals. But he knows that we have reason to be concerned, too:

We have just witnessed what could be a turning point in the Obama presidency. In many respects we can thank Scott Brown. For it took the humiliating loss of Ted Kennedy's senate seat, and the even deeper incipient humiliation of lost health reform, for Obama to be reborn as a fighter. It remains to be seen whether he will match the resolve that he finally summoned on health reform with comparable leadership on all of the other challenges he yet faces.

But even those of us who were lukewarm on this bill should savor the moment and honor Obama's odyssey. His Saturday speech was simply the greatest of his presidency. It reminded us of the inspirational figure in whom so many of us invested such hopes last summer and fall. If you have been on Jupiter and somehow missed the speech, you owe it to yourself to watch it.

Tags: health care reform, obama administration

It's official: the health care bill passes!

The passage of the health care bill is certainly an historic moment and a victory for Obama and the Democrats: House passes healthcare overhaul by Noam Levey, Janet Hook, Mark Silva and Michael Muskal Los Angeles Times 02/21/10.

I have very much supported comprehensive health care reform. But I have mixed feelings about the result.

The bill has some features that will be real benefits, like expanded community health centers. And if the regulations on insurers are serious enforced and if the insurance companies show a minimum of good judgment, this could go a long way toward controlling costs and increasing access in a major way. But for a private-insurance-based system like this to work reliably in the United States, it needs to have a public insurance option available. Given the concessions Obama made in backroom deals to the insurance industry (the individual mandate) and the hospital lobby (no public option), I don't have high confidence that this administration will enforce the regulations in the bill adequately. And the Republicans when they win the White House find various ways to just not enforce laws and regulations they don't like.

With a public option, individual mandates to buy insurance makes great sense. This bill's individual mandates without a public option is bad policy. And it could turn out to be bad politics for the Democrats, too. I don't want to be gloom-and-doom about that aspect. But hardline public option advocate Jane Hamsher asks, Will Mandate Mania Be the Gay Marriage of 2010? Firedoglake 03/21/10.

We still need the public option.

Tags: health care reform

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

Mr. President, what part of NO do you not understand?

Thursday's "bipartisan" summit was pretty much a non-event to me. We knew when Congress adjourned for its summer break last July that the Republicans were taking a fundamental opposition position toward health care reform, i.e., "just say no".

And what the Democrats need to do in the face of that opposition hasn't changed, either. They need to jam through a good health care reform with a public option with nothing but Democratic votes if they have to. Then make the Republicans own their opposition to popular and constructive programs.

I listened to most of the afternoon segment. The weirdest moment to me was one that also caught Joe Conason's attention (Propaganda meets professor at the health summit Salon 02/25/10):

The Republican attitude about these questions was summed up crisply by Sen. John Barrasso, a Wyoming orthopedist who blurted out a rather jaundiced view of his patients, and by extension the American people. It turns out that Barrasso thinks full coverage is bad, because when people have the same kind of coverage as senators do, they don’t worry enough about the costs. If they only have catastrophic coverage, according to him, then they will become better consumers.

What kind of doctor wants his patients to worry about whether they can afford the tests and treatments they might need? What kind of doctor would abdicate responsibility for those crucial health decisions to the market? It was hard not to feel sorry for Barrasso’s patients - and easy to think that they, if not the rest of us, are better off with him in Washington rather than Wyoming. [my emphasis]

As Conason observes, even Oklahoma's often-egregious Sen. Tom Coburn sounded downright sensible in comparison.

What matters now is what mattered last July: how aggressive the Democrats are in passing a good bill and how good they are in explaining their position against Republican obstructionism.

No doubt in my mind that the Democrats came off better in yesterday's confrontation than the Republicans did. Although I'd have to say that the Dems generally do a lousy job in explaining the Republicans' false claims about allowing interstate competition among insurance companies. Health insurance companies can and do sell across state lines now. The Republicans' proposal is to allow them to do so on the terms permitted by their home state, not under the rules of the state in which those buying the policies live. The purpose of that and the main effect of it would be to create a race for the bottom among the states to minimize consumer protections on health insurance policies.

Digby sensibly points out that many voters who haven't been following the health care debate as closely as us political junkies have been may not take away from Thursday's event the impression that the Republicans are being irrational obstructionists (Equally Earnest Hullabaloo 02/25/10):

The president was in command of the facts, competently defended the Democratic position and successfully batted back many of the GOPs misrepresentations. The Republicans were effective in repeating their usual talking points and non-sequitors.

However, if I were to tune in to this summit without having a fairly good grasp of the politics in play, I’m afraid I might come away from it thinking that both sides are equally earnest in trying to fix the problems with our health care system and they both have equally good ideas. After all, they told us that all day and the picture of these people all sitting around a table politely exchanging ideas creates that appearance. But the fact is that the substantive disagreements between the two parties represent more than an abstract philosophical difference of opinion. They represent a hardcore, political impasse.

Much, as always, depends on how the media chooses to frame this summit, but I’m afraid that many people are nonetheless likely to be left with the impression that problems passing this bill are the result of Democrats refusing to put all these neat Republican ideas into the mix --- and if they can just agree to do that, we can all hold hands and sing kumbaaya. [my emphasis]

The bottom line is that Obama and the Democrats have solid majorities in both the House and the Senate and a mandate from the voters to pass health care reform. If they don't get it done, they have no excuses. Loyal Democratic voters won't be switching in mass numbers to voting Republican if they fail. But for the small segment of swing voters and for the enthusiasm among Democratic base voters for going to the polls and for getting out other voters, failing on health care reform would almost certainly damage the Democrats in November's Congressional elections and probably at the state level, as well.

It also matters what kind of reform the Democrats enact. The current private-insurance-based approach of both Senate and House bills requires employer mandates to buy insurance, individual mandates, and a ban on insurance companies applying pre-existing conditions exclusions. For that to provide universal or near-universal care, control costs and protect consumers, a public option is necessary. I actually would prefer to see the bill voted down than to pass it without a public option.

This is one case where bad policy also makes bad politics, which is not always the case. If an individual mandate is passed without the public option, individual consumers could wind up being required to buy expensive insurance policies with high deductibles that for most routine medical needs would be the same as having no insurance. And we've seen how potent the insurance lobbies have been in affecting the policy debate this year and last, even before the Citizens United decision that gives corporations even more freedom to buy elected officials. The big incentive for them to support the Obama/Lieberman corporate-friendly version of reform was the individual mandate, which guarantees big new profits for them.

If the public option is left and the individual mandate is eliminated, then the Democrats would have something to bargain with the insurance giants over. If they enact the Senate version of individual mandates with no public option, the insurance lobby will have no reason to do anything but oppose future attempts to set up a public option. The public option means effective competition for them which means less freedom to rip off consumers.

Under the current approach, the individual mandates wouldn't take effect right away. So the Democrats in the short run might be able to market the Lieberman approach as providing solid health insurance reform. And the Senate bill has some undoubtedly good features like expansion of community health centers. But it gives the Republicans plenty of ways to attack it. And when the mandates kick in, if there isn't a public option or effective consumer regulation, a lot of people will have good reason to think it's a bad idea.

The Democrats need to be worrying about passing good policy, not daydreaming of a "bipartisan" love fest over this thing.

Tags: democratic party, health care reform

A final push or more dithering?

Politics Daily reports Obama Invites GOP to the Table on Health Care Reform Bill02/07/10:

Obama told CBS News' anchor Katie Couric in an interview taped before the Super Bowl that "I want to ask them [the Republicans] to put their ideas on the table, and then after the [congressional] recess, which will be a few weeks away, I want to come back and have a large meeting, the Republicans and Democrats, to go through systematically all the best ideas that are out there and move it forward."

The Washington Post reported that Obama had invited Republicans to take part in a half-day summit that would be televised live later this month, just as his meeting last week with House Republicans at their Baltimore retreat was open to cameras.

Hope springs eternal, as they say. If the White House uses some such ploy to put the Republicans on the spot for opposing a popular health care reform, this could work for both passing a bill and for setting up the fall Congressional campaigns in a favorable way for the Democrats.

But it doesn't sound good at all to me given this administration's record that they are talking about a delay of even more weeks topped off by more negotiations to achieve a "bipartisan" consensus that's never going to happen. And this far into the process, the fact that the White House still seems to be dithering publicly on what they want to see in the bill tells me that may well be sticking with the one that they did come down hard in favor, the Obama-Lieberman Senate bill.

Tags: health care reform, obama administration

Democrats prepare to commit political suicide

Odum at Firedoglake Whither Bernie? 12/19/09 talks about the political risk that the Democrats are taking if they pass the Lieberman-Nelson Predator State version of the health care refomrm bill. And contrasts that with the popularity of the public option, which could have made all the difference between a good bill and a fundamentally flawed one.

There may be some good that comes out of the final version of the bill. If the Democrats with a popular new President and large majorities in both Houses couldn't get the public option and solid consumer protections - most of which in practice depend on having a public option - passed in a package that gives huge benefits to the insurance monopolies, they certainly aren't going to be willing to do so after they've given the insurance companies the enormous gift of a guaranteed expanded market. If the Democratic members of Congress were serious about doing any such thing, they would insist on stripping out the individual mandates from the Lieberman-Nelson bill. After all, they don't start for four years, so why give away all your leverage with the insurance companies if you have some intention for going back for improvements? Meanwhile, Odum gives a summary of "what makes this bill worse than nothing" both policy-wise and in terms of wrecking the Democrats' political position to carry through on those already-empty promises of future improvements:

The lack of regulation, of cost control, an uninhibited insurance and pharmaceutical industry with a direct, legally-enforcable line to every American’s bank account [the individual mandates]; these are not theoretical concerns from high minded liberal elite, as the administration’s allies are trying to pass them off as. These are practical realities that will hit everyone and will hand control of our government right back to the Republicans in the quite understandable political backlash.

Taylor Marsh in On NBC’s MTP, No Women to Discuss Healthcare 12/21/09 suggests a way to gauge the potential political damage to the Democrats of what we might call the unilateral mandate, i.e., consumers are required to pay for insurance but get minimal protections from insurance company anti-consumer tactics like extremely high premiums:

Listening to David Axelrod say that Obama’s mandate won’t got above 8% of anyone’s income if they can't afford it, I just did the math. Democrats are simply clueless about what the middle class are experiencing financially. The current Senate health care bill proves it beyond any doubts.

The individual mandate was always problematic in itself. But there would be a whole different context if people knew they had a solid public option alternative with reasonable deductibles that didn't have a business incentive to cut off the insured as soon as they got sick or find other tricks to deny them coverage. The presence of the public option would then put real pressure on insurers to provide affordable coverage and good service.

But we're about to get an Obama-Lieberman-Nelson Predator State version instead: individuals required to pay up to 8% of their incomes directly to insurance companies with no effective protection against exorbitently high deductibles, recissions of coverage when people get sick, or even against all forms of denial of coverage for "prior conditions."

Tags: democratic party, health care reform

Political theory digression: what should we call the current state of things in America?

Marcy Wheeler and Glenn Greenwald have begung trying to analyze the style of governance represented by the Obama administration pro-Lieberman, anti-consumer stance on health care reform.

Marcy is calling it "neo-feudalism" for now. Her contributions on the subject at Emptywheel include Health Care on the Road to Neo-Feudalism 12/15/09 and Brainstorming Future American Neo-Feudalism Today 12/20/09.

Glennzila in The underlying divisions in the healthcare debate Salon 12/18/09 calls it "corporatism". His analysis is good, as usual, but I think he's fantasizing about in what he says about some new left-right coalition against it.

And the brilliant Digby has been working along the same lines, as in Clarifying Debate 12/19/09. In that piece, she quotes a good explanation from Robert Kuttner on how the Obama-Lieberman-Nelson health bill fits the kind of situation that she, Marcy and Glenn are describing:

Think about it, the difference between social insurance and an individual mandate is this. Social insurance everybody pays for it through their taxes, so you don't think of Social Security as a compulsory individual mandate. You think of it as a benefit, as a protection that your government provides. But an individual mandate is an order to you to go out and buy some product from some private profit-making company, that in the case of a lot of moderate income people, you can't afford to buy. And the shell game here is that the affordable policies are either very high deductibles and co-pays, so you can afford the monthly premiums but then when you get sick, you have to pay a small fortune out of pocket before the coverage kicks in. Or if the coverage is decent, the premiums are unaffordable. And so here's the government doing the bidding of the private industry coercing people to buy profit-making products that maybe they can't afford and they call it health reform. [my emphasis]

I'm going to stick with Jamie Galbraith's term "Predator State" governance for now. But I agree with both of them that after the Cheney-Bush Presidency now followed by a corporate, prowar, anti-consumer Democratic administration, some kind of qualitatively new stage in American democracy has established itself.

Tags: health care reform, predator state

Health care reform and grumpy Jacksonian Democrats

Old Hickory battles the Money Power

I'm definitely one of the grumpy Jacksonians. The country was basically a one-party state in the 1820s, with the Democrats being that party. Actually, it was generally referred to as the Republican Party in those days, which can get confusing. John Quincy Adams became President in 1825, following the established succession up until that point of becoming Secretary of State and then President.

Adams was a decent guy. But as President he was pretty much the willing servant of what the Jacksonians called the Money Power. And it was because Jackson and the movement behind him, which included the early labor unions, took on the Money Power in the form of the Bank of the United States and won that the Democratic Party still holds "Jefferson-Jackson" dinners, Jackson being considered a co-founder of the Democratic Party, which started calling itself that during Jackson's Presidency.

Given what the health care debate to this point has shown about today's Democratic Party, they should start calling those dinners the Adams-Cleveland Dinners, after John Quincy Adams and Grover Cleveland, the most conservative of the post-Civil War Democrats. Cleveland once explained his veto of some bill that might have benefited someone other than rich people by saying, "Though the people support the government, the government should not support the people"!

We're at a stage now where the Obama administration and the corporate Democrats are in full-stage pressure mode against the disgusting hippie liberals (to demand that they all support the bill because otherwise 30 million people will suffer. If I had seen them bring anything like that kind of pressure on Harry Reid and Joe Lieberman to get with the program, I might take them seriously.

It's impossible to completely separate policy and politics in a bill like this. But I actually do think in the form of the Senate agreement as we know of it today, this is a bad bill. And in an up-or-down vote on the Lieberman-Nelson-Senate version, I would much prefer to see it voted down on policy grounds alone. Apart from the likely disastrous political results for the Democrats, requiring people to buy insurance at a cost of up to 8% of their incomes without minimal consumer protections is just unfair. If what I understand about the provisions for allowing insurance companies to sell nationally is correct, a "rush to the bottom" on state regulations on health insurance could follow passage of the bill and leave consumers with even fewer protections than today. And because there is little or no protection against exorbitantly high deductibles, in practice it can't reach the goal of coverage for all or bringing costs under control.

Republicans and corporate Democrats know that negotiation requires that if your side's bare minimum demands are not met, you're willing to walk away from the negotiating table. After Obama made it clear by coming down hard for the Lieberman Predator State approach to health care reform, it's difficult to know how much of Lieberman's grandstanding was just political theater coordinated with the White House. But what is clear is that Joe Lieberman, Ben Nelson and Bart Stupak can make demands against the public interest and get their ideas incorporated in the bill.

It seems that no liberal Senator at all is willing to block the Predator State version of the bill in the Upper House the way Lieberman and Nelson were evidently willing to block the public option which was the key to making this whole program work.

Rahm Emmanuel is practically sneering at Senate liberals in public because he rolled them on an issue this critical to the country and to the future of the Democratic Party. If he can roll them this badly on health care reform, he can roll them on pretty much anything important. The White House doesn't respect the Senate liberals' opposition to Predator State approaches because they know they don't have to.

I'm not doing "whip counts", so I don't know if every member of the House who promised not to vote for a health care reform package without if that would be enough to block passage. But if they don't follow through and vote against it, the White House will know it doesn't have to take them seriously either.

If they can succeed in voting it down in the House, then let Obama and Harry Reid and Joe Lieberman explain why they are willing to oppose a measure that has so many positive features and would provide health insurance to 30 million more people. After all, it would be wrong of them to "make the perfect the enemey of the good" and, after all, "this is only the beginning" and "we'll have plenty of time to fix it later".

The White House deal puts a new light on a couple of things from this past summer's Netroots Nation national convention in Pittsburg. Bill Clinton was well received. But he made it a point to say that "the left" should not desert Obama the way they (supposedly) deserted him on health care reform. Historical questions aside, even though Clinton encouraged people to fight for the public option which the Progressive Caucus had already clearly established as their bottom line requirement, he seemed to think that the final result would likely be very displeasing in some way to the Party base.

Then there was White House senior advisor Valerie Jarrett, who did an interview-style presentation with the feckless Baratunde Thurston asking the questions. In response to a badly-worded question by Baratunde, she said flat-out that the White House had no intention of bringing political pressure on the Blue Dog Democrats to support the public option. The evidently star-struck Baratunde apparently didn't realize what a stunning admission that was and didn't press her on it.

It's clear in retrospect that the White House message to the netroots was, yeah, we're going to flush the public option in the end and we expect you peons to support the result anyway. By the way, I'm real sorry the rightwingers are trashing Valerie Jarrett. I hope she doesn't do anything dumb like thumbing her nose at the very people in the Party base most likely to defend her.

I assume that it's publicly available: at the Netroots Nation Facebook page on August 15 I bitched and moaned about what a lousy job Baratunde did interviewing her. Someone named John McDade responded: "Bruce: Are you frightened by the truth. You dno't know the woman or the man. Start thinking for yourself!" Yeah, I guess I didn't know the woman or the man, the latter of whom is presumably Obama. I thought they might actually be in favor of the public option like they said they were and like he campaigned on in 2008.

I just posted this on the Netroots Nation Facebook wall:

Back on August 15 after Valerie Jarrett's presentation at Netroots Nation, I put some comments on this Facebook page criticizing both her presentation and Baratunde Thurston's feckless approach to interviewing her. I didn't mention the most jaw-dropping comment she made, which was that the White House had no intention of putting political pressure on the Blue Dog Democrats to support a public option for health care reform. I guess now we know why she said that: the White House never wanted the public option in the bill in the first place. Everyone still happy that star-struck Baratunde didn't follow up and press her on that amazing comment?

Tags: democratic party, health care reform

The era after this week

The battle over health care isn't over yet, as Marigolds2 just noted. Both the two major labor groups, SEIU and the AFL-CIO are opposing the Lieberman bill but hoping to improve it before it passes. The best scenario along that line I think is possibly feasible right now would be to eliminate the individual mandates and keep some of the restrictions on insurance company conduct.

There is a flurry of commentary already over the reaction of liberals to Obama's and Harry Reid's capitulation to Joe Lieberman this past week on gutting the health care reform bill. In received Beltway Village wisdom, of course, slapping the hippies is always a sign of the highest statesmanship. I'll be curious to see how they handle it on the David Brooks and Mark Shields Clown Show segment of the PBS Newshour Friday. It should be entertaining in a midnight-movie kind of way.

David Dayen of FDL News Desk gives us a good overview of the intra-Democratic Party disputes of this past week over Obama and the Health Insurance Profit-Gouging Guarantee bill that Joe Lieberman succeeded in turning the Senate health care reform bill into in Absolutism And Constructiveness In The Health Care Debate 12/17/09. Joan McCarter has been following the health care reform debate closely for months, and she's currently wading through the murky details of the Lieberman plan. Banning the insurance companies from denying coverage for existing conditions? Well, kinda-sorta. Especially if you don't consider age a pre-existing condition. If your pre-existing condition requires you to work with, say, a kidney specialist, that could get tricky. Ending recissions, the practice of terminating coverage when someone gets sick? Depends on what you consider fraud and who gets to decide that.

But even if what limps through Congress hasn't had every single consumer-friendly feature stripped out by the time it requires everyone to pay tribute directly to the insurance companies - Marcy Wheeler calls the Lieberman mandate system "neo-feudalism" - this last week is likely to be remembered as a major turning point for the attitude of labor and progressives toward Obama. Because up until Obama finally came down hard on the side of the Lieberman bill, the Democratic base had been willing to cut him a lot of slack. Many of us were very unhappy about the escalation(s) in Afghanistan, but anyone who was surprised by them wasn't paying attention to what he was saying clearly in the 2008 campaign. There haven't been any breakthrough foreign policy successes, but his moving to a pragmatic approach to diplomacy on most fronts is a welcome change from the Cheney-Bush years. And most people probably figured that an economic recovery plan focused on bailing out failed financial wheeler-dealers with virtually no requirements for better behavior imposed was more constructive and effective than what that bold Maverick McCain would have done.

Those who have been following the torture story knew that Obama's aggressive defenses of government secrecy, the treatment of "enemy combatants" and of insulating torture perpetrators from prosecution were really, really bad signs. But even there, it's not a familiar issue, though Obama's inaction has insured that it will become so. And despite his own reluctance, the legal and diplomatic implications of letting the Cheney-Bush torturers just skate without being charged mean that it's very possible that he will be forced into prosecuting them. Because the torture issue isn't going away.

What's different about health care reform is that here Obama finally made a stand on a decades-long goal of the Democratic Party, one that the basics of which the voting base understands and regards as extremely important, and one that labor and progressive groups have been actively supporting what most of us thought was the Democratic approach, not the Joe Lieberman approach. I think it's fair to say that this was Obama's first clear stand as President on a major domestic policy issue.

And he came down hard on the side of Lieberman's corporate-coddling, consumer-hostile plan that will mean a profit bonanza to insurance monopolies but few actual protections for the consumer and one which will not solve the problems of covering the uninsured or controlling costs. It was the Democrats, not Joe Lieberman's best buds in the Republican Party, who were supporting what we thought was Obama's health care position against the Tea Party hysterics and total Republican obstructionism. It's been a months-long, difficult fight in Congress. And when the Senate is on the verge of passing a bill, Obama dumps the base and endorses the insurance lobbies' position.

Labor and progressives are very unlikely to give Obama the benefit of the doubt on any policy issue until he shows us he can stand by his own Party and take a strong, effective stand for some major issue that Joe Lieberman won't support.

I suppose the level of psychological shock varies, depending on how much personal faith one put in Obama. But on the practical level, what are labor and progressive groups going to think? That they should put time, money, energy and influence into fighting for months for a constructive legislative accomplishment and then watch Obama push hard for only what John McCain's biggest 2008 supporter Joe Lieberman wants done?

The next major domestic legislation set to be taken up is comprehensive immigration reform. If the pro-immigrant groups aren't looking closely at Obama's cynical performance on health care reform, then they might as well quit now. They will have to approach immigration reform on the assumption that they will have to place Obama in a position of accepting a practical reform without draconian anti-immigrant measures included and not place any reliance on any promises from Obama that aren't in the form of directly pressuring members of Congress to support the Democratic Party position. And they will have to look at getting the Senate to pass immigration reform through one of the majoritarian options available to them, like the legislative reconciliation procedure or by abolishing that reactionary filibuster/cloture rule once and for all.

What's clear from the health care reform battle is that Obama respects the opinions of insurance and pharmaceutical lobbyists. And that of Joe Lieberman and Ben Nelson. And even of his Christian Right pal Rick Warren. But not those of people with Obama stickers on their cars. He doesn't respect their opinions, he just assumes they will go along with whatever corporate surrenders he negotiates with industry lobbyists.

And the cold fact is that Joe Lieberman and Ben Nelson are willing to use their own clout to kill legislation that Obama wants. Until the Progressive Caucus in the House can show they are able and willing to do the same, he's going to ignore them, or worse. I don't even mention the Senate because so far, I haven't heard of a single Democratic Senator threaten that they would vote against cloture to oppose the Lieberman bill. Until liberals in Congress start actually denying Obama legislation he wants, he'll be happy to please the Village pundits by punching the hippies, i.e., striking rotten deals like the one with Lieberman this past week.

It's a new day. And now we know Obama isn't going to fight for any major progressive legislative initiative until the liberals and progressives in Congress organize to kill his favored bills unless he gives them what they need. When Obama has to worry more about Congressional liberals killing a bill than Joe Lieberman or Ben Nelson, then he'll start delivering on his Party's program. But it's not going to happen until then.

Also on these topics: Scarecrow, How Would a Moderate-Conservative Republican President Do Health Reform? FDL The Seminal 12/16/09

John MacArthur, More and more, Obama seems a faux liberal Providence Journal 12/16/09

And this interesting but also peculiar article by Max Blumenthal vaguely talking about Obama's followers "messianizing" him, Obama, The Fallen Messiah and The Problem With Secular Salvation Narratives TPM Cafe 12/17/09.

Tags: barack obama, democratic party, health care reform

The death of health care reform yet again?

Gregg Levine in this column (Kill Bill? Latest Flips by Lieberman, Nelson Predictable; Require Hard-Line Response Firedoglake 12/14/09) doesn't mention to obvious option of abolishing the filibuster rule, though he does explain why it's almost unthinkable at this point that any meaningful health care reform bill will win 60 votes in the Senate. The Democrats have no excuse on this one. It takes a majority vote to abolish the filibuster rule. And with the "Gang of 14" agreement in 2005, the Republicans essentially declared that they will only recognize the filibuster rule as sacrosanct when it immediately benefits them.

But Levine does give a good description of the kind of scenario that could well lead the Progressive Caucus in the House to vote down the compromise:

It is quite possible that the Senate will produce a bill that contains no public option—or, likely, a mythical and weak PO resting behind a trigger well-nigh impossible to pull—no ban on annual or lifetime caps, no repeal of the insurance anti-trust exemption, no pharmaceutical reimportation, and no real Medicare buy-in (and let me add no community rating and a meaningless loss ratio), all accompanied by an easy opt-out, and a time-lag on any benefits that could be as much as four years. It is also likely the bill will still include an individual mandate, a massive extension on patent protection for biologics, permission to sell national plans, and all the garbage that has been tossed in along the way (like money for abstinence-only education and start-up/conversion funds for state-based cooperatives). And (and I admit I am saying this without any evidence but a gut feeling), I fully expect that, when the smoke clears, we will discover loopholes in the bans on the exclusion of pre-existing conditions and rescission. With all of that, what do we have?

Well, we do have conference, and, as we have said all along, our leverage is with the House, with the Progressive Caucus, and with individual representatives; so, of course, we hold our allies to their commitments to a robust public, and hope that they demand whatever comes out of conference include one (and include one without triggers). But what if what comes out of that meeting between Pelosi and Reid (with a soupcon Emanuel and Obama thrown in) is something much closer to the Senate beast I outlined above? Then what?

The bottom line is this. Joe Lieberman and the Republicans can gut health care reform because they're willing to kill the whole thing if they don't get what they want. Unless the Progressive Caucus is willing and able to do that, too, the White House and the Congressional leadership will just assume that they will always come along in the end on votes like health care reform, even for a genuinely bad bill.

Tags: democratic party, filibuster,, health care reform

Democratic blues

Markos Moulitsis in Idiocy 12/09/09 expresses his outrage over the Senate Democrats' and the President's sorry performance on health care reform by reacting to a fund-raising e-mail he got from the MyDemocrats.org. Signed by President Obama, it asked for help against "big insurance company lobbyists and their partisan allies." Markos comments:

This is so freakin' obnoxious I can hardly stand it. We are about to get a turd of a "reform" package, potentially worse than the status quo. We have the insurance industry declaring victory, Republicans cackling with glee, and the administration is using that piece of s**t to raise money?

Obama spent all year enabling Max Baucus and Olympia Snowe, and he thinks we're supposed to get excited about whatever end result we're about to get, so much so that we're going to fork over money? Well, it might work with some of you guys, but I'm certainly not biting. In fact, this is insulting, betraying a lack of understanding of just how pissed the base is at this so-called reform. The administration may be happy to declare victory with a mandate that enriches insurance companies, yet creates little incentive to control costs or change the very business practices that have screwed so many people. But I'll pass.

Democrats are demoralized, and have little incentive to turn out next year. The teabaggers will turn out. If this is how the Obama camp thinks we can energize the base -- by promising them a health care pony for $5 to the same Democratic Party that is home to the likes of Baucus, Nelson, Lincoln, Lieberman, and the rest of the obstructionist gang -- then we're in for a world of hurt in 2010.

Jane Hamsher weighs in with a response to those who are resistant to recognizing that Obama's team has been pushing all along for a public option "trigger", which in practice nullifies the public option (Obama Fought Hard For Triggers, Why Won’t He Own Them? FDL Action 12/09/09):

It’s time that people took off the rose colored glasses and faced the fact that Obama’s “leadership” on health care was empty and passive. He went for the corporate-friendly “win” that enriches the insurance and drug companies, just as he has enriched the banks and failed to hold them to account. Those who look first to others as scapegoats for his actions have apparently not come to grips with the fact that as President of the United States, he’s a very powerful man who is not using that power to advance the progressive agenda they attribute to him. [my emphasis]

We have a sad national political situation in the United States. In a two-party system, we have one conservative Party, the Democrats, and a reactionary-authoritarian Party, the Republicans. It's not that the Democratic base or even a majority of Democrats in Congress are conservative. They're not, they are liberal (in American terms) or progressive. But the awful spectacle we're seeing in the Senate this week shows how a really small number of corporate-conservative Democrats like Ben Nelson, Mary Landrieu and Joe Lieberman (who was re-elected in 2006 in opposition to the Democratic Party candidate) can dominate the entire Congressional Party.

So here we have a form of bipartisanship that makes a major strategic difference: the Blue Dog Dems can make a coalition with obstructionist Republicans that blocks meaningful reform. Two weakness I see that could be easily removed that would make an immediate difference in the chances for progressive legislation are (1) the filibuster rule, which the Democrats should just abolish; and, (2) Harry Reid, who the Democrats should kick out of all leadership roles and maybe the Party, too.

And is there an appropriate metaphor to use for the role of our national press that doesn't sound completely melodramatic? Because only something like "the poison dagger sticking in the staggering, dying body of American democracy" seems description enough. That's not nearly so easily fixed. But boy-hidey, they've got the Tiger Woods sex story covered! I'm thinking about claiming to have had an affair with Tiger Woods myself just so I could get national coverage for about two seconds to say "we've got to have a public option!"

Seriously, when a reform as popular, as widely demanded and as practical for American business and the American economy generally as health care reform along the lines of that of Switzerland (itself more conservative than the successful ones most western European countries use) can't make it through Congress with a huge majority of the pro-reform Democratic Party in the House and a popular President who came into office claiming the reform mantle and making health care reform with a public option a major issue in his campaign - then American democracy is continuing to break down, to the point of practical paralysis when it comes to innovations needed by the general public.

Prospects for a major third party remain practically non-existent. If the progressive movement can't make the Democratic Party deliver on health care reform or dump Harry Reid from the Senate leadership, it certainly can't create a left Labor Party that can replace the Democrats. There's always the option of swearing off any real pretence of trying to influence policy decisions that matter to the lives of working families while declaring doctrinal purity. Chris Hedges gives an example of how to do that in Liberals Are Useless TruthDig 12/07/09. It's nice to be pure. And easy when you just wash your hands of the political battles that affect people's lives in a major way. Ironically, one of the accusations he makes against Democratic Party liberals he delivers with no hint of self-reflection at his own purist rant: "This sterile moral posturing, which is not only useless but humiliating, has made America’s liberal class an object of public derision."

A line like that is not something you would be surprised to hear at a Tea Party rally. And it also doesn't reflect the realities of this political moment. With the Republicans in pure Wrecker Party mode and just saying "no" to health care reform with a purity equal that that assumed by Chris Hedges, the real real fight over health care has been within the Democratic Party. And it has come down a few Blue Dog Senators operating with the ridiculous Senate filibuster rule and a feckles, conservative-leaning Senate Majority Leader being able with the support of the President to defend the insurance industry positions.

But progressives do very much need to distance themselves from the institutional Democratic Party. An obvious way to do that is to direct any political contributions and direct activism toward progressive candidates, especially including primary challengers to corporate Blue Dog conservaDems. And to organizations that actively assert progressive causes against conservative Democrats as well as against Republican. The Stupak Amendment incident in the House brought new negative attention to NARAL, for instance, a high-visibility anti-abortion group that shows signs of reflexively supporting Democrats like Joe Lieberman and using things like the Stupak Amendment to raise funds after the fact - but wasn't there raising a stink before Stupak passed.

Certainly there are groups like the ACLU and the Center for Constitutional Rights (CCR) that are actively pushing for a return to the rule of law on torture and war crimes that are fighting the efforts of Congress and the Obama administration to protect perpetrators from prosecution and to preserve and expand the government secrecy on which they depend.

There are ways to support practical progressive reform without directly supporting keeping Harry Reid as Senate Majority Leader, in other words.

Tags: democratic party, health care reform, obama administration

Health care reform - or what's left of it?

As of just past my normal weekday bedtime, even the bloggers who have been following this the closest don't know what kind of deal the Senate Democrats have worked out on the public option in health care reform. Which in itself is an indictment of how badly the Senate Democrats have performed on this issue. From the statement that "Give 'em whine Harry" Reid put out late Tuesday, it looks like the Senate Dems used the filibuster as an excuse to cave to the insurance companies and sell the public down the river on the public option. Which in this context means, a health care reform that may literally be worse than none at all. If Brian Beutler's report is right and the public option is now reduced to a trigger, aka, has been eliminated from the plan in all but name, the Senate has agreed to gut health care reform. If this is what the Senate passes, I'd rather see the House Progressive Caucus kill the whole thing than pass a plan that would magnify the current problems instead of solving them. Which is what individual mandates to buy health insurance without the public option would be.

It's not over until it's over. But the Democrats' performance over this has been genuinely pathetic. And since we know from the "Gang of 14" incident over judicial nominations that the Republicans wouldn't hesitate to flush the filibuster rule over something important to them, the filibuster is no excuse. If the public option and health care reform with it go down, it's the fault of President Obama and the sad excuse for a Senate Majority Leader Harry Reid. Yes, the Republican Wrecker Party has been totally negative. But the Democrats have their 60-vote majority that would be enough to overcome a filibuster even without abolishing the filibuster rule which they should do in any case.

If health care reform goes under - and passing a castrated, industry-friendly version is the same as it going under or even worse - it's a whole new political ball game in the United States. And I don't think any of us have an idea of what it's going to look like. Except maybe Jerry Brown, who seems to be able to see decades ahead on some of these major things.

The Democrats have no excuse for failing on health reform. No excuse.

Tags: democratic party, harry reid, health care reform