Mike the Mad Biologist

Chris Bowers and Digby both comment on the failure of the Congressional progressives to exact demands on healthcare (and many other issues), as opposed to the conservative Democrats who really did drive the debate. Digby writes:

In the case of health care, as I wrote way back when, the congressional liberals were always going to be jammed at the end because the Medicaid expansion alone is something they desperately wanted for decades and couldn’t ever get (which doesn’t excuse why they negotiated with themselves the whole way along.) There was just no way that a progressive bloc strategy was ever going to hang tough with health care reform, although it was useful for them to work together to improve the bill and shape the negotiations with various threats and admonitions. (After all, there was no guarantee that it would end up with even the subsidies or Medicaid expansion at all.) Still, everyone knew from the beginning that as long as this bill covers many millions of the working poor they were not likely to vote against it in the end. Lifting up the poor is the holy grail for liberals.

I think Digby is right, but what has bothered me about this is that the one thing in healthcare–the only thing in healthcare–that was ever popular (and still is popular despite months of a one-sided political counteroffensive) was expanding Medicare to all (a strong public option). That this could not pass demonstrates a fundamental weakness of the U.S. political system to enact legislation that reflects the will of the majority. I also can’t comprehend how progressives and liberals were unable to use this popular support to mobilize the votes (unless the Congressional retirement plan was at play here). If Democrats had passed a bill with Medicare for all, they could have browbeaten Stupak and his allies back into line: for example, would Kaptur really have been able to oppose a popular bill because of her anti-abortion views? Probably not.

While reform of the Senate would be a big step forward, I’m not sure that will be enough. To me, the gap between what the public wanted (whether you thought it was a good idea or not) and what was passed suggests that there are multiple problems, not just with the current political parties, but also with how things are portrayed. And I’m not sure what we do to fix that.

Comments

#1 Christopher Gwyn
March 20, 2010

One of the changes needed is to stop trying to pass great big bills that will solve everything. Approaching health care reform with a plethora of smaller bills would have enabled progressives to lose or walk away many many times while still winning in the end. Smaller bills, particularly if they are written in plain English, would also have the advantage of being a lot more accessible to a lot more people (“We don’t know what is in it” would be seen for the idiotic remark that it is – lots of people may be intimidated by reading 1,000 pages in a weekend, but reading two or three double-space wide-margin pages….few people would be willing to admit they can’t take the time to read and understand something short and clearly written).

A multiplicity of smaller bills would enable progressives and Democrats to walk away from ridiculous compromises, and facilitate Democrats dropping their stupid habit of ‘pre-compromising’.
#2 JasonTD
March 20, 2010

I’ve been checking the Kaiser polls every so often. I like them because they go into a reasonable amount of detail about what people think. Two things that jump out as you go through their ‘chart pack’ are: 56% of people either think the process should start over or that they should stop working on it entirely for now, and that 55% think that the CBO has scored it as adding to the deficit over 10 years.

It’s pretty clear that a lot of people on both sides are unhappy with how disfunctional Congress as a whole has been on the issue. 73% of all responders, including 67% of Democrats, feel that the health care debate shows that the whole policy-making process is broken.

At the same time, it is also clear that the people don’t know as much as they think they do about the proposals. Even after all of the gimmicks and combinations of Medicare cuts and tax increases built into the bill to get it to come out as reducing the deficit on the CBO score, and only 15% of people answered that question correctly? Even 42% of Democrats said that the CBO scored it as increasing the deficit. Now, I should say that I’m of the opinion that it will end up increasing the deficit, but I pay more than enough attention to know what the CBO has said about it. Perhaps people were more responding based on their expectations about how it will affect the budget, rather than what facts they remember from news reports.

In one sense, you are correct. If Obama and the Democrats in Congress had crafted a bill that accurately reflected a solid majority of popular opinion, even the Republicans would have had a hard time opposing it outright like they are. The whole thing has been a train wreck played out in slow motion.
#3 Comrade PhysioProf
March 20, 2010

The FiveThirtyEight dude has done some very detailed analyses that suggest that progressives couldn’t really have done much better no matter what negotiating strategy they used.
#4 dcotler
March 20, 2010

He who wants the deal the worst gets the worst deal. This bill represents a fundamental change in the expectations Americans will have of our government. Our whole world shifts in the progressive direction. Of course Sanders and Kucinich will give up a few ribbons and bows to get the pony they really want.

and re @2: Republicans announced their intention to defeat the bill and “break” Obama before there was a bill. The present bill includes many things R’s support. But the biggest deficit-reduction bill (oh, and it also deals with health care) since 1993 will proceed just as that one (Clinton’s first budget) did: without a single opposition vote. That was precedent-setting in 1993, but the R’s seem to be making a habit of it.
#5 BrianR
March 20, 2010

real health care reform is just beginning with this bill … progressives should only spend a few days lamenting and pining and then get back in there to start working again
#6 JasonTD
March 20, 2010

This bill represents a fundamental change in the expectations Americans will have of our government.

Personally, I view this as a bad thing. There are limits to how much the government can do for people, and, modest as progressives view this plan to be, it is pushing the envelope ever further toward those limits. We already have more obligations than we have funding for long-term in our social programs. Also, how much does the plan do to address underlying issues of cost? For that matter, do we really even understand what the cost drivers have been in health care over the last 20-30 years? If there are economists out there that have explanations that are backed up by solid data, I haven’t seen them.

It’s really the same situation with college tuition and public school spending. I hear all the time how tuition has greatly outpaced inflation, claims from school ‘choice’ advocates about how public school spending has increased more than two-fold, etc. But then no one making any of these arguments ever bothers to explain why those costs are going up as part of their arguments. It is very frustrating that the media isn’t asking these questions persistently, if at all. Every politician who stakes out a position, one way or the other, on an issue so closely tied to cost should know those answers. They should then be able to clearly point out why their proposals will improve not just some people’s lives in the short term, but to improve the overall economics of the situation so that it doesn’t just shift costs from one set of people to another.
#7 dcotler
March 20, 2010

This bill saves 1.2 TRILLION (net, after accounting for costs) according to CBO, and bends the cost curve downward, and extends Medicare solvency by 9 years, all while extending coverage to 32 million more people. How much government should do for us is certainly a fair subject for debate, but this bill moves us towards the position of every other country that we consider modern, so I believe that my opinion has significant support.
#8 Pierce R. Butler
March 20, 2010

Just cleaning up US elections will require -
* severe campaign finance reform,
* instant-runoff voting,
* replacing untrustworthy voting machines (particularly since one company now has a near-monopoly on same),
* ending racist felon disenfranchisement,
* independent redistricting commissions held to high standards,
* legislative ethics committees with serious enforcement power, held to high standards,
* serious civics education in and out of schools,
* major antitrust actions against media oligopolies,
* abolition of the Electoral College,
* …

And that’s just the beginning: then we’ve got to solve some BIG problems!

Yeah, I know. Try the marshmallow veal flambe’, and don’t forget to tip your waitress. I’ll be here all week.
#9 Tyler DiPietro
March 20, 2010

The underlying dynamic doesn’t favor progressives. Healthcare reform is their project, they are the ones who want it passed. Conservadems either don’t care or actively oppose it. This considerably limits the leverage progressives have.
#10 dcotler
March 20, 2010

From the quality of these comments, it seems that a simple cure for our political ills is to put more science bloggers in charge.
#11 JasonTD
March 21, 2010

dcotler,

Be careful in admitting that you accept CBO estimates at face value. I live in Florida and might just have some swampland for sale.

The CBO might be nonpartisan, but they can only score proposed legislation as it is written. They are not permitted to make judgments about how realistic assumptions built into the bills are. There is also some double counting going on, where things counted as revenue that will offset spending in the bill is actually relied on by other programs.

Check this out at the NY Times and tell me you are still confident that this will reduce deficits over the long run.

Here’s some highlights from that article:
- The ‘Cadillac’ plan tax was moved to 2018 and the price at which it takes effect raised. In other words, no one in Congress actually believes it will ever be implemented in practice.
- $53 billion in revenue is from expected increases in Social Security tax revenue as employers drop coverage and instead increase wages. I suppose Social Security doesn’t need the money, so we might as well spend it on health care instead, right?
- Extending the Medicare tax to include investment income for the first time ever. This isn’t a gimmick, but I do view it as a bad idea.
- The Governor of Tennessee (a Democrat, btw) sent a letter to two of the Reps from his state worrying about how the Medicaid expansion part of the bill would affect his state’s budget. In other words, this bill comes out as reducing the deficit at least partially because not all of the new spending required by it will be paid for by the federal government. The CBO doesn’t do anything to consider the legislation’s impacts on state budgets. If the states complain loudly enough, Congress and the President might do more ‘block grants’ to the states, like in the ‘stimulus’, but those won’t be counted as costs of this legislation.
- The ‘doc fix’ ($247 billion in planned cuts in Medicare payments to doctors, which have been postponed every year) is out of this legislation, allowing the bill to claim as savings something no one believes will materialize.
- The student loan plan Democrats have been talking about gets tossed into a bill about health care reform in order to claim the savings from it. Another example of something not a gimmick, but it is completely extraneous to the topic at hand.
- $72 billion in revenue from a disability insurance program (CLASS act), but those are premiums that will be needed to cover the benefits of that program, not expanding coverage through other programs.

The deficit reduction claimed in the first ten years is wiped out by the revenue claims made for other programs (Social Security and CLASS act). The ‘doc fix’ adds in a couple hundred billion more. The bill does essentially nothing visible to encourage people to be more cost-conscious with their health care spending (‘cadillac plan’ tax that is unlikely to ever be implemented). So, I’m not sure where your $1.2 trillion figure is from (maybe the very uncertain 2nd decade estimates?), or your assertion that it will bend the cost curve down, but neither of those seems remotely likely to me.