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August 20, 2009

Emerging narrative: Shut up, liberals. You're ruining it.

"I don't understand why the left of the left has decided that this is their Waterloo," said a senior White House adviser, who spoke on the condition of anonymity. "We've gotten to this point where health care on the left is determined by the breadth of the public option. I don't understand how that has become the measure of whether what we achieve is health-care reform."

"It's a mystifying thing," he added. "We're forgetting why we are in this."

Another top aide expressed chagrin that a single element in the president's sprawling health-care initiative has become a litmus test for whether the administration is serious about the issue.

"It took on a life of its own," he said. [WaPo]

The foregoing paragraphs sparked massive speculation when they appeared on the front page of Washington Post yesterday in a story by Michael Shear and Ceci Connolly.

If the president really favors a public option, why would members of Obama's inner circle undermine him in the Washington Post?

Over the past several days, there's been a pattern out of the White House. On Saturday, Obama told a town hall in Colorado that a public option was just that, an option--not the be-all-end-all of reform. 

At Netroots Nation, key Obama adviser Valerie Jarrett made it clear that the "American people" were going to have to push the Blue Dog Democrats. Because the White House wasn't going to.

Secretary Kathleen Sibelius said the public option wasn't an essential component of reform, though yet another anonymouse later insisted that she misspoke. (Arguably, a Freudian slip is a manner of misspeaking.)

The Republicans have made it clear that they will attempt to filibuster any bill that's put before them. On a good day, the Democrats have 60 senate votes, which is enough to break a filibuster, but only if all 60 fall in line.

That gives potential defectors a lot of power. Enumerable compromises have already been made in the hopes of securing the support of the conservative Blue Dogs.

The last straw was when Sen. Kent Conrad (D-ND), a member of the committee tasked with writing the senate bill, went on Fox News to declare the public option dead.

The liberal base is pissed. Even the Associated Press took time out of its busy schedule to register our disaffection. 

Washington takes it for granted that the Blue Dogs can and will scuttle any healthcare bill they don't like. It's considered their divine right to veto any bill that displeases them. If the Blue Dogs ultimately vote against the bill, the Serious People will blame the progressives for trying the Blue Dogs' patience. But if progressives vote against the bill, nobody will blame the Blue Dogs for their imperious intransigence.

With such a narrow margin of victory, liberal senators could exert the same kind of leverage. What if Bernie Sanders refused to vote for a bill without a public option?

Now, that would be an impetus for negotiation. The White House would suddenly have an incentive to stand up to the Blue Dogs on the Finance Committee. If they don't write a bill that the progressives will pass, healthcare reform will die.

Of course, the White House would rather preempt a two-front war in the Senate. I suspect that they're using strategic leaks to subtly psych out the progressives. Notice how Anonymouse 1 (cough, cough, Rahm Emanuel) uses the phrase "their Waterloo," echoing the Republicans' threat to make healthcare Obama's Waterloo. The implication is clear. "The left of the left" had better fall in line or everyone will blame them.

The Daily Beast has a piece today by John Avlon headlined, "The Coming Liberal Suicide," a cautionary tale about how everyone will blame liberals for getting hung up on that crazy fringey dirty hippie "public option" of theirs. 

Joe Klein, who conducts the conventional wisdom like copper conducts electricity, goes even further: "This year, the liberal insistence on a marginally relevant public option has been a tactical mistake that has enabled the right's "government takeover" disinformation jihad." So, it's already our fault and we haven't even done anything.

Optimistic progressives see the Washington Post's anonymice as self-serving rogues. I think they were on message all along.

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Meanwhile, the Obama team has also leaked to the WSJ that it's possible to pass a health care bill by putting its more controversial aspects in a filibuster-proof reconciliation conference.

We've known that for a long time.

No, Obama originally promised not to use reconciliation for health care.

"With such a narrow margin of victory, liberal senators could exert the same kind of leverage. What if Bernie Sanders refused to vote for a bill without a public option?

Now, that would be an impetus for negotiation. The White House would suddenly have an incentive to stand up to the Blue Dogs on the Finance Committee. If they don't write a bill that the progressives will pass, healthcare reform will die. "

Well, yeah. Which is why Bernie Sanders won't do that. Assuming you come out with an otherwise good bill that's an improvement over the status quo, Bernie Sanders is not going to vote against something that would make millions of lives better because it could theoretically be even better. Nor should he.

This argument reminds me of the constant sturn und drang about whether or not you need the base or the middle to win an election. Of course the answer is that you need some combination of both, and if you actually consider the implications of the argument, no one should ever win elections. You've got the same thing here; if conservative Democrats won't vote for a public option and liberal Democrats won't vote for a bill without it, you have a stalemate. And a stalemate means the status quo prevails. So in that dynamic, the winner is going to be whichever side is happier with the status quo. And I don't think that's progressives.

Now, this isn't an argument against the public option by any means, and on some level I kind of agree with the White House staffer. For the life of me I don't know why we're arguing about this now, given that the fate of the public option is pretty much set already; there will be one in the House bill, there probably won't be one in the Senate bill, and then everyone will fight it out over it in conference. But this is an argument for knowing when to give up the game. If the public option can't make it out of conference, but the bill that does come out is otherwise solid, progressives absolutely should not torpedo the bill. For one thing, a package of just the core insurance regulations that are on the table would be a bigger step towards universality than we've ever gotten in this country. For another, there just isn't anyway to win at that point. Yes, progressives could kill the bill unless their demands are met, but what good does that do? Are the Blue Dogs suddenly going to be cowed into voting with the progressive caucus because they just really want a bill to pass at all costs? I don't think so, so you'll just come away with the status quo. And that's more unacceptable than not getting the weak sauce public option in the House bill to me.

Why is it considered the Blue Dog's divine right to kill anything they don't like on a whim, whereas progressives are always expected to subordinate their agenda to the greater incremental good?

That's a shitty negotiating position to be in. It's self-perpetuating, too. If people expect you to suck it up for the greater good and feel entitled to your deference, you are always going to get screwed.

The point is not wanting killing the bill, but making it known that you're willing to kill it unless you get a reasonable compromise. It's about dealing in good faith. All negotiations need to be backed by credible threats, otherwise there's no leverage.

A public option is not a fringey demand. It's a basic plank of reform. It's the norm in just about every developed country worldwide.

"Why is it considered the Blue Dog's divine right to kill anything they don't like on a whim, whereas progressives are always expected to subordinate their agenda to the greater incremental good?"

Because what is the progressive agenda if not improving people's lives, especially those of the most needy? Again, I'm not arguing for a pre-emptive concession of the public option, but if it can't get out of conference because it's just not going to get through Congress, progressives absolutely should take whatever they can get, especially if that something is more than we've ever gotten, which it probably will be.

"The point is not wanting killing the bill, but making it known that you're willing to kill it unless you get a reasonable compromise. It's about dealing in good faith. All negotiations need to be backed by credible threats, otherwise there's no leverage."

But that only works if you're actually willing to walk away from whatever's on the table. And walking away from what looks to be the bare minimum of a bill means consigning the 60-75 million or so people who are severely underserved by our health insurance system to an indeterminate period of continuing that circumstance, when you could have passed a package that, albeit a disappointing bit of incrementalism, still would have been a significant improvement in their lives. I'm simply not willing to do that for a political game or for future political leverage, and I would very much hope that at the end of the day there aren't progressives who actually would be willing to do that.

I'm not convinced that the plan as it's shaping up will dramatically improve the lives of the needy. If we're not going to get a public option, let's just pass some bills banning rescision and discrimination based on preexisting conditions and be done with it. Republicans are not going to filibuster those. Co-ops would be a very expensive boondoggle.

The ironic thing is that the Blue Dogs are the ones whose seats are on the line if healthcare reform fails. After the Clinton plan went down it was the conservative Dems who lost their reelections, not the progressives.

Brien Jackson -

Subsidizing the purchase of private insurance will drive up premiums.

Without another element in the bill to drive down premiums, such as a public option, the federal government will be on the hook to hand more-and-more money to private insurance companies. Those companies will become even more powerful, and be able to get regulations in the bill repealed.

I'd be fine with a bill which only expands Medicaid to cover everyone who can't afford health insurance, and does nothing else.

But not with a subisidizing-private-companies approach which drives up health insurance premiums like Medicare Part D drove up drug prices.

"If we're not going to get a public option, let's just pass some bills banning rescision and discrimination based on preexisting conditions and be done with it."

That's pretty much what we're talking about.

No, the big ticket items in the reform package are likely be co-ops (or a public option), and subsidies to private insurance companies.

After the Clinton plan went down it was the conservative Dems who lost their reelections, not the progressives.

Not sure that any of these - who lost their seats to Republicans presumably - lost their seats over health care. They lost seats because they were swamped in the Contract with America tide, to people who may have been more opposed to Hillarycare than Blue Dogs ever would have been.

These anonymous administration quotes appear to me to be asking the question which was obvious from the start of Obama's administration, what would he accomplish? I am of the opinion that Lindsey is right to bring this point in the media up as a place to take a stand.

The question comes down to if the consequences of the financial crisis justify reforms or not. Justification being how a political force is expressed. Are enough people adversely affected by the crisis to motivate doing something to how the current system doesn't work. The basic assumption going into the crisis is that the whole system works well. Thus the push back from the Health industry to stop change, or the return of financial rewards to top management in the banks.

It's my opinion that reform is justified. So the questions from the administration really are fundamental to the moment. Obama seems to have caved into the previous era in how to approach the system. Even to the point of jettisoning real Health Care reform.

The right wing grass roots threats are a sign to me of political weakness. Yet Obama and his administration are treating them as a sign of strength. I see the basic presumption that the system is in danger of serious collapse unless some sense of reforms are put into place almost immediately. And the public pressures coming out of the crisis would compel that to happen one way or the other.

Lindsey's point is to reveal the real reformist strength in the U.S. However, the reality may be that congress is not yet to the point of such assertions. Congress may come to that as events unfold. Or reforms may stall out waiting for more radical pressures to make things happen.

"No, Obama originally promised not to use reconciliation for health care."

And he promised the negotiations would be broadcast on CSPAN.

Obama and his top lieutenants have been signaling since March that that reconciliation is an option.

So, the latest "leak" to the WSJ isn't telling us anything we didn't already know. This week Harry Reid told the whole world that Dems were willing to pass a bill by any legislative means necessary. (Harry Reid riffing off Malcolm X, who'da thought that day would come?)

Why is it considered the Blue Dog's divine right to kill anything they don't like on a whim, whereas progressives are always expected to subordinate their agenda to the greater incremental good?

Blue Dogs block or water down progressive legislation. It's what they do. It's not they who campaign promising universal health care, but the progressives.

When there's a wave of unsolved murders I'm not going to blame the criminals, but the police - just like after a terrorist attack, I'm going to ask, "Why didn't they prevent it?". What you're proposing is the legislative equivalent of the police going on strike in response to public criticism of their ineffective response to the crime wave.

It's the norm in just about every developed country worldwide.

Did Germany, the Netherlands, Switzerland, and Singapore suddenly get downgraded to third world status?

I'd be fine with a bill which only expands Medicaid to cover everyone who can't afford health insurance, and does nothing else.

That would solve very little. Even laxer means testing would almost certainly exclude people who're starting their own businesses and people who're moving between jobs, to say nothing of people who're uninsurable. The US has many more public health issues than just near-poverty, and the more of them reform addresses, the more likely it is to answer the "What will it do for me?" question. Even Switzerland, whose health care system is the most privatized in Europe, has tight regulations that make sure everyone's insurable, and decouples health care from employment.

Lindsay you're such a good writer. Thanks for this.

test?

Why is it considered the Blue Dog's divine right to kill anything they don't like on a whim, whereas progressives are always expected to subordinate their agenda to the greater incremental good?

"Blue Dogs block or water down progressive legislation. It's what they do. It's not they who campaign promising universal health care, but the progressives." Yes, but the Blue Dogs are a minority in the party that holds power in both branches. Their ability to vote against legislation favored by the majority of their party doesn't mean that their regressive agenda should be considered valid or that they shouldn't be subjected to party discipline. Lyndon Johnson would have had these bastards' guts for garters, and rightly so.
Somehow the progressive agenda is still considered disreputable in DC, despite, in the case of health reform, the support of a great majority of Americans across party lines. Why are the Dem leaders allowing a few Blue Dog yokels to hold up such important legislation?

"Did Germany, the Netherlands, Switzerland, and Singapore suddenly get downgraded to third world status?" I don't have the time to address all your disinformation, but at least 85% of Germans are covered by universal health insurance and have been since the late nineteenth century.

My point about Medicaid is that any money they're planning to spend to subsidize private insurance for people who can't afford it could be used to expand Medicaid instead.

If someone has too much income to qualify for subisidies than he would have too much income to qualify for an expanded version of Medicaid and vice versa.

We shouldn't give public money to private companies for things the public sector can do better.

Yes, but the Blue Dogs are a minority in the party that holds power in both branches.

The Blue Dogs are the median group of members. Democracy is rule by the majority, not by the majority of the majority.

I don't have the time to address all your disinformation, but at least 85% of Germans are covered by universal health insurance and have been since the late nineteenth century.

Lindsay didn't say "universal." She said "public": "A public option is not a fringey demand. It's a basic plank of reform. It's the norm in just about every developed country worldwide." In Germany, there's near-universal insurance paid half by the government and half by employers. In Switzerland, the Netherlands, and Singapore, health insurance is private, with tight regulations and provisions for subsidized health care for the poor. To imitate those countries, the US would not need a public option. It would need to,

a) Decouple health insurance from employment,
b) Regulate away insurers' ability to discriminate based on preexisting conditions,
c) Expand Medicaid eligibility, and
d) Implement general efficiency measures such as computerized health records.

Part a) has appeared in the health plans of many conservatives; if bundled into a health care reform, it presents an opportunity for an attack on the Republicans that they're so obstructionist they vote down their own proposals when a Democrat suggests them.

As I was just telling Alon after lunch yesterday ("9 to 5" was quite entertaining!), Germany, Switzerland, Singapore, etc, etc, are different kettles of fish than the USA. The first obstacle is that the level of regulation of the system in those countries is so high that it would completely reshape the structure of the American market to the point that American insurance companies would not exist as we know them. That level of regulation would be as politically impossible in the USA as single-payer health care. You would have to do a lot more than the list Alon provides---for example, Switzerland has a global list of rates for procedures with which doctors must comply.

Furthermore, these are countries with traditions of regulation to ensure social welfare and greater economic efficiency to an extent that is quite alien in the USA. The sum total of this kind of regulation means that it is feasible for someone in, say, Switzerland to pay a high deductible without fearing homelessness or starvation. The same is true of Singapore.

For this to work in the USA, insurers would have to be regulated to provide low-deductible insurance to everyone, so that someone living in Flint, Michigan can actually access health care without going bankrupt because the deductible was too low to cover a gall bladder removal or something. The government would have to negotiate rates with the AMA.

Like I said, this is no different politically from a single-payer system. Worse and more complicated even. Its sole purpose would be to preserve and comply with a rhetoric in the United States that has hindered progress in social welfare in general.

I agree with Lindsey. There cannot be a subsidy for insurance without a public option.

Singapore doesn't have social welfare. It has no unemployment benefits, no real unions or minimum wages or fair pay laws, and no social security beyond mandatory savings (if you're out of money by 73, you're welcome to wait tables). And its health care system is ranked 6th in the world for reasons that are still beyond me.

Politically, to imitate Canada, the US would start from a single-payer system in one state - preferably one with money to pay for it, such as Massachusetts or New Jersey. It would be successful so that more and more states would adopt it, leading to federal legislation mandating it nationwide.

That said, the US has a health care crisis that no country in Europe faced, save perhaps Britain. This means that everything is politically an easier sell, and there's no need to bundle universal health care system with welfare as in Britain or Germany.

Alon, you're attacking a straw man. I didn't say that all developed countries have a public option. I said that most do. Even the U.S. has public options for certain populations (veterans, seniors).

Germany has a multi-payer universal healthcare system where everyone has to buy insurance from one of many tightly regulated "sickness funds", and there are both public and private sickness funds to choose from. So, that's a classic public option.

Singapore has a very big subsidy on housing that I suspect makes a huge difference in the ability of much of the populace to afford health calamities.

It also has old people working until they drop too, of course. But the big barrier to health care for many is the ability to keep a roof over the heads of their children.

Also, being a single city, it is easy to exert very strong regulations on the price of health care.

And in Canada, single-payer care came into being in a rural province that is largely still a low-population environment. If it weren't for the strange cultural politics of the USA, I suspect the place to expect a single-payer system to bloom would be places like the Dakotas.

Lindsay, in Germany the multi-payer system ensures that nothing is truly public or truly private; it's paid for by both sectors. And the fact that Switzerland, Singapore, and the Netherlands (plus, I believe, Japan and Hong Kong) rely on private provisions for most people with reasonable success means that the public option is present in most developed countries, but not "just about" all of them. It certainly means that progressives shouldn't vote down a reform bill just because it doesn't have a public option.

Mandos, as I explained in person, Singapore subsidies housing, but even with the subsidy, people can't always afford staying above water. For example, taxi drivers, whose fares have remained constant since 1990, can barely afford renting their taxis from their parent companies, and can't miss work to get checkups.

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