Health Care Reform in 2024? Nein, Danke

17 Dec

This piece at Kos got me thinking that maybe it’s time to take a step back and assess whether the health care reform – such as it is, sans public option – is still worth doing in its current state.

To a large degree, it’s the same cast of characters, with the same tone to the arguments. It’s the policy wonks versus the activists. On the wonky side, there is (and was, in 2003) a resigned sense that this isn’t an ideal action, but that we don’t live in an ideal world, and that consequently we should suck it up and support an imperfect initiative. On the other, there is (and was, in 2003) a resistance born of an awareness that Congressional Democrats will more often than not — and often unintentionally — screw themselves and the country, out of a misguided belief that powerful forces with agendas very different from that of the Democratic Party can be managed and trusted.

While Kos, echoing Howard Dean, advocates killing the bill, Ezra Klein, whom I’ve been following during the whole health care sausage-making debacle, thinks it’s better than “better than nothing”. Klein thinks the bill is critically important and very good. Nate Silver agrees, and offers up 20 questions for bill-killers, which Kos answers. John Cole at Balloon Juice also supports the bill, and I generally agree with pretty much every damn thing written over there.

And that’s the nature of a representative democracy such as ours – you have 535 individual representatives with unique constituencies and political philosophies. The President can’t just impose a health insurance reform package on us by fiat, and that’s a good thing. The fact that lawmaking is a dirty business that tends to water stuff down and transform it is not news. The difference here is that the Democrats have a majority, but even so what happens in the Senate is significantly different from what happens in the House, and there are Senators on the fringes whose votes are critical yet whose positions are fluid. So, yeah, we’re stuck catering to Joe Lieberman, Susan Collins, and Olympia Snowe because we have to. Because the rest of the Republicans knee-jerkedly refuse to give the Democrats a victory on any sort of health care reform, because they know that a decent health care bill that expands coverage and adds in critically needed consumer protection is a massive victory. As Klein points out, if you’re not pleased with its scope, these sorts of programs seldom shrink.

Look at the development of Medicare and Social Security, of Medicaid and S-CHIP, the Swedish and Canadian health-care systems, public education. Social Security was designed to exclude African Americans. Medicare didn’t cover prescription drugs. Medicaid was mainly for pregnant women and their young children. Canada’s system was limited to a single province. There was no University of California at Los Angeles.

People think a loss of the public option is a betrayal by Obama. But when Obama was elected, no one really knew what health insurance reform would take place, or what it would look like.

If we kill this bill, which is good but not perfect, the teabaggers and obstructionists win. If we pass this bill, it will be a win for the non-teabagging, moderate Republicans who are actually in Washington to work rather than play games, and for the blue dogs. But it will be a win nonetheless, and will succeed in doing what Clinton failed to do in the early 1990s.

And frankly, I don’t want to wait another 15 years for health insurance reform to come down the pike.

20 Responses to “Health Care Reform in 2024? Nein, Danke”

  1. Don Eppers December 17, 2009 at 10:52 am #

    I listened to Howard Dean this morning on TV. It sounded like his beef was the amount of input the insurance lobby had on the current proposed legislation. Even without the public option he would support the legislation if the pro insurance provisions were purged. What I heard was general but he was specific on some features for which he believes his State already has a better plan. Seems to me that what is needed is a lot of work in committees and a backing off of the idea that it is either done before Christmas or it is killed.

  2. Dan Davis December 17, 2009 at 11:03 am #

    Mixed emotions here. Leaving it up to the insurance company competion? 17% to 20% of your income for health care? That’s not what I voted for. On the other hand, maybe it will help to show what the real cost is to leave health care to free market enterprise with no controls. Funny, isn’t that what happened to the finacial system?

  3. Eric Saldanha December 17, 2009 at 11:45 am #

    As Atrios said, forcing people to buy shitty insurance they can’t afford is not reform. We don’t need a politically expedient action here (which will end up being anything but)….we need real reform and there will be no better opportunity than now.

  4. Ethan December 17, 2009 at 12:23 pm #

    This bill is both imperfect and the enemy of the good. I’m with Dean: sink it.

    • Ethan December 17, 2009 at 1:08 pm #

      Jon Walker at Firedoglake also has a nice rebuttal of Nate Silver’s (excellent) 20 Questions, here.

    • Ethan December 17, 2009 at 1:19 pm #

      Alan- a number of writers have made this connection, and I think it’s worth making here:

      Has anyone else noticed that the split in the progressive blogosphere between those who are saying “it’s a good bill in spite of everything” (Kevin Drum, Matt Yglesias, Ezra Klein, Josh Marshall, to name a few) and those who just can’t bring themselves to support Liebercare (Markos and Digby come to mind, among bloggers who have been at it since 2003*) is eerily similar to the split between those who grudgingly backed the invasion of Iraq and those who fought against the war seven years ago? ref

      If history is any guide–and yes, I know it isn’t always, but it is sometimes–then I like the company I’m keeping better than the company you are.

  5. mike hudson December 17, 2009 at 3:16 pm #

    the only reason to support the proposed legislation would be to give obama the luxury of saying he “accomplished” something during his first year in office. dean opposes it, kos opposes it, even nutty old olbermann opposes it. these are largely the same people who convinced the democratic party to abandon hillary clinton and pin its hopes on an inexperienced young senator from chicago in the first place.

    less than one year on, his policies have failed to improve the economy despite spending billions on bailouts, escalated the war in afghanistan, maintained the status quo in iraq, kept the black hole of guantanamo open for business, and now failed to deliver promised health care. carter lite? hell, he’s bush lite.

    • Jon Splett December 17, 2009 at 10:06 pm #

      I’m with you but to imply Hillary would have gotten any of this done is wishful thinking.

      As long as the Democrats keep putting up establishment candidates, the establishment that’s preventing any real reform will remain in power. Hillary and Obama were both answering to the same lobbyists.

  6. mike December 17, 2009 at 4:33 pm #

    hillary who?

  7. Peter A Reese December 17, 2009 at 7:36 pm #

    How can any rational Democrat stomach what health care “reform” has become? Its time for people of integrity to walk away. Put out a bill which makes some sense and, as Dennis Kucunich would say, “call the roll”. Let’s see who is for reform and who is a pawn of the insurance industry. At least we will know where we stand and who our friends and enemies are.

    • Eric Saldanha December 17, 2009 at 8:19 pm #

      We know who the Whores of Babylon (Babylon, in this case, being the status quo dominated by Big HealthCare) are….two of the most notable slatterns are the Senators holding up any compromise due to their pettiness (Sen. Joe Lieberman, Connecticut For Lieberman-CT) or that they want to control every woman’s uterus (Sen. Ben Nelson, Neanderthal-NE).

      The argument against “killing the bill” (and I think it’s a compelling one) is that there are literally millons of Americans who can’t afford to have this incremental reform (however shitty it ends up) not pass by the New Year.

  8. Dave December 17, 2009 at 9:42 pm #

    I’m not sure about the bill, but I am sure of one thing… Joe Lieberman is a world-class tool.

  9. mjp December 17, 2009 at 11:08 pm #

    The Iraq=healthcare argument is asinine.  The stakes are completely different: failing to pass reform means *more* people dying, not fewer.  The risk profile is different: failing to pass leads to *more* risk, not less.  And the political alignment is different: passing means absolutely *no* Republican support either way.  Those who use the “this looks like Iraq” debate are being intellectually lazy, which is just not tenable given the stakes.

  10. mike hudson December 18, 2009 at 7:28 am #

    the dems have an advantage of 257-178 in the house and a 58- 40 advantage in the senate (plus independents liebermann & sanders). also, they control the white house. if the democratic party had the will that the republican party has shown over the years, or any will at all, it could pass any sort of health care bill it wanted.

    to blame liebermann, or even the whole republican party and lieberman, for the debacle now taking place in washington is to offer apologia for a guy who is fleeing to copenhagen, where the world community will reject another of his dubious causes.

    • Alan Bedenko December 18, 2009 at 7:33 am #

      You cite Sanders and Lieberman two independents who caucus with the Democrats. I think their divergent political views speak for themselves, so it was handy of you to include the counterpoint with your own point.

    • Dave December 18, 2009 at 1:47 pm #

      Don’t get me wrong, I’m not blaming Lieberman for any heath care plan failures. I’m just saying he’s a political whore. And a tool.

  11. mike hudson December 18, 2009 at 8:42 am #

    lieberman and sanders cancel each other out, no? the democratic majorities, percentagewise, remain the same, so i’m not understanding why you seem to think it’s important.

    the bottom line is that the american people are about to be screwed, no matter which way the vote goes on this abortion, yet many seek to place the blame anywhere other than on the shoulders of the “leader” responsible for the debacle. in baseball, they fire lousy managers.

    • Alan Bedenko December 18, 2009 at 12:37 pm #

      Perhaps Sanders and Lieberman cancel each other out, but you ignore the fact that the Democratic Party is and always has been a coalition party bringing together extreme liberals and centrist moderates. You can’t ever expect all of the Democrats to vote or think or act the same way on any issue, especially one that involves a big outlay of money and an expansion of entitlements.

      Either way, despite your disdain for Obama, the person whom you backed is in his administration. I have a very, very hard time believing that a Clinton administration would be pushing something somehow more lefty or liberal than what an Obama administration is, but perhaps you have information I don’t.

      Obama campaigned on three principles for health care reform:

      1. Quality, Affordable & Portable Health Coverage For All
      2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
      3. Promoting Prevention & Strengthening Public Health

      In fact, it was Hillary Clinton who advocated for a plan that included an insurance mandate – something that is in the Senate bill. Among the proposals he put forth to promote universality were:

      * Establishing a new public program that would look a lot like Medicare for those under age-65 that would be available to those who do not have access to an employer plan or qualify for existing government programs like Medicaid or SCHIP. This would also be open to small employers who do not offer a private plan.
      * Creating a “National Health Insurance Exchange.” This would be a government-run marketing organization that would sell insurance plans directly to those who did not have an employer plan or public coverage.
      * An employer “pay or play” provision that would require an employer to either provide health insurance or contribute toward the cost of a public plan.
      * Mandating that families cover all children through either a private or public health insurance plan.
      * Expanding eligibility for government programs, like Medicaid and SCHIP.
      * Allow flexibility in embracing state health reform initiatives.

      I don’t see public option anywhere in there. Frankly, the current bill more or less tracks what Obama was campaigning for in early 2008 pretty closely.

      I don’t think the American people are about to be “screwed” any more than they already are. In fact, the mere addition of sensible consumer protection provisions as well as the elimination of discrimination for pre-existing conditions guarantees less screwage. The bill is not perfect, nor could anyone expect it to be. The funniest part is that Obama’s position on this places him squarely in the center, as opposed to him being the socialist his enemies claim him to be. You consider him, on the other hand, to be as bad as Bush. That’s of course silliness and hyperbole, but you, like the Republicans, have already declared Obama’s four-year term to be a failure just one year in. While that’s certainly your right, I’d argue that it’s premature.

      So, you can pretend like the Senate Democrats are all one singular bloc of like-minded voters with identical, progressive constituencies and ideologies, but that’s neither true nor reasonable.

  12. mike hudson December 18, 2009 at 4:16 pm #

    obama is the leader of the democratic party, by any standard. but when a leader says “let’s go here” and the rest of the party decides to go off in a hundred different directions, he can continue to call himself the leader all he wants to but he’s not a leader at all.

    clearly, his chilly reception today in copenhagen indicates our friends and trading partners around the world have already come to realize this.

    i have obviously not declared obama’s four year term a failure after one year, but have characterized the one year a failure. to say it’s been anything else is of course silliness and propaganda.

    if having a democratic president in office and having majorities in both houses of congress does not mean that a democratic agenda will take effect, what’s the point?

  13. Peter Herr December 19, 2009 at 10:47 pm #

    Hate to agree with Hudson…..on anything….but there is some truth in the words. If McCain had won, we’d already have tax cuts for the rich. The Senate vote for tax cuts took place 4 months after Bush took office.

    I appreciate that Dems are an inclusive party and that there are more extremes in or positions and constituency, but get er done for heaven’s sake. If they don’t, lots of dems looking for work after the midterms.

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