Needlenose

It’s becoming obvious now that the protracted drama of the Senate Finance Committee, long feared to be the beginning of the end for meaningful healthcare reform, really was just the end of the beginning.  Now that a version of the bill has been pried loose from Sen. “Max Tax” Baucus and his committee, the real negotiations — and posturing — have started.

That’s why Joe Lieberman and Evan Bayh are making noises about not ruling out a filibuster — but hey, they can be bribed persuaded not to join one, too!– and why Jay Rockefeller and Chuck Schumer (and Nancy Pelosi, on the House side) are applying pressure in the media for a robust public option.  Everyone’s jockeying for position.

Jon Walker’s post at FDL Action today sums up the state of play nicely with a quote from Tom Harkin:

There are 52 solid Democrats for a public option and only about five Democrats really kind of opposed to it…. One has to ask if the 52 should give into the five or if the five should come on board with the vast majority.

And you know what?  That’s how everyone knew (or should have known) this was going to wind up back in January — with a handful of faux-centrist Senators threatening to sabotage a Democratic president for at least the third straight time, and everyone else wondering how to get around that obstacle.

But this also means that of all people, Barack Obama should have a plan for how to deal with this situation.  I’ve been more naive optimistic than many progressive bloggers, holding out hope that Obama really does want a public option in the final healthcare bill — not out of his innate progressive nature or the goodness of his heart (always a bad bet when it comes to politicians), but due to his own stated recognition that whatever passes needs to work, or he’s going to pay the political price for the resulting fiasco just as surely as if the bill had been defeated.

That’s why I’m not surprised to read that Harry Reid is reportedly working behind the scenes “for the best possible public option coming out of conference” (though those last four words are worth noting, and perhaps being alarmed over), or to see Nancy Pelosi’s forthright defense of a public option yesterday just before appearing with President Obama at two events in San Francisco (where his praise of her would seem odd if she’d just thrown his alleged secret desire to kill the public option under the bus).

But now’s the time for Obama to stop forcing us to imagine what his real intentions are. We all know how solicitous he’s been of Max Baucus’s endless delays and whatever whim Olympia Snowe chooses to express on any given day, and not openly pressuring Democratic senators who have spoken against a public option.  I’ve tried to give Obama the benefit of the doubt, figuring that he’s worked directly with these bozos colleagues in the Senate and knows what preening, obnoxious assholes they are how sensitive they are to being pressured.

At the end of the day, though, he’s got to persuade them to do the right thing.  And the end of the day is rapidly approaching.

(Cross-posted at Firedoglake.)

The Obama Honeymoon is over.  The Nobel Committee didn’t do him any favors by giving him a ‘Peace Prize’ for doing nothing other than not being Bush, because it reminded us that Obama hasn’t really done much of anything at all!  Seems to be the theme now on even Administration-friendly shows like The Daily Show and Rachel Maddow.

Seriously Mr. President, our party controls the White House, Congress, and the Repug party is in complete disarray.  The Wing-Nut Media and Repugs are sniping at each other.

What more do you fucking need to get off your ass?  It’s great that you aren’t Bush, don’t get me wrong, but the winning strategy here is a full frontal assault on all issues.  Don’t back off things because you are ‘too busy with Healthcare,’ now is the time to hit the Reactionaries with everything you’ve got, so they stay on the defensive.

And don’t put forth milquetoast proposals, go for Socialism, then let the Yellow Dogs whittle it back to something reasonable, rather than starting with reasonable and ending up with squat.

As things are going, I bet we’ll lose seats in Congress and who knows what might happen in the Senate?  Unless you take some action, you may end up like Carter – a guy who did more after he left his one term in office then he did during his term.  But at least you’ll get your Peace Prize in advance!

Matt Yglesias wrote yesterday:

Representative Alan Grayson’s statement that the Republican plan for health care amounts to “don’t get sick” and if you do “die quickly” probably doesn’t meet a test of literal accuracy. . . . But so what? The idea of a hubbub about this is absurd.

I think the real issue—and the real import—of Grayson’s statement is that it involved breaking one of the unspoken rules of modern American politics. The rule is that conservatives talk about their causes in stark, moralistic terms and progressives don’t. Instead, progressives talk about our causes in bloodless technocratic terms.

This isn’t a terribly new insight (for instance, Drew Westen attracted a lot of attention with a book about it two years ago), but it’s accurate nonetheless –and it’s a big part of why Grayson’s remarks have drawn such disproportionate condemnation from people who routinely give Republicans a pass for similar rhetoric.

Having written some on the subject myself, I disagree with Matt’s rationale for the discrepancy (“substantially more people identify as conservatives than identify as liberals. Consequently, progressive politicians are at pains to describe their proposals as essentially pragmatic and non-ideological, which doesn’t lend itself to moralism“). Plenty of Democratic politicians’ tics can be ascribed to an inordinate fear of offending non-liberal voters, but I don’t think this is one of them.

Instead, my sense is that progressives approach politics from an essentially rational perspective — “What solves the problem?” — whereas conservatives tend to think more in terms of respecting authority, if not outright opposition to the notion of solving problems (which, for many politicians, is encouraged by their fealty to the special interests responsible for causing the problems). As I wrote back in 2007:

Too often, Democrats and other progressives treat politics as a courtroom or a classroom, where the most comprehensively documented and tightly reasoned case will carry the day. While that may appeal to our way of thinking, sadly it just isn’t so for everyone; many voters simply don’t have the time or the inclination to pay that much attention.

And as I wrote even longer ago (in 2006), I think the ultimate goal for progressives should be to reframe the pragmatic value of pursuing real solutions to real problems as being just as morally grounded as (and, in fact, more genuinely so than) the latest sanctimonious Republican posturing.

With a president who often seems unwilling to say “I’m right, and you’re wrong” — indeed, who consciously positions himself as a walking advertisement for calm, dispassionate politics — that can be difficult. But not everyone has to approach the problem the same way; you can have “good cops” like Obama who promote a rational, problem-solving mentality as well as “bad cops” who show that passion and moral clarity are not exclusively conservative characteristics.

So, the specifics of what Grayson said aside, it’s good to see a Democratic politician willing to inject some raw emotion and a sense of morality into our discourse. It’s a start.

(Cross-posted at Firedoglake.)

Lindsay Beyerstein of the Media Consortium caught up with Howard Dean after an event in New York, capturing her brief, exclusive interview with him on video.

She asked Dean what it would mean if Democrats passed healthcare reform through the Senate using budget reconciliation rules, rather than relying on the whims of faux-centrists (Snowe, Lieberman, Nelson, et al.) to get a filibuster-proof 60 votes.

His response was that reconciliation would produce a better healthcare reform bill, and not just (as Lindsay notes) because of a lessened need to water the legislation down.

Saying that “the best way to do the public option is to have it be part of Medicare,” Dean points out that using reconciliation rules for a budget resolution would force the bill in this direction, because “there would be no question that an expansion of Medicare was germane and permitted in the budget resolution.”

Another benefit, Dean adds, is that “for political reasons, the Democrats need to get this done by 2010, so some people can sign up for it by 2010. And the only way to do that is to use an existing bureaucracy.”

The advantage isn’t just the typical desire of politicians to point at tangible results of their legislative work, either:

Implementing it [a public option] immediately for significant numbers of Americans is going to deflate all the lies that Republicans tell about this bill. Once people actually start to sign up, they’re going to find out that all those things weren’t true.

. . . Once health care reform actually goes into effect, the Republicans who are only selling fear and anger — that’s all they’re selling — that has to go away, because reality will always trump fear and anger.

Dean cites his experience with civil-unions legislation in Vermont as proof of this. All Democrats need to do is find the will to make the reality happen.

(Cross-posted at Firedoglake.)

Alec MacGillis of the Washington Post attended the AFL-CIO convention in Pittsburgh yesterday, and wrote this about President Obama’s speech there:

In a fiery speech to the nation’s largest labor federation, Obama urged members to get behind his proposal to overhaul the health-care system, which he vowed would pass in the next few months. To his audience’s satisfaction, he reiterated his support for including a government-run insurance plan, or public option, among the choices for consumers — a top priority for AFL-CIO leaders. And he dropped some of the language he used in last week’s health-care address to Congress in which he seemed to play down the importance of the public option.

But Jeff Zeleny of the New York Times was also there, apparently in the same convention hall but a different world:

A week after he asked Democrats in Congress to support the outlines of his health care plan, Mr. Obama made a similar but broader case to union audiences here and earlier Tuesday in Ohio. . . .

Yet despite the thunderous applause he received, his mentioning the term “public option” only once during a 35-minute speech at the convention did not go unnoticed. Many delegates carried signs and wore T-shirts declaring that a government-run insurance program was a nonnegotiable piece of health care legislation.

I suppose this is better than MacGillis and Zeleny getting together and deciding among themselves what the approved spin should be.  But still…

As you may know, there’s a psychiatric condition known as Münchausen syndrome by proxy, one of the manifestations of which can be loosely defined as putting someone or something else in jeopardy so that you can be a hero by “saving” it.

For obvious reasons, this came to mind as I watched a surprisingly reinvigorated Barack Obama give his speech to Congress on Wednesday night.  As columnist E.J. Dionne wrote for the Washington Post, “After a listless summer during which his opponents dominated the health-care debate… it seemed as if a politician who had been channeling the detached and cerebral Adlai Stevenson had discovered a new role model in the fighting Harry Truman.”

Then again (though I know I might be inviting sneering about “multi-dimensional chess” and the like), there may have been a method to the seeming madness of Obama’s lackadaisical summer attitude toward healthcare reform.  A New York Times story a few days ago navel-gazed about how Obama has attempted to learn lessons from the failure of Bill Clinton’s healthcare proposals in 1994:

That 15-year-old lesson underscores how much the Clinton debacle has defined Mr. Obama’s drive for his domestic priority from the beginning, providing a tip sheet for what not to do. Even Mr. Obama’s decision to address a joint session of Congress on Wednesday night to jumpstart his health initiative left some aides wary, given the inevitable parallels with Mr. Clinton’s September address 16 years ago to introduce his ill-fated plan.

I can point out a key difference just from the numbers in the quote above — Clinton’s speech was in September 1993; his reform bill died nearly a year later.

Obama quite likely concluded that the momentum from a single speech (particularly given the ever-shortening modern news cycle and attention spans) couldn’t possibly last an entire year.  It could, however, trigger a short legislative sprint of two months or so.

Thus the now-obsolete insistence earlier this year on a health bill by August wasn’t really intended to get a bill by August; rather, it was intended to provoke enough movement that a bill by Thanksgiving would be in striking distance.  (The declaration in the spring of an October 15 target date for invoking reconciliation is further evidence of this.)

All this, of course, leaves open the question — which, you might have noticed, is being pressed rather forcefully in many parts of the liberal blogiverse — of what kind of bill Obama hopes to pass with this last-minute rescue effort.  To go out really far on an optimistic limb, think about the president’s especially Munchausen-like treatment of the public option, which has been not merely thrown under the bus but tied to railroad tracks, hung over the edge of cliffs, and subjected to every other imaginable sort of peril in news reports.  And yet Obama continues to include it, at least nominally, in his proposed legislation.

Everyone who understands how important a public option is to successful healthcare reform feels terribly jerked around by now.  But then, the corporate-owned “centrist” types who have balked at a robust public option are probably feeling the same way about Obama’s refusal to officially kill it.  Like the old story of the carrot and the stick tied to the donkey’s back, the public option’s demise seems eternally just a few inches away, but never arrives.

Perhaps Obama is just waiting for the very last second to throw it away as a bargaining chip.  But if I were one of those hacks centrists, I’d be very nervous about the resilient popular support for a public option tempting Obama to champion it in fall rallies, daring them to vote against it.  As many other folks have observed, the momentum would be almost impossible for any politician, no matter how thoroughly bought off by the insurance companies, to resist.

Of course, that same possibility will make it all the more shameful if Obama really does surrender on the public option.  But I’ve waited 15 years just to have hope again, so I’ll cling to it for a few weeks longer.

(Cross-posted at Firedoglake.)

Highlights from the partial text released by the White House:

I am not the first President to take up this cause, but I am determined to be the last. . . .

Our collective failure to meet this challenge – year after year, decade after decade – has led us to a breaking point. . . . During that time, we have seen Washington at its best and its worst. . . .

Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week.  That has never happened before. . . . And there is agreement in this chamber on about eighty percent of what needs to be done, putting us closer to the goal of reform than we have ever been.

But what we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government.  Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise.  Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge.  And out of this blizzard of charges and counter-charges, confusion has reigned.

Well, the time for bickering is over.  The time for games has passed. Now is the season for action. . . .  Now is the time to deliver on health care.

The plan I’m announcing tonight would meet three basic goals: It will provide more security and stability to those who have health insurance.  It will provide insurance to those who don’t.  And it will slow the growth of health care costs for our families, our businesses, and our government. . . .

Here are the details that every American needs to know about this plan: First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have.  Let me repeat this: nothing in our plan requires you to change what you have.

What this plan will do is to make the insurance you have work better for you.  Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most.  They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime.  We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick.  And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care. . . .

Now, if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices.  If you lose your job or change your job, you will be able to get coverage.  If you strike out on your own and start a small business, you will be able to get coverage.  We will do this by creating a new insurance exchange – a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices.  Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage.  This is how large companies and government employees get affordable insurance.  It’s how everyone in this Congress gets affordable insurance. . . .

This is the plan I’m proposing.  It’s a plan that incorporates ideas from many of the people in this room tonight – Democrats and Republicans.  And I will continue to seek common ground in the weeks ahead.  If you come to me with a serious set of proposals, I will be there to listen.  My door is always open.

But know this:  I will not waste time with those who have made the calculation that it’s better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are.  If you misrepresent what’s in the plan, we will call you out.  And I will not accept the status quo as a solution.  Not this time.  Not now.

Obvious comment:  Who is this assertive, confident guy, and where has he been hiding the past several months?

Maybe it’s just, as someone once said, that you don’t roll out a new product before Labor Day….

Update: On the public option…

Now, I have no interest in putting insurance companies out of business.
They provide a legitimate service, and employ a lot of our friends and
neighbors. I just want to hold them accountable. The insurance reforms
that I’ve already mentioned would do just that. But an additional step we
can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear – it would only be an option for those who don’t have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up.

Despite all this, the insurance companies and their allies don’t like this
idea. They argue that these private companies can’t fairly compete with the
government. And they’d be right if taxpayers were subsidizing this public
insurance option. But they won’t be. I have insisted that like any private
insurance company, the public insurance option would have to be
self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers. It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.

It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated – by the left, the right, or the media. It is only *one* part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end – and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

For example, some have suggested that that the public option go into effect
only in those markets where insurance companies are not providing affordable
policies. Others propose a co-op or another non-profit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.

After all the brouhaha about the competing interests in the Democratic party, and how the Dems were going to self destruct because they couldn’t agree on such elemental concepts as the public option, it looks like the give-and-take of politics may actually have a positive outcome. In the House, where 60 Democratic members have written a letter to Obama telling him that they can’t vote for a bill without a public option, word is that they’ll get the chance to vote for the bill they want. In the Senate, where, especially with the demise of Ted Kennedy, the trend is towards a “trigger” bill, in which the public option is delayed while the insurance companies have a chance to comply with preset savings and inclusion goals, scuttlebutt is that they’ll get the bill that they want. These bills will then go to conference, where the outcome will be a fairly robust trigger-based bill.

Why is this a good outcome? Well, that depends on whether you believe that the insurance companies have the remotest motivation or desire to actually “use the free marketplace to solve America’s health care challenges”, as the Republicans love to claim. Rather than banging our heads against a “public option now, or nothing” platform with a slim-to-none chance of passage, if we’re smart we can have our cake and eat it too. We can put hoist Republicans on their own petard of free market reform, which we know won’t work, and which they don’t really believe anyway. We can get a public option, albeit a bit later than we’d like, by allowing the triggers to kick in and force the reforms we need. And we can get out from under the mantra that “it’s Dems who are stopping reform”, which has been very effective politically for the Repugs, by using the natural divisions in our party to create a compromise that’s really not a compromise (except in immediacy of implementing the public option).

One of my sincerest hopes is that the Democrats can avoid the self-immolation that the Republicans are living through now, in which the right and far-right factions are tearing the party to shreds.  If we can craft a scenario in which both of our factions, the “public option now” left and the “we can’t afford it with this $9 Trillion deficit” Blue Dog crowd can each vote their conscience, and we can end up, say, five years down the road, with a public option triggered by the insurers inability to control their own greed and ineptitude, and humiliate free-market Republicans in the bargain, someone help me understand why that’s a bad outcome.

Jackie Calmes of the New York Times reports tonight:

President Obama is planning for “a new season” of more hands-on advocacy for his troubled domestic priority, an overhaul of the health care system, according to his advisers. Among the likely steps would be a nationally televised speech that close allies have urged, and a 10-year price tag for the overhaul below the $1 trillion mark.

Mr. Obama met on Tuesday with advisers including Rahm Emanuel, the White House chief of staff, and David Axelrod, a senior strategist, to prepare for Congress’s return to work next week after a month in which many lawmakers have been spooked by contentious townhall meetings and polls registering slipping support for the president and his health care plans.

. . . The White House recalibration in part reflects how patience has run out with the efforts of the Senate Finance Committee chairman, Senator Max Baucus, Democrat of Montana, to reach a bipartisan deal after two of his three Republican negotiating partners—Senators Mike Enzi of Wyoming and Charles E. Grassley of Iowa—in recent days attacked the Democrats’ efforts publicly.

Of course, anyone with any sense knew from the start that the Baucus “bipartisan deal” effort was a waste of time (in fact, an intentional one).

In the Washington Post, Norman Ornstein offers a lame rationalization reasonable-sounding explanation of why Obama & Co. put up with it.  I’m not sure that it’s more convincing than the competing theories (e.g., sheer stupidity, or fealty to corporate interests), but I’m sufficiently traumatized — yes, still — by the 1994 debacle to sit back and let the results, or lack of them, speak for themselves.

Phoenix Woman wrote at Firedoglake yesterday (actually, twice) about the emerging Village contention that, why, of course Ted Kennedy would have swiftly and gleefully traded away the public option to pass something that could be called healthcare reform legislation, however useless the end result might be.

The latest attempt to make this leaden trial balloon fly comes from columnist Steven Pearlstein in this morning’s Washington Post:

Asked about his greatest regret as a legislator, Ted Kennedy would usually cite his refusal to cut a deal with Richard Nixon on health care.

. . . [in 1971], Nixon asked Congress to require for the first time that all companies provide a health plan for their employees, with federal subsidies for low-income workers. Nixon was particularly intrigued by a new idea called health maintenance organizations, which held the promise of providing high-quality care at lower prices by relying on salaried physicians to manage and coordinate patient care.

At first, Kennedy rejected Nixon’s proposal as nothing more than a bonanza for the insurance industry that would create a two-class system of health care in America. But after Nixon won reelection, Kennedy began a series of secret negotiations with the White House that almost led to a public agreement. In the end, Nixon backed out after receiving pressure from small-business owners and the American Medical Association. And Kennedy himself decided to back off after receiving heavy pressure from labor leaders, who urged him to hold out for a single-payer system once Democrats recaptured the White House in the wake of the Watergate scandal.

Thirty-five years later, the single-payer dream of Democratic liberals still remains politically out of reach. . .

The simple lesson from this story — and certainly the one Kennedy himself drew — is that when it comes to historic breakthroughs in social policy, make the best deal you can get, leaving it to subsequent generations to perfect.

But not so fast.  As anyone who saw Sicko might remember,  what Pearlstein describes as Kennedy’s initial reaction was, in fact, an entirely accurate assessment of Nixon’s motivation in promoting HMOs — as confirmed by a taped conversation between Tricky Dick and aide John Ehrlichman: (transcript condensed to remove cross-talk)

Nixon: “. . . You know, I’m not too keen on any of these damn medical programs.”

Ehrlichman: “This is a private enterprise one.”

President Nixon: “Well, that appeals to me.”

Ehrlichman: “Edgar Kaiser is running his Permanente deal for profit. . . . I had Edgar Kaiser come in [and] talk to me about this, and I went into it in some depth. All the incentives are toward less medical care, because the less care they give them, the more money they make.”

President Nixon: “Fine.”

Ehrlichman: “… and the incentives run the right way.”

President Nixon: “Not bad.”

Maybe any deal that a leading Republican politician and his corporate allies would have signed off on in 1971 wouldn’t have been worth agreeing to.  Maybe that’s still the case now.

(Cross-posted at Firedoglake.)