Begging For Pitchforks Part 77

by digby

Vandehei and Allen have the latest conventional wisdom on health care, which is that everything's going to hell in a handbasket fast. The sky is falling because of the deficit, the cost of reform is much too high, the Democrats are trying to do too much, businesses aren't happy and Pete Peterson is just dreamy.(Ok , that last part is just something I read between the lines.)

They are probably correct as far as the beltway is concerned. It's pretty clear to me that it's in trouble too, although I would lay the blame more solidly at the feet of Dems who keep getting punk'd by silly things like the premature release of the CBO report and the administration's fear of looking "irresponsible" to David Broder, but I think there are elements of all the things they mention. Most importantly, it's more and more obvious that the insurance companies are dictating the terms. Here's Scarecrow at FDL:

As I've said over and over, a public "exchange" is not a plan; it's a market place where you choose between plans. It's not one of the products, and it's definitely not a public option product. You can only buy private plans in this exchange. So there's no meaningful choice. Why is this so hard to grasp?

So what do we have left?

1. The insurance companies get the federal government to mandate that everyone must purchase insurance. (Insurance companies 1, consumers 0)

2. There are only private insurance plans available. (Private Insurers 2, consumers 0)

3. The federal government gets states who feel like it to create an exchange to help consumers shop for -- and insurance companies sell -- their private insurance. (Private insurers 3, consumers 0) [And insurance companies get an extra point in states that don't like federal intrusion]

4. The federal government then subsidizes consumers to help them pay the full premiums charged by the private insurance plans. Insurers win! 4-0!

Does this look familiar? Well, yes, because this is exactly what the private insurers proposed months ago, and are now salivating about.

The question really comes down to whether or not Obama is willing to use his political capital to get through a serious systemic reform or whether or not he will end up backing an incremental small bore plan promising to take another bite at it down the road. The problem is that unless he uses the moment to institute a public option, that incremental plan won't work either.

The logic of incrementalism on something like this is that you just want to get your foot in the door. Once a something exists, it's harder to completely scrap it in the future, so even if it's imperfect, you have a foundation on which to build to make it more robust as time goes on. But if they give up on the public plan as part of reform, the only thing we'll get is a bunch of new regulations and "voluntary" efforts that will be subject to change and interpretation. They need to institutionalize this or it will be a temporary, cosmetic fix that in the worst case will end up failing spectacularly and further alienate the public from government programs. Doing it wrong is far more politically risky than not doing it at all.

The Politico article says that Organizing For America is going to form the grassroots campaign to support health care (and start organizing for the midterms.) That will be very interesting to see unfold. If Obama were to come out right now and say unequivocally that he wants a public option and puts his organization to work in conjunction with all the other grassroots/netroots groups, it could be a formidable pressure point against the medical industrial complex. If he enlists his supporters to work for something phony and incomplete, he will likely lose many of them and almost certainly lose the rest of us. We will see before too long whether he wants to use the "yes we can" voters as a counterbalance the influence of the big donors or if he just took their money and their volunteered time and is doing the bidding of the big money donors anyway.

The Politico article says that the administration believes it's too early to start cracking heads. But if they plan to (and it's completely unknown if they do and for what) they'd better start to make their move soon because this thing is moving very quickly and they are losing control of it.
Universal health care is fundamental to progressives. If the Democratic Party cannot get this done with a large majority, an economic crisis that is making hundreds of thousands of average Americans lose their insurance, and a president who ran explicitly on the issue and has a large mandate for reform, then they are in danger of creating a huge hole in their coalition that will be very difficult to repair. Health care is the big one.

The disappointment at failure will be immense, and not just among grassroots activists, but among the public at large if Obama doesn't fulfill this promise. There is no good political reason not to do this right and every reason to avoid doing it wrong. It's incomprehensible to me that they would put this on the table and then fail to follow through. It's the worst of all possible worlds.

I never thought Obama particularly cared about Health Care reform. He was basically interested in foreign policy and more modern, sexy issues like climate change, which are obviously incredibly important and are good reasons to have supported him. But health care is the kind of issue with which Democrats build majorities and accumulate trust and political power for things like climate change. If the DLC market orientation still pervades the party the way it did for the past two decades, even in light of the fearsome economic crisis we face, then the party is going to see a serious populist threat from both the left and the right. We've already seen the foreshadowing of that in the past two decades with the Perot and Nader campaigns, both of which were exceedingly significant in terms of electoral outcomes. They should not write them off as discrete eccentricities. This is a building political wave.

Propping up the old economic order is already happening with the financial bailouts. But I'm disinclined to read anything political into it because I think the crisis hit so hard and so fast that the lessons are still being absorbed. (Not that I'm sanguine that they are learning the right things from it, just that it's still unfolding and I don't think anyone knows the full extent of the damage yet.) Health care, on the other hand is a very well studied and understood problem. They know what they need to do. There's no need for high priests or seat-of-the-pants mechanics to reinvent the wheel.

Fixing the health care system is the first real test of whether or not the Democratic Party understands the new political era in which it's governing. The next couple of months will tell the tale.