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Thursday, September 03, 2009

Self-Preservation Strategy

by dday

House liberals will not go quietly, Mr. Emanuel.

In a letter delivered to the White House moments ago, the two leaders of the bloc of House progressives bluntly told President Obama that they will not support any health care plan without a public option in it — and demanded a meeting to inform him face to face.

The not-yet-released letter — the first joint statement from progressives since news emerged that Obama might not address the public option in next week’s speech — is their sharpest challenge yet to the president, given the extraordinary sensitivity of this political moment. The letter urges him to mention the public option in his speech.

“Any bill that does not provide, at a minimum, a public option built on the Medicare provider system and with reimbursement based on Mediare rates — not negotiated rates — is unacceptable,” reads the letter, which was sent over by a source. It was signed by Reps. Lynn Woolsey and Raul Grijalva, the two leaders of the Congressional Progressive Caucus.

They're buttressed by the Speaker of the House, quoted again as saying that a bill without a public option cannot pass the House and that its elimination would be a major victory for insurance companies. Not much room to climb down from those remarks.

Some chin-scratchers are wondering why the public option, the so-called "sliver" of the legislation but not its entirety, has taken on such prominent significance. I think this gets at part of it.

To help understand, I think it’s useful to read past the sarcastic opening to this Chris Bowers post and read him lay out the strategic thinking in detail. I think what you’ll see is that while the movement on behalf of the public option certainly wants a public option and believes the public option is important, the larger goal is to “to try and make the federal government more responsive to progressives in the long-term” by engaging in a form of inside-outside organizing and legislative brinksmanship that’s aimed at enhancing the level of clout small-p progressives in general and the big-p Progressive Caucus in particular enjoy on Capitol Hill.

That requires, arguably, some tactical extremism. If you become known as the guys who are always willing to be reasonable and fold while the Blue Dogs are the guys who are happy to let the world burn unless someone kisses your ring, then in the short-term your reasonableness will let some things get done but over the long-term you’ll get squeezed out. And it also requires you to pick winnable fights, which may mean blowing the specific stakes in the fight a bit out of proportion in the service of the larger goal.

There's more to it than that, however. First of all, whatever the state of the public option on offer - and I don't think it's sufficient - can be improved upon if it just gets past the post and into circulation. I cannot believe that Ezra Klein would think that something like a public option could be introduced as an add-on later, as long as the "basic structure" of universality gets enacted now. A government-administered insurance plan is not a minor fix; getting one installed for Medicare or Medicaid took a number of years and tough battles, and we still leave out everyone under 65 who isn't impoverished. Adding it later would not be a "relatively simple matter," as he says. We get a crack at this now, or we create a forced market through an individual mandate that makes it a crime not to buy private health insurance. Given our crack regulatory structure in the US of A, that won't hold, the insurance companies won't live up to their end of the bargain, and costs for everyone will continue to soar. And if the subsidies are too low, this won't even get out of the gate - both parties would be clamoring to repeal it. Adding the public option offers far more opportunities to improve upon the system, rather than not having that option and having to do a supreme lift to get it. I agree that the coverage subsidies and the design of the exchanges are important, but the public option stands with those as a pillar of the plan.

And I know that because none other than Max Baucus told me so in his original white paper on the subject.

Tell me how this sounds for a health care reform plan.

• A national health care exchange
• Buy-in to Medicare at age 55
• No discrimination against those with pre-existing conditions
• No waiting period for Medicare for disabled
• CHIP covers up to 250% of poverty level
• Credits for small businesses and individuals to make health care affordable

Oh, and don't forget this bit:

• A public option

Now, it may surprise you to learn this. But the architect of this program is none other than Max Baucus--the guy who has been pushing against a public option since the insurers were allowed to drive this debate. Here's the language from his white paper--dated November 12, 2008--on the public option:

The Exchange would also include a new public plan option, similar to Medicare. This option would abide by the same rules as private insurance plans participating in the Exchange (e.g., offer the same levels of benefits and set the premiums the same way). Rates paid to health care providers by this option would be determined by balancing the goals of increasing competition and ensuring access for patients to high-quality health care.

There was a time (known familiarly as "last year") when conservative Democrats tried to determine how to best deliver a quality health care bill, and some dumb-as-a-stick bloggers and activists went ahead and looked at the proposals and actually agreed with them. Silly rabbits!

And contrary to popular opinion, Blue Dogs actually need health care reform far more than progressives. Sure, they want to do it in such a way that preserves corporate profits. But progressives can see the desire to pass something and exploit that for their own ends, which is approximately how politics works, basically.

The reason I disagree with Klein is fairly simple: if no health care legislation passes, and Democrats lose seats as a result, Blue Dogs are the people who will lose the seats, not Progressives. Even if Klein is correct and Democrats lose a bunch of seats because Progressives blocked it, Blue Dogs are actually the ones who will bear the brunt of those losses. As such, Blue Dogs have more to lose if health care fails to pass than Progressives [...]

If we feel that we have to protect Blue Dogs at all costs, then of course it will be impossible for Progressives to have as much leverage as Blue Dogs. However, as soon as we make it clear that we don't feel much of a need to protect Blue Dogs, then they are the ones who have a lot more reason to cave into our demands. If another Republican wave really is coming, Blue Dogs will be the first Democrats to lose.

I see nothing wrong with a maximalist strategy, which also corresponds to the stated goal of cutting health care costs and helping people get coverage. It does have an importance for future fights. But it also has an importance for right now. A health care reform that forces people to buy private insurance will destroy the party that builds it. And because of the emphasis placed on the public option, which is really out of the control of Washington at this point, a failure to incorporate it into the final legislation will dispirit the base and lead to a slaughter in 2010. In addition to being smart politics, the progressive revolt is a self-preservation strategy for the Democratic Party.