As a lobbyist I'm often in the position of trying to figure out an answer to this question: should we fight, and hold out for what we want, or should we take what we think is the best we can get now, even though it's a lot worse than what we want, and try to get more later?
This is the question that activists are addressing on the health care bill. On the one hand we have people like born-again Democrat Howard Dean and many posters at GMD, arguing that the bill is so bad that it would be better to kill it. On the other hand, we have Democrats and pundits who have been reliably progressive voices but are now being targeted as sellouts for supporting passage.
In evaluating this question, a number of other questions come to my mind:
1. The public option? Really? That's what we wanted?
It's not the only argument against passing the bill now, but the fight over the public option was what fueled much of the controversy through the summer and fall, and particularly the treachery of Joe Lieberman. We need to keep in mind, though, that the public option was always a weak compromise, a recognition that progressives can't get what we really want, single-payer, at least this time around. At GMD we've mocked Catamount Health, Vermont's version of the public option, but we recognize that even an inadequate program is better than nothing.
The public option was definitely an idea worth having, and so was Medicare buy-in. Still, it's a matter of displacement of our true desires that leads us to think the public option is something we need to fight to the death over.
2. We were never going to get anything close to what we wanted.
In these times we know that we need sixty votes in the Senate to get anything passed. In a controversy like this, where getting anything at all passed depended on getting the majority of a handful of moderate Republicans–Snow, Collins, Landrieu, Lieberman, and Nelson, none of whom really care about passing anything, means that the bill that passes will be a compromise of a compromise. That's the way life is and there's not much point in calling Reid and Obama useless, ineffectual losers because they can't get 100% of the votes in their putative caucus.
3. What's the alternative?
One concept in negotiation theory is BATNA, the best alternative to a negotiated agreement. For our purposes, before telling our representatives to kill the bill we should think about what will happen if they do.
I don't see any likelihood that we will see anything approaching health care reform if this bill is killed in the foreseeable future. None of the conditions that are present now, or that are likely to come about in the future, are going to get any better than what we have now.
First, the politics aren't getting better. We have seen several Democratic representatives announce they are retiring, and there are a number of Democratic senators, including Harry Reid, Chris Dodd, and Arlen Specter*, who are in trouble and may not get reelected. This is consonant with the fact that the President's party typically loses votes in the off-year election; I don't see any signs that this won't happen in 2010.
Second, the economics aren't getting better. Whatever the costs of health care are now, and whatever we need to spend to cover those costs, they will only go up. This means that every year into the future will be harder to create a health care financing program than it is now.
Third is the fiscal situation. The Bush deficit, the costs of the bailout, and the costs of the war, are all combining to make federal budgeting problems worse in the next five years than they are now. We can wait for a recovery, but a strong recovery isn't likely to happen in the next five years.
4. Things in Congress are different now.
Changes in party alignment have made it harder to accomplish important things now than it was in the past. For many years people talked about the parties as “big tents”. For most of the 20th Century both major parties tried to follow a big tent strategy, forming their parties out of ideological and regional coalitions. The Democratic Party included northeast liberals and southern racists; the Republican Party included western free-landers and northeast financial types who were not particularly committed to social issues.
This started to change with Nixon's Southern Strategy, a frank, and successful, appeal to southern racists; it continued through the 1980's under Ronald Reagan and Lee Atwater with continued appeals to racism and religious intolerance, and is essentially complete today. The defections of Jim Jeffords and Arlen Specter signaled the completion of the Republican purge of any but the most extreme conservatives.
This has not happened in the Democratic Party. Our party has always been more pluralistic, and has exercised less doctrinal discipline, than the Republicans, and the same is true today. The ideological range in the Democratic Party in 2010 is much broader than that of the Republicans, which means that it is easy for the Republican leadership to dictate the position of every member of the caucus, but it is not possible for the Democratic leadership to do the same thing.
An example from the past is instructive. The 1964 Civil Rights Act passed the Senate 73-27, and passed cloture 71-29 (at a time when 67 votes were needed to support cloture).
What is more interesting is the party breakdown. Democrats in the Senate supported the bill 46-21 and Republicans supported it 27-6. (This is what gives Republicans the support for their claim that it was the Republicans who actually passed the Civil Rights bill.) On both sides we see a tremendous amount of cross-party voting.
We don't see this today: the strongest wish for bipartisan support for this bill is that one or two Republicans, presumably one of the two senators from Maine, would support some form of health care reform. We now know that will never happen. It is unimaginable that we will ever see 27, or even 6, Republicans with the decency or political sense that they need to support something like reformed health care financing.
What does this mean? I suggest it means that we can't pass anything important without close to unanimous Democratic support. That also means that, as much as ever, if not more so, anything that comes out of Congress will have to be a huge compromise, and the negotiating or compromising parties are not the Democrats and the Republicans, because the Republicans are determined to block anything the Democrats, and particularly the Democratic President, want to accomplish. No, the compromise must be reached between the real Democrats and the right wing of the party.
That's what we have today.
I am not willing to say the bill should be killed because I don't see any chance of getting anything better than is before us now at any time in the next five, ten, or fifteen years. As my colleagues have pointed out, this is an extremely weak bill. Nevertheless, It's the best we're likely to see. It's our best chance to get something rather than nothing. It's only after we have something that we can start the equally important work of fixing it.
Oh yes–one other thing. I don't hold Reid responsible for not being able to get 100% of his nominal caucus to line up on health care. I do hold him responsible if he lets Lieberman keep his committee chairmanship and other positions of responsibility within the caucus.
That is #3 – “What’s the alternative.”
Logically, the alternative is no change to the status quo.
The question, then, turns on whether this latest version of the bill is better or worse than the status quo.
I believe that it has been repeatedly demonstrated that this bill would be worse than the status quo.
What I see repeatedly in arguments for this bill like this one, is a detailed recitation of the political dynamics, what we can expect, who’s to blame, etc. But what I never see is an argument about the bill on its merits.
As you say, I supported Catamount Health because it was better than nothing on the policy merits.
Likewise, it seems clear that this Liberman/Nelson bill is not better than nothing on the policy merits.
I can’t find your post persuasive, then, unless you can at least tell me why you believe it would be better than nothing based on those merits. My concern with a lot of Democrats (and I’m not saying this about you, Jack, but just to make a broader point), is that they’re arguing in favor of getting Obama and the Dem caucus a win, but they long ago lost track of what the actual policies they were promoting were.
So – what about this bill do you think is better than the alternative (nothing)?
Instead, they are only practicing the art of capitulation.
First, put forward the 50 vote bill. The 50 vote bill that the American people overwhelmingly support and which actually provides access to health care. Put up a fight. Until the pro-reform Democratic wing of the Democratic party loses a fight, they haven’t even established the ball park in which the game is played.
Politics 101: Put forward a good bill and challenge the opponents to filibuster it.
Use all the good things in the bill – the measures that actually provide access to health care – that the conservatives are blocking against them as a wedge in the next election and as pressure to break the filibuster.
Fall back position – IF NECESSARY – go with the 60 vote shitty bill – IF NECESSARY.
Note: “Legislation 101” requires a dose of “Leadership 101,” which has been lacking since the beginning of the debate.
Instead, the strategy has been to force liberals to make concessions and give the store away to conservatives. The White House and Dem. leadership has steadfastly avoided using the sticks available to it to threaten and whip the conservatives into compromising. Again, Legislation 101 requires Leadership 101 which is totally absent in the Democratic caucus.
What actions taken now at the end of this mess will leave opponents weaker? If killing the bill shifts the balance left, good, but lets not use the same battle plan next time. The Senate climate change legislation is lining up in a similar manner.Kerry,Lieberman and Graham have open with a compromise will deal down.They are starting with lemons making gurry* not lemonade.
Regarding the fact that the compromise must be reached between the real Democrats and the right wing of the party,this was known by Obama ,Rahm ,Reid and Pelosi from the start .Lieberman,blue dogs and the insurance lobby didn’t just appear out of vapor.This outcome wasn’t inevitable,but without some of that change it is being rewound to start again.
*a whaling term for the refuse left over from processing whale blubber
Repubs and right wing Dems will be running on “reforming” Medicaid and Medicare in ’10. After all, with this wonderful massive tax increase meant to feed the already glutted health insurance industry, we now will have the mechanism to move the poor and elderly away from those despised public programs.
This will not reduce insurance increases. There will be no large government plan putting downward pressures on hospital costs .. this will duplicate what happened with the pharmaceuticals after Medicare part D kicked in and the government was no longer able to negotiate lower prices (with a few exceptions).
This will not reduce deficit expenditures (if you think it will … where?). Reality check: once the tax increases needed to fund the subsidies are discussed we’ll see two things happen: 1) cut into other much needed domestic programs, and 2) borrow the rest.
Massive tax increases or huge government deficits are okay as long as they are feeding the rich and infamous, but if they are used to actually help the rest of us … forget about it.
More money funneled to the enemies of reform .. done in the name of reform.
That’s what this bill is all about. That’s what this bill will do.
The proposal put forth right now by the DC Dem surrender monkeys is a loss for all but the richest 5% or so.
There should be a lot more attention paid to the fact that this bill introduces a new and very dangerous element into our system .It will be the first time the government forces people to pay the private sector with fines backed by the IRS. Take a look at what corporations are doing, privatizing water, junk health insurance, junk banks. This is a very bad precedent with little to offer .Kill the bill and let the Whitehouse stop being so smug about owning the left and dissing it at every opportunity. Bernie was bought off far too cheap. Only the Nelsons and Stupaks play hardball with women’s rights. If you think the private health insurance companies will do anything but continue their rush to profits no matter who dies you haven’t been paying attention. All that matters is money. I say lets spread the idea that no birth is free anymore, a million dollars a pregnancy or no new people for your corporate hell on earth.
I was not surprised at how quickly and easily the senators caved in to Aetna, United Health Care, Wellpoint, and all the rest of them — since these companies pay a lot of our premiums dollars for them — but the whole process is a disgusting travesty of anything remotely democratic. The Lieberman/Nelson bill is just a sop to the insurance companies.
But I also agree with Jack. The democrats are going to get pulverized in the next election and, never again in at least my lifetime, will the chance to reform our mess of a health insurance system come around. The only hope for anything rational is the reform that the Vermont legislature promises to take up this January.
Still, I am very depressed about this idiocy and sorely wish that Vermont could become another Canadian province.
I wholeheartedly agree. They walked away from anything real, too afraid to take on the problem for fear of losing campaign dollars and other lucrative cash cows for themselves. Once again, it is just a transfer of wealth from the middle class to big business. Let’s see how Obama does with a GOP majority in 2010. That’s what he will get.
Thanks so much. You just know the democrats will get creamed this upcoming election. I loathe the thought of it. But Americans are just as likely to return to the gop now, despite what they have done to the nation and the economy.