washington, dc

The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Democratic Strategist

Big Stakes, Big Risk

At 538.com, Tom Schaller points out a reasonably obvious but oft-forgotten reason for the steady erosion of President Obama’s approval ratings over the last few months: he’s trying to do a lot, and trying to do a lot depletes political capital more rapidly than trying to do very little:

Big change is costly, and not just in actual dollars from the Treasury, but in terms of how much of his capital reserves a president is willing to spend to get what he wants. Obama is not plugging for school uniforms, folks. He’s re-regulating Wall Street, trying to stimulate the economy by pumping nearly $1 trillion into it, and attempting to tackle the policy problem too many of his predecessors never could: reforming our messy, complicated health care system. Accordingly, he’s paying the price for even trying.

To put it another way, what would you prefer if you are a Democrat: that the President keep his approval ratings above 60 without working to implement the agenda he campaigned on, or lose some points and mybe get something done that won’t have to be done later or left undone entirely?
No gain without pain, folks.


The Public Option and Its Passionate Defenders

If you’re wondering why the so-called “public option” in proposed health reform plans is such a line-in-the-sand non-negotiable requirement for so many progressives, you should definitely read Mark Schmitt’s brief item for The American Prospect explaining the history of this concept.
It all started, Schmitt explains, among single-payer advocates who had been convinced by pollster Celinda Lake that their approach just didn’t have enough popular support to carry the day:

One key player was Roger Hickey of the Campaign for America’s Future. Hickey took UC Berkley health care expert Jacob Hacker’s idea for “a new public insurance pool modeled after Medicare” and went around to the community of single-payer advocates, making the case that this limited “public option” was the best they could hope for. Ideally, it would someday magically turn into single-payer. And then Hickey went to all the presidential candidates, acknowledging that politically, they couldn’t support single-payer, but that the “public option” would attract a real progressive constituency.

John Edwards signed on, and then Obama and Clinton, and a hybrid proposal that added the public option to the prevailing concept of a competitive system of private insurance plans became the standard Democratic approach.
But baked into the cake was a subtle but important difference in perspective between single-payer fans who viewed the public option as the sine qua non, and other progressives who viewed it as just one of many moving parts in a comprehensive system.
That division continues today. Here’s how Schmitt describes the passion of single-payer advocates for a “robust” public option, as many House Democrats call their demand:

So now this energetic, well-funded group of progressives is fired up to defend something fairly complex and not necessarily essential to health reform. (Or, put another way, there are plenty of bad versions of a public plan.) The symbolic intensity is hard for others to understand. But the intensity is understandable if you recognize that this is what they gave up single-payer for, so they want to win at least that much.

So hard-line defense of the public option is about substance, but it’s also about emotion, and about people who think they’ve already compromised enough by accepting a system built around private health insurance. This is all worth remembering when the final deals get cut in Congress on health reform.


Democrats: In objecting to people who bring guns to town halls, don’t insult the large numbers of Americans who carry weapons for legitimate reasons. The majority are considerate of others and do not bring guns into settings where they do not belong.

The report in TPM today that two of the men seen carrying guns at the recent town halls are linked to right-wing extremist groups is an extremely disturbing development.
But, in responding, it is important for Democrats to remember that most of the Americans who carry weapons do so for legitimate reasons – security guards, night watchmen, private detectives, parole officers, and businessmen who have to carry large quantities of cash.
These normal, law-abiding Americans would never dream of wearing their gun at a wedding, or a PTA meeting, or a decent restaurant. They would leave their weapon in the glove compartment of their car instead. (one friend of mine, a lanky Vietnam vet named Pete, always leaves his sidearm in his car before going into Waffle House to sit around and joke with the waitresses. “It wouldn’t be polite” he explains).
What the “pistol-packers” showing up at the town halls are doing on the other hand is the exact opposite – they are being intentionally provocative and deliberately seeking to offend. Their behavior has absolutely nothing to do with the second amendment or gun control. The “pistol-packers” know perfectly well that they are deliberately violating the norms and values of their communities and the code of behavior followed by the vast majority of responsible gun owners. Their second amendment rhetoric has no purpose other than to obscure this basic fact.
Dems should not let the pistol-packers hide behind legitimate gun owners. The simple fact is that normal law abiding citizens do not carry their weapons into settings where their presence is inappropriate. The pistol-packers are making a point of it.
Don’t confuse the two.


Can Co-Ops Be a Public Option?

Sorting out the pros and cons of the co-op option vs. the public option is the challenge of the hour for progressives who want real health care reform, and it will certainly be hotly debated. Most just-published articles and blogs equate ‘public option’ with a government plan. But it seems important to ask, is there any way that a co-op can be a public option? There is no shortage of opinions on the topic:
The New York Times has “Alternate Plan as Health Option Muddies Debate,” a probing article by by Robert Pear and Gardiner Harris. The authors spotlight some key problems with the co-op approach:

As the debate rages, lawmakers are learning that creating cooperatives — loosely defined as private, nonprofit, consumer-owned providers of health care, much like the co-ops that offer telephone, electric and other utility service in rural areas — will not be easy.
The history of health insurance in the United States is full of largely unsuccessful efforts to introduce new models of insurance that would lower costs. And the health insurance markets of many states suggest that any new entrant would face many difficulties in getting established.

More specifically,

The government would offer start-up money, perhaps $6 billion, in loans and grants to help doctors, hospitals, businesses and other groups form nonprofit cooperative networks to provide health care and coverage.
The co-ops could be formed at the national, state or local level. Proponents say that a health co-op might need 25,000 members to be financially viable, and at least 500,000 members to negotiate effectively with health care providers…they would need time to buy sophisticated information technology and to negotiate contracts with doctors, hospitals and other health care providers.
…In the 1990s, Iowa adopted a law to encourage the development of health care co-ops. One was created, and it died within two years. Although the law is still on the books, the state does not have a co-op now, said Susan E. Voss, the Iowa insurance commissioner.

Not a very promising prospect, according to ‘the newspaper of record.’ Worse, $6 billion is about what we spend occupying Iraq in one month. Iraq and Afghanistan are the ignored elephants in rooms where health care reform is being debated. Few would doubt that half of what we spend on these two wars annually could go a long way toward bringing real health security to America.
Columnist Bob Herbert is even more dismissive in his NYT op-ed, “Forget about the nonprofit cooperatives. That’s like sending peewee footballers up against the Super Bowl champs.”
In his Alternet post “It’s Now or Never for a Public Option: Why We Need to Take a Stand Against the Insurance Industry’s Greed” Joshua Holland explains,

In 2000, the Government Accountability Office conducted a study of the impact similar purchasing schemes had had to date. “Despite efforts to negotiate lower premiums,” the GAO concluded, “cooperatives have only been able to offer premiums that are comparable to those in the general small-group market. The cooperatives we reviewed typically did not obtain overall premium reductions because: 1) their market share provided insufficient leverage; 2) they could not produce administrative savings for insurers.”
The Commonwealth Fund did an analysis of the impacts nonprofit co-ops would have as well (PDF), and its findings were similar. Researchers found that, “with very few exceptions,” premiums offered through co-ops “have not been lower than those available to small employers elsewhere” because they “have not been able to reduce administrative costs … they have not had enough market share to bargain for discounts.”
Because of their inherent limitations, former Vermont Gov. Howard Dean told me in an interview last month that the co-op scheme is a “fake public option,” and “really not [a] serious health reform.” He predicted that if they were created, they would “be crushed just like Blue Cross was crushed. Most Blue Cross chapters are now for-profit. They’ve been taken over by the insurance industry. Any reasonable-sized insurance company can crush a not-for-profit co-op.”

And, in The Nation, Katha Pollit writes of co-ops,

…They’re untested, small, unregulated, that they exist in twenty states and that Senator Kent Conrad of North Dakota really likes them–but I didn’t discover what they actually are. I understand “public option,” and “public” has a good, strong ring to it–it says, Healthcare is a right, part of the common good, something everyone should have, and if you can’t afford it in the marketplace, the government will provide it. “Insurance co-op” speaks a whole other language, of commerce and complexity and exclusivity

Writing in the Washington Post, David S. Hilzenrath and Alec MacGillis explain:

“It’s very difficult to start up a new insurance company and break into markets where insurers are very established,” said Paul B. Ginsburg, president of the Center for Studying Health System Change. “I don’t see how they’re going to obtain a large enough market share . . . to make a difference.”
Karen Davis, president of the Commonwealth Fund, a foundation focused on health care and social policy research, said co-ops may not enroll enough people to negotiate favorable rates with health-care providers.
…Co-ops would lack perhaps the main advantage of the public option: reimbursement rates for doctors and hospitals set by federal law, like those paid by Medicare, the program for older Americans. Federally determined reimbursement rates were central to the cost-saving promise of a government-run health plan and a potentially powerful competitive advantage. They were also a lightning rod for intense opposition from health-care providers and private insurers, who denounced the public option as a threat to their financial survival…Co-ops would lack the ability to piggyback onto existing government institutions, like the ones that help administer Medicare.

On the other hand, Co-ops have some advantages and “could serve a useful purpose in health care — just as credit unions compete effectively with banks, prompting them to offer higher interest rates on deposits and lower rates on loans,” explain Pear and Harris, summarizing the views of Ann Hoyt, a University of Wisconsin economist who has written extensively about co-ops.

…Professor Hoyt said she had been a member of the Group Health Cooperative of South Central Wisconsin since 1985, and she reported that “the care is excellent.”…Larry J. Zanoni, executive director of the Wisconsin plan, said: “We are a testament to the success of a health care cooperative. But it took us over 30 years to get where we are today.”
Representative Earl Pomeroy, Democrat of North Dakota, said the proposal for cooperatives was “a very worthy idea.”…“The market here is uncompetitive,” said Mr. Pomeroy, a former state insurance commissioner. “A cooperative could provide an alternative source of insurance and some interesting competition for premium dollars. A co-op could operate at lower costs, in part because it would not need to pay its executives so generously as the local Blue Cross Blue Shield plan.”

There are plenty of co-ops already operating, note Harris and Pear:

…In a study published in March and financed in part by the federal government, Professor Hoyt and other researchers at the University of Wisconsin identified nearly 30,000 cooperatives with revenues of more than $650 billion a year. They include farm co-ops, retail food co-ops, rural telephone and electric co-ops and credit unions — entities as diverse as Ace Hardware, The Associated Press, Blue Diamond Growers (almonds), Carpet One, Land O’Lakes (dairy products), Ocean Spray (cranberries) and Sun-Maid Growers (raisins).

If co-ops are going to do any good, they must be adequately capitalized, particularly since guaranteeing coverage of pre-existing conditions is a cornerstone of Obama’s and Progressive concepts of health care reform. Also, there are more well-established ethics and accountability rules and regulations in government. And it is a fair question to ask if co-op employees would have enough of a commitment to public service, as well as the competence and resources to protect the health security of Americans. Also, how do you level the playing field, so giants like Blue Cross-Blue Shield don’t have such a potent edge over new start-ups?
Can co-ops actually be a sort of public option, performing a very similar role as does government? As Republican Sen. Orrin Hatch, quoted in The Times article, says “You can call it a co-op, which is another way of saying a government plan.” And, noting that Democratic Majority Leader Harry Reid called co-ops “some type of public option,” Chris Good adds at The Atlantic ‘Politics’ blog:

The RNC forwarded a press release/research memo to reporters today claiming that a “‘public option’ by any other name is still government health care.”…The idea is that co-ops (whether it’s one national co-op, state co-ops, or a national co-op with state affiliates) would serve the same function as government-administered health insurance, in that they’d operate as non-profits and perhaps utilize some added bargaining power or lower payment rates, thus forcing for-profit insurance companies to drive their own costs down, out of sheer economic necessity, once they had to compete with a non-profit that had some consumer cost advantages.

According to Rep. Anthony Weiner, as many as 100 members of the House of Representatives may see a bill with no ‘public option’ as a deal-breaker. In the Senate, however, Nate Silver guestimates only 41 solid votes for a ‘public option,’ compared to Chris Bowers’ 43. It’s hard to define the congressional consensus on the ‘public option’ between the House and Senate.
Is it ‘either/or’, or ‘both/and’? Might some kind of hybrid, that taps some of the advantages of both co-ops and government be possible? Much depends on whether co-op advocates can provide credible answers to these and other questions.


RIP Robert Novak

Robert Novak, who died today of brain cancer at the age of 78, had such a long and varied journalistic career that different people probably remember him in different ways. Some younger readers may completely associate him with the Plame saga, or with his career as a conservative gabber on cable. Others may recall the many years in which his syndicated newspaper column was (as David Stockman once put it) a “bulletin board” for movement conservatives who wanted to make their views known to members of the Washington establishment–or sometimes, vice versa. And a few of us oldsters will remember his earlier days, when he was actually a Democrat and an old-fashioned shoe-leather muckraking reporter, in association with his Odd Couple co-columnist (and co-participant in his pioneering cable television show) Rowland Evans.
The book Evans and Novak wrote about LBJ, Lyndon Johnson: The Exercise of Power, remains one of the best political biographies around, particularly if you are interested in the arcane operations of either the U.S. Senate or the White House. I haven’t read his recent autobiography (entitled, in a reference to his longtime nickname in Washington, The Prince of Darkness) but through other obituaries I am hearing that it’s a fascinating book even if you deplore the author’s politics, and intend to go out and buy it directly.
I only met Novak once, just a few years ago, when I had the strange experience of being on a political panel seated between the Prince and another right-wing legend, Paul Weyrich. I found Novak to be smart, cynical, and appropriately scary. By then he had undergone a late-life conversion to Catholicism, reportedly via the agency of the mysterious conservative organization Opus Dei. That, too, was fitting, given his long association with the Cultural Right. I gather his final illness was characterized by excrutiating pain. Much as I dislike large elements of the man’s journalistic and political legacy, I hope his faith gave him comfort, and may he rest in peace.


Clash At the End of the Tunnel

Believe it or not, it’s becoming possible to get a feeling for how the health care reform struggle may play out this fall.
The House will almost certainly pass a bill that includes a “public option.” The Senate won’t; any Senate bill will almost certainly be based on some version of the “health care cooperative” idea. Votes in both Houses will be very close, leaving little room for error. In the Senate, vast concessions will have to be made, on the bill in question and on other issues, to get to 60 votes, and even then, a couple of Democrats will vote “no” and a couple of Republicans will have to be pulled across the line. Perhaps a couple more Democrats will vote for cloture and then vote against the bill itself.
Then the real fun will start, in a House-Senate conference where the White House will be a very active player. As Jane Hamsher reminds us, enough House Democrats have pledged not to vote for any bill that doesn’t include the public option to sink a conference report. And Sen. Kent Conrad is probably right that there aren’t and never have been 60 votes for a plan with a public option in the Senate.
So somebody will have to flinch, and that’s where it will become important to pay close attention to all the less-prominent, but potentially critical, issues that will be at stake.
At TAPPED today, Dana Goldstein has a good list of those issues, including the size and strength of cooperatives, the breadth of a Medicaid expansion, coverage of legal immigrants, and the adequacy of subsidies.
It’s possible, of course, that House progressives and Senate centrists will get so dug in on the public option issue that no conference report can be crafted that can get a majority in the House and 60 votes in the Senate, and nothing at all will happen this year even if there is substantial agreement on other issues. That’s why it’s pretty important that the White House and the congressional leaders tell Members from all factions to stop issuing public threats that this or that provision is a deal-breaker. They should also strongly discourage participation by Democrats in any bipartisan “gangs” that purport to control the outcome (e.g., the one that has already formed to control the Senate Finance Committee markup). A deal that works in one House probably won’t work in the other, and promises to impose provisions on one House or the other in a conference committee aren’t worth a whole lot. So it makes abundant sense to push back the ultimate bargaining to big barbecue that will be held at the very end of the tunnel.


Setting the Record Straight About 2008

The remarkable 2008 presidential election isn’t that far in the rear-view mirror. But as many arguments about alleged contradictions between Barack Obama’s campaign message and his current agenda show, memories fade quickly, and history quickly becomes spin.
So it’s a very good thing that Dan Balz and Haynes Johnson have published an old-fashioned, Teddy-White-style Big Campaign Book that captures what actually happened in 2008, enriched by lots of insider interviews and some sure-footed analysis of events as they occurred.
I’ve written a review of the book (The Battle for America 2008: The Story of an Extraordinary Election) for the Washington Monthly, which in advance of their print edition is available online here.
I offered a lot of praise for the book’s command of details and its handling of several key issues, from Hillary Clinton’s fateful decision to go for broke in Iowa, to John McCain’s vetting process for Sarah Palin. I had a few criticisms as well, but the more I hear people mangling the facts about this election, the more I am grateful for Balz’s and Johnson’s efforts to set the record straight.


“My” Medicare

One of the best-known ironies of the health care reform debate is that beneficiaries of the government-run Medicare program are perhaps the least likely category of Americans to support universal health reform. There are many jokes and anecdotes about Medicare beneficiaries angrily telling Members of Congress to “keep the government out of my Medicare.” And unsurprisingly, some reform proponents suspect that folks on Medicare have an “I’ve got mine” attitude about health insurance based on indifference to the plight of the uninsured or a general antipathy towards Obama or “liberals.”
But I’m guessing there’s something more than sheer ignorance or selfishness at play here: a sense that Medicare, unlike the insurance that would be offered along with subsidies under the proposed reforms, is an earned benefit, while government-provided or -financed health insurance for non-retirees is welfare.
That’s at best partially true. Current payroll taxes and premiums cover a little over half of Medicare expenditures (though even there, it’s important to understand that it’s current workers’ payroll taxes, not “banked” payroll taxes from retirees, that we are talking about); the rest comes from general federal revenues. Moreover, only the poorer beneficiaries of a new system would get anything like full federal subsidies for their premiums. So Medicare’s not fully an earned benefit, and the new benefits won’t be fully “welfare.”
But these are powerful perceptions, and not the sort of thing that pollsters have been looking at lately, so far as I can tell. And the idea that many of the currently uninsured will be given something that Medicare beneficiaries don’t have–not the insurance itself, but the means to pay for it–helps explain why lots of retirees feel no particular solidarity with the uninsured, and are open to right-wing arguments that health reform is an exercise in “socialistic” big-government “redistribution.”
Now I do not recommend that reform proponents deal with these perceptions by lecturing Medicare beneficiaries that they are themselves “on welfare,” though it remains important to remind them that Medicare is a government program, and that government’s role in the new system will be more as a catalyst than as an owner-operator. But the better approach is probably to stress the fundamental idea of universal insurance against medical circumstances beyond anyone’s control, and the injustice of losing access to health care because you get sick, your employer drops coverage, or your premiums keep going up. The truth is that most beneficiaries of health reform will be middle-class working folk with bad luck; that reform is the best way and the only way to get costs under control; and that everyone will benefit from a country where everyone has health insurance.


Dems: we need to face the fact that the health care campaign suffered a significant setback in the last few weeks. Obama and the Dems lost needed support and even lost control of the whole reform narrative. We need to prevent this from happening again

With Obama now meeting friendly crowds as he tours the country and with other local town hall meetings becoming less confrontational, it is starting to look like the Dems may be regaining their balance and stabilizing the situation.
But it would be a major strategic mistake for Democrats to minimize or dismiss the setbacks of the last few weeks as just an unavoidable speed bump in the campaign for health care reform. The decline in public support for the current Democratic attempts to design a health care reform package — and more specifically of support for Obama’s handling of the issue — must be considered troubling – especially the drop in support among political independents. Moreover, in a deeper tactical sense the Dems temporarily lost control of the health care narrative – the national debate stopped being about the major elements of the proposed reforms and became a shouting match on the opponents’ issues and terrain
The increased opposition – which was particularly notable among the active town hall protesters but also visible among a significantly wider group of Americans – was not generally a response to the actual provisions of the various proposed bills. Rather, it has been about something else. At the town hall meetings the protesters generally raised much broader objections – against “the government taking over everything”, “the systematic dismantling of this country”, “the government playing God” or “turning us into Russia” or “undermining the constitution.” All these suspicions – which were deliberately stoked by the Astroturf firms but which were sincerely expressed by the individual protesters – reflected a deeply held fear that something was being foisted on average Americans that was far more than just a new social program. Their comments charged that the Democrats health care reform plans were actually a Trojan horse for something deeply and profoundly sinister.
It is easy to dismiss this as simply irrational, but it is important for Democrats to understand how this view became politically significant.
When he took office, Obama immediately had to manage massive government intervention in both Wall Street and the Auto industry – interventions almost entirely conducted in private, closed-door negotiations – and also to create a recovery program that vastly increased the federal deficit. Opinion polls revealed, however, that people basically blamed the Republicans and accepted that the government could not avoid taking significant actions.
Conservatives first tried to create opposition to Obama by calling his measures “socialist,” but this line of attack provided relatively little traction or resonance (Several polls actually demonstrated that “socialism” was no longer an effective “scare word” , particularly among the young, and focus groups conducted by the U.S. Chamber of Commerce revealed that for many Americans the word “capitalism” actually had very negative connotations of greed and of the powerful dominating the vulnerable)
Conservatives then switched to the term “fascism” and particularly the German, “Nazi” version of fascism. The one superficial analogy they offered for this accusation was that the major fascist countries during the 1930’s had also included extensive government intervention in industry but to liberals the accusation seemed obviously absurd because the two central features of Nazi fascism — the creed of Arian racial superiority and the ethos of glorious national military conquest — seemed so utterly and self-evidently right wing rather than left-wing ideals.
But in fact, what the conservative propagandists like Rush Limbaugh, Glen Beck and Bill O’Reilly had done was essentially to redefine the word fascism to something entirely different from its original definition. In their vocabulary it has now essentially become a synonym for “coercive liberal social engineering” or “creeping liberal totalitarianism” – it is the image of pointy-headed Harvard liberals using the coercive power of the state to impose left-wing values and behavior on average Americans


Lupica Scalds Town Hall Swiftboaters

Hopefully, most TDS readers saw at least a news clip or two of President Obama’s successful town hall meeting in Montana on Friday. For those who didn’t, the next best thing is to read Mike Lupica’s column in today’s Daily News. Lupica leads with the view of a woman who watched the town hall in an airplane hangar in Belgrade, Montana:

“Yes, there were a few protesters en route. But the Montanans who were excited to hear the President far outnumbered the fringe groups.”…Then she said this about Obama: “He was smart, fair, funny.”

Lupica adds,

…This wasn’t an occasion when people with legitimate concerns and legitimate points to make were overwhelmed by the wing nuts and screamers who take their marching orders from right-wing radio and television and the Internet…Those idiots come to these town hall meetings more to be seen than heard, and think creating chaos makes them great Americans.

Lupica, known to most of his readers as a tell-it-straight sports writer, doesn’t mince words:

Those people have been convinced by the current culture that we are dying to hear from them, and the louder the better. People who think that all they need to star in their own reality series is a couple of TV crews…We hear that all of this is democracy in action. It’s not. It’s boom-box democracy, people thinking that if they somehow make enough noise on this subject, they can make Obama into a one-term President…The most violent opposition isn’t directed at his ideas about health care reform. It is directed at him. It is about him. They couldn’t make enough of a majority to beat the Harvard-educated black guy out of the White House, so they will beat him on an issue where they see him as being most vulnerable.
…With that kind of zealotry, screaming about government programs as if Medicare isn’t one. It is why so many of them, all these wild-eyed red faces in the crowd, look completely certifiable, screaming about how Obama wants to kill Grandma, as if he’s suddenly turned into Jack Kevorkian.
…They couldn’t win the fight last November, when he laid out John McCain and Palin and a whole party with one election, so they try to do it now, with lies and rather amazing distortions. They want everybody to believe that if Obama gets his way, he’ll eventually be in charge of insurance and doctors and whether you use CVS or Duane Reade. He’s a Socialist selling socialized medicine. He’ll kill Grandma. Come on. The notion that this is all honest dissent is just one more lie.
Even in Montana, the Swift Boaters who would line up against any health care plan endorsed by Barack Obama ran one television ad 115 times over a day and a half before the President arrived.

The President himself, quoted by Lupica, summed it up well:

“Every time we are in sight of health insurance reform, the special interests fight back with everything they’ve got,” the President said outside Bozeman. “They use their influence and run their ads. They use their political allies to scare the American people.”

Yes, we know, some protestors are sincere and fair-minded, even when not well-informed. But the health care swiftboaters being mobilized to preserve the status quo need to be called out, and this morning Mike Lupica did just that. You can watch President Obama’s Saturday town hall meeting on health care reform in Grand Junction, CO on Saturday, on C-SPAN right here.