Four members of Congress who are not winning any popularity contests this week are House Blue Dogs Bart Gordon of TN, Baron Hill of IN, Mike Ross of AR, and Zack Space of OH.
These members of the Energy and Commerce Committee, as you may have heard, have agreed to vote for a Democratic health reform plan, giving it enough votes to get to the floor and probably to secure passage there, in exhange for a number of concessions. Said concessions drove a group of progressive House Democrats to fury and very nearly to open rebellion.
But it’s not like the four Blue Dogs are getting any love from hard-core critics of Obama’s health care efforts. At Redstate, one of the leading conservative blogging sites, head honcho Erick Erickson’s post on the deal had this calm title: “The Four Blue Dog Democrats Who Sold Out America.” The subtitle was also pretty even-handed: “Judas only needed 30 pieces of silver to sell out Christ. How much did these four need to sell out their country? ”
When he wasn’t comparing Blue Dogs to Judas–and presumably, the existing health care system to Jesus Christ– for agreeing reluctantly to support their own party, Erickson was fulminating about Republican Senator Lamar Alexander’s treachery in deciding to support Sonia Sotomayor’s nomination and–horror of horrors!–introducing a bill to ban mountain-top coal mining.
Everybody’s a critic.

Since you’d get the general idea from news coverage that Democrats are at each other’s throats, and are gravely dissatisfied with President Obama, it’s always interesting to look at those few public opinion polls that supply breakouts not only by partisan self-identification but by sub-category or faction.
The headline on the latest national survey by Pew is the alarming “Obama’s Ratings Slide Across the Board.” What that actually means is that the President’s job approval ratio has dropped from 61/30 in June to 54/34 today, hardly the stuff of apocalypse since Obama was elected by a margin of 53-46, which was considered a semi-landslide at the time.
But with all the talk of Democratic unhappiness, particularly among “moderates” and “Blue Dogs,” with Obama’s agenda, here’s where rank-and-file Democrats stand on the President’s job performance during the summer of their deep discontent:
Democrats as a whole–85/8 (down from 88/8 in June).
Conservative/Moderate Democrats–82/10 (down from 85/10 in June).
Liberal Democrats–95/5 (up from 93/4 in June).
Not exactly a collapse in support, eh?
Meanwhile, Gallup’s tracking poll on Obama’s job approval, which also shows a general decline in July, has him at 56% as of July 20-26. Among Democrats, his approval rating plunged all the way from 92% during the week of July 13-19, to 88% July 20-26.
And here are the ideological breakdowns:
Conservative Democrats–77% (down from 80% the previous week)
Moderate Democrats–86% (down from 91%)
Liberal Democrats–92% (down from 95%)
Keep in mind that we are in a period when pundits are saying that Barack Obama is “splitting with moderates” and “threatens to break the Democratic coalition.” With 86% of self-identified moderate Democrats and 77% of self-identified conservative Democrats thinking that Obama’s doing a good job, I’d say the reports of Democratic discontent and disunity are more than a bit exaggerated.

DemFromCt has a pair of good posts at the Daily Kos trying to sort out the latest public opinion on health care reform. In the first link-rich post, “NBC/WSJ and CBS/NYT Polls: Americans Are Divided On Health Care, Down On The Economy,” he analyzes recent polling data on support for President Obama, approval of the job congress is doing and support for health care refom and suggests a strategy:

The bottom line from both polls: Americans are persuadable but are not sold on what they hear on the news. Specific plans sell, but the opposition is well financed and quite skilled at obstruction. Still, the odds are that reform will pass and a bill will emerge from each chamber, and nothing drives polls like success. Depending on the public to drive the process is fraught with difficulty. This will take White House salesmanship to get the job done.
As for regaining momentum, that’s easy and takes two steps. First, bring it down to ordinary people’s level over the August break about what it means to them (affordable medical care you don’t have to worry about losing), and second, have an actual bill to debate rather than Mike Enzi’s version of how to stop whatever is emerging. Nothing succeeds like success.

In his second post, “TIME Poll: Americans Back Reform but Worry About Details,” DemFromCT reviews numbers showing a strong mandate for comprehensive coverage for “all Americans” and for the public option, and he concludes:

Bottom line here, when looking at all the polls: critics in the GOP have raised doubts about Obama’s plan, but he remains 15-20 points ahead of Congressional GOP in terms of public preference. And though doubts are there, especially about cost, people are anxious, fear losing what they have, and crave stability. They want details, and they want Obama to explain and reassure.

Mark Blumenthal’s Pollster.com post “Health Care: ‘Losing the Message War?‘” cites Kaiser Foundation data indicating strong support for fundamental reforms, despite persistent anxieties about cost and coverage:

…The Kaiser Foundation surveys are typically the most comprehensive on the subject of health care and this latest tracker is no exception. The found a majority of Americans continuing to support the goal of reform and large majorities expressing support for a “variety of methods of expanding health insurance coverage, including Medicaid expansion (74 percent), an individual mandate (68 percent), an employer mandate (64 percent) and a public plan (59 percent).”..

Both DemFromCT and Blumenthal cite the effectiveness of anti-reform messaging in keeping public anxieties high. But Democrats do have a strong tailwind in the public’s recognition that substantial reform is urgently needed, and recognition that Republican obstructionists have failed to deliver even a semblance of meaningful reform. The challenge is now for the President, congress and reform advocates to refine and simplify their messaging and raise the confidence level of the insured that their health security will benefit from the Democratic reforms.

In his current ‘Public Opinion Snapshot‘ at the Center for American Progress web pages, TDS Co-Editor Ruy Teixeira spotlights a new 25-nation ‘Global Attitudes Survey” by Pew, which clearly indicates that President Obama’s foreign policy has been a stunning success. Described by Teixeira as “heavy on consultation and diplomacy and notably light on the unilateral use of U.S. power,” Obama’s foreign policy has produced a dramatic turn around in America’s image abroad, as Teixeira explains:

…From 2008 to 2009, favorability toward the United States increased in 21 of 24 nations, excluding the United States. This increase in favorability included double- digit rises in 11 nations: France (up 33 points), Germany (+33), Indonesia (+26), Spain (+25), Mexico (+22), Britain (+16), Argentina (+16), Nigeria (+15), Brazil (+14), Canada (+13), and India (+10).

The survey credits President Obama with leading the remarkable transformation, notes Teixeira, who cites:

…An enormous increase in the number of people internationally with a lot or some confidence that the U.S. president will do the right thing in world affairs. The median level of confidence in the U.S. president among the 21 countries surveyed in both 2008 and 2009 shifted from just 17 percent for Bush in 2008 to 71 percent for Obama in 2009.

Teixeira explains that the extraordinary transformation is attributable to two factors — Bush’s dismal performance in foreign affairs and President Obama’s exceptional credibility as a world leader. Says Teixeira: “It’s good to know that a progressive foreign policy has been able to repair some of this damage so quickly.”

This item was cross-posted at The New Republic.
While Jon Chait is definitely right that much of the difficulty with House Blue Dog Democrats on health reform (like climate change) has had to do with the legislative timing, there is still a residual question about their generally reluctant position with respect to much of the Obama agenda. And the oversimplistic answer to this oversimplistic question has often been that Blue Dogs tend to represent marginal districts they could lose by toeing the party line.
So now comes the ever-insightful Mike Tomasky with an analysis of exactly how vulnerable those Blue Dogs really are. He keeps this analysis clean by limiting himself to those Members from districts carried last year by John McCain—i.e., those where fears of a voter backlash are most reasonable. And his conclusion is that the vast majority of Blue Dogs seem to have little to worry about based on their 2008 performance.
His conclusion:

Yes, some Democrats have to be very careful and not be seen as casting a liberal vote. But they’re a comparatively small number. A very clear majority of these people have won by large enough margins that it sure seems to me they could survive one controversial vote if they [put] some backbone into it.
But many of these folks manage to sell this story line to Washington reporters who’ve never been to these exurban and rural districts and can be made to believe the worst caricatures. I say many of these Democrats are safer than they contend. People need to start challenging them on this.

Mike’s post is very valuable in dealing with broad-brush stereotypes of the Blue Dogs and of Democratic “centrists” generally. He doesn’t, of course, deal with alternative explanations, including the diametrically opposed possibilities that they believe what they say they believe on policy issues as a matter of principle, or that they are deeply beholden to interests (whether home-grown or national) who oppose Obama’s agenda.
But let’s stick with electoral calculations. Mike plausibly assumes that any Democrat in a “red” district whose 2008 margin of victory exceeded McCain’s might be in a pretty strong position to take a bullet for the donkey team. Here, however, are three provisos to this argument:
1) Risking serious GOP competition” is not as compelling a motive as “risking defeat,” but anyone familiar with how Members of Congress think would understand that the former is treated as a personal disaster by anyone ill-accustomed to heavy fundraising and campaigning. This is hardly a Blue Dog exclusive: some may remember the disputes over racial gerrymandering during the early 1990s, in which some members of the Congressional Black Caucus stoutly defended the “packing” of their districts with African-Americans, at the arguable expense of overall Democratic prospects, on grounds that they deserved a safe, not just a winnable, seat. (To their credit, many CBC members volunteered for less safe seats during the next round of redistricting). And in all fairness, it should be remembered that many of the “loyal” Democrats who fulminate about Blue Dog treachery haven’t had a competitive race since their first elections. Avoiding actual accountability to voters is hardly an honorable motive, but it’s real.
2) It’s generally assumed by many analysts that 2010 is likely to be a pro-Republican year, particularly in districts carried by McCain in 2008. So 2008 performance levels aren’t necessarily dispositive of 2010 prospects. But equally important, more than a few Blue Dogs are from states where Republicans are likely to control redistricting after 2010. Invincible Members tend to be treated kindly in opposition-party redistricting; potentially vulnerable Members could wind up with much more difficult districts than they represent today. This may seem to be a remote worry, but again, it’s real.
3) Most Blue Dogs, whatever you think of their principles, loyalty, or ethics, are not stupid people. They understand that association with “liberal” Obama initiatives may be a problem, but that the value of the “D” next to their name on the ballot also depends on Obama’s success as a president. So like any politician, they undertake a personal cost-benefit of their positions on legislation and the overall effect on Obama, the party, and political dynamics generally. This, as much as concerns over “timing,” helps create the Kabuki Theater atmospherics of Blue Dog rhetoric. Most Blue Dogs want Barack Obama to succeed, but many would prefer that he do so without their own votes.
This last factor helps explain why, in addition to the important timing concessions, the Blue Dogs have reached an agreement with Henry Waxman that will allow health care reform to emerge from the House, but probably with only enough Blue Dog votes to avoid disaster. It remains to be seen how many of the conceded and ultimately insignificant “no” votes from Democrats can be sorted into the principled, the suborned, or the politically endangered. In any event, the Blue Dog bark may be worse than its bite.

Just over a month ago we featured a Democracy Corps analysis from TDS Co-Editor Stan Greenberg, James Carville and Andrew Baumann about the case that needed to be made to create a “sustainable majority” for health care reform.
To recapitulate, DCorps set up five criteria for winning the “health care swing vote:”
1. Voters need to hear clearly what changes health care reform will bring.
2. Build a narrative around taking power away from the insurance companies and giving it to people.
3. The president and reform advocates have to explain concretely the changes that will mean lower costs.
4. Show all voters and seniors that there are benefits for them, including prescription drugs.
5. All of these points should be made with the dominant framework that continuing the status quo is unacceptable and unsustainable.
Today Nate Silver of 538.com used these five criteriato grade the Democratic reform effort so far.
You don’t have to share his harsh assessment–and it is harsh–to agree the public case for health care reform has yet to be made.

Amid reports that the Senate Finance Committee’s version of health care reform does not include a “public option” for insurance, and after many weeks of line-drawing by various progressive organizations making the inclusion of a public option a sine qua non, Ezra Klein has an important post challenging the whole premise that this issue is central:

The public option, as it exists in any bill moving through Congress, is not the core of reform, nor anything near it. It is, for one thing, limited to the Americans who buy into the Health Insurance Exchanges, and the exchanges are in turn limited to the unemployed, the self-employed and small businesses. In the House bill — which is the strongest of the bills — the Congressional Budget Office estimates that 27 million Americans would be in the exchanges by 2019. That’s not nothing, but it’s not much. Imagine half choose the public option (CBO estimates many fewer than that). You now have 13.5 million Americans in a public insurer with no substantive advantages over private insurance. That’s not a gamechanger, it’s a tweak.

Even if you dispute some aspects of Ezra’s analysis of the substantive importance of the public option, it’s worth listening to his broader, historical argument: progressives have in the past supported a variety of health reform proposals that did not include a public option:

The public option is not now, and has not ever, been the core of the argument for heath-care reform. It is the core of the fight in Washington, D.C. It is an important policy experiment. But it was not in Howard Dean or John Kerry or Dick Gephardt’s plans, and reformers supported those. It was not in Bill Clinton’s proposal, and most lament the death of that. It is not what politicians were using in their speeches five years ago. It is a recent addition to the debate, and a good one. But it is not the reason were are having this debate.

But I would observe that Ezra doesn’t mention one of the reasons for the current focus on the public option: a significant element of health care reformers didn’t really support the Dean or Kerry or Gephardt plans, or the Clinton plan as it was eventually shaped, other than as a compromise with an unacceptable status quo. They supported, and still support, a single-payer system, and now either (a) hope, just as reform opponents claim, that a public option is simply a way-station to single-payer, or (b) want to maintain the priniciple of a public insurance provider as the only way to curb the abuses associated with private health insurance.
So while some progressives view the public option as merely a means to an end that is perhaps less important than several other aspects of health reform, others do indeed view it as “the core of reform.” It’s not clear at this point whether they are willing, this time, to take a dive on health care reform if the eventual legislation lacks a public option, but there’s no particular reason to doubt their sincerity or its origins.
I don’t happen to share the reflexive enthusiasm for single-payer of many progressives, but I do understand why its advocates feel frustrated. There was a moment a few years ago when single-payer seemed finally to be sweeping the progressive world; it was endorsed by Al Gore way back in 2002, and by the Editors of The New Republic, and by most if not all progressive health wonks. But in the 2004 and 2008 presidential campaigns, all of the Democratic candidates other than Dennis Kucinich rejected the single-payer approach.
Moreover, single-payer fans may rightly note that for the second time in fifteen years, a health reform proposal by a Democratic president is being imperiled by its complexity. Single-payer is nothing if not easy to understand, and while a public option in a competitive system isn’t that simple, comparisons to Medicare make it somewhat more comprehensible than, say, health insurance exchanges.
Still, Ezra is issuing the right challenge to those who make the public option non-negotiable out of a displaced preference for another approach to health reform altogether: is failure acceptable, given how rarely the opportunity for health care reform comes around?
Maybe progressives won’t ultimately have to make the choice between a bill without a public option and no bill at all. But I wouldn’t bet the farm, or health reform, on it.

Businessweek, via MSN Money has an article, “What’s most likely to bankrupt you” that ought to be required reading for every Democrat. And, as President Obama takes the campaign for health care reform on the road, it wouldn’t hurt to include this graph from the article as selling point #1 for those who think their health insurance is adequate and reform may not be so necessary:

Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illnesses, including 60.3% who had private coverage, not Medicare or Medicaid.

If anyone can find a better short paragraph that explains why we need a public option, please share. Wondering if health security has been getting better or worse? Here’s the next graph:

Medically related bankruptcies have been rising steadily for decades. In 1981, only 8% of families filing for bankruptcy cited a serious medical problem as the reason, while a 2001 study of bankruptcies in five states by the same researchers found that illness or medical bills contributed to 50% of all filings.

The article goes on to add that the bankruptsy filers were “for the most part solidly middle class before medical disaster hit. Two-thirds owned their homes, and three-fifths had gone to college.”
In other words, those poll respondents we’ve been reading aboout who feel secure about their health insurance may be marinating in self-delusion. As the authors of the cited study, which is being published in the American Journal of Medicine, Drs. David Himmelstein and Steffie Woolhandler of Harvard Medical School, Elizabeth Warren of Harvard Law School and Deborah Thorne, a sociology professor at Ohio University, conclude:

“For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse,” said lead author Himmelstein. “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy.”

Woolhandler adds,

Covering the uninsured isn’t enough,” she said. “Reform also needs to help families who already have insurance by upgrading their coverage and assuring that they never lose it.”

As President Obama takes his case on the road, this is the kind of information that can help him persuade middle-class, insured Americans why they need health care reform. It’s important that all Democrats — office holders, rank and file and others use it as well. The uninsured know why we need health care reform. It’s time to educate the insured as well, and that’s a worthy challenge for all progressive journalists at this critical moment.

One of this week’s “must-reads” is an eloquent, angry piece by Hendrik Hertzberg for The New Yorker that explains and laments America’s “health care exceptionalism,” and attributes it largely to our constitutional system. An extended quote is in order:

In other free countries, legislation, social and otherwise, gets made in a fairly straightforward manner. There is an election, in which the voters, having paid attention to the issues for six weeks or so, choose a government. The governing party or coalition then enacts its program, and the voters get a chance to render a verdict on it the next time they go to the polls. Through one or another variation of this process, the people of every other wealthy democracy on earth have obtained for themselves some form of guaranteed health insurance or universal health care.
The way we do it is, shall we say, more exciting. For us, an election is only the opening broadside in a series of protracted political battles of heavy artillery and hand-to-hand fighting. A President may fancy that he has a mandate (and, morally, he may well have one), but the two separately elected, differently constituted, independent legislatures whose acquiescence he needs are under no compulsion to agree. Within those legislatures, a system of overlapping committees dominated by powerful chairmen creates a plethora of veto points where well-organized special interests can smother or distort a bill meant to benefit a large but amorphous public. In the smaller of the two legislatures—which is even more heavily weighted toward conservative rural interests than is the larger one, and where one member may represent as little as one-seventieth as many people as the member in the next seat—an arcane and patently unconstitutional rule, the filibuster, allows a minority of members to block almost any action. The process that results is less like the Roman Senate than like the Roman Games: a sanguinary legislative Colosseum where at any moment some two-bit emperor is apt to signal the thumbs-down.

He’s right, of course; America does differ fundamentally from countries with parliamentary systems where parties run on manifestos that are almost immediately implemented; intraparty dissent may well exist, but not on such basic issues as health care. Hertzberg could have gone further in his analysis of American exceptionalism: here party identity among candidates for Congress is largely self-selected, with primary voters offering the only (and rarely exercised) curb. Currently, 49 Democratic House members represent districts won by John McCain in 2008; ten Democratic senators represent states carried by McCain. There’s a strong presumption that the switch from total control of the federal government by Republicans prior to 2006 to total Democratic control today will create a natural backlash against Democrats in 2010 and perhaps beyond, especially given the dire economic situation. This is one of many factors in our system and our traditions that militate against big legislative reform efforts, particularly when, as is the case today, the “out” party decides to operate as an obstructionist force.
Add in the chronic mistrust of the federal government and particularly Congress among Americans from both parties and no party, and the power and money deployed by a threatened private-sector health care industry, and the extraordinary difficulty facing the Obama administration and its congressional allies in enacting meaningful health care reform is no big surprise.
So let’s continue to cut Barack Obama some slack in how he’s handled health care reform. He could have postponed action for a year, pleading the economic emergency; had he done so, he would have earned standing ovations from many pundits of the center and center-right. He could have “gone incremental” right away, and lowered expectations to a manageable level. Instead, for all the tactical manuevering going on right now, he’s still pushing pretty much the same ideas for reform that he campaigned on. But make no mistake: reforms of similar magnitude in the past required either gigantic majorities beyond anything Democratic currently hold (the New Deal, Medicare and Medicaid), or significant support from Republicans (the Civil Rights and Voting Rights Acts). Hertzberg is right in finding many aspects of our system frustratingly reactionary. But if we wait for, say, a parliamentary system to save us, we’ll be like premillienialist Christians waiting for the Rapture: standing in place, looking beyond the skies for redemption.

The California budget crisis has gotten a lot of deserved attention over the last few weeks, leading to all sorts of theories, some bordering on collective psychotherapy, about the Golden State’s fiscal dysfunction.
But it doesn’t seem to have quite penetrated the consciousness of the chattering classes that California’s only an extreme example of a fiscal meltdown that’s occurring all over the country, and probably isn’t getting any better any time soon.
New figures published last week by the Center for Budget and Policy Priorities paint the full bleak picture. For fiscal year 2010 (which began on July 1), states faced cumulative shortfalls during their budgeting processes of $162 billion, which amounts to 29.3 percent of state budgets. That’s significantly more than the $111 billion in shortfalls the states had in FY 2009, when the financial crisis hit.
But if current trends hold, states are expected to encounter an even higher level of shortfalls–$180 billion–in Fiscal Year 2011, for which they are just beginning to make plans. They are far past the ability to borrow from reserve funds, cancel major new investments, or cut out “waste.” We’re talking serious cuts in services and employment, and the kind of tax increases that no one likes and that could combine with spending cuts to further depress state and even national economies. And it would all be a lot, lot worse if funding for the states (albeit primarily just for Medicaid) hadn’t been included in the economic stimulus package.
So mock California all you want: as is often the case, they really have been a trend-setter in the advent of unmanageable fiscal problems.