As you probably know if you’ve been following the presidential campaign news, Barack Obama released his long-awaited health care reform proposal earlier this week, and it’s getting decidedly mixed reviews from the chattering classes. Two progressive blogger/journalists with pretty good street cred on health care issues, Ezra Klein and Jon Cohn, have published quite similar takes, praising many of the details of the plan but decrying its timidity in challenging the health care status quo–most particularly its failure to provide universal coverage (other than for children). On the positive side, it does indeed seem that Obama’s plan represents sort of a greatest hits collection of incremental health care reform ideas. It picks up John Kerry’s underappreciated 2004 proposal for federal reinsurance of catastrophic health costs, which could have a big impact on rising insurance premiums. It adopts the federal employee health plan model for a national insurance purchasing pool, which makes abundant good sense substantively and politically. It calls for a federally-driven shift towards prevention and chronic disease management, along with IT investments to help control costs and improve quality, which ought to be a point of agreement among those who may disagree on financing mechanisms and/or the role of public and private sectors. It includes a direct assault on health care industry abuses through federal regulation, instead of treating such abuses as an unavoidable byproduct of for-profit involvement in health care. It does cover all kids, which makes sense if you aren’t going to cover everybody. And it provides very robust subsidies to make voluntary health insurance affordable to as broad a segment of the uninsured as possible, along with an employer mandate to avoid erosion of existing coverage. Those are a heap o’ positives, but the negatives, most especially the plan’s failure to include a universal individual mandate for health insurance, and its complexity, are likely to get more attention, on both substantive and political grounds. Substantively, the plan obviously fails to fundamentally overhaul the current system, with its patchwork of public and private programs, its heavy reliance on economically damaging and arguably regressive employer-based coverage, and its failure to cover everyone. And politically, the plan will reinforce claims that Obama isn’t quite the transformative, great-leap-forward progressive so many have seen in him. One particular problem for Obama is that his plan superficially resembles the Massachusetts initiative signed by Republican presidential candidate Mitt Romney, with the crucial exception that Massachusetts did include a universal individual mandate for coverage (underfunded, to be sure, but still in place). Another is that Obama’s plan achieves less than universal coverage at a pretty steep price tag, given its lavish subsidies to tempt rather than force individuals into obtaining insurance. Beyond the initial reactions, perceptions of Obama’s plan will be crucially influenced by his rivals for the Democratic presidential nomination. John Edwards is already in a position to exploit Obama’s incrementalism on health care, given his own comprehensive universal plan, which not only embraces an individual mandate for coverage but also provides a stronger Medicare-style public option attractive to Democrats who favor a single-payer system. Given Edwards’ competition with Obama for the support of left-leaning Democrats, this could become an important point of distinction between the two candidates, at least among activists. But the other shoe that will soon drop is Hillary Clinton’s; she’s slowly rolling out a very thorough and comprehensive health care reform proposal, building on her unquestioned expertise in this field. Still under wraps is what she would do to achieve expanded coverage. If she goes for a universal plan (which is quite likely), then Obama will begin to look like an incrementalist outlier among those who care about policy details.
TDS Strategy Memos
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By Ed Kilgore
Watching an intra-Democratic argument on voting rights strategy intensify in Washington, I offered some advice to both sides at New York:
There has been an underlying disagreement within the mostly Democratic coalition favoring voting rights that was nicely captured in this New York Times report on Friday:
“A quiet divide between President Biden and the leaders of the voting rights movement burst into the open on Thursday, as 150 organizations urged him to use his political mettle to push for two expansive federal voting rights bills that would combat a Republican wave of balloting restrictions … In private calls with voting rights groups and civil rights leaders, White House officials and close allies of the president have expressed confidence that it is possible to ‘out-organize voter suppression,’ according to multiple people familiar with the conversations.”
Both sides in this argument are partly wrong. Those who expect Joe Biden to force the For the People Act or the John Lewis Voting Rights Act through the Senate via some major revision in the ability to filibuster are probably expecting the impossible. Yes, perhaps if Biden personally and insistently and abrasively lobbied Arizona’s Kyrsten Sinema to abandon her very consistent defense of the filibuster, up to and including encouragement of a primary challenge to her when she is up for reelection in 2024, she might decide her current and very insistent independent-maverick “branding” isn’t going to keep working for her. But Joe Manchin? He would be thrilled to get attacked by a Democratic president or Democratic advocacy groups for insisting that he won’t support voting-rights measures unless at least some Republicans support them. His state is so very red that the threat of a primary challenge to the sole remaining successful West Virginia Democrat is a laugher.
Short of a nuclear attack on West Virginia, it’s hard to identify anything Biden might do to Manchin that wouldn’t run a high risk of backfiring. And he does need Manchin on the reconciliation bills Democrats are using to get around the filibuster to enact Biden’s social and economic agenda. It’s just too bad voting-rights bills don’t qualify for reconciliation.
Yes, it is intensely frustrating that Biden cannot bring himself to come out forthrightly for filibuster reform, but it probably doesn’t matter since it is not happening unless the Democratic Senate Conference gets bigger, making senators like Manchin and Sinema irrelevant on the subject. So at some point voting-rights advocates need to focus on that goal.
At the same time, White House claims that Democrats can “out-organize voter suppression” are partially wrong as well. Yes, restrictive provisions like voter-ID requirements, limits on voting by mail, and even voter-roll purges can be countered and perhaps overcome by intensive efforts to educate and energize the voters Republicans are trying to keep from the polls. But you cannot out-organize a partisan gerrymander, or a law that lets election officials or state legislators overturn the outcome of an election after votes are cast.
Voting-rights advocates will eventually have to play the cards dealt to them by the system as it currently exists. That means refraining from too much anger aimed at Democratic pols who have little choice but to concede defeat on some legislation and concentrate on legislation (i.e., those reconciliation bills with many items vital to the people whose voting rights are also under attack) they can enact with no margin for error in the Senate and little in the House. At the same time, Biden and his staff and Democratic “pragmatists” in Congress should never for a moment be cavalier about the legislative obstacles they face in defending democracy itself. They may have to accept a tactical defeat on voting rights in this Congress. But they should never, ever, give up on making it happen later if not sooner.