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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Health Reform Drama Moves To Stage Left

It’s been an insanely busy and confusing week already on the health care reform front, but after a meeting between President Obama and the Senate Democratic Caucus, this much is clear:
(1) Joe Lieberman, for the moment at least, has prevailed, and the bill that will be submitted for an actual Senate vote (tentatively scheduled for December 23) will not include a Medicare buy-in or a federally created national non-profit plan for health insurance. Lieberman sounds like he will now support this bill. Ben Nelson, however, still seems to be holding out for some accomodation of his demands for additional restrictions on coverage of abortion services in plans offered through the health care exchanges.
(2) Most, perhaps all, key Senate liberals are going along with this pared-back bill, most conspicuously public option stalwarts Sherrod Brown and Jay Rockefeller. Russ Feingold and Bernie Sanders, however, are not officially on board.
(3) The House Democratic leadership is sounding confident about its ability to get a conference committee passed even if it strongly resembles the Lieberman-approved Senate bill. But the 77-member Progressive Caucus in the House still has to say or do something about its past threat to vote against any bill that doesn’t have a public option.
Meanwhile, in Progressive OpinionLand, a very fractious debate is erupting between those who view this bill, or virtually any bill, as significantly better than the status quo (and/or as politically necessary), and those who would prefer to kill it as insufficiently progressive or even as worse than the status quo.
The ballgame here is obviously whether or not “kill the bill” advocates can convince one Democratic senator or a significant bloc of Democratic House members to throw sand in the gears of the wheezing legislative engine that’s finally approaching the station.
The most notable figure in the “kill the bill” faction is Howard Dean, who is arguing that reform advocates in the House restart the process with a reconciliation bill that could then theoretically be moved through the Senate requiring only 50 votes.
In the blogosphere, Markos Moulitsas of DailyKos and Marcy Wheeler of FireDogLake appear to be leading the opposition to acceptance of the Senate bill.
Both Markos and Wheeler emphasize a point that a lot of their critics may be missing. It’s not the absence of a public option per se that leads them to the kill-the-bill position; it’s the absence of a public option in combination with an individual mandate to purchase private health insurance. From their point of view, the mandate represents a massive public subsidy for for-profit health insurance, which they, like most single-payer advocates, view as inherently invidious in the first place. Wheeler’s rhetoric pretty clearly expresses the sentiment which is driving the kill-the-bill movement:

I believe that if the Senate health care bill passes as Joe Lieberman has demanded it–with no Medicare buy-in or public option–it will be a significant step further on our road to neo-feudalism. As such, I find it far too dangerous to our democracy to pass–even if it gives millions (perhaps unaffordable) subsidies for health care….
It’s one thing to require a citizen to pay taxes–to pay into the commons. It’s another thing to require taxpayers to pay a private corporation, and to have up to 25% of that go to paying for luxuries like private jets and gyms for the company CEOs.
It’s the same kind of deal peasants made under feudalism: some proportion of their labor in exchange for protection (in this case, from bankruptcy from health problems, though the bill doesn’t actually require the private corporations to deliver that much protection).In this case, the federal government becomes an appendage to do collections for the corporations.

It would follow that elimination of the individual mandate–also a major bugaboo to conservatives–is the goal here as much as resurrection of a public option.
It’s fair to say that the majority of progressive health care wonks and political “pragmatists” don’t share this point of view; Steve Benen has a good round-up of their initial reaction to the kill-the-bill campaign. Matt Yglesias has the most direct response to Wheeler’s “neo-feudalism” claim, in a way that points out its similarity to conservative attacks on Obama:

I’ve seen Marcy Wheeler characterize the plan as an “industry bailout.” And, indeed, if I were a small government conservative one political tactic I would employ would be to start characterizing all initiatives involving government spending as a “bailout.” You could say that ARRA’s provisions funding K-12 education are a “bailout for teacher’s unions.” You could call ACES a “bailout for windmill makers.” And you can call the health care bill an “insurance company bailout.” But the mechanism by which insurers can get extra money under reform is that . . . more people get health insurance at a price they can afford. The bill will also expand Medicaid eligibility to include many currently uncovered poor and near-poor people.

The thing to watch for over the next few days (aside from what Ben Nelson decides to do) is whether the kill-the-bill argument finds a Democratic champion in Congress, beyond the ranks of those, like Dennis Kucinich, who haven’t been on board with previous legislation. But beyond that, the intra-progressive argument over the endgame of health reform legislation reflects a broader set of disagreements about the ideological character and political impact of Barack Obama’s leadership, which extends to issues ranging from Afghanistan to financial reform. I’ll have more to say about that subject directly.

2 comments on “Health Reform Drama Moves To Stage Left

  1. mjshep on

    I’m with Marcy on this one.
    It is unconscionable and undemocratic (small “d” or big “d” both) to require, under some penalty of law, that citizens buy a product from a private for profit company.
    If this passes with mandates and no public mechanism for providing what the mandate requires through an affordable,non-profit entity, then Democrats will have committed political suicide. Republicans will rail against this bill and call it all sorts of names, and they will be right.
    And let’s get one more thing straight. This bill doesn’t cover 30 million more Americans, as its proponents claim. It forces them to buy a private product that they can not afford with inadequate subsidies and no effective cost control on the price of that product. Many will simply be unable to, or refuse to do this. If they face a penalty for that, watch for the political sparks to fly and watch Democrats squander the political opportunity of a generation in order to become a despised minority.
    What most disturbs me is that I get the feeling that this bill, contrary to his campaign promises, is what Obama, and Rahm Emanuel, always wanted.


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