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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

J.P. Green

Can ‘Party Discipline’ Make 60 Votes Count?

Despite all the hand-wringing to the contrary, political commentator Bill Press makes a well-stated argument that 60 Senate votes are more than enough for Democrats to get a progressive legislative agenda enacted. Writing in his syndicated column today, Press says:

For six months, we’ve heard nothing but complaining from Democrats: Our hands are tied, they insisted. We can’t deliver a public plan option for health care, or pass the Employee Free Choice Act, or repeal the Pentagon’s Don’t Ask, Don’t Tell policy, or do anything else we promised to do if re-elected — because we don’t have 60 votes. We have to compromise with Republicans, instead.
That excuse was phony, of course. Senate rules require only 51 votes to pass legislation, not 60. Democrats should never have allowed Republicans to pretend otherwise.

Press believes the filibuster obstacle is overstated, particularly if the Dems can find the gonads to invoke a little party discipline:

As for those wayward senators like Nelson or Landrieu, there’s only one thing Democrats are lacking: discipline. This may be a whole new concept for Democrats, who are not used to marching in lockstep. But if Barack Obama and Harry Reid are willing to play hardball by withholding committee assignments, White House invitations, campaign contributions, and endorsements, they’ll be surprised how soon Democrats will get in line.

Press is dismissive of the contention that Senate Democrats need a few Republicans to join them

The truth is, Democrats don’t need Republican votes anymore. It’s time for Democrats to pull together, flex their muscle, and deliver their promised agenda: a strong climate bill; the Employee Free Choice Act; immigration reform; repeal of Don’t Ask, Don’t Tell and the Defense of Marriage Act; and, most important, universal health care — with a public plan option, but without a tax on health care benefits.

And he is equally-skeptical about the argument that there are not enough of the Dems to enact reforms like the public option:

…Democrats will never have a better opportunity. But, even before Al Franken was sworn in, some spineless Democrats were already offering a new round of excuses. The so-called “Super Majority” of 60 votes is illusory, they say, because you can’t count on Ted Kennedy or Robert Byrd being healthy enough to show up and vote. Plus, there are a handful of “DINO’S” (Democrats in Name Only) — think of Ben Nelson or Mary Landrieu — whose votes you can’t count on, even when they’re present. Neither excuse is valid.
It’s true that Kennedy and Byrd suffer serious health problems. But Senate passage requires 51 votes, remember, not 60. In fact, just 50 votes are good enough, with Joe Biden standing by to break a tie. Besides, no matter how sick, there’s no way Teddy Kennedy’s going to miss a vote on establishing universal health care. He’s worked hard for it all his life.

Regarding the public option for health care reform, his blog “The Bill Press Show” identifies nine Democratic senators who have “not agreed to support it.,” including: Blanche Lincoln (AR); Tom Carper (DE); Maria Cantwell (WA); Ron Wyden (OR); Bill Nelson (FL); Mary Landrieu (LA); Kent Conrad (ND); Dianne Feinstein (CA); and Max Baucus (MT).
Regardless of party discipline, most of these senators have substantial moderate/conservative constituencies to answer to. Still, opinion polls indicate that the public option has broad and deep support across much of the ideological spectrum, as Ruy Teixeira explains. Invoking some carefully-targeted party discipline can’t hurt much, and might help with some of them.
Press’s aforementioned list of the nine senators is hot-linked to their websites, for those who want to contact the wobbly nine and encourage them to support the public option. If there was ever a time for progressive activists and bloggers to launch an all-out lobbying campaign targeting a group of senators to pass legislation that can save countless lives and create a new sense of security for millions of families, that time has now arrived. Every one of these senators should be made to understand that their political futures will be sorely damaged if they fail to support the public option. More party discipline from party leaders is needed, but party discipline from voters is better yet.

Needed: Simplified Framing for Health Care Reform

While the basic principles of health care reform should be simple enough for progressive political leaders to frame as opposing forces gird for the battle over health care reform, American voters are being presented an ever-expanding range of complex issues and policies . As WaPo‘s Dana Milbank put it in his July 2nd column,

…Americans are passionate and confused about it — and their opinions are all over the lot.
A CNN-Opinion Research poll found that 51 percent of Americans favor Obama’s health-care plan, but a Wall Street Journal-NBC poll found that only 33 percent think it is a “good idea.” A New York Times-CBS News poll found that nearly six in 10 would be willing to pay higher taxes so that all could be insured, but a Kaiser poll found that 54 percent would not be willing to pay more to increase the number.
A Quinnipiac University poll found that a majority — 54 percent — believe that reducing health-care costs is more important than covering those who lack coverage, while the Times-CBS poll found that 65 percent thought that insuring the uninsured was a more serious issue. A Washington Post poll found that 57 percent of Americans are dissatisfied with the health-care system — but 83 percent are satisfied with the quality of their own care.
In short, when it comes to health care, the state of the union is confused. The confusion won’t be cleared up by the complexity of the debate, with all the jargon about community ratings and insurance exchanges and risk adjustments and guaranteed issues…

A point made also in Mark Blumenthal’s July 1 post at Pollster.com:

Let’s start with what is hopefully obvious: Democrats in Congress are drafting multiple proposals, and the Obama administration has not specifically endorsed any of these. So a well informed respondent ought to have trouble evaluating “Obama’s plan,” since Obama has not yet committed to a specific plan. Even more important, very few Americans are following that debate with rapt attention. Last month’s CBS/New York Times poll, for example, found only 22% of Americans saying they have heard or read “a lot” about the health care reform proposals (50% said they heard or read “some,” 23% not much, 5% nothing).

“Softness” of responses is also a concern with analyzing polling data, particularly regarding health care reforms. As Blumenthal notes of the difficulty of overgeneralizing about polling responses:

When pollsters push as hard as CNN/ORC for an answer, a lot of the responses are going to be very soft, often formed on the spot and based on very superficial impressions. Nonetheless, if I were charged with conducting a benchmark survey for a candidate over the next few months, and I had room for only one question about health care reform, I would be tempted to ask a very general question about “President Obama’s plan to reform health care” (though I’d strongly lean to the NBC/WSJ version that explicitly prompts for “no opinion”).
Yes, public opinion on health care reform is multi-faceted. Americans come to the debate with a rich set of values and attitudes about what they like and dislike about the health care system, what they would change and what they worry about changing. Most have not yet focused on the details of the legislative debate. Many never will. So questions about specific policy proposals can produce results all over the map. As Slate’s Chris Beam puts in an excellent summary this week, “health care polling is especially variable, depending on the wording, the context, and the momentary angle of the sun.”

The Kaiser Family Foundation adds in its wrap-up of some recent public opinion polling on‘Footing the Bill’.

What the public thinks about health care reform from this point will depend on what they learn about any proposals over the course of the summer – whether it be the actual details of any plan that might emerge or the spin on such a plan that will inevitably come from ideologues on both sides, the health care industry itself, and interested advocacy groups. Our surveys have repeatedly found that opinion on most specific proposals is quite malleable and can be moved in both directions. Expect this to happen.

It’s not hard to see why framing is critical to the success of any health care reform package. President Obama has settled on a current strategy of framing the debate in terms of cost. In his article in The Atlantic on “Obama’s Inversion Of Harry And Louise,” Mark Ambinder notes of the President’s framing of the health care reform debate:

His basic message: your health coverage will be taken away if we don’t reform health care this year.
His arguments for reform have focused heavily on rising costs and the unsustainability of the current system. His public remarks on the matter are rife with figures about how much costs have risen and will rise in the future, and how soon the nation won’t be able to pay them.
“In the last nine years, premiums have risen three times faster than wages. If we don nothing, they will rise even higher. In recent years, over one third of small businesses have reduced benefits and many have dropped coverage altogether since the early ’90s,” Obama told the audience at his town hall meeting on health care in Annandale, Virginia Wednesday.
“If we do not act, more will lose coverage and more will lose their jobs. Unless we act, within a decade, one out of every five dollars we earn will be spent on health care,” Obama said.
Obama’s economic rhetoric is all about how things can’t remain the same. It’s the same point the Harry and Louise ad made, but backward, and in Obama’s version, the “naysayers” who oppose health reform are the ones who play fast and loose with the coverage Americans currently enjoy. And as polling indicates that Americans are concerned heavily with costs, the president has, in turn, stuck to telling people about the costs of not passing his plan…And so part of his rhetoric is about shaking people with fear into supporting his reforms. If Harry and Louise made people afraid of passing Clinton’s reform plan, Obama is making people afraid of not passing his.

President Obama is undoubtedly right that cost-containment is a critical element of any successful health care reform pitch. But any successful pitch is also going to have to explain in simple terms how the reforms will improve health security for millions of Americans. Ruy Teixeira argues in a TNRtv clip that the public option of health care reform proposals has surprising bipartisan appeal in recent polling, which suggests it could have merit as a key messaging/framing point.
George Lakoff, along with co-authors Glen W. Smith and Eric Haas offer ten excellent messaging/framing suggestions in their HuffPo article “Health Care Reform: Some Basic Principles,” including

Principle 3. Health care is central to the moral mission of the American government.
The American government has twin moral missions: protection and empowerment of the individual – equally for everyone.
Protection includes not just the military and police, but also consumer protection, worker protection, environmental protection, safety nets, investor protection, and health care.
Empowerment is what enables Americans to make a living and have a good life if they work at it. It includes systems of public road and buildings, education, communication, energy, banking — and health.
No one can make a dime in America or achieve their goals in life without protection and empowerment by America’s government.


Principle 7. The American Plan provides care instead of denying it.
Why do HMO’s have a high administrative cost – 15 to 20 percent or more? They spend money to justify denying you the care you need and all too often delaying care so much that you are harmed by the delay.
The American Plan is there to provide you care, not deny or delay it. Its administrative costs would be low, about 3 percent.

And, also at HuffPo, In his post “Hoping for Audacity,” Drew Westen emphasizes the need to tell the “how we got here” story as a prerequisite for good framing of reforms:

The American people would understand why we need to offer at least one health insurance plan not controlled by the insurance companies if someone would just tell them the story of how it came to be that our premiums have doubled as millions more Americans have lost their coverage.
…The President is offering the public a series of stories that are all missing half the plot and half the characters–namely, the part of the plot that says how we got where we are (e.g., 50 million without health insurance…He is trying to sell health care reform without calling out the drug and insurance industries, whose profits have soared at our expense.

We should have no doubts whatsoever, that the opponents of health care reform are now focusing with utmost intensity on which frames will be most effective in obstructing meaningful reform, as my May 6 post noted. Let’s not be caught unprepared.

Senator Franken

When Al Franken takes his seat in the U.S. Senate on Monday, it could mark a pivot point for the Democratic Party, as well as the nation. Senator Franken will give the Democrats a significant edge in filibuster politics, the 60th vote that could make possible enactment of real health care reform and other needed legislation. Indications are Franken will be a staunch progressive Senator in the mold of Paul Wellstone, who he strongly supported, and a reliable advocate of needed social reforms.
Credit Franken, not only with running a good campaign that unhorsed an incumbent and rising GOP star, but also playing a chill hand in the 7 plus months after the election. Franken avoided getting suckered into name-calling battles with Coleman, kept a high tone and handled the media with impressive skill. His image as a sober and serious U.S. Senator improved steadily during the recount and post election conflicts, as Coleman’s image deteriorated into one of a quarrelsome obstructionist. Franken’s 5-zip win from the Minnesota Supreme Court sealed the deal. Coleman, rumored to be interested in running for Governor, would have destroyed his political future if he persisted after a unanimous state Supreme Court decision against him. Hopefully, he has already been damaged by his obstructionist antics.
Franken could be an important Senator, if he rises to the challenge presented by Wellstone’s example and becomes an energetic champion of the progressive agenda. He certainly showed he had the mettle for battling the right-wing in his conflicts with Bill O’Reilly and Fox news. Franken smartly restrained his SNL-honed snark and wit during the campaign and aftermath, but he should be able to let fly a well-targeted zinger once in a while to enliven Senate debates.

Obama’s Third Option in Iran

Gabriel Schoenfeld’s article in today’s Wall St. Journal, “What If Obama Did Want to Help Iran’s Democrats?” argues that the Obama Administration may be crippling its Iran policy by not recognizing the efficacy of “covert political action.” As Schoenfeld, a senior fellow at the Hudson Institute in Washington, D.C. and a resident scholar at Princeton’s Witherspoon Institute explains Obama’s problem:

In a better world, toppling this vicious regime and altering the tide of history would be a primary objective of U.S. foreign policy. Yet even if President Obama miraculously came to that conclusion, how could he realize such an objective? This is a useful question to ask because it reveals how much the United States has disarmed itself in the vital realm of intelligence.
…Harsh criticism of such operations — beginning in the 1970s when all the CIA’s secrets spilled out — is what prompted the U.S. to dismantle its capabilities in covert political action. Interfering in the internal affairs of other countries, legions of agency critics said, was both immoral and illegal.
As a matter of law, the critics are right. Such covert action is indeed illegal. But legality is beside the point. Espionage is by definition illegal and yet all countries engage in it. This is what the Soviet Union did in Italy, and it is what Iran, by organizing terrorist structures in the Middle East, Europe and elsewhere, has been doing intensively for 30 years.

Schoenfeld’s article, subtitled “The CIA is no longer in the business of influencing politics abroad,” credits CIA funding of centrist political parties in Italy during the 1950’s as an effective strategy to counter the rapid growth of Italy’s Communist Party, thereby helping Italy to remain a “stable democracy today.” But Shoenfeld’s characterization of Italy’s Communist Party as undemocratic is unfair, since they did participate in elections.
If covert ops have any legitimacy, they should be narrowly focused on supporting pro-democratic, not exclusively “centrist”, forces in dictatorships and in nations at risk of becomming dictatorships. Using U.S. resources to oppose democratically-elected governments, as we did in Chile, or to influence elections in other nations, is immoral, unwise and can easily backfire.
But if Schoenfeld is right that U.S. support of centrist political parties was the pivotal element in achieving our foreign policy objectives in Italy, however misguided, without expensive military action, then perhaps there is an instructive strategic lesson for our policy toward Iran.
The debate over U.S. policy toward Iran is usually cast in terms of military vs. diplomatic action, with very little discussion about the possibilities of covert political operations, or even expanding our propaganda outreach in Iran. The latter wouldn’t be hard since our current effort is so weak. The current issue of The New Yorker for example, features an eyewitness report on the June 15th protest against the stolen election, in which the author notes,

…the government tries to jam all foreign TV stations—in particular, the BBC’s Persian-language channel. This channel, beaming images and reports sent by normal Iranian citizens back into the country, has been hugely influential in spreading news of the protests to Iranians who would otherwise have relied on state television or the inferior American-based Persian-language channels.

Peruse recent public opinion polls on the topic of U.S. policy toward Iran going back 5 years or more, and you won’t find any mention of enhancing intelligence, propaganda or covert ops as a choice in polling questions. (A CBS News/New York Times poll conducted 9/21-24, 2008 indicates the public favored “diplomacy now” over “military action now” in Iraq by a margin of 61 to 10 percent)
Perhaps the pollsters assume the public has a “don’t ask, don’t tell” attitude regarding covert ops, or they include it conceptually as an intelligence function under the rubric of “diplomacy.” But if the U.S. becomes more vigorously engaged in the struggle to win hearts and minds as a third option, it could prove to be a highly effective use of our resources in achieving foreign policy objectives in trouble spots like Iran. (More on this topic here)
According to Schoenfeld, the U.S. is not getting much credit for our disengagement from Iranian politics:

The great irony in all this is that even as the U.S. seeks to claim the moral high ground by not “meddling” — to use Mr. Obama’s term — we and our allies are getting blamed all the same. “There are riots and attacks in the streets that are orchestrated from the outside in a bid to destabilize the country’s Islamic regime,” says Sheikh Naim Qassem, a ranking figure of Hezbollah, Iran’s obedient instrument in Lebanon.

A fair point, Perhaps some thoughtful “meddling,” if not by the CIA, then by other U.S. agencies concerned with foreign policy could help encourage a stable democracy in Iran. Diplomacy is almost always a better choice than military action. But strengthening our on-the-ground intelligence in Iran and in other Arab nations and using it to promote the spread of democracy, instead of U.S. military dominance, should become a leading strategic objective.

Conservatives Should Disown Hate Speech

Joan Walsh’s post, “Can right-wing hate talk lead to murder?” at Salon asks an important question that merits a thoughtful response. Walsh writes and talks in a “Hardball” video clip about the murders of Dr. George Tiller and Steven Tyrone Johns, a security guard at the Holocaust Museum, both by right wing extremists. Walsh focuses more on the murder of Tiller, because it was preceeded by some extreme rhetoric by Bill O’Reilly. As Walsh explains,

O’Reilly more than demonized Tiller; night after night he called him a baby killer, compared him to the Nazis, and suggested that he must be stopped. Roeder stopped him, all right. If I were O’Reilly I’d feel terrible for putting a private figure in my public sights night after night, simply for doing his lawful job. But O’Reilly has no conscience, so he’s proud of it.

Walsh goes on to cite the demonization of President Obama and Supreme Court nominee Sonia Sotomajor as current concerns. Walsh is on to something with her point about demonization nurturing future violence. It’s too easy to dismiss the murder of Dr. Tiller as the work of a religious nutcase and the killing of Mr. Johns as the act of a neo-Nazi, and let it go at that. Violent extremists don’t exist in a vacuum; they are nourished in a culture or subculture.
I always felt that Ronald Reagan, who in 1980 launched his campaign for the presidency in Philadelphia, Mississippi , known primarilly as the place where three civil rights workers had been murdered in 1964, and Newt Gingrich, both went way over the top in their wholesale bashing of government. They ratcheted up the rhetoric of hatred and contempt for government, perhaps to an all-time high. Such a climate of hatred for government helped to nurture Timothy McVeigh, who bombed the federal building in Oklahoma City in 1995.
Walsh rightly points out that not all conservatives are violence-prone. In fact, I would argue that true conservatives don’t like extremist rhetoric. And I have to admit that I have on occasion heard my fellow liberals parroting hateful denunciations of conservatives. But I do believe that the problem of hateful rhetoric is growing among right-wing ideologues, particularly public figures, and seems to be undergirded by racist attitudes, religious bigotry and xenophobia. Conservative intellectuals have a responsibility to provide a little leadership to tone down the hate-mongering. There is probably not much that can be done about ideologues like O’Reilly and Buchanan, other than boycott O’Reilly’s sponsors. But it couldn’t hurt for serious conservatives to urge a little more civility and fewer ad hominem attacks.
The important thing for Democrats and progressives to keep in mind is that we also have to clean up our own act and discourage nasty personal attacks from liberal spokespersons. Vigorous criticism of ideas and policies, yes. A little snark is even OK in debating ideas and policies, but ease up on the name-calling and personal put-downs. In so doing, we will help make clear which party is being lead by the grown-ups.

Health Care Industry Has Huge Stake in Reform

E.J. Dionne, Jr.’ “Harry and Louise Have Changed” in today’s WaPo explores the strategic implications of the fact that comprehensive health coverage for all Americans means “fifty million new customers” to the industry. It is an important point, and one which gives significant leverage to the reform movement. Not that the insurance companies won’t fight the public option, forced coverage for pre-existing conditions and other specific reforms with a multimillion dollar ad campaign. However, as Dionne explains:

Many have expressed amazement that the interest groups historically opposed to fixing the health system seem ready to work with the reformers. Their public-spiritedness reflects enlightened self-interest: The health system is so unstable that even the drug industry and the insurance companies are worried that it will crash on top of them.
Health-care reform could bail out these interests by adding the currently uninsured — fast approaching 50 million people — to their customer base and by preventing more individuals and employers from dropping insurance altogether…Leaders of the health industry know that unless more government money flows into the system, they will suffer along with everyone else.

It’s a survival issue, and they know they need government help to stay afloat. They will fight the public option, but they know that some form of expanded government health coverage is inevitable. Still every health insurance company, hopes to get a share of the 50 million new customers. Dionne says the real fight in congress will be about cost containment, and he concludes “So by all means, let’s welcome the drug and insurance companies to the health-care bargaining table. But let’s also remember that they are sitting at that table as a matter of urgent necessity.”
Lisa Girion riffed on the same topic in the Sunday L.A. Times, explaining that

The customer base for private insurance has slipped since 2000, when soaring premiums began driving people out. The recession has accelerated the problem. But even after the economy recovers, the downward spiral is expected to continue for years as baby boomers become eligible for Medicare — and stop buying private insurance.
…The industry’s real trouble begins in 2011, when 79 million baby boomers begin turning 65. Health insurers stand to lose a huge slice of their commercially insured enrollment (estimated at 162 million to 172 million people) over the next two decades to Medicare, the government-funded health insurance program for seniors

Meanwhile John Harwood reports in The New York Times “The Caucus” that a new “sense of inevitability” about health care reform has taken root, as key political leaders and interest groups begin an earnest search for consensus. Regarding funding for reforms, Harwood adds:

No one has spelled out how to finance the roughly $1 trillion over 10 years for an overhaul that would provide care to the uninsured. But two recent Obama White House shifts have made that easier.
First, Mr. Obama vowed to find another $200 billion to $300 billion in savings from Medicare and Medicaid, beyond the $300 billion or so already proposed. That would leave lawmakers needing about $500 billion in higher taxes.
Second, Mr. Obama signaled that he could support acquiring part of that money from limiting the existing tax exclusion for employer-provided health benefits — a concept he criticized Senator John McCain, Republican of Arizona, for proposing in the 2008 presidential campaign. Taxing only the most lavish 10 percent of benefit plans would raise an additional $336 billion in income taxes, according to the nonpartisan Tax Policy Center.

Via Consortium News, Alternet leads today with an article by Robert Parry, “119 Million Americans Want a Public Health Option — Why Aren’t Politicians Listening?” Parry discusses Republican Sen. Chuck Grassley’s assertion at Politico that,

“As many as 119 million Americans would shift from private coverage to the government plan,” Grassley wrote in a column for Politico.com. That migration, Grassley said, would “put America on the path toward a completely government-run health care system. … Eventually, the government plan would overtake the entire market.”
Grassley’s logic is that so many Americans would prefer a government-run plan that the private health insurance industry would collapse or become a shadow of its current self. That, in turn, would lead even more Americans entering the government plan, making private insurance even less viable.

Wait a minute. Polls indicate millions are happy with their current insurance, so where does the 119 million figure come from? Are they so happy with their current plan that they would be willing to switch to a public plan just for kicks? Perhaps Grassley’s argument is based on some other factor. In one of the more revealing graphs, Parry also notes,

…Grassley’s various political action committees have collected nearly $1.3 million in donations from the industries related to the health insurance debate, according to OpenSecrets.org. Grassley’s top four donor groups were Health ($411,956); Insurance ($307,348); Pharmaceuticals ($233,850); and Hospitals ($197,137). Eighth on Grassley’s donor list were HMOs at $130,684.

Today’s Wall St. Journal ‘Review and Outlook’ section has a more thougthful critique, “Obama’s Health Cost Illusion,” which notes:

Now the White House — especially budget chief Peter Orszag — claims there is new cause for hope. The magic key is the dramatic variations in per patient health spending among U.S. regions. Often there is no relationship between spending and the quality of care, according to a vast body of academic research, most of it coming out of Dartmouth College. If the highest spending areas could be sanded down to the lowest spending areas, about 30% in “waste,” or $700 billion each year, would be saved. More than enough to pay for ObamaCare. Or so the theory goes.
But — how? Mr. Orszag’s ideas include more health information technology; emphasizing prevention and healthy living; rejiggering reimbursement policies so doctors and hospitals are paid more for quality care; and funding federal research that compares the effectiveness of medical treatments. These are the lovable bromides of all politicians, and some of them may or may not improve health overall. But there’s scant evidence that any of them will ever save real money.

Most worrisome of all, former Secretary of Labor Robert Reich writes in Salon today that “Big Pharma and Big Insurance go on the attack: Lobbyists are working behind the scenes to kill the public option in the healthcare bill. And they’re succeeding.” Says Reich:

So they’re pulling out all the stops — pushing Democrats and a handful of so-called moderate Republicans who say they’re in favor of a public option to support legislation that would include it in name only. One of their proposals is to break up the public option into small pieces under multiple regional third-party administrators that would have little or no bargaining leverage. A second is to give the public option to states where Big Pharma and Big Insurance can easily buy off legislators and officials, as they’ve been doing for years. A third is to bind the public plan to the same rules that private insurers have already wangled, thereby making it impossible for the public plan to put competitive pressure on the insurers.

Reich’s challenge ought to send reform advocates to the barracades:

This is it, folks. The concrete is being mixed and about to be poured. And after it’s poured and hardens, universal healthcare will be with us for years to come in whatever form it now takes. Let your representative and senators know you want a public option without conditions or triggers — one that gives the public insurer bargaining leverage over drug companies and that pushes insurers to do what they’ve promised to do. Don’t wait until the concrete hardens and we’ve lost this battle.

Toward Single Payer Reform — Step by Step

It’s hard to find anyone inside the D.C. beltway who actually believes single payer health care reform can be achieved in this session of congress. The majority of progressives seem to have settled for the “public option,” which can be seen as a step toward achieving a single-payer system down the road, make that way down the road.
The public option does seem to be the most promising proposal for achieving a progressive consensus for this session of congress. But I do hope the single payer warriors will keep the heat on as the ‘scary left’ that makes the publlic option seem like a moderate alternative.
I applaud incremental reform as generally a more practicable approach than “big package” reform. By providing a smaller target and a simpler policy, precisely defined incremental reforms have a certain edge in winning hearts and minds. Incremental reforms have less baggage than “big package” reforms and they reduce the opposition’s ability to use red herrings to distract voters. Republicans, for example, had an easier time of it trashing ‘Hillarycare’ than they would in fighting a bill that forces insurance companies to do one simple thing — cover pre-existing conditions.
The oft-cited advantage of big package reform is that you can build a broader coalition. Well, that’s true. But it gives a well-organized opponent plenty of targets for mobilizing opposition. The right is very good at distracting voters with specific objections to proposals that offer otherwise beneficial reforms. See our staff post yesterday on William Galston’s New Republic article to get a sense of how complicated are public attitudes toward various health care reforms.
Incremental reforms are often portrayed as a ‘sell-out’ of progressive principles because they invariably leave some constituency out. The pre-existing coverage requirement, for example, still leaves millions without coverage. But if there is an understanding that other specific reforms to broaden coverage will be strongly advocated shortly after pre-existing coverage is enacted as part of a coalition commitment, then it could become possible to achieve something resembling universal coverage in fairly short order. Voting on highly specific health care reforms one by one in rapid succession may be a quicker way of getting to universal, comprehensive reform than having a grand battle over a highly complicated health care reform bill with many moving parts that have to work together in synch.
Incremental reform is not a new idea. Governor Howard Dean proposed insuring all children first, which is a good example of a politically-attractive initial reform. I like the idea of first guaranteeing catastrophic coverage to everyone — codifying the principle that no one loses their home or retirement assets because of an illness. It would be politically-popular by providing a huge sense of relief to millions of voters and it could be financed through a single-payer mechanism, sort of a partial single-payer reform. Let the private insurer reforms and the public option address other coverage issues — for now. A comment by Daniel Bliss in response to an Ezra Klein post on health care reform at The American Prospect made the argument nicely:

The key thing, as I see it, is that a final plan will not be successful in the long run unless it has a single payer component. Note the qualifying word, “component.” It merely has to share the risk and streamline the core of the system, but does not have to be single-payer in its entirety, and indeed probably shouldn’t if we want the best possible system. There is after all a great deal of difference in how applicable a market is to something that people simply won’t do without (e.g. accident and emergency) compared to something that is relatively more discretionary (non-urgent care administered in relatively small and affordable increments, such as chiropractic treatment). It’s worth noting that the top-rated health care systems in the world, according to the World Health Organization, tend to embody this concept of mating single payer for catastrophic coverage with supplemental insurance taking care of more discretionary parts of health care. France is the outstanding example.

If the Obama Administration can say 3 years from now, “We eradicated the fear of ruinous health care costs for all American families,” that’s a hell of an impressive achievement to run on on 2012.
Given the complexity of attitudes toward health care proposals, I’d prefer to see a series of specific health care reforms debated, voted and enacted in succession, each piece standing on its own merits, rather than having them all linked together and inter-dependent on each other. It would bring more clarity — and simplicty — to the debate over health care reform, and my hunch is consumers/voters would welcome it.

Health Care Battlefield Takes Shape

Contending forces are streaming on to the field for what is certain to be the fiercest battle over health care reform ever fought. The health and economic security of millions of Americans are at stake, along with the fate of a huge industry and many billions of dollars. One important change over the last great battle, over “Hillarycare”: Thanks primarily to the blogosphere, this time around there will be a surfeit of good information about reform options immediately available to health care consumers who want to make informed choices. Those who want to get up to speed on the politics of health care reform will find no shortage of good reporting on the eve of the battle.
Here’s the basic timetable, according to a succinct summary by USA Today‘s Susan Page:

This year’s fast-track timetable on health care calls for leaders of key congressional committees to unveil legislation this month, debate it next month and pass it before leaving for the summer recess in August. Final passage would follow in September or October, before next year’s elections start to complicate things.
That, at least, is the plan.

Deepak Bhargava’s Huffpo article “Health Insurance You Can Trust,” makes a short, but tight case for insisting that there be a public insurance option. Bhargava notes:

According to the Harris Poll only 7% of people judge private health insurance companies to be “honest and trustworthy.”…a Lake Research poll found that a whopping 73% of voters want everyone to have a choice of a public health insurance plan while only 15% want everyone to have private insurance.

Bhargava recounts a familiar litany of horror stories of care denied and economic disaster for consumers and adds,

A Harvard study found that 50 percent of all bankruptcy filings were partly the result of medical expenses. Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.

At Daily Kos, RDemocrat has a long post that covers a lot of interesting ground regarding the politics of health reform. The author makes a strong case for establishing a single-payer system, which most observers believe is off the political table this year. But he also provides a wealth of facts for challenging the argument that the private sector can best deliver quality affordable coverage, including:

Fact One: The United States ranks 23rd in infant mortality, down from 12th in 1960 and 21st in 1990
Fact Two: The United States ranks 20th in life expectancy for women down from 1st in 1945 and 13th in 1960
Fact Three: The United States ranks 21st in life expectancy for men down from 1st in 1945 and 17th in 1960.
Fact Four: The United States ranks between 50th and 100th in immunizations depending on the immunization. Overall US is 67th, right behind Botswana
Fact Five: Outcome studies on a variety of diseases, such as coronary artery disease, and renal failure show the United States to rank below Canada and a wide variety of industrialized nations.

Meanwhile the U.S. Senate’s two Democratic heavyweights on health care, Ted Kennedy and Max Baucus are talking unity, despite their differences about providing a public option. Kennedy is leading the charge for “a robust public public health care plan,” while Senator Chuck Shumer reportedly has a compromise in the form of a watered down public option Baucus may find acceptable. Baucus wants a bill that passes with a filibuster-proof 60 vote majority, while Kennedy and other Senate liberals are ready to rumble with 51 votes in the budget reconciliation maneuver. According to a head count by Open Left‘s Chris Bowers, the 51 votes are in place.
Bring it on. Whatever it takes to put an end to profit-driven health care in America and the unending stream of horror stories, a few of which were recounted by Bhargava in his HuffPo post, will be long overdue. Given the amount of money at stake, we can safely assume that we are about to see a tidal wave of health care provider propaganda on a scale never before experienced. Democrats of all stripes have two choices this summer: get rolled or get unified and bring their “A” game.

National Sales Tax: Tough Sell to Progressives?

In his “E.J.’s Precinct” blog at WaPo, E.J. Dionne is hosting an interesting discussion about the national sales tax, a.k.a. value added tax, as a not-so-new idea generating fresh interest among Democrats. Dionne’s blog riffs on a WaPo article by Lori Montgomery in Wednesday’s edition entitled “Once Considered Unthinkable, U.S. Sales Tax Gets Fresh Look.”
Broadly defined the VAT is a regressive tax, and rightly opposed by most progressives. Still the advantages are impressive and acceptable to most other social democracies, as Montgomery explains:

Enter the VAT, one of the world’s most popular taxes, in use in more than 130 countries. Among industrialized nations, rates range from 5 percent in Japan to 25 percent in Hungary and in parts of Scandinavia. A 21 percent VAT has permitted Ireland to attract investment by lowering its corporate tax rate.
The VAT has advantages: Because producers, wholesalers and retailers are each required to record their transactions and pay a portion of the VAT, the tax is hard to dodge. It punishes spending rather than savings, which the administration hopes to encourage. And the threat of a VAT could pull the country out of recession, some economists argue, by hurrying consumers to the mall before the tax hits.

And pressure seems to be mounting to at least open a discussion about some form of the VAT. Montgomery quotes Democratic Senator Kent Conrad “I think a VAT and a high-end income tax have got to be on the table.” And even in its most regressive form, taxing nearly everything that is sold, using the revenues to finance universal health care for example, might make it more palatable to progressives. According to one estimate cited by Montgomery, “a 10 percent VAT would pay for every American not entitled to Medicare or Medicaid to enroll in a health plan with no deductibles and minimal copayments.”
Dionne, who has opposed the VAT as regressive in the past, now says “I am starting to think such a tax may be inevitable because government is going to need a lot of revenue in the coming years.” One of the more interesting comments responding to Dionne’s blog comes from Tomscanlon1, who notes that a VAT can be modified to make it less regressive:

Canada was in a deep hole in the early 90s and bit the bullet on a very unpopular national sales tax of 7%. It saved them and today it’s down to 5%. It exempts basic necessities like food, rent and kid’s clothes, so it doesn’t punish the poor. Canada’s finances look a hell of a lot healthier than those of the US.

Certainly, alcohol, tobacco, fatty and sugar-heavy foods and sodas that cause so many health problems should be taxed more rigorously for health reasons as well as for enhancing federal revenues. Healthy food should be exempt. Jennythacker adds in Dionne’s blog:

The fed could follow California’s example and choose not to tax necessities. Food items bought in stores would not be taxed although restaurants might be. Entertainment items like theater tickets, ball games, etc. would be. Home utilities (heating oil, water, garbage pick up, recycling, electricity) might be considered basic necessities and therefore not taxed.
Or the fed could follow Virginia’s example and tax only luxury goods (cars, boats, RV’s etc. costing more than $20,000)…We can also keep the tax small. Few people will be severely hurt by a 1% tax, but the benefits to our federal budget would be enormous…There are ways to make the tax happen. There are ways to make it effective. And there are ways to do it that don’t necessarily hurt the poor more than the well-t-do. It is possible, and it might be a very good idea.

It may be that American voters will be more receptive to a national sales tax in the current economic crisis. As another commenter, Spencer99, adds,

…If we are going to promise European benefits, we need European taxes. Europeans vote for government benefits knowing they will actually be paying for the benefits. the VAT system is much closer to this

A commenter named Garak makes this point about a national sales tax being a tough sell, politically:

Any national VAT or sales tax will pressure states to cut their sales taxes. The higher the total sales tax, the more resistance from the public. It’s easier to pressure state and local governments to cut taxes than it is to pressure the federal gov’t.
Further, states will resist because first, sales taxes historically are reserved to the states, and second, because states rely on them to a very high degree. You will see states fighting a national VAT/sales tax tooth and nail…Europe doesn’t have this problem because taxes are primarily national taxes, not provincial.

Clearly there are lots of problems associated with federal sales tax proposals. But it’s not like income tax hikes are a cakewalk for the Administration. As the contributors to the discussion at E.J.’s Precinct have demostrated there are a range of modifications that can make the VAT an easier sell to American voters. Maybe now would be a good time for the Democratic Party to hold public hearings across the country to generate further discussion about creative ways to make a national sales tax a progressive alternative.

Obama, Dems Challenged to Improve Government’s Image

Bob Herbert’s latest New York Times column, “Our Crumbling Foundation,” updates the argument for major infrastructure upgrade projects as a near-perfect match for the nation’s employment needs. It’s a familiar argument that’s been made for decades, though seldom with such supportive economic realities, and Herbert makes his case about as good as can be done in the columnist’s limited format:

It’s not just about roads and bridges, although they are important. It’s also about schools, and the electrical grid, and environmental and technological innovation. It’s about establishing a world-class industrial and economic platform for a nation that is speeding toward second-class status on a range of important fronts.
It’s about whether we’re serious about remaining a great nation. We don’t act like it. Here’s a staggering statistic: According to the Education Trust, the U.S. is the only industrialized country in which young people are less likely than their parents to graduate from high school…We can’t put our people to work. We can’t educate the young. We can’t keep the infrastructure in good repair. It’s hard to believe that this nation could be so dysfunctional at the end of the first decade of the 21st century. It’s tragic….The link between the need to rebuild the nation’s crumbing infrastructure and the crucial need to find rich new sources of employment in this economic downturn should be obvious, a no-brainer.

Over the years, numerous Democratic candidates for congress and the white house have urged making infrastructure upgrades as a major federal priority. Yet the idea never gets much traction, despite the clear logic of the need for action. The political will ought to be there, but it hasn’t emerged thus far. Democrats just didn’t have the votes in congress to significantly increase expenditures for fixing America’s decaying roads, bridges, sewerage systems, port security and other critical public facilities.
Herbert didn’t analyze opinion polls for clues to how voters feel about infrastructure projects as a major federal investment. If he had, he would have seen that there is strong public support for the concept of a major government investment in shoring up our infrastructure. A poll conducted 12/22/08 by Luntz Maslansky Strategic Research (yes, that Frank Luntz) for Building America’s Future, an organization which promotes infrastructure projects, found 81 percent would pay an extra 1 percent on their taxes to pay for infrastructure repairs, while 84 percent believe their state governments should increase spending on public works.
But he would also have seen that the government does have a persistent image problem, which prevents needed political action. The BAF poll found, for example, that 51 percent said their governor had been very effective in improving infrastructure in the last five years, compared with only 22 percent who said the same for political leaders in Washington. (although here I wonder if Luntz’s Republican leanings have biased questions to get a desired the result). Government-bashing is still fashionable among conservatives and some moderates, though to a lesser extent than a decade ago. Asked “…which of the following will be the biggest threat to the country in the future: big business, big labor, or big government?,” 55 percent of respondents in a Gallup poll conducted 3/27-29 said ‘big government,’ compared to 10 percent for ‘big labor’ and 32 percent for ‘big business.’ Other recent polls show public opinion more evenly divided on the question of whether the federal government should do more or less.
Knee-jerk government-bashing is now boilerplate rhetoric for GOP politicians. Thus far the Democratic response has been decidedly limp, usually changing the subject or ignoring the Republicans. What is absent is any party-wide commitment to address the problem head-on — to use the resources of the white house and the Democratic Party to strengthen the image of the federal government. I’m not talking so much about individual Democrats more assertively defending the federal government. What is needed is a major national campaign to educate the public about the positive accomplishments of the federal government, including federally-funded documentaries on key government agencies broadcast on PBS and major networks, public service advertising on television, radio and the internet, and generally making more aggressive use of public relations to educate taxpayers about the bargain they get for their taxes.
Ken Burns is premiering his new 12-hour documentary series on America’s national parks on PBS this Fall.. Presumably he will show viewers the wonderful resources of the federal parks and also reveal the need to better protect those resources. After giving due credit to Burns as a great private-sector documentary-maker, the question arises, why isn’t there already a great federally-funded documentary series on the federal parks? Or the FDA, NTSB, the NLRB and numerous other federal agencies that save taxpayers’ lives and money.
That’s what the private sector does when a company or industry develops an image-problem. They educate and advertise, and they do it because it works. It makes little sense for the Dems, including President Obama, to cede the case for government-bashing to the GOP, especially when we have a strong counter-argument and the resources to publicize it. A public education campaign about the very real accomplishments of the federal government, on the other hand, might help millions of taxpayers to see the folly in the GOP’s trashing of government and be more supportive of Democratic reforms.