It’s becoming increasingly obvious that not only wholesale Republican opposition, but Democratic divisions, are risking the enactment of health reform legislation this year. Some of those divisions are rooted in relatively narrow objections this or that bill–e.g., jurisdictional squabbles between committees or between House and Senate approaches–or this or that provision–e.g., union opposition to taxation of high-end employer-sponsored health benefits. But the bigger division which falls roughly along ideological lines involves “moderate” Democrats (sometimes, as in last week’s Senate “gang of six,” working with like-minded Republicans) who seem to prefer delaying action on health reform to enactment of anything that vastly increases federal budget deficits, fails to reduce health care inflation, or exposes Democrats to conservative attacks on “big government.”
It’s fair to say that the prevalent attitude among other Democrats towards these “moderates” is one of anger and betrayal, on the theory that only political cowardice or total submission to the health care industry could possibly explain their point of view. And one talking point heard often in denunciations of Democratic foot-draggers on health care is that as “everyone knows,” the failure to enact health reform in Bill Clinton’s first two years caused the Democratic midterm debacle of 1994. Steve Benen, for example, stipulates this assumption about 1994 and quickly goes on to suggest that maybe “centrist” Democrats don’t really give a damn if their party loses seats or even control of Congress in 2010. This attribution of evil motives is also more-or-less incorporated by reference in an otherwise fine post today by TNR’s Jon Cohn on the Democratic politics of health reform.
As someone with still-vivid memories of 1994 and of the raging and inconclusive debate that ensued about the origins of that electoral debacle, I have to say that no, it’s not at all self-evident that the failure of a Democratic-controlled Congress to enact universal health coverage was the primary cause. For one thing, there was a lot going on in November of 1994–a vast number of Democratic retirements, the final stage of the ideological realignment of the South (exacerbated by racial gerrymandering in the House), and residual resentment of a Democratic majority in the House that had been in place since 1954. But even if you believe health care was the single largest factor in the 1994 results, it’s not entirely clear that the failure to enact health reform, as opposed to the unpopularity of the reforms being proposed (not to mention the timing of the health care debate, which in 1994 was on the very brink of the midterm elections), was the predominant factor.
And even if health care was the predominent factor, it’s not at all clear that the defeat of the Clinton health plan, as opposed to the composition and presentation (at least as perceived by the public) of the Clinton health plan, was the vote-killer. Yes, there has always been a point of view in the debate over 1994 that “disappointment” over the Clinton administration’s strikeout on health care, compounded by other White House strategic decisions (most notably the promotion of NAFTA and GATT and the prioritization of deficit reduction at the expense of “investments” in the budget), “discouraged” the Democratic “base” and led to conservative-skewed turnout patterns in 1994, and depressed Democratic performance among those who did turn out. But it’s just a point of view, not incontrovertible fact. A Kaiser Family Foundation election-night survey in 1994 that focused on health care reached a different conclusion:

The survey shows that the voters’ vision of health care reform has shifted toward that held by many moderate Republicans and Democrats. Thirty-one percent of those surveyed said they were less supportive of major health reform than six months ago, with half of those citing as their reason that they did not think the government would do it right. More voters now want Congress to make modest changes in the health care system (41%), rather than enacting a major reform bill (25%). In addition, one in four voters favor leaving the system as it is. [Tables 4 and 5] “These results say that voters want the new Congress to place health care high on their legislative agenda,” said Dr. Robert Blendon, Professor and Chairman of the Department of Health Policy and Management at Harvard University. “But what the public means by health reform now comes closest to a more moderate vision: one which is more limited in scope, incremental, and that involves a much more limited role for government.”

My point here is not to argue that this or that theory about 1994 is the gospel truth (though I personally think there are elements of truth in the “discouragement” and the “rejection of big government” theories, along with non-issue explanations). It’s that I wouldn’t buy the idea that go-slow Democrats today know their position on health care will produce an electoral disaster, and just don’t care. For every good, loyal Democrat who has internalized the “discouragement” narrative about 1994, there’s another good, loyal Democrat who “remembers” 1994 as a tale of an “over-reaching” White House and an arrogant congressional Democratic leadership who relied on a secretive process to produce a highly complex health plan that was then marketed as a giant new government entitlement, repelling swing voters.
In the end, motives for the current behavior of Democrats on health care only matter so far. As it happens, I favor the argument that Senate Democrats ought to be pushed (with real consequences) to support a cloture vote on health care–and on climate change–no matter how they feel about the underlying legislation, which would make it a lot easier to get something done.
But the intraparty debate will become an unfortunate dialogue-of-the-deaf if the contending factions base their political assumptions about the consequences of various courses of action on health reform are based on different interpretations of an election held fifteen years ago.

Despite the best efforts of the Bush Administration, including relentless bashing of government investments in scientific research, they were never able to get a full-scale war against science off the ground. The primary reason for their failure appears to be that the public just doesn’t buy into the GOP meme that scientific investments are best left to the private sector, as indicated by recent opinion data. As TDS Co-Editor Ruy Teixeira reports in his current ‘Public Opinion Snapshot’ at the Center for American Progress web pages,

The Obama administration has put a strong emphasis on scientific research, backed up by funding commitments in the 2010 budget. And this appears to be simpatico with the views of the American public. A new survey from the Pew Research Center shows that the public, by 60-29, thinks government investment in research is essential for scientific progress, rather than believing that private investment can ensure scientific progress without government investment.

And breaking down scientific research into two basic components:

And when queried about whether government investments in basic scientific research—and in engineering and technology—pay off in the long run, the public overwhelmingly said yes in both instances: 73-18 for basic scientific research and 74-17 for engineering and technology.

It appears that the GOP war on government-sponsored scientific research is safely dead for the forseable future. As Teixeira concludes, “…The public is not only very supportive of scientific research, but is clearly willing to put its money where its mouth is. This supportive environment should allow scientific research in our country to flourish in the coming years.”

Zackary Roth has an important piece up on the TPM site that notes the profoundly disturbing way many news networks competed for interviews with Mark Sanford by promising to go easy on him and let him spin the “hiking” story the way he wanted. E-mails sent to Sanford’s press people included the following:

• David Gregory: “coming on Meet the Press allows you to frame the conversation as you really want to… You know [Sanford] will get a fair shake from me and coming on Meet the Press puts all of this to rest.”
• Producer for the MSNBC Morning Joe show: “Of course the Governor has an open invite to a friendly place here at Morning Joe, if he would like to speak out.”
• Producer for MSNBC anchor Contessa Brewer “…Mark could spin this favorably if he talks it up as the outdoors man in the woods etc. For all we know he’s contemplating the last year of his term and thinking through his priorities before he goes on his family vacation.”
• Anchor for WIS-TV – “Off the record, I think this whole thing is ridiculous. Sounds like slow news day stuff.”

This promise of favorable treatment as an enticement to get a political figure to appear on a particular show is disturbing enough in the case of a governor like Sanford. But its implications are even more – there’s no other word for it – sinister — in the case of two other figures who every TV show is going to be absolutely desperate to snare – Sarah Palin and Mitt Romney.
Palin, obviously, will be desperate to limit her exposure to easy “softball” interviews and it’s all too easy to imagine the sleazy promises many shows will make to get her – “Don’t worry, no Cokie Roberts type-stuff”, “we’ll ask you the right kinds of questions ” etc. Romney also will want to avoid all manner of challenges about his changing positions over the years. Obviously, hard-right conservatives like Palin know that they can get a free ride on a FOX show, but so does the audience. It’s much more disturbing to imagine a competition in laxity among all the other networks as well.
Let’s say it plainly: the competition for these two political figures is going to be a vile, no-holds barred race to see which interviewer can flush every speck of his or her journalistic integrity down the toilet — a championship face-off in the World Olympics of media pandering.
But what can Democrats do about this?
Here are three quick ideas:

1. Democrats should insist that TV or other interview shows reveal the terms of any deal they offer Palin or Romney in order for them to appear. If the shows refuse to disclose this, they should be called on it. In fact, under federal communications law, undisclosed “sweetheart” interview deals might even qualify as kickbacks – they are far more valuable to the subjects than cash.
2. The moment any TV show announces an upcoming interview with Palin or Romney, Democratic magazines and websites should immediately begin proposing questions that the interviewer should ask. The Republicans made a big and effective stink claiming that a network show featuring Obama on health care would be slanted before it even aired. Democrats should make no less of an advance stink about likely kid-gloves treatment of Palin or Romney.
3. Desirable Democratic interview subjects should make it clear that they will avoid interviewers who give Palin or Romney kid-gloves treatment and will seek out honest journalists instead.

George Carlin used to have a comedy routine about the TV commercials that promoted new drugs by saying “remember to ask your doctor to prescribe XYZ”. Carlin commented: “When you name the drugs you want your doctor to prescribe, he’s not a doctor any more, he’s a pusher.”
In the same way, when the producer of a network news show promises a political guest control over the questions and formats of their appearance in order to get them to appear on a particular show, he or she is not a news professional any longer, but the journalistic equivalent of a streetwalker.

Pollster.com Editor Mark Blumenthal wades through the confusion about recent polling on health care reform attitudes in his post “Health Care Goals: Cost, Coverage or Both?” and makes a key point reform advocates should keep in mind in discerning trends in public opinion on the topic:

…Democratic pollster Mark Mellman attempts to make sense out of some very divergent obtained by national pollsters recently on the question of whether Americans consider controlling costs or expanding access to coverage the more important goal for health care reform. The column is worth reading in full, but I want to add one thought: I’m not a fan of the costs-or-coverage question….

Blumenthal then presents recent data from seven different polls, all of which share one thing in common:

…All of the questions above force respondents to choose between the goals of reducing costs and expanding access to coverage. What if they feel strongly about both goals?
The new USA Today/Gallup results released this week suggest that many Americans do exactly that. Their survey begins with a list of ways health care reform “might affect you personally,” and asks respondents to rate the importance of each. They find:
86% rate “being able to get health insurance regardless of your job status or medical situation” as at least very important (including 43% who consider it extremely important)….83% rate “making your health insurance more affordable” as at least very important (including 40% who consider it extremely important).
Conceptually, both goals involve the issue of costs. Most Americans understand that if they lose their job or attempt to purchase insurance with a pre-existing condition their personal costs will be significantly higher than with ordinary, employer-provided health coverage. So it would not surprise me that many Americans have trouble disentangling the goals of cost and access to coverage.
…The notion that Americans worry mostly rising health care costs or mostly about covering everyone can mislead us about what those Americans who want it really want out of health care reform. It’s not about cost or access to coverage. It’s about both.

Hopefully, members of Congress will take Blumenthal’s reasoning into account, as they try to figure out what their constituents want. As Ed Kilgore pointed out yesterday in his TDS post on “The Less-Information Lobby,” there is nothing wrong with more polling data, especially if it is interpreted with common sense.

A few weeks ago I wrote about the strange involvement of the highly secretive evangelical “leadership” group “The Family” in the adultery sagas of both John Ensign (who lived at The Family’s C Street townhouse on Capitol Hill and negotiated with the wife of his mistress there) and Mark Sanford (who apparently was counseled on his marital and extra-marital issues at the same place).
Today’s news brings the revelation of another adultery scandal involving a Republican pol who was very close to The Family: former U.S. Rep. Chip Pickering, once a big-time rising star on the Right, whose estranged wife is suing his alleged mistress for “alienation of affection.” Her complaint in court claims that the affair was in full bloom while Pickering was living at “the well-known C Street Complex.”
I don’t know what’s more notable here: the high prevalence of marital infidelity among the hard-core adherents of this quasi-theocratic group, or the fact that the publicity must be driving its leaders completely crazy. In any event, the “C Street Complex” is beginning to appear as something of a house of questionable repute.

Michael McDunnah’s post, “New Project Vote Report Evaluates Fifteen Years of the NVRA” at Open Left flags an important study, which could have have a significant impact on the Democrats’ prospects in upcoming elections. McDunnah discusses the just-released Project Vote Study “The NVRA at Fifteen: A Report to Congress,” written by Estelle Rogers. The conclusions of the study about National Voter Registration Act ought to alert Democrats and the Administration to an impending threat and an opportunity.
The NVRA should be enforced as a critical priority for American democracy, regardless of partisan concerns. For Democrats, however, the threat is that continued lax enforcement of the NVRA could help hand the Republicans an early comeback. Conversely, the opportunity for Democrats is that full enforcement of the NVRA could help secure Democratic majorities at the federal state and local levels for years to come.
Lax enforcement of the NVRA has undermined the integrity of our elections for all voters, regardless of their party preference. McDunnah explains:

During the first two years of its implementation, the NVRA contributed to one of the largest expansions of the voter rolls in American history. But many states have resisted or rejected the mandates of the NVRA since its passage, often challenging them in court, while others have been allowed to ignore their responsibilities due to lax enforcement by the Department of Justice. As a result, fifteen years after the passage of the NVRA, voter registration was once again cited frequently as THE PROBLEM marring the 2008 election. Tremendous disparities in the electorate still remain, controversies rage across the country over voter registration and list maintenance issues, and some seven million Americans-according to the 2008 Cooperative Congressional Election Survey-either attempted unsuccessfully to vote or were discouraged from voting by administrative barriers. It is clear that many problems the NVRA sought to address remain uncured, and its full promise remains unfulfilled.

What’s behind the failure of enforcement of the Act? McDunnah quotes voting rights scholar Frances Fox Piven in her forward to the study:

…The reform of American registration procedures has met widespread resistance, some of it attributable no doubt to bureaucratic inertia, and some of it perhaps politically motivated.”

Rogers, via McDunnah, breaks down the failure into four key elements:

“It is important to assess what has been accomplished and suggest what might be done to achieve the level of civic participation envisioned by the statute’s drafters in 1993,” Rogers says. The NVRA at Fifteen is the first in-depth evaluation of how four major provisions of the NVRA have-and more importantly haven’t-been successfully implemented: the “motor voter” program, establishing voter registration through motor vehicle offices (Section 5 of the NVRA); the creation of a simple, universally accepted mail-in registration form (Section 6); voter registration through public assistance agencies serving low-income families and people with disabilities (Section 7); and the regulation of how states can and cannot remove voters from the rolls (Section 8).

Rogers also cites “poor training requirements and lack of oversight and accountability of motor vehicle offices have led to problems with noncompliance” and,

After initial success in its first two years of implementation,” Rogers writes, “Section 7 has been largely neglected (and in some cases almost wholly ignored) by many state agencies. A lack of authority on the part of chief election officials over state public agencies, and a failure on the part of the Department of Justice to enforce the requirement, have contributed to the pervasive failure of Section 7, to the disadvantage of millions of eligible low-income and minority Americans.”

Project Vote estimates that compliance with the NVRA provisions could bring 2 to 3 million new low-income voters into the counts yearly. Not surprisingly, the Bush Administration Department of Justice pretty much ignored the Act. I’ve got to believe that President Obama, himself a former voter registration organizer, will provide stronger leadership to enforce the NVRA. As president, however, he’s got a longer list of higher priorities, so we can’t assume that the Adminsitration will provide adequate leadership to make the NVRA rise to its potential.
Then there is also the thorny issue of weak enforcement by Democrats in power. As, Bruce Dixon, one of the commenters to Mcdunnah’s post notes:

I worked in county govt – Cook County in Chicago, the office of David Orr, the county clerk office which is responsible for registrations and elections in the half of the county outside the city of Chicago. I recall we had no end of problems with the state of Illinois resolutely refusing to carry out the provisions of NVRA. We were able to get them to allow us to place registrars in Chicago city and suburban motor vehicle registration facilities and a very few other state offices. But we never got deeper cooperation than that, and certainly there was never anything like statewide implementation of NVRA…This was the case even though a Democrat held the office of state attorney general most of that time. Our office asked, requested, importuned and begged that elected Democrat for years to come out with some kind of advisory opinion to the effect that the state was somehow obligated to do so, but to no avail.

Dixon identifies the Illinois A.G. as Roland Burris, now U.S. Senator. The point here is not to target Burris as the only Democrat who didn’t provide the needed leadership to enforce the NVRA. No doubt there are other states in which Democrats, as well as Republicans, failed to provide the needed leadership. No matter how strongly President Obama rises to the challenge of enforcing the legislation, there is still the problem of limp enforcement at the state level, a worthy challenge not only for Democratic leaders who undertand the importance of this legislation in securing their party’s future — but for all Americans who believe that healthy turnouts keep democracy strong.

While the AMA endorsement of the House bill represented yesterday’s good news on the health care reform front, the less-so-good news was testimony by CBO director Douglas Elmendorf that the plans CBO has reviewed lack sufficient measures to reduce overall health care costs. This testimony will, of course, be brandished as a club by anyone opposing health care reform.
The biggest problem is that some of the very people wailing about costs oppose the available cost-containment measures, including some already in the existing bills. The Blue Dogs, as J.P. Green reported yesterday, even as they threaten to defeat the House bill based on cost concerns, want higher reimbursement rates for rural doctors under Medicare, and also want higher exemptions for small businesses that would otherwise be subject to play-or-pay costs.
And some of the most effective cost-containment provisions are just politically toxic. Elmendorf made it clear he thinks Congress should limit the tax exemption on employer-sponsored health benefits, which would not only generate revenues to help pay for expanded coverage, but would also arguably reduce a subsidy for over-utilization of health services. The trouble is, this idea is opposed by Speaker Pelosi, Majority Leader Reid, the White House, the labor movement, and (according to every poll) a large majority of the American people.
Another oft-cited cost control measure is called “comparative effectiveness research,” which would make federal reimbursement rates for specific procedures dependent on their medical effectiveness and their cost effectiveness. Many physicians bitterly oppose this approach as interfering with the doctor-patient relationship and their basic responsibility for diagnosis and treatment.
Ezra Klein today offers a useful quick summary of cost control options, and suggests that any politician who complains about the cost of health care reform should be forced by reporters to explain which of these options they favor.
The only problem is that most Republicans and maybe even some Democrats wouldn’t have big problems just sticking with the status quo, which health reform critics are increasingly prone to defend as the debate continues. That inertia, and the willingness to promote irreconcilable goals, are probably the two biggest obstacles to real congressional action on health reform in this congressional session.

While J.P. Green is appropriately concerned about Blue Dog threats to derail health care reform in the House, the House effort got a big and somewhat surprising boost today when the American Medical Association endorsed the three-committee House proposal.
This changes the dynamics of health reform in some pretty dramatic ways. It elevates the House proposal from a liberal marker set down to constrain less ambitious Senate plans into something with its own momentum (reinforced by CBO’s estimates of its high impact and within-budget cost).
But more importantly, it will be much harder now for conservatives to demonize the entire health care reform effort as aimed at “socialized medicine” and as destroying the right to choose a doctor or allow doctors to control treatment decisions. The AMA has a well-earned reputation for conservatism in health care policy (it opposed Medicare–and for that matter, Social Security–when originally proposed). Americans who don’t follow the details of specific proposals but trust their Docs will pay some serious attention to this endorsement.
Jon Chait at TNR has some important questions about the price the AMA has secured for this action, but for the moment, it’s a welcome development.

Dierdre Walsh has a CNN.com report, “‘Blue Dog’ Democrats may block health care bill,” quoting a Blue Dog House leader Mike Ross (D-AR) on the Democrats’ health care reform legislation

“We remain opposed to the current bill, and we continue to meet several times a day to decide how we’re going to proceed and what amendments we will be offering as Blue Dogs on the committees.”…Asked whether the Blue Dogs on Energy and Commerce are considering voting as a group against the bill if it remains unchanged, Ross replied, “absolutely.”

According to Walsh, the Blue Dogs are concerned about inadequate cost containment in the bill, as well as new mandates on small businesses in the bill and a failure to fix inequitable health care costs for rural physicians and hospitals. As the bill reads now, small businesses with payrolls less than $250K would be exempt from penalties for not providing health insurance, and presumably, their employees could access the “public option.”
The House Energy and Commerce Committee takes up the bill today. Walsh reports that Dems have a 36-23 edge over Republicans on the committee, although 8 of the Dems are Blue Dogs. If 7 Dems vote with the Republicans, it could stop the bill from advancing.
Perhaps the $250K penalty cut-off could be raised to $350K to win the support of some of the Blue Dogs and the bill could be lightly tweaked to accommodate other of their concerns. Meanwhile, however, Nate Silver has a FiveThirtyEight.com post “Blue Dog Districts Need Health Care More than Most” which ought to make Blue Dogs think a little more carefully before jumping on the GOP’s obstructionist bandwagon. Silver notes an interesting statistic regarding the 48 congressional districts represented by Democrats that voted for John McCain:

The median Congressional District has an uninsured population of 14.6 percent, according to Gallup’s data (the average is slightly higher at 15.5 percent). Of the 48 McCainocrat districts, 31 (roughly two-thirds) have an above-median number of uninsured.

Silver then lists the 31 districts, identifies their representatives and ‘Blue Dog’ status and the percentage of residents of each district who are uninsured. Silver’s conclusion:

The bottom line is that the health care bill, among other things, is designed to help out the poor and the uninsured, and somehow or another will tax the rich in order to do so. I can understand if, say, Jason Altmire from PA-4 wants to vote against the health care bill. His district is suburban and pretty well off, and almost everyone there has health insurance. But Mike Ross of the Arkansas 4th, where almost 22 percent of the population is uninsured? This is a bill designed to help districts like his. And the same goes for most of the other Blue Dogs. A lot of the time, these guys are stuck in a tough spot between their party and their constituents. Here, those interests are mostly aligned. If a lot of the people on the top half of this list are voting against health care, first check the lobbying numbers, and then check to see if they’re still in office four years hence.

Blue Dogs will understandibly seek modifications in the bill that address their constituents’ concerns. But they would do well to give Silver’s post a thoughtful read before voting to maintain the status quo.

One of the hardiest lines of argument in American politics, going back for decades now, is that public opinion research, or more colloquially, “the polls,” are a threat to good government, accountability, principled leadership, or even democracy itself. Few insults carry as much wallop as the claim that a politician or a political party is “poll-driven.” And in sharp distinction from most anti-information campaigns in public life, hostility to polls is not a populist preoccupation, but an elite phenomenon.
Last week Conor Clarke offered a vintage summary of the no-polls position at The Atlantic Monthly. Clarke’s fundamental contention is this:

News organizations are supposed to provide information that holds government accountable and helps the citizenry make informed decisions on Election Day. Polls turn that mission on its head: they inform people and government of what the people already think. It’s time to do away with them.

Note Clarke’s planted axiom about the purpose of “news” as a one-way transmittal belt of information to the citizenry. Under this construction, government feedback from the public is limited to the “informed decisions” made on election day. This is not terribly different from George W. Bush’s taunting remark in 2005 that he didn’t need to pay attention to critics of his administration because he had already faced his “accountability moment” in November of 2004.
Putting that dubious idea aside, Clarke goes on to make three more specific arguments for “getting rid of polls:” they reinforce the “tyranny of the majority; they misstate actual public preferences (particularly when, as in the case of polling on “cap and trade” proposals; they public has no idea what they are being asked about); and they influence public opinion as much as they reflect it.
In a response to Clarke at the academic site The Monkey Cage, John Sides goes through these three arguments methodically, and doesn’t leave a lot standing. He is particularly acerbic about the argument that polls misstate actual public opinion:

[P]eople tell pollsters one thing, but then do another. Sure: some people do, sometimes. Some say they go to church, and don’t. Some say they voted, and didn’t. All that tells us is to be cautious in interpreting polls….
So what do we do? We triangulate using different polls, perhaps taken at different points or with different question wordings. We supplement polls with other data — such as voter files or aggregate turnout statistics. Polls can tell us some things that other data cannot, and vice versa.

In this response Sides hits on the real problem with poll-haters: the idea that suppressing or delegitimizing one form of information (and that’s all polls are, after all) will somehow create a data-free political realm in which “pure” or “real” or “principled” decisions are made. Willful ignorance will somehow guarantee honor.
As Sides suggests, the real problem isn’t polling, but how the information derived from polling is interpreted and combined with other data–from election returns to weekly and monthly economic indicators–to influence political behavior. And that’s true of the variety of polls themselves. We’re all tempted to cite poll results that favor our predetermined positions. But the use of questionable polls for purposes of spin (e.g., the ever-increasing dependence of conservatives on Rasmussen’s outlier issue polling) is, as Sides says, an issue of interpretation rather than of some inherent flaw in polling:

Clarke is right about this: we are awash in polls. The imperative for journalists and others is to become more discerning interpreters. The imperative for citizens is to become more discerning consumers. When conducted and interpreted intelligently, we learn much more from polls than we would otherwise. And our politics is better for it.

So instead of fighting against the dissemination of polls like Odysseus lashing himself to the mast to keep himself from heeding the Sirens, political observers would be better advised to listen more carefully and process the information more thoughtfully. The desire for less information is a habit no one as smart as Conor Clarke should ever indulge.