Editore"s Note
Tilting at Windmills

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December 13, 2009

EVEN PASSAGE ISN'T THE END.... On Friday afternoon, a couple of fairly reliable progressive senators talked a bit about what to expect from the rest of the debate on health care reform, and both seemed to be making an effort to lower expectations.

In a conference call with reporters on Friday, Sen. Sheldon Whitehouse (D-R.I.) and Debbie Stabenow (D-Mich.) both stressed that they will continue to try to tinker with changes to the health care insurance and delivery system and the pharmaceutical industry, even after legislation passes.

"This is fairly clearly the beginning and not the end of health care reform," said Whitehouse. "There is going to be an awful lot of oversight of the big programs, which is necessary. We have got to change the delivery system so it provides better health care to Americans with less... And the ongoing nature of this continuing effort to make the American health care system one we can be really proud of is one that will allow plenty of time for people to continue to advocate for their views. It is not as if, if you don't get your voice heard in this particular episode, or if you don't win the program or position that you wanted in this particular episode, you have to walk away forever. This is going to be continuing."

At face value, it's easy to see this as pacifying, unsatisfying spin -- the senators were effectively telling reform advocates not to be disappointed with the final bill, even if it falls short in some areas, because a) it would still be a major step forward; and b) the overall policy will continue to be improved in the coming years.

And while "You Can't Always Get What You Want" seems to be playing in the background, I happen to find the spin fairly compelling.

We've been here before. When Medicaid passed, it did very little for low-income adults. When Medicare passed, it all but ignored people with disabilities. When Social Security passed, the benefits were negligible, and the program excluded agricultural workers, domestic workers, the self-employed, railroad employees, government employees, clergy, and those who worked for non-profits. The original Social Security bill offered no benefits for dependents or survivors, and included no cost-of-living increases.

These are, of course, some of the bedrock domestic policies of the 20th century, and some of the towering achievements of progressive lawmaking. But when they passed, they were wholly inadequate. There were likely liberal champions of the day who perceived the New Deal, the Great Society, FDR, LBJ, and their congressional Democratic majorities as disappointing and incompetent sell-outs who failed to take advantage of the opportunity before them.

But once the programs were in place, they improved, expanded, and became integral to the American experience. It took years and perseverance, but progress happened after the initial programs were in place.

The key, in each instance, is creating the new foundation. If/when health care reform passes, and Americans have a baseline of coverage and protections, improvements can be made. Exchanges can be expanded. Public options can be strengthened (or, I suspect, created).

If reform dies -- or, more accurately, if it's killed -- we can expect 20 years of inaction and adverse political consequences for those who tried.

If reform survives, it means coverage for the uninsured, new protections for those who are already covered, and an ongoing fight to keep building on the foundation.

Steve Benen 8:05 AM Permalink | Trackbacks | Comments (24)

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Comments

I've been a staunch advocate of the single payer concept for many years, but in the US, it's always been a question of the transition. It was never going to be single payer overnight. Competing interests are simply too powerful for radical surgery in the short to medium term

The transition costs will be real and high, and the political battles are only beginning. But enough additional people will be able to obtain reasonable health insurance coverage - and fewer families will be forced into bankruptcy - that reality will eventually seep in...20, 30 years from now, our kids and grandkids will have the sort of system that we've needed for decades.

Posted by: JM on December 13, 2009 at 8:15 AM | PERMALINK

JM: Some on the right think the "reality" seeping in will be the disaster they fear, because the better informed amongst the right have managed to frighten them. But the latter group within the right fears the "reality" as you see it, and as I see it: the American people will come to support any meaningful health care reform, and will protect and expand it over time.

Posted by: Marc Wohl on December 13, 2009 at 8:43 AM | PERMALINK

I suppose Sunday morning is a good time for optimism.

Posted by: par4 on December 13, 2009 at 8:51 AM | PERMALINK

The key, in each instance, is creating the new foundation. If/when health care reform passes, and Americans have a baseline of coverage and protections, improvements can be made. Exchanges can be expanded. Public options can be strengthened (or, I suspect, created).

I keep hearing that use of the passive voice all over the place regarding health care reform, and I don't like it. Somebody has to own the baby for it to grow. As it is, it sounds like a magic pony that will flourish overnight, on its own.

I especially find it troubling that it will change from a "here's a lot more money for you guys!" holiday gift to the insurance industry--given that they're currently in self-applaud mode, always a bad sign--to a "we're putting mechanisms in place to compete with you guys" effect, with nothing to explain how it's going to move from point A to point B. It's one thing to expect an entitlement program to garner support over the years from friendly administrations and sensible congresses. It's another to see it turn into its opposite in the face of an administration that doesn't care about a public option, and a congress that has evolved into a do-little and do-nothing party. Explain to me again why I should be pleased with the outcome, Steve? I think it's a disaster, a defeat with a victory stamp to look good.

Posted by: Balakirev on December 13, 2009 at 9:10 AM | PERMALINK

When Medicaid passed, it did very little for low-income adults. When Medicare passed, it all but ignored people with disabilities. When Social Security passed, the benefits were negligible, and the program excluded agricultural workers, domestic workers, the self-employed, railroad employees, government employees, clergy, and those who worked for non-profits.

But in the beginnings of those programs the federal government wasn't paying hundreds of billions of dollars to boost the profits of private corporations. Insurance corporations will get a huge windfall, but will be able to continue business as usual.

Uninsured Americans will be forced to buy crappy policies -- apparently with annual limits of coverage. The insurance corporations will still be able to deny or drop coverage, it will just cost them a little bit of a fine. Premiums will continue to go up for those of us with insurance. And we'll all have a harder time finding general practitioners who are dedicated enough to accept reduced reimbursements.

It's Halliburton and KBR all over again -- but hundreds of times bigger.


Posted by: SteveT on December 13, 2009 at 9:20 AM | PERMALINK

I get that this is a long fight, a process. But dammit, we've seen what the status quo does for a long, long time--how it destroys lives, families, and the needless suffering resulting from the power of a greedy few. We've also known for a long, long time what is needed to fix it.

Thus, I'm simply tired of the excuse that it takes a long time to fix this. Why can't we do what is right in one, fell swoop? It isn't as if we're slowly trekking into unknown territory, wary of the dangers there that are yet to be discovered. But I suppose that's the way it is. Meantime, while we're 'walking gently, carefully' to appease those who would rather people die, people will die in the interim, deaths that will be traced directly to this gentle walk approach. I guess it sucks to be sick and poor now, but hey, your poor, sick kids will be alright in a decade or so.

Posted by: terraformer on December 13, 2009 at 9:21 AM | PERMALINK

Cue: pony-wishing progbaggers telling us all how we're "sellouts", how everything is supposed to get fixed right away, and could, easily, but won't because we're corporate Rahmbama worshippers, etc.

Posted by: BrainGenius on December 13, 2009 at 9:51 AM | PERMALINK

What terraformer said.

I could live w/ the thought that "it's some reform" and "it will improve in coming years" but while it's helping some, the individual mandate and the ability of insurance companies to still apply coverage limits at their discretion are screwing a lot of other people and all so we can protect the profits of these health care pirates.

I'm disgusted because we could have done better. We should have done better. This whole process was botched from its very roll-out.

Posted by: Missouri Mule on December 13, 2009 at 9:52 AM | PERMALINK
Cue: pony-wishing progbaggers telling us all how we're "sellouts"

No, we're going to tell you that you're a fucking moron, who wants to shoot the messenger because you're too fucking stupid to understand that the Dems will get creamed by the voters because they did fuck-all for ordinary people, not because somebody criticized them on a blog (boo hoo).

Posted by: Steve LaBonne on December 13, 2009 at 10:12 AM | PERMALINK

I wholly agree and I thought I was the only one saying this. Pass a bill now - okay, not ANY bill, but the best one possible. Give up the public option - for now - get whatever concessions you can get from that, and just pass the damn thing.

Thhhhennnnnn... priority one - public option. Use reconciliation for that. Forget the filibuster "dinosaur". Then keep adding in more and more consumer protections, cost control, etc. - using cloture when possible, reconciliation when needed. I guarantee when people see that the Apocalypse the Teabaggers are predicting doesn't materialize, there will be a lot of support for even more reform.

So, if we pass a bill, even a flawed bill, at least there will be something to fix. If we don't pass anything at all, there will be nothing for at least 20 years. Are there really progressives out there who want that? Get real, folks!

Posted by: Geneva Mike on December 13, 2009 at 10:17 AM | PERMALINK

The whole endeavor of health care reform is a microcosm of the criminality and indecency of this country. A rather large microcosm, too,and so visible to many more people here and around the world.

The US is run by a Taliban of the Corporations and the Banksters. It is said that 44,000 die every year just due to the Corporate Taliban's collusion with the Medical Insurance corporations.

There are, no doubt, countless other annual deaths attributable to the Corporate Taliban in Washington.

Posted by: neill on December 13, 2009 at 10:21 AM | PERMALINK

My permanent political pragmatism is matched only by my sense of deep discouragement.

Posted by: shortstop on December 13, 2009 at 10:33 AM | PERMALINK

From 12/13/09 Chicago Tribune:

"If Americans 55 to 64 years old are required to pick up the full cost of a Medicare benefit, they could have to pay nearly $635 a month, the nonpartisan Congressional Budget Office estimated last year."

"By comparison, Americans 60 to 64 who now buy individual coverage from commercial insurers pay about $480 a month on average, according to the annual survey by America's Health Insurance Plans. Monthly premiums for those 55 to 59 are slightly lower, at about $408."

"In addition to being more expensive than a private plan, a full Medicare buy-in plan could also leave some beneficiaries with relatively high out-of-pocket costs for care."

WHAT, EXACTLY, IS SUPPOSED TO BE WRONG WITH PRIVATE INSURANCE??

DEMOCRATS CLEARLY BELIEVE THE AMERICAN PEOPLE ARE TO STUPID TO CATCH ON TO THEIR SCAM. THEY WILL BE SORRY FOR THAT, HOWEVER.

Posted by: DJCILLINOIS on December 13, 2009 at 12:09 PM | PERMALINK

I've been reading Nixonland while this debate is ongoing and it's amazing to me how many people seem to have forgotten that there were giant holes in the Civil Rights Act of 1964 that had to be (imperfectly) plugged up four years later with the Civil Rights Act of 1968, and that we've been passing pieces of civil rights legislation ever since. And yet it's the bill of 1964 that's remembered as the huge landmark victory for Johnson, not the ones that fixed the problems with that bill.

Will someone please name the legislation in the US that the healthcare bill should emulate because it completely fixed a problem the first time without requiring any tweaking? Look at the history of the New Deal sometime if you think that giant project got off the ground with no false starts.

I realize you guys all thought that Obama was going to be your perfect Jesus who would cast a magic spell and fix every problem the Republicans have created in the last 8 years within his first few weeks in office, but those of us living in the real world knew that the insurance and pharmaceutical industries were not going to give up that easily. Who do you think was financing all of the "death panels" talk over the summer?

Posted by: Mnemosyne on December 13, 2009 at 12:19 PM | PERMALINK

In order to get good lasting reform, these health care bills need to be tossed out and real bipartisan reform begun with Republicans (yes incorporating many of their ideas). The current bills are less about reform than filled with provisions giving out money to favored constituencies - a political power grab. However, righteous many on the left feel about their goals and beliefs this will not end well. The voters will respond at the voting booth by tossing out a lot of Democrats.

Posted by: Otiose on December 13, 2009 at 1:34 PM | PERMALINK

This isn't the first time Steve has lowered HCR expectations by pointing out the evolution of SSN, Medicare, etc. from miserly to not-too-shabby. However, if you look at his last post (Ungovernable), you will see another of his frequent screeds; this GOP party is totally unlike anything ever seen before.

You can't have it both ways. The Rethugs WILL scuttle any meaningful reforms in the area of HCR, financial oversight/regulation, global warming etc. And they have the help of "moderate" Donkeys, big money business and the MSM. Whatever comes to Obama's desk is likely to be WORSE than the current status quo. For example, automatic TARP triggers for too-big-to-fail banks when they screw the pooch again - and they will. Or a HCR bill that requires universal enrollment but has coverage caps, no meaningful plan choices, reductions in covered services, capitulation to drug prices, and probably more caveats and loop holes than a block of swiss cheeze at a shotgun target range.

I hope like hell I'm horribly wrong, but I have no expectation that the current crop of congress critters will EVER do the right thing. EVER.

Posted by: Chopin on December 13, 2009 at 4:47 PM | PERMALINK

You make a good point.

In particular, the exceptions you note in the original Social Security bill were added intentionally to exclude most female and black workers, to satisfy conservative and Southern legislators.

History certainly repeats itself.

Something to think about for us critics of a "watered down" bill.

Posted by: Nancy Irving on December 13, 2009 at 5:27 PM | PERMALINK

American culture for all it's "patriotic" blathering and relentless "American exceptionalism" slogans is quite slow in actually attending to it's own people.

It's not okay for "foreigners" to kill Americans but for American businesses to do it is just dandy. One of the more freakish things about America.

Posted by: Silver Owl on December 13, 2009 at 5:41 PM | PERMALINK

So what this piece asserts is that if Congress doesn't pass what you hippies want, because 60%+ of the country doesn't want it and going forward is political disaster, then we'll sneak it through anyway over the next few years.

Courage!

Health care isn't a right. You buy yours, I'll buy mine.

Posted by: Pablo on December 13, 2009 at 10:43 PM | PERMALINK

So what this piece asserts is that if Congress doesn't pass what you hippies want, because 60%+ of the country doesn't want it

The polling on the question of health care reform varies so wildly depending on the scare in the air that week and the framing of the question as to be completely unreliable. Having said that, most reliable polls over the past few years have shown majority support for health care reform and some form of public option.

Health care isn't a right.

In fact, it is arguably the most fundamental human right, as well as an American right. In our society we don't even deny health care to prisoners; how is it not a right for the free? By law patients must be treated in emergency rooms, and Good Samaritan laws make it illegal to fail to stop and help someone who is injured. Our country is even signatory to treaties that define health care as a basic human right.

Voting used to not be a right unless you were white, male, wealthy, and/or educated. Now we know better. Those who place perceived self-interest above the common good are always trying to deprive others of rights.

You buy yours, I'll buy mine.

The thing is, eventually you won't be able to buy yours because premiums are doubling on average every ten years and costs of procedures are rising while wages are stagnating. The day is coming when you simply won't be able to afford it any more, nor will tens of millions of Americans.

Why on earth would you be happy with a system that is heading toward an economic iceberg; that is completely capricious and can be taken from you at any time if you get sick or lose your job; that is rewarding bureaucrats for denying you coverage; and that ALREADY costs on average twice as much as superior systems in other countries that would actually control costs better, be cheaper, and protect your rights?

That was a rhetorical question, as there is no sound answer to that.

Posted by: trex on December 13, 2009 at 11:21 PM | PERMALINK

Trex, I have no idea what Constitution you're reading. The Bill of Rights protects an individual from govt action. That's it. There are no positive rights. If you can show me where in that document it says anything that can tenuously be tied to health care as a right, I'll pay for everyone's medicine myself.

Until then, I pay for mine, you pay for yours.

(And keep telling yourself everyone's for this scam. Because you'll be telling it to a President Palin or President Thune in four years if your buddy keeps up his similar delusion.)

Posted by: Pablo on December 14, 2009 at 2:31 AM | PERMALINK

You should slowly introduce any new horses to the pasture.

Posted by: Horseville on December 14, 2009 at 5:52 AM | PERMALINK

The difference between this and the prior social legislation is that HCR is laced with false accounting and promises, does not just add unsustainable debt, but debt on top of atrocious debt, protects an entire lobby that underwrites legislative campaigning (trial lawyers, single the most expensive unreformed component of HC), and ignores less draconian solutions (portability and transparency of pricing). These bills are not about social progress, they are about power and money grabs under the veil of social progress. If the Dems in power were truly interested in HCR, they would have included tort reform, transparency, and portability; their president would not be calling for email snitching; the legislative leaders would not be calling people un-American for dissenting; they would not be racking up big deals with pharmaceuticals; and they would have even a little more regard for honesty in advertising. Support for this has dropped to far-more-now-opposed-than-supporting because it is bad legislation, poisoning a sick patient. Start over.

Posted by: Luke Liberty on December 14, 2009 at 11:52 AM | PERMALINK

I am not too sure that 'progressives' who tend - like birds of a feather - to flock together really understand how far they have overstepped this time.

The things that are going on which they regard as laudable are anathema to the majority of this center-right country.

Have you looked at the increased rate of gun sales in this country? Not hunting rifles - those sales are flat - but pistols and defensive shotguns and similar? Same thing for ammunition sales for these weapons.

A sizable minority of the population has been pushed way too far and way too fast. Their brethren in the center-right majority are all that is currently restraining them but it is reaching the point where the majority is going to say that while they personally would never resort to violence themselves, they 'understand' why this group is so angry.

That's all it will take, really, for the violence to start.

It was never about getting 50.00001% in the House or 60 votes in the Senate and inflicting your views on everyone else. It was about everyone accepting those compromises that let us all live together without violence. That consensus is the one we have to worry about, and it's fraying more with each passing day.

Posted by: George Hanshaw on December 14, 2009 at 12:54 PM | PERMALINK
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