Editore"s Note
Tilting at Windmills

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December 15, 2009

THE FIGHT OVER THE FIGHT.... For the last several months, there's been a relatively quiet debate among progressive supporters of health care reform. While the participants tend to agree on nearly all of the relevant policy details, there's been an important point of division: whether a bill that lacks key liberal goals should be passed anyway, or whether such a bill should be scrapped altogether.

In light of recent events, this fight is getting significantly louder. As Greg Sargent noted, the dividing line seems fairly clear: "[O]ne thing that's interesting is how cleanly it breaks down as a disagreement between operatives and wonks. The bloggers who are focused on political organizing and pulling Dems to the left mostly seem to want to kill the bill, while the wonkier types want to salvage it because they think it contains real reform and can act as a foundation for further achievements."

Quite right. Leading progressive activists now consider the reform bill a failure worthy of defeat. The group includes, but is by no means limited to, MoveOn.org, Markos Moulitsas, and much of the FireDogLake team.

Leading progressive wonks take a far different view.

Nate Silver:

For any "progressive" who is concerned about the inequality of wealth, income and opportunity in America, this bill would be an absolutely monumental achievement.

Jonathan Cohn:

Disappointed progressives may be wondering whether their efforts were a waste. They most decidedly were not. The campaign for the public option pushed the entire debate to the left--and, to use a military metaphor, it diverted enemy fire away from the rest of the bill. If Lieberman and his allies didn't have the public option to attack, they would have tried to gut the subsidies, the exchanges, or some other key element. They would have hacked away at the bill, until it left more people uninsured and more people under-insured. The public option is the reason that didn't happen.

And if public option supporters lost in the Congress, they won in the country as a whole. The underlying political problem for liberals remains what it has been for a generation: profound and widespread distrust of government. But polls consistently showed voters thought the public option advocates were right--that, at least when it comes to health insurance, government can be trusted. It was a small victory, but it's on top of such small victories that political movements are built.

Paul Starr:

The moment of decision on health-care reform is arriving for progressives in Congress. Some of them have insisted they will refuse to vote for any bill without a public option, and that is now the only bill that has any chance of passing. If they hold to their position, the most significant social reform on behalf of low-income Americans in 40 years will go down to defeat.

Ezra Klein:

A lot of progressives woke up this morning feeling like they lost. They didn't. The public option and its compromised iterations were a battle that came to seem like a war. But they weren't the war. The bill itself was. When liberals talked about the dream of universal health-care insurance 10, 20 and 30 years ago, they talked about the plight of the uninsured, not the necessity of a limited public option in competition with private insurers.

"This is a good bill," Sen. Sherrod Brown said on Countdown last night. "Not a great bill, but a good bill." That's about right. But the other piece to remember is that more than it's a good bill, it's a good start.... On its own terms, the bill is the most important social policy achievement since the Great Society. It will save a lot of lives and prevent a lot of suffering. But moving forward, it also makes future improvements and expansions easier.

I want to emphasize that the distinction between activist/operatives and wonks is often blurred. To argue that Markos and Jane Hamsher, for example, don't care about substantive policy details is absurd. Likewise, to think that Nate and Ezra are blithe to the concerns of the larger progressive movement is equally mistaken. I'm noting the distinction/debate here, but I'm using terms like "activist leaders" and "wonks" loosely.

I should also emphasize that there is no actual "bill" as yet, so it's probably premature to give a still-unfinished product the thumbs up or thumbs down.

That said, as far as I'm concerned, the question is whether the reform framework in the Senate is a step backward or an incremental step forward. Does it make the status quo worse, or does it make improvements with the promise of additional progress? If it's killed now, are reform proponents more or less likely to have success in the years to come?

Given what we think we know about the state of the legislation, I think the effort is clearly a step forward. It's not the bill I'd write if I were dictator, but it advances the cause of reform, and creates a foundation that can be built on in the future. If this bill were to fail, I suspect it would be decades before anyone even tried to improve the broken status quo. In the meantime, the effects on those suffering under the current system would get worse.

As we've talked about recently, progressives have faced this situation 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 the programs passed, and once they 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 became law.

The key, in each instance, is creating the new foundation. The Democratic reform plan does just that.

Steve Benen 2:25 PM Permalink | Trackbacks | Comments (98)

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Comments

Reid should allow the filibuster. Then play it like Mansfield:

From Wikipedia's entry for 'filibuster'

A filibuster can be defeated by the governing party if they leave the debated issue on the agenda indefinitely, without adding anything else. Indeed, Strom Thurmond's own attempt to filibuster the Civil Rights Act was defeated when Senate Majority Leader Mike Mansfield refused to refer any further business to the Senate, which required the filibuster to be kept up indefinitely. Instead, the opponents were all given a chance to speak, and the matter eventually was forced to a vote.

Posted by: Gridlock on December 15, 2009 at 2:32 PM | PERMALINK

Steve, let me ask you this: is there anything that could happen that would make this bill no longer worth supporting?

I would vote for the bill if I had the chance, but my sense is that Ezra and others would support any bill called "health care reform," regardless of what it was, because they are so invested in getting something, regardless of the consequences to the base, future elections, future reform chances, etc. And I have to say I have complete sympathy with the folks who say they will wash their hands of the Dems for their unwillingness not only to not fight, but to give in without even the hint of a fight.

This has consequences, IMHO, beyond this bill.

Posted by: Dems lose huge in 2010 on December 15, 2009 at 2:34 PM | PERMALINK

For those in the Kos/Firedoglake camp, my question is, if not this bill, what's the path to getting a good one? I don't have a good answer for that. If the answer is "reconciliation" I need to understand the details.

Posted by: alkali on December 15, 2009 at 2:36 PM | PERMALINK

WTG

Steve...

You are the go to star in all of leftblogistan now.
You thread the needle man.
Totally thread it.

Posted by: koreyel on December 15, 2009 at 2:36 PM | PERMALINK

But Steve, even if you consider this a baby step forward, the true test is the hazy period between the bill being possibly signed and the moment the benefits (such as they are) actually begin.

Republicans are already testing 2010 platform prospects, one of them being "vote for us so we can repeal this evil healthcare reform package." If elements of the reform package don't kick in until 2014, then their rhetoric takes on a more urgent tone: "we have to stop this BEFORE it starts." And of course, millions of Americans are dopey enough to believe them and vote for them and fight for them.

As disheartened as dems can be over the state of reform (and I include myself amongst the disheartened), major losses in 2010 and 2012 could result in the "incremental/start of something big" healthcare bill being scuttled, even if it IS passed by this Congress. And the complacency and cowardice of the Senate Dems and the White House has made the possibility of that happening THAT much more likely.

Posted by: slappy magoo on December 15, 2009 at 2:39 PM | PERMALINK

There has been a lot of talk about putting the legislation in place as a good foundation and then building on it later. But is that realistic? Wouldn't we still be staring down the barrel of a filibuster every time efforts are made to improve on the legislation? Wouldn't the same corporately-owned politicians fight legislation that would dare provide consumer protections against the insurance companies? Why should we believe that politicians who refuse to fight for the middle class now will do so on an incremental basis later?

Posted by: PS on December 15, 2009 at 2:39 PM | PERMALINK

Yeah that seems to be the issue with "killing the bill." What next? If you're going to have to fight yet another fight for the public option/Medicare expansion anyhow, then shouldn't it be an easier fight without also having to worry about the private insurance regulation piece?

Posted by: Christopher on December 15, 2009 at 2:39 PM | PERMALINK

It doesn't matter at all whether this bill passes or fails.

Neither the wonks nor the activists are correct.

The third way is that the bill will be a poke in the eye of the American peeps (and the Repugnants and the MSM, without scruples, will make sure of that).

Or: The failure of the bill will be a poke in the eye of the American peeps (and the Repugnants and the MSM, without scruples, will make sure of that).

Posted by: neill on December 15, 2009 at 2:40 PM | PERMALINK

First bite at the apple. Still robust public option or expansion of medicare or both should come up under reconciliation early next year. Now that the insurance reforms look like they will pass, reconciliation is the way to get the public option or medicare buy in (and why limit it to 55+?) Medicare as an option for all...

Posted by: richard wang on December 15, 2009 at 2:42 PM | PERMALINK

Gridlock, the filibuster doesn't work that way any more.

Posted by: rea on December 15, 2009 at 2:43 PM | PERMALINK

The plan forces people to buy insurance they don't want from insurance companies that will cheat them. There are some positive elements in the plan, but not enough to make up for the fundamental evil of forcing consumers into the hands of these sharks. Argue all you want, but the Democrats will pay for this in 2010, and Obama will pay personally in 2012. You can believe that future Democratic majorities will improve this piece of shit; but there's not going to be another Democratic majority. They had their chance.

Posted by: anon on December 15, 2009 at 2:43 PM | PERMALINK

Wouldn't we still be staring down the barrel of a filibuster every time efforts are made to improve on the legislation?

Not necessarily. Senate seats change hands often, and a bit better organization toward a Medicare buy-in could go a long way.

Posted by: Christopher on December 15, 2009 at 2:44 PM | PERMALINK

Often, as the bill has proceeded, it has seemed to me that the debate on the Left was between those who want to expand health care coverage to those who don't have it vs those who want to punish the Insurance Companies for denying coverage in the first place. The Public Option became the Holy Grail as far as forcing insurers to lower their prices. I've always felt that the potential savings were being overstated and that the windfalls the PO were supposed to address were largely illusory.

My view hasn't changed. This is the bill that proves that health care reform can happen. It will be up to future bills to get the process right.

Posted by: Paul Dirks on December 15, 2009 at 2:44 PM | PERMALINK

I don't know what people are talking about when they talk about Dems "giving in".

People should take a good look at the benefits of HCR sans the public option. No lifetime limits (tens of thousands are uninsured because they ran out of insurance), subsidies for the poor and lower middle class, preventive care, limits on out-of-pocket amounts, outlawing rescission, outlawing rating/denials based on pre-existing conditions,... These items alone will save lives.

As Cohn wrote, "The campaign for the public option pushed the entire debate to the left--and, to use a military metaphor, it diverted enemy fire away from the rest of the bill." Get to know the rest of the bill before you urge your representatives to sink it. Lives are at stake.

Posted by: Chris on December 15, 2009 at 2:45 PM | PERMALINK

I agree with the "wonks" and with Steve on this. I think it is optimistic to think that we can sweep away all the entrenched interests that have a lot to lose from reform with one bill; apart from that, there is the sheer difficulty of changing the system we have for something new, and the fact that people are worried about their health care, and expect the worse when change is proposed. I am disappointed that we wont have a public option, but it just doesn't make sense to give up the progress we have made. Some of the reforms are compromised, to be sure, but others will make a difference for people. I don't think that I am owed the bill I want, and I will take some progress over no progress.

Posted by: Christopher D Coccio on December 15, 2009 at 2:45 PM | PERMALINK

The Moral majority has been sold down the river by the amoral politicians. It' more important for Congress to have medical insurance than it is for Americans. That is the message sent. Kill Americans by not having insurance. Kill Americans in War for the benefit of the rich.

Posted by: MlJohnston on December 15, 2009 at 2:45 PM | PERMALINK

Okay, I probably needed to hear this from a blogger I respect, BUT I'M STILL REALLY DISGUSTED WITH THE DEMOCRATS. I've been an independent since I first voted in 1976, but tend to lean Democrat - more recently, I've viewed myself as a progressive. But the current HCR "debate" tends to reinforce my tendency to see the Democrats as more concerned with their self-interests than the public interest. I feel like I'm being taken advantage of since I won't actually vote for the Republicans. But maybe I'll vote for a third party candidate and that will be my way of sending a message to the Democrats to pay closer attention to the people who actually VOTED for them as opposed to those who fund their campaigns.

Sigh.

Posted by: Mike on December 15, 2009 at 2:46 PM | PERMALINK

PS: Just the opposite: if this bill passes, the changes to the framework (increasing subsidies, increased Medicaid coverage, Medicare buy in or expansion, robust public option) can all be undertaken via reconciliation. Thus, once we beat the filibuster now, we never have to deal with it again on health care, provided that what we want to do is about getting money and spending money.

Posted by: Rich C on December 15, 2009 at 2:46 PM | PERMALINK

Thanks, Steve. I agree with koreyel. This is where I come to for sanity and reason and clear information right now. I don't want to be aligned with people whose motto is the same as the teabaggers.

Posted by: citizenjane on December 15, 2009 at 2:46 PM | PERMALINK

I'm not sure I get the point.

Should progressive legislators vote for a bill that gives them something but not everything? Sure. But unless they constantly push the public-option Lieberman and the Rs will eviscerate everything else in the bill and we'll get nothing.

So, it seems to me, the answer is to keep pushing the public-option but vote for less when it gets here. Right?

Didn't you just bemoan giving the gameplan away in the last post?

Posted by: Sarcastro on December 15, 2009 at 2:49 PM | PERMALINK

And I have to say I have complete sympathy with the folks who say they will wash their hands of the Dems

By all means, let's just hand the government back over to the Republicans. They'll enact the perfect progressive health care reform bill for you.

(rolls eyes in disgust)

Posted by: Screamin' Demon on December 15, 2009 at 2:49 PM | PERMALINK

"Foundation"? Of what?

Requiring all Americans to purchase something from a private, for-profit enterprise?

It's a fucking corporatist dream.

Posted by: a on December 15, 2009 at 2:49 PM | PERMALINK

It's looking like this bill will simply screw me over.

Posted by: MNPundit on December 15, 2009 at 2:51 PM | PERMALINK

Nate Silver says I'm batshit crazy for not supporting a bill that will force millions of people to pay a substantial portion of their income to private insurance companies.

Really, Mr. Silver? I'm batshit crazy?


Posted by: kc on December 15, 2009 at 2:51 PM | PERMALINK

Please correct me if I am wrong: The plan requires the government to subsidize lower income people so they can buy health insurance.

If this is correct, is it not a government run program in that taxpayer money is funding premiums?

And what of the conservative argument that government shouldn't be in the business of health insurance? Is it OK for them to have government pay for lower income peoples' premiums to a private company, but the government itself has no role in actually OFFERING LOWER COST INSURANCE?

rhetorical questions of course. I'm not sure why the democrats aren't beating the hypocrisy of this with a battle axe, day in and day out, plastering the airwaves... Oh wait, they're Democrats. How could I have forgotten.

I hate what this country has become.

Posted by: citizen_pain on December 15, 2009 at 2:52 PM | PERMALINK

You're dreamers, just like Obama. I can't convince you, but I'm certain that Holy Joe will have the last word.

Posted by: bob5540 on December 15, 2009 at 2:52 PM | PERMALINK

These sorts of fights--i.e. the ones that establish new government reponsibilities--are the hardest because they basically involve moving the center. After this, universal healthcare moves from liberal wishland to being the Status Quo. The next steps of reform should be easier.

Frankly, I'm tired of Kos and all his ilk. Their worldview is no different from the Republicans. They see everything as a zero-sum battle, and their reactions are always emotional. I think Kos's comment about this topic was informative: "The insurance companies won." He cares more about The Enemy winning a tactical struggle instead of helping millions of people get better, cheaper healthcare.

Look, I'll agree that this reform bill wouldn't be my first choice. I don't think it's anyone's first choice. But I'm sick of hearing so-called progressives whine about how Obama or Reid or whoever didn't go after the insurance companies enough. The point of healthcare reform isn't to break the insurance companies, it's to make healthcare better and more affordable, to ease suffering and improve peoples' lives. That will mean taking on insurance companies on occasion. So be it. But that isn't the point of the thing. And anyone who can't get this straight is just another power broker, regardless of how much of an idealistic progressive they make themselves out to be.

Posted by: Lev on December 15, 2009 at 2:53 PM | PERMALINK

The wonk - activist divide seems to imply that the compromise should be accepted.

But once you start digging in who is in what category that falls apart.

As the conclusion says - it is an open question whether this construction works at all. A requirement to buy insurance with no direct provision of care - seems dangerous.

And practically there is nothing in the bill right now that people can readily understand and say - that's great! The single most marketable idea was expand Medicare - and it is no surprise that the attackers hit that hard and fast.

Posted by: Samuel Knight on December 15, 2009 at 2:57 PM | PERMALINK

On the surface, I'd agree with this, rather simplistic divide; it's the easiest, most visible way to set up a discussion of Where We Are and What To Do Next. However, I think the fail here is just that: the analysis is simplistic, it's surface... and that's been the real problem with the "healthcare reform" process all along.

The reality is... there is no bill. The potential bill that might - and I think "might" is a very key word here - pass the Senate now differs substantially from the House Bill. That means a conference committee, and basically eviscerating work that the House already finished, or cobbling together a compromise that would very likely fail - again - to get the 60 necessary votes for cloture. I don't think it's at all clear that there's a path to a final bill at this point, that can pass both houses, and contain changes which are meaningful enough to justify the pain required for passage.

Then again, I think this process has been a has all along, a project where political success long ago overtook good policy arguments and a sensible open process for developing good legislation. We got to the most recent "compromise", one might recall, because it was, itself, a desperation play: with no likelihood of passing a "public option", a group of 10 Senators cobbled together a last minute fix (one of a series of such arrangements) which, at the outset proposed a Medicaid expansion, a Medicare expansion and some subsidized insurance. First the Medicaid piece died. Then the Medicare piece got nitpicked... and then it died. And now we're left with... not so much.

At this point, the bill offers some modest reforms of existing insurance, some discussion of expanding Medicaid with no real attempt to solve that program's core issues of funding and control, and some verbiage about trying to rein in Medicare with no real attempt to reduce outlays or change fee for service in a substantial way. Never mind if that's "progressive" enough... what is it? What meaningful change will it make to what already exists? I'd say... not so much. Which, really, is both what's been in the cards all along, and is, really, not worth having.

It's easy to blame the apologists and incementalists - unlike many, and because I've seen his evolution, I do not find Ezra Klein especially expert or insightful on much of this, just for starters - because they've been arguing, repeatedly, that every bad turn is somehow okay; but that's only half the problem: the other half is that the group Benen classifies as "activist" have been muddled in their goals as well: turning a "public option" into a symbolic stalking horse for single payer (which was always a pie in the sky fantasy), and pressing for political gains (we'll show Snowe! And Lieberman!) instead of a clear eyed approach that focused on important progressive policy gains (one word: Medicaid, Medicaid, Medicaid), and ignored hype and hyperbole.

There isn't a divide; what there is, what we're left with, is the point at which an arguably bill became quite simply a hopeless cause. Even if there's a salvageable "compromise" to be had in the Senate... it's not worth the pain, effort and time it will take to make it stick. If some gargantuan effort gets passed, we'll get told that it ends preexisting conditions and expands Medicaid and makes a stab at Medicare reform... all of which could have done, months ago, without this embarrassing, pointless, painful process. It's not ust that we expected more... it's that we need not ust more, but different: a different way to think about healthacre, how we get it, how it's delivered, and how we pay for it. Instead we've got debatable insurance "reforms" that will change almost nothing, probably codify some of our problematic aspects, and do nothing to address the most pressing problems we face. That won't change. And we're no closer today than we were yesterday to a real soolution... and no closer than we'll be tomorrow, with or without the bill we're dealing with.

Posted by: weboy on December 15, 2009 at 2:57 PM | PERMALINK

No lifetime limits = forcing people to buy more expensive policies

preventive care = forcing people to buy more expensive policies

limits on out-of-pocket amounts = forcing people to buy more expensive policies

outlawing rescission = it is already outlawed

outlawing rating/denials based on pre-existing conditions = forcing some people to buy more expensive policies to pay for others

subsidies for the poor and lower middle class - the only part of the plan I don't hate

Posted by: anon on December 15, 2009 at 2:58 PM | PERMALINK

@lev -- nice crock of shit served there, lev...

which insurance company do you work for?

even barack obama admits that the insurance companies' existence is the problem -- he said as much last august. obama just admitted he couldn't do it, so the next best thing is to force them to comply to cut costs (ie, the public option...).

Posted by: neill on December 15, 2009 at 2:59 PM | PERMALINK

Here's the deal. To the extent that the debate is between "kill it now and revisit it later" and "pass it now and fix it later", IMHO the key question is whether you will have more leverage in the future by killing the bill or not.

My sense is that a lot of liberals are terrible negotiators because they focus exclusively on what they want and ignore the bargaining positions of the other stakeholders.

There wouldn't even be a bill if there weren't provisions that insurance carriers and pharmaceutical companies really want: E.g. the individual mandate and extended patent terms.

If you kill the bill now, those carrots will remain out there to bring the stakeholders back to the table in the future. But if you pass a weak bill that bargains away all your negotiating leverage...you will never be able to fix the broken legislation because liberals will have nothing to negotiate with. Rather than improving the bill, I predict that it will be slowly weakened over time as uncontrolled cost increases force Congress to scale back coverage.

Ezra Klein and Matt Yglesias may know a lot about policy, but they appear to know jack squat about negotiation.

Posted by: square1 on December 15, 2009 at 3:00 PM | PERMALINK

Howard Dean: Kill The Senate Bill

In a blow to the bill grinding through the Senate, Howard Dean bluntly called for the bill to be killed in a pre-recorded interview set to air later this afternoon, denouncing it as the collapse of health care reform in the United States Senate, the reporter who conducted the interview tells me.

Dean said the removal of the Medicare buy-in made the bill not worth supporting, and urged Dem leaders to start over with the process of reconciliation in the interview, which is set to air at 5:50 PM today on Vermont Public Radio, reporter Bob Kinzel confirms to me.

The gauntlet from Dean whose voice on health care is well respsected among liberals will energize those on the left who are mobilizing against the bill, and make it tougher for liberals to swallow the emerging compromise. In an excerpt Kinzel gave me, Dean says:

This is essentially the collapse of health care reform in the United States Senate. Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.

Kinzel added that Dean essentially said that if Democratic leaders cave into Joe Lieberman right now theyll be left with a bill thats not worth supporting.

Dean had previously endorsed the Medicare buy-in compromise without a public option, saying that the key question should be whether the bill contains enough real reform to be worthy of progressives support. Dean has apparently concluded that the real reform has been removed at Liebermans behest which wont make it easier for liberals to swallow the emerging compromise.

http://theplumline.whorunsgov.com/health-care/howard-dean-kill-the-senate-bill/

Posted by: Lose the rose colored glasses on December 15, 2009 at 3:00 PM | PERMALINK

I think we just found out what Howard Dean's 2004 incomprehensible scream was all about...

Posted by: neill on December 15, 2009 at 3:03 PM | PERMALINK

I am both a wonk and activist and have been in the trenches for a long time and can fight the battles over policy and politics with the best of them. I understand why the organizers feel this bill has to go down. At the moment the perception is that the left has taken a hit and too often in politic, perception is reality. But then you take a step back and see what the likely outcome is should a bill more or less in current form passes, the medium and long-term politics are much different. A new entitlement will be created, it will almost certainly only get better over time, and it is here to stay and just like with Social Security, unemployment insurance, the minimum wage, and any host of other progressive legislation, is inviolable.

Now allow me to bring the politics and policy down to the personal. My 21 year old daughter will be off my insurance in 4 months. She will be forced to find insurance on her own and since she has lupus, there is zero chance under the current system that she will be able to get insurance at any price. That number of uninsured people who die every year will almost certainly add her to the list at some point. This bill, as flawed as it might be, will have a life changing impact on her should the pre-existing condition language survive. I dont care what Kos or Hamsher or any of the others say, and I respect them deeply, this is progress in a very tangible sense.

Posted by: dmh on December 15, 2009 at 3:03 PM | PERMALINK

I have a great deal of sympathy for both sides of this one. Of course, it's impossible to believe any of this matters. Until Lieberman says unequivocably that he won't filibuster, discussing whether this compromised compromise of a compromise that was compromised in compromise will actually be any good seems depressingly abstract.

Posted by: SpaceSquid on December 15, 2009 at 3:16 PM | PERMALINK

Some wise woman was just on MSNBC saying this is not Health Care Reform, this is Insurance Reform...
she said it's harmful because premiums will still skyrocket and more folks will be required to get insurance...yet Obama is saying now families will save on their premiums...I just want to know if that's true..because my premiums have escalated tremendously willy nilly...

where is that part in the bill?

Posted by: Insanity on December 15, 2009 at 3:16 PM | PERMALINK

I think progressives should let the bill pass, then work to improve it in direct, small, populist ways such as: kill the individual mandate in 2010. Leave all the insurance regulation in (no medical underwriting etc), but neuter the insurance industry's golden goose.

Heck, even the teabag partiers would help with that, and I don't think the corporate/lobbyist wings could stop it in an election year.

No, that's not Good Government, but if that's how they want to play the game we can do it too.

Posted by: ElegantFowl on December 15, 2009 at 3:16 PM | PERMALINK

I read pretty much everything that comes out of FDL and all that Steve's writing here, and I've appreciated hearing both sides of the debate.
To be honest, I don't recall Steve posting about the negatives in the bill, and why they're enough of a concern to give prorgessives pause.

Looking at the big picture, I think I would probably vote against the Senate bill (as I understand what would be in it). I understand that this is a rare opportunity, and if it fails it'll be years before it'll come around again. And that this political defeat could exacerbate the midterm losses the Dems are sure to experience, pushing progressive goals further away (though in any event, those likely midterm losses makes Steve's contention that the bad in the bill can be/will be fixed that much more unlikely in the near term).

All the same, I'm not actually sure that the good outweighs the bad of establishing mandates without adequate subsidies, doing nothing to slow the cost curve (I'd argue it'll get worse if/when insurers who want to maintain their profit levels can no longer engage in rescision), and establishing 60% actuarial value plans (http://news.firedoglake.com/2009/11/19/bronze-plan-meager-in-senate-health-care-bill/). And politically, the bad is going to come back and bite Dems on the ass when stories come out about how someone was required to buy in, and still wasn't protected when a medical crisis hit, resulting in medical bankruptcy. The follow-up analysis will focus on how much money was spent, and still the same problems are occurring. And these problems are in addition to the long delay before the bill is implemented, and the possibility (to be determined) that Stupak/Pitts will move reproductive rights backwards.

Posted by: argo0 on December 15, 2009 at 3:18 PM | PERMALINK

Obama should have been making similar speeches this forceful and clear from day one...

He's just selling the skeleton of what's left.

Posted by: Insanity on December 15, 2009 at 3:19 PM | PERMALINK
Leading progressive activists now consider the reform bill a failure worthy of defeat....Leading progressive wonks take a far different view.
In other words, people who know what they're talking about say we should go ahead and pass the compromised bill, and people who are clueless say we should let it fail.

Gosh, whose opinion should carry more weight? Tough call...

And if you still don't get it, read dmh above. Then try to justify letting tens of thousands more people die.

Posted by: Tom Hilton on December 15, 2009 at 3:23 PM | PERMALINK

Lev and others who are tired of "Kos and his ilk",

People like us are an important part of the political left. Be tired of us - that's fine - but don't disparage the contribution we make to the left's political discourse and movement politics.

Those of you on the left that are so-called political realists make important contributions too. That's why I think you should consider the intangibles we are looking at in this debate.

Caving to someone like Lieberman once again and compromising from Single Payer to Public Option to Medicare Buy-In to nothing (which controls cost or provides competition in the insurance markets) reinforces something with the American people. Democrats are weak and will fold on the issues they care most deeply about (what was our healthcare reform activism about this past summer if not one of the most crucial aspects of HEALTHCARE REFORM?)

Impressions can and do become reality to the American voter. Carter and the Democrats weren't weak back when Reagan took power, but that was the impression.

The American voter saw a landslide election with large majorities given to Democrats in the House and Senate. They expected something substantial to come of this, particularly with healthcare reform.

The HEALTH INSURANCE REFORM they actually get may be a big step forward but most voters will probably still see FAIL alongside the Democratic Party name. They will remember their craven caving to the likes of Lieberman and Nelson.

Remember Howard Dean? His campaign took off when he said he was here to lead the Democratic wing of the Democratic Party. People on the left were and still are inspired by that kind of forthright courageous leadership.

Really, failure to give Americans healthcare reform, not showing there are consequences for betrayal within the party, and disparaging us and our ilk will depress activism and needed help during the 2010 and 2012 election cycle.

For the less well-informed Independents and occasional Democratic Party voters, they will probably not see a reason to vote at all.

I think we are being pretty realistic in being opposed to this bill and demanding Democratic Party leadership to show some stones. If you don't see this perspective as realistic, you and your realist left folk ought to at least respect our effort to stretch our party back to the left so the American voter knows what the Democratic Party still stands for.

Posted by: pbriggsiam on December 15, 2009 at 3:23 PM | PERMALINK

Why is everything always a duality? "Kill it and start over or pass it and fix it." There are other options:

1. Kill the filibuster (the nuclear option), the Repubs already laid the groundwork on this. Biden and 50 members can kill it.
2. Reconciliation.

Option #1 would be drastic, but would be good long term for the budget, maybe even better than HCR itself. I have no idea why Option #2 was not used.

But, the main issue is that you cannot pass mandates without cost control. Obama ran against mandates and for cost control.

Pass the crap bill with the insurance language. Then let Obama hold the bill while the public option and medicare extension are passed in reconciliation. Then sign them together.

Posted by: Patrick on December 15, 2009 at 3:23 PM | PERMALINK

Why do the conservatives accept the US government subsidizing socialized medicine in Israel, but not the US?

More evidence our country is a laughing stock, a joke, and really not worth all this fucking bickering about. Fuck this country, it sucks.

Posted by: citizen_pain on December 15, 2009 at 3:24 PM | PERMALINK

And I have to say I have complete sympathy with the folks who say they will wash their hands of the Dems

By all means, let's just hand the government back over to the Republicans. They'll enact the perfect progressive health care reform bill for you.

(rolls eyes in disgust)

What are you going to do when it happens? Keep rolling your eyes?

If you have informed progressives talking about this, what in the world do you think the more stay at home casual voter is already thinking?

They already think the Democrats have screwed them. They started thinking that when Obama bailed out the rich and left them behind. And having the Republicans showing everyone how HCR will FORCE them to buy crummy insurance they cannot really afford will put the icing on the cake:

http://www.huffingtonpost.com/2009/12/15/rep-capuano-tells-fellow_n_392685.html

Posted by: Glen on December 15, 2009 at 3:26 PM | PERMALINK

Please name one area that conservatives have compromised on. Can you name just one? You can't because they haven't, not once.

If all you are asking is for one side to chuck their aspirations, that isn't compromise. I'm with Governor Dean.

I will say that I feel the plight of the poster above who's daughter won't be able to get insurance because of a pre-existing condition. I'm sorry but it isn't progressives that are to blame if she can't. Mandating citizens to buy coverage without controlling the price of a policy would mean policies for the sick & elderly will skyrocket. Citizens would blame the Democrats and Democrats would lose elections for several cycles. I'm supporting killing the Senate bill so that Democrats don't end up being in the minority again. Funny how the 'wonks' don't address that part of it.

Posted by: kindness on December 15, 2009 at 3:27 PM | PERMALINK

dmh @3:03 nailed it.

Will HCR (without the public option and without Medicare expansion) save lives or will it not? If yes, then we should unite to get it passed.

Posted by: CJ on December 15, 2009 at 3:31 PM | PERMALINK

I guess I'm discovering I'm a wonk. It's unthinkable to me that we could kill HCR when it will save lives -- upwards of 150,000 over ten years, according to Ezra Klein -- simply because something we really want isn't in it.

I wonder what percent of those who think it should be killed are without health care insurance?

Posted by: Lynn Dee on December 15, 2009 at 3:37 PM | PERMALINK

The plan forces people to buy insurance they don't want from insurance companies that will cheat them. There are some positive elements in the plan, but not enough to make up for the fundamental evil of forcing consumers into the hands of these sharks. Argue all you want, but the Democrats will pay for this in 2010 . . .

Waitaminute. If this is going to have such devastating consequences in the next ten months, why do you think the Democrats are going to be the ones taking the blame? The Republicans have been, and will continue to be, campaigning to shovel more and more money to the insurance companies. If the Insurance companies play this bill as obliviously as Aetna has for the last few weeks, the Democrats can run against them next fall and win some seats.

Further, all of the cost controls and protections, including the Medicare clause, are valid reconcilation measures. If the insurance companies start punishing people immediately, the Democrats can come to the rescue with any number of "emergency" measures, if they've got the brains and guts.

Posted by: Midland on December 15, 2009 at 3:40 PM | PERMALINK

Here's the problem with this reasoning:

The health care industry is basically spiraling out of control *right now*. And it's happening in the midst of a terrible recession. Pharmaceuticals cost $700 per person in 2004, and they're slated to cost $1,300 per person in 2013. Insurance premiums are going through the roof.

The CBO has correctly said that the insurance reforms in these bills will lower premiums for lots of people by a significant amount, but those cost curves are going to keep rising. So my fear is that, however many subsidies you hand out to people, and however many new people sign up for insurance (thereby driving costs down), the reason why the industry is so out-of-control in the first place is not really being challenged by bills like the Senate Finance Committee's.

So, if you ask, "What's more important, driving down costs, or saving thousands of lives by implementing insurance reform?" I'd say, well clearly they're both of the utmost importance, but which one carries the most political capital? Cost-containment. Unless normal people see their premiums start to go down (and keep going down), the Democrats will reap the whirlwind of having gone through a year of this bullshit just so they could pass a weak bill.

In other words, the Democrats have now taken ownership of this entire issue, and if the cost-control problem isn't solved, they're going to lose a lot of political capital.

The only way I see this working is if the Democrats now go on to pass an expanded Medicare buy-in (or a public option) via stand-alone reconciliation bill. Thing is, I doubt that's going to happen.

You can't just keep saying, "We'll keep fixing it as we go." That's a very risky game when you have a 3/5ths filibuster rule in the Senate that basically ensures that the only real reform that will get passed is watered-down and incremental. And when you've got the Republicans looking to be resurgent in 2010.

The reason I was so excited by the idea of a Medicare buy-in expansion in six months, was that this would be awesome for the Dems in 2010. It would rope in a bunch of older moderates and independents, who are the main group we need to appeal to right now. Now, unless things change, this isn't going to happen, and then the chances are slim that Obama will be able to pass through significant reform during the latter half of his presidency. His first year has already been a failure on the whole (although he's done some good things). He can't afford big losses in 2010.

Posted by: Zach on December 15, 2009 at 3:41 PM | PERMALINK

When liberals talked about the dream of universal health-care insurance 10, 20 and 30 years ago, they talked about the plight of the uninsured, not the necessity of a limited public option in competition with private insurers.

Ezra Klein is allowing conservatives to frame the liberal dream and he is wrong.

The liberal dream was for universal health-care, period, not universal health-care INSURANCE. It's an important distinction that is being buried by the notion that providers can't serve patients without a for profit beauracratic middle-man.

Posted by: Winkandanod on December 15, 2009 at 3:44 PM | PERMALINK

Given Congress' incestuous relationship with corporations the probability that even "health insurance reform" will be watered down, modified or not enforced is pretty high and rightfully expected. Loopholes created and inserted in order to benefit a favored contributor that launched a thousand lobbyists to pamper, seduce and persuade.

Congress does not have a high approval rating, be they democratic or republican for actually representing the American people and addressing issues.

The Dems have shown they are willing to remove anything that benefits the American people to appease executives and republicans. They caved easily there is no reason to assume they will not cave again and again and again in the future.

Posted by: Silver Owl on December 15, 2009 at 3:49 PM | PERMALINK

Sorry, but I can't sign on to universal coverage at any price. Zach is right. If Democrats ignore the cost-containment side, they will be rolled out of office and the GOP will gut the legislation.

Universal coverage is an ideal that I strive for. But America has been strong economically without universal coverage. But America cannot be strong without cost-containment.

Posted by: square1 on December 15, 2009 at 3:51 PM | PERMALINK

"The Dems have shown they are willing to remove anything..."

It makes no sense to punish the entire Party, hard core progressives included, for the actions of a few ConservaDems. This crap doesn't motivate me to stay home on election day. It motivates me to show up for the primaries.

Posted by: Chris on December 15, 2009 at 3:55 PM | PERMALINK

This is a really bad roller coaster ride with far too many ups, downs and sideways turns...enough to make me toss my cookies. I literally can't follow the discussion anymore about what's in the bill, what's gone, who's for it, who isn't, whether it's good or it sucks big time.
When I see the market numbers go up for health insurance and pharmaceutical companies, I'll know that the public lost this battle even if some dogturd of a bill got passed.

Posted by: VaLiberal on December 15, 2009 at 3:58 PM | PERMALINK

Arguments that not passing this Health INSURANCE Reform package because thousands will die is stupid.

We can make arguments all day that choices made here or choices made there by the government involve trade-offs that cost people lives. Healthcare INSURANCE Reform is no exception.

Is it a good bill?

Does the bill enhance Democratic Party chances to hold or increase their majorities?

Does it motivate the activists on the left to work for candidates and donate?

Does it impress the Independents and occasional Democratic Party voters to turn out in 2010 and 2012?

I'm thinking no to all these questions.

Posted by: pbriggsiam on December 15, 2009 at 4:03 PM | PERMALINK
The CBO has correctly said that the insurance reforms in these bills will lower premiums for lots of people by a significant amount, but those cost curves are going to keep rising. So my fear is that, however many subsidies you hand out to people, and however many new people sign up for insurance (thereby driving costs down), the reason why the industry is so out-of-control in the first place is not really being challenged by bills like the Senate Finance Committee's.
The public option wouldn't have done shit for cost control. Bending the cost curve means addressing the details of how healthcare is delivered and paid for; a public option is orthogonal to those things. The bill as it currently stands does have a host of programs aimed at cost containment, but the CBO doesn't score them because it's impossible to say which ones will work, and how well. The lack of a CBO score doesn't mean there aren't any cost containment efforts, though.

Atul Gawande has an excellent piece about this in the current New Yorker. Go read it all.

Posted by: Tom Hilton on December 15, 2009 at 4:03 PM | PERMALINK

Reading here what the "wonks" have to say leads me to say that they are full of shit. Passing this crappy "reform" because it is somehow better than nothing will not make the Democrats any more attractive in 2010 or 2012 than if it is allowed to die. I'm not buying the hyperbole.

Posted by: qwerty on December 15, 2009 at 4:07 PM | PERMALINK

Tom,

Political victories matter too. If you have time see my earlier comments above.

Posted by: pbriggsiam on December 15, 2009 at 4:07 PM | PERMALINK

Howard Dean purportedly said to kill the Senate bill.

http://www.dailykos.com/storyonly/2009/12/15/814742/-Howard-Dean:-Kill-the-Senate-Bill

My expectations are not high this will happen.

Posted by: pbriggsiam on December 15, 2009 at 4:10 PM | PERMALINK

Ezra Klein:

"With $900 billion in subsidies already in place, it's easier to add another hundred billion later, if we need it, than it would be to pass $1 trillion in subsidies in 2011. With the exchanges built and private insurers unable to hold down costs, it's easier to argue for adding a strong public option to the market than it was before we'd tried regulation and a new competitive structure. With 95 percent of the country covered, it's easier to go the final 5 percent. And with a health-care reform bill actually passed, it's easier to convince legislators that passing such bills is possible.

On its own terms, the bill is the most important social policy achievement since the Great Society. It will save a lot of lives and prevent a lot of suffering. But moving forward, it also makes future improvements and expansions easier. A lot of the hard work of health-care reform -- in particular, the money for subsidies -- will finish this year. If reformers want to come back for the public option or more subsidies in a future year, they won't be doing it atop a $900 billion price tag that's being battered by tea parties and industry and everyone else. This bill doesn't have all the good stuff it should have, but reformers can stand atop what good stuff it does have and focus their energies on what good stuff is left to achieve."

Posted by: Chris on December 15, 2009 at 4:14 PM | PERMALINK

Political victories matter too.

More than tens of thousands of human lives?

You're right that passing a bill that isn't pure enough for the lefty activists will tend to depress lefty activism. What you don't seem to get is that not passing a bill at all will depress activism and hurt the Democrats (good, bad, and indifferent) even more. If a progressive hissy fit succeeds in killing the bill, it might well make progressives feel less pathetically ineffectual, but in practical terms (which are, after all, the only terms that matter) it'll be a short-term and long-term catastrophe for progressives.

But those are just political calculations. In the end, what matters is whether it'll help people who need help. Imperfect as it is, in its present form the bill will do that.

Posted by: Tom Hilton on December 15, 2009 at 4:18 PM | PERMALINK

In other words, people who know what they're talking about say we should go ahead and pass the compromised bill, and people who are clueless say we should let it fail.

Dr. Howard Dean is "clueless"? He knows more about healthcare policy than you and all the inside the beltway/villager "wonks" combined.

Dean says kill the bill, and frankly I don't see much left worth supporting or getting excited about, and I don't see anything to "build on".

Posted by: Allan Snyder on December 15, 2009 at 4:19 PM | PERMALINK

"Arguments that not passing this Health INSURANCE Reform package because thousands will die is stupid. We can make arguments all day that choices made here or choices made there by the government involve trade-offs that cost people lives..."

This quote disgusts me.

Yes we can make such arguments all day. And, when actually applicable, we should--every time.

Posted by: Chris on December 15, 2009 at 4:21 PM | PERMALINK

I'm not a wonk, I'm not an activist. I'm someone that has been a loyal democratic voter since 1988. I do take a passing interest in reading blogs(get more news here than the paper), I like to stay informed and I also like to sense what other people are feeling about the events of the day.

That said. I can't see how anyone in their right mind thinks that the bill as it stands now would be a good thing for democrats. Pass a bill that basically makes people pay for something they don't have to pay for now is political suicide. Hello, people barely have the money to pay for groceries right now. And that doesn't even delve into the jobs issue.

If you don't think that Republicans can hammer home that simple message to voters all year long in 2010 you are sadly mistaken. You obviously didn't think Joe Lieberman would do everything in his power to kill this and keep his name in the headlines.

Posted by: Scott on December 15, 2009 at 4:23 PM | PERMALINK

I do not think these self-professed "wonks" have any grasp of reality. A Class V shit-storm is going to hit the Democratic Party when Americans realize that the solution to universal health care is...fining people if they don't buy unaffordable health insurance. Brilliant idea, that one. Maybe the Democrats can improve the bill by forcing me to buy a Ferrari, a slopeside Condo, and a few cases of vintage port.

Posted by: square1 on December 15, 2009 at 4:29 PM | PERMALINK

I support this bill and would vote for it, only because it seems it is the best we can get. But I am pissed off.

I'm not sure who I'm pissed off at yet -- Obama for his hands-off approach, the Dems for their feckless incompetence, the Repubs for their blatant evil, or America itself for its apparent inability to climb out of the drain that it is circling down.

Will my anger translate into electoral action or inaction? I can't say. Time, and hindsight, will tell.

Posted by: Remus Shepherd on December 15, 2009 at 4:34 PM | PERMALINK

Tom, you are correct that the reason why costs are rising so quickly is largely a result of the ways that providers and hospitals and drug companies have the incentive to provide more expensive care and less cheaper preventative care.

But my point was that I don't see how merely implementing health insurance reform will deal with this fundamental cost-containment problem over the long run. Over the long run, we need to get either a robust public option or expanded Medicare coverage set in place so that we're on the road to eventual single-payer. The way that Medicare is able to set cheaper rates for things like prescription drugs is the model we have to follow for cost-containment.

So if we expanded Medicare coverage, over the long run this would solve both our insurance access and quality problems and our cost problems. You correctly point out that the House bill's public option is so weak that it wouldn't initially do much to control costs (although the CBO itself said it would do some good). My expectation for either a P.O. or a Medicare buy-in is that this will get our foot in the door so that making them more effective will be easier and more popular.

Nate Silver wrote that, by the CBO's estimate, a family of four making $54,000 in 2016 would be paying $9,000 for health insurance under the Senate Finance Bill -- right now, they are paying around $7,500. That is not health care reform. Hell, people are royally pissed at how high insurance costs are right now -- and I don't foresee people being better off financially in six years than they are now, to be honest.

That situation will not fly, and eventually we will have to start rolling the ball towards single payer. My problem with these recent developments is that we're putting off that reality by hoping we have the votes in Congress to make the bill better from year to year (just like with Social Security and Medicaid, as Steve Benen pointed out). And my point is that this hopeful scenario fails to account for the fact that we are currently facing a cost crisis in the health industries, and are simultaneously facing a severe and lasting economic recession. Which is why I'm much less convinced that Benen is correct in what he's written here.

Posted by: Zach on December 15, 2009 at 4:43 PM | PERMALINK

MAYBE we should remember what Kennedy said. He would have taken Nixon's deal if he has known we would have spent ANOTHER forty years fighting for it. We COULD have spent those forty years making it BETTER. I am tired of the 'my way or the highway'...LET'S GET IT DONE!!!

Posted by: SYSPROG on December 15, 2009 at 4:51 PM | PERMALINK

"Arguments that not passing this Health INSURANCE Reform package because thousands will die is stupid. We can make arguments all day that choices made here or choices made there by the government involve trade-offs that cost people lives..."

And it disgusts you, Chris? You missed my point. By your rationale, the government is killing people every time it passes significant legislation - because there are opportunity costs/trade-offs to every decision we make as a society. The healthcare reform debate is no different.

Using your rationale I could dream up scenarios where your own support of this tremendously flawed bill in the Senate would kill thousands of people too - especially when it leads to Republicans kicking our ass in 2010 and 2012 and running the country deeper into the ground.

Stop using the "people will die - oh my God" argument. It is baseless.

Hey Tom,

Stop with the needless insulting langauge too. It undermines your rational thinking - albeit flawed perspective.

Posted by: pbriggsiam on December 15, 2009 at 4:54 PM | PERMALINK

MAYBE we should remember what Kennedy said. He would have taken Nixon's deal if he has known we would have spent ANOTHER forty years fighting for it. We COULD have spent those forty years making it BETTER. I am tired of the 'my way or the highway'...LET'S GET IT DONE!!!

Maybe we should ask Obama to offer Nixon's deal. It's a better deal than what we're looking at now.

Posted by: Glen on December 15, 2009 at 4:57 PM | PERMALINK

Do we still get subsidies for those without healthcare from work?

Do we still get to throw away pre-existing conditions crap?

What's in the current bill?

Posted by: Crissa on December 15, 2009 at 5:02 PM | PERMALINK

Zach,

First of all, you appear to have misread Nate's post. The 2016 figure is $4,000 for premiums and $5,000 in cost-sharing (for $9,000 total); the $7,925 present-day figure is for premiums only. So there is a projected reduction in premiums--not the increase you see.

Secondly, the Medicare model for cost-containment (i.e., lower reimbursement rates) doesn't do anything to address the things that actually drive healthcare costs; it's a short-term, brute-force 'fix' that doesn't really do anything for the long term. The same is true for even the most robust public option. The cost problem is a function of a whole lot of different factors that need to be addressed individually, and aren't susceptible to a global solution. The current bill does take a stab at addressing a lot of those individual issues.

Thirdly, single-payer is probably a pipe dream in this country--but if it is going to develop eventually, it'll be built not on the public option but on the exchanges, which are still in the bill.

Posted by: Tom Hilton on December 15, 2009 at 5:08 PM | PERMALINK

pbriggsiam, what insulting language?

Posted by: Tom Hilton on December 15, 2009 at 5:10 PM | PERMALINK

Reflexive counter-Broderism is no more reasonable than reflexive Broderism.

If you're going to kill your own bill just because it has been tainted by compromise, you're not going to accomplish much.

Posted by: Quaker in a Basement on December 15, 2009 at 5:15 PM | PERMALINK

Hi Tom,

This:

"If a progressive hissy fit succeeds in killing the bill, it might well make progressives feel less pathetically ineffectual..."

It's not what you say but how you say it.

I think you happen to be wrong but I don't throw in adjectives about so-called realist lefties as if they are weak-minded children.

Posted by: pbriggsiam on December 15, 2009 at 5:27 PM | PERMALINK

I would point out, that while the public option may have drawn enemy fire, keeping the subsidies, exchanges and other benefits from being gutted, we still don't have a fucking bill. Lieberman is still on the fence; so is Snowe; so is Nelson and Landreau. So, now that the bird is wounded, look to the rest of the opportunistic vultures to descend on it and eviscerate it cleanly. Failure. Not an option. A done deal.

Posted by: Charles Gerlach on December 15, 2009 at 5:33 PM | PERMALINK

Democrats have to win and they have to win with a popular bill. They can't fail to pass something now. Such a failure would energize the GOP base heading into the '10 elections. Democrats won't be turned out of office for supporting HCR; they will be turned out for supporting HCR and failing to pass HCR. The second element is that there must be something good in the bill. Obama is trying to stay so distant that he won't get scarred by whatever happens. Unfortunately if he screws this up he's looking at a possible GOP congress with subpoena power.

If you are going to fight, you had better win.

Posted by: rk on December 15, 2009 at 5:35 PM | PERMALINK

Look at the domains for all your "wonk" references.

I would suggest that what they really have in common has a lot more to do with where they work and who they work for, then their policy/politics orientation.

Posted by: tatere on December 15, 2009 at 5:55 PM | PERMALINK

Based on what I've read today, it seems like the "killers" and the "settlers" are focused on entirely different things. The former evaluate the forthcoming senate bill in terms of what it will do for insurance companies, and the latter evaluate it in terms of what it will do for the uninsured. I think system vs individual is a more operative fault line than idealist vs pragmatist or liberal vs moderate.

Posted by: Dan on December 15, 2009 at 6:00 PM | PERMALINK

If we outlawed the automobile, we could save 4 million lives over the next 10 years. So, lets all get behind a bill to do that.

Posted by: Patrick on December 15, 2009 at 6:26 PM | PERMALINK

We should pass this bill now, and then (without broadcasting our intentions) comeback next year and expand Medicare via reconciliation. I believe it would expire in 5 years, but once "Medicare for All" is in place, it's a losing issue for Republicans going forward.

Posted by: CJ on December 15, 2009 at 6:28 PM | PERMALINK

"Unfortunately if he screws this up he's looking at a possible GOP congress with subpoena power." - rk

I can't wait to see the strongly worded letters from the GOP when nobody shows up.

Posted by: Marko on December 15, 2009 at 6:39 PM | PERMALINK

Marko, I think that bills under reconciliation only sunset after 5 years if they increase the deficit.

Posted by: Andrew on December 15, 2009 at 6:58 PM | PERMALINK

How can a bill which requires everyone to buy insurance from private offerers, with no real competition from a PO, be something progressives should admire and support? (If that's how it will turn out.)

Posted by: delver on December 15, 2009 at 7:43 PM | PERMALINK

The point about drawing fire is well taken, EXCEPT that now that it is gone, the rest of the bill will draw Lieberman's fire. He doesn't want anything passed and he will keep finding fault with it until nothing is left. Then progressives get blamed.

Posted by: Texas Aggie on December 15, 2009 at 8:09 PM | PERMALINK

Thanks Steve. I've been waiting for you to write this post. You came down the way I thought you would and your calm, cool and collected way of observing the insanity makes it notable.

In the environment we are maybe it's just too much to expect that something this big would come down any easier or more overtly satisfying to the side trying to scale the walls.

Lieberputz is still an ass.

Posted by: burro on December 15, 2009 at 9:53 PM | PERMALINK

"I guess I'm discovering I'm a wonk. It's unthinkable to me that we could kill HCR when it will save lives -- upwards of 150,000 over ten years"

That's not what it will do, merely what it might do if not eviscerated -- which, due to the utter gutlessness of the Democratic Party and a resurgent right, it will be (barring divine intervention).

"If this is going to have such devastating consequences in the next ten months, why do you think the Democrats are going to be the ones taking the blame?"

It's what they're for. They don't take action, they are acted upon. (Anybody remember wexlerwantshearings.com? Anybody seen Wexler lately? All I got out of him was spam.)

Posted by: Forrest on December 15, 2009 at 10:59 PM | PERMALINK

Settle for political reasons: a win is a win and if the GOP stops this they have momentum all the way to Nov. 10. There's a difference between being disappointed and angry at Obama and Reid and letting the GOP get back in.

Kill for policy reasons. For all the baby steps, we'll fix it later hopefulness that some are advocating, this bill is a fork in the road on putting private healthcare insurance (a colossal parasite on the economy) on the path to extinction or propping it up for another generation. Minus the public plans the HCR bill props up the private insurers.

Finally, even if passing the bill is good politics, it's good politics to get mad as hell at the leadership for their slowplay bait and switch on the public option. Maybe fence sitting senators can feel good, although that's probably overplayed, but more importantly a big ankle grab here by the liberals won't get us anything. Pelosi gave Obama a war bill, he came back for another. Congress gave Bush a big bailout, Obama came back for more.

Take a cue from Lieberman who showed that it's better to be feared for what he might do than respected for his loyalty.


Posted by: angler on December 15, 2009 at 11:38 PM | PERMALINK

Put the public option back in and let ANY or all of the conservative "Democratic" Senators and the Republicans kill it. Then we will have them right where we want them: OUT OF OFFICE.

Posted by: Doug on December 16, 2009 at 1:24 AM | PERMALINK

What is the Senator from Tel Aviv's real goal? Foriegn policy clout most likely. Health care stuborness is the way there. Just what the world needs now.

Posted by: ToMae on December 16, 2009 at 3:58 AM | PERMALINK

Steve, I think you're the best, but please don't describe Cohn, Klein, and Silver as "progressive wonks". An Obama supporter is not, ipso facto, a progressive, as each of these pundits has demonstrated.

As one poster wrote, is there any bill that would be unacceptable to them?

Social Security and Medicare relied at their core on the government doing something for people. That element is missing from this bill, which does nothing more than permanently enshrine private industry as our "health care" overseers, with no governmental role, which is why real progressives are abandoning it.

Posted by: Mike70 on December 16, 2009 at 9:25 AM | PERMALINK

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Posted by: Rico on March 3, 2010 at 11:07 AM | PERMALINK

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U wilt geld lenen zonder BKR toetsing? De opties hiervoor worden groter, kijk verder en ontdek hoe u wél geld kunt lenen, snel & eenvoudig.

Posted by: lenen on August 4, 2010 at 3:02 PM | PERMALINK

Only two things are infinite, the universe and human stupidity, and I'm not sure about the former.

Posted by: Janne Marrisrgd on November 15, 2010 at 9:46 AM | PERMALINK

Resources like the one you mentioned here will be very handy to me! I will post a link to this page on my blog. I am sure my website visitors will find that very handy. My best wishes, Arnita.

Posted by: Arnita on November 22, 2010 at 10:01 PM | PERMALINK

I love quotations because it is a joy to find thoughts one might have, beautifully expressed with much authority by someone recognized wiser than oneself.

Posted by: Best Man Speech Ideas Keys on November 25, 2010 at 10:38 AM | PERMALINK




 

 

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