March 18, 2010
THREADING AN IMPOSSIBLE NEEDLE.... It's probably an esoteric point, but it's worth pausing to appreciate just how ridiculously challenging it was to craft this health care reform proposal. There's a very good reason this legislation has never passed up until now, and why presidents who've tried have failed, and it goes beyond just right-wing hysterics and corporate pushback.
Think about the scope of the task -- Democrats were told they needed a health care reform bill that spends a lot of money on covering the uninsured, lowers the deficit, strengthens Medicare, helps businesses, eases government budgets, protects consumers, and controls costs, all at the same time. It would also need to earn the blessing of Congressional Budget Office, the American Medical Association, the AARP, and the nation's largest labor unions.
Democrats were also told they needed to do all of this in the face of unanimous and apoplectic Republican opposition, far-right manipulation of gullible conservative activists, and media coverage that largely ignores the substance of the bill while pretending every right-wing attack deserves attention.
This is a needle that's almost impossible to thread. And yet, that's exactly what the White House and congressional leaders have done. It's no small feat.
But it might yet fail anyway, in part because some Dems prefer cowardice to success. Ezra Klein does a nice job setting up the substantive dilemma facing Democratic lawmakers who are thinking about siding with far-right Republicans to kill the legislation.
If you're a liberal House Democrat, here's what you'd be voting against: Legislation that covers 32 million people. A world in which 95 percent of all non-elderly, legal residents have health-care coverage. An end to insurers rescinding coverage for the sick, or discriminating based on preexisting conditions, or spending 30 cents of each premium dollar on things that aren't medical care. Exchanges where insurers who want to jack up premiums will have to publicly explain their reason, where regulators will be able to toss them out based on bad behavior, and where consumers will be able to publicly rate them. Hundreds of billions of dollars in subsidies to help lower-income Americans afford health-care insurance. The final closure of the Medicare Prescription Drug Benefit's "doughnut hole."
If you're a conservative House Democrat, then probably you support many of those policies, too. But you also get the single most ambitious effort the government has ever made to control costs in the health-care sector.
Greg Sargent added, "The House Dem leadership's game plan all along has been to tell wavering conservative Democrats who voted No last time that they have now gotten their way -- a bill with no public option, a bill with stronger cost controls, a bill that's more fiscally responsible, etc."
In a divided Democratic caucus, featuring liberals and conservative Blue Dogs, the trick was to find a way to deliver on what both contingents wanted to see in a reform bill. As impossible as this seemed, the final Democratic reform proposal does just that.
I have no idea what's going to happen when the final roll call is held, but Democrats have no reason, no excuse, no coherent rationale for killing the best chance the United States has ever had to pass health care reform.
—Steve Benen 2:20 PM
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"...Democrats have no reason, no excuse, no coherent rationale for killing the best chance the United States has ever had to pass health care reform."
Unless they are corporately owned!
Posted by: AngryOldVet on March 18, 2010 at 2:25 PM | PERMALINK
If only there had been some simpler, smaller bill, say...30 pages, that extended Medicare to all.
Posted by: NTodd on March 18, 2010 at 2:30 PM | PERMALINK
Democratic lawmakers who are thinking about siding with far-right Republicans to kill the legislation
This is a bullshit frame. They're not siding with the far right. Sorry votes are binary, but saying this is akin to saying anti-war folks side with terrorists. I expect better from you.
Posted by: NTodd on March 18, 2010 at 2:32 PM | PERMALINK
>>>I have no idea what's going to happen when the final roll call is held, but Democrats have no reason, no excuse, no coherent rationale for killing the best chance the United States has ever had to pass health care reform.
Hear! Hear! The ball is in the Dem's court!
Posted by: ted on March 18, 2010 at 2:34 PM | PERMALINK
But clearly if Obama TRIED harder we'd get PerfectPony Health Care instead, not this horrible horrible bill! If the people demand it, it just happens, it's so easy to work the process!!!! Power to the people, power to the people, yeah.
Posted by: Wellington R. Smythe on March 18, 2010 at 2:37 PM | PERMALINK
I'm still having a hard time believing that somebody could run and get elected as a Democrat, and then even consider voting against this legislation. Voting against this HCR bill would be bait-and-switch of the highest order.
Posted by: Chris on March 18, 2010 at 2:38 PM | PERMALINK
Is it true that Obama made a secret deal last year to kill the public option? I guess that explains what happened to any progressive reforms in the bill.
Posted by: AnneD on March 18, 2010 at 2:39 PM | PERMALINK
It does seem ironic that we have to pass a flawed bill in order to fix the bill. I don't know why we couldn't have just passed a "medicare for all" bill to begin with.
Posted by: Gracious on March 18, 2010 at 2:40 PM | PERMALINK
This is a bullshit frame. They're not siding with the far right.
Really? Then who are they siding with? What is different about their opposition than the Party of No?
I'll give you the Congressional Hispanic Caucus; they have a legit issue. But now that the most notable hold-out from the left is voting 'yes' (Kucinich), I don't think the accusation is out of line.
Lynch certainly isn't claiming the Cadillac Tax is the problem out of some overwhelming pro-labor stance: the unions support a yes vote.
Any proof that the remaining holdouts you defend are somehow more noble than the Boehners and Cantors of the world?
Posted by: zeitgeist on March 18, 2010 at 2:42 PM | PERMALINK
Really? Then who are they siding with?
Siding with states that want to be able to establish their own single-payer systems without Federal interference, for one.
Posted by: NTodd on March 18, 2010 at 2:49 PM | PERMALINK
Any proof that the remaining holdouts you defend are somehow more noble than the Boehners and Cantors of the world?
I wasn't defending anybody specific. The frame has been around before DK switched, and it's still bullshit. People have different reasons and when there's a binary choice, it makes it easy for you to ignore the nuances and other ideas.
Posted by: NTodd on March 18, 2010 at 2:51 PM | PERMALINK
But clearly if Obama TRIED harder we'd get PerfectPony Health Care instead, not this horrible horrible bill!
I'd submit if we the people had collectively tried harder through escalating, strategic direct action, we'd have single-payer.
Posted by: NTodd on March 18, 2010 at 2:52 PM | PERMALINK
People have different reasons and when there's a binary choice, it makes it easy for you to ignore the nuances and other ideas.
Hypothetically speaking, yes. But these aren't hypotheticals, these are actual assholes. More than half of the non-Yes Dems that The Hill is tracking are still spouting unsupportable Republican talking points that are provably wrong (the anti-choice crowd) or unsupported by the best evidence (the "we cant afford it" crowd).
Although you didn't name names, even assuming someone is using your defense -- state freedom for single payer -- due to the pervasiveness of the federal hand through Medicare, Medicaid funding, regulations, etc. a state won't have any real autonomy to do single payer without this bill and arguably the best chance for state-based single payer programs would be through the pilot programs the HCR bill permits.
No, still not buying it. The preponderance of no-voting Dems are just being difficult, cowardly, Republican-esque pricks.
Posted by: zeitgeist on March 18, 2010 at 2:58 PM | PERMALINK
It's a horseshit corporate give away of a bill and the Dems are going to pay dearly for it. So will the true progressives and most of the rest of the country in the long run.
Posted by: par4 on March 18, 2010 at 3:00 PM | PERMALINK
I'd submit if we the people had collectively tried harder through escalating, strategic direct action, we'd have single-payer.
And a pony? Please? Pretty please?
I'm 100% with you in terms of what would be desirable. I just think there's no way to get there without intermediate steps, and this is one of them.
Posted by: Crusty Dem on March 18, 2010 at 3:05 PM | PERMALINK
I'd submit if we the people had collectively tried harder through escalating, strategic direct action, we'd have single-payer
Why do you act as if it's over? Who has given up here?
Posted by: Christopher on March 18, 2010 at 3:06 PM | PERMALINK
"Corporately owned" is a big load of bullshit.
It's about juggling chainsaws. On one hand, you have all the people who don't have health care/understand the problems inherent in the system/etc. On the other hand, you have the corporati...
No. Not really. On the other hand you have all the people who work for the current insurance industry, you have people who have real investments in the markets who rely on the status quo to continue (even if they don't realize it), all the people who believe that success should have certain rewards (like better health care).
This isn't "corruption". It's the fact that a good portion of the voting populace are selfish to a fault, and even if they say that maybe they prioritize health care, well look at the tantrums that occur if the Dow drops or their home value drops.
Posted by: Karmakin on March 18, 2010 at 3:08 PM | PERMALINK
Are some people actually arguing that Obama, the Dems, the GOP, and the insurance companies are all engaged in some giant kabuki, and that they are all secretly on the same page in "handing over" the middle class to insurance companies?
And I thought the teabaggers who said Obama was born in Kenya were irrational conspiracy theorists..
Posted by: Archon on March 18, 2010 at 3:10 PM | PERMALINK
"Really? Then who are they siding with?
Siding with states that want to be able to establish their own single-payer systems without Federal interference, for one."
Did they take that out? Too bad.
But I'll tell you what: California is still going to go for single-payer and then sue in federal court.
The fight is not over. It has just begun.
Posted by: bdop4 on March 18, 2010 at 3:12 PM | PERMALINK
"It would also need to earn the blessing of Congressional Budget Office, the American Medical Association, the AARP, and the nation's largest labor unions."
Plus, it appears the drug companies -- and a few others. I think if this is successful, and I pray it will be, people will look at this as a victory of historical proportions where the Obama Administration, having learned the mistakes of the past (eg Clinton), succeeded in dividing the opposition.
That said, PTDB. No Dem (or liberal for that matter) can be against this.
Posted by: leo on March 18, 2010 at 3:13 PM | PERMALINK
I don't know why we couldn't have just passed a "medicare for all" bill to begin with.
Because they didn't have the votes.
Posted by: Allan Snyder on March 18, 2010 at 3:13 PM | PERMALINK
I'd submit if we the people had collectively tried harder through escalating, strategic direct action, we'd have single-payer.
I'd submit that you are floating gently and euphorically in a reality-barring ether where legislation makes itself, free of the corporate influence, human frailties and cultural resentments that dog the system in which we're currently actually working.
Siding with states that want to be able to establish their own single-payer systems without Federal interference, for one.
Oh, for Christ's sake. Next.
Posted by: shortstop on March 18, 2010 at 3:15 PM | PERMALINK
Are some people actually arguing that Obama, the Dems, the GOP, and the insurance companies are all engaged in some giant kabuki, and that they are all secretly on the same page in "handing over" the middle class to insurance companies?
It's triple quadruple reverse psychology, real high level ninja stuff, you wouldn't understand.
Posted by: Allan Snyder on March 18, 2010 at 3:17 PM | PERMALINK
Because they didn't have the votes.
But...we could get them. If we believed. You people just don't believe. You compromised away our belief while we were busily believing. Shame. Shame.
Posted by: firebagger #9 on March 18, 2010 at 3:17 PM | PERMALINK
It's hard for me to oppose the bill when I go over to FDL and read how Stupak is a courageous man of principle, while Donna Edwards and Dennis Kucinich are corporate-whore sellouts. It's also hard for me to oppose it when they call it "fascist."
Posted by: Christopher on March 18, 2010 at 3:18 PM | PERMALINK
I hope the fight is not over. If we get Meg Whitman as governor in California she will veto single payer the same way that Arnold did. Arnold vetoed the bill twice! This nightmare would be over for California right now. I wish Jerry Brown would begin to campaign and not take his win for granted, because there is a very large "nut factor" in California.
Posted by: Gracious on March 18, 2010 at 3:20 PM | PERMALINK
It's also hard for me to oppose it when they call it "fascist."
You know, I was kinda defensive of the Senate bill's critics, because it's far from my ideal bill either. But this is the only way forward, and the folks on "our side" who are saying the exact same ridiculous things as those on the right deserve to be dimissed as "firebaggers". Totally disconnected from reality.
Posted by: Allan Snyder on March 18, 2010 at 3:22 PM | PERMALINK
I'd submit that you are floating gently and euphorically in a reality-barring ether... -shortstop
Lake Michigan?
Posted by: doubtful on March 18, 2010 at 3:47 PM | PERMALINK
This bill, when it passes, will be the most progressive thing Congress has done in my lifetime. Period.
Things the bill doesn't do are totally uninteresting, unless the question is "those things the health care bill doesn't do, how can we do them next?"
Posted by: mcc on March 18, 2010 at 3:53 PM | PERMALINK
My dear, either you don't know what "euphoric" means or you've been swimming in the lake less recently than I have.
Posted by: shortstop on March 18, 2010 at 3:53 PM | PERMALINK
People have different reasons and when there's a binary choice, it makes it easy for you to ignore the nuances and other ideas.
Posted by: NTodd on March 18, 2010 at 2:51 PM
And I'm supposed to give a flying duck about that non-binary nuance? My donut hole will be, somehow, more nutritious, because you had my best interests in your heart? My uninsured hell will be, somehow, less hot, because your intentions were good, when you were paving it, unlike those bad intentions of the right-wing? And all I have to do to die happy is to perceive the subtleties in the difference?
Posted by: exlibra on March 18, 2010 at 4:47 PM | PERMALINK
exlibra wins the thread.
(mental note: do not cross exlibra. . .)
Posted by: zeitgeist on March 18, 2010 at 4:52 PM | PERMALINK
Threading needles is very difficult if one lacks opposable thumbs.
Threading legislative needles is also very difficult if one lacks balls.
Public option would have saved everybody except the insurance companies.
Posted by: David on March 18, 2010 at 5:58 PM | PERMALINK
"Think about the scope of the task -- Democrats were told they needed a health care reform bill that spends a lot of money on covering the uninsured, lowers the deficit, strengthens Medicare, helps businesses, eases government budgets, protects consumers, and controls costs, all at the same time. It would also need to earn the blessing of Congressional Budget Office, the American Medical Association, the AARP, and the nation's largest labor unions.
This is a needle that's almost impossible to thread. And yet, that's exactly what the White House and congressional leaders have done."
Yeah, except for the part about helping the uninsured, strengthening medicare, protecting consumers, and controlling costs. In short they managed to thread the needle for everything but the things the left actually wanted. But industry giveaways? Shit yeah they nailed that one. Meaningless regulations with giant loopholes and no enforcement. Yep, it's in there.
The only thing this bill is missing is anything worth actually voting for. But that's okay because "not worth voting for" is apparently the new dem mantra. We'll see how that works out for them.
Posted by: Tlaloc on March 18, 2010 at 9:00 PM | PERMALINK
"And I'm supposed to give a flying duck about that non-binary nuance? My donut hole will be, somehow, more nutritious, because you had my best interests in your heart? My uninsured hell will be, somehow, less hot, because your intentions were good, when you were paving it, unlike those bad intentions of the right-wing? And all I have to do to die happy is to perceive the subtleties in the difference? "
A perfect example of why you're an idiot. Your uninsured hell is going to be exactly the same after this bill passes (except you'll be paying for insurance you can't use) precisely because you can't distinguish between those who want the status quo and those who want something better.
Progressives want something better, and we damn well know this bill is something worse, and makes the better thing impossible to get to. But you're too busy being blindly self righteous to notice. And so you frankly deserve the hell you're in because you're trapping me in it as well.
Posted by: Tlaloc on March 18, 2010 at 9:04 PM | PERMALINK
"A perfect example of why you're an idiot."
Grow up. Name-calling and throwing up long-ago debunked nonsense do not win a debate.
And don't talk about what progressives want, because you clearly aren't one. We progressives want *progress*, rather than a poorly conceived excuse to simmer in our own self-righteousness.
Posted by: Shade Tail on March 18, 2010 at 9:39 PM | PERMALINK
And so you frankly deserve the hell you're in
I think I saw something like this already this week. . . oh yeah, it involved teabaggers and someone with Parkinsons. Its so hard to tell the difference.
Posted by: zeitgeist on March 18, 2010 at 9:44 PM | PERMALINK
"Grow up. Name-calling and throwing up long-ago debunked nonsense do not win a debate."
long debunked = "we don't want to hear it."
"We progressives want *progress*, rather than a poorly conceived excuse to simmer in our own self-righteousness."
Then why is simmering in self righteousness all you do? And why do you do it while championing a bill that takes us immeasurably backwards?
If you want progress why aren't you actually fighting for it instead of attacking us progressives who have?
Oh right. Because you're progressives in the same sense as Obama- when you want something from us...
Posted by: Tlaloc on March 18, 2010 at 11:29 PM | PERMALINK
"I think I saw something like this already this week. . . oh yeah, it involved teabaggers and someone with Parkinsons. Its so hard to tell the difference. "
Well that's hardly surprising, you guys suck at making distinctions. Oh and separating fact from fiction. You really blow chunks on that score.
Which is exactly why you are blindly supporting a bill that shits all over you. Authoritarian cultism is apparently just as strong on the right as left.
Posted by: Tlaloc on March 18, 2010 at 11:32 PM | PERMALINK
"Nobody expected" Corporate insurance salespeople like Steve Benen to have had such a pernicious influence on progressivism.
Selling US CORPORATE insurance and masquerading it as something progressive will set back the attempt at REAL healthcare by decades.
This is NOT 'healthcare', at best it's INSURANCE 'reform', except the 'reform' comes at the price of forcing millions to buy shtty CORPORATE insurance from the same predators that have been scrwing US for decades.
Corporate insurers will use their billions in MANDATED profits to pick off any politicians that keep insisting on real "change".
Those that think this will be 'fixed' later are either deluded or lying.
Tlaloc's correct: "Authoritarian cultism is apparently just as strong on the right as left."
It's NAFTA all over again: Bad policy and worse politics.
Posted by: Annoyed on March 19, 2010 at 2:17 AM | PERMALINK
PAY ATTENTION TO MEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Posted by: Tialoc on March 19, 2010 at 7:56 AM | PERMALINK
"And I'm supposed to give a flying duck about that non-binary nuance? My donut hole will be, somehow, more nutritious, because you had my best interests in your heart? My uninsured hell will be, somehow, less hot, because your intentions were good, when you were paving it, unlike those bad intentions of the right-wing? And all I have to do to die happy is to perceive the subtleties in the difference?"
Well, I didn't realize this massive health care bill was all about you. I thought it might attempt to be about the whole country, those of us with health care currently, and those without... Somehow, we have to figure out how to help the ones without insurance while not screwing over those with insurance, you selfish prick.
Posted by: PCR-87 on March 19, 2010 at 12:13 PM | PERMALINK
I don't know why we couldn't have just passed a "medicare for all" bill to begin with.
Not only because we couldn't get the votes but without the rest of the bill, the whole system goes kaplooey, Medicare and Medicaid first, then the US.
There really are many provisions to fix the awful system that is the worst of the "first world" countries. While people obsess about the 45,000 who die due to lack of care, they ignore the 198,000 who die each year from in hospital PREVENTABLE medical errors and the 30,000 killed by unnecessary ineffective procedures.
Thus, the provisions in this bill that work to reduce the medical errors and the unnecessary procedures will be of more (numerically) importance that the coverage provisions. True, but not obvious: improving quality reduces health care costs.
Changes in financing can be fast and quantifiable. Changes in provision of care will be slower and unquantifiable, but ultimately will impact the amount of financing needed from us all.
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