Notes On the Health Care Battle: Dust and Smoke

Only vague first impressions; it’s difficult to get any real perspective while so much dust and smoke hangs in the air after the conflagration.

Paul Krugman, before the vote:

So what’s the reality of the proposed reform? Compared with the Platonic ideal of reform, Obamacare comes up short. If the votes were there, I would much prefer to see Medicare for all.

For a real piece of passable legislation, however, it looks very good. It wouldn’t transform our health care system; in fact, Americans whose jobs come with health coverage would see little effect. But it would make a huge difference to the less fortunate among us, even as it would do more to control costs than anything we’ve done before.

This is a reasonable, responsible plan. Don’t let anyone tell you otherwise.

Republican David Frum on the political fallout:

At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo – just as healthcare was Clinton’s in 1994.

Only, the hardliners overlooked a few key facts: Obama was elected with 53% of the vote, not Clinton’s 42%. The liberal block within the Democratic congressional caucus is bigger and stronger than it was in 1993-94. And of course the Democrats also remember their history, and also remember the consequences of their 1994 failure.

This time, when we went for all the marbles, we ended with none.

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.

Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views? To finance it without redistributive taxes on productive enterprise – without weighing so heavily on small business – without expanding Medicaid? Too late now. They are all the law.

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

Meanwhile, nobody seems especially happy with it. That’s one part of the PR scheme that remains perplexing. Surely enough, the Socialists are sputtering suspicion and complaint. The Republicans are providing some interesting fare. Suffice to say they’re not happy. Nobody is. What slays me right now is how some would portray this moment. And, maybe in the long run, it will turn out to be a pivotal bill on which a nation’s future hinged. At best, it has inserted the idea of health even further into the public discourse. It is as if we have achieved an abstract threshold: from this point on the health care debate will take place in a new context, one in which the federal interest is standing law. This, more than anything, is what Democrats are celebrating. The specifics of the bill? Let us hope Krugman is correct. But nobody seems particularly pleased with the outcome, except perhaps that seeming fringe element among conservatives that are laughing with glee: They passed it! That’ll show ’em! Now we’ve got ’em right where we want ’em ….

Which is also the down side of this vote. These conservative theatrics and shenanigans are likely to go on for a while.

In the meantime, we’ll see what comes. The fireworks definitely aren’t over on this one. Not with an election season coming up and the GOP having nothing to show—and the spectre of opposing banking reform haunting them as the Democrats push forward with the Dodd bill—for their McConnell Plan for steadfast oppositional posturing. They will be fighting an uphill battle, to say the least.

The first immediate change, then, will be not in the political rhetoric itself—that will take some time—but in the shifting of presumptions. Fighting against established law is difficult enough in itself, but as Frum notes, Republicans will find themselves in the uncomfortable position of suing against health coverage, or voting to repeal even the most desirable and saleable parts of the reform bill. While any number of social programs have included recognition of a society’s obligations toward people’s health, the present reform bill, for all people seem to wish to hold it at arm’s length, installs the general consideration of health care and healthy conduct permanently into the whole range of American political argument. Indeed, among the left, this seems to be the underlying cause for celebration.

And here we might encounter a strange consideration of the American political character, a strange form of amnesia that has often driven me proverbially batshit. Namely, people’s historical recollection seems askew in the United States. By early 2008, one would have thought that history—war, terrorism, finance, energy, taxes, everything—started in January, 2007. Democratic Congress, Democratic problem. And while it is their problem to dig out of the troubles visited on us by their predecessors, it seemed unproductive, at least, to blame them for the fact that the problems exist, especially when such rhetoric only subverts any chance of progress in the issue. We saw it again with the bailout after Obama’s inauguration. Some would have us think that the economy didn’t collapse until about January 21, 2009.

How will this play out for the Republicans come autumn? Will November be a referendum on health reform, or a rebuke of the GOP’s stubborn refusal to let go of a battle they already lost? That question hinges on whether the swing blocs hang with the Tea Party, or follow the more consistent American pattern of accustoming themselves to the way things are, and reorienting their perspectives accordingly. Admittedly, compared from the transition from Drug War into the War on Terror, the idea of reforming our health care complex in the United States seems to scare the bejesus out of some folks for its unprecedented scale. But even that seems an absurd proposition. To the one, You have the right to receive useful medical care. Oh, for shame! To the other, You have the right to … um … er … well, you’re under arrest, and you have no rights.

So when I see and hear protesters screaming for Obama and the Democrats to give them back their country, I do stop to wonder, “Really?” It’s one of those things that has to be witnessed in real time. The slow-moving beast shudders to life, roars an absurdity, and glares out at whatever camera eye might be on hand to witness. The idea that an insurance company cannot cheat you out of your premiums and refuse to perform its obligations at the moment in which you most need them is the America you want back? Government is such an easy scapegoat that people don’t think about it anymore. They’re afraid of being screwed by the government, so they will, petulantly, declare that they will not be screwed over at all, unless it is by a private enterprise, and God bless America.

Government is an easy target, but people need to consider the underlying social contract. Yes, it is an unwieldy and often tiresome beast, but nobody we elect is going to do the job right without the People constantly hounding them toward propriety. And as history shows yet again, and as we might only hope people figure out in real, applicable dimensions in the near future, the Chicken Little strategy just isn’t effective when important issues are on the line. It isn’t effective when scrutiny will undermine the complaint. For everything, the sky was falling. The very idea of health reform was denounced by protesters as white slavery; the vociferous complaints of the GOP about the art of the filibuster disappeared in a storm of sound and fury as Republicans forsook anything resembling an affirmative agenda, earning a reputation as the “Party of No“. The idea of maneuvers around obstructionism were the end of the world, to be sure, and ending with an irony among ironies. As the deem and pass controversy erupted, an associate wrote that the Democrats “now have settled on a last ditch strategy to pass it without really voting on it”.

I don’t drag this up to gloat; I already have. But something about how that went down just doesn’t seem right. Michael W. McConnell wrote for the Wall Street Journal:

Democratic congressional leaders have floated a plan to enact health-care reform by a procedure dubbed “the Slaughter solution.” It is named not for the political carnage that it might inflict on their members, but for Rep. Louise Slaughter (D., N.Y.), chair of the powerful House Rules Committee, who proposed it. Under her proposal, Democrats would pass a rule that deems the Senate’s health-care bill to have passed the House, without the House actually voting on the bill. This would enable Congress to vote on legislation that fixes flaws in the Senate health-care bill without facing a Senate filibuster, and without requiring House members to vote in favor of a Senate bill that is now politically toxic.

It was the end of the world this time for sure. Even allegedly liberal-biased newspapers pled with Speaker Pelosi to not follow the deem and pass route. Editorial cartoonists certainly had their say.

But the Democrats cobbled together a majority and put that whole question to shame. And what we see in my associate’s assuredness, in the irony of McConnell’s discussion of the “Slaughter solution”, is a conservative bluff overplayed. They set themselves up so that the final smack in the face was a majority vote in the House of Representatives. All of that fear, all of that panic and fury. The difference between today and this time last week is that a national health care interest is now established law, and the best Republicans have in fighting back against reform is to tear open the doughnut hole, fight to cancel people’s coverage, and support desperate lawsuits and legislative maneuvers intended to declare to various voters in the states that their representatives won’t let reform and health security anywhere near the people.

It is, actually, rather a large difference, at that. Whether or not any of the myriad political lessons this episode offers will be learned remains to be seen. But the GOP must realize that there are limits to phobic populism. Far less certain even than that is whether or not the Democrats will ever learn that there comes a time when they have to step up and do the job. And that includes forging a good bill out of the fires of Congressional chaos. This whole routine of grudgingly voting for a bill you don’t really like is getting old. Stop compromising with clearly unreasonable elements that only wish to stem the tides of inevitability. Certain things must be done. The prescriptions for cure may be many and mysterious, but the one that will never do is the same regimen that brought us to our troubles in the first place.

And so it goes. President Obama may have secured his place in history, but only time will tell how that station is defined.