Obama, Progressives and Health Care Reform

In the last few weeks, a variety of groups have been more forthright in expressing criticisms of the Obama administration now that it is more than half a year old, and disquiet in particular about the direction of the health care reform debate and legislation. The right has risen up with increasing virulence, and its ability to turn out some loud shouters at town hall meetings around the country came in recent days to dominate the media narrative about health care reform. It's far from likely that their angry rejectionism, resonating with ridiculous charges of socialism, communism, fascism, you name the -ism, and tinged in too many places with the familiar -ism of racism, will carry the day, that it represents more than a vocal disaffected fringe, or that it won't boomerang against them, as so much of the right's reaction to candidate and President Obama has. But at the moment it seems to have left a mark, and shifted the story line to "health care in trouble."

The left is increasingly worried that the President is too quick to compromise and insufficiently directive about what he wants in a final bill. Many don't like the deal he struck with the drug companies, which at the time it was announced some weeks ago produced a bit of grumbling, but was mostly seen as a deft move to bring a big and potentially disruptive player into the health care reform tent. They worry that the public option, which has somehow come to seem -- wrongly, in my view -- as the only meaningful measure of significant reform, as opposed to the best but not the only means of checking the insurance companies, is about to be thrown over the side of the leaky ship.

Some call the President naïve for thinking he could ever rise above partisanship and bitter division, and want him to be more fiery, leading progressive forces into intense battle with enemies to whom no quarter should be given. This criticism dogged Obama during the campaign, and he ignored it, going steadily on his way. When things are looking good it is muted. Not so much at times like the last few weeks. In addition, whatever their personal admiration for the President, many influential voices on the left have never seen him as a sufficiently ideological figure, and since his inauguration have been lamenting his failure to seize the Rooseveltian moment to forge transformational change, particularly with respect to the financial system. Paul Krugman's op-ed in today's New York Times is the quintessential expression of this concern (though outrageously framed in terms of whether Obama can be "trusted," raising to the level of a character issue what is a legitimate set of differences on strategy, if not ideology).

The center, at least that part of the population that is engaged in political life but not sharply ideological or partisan, also seems restive. They seem to think that the mistake the President has made is in deferring to liberals in Congress, particularly Speaker Pelosi and the House, and that he is wrong in relying on his strong November vote and personal popularity, exploiting the economic crisis and the desire for corrective action, to push a much-too-bold agenda, expanding the social welfare net in a way that further mortgages the nation's future with excessive spending. You get a bit of this from David Brooks, and also from slightly right-of-center European outlets like The Economist and The Financial Times.

The President and the people around him could be forgiven some frustration over these mirror-image critiques, since the advice they get with increasing decibel intensity - expected and moreover welcome in a democracy -- is often contradictory, and in some cases at odds with the known record. (For instance, remarks over the weekend by the President and Secretary Sebelius reaffirming support for the public option but refusing to declare it non-negotiable varied not a bit from what the administration has been saying for months, but in the more intense media environment were portrayed as a concession, sending already-unsettled liberals into panic mode. At the same time, I heard a prominent Democratic fundraiser and investor, an Obama supporter, complain in a small gathering recently that the President needed to argue for health care in terms of the unsustainable cost to the economy of continuing the status quo; those of us listening to him were at some pains to gently remind him that this has been a central and consistent tenet of Obama's message since the Presidential debates.)

Many across the political spectrum, at least from center to left, have had a tendency since Barack Obama first appeared on the scene a few years ago, to read into him their own views and aspirations. While pandering and triangulating less than any politician in memory - for instance, maintaining boldness and integrity on a range of foreign policy issues from Cuba to the Middle East -- Obama has somehow managed a pretty long run of keeping these disparate actors satisfied. (For example, at a dinner a few months into the administration, when our host went around the table asking for ratings, all gave high marks to the President, from Peace Now types to hardline Israel supporters, from those like myself perturbed at the insufficiency of financial reforms to libertarians upset that he might restrict executive compensation.)

This balancing act - which says more about us than Obama, I think - is getting harder to sustain, but if expectations are hitting reality, perhaps they were unrealistic from the start. If you look carefully at what Obama has been saying all along, he has never believed his own hype, and indeed has warned, correctly, that there will be very tough times when his political capital will be low. As he told Richard Wolffe, who chronicled his Presidential campaign in the recent Renegade,

"...you're always more popular before you're actually in charge of things. And then, once you're responsible, then you're going to make some people unhappy. That's just the nature of politics. And these things go in cycles. Even during the course of this campaign, there have been months where I'm a genius and there are months when I'm an idiot. At least, if you read the newspapers."

Unfortunately, few progressives have as wide a frame as Obama, or as steady a constitution. When things get rough, as they inevitably have with health care - was anyone naïve enough at the start of this to think the increasingly base-bound Republican Party would lie down and play dead? That Max Baucus and Ben Nelson and Kent Conrad and the like would simply take marching orders from the White House? That the 24-7 gladiatorial media culture would not break out in a frenzy at signs of conflict? -- progressives too often start pointing fingers at one another, badmouthing their allies, and second-guessing their leaders. If that behavior, of which we've seen too much in the last difficult days, does not change, we won't deserve to get health care reform, though it won't be Beltway denizens and the blogosphere that will pay the price, it will be millions of Americans praying not to be plunged into bankruptcy by sudden illness or unemployment.

Nothing succeeds like success, what seems brilliant (how masterfully Obama has staffed the White House with experienced Congressional hands, how smart to let Congress take the lead, rather than ram a bill down the throats of the old bulls, like the Clintons are said to have done!) when things are going well has a thousand critics when the going gets rocky.

The fact is, we did not expect, and until late in his Presidential campaign had no reason to expect, that Barack Obama would stake his Presidency on achieving the health care reform that has eluded every President since the first Roosevelt. He had every excuse, once the economy went into tailspin, to treat health care as a desirable thing that could not be afforded given the mess the country is in, an item on a wish-list that must be deferred to another day. But he did not. He has continually doubled down on it, and there is no way on earth we would be in the middle of an encompassing national debate on health care, with the prospect for significant legislative action still much better than even, if Barack Obama hadn't led and if he didn't continue to lead. The organizing and public education done over the last year by Health Care for America Now, by the unions, by the Center for Community Change and myriad organizing and issue groups was critical in setting the table for Obama's leadership. But if he had not been receptive to it, and made it his signature issue, we would not be anywhere close to the likelihood of a health care bill today.

Let's do a reality check here: four of the five committees of the Congress that need to pass a health care bill have done so, and all four to date are strong reform bills including a public option. In the same week that the White House rattled progressives by reiterating strong support for the public option while refusing to declare it non-negotiable, it also made clear that it was ready to give up on the holy grail of a bipartisan bill - something that will hurt the Administration with its centrist supporters, but you would never know that from the dominant chatter on the left this week. In the 1994 Clinton Administration health care push, no bill ever made it out of committee.

Nevertheless it is healthy to keep expectations of politicians in check and grassroots action intense. Whether it is because the President has too much of a penchant for compromise, certainly for take-no-prisoners liberals who have never been able to elect a pure populist firebrand President and never will; because the Constitution and the minority-favoring Senate rules amplify the power of Max Baucus, Kent Conrad and a few others small-state big guys, despite the "filibuster-proof" majority in the Democratic Senate; or because the country is - I know this will shock many -- well to the right of the Hyde Park/Park Slope/Berkeley/Brookline/Dupont Circle universe in which I dwell and whose general policy preferences I share, let's assume we are going to have to work like hell to get anything close to the kind of health care reform and society we want, no matter who is President.

We have have only a matter of months, maybe weeks, to determine the fate of health care reform and with it, any chance of success on other hard battles like immigration and tax reform. We can spend our time working to win support for a positive vision of change, creating a stronger climate for President Obama and potential allies in Congress to rise to their best, or we can complain and attack. The choice is ours. There won't be another opportunity, I am fairly certain.

 

Comments

[joyonboard]

Should healthcare be for profit?

In case you aren't aware of when the healthcare system went downhill, please check out these sites:
http://www.rockridgeinstitute.org/research/rockridge/the-logic-of-the-health-care-debate@b_start%
253Aint=4.html and http://www.youtube.com/watch?v=9QkgUkM0o6Q
Richard Nixon. Republican version of "health care reform". I can't understand why no one in the media is bringing this up. I don't care that Nixon was a Republican, it is more important for the public to HEAR THE TAPE; that the current health care system was set up to "GIVE LESS CARE, AND MAKE MORE MONEY".

There is frequent chatter that there is nothing in our constitution that leaves room for the government to be involed in our health care.
*Preamble of our Constitution:

“We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.”

PROMOTE THE GENERAL WELFARE of it's people. Wouldn't afforable health care be part of that mission statement? No one is talking about this either...not even as a matter of debate. For those who site Jesus on everything; I don't think Jesus would approve of the GREED over Care, I know i don't.

[onedivasinger]

Could you forward your post to Jane Hamsher @ Firedoglake?

[twitter-YesPublicOption]

Steny Hoyer says that the public option may have to go -
WRONG! 5th dis MD [phone] http://hoyer.house.gov/contact/email.asp

[pinellas]

Oh many thanks for addressing this! I've been trying to figure out how to articulate it for awhile now & Mr. LaMarche has summed it up nicely.

The 'circular firing squad' capabilities of a number of folks on the political left bug the cr@p out of me...

[NetworkGuy]

So are the Borg like assimilation and mindless rigidity of the right more to your liking?

[jemborg]

Wow! I'm a freedom loving Aussie and I find this paranoia over decent pubic health care amazing.

We've had it for almost 30 years.

I've expounded on this in many of Huffo's threads but let me simply say... America you deserve better, do not believe the Conservative lies.

NB: It took two goes in my country to get universal Medicare established. The Conservatives got rid of it when they got voted back in. The Labor Party re-established it at the next election after that. And although they have undermined it every time they got back into power the Conservatives don't dare try to get rid of it again. What I am getting at here is you have to push HARD for it- it's NOT going to happen through bi-partisanship.

[johnsonc20]

This is why it important to stake out a strong position now and "help" Obama give us real health care reform by criticizing him when he waters the bill further. He has already done enough damage negotiating it so far. It has to stop now. Otherwise, we will have start from square one again. A bad bill that passes for health reform but is an unaffordable bonanza for special interests is worse than no bill at all. Ask people in Massachusetts how well they like their health care. It is the most expensive in the country now. This is the Mitt Romney model that Baucus, Grassley, and Obama (?) would like us to accept. It won't cut it.

[pragmaticdallasite]

No way buddy I'm not buying your justifications or delusional view that most of the country "is to the right" of whatever circles you frequent.....how would you know? The fact of the matter is that you fail to address how costs will be contained without a public option (wrestling market share of primary care from private insurers).

All you have to do is look at the evidence from around the world. There is only one way to reform: a larger, stronger and smarter role of the government in the financing of the system. The current players in the health finance game (that would be partially eliminated with a public option) squeeze as much money out of the system and cause monetary inefficiencies, period.

So you can take your DLC/beltway view and......

[gfulmore]

An analogy with health care costs in the U.S. could be made with vehicle servicing and repairs. Let’s say that we have a nation full of cars and trucks that need frequent servicing and repair. As a result, a huge industry develops for this purpose, namely to keep vehicles running and in productive use on the road. There is a decent industry balance between supply and demand, and for the most part the public feels that the system “is working.” But its costs continue to rise due to the inflation of parts, procedures, wages and salaries within the industry.

At some point, it becomes obvious that this industry is taking its toll on the American economy. It is simply too expensive, relative to other household and company costs. Something needs to be done to end the escalating costs, which are termed “unsustainable.”

Change is implemented, and, over time, as the newer and less-costl­y-to-maint­ain vehicles become the norm on our roads and highways, and, as servicing and repairs for the other vehicles are made to become more efficient via “evidence-based” guidelines, the overall costs of vehicle servicing and repairs, per vehicle, are reduced dramatically. Also implemented, is a system where all vehicles face annual inspections to ensure that they meet minimum pollution standards.

[DSimpson]

Are the annual inspections for the cars to be conducted by the death panel?

[jemborg]

Ha!

[jemborg]

Look I understand where you are coming from... but analogies aside (and analogies are always limited)... you will NOT make a gradual step from no Public Option to having one. Apart from the pressure against it, it is too momentous a change.

The simplest step would be to eliminate the age requirement of your existing Medicare.

[NetworkGuy]

So, a well off CEO attempts to 'shush' the liberals. He derides the public option but offers no real alternative. He also seems to ignore the fact that regardless of what bill is written, the GOP will simply vote no. We are told that if we don't toe the line that 'reform' won't pass. I'm reserving judgement until we have real legislation, but I'm not holding my breath. I think it will be an odious series of half measures that don't fix underlying causes. Bandaid on a bullet hole. No one except the current money makers will be happy. I realized several years ago not to 'settle' when it comes to something I feel is important. When you settle, you are left with an eternal resentment for what you got instead.

[Polly]

So as a liberal I am always to just roll over - well not this time and never again!! And I will fight and complain if I don't see the change we voted for!!!

[AlanSF]

HCAN is the MoveOn of health care reform -- designed to co-opt progressive energy so that the DLC can go about its corporate sell-out.

[wonketteRAWKS]

Sounds like the troops are out in force preparing us for the big let down of no public option.

I guess complain and attack was good ONLY during the campaign season, and so what if the voters weren't paying attention to what "Obama has been saying all along" and had their facts wrong. They were out there believing what they were saying and getting the votes in. No need to clarify anything until after the election.

[Teresa201]

Really......

What happened today to make you think that?

[AlanSF]

Bull fucking shit, Mr. LaMarche. 76 percent of the American people want a public option. There's no such things as "centrists" -- only low-information voters who are confused by idiotic analyses like yours, and politicians who take the favors of the Democratic Party while supporting Republican policy. Get your head out of the fucking clouds.

[den1953]

When will the law makers start writing bills that are straight to the point and can be read by the average person they ramble on about crap that hasn't any thing to do with health care? No wonder the other party can pick things out and twist it around!

[Teresa201]

Sorry but the twisting you are talking about.......

Living Will......Written by a Republican.
Covering Illegals...Nowhere in any Bill
Covering A bor tion.....Never by the federal government and not in Bill

No twisting...
Just falsehoods being spread.

[pjwertz]

I wonder why we sheep keep repeating the phrase "health care reform." The administration's "rally the troops" emails of late have shifted. The Obama team is now calling it "health insurance reform." Meaning there is a full surrender to the long-term dominance, and bleeding, of our health care by insurance companies free from the threat of real competition that a public option would bring. It is sickening that the Obama White House thinks it can slip the new phrase by us as if the protection of the health insurance industry was its announced objective from the beginning. It wasn't. This change in phraseology is a symbol of the President's capitulation; and his staffers apparently think they can rewrite their own history by dropping the new "health insurance reform" phrase on us in the top of the ninth inning.

And by the way, "pre-existing" condition is redundant. But, we sheep will keep repeating that, too.

[DocTwain]

"certainly for take-no-prisoners liberals who have never been able to elect a pure populist firebrand President and never will."

This is a lie; we got FDR elected 4 times.

"They are unanimous in their hatred for me; and I welcome their hatred."

"Government by organized money is no better than government by organized mob."

What more do you want?

[Polly]

Right On!!