Lesson 1: The Center Does Not Hold Without the Left
Not long after Bill Clinton's health care reform proposal went down to defeat in the Senate, Bill ran into Bernie Sanders, Congress's only avowed socialist. Bernie approached him with a grave look on his face. "Mr. President, I am so sorry. I failed you on health care."
Clinton was puzzled. Sanders had supported his reforms. "What do you mean, Bernie?" said Clinton. "You were with me every step of the way!"
"Exactly," replied Sanders. "I should have been burning you in effigy on the steps of the Capitol. Then people would have understood how moderate your plan really was."
The policy now known as the "public option" began life as a middle-of-the-road compromise proposal between the right's preferred option - keeping all private health insurance - and the left's preferred option - switching from private insurers to a "single-payer" plan like Medicare, which would take the profit motive out of health coverage and save $300+ billion that private insurers spend on administrative costs every year. It is a market-based, "third way" approach rather than a government-imposed solution, and its main purpose would be to use competition to hold down costs in the health insurance industry as a whole.
Yet today the "public option" is seen as a dangerously liberal idea, so much so that self-styled "budget hawks" criticize it as a big-spending plan even though cost containment is its primary virtue. Why? Because in today's debate, it literally is the most liberal thing imaginable - there is nothing to the left of it. The more liberal, "single-payer" approach was seen as not politically feasible, so Obama did not bother to make sure it was on the table, and the few people trying to explain and promote it have been marginalized from the start. Like Sanders in 1994, liberals have embraced the moderate third-way "public option" approach. But liberals' support does not strengthen the moderate position, it weakens it. Think about it: if liberals all give up their own way for the moderate third way, then there are not three ways anymore. There are just two: the conservative way and the moderate way. The "third way" becomes the new liberal position, just shifted further to the right.
Obama has re-learned this lesson the hard way. The "public option" that was at the core of all three Democratic candidates' health plans is now on political life support, a free-market policy tarred as a government takeover.
Lesson 2: For the Right, Compromise is Death
On December 2nd, 1993, as Bill Clinton was gearing up to pass his healthcare reform proposal, Bill Kristol sent his fellow Republican leaders a memo. It read, in relevant part:
"... [T]he long-term political effects of a successful... health care bill will be even worse - much worse... It will revive the reputation of ... the Democrats as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class..."
In short, Kristol urged his follow Republicans to oppose any health care reform, not because they thought the policy would not work, but because they knew it would work, and Americans would like it, and they would reward Democrats with their political loyalty the way Depression-era voters voted Democratic forever out of gratitude for the New Deal and Social Security. Healthcare reform became an existential battle for the Republicans: lose it, and they would be banished to the political wilderness for generation or more. At the time, Republicans were already in the wilderness, having just lost the White House and controlling neither house of Congress. But by following Kristol's recommendation, successfully demonizing and defeating healthcare reform, they staged a great political comeback and seized control of Congress in the 1994 elections.
If Kristol's advice was spot-on in 1993, it is even moreso today. Ronald Reagan is a distant memory, and George W. Bush has badly tarnished what was left of his legacy. Barack Obama was ushered into office as a historic and potentially transformative figure. If he delivers on sweeping health insurance reform, the Republican party could be utterly discredited. Do not look to Republicans to help pass a healthcare reform bill. It would be political suicide, and they know it.
Obama has re-learned this lesson the hard way too. His incredible patience with the Senate's dithering bipartisan "Gang of Six" has sapped the momentum not only of health reform, but of his Presidency as a whole: his approval numbers have steadily sunk as Americans have become increasingly frustrated and unnerved by what they see out of Washington. A few weeks ago, Republican Senators finally admitted in public what Kristol had recommended in private: that they have no intention of supporting the kind of moderate bi-partisan compromise they've supposedly spent the last few months trying to craft. But they only gave up the game because they think the damage has already been done.
Lesson 3: To Win the Middle, Go Left
In July 1964, Ronald Reagan stood before the Republican National Convention to discuss Democrats' "Medicare" proposal to provide guaranteed health insurance for the elderly. "Will you resist the temptation to get a government handout for your community?" Reagan asked. "Realize that the doctor's fight against socialized medicine is your fight. We can't socialize the doctors without socializing the patients. Recognize that government invasion of public power is eventually an assault upon your own business." He didn't mention any death panels, but Reagan and his fellow Republicans were every bit as adamant in their opposition to Medicare as conservatives are in their opposition to health insurance reform today.
A year later, President Lyndon Baines Johnson guided the original Medicare bill through the Congress despite all those Republican objections. But a curious thing happened as the bill neared passage. Once Congressional Republicans saw that Democrats were going to make Medicare a reality despite their scare tactics, many of them quietly switched their votes and supported the bill. In fact, more than 40% of Republican Senators and more than half of the Republicans in the House voted for the bill in the end, despite all the earlier Republican opposition.
If this inconsistency surprises you, go read Kristol's memo again: Republicans oppose health insurance reform not because they think it won't work, but because they know it will. And they are right: Medicare recipients report much higher satisfaction with their health care than privately insured Americans do, and independent studies find that they receive better care. Faced with a reform that is going to pass with or without them, and which they know their constituents will like, any Republican who might ever have to fight to get re-elected is going to support it, because they don't want to have to explain to their constituents why they voted against their favorite policy. That's how Medicare was passed as a bi-partisan bill: Democrats came together and presented it to Republicans as a done deal, and Republicans got smart and came around.
Today, the political situation is ideal for Democrats to use the same strategy again. The electorate has not only demanded change, it has given Obama Democratic majorities in both Houses of Congress to make it happen. Obama has made his preference for a bi-partisan outcome very clear, and that's exactly what LBJ got.
But it is not clear whether Obama has learned this last lesson. Instead, he has seemed to seek bi-partisan compromise in the center, where Kristol's memo makes clear he will never find it.
The Choice: Pivot or Capitulate
So what do these history lessons suggest to Democrats today? First and foremost, Obama should do what LBJ did to pass Medicare in the first place and forge a Democratic bill that Republicans will be forced to support. His speech on Wednesday is the perfect occasion to pivot to this new strategy, starting by re-telling our story so far: Democrats have made every effort to accommodate Republican ideas, but Republicans have shown themselves to be opposed to any change in the system and willing to deliberately mislead and scare their fellow citizens to get their way. With that understood, Obama can explain that he has no choice but to work with Democrats alone to do the work he was sent to Washington to do. This would finally show strong leadership: Democrats would be overjoyed, and the independents who voted Obama into office would be greatly reassured to know that their guy was finally taking charge in Washington.
Obama should also act on Bernie Sanders' lesson, however belatedly. When Obama explains that it is time to forge a Democratic plan, he opens the door to consider the full range of Democratic proposals, including ones to the left of anything currently under discussion. For instance, Teddy Kennedy's recent passing offers a perfect opportunity to spotlight his Medicare-for-all approach, which would just replace all private insurers with a Medicare-like system - the "public option" without the option, basically. Democrats could also suggest consumers should be able to choose a government-run health plan with care providers on government salary, like at the Veterans' Administration health system (rather than a Medicare-style plan where government-run insurance pays private care providers). Both of these policies are significantly more liberal than a Medicare choice/"public option," and both have strong policy arguments behind them. By bringing these ideas into the public discussion, Obama would make the "public option" moderate and palatable again.
(Obama might also seize the opportunity to rechristen the "public option" with a less unappealing term. Recent polling found that using the word "choice" to describe the policy pushed its public approval numbers from 43% to 77%. Just calling it a "Public Choice" or a "Medicare Choice" or something more lively could do wonders for this effort.)
The happy ending is right there waiting for us, but it's not clear that that's where we are going to end up. The danger now is that Obama will not heed LBJ's lesson to pursue a Democratic plan. Instead, Obama may apply Bernie Sanders' lesson against himself, and drop the "public option" policy that has become tarred as an extreme liberal measure so he can portray the remainder of his reforms as a moderate, acceptable compromise and just pass those. The New York Times recently reported that the Obama Administration is heeding a list of six lessons from previous efforts to reform health care. Unfortunately, the three most crucial lessons (above) were left off the list. Instead, their lesson 6 counsels "Take what you can get" - in other words, "Drop the public option."
Dropping the "public option" may seem like the path of least resistance, but it's actually much riskier than just getting Democrats together to pass their own plan. Liberals who gave up Medicare-for-all for the compromise of just giving people a choice of a Medicare-like plan are in no mood to support a watered-down bill that leaves that out too, as that would leave private health insurers in place un-threatened, able to continue to raise costs at will. And as Kristol makes clear, when push comes to shove no Republican will support any bill they think will be effective enough to win any middle-class gratitude. If Obama tries to force a bill without the "public option," there is a real possibility that no bill will pass at all. That would be a political catastrophe for Obama, and leave his Presidency and his party looking impotent. Remember where we were left after President Clinton's reform effort went down, with the President of the United States reduced to asserting that he was still relevant?
We will not repeat the history of failed reforms if we just heed history's lessons. This administration is run by a lot of smart people and students of history. I still have hope. We will see on Wednesday night.
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This unfortunate break in semantics is terribly misleading; the cost of health care will follow the rate of inflation, period.
What IS true, is that the PRICE of health care will double in 7-years if we don't require Medicare, Medicaid, and now most of the insurance industry to Pay The Actual Cost of Services as the minimum claims reimbursement standard.
The heavy cost-shifting to the uninsured and the few Golden Cadillac policies that still pay "retail", or what is billed by the hospital, is the culprit here. The price of health care on a per patient basis will fall by a factor of 7, to equal the actual cost per patient, when all coverage plans, governmental plans included, are required to pay the entire cost of each patient's care.
What other industry do we allow to pass the cost of services so blithely to the rest of us, regardless of the advanced age or low income level of others?
http://axisofreason.com/2009/09/07/gop-grand-obstructionist-party/
IMHO, the President appears to be taking the conservative centrist position on most issues, apparently feeling the need for bi-partisan co-operation above actually reaching the goals we all elected him to reach on our behalf.
My brilliant 9yo daughter explained this to me: Daddy, he's black. He's just afraid all the crazy old people will get scared if a black man changes a bunch of stuff.
Hmmm... well, maybe she has something there. Perhaps a unilateral push of a (relatively) radical social agenda, telling the GOP to either help or simply get out of the way, would generate a backlash of fears and hatreds that date back to the early 60's.
Although the ends would certainly justify his doing so, perhaps Mr. Obama sees the rest of this term, and then another as ample time to get the agenda over the goal-line.
My fear is that the nation that elected him with such hope, will abandon him at the end of the first term, cutting his window in half. With only 3+ more years available to him, there is nothing to lose politically by throwing himself on those swords: universal health care access for all Americans, regardless of the cost and climate change provisions that dramatically penalize the carbon footprints of the fossil-fuel industry.
"This administration is run by a lot of smart people and students of history."????????
Perhaps these folks' IQ has to be measured by some mechanism that does not exist, so I'm sure a worshiper, er, ah, hm, a scientist of some sort/with free time on his/her hands will make up, er, come up with the proper measuring stick. That new IQ measurement is sorely needed for these folks to be considered "smart", and a label without substance is such a waste of effort and ink. Oh, ah, er, oops! Rephrasing that last sentence, "...a label need not reference the substance inside the package, for looks can and have won over substance. Hm, ah, er, let me rephrase the rephrased: smart is as smart gets away with, ah, what did I just say? You know what I mean!
As for students of history populating the Obama administration, seems more like folks steeped deep, oh so knee deep into imitating the history of Reagan/Bush same old same old---Trickle Down Economics, Obama style. Give to the rich and powerful evermore than before, and some scraps will eventually fall our way. All we have to do is wag our tails and beg. Well, on third thought, I've changed my mind about the Obama administration. Just like the author, I still have hope.
The only way to lower government’s costs while delivering high quality health care is to use “governments unfair advantages” by taking the job of raising and distributing money away from the insurance companies and using only government owned hospitals, operated by government employed doctors and care providers, for dispensing all government funded services.
A national sales tax is the cheapest way to raise money to pay for public health care.
To preserve a vibrant private health care industry all government mandates should be removed from private insurers and care providers.
The private system should no longer be required to deliver services to patients who can not pay.
Tort reform would do wonders for private health care.
Costs for all programs funded by The United States Government including Medicare and Medicaid, would be hundreds of billions of dollars cheaper annually if delivered through the new public system.
Everyone selecting public care would receive all care and medications free no restrictions, no insurance and no co pays required.
Businesses selecting the public option for their employees would no longer have any requirements to pay for or be involved with health care in any way.
Going back and forth between free public, and user purchased private care, may suit some people, and it would provide unlimited choices, ultimate freedom, and always free public care would be available when it is needed or desired to everyone who asks for it with no restrictions.
They've left us no choice; which may be why Obama has left the moment of truth lay fallow this long.
But they HAVE done us the favor of being explicit about their strategy, and about why we must now circumvent them, in the process.
Medicare for all seems like a good idea. But at the same time its strengths are touted - high user satisfaction, efficiently run, etc - the big argument against it - cost - needs to be addressed.
How will costs be contained in the current Medicare, and then in an expanded Medicare? This will be a right-wing shouting point, and also needs to be addressed in the real world.
All VAT income would not go into the general treasury, but would be placed into a separate lockbox pool specific for health care funding.
All American citizens would receive government-funded health insurance with a choice of either a private plan or Medicare.
American manufacturing corporations would be shielded from paying health insurance for their employees, and could better compete in the world market as well as receive domestic protection without violating any World Trade Organization treaties.
State taxes and local property taxes would decrease, because these governments would not have to pay health care benefits for their employees, legacy premiums for their pensioners or Medicaid charges.
Although the VAT is a regressive tax, the indigent formerly receiving Medicaid and the working poor would receive medical insurance benefits far in excess of what they would pay into the system in any given year.
There would be an end to so-called cost shifting. This is the accounting practice in which hospitals inflate the prices of service and procedures so that those who can afford to pay for them also wind up paying the medical costs of the indigent. This adds an average of 13% to the medical bill and to the price of private health insurance.
Home and automobile insurance would decrease, because potential liability claims would now exclude medical costs.
On the other hand, most of us spend way less than 10% of our income on health which is why so few people get a tax break for such spending because it only kicks in after spending exceeds 7% of income.
so most of us are spending much more for health than is now the case, but the total cost is being cut by a third. interesting concept. who gets to keep the difference?
Universal health insurance is fading away into the realm of just another empty campaign promise. So, thank you so very much Mr. Baucus, Mr. Reid, Mr.Grassley and Mr. Obama.
Those who need it will not get it; those who have it will keep getting it in the neck, and those, like yourselves, with the golden policy will keep making promises you do not intend to keep.
"If the nations farmers vote Republican this year, then they will be the greatest ingrates on the planet. Let me ask you, which party rescued the farms and prevented massive starvation when our nation's industrial might collapsed? Which party fought tooth and nail against every rescue effort?" - Harry Truman, November 1948
"The public option in my plan is not negotiable. We've had a public option for the last forty-five years, and it's called Medicare. Medicare has never pulled the plug on Grandma, but what private plan has never effectively pulled the plug on little Johney or little Ashley after their benefits were denied for an illness that went on too long or cost too much?" - Barack Obama - Hopefully this Wednesday.