Getting Higher on the Page
I was at a retreat over the weekend with musicians and managers of musicians regarding how to best involve musicians in making social change. The organizer of the event asked me to do a brief overview of what public policy advocacy actually means, so I drew some lines on four different pieces of posterboard to show people. Given that these simplistic, dumb-looking charts seemed to put advocacy into perspective for folks, and given the intensity of emotion we all feel about what is going on in the health care fight, I thought it would be worth reproducing them for a blog post.
Before I show them to you, I wanted to say a couple of things regarding this health care fight, and all other policy fights for that matter.
The cool thing about elections is that you can pick a side, and then you have one goal you are focused around that is simple and clear-cut: if your candidate wins, you are happy, and if they lose you are not (unless you are one of those folks who are into "moral victories" where you lose but feel good about the effort anyway. I am not one of those people). Legislative fights, especially on the big, complicated, messy issues like health care, are not like that at all. Progressive minded people who all share the same values, or at least many of them, can come to starkly different judgments on whether a bill is good or bad, worth passing or not, a victory or defeat. And beyond the policy compromises, the process itself is an utterly confusing mess, leading people to vastly different judgments about whether certain tactics were the right ones or not.
All of this complication leads to a lot of anger and a lot of angst. That's natural and it's okay -- these issue debates are worth getting passionate about. For example, while I am more sympathetic to Pelosi when she had to make a choice between health care dying vs. having to accept the Stupak amendment in this round (knowing that she could very likely kill it in conference committee), I am very glad that grassroots people are so mad about this, because we have to kill this terrible amendment and the grassroots anger helps us do that. The legislative process is such a mess, and the tactical decisions you have to make are complicated, that getting angry at each other is natural and healthy.
What I hope can happen, though, is that we can stay long-term allies in the process. I am upset at Kucinich and Massa right now for voting no on the bill Saturday night, but I still admire them as strong progressives and am glad they are out there fighting for progressive policies. I strongly disagree with those of you who don't think this bill is good enough to move forward on, and know many of you think I'm wrong for continuing to support it, but I hope as progressives most of us can agree to disagree and not question each other's motives. People in movements throughout history have always had strong disagreements with each other over specific tactics, or what compromises to make when, but also kept working together for the common goal. All of us have to figure out whether given bills do more good than harm, are a step forward or not, and on the complicated bills, those are tough calls. For me, getting everyone covered, ending insurance abuses on pre-existing conditions/recissions/lifetime caps, and getting a public option off the ground that can be strengthened over time is worth the considerable imperfections in this bill. And understanding that if we lose on this bill, it will make the Democrats fearful of ever trying to take on health care or any big issue again for a long, long time, makes it even more important to get this done. If we get a decent bill, we can build on it over time, and we give some confidence to the Democrats that something big can get done.
Which brings me to these simple drawings I did. The basic idea is that there are two lines, one representing the best policy, the other representing what is possible to get done. In my first chart, the two lines are separate from each other, never intersecting at all, which is unfortunately what happens most of the time:
The next chart is what happens the next most often, which is that they intersect near the bottom of the page: maybe you get a little bit of good policy done, but you are disappointed by the result. When the lines intersect this low on the page, you have to really think through whether it's worth it to go forward, whether it might do more harm than good even.
My 3rd chart is where the two lines intersect solidly in the middle -- you fall well short of ideal, but you still get some very good things done.
And my final chart, which happens very rarely, is when the two lines intersect towards the top. I am not aware of a single piece of legislation in the history of the country where the best policy imaginable, at the very top of the line, was passed, but every so often -- Social Security, the Civil Rights and Voting Rights bills, Medicare, a few other times -- you get close to the top of the page.
The goal of issue advocacy campaigns, of movements, is to get the intersection as close to the top as you possibly can.
On health care, my view is that we are somewhere in the middle of the page, and that the middle is worth doing. Your mileage may vary.
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So here's you from OpenLeft: " If the public option gets pulled, if the Stupak amendment stays in, if affordability for the middle class gets considerably worse, if insurance regs re pre-existing conditions, recissions, lifetime caps, etc get weakened- if any of those things happened, I would oppose this bill."
It's a very weak stance. Everybody knows the public option will get crippled further because there are 1-5 Democrats who will filibuster. It's unlikely however that the public option will ever get completely "pulled". Someone will come up with a way to make sure it can't get off the ground, and declare victory.
As for the Stupak amendment, conceivably any small tweak could retain your support. I believe firmly that the Hyde compromise
The other stuff you're touting is peanuts. The subsidies in these bills are far worse than in Massachusetts--and affordability is a problem even there. No pre-ex, recissions, or lifetime caps (like the individual requirement) all increase industry revenue by about a trillion dollars over ten years. So you're not going to get much fight from Karen Ignagni on that.
I don't support the bill because of the mandate to buy overpriced private insurance coupled with the Cadillac tax which is a stealth middle class tax increase. I'll get back on the bus when those things are taken off.
This healthcare bill mandates you get health insurance or be fined so yes everyone will get insurance, here is the problem it will be structered like auto insurance witch means the will give you low preiums and high ductables. you will have health insurance and can't afford to get sick thank you, so thank pres obama and the corp dems.
And it creates market conditions that will make it impossible for women to purchase plans that cover abortions with their own money. And it extends the "no generics" period for biologic drugs to 12 years. It's a terrible bill.
I just posted this elsewhere.
The problem w/ all this "compromise" is that everytime you inch closer to the Republican position..
What’s cool about candidates & their broken promises & the reality of them betraying the people & issues they campaigned on & for, is that we get to call BS on the deceit we are asked to choke down by sophomoric arguments. Many people believe that the House bill gives huge profits to the Insurance industry & Big Pharma & continues the excessive greed/profit driven health care system we have now. There is little "progressive" content & the arguably most visible Progressives, like Dr Dean & Dennis Kucinich, Weiner and Greyson have been intentionally marginalized and their efforts belittled & ignored by the Dem "leadership". After the "compromise" of the Public Option instead of Single-payer HR676, we saw a continual erosion of genuinely progressive views & content until now we are left with a shell of change surrounding a rotten, business as usual greed-driven core; a campaign contributi
....of water at some undefined future date.
Thanks for admitting you, Lux, strongly disagree with my opinion that now is the time to kill this mortally wounded animal. Bailouts for insurance industry and Pharma industry doesn't make sense, since they will be paid for with taxpayer dollars. Worse, our country's ranking in delivering health care will drop from 37th in the world to who knows how low we'll go. For eight years, we put up with tax cuts for the wealthy, assault on our rights, a measly 3 million jobs creation, and the list goes on. You want us to accept more of the same from these yahoos lapping up the corporate welfare bribes? Let's keep the few dollars we have in our pockets. Let's go after the Democrats that have voted for insurance and Pharma bailouts, and next time, let's put Single Payer on the table.
See Jim Jaffe's Profile
The sobering reality is that the legislative process usually gropes for the least worst solution. The best is seldom in reach. That's why I have some difficulty understanding why some say they'd sink a bill that provides coverage to millions who are uninsured if they thought the price was denying public payment for a few hundred abortions. Personally, I'd rather up my contribution to Planned Parenthood to assure that need was met. More troubling yet is hearing those who are well-insured who are willing to deny protection to the uninsured because they product doesn't meet their demands for a public plan. The debate would be a lot smoother if we could bar participation about providing coverage to those already insured.
And you are a blogger for HuffPo? You certainly can have your opinion on Stupak amendment and the House bill. But do not misrepresent why there has been an outcry over Stupak and the issues it involves.
The amendment prevents insurance plans on an exchange from *offering* services currently available on 80% of all employer plans now (the Prez told us we would not loose our current coverage). No one was pushing for use of Federal dollars (Hyde) for abortions. But Stupak deliberately tries to take the medical coverage off the table -- for private payers on the exchenge. Punishing *families* as well as women by denying insurance coverage of reproductive medical care. Again no seeking federal funds for abortions. Got it?
See Jim Jaffe's Profile
First, allow me to apologize if I've failed the litmus test for Huffpost bloggers, which I had previously been ignorant of. Second, let me say I hope the language restricting abortion does not appear in the final bill.
Still, from my perspective a deal that offers the uninsured coverage that doesn't include payments for abortion is preferable to leaving them totally unprotected. And while the President did not sign on to the House bill, which makes it hard to argue his commitment has been breached, I'd argue that the House action imposes no restrictions on those of us who comprise the majority that are already insured. On balance, the House bill extends coverage without limiting the benefits those of us already insured are receiving.
"The debate would be a lot smoother if we could bar participation about providing coverage to those already insured.
Hmm. Let's see. The least worst "solution" will result in higher taxes for me, the rates for my health insurance will go up dramatically to pay for the sick people who will now be insured, I'll end up with an even worse plan, and we will still not achieve universal coverage. The insurance companies will be in good shape, though. Yeah, I guess the debate would be smoother if those of us who will affected would just shut up.
Might be wise to think of the Stupak amendment as an analogue to decision made to continue to allow slavery - if they had not, the Southern colonies would not have been willing to form the United States.
There has been a lot of pain involved and it is FAR from perfect, but we benefit from this nation's existence. The current bill with the Stupak amendment is FAR from the ideal of health care reform, but it does legitimately inch us closer to the goal of ensuring that Americans don't die due to a lack of coverage.
Excellent as usual. You're one of the best bloggers on this Post. Incredibly thoughtful, rational, well-written pieces. Thank you.
I'd love to be able to ask...
1)How soon do you plan on coming back to improve on this bill....ne
2)Are you confident that even though the bill isn't perfect, the elements in it will do no harm to those who need it most and what there is will benefit to those who are in need?
3)Does this bill provide actual affordable insurance for people NOT elegible for Medicaid or just make it avilable if you are willing and able to pay the price?
4)Is money being spent on half measures that will be of no benefit? (if so shouldn't the price tag be vastly reduced along with letting go of the 'perfect')
5)Would Presidents Obama and Clinton and members of Congress be willing to speak to those who aren't able to be helped right now and honestly explain that they have done their best? (I accept that they can't get all they want, but we would like to know those being sacrificed and may lose everything are acknowledged as real people and not just avoided as statistics)
1 - As soon as every single payer advocate gives the max $30K+ annual donation to the Democratic Party
2 - They're just women and poor people. Sometimes you have to break a few eggs.
3 - No, they aren't suffering enough or rich enough to count.
4 - I don't think you know how much a win would mean for Team Blue.
5 - They are very busy.
"If we get a decent bill, we can build on it over time, and we give some confidence to the Democrats that something big can get done."
It's not apparent it's going to be a decent bill at all.
But, wait. The progressives are supposed to support a party and Prez who sells them out all the time, *so that the Democrats can have confidence?!* All that work in 2006 and 2008 just was not enough, huh? The reality is Congress and the super majority Dems have no integrity nor backbone. No amount of subjecting ourselves to being thrown under the bus is going to give it to them. It is exactly *this* kind of mindset that sets progressives back, each and every time.
Mike,
You're a personal hero of mine. The work you do is fantastic. Your books are required reading.
but...
those are the 4 least informative napkin drawings in history.
maybe you could put something on the axes, like "level of progressive action", or "congressional approval elasticity"
I kinda get your point here, but you know... get some new pics
The secret to success is knowing when to compromise. Unfortunately the correct choice can seem apparent only afterward. However, progressives really thought they were instrumental in getting Dems and Obama elected. Progressives have started to feel betrayed and are rightly distrustful now of Washington.
Too many people like you, Lux, have been urging progressives to support an establishment gives us *nothing* --it actually takes away -- repeatedly. The WH and Dem Congress have are a big problem: Not only are they betraying the values that distinguish them form GOP (before GOP became nihilistic and obstructionist), they cynically decided that the GOP's self-destruction is the excuse they need to more openly do the bidding of their patrons, the special interests and the corporations. After all, who else will citizens vote for? Wise to this, progressives should focus on perhaps a third party.
If progressives didn't push Democrats to support gay rights, stop torture, support choice and equal rights for women, improve schools, separate church and state, and hold corporations accountable for their actions, it would be much easier for them to win Republican donors and votes. And that's what it's all about.
The bad thing about elections is that you pick a party, and all of our elections have become all about political party power, not really issues. The lies and misinformation flooding the media proves that. Health care reform is the perfect example of that. Many republicans are against it mostly because they don't want the democrats to succeed. It's not about whats good policy or what's possible. The two parties have gridlocked progress to a crawl and we the people can rot before anything of substance is accomplished. Add to that corporate lobbying and funding of both parties and you get nothing accomplished that serves the interests of the common people. It's all about power and money. The two party system has become so corrupt that little of any value will come of it, and it's only getting worse.
"The cool thing about elections is that you can pick a side"
Right. It's really cool to pick between the Party of Sarah Palin or the Party of Arlen Specter. Really cool.
"I hope as progressives most of us can agree to disagree and not question each other's motives"
Your motives are not the issue.
"For me, getting everyone covered, ending insurance abuses on pre-existing conditions
There will be no public option when the final bill is hammered out. Will you still be cheerleading then?
With all due respect, you don't have the slightest idea whether there will be a public option in the final bill. You want to pretend that you know, so that you can feed your cynicism and make yourself feel smarter than everyone else, but you have no more insight into this process than anyone else here. Let me turn your question around on you (but without the faux certainty): If the final bill *does* have a public option, will you still be as self-indulgently derisive then?
"you don't have the slightest idea whether there will be a public option in the final bill"
Joe Lieberman says there will be no public option. I'm taking him at his word and I believe that qualifies as a "slightest idea". In case you are unaware of this, he has partners in crime in the Democratic Party who are using him for cover.
"you have no more insight into this process than anyone else here"
That is correct. Lieberman has been making his statements in public.
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