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Richard (RJ) Eskow

Richard (RJ) Eskow

Posted: December 16, 2009 04:17 PM

Getting Real: Ten Myths Behind Progressive Support for the Senate Health Bill

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We're hearing a lot of raised voices on the left side of the aisle as progressives square off into two camps. Some want to accept the Senate's health bill as is, while others want it scrapped. Both views deserve a hearing, but there are some assumptions behind the pro-Senate position that seem so implausible they might best be described as "myths." Before some progressives lecture others on "getting real," it's worth taking a closer look at what's "real" and what isn't.

Ezra Klein, Kevin Drum, and others have weighed in with what might be called legislative-realpolitik arguments, progressive variations on the "Forget it, Jake, it's Chinatown" theme. While I don't want to be oversimplify their positions, they seem to be saying essentially "let's get what we can and fix it later." While that may sound hard-nosed and "realistic," that strategy actually calls for a lot of wishful thinking - and a whole lot of assuming.

For example: Why would we assume the same crowd that repeatedly failed to deliver what they promised the first time will suddenly deliver more than they promised next year? That calls for a lot of faith - faith that the same people who botched this thing the first time around will fix it at some later date, miraculously making the tough decisions then they wouldn't make when they were under the gun.

It will be harder to get this right in the future, not easier. Some of this bill's provisions are going to hurt the Democrats and will probably cost them seats unless they're removed. How can a smaller group of Congressional Democrats do what a bigger group could not?

The Senate might fix everything next year - but do you really believe that?

Assumption #1: The same guys who broke health reform will magically fix it ... next year.

People love to point out that Medicare was improved after it passed. But back then you had LBJ and Sam Rayburn there, not the guys we have now. (And in answer to the question "what would LBJ have done differently?" I suspect he would've said 'Joe, I'd sure hate to see you lose your chairmanships. Ben, I'm sorry there'll be no more money for your re-election campaign. Kent, you buck me on this and I'll be in your state come election time reminding the folks how you let me down ...")

And, please - don't 'Lieberman' me, Democrats! I'm starting to wonder if Joe isn't a useful stalking horse, a 'bad cop' for more highly-placed Dems. (And you know who I'm talking about.) Of course, they can always disprove that theory by putting the squeeze on Joe today. But they won't do that unless somebody puts the heat on them.

Assumption #2: It's all Joe's fault. I'm no Lieberman defender, but the President and Harry Reid need to be held accountable for the bill. It's too easy to use Lieberman as the "bad cop." You don't get to play that card until you've put real pressure on him.

Progressives should also consider the real-life consequences of caving in to Lieberman's demands. Surrender will embolden Ben Nelson to become the next holdout, so he can slash away at a woman's right to choose. The most practical way to end the threats is to draw the line now. The Senate has a hostage crisis, and some progressives seem to suffering from Stockholm Syndrome.

Assumption #3: If we cave now there will be no more demands.

What happened to all the discussion of reconciliation? Suddenly the pro-Senate-bill crowd has changed the subject. Why aren't the pro's and con's of that approach still being debated? (Here's a thought: Get Lieberman's vote, promise him there'll be no public option reconciliation bill afterward, then do it anyway! Why not? He broke his word ...)

Assumption #4: We need 60 votes, and reconciliation has no part to play in the process.

As for the political impact of the bill, read this poll on just one of the Senate bill's provisions and tell me that Dems won't lose more seats than they'll gain if they pass this bill. Some will respond by saying that the party will lose even more seats if it passes nothing, but I haven't seen a comprehensive side-by-side poll on that.

Assumption # 5: This bill is a political winner and a vote-getter. Health reform's popular, but this particular bill isn't. And speaking of this particular bill ...

The process isn't over. The Senate's still talking, hamstrung mostly by the President's arbitrary Christmas deadline. The House/Senate conference hasn't even begun. Question for progressives: Even if you believe that this is significantly better than nothing, why cave in now?

Assumption #6: It's this bill or nothing. There's no more time to change it.

Then ther's Nate Silver, who says "let's stop being polite and start being real" in a post he calls "Why Progressives Are Batshit Crazy to Oppose the Senate Bill." As I pointed out in my response, "Why Progressives Would Be 'Batshit Crazy' to Listen to Nate Silver on Health Reform," his math is good but his assumptions are bad. It would take too much time to address the entire argument here, but consider this: Silver reviews the effect of the Senate bill on a family of four making $54,000 a year. If you don't think forcing that family to pay a private insurance company $4,000 a year in premium and then leaving them with up to $5,000 in out of pocket costs isn't both unreasonable and political suicide, we're not living in the same reality. And forcing them to pay those premiums without a public option or meaningful cost containment is pretty much indefensible politically.

Assumption #7: Low earners and middle class households will jump for joy when this bill is passed. I don't think so.

Silver also embraces the idea that the excise tax and other "cost cutting measures" will reduce costs, despite the experience of history. Like many others, he embraces the idea that this bill creates incentives for insurers and employers to cut costs. This is perhaps the most naïve assumption of all. Similar "incentives" have existed for years, as far back as the early 1970's when Richard Nixon signed the HMO Act. Insurers and employers have always responded to financial incentives by raising people's premiums, lowering benefits, and pocketing the difference. A great example of wrong-headed "cost-cutting incentive" thinking is the Senate's misguided "Cadillac tax," which essentially selects health plans almost at random and pressures insurers and employers to slash benefits. (See my conflict-of-interest statement below.)

Assumption #8: This bill will meaningfully contain health care costs with 'cost cutting' incentives lead to smarter coverage, rather than simply less coverage. Increasing out of pocket costs for individuals and decreasing expenditures by governments and insurers - the most likely result of this misguided plan - is not "cost cutting." It's cost-shifting onto the back of beleaguered consumers.

It gets worse. Silver embraces the "27% increase in benefits" touted by the CBO, believing somehow that the Senate can mandate more comprehensive coverage without seeing a dramatic rise in premiums. I guess the money to pay for all those new benefits will appear from nowhere. Or maybe insurance companies - who were already planning to hike rates by an average 10% - will suddenly decide to absorb all this added cost out of the goodness of their hearts.

Assumption #9: This bill will provide new coverage at no additional cost, despite the lack of cost controls or cost containment provisions.

Linda Bergthold, who writes for The Huffington Post, argues that "It Takes Guts to Support Health Reform." (Really?) She contemptuously dismisses as "grandstanders" the courageous politicians who have faced down their leadership and their President in order to push for genuine reform. Like so many on the accommodationist side, she lectures others that "this is how politics works," with "this" being inevitability of a bad bill.

No, this is how politics work: If you ignore your key constituencies in crafting a bill, if you create bad policy based on flawed assumptions, and if you refuse to use available techniques like reconciliation to overcome the cynical maneuverings of individual senators, then your bill may fail.

Assumption #10: This is how politics works, and if you don't think so you're not a realist.

Here's the reality: It's all "how politics works"! All of it - Lieberman's attention-seeking betrayals, Howard Dean's opposition and Robert Gibbs' graceless ad hominem response, those people pushing the Senate bill and those of us opposing it, you reading these words on your computer screen ... it's all part of the process. This is how it works: People study, argue, and push their agendas until the fight is over. Which gets us back to the fact that ...

... hey, people! It ain't over! The people pushing this bill are surrendering too soon. Even those who would never move to block the final bill should act as if they would, if only to maintain their leverage. An organized resistance to this flawed documents empowers progressives and put the Democratic leadership on notice that they must be dealt with. And you know what?

That's politics, too.

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(Conflict-of-interest statement: I'm actively campaigning against the health excise tax with the Campaign For America's Future (www.NoMiddleClassHealthTax.com). But to assume I oppose the tax because I'm part of the campaign is to confuse cause and effect - a common error in the health policy world. Still, in the interest of full disclosure, there you have it.)

RJ Eskow blogs when he can at:

A Night Light
The Sentinel Effect: Healthcare Blog

Website: Eskow and Associates

 

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