Can Obama Re-Unite Liberals and Moderates?

The 2008 Political Play of the Year was Barack Obama's ability to unite political liberals and moderates in their opposition to the Bush/Cheney economic policies and military engagements. His short resume and soaring rhetoric (short on specifics) allowed him to maintain appeal to a loyal cadre of liberal volunteers (and many who were not so liberal) knocking on the doors of enough moderate voters to win the presidency and at the same time elect a bunch of new Democratic congressional representatives who were moderate enough to be successful in traditionally Republican districts.

The 2009 Political Play of the Year may turn out to be the Republican policy of "just say no," because it puts maximum pressure on Democrats to keep their two wings flapping in the same direction. The strategy seemed high risk when Obama owned sky high job approval ratings and political momentum, and it may yet backfire, but it challenges Democrats to bridge the span between their most liberal and their most moderate members to get anything done, something that has proved to be a real challenge in the past.

And nowhere is this more evident than on the issue of health care reform, where all of the current discussion focuses on the areas on which Democrats disagree with other Democrats, and very little attention is being paid to the important provisions of the proposals that would do the most to help real people: health insurance reform, health insurance exchanges, and assistance to help people afford insurance.

"The Cause of My Life"

Let's talk about some real people. Shortly before his death, Senator Edward M. Kennedy shared a letter he had received from Mary Dunn, a 58-year-old schoolteacher in Eden, S.D. Mary wrote that she was unable to get health insurance after being laid off from her job due to a pre-existing condition, Type I diabetes. In her letter Ms. Dunn asked, "What am I to do after 39 years of teaching to acquire adequate health coverage?" In his Newsweek essay entitled, "The Cause of My Life," Kennedy asked, "How will we, as a nation, answer her?"

Kennedy raised a second example, Cassandra Wilson, a 14-year-old competitive ice skater, whose parents have run up huge expenses because she suffers from petit mal seizures and can't get insurance. In his Address to the Nation in August, President Obama introduced several examples of his own. Political groups like MoveOn.org and Democracy for America have introduced us to thousands of individual stories of people who are being crushed by the current health care system.

The liberal groups Progressive Change Campaign Committee and Democracy for America went as far as to run this attack advertisement against Democratic Senator Ben Nelson of Nebraska. In the ad we meet Ralston, NE restaurant owner, Mike Snider, whose health insurance rates are increasing 42% forcing him to consider dropping insurance for his business and his family.

All of these stories have one thing in common; they can be addressed through a combination of health insurance reforms; health insurance exchanges and other efforts to lower the cost of health insurance for families and business that are common to all of the bills in congress.

The health insurance reforms that are part of every bill under consideration will help Mary Dunn, Cassandra Wilson and millions of others by ending exclusions for pre-existing conditions and yearly or lifetime limits on coverage for people with expensive illnesses. For most of the individual who have become discussed by all of the groups supporting health care, these are the protections that will matter most replacing the anxiety of people with illnesses and nowhere to turn, with the security of coverage that you can keep even if you are sick or get sick.

Health Insurance Exchanges, also in every bill that is under consideration, continue to be the most important and least talked about aspect of health care reform. The exchanges are markets for health insurance created by government at the state, or regional, or national level (regional or national exchanges make the most sense, to break up local monopolies and so small states can be part of larger markets) and they offer the individuals and smaller businesses that qualify to enter them a broad range of choices of insurance plans to buy.

Health Insurance Exchanges are modeled after the popular health insurance system all federal workers use and they are just what Mike Snyder needs to keep costs for insuring his workers manageable so he can keep his restaurant business going and create jobs. He would be able to shop among a half dozen or more plans that meet the to-be-defined minimum standard, as well as others that offer stronger coverage for a higher price.

And Exchanges are the nuts and bolts necessary first step toward other insurance options like health insurance coops or the much debated public insurance option. If, like us, you support a pubic option, then you have to strongly support the establishment of Exchanges as soon as possible, because they are the markets in which any public option would compete, and it is likely to take a couple of years to get the Exchanges up and running. Whether some form of a public option makes it into the reform package this year (or in subsequent bills in future years) is a matter of little consequence if the work to build the Exchanges does not get started this year.

The path from here forward could be very easy or very hard.

Thomas Friedman is fond of paraphrasing Golda Meir, in saying that there will be peace in the Middle East when both sides love their children more than they hate their neighbors. Well health care reform would be easy if people wanted their policy proposals more than they want to deal defeat to their enemies.

Nearly every Republican has made their choice; their goal for health care reform is to ensure that Barack Obama does not win. On the other side many Democrats are threatening to withdraw their support from any bill that does not punish the Insurance companies, which many define as any bill that does not include a public option.

The most important elements of health care reform are not the most controversial. As President Obama has noted, eighty percent of the policy proposals are common to every bill. It is possible to see how a bill could get through the obstacle course ahead - pass a Senate floor vote, and a House floor vote, get through a Conference Committee, and then pass each chamber again and then get to the President's desk - fairly easily.

But at other times the path ahead looks too long, steep and narrow. A week ago it looked like any bill without a Public Option was dead in the House and any bill with one was dead in the Senate. Creative people are trying to come up with compromise solutions that try to split the difference between seemingly mutually exclusive principle -- and these efforts may prove successful.

Our favorite contender was recently introduced into the discussion by Senator Thomas Carper (D-DE). We have been calling it the Public Option Option (POO) which sets up Exchanges and lets states decide if they want to add a Public Option or not. Massachusetts already has one, California can't afford one, and other states can decide if they want one or not.
In the final analysis optimism has gained the upper hand over pessimism. Despite Republicans sitting on the sidelines, Democrats have to have "Quote: health care reform, unquote." And there are enough areas of agreement to make compromise possible. But the real reasons to bet on success are Mary Dunn, Cassandra Wilson, Mike Snyder, and all the individual stories of people who need health care reform right now.

Elected officials like to threaten to withhold their vote to gain bargaining leverage, but few who support the idea of health reform will hold out for their ideological principles when it means they would be voting against a bill that helps Mary, Cassandra, and Mike.

This article is the third in a series on CenteredPolitics.com.
Part 1: Compromise Needed to Pass Health Insurance Reform
Part 2: 5 Steps to Major Health Care Reform
This is Part 3: Can Obama Re-Unite Liberals and Moderates?

Follow Sheri and Allan Rivlin on Twitter: www.twitter.com/CenteredPols

Comments

[Karl Zollner]

Just a couple of points:
1) Everyone NEEDS health care at some point in their lives-nothing optional here
2) There is a significant body of the population who are trained to provide health care, many of whom have dedicated their lives to this.
3) There exists a need for a system which bridges 1) and 2), providing unfettered access to health care and ensuring just compensation for those who provide such.

Insurance, as a for-profit enterprise is, by definition, at odds with 3). There never will be a for-profit based Insurance system which provides *universal* coverage and *just compensation*. Not now, not ever. We can reform health insurance until the cows come home but what the* people hope for will never come to fruition in any health insurance reform. The so-called "Public Option" is the only thing left in the current health care debate which has any real bearing on health care. If our legislators fail to pass legislation including this "Public Option" they will have failed to actually address the health care issue at all, and they will have signed into law the greatest entitlement legislation for a particular industry which any nation has ever seen-forcing Americans to tithe 10-20% of their income to for-profit Insurance corporations. There can be no middle ground on this issue: conditio sine qua non=Public Option. Public Option means OWNERSHIP of mutual obligation, the thread of which every society is woven.

[Sheri and Allan Rivlin - Huffpost Blogger]

Very interesting commentary. And we are sure this represents your views and the views of many Huffington Post readers quite well. It is a cogent case for socialized medicine, right? Your un-numbered point 4 is that the private sector cannot get the job done, so we need government intervention in the form of the public plan. If we have this wrong, please correct us.

You have to understand that there are many Democrats that do not agree with this. There are real Democrats who support the free enterprise system, and reject socialism, and would neither be true to themselves or the voters who elected them if they shared your views.

An alternative point of view will follow in another comment.

[Sheri and Allan Rivlin - Huffpost Blogger]

An alternate point of view to Karl Zollner:

If you swap the word “food” for “health care” in your points 1) 2) 3) and 4) the fallacy emerges. It is almost certainly true that people would starve without public assistance for food. It is good then that we have the Food Stamps program. But that does not mean we need a public food option to compete with the private sector operating grocery stores and restaurants.

We have public assistance for health care in a program called Medicaid. It should cover more people than it does now and there are 30 to 40 million gaps that need to be plugged. We hope health care reform will plug many of them. We also support a public plan as good public policy but the be-all-and-and-all view of the public option is unnecessary – it is a very small part of the big picture of what we need to do on health care reform and its distortion of the debate is really regrettable.

[Karl Zollner]

My initial response to your blog was 1300 words long: http://iwbcman.wordpress.com/2009/10/08/24/

My comment was not an attempt to formulate a cogent case for socialized medicine. Although I have no problems with socialized medicine having recently returned from Germany after 15 years(great system, w/ some problems BTW).

And no I was not trying to attack "free enterprise"- for-profit organizations provide for a wealth of services and products that no other form of economic organization could ever provide.

But the for-profit insurance industry cannot, qua definition- as free enterprise, provide *universal* coverage. If the insurance companies are mandated by law to provide coverage for all people then they are no longer "free enterprise" and shy of laws mandating universal coverage insurance corporation must pick and choose who they cover(not to mention who can actully afford such insurance) which means some people will not be covered. Once we start doing the math and see what it costs to treat 25,000,000 uninsured(which is the projected # by the senate in 2019) exclusively via emergency room visits we begin to see why health care reform is necessary.

Free enterprise *alone* cannot solve the health care crisis afflicting America, no matter how you stretch it. The Public Option will not solve these problems by itself either- but without the PO there is no point in even talking about universal coverage-and without discussing universal coverage there can be no cost containment.

[amiri1]

Can Obama Re-Unite Liberals and Moderates? It is not President's Obama's responsibility to reunite Liberals and Moderates. The debate in the healthcare reform kitchen was overheated over the last few months. It was a robust and passionate process. Passion was the key. If we continue to voice our beliefs and work towards a common goal there is nothing that we cannot accomplish. President Obama has more important issues to ponder. It is OUR collective responsibility to coalesce and continue to be the American voice of change.

[Mary Alice]

Do the Blue Dog Democrats want to be in the picture in the paper when President Obama signs the first meaningful health care reform bill? We'll see.

[obidonwan]

OK; the hatred issue. Time to put it down.

Liberals are currently acting as if hatred against a sitting president is brand new. They thought they had a Teflon president, but apparently he's not.

The way liberals hated Richard Nixon and George W. Bush helped set the standard for presidential hatred, and now they're reaping the benefits of what they accomplished.

Not that the Republicans are innocent--they're not. But don't pretend there isn't a history here as complex and long-standing as any feud.

Where did it begin? With Lincoln? No, before that even.

And each generation of haters produces the next, each more dedicated than the previous one to roiling the waters, playing havoc with civil peace, challenging the Constitution by stretching "freedom of speech" to its utmost.

As long as people believe that hatred is a positive force, this will go on.

We should teach in schools this truth, as a poet or philosopher has said: "Hatred is a poison that a person consumes in the hope that it will hurt someone else."

Hatred always turns on the hater, and the only defense is to stop hating.

[Sheri and Allan Rivlin - Huffpost Blogger]

We were not sure where you were going at the top of this comment but we definitely agree with where you ended up.
We also see political anger as a partisan issue to a degree.
If you accept the premise that Democrats largely are the pro-government party and Republicans are largely anti-government, and also the assertion that anger tends toward disfunction. Then an-eye-for-an-eye, retributional, "the other side is a bunch of idiots" disrespectful disourse is a strategic advantage for Republicans, and respectful discourse is an advantage for Democrats.
This view explains a lot -- including FOX News, right wing talk radio, and Ann Coulter, as well as many Republicans insistance on referring to my party as the "Democrat Party."
And in this view the “angry left” is somewhat self-defeating until it finally figures this out.

[BillZBubb]

The public option isn't necessary to "punish" the insurance industry. Nice spin. The public option is necessary because, absent the real solution of single payer, it is the only method guaranteed to have a chance to contain costs going forward.

There is no real competition on price when a few very large insurance companies control the game. Put in a public option and the insurance companies face real competition for a change. They would have to change their bloated overhead and executive compensation practices. This is not punishment, it is correcting a market flaw.

[Sheri and Allan Rivlin - Huffpost Blogger]

BillZBubb wrote: “The public option is necessary because, absent the real solution of single payer, it is the only method guaranteed to have a chance to contain costs going forward.”

We agree with every word in the statement except the words “only” and “guaranteed.” We support the public option but think it is a gross oversimplification to equate the public option with cost containment. The public option is neither a necessary nor sufficient measure to achieve the very difficult goal of real cost containment over the long term and to say so is myth making. Some form of a public option would improve this round of health care reform (or could be added in a future round as long as we get the Exchanges up and running), but it has been raised to the level of Deus ex Machina by some supporters well beyond reasonable expectations of serious policy analysts.

Real cost containment will require a substantial amount of rationing of care. And regardless of the details of the reform that passes, this will include both rationing by insurance companies and by the government. All this debate will adjust those proportions by a matter of a few percentages. The good news is that there is so much unnecessary care being delivered these days that cost cutting efforts can be quite effective in finding savings.

[MarionWatts]

Thank you for putting it so succinctly. Unfortunately, there are as many narrow-minded people on the left side of the political spectrum as there are on the right, and I say that as someone from the left. They won't listen. They think they're right. They know more about the benefits of a single-payer than someone who's actually lived under that method.

http://emiliawahoo76blogspot.com
http://myspace.com/virginiadem

[TryToBeFlexible]

If somone is threatening to kill you, after stealing everything you own, and you want to find a way to get away from them and lock up your possessions, then I don't know if that is really "punishing" them. I guess, since the insurance can only survive by stealing and killing, then us protecting ourselves is somehow just us punisning them? How awful of us. If we were nice people, we would just give them all our money, then die quietly, so they can keep living the high life.