Compromise Needed to Pass Health Insurance Reform

Try telling conservatives that Barack Obama is no liberal and you just get blank stares. Reading their own talking points, they will never understand how one could possibly suggest that the president who has tripled the deficit and wants to socialize everything could be anything other than a liberal unless you want to call him a socialist.

But liberals are certain Barack Obama is not a socialist and they are just starting to realize he is no liberal either. Progressives are just now finding out who they elected president last fall, and he is just as he campaigned, a remarkably audacious pragmatist. Audacious for everything he is trying to get done in his first year, but there is so much compromise in getting each element that the true left is wondering if the core kernel of progressive goals is getting bargained away.

An aggressive agenda full of compromise to get it done
After the stimulus bill and several bailouts, and in addition to new overtures to countless international allies and adversaries, the domestic agenda for 2009 includes health care reform and climate change and a host of other issues that only seem small by comparison -- but in each case, don't be surprised if compromise is the order of the day.

For instance, earlier this month, Congress passed and the President pledged to sign legislation that for the first time allows the Food and Drug Administration authority to regulate cigarettes - once thought a liberal dream - but some liberals are complaining that in crafting the Bill that Phillip Morris supported, so many compromises were introduced that the FDA is blocked from doing many of the things; such as regulating the dosage of nicotine or banning existing tobacco products; that might have the greatest impact on public health.

Our point is not to criticize the progressives who will view this and other compromises as inadequate to the task of solving our most pressing problems. What they are saying is true and important, and this is America -- everyone has the right to voice opposition to a proposed piece of legislation. To a degree, principled voices on the left help move policy toward the left. The stronger the support for the left position the greater the leverage Obama has to get the best deal he can for his compromise position - one that has the peculiar benefit of being passed by Congress, signed by the President of the United States, and therefore the law of the land.

But taken too far, these progressive voices can become an impediment to progress. This happens when some leftists start to see the center-left compromise-to-get-the-deal-done style Obama represents as an adversary of progress rather than as a means to achieve it. When the true believers on the left stand in opposition to the center-left, the right wing celebrates. The right wing has just been soundly defeated by the coalition of the left and center left, but it could gain new life if this coalition splits.

We live in a Democracy and a Democracy is not about being right, it's about having a majority. Barack Obama (and Hillary Clinton) campaigned as a pragmatic center-left Democrat and Dennis Kucinich campaigned as the true representative of the far left. Obama won the nomination and we all rallied around him. He was not for "single-payer" national health insurance in the campaign and he is not for it now. There has been no sellout.

Passing health insurance reform is going to be very, very hard.
Bill Clinton's Pollster for the 1993-1994 health care reform effort Stan Greenberg wrote an article in this week's New Republic that is basically a repeat of what we wrote four months ago here. Greenberg has been looking at his own polling in 2009 compared to the polls he took in 1993, and he concludes (just as we did) that public views are not very different now than they were then, but to the degree they have changed, current attitudes are less supportive for reform.

The big problem is, the views that undercut reform in 1994 - the majority's satisfaction with their own coverage, the public's desire for reform that saves them money (covering more people is just a bonus unless you don't have coverage now), and especially the public's rejection of any new taxes on themselves - are stronger now than then.

Casual readers of the polls may miss this because healthcare polling is fairly confusing. In the abstract, the public strongly supports the idea of "health reform," but this is because they hope it will save them money, so they are just as passionate in rejecting any mechanism to pay for it if it might mean that they would pay additional costs.

The most recent release from the Diagio/Hotline poll is typical. The headline: "High Public Support for Major Overhaul of Health Care" but this is followed by the sub-headline; "Taxing Health Benefits Strongly Opposed."

Like most other polls, this one finds a strong majority (62%) supporting "a major overhaul of the U.S. health care system." But when they tested the current best idea anyone has come up with so far to pay for it, taxing employer paid health benefits as income, by 26% to 62% an equally strong majority says "no way."

The latest NBC News Wall Street Journal poll find little difference when the proposal is more clearly defined and limited to people with the most expensive plans. When their list of possible elements of reform includes "require people with expensive health plans with more generous benefits than a standard plan to pay taxes on a portion of that plan's costs" 33% find it acceptable but 59% say it is unacceptable.

People understand that health care reform will mean sacrifices but they want the sacrifices to fall on someone else, not them, and health care reform cannot pass until someone comes up with a politically viable way to pay for it.

Obama's Going to Need Room to Maneuver Not Lines in the Sand:
So far progressives have drawn two lines in the sand on this issue, one is certainly not going to be in the final bill, and the other may take a disappointing form if it does not get bargained away all together. Some see "single payer" national health insurance as the only legitimate goal for health care reform, while others like MoveOn.org are defining the "public option" as the sine qua non for reform.

The President and most of Congress have rejected single payer as politically unfeasible, dismaying supporters who claim that the proposal has the backing of a majority of Americans. The president is right on this point, and the selective poll results are meaningless. If the question included the counter arguments - the cost, the bureaucracy, that many people who like their current arrangement would have to change to something new, etc., etc. - and still received majority support, well that would mean something.

The existence of a "public option" (vaguely defined as a health insurance plan available from the government) is as much a line in the sand for Republicans who oppose it as a form of back door path to single payer. There is plenty of room for debate but also plenty of room for compromise. As CenteredPolitics.com Health Editor Jim Jaffe has pointed out here, a lot of different things could be arguably called a "public option." If the Deal-Maker-in-Chief needs to accept something less than the perfect definition in order to get "Health Insurance Reform" signed this year, we should all be ready to celebrate the achievement.

Comments

[hsr0601]

Human health, in a sense, may precede all the other basic human rights as everything means nothing for someone without it. As far as my common sense goes, the major role of government will be to protect basic rights of the public from any threat. That is why all of the industrialized countries have public policy in place, I guess.
Under this premise, the strong public option needs to be cited as a part of 'PROTECTION' like anti-trust law rather than intervention.
The intention to introduce the public choice would be to protect the uninsured, economy and keep the medical industry honest, not be to drive it out.
Hopefully, the health industry can provide reasonable,fair, competitive prices and quality service via tireless innovations like most of the EUROPE, instead of concerning about its monopoly prices, otherwise the forthcoming health start-ups will likely fill in the blanks with competitive terms over time

[hsr0601]

I think, given the fact that health insurance premiums have doubled over the last decade at an unsustainable rate three times faster than wages, the status more than 97% of all Massachusetts residents,the highest in the U.S., are now covered could be touted as success model, which features 'mandating insurance' and an option to purchase coverage through the "Connector," a program in which private insurers are required to offer coverage to those who can't get other insurance, regardless of age or health status.
But the Massachusetts model has a problem with costs control, because it relies exclusively on private insurers as Massachusetts' insurers implemented average premium increases of 8% to 12% only in 2008. And it highlights the necessity of having a publicly financed insurance option
To be sure, in case the president's proposal with respect to the strong public option, medical IT, increased efforts in prevention, and a broader array of cost-saving plans and beyond adds to the Massachusetts Plan with the provision of employer mandate and an individual mandate, the cost containment does not matter at all. And most importantly, the promising stem cell research is making its way.

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[PacificJohn]

"Progressives are just now finding out who they elected president last fall, and he is just as he campaigned, a remarkably audacious pragmatist­."

Huh, hum.

Slightly more than half the party knew who this guy was in the primaries and voted that way. Exits polls show that Obama only reliably took upper-income/white male and African American blocs. Only one of the two blocs voted based on ideology. So you tell me who was naiive? This looks very much like a white male coup to me. Heckofajob.

[Sheri and Allan Rivlin - Huffpost Blogger]

My wife (a Hilary Clinton supporter) and I (an Obama supporter) started our website, CenteredPolitics.com as an effort to bridge the gap between supporters of the two candidates. We invite you to read what we were writing during the period you are discussing.

But I do not recall there being a spit when it comes to ideology of the type you suggest now. Are you saying Hillary was claiming to be to the left of Obama? I seem to recall a suggestion that only she could carry states like Pennsylvania and Ohio. Was that because she was more liberal than Obama or more conservative? I am confused by your suggestion. Our view is both were attempting to occupy the same ideological space in the center-left.

The question we face now as progressives is -- Do we continue to unite as a majority as we did last fall or do we claim our minority is correct on the issues and split and lose? Center-left and left must keep working together even as the going gets tough.

[olip]

I am a health insurance agent in Utah. I sit on the board of the Utah health underwriters as webmaster for http://www.benefitsmanager.net/ and http://www.uahu.org/. I was heavily involved in designed a web connector to help Utah residents by pulling private and state sponsored insurance mechanisms together. It had a low budget of around $150k that virtually guaranteed health insurance coverage through either the private or state programs. Better yet all the local carriers agreed to split the costs. Our state insurance task force committee rejected the idea. They elected to go for a Massachusetts type connector program that isn't working well when you actually dig deep and check facts of where they are now. Our state approved H.B. 188 with a zero fiscal note attachment! My point is, I have been a fly on the wall in countless legislative meetings, insurance board meetings, hospital board meetings, the list goes on. The problem is conflict with the market demanding profit in all sectors of the system. Tough order to fill and keep costs down? You are absolutely right when you claim that healthcare is now unsustainable. I have been crying that a long time. Nobody listens.

[droftim]

This is not change we can believe in; it's business as usual Washingtonian horsetrading. Focusing on ideologues in Congress is not going to fix this urgent problem.

President Obama said that anyone who was satisfied with his plan could keep it. He didn't say though, how that would be possible if one works for one of a growing number of companies who think what is going on today is unsustainable and are sharply cutting back on benefits
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http://www.nytimes.com/2008/11/15/business/15insure.html
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Nor did he address the issue of not being able to actually get care because ones health dollars were completely consumed by the premiums.
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http://www.nytimes.com/2009/03/16/health/policy/16mass.html?scp=1&sq=massachusetts%20healthcare&st=cse
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Soon we'll find that government employees will be the only people with employer-paid (taxpayer actually), full coverage. That's okay though, because President Obama also told us that everyone would be able to opt into a plan that would deliver coverage comparable to Congress.
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The bogus "public option" doesn't stand a chance in hell because a crippled public insurance plan will do nothing toward cost containment, will cover relatively few people, and will cost a fortune to initiate. Nor will it do anything about the bankrupting effect the current model is having on individuals, companies, and the nation. All these CBO estimates should be scary; the plans are all illconceived attempts to preserve the primacy of a collapsing model: employer-paid, for profit insurance.

[droftim]

Instead of talking to political strategists who "know" what is out of the question, the administration should start talking to various Fortune 500 executives -- all of whom do business internationally -- and ask them which of the various Single Payer, Universal Health*care* models they prefer and why. Then he should get commitment for them to support whatever that is at current benefit levels and go forward with REFORM. That's the only path out of the mess that has any hope of delivering what President Obama talked about. It has the added advantage of costing far less than what we as a nation are now spending.

President Obama did not get elected by Washingon insiders who "knew" that he didn't have a chance and we won't get healthcare reform by listening to them either.

[razingfools]

I could not agree with you more on your post. I can only imagine how eager corporate America would back a public health plan so as to get the monkey they have now off their backs. A public health plan would give their bottom lines a leg up without a doubt. I'm very curious as to why the rethugs aren't drooling all over themselves because of this simple fact.

[razingfools]

droftim: I couldn't agree with you more on your post. Corporate America would probably wet themselves if they could get some or most of the burden of insurance off of their backs. I'm rather curious as to why Republican members of Congress haven't come out on the side of public health option, unless they want to be able to toot their own horn over this. Dems better be very careful on this as it will surely cost them in 2010 & 2012.

[Sheri and Allan Rivlin - Huffpost Blogger]

Why so angry at political strategists? Would you prefer that he not talk to political strategists? He would never have been elected -- to the State Senate, let alone the US Senate and President. Or do you mean he should not listen when they say something you do not find agreeable.

Your suggestion that he listen to Fortune 500 executives is a very good suggestion. There are thousands of them, and their views are quite complex, and not nearly so easily summarised as you suggest. They are not all so supportive of single payer as you suggest. I know, [Allan typing here] It is my job to know.

The way a President acts on your suggestion is to have staffers find out which fortune 500 executives have a point of view on this issue and invite them to comment, in writing, in phone calls and in meetings with top staffers and sometimes with the POTUS himself. That's what Washington insiders do. What you call "Business as usual, horsetrading" in your first post is actually what it takes to follow the suggestion in your second post. Real change isn't hating on everything that goes on in Washington, it is understanding that real people are trying to solve the real difference between people and their quite complex views of what needs to be done. If everyone agreed with you, it might be a much etter world, but that is not the world we live in.

Peace Droftim, Peace.

[freelyb]

Honestly, this is why centrists are problematic. When there is a polarity of thought, the factual realities represented by both are best incorporated in such a way that the final solution transcends either of them. But damn, this is just lukewarm justification for doing absolutely nothing.

[iridium53]

You write, "If the Deal-Maker-in-Chief needs to accept something less than the perfect definition in order to get "Health Insurance Reform" signed this year, we should all be ready to celebrate the achievemen­t."

Couldn't possibly disagree more.

Advancing the ball a couple of yards does not constitute winning the game. It's not even a first down.

Obama didn't accomplish anything with the banks except support the bankers.
We can expect that he'll be just as successful with health insurance - he'll accomplish nothing but enrich the health insurance companies.
That's not enough. Not hardly enough. It is just a corrupt sham.

[Sheri and Allan Rivlin - Huffpost Blogger]

Delighted to discuss the football analogy -- [This is Allan typing.]

Supporters of single payer seem not to realize that it is a long bomb and more accurately a "Hail Mary." Far too many Democrats know it would cause their defeat in their state or district if it passed for it ever to pass. This may not be obvious if you live in San Francisco, Portland OR, or the blue patch from Maryland to Boston, but we Democrats have been winning recently in the Mountain West, and in Virginia, North Carolina and some congressional districts in the deeper south. Single payer will not get those votes because the public does not want it. A defeat for health care reform this year does not mean we try "real reform" single payer next year it means we get nothing for decades and republican victories in 2010. That is the likely INTERCEPTION a Hail Mary gets you.

Take the 4 yards on first down and keep working on 2nd down.

[Sheri and Allan Rivlin - Huffpost Blogger]

If there are any progressives who are also football fans (guilty) reading this, then all we are asking for is the kind of discipline that any football team needs to win.

Instead of throwing their blocks and making their plays, why are so many Huffington Post readers arguing that the guy we chose as Quarterback called the wrong play while the ball is live?

"Hey I know you called it up the middle but we really should be running to the left." That kind of football ain't going to win championships.

You can argue that healthcare is more important than football. Yea, I know. I don't like to lose either one, discipline in passing health care reform is more important.

[Richrdh]

Health care reform is going to be "very, very hard." "It is only hard if you make it that way," is my response to not fixing the health care system 40 years ago. Congress is making reform difficult, it is not the progressives demanding a single public health payer system or a public plan option. The progressives are wanting a solution and the only way is to have a public health plan. No proposal is worth looking at unless it contains the public option. Anything less will not work.

You are right the public option can mean anything. There in lies the hope of democrats and republicans who are afraid to do the right thing. They want to protest their lobby money and get our vote too. Do you really believe if a Congressman went home and voted in comprehensive reform that the voters would say get them out of Congress? The attitude you can take health care reform too far is an an assault on intelligent progressives.

[Sheri and Allan Rivlin - Huffpost Blogger]

"Do you really believe if a Congressman went home and voted in comprehensive reform that the voters would say get them out of Congress?"

The simple answer is "Yes." And it already happened. Congress (controled by Democrats) passed a major Catestrophic Health Insurance Bill in the late 80's and it was signed by the first President Bush signed it. It provided coverage against major expense to seniors but it also raised taxes on seniors. The public outcry was tremendous and Congress repealed the law. If you don't know ths history, read all about it on Centered Politics.com "Are we learning from the correct failed Health Care reform?"