Robust Health Care Reform is the Moment of Truth for Obama and the Democrats
Fellow Americans, and fellow Democrats and Obama supporters, we are at a moment of truth, a pivotal turning point -- in the form of what happens in the next days and weeks with robust, universal health reform. A fork in the road socially, economically -- and politically. It could go either way depending on Obama and the Democratic officeholders many of us worked so hard to elect. They have the power to act, but will they use it -- or lose it?
If at this remarkable juncture Obama and the Democrats cannot enact a robust health care reform -- with a strong nationwide public option, cost controls, and nearly universal coverage -- I would not want to be in charge of fundraising and mobilization for them in the 2010 and 2012 elections! Most of us who supported them last time will of course not vote for a Republican.. But if Obama and the Democrats cannot act now on a once in a half century challenge and opportunity, they are not worthy of extra energy. And those of us who wrote big checks last time will tell the Democrats -- especially in the Senate -- to hold pharmaceutical fundraisers instead.
Key leaps forward for U.S. public social provision -- Social Security, Medicare, etc. -- have NEVER happened through "bipartisan" compromises and they always happen in close votes. They have always sqweaked through after gargantuan effort, strong presidential pressure, and refusal to allow eviscerating compromises. Think of Social Security if the Clark amendment -- allowing corporate opt-out -- had passed in 1935. We would not have it. And conservatives and the medical and insurance establishments cried "socialism" in 1965, too. We would not have Medicare if we had listened.
Obama and the Democrats are coming off a historic, landslide election. They have all the popular support for robust reform they will ever have. Good policy design as well public desire for change and considerations of social justice and economic efficiency insist that they enact health care reform with a strong public plan in the mix. That is the only way to move toward cost control and guaranteed access with quality to all -- especially for Americans in lower economic strata or in rural states where one or two private insurers call the tune. There is no need for "bipartisanship" and the calls for it from some weak-kneed Democrats are merely excuses for doing the business of the medical-insurance establishment. Senators Baucus, Conrad, Feinstein, Nelson, Landrieu, Bayh -- this means you. All of you come from states where people really need robust reform and you should step up.
The stakes here in political-economic terms are NOT between a "free market" and "government control." They are between two alternative uses of government regulations and subsidies: We will in America continue on the path set over the past thirty years: using government regulations and subsidies to distribute income and security upward, to guaranteed private profits; or will we redirect government interventions toward expanding popular security and leveling the economic playing field for various businesses? So-called conservatives seeking "compromise" on health care reform want more subsidies for their buddies' profits, and want to force more Americans to buy inefficient products (through a mandate to buy private insurance). If Obama and the Democrats agree to such compromises under the name of "reform" they will have squandered the country's future economically -- and undercut their own political fortunes for the future.
Because let's not kid ourselves: WHATEVER passes this year will make the Democrats owners of the health care mess going forward. If they just throw more subsidies and piecemeal regulations into the current system, they will ensure galloping public costs for residual arrangements and for subsidies to private insurers who will easily find ways to avoid sick or costly patients. Businesses and citizens will grow more and more irritated as time passes, and will blame the Democrats. Rightly so.
And to return to my theme at the start: no matter if Senate Democrats still think they are operating in the world of the 1980s or 1993, they are not. Activist Democrats -- mobilizers, volunteers, bloggers, analysts, and donors -- are watching them. We will know exactly who blocks or eviscerates real reform here. We WILL blame the Senate and the responsible individual Senators. And many of us will blame the Obama adminsitration if it does not take a strong stand on the public option and real reform, starting right now. Whatever he says in public, Obama needs to draw lines in the sand with Democrats in private -- and get tough. If he does not, and this fizzles into no legislation or reform in appeance only, energy will dissipate from the Demorats and the Obama movement. There will be the wrong kind of turning point for them -- and for America.
So step up now, Obama and the Democratic Party. Your moment is here and now.
Show your support for the public option by signing this petition: http://wewantthepublicoption.com/
Your name might even be shown in a TV ad in DC!
June 24, 2009 9:59 AM | Reply | Permalink
Don't sign a petition for a public option. We need single payer - sign this petition instead
http://sanders.senate.gov/petitions/index.cfm?uid=7fd59f2e-88e1-477a-8eaf-762a5b050809
June 24, 2009 2:03 PM | Reply | Permalink
Where is the petition for fully socialized medicine? That's the one I want to sign.
Yes, single payer is clearly the better solution. But that ship has already sailed. I don't like it either. But if my choice at this point is for a strong public option, or no public option, I'll hold my elected representitives responsible for the former, in this cycle.
We'll have to work on single payer next. And then a fully socialized medical system after that. Maybe before I die (but I doubt it).
-- ARG
June 24, 2009 2:21 PM | Reply | Permalink
Single payer is definitely good, but most importantly I'd love to see one that beneficial for couples who have a hard time raising families and children. There are so many women and men working so hard to make ends meet. Cant something just help them?
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A couple of questions in response to this insightful post.
"There is no need for "bipartisanship" and the calls for it from some weak-kneed Democrats are merely excuses for doing the business of the medical-insurance establishment."
Was it not our President himself who so loudly and determinedly led the chorus for bipartisanship?
"If Obama and the Democrats agree to such compromises under the name of "reform" they will have squandered the country's future economically -- and undercut their own political fortunes for the future."
Then why even bother with the public option at all? Why not do what really needs to be done and skip this phase and go directly to single payer which is the best, most cost efficient and effective way to manage our health care system?
The President and his colleagues on Capitol Hill started from a position of weakness allowing the drug and insurance parasites to dominate the entire process and by so unwisely taking single payer off the table. Now, because the Dems tied one hand behind their back before the fight even began we are supposed to think the public option is the best that can be done. Isn't that fundamentally foolish on the part of Democrats and so isn't the current situation almost certain to end badly for the Democrats not to mention the American people and their health?
June 24, 2009 10:51 AM | Reply | Permalink
It makes you wonder if the fix hasn't been in all along and they never ever intended to actually deliver universal healthcare. Watch the weasel words. "Expand coverage" is a favorite of Senators like Feinstein and Klobuchar and probabably others. Notice how LOW they set the bar. Notice the almost total lack of commitment. Notice the entire absence of passion. Notice the poverty of empathy. Notice the disconnection from the health emergency facing so many Americans.
Is there any bill they could pass where the weasels would not be able to claim that they had "expanded coverage" even if even that is a big whopper?
June 24, 2009 11:10 AM | Reply | Permalink
One area in which I've noticed an abundance of empathy and concern on the part of Washington DC Democrats is their genuine caring for the continued maintenance and care of the insurance and drug interests that have been exacerbating every problem we have in health care. It's good to know "The Party of the People" demonstrates such caring and concern dont' ya think? While the nation's health and economy grow worse, the important thing is to make sure that those who profit from this rotten system maintain their wealth and power. After all, we wouldn't want them to bite the hand that feeds them would we?
June 24, 2009 12:57 PM | Reply | Permalink
Well, they did the same thing for the banks.
Largess for the "haz-way-too-muches" and not near enough for the "not-haz-enoughs," methinks.
June 24, 2009 10:48 PM | Reply | Permalink
Obama and the Senate Democrats are confusing bipartisanship with consensus. We already have a consensus: 72% of Americans want a public health plan option, the Republicans have just a 25% approval rating, and there are nearly 60 Democrats in the Senate.
Senators fetishize "party" at the expense of people. Their whole lives revolve around party. If there were 90 Democrats in the Senate and 10 Republicans, some Democrats would still be worrying about winning over one or two of them for fear of being called "partisan."
Bipartisanship is meaningless. Consensus is what matters.
June 24, 2009 1:01 PM | Reply | Permalink
The same poll that showed that 72% of Americans want a public option also showed that 50% of REPUBLICANS want a public option. So I'd say we have both consensus AND bipartisanship.
June 24, 2009 2:00 PM | Reply | Permalink
Exactly. The only thing we lack is representation.
-- ARG
June 24, 2009 2:09 PM | Reply | Permalink
good post and good comments. I have noticed dems falling back on ambiguous phrases like "expanded coverage" and "access to quality affordable healthcare". What constitutes "affordable"? By whose measure?
June 24, 2009 11:25 AM | Reply | Permalink
Boxer did exactly that in answer to my email urging public option
Those are the Obama Principles. You get those back from Dems who do not want to commit to this or that specific
It is a sign of indecision at best, temporizing in many cases
June 24, 2009 11:34 AM | Reply | Permalink
Organizing for America - Find a Health Care Mobilization event near you
http://www.barackobama.com/index.php
June 24, 2009 11:32 AM | Reply | Permalink
stop promoting the public option. It is a sham.
We need single payer.
June 24, 2009 2:07 PM | Reply | Permalink
They must hang together for the public option, or surely they will hang separately!
June 24, 2009 11:33 AM | Reply | Permalink
Yup. A fork in the road, or a fork in the roast, so to speak....
June 24, 2009 11:40 AM | Reply | Permalink
I don't see how it's possible to have some of the things you want (no exclusion for pre-existing conditions, community rating) without also having something you don't want (mandated coverage). Consider the two examples you've listed: Social Security and Medicare. Both are mandated participation. What all these things have in common is risk and cost pooling. If young healthy people are allowed to opt out the costs become unmanageable.
June 24, 2009 11:50 AM | Reply | Permalink
Both are funded by taxes not by individual private payments and the government has made a commitment to deliver both. Where is the commitment to deliver healthcare in the reform bill? That is going to be the question for me. I hear a lot about cutting costs but where is the commitment to deliver univeral healthcare?
June 24, 2009 12:11 PM | Reply | Permalink
It's somewhat of a chicken-and-egg situation. You can't manage costs unless you have universal participation, but you can't mandate universal participation unless you can manage the costs to make it affordable.
June 24, 2009 1:25 PM | Reply | Permalink
We don't require war to be affordable. If Democratic leadership wanted to find the money they'd find the money. They just don't give a damn. I was just listening to Conrad on Big Ed's show and it's enough to make you sick (if you could afford to be sick). It doesn't matter what the American people want according to Conrad. The people are irrelevant. The only thing that matters are the oligarchs running the Senate. You'd think Marie Antoinette was chairing the committees.
June 24, 2009 3:33 PM | Reply | Permalink
The politicians calculate that We the People just don't care enough about it to make much of a stink.
Aside from a few pointed posts by bloggers on the intertubes, they can count on the majority remaining docile (even if they would rather have a public option), and the media spinning it as just another round of the usual political gamesmanship.
Do these politicians miscalculate this time? Unfortunately, I doubt it.
-- ARG
June 24, 2009 5:10 PM | Reply | Permalink
You misunderstood. I meant affordable as in the people who pay for it have to be able to afford it. You can't mandate coverage and expect people to pay $1000 a month. But you can't get the cost down as long as young healthy people are allowed to opt out. Just as Medicare and Social Security would never work if people were allowed to opt out until they got older and needed it, health care coverage works the same way.
June 25, 2009 10:58 AM | Reply | Permalink
OK, I agree with you there.
June 25, 2009 11:10 AM | Reply | Permalink
When I first studied Obama's position on health care, about 2 years ago, I was very disappointed. It was clear then, and it is clear now, that Obama is not in favor of any form of universal health care coverage, preferring to make incremental improvements that may at some time lead to universal health care. This is not an interpretation of his position, it is his position.
His reasoning even back when he had no reason to expect to be elected, let alone be elected in a landslide as he was, was that he wanted a system that could be passed with bipartisan support in Congress, and a "pure" system would never get that. He was not thinking clearly on the subject then, and he is still not thinking clearly on the subject.
Theda is absolutely right. This is the time to pass a universal health care system, and the public option is, in fact, such a system even though it is not being called that. If we don't get this done now, and don't riot in the streets as a result, we deserve to be treated with all of the disrespect that the Senate is now treating us with. Many, if not most of us, will withdraw from active participation in the electoral process as a result.
June 24, 2009 1:45 PM | Reply | Permalink
thanks for making this point. if rahm is obama's outspoken half, then it's clear what obama wants. he wants a win, he wants a bipartisan win, and he wants to look like something big has happened regardless of whether it has. this is all incredibly sad, but hey, you get the centrist non-feather-ruffling president you voted for...
June 25, 2009 11:15 AM | Reply | Permalink
Sounds like many don't know the difference between the public option (which House Dems and maybe Obama want)and a single payer system. You would do yourself a great favor to watch this video that explains how the single payer system works.
http://1payer.net/what-is-single-payer-healthcare-animated.html
The public option is a sham that will not give us universal health care and under the current proposal in the House will only cost us more money with terrible results.
I guarantee that the public option will not allow public insurance to compete on a level field. If the public insurance plan could, all of the for- profit insurance companies would go out of business. If Congress mandates coverage and subsidizes those that can't afford insurance, the insurance companies will win. They will rig to system to make it harder for public insurance to compete and we will be subsidizing new customers for the for profit insurance industry. We don't need the insurance industry. They add nothing to the system but inefficiency and waste.
The single payer is the only way to go.
June 24, 2009 2:19 PM | Reply | Permalink
See, now you're thinking about a strategy. A way to get from where we are to where we want to be.
I'd like it to be done neatly on one vote, next month. But we're going to have to fight this war for years. Dig in. This is just the first battle.
Another possible strategy -- no health bill this time around, due to arguments over the public option, leading to actual serious pushback from the public (can you imagine?), leading to single payer instead of a "public option", or a strong enough public option to actually lead to single-payer in another few years. Far fetched, I know, but I'm a dreamer.
As I said above, I won't be happy until we have socialized medicine: no capitalists making money off of the misery of the sick.
-- ARG
June 24, 2009 2:32 PM | Reply | Permalink
I'm as much in favor of a single-payer system as anyone, but I'm also a realist. It has no chance of being passed this year. None. You can stamp your feet, hold your breath and insist until New Years that single-payer is the best way to go, but it will make no difference.
The public option is at least a step in the right direction. Sometimes one step is all you can manage, but you know the old Chinese proverb...
June 24, 2009 3:07 PM | Reply | Permalink
But why then go for the public option when all it will do is perpetuate the rotten system we have, cost more in the short run, and delay the day when we get single payer system that serves the public interest? Seems a bad compromise to me unless we have a timetable for how long it will take a public option to put all the insurance parasites out of business.
June 24, 2009 3:50 PM | Reply | Permalink
Another possible strategy: public financing of elections.
I have said before that I don't believe we can ever get real reform of the med biz until or unless we get election finance reform. The entrenched interests just have too much money.
-- ARG
June 24, 2009 4:17 PM | Reply | Permalink
Having access to affordable health care coverage as costs rise, is a key issue for many Americans right now and should be Congress’ top priority. Friends of the U.S. Chamber of Commerce supports alternatives for individual health coverage. Learn more about some of the proposals and sign a petition at http://www.friendsoftheuschamber.com/takeaction/index.cfm?ID=40 .
June 24, 2009 5:41 PM | Reply | Permalink
Theda's right on the issues of course but... she was so venemous against Hillary during the primaries that to see her say that healthcare is Obama's "make or break" moment is kinda funny.
June 24, 2009 8:39 PM | Reply | Permalink
Also.
June 24, 2009 8:52 PM | Reply | Permalink
? What does the one have to do with the other?
June 24, 2009 10:51 PM | Reply | Permalink
I guess it's that universal healthcare was her issue for such a long time and during the primaries and it wasn't really Obama's, so a lot of us who were Hillary supporters were worried about this one, should Obama win the White House. And... he's done a great job. But... go back into the archives and Theda was just mean to Hillary and to Hillary supporters throughout the primary. Now she has the nerve to say that healthcase is the defining issue? I mean... a little more grace from her during the primary would have been nice, in light of this.
Though, to be fair, I was not entirely graceful back then either.
June 24, 2009 11:30 PM | Reply | Permalink
You were a saint by comparison, destor.
June 25, 2009 2:46 AM | Reply | Permalink
Well, I can sure see where she is coming from. Women of a certain age who fought hard against a woman of our generation (e.g., me) did so hoping that we were going to be getting a stronger advocate on a wide range of issues, war in particular, than we'd get with Hillary. Instead, we got Hillary at State, abundant funding for war, nothing significant on any other liberal issue, and this reform farce on healthcare.
June 25, 2009 11:21 AM | Reply | Permalink
The argument is clearly coming from someone who supports single payer (as I do, and Obama at least used to say he did). The question is focused on the politics at this point in time where the rubber hits the road in Congress and its relations to the Administration.
(Incidentally, as a strong Obama supporter, donating to his campaign starting B.O. [before oprah became central to the campaign, giving the first glimmer of hope that Obama might actually win] I remember LOTS of venom in the campaign, almost ALL of it against Obama mainly from Hillary supporters, including high up in the campaign. I don't know who said exactly what, but people should check out the mountains of threads attacking Obama for not cancelling an engagement at the last minute with gospel singer Donnie McClurkin, a name most folk have since forgotten, if they ever knew it. That was some campaign -- replete with race-baiting and hints/charges of anti-Americanism and even the repeated claim that Obama was a Moslem. I myself got pretty sharp in response to some of that.
Now, like so many others who supported Obama PRECISELY because he at least held out the HOPE that he would not just be another Clinton/Al From Democrat, and on energy, health care, a range of human rights issues both explicit and otherwise, the same old pattern of pseudo-compromise that only turns out to be unstrategic as well as unprincipled is rearing its ugly head again.
The energy bill is so bad that I for one feel it would be better to just pass the clearly positive and relatively hard-to-vote-against parts of the bill, and let the whole cap-and-trade thing wait for next year. At the very least the legislation MUST have a non-lockin clause that allows for tightening of standards as scientific findings suggest the need for it.
On health, the same pattern applies. Obviously we won't get single payer, although the way the huge support for it has been marginalized by fiat in the debate has been obscene. And COngress isn't Iran -- Obama need not take a hands-off approach to that. At this point, one CRUCIAL provision, like the non lockin provision on energy would be something that makes clear (and formulates the bill to make it possible) that this reform does NOT preclude a future transition to single payer. Also, states should be explicitly empowered to opt for statewide single payer systems without prejudice to their federal aid or eligibility for it. This "state system" option should be ALONGSIDE and not instead of the national public option.
And yes, Obama needs to draw a line in the sand on public option. But what does Skocpol mean about "privately"? My question on health care is what can folk like Theda Skocpol and the many prominent intellectuals and medical professionals she knows or has access to do at this point?
I suggest they run a full-page ad in the NY Times (and possibly elsewhere) specifically noting that many of the signatories support single payer and consider it regrettable that single-payer was excluded from discussion and that Obama not insist that it at least be seriously included as a possibility. (This would be a subordinate point). Then it would insist that, as an ABSOLUTE and NON-NEGOTIABLE minimum, Obama MUST publicly and explicitly draw a line in the sand on a meaningful and robust public option, with various specific parameters, and threaten to veto any legislation that lacks such a provision at the very least. Hopefully, such a statement could include the "nonpreclusion of single-payer" clause I mentioned above as something they suggest, even if not as part of the 'line in the sand'. And then there could be oodles of intellectuals, doctors, medical professionals, some members of Congress and other politicians and notables, and a call to support the statement, donate, etc. This would generate news, (like the Betray-Us ad, whatever else one might say about it, succeeded in doing), and have a lot more impact than all the 'petitions' in the world, and the relatively meager mass demonstrations that have been held.
If I were rich, I could offer serious money towards this, but no doubt there ARE such rich folk around who could and might pony up what is needed to finance both the ad and the organizing/name-culling effort.
Perhaps Ms Skocpol, others at TPM Cafe, or some who folk know are in a position to get a ball like this rolling. It could, in my arrogant opinion, make a difference
June 25, 2009 11:58 AM | Reply | Permalink
I sent an email to the DNC this week that said this very thing. I got a stock email in return, but who knows someone in the so called *leadership* may get around to reading it some day. I'm glad you are lending some heft to the issue, Theda. They may listen to you.
June 25, 2009 2:03 PM | Reply | Permalink
As I've been a contributer to both Democratic congressional campaign committees in the past, I wrote them a letter informing them that if the public option fails, in the future, I will support Democratic members of Congress on an individual basis, rather than give to a fund that rewards the Democrats in name only, along with those who seek to provide affordable health care that can't be denied or taken away by a corporation who's primary goal is the bottom line.
Those who see their corporate contributors (to the tune of hundreds of thousands of dollars) as their true constituency, clearly don't need my money anyway.
June 27, 2009 4:09 PM | Reply | Permalink
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Its the classic battle between good and evil; the public against the money changers and those in Congress they can buy.
June 29, 2009 1:41 PM | Reply | Permalink
bust, universal health reform. A fork in the road socially, economically -- and politically. It could go either way depending on Obama and the Democratic officeholders many of us worked so hard to elect. They have the power to act, but
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