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Just Another DLC Failure on Health Care Reform
Like many in this country, I truly thought that in choosing Obama as our President, we had at last elected a credible leader capable of pursuing legitimate change in the way business is taken care of in Washington. The dire state of our economy and the global situation including two hot wars intensified the need - and, thus, the opportunity - for a populist leader to assume the Presidency. With things in such disarray, such a populist leader would be given wide latitude in doing the people's work instead of kow-towing to the corporate lobbyists who have corrupted nearly every notion of democracy ("of the people") that supports this Republic.
Instead, it seems we have once again been bamboozled by the same old DLC type creampuff casper milquetoast know-nothings who try to legislate from within the cesspool that is Washington pay-to-play politics and end up with little more than their pants around their ankles and a wtf look on their face.
Once upon a time in this Obama campaign and Administration, there was opportunity to pursue principle over politics, and it was in building a populist campaign for health care reform that this could most strongly have been realized. We could have been proud of at last taking a victory from the lobbyists and the corporations who own Washington, and maybe we could have learned a few things that would lead to actual political reform as well.
It is in hope of such an opportunity being realized that I truly thought we were getting "Change We Can Believe In" when I cast my vote for Obama. Instead, it's looking like we got some hick from Illinois who thought he could win at the Washington lobbyists version of three card monty, and we are all the greater fools because of it.
Instead, it seems we have once again been bamboozled by the same old DLC type creampuff casper milquetoast know-nothings who try to legislate from within the cesspool that is Washington pay-to-play politics and end up with little more than their pants around their ankles and a wtf look on their face.
Once upon a time in this Obama campaign and Administration, there was opportunity to pursue principle over politics, and it was in building a populist campaign for health care reform that this could most strongly have been realized. We could have been proud of at last taking a victory from the lobbyists and the corporations who own Washington, and maybe we could have learned a few things that would lead to actual political reform as well.
It is in hope of such an opportunity being realized that I truly thought we were getting "Change We Can Believe In" when I cast my vote for Obama. Instead, it's looking like we got some hick from Illinois who thought he could win at the Washington lobbyists version of three card monty, and we are all the greater fools because of it.
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Obama's rhetoric of "hope" and "change" was designed to provide the appearance of populism even while his agenda lacked the substance. Unfortunately it looks like you might be one of the many who was misled by this. Many more (See: Daily Kos) are still.
It was always clear that his economic policies were center right on health care reform, since a majority of the public likely favors a single payer system, and neither Obama nor any other Democratic candidate came out for this approach. There's some case to be made that Obama has shrunk somewhat even from the goals he laid out in his campaign, and on health care the continuing ban on drug importation is a big example, but nobody should have had illusions that Obama was a leftist.
October 12, 2009 3:58 PM | Reply | Permalink
It is not correct that a majority favors a single payer system. Single payer was favored in polls when the only alternative was the status quo. In polls with other reform alternatives included, single payer finished relatively far down on the list, and was a minority view. That was single payer in the abstract. I suspect it would do even worse now if fleshed out as a legislative proposal subject to specific points of attack.
Polling aside, however, single payer was not a realistic option at this time in our history. That is not to say it might not be of value later; among the nations that surpass us in providing healthcare, some utilize single payer, but a majority utilize either public/private combinations or exclusively private coverage that is rigorously regulated, and all these systems perform at roughly the same level.
Currently, however, I think it would be hard to find many economists, liberal or conservative, and including those sympathetic to single payer, who would argue to begin its establishment in the current economic climate. Healthcare reform will require dramatic reductions in the excess of facilities, tests, procedures, and specialty referrals that make our system so expensive. Those reductions will entail painful job losses. To add to that burden the dismantling of an entire industry (private insurance) would be perceived by almost all economists as catastrophic in the midst of a deep recession. Single payer is an option to reserve for the future if needed - for economic reasons rather than exclusively political ones.
October 12, 2009 5:18 PM | Reply | Permalink
Many of the polls on Medicare for All in the link I provided do not list alternatives: like most polls on the public option, they simply ask whether the policy is favored or not.
The answer is most often yes. Of course, if you ask about "a mix of public and private plans" and frame the issue as having a choice between the two, then this will certainly do better than either a totally private system or a totally public system. (This is exactly the poll that HCAN did a while ago.) But the way that these polls frame the issue is obviously flawed. For example in the HCAN poll they got something like 15% in favor of the current totally private system, which is absurd.
One might ask why, if many other options such as "just add subsidies, guaranteed issue and community rating to the current system" do better than single payer, why favor single payer? Because these other policies will not reduce costs unless they are combined with much more radical proposals not currently on the table, like ending employer based insurance.
This is not an easy call to make. Have you actually tallied up the other advanced nations? For example, among the biggest we have:
Japan - private insurers
Germany - private insurers
France - public insurers
UK - public insurers
Italy - public insurers
Of course, this is somewhat misleading because, for example, in Japan's system insurers do not compete and the government negotiates fees directly with providers, so it functions like a single payer system.
The question is also not how we could institute Medicare for All in the current dreary economic climate, since Medicare for All would save an estimated $400 billion per year in administrative expenses and pharmaceutical bulk purchases alone, a figure that does not include the bargaining power it would have with providers. Given the cost savings, the real question is how we can afford not to do it. The layoffs in the health insurance industry are not really a factor because the services these people provide would be replaced, so the economy as a whole does not lose out.
Krugman has agreed that single payer has been a "smashing success" where instituted and has not expressed any reservations about the current economic climate. The reason he doesn't campaign for it now is because he feels it's not politically feasible. This is not about economics, although it is about defeatism.
October 12, 2009 8:08 PM | Reply | Permalink
Medicare for All is not a panacea and the bill that came before Congress this year, HR 676, was destined for failure. I missed the poll question that asked how many Americans would prefer to totally replace the current system with one that is purely non-profit and government run.
That is what HR 676 would have delivered and it would have never passed in a million years.
Krugman said single payer would be a smashing success if he could start from scratch, which he can't. I am not sure how this hypothetical supports your case. Medicare is broken for a number of systemic reasons that have not been addressed by any legislation. It actually contributes to the instability of the system by virtue of how it negotiates sub-market rates and only pays 80% of its bills.
I think using Medicare as the public option and combining all existing government health programs into a single program that can be cured of its many current problems makes a lot of sense, but simply taking what we have now and replacing it whole cloth with Medicare is a huge mistake that would gain very little support when put that way by pollsters and wouldn't even work to boot.
This makes "Medicare for All" the worst possible idea, even when compared to doing nothing, since making the situation worse or trading one set of problems for the other isn't progress in my book.
October 13, 2009 7:37 AM | Reply | Permalink
Read more closely. There is a poll that asks this question in the link I provided: it gets 49% support, versus 59% for national health insurance that only covers emergency medical treatment. Presumably an actually existing national health care system would be somewhere in the middle. HR 676 is a starting point.
You might want to read that again. He says where it has been introduced, it's been a smashing success. Krugman has previously favored single payer, but he doesn't now not because of economics but because of defeatism.
I would go through and refute this thoroughly, but you evidently aren't even paying attention.
October 13, 2009 10:20 AM | Reply | Permalink
Krugman prefaced the success of single payer by noting the need to build such a system from scratch, which is what makes such an opinion hypothetical in this context as it is totally a political non-starter.
I read all the different poll questions and the one about replacing what we have with a pure single-payer system is still less than 50% approval, which is hardly a slam-dunk politically.
Again, HR 676 was a horrible bill that could never be funded, much less passed, so it was less than a starting point as it was a distraction. HR 676 turned a reasonable public option into a perceived Trojan Horse for single payer, which 51% of the country doesn't support by your numbers.
I am quite happy to use what is emerging from Congress as a starting point to reforming the system we already have, which will continue to be a mixture of public and private, like most other developed countries that don't use pure single-payer systems.
October 13, 2009 10:31 AM | Reply | Permalink
No existing single payer system (Canada, Australia, France, etc) covers all medical treatments and is completely universal. Generally they cover primary care, which does make up the majority of costs, but not everything. HR 676 does cover everything but is the same basic model.
Here's the poll I was talking about.
CBS/NYT CBS/NYT
Now 1/1979
Private enterprise 32% 48%
Government – all problems 49 28
Government – emergencies 10 12
Don’t know 9 12
Nowhere does it say 51% are opposed. Krugman doesn't favor it for political reasons. My point was that he's said it has been a "smashing success" where it could be passed.
I am not going to reply to this any more since you plainly could care less about the facts.
October 13, 2009 11:05 AM | Reply | Permalink
You keep providing "facts" that don't back up your assertions. That poll you keep citing is hardly a slam-dunk case for the American people wanting to move to the system outlined in HR 676.
It's not that I don't want to discuss the facts. I just don't agree with your interpretation of the numbers. Call that what you will, but it certainly isn't an inability to understand the information you choose to provide.
This whole issue and the American people's thoughts on it can hardly be summed up by a couple of polls that are hardly conclusive no matter what solution set one favors.
October 13, 2009 11:13 AM | Reply | Permalink
I was actually misled by nothing regarding Obama's propensity to stick with the DLC line of "opportunistic liberalism" whose primary schtick is to stretch the liberal rhetoric only as far as it might be approved by the corporations that own Washington.
Inasmuch as I was willing to grant Obama any credit beyond the basic bottom-feeding pol that populates the system these days, it was in a belief that he would find quite attractive the opportunity to "do the right thing" if that were presented to him. My point here is to explain that we at last had opportunity to wrest control of the legislative process away from the lobbyist bagmen and the whores they target. And when push came to shove, Obama and Emanuel and the rest just couldn't resist playing the game by the rules in place rather than stretching themselves as leaders.
Call it the Audacity of Dopes.
October 12, 2009 7:47 PM | Reply | Permalink
Catchy phrase there Sleepin!
Given the vast national emergency Obama walked into one would have thought he would realize the urgency of actually following through on the change thing. But he didn't. He is isolated in the DC mirk as he was before he becamse President. I honestly don't think he gets it in terms of how bad things are for people, how the repercussions of the economic collapse is not over, what a collosal error he has made by aligning himself 100% with Goldman Sachs and the rest of the uber con men of Wall Street against the common people. You are right that he and Rahm are playing the game according to the rules when they could have rewritten them. But you know, I'm just starting to think those guys just aren't big enough, don't have any real vision beyond platitudes, and that a real leader will emerge because necessity demands it. Who it will be is anyone's guess. I'm sure likin Rep. Grayson though I can tell ya that! He gets it.
October 13, 2009 2:47 AM | Reply | Permalink
I just read Grayson's wikipedia entry. He went from clerking for Robert Bork to becoming a major whistle-blower on corrupt defense contracts. Pretty cool.
October 13, 2009 7:23 AM | Reply | Permalink
Still waiting for the populist uprising that is sure to come any day now. As far as I can tell, the only popular movement right now is the Tea Party movement. Ironic that the far right and libertarians have become your only ally, huh?
Anyone who thought they electing a revolutionary in Obama really wasn't paying attention at all to what the man was actually saying and what he wrote. The über liberals of the democratic party couldn't even make it out of their own primary, let alone win a national election right now.
The president firmly believes that we need to change the nature of how we practice politics in this country before any truly evolutionary changes can take place. We need to mitigate the fringes of both parties by inspiring the 70-80% who normally don't vote in primary elections to get involved.
That Obama has to fight the left and right wings of both parties tells me he just might be on track if his goal is more than the illusion of progress by way of barely passing massive new government programs we can't afford and continued partisan warfare that keeps us from fixing those things we can.
October 13, 2009 7:44 AM | Reply | Permalink
You know jason? Your one-trick pony about how brilliantly you and Obama manage the "invisible middle" has just about run its course.
The point here, jason, is that oftentimes in our history severe circumstances have "made the man" in terms of our leadership. Indeed, Lincoln himself would hardly be recognized as a "major" President were it not for the Civil War he confronted. (Hmmmmm.... Civilian C in C who actually kept his generals under control? What a concept!)
We are in such times now with challenges on nearly all fronts. And yet Obama has shown little inclination to seize the opportunity to provide real leadership, but instead remains on the leash provided by his corporate owners and his handlers like Emanuel. Call it playing chess while Rome burns.
Gawd, what a magnificent platitude you keep spewing here in supposed defense of someone who is showing himself to be anything BUT a transformative politician. Maybe he simply missed the memo, eh.
It would seem a pretty good place to "change the nature of how we practice politics" would be to start reestablishing democracy over plutocracy. Goldman Sachs remains in charge of our Treasury and of our economic recovery; a recovery that stops somewhat short of Main Street in the event you hadn't noticed.
Obama strategically allowed the Insurance Industry to handcuff the discussion regarding anything like the true reforms we need in our health care system. It's been a boon for campaign coffers. Not so much so for "Change You Can Believe In." And it ain't nothing but more of the same pay-to-play politics that has poisoned this Republic for far too long.
We have yet to see just how closely he adheres to the "War is Peace" meme that has been so successfully applied in the interests of what little manufacturing base that remains in this country. "War is Domestic Economic Development?" Is THAT the change we are to believe in?
Meanwhile, your continued shilling for the health insurance industry on these pages has really become pretty shopworn. It's not your fault. It is difficult to maintain even a slight patina of legitimacy over weeks and months of repeating industry talking points that are predicated upon obfuscation and strategic diversions rather than an interest in actually advancing the topic of health care reform.
Gotta' admit, however, that it does become a bit aggravating, kinda' like answering questions from the toddler who doesn't listen, but instead always comes back with another "But, why?" whine.
October 13, 2009 11:48 AM | Reply | Permalink
I am still waiting for a single link to a blog or comment that could be construed as shilling for the insurance companies. Forgive me if I don't hold my breath while you try to manufacture evidence for this continued caricature.
As far as changing the nature of politics and Obama's Achilles Heel standing in the way of that transformation, I don't suspect you will ever understand my point or even make an legitimate attempt. You'll just keep pounding on the partisan drum for all you are worth.
This predictable non sequiter fails to address my actual comments on health reform and partisan politics, so I will leave it up to the TPM readers to judge who is looking for reasonable debate rather than continue correcting your numerous misapprehensions.
October 13, 2009 12:27 PM | Reply | Permalink
Your protests would perhaps be deemed legitimate if the criticisms of your tripe weren't so universally acknowledged by nearly everyone you encounter on these pages. (See khin, above, as simply the latest of your many effective challengers.) At some point, it becomes ludicrous to keep spewing the same nonsense in the face of such reasoned rejection while maintaining that only YOU hold the keys to enlightenment.
As for your shilling for the insurance industry, the record plainly speaks for itself. I've seen your schtick on the health care reform effort over these many weeks and months. You have been a mere mouthpiece for the industry and your arguments are taken directly from their talking points. It is predicated upon a strategy of confusing the issue by supposedly favoring reform while offering nothing more than know-nothing excuses why reform is impossible. You build strawmen out of legislative proposals like HR676 taken in toto, treating them as the ONLY option presented in opposition to the status quo - and then offer really nothing in its place other than window-dressing that ensures the insurance industry profits remain unchallenged or even enhanced.
It remains difficult to assume you are anything but a sock puppet here, jason. There is simply no other way to explain the way in which you so incredibly defy any appeal to logic or reason to sway you from your talking points. It ain't a discussion with you. Instead, it's a strategic dance too much like trying to argue directly with the insurance industry lobbists.
I would truly love nothing more than to be proven wrong. But in the meantime, I will call it as I see it.
October 13, 2009 12:57 PM | Reply | Permalink
Reforming Medicare as the most logical place for the public option is an insurance company talking point?
Supporting the substantive health insurance reform coming out of the Finance Committee is supporting the health insurance industry?
The record is clear, but not in your favor.
October 13, 2009 1:57 PM | Reply | Permalink
I think you totally misjudge the mindset of that 70%. They're as fed up with both parties as are the "fringe" on the left and right. It's a fine time to start a 3rd and even a 4th party. The existing 2 are working on the side of virtually no one but a gaggle of lobbyists.
October 13, 2009 2:06 PM | Reply | Permalink
I passed no judgment as to the mindset of that 70- to 80-percent, only that getting them involved in the primary elections will lead to a more representative government.
Incumbents in both parties have to get through the primaries in order to be influenced by lobbyists in Washington. I think the fact they are fed-up with both parties will likely lead to massive turnover in both parties rather than the formation of something new.
There is really no precedent for that sort of thing in our country, so I find it unlikely that a 3rd or 4th party movement will spontaneously erupt anytime soon.
October 13, 2009 2:30 PM | Reply | Permalink
People get involved when they are passionate about a candidate, an issue, or major current events. They don't get involved because some DLC wonk writes a nuanced amendment to funnel more cash to a favorite lobbyist however centrist he may be.
October 13, 2009 2:44 PM | Reply | Permalink