Tuesday, June 23, 2009

The Big Picture and The Strike: Health Care Prognosis

The following was a reaction dialogue to this paragraph, which appeared in Ezra Klein's blog on washingtonpost.com:

That, I'd bet, is how health reform will close out as well. We will spend a trillion or a bit more covering the un- and underinsured. We will regulate a fairer and more decent insurance market into existence. We will expand Medicaid and build out subsidies to at least 300 percent of poverty and create health insurance exchanges. We will fund all this through sharply progressive taxes. We may even have a public plan. In 2006, it would have been a great deal. But as the legislation winds its way through the Senate, there will be unpleasant compromises, and unconscionable omissions, and the constant knowledge that though this is progress, it is not sufficient, and the people who stand in the way of a better bill are frequently incoherent or disingenuous. And that will be terribly frustrating for supports of the effort. The result will probably be a historic win when compared to the status quo, but I doubt it's going to feel like that for supporters of the initiative."

The Big Picture: The stimulus is to health care what the invasion of Afghanistan was to the invasion of Iraq: like invading Afghanistan, there basically had to be some sort of counter-cylical spending-and-tax-cuts stimulus response to the Great Recession. I would really have been surprised if actually nothing had been done. I think Obama made it better than it could otherwise have been, though not nearly good enough, but there would have been something. But on health care, he almost didn't even attempt it this year. That was the advice of Biden among others. And who knows if he would have the political capital to try it later. So it's highly possible that, like the invasion of Iraq, if it wasn't for the boldness of the President overcoming the doubts of some cautious advisers and pushing an issue right to the fore, it wouldn't even be happening. That's what makes any accomplishment on health care all the more impressive.

The Strike:
Yeah very good point Ezra made though about how we’ll inevitably end up disappointed. In some ways it’s frustrating. In 2002, the Giants had a season that brought me amazing memories, and they won the pennant, but I have overall sour feelings on that season. That definitely happened with the Collins-Nelson crap on the stimulus, and will most likely happen with the health care plan and energy bill. It’s hard to separate being happy about something finally getting done (something we could only dream of in 2006), and being disappointed that we couldn’t get something better given the current conditions. That’s why, as you’ve said, we need to set out parameters now of what a successful bill will look like, so we can objectively determine whether to be happy or not.

The Big Picture:

But there really are some big differences between the stimulus and health care. Given the context, it really wasn't that much of an accomplishment to pass the stimulus - it only got to the point where it was sort of in question because of a bunch of absolutely loony behavior that I think people will look back on as "what the hell was that about?". As we've said, it didn't exact any real costs. While it built the safety net, which is great, and did other good things and overall was progressive, it was very very easy to say this is an urgent response, and anybody serious was in favor, as it really benefited business as much as anybody. The goddamn Chamber of Commerce was in favor it! Some parts tried to create structural change, but for the most part it was a response to prop up the existing system, a counter-cyclical measure. And it's especially hard to get excited about it because for the most part it's making things slightly less bad for a short time - waay better than nothing, but tough to call it a great accomplishment of liberalism.

Health care in contrast has been the Holy Grail for American liberalism for 70 years. Even getting what Ezra predicts we'll be disappointed would make it the most successful liberal reform in 40 years, and the biggest victory for liberalism against the power of big business and conservative ideology in that long. Also, in contrast to the stimulus, I really think it's on the Herm Edwards "We can build on this!" track. While I think the passage of the first stimulus - with the way that debate went - will make it very difficult to pass another one, I think health care reform will be a building block, all about getting over that hump.

The Strike: If someone said in 2006 that we’ll have a public option that’s forced to follow the rules as private companies, I would have probably been like “good it looks like the Republican majority is being forced to make some compromises!” In other words, this isn’t the end that we were looking for. Every time we’ve imagined a Democratic President enacting health care reform, we dream of “universal health care.” The public plan may make things a lot better, but will it make the movie Sicko obsolete? I think that’s a good measuring stick to see if the plan is good enough. From what we’re looking at now, it almost certainly will not make it to that level.

The Big Picture: Well you're kinda taking the opposite position from me. I'm saying that health care reform, even Ezra's predicted watered-down version, will be a much more far-reaching and impressive accomplishment than the stimulus, and will be the biggest liberal triumph in decades. It doesn't make Sicko obsolete, but it takes real steps to get there, and the problems identified by Sicko are huge. The stimulus barely addressed the structural flaws in American society. Even a not-great health care reform will in a major way.

The Strike: Well I think Ezra’s point was that the feeling we take away from health care reform will almost certainly be disappointment, much like the stimulus. I think it will be MORE disappointing, because it’s something we’ve been trying to do for a generation. On the other hand, you’re right that no matter what’s in the final bill, it will be a the biggest liberal triumph in a generation and will contribute to a major structural change in our society. So I guess I’d say that I think liberals will be more disappointed if this kind of bill passes than they were after the stimulus, but the bill itself will actually be far more important, if that makes sense.

The Big Picture: Yes I agree. As gung-ho as I am now, as long as the plan isn't just a ridiculous sell-out punt (and that means more than just public plan or not, also other cost containment, changes to incentives, how it's paid for) I will be happy and it will be a proud moment to be a liberal, even as we won't be satisfied. It's taken a lot of organizing and a lot of good thinking to get the point we have now with this broad consensus for health care reform - in fact I really disagree with how you would have felt about the public option in 2006. Health care reform was way way off the table at that point. Any sort of reform. Government involvement was too far left for Hillary and Obama to touch at that point, until Edwards pushed it after some great think-tank work to craft the brilliant public plan idea that could satisfy moderates and liberals. No chance in hell that a Republican Congress would have EVER even addressed a public plan. The best we could hope for would be maintaining the status quo and not giving huge subsidies to Pharma and the Insurance companies. A ton of positive change since then. And you have to remember how little liberals have accomplished for the last four decades on the major issues when they're really confronting conservative economics and big business and the self-interest of the upper middle class. Far more has been in the opposite direction, liberals barely hanging on, often losing, but conservatism and business always on the offensive.

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