Sunday, December 20, 2009

What the hell do we do now?

As a lobbyist I'm often in the position of trying to figure out an answer to this question: should we fight, and hold our for what we want, or should we take what we think is the best we can get now, even though it's a lot worse than what we want, and try to get more later?

This is the question that activists are addressing on the health care bill. On the one hand we have people like born-again Democrat Howard Dean and many posters at GMD, arguing that the bill is so bad that it would be better to kill it. On the other hand, we have Democrats and pundits who have been reliably progressive voices but are now being targeted as sellouts for supporting passage.

In evaluating this question, a number of other questions come to my mind:

1. The public option? Really? That's what we wanted?
It's not the only argument against passing the bill now, but the fight over the public option was what fueled much of the controversy through the summer and fall, and particularly the treachery of Joe Lieberman. We need to keep in mind, though, that the public option was always a weak compromise, a recognition that progressives can't get what we really want, single-payer, at least this time around. At GMD we've mocked Catamount Health, Vermont's version of the public option, but we recognize that even an inadequate program is better than nothing.
The public option was definitely an idea worth having, and so was Medicare buy-in. Still, it's a matter of displacement of our true desires that leads us to think the public option is something we need to fight to the death over.

2. We were never going to get anything close to what we wanted.
In these times we know that we need sixty votes in the Senate to get anything passed. In a controversy like this, where getting anything at all passed depended on getting the majority of a handful of moderate Republicans--Snow, Collins, Landrieu, Lieberman, and Nelson, none of whom really care about passing anything, means that the bill that passes will be a compromise of a compromise. That's the way life is and there's not much point in calling Reid and Obama useless, ineffectual losers because they can't get 100% of the votes in their putative caucus.

3. What's the alternative?
One concept in negotiation theory is BATNA, the best alternative to a negotiated agreement. For our purposes, before telling our representatives to kill the bill we should think about what will happen if they do.
I don't see any likelihood that we will see anything approaching health care reform if this bill is killed in the foreseeable future. None of the conditions that are present now, or that are likely to come about in the future, are going to get any better than what we have now.
First, the politics aren't getting better. We have seen several Democratic representatives announce they are retiring, and there are a number of Democratic senators, including Harry Reid, Chris Dodd, and Arlen Specter*, who are in trouble and may not get reelected. This is consonant with the fact that the President's party typically loses votes in the off-year election; I don't see any signs that this won't happen in 2010.
Second, the economics aren't getting better. Whatever the costs of health care are now, and whatever we need to spend to cover those costs, they will only go up. This means that every year into the future will be harder to create a health care financing program than it is now.
Third is the fiscal situation. The Bush deficit, the costs of the bailout, and the costs of the war, are all combining to make federal budgeting problems worse in the next five years than they are now. We can wait for a recovery, but a strong recovery isn't likely to happen in the next five years.

4. Things in Congress are different now.
Changes in party alignment have made it harder to accomplish important things now than it was in the past. For many years people talked about the parties as "big tents". For most of the 20th Century both major parties tried to follow a big tent strategy, forming their parties out of ideological and regional coalitions. The Democratic Party included northeast liberals and southern racists; the Republican Party included western free-landers and northeast financial types who were not particularly committed to social issues.
This started to change with Nixon's Southern Strategy, a frank, and successful, appeal to southern racists; it continued through the 1980's under Ronald Reagan and Lee Atwater with continued appeals to racism and religious intolerance, and is essentially complete today. The defections of Jim Jeffords and Arlen Specter signaled the completion of the Republican purge of any but the most extreme conservatives.
This has not happened in the Democratic Party. Our party has always been more pluralistic, and has exercised less doctrinal discipline, than the Republicans, and the same is true today. The ideological range in the Democratic Party in 2010 is much broader than that of the Republicans, which means that it is easy for the Republican leadership to dictate the position of every member of the caucus, but it is not possible for the Democratic leadership to do the same thing.
An example from the past is instructive. The 1964 Civil Rights Act passed the Senate 73-27, and passed cloture 71-29 (at a time when 67 votes were needed to support cloture).
What is more interesting is the party breakdown. Democrats in the Senate supported the bill 46-21 and Republicans supported it 27-6. (This is what gives Republicans the support for their claim that it was the Republicans who actually passed the Civil Rights bill.) On both sides we see a tremendous amount of cross-party voting.

We don't see this today: the strongest wish for bipartisan support for this bill is that one or two Republicans, presumably one of the two senators from Maine, would support some form of health care reform. We now know that will never happen. It is unimaginable that we will ever see 27, or even 6, Republicans with the decency or political sense that they need to support something like reformed health care financing.

What does this mean? I suggest it means that we can't pass anything important without close to unanimous Democratic support. That also means that, as much as ever, if not more so, anything that comes out of Congress will have to be a huge compromise, and the negotiating or compromising parties are not the Democrats and the Republicans, because the Republicans are determined to block anything the Democrats, and particularly the Democratic President, want to accomplish. No, the compromise must be reached between the real Democrats and the right wing of the party.

That's what we have today.

I am not willing to say the bill should be killed because I don't see any chance of getting anything better than is before us now at any time in the next five, ten, or fifteen years. As my colleagues have pointed out, this is an extremely weak bill. Nevertheless, It's the best we're likely to see. It's our best chance to get something rather than nothing. It's only after we have something that we can start the equally important work of fixing it.

Oh yes--one other thing. I don't hold Reid responsible for not being able to get 100% of his nominal caucus to line up on health care. I do hold him responsible if he lets Lieberman keep his committee chairmanship and other positions of responsibility within the caucus.


Blogger libhom said...

The BATNA for this is definitely killing the bill. It is even worse than the status quo. It fines tens of millions of Americans for not being able to afford expensive private health insurance. Even worse, the fines and mandates will increase premiums dramatically because people won't be as able to walk away, and the HMO/health insurers will exploit this to maximize their profits.

Medicare will be slashed. The "restrictions" will not be enforeced, given the fact that both Republicans and Democrats in the White House have consistently refused to enforce federal laws against fraud and murder against those corporate executives.

This bill is worse than nothing and needs to die.

December 20, 2009 3:27 PM  
Anonymous JD Ryan said...

It's a tough call, because at this point the national Dems are fucking useless. We have two "shoot me now" options... withhold support, more Repubs get back in there. Or take the latest shit sandwich they offer us, and they will continue doing what they do, and still lose seats. I'm all for third party at this point, but I know that's not a realistic option. But the Dems are not worthy of governance, either. I hope the bill is killed.

Obama fucked this up so bad. All he had to do was come out and say in the beginning, "I won't sign anything without a public option". It would have set the debate. But he didn't, he sat around with his thumb up his ass, and let the Senate fuck itup ten ways to sideways.

December 20, 2009 8:01 PM  
Anonymous Tom McC said...

I agree that we should support this bill, and the strongest argument I have is a reference to Brad DeLong, who says that rule #1 is that Paul Krugman is always right and that if he's wrong, refer to rule #2. Krugman makes a very persuasive argument that projects like this are generally weaker when they are passed and become stronger over time. For example, SS did not cover everybody first but has now become a strong barrier between retired people and poverty. Conversely, he says that, when projects like this fail, they generally come back in weaker form. Health care reform, for example, would have been better if Democrats had cut a deal with Nixon or if Clinton had cut a deal with moderate Republicans (back when such a thing existed).

Cut down this reform now, and what we'll get will be worse. Pass it now, and it can (won't necessarily, but can) become better.

We may not be the center-right country that pundits like to say, but on the other hand, we're not a country that looks kindly on anything that is or that is painted as socialist. So, as you said, we were never going to get the deal that progressives really wanted, but we're getting better than what we have now.

I say support the bill.

December 20, 2009 10:27 PM  
Anonymous Anonymous said...

The alternative to passing the bill would be a defeat of the bill in one form or another. THAT we cannot afford. It would brand healthcare reform as "Unpassable" forever.

Mark McC

January 15, 2010 11:07 AM  

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