Best of 2009 #5: "Health Care, Health Care, Health... WHAT??!!"

We've been consumed by it all year... And it looks like we'll still have to be dealing with it in 2010. The health care debate has taken some interesting twists and turns ever since President Obama was inaugurated early this year. And when Arlen Specter switches parties, Al Franken was seated, and Democrats finally had "60 votes" (at least on paper) in the Senate, it seemed like universal health care was a go...

But was it ever really? Now that the Senate bill is passed, a real debate has opened on what to demand out of the final bill, whether to support the final bill at all, and how to work with Democratic leaders (including President Obama and Senator Reid) from now on. So considering how important this is nationally, as well as how big of a role Nevada has played in the health care debate with Harry Reid often taking center stage (just before the 2010 Election), I figured I just couldn't leave this off the list.

So on this note, let me start with something I wrote earlier this month...

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There we have it. Senator Reid couldn't have said it better. It's about us, our stories, our struggles, our health care. Besides, I thought this would be a nice segway from all the talk lately of the politics of Harry Reid and 2010 to the facts of the matter.

We haven't stopped by and visited Desert Beacon in some time, and that's all my fault. Sorry. Now pay attention to what she says:

The difference between legislation and public relations (campaigning) also serves to obfuscate the issue. This crucial difference gets lost in the efforts to offer prognostication about the passage of reform measures. There is a common narrative in American political reporting which is often more applicable to NASCAR than to the legislative process. Simply put, the narrative seeks to find winners and losers, who is leading, who is behind, whose poll numbers are up, and whose are down. What is the "percentage" prospect that a particular bill will be passed, and what are the "odds" it will fail? This narrative frame works well when discussing which drivers have the best statistical chance of placing in the top 12 contestants for the Sprint Cup, but not quite so well when attempting to explicate the legislative process.

The narrative frame is useful for describing the political implications and ramifications of races, national, statewide, and district; but, it rarely serves well as a vehicle for policy analysis. The upshot is that Americans get a healthy serving of political news each and every day, but not quite so much in the way of legislative process information, and even less policy analysis and discussion.

Most of the stories from political reporters are precisely what a reader should expect from political reporters...politics: The summation of poll numbers; The probability of electoral success; The nature and viability of the opposition. If we take as given that most of the news average citizens are getting about health care reform legislation pertains to the political maneuvering and ramifications thereof, then it's easy to conclude that process will run second, and the policy analysis will be the stepchild in the narrative. This, too, adds to the confusion factor.

The health care reform legislation debate is a prime example of how imbalances in coverage (or perceived coverage) translates into electorate confusion. Republicans are eager to note that they've captured the "narrative," and that the Democrats have made inadequate efforts to secure public favor for their proposals. But, wait; notice the internal numbers in the polling cited in the opening paragraph. Only 9% of Nevadans are pleased with the status quo. Only 16% say the system needs only minor changes. If the Republicans are pointing to a generic dissatisfaction with Democratic proposals, they may be missing the specific dissatisfaction with the status quo they are attempting to maintain. In short, the GOP may have "won" the road race narrative but appear to be well behind in policy acceptance, perhaps because legislation doesn't happen on a perfect oval.

There you have it. Behind all the pundits saying this and predicting that, and behind all the confusion created by all the ads flooding the media, we have people who want to see reform but don't know what to think of what's being discussed in the media.

And of course, what Digby says:

In opinion polls a majority of the nation’s voters display generally progressive values. But they do not label themselves liberals. A majority of Americans (57%) also agree, “When something is run by the government, it is usually inefficient and wasteful.” Thus, a skeptical public needs to be convinced of the renewed competence of government. This is not an overnight task particularly in light of the massive failings of the Bush era. Activist government requires very good communication to the public. This is the President’s hallmark.

So this is the problem. Americans are increasingly espousing progressive values and support for "activist government", but they don't know yet if the government can actually be made to work. We can thank the GOP and "ConservaDems" for that.

And when they constantly hear of more corporate bailouts, more talk of protecting HMO profits, and more giveaways to the pharmaceutical companies, they must be wondering what this health care debate is really about. And again, this is the problem.

We need to cut through the lies and give people health care reform that they can understand and they will actually benefit from.

There. Simple as that. Perhaps Reid made some errors in letting "The Baucus Caucus" spend so much time confusing everyone over co-op this and co-op that, Perhaps Obama made some errors in not showing leadership early on in clearly defining what he wants presented to his desk to sign into law. Ultimately, there's still time to cut through the BS and deliver to the American people what they want out of this big mess.

Let's hope that happens ASAP.

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And I'll finish off with something I wrote more recently. And yes, I promise to talk more about health care when Congress is back in session after the holidays and we finally see a final bill. I just hope it will be worth supporting, and that it will actually do some good for people in need.

But in the mean time, I'll just end with this.

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Honestly, I'm exhausted right now. I'm tired. I'm drained. This health care fight has delighted me at times, infuriated me at times, and has left me fighting with just about everyone over everything.

So what exactly am I fighting for? Thank goodness Desert Beacon is here to remind me!

[S]top sweating the small stuff. OK, it's not small to you that there is no public option proposal in the Senate version of the legislation, and it's not small to you that there is no Medicare buy-in for those aged 55-64. Those were proposals (and reasonably good ones) intended to bring down the cost of health insurance plans sold by private corporations. They are not now and never were central to the health care reform legislation. While we got down in the weeds with public options and buy-ins we've not been focused on the essential feature of the proposals -- the subsidy levels for insurance premiums and the income standards attached thereto. If anything, we ought to be arguing about whether or not the standard 250% above our unrealistically low assigned poverty level is sufficient to assist most working families in this country. I'd like single-payer, but that was never in the cards; and, I'd have been pleased to get a public option included in the insurance exchange and/or Medicare buy-ins, but I'm not ready to toss the positive aspects of the current Senate bill out with the bathwater du jour.

Yep, she brings up some valid points that I remember discussing last week, back when the Medicare buy-in became the "conflict du jour". There are still worthy elements of the bill worth passing, such as the increased regulation and improved subsidies.

However, I must admit I'm still afraid of any type of individual mandate to buy insurance if there's no public option available on Day One of reform. As I was saying yesterday, this is simply bad policy because it forces the working poor and middle class to buy crappy HMOs that they really can't afford. And of course, this also makes it bad politics since Democrats will be taking ownership of the individual mandate.

But then again, would it really be better for us to throw it all down the drain, as some progressives are now suggesting? Is reconciliation the "magic bullet" that we really want? Again, I'll defer to Desert Beacon.

Third, nothing would please the Republicans in the Senate and their corporate masters quite so much as to have the liberal and moderate wings of the Democratic party do their work for them. It's been the GOP intention all along to scuttle any and all health care reform legislation. We can assume this is so because they've hewed to their Luntz Talking Points from the beginning: Government Takeovers, Rationed Care, Bew-row-crats in your health care. They carped about imaginary "Death Panels," and they've whined about "Killing Granny." However, it's reasonably obvious that the last thing they wanted was to directly address the insurance company practices (exclusion/rescission) that helped create the crisis in health care we face today. Instead of addressing specific issues, they've consistently resorted to generalities and fear-mongering. Instead of steadily working on the legislation, they've consistently stalled and obstructed any attempts at progress (witness the Gregg Memo). Tossing the package out now because it doesn't sate progressives' advocacy for single-payer/public option/Medicare buy-ins plays directly into GOP obstructionist hands.

Fourth, there are no cheap fixes. The much touted, and much misunderstood, reconciliation process in the Senate is not an option if we really want the insurance reform we say we do. [Emphasis mine.] Senator Dick Durbin (D-IL) explained, "reconciliation is a very spare and thin process with limited opportunities." Reconciliation applies only to the money parts of the bill; it would not serve to pass insurance reforms that are at the heart of regulating the insurance corporation practices as they abuse their exclusion and rescission clauses.

So there you have it. Reconciliation can be done, but with tight limits and requiring far more time. And since it already looks like this process (as it is now) will drag into 2010, do we really want to risk health care being drawn out even closer to the midterm elections? And do we want to complicate things further by trying to figure out what can be done with reconciliation and what can't?

Again, we face some tough choices in the next few days... So maybe it's best for us to wait and see what happens next. After all, we don't even know all of what's in this new bill yet!

Oh yeah, and we finally have some good news in House Democrats inserting themselves back into the debate by demanding Conference to merge the House & Senate bills. This is good for us, as this actually keeps the public option alive and kicking. After all, remember that the House version has a public option and that House progressives are refusing to support any final bill with no public option.

And getting back to the Senate, let's remember something else. As hard as I've been sometimes on Harry Reid, I still understand that he doesn't have an easy job here. Matt Yglesias explains.

I think it’s worth sparing a thought in this regard for the much-maligned Harry Reid. It seems like it was only three years ago that [Beltway pundit] Jacob Weisberg was explaining to people that Reid and Pelosi were so icky, liberal, and inept that Republicans could stay in power forever or something. And liberals have rarely found themselves hailing Reid’s leadership. But the fact of the matter is that there’s almost no precedent for the legislative mission he’s been asked to accomplish of turning 59 Democrats, one loosely Democrat-aligned Independent, and two slightly moderate Republicans into 60 votes for a package that’s simultaneously a dramatic expansion of the welfare state and a measure that reduces both short- and long-term deficits.

On top of the intrinsically difficult nature of the task, he’s facing a really ugly political situation back home. Since Beltway mores dictate that you can never hold a member of congress morally culpable for actions undertaken in the name of raw politically self-interest, it must have been very tempting for Reid to get distracted. But he’s stayed on point and focused, dealt with the timid members of his caucus, dealt with the ignorant members of his caucus, dealt with the egomaniacal members of his caucus, and dealt with the all-too-typical Senatorial combination of policy ignorance, egomania, and political cowardice among some members. For his troubles it looks like we’re going to get a bill that liberals feel churlish about at best. But it’s really an extraordinary achievement.

So let's remember this. All of this. The final bill that emerges won't be perfect, but we still have time to possibly improve it. The Senate still requires 60 votes to get this done, since reconciliation isn't the "easy backdoor process" that some progressives dream of it as. And no matter how good and/or bad the final bill is overall, there are some inherently good elements of it that need to become law ASAP (before the window on health care closes yet again on Capitol Hill).

So excuse me while I take a breather for a bit. I will be analyzing and investigating whatever is thrown out next as "today's official Senate health care bill", and I will do my best to be more careful before praising it or trashing it.