Mr. Baucus says his group will produce the bill that best meets Mr. Obama’s top priorities, broadly expanding coverage to the uninsured and curtailing the steep rise in health care spending over the long term, what policy makers call “bending the cost curve.”
Still, if the three Democrats and three Republicans can pull off a grand bargain, it will have to be more conservative than the measures proposed by the House or the left-leaning Senate health committee. And that could force Mr. Obama to choose between backing the bipartisan deal or rank-and-file Democrats who want a bill that more closely reflects their liberal ideals. (Source: NYT)
If you're not familiar with them already, you can read the depressing details about Baucus's Finance Committee approach in the article: no public option, no employer mandates, no surtax on the wealthiest. And so on. The Baucus plan has all the signs of becoming for the insurance industry what the Bush Medicare Prescription plan was for Pharma.
I haven't been writing anything about health care because I didn't want to indulge my pessimism or my growing frustration with Obama's timidity. What's the point? And the truth is I don't really know where Obama will draw the line. What will he go to the mat for? I'm not sure. The political calculation seems to be that he needs a win, and it doesn't matter much what the program is so long as it can be sold as reform, even it it's reform as defined by Baucus, et al.
But why when 70% of Americans and even 60% of doctors are ok with a single-payer system (i.e., to extend a modified Medicare to younger people) is opposition to even a public plan as an option so powerful? There's a broad, fairly widely accepted narrative that has developed that you would think would undermine the political potency of those who would oppose robust reform. Republicans have no credibility; their only goal is to obstruct. Their arguments, if that's what you would call them, are dishonest and illegitimate. Blue Dogs, like Baucus, have no credibility, despite the silly, puff-piece reverent tone of the NYT article above. ("Each senator now claims the same seat — “just like kids in school,” Ms. Snowe said in an interview.) They are being widely outed as neither conservative nor centrist, but on the payrolls of the Insurance industry.
It doesn't matter to me whether this narrative is unfair or stereotypical. My sense is that these politicians are more intellectually incoherent, self-deluded reeds bending with the wind than they are hypocrites or blackhearted villains.** The bottom line is that this group from states with minuscule populations has far too much influence. And their credibility or national reputation doesn't matter so long as they are secure in their own districts or states. Being a moderate or conservative Democrat means that you have constituents that elect you primarily to serve these corporate interests so long as they believe you are moderate or conservative on social/cultural issues. That's politics in America, and that's the bind we're in. What could deliver us from this bind? Maybe a forceful, eloquent political leader who would take the bully pulpit to inspire the American public with a vision of a future America that transcends culture-war quagmire. But where would we find someone like that?
This issue has been framed as if it's a loss for Obama if something, anything, doesn't get passed this year. Maybe that's true, but the more important question is whether the program taking shape is a bigger win for Insurance and Pharma than it is for the broad public. And the question has yet to be answered: What will Obama fight for because if what he's doing now is "fighting" the game is up.
It's hard to make any definite judgments about what Obama will accept as a win, because so little is known about what he's ok with beyond some broad principles about which we have little reason to believe he won't cave. And so if what emerges is a program in which everybody is forced to buy insurance at rates determined by the insurance industry or in which the public option, if there is to be one, becomes simply a dumping ground for the sickest and least profitable patients, what has changed for the better?
Maybe there's something I'm not understanding correctly, but despite assertions about the central importance of constraining costs, without a robust public option, I don't see how that can be achieved. Does Obama have the spine to insist it be a strong component. I'm waiting for him to show me he has one.
I'm all for being politically realistic. We should be willing to accept a gradualist approach to reforming healthcare. We don't need everything all at once, but we don't need a program that's a variation on the Bush medicare prescription boondoggle, and we don't need a system that will be structured as it is now around profit-centered insurance-company strategies that have proved incapable of constraining costs and providing broad access to quality care. Laying a solid foundation now is more important than getting the whole enchilada, and the only real, long-term solution is gradually to take healthcare out of the for-profit sector. By all means do it gradually, but at least start us down that road. A robust public option could possibly be a way to start us on it.
I'm pessimistic much good is going to come out of all this, because I just don't see a powerful enough constituency to counter the enormous influence of Insurance and Pharma, and so unless Obama has some brilliant strategy he's witholding from view, the signs are not good that we are going to get anything close to what we really need. A combination of Republicans and Blue Dogs seem bent on prevent that. Obama has been so far a bitter disappointment. He's just not ready for this fight, and should have waited until he was. Delight me by proving me wrong.
**Digby makes the same point:
The real problem is the power of this faux "centrism" that's been adopted by dwindling numbers of both parties who actually seem to be among the dullest and the least creative of a pretty dull and uncreative group. Which isn't surprising. Centrism as currently constructed is nothing more than facile claptrap that says "the middle" is always right and finding some arbitrary number that means absolutely nothing is somehow the "smart" way to govern. These centrists are actually intellectually lazy people who won't (or can't) judge ideas and policies on the merits, and instead adopt the easy attitude that something between the two poles is always superior. (I realize I'm making the assumption that these "centrists" don't know what they are doing but I actually think they are pretty stupid and subject to flattery from their powerful, wealthy benefactors. They are tools not brains. Think George W. Bush in his compassionate conservative guise.)
***
UPDATE: Nate Silver on the implications of having an individual mandate without the employer mandate, which is in the Baucus committee plan--
Just to underscore this point: when it scored a similar bill, the CBO estimated that 15 million people would lose their employer-provided coverage. Most of these people are likely to be lower-to-middle income persons with somewhat tenuous employment situations, a group that tends classically to be swing voters.
Now, how are those 15 million people going to feel about health care reform when they find out that:a) Although the bill was supposed to guarantee access to health insurance, they've in fact lost theirs;
b) They're required to buy an expensive, private plan on their own, or to pay a fine;
c) They're probably not getting any government assistance;
d) They certainly don't have any Medicare-like alternative to fall back upon;
e) All of this cost the country about $1 trillion dollars.You think those 15 million people are going to vote for the Democrats again, like, ever?
Forcing people to buy insurance they can't afford is not healthcare reform. To think that this kind of thing is being even considered . . .
See also Silver's grading out of the Obama administration in their communication effectiveness selling healthcare reform to the public here.