3 posts tagged “health care reform”

Sep. 05, 2009 |

The difference between parties and movements is simple: Parties are loyal to their own power regardless of policy agenda; movements are loyal to their own policy agenda regardless of which party champions it. This is one of the few enduring political axioms, and it explains why the organizations purporting to lead an American progressive "movement" have yet to build a real movement, much less a successful one.

Though the 2006 and 2008 elections were billed as progressive movement successes, the story behind them highlights a longer-term failure. During those contests, most leaders of Washington's major labor, environmental, antiwar and anti-poverty groups spent millions of dollars on a party endeavor -- specifically, on electing a Democratic president and Democratic Congress. In the process, many groups subverted their own movement agendas in the name of electoral unity.

The effort involved a sleight of hand. These groups begged their grass-roots members -- janitors, soccer moms, veterans and other "regular folks" -- to cough up small-dollar contributions in return for the promise of movement pressure on both parties' politicians. Simultaneously, these groups went to dot-com and Wall Street millionaires asking them to chip in big checks in exchange for advocacy that did not offend those fat cats' Democratic politician friends (or those millionaires' economic privilege).

This wasn't totally dishonest. Many groups sincerely believed that Democratic Party promotion was key to progressive movement causes. And anyway, during the Bush era, many of those causes automatically helped Democrats by indicting Republicans.

But after the 2008 election, the strategy's bankruptcy is undeniable.

As we now see, union dues underwrote Democratic leaders who today obstruct serious labor law reform and ignore past promises to fix NAFTA. Green groups' resources elected a government that pretends sham "cap and trade" bills represent environmental progress. Healthcare groups promising to push a single-payer system got a president not only dropping his own single-payer promises, but also backing off a "public option" to compete with private insurance. And antiwar funding delivered a Congress that refuses to stop financing the Iraq mess, and an administration preparing to escalate the Afghanistan conflict.

Of course, frustrated progressives might be able to forgive the groups who promised different results, had these post-election failures prompted course corrections.

For example, had the left's preeminent groups responded to Democrats' healthcare capitulations by immediately announcing campaigns against these Democrats, progressives could feel confident that these groups were back to prioritizing a movement agenda. Likewise, had the big antiwar organizations reacted to Obama's Afghanistan escalation plans with promises of electoral retribution, we would know those organizations were steadfastly loyal to their antiwar brand.

But that hasn't happened. Despite the president's healthcare retreat, most major progressive groups continue to cheer him on, afraid to lose their White House access and, thus, their Beltway status. Meanwhile, the New York Times reports that Moveon.org has "yet to take a clear position on Afghanistan" while VoteVets' leader all but genuflected to Obama, saying, "People (read: professional political operatives) do not want to take on the administration."

In this vacuum, movement building has been left to underfunded (but stunningly successful) projects like Firedoglake.com, Democracy for America, the Progressive Change Campaign Committee and local organizations. And that's the lesson: True grass-roots movements that deliver concrete legislative results are not steered by marble-columned institutions, wealthy benefactors or celebrity politicians -- and they are rarely ever run from Washington. They are almost always far-flung efforts by those organized around real-world results -- those who don't care about party conventions, congressional cocktail parties or White House soirees they were never invited to in the first place.

Only when enough progressives realize that truism will any movement -- and any change -- finally commence.

© 2009 Creators.com

Sep. 04, 2009 |

Achieving humane and affordable healthcare in America was never going to be easy, even with an audacious new president and large majorities in both houses of Congress. Compromise between the Democratic Party’s diverse representatives -- let alone with the tiny handful of Republicans who actually care about the need for reform -- was always inevitable. And when the moment for compromise arrived, the result was certain to disappoint many of the president’s most ardent voters, who cherished his campaign’s promises of change. But the mundane grind of making legislation need not have been quite as painful as it is today, when progressives feel betrayed, and Democrats feel deflated. 

The essence of President Obama’s problem can be found in an anonymous quote, attributed to a White House official, that appeared on the front page of the New York Times last Wednesday. “It’s so important to get a deal,” confided the unnamed aide, that the president “will do almost anything it takes to get one.” Such desperate confessions of politics as usual, which have appeared in dozens of such remarks in the press over the past several months, not only serve the president poorly but damage the fresh brand that he brought to Washington after his triumphant election last year. They are the residue of an ill-conceived strategy that has left Obama politically vulnerable, attenuated his connection with loyal progressives, and blurred his most important message. 

That message was Obama himself, of course -- meaning what he represented and what he meant to accomplish. From the outset of the 2008 campaign, the rationale for his long-shot candidacy was that he stood firmly for a set of principles in policy and governance and against political business as usual, as well as a style of politics that emphasized citizen activism. He would drive the corporate lobbyists away from Capitol Hill, the White House and the federal agencies. He would insist on transparency and integrity in conducting the people’s business. Above all, he would pursue the public interest forthrightly rather than inch forward triangularly and incrementally. 

Perhaps none of these happy promises was likely to be fulfilled, and perhaps that was something Obama and his campaign aides always understood. But as the new White House came to terms with the realities of Washington, they seem to have thrown off their original images and ideals insouciantly -- as if unburdening themselves of unfashionable baggage that embarrassed them in the big city. 

Nowhere has this fundamental mistake been more visible than in the effort to reform healthcare. From more than six decades of struggle over the question of universal coverage and cost control, the Obama team must have known that they would face enormous opposition. They should also have known, from the ugly mood of the Republican campaign during the final weeks of the election and the partisan history of the past 15 years, that chances for bipartisan agreement were minimal. And they ought to have realized that the energy of the progressive movement, expressed in their own campaign, could become their most formidable weapon in that battle. 

That was the insight attributed to FDR in a famous anecdote. When progressive leaders approached him with a wish list of reform programs and liberal legislation, he nodded. "I agree with you, I want to do it. Now make me do it." Although Roosevelt biographers consider that story apocryphal, it expresses a truth of political history that remained salient from the labor organizing of the Depression through the civil rights, antiwar, feminist and environmental movements. For a president who wants reform and change, citizen agitation is an important instrument of power, not an obstacle to deal making. 

But this president surrendered that powerful weapon when he chose aides who prefer lobbyists to activists and adopted a strategy that ranks bipartisan agreement above policy substance. The telltale remark came from still another anonymous aide who boasted recently that the White House would welcome a "confrontation" with Democratic liberals over healthcare because it would "show he is willing to stare down his own party to get things done." 

No doubt this willingness to further divide Democrats and punish liberals is pleasing to Beltway pundits. It arises from the same instinct that welcomed a parade of lobbyists into the White House and that fawned over Republican senators and Blue Dog representatives, even as they conspired to wreck reform. Meanwhile, the political environment was suffused with right-wing messages about the president and his program, while the White House failed to promote or explain its plan. (No great sophistication is required to determine who, aside from the president himself, bears the greatest blame for these tactical and strategic errors.) 

While this depressing scenario may seem preordained, especially in the conventional idiocy of Washington politics, there were other possibilities, had Obama remained true to his promise and platform. Instead of seeking to silence supporters of a single-payer, Medicare-for-all plan, for example, the Obama team could have encouraged those organizations to create pressure from below. Then the public option might have become part of the ultimate deal, rather than an ideal that gets traded away. All the whispered White House waffling over the public option -- which remains on Obama’s own Web site as a central feature of his reform plan -- has only made him appear weak, indecisive and unreliable. 

Can he regain the initiative and restore his brand when he addresses a joint session of Congress next week? Only if he returns to the principles enunciated in his campaign and his inaugural address. He must tell the people and their representatives again that it is time to put away childish things. He must explain why it is imperative to bring our healthcare system into the 21st century, like every developed nation that accomplished this fundamental task long ago. He must stand fast for universal coverage. 

And he must vow that he will do whatever must be done to achieve that promise -- rather than sell off whatever he can, including the security of millions of families, simply to pass any bill.

Aug. 18, 2009 |

To judge from his faltering campaign for healthcare reform, President Obama, well-read as he is, appears to have neglected to read Machiavelli. If he had done so, the American president would have learned this from the Florentine statesman and philosopher in "The Prince":

"It must be considered that there is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order, this lukewarmness arising partly from fear of their adversaries, who have the laws in their favor; and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual experience of it. Thus it arises that on every opportunity for attacking the reformer, his opponents do so with the zeal of partisans, the others only defend him half-heartedly, so that between them he runs great danger."

"For the reformer has enemies in all those who profit by the old order ..." Machiavelli's observation is particularly apt in the case of healthcare. The American healthcare system costs nearly twice as much as the average among similar industrial democracies, and yet overall it does not provide better care. American doctors make more money than doctors in similar societies; American drug companies gouge American consumers, in order to make up money lost in other countries where governments control drug prices; and private insurance and hospital and doctors' office bureaucracies consume other resources. For this very reason, the groups that contribute to the problem -- the medical profession, the pharmaceutical industry and the private insurance industry -- have every incentive to spend enormous sums to bribe or intimidate politicians and mislead the public in order to continue extracting their even more enormous rents from their fellow Americans.

" ... and only lukewarm defenders in all those who would profit by the new order ..." Here, too, Machiavelli's observations could not be more apposite. The Obama administration and the Democratic majority in Congress claim that most Americans who are now covered by employer-provided health insurance would be better off in the long run as a result of Democratic reforms. Universal coverage must come first, and cost reductions can come later. The political problem arises from the fact that only a minority of people in the U.S. lack employer health insurance. As in the 1990s, the majority of insured Americans are more concerned about rising deductibles than about universal coverage. However, cost reductions as a result of measures like comparing effective treatments are likely to manifest themselves only in the long run, rather than in the near future. The insured majority are thus being asked to support a reform that will chiefly benefit the non-insured minority in the short run, in the hope that maybe in the long run their own costs will go down -- maybe. Small wonder that not only many Democratic voters but their elected Democratic representatives have been "lukewarm" at best in supporting reform.

"... this lukewarmness arising partly from fear of their adversaries, who have the laws in their favor ... " Machiavelli was talking about revolutions from below or above. In the case of the contemporary U.S., his quote should be amended to read "this lukewarmness arising partly from fear of their adversaries, who have the law-makers in their favor ... " The fight over healthcare reform dramatically illustrates the extent to which the American political system has been colonized by producer lobbies, in healthcare and other industries. This phenomenon is neither new nor unique to the U.S. In every society, consumers of goods and services outnumber producers. But the vast constituency of consumers tends to be disorganized and inattentive, while producers, although numerically far fewer, are focused and mobilized. Because politicians respond to intensity and money and not just electoral numbers, the doctors, drug companies and insurance companies may not have the laws in their favor, but thanks to their successful lobbying they have many lawmakers in their favor.

" ... and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual experience of it." Machiavelli's second kind of "lukewarmness" is also evident in the debate over healthcare. The Republicans defeated the Clinton healthcare reform by making the case that, as bad as American healthcare might be now, the alternative might be even worse. That strategy worked once before; why not again? Particularly in the midst of the greatest economic downturn since the Depression, people are risk-averse when it comes to the trade-off between risking benefits that exist and going for possible gains. In the words of the children's rhyme by Hilaire Belloc, "It's always best to cling to Nurse/ For fear of finding something worse." 

In addition to exploiting one kind of "incredulity" -- disbelief that change will be better -- many conservatives shamelessly have exploited the incredulity and ignorance of poorly informed voters, who are being told that the Democratic plan will lead to euthanasia for the elderly and the disabled. It is no defense of these vile tactics to observe that the Democrats have made themselves vulnerable to wild conspiracy theories by not being completely candid about healthcare.

The president and the congressional Democrats have claimed that we can cover every American, allow people who want to keep their employer-provided insurance to do so, not raise taxes on the vast majority of Americans, not ration healthcare and cut costs. This cannot possibly be true. According to the CBO, the plan in its present form would cost more than a trillion dollars over a decade. An extra hundred billion a year for real healthcare reform could be a bargain, but let's not pretend that any significant reform can be revenue-neutral.

Progressive supporters of a public option are being less than candid when they claim that a public plan will not put private insurance out of business -- when in fact their not-so-secret hope is that over time the public plan will grow into universal single-payer by putting private insurance out of business. If not, why is the left so supportive of the public plan? A supporter of single-payer, I have no problem with the goal, but instead of trying to sneak the seed of single-payer in by stealth, proponents ought to make the case on its merits. Crude pseudo-Machiavellianism based on misdirection is likely to backfire. (In "The Prince," Machiavelli -- a small-r republican who preferred the many to the elites -- says that the best leaders are those whose reputations for virtue and honesty are actually justified.)

In short, by claiming all gain and no pain -- no rationing of any kind, no middle-class tax increases, no limits on doctor choice, no price controls, no seed of single-payer -- the Democrats have created an LBJ-like "credibility gap." Just as the discrepancy between the Johnson administration's pretext for escalation in Vietnam and its actual strategic motives created a gap that was quickly filled by conspiracy theories, so the gap between the promises of the Democrats and the reality of hard trade-offs has opened a door to false and revolting conspiracy theories, like Sarah Palin's claim that under the Democratic plan her Down syndrome child might have been euthanized.

If Machiavelli were around today, he would not give the Obama administration and the Democratic Congress high marks for Machiavellianism. Indeed, the wily Florentine probably would have been stunned by the fact that the Obama administration and the Democratic congressional leadership announced a schedule for passing the Democratic healthcare plan before there was a Democratic healthcare plan. The Renaissance equivalent would have been an agreement by Florentine conspirators to set a date certain for overthrowing the Medici tyrants, and deciding only later how to do it and whom to include. Right now the evolving Democratic healthcare bill consists of different versions that are not understood either by most defenders or most opponents. Democrats insist that we need to hurry up and pass whatever-it-is, while Republicans are against whatever-it-is, sight unseen.

But while he might have been surprised by the willingness of the Obama administration to campaign for a plan that is not even finished, Machiavelli would not have been surprised that healthcare reformers for the second time in a generation have underestimated the difficulty of reform. The Democrats must hope that Machiavelli's words in "The Prince" are not an epitaph for the latest attempt to provide universal healthcare: "Thus it arises that on every opportunity for attacking the reformer, his opponents do so with the zeal of partisans, the others only defend him half-heartedly, so that between them he runs great danger."