The Health Care Bill Sucks--and What to Do About It
Crossposted on Firedoglake
The public option was always a fig leaf. Thus, its demise will not really change the fundamental nature of the health care bill, in my opinion. It merely pushes the bill a small step further down the road. I'd argue that a more important issue is the funding, which is changed in the Senate bill from a progressive income tax on the wealthy to taxes on high-end insurance plans and on insurers and providers. These taxes may well be regressive.
According to the CBO, the effects of this bill on overall premiums will be a negligible 1% increase overall. They may be wrong, but that seems hard to predict for sure.
On the other hand, the benefits of the bill are clearly progressive. Medicaid is offered to low-income people and in the exchanges the subsidies benefit the middle and lower middle class.
With that off-the-cuff look, I'd say the overall effects of the final bill are tending towards positive. Yes, it will do nothing to change the overall structure of the system. Yes, costs will continue to spiral out of control in an unsustainable manner. But will the bill make the situation worse? It's hard to see how.
Then there is the question of political calculus. There's the cost-benefit analysis of whether the Democrats have more to lose by jettisoning the current bill or else by passing an unpopular bill. There's also another question that may be getting short shrift: how much the Democrats winning or losing actually impacts what most of us really care about, namely progressive change. These are tough and subjective questions.
I don't know the answers, but at least we can outline what the answers depend on. The first answer depends on the public reaction after the bill is passed. If the public hates the bill and wants it reversed, the Democrats will suffer. In Massachusetts the public reaction has been positive several years on, but right now nationally the bill is unpopular.
The second answer depends on the existence of a viable political alternative to corporate Democrats that isn't the Republicans. In other words, say the Democrats somehow lose politically from this. Either they lose because they pass the bill and the public hates it, or they fail to pass it and the public punishes them for weakness. Is the opposition likely to be Republican or leftist?
My view about this bill is similar to the view that David Himmelstein expressed earlier this year. When asked about how Congresspeople should vote, he said they should abstain. He did not say oppose. I don't think we should waste effort attacking Congresspeople strictly for voting "yes" to this bill. I think whether to vote for or against this bill is an issue that reasonable people can disagree about because the logic depends on matters of political calculus that are hard to understand and predict. I certainly don't think we should attack politicians like Anthony Weiner or Bernie Sanders for their choice here.
"But," you're saying, "somebody has to pay. We didn't get into this mess through the actions of reasonable people. We got into it because of corrupt sellouts and hacks." True. But we need to discern the best place to focus our efforts. The truth is that the story of sellouts and hacks began far before the final vote on this bill. It began far before, in fact, the so-called public option and Medicare buy-in were jettisoned in favor of the demands of Lieberman and Nelson. The story begins with the fact that most Democrats--meaning most, i.e., a majority that does not just include Blue Dogs but rather the actual center of gravity of the party, are beholden to the moneyed interests of insurers and especially providers on this issue. Even in the more democratic House, a mere 90 or so representatives out of 250 Democrats favor Medicare for All. In the Senate, the domination of money is nearly complete, with maybe three or four people in favor. This is in a country where two-thirds of the population may well favor Medicare for All given sufficient information about the topic. (See Kip Sullivan's recent must-read piece.) The problem is not some "tail" of the Democratic Party, as certain apologists and misinformed people sometimes say, with Robert Kuttner for example coming to mind on the recent Bill Moyers Journal. The problem is at least two-thirds of the elected officials in the party.
If "we" is progressive activists, then by the principle that tending to one's own house is one's first and foremost responsibility, our first concern should be to truly come to grips with this. In the end we can hardly blame anyone else for the abject state of affairs of health reform if we are still accepting the absurdities pushed by certain so-called "progressive" figures. Howard Dean comes to mind: he is now angrily calling for the demise of the Senate bill and fulfilling his usual role of superficial progressive hero, even while he denounced single payer from the start and said that anyone attempting it would "pay an enormous price at the polls" because "you can't take choice away from Americans."
The founders of the major progressive blogs are deeply compromised right now. Markos Moulitsas is behaving like the clown and hack he typically does, which is entirely predictable given that his blog is quite explicitly "not a liberal blog" and is officially wedded to the current Democratic Party. No one with any intellectual honesty could wed themselves to that beast (not that Moulitsas makes much pretense of having any). Chris Bowers, Mike Lux and similar "progressives" provide a more intellectual but ultimately just as vacuous perspective. Firedoglake is hardly immune either with its sponsorship of slinkerwink the public option propagandist over at Daily Kos, of "Public Option Please," and so on. The only blogs I know of that actually align on health care with the interests of the general unwashed masses (contrast to educated bloggers) are Corrente and ZBlogs.
So yes, let's make somebody pay--but let's make it count. The first order of business of bloggers needs to be changing the blogosphere. The problem is that this is not really a matter of blogging, rather it's about supporting blogs that are actually progressive and even of forming new blogs. We should cut down the legitimacy of faux-progressives by leaving their blogs as much as possible, whether they're Kos-like clowns or Bowers-like intellectuals. I refuse to post on Daily Kos or Open Left, and only post on Firedoglake because of the great community here, not because of its editorial activities. I stick around on TPMCafe probably due solely at this point to Dean Baker. I strongly suggest that everyone crosspost all their work at Corrente. ZBlogs is even better but without enough responses to be a viable community at present. We should work on that.
Corrente is obviously not as large an operation as Firedoglake, let alone King Kos. It clearly needs software as well as fiscal help. That also goes for ZBlogs, not to mention as yet uncreated blogs. The blogosphere at present is not structured democratically, but for the most part is dominated by opportunists who happen to have the expertise in software and management on their side. If we're going to democratize it then progressives need to capture the technical and managerial expertise. I myself am a computer science major and might try to lend a hand if my personal life ever allows the time, which at the moment it doesn't.
Progressives in general need to understand that the Democratic Party is at least two-thirds rotten. Democratic leaders are not idealists, they are power players who are simply acting in their own self-interest. Chuck Schumer for example is a brilliant politician in one of the most Democratic states in the country, yet he certainly is no Medicare for All advocate and hence has sold out a majority of the US population, not to mention the even larger majority that must exist in New York. None of this bothers him in the slightest because he's dedicated not to progressive ideals but to getting elected by the widest margin possible. The interests of Democrats and of the public are not always or in fact even mostly the same. They just happen to be superior to the Republicans.
Finally, we need to get better organizations. Moveon.org is now calling for the demise of the Senate bill in a fashion reminiscent of Moulitsas, Dean, and other fakers. A far better organization is Progressive Democrats of America, which is actually economically progressive, unlike Moveon which was founded by wealthy entrepreneurs in classic liberal elite style.
It goes without saying that Health Care for America Now is simply a shill to the Democratic establishment and explicitly rejects the idea of meaningful opposition. It is perhaps with them more than anyone that we should place our blame for the disaster that is this bill. After all it is rather easy for politicians to resist a mass movement when there are groups like HCAN working to distract from any movement because it's "infeasible." We put our faith this time around in an organization that explicitly favors politics and "process" over policy and populism. It's time to buck up and realize that no win is possible without a fight. Let's get behind Healthcare-NOW! and Progressive Democrats of America.