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The last war (on health care)

Interesting summary from Brad DeLong. go read.

Yeah, it's about a book Broder co-authored. But the narrative seems sound enough for me.

I can see how Unity might be helpful in such a context, if Obama could get away with running right and governing left. But helpful isn't the same as successful, and the Republicans are as malevolent now as they were then. Maybe more so. Ditto the press.

Sigh. I guess I feel we should win the partisan war, not call a truce. And I worry that Obama's snatching defeat from the jaws of victory.

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vastleft's picture
Submitted by vastleft on

... where I dig out my favorite Washington Monthly quote:

Early on in Clinton's presidency, GOP leaders explicitly decided to make the failure of Clinton's presidency their overriding goal, regardless of, and indeed in spite of, his attempts to move to the middle. The most telling moment came during Clinton's second big initiative, health-care reform. By any objective measure, the United States had--and still has--a terrible system, which spent far more per capita on health care than any other country while leaving a higher percentage of our population uninsured than in any other advanced industrialized nation. While many Republicans were skeptical of Clinton's preferred solution to the problem, they at first accepted a responsibility to pass some sort of plan. Yet they came to be persuaded by the advice of conservative operative William Kristol, who urged in a series of influential memos that the GOP oppose the Clinton plan "sight unseen," and commit to sinking whatever plan was devised--on the grounds that successful passage of any plan would keep the Democratic Party in power. In keeping with this advice, Senate Minority Leader Bob Dole even abandoned his own health-reform proposal, the better to create gridlock.

When the Republicans took over Congress in 1995, the polarization began to get even worse....

That's not to say the Clintons' approach was perfect, just that it was doomed by the Conservative Movement.

Submitted by lambert on


The moral bankruptcy was on the part of the Republican Party's power structure, which thought (correctly) that placing the government into total gridlock was a road to political success, and cared not at all for making public policy better along any dimension.

The case for Unity is here:

Magaziner had two major flaws. His first was that his instinct was always to make things more complicated. Faced with a choice between doing 90% of a job with an organization that has 10% of the present complexity and doing 100% of a job with 200% of the present complexity, he would always choose the second. He had no sense that complicated organizations tend to break, to exhibit bizarre and unplanned behaviors, and are hard to explain--but he had never run and had spent little time working in large human organizations, and when he got his chance to do so during health-care reform he rapidly proved to be incompetent at marshalling resources and using his people's time effectively.

His second flaw was that he thought like a management consultant. A management consultant's principal goal is to win a debate in front of his employer, the senior decision maker, the "Principal." You win a debate by making intellectual arguments, controlling the flow of information to the senior decision maker, walling-off potential adversaries from the process, and winning the confidence of the Principal by telling him things that he likes to hear: that he is smart, that his goals can be achieved, that the nay-sayers just don't grasp the issues.

But that's not how you develop a policy. You develop a policy by forming a large coalition all of whom agree that the proposal will make the world a better place, and that it is close to the best that can be attained at the current moment. Then you have a large group of people who are enthusiastic about the proposal: they will go out and make your arguments for you. The compromises and concessions that had to be made within the policy-planning group in order to form the coalition will then perform a very important exeterior purpose: just as they brought people within the process onboard, so they will bring other people outside the process who think in a similar fashion onboard as well.

Now, I didn't say that helpful was sufficient. But it's an argument. (It also assumes that there really are policy wonks on the Republican side instead of naked partisan ideologues. Whatever the case may have been 13/14 years years ago, I'd go with door #2 today.)

[x] Any (D) in the general. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.

chicago dyke's picture
Submitted by chicago dyke on

we'd have to get serious and organized for that to happen...

this part:

By any objective measure, the United States had—and still has—a terrible system, which spent far more per capita on health care than any other country while leaving a higher percentage of our population uninsured than in any other advanced industrialized nation.

am i the only one who remembers the huge pushback/silencing of this point, when some few reality-lovers pointed it out? there was 'harry and louise' and the whole 'debate' that our health care was the either best in the world, or the second/near best? that's what i think allowed them to get away with it, and crush true/any health care reform.

right there, if the Big Dog was a smart as people say he is, action should've been taken. that is, he could've played a little "i'm the president and i can make your life suck" chicken with big media execs.

the lack of a fair media doomed him as much as anything else, in terms of being able to enact truly progressive policy. now, i wonder that it isn't too late to successfully challenge them.

Submitted by lambert on

The Conservative Movement means that Republicans always have a national powerbase.

Clinton was from Arkansas. I'm sure he had no concept at all of the scale of what he was getting into; what could prepare anyone for it?

Not to trash Arkansas; Dukakis, for example, would have had exactly the same problem.

And I'm thinking of Obama's Illinois roots, here. Like it or not, HRC et al are national powers now.

[x] Any (D) in the general. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.

Submitted by [Please enter a... (not verified) on

One of the numbers that was tossed around then, and still gurgles to the surface occasionally like an overripe turd, is the claim that "85% of Americans have health insurance, it's just that last 15% who have a problem and we can tweak around the edges to get some and leave the rest to charity."

This of course sounds very relieving, making the problem No Big Deal. This has already led to the much more frequent use of numbers instead of percentages, i.e. "There are 43 million Americans without access to healthcare because they have no insurance." That carries a much bigger "ouch" factor. That is a Big Problem, WTF are We Gonna Do. Which is good, because it is.

The bolus still making its way up out of the murk is the converse of the above: How many of that (supposed) 85% who "have health insurance" have junk/WalMart level coverage? Big payments every month for premiums, leaving you that much less in your pocket to cover the deductible/copay/nickel-and-dime (except it's Jacksons and Grants and Franklins) that confront you upon a trip to an actual medical provider?

Heard a poster somewhere the other week saying that they had just got notification of the new year's adjustment in rates, and they were now going to be paying $700/month for a $5000 deductible policy.

That's insane.

Junk's the Next New Thing in this discussion.

Personally I would encourage anybody in such a fix to just go naked. Dump the "coverage" entirely. Take the money that was going into those premiums and stick it in a coffee can under the bed (I would have said "in the bank" but maybe not right now) and pay the couple hundred doc-and-testing charges out of pocket.

I would make a comparison between the bubble in the price of slaves in Virginia in the late 1850s and the bubble in insurance rates right now but used up my Civil War geek exposure already today. Maybe some other time. :)

Submitted by lambert on

People need health care.

Universal health care, duh.

That data point on a price bubble in slaves is just amazing, Xan. I wish you would bring that world and this world together, in these intriguing juxtapositions, much much more.

IOW, if your limitation on civil war geekdom is in any way self-imposed for the good of Corrente, please disabuse yourself of this notion and post more, more, more. Not only is it interesting in its own right, the hit slut in me wants that new population of users...

[x] Any (D) in the general. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.

Submitted by [Please enter a... (not verified) on

...because the long has to wait till i can look up some sources and see what's online....

is that slaves werent' just workers, which is the way we think of it today, field hands vs. house servants etc. Slaves were ASSETS, the same as land or a building or business or carriage or cattle or the like. You could, and many did, borrow against their value or use them as collateral for all sorts of transactions.

Virginia was a wealthy state compared to others of the slaveholding South in some part because they had a positive balance of trade in slaves. After importation became technically illegal in 1808 the slave population could only grow by "natural increase" as they liked to put it.

Virginia is relatively temperate climate-wise. The farther south you went the worse the heat was for everybody, and the harder work was. Sugar plantations were notorious for requiring a constant new supply of laborers as the previous ones simply dropped dead.

Plus you had the assumption--remember this is the 1850s here, although some of these trends started earlier--that the west was going to be opening up as soon as more of the pesky present occupants were shooed away. The whole acquisition of Texas as a slave state opened up a huge portion of the continent wherein slavery had previously been illegal (Mexican law forbade it.)

People were sending younger sons out to look into new properties in places like Kansas and Nebraska too, and of course they had to be accompanied by "servants" for status as well as practical things like cooking, horse care etc.

Upshot was, everybody saw a great new birth of freedom coming, for slaveholders that was. Dred Scott case had put the SCOTUS stamp on the notion that you could take a slave through free territory and he remained a slave. The Taney court had also upheld the Fugitive Slave Law (so much for states rights, like to outlaw slavery inside their borders.) It is almost certain that had the slaveocracy pursued their case through the courts rather than pulled the cord on Ft. Sumter slavery would have been re-legalized throughout the US.

Demand for slaves was up and prices followed. As prices went up--some of this may start to sound familiar--owners of the same slaves that they had had for years were finding themselves richer on paper. All was good.

Comes to 1865 and, um, "progress in the theater of combat has not been entirely to our advantage" as somebody phrased it later, and slavery is outlawed. The south discovers that something like $4 billion in capital has, um, Gone With The Wind.

The banking system is in a turmoil unlike even the Great Depression--and there was no nationwide monetary system anyway, banks printed their own money backed by their own assets.

So there's your comparison between the Slavery Bubble of 1860 and the housing bubble of today. Sources provided on request but it's mostly from a history professor of some years back who is now dead, and background on slavery from the invaluable Many Thousands Gone by Ira Berlin.

chicago dyke's picture
Submitted by chicago dyke on

"the war between the states/of northern agression/civil war wasn't about freeing the slaves, it was about money."

i'm sorry, but i still and will always think it's true.

i don't think so for the same reasons xan does. i think so b/c i know, via family narrative and oral history, of what northern white abolishionists were really like and what they really thought. "property" is the operative and correct word, when speaking of their charges. it was a matter of industrializing 'slaves,' and making anyone open to that category, anyone not already rich. wow! that's so unfamiliar and new, not.

slave labor is tricky. one the one hand, there are benefits. on the other, it doesn't compete so well with, um, 'lesser' forms of industrialized slavery. like, child labor or the profits one can make enslaving young, single not-black women in a newly industrialied age. what are we really talking about here? or: why do "we" go to war? "we" go to war b/c because some set of rich people are angry with some other set of rich people, re: the ability to make gross and obscene profit off the labor of a toiling mass of disempowered second class people. that hasn't really changed. "made in china" anyone?

some black people did really well, those first few decades after the end of slavery. some went west, and north, and farther north, and established communities which to this day have an impact on area politics and culture. some were left behind, forgotten by white 'liberators,' until their beaten former masters had no choice but to offer them "juneteenth." for long decades afterwards, up and until today, there is still a slave mentality, when it comes to understanding the contribution of working Black people to our shared economy. white CEOs get credit and millions for ruining a company, but unemployed black men are told that it's all their fault for failing to advance in a rigged system that hates, jails, fines, and beats them just because of their 'race.' etc.

slavery is hard to make go away. my slavery issue today: enslaved prostitutes from "developing" countries, and in the child-sex intertubes cultures of today. zillions of dollars, indeed, mostly the whole intertubes, are funded by pr0n and suchlike. but for some reason, speaking plainly about that, or the white, brown, asian, black, whatever people caught up in it, means that you quickly get relegated to "the radical, irrelevant, left." mix the drug trade/prison-industrial complex into it all, and you soon understand that "slavery" has yet to die in this country, or most others.

At the risk of alienating the civil war buffs, I have to agree with chicago dyke that the civil war was not about slavery but money. I consider that war the first major policy mistake by a Republican president. If Lincoln had just told the seceding states to "Have a nice day" and left it at that, there might have been a great deal more progress toward equality than we made by retaining the dead weight of the racist South in our government for another hundred years.

As for the original topic, I very heartily agree with lambert that we need to move the discussion from universal health insurance (something the nation cannot possibly afford) to universal health care. I don't want insurance with its deductibles, co-pays, closed drug formularies, and denials of claims by faceless bureaucrats. I don't want my physicians swamped by needless paperwork and required to see ever larger numbers of patients per day to pay for clerical staff on the discounted rates provided by the insurers. I want health care, and I want it for every American.

The idea that somehow universal single-payer is not politically feasible because of the opposition of the medical, insurance, and pharmaceutical lobbies is ridiculous. They will oppose even a minimal plan that could impact their bottom line. If we must fight them, let's fight them to win something simple - universal health care with no claim forms, no deductibles, no closed panels of physicians, no second-guessing by bureaucrats. That's a fight worth winning.