David Sirota: Health Care Puts Progressives On the Verge of Changing the Power Dynamic
Tue Aug 25, 2009 at 09:15
So, here's the deal, folks: Looking at the current state of play on health care through the multicolored lenses I acquired working on Capitol Hill and then working in politics out here in the West, I'd say it's a good bet that the House will pass a health care bill with a solid public option in it, and the Senate will pass a health care bill without a solid public option in it. I'd say it's also a good bet that the major reason - though probably not the only reason - Obama has gone back and forth on the public option is because the administration is solely focused on getting bills - any bills - passed through each chamber and into one conference committee for a final negotiation. Once that happens, the health care shit hits the legislative fan. We won't have to speculate anymore about whether the president is really committed to the public option, nor will we have to speculate about whether top senators and House members on the conference committee are committed to the public option. At that point, their actions will be far louder than their words.
Obama will be forced to take a position on the public option as he either draws a veto line in the sand, or doesn't - and if he doesn't on the public option, it means he's willing to sell out the public option. Similarly, conference committee lawmakers will either have to vote for a public option, or vote with the insurance industry against it.
A month ago, I would have said that the administration was planning to lay low while two templates got into a conference committee, and then sell out the public option in that committee, believing that ultimately, progressives will vote for a bad health care bill (ie. one sans public option but with a few regulatory goodies) rather than kill it outright. The White House is, after all, packed with staffers like Rahm Emanuel and Jim Messina who have made their careers coddling corporate lobbyists - and the president himself is a guy who has often chosen to seek common ground instead of confrontation with moneyed interests when an avenue is available to do that. That's why, for instance, this administration has exhibited two different standards for dealing with progressive and conservative Democrats - it tries to push progressives around while kissing the fat, mostly white and mostly southern asses of the so-called Blue Dogs.
A month ago, all of these forces might have made the "roll the progressives, sell out the public option" strategy a legislatively successful one, even as it would produce a bill that would likely be terrible public policy. I say that because let's be honest: the bloc of congressional progressives who the White House would be hoping to steamroll, while fighting the good fight in the lead up to key votes, has nonetheless capitulated on nearly every single do-or-die final-passage vote in recent memory (and I say that sadly, having served as an aide to Progressive Caucus leader - and dear friend - Bernie Sanders).
However, after the fantastic organizing/whipping/fundraising being done by Firedoglake, OpenLeft and Moveon and after the strong progressive media pressure on radio, TV and in newspapers, I believe the dynamic - and therefore the White House political calculus - could change.
David Sirota :: Health Care Puts Progressives On the Verge of Changing the Power Dynamic Indeed, all the forces seem to be coming into line: Polls show local Democratic dissatisfaction with easily primary-able Democrats, putting huge pressure on those Democrats to get in line; the Paul Krugmans of the liberal punditocracy, often offering up "on the one hand, on the other hand" dithering at the end of legislative fights, have now come out pretty strong for a public option; mainstream Republican editorial boards like the Denver Post are saying the public option is necessary; the decline in Obama's poll numbers are being fueled by progressive - not conservative - dissatisfaction on health care; fundraising for the public option campaign is intensifying; and the organizing work to support the public option is in full gear. Taken all together, the aimed at A) forcing House Democrats to pledge to vote against a public-option-free health care bill and B) getting Senate Democrats to state their support of a public option may be making the easier legislative path the one that squeezes the Blue Dog Democrats - not the progressive movement that got Obama elected.
Obviously, the pressure on the House Democrats is the most important. The Senate is basically a wholly owned subsidiary of the insurance industry - the best we're probably going to do is get enough members to say they support the public option, but it's probably too big a lift to hope to get many of them to pledge to vote against an insurance-industry sop, if that's what the final bill ends up being. However, that's less significant because enough House members taking that pledge - and sticking to it, rather than publicly undermining it - creates a veto power all on its own. That is, it creates a Ben Nelson Effect for the progressive movement.
What is the Ben Nelson Effect? Back in 2007 while reporting my book The Uprising, I wrote a post about progressives learning lessons from the Ben Nelsons of the world - about us learning to use the conservadem tactics of threatening to torpedo a bill to further progressive goals. Back then, Moveon and many other progressive groups as well as many congressional progressives refused to play this kind of hardball, and, as The Uprising showed, our nation paid for it in substantial blood and treasure. So I'm absolutely thrilled that it looks like we're finally embracing the kind of tactics that could force legislative change.
And that's the key word - "force." As Glenn Greenwald has said, this isn't about trust in Obama, or loyalty to Democrats or affinity for particular legislators because they happen to be nice people. This, like every political issue, is about raw power - something many of us on this site have been saying for years, something that many progressives in the throes of Democratic Party/Obama sycophancy have refused to consider (and, indeed, many of us who have been talking for years about changing from partisan to movement psychology have been the target of more than a little anger/vitriol/hate from the sycophants).
We will get only what we force both the Democrats and the Republicans in Congress to give us, taking into account exactly how the Congress works. This is, once again, the "Make Him Do It Dynamic" - and right now, that requires us to build the Progressive Block, as Chris Bowers calls it. We must focus laser-like efforts on constructing a group of House members who delivers on a promise to vote against a public-option-free health care bill. If we do that, we will change the power dynamic in the health care debate by forcing the administration to use its power to make the public option a reality in the final bill that is reported out of the conference committee. And even more broadly, it may change the power dynamic on every other issue by finally establishing the progressive majority in the Democratic caucus - and not the corporate whores - as the final "deciders" on other major bill.
These are the stakes, and they are high. While they aren't going to get us all the way to single payer (which I've long said was a huge missed opportunity), they may deliver us a public option that represents genuine progress. It all depends on us. If we can ignore the professional naysayers and power appeasers in the Washington Punditburo (especially the D.C. liberals who keep going back and forth with overwrought handwringing/bedwetting), if we can substitute real pressure for partisan apologism, if we can refrain from making our typical excuses for Democratic politicians, we can actually deliver this Progressive Block and have a real shot to be successful.
1. Since Sirota mentions an Obama veto or Obama "selling out", I'll post this from Ezra Klein for some
What Social Security Teaches Us About Health Care
Paul Begala has an op-ed in this morning's Washington Post that's the most important argument you'll read today. I'm going to quote a nice big chunk of it here.
I think my fellow progressives ought to give Max Baucus and other members of the Senate Finance Committee a little breathing room as they labor to produce a health-care bill that can garner enough votes to pass the Senate.
Progressive politics is, in my view, a movement, not a monument. We cannot achieve perfection in this life, and if that is our goal we will always be frustrated. The right has far more modest goals: At every turn, its members seek to advance their power and protect privilege. I've never seen the Republican right oppose a tax cut for the rich because it wasn't generous enough; I've never seen them oppose a set of loopholes for corporate lobbyists because one industry or another wasn't included. The left, on the other hand, too often prefers a glorious defeat to an incremental victory.
Our history teaches us otherwise. No self-respecting liberal today would support Franklin Roosevelt's original Social Security Act. It excluded agricultural workers -- a huge part of the economy in 1935, and one in which Latinos have traditionally worked. It excluded domestic workers, which included countless African Americans and immigrants. It did not cover the self-employed, or state and local government employees, or railroad employees, or federal employees or employees of nonprofits. It didn't even cover the clergy. FDR's Social Security Act did not have benefits for dependents or survivors. It did not have a cost-of-living increase. If you became disabled and couldn't work, you got nothing from Social Security.
If that version of Social Security were introduced today, progressives like me would call it cramped, parsimonious, mean-spirited and even racist. Perhaps it was all those things. But it was also a start. And for 74 years we have built on that start. We added more people to the winner's circle: farm workers and domestic workers and government workers. We extended benefits to the children of working men and women who died. We granted benefits to the disabled. We mandated annual cost-of-living adjustments. And today Social Security is the bedrock of our progressive vision of the common good.
Health care may follow that same trajectory. It would be a bitter disappointment if health reform did not include a public option. A public plan that keeps the insurance companies honest is, I believe, the right policy and the right politics. I believe subsidies should extend to as many Americans as need help and that the hard-earned health benefits of middle-class Americans should not be taxed. I believe insurer abuses like the preexisting-condition rule should be outlawed. The question is not whether I or other progressives will support a health-reform bill that includes everything we want but, rather, whether we will support a bill that doesn't.
Baucus and the others working on health care have earned the right to take their best shot, and we progressives should hold them to a high standard. I carry a heavy burden of regret from my role in setting the bar too high the last time we tried fundamental health reform. I was one of the people who advised President Bill Clinton to wave his pen at Congress in 1994 and declare: "If you send me legislation that does not guarantee every American private health insurance that can never be taken away, you will force me to take this pen, veto the legislation, and we'll come right back here and start all over again." I helped set the bar at 100 percent -- "guarantee every American" -- and after our failure it's taken us 15 years to start all over again.
I would disagree on one point: The original Social Security legislation wasn't "perhaps" a "cramped, parsimonious, mean-spirited and even racist" program. It simply was those things. But it was something else, too. A start. Over the next 50 years, it was built upon. But not only by Democrats. Some of the largest advances came when Republicans saw political opportunity in strengthening the entitlement. Begala implies that progressives eventually added cost-of-living increases to Social Security. In fact, it was Richard Nixon who signed that bill. Similarly, whether you like the structure of Medicare's prescription drug benefit or not, it was a massive expansion of an entitlement program, and it was proposed and signed by George W. Bush.
The trickiest part of my job right now is to balance the desire for a better bill with the need to argue that the bill that's likely to emerge still makes for a better country. You don't want to ease the pressure on Congress too early, but you don't want to see your allies forget that this is about more than the public option. Imagine for a second that health-care reform looks exactly like the House bill, but the public option is excluded. What will be easier over the next 10 years? Passing a simple piece of legislation that establishes a public option? Or starting from scratch with a 1,000-plus-page bill that spends $1.3 trillion expanding coverage, and regulates insurers, and creates health insurance exchanges, and reforms the delivery system, and cuts payments to the private insurers overcharging Medicare ... and all the rest of it?
You don't want to compromise too early. But nor do you want to realize that you should have compromised only to learn that it's too late. I don't know where we are along that continuum. But Begala has seen this fail before, and it has taken us 15 years to return to the place where we can conceive of passing a worse piece of legislation. He's worth listening to.
Edited on Tue Aug-25-09 11:22 AM by Vinnie From Indy
I think Begala purposely understates the movement that has ALREADY taken place by progressives in regard to healthcare. We began at single payer and have moved now to simply trying to keep a workable public option in a healthcare bill. To repeat, we have already compromised!
I also take issue with the notion that progressives, the people that got Obama the nomination and worked tirelessly for his election, should be the ones sat down like children and given a lecture about being naive in our expectations. Why in the world should progressives move from single payer to public option to unworkable co-ops? These co-ops aren't worth the effort. By most accounts, co-ops would mandate a gargantuan financial windfall for the very crooks that brought us to this point? If that is the compromise Begala is asking us to consider, he is delusional.
Begala's op-ed is just plain silly. He writes, "The left, on the other hand, too often prefers a glorious defeat to an incremental victory."
Really Paul? So I guess the taking back of Congress in 2006, the tireless work to get Obama the nomination and the last election are not incremental enough for you? You said yourself that it has taken us fifteen years to get back to this point. That seems pretty incremental to me.
Begala never discusses in his op-ed the "why" of it all. Why should we compromise further? Who exactly does he think we are compromising with? Big insurance? The Republicans? We are nowhere close to even contemplating compromising away a public option. To offer this BS at this time indicates to me that Begala is trying set the stage for the death of the public option.
Lastly, the progressive movement behind healthcare reform is asking for nothing more than an honest, public and forceful effort to fulfill one of the central campaign promises offered by Barak Obama during his run to the White House.
put them in power. I'm sick of lectures from these psychophants, as David Sirota so correctly calls them. If they think this strategy will work, putting down those they need more than any group to stay in power, they haven't been paying attention.
Out here in the real world for Begala's and Ezra Klein's information, it is guaranteed, talking to people who voted for them for decades, that if they throw away this opportunity to get done what needs to be done, they are in for a big shock in 2010. The tactics they used, and again David Sirota is correct, shutting down any dissent or warnings from the so-called 'left', iow, the people who were always right, will not work in the election. Bush was the reason people worked so hard to give Democrats a majority.
If that majority does not achieve at least some of the goals which were the reason they were elected, many people will just stay home as the conclusion will be that it makes no difference which party is in power, whether that is right or wrong.
Never been very impressed with Begala. He is too close to his Republicans friends who he respects far more than real Democrats. Nor have I ever been too impressed with Ezra Klein either, whose views are often far too in line with those of the DLC.
David Sirota otoh, is smart, clear-thinking and he is and has been right about most of these issues.
And he is right again. We do NOT need to wait any longer and give Baucus a chance. As he says we need to push them and it appears to be working. Without the pressure from those who elected them there would be no hope at all of a public option.
4. Big difference between Social Security and health care reform
Social Security may have started in a limited and parsimonious manner -- but it wasn't a sellout to anybody. It wasn't an add-on to an existing for-profit pension system. It didn't force workers to invest their retirement savings in the stock market, where the money might or might not be there when it came time to retire. It did not have well-entrenched private competitors that would have fiercely resisted later attempts to expand it.
None of that is true of health care reform. Starting small in this case would not be building a little house on the prairie, with open space in every direction. It would be like building a little house in the middle of midtown Manhattan and insisting there's plenty of room for later growth.
The item quoted in the OP says, "What will be easier over the next 10 years? Passing a simple piece of legislation that establishes a public option? Or starting from scratch with a 1,000-plus-page bill that spends $1.3 trillion expanding coverage, and regulates insurers, and creates health insurance exchanges, and reforms the delivery system, and cuts payments to the private insurers overcharging Medicare ... and all the rest of it?"
My answer to that would be that establishing a public option is doable now only because the system is in crisis. Once a certain amount of reform is in place, and $1.3 trillion in government money is being pumped into the private insurers, it will become completely impossible.
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