Saturday, January 9, 2010

Health Care: Where do we Go in 2010?

By Lauren Reichelt Tikkun Daily

I’ve spent the last two weeks in a funk, listening to the debates about the future of health care reform. I am pleasantly surprised by two phenomena: 1] public dialogue around health care is both vibrant and incredibly substantive ; and 2] conservatives have absented themselves from discussion.

I grew accustomed to palliatives and drivel during the Bush years. (Remember when plastic sheeting and duct tape were promoted as public health policy? In the event of an epidemic, we were instructed to wrap our homes in plastic!) I am surprised at the enthusiasm and diversity of our civic dialogue. This is a huge positive change and a sign of our improved civic health.

On the other hand, the Republican Party has descended into utter moral and intellectual bankruptcy. They have determined that the only quick route back to power is to prevent legislative action, then brand Democrats as ineffectual. Their most fervent followers believe America is a white Christian nation under attack. As a result, they are opposing anything and everything. Jack Kemp, the Party’s self-described “bleeding heart conservative” passed away in May after a decade of political exile. As long as the far right wages primaries against Republicans who fail their ideological “purity test,” there will be no new Jack Kemp, no ideas, no discussion within the “big” GOP tent. Alert Democrats can capitalize on their failure to build.

Building the Ship of State

Actual dialogue has been confined to two progressive factions, and it is fueled by a structural question. Out of what material do we build our ship of state?
The “New Democrats” (or “Reagan Democrats”) who rose to power during the Clinton years, incorporated Reagan’s distrust of government into their philosophy. They have replaced conservatives in public discourse. They view government as a regulator rather than a provider of service. According to this wing of the Democratic Party, the private sector should be entrusted with service delivery whenever possible. Private for-profit corporations are the best entities to provide health care, education and other services. Reform basically means “insurance reform.” The government should establish and enforce strict rules governing the industry.

The difference between these “new conservatives” and the old Barry Goldwater Republicans is that they advocate strong regulatory powers for the federal goverment. (In theory…practice might be another matter!) In the past, conservatives opposed government regulatory powers over industry.

Proponents of this model such as Rahm Emanuel, the Clintons, Geithner, Summers, et al, are prominent within the Obama administration and are often described as “pragmatists.” Corporations are powerful, so it is pragmatic to incorporate them into the Democratic philosophy of governance.

While I do not subscribe to their philosophy, I think it is important to acknowledge it as a valid point of view. I work for a local government. In my experience it is true that without strong leadership, government tends to accumulate employees who are comfortable with the security of a status quo, and who will not innovate. Entropy being what it is, after several decades without a shake-up, bureaucracy can become lethargic and unresponsive. Reagan’s appeal to the masses in the 80s did not consist only of his promise to lower taxes or in his appeal to personal greed. The average citizen’s interaction with government consisted mainly in their dealings with local officials. In its glory days, the Democratic Party built powerful patronage systems that had grown unresponsive to citizens’ needs.

The other Democratic wing particpating in the debate consists of what Howard Dean calls “the Democratic Wing of the Democratic Party.” Rabbi Lerner, Howard Dean, Anthony Wiener, John Conyers, Jane Hamsher of FireDogLake, and Daily Kos bloggers nyceve and slinkerwink are some of the most prominent and fervent proponents of this school of thought.

Left-leaning lefties believe that there is indeed an important role for the government to play in the actual delivery of services. They envision a public sector alternative to private for-profit insurance. During the campaign, Obama played heavily to the progressive left to distinguish himself from Clinton, and the left was an important factor in his ground campaign.

This school of thought holds that there is no role to be played by for-profit corporations in the administration of health care. Because corporations are beholden to their shareholders rather than the general public, they will always find ways to maximize profit at the expense of service delivery. They point to the rapacious greed of a poorly regulated industry as proof. In truth, left unchecked, the private sector also becomes unresponsive and hostile to innovations. It tends to attract bandits and to allow them to rise to the top.

Jane Hamsher recently provoked a firestorm in Left Blogistan by collaborating with Grover Norquist to call for an investigation into Rahm Emanuel’s activities while serving on the board of Freddie Mac. While Hamsher was making the point that the progressive left can pressure the Obama administration by voting along with Republicans against democrats who pass the current Senate bill, the idea of lending legitimacy to Grover Norquist was repugnant to many. Norquist and Americans for Tax Reform were key players in Abramoff’s schemes to enrich the Republican Party by defrauding Native Americans. He spearheaded successful Taxpayer Bill of Rights or TABOR referenda in Colorado and other states that have helped to eviscerate state governments’ abilities to regulate industry, administer health care, or serve effectively in many arenas. The downside of teaming up with Norquist is that we serve to legitimize him. It’s better to allow him to drown in the bathtub of his own making.

What do we do About the Senate Bill?

The question facing the progressive community after the passage of the dubious Senate HCR Bill is, “Where do we go from here?” Do we kill the bill and start over? Or do we pass something and come back for more? This compendium available at summarizes the opinions of most of the wonks including my favorite, Paul Krugman.

Several days ago, Democracy Now aired a great discussion between former-Aetna-exec-turned-HCR-advocate Wendell Potter and FDL health policy analyst Jon Walker entitled Kill the Bill or Support Passage. Like Krugman, Potter argued that failure to pass a health care reform bill now, while the Dems have a clear majority in Congress, will cripple reform efforts for decades. He suggested a number of substantive changes to the bill that can be made in conference. Among his suggestions: expand Medicaid to cover more adults by increasing the federal poverty level, create a federal insurance exchange (rather than leaving exchanges to state governments that have already been drowned in Norquist’s bathtub), eliminate taxes proposed in the bill on those who currently have insurance that works, and strengthen regulations on insurers.

Notably, the debate between Potter and Walker was around strategy, not substance. Walker argued that the Democratic Congress will pass something now because it must, but that by rejecting the Senate bill, progressives can force Reid and Obama to resort to the use of reconciliation, thereby producing a better bill, and kicking Lieberman and Nelson to the curb.

I find it fascinating that in order to win Nelson’s vote, Medicaid will be expanded in Nebraska to the point that it might form the basis for single payer health care while the rest of the country gets squat!

Along with other bloggers, I find Hamsher’s alliance with Norquist utterly repellent. Nevertheless, I think she has done progressives an overall service. She has redefined the term “left” through her actions and, by association, the term “moderate.” Wonky bloggers like Krugman are now “moderates” instead of flaming communists. And America loves to be “moderate.”

I agree with Walker. Polls indicate that progressives will not turn out to vote in this year’s elections if they are unhappy about the final HCR bill. Now is the time to scream for the changes we want. Force the passage of meaningful insurance regulation which cannot by law occur through reconciliation. Use reconciliation to pass a meaningful insurance exchange and Medicaid or Medicare expansion. Kick Lieberman to the curb.

Here is a link to the FireDogLake War Room.

Health care reform is a process that will take decades to complete. The eventual product will probably strike some sort of balance between public and private sectors. Let’s make sure that balance includes meaningful government regulation of the health care industry along with an option to buy into publicly administered health care.