Posted by: mutantpoodle | December 15, 2009

Grow Up

Calvin and Hobbes, by Bill Watterson

Well, as predicted, the public option is gone. Gone, too, is the Medicare buy-in for 55-64 year olds. What’s left is a bill that puts a tighter collar around insurance companies, and (assuming the annual limits loophole gets removed), will largely prevent people from going broke because they get sick.

The usual suspects on the left are braying about this entirely predictable turn of events. Obama should have twisted more arms, harder. Harry Reid should have shown Joe Lieberman who’s boss. The Democrats should have used reconciliation. (Never mind that reconciliation would be fiendishly complex, and would have omitted critical regulatory elements of the package that survives.)

Howard Dean (among others) says the Senate should kill the bill. Nate Silver, bless his mathematicians’s heart, shows why that notion is batshit crazy. (His phrase!)

I think everybody needs to grow up.

A camel, the saying goes, is a horse built by a committee.  Well, this imperfect legislation is good legislation that’s gone through the Senate.

Would I have liked a public option? Sure. Medicare buy-in? Absolutely.  But even though this bill probably won’t make my life better anytime soon, we need it. here’s why.

1. It won’t be easier next time, whenever that might be. As Ezra Klein wrote in early November,

Truman sought single payer. His failure led to Kennedy and Johnson, who confined their ambitions to poor families and the elderly. Then came Nixon, whose reform plan was entirely based around private insurers and government regulation. He was followed by Carter, who favored an incremental, and private, approach, and Clinton, who again sought to reform the system by putting private insurers into a market that would be structured and regulated by the government. His failure birthed Obama’s much less ambitious proposal, which attempts to reform not the health-care system, but the small group and nongroup portions of the health-care system by putting a small minority of private insurance plans into a market that’s structured and regulated by the government, and closed off to most Americans.

Failure does not breed success. Obama’s defeat will not mean that more ambitious reforms have “a better chance of trying again.” It will mean that less ambitious reformers have a better chance of trying next time.

Conversely, success does breed success. Medicare and Medicaid began as fairly limited programs. Medicaid was pretty much limited to extremely poor children and their caregivers. Medicare didn’t cover prescription drugs, or individuals with disabilities, or home health services.

But once the programs were passed into law, they were slowly and continually improved.

2.  Passage of this package now – which entails significant regulatory reform and real subsidies for lower-income purchasers of health insurance – gets on the books elements of reform that could not be had through reconciliation.  I touched on this point here, Klein’s take is here.

3.  For all its flaws, this bill does exactly what the Republican Party appears to oppose most: it establishes health care as a fundamental American right, not a privilege. (How to categorize health care came up during last fall’s town hall style debate, and McCain, unsurprisingly, couldn’t bring himself to call it a right. Obama said it “should be a right for every American.”)

4. From a progressive political perspective, spiking this bill would be self-defeating. People would remember the failure, and not the monolithic GOP opposition that enabled it. And, in fairness, it’s not the GOP that scuttled the good parts of this bill. It’s a few Democrats.

Which brings me to the losers in this process.  They are:

  • Anyone represented by a Republican Congressperson or Senator. I can’t think of a member of the Congressional GOP who engaged in an honest debate on the merits of this legislation.
  • Joe Lieberman. But wait, you say – he won! The bill won’t have a public option, or Medicare buy-in, and who knows what else he’ll try to bargain away. But in what will almost certainly be his last term as a Senator from Connecticut, he has distinguished himself by his dishonesty and pettiness.  What do you say to someone who bases their opposition to an element of health care reform on liberal support of that same element?

I wrote a few weeks ago about the leverage the left did not have on health care reform.  In short, progressives really want health care reform, and they’d prefer it with a strong public option and/or medicare buy-in; Republicans (except, maybe, Olympia Snowe, and I have my doubts) want nothing at all. If they get it by voting it down or by progressives jumping ship it doesn’t matter: no bill is a win. (As I pointed out before, take this dynamic to a car dealer and you end up paying way more than sticker.)

Clearly Joe Lieberman (and, to some extent, Ben Nelson) are saying that they are willing to torpedo health insurance reform, even if, as Ezra Klein points out, hundreds of thousands of lives are at stake. Or, as he puts it, Lieberman is “willing to cause the deaths of hundreds of thousands of people in order to settle an old electoral score.”

Matthew Yglasias describes this attiude as “sociopathic indifference to the human cost of [his] actions.” And if Ben Nelson chooses to scuttle this bill because a few federal dollars might subsidize an insurance policy that covers abortions, then he, too, demonstrates this hideous attribute.

Which is why, contra conventional wisdom, I think Joe Lieberman will end up being the biggest loser coming out of this process. Sure, he’s tweaked the left and made the Senate bow to his whims – all due to his power as the 60th vote – but he has, in the process, doomed himself in Connecticut electoral politics, and revealed himself (to those who didn’t know it already) to be a small, small man.  His legacy – and this is a man who marched for Civil Rights in the South 4+ decades ago – will be not of that kind of courage, but of venal pettiness borne out of the left’s successful 2006 primary challenge that forced him into his own eponymous political party. (Does anyone else think it’s telling that his party was called “Connecticut for Lieberman”, and not the other way around?)  Rather than the non-ideological reasonable moderate he likes to present himself as, he has acted reflexively ideological, no matter what the cost.

The winners are those who have kept pushing this boulder uphill.  Ezra Klein (yes, he’s getting a lot of linkage, but he really is the go-to guy on this stuff) names them:

…let this serve as an encomium to Ron Wyden, Tom Harkin, Chuck Schumer, Sherrod Brown, Chris Dodd and Jay Rockefeller, among many others. All of these senators could have been the 60th vote. All of them had issues they believe in and worked for. Chris Dodd built and passed a bill. Sherrod Brown whipped up liberal support for the public option. Chuck Schumer spent countless hours devising compromises and searching for new paths forward. Ron Wyden spent years crafting the Healthy Americans Act, getting a CBO score, pulling together co-sponsors, speaking to activists and industry groups and other legislators. Jay Rockefeller has spent decades on this issue and wasn’t even invited into the Gang of Six process.

But you know what? They’re all still there. Because in the end, this isn’t about them, and though their states and their pet issues might benefit if they tried to make it about them, the process, and thus the result, would be endangered.

I have one more name to add to the list: Teddy Kennedy.  He wasn’t around to make this final push, but it may just be that his lifetime passion is realized in the year of his passing.  Here he is, 30 years ago, making the case:

These were just some of the grown-ups who have gotten us this far.  We are limited by the de facto veto wielded by the combination of Joe Lieberman’s pettiness and the unfortunate accident of him being vote #60. (Although it would be far worse if he was vote #59, and we needed to get Olympia Snow on board. Small blessings.) So, on a day when people are venting understandable anger and frustration, here is my plea:

Let Joe Lieberman, and Ben Nelson, and Mitch McConnell, be the tantrum-throwing children. Be the grown-ups: step back and look at what we’ve gotten.

And next year, start fighting like hell to make it better.



  1. I appreciate your point of view and I am torn by seeing both sides of the argument but defending this mandate is going to be a tough sell especially while Republicans demigod it and the budget defecit. The Liberal base feels shit on and yes, some of is from the perpetual pouters but tuns of other advocates and progressive foot soldiers feel let down. The Administration needs to give them a major bone because fighting the ass hole Republicans with a defeated group will be very difficult in the upcoming elections.

  2. Given current realities, I don’t know what bone the Administration could give. Yes, the bill could be much better. absent progressive pressure, it could also be much, much worse. It’s hard to have perspective now – that was sort of the point of my piece – but if progressives stay home because Joe Lieberman is a dick, then they’re hurting themselves. And millions of others.

    I get you point. But all that can be done is a lot of selling.

  3. I was thinking tonight that maybe Dean and Kos are saying kill the bill so Loserman will stop with his hostage demands.

    I would like to see these exchanges opened up so anyone can get in them and the dates moved up.

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