The Health Care Follies Continue

I think the idea of civil war in the Democratic Party is as overblown as the talk of civil war among the GOP earlier this year, but it's still entertaining to consider the thought. Plus Howard Kurtz turns a nice opening image into a pretty substantive commentary, before providing some links that are worth exploring...

That splashing sound you hear is liberals jumping off the health care ship.

For all the talk of a Republican civil war earlier this year, it is remarkable to watch the left wing of the Democratic Party splitting off and vowing to defeat the measure that has been President Obama's top priority.

Finger-pointing is common when legislation is teetering on the brink, but the level of vitriol that has erupted in the past couple of days is nothing short of stunning.

Some liberals are angry at Howard Dean for suddenly leading the charge against the Senate bill. Others are furious at Joe Lieberman for forcing his former party to drop the remnants of a public option and Medicare buy-in. Still others are blaming Obama for letting this thing turn into an increasingly unpopular morass.

It's not that the criticism is unfair. Dean has never been much of a team player. Lieberman keeps wavering to maximize his leverage. Obama let Congress write the bills without much pushback. The Democrats have a big majority in the House and 60 votes in the Senate -- sort of -- and they still can't seem to get this done.

Harry Reid has drawn his share of criticism, but could LBJ or any other majority leader have cobbled together an acceptable compromise? When he adds something that liberals like -- the 27th iteration of a public option -- he loses moderate senators whose votes he needs to choke off a filibuster. When he makes concessions to the moderate side, the liberals get angry. Then there are the thorny side issues such as drug reimportation and abortion funding. The bill (which still must be reconciled with the House version, if the Senate gets that far) now has something for everyone to hate.

...Is it still worth passing? The president certainly didn't campaign for a public option. But to add, say, 30 million Americans to the health insurance system through a mandate -- a laudable goal, on the surface -- could really lead to soaring costs without a strong mechanism to keep prices under control. And that seems to be lacking, especially given Congress' record on calling for cuts in programs like Medicare but flinching when it's time to carry them out.

Joe Biden said on "Morning Joe" this week that health care reform would be dead for a long, long time unless this bill passes soon. And he's right. The Obama White House and the Congress made a mighty, yearlong effort in the face of near-unified GOP opposition. They're not likely to try again.

So the question for the Democrats is whether it's better to pass a flawed bill and claim victory -- even though most of the good stuff doesn't kick in for years -- or appear to be a totally dysfunctional party by failing to pass anything at all.

Strangely, I sympathize a lot with the progressive left. A lot of the best dreams of the right did not materialize during W.'s eight years, for various reasons. He compromised on school choice, for example, to get No Child Left Behind. He blew social security reform. But Obama's failures on health care are a glaring failure in a different way -- he refused to put up his political goodwill in the fight, and left the heavy lifting to Congress, which had competing priorities. The moderate Democrats in the center wanted one thing, while the liberal progressives on the left wanted something else. The President made it sound like he wanted everything, but never fully laid out where he would take a stand. This meant that people in his own party -- people who would like his Presidency to succeed -- didn't have a guiding principle to follow in the process. The question is why. Glenn Greenwald, of all people, does a great job laying the blame at the White House's feet, but seems to think this is all part of the White House strategy...

Of all the posts I wrote this year, the one that produced the most vociferous email backlash -- easily -- was this one from August, which examined substantial evidence showing that, contrary to Obama's occasional public statements in support of a public option, the White House clearly intended from the start that the final health care reform bill would contain no such provision and was actively and privately participating in efforts to shape a final bill without it. From the start, assuaging the health insurance and pharmaceutical industries was a central preoccupation of the White House -- hence the deal negotiated in strict secrecy with Pharma to ban bulk price negotiations and drug reimportation, a blatant violation of both Obama's campaign positions on those issues and his promise to conduct all negotiations out in the open (on C-SPAN). Indeed, Democrats led the way yesterday in killing drug re-importation, which they endlessly claimed to support back when they couldn't pass it. The administration wants not only to prevent industry money from funding an anti-health-care-reform campaign, but also wants to ensure that the Democratic Party -- rather than the GOP -- will continue to be the prime recipient of industry largesse.
As was painfully predictable all along, the final bill will not have any form of public option, nor will it include the wildly popular expansion of Medicare coverage. Obama supporters are eager to depict the White House as nothing more than a helpless victim in all of this -- the President so deeply wanted a more progressive bill but was sadly thwarted in his noble efforts by those inhumane, corrupt Congressional "centrists." Right. The evidence was overwhelming from the start that the White House was not only indifferent, but opposed, to the provisions most important to progressives. The administration is getting the bill which they, more or less, wanted from the start -- the one that is a huge boon to the health insurance and pharmaceutical industry. And kudos to Russ Feingold for saying so:

Sen. Russ Feingold (D-Wis.), among the most vocal supporters of the public option, said it would be unfair to blame Lieberman for its apparent demise. Feingold said that responsibility ultimately rests with President Barack Obama and he could have insisted on a higher standard for the legislation.
"This bill appears to be legislation that the president wanted in the first place, so I don’t think focusing it on Lieberman really hits the truth," said Feingold. "I think they could have been higher. I certainly think a stronger bill would have been better in every respect."

Let's repeat that: "This bill appears to be legislation that the president wanted in the first place." Indeed it does. There are rational, practical reasons why that might be so. If you're interested in preserving and expanding political power, then, all other things being equal, it's better to have the pharmaceutical and health insurance industry on your side than opposed to you. Or perhaps they calculated from the start that this was the best bill they could get. The wisdom of that rationale can be debated, but depicting Obama as the impotent progressive victim here of recalcitrant, corrupt centrists is really too much to bear.

Of course, this imagines that the President's allegedly brilliant maneuvering (although Greenwald seems to think the maneuvering has been a load of hooey as well) will produce a bill that passes, and that's in question. What's not in question is that the process of putting together the bill, in the face of mounting public opposition and an economic crisis, has put a severe dent in the Democrats' chances of maintaining control of the House and keeping a filibuster-proof Senate majority. I know I'm hoping for the failure of this bill, but both sides are now fully invested in getting Ben Nelson on their side in Nebraska. He seems to be the final vote that Harry Reid needs, but let's not forget Jim Webb as well. If Webb suddenly throws a wrench in the process, the Dems could be in for a depressing holiday break. I think Webb will actually vote for cloture and then against the bill, but I could be wrong.

There's a tight schedule by which Reid might get the bill approved before Christmas. Of course, now Mother Nature may screw with the schedule as well. And if this thing doesn't get passed before the New Year... well, it gets more unpopular by the minute. By President's Day, health care reform might be less popular than swine flu.