Processing Health Care Compromises, A Strategic Look

It’s important for people who work in politics, policy, and activism to recognize what world it is they are operating in. This sober understanding should influence how strategies are formed and tactical choices are made. I think we’re approaching a point in the health care reform fight were the online progressive community needs to evaluate what world we are operating in and chart a course forward accordingly.

When Barack Obama was elected President, with a huge majority in the House and fifty-nine Democratic caucus seats in the Senate, we were told, “Now is the moment for health care reform.” There was a presumption that this was an historic time, whose existence was not only unprecedented but unlikely to ever come again. As such, passing health care reform in the first year (or so) of the Obama presidency became essential to his administration’s chances for success.

What was ignored in this evaluation, though, was an assessment of the actual landscape of the Democratic majorities in the House and Senate.

In the House, conservative Blue Dogs and New Democrats have not exerted the same degree of influence as their conservative Democratic counterparts in the Senate. Nonetheless, Blue Dogs have spent the better part of the last year screaming for a deficit-neutral bill with a low price tag. These efforts have effectively kept the entire discussion of health care reform costs, which experts say should be in the neighborhood of $1.2-1.3 trillion over ten years, to around $800-900 billion. More recently, conservative Democrats in this coalition forced the House to accept the repugnant Stupak Amendment, which rolls back the right to choose further than any other legislation since Roe vs Wade.

In the Senate, Democrats started with only fifty-nine members of the caucus, including perennial problem children Joe Lieberman, Ben Nelson, Mark Pryor, Blanche Lincoln, and Mary Landrieu. Ted Kennedy and Robert Byrd began 2009 fighting life-threatening illnesses and were almost exclusively not in attendance. Arlen Specter switched parties, temporarily giving the Democrats a 60 seat caucus on paper, pending Al Franken taking his seat. But Al Franken wasn’t seated until July of 2009, only weeks before Ted Kennedy passed away.  In the final months of his life, Kennedy was rarely on the floor of the Senate and could not be counted on to vote outside of extraordinary situations.

Illness, death, and delayed seating has prevented Democrats from actually having 60 members of the caucus, effectively from Day One of the Obama administration until late September, 2009, wiping out nine months where health care reform was truly possible within the confines of a Democratic caucus alone (on paper). The result was for every piece of legislation in the Senate up until September, the Democratic leadership had to count on at least some number of Republican votes to move forward. That is, the landscape was not what everyone had been told.

From Employee Free Choice to health care, moderate Republicans like Olympia Snowe and Susan Collins became the real arbiters of what legislation might look like. Even with sixty votes in the caucus, conservatives like Lieberman, Ben Nelson, and Lincoln have effectively had veto power over what the contents of reform legislation are. To anyone following this process closely, it should be clear that having sixty seats is not the same as having sixty votes. A super majority is no magic tonic that will ensure the passage of a liberal Democratic agenda like the one President Obama was elected to enact.

Or, to put it a different way, the Conventional Wisdom which said 2009 was the critical moment never to be found again to pass national health care reform legislation was fundamentally wrong. The cohort of conservative Democrats in Congress – in the House, but most especially in the Senate – is simply too large for this moment to be realized as it had been envisioned.

But the responsibility for where we are does not lie solely with the conservative Democrats in Congress. The administration and the Senate leadership has either not been able to or has refused to create caucus discipline on procedural votes on health care reform. No conservative Democrat has been punished for their public opposition to progressive policies. No force has been exerted to bend Lieberman, Lincoln, Landrieu, or Nelson to the will of the caucus. The conservative Democratic senators have grabbed the veto pen and no one has taken it back from them. This is a very large contributing factor to the unwinding of the idea of this being the time to get health care reform done.

What’s troubling is that the continued slowness of reform makes Democratic electoral successes less likely. While it looks like conservative Democrats are in trouble, with progressives in good shape, electoral fear is clearly influencing people in DC to continue to frame health care reform as something that must get done, regardless of policy content.  From a realization of good policy standpoint, the defeat of conservative Democrats should make progressives  in both chambers stronger relative to the size of the caucus, which is a good thing. But if there isn’t a path to sixty votes in the Senate to get cloture on procedural votes, then policy implementation hits a wall, especially as long as the Democratic leaders of the Senate, White House and particularly the progressive bloc in the Senate are so strategically inept.

Taken all together, it’s hard to see that this is in fact the time that health care reform must happen, or even can happen.  At least not how so many progressives expected it to happen, let alone how President Obama campaigned on changing health care in America. That is not to say that I don’t think reform legislation should be moved now, but the range of what is actually possible to achieve seems to be getting smaller and smaller, a reality that needs to be recognized so strategies could be adjusted accordingly. Single payer is long gone. A meaningful, robust public option seems almost equally as far from achievable. The various compromises being discussed won’t get the job done, but they will be better than the current scenario, in most likelihood.

There’s no reason Democrats need have been so weak this year.  But they are. And it has horrible consequences, both in terms of the quality of health care reform that is achievable and the chances for future growth of the Democratic majority.

Now is a time for activists online to recognize that what we thought we bought in 2008 — and in the elections of 2004 and 2006 — was not what was advertised. A sixty seat majority does not equal sixty votes. The possession of large political mandates for change requires agents who are willing to strategically and forcefully use accrued political capital to marginalize and disempower conservative elements of the Democratic Party. These things are possible, but they are not possible with the selection of officials we have currently placed in office. Expectations must be adapted and so too must the strategies and tactics we use to try to influence these officials.

What does this mean for where we are today? Well, as I said the other day, it means we have to find new ways to be effective at moving the positive progressive agenda.  I’m not certain that becoming obstructionist or trying to tear down the watered-down legislation that is moving is a good move, as it is not likely to garner support from progressives in Congress. Instead, I think campaigns like the Progressive Bloc strategy orchestrated by Jane Hamsher and Chris Bowers to try to hold a line in the sand on the public option is best. It involved elected officials from the left becoming more strategic, while simultaneously building close relationships between politicians and the activist base. Perhaps that means selecting a number of specific policy comments of substantially smaller grade than the public option and seeking to hold lines there, as Stupak and Nelson have done on rolling back choice rights. The value of this method is that it involves slowly helping to redefine the political landscape within which we are operating.

It’s not news to say that the large majorities in Congress and control of the White House are not the promised land progressives hoped for.  There’s certainly a lot of desire to throw up our hands now and say, “Screw these Democrats.” But that won’t help this country. Finding ways to continue to gradually build strength, build relationships, and build playbooks for effective advocacy strategy, on the other hand, allows us to change the reality we’re working in. Keeping hope after the year we have seen is hard, unto fundamentally challenging the ability for dedicated progressives to have any faith in Democratic elected officials. But the consequence of not continuing to work for real, progressive policy change is too dire to drop our hands. In the words of Al Gore, our disappointment must be overcome by our love of country.

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