Category: Health Care

Lieberman’s Last Straw?

You know a senator has jumped the shark when Ezra Klein writes something like this:

The Huffington Post and Roll Call are both reporting that Joe Lieberman notified Harry Reid that he will filibuster health-care reform if the final bill includes an expansion of Medicare. Previously, Lieberman had been cool to the idea, saying he wanted to make sure it wouldn’t increase the deficit or harm Medicare’s solvency. That comforted some observers, as the CBO is expected to say it will do neither. Someone must have given Lieberman a heads-up on that, as he’s decided to make his move in advance of the CBO score, the better to make sure the facts of the policy couldn’t impede his opposition to it.

To put this in context, Lieberman was originally invited to participate in the process that led to the Medicare buy-in. His opposition would have killed it before liberals invested in the idea. Instead, he skipped the meetings and is forcing liberals to give up yet another compromise. Each time he does that, he increases the chances of the bill’s failure that much more. And it’s hard to imagine there’s a policy rationale here, as he decided against even bothering to wait for the CBO’s analysis before moving against this idea. At this point, Lieberman is just torturing liberals. That is to say, he’s willing to directly cause the deaths of hundreds of thousands of people in order to settle an old electoral score.

Well, yes. And this is something that progressives have been saying online with regard to Lieberman for a while. A great deal of outrage accompanied Congressman Alan Grayson when he said the Republican health care play was to not get sick and if you do, die quickly. Klein is effectively making the same point here. When you peel back the onion of DC patois, opposition to health care reform has real human consequences. Blocking change will have the direct result of hundreds of thousands of American dying in coming years due to a lack of insurance.

I think there is a real opening for using this to push the Overton Window on health care reform. When Alan Grayson or DFHs online say not passing reform will kill tens of thousands of Americans every year, it was a scandal. Ezra Klein of the Washington Post is now saying the same thing with regard to Lieberman’s posturing.

Maybe Democrats and liberal advocacy groups won’t be able to move Lieberman through any volume of public scolding, but such an effort should be able to increase the level of honesty and candor in the debate on health care reform. Doing so would help Democrats take, possibly for the first time, the moral high ground in this debate. It could move more support back into the column of reform and could perhaps be a means of pulling one of the moderate Republicans senators from Maine to support a cloture vote to get the bill to a final up or down vote.

I don’t like being in a place where health care reform depends on a single Republican vote. Thinking about how we got here is incredibly depressing. But this legislation needs to move and it’s time Democrats stop treating Lieberman and other conservatives in the caucus with kid gloves. Their opposition has fatal consequences of a sickening scale and they should not be allowed to get away with it.

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.

Closing the Wallet

Linda Hirshman makes a great point on Salon — namely that pro-choice donors in general and women in particular should loudly proclaim they will not be donating to Democrats as long as the party treats their rights like an afterthought. Gay donors have joined a boycott, lead by John Aravosis of AmericaBlog, to withhold contributions to the DNC, OFA and the Obama campaign until the Obama administration and Congress start working on behalf of LGTB Americans who support them. Hirshman writes:

Now the Democratic majority the women enabled is about to make the Hyde Amendment worse, and women are negotiating only about how much worse it’s going to get. Anyone who knows anything about bargaining recognizes the dynamic: give in the first time, and you’re weakened in the next round. And so it goes until you finally stop going along.

All histories of the gay movement record how much the founders took from the racial civil rights movement and the feminist movement that came before. It’s time for women to return the favor. Gay leaders can threaten the Democratic Party with a few paltry million-dollar donations. To paraphrase the lady at the diner in “When Harry Met Sally,” I’ll have what they’re having.

Promises have been made for years by Democratic politicians to both these communities. It’s clear that the party, under the leadership of the President, is not currently prioritizing honoring their commitments. Now is the time to withhold money and show elected officials that the base won’t stand for rollbacks of women’s rights under a Democratic administration. Making influence felt through money may be somewhat cynical, but it’s this cynicism that is needed. We know the other side will do everything they can to make their influence felt when they want to curtail the right of choice or prevent loving couples who aren’t straight from being able to marry. It’s time for progressive interest communities to up the ante and the force of the tactics they use.

Stupid Amendments

Steve Benen, writing on the Republican strategy to slow health care reform legislation through amendments, notes:

Ordinarily, amendments are proposed to improve the bill. It’s what makes the Republican amendments pointless — even if their measures pass, they’ll still oppose reform. But the GOP caucus is nevertheless lining up hundreds of possible proposals. They’re also strategizing about having amendments read word for word to slow the process down even further.

Of course this is largely the strategy that was used by conservative Democrats in the House as well. To wit, the Stupak amendment made the House health care bill markedly worse and twenty-three Democrats who voted for it still opposed the whole bill.

The Republican Senate amendment strategy sucks, just like the House Blue Dog amendment strategy sucked. The challenge for Democrats will be to make sure that the press and the public understands that the Republicans, like these 23 House Democrats, are not legislating in good faith when it comes to health care reform and, as such, there amendments should be given no attention.

Oh Really?

Carl Hulse of the New York Times, reporting on Democratic efforts to get moderate Republicans to support health care reform, writes:

While the two women are the main focus of Democrats at the moment, officials said they would seek opportunities to appeal to others. They also hope any final joint House-Senate proposal could attract at least a few Republicans in each chamber.

Really? While we don’t know what the final Senate bill will look like, we can assume that it will be more conservative than the House bill that passed last weekend. When you merge the more liberal house bill with the more conservative Senate bill, what you’re likely to get is something in the middle. That is, a bill that is more conservative than the House bill but also more liberal than the Senate bill.

While it may be possible that the conference committee report moves to the right enough that more House Republicans will vote for it, I don’t see how any commentator or operative can realistically expect that the conference committee report will draw more Senate Republican support than whatever the bill currently under consideration gathers in the end. The Senate bill will be the rightward end for health care reform legislation, but as we’re currently going, it is unlikely that a single Republican will support it. When that bill is made somewhat more liberal in conference, it will not bring any more Republicans to the table in the Senate. In fact, there’s a distinct chance that even if Snowe or Collins supports the current Senate bill, the conference process will move the bill too far to the left and result in less GOP support for the merged bill.

So, in short, either Hulse is fundamentally misunderstanding the process as it’s being described to him or these anonymous Democratic sources are not being realistic about what the melding of these two bills will look like from a substantive standpoint. Of course, there is a third option: that these anonymous Democratic officials plan on using the conference committee as a means of producing a bill more conservative than both the House and the Senate in order to win the patina of bipartisanship. I hope that’s not the case, though, as it would be one of the most cynically political moves I can recall in recent history.

Senate Health Care Bill

I don’t think it’s a surprise to anyone that, on first blush, the Senate health care reform bill isn’t as good as the House health care reform bill. That said, I think the bill — again, on first blush — is far better than what I had expected from Senator Reid. There is an opt-out public option, which is better than most of the last year’s discussion of what conservative Democrats in the Senate would have suggested. There’s also better provisions, though not great, on providing coverage for abortion. It won’t exist in the Senate public option, but there isn’t the punitive, Stupak-like measure of limiting it from being in private plans in the exchange.

I want to see where the wonks shake out on this before I really know what this bill does and does not do.

The best thing about the Senate bill, though is that it comes with a huge process advantage for progressives.

If the consensus is that this is a generally good bill and something that moves the ball forward for health care reform, the way the Senate works makes further changes unlikely. Essentially anything that is controversial and subject to amendments on the floor will require 60 votes to pass. That is, if there is an effort to make the bill either substantially more progressive or more conservative, a super majority will be required. Contrast this to most non-controversial amendments, which will likely require a simple majority.

This means it is unlikely that the Senate will do worse than an opt-out. It is unlikely that anti-choice senators will be able to do the same damage as Rep. Stupak. It is also unlikely that the public option will be improved or affordability dramatically increased or employer responsibility increased.

In essence, what we see now with the Senate bill is the opportunity to move the ball forward to conference with the House bill. The two bills are going to end up being closer together than a lot of us had thought. Proximity likely makes movement more possible, but less impactful. This will hopefully mean that the final product is better than the Senate bill and not significantly worse than the House bill.

There’s still a long way to go, but at least for now, this is a victory in the path towards health care reform.

Dear Jim Wallis

Dear Jim Wallis,

The Stupak Amendment does not achieve “neutrality” by the government when it comes to funding abortion coverage. It makes it impossible for a woman to buy insurance that covers abortions, which are, by the way, legal procedures in America. By creating a two-tiered health care system where wealthy women can have abortion insurance (and, subsequently, afford to have abortions if needed), but poor women do not have the option of health insurance that covers abortion on the exchange or in the public option, the Stupak amendment creates precisely the sort of situation where women may be forced to turn to back alley abortions or dangerous self-inflicted procedures.

Please stop telling women and progressives that they are unreasonable to oppose this dangerous legislation.  Demanding that their legal rights be preserved by health care reform legislation is not “secular fundamentalism,” but your refusal to stand up for poor women who want to legally obtain abortions is, in fact, a pretty shade of religious fundamentalism. That it comes from an ostensibly progressive religious leader is all the more disconcerting.

Thanks,

Matt BH

No One Could Have Predicted…

No one could have predicted that a behind-closed-doors deal between the White House, Max Baucus, and the pharmaceutical industry to voluntarily cut their costs would not be honored by Big Pharma.

But the drug makers have been proudly citing the agreement they reached with the White House and the Senate Finance Committee chairman to trim $8 billion a year — $80 billion over 10 years — from the nation’s drug bill by giving rebates to older Americans and the government. That provision is likely to be part of the legislation that will reach the Senate floor in coming weeks.

But this year’s price increases would effectively cancel out the savings from at least the first year of the Senate Finance agreement. And some critics say the surge in drug prices could change the dynamics of the entire 10-year deal.

I expect we’ll see strong defenses from both Baucus and the White House of the pharmaceutical industry, accompanied by continued efforts to legislate any required cost schedules for brand-name prescription drugs. We will continue to be asked to trust Big Pharma and not cut into their bottom line by bulk negotiating drug prices, importing from Canada, or reducing the patent lifetimes that keep generics off the market.

The reason we’ll still see the White House and Baucus stand by Pharma is that they are both afraid of the pharmaceutical industry spending hundreds of millions of dollars in television advertising attacking reform. Now, the slight voluntary cost cuts in exchange for no negative ads will be traded in for maintaining the status quo in exchanged for no negative ads.

Cynics, myself included, have long expected that health care reform would be reform in name only. I never really expected that it would so literally be reform in name only, as we’re now seeing from the White House’s deal with Big Pharma resulting in literally no change in costs to consumers. Hopefully today’s news will show Baucus, the White House, and other Democrats on the Hill that non-binding verbal agreements are simply not going to be honored by the pharmaceutical industry. The only answer is to legislate reform. If the administration and leading Democrats on the Hill can’t see that, they will hopefully at least be clear-eyed about the electoral consequences for fake reform.

Targets

Twenty-three Democrats voted in favor of the Stupak amendment to dramatically ban the sale of insurance plans that offer coverage for abortion in the insurance exchanges that will be created in the health care reform bill, and subsequently voted against the House bill on final passage. That is, they made a move to make the legislation immeasurably worse, despite having zero intentions to support the bill.Here is the list of these Democrats in name only:

Jason Altmire (PA-4)Bobby Bright (AL-2)John Barrow (GA-12)John Boccieri (OH-16)Dan Boren (OK-2)Ben Chandler (KY-6)Travis Childers (MS-1)Artur Davis (AL-7)Lincoln Davis (TN-4)Bart Gordon (TN-6)Parker Griffith (AL-5)Tim Holden (PA-17)Jim Marshall (GA-8)Jim Matheson (UT-2)Mike McIntyre (NC-7)Charlie Melancon (LA-3)Collin Peterson (MN-7)Mike Ross (AR-4)Heath Shuler (NC-11)Ike Skelton (MO-4)John Tanner (TN-8)Gene Taylor (MS-4)Harry Teague (NM-2)

While some of these representatives serve in strongly Republican districts, not all of them do. Paul Rosenberg paired the full list of Yes on Stupak Democrats with their demographic information for their district. Altmire, Boccieri, Chandler, Holden, Marshall, McIntyre, Peterson, Ross, Shuler, Tanner, and Teague come from districts that range from Lean Democratic to Swing to Lean Republican. Barrow and Artur Davis come from Strong Democratic districts.Additionally, Chris Bowers points out that over one out of every twelve dollars the DCCC spends has gone to these 23 people.First, these 23 Democrats should no longer receive the benefit of DCCC contributions. They add no value to the caucus and have substantively made it a less effective body, thereby damaging the reelection chances of actual liberals in swing districts.Second, this list should be the basis for groups seeking to run primary challengers against conservative Democrats. It is especially true for the 13 that come from districts that are Democratic, swing, or only slightly Republican. Barrow and Artur Davis should be facing immediate, credible challengers backed up by the weight of the progressive infrastructure.This group of Democrats are the tip of the spear when it comes to the path that will lead Democrats out of the majority. The House caucus would clearly be stronger without them. At best there should be active campaigns to excise them from office. At worst, not a cent should be spent defending them.Update:Artur Davis is not running for re-election. Kristopher in comments points this out, as did a friend who read the post. Davis is, however, running for Governor of Alabama in a contested Democratic primary. So while the DCCC won’t have to spend money to defend Davis, Democrats in Alabama and elsewhere may want to think about supporting someone else in that race.

Why Last Night Means Nothing for Health Care Reform

Prior to people going to vote yesterday, the national media narrative was focused on the New Jersey and Virginia governors races, as well as the race in New York’s 23rd Congressional district as loci for an assessment of the public’s support of President Obama. This was always absurd, as gubernatorial races are about local issues (traffic congestion dominated in VA and local taxes in NJ). Additionally, the NY-23 is one of the most long-standing Republican held districts in the Northeast; no Democrat had ever won there before last night. In any event, the popular push in the press was, not surprisingly, that only Democratic losses were possible and meaningful. Indeed, this morning pundits are already telling us that only the Democratic losses in Virginia and New Jersey mean anything.

Reading tea leaves for national meaning on an election day that saw the Republicans take two governor’s mansions, Democrats take two House seats,  one win (Washington) and one loss (Maine) for marriage equality, and two defeats of TABOR ballot initiatives (Maine and Washington). Instead, I’m interested in how these results will impact legislative debate in Congress, primarily on health care reform.

Going into yesterday, there was already discussion by Blue Dog Jason Altmire that Democratic electoral losses would strengthen conservative Democrats and slow the pace of reform, something that he bizarrely thinks is a good thing. Similarly, the Glenn Beck Teabagger set, including leading voices like Erick Erickson of RedState.com, predicted that conservative candidate Doug Hoffman’s expected win in NY-23 would lead to an emboldened Republican base and greater opposition to change.

On the other side of the aisle, there were a good number of savvy progressives who pointed out that since the gubernatorial races didn’t have anything to do with the Obama administration, they shouldn’t be seen as informative of the course for reform. Additionally, the results of a district Democrats have no tradition of being competitive in wouldn’t be informative, either.

But here’s the thing – last night’s election was really very similar to the August congressional recess. During the recess there were rabid, disruptive protests by teabaggers that received widespread attention. There were also even larger numbers of town halls filled by supporters of health care reform, calling on Congress to get the job done. As a result, elected officials returned to Washington after the August recess…but no one had changed their minds. Those who opposed reform looked at the angry teabaggers and cited their actions as evidence that they are right to oppose reform. And those who support health care reform listened to the pleas from their constituents and felt greater resolve in their drive for change.

Expect the same thing from Tuesday’s election results. Erickson is trumpeting even the NY-23rd loss as a win for conservatives and for opposing health care reform.  But Democrats gained two House seats, both votes for Nancy Pelosi as Speaker and likely both votes for whatever health care reform legislation Pelosi puts forward. Additionally Doug Hoffman, the most rapid advocate of “No” on a ballot yesterday, was defeated. Expect liberal members of Congress to see the federal results as support for the work they are doing.

All of that adds up, in my view, to the election having no meaningful impact on the course of health care reform legislation. Positions will be hardened on both sides, but don’t expect anyone to move an inch. As far as the prognosticators go, expect most of them to miss this point in an effort to create a story around a non-existent rebuke of Obama. Plus ça change…