A few months ago, Booman noted the difficulties and complexities of getting health care reform passed. In doing so, he pointed out some inconvenient truths about the process — truths that, upon annoying the lefty ‘sphere with their truthfulness, invoked the derisive term “11-Dimensional Chess” from people who didn’t know better.
My short answer to this critique is that the health care bill is multi-dimensional and any strategy would have to reflect that. Start with the fact that the health care bill has to pass through three House and two Senate committees, all with their own unique membership and temperaments. That’s five dimensions. Then, consider that the three House bills have to be condensed into one House bill and the two Senate bills have to be condensed into one Senate bill. That’s seven dimensions. After that, each bill has to pass through its respective house of Congress. That’s nine dimensions. Then those two bills have to be melded into one bill and sent back to pass each house of Congress again. That’s eleven dimensions (or, maybe, twelve dimensions). (Emphasis mine)
A little-known fact about last August’s silly season is that Rahm Emanuel, the man progressives love to hate, was already in favor of reconciliation by the 19th. This was three days after Olympia Snowe signaled that she would not vote for cloture on the Senate bill, leaving exactly sixty Senators with which to meet the Senate’s 60-vote cloture rule. When Rahm Emanuel said “there are no liberals left,” he wasn’t being obtuse.
Senate careerists use cloture to extract bribes and scalps. The last two holdouts were Ben Nelson and Joe Lieberman; the former wanted a bribe and the latter a scalp, said scalp being the public option (and then Medicare expansion — whatever would annoy the left and make them angry enough to sabotage the progressive agenda). Nelson was so embarrassed by leaked details of his bribe that he actually asked to have it removed before Congress was back in session.
It is an axiom of politics that you begin reform with the Congress you have, and not the Congress that you might wish to have. Obama has a weaker reform majority than FDR or LBJ.
Lefties have screamed for Obama to twist arms, break necks, and otherwise imitate Dwayne Johnson’s SNL sketch; but when Obama said that he wanted to change the way Washington works, he was referring to arm-twisting and partisanship. Sorry, but you know it’s true. Instead, what we have seen from this president is extraordinary patience. In short, the principles of non-violence have been applied to politics — with agonizingly slow, but relentlessly determined, success.
He has refused to weaken and even held a seven-hour meeting to discuss the bill. Obama’s Wednesday speech has shifted the narrative: his “last stand” is in fact the Republicans’ Last Stand. There is no depth to which they will not sink and the MSM has become quite satisfied with the president’s bipartisanship. Bipartisanship, by the way, is actually quite rare with a Democratic majority; Republicans themselves keep on using this word as a weapon against reform, but even inside the Beltway it has been blunted by overuse. No one is fooling anyone but themselves.
This White House has many battles left to fight and intends to win them all. We would not be here without a full year of Obama’s “bipartisanship fetish” and a full year of GOP grandstanding. Health care reform has in fact become a means to an end to break the minority party — but through consistent, patient progress instead of gate-crashing. One must remember the necessity of climate change legislation to understand why this “Waterloo” is capable of being a watershed.
Which brings me back to the enterprise of health care reform. Whether we like it or not, a simple majority is not enough for reform worthy of the name. Senate rules can be changed, but trying to change the rules is a sign of weakness (i.e., it’s what Republicans are doing these days). Obama consistently signals strength because weakness is the bane of reformers. As always, the president prefers quiet, but insistent, pressure.
After cloture, the House could pass the Senate bill and the Senate could pass fixes, even a public option, through reconciliation rules. That chain of events was always possible; indeed, in a sense it was inevitable. When Emanuel wanted reconciliation, though, he learned what the Senate Parliamentarian (the very one Republicans now pretend to mistrust) probably told him: you cannot pass the entire Senate bill that way.
As Nate Silver put it, “reconciliation is a great AND strategy, but a poor OR strategy.” Only questions of great fiscal consequence can pass without cloture; rescission, pre-existing conditions and lifetime coverage limits are not included in that category.
See? Not so simple.
During the month of September, the strategy evolved into getting a bill, any bill, out of the Senate before Christmas. Reid got that critical sixty-vote majority, though he had to shed the public option at Lieberman’s insistence. Which brings us back to the “and” strategy of reconciliation, because independent public option whip counts had a 51-vote majority for the public option a long time ago and it somehow escaped notice in the blogosphere.
Instead, bill-killers and firebaggers predominated the progressive ‘sphere after September, beginning with backlash to the PhRMA deal — now conspicuously changed to the detriment of PhRMA, by the way; the pill-makers are the only stakeholders who’ve felt a knife in their backs. Together with the AMA and AHIP, they have traditionally been able to block reform. Obama successfully wooed the AMA (it was time; they had little left in common with the others), cut a deal with PhRMA that lasted about twenty-four hours after December’s cloture vote, and kept AHIP on hold long enough to get cloture. It’s classic “divide-and-conquer” strategy.
My degree is political science, and in fact politics is a science — the “master science,” as Aristotle would phrase it. During the slow and steady progress of the HCR project (it has its own acronym thanks to Twitter), I have argued these facts in many places; I never fail to get at least one angry commenter asking “WHO DO YOU WORK FOR?!” then why I “defend” Obama, Emanuel, Reid, etcetera.
The answer is that I don’t defend them. I don’t have to. They’ve done what they’ve done, and we’ll judge them by the merits of the final thing that arrives in our public libraries as law.
Until then, what I mostly see is progressives bitching about every move these figures make; there are an awful lot of amateur political scientists out there. For instance, they will throw a Wall Street Journal link at you and say that Emanuel “retreated” on the public option. As he was “retreating” (“No public option? What about a trigger? No trigger? How about Medicare expansion?” And so on), the Senate came up with a good bill Obama could tweak to make better:
1 ) No more asset tests for Medicaid, plus program expansion
2 ) Clinics
3) No preexisting conditions, lifetime limits, etc.
4) A tax and subsidy system
5 ) A mandate over $19,000 income
6 ) Plan cost limiters (“Cadillac taxes”)
7 ) Rate control (yes!)
8 ) 15% margin for gross profit (really!)
This is the complete picture of reform the president now offers. AHIP did not volunteer to have New York-style rent control on the profits of its member corporations. Nor did those corporations agree to serve as de-facto public utilities forced to compete in state exchanges. You cannot tell me this is what Aetna wanted — not with a straight face. These are terms of their surrender.
The “Cadillac tax” is to be set at exactly twice the current median cost of a basic plan in 2009 — and I reiterate that basic plans don’t deliver less care, just less customer service from the insurance company. Doctors and nurses provide the care; all insurers do is cover it. That is the point: when you control the coverage you can bend the cost-curve. Moreover, employers (who pick the actual plans for most Americans) will have incentive and opportunity to find a cheaper plan.
What part of that is the caving-in part? I don’t see it.
The idea that Americans will balk at buying insurance once it is cheaper and available on demand…well, it just doesn’t make much sense. Most Americans will not complain, they will buy insurance. Those who make enough to afford insurance, but choose not to buy it, will have to pay a few hundred dollars a year to ensure they are covered at the emergency room — not to mention the ICU. In America we call it a “mandate;” in Canada it’s called “taxes.”
Paul Krugman calls it single-payer the hard way, and in fact that’s exactly what the president’s plan is: the most complicated form of single-payer ever invented. Everyone would be covered one way or another; plans would be more affordable. As complex a Rube Goldberg-device as this might seem, a public option would be almost inconsequential by comparison, covering at most 3 million Americans who can already be covered. It would help bend the cost-curve and add more deficit reduction, but why risk the entire enterprise for the one piece that keeps drawing enemy fire?
Which it did, and until now that has been its main function. Joe Lieberman got his scalp, and well may it profit him if a public option passes anyway via reconciliation. It would not do, however, to tell your enemy ally you plan to circumvent him later when you are trying to get him signed on for the parts of the bill that CAN’T pass through reconciliation.
Because passing a bill — any bill! — through the Senate is the object of getting those sixty votes. See how that works?
These are not accidents. The Senate requires a consensus for reform and Obama got it; now he will finish it in a manner allowed by the Parliamentarian and the Constitution. The more Republicans pretend this is unprecedented, the more precedented all of this maneuvering turns out to be. That is the point: every time they say “no” they offer another excuse, and they are out of excuses.
Moreover, Obama’s level of personal involvement has risen with time, producing the opposite effect from 1993’s health care debacle: he now has Democrats saying “at last! Leadership!” instead of “don’t ram this down our throats!”
Are you getting the picture? All that psychological projection the teabaggers aim at Obama is exactly wrong. He hasn’t been dictatorial, he’s been deferential. He hasn’t sent the PATRIOT ACT to Congress in the dead of night or posted a bill without giving Senators adequate time to understand and ask questions. He hasn’t engaged in partisan sniping (e.g., he focused most of his SOTU ire on the Senate as a whole). Which brings us to the idea of a weak, impotent, turncoat Obama — a projection teabaggers share with firebaggers.
Like all of the projections cast on Obama, it’s bunkum with no empirical basis. The empirical view of this president and his approach to reform is that he will persist in getting as much reform as he can get no matter how long it takes or how loud the opposition gets. As long as I’m setting myself up to be accused of historical revisionism by pointing out all these facts, I’ll even include Max Baucus:
“Baucus’ bill was the first to establish the principle that Congress could expand coverage while reducing the federal deficit; now that’s the standard not only for the Senate but also the House reform legislation. And, perhaps even more importantly, the Reid bill maintains virtually all of Baucus ideas’ for shifting the medical payment system away from today’s fee-for-service model toward an approach that more closely links compensation for providers to results for patients.”
Which was, I thought, the whole point of reform: to stop health care costs from breaking everyone from the top down. To that end, an awful lot of leftward projection has mirrored the teabaggers; I keep hearing progressives say that Obama has been “captured” by foul interests, which is nonsense. What gets denounced as “triangulation” is realism; “failure” is actually patience and “betrayal” has turned out to be strategem.
I reiterate: reform is extremely hard. The Constitution sets a high bar, and Senate rules set it higher. It’s built-in to the social structure of Washington, D.C., a southern city and inherently conservative in that sense. Or as Evan Clayton sings: “Remove the cause thinking you’re gonna alter the symptom / and before too long you’ll find you’re one of them.”
It is easy to mistake analysis for bias or excuses. It is not easy to appreciate reform before it is finished. But the signs are good, and may improve if we stop whining and do something to help. After all, we ARE the 1st dimension of 11-dimensional chess. When progressives say that a public option might only pass “because of progressives and not because of Obama,” I respond: “isn’t that the point?”
For I’ve just celebrated a birthday; nearing forty, I’ve come to realize the progressive generation that elected this president would rather be left to its iPods and sexting. They imagined this president would fart a socialist green-energy workers’ paradise from his armpit and are disappointed to learn their responsibility to American democracy did not end at the ballot-box. They by no means pretended he was God, but they didn’t understand Congress or government and thought civil rights didn’t require civil action.
I blame the decline of civics education for this (and for that, I blame wingnuts). As long as I’m handing out notes: Organizing For America should be far more active, talking up the pros of legislation as well as organizing for a progressive surge of pressure on Congress a long time ago. I’m glad they’ve managed to get hundreds of thousands of calls to Congress, but it ought to be millions.
Obama shouldn’t have been seen as “caught off guard” by the town hall zombies of August. He also might have asked Harry Reid to extend the Senate’s three-day work week at any time between April and December.
Here are two criticisms of Emanuel: he shouldn’t have argued for breaking up the health care bill (it works for jobs bills, but not for this project) or against trying terrorists in the US (thank God he didn’t win on that). But what I do not understand is the logic that blames Emanuel for weakness while simultaneously decrying the Clinton-era bruiser. Again: contradictory memes indicate an absence of empiricism.
My fact-based, reality-based, bias-filtered analysis is that Obama and Rahm and even Harry Reid are winning the 11-Dimensional Chess game of health care reform. You may say that all of this has been an accident, but that would be nonsense on its face; the final product resembles the same outline Obama offered in the 2008 campaign.
They let the Grand Old Party and false Democrats make their choices. That is the point. The president, as in all his debates, prefers to let his opponents go first. Health Care care reform has been debated to death; and that debate — not the public option, or reform — is what died yesterday, March 3rd, 2010. All that remains is kabuki from Democrats and theatre of the absurd from Republicans.