Health Care Reform And Our Myopic Polity

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Health Care Reform And Our Myopic Polity

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One day, I hope, we will look back at the health care debate as a low point in our national political psyche. The Obama administration and its allies in Congress are on the cusp of bringing some measure of reason to the health care system -- a system so profligate, irrational and cruel that nearly any reform born of deliberate intent could not help but improve it significantly. It's a reform designed in the mold of classic moderate Republicanism, melding fiscal responsibility and compassion for the poor and sick with a series of bold experiments to nudge medicine toward efficiency. But across the political spectrum, myopia is the order of the day. A few recent items give expression to this myopia.

Begin with the left. Without a doubt, Obama's proposals would leave the health care system far short of what most progressives, myself included, would design in the absence of political constraints. But also without a doubt, it would lift the system far above the status quo that is the only near-term alternative. Here it is, the most dramatic improvement in social justice in at least four decades fighting for its life in the home stretch, and the left can barely be roused to fight for it. The somnolence is far from universal, but on the left there is at least as much passion against health care reform as for it. One of many considerations the vulnerable Democratic moderates who hold reform's fate in their hands must balance is, in return for the limitless rage of the right, will they get any credit from the left for backing this reform? At the moment when every voice counts, when every ounce of pressure could prove decisive, here is FireDogLake:

Lynn Woolsey says she’s a definite “yes” vote on the Senate health care bill. Even if it lacks a public option. Despite the fact that it’s the biggest blow to a woman’s right to choose in a generation, and may come at the price of a stand-alone vote that allows Blue Dogs and ConservaDems to join with Republicans and roll them back even further in order to get Bart Stupak’s support.

Any ability for progressives to negotiate, to achieve meaningful concessions, to exert their influence and make the bill better just disappeared.

It’s time for Lynn Woolsey to resign as the head of the Progressive Caucus.

Yes, that is what it is time for! One day, when progressives study this moment in history, they will evaluate all of us by this single standard: What did they do to stop Lynn Woolsey?

The right, meanwhile, has whipped itself into a spiraling rage of ideological fanaticism and grotesque partisanship. Republicans have convinced their base that a close replica of the 1993 Senate Republican health care plan and Mitt Romney's Massachusetts reform is socialism and the end of freedom in America, and as the base spins further out of control, it drags the party still further into scorched-Earth opposition. Thus the Republicans who saw the need for reform were whipsawed one by one by the base and the party leadership into abandoning all negotiations.

The latest Republican gambit, put forward by John McCain (who has become a pure stalking horse for the party leadership) is to demand that no change to Medicare be permitted through budget reconciliation. This means that the very difficult task of getting a majority of both Houses to approve a Medicare cut would become the nearly-impossible task of getting a majority of the House plus a supermajority of the Senate to do the same. Of course, Republicans as well as Democrats have used reconciliation numerous times to wring savings out of Medicare. But this proposal is not just the usual staggering hypocrisy. The immediate purpose is to render Obama's health care reform impossible. But the long term effect would be to render any Republican reform impossible. How do Republicans propose to fulfill their vision of government when any forty Senators can block a dime of Medicare cuts? Don't they ever aspire to govern?

In the lonely center of this howling vortex stands the Obama administration, diligently pushing its morally decent technocratic improvements. For this, the salons of establishment thought have given the administration little but grief. Sunday's Washington Post editorial offers a fair summary of the response from the center. The editorial does allow that Obama's plan would be ever so slightly preferable to the status quo. The Post editorial page is disappointed that Obama agreed to delay a tax on high-cost health care plans, and to replace the lost short-term revenue with a tax on the rich: "We think that it is not asking too much," demands the editorial, "given the dire fiscal straits, for Washington to show that it can swallow distasteful medicine while, and not after, it passes out the candy." Centrist critics have habitually used terms like "candy" and "dessert" to describe the provision of medical care to those currently suffer physical or financial ruin by the lack thereof. It is one of the most morally decrepit metaphors I have ever come across.

As Harold Pollack notes, Obama has successfully fought, over the opposition of lobbyists and Congress, to include numerous delivery reforms, such as an Independent Medicare Advisory Commission, bundled payments, and numerous other cutting edge steps. Centrists give these reforms little or no credit -- after all, because they are untried, they have no record and the Congressional Budget Office can't calculate their potential savings. The CBO can credit things like the excise tax, but the centrists give that little weight as well -- after all, Obama agreed to delay the tax in order to let labor contracts adjust. He replaced the lost revenue by extending the Medicare tax to capital income earned by the affluent. But tax revenue from the affluent somehow counts less, too. The Post dismissively calls this "the politically easier option of extending the Medicare tax to unearned income of the wealthy," as if raising taxes on the most powerful and well-connected people in America, in an atmosphere where one party opposes any taxes on the rich with theological fervor, is the kind of solution that's just sitting there for the taking.

I don't mean to be too glum. Heath care reforms still stands a good chance of passage, and it hardly lacks for supporters. Still, the general thrust of elite sentiment has been, as I said, depressingly myopic. It's natural to focus on improving a piece of legislation whose details remain in flux. The problem comes when the desire to improve becomes the dole focus for evaluating it. Nearly any of the great political advances in American history, viewed from ground level, looked like a pastiche of grubby compromises and half measures. At some point the imperative is to take the broader view. If they ever do that-- whether health care reform succeeds or fails -- the critics from the delusional left, the hysterical right and the sullen center will feel ashamed.

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