Health Care Reform and Progressive Clout

Glenn Greenwald writes:

What's not debatable is that this process highlighted -- and worsened -- the virtually complete powerlessness of the Left and progressives generally in Washington. If you were in Washington negotiating a bill, would you take seriously the threats of progressive House members in the future that they will withhold support for a Party-endorsed bill if their demands for improvements are not met? Of course not. No rational person would.

I think it's kinda stupid for Glenn to draw broad conclusions like that from how things played out on this bill.  You don't kill your biggest legislative priority of a generation so that people will take you seriously on lesser stuff; there's just no net payoff there.

Besides, progressive threats to kill the bill were obviously empty from the beginning: Republicans and centrist Dems clearly had less interest in the bill's success than they did.  So who was going to be threatened?

We progressives will have many, many opportunities to threaten to kill legislation that is less important to us than health care reform, because practically every bill will be less important to us. And there will be plenty of bills that are more important to the center or the right than they are to us.  There will be situations where half a loaf is worse than none at all (e.g. financial regulation), and there will be legislation whose success would be nice, but not particularly important.

In short, the world will be full of better opportunities than this one for progressives to flex their muscles.  There could hardly have been a worse one - or a less representative one.  And that's why Glenn is wrong here.

Comments

[Sir Charles]

Yeah, once again Greenwald just doesn't seem very politically savvy. He must not have done a lot of negotiating as a lawyer. Everything comes down to leverage and you have to be able to clear headedly assess when you've got it and when you don't. There will always be some disporportionate force working against progressives because we affirmatively want the federal government to do things. The other side usually just wants to stop things -- something that is relatively easy to do under the American system.

[oddjob]

You don't kill your biggest legislative priority of a generation so that people will take you seriously on lesser stuff; there's just no net payoff there.

Precisely. Big time HCR tends to come up only once per political generation. If it came up more often than that I think maybe Glenn would have a point, but when this comes up so rarely how can his argument possibly make any sense? How many times already has HCR died because the latest proposed iteration wasn't perfect enough, and so was killed - in part by liberals who wanted to prove they had the clout to get a perfect bill through the Congress, only to find that by the time the subject was raised again a whole generation had passed and no one remembered the previous attempts at teaching a lesson?

No, on this topic you go with what you've got because it matters too damn much to walk away in a snit because what's on the table isn't anywhere near as good as it should be.

[Neil the Ethical Werewolf]

Of course, I agree with you guys. And I'd fail to live up to my creed as a Pelositheist if I didn't point out that through the Speaker's office and committee chairs like Henry Waxman, we exercised significant control over this process from the beginning.

Measuring progressive power by the fact that nobody respected Raul Grijalva's ultimatums is ridiculous.

[Sir Charles]

Hey Neil!

You forgot to mention that Raul Grijhalva is "history's greatest monster."

So has Nancy done her magic and gotten to 216?

[Joe]

I think the problem here is that Progressives shouldn't have continuosly said they were going to kill the bill over things like the public option if they obviously weren't going to.

Progressives had to come up with a serious threat (like moving multiple health care bills: one through reconciliation and one through regular order) or not made the threats at all.

At some point, the leadership and/or the Administration should have said something like: it's unlikely that there's votes for the public option and its not a priority this time around (which is clearly what everybody was thinking). Instead, they let progressives go through the motions without anyone in leadership having a realistic strategy to pass progressive proposals.

I think leadership's reasons for jettisoning progressive aspects of the bill are pretty stupid (deference to Senate Conservadems, wanting bipartisanship, preventing insurance companies from attacking the bill in public). But I've never been elected to be a dog catcher.

Regardless, it would have been nice to know that the Senate Finance Bill was basically what we were going to get. Progressives would not have been so infuriated by the process if the leadership had prepared people with realistic expectations.

[oddjob]

“For immediate release:
March 19, 2010

Washington, D.C. – After careful review and consideration, the American Medical Association (AMA) today announced its qualified support for the current health reform bill as a step toward providing coverage to all Americans and improving our nation’s health system.

“The pending bill is imperfect, but we cannot let the perfect be the enemy of the good when it comes to something as important as the health of Americans,” said J. James Rohack, M.D., AMA president. “By extending health coverage to the vast majority of the uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research, this bill will help patients and their physicians.” ...

The post I've linked to actually directs you to today's HCR speech by Obama, in Virginia. Apparently it was an unusually good one. The press release I've partly quoted is in one of the comments, just a couple down from the beginning of the thread.

[Sir Charles]

Joe,

I've been told by journalists who cover the White House that they simply never thought the public option would happen and it wasn't a priority for them. So I think you're right -- they sort of let that part of the process get away from them and become the sine qua non of what a good bill was supposed to lool like, with nearly disastrous results.

[Corvus]

You know, I clicked through to post a comment here, but I see that Neil and Sir Charles have already made them.

Progressives don't have any power? Progressives run the House. This legislation was shaped by Pelosi, Waxman, and Dingell, fans of single payer all. Maybe they didn't get exactly what they wanted, but they set the terms of debate. If those positions had been staffed with moderates, the bill wouldn't be nearly this good, and likely wouldn't have passed.

I can't think of a single other blogger who combines such a shockingly high level of technical expertise with a complete obtuseness to strategy and procedure than Greenwald. Give him a post about the incorrectness of some ruling or policy idea, and he can just eviscerate it, but he never seems to show any understanding of the procedural and political obstacles that sometimes necessitate those decisions, or the ramifications of basically any political act. I think Neil's point about Grijhalva being a kind of political stuntman in this situation (the point isn't that he gives up and votes yes, it's that his initial option makes the bill seem more palatable to the center) is a much more accurate reading of what is going on in these deliberations than this crap about progressives being punching bags.

[Joe]

Corvus, Baucus set the terms of the debate. The Senate Finance Committee Bill is (with a few exceptions) the health reform bill that is currently being voted on. Now Baucus clearly understood the nature of the Senate and what it took to get the conservadems to sign on. But to say the bill was shaped in the House is denying reality-- the bill was shaped in the most conservative Senate committee with the 5-10 most conservative Democratic Senators in mind.

As for Grijhalva,I don't think he was playing 19 dimensional chess. I think he made a threat that he really couldn't back up and had to climb down from. If you disaprove of something, there are ways to make that clear without climbing onto a limb-- the way the House progressive caucus did. For the record, I think the Stupak block is making the same mistake now. They are making threats, that, at the end of the day, they aren't going to back up.

[Corvus]

Joe, while Baucus had a definite role in shaping the bill in a more moderate/conservative direction, I still don't think it is correct to point to him as some kind of grand author of the bill. The house passed that their bill first, and all of the bills were about 80% identical. They all had the exchanges, the removal of preexisting conditions, and the mandate. They just differed in terms of funding mechanisms and the allotment of subsidies, and the House included a (really weak) public option. On almost all of those measures, there have been compromises that have resulted in a bill halfway between what both bills offered, so yes, the Baucus bill has pulled things back from the house standard. But the Baucus bill was pulled forward a bit when it was blended with the HELP bill even before that, and remember, Baucus' primary concern seemed to be getting a bill that enjoyed support of Finance Committee Republicans. If he had been primarily responsible for the shape of this bill, comprehensive healthcare would have been structurally vastly different, if it was even comprehensive at all.

But all the bills were basically based upon the bills put forwards during the presidential campaign, which were all basically based on consensus ideas from liberal policy thinkers. So perhaps it is slightly incorrect to say the bill was shaped by the House, but I think it is even more incorrect to say that it was shaped in Finance. A bill springing straight from Finance would have looked nothing like this.

[Joe]

I think that your last statement is fairly accurate that all the bills are in the ballpark of what is/was thought to be attainable by the policy wonks in the Democratic Party. I don't think it represents the consensus among Democrats and Democratic wonks generally, most of whom would prefer a single payer system. However,the Baucus Bill is the rightward edge of that consensus. (the exception being Stupak/Nelson restrictions on abortion rights). Moreover, the Baucus Bill inserted the worst aspect of the final bill- the ban on allowing illegal immigrants to purchase health insurance.

I also don't know if a bill straight out of finance would have looked significantly different than the final product- because there is only so far you can push even the Democrats on the Finance Committee-- especially given the fact that only Snowe ever even considered voting for any health care reform bill.

The proof of the pudding is in the eating. It was not conservative dem senators who were angry with the final bill- it was/is House liberals and House Democrats generally. I think that shows who's priorities made it into the final bill- and that the final bill is closer to the Baucus Bill than the leftward edge of the Democratic consensus. But at the end of the day, it's a somewhat subjective determination.

[Corvus]

I agree with that assessment.

[oddjob]

he never seems to show any understanding of the procedural and political obstacles that sometimes necessitate those decisions, or the ramifications of basically any political act

He is (or was anyway, when he lived in the USA) an attorney, right? Those of you who are attorneys, what sort of work (beyond punditry or academia) could such an attorney do? What firm would hire someone like him, and for what task(s)?

I agree with Corvus. Greenwald seems to have a terrific mind for certain sorts of questions and legal topics, but my non-attorney-trained mind can't imagine him ever actually handling actual litigation. Isn't litigation usually just another of the life scenarios where you negotiate the best possible outcome for yourself (or your client, or your constituency) that you possibly can? Greenwald seemingly has absolutely no talent for that whatsoever.

[oddjob]

Greenwald's stance only makes sense if single-payer is sine qua non, but nice as it would be to take that stance and win, we aren't there now. We aren't going to be there until the right group of people come along to make the case loudly and persuasively enough that if single payer works so well for America's seniors there's no reason at all that we can't find a way to make it work for anyone else here who wants it, too.

Getting that idea to propagate successfully through enough of our countrymen's heads requires an effective propaganda campaign, and years of groundwork.

That hasn't been done anywhere near thoroughly enough yet.

[Sir Charles]

oddjob,

Greenwald reminds me of a pure litigator. I've known quite a few of them in my career. They can be excellent advocates and lawyers within the confines of what I'll call, for lack of a better term, being technocrats. The best of them are really good writers, good on their feet, and usually pretty fierce opponents.

They tend, however, not to see the big picture. They are lousy general counsel material, often poor with cost benefit analysis, and sometimes really detrimental to long term relationships with constant adversaries, e.g. longstanding labor-management relationships. There can be an automaton-like aspect to the way that practice -- they litigate by the numbers, aren't creative about settlement possibilities, and forget to think about lving to fight another day.

They are poor lawyers for institutional clients -- where you need to develop an organic feel for the clients business and culture -- and they are often weak in terms of client development and retention.

You wouldn't want a law firm made up of too many such folks, although if you know how to use their skills (and their good) they can be very useful.

[Sir Charles]

Jesus. "They're" good -- not "their" good. I am having a huge problem with homophones this week. It seems to happen a lot when I'm typing fast and I've been drinking.

[oddjob]

LOL! You can imagine how aggravating I find the same problem, given that it happens to me regardless of whether I'm drinking or not!

:)

And thanks very much for explaining. I think I understand now. I take it then that attorneys like Greenwald are "hired guns", and if you are a law firm with a big enough litigation caseload you probably do have some of his ilk on the payroll. But they aren't there for the day-to-day hand-holding work of shepherding clients through their day-in, day-out everyday legal stuff (including contract negotiation if you're a firm hired for that sort of work). Instead attorneys like Greenwald are hired to work in the courtroom when you need a serious arguer who is more than able to eviscerate the opponents' cases.

[Sir Charles]

oddjob,

Some of them are definitely hired guns -- others are just tempermentally that way. It's just what they are drawn to and what they are good at.

I understand it too -- because I'm a pretty fair litigator. I was a very strong brief writer as a young lawyer -- I used to say that I could write faster than anyone who could write better and write better than anyone who could write faster -- and I found it really satisfying. And I love the courtroom -- love cross examining people. I can think of few things more intellectually satisfying -- it's so immediate, so reactive and adrenaline filled. After a really good cross examination, you feel like lighting a cigarette.

Alas, in my business anyway, what really pays the bills is the client relationships and the ability to provide a wholistic set of skills to institutions that need an array of advice. I haven't set foot in court for about two years now -- same with writing a brief. I miss it --the counseling role is laden with ambiguity, room for self-doubt and second guessing. You don't end the day that often thinking you've kicked ass.

[Corvus]

Hah! How's all that Yglesias bashing sitting with you now, Sir Charles (coos the Lord of Typos)?

[oddjob]

I probably would have been one of those better, but slower, brief writers.

Regardless, it's not my field and I know that. As I've indicated before, I become enraged too easily to be a worthwhile lawyer (at least in the courtroom).

[Sir Charles]

Corvus,

The difference is that when I put up a post I actually spell check it. (Okay and then I still end up editing a second and third time.) I do always wonder why they don't assign someone to help Yglesias with this aspect of his blog. The guy is incredibly productive -- he just cranks stuff out, most of which is quite good. But someone should give him a little bit of help with old proof reading thing.

The comments are a different story. I crank them out and hit post and then feel the embarrassment.

[oddjob]

My just sent email to my representative (John Tierney):

During the last week I have been paying close attention to the news regarding you and your commitment (?) to the bill now before the House.

VOTE FOR IT!

NOT voting for it would be electorally unwise........

No, it's not a perfect bill by any means, but neither was the Social Security bill signed into law by Franklin Roosevelt!

PASS. THE. DAMN. BILL..................

By the way, I ask this of you as a constituent (only a few years younger than you) who was apparently born with epilepsy. I had my first seizure as a nine month old infant, the first time I got a cold & a fever.

Obviously, I have a pre-existing condition. I know the bill isn't "single payer", doesn't have a "public option", etc., and I would be in favor of any of those.

NONETHELESS! As a constituent with an apparently congenital pre-existing condition, I urge you to vote for the health care reform bill soon to be presented to the House!!!

[big bad wolf]

i think at this point that the errors are part of "matt yglesias," intelligent generalist and wunderkind writer of a preposterous number of posts. the right career move for matt is to gradually age out of the typos; suddenly correcting them all upsets the world he has usefully created, one in which the typos signify both that the brain is quicker than the hand and that you are reduced to red-pen comments because you cannot undermine the substance of my argument. it's a brand: any young geek can spell check---i dare not to.

(old guys like me, not so much. if there is a way to spell check comments, i don't know it. my brain has slowed but my fingers have too, crimping in a way that lets me make physical errors where they once, for a year or two decades ago, might have been brain-racing errors)

the paradox of court is that you can do really well and feel really great about it and still lose. this is so for two reasons. the first is that skill can't necessarily trump difficult precedent or bad facts. the second is that some pure litigators never let the result bother them; they were better, they were right, anyone who went against them was a knave or a fool and thus the result can't detract from their great and principled performances. this is a bit scary and is why law firms have a mix of people, but it can be damn useful in the courtroom.

[Calvin Jones and the 13th Apostle]

Sir Charles:
Greenwald has been in court before. See his Wikipedia page:

http://en.wikipedia.org/wiki/Glenn_Greenwald

I do think Joe has it right. Progressives care about a functioning government. About getting things done. Can you say the same about Ben Nelson? I can't. So that puts us in a bind. Because given the rules of the Senate, and people like Ben Nelson voting with Republicans re: cloture, we are stuck. So I think Glennzilla is right. Why do you think people like Atrios were writing about President Snowe, and President Graham?

[Ian Welsh]

I'll bet on Glen, and not on you, I'm afraid. Progressives won't kill squat that matters, because they are wimps who don't know how to negotiate and who buckle repeatedly. This is a pattern, not a one-off.

[Neil the Ethical Werewolf]

Sir Charles, if Jeff Zeleny is right here, she's got more than 216 and is just looking at who she wants to set free.

[oddjob]

Ian, over the decades the pattern on HCR has been to kill it because it's never been perfect.

[Calvin Jones and the 13th Apostle]

oddjob:
But that's not happening this time. It's the Democrats on the right who always have to be satisfied now(See Stupak bloc).

[Sir Charles]

Calvin,

I think you kind of missed what the point of the thread was vis a vis Greenwald. It's not that he hasn't been in court -- it's that he has spent too much time in court where an impartial official attempts to dispense platonic justice. That's not exactly the way the legislative process works.

I don't think there are any of us here at Cogblog who would not like to see the filibuster eliminated. I certainly would. However, the prospects of senators like Nelson, Snowe, Lieberman, et al. giving up their leverage by agreeing to the elimination of the filibuster is a pretty remote possibility.

Ian,

I get a little tired of the notion that this is somehow a question of will. It's a question of votes and how to cobble together the necessary support for reform. In an ideal world we would not have to deal with a Senate structured the way that it is and with the rules that it has, but that's not our reality.

I'm always a little amazed that folks from Canada and England weigh in on our politics with such a sense of authority. I can't really imagine presuming that I know enough about either Canada or England to lecture anyone about how to implement major policy changes in either place. This is a big, complicated country with a rather unique history and political structure. I've spent fifty years living here immersed in its culture and social and political history and I think have a pretty good sense of how difficult implementing progressive policy reforms have been. The notion that such changes have not been accomplished because we on the left here are wimps is just reductive and insulting.

And I'm pretty sure not a charge you'd be willing to make to my face.

[Mandos]

Besides, progressive threats to kill the bill were obviously empty from the beginning: Republicans and centrist Dems clearly had less interest in the bill's success than they did. So who was going to be threatened?

This. It's been obvious for a while now that the other side was willing to walk off at the slightest hint of something that might *possibly* lead to a single-payer equivalent, which basically consists of the complete set of what progressives might have wanted.

People thinking that progressives should hold out longer---and that they're "wimps" for not doing so---are...seriously mistaken.

[Prup (aka Jim Benton)]

I'm part of the PTFB, Already crowd, but you have to admit that it could have been handled better, had Obama realized the political environment sooner. To my eyes the two biggest mistakes made were not 'ruling out single-payer' which never had a chance to get enough votes.

But Obama should have had a committee start preparing a bill before he was elected, thrown it out, and said 'start there!' Instead, because he succeeded a President who -- we forget -- ran roughshod over the Congress and used 'signing statements' to pretend than Congress had passed bills they hadn't -- and possibly because he came from the Legislature himself -- he paid them too much deference, and let them write the bills themselves. Which mean there were always six different groups working on their own ideas, and a mess putting anything together -- and, unavoidably, too much power in the hands of the Lincolns, Nelsons, Stupaks and Snowes.

The second -- and even more serious mistake -- seemed minor. When the Baroness Munchhausen brought up the idiotic 'death panels' the Democrats shrugged their shoulders at the idocy and went ahead and removed the provision for end-of-life counseling, thinking it would 'shut them up.' Instead it carried the message that 'factless insanity' if shouted noisily enough, could actually succeed. Since then, Democrats and Progressives have been on the defensive.

[Joe]

I think, in part, Glenn Greenwald is much more concerned about civil rights issues than health care. To wit, Greenwald has been studiously agnostic on whether this HCR bill should pass. He sees himself as a civil rights absolutist- following general liberal theory that civil rights should be beyond the reach of democratic processes and the whims of the mob.

However, his disappointment with the Dems and Obama Administration has, to some extent, leached into his thinking on purely political issues- like expansion of the social safety net. But Greenwald makes the mistake of transferring his absolutist civil rights rhetoric to HCR which a purely political issue forged through democratic processes. His rhetoric doesn't match up well in regard to political questions.

However, all that being said, Glenn is right. Progressives don't have the ability to enact any aspect of their agenda despite being most of the Democratic Party, and having a near majority or maybe an absolute majority in Congress (depending on how you define liberal/progressive).

[Prup (aka Jim Benton)]

I am older than Sir Charles -- some days I feel like I'm older than everybody -- and have been watching politics a little longer than he has been alive. Not only is he right to remind Canadians and Brits (not Litbrit, of course) that there are basic differences in our systems that can be masked by surface similarities -- much the way baseball and cricket, or hockey and soccer are superficially similar but the strategies and actions are entirely different.

More importantly, our system has been changing, rapidly, in ways that make it even harder to manage. (Sadly, many of the changes have been instituted by progressives, but the results are that it is harder to get progressive legislation passed.) Log-rolling, arm-twisting, vote-trading, all of the 'sausage-making' aspects of legislating, have been minimized, and 'transparency' is the new watchword. Unfortunately, the cameras have produced not 'reality' but 'reality TV,' because people act differently when they know everything is viewable. And 'purists' used to hate the fact that the parties overlapped so much. But because they did, you could work truly 'bipartisan' deals with those of the other party who shared your ideas. Now it is 'treason' to the Republicans to 'reach across the aisle' and there are no more progressive -- or even moderate -- Republicans willing to do so.

Add the fact that there have been substantial groups of Democrats who accepted the Republicans turning 'liberal' into a 'dirty word' and who have, by 'running to the center' moved 'the center' ever more rightwards. And then add in the perversion of the filibuster, aqnd the idea that progressives have 'wimped out' is shown for the nonsense it is.

[minstrel hussain boy]

thank the good lord that i've got myself a sweet gig in beautiful san diego this weekend. it's outdoors at humphrey's by the bay, showtime is right around sundown, so as i play i get to watch the sunsetting over the pacific.

we shall see with the bill. i figure, something's better than nothing at this point. alan grayson has a medicare buy-in bill, which will most likely die and ignominious death. but, there's no lacking of will there, he won't quit. i love the guy.

tomorrow i play at the old mission de san diego. they have a gorgeous old french concert harp there, i'm doing a mendelsshon "magnificat" with one of my favorite sopranos. the acoustics in some of the old missions are phenomenal. i especially like the ones that are still working churches. and it's always a plus when i get to charge the catholics union scale (with my seniority it's a hefty chunk, and it's on day rate. i play one mass and get paid high end scale for what would have been a full day).

sometimes it rankles me to play for that bunch of corrupt bastards, but, money's money yo. at least for now.

besides, i'm playing a christian work, done by a jewish composer. it didn't bother the beautiful felix when the emperor franz joseph told him to write this magnificat (i think the emperor was most likely fucking the soprano it was composed for, it's good to be the king). he did his duty as a court musician.

oh, yeah, and my dog (12 year old german shepherd) is not doing very well...

pass. the. goddamned. bill.

[Sir Charles]

mhb,

Enjoy San Diego -- it's such a beautiful place. It's quite lovely here today. It hit 72 here today and the entire city seems like it was trying to have lunch outdoors.

Sorry to hear about your dog. They really get into your heart. It scares me how attached I've become to mine in less than a year. I am thankful that he is only 18 months old right now -- and I hope he is going to be around for a long time.

[minstrel hussain boy]

for my before the show meal i'm hitting a legendary fish taco cart at crystal pier near tourmaline surf park.

lunch tomorrow is going to be a van dinh's restaurant, "best pho in the barrio."

my sister, who is dog sitting, thinks that it's a stroke. she doesn't appear to be in any discomfort, but her hind legs aren't working well. she's mainly sleeping. they have puppy pads under her. we shall see when i get home on monday.

san diego is right up there on my favorite cities in the world. the live theatre and music scenes are alive and vibrant. the weather, well, it's about as close to perfect as one can ask for.

it's pretty rock rib republican, but, they have pockets and enclaves of progressives, and being so deep into enemy territory makes them tough.

the singer i'm working for tonight has some perfect songs listed for when we are all watching the sun go down tonight. i like folks who think like that.

i intend to channel my worry about the dog through my bottleneck. snotty, greasy licks will ensue.

best to you and the fambly.

[Corvus]

Joe, I continue to think you are wrong about the progressives having no control over the agenda. Look at it this way. Did the Republicans attempt to reform the healthcare system when they ran everything? No, because they don't care about healthcare. And there is a continuum there. The less liberal just don't care about healthcare. Which means, without a certain base of liberal influence, we never would have dealt with this issue in the first place.

Consider a counterfactual. The entire Senate Democratic Caucus holds the views of Ben Nelson. Does this Caucus enact the present healthcare bill?

I vote no. In fact, I doubt they would consider any type of comprehensive reform. Health care reform would not be on the agenda.

But it is on the agenda. In fact, it looks like it will pass. It even got Ben Nelson's vote! And Bernie Sanders vote! Therefore, progressive must have some influence over the agenda (and how Ben Nelson votes) and since this would not have been on the agenda without them, the ability to set the agenda as well. They just can't make the bills fit to their every wish, that's all.

[Mandos]

Well, it isn't just their every wish, but this bill does not go even an iota in the direction in which most of the American left (from the mildest to the most commie) has wanted for a very long time, which is beginning the process of disestablishing the private insurance system. Even though I believe it should pass, I understand the disappointment in some quarters---fine, no single-payer right away or even on the horizon, not surprsing; but not one step towards reducing the market share of the private insurance sector?

[Krubozumo Nyankoye]

I guess I will channel in from here in the rain forest.

I can't offer any insights regarding the personalities involved here whether they be pundit or plutocrat, but one thing that strikes me as very odd is how for so long the US had this perverse aversion go the horrid sin of "gambling", yet, what exactly is the insurance business if not gambling by house rules? And quite obviously the game is rigged. So on principle alone one would think that it would be a no brainer to take the actuarial aspect of business out of health care. Not so is it.

Even more bizzare is that when you throw the dice and "win" - diagnosis adenocarcinoma of the esophagus for example - the "house rules" are such that they can say, sorry, your chips were levitated 200 microns off the felt so your bet did not register. You're out of luck.

That is a small part of the absurdity of the whole thing to me.

I tend to be rather ungenerous towards anyone who thinks that the health insurance industry deserves to exist. To put it as bluntly as I can they make money off other people's suffering and ill luck. In biology the term for that is parasite.

In a broader sense this whole tizzy bodes unfairly for the general welfare of the US. Addiction to unsustainable energy policies will be an even more contentious and divisive struggle to deal with, whilst the reality will march on unperturbed and the situation will worsen.

MHB - one of my favorite haunts was Pho Hoa on the edge of Torrance when I was whoring my expertise to the DOD back in the '80s. Spring rolls with fish sauce and cafe
Shua da. Heaven.

Sympathy for your alien companion, i.e. dog. I know how hard it is to lose them.

Prup, I think you are largely right, reasoned response to blatent lies is not only foolish but counter productive. It only encourages them to lie more. We should be calling them liars loudly, outrageously enough to get the narrative out of the echo chamber. Meekly claiming that is not true, is worse than saying nothing.

I cannot read Obama's mind. Perhaps he is too taken with his cumulative success to realize he is in a fight of a different kind, perhaps he is much wiser than me. Perhaps he is just another tool of the overall establishment that is dedicated to the principle of steal from the weak. I just don't know. But there is a horrendous risk in tempting the right wing with new visions of regained power. They deserve nothing but prosecution for their many crimes.

SC - a couple of your posts up thread regarding the bent of various types of avogadros. I have had zero experience in courts although I have frequently been petitioned and once or twice supeaned (sp?) to testify in fraud cases concerning mines. Evidence in science is a distinctly different thing from evidence in jurisprudence. I understand the advocacy role that attorneys are bound by, but for myself, I cannot argue in favor of what I know is not true. I have managed to avoid giving any testimony as an expert witness or as a responsible party simply by sticking to the scientific truth. No one really wants to hear it.

There is a great irony involved in my limited experience that I think may well apply here as well. There are many con artists who promoted spurious projects but were wise enough not to call on me to defend their claims because they knew I would not, and there are almost equally many legitimate prospects that never called upon me to support their claims because they never exaggerated them enough to attract investment.

I leave it to the discussion to hash out what should have happened.

I would have addressed several other points made in the thread but it is late and I am very tired.

Ciao,

[Corvus]

Mandos, I actually think this bill does start to move us in that direction. Not but actually moving us in that direction—you are right that it doesn't decrease private insurance's market share—but by laying that necessary groundwork for moving us in that direction.

A straight single payer bill is impossible. Healthcare is now a sixth off our economy. You can't nationalize a sixth of our economy in one fell swoop. All the countries that have something like single payer achieved that step when health insurance was a much smaller fraction of the economy. Doing it now just can't really be done; there will just never be the political will for a bill that big and sudden, unless we were actually in the middle of some type of total disintegration of the healthcare system. We don't want to wait that long. So a single-payer bill is out.

But this bills sets up the exchanges, which are a government-regulated private insurance dispersal system. Through the exchanges, we can eventually set up a public option, either weak, and then strengthen it later, or strong off the bat, once we have votes for it. Once it's basically a medicare buy-in, lots and lots of people will switch to it. the vast majority in fact! This will eventually reach a critical mass, in which either enough people are just buying non-profit insurance from the government that that money can be turned into a tax (think of it being sold as one less check you have to mail out every month) with people having the option to buy additional insurance from private companies, or we just don't bother, because everyone has access to medicare quality service anyways, and making it a tax doesn't really make it any cheaper. Either way, it doesn't matter as long as everyone has access to medicare-type insurance (total coverage, no deductible) at an affordable cost. That's the real goal.

So, yeah, we didn't get a public option this time. Single payer got pushed a little farther away. But it didn't preclude it from happening.

Take what you can; give nothing back.

[oddjob]

Big Labor pressures Rep. Lynch (D-MA).

[oddjob]

It would appear the present HCR landscape (the post-Brown election landscape) owes a lot to Nancy Pelosi.

[oddjob]

John Tierney is a yes.

So also is Michael Capuano.

[oddjob]

Insightful reading.

[Corvus]

UnAmerican, oddjob, unAmerican.

(Not you, of course. The insightful reading.)

[ballgame]

I think it's kinda stupid for Glenn to draw broad conclusions like that from how things played out on this bill. You don't kill your biggest legislative priority of a generation so that people will take you seriously on lesser stuff; there's just no net payoff there.

Besides, progressive threats to kill the bill were obviously empty from the beginning: Republicans and centrist Dems clearly had less interest in the bill's success than they did. So who was going to be threatened?

Your logic here escapes me, Sir Charles.

First, it certainly wasn't obvious to me that the Progressive Caucus was bluffing when they said they wouldn't vote for a health care "reform" bill which lacked a robust public option. For me, a very key part of progressivism is challenging the domination of our economy by corporate and wealthy interests. Given that the health care measures under consideration incorporated the requirement that Americans purchase this insurance from private entities that are in essence monopolies for large numbers of Americans — and that, moreover, pricing by such monopolies might not be tightly regulated — it doesn't make any sense at all to assume that progressives would 'of course' vote in favor of such a bill. Indeed, others have made persuasive arguments that progressives should 'of course' vote against such a bill (though such arguments apparently lack a following here). As a progressive, I would not characterize such a measure as the "legislative priority of a generation" for which the votes of like-minded progressives could "obviously" be taken for granted.

It also seems odd to imply that progressives were bluffing "so that people will take [them] seriously on lesser stuff" … I haven't seen anyone but you suggest that this was the intent; it's certainly not what Greenwald was saying. It seems clear to me that the intent was to be taken seriously on this bill (or, more accurately, to appear to want to be taken seriously on this bill). I don't know why anyone would assume that progressives would inevitably vote for any bill with the "health care reform" label on it, even if such a bill was based on the idea of compelling the middle class to pay private insurance monopolies any amount those monopolies deemed fit to charge.* I believe Greenwald's central point was simply that progressives in Congress took a stand, but rolled over when push came to shove, and that any similar moves on "Party-endorsed" legislation are unlikely to be taken seriously in the future. I find it hard to believe you actually disagree with that conclusion.

Finally, I'm not nearly as certain as you are that the bill that is now under consideration was more important to the progressives than anyone else in Congress. Obama clearly staked a great deal on the passage of health care reform. masaccio at FDL concluded that health insurance giants stood to enjoy over a trillion dollars in premiums during the first eight years of a health care environment where there was no public option but health insurance purchase was mandatory. I have also seen references to health insurance companies having a high level of investment in commercial real estate (This 2001 Texas Dept. of Insurance report notes that "The $13.2 billion of commercial mortgages reported by 139 of the [life and health insurance] companies represented the largest category of investments.") Given that commerical real estate is rumored to be the next 'bubble', one wonders if perhaps this health care "reform" bill was in fact more important to the health insurance industry than many people realize.

*I am not saying this is the character of the bill(s) now being voted on.

[Sir Charles]

KN,

Lawyers should never represent something that they know to be false in court as true. If a judge catches you doing that you will be in deep trouble. Lawyers are supposed to make the best legal argument that they can with facts that they believe to be true. Of course, facts are often in dispute and that's why you have a discovery process and, if necessary, trials.

Expert witnesses can be really dubious though. A good number of them seem like they will say anything for a check. But because of that, they are often surprisingly easy to demolish on cross examination. they go a bridge too far, gild the proverbial lilly, and then get their heads cut off by good opposing counsel. I took one an economist apart in a jury trial one time in a wrongful discharge case and it was a very satisfying moment. He had zero credibility by the time he left the stand.

Mandos,

I think the goal is not going to be single payer or the elimination of private insurers, but eventually a move to a completely regulated insurance market -- which will not be disimilar to much of what Western Europe has. Think of insurers in this context as highly regulated utilities. Profits will be minimal -- as a result, I think you will eventually see these companies cease to be attractive to Wall Street.

ballgame,

Low-tech cyclist wrote this post not me -- not that I disagree with him. The point is that progressives really want to expand health insurance to tens of millions of people. Our opponents don't care. the status quo is fine with them. Hence the lack of leverage.

By the way, health insurers are not generally big players in the commercial real estate market. Your confusing them with the life insurance companies -- John Hancock, MetLife, Prudential, etc. None of these companies are really players in health insurance, which is dominated by Wellpoint/Anthem, CIGNA, Aetna, and the big HMOS like Kaiser.

You seem like you are trying to turn HCR into some bailout conspiracy. Also, the additional premiums will be offset by larger claims, no pre-existing condition clauses, and tighter regulation -- it is not trillions of dollars of pure profit. Indeed, whether this will be more profitable to health insurers is quite debatable. Once again, FDL is not the place where I would look to for a credible or nuanced analysis of this issue.

[zunguzungu]

"Our opponents don't care. the status quo is fine with them."

Which is why no amount of cowtowing to republicans was necessary; they will vote against everything no matter what compromise is made. This was an intra-democratic party debate, and always was; his point is therefore that instead of whipping the right of the democratic party into supporting a progressive bill, they whipped the left into supporting a bill modeled on Romney-care, that within the democratic party, the left is both uninfluential compared to the "center" and this political cycle has only deepened that fact. Nothing you or low fi cyclist wrote makes me disagree with Greenwald's assessment. Like ballpark, I don't understand what your argument is supposed to be and I suspect your failure to address what he actually said stems from not having actually taken what he was saying very seriously, something the quickness of people on this thread to call him stupid just illustrates. He isn't. He might be wrong, of course. But calling him stupid just makes you look like unserious hacks, and y'all are better than that.

[oddjob]

zunguzungu, do you want Americans to go uninsured or not?

[Joe]

Oddjob, you can both desire that Americans have insurance and notice that the Progressive/liberal wing of the Democratic Party got rolled on this legislation. You can support this legislation and hope for it to pass, and still believe that the progressive/liberal wing of the Democratic Party got rolled during the process (which is what I believe). The only reasonable counter-argument to the contrary is Corvus' (that any healthcare reform is a result of liberal efforts and a concession to liberals).

You're argument seems to conflate Glenn Greenwald with Jane Hamsher. He's not arguing to kill the bill. Moreover, it's important to analyze what happened and what went wrong because the next battles are going to be more dicey (and, in the long run, more important because we can now move health care left incrementally)-- cap & trade, financial regulation, immigration reform, labor law reform.

In this bill, we got a beachhead and got stuck in the Hedgerow Country (to use a WWII analogy). We didn't cross the Rhine or even make it to Paris. Greenwald is giving us a hypothesis why this happened. Telling people to clap louder like trained seals isn't going to change what happened. If you think this is absolutely the best the Democratic Party could have achieved on HCR, that's your opinion. Lot's of people on the Left don't share that opinion and want to know why.