Justin, a Friend of the Blog, isn’t terribly happy with the language Rep. Grayson (infamously?) used to describe the Republican health care alternative:

There is no sense in which the Republicans want people to die.  Nothing even approximately close.  Republicans have their reasons for disagreeing with health care reform, many of which I think are bad (slavish devotion to an ideal of the free market, distorted ideas of what will happen).  Many legislators have worse reasons (pandering, insurance industry donations).  But the idea that they want people to die explains nothing.  It’s not hyperbole, it’s pure rhetoric, and it doesn’t appeal to any rational consideration, but pure fear.

As a purely substantive matter, I kind of disagree.  Republicans know – or have some idea – that upwards of forty-five thousand Americans die annually because they lack health insurance.  And Republicans know – or at least have some inkling – that thousands more Americans die because their insurers refused to cover a treatment or a procedure or even a medication.  Republicans might not want people to die, but they are fighting very hard to maintain a system that needlessly claims lives and livelihoods as a matter of course.  So, at the very least, Republicans seem to have a complete and total disregard for the human cost of our health care “system.”  Which, honestly, isn’t much better than wanting people to die.

That said, Justin is right to say that Rep. Grayson’s bit of hyperbole was a direct appeal to fear.  But it wasn’t solely an appeal to fear; no, it was also an attempt to inject some needed moral urgency into this debate.  Since I’m, one of the most powerful verses in “The Message” by Grandmaster Flash and the Furious Five (which is a pretty powerful song altogether) is towards the end, where Melle Mel details the bleak life of a young stick-up kid.  Melle Mel tells us that in prison, the kid is “used and abused and served like hell,” and I bring that up because it is also pretty much how our health care system treats millions of Americans.  For those not fortunate enough to have good employer-provided health care – and even for those that do – our system regularly under-serves, bankrupts and kills.  Everyone knows this.  And the fact that we don’t actively talk about it is completely ridiculous.

Yesterday, Matt Yglesias correctly pointed out that – by the conventions of American politics – liberals simply aren’t permitted to bring any notion of morality or justice to bear on our opposition.  To be taken “seriously” at all requires us to sheath our swords and turn to the bloodless language of bureaucracy.  Which is all good and well, except that we become so bogged down in bureaucratese that we forget acknowledge that there are real lives at stake.  Yes, Rep. Grayson shouldn’t have called the status quo a “holocaust,” but if his hyperbole can create the space for liberals to make a moral argument, and freely point out the human costs of Republican obstinacy, then I’m inclined to defend his speech as a good and necessary corrective to the monstrous abstraction which has consumed this debate.

David Rivkin and Lee Casey take to the pages of the Wall Street Journal to claim that any individual insurance mandate would “likely” fail to pass Constitutional muster under even a modern understanding of Constitutional law and the commerce clause.  Whatever my thoughts on the value of an individual mandate, this is a shoddy piece of legal commentary that is transparently intended to provide legal cover for the claim that Obamacare is somehow unconstitutional in a way that Social Security and Medicare are not.

Let me start by saying this: if you want to go with a more or less purely originalist interpretation of the Constitution and 10th Amendment, I think you’ve got a strong claim that the mandate is unconstitutional.  Unfortunately, this interpretation of the Constitution hasn’t held sway for a good 75 years. 

What is so strange about the Rivkin and Casey piece is that they don’t even try to go this route, and instead try to make their argument by accepting the state of commerce clause jurisprudence.  They even approvingly quote the infamous recent case Gonzales v. Raich (the medical marijuana case) for its language that the commerce clause can be used to regulate an activity so long as there is a “rational basis to believe that such ‘activities, taken in the aggregate, substantially affect interstate commerce.’”  The implication is that the failure to purchase health insurance does not, in the aggregate, substantially affect interstate commerce.

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Yglesias breaks it down: [Read more →]

The health care debate is ramping up.  We now have a bill going forward in the Senate and one in the House, and pretty soon the twain shall meet.  In the midst of all of this, Senator Ron Wyden is finally coming out swinging. In fact, he has a very smart, very important piece out in the New York Times today which I’d like to excerpt (skip ahead if you want, it’s a long excerpt):

I believe there is a way to work with the present employer-based system to guarantee that all Americans have choices, and I am proposing it in an amendment to the latest Senate health care bill. My amendment, called Free Choice, would let everyone choose his health insurance plan.

It would impose only one requirement on employers — that they offer their employees a choice of at least two insurance plans, one of them a low-cost, high-value plan. Employers could meet this requirement by offering their own choices. Or they could let their employees choose either the company plan or a voucher that could be used to buy a plan on the exchange. They could also simply insure all of their employees though the exchange, at a discounted rate.

All payments that employers would make, whether in the form of premiums or vouchers, would remain tax-deductible as a business expense. Reinsurance and risk adjustment mechanisms already in the bill would balance the costs of employers who end up with disproportionately sick pools of workers, and this would avoid any disruption to existing employer coverage. Any employers that did not offer either their own choices or insurance through the exchange would be required to pay a “fair share” fee to help support the system.

My plan would actually strengthen the employer-based system by making it possible for even more employers to afford coverage than can today. Employers who offer high-quality health insurance to attract first-rate employees could continue to do so. And employees who like the coverage they have could keep it. Those who don’t, however, would be able to shop elsewhere.

According to one estimate, injecting this kind of competition into the employer-based system would save people and businesses more than $360 billion over 10 years. At the same time, it would improve the quality of health care.

Americans could take advantage of this change, or ignore it if they like; it would not be forced on them by government mandate. Ultimately, by empowering people to select the health insurance that makes the most sense for them and their family, we could end up with a system that works better for everyone.

Turns out, also, that the President has recently met with Senator Rockefeller and with Senators Bennett and Wyden at the Whitehouse, which may be a good sign that the President is taking seriously – if not their bill – then at least Wyden’s Free Choice Proposal which he’d like to add to the  Senate bill.  This is a good idea, even though the CBO has given the current Baucus proposal a pass, and Stan Collender thinks it’s fiscally sound.  Wyden’s proposal would help make it even more fiscally sound, not just for the government, but for consumers of health care. [Read more →]

by Dan Summers

I watched President Obama’s speech last night with interest. As an unabashed supporter of health care reform, I was heartened by how clearly the President described the intentions of his reform package, and why the need for reform is pressing. As I mentioned in my discussion with Scott a little while ago, I think the need for insurance industry reform is particularly urgent, so I was glad to see that point hit early and hit hard. (It was also somewhat gratifying to see that doing away with such things as preexisting condition exclusions and rescission could get even Republicans on their feet.)

As a physician, I was also glad to hear that the President is willing to consider GOP proposals for malpractice reform. While the impact of malpractice costs per se on the overall cost of health care in America may be smaller than the Republicans would have us believe, the actual impact may be harder to measure. [Read more →]

Well I listened to President Obama’s speech on NPR last night whilst playing with my daughter and Curious George.  Suffice to say, I didn’t catch the entire thing, though what I did catch sounded pretty good.  A few thoughts:

CNN says it boosted support for Obamacare.  We’ll see if it lasts.  Speeches, especially those of masterful orators like Obama, can certainly sway us – but is it sustainable?

If reforms to the health care industry do not cover illegal immigrants (I hate the term “alien”) then who will cover the costs of their medical care?  It’s beyond wishful thinking to believe the immigration problem will simply fade away regardless of which side of the debate you fall on.  And until then, illegal immigrants will need medical care, as will their children.  Either the brunt of that expense will fall on local community emergency rooms or we can talk about spreading out those costs.  This is the same problem we have with legal, low-income uninsured.  Ignoring it will not make it go away.

***

That outburst from Joe Wilson…what can one say?  My favorite reaction was this from Yglesias.  I’m all for heckling.  I think we should institutionalize it.  Then again, Ezra Klein writes:

If we’re going to adopt British norms of political behavior, we should also adopt British norms of governance. It’s fine to have a polarized system when the majority can wield power. You just can’t have it when you need a supermajority — which is to say, a high level of consensus — to get anything done. So if we’re going to move toward British-style heckling, lets also move toward British-style majority rule. Deal?

Yes, then we could have Britain’s lovely health care system, high taxes, high unemployment, high cost of living, and endless rain. [Read more →]

President Obama’s two biggest problems politically are 1. a frankly crazy and irresponsible minority GOP party (with plenty of enablers to be sure) and 2. His own party affiliation. In the immortal words of Will Rogers, President Obama is not a member of any organized political party, he’s a Democrat.

If the House Dems are serious about refusing to pass any bill without a public option then this is going to end badly.   It’s likely headed for a re-play of 1994: no bill passed and Dems potentially losing the House in 2010.*

I know there are some Dems out there who think this is a great thing, that they are finally getting a spine. But this is like growing a spine out of your hip.  The liberal wing of the Democratic Party learned the lesson that they need to put pressure on Democrats else they cave in to centrist triangulation.   But the lesson they should have learned (and the party as such needs to learn) is how to actually govern as a majority party in America.  They used to know how to do it.

It simply does not appear that there are the votes for the public option in the Senate, period.  And yelling about how the President needs to show more leadership is doing nothing but hurting their own party (a thing Democrats have perfected to an art form).

This one is for you Mr. President:

*Update:

There is some evidence that the House would back off that strong stand on no bill if no public option.  Speaker Pelosi seemed more open to the idea at a presser with Majority Leader Reid yesterday. And Steny Hoyer has explicitly said the House would pass a non-public option bill.

I think what could pass is a trigger for public option.  As we saw with the stimulus, as goes Ben Nelson, so goes Olympia Snowe and Susan Collins.  Baucus and Kent Conrad would likely follow.

Generally, I’m loath to give the Bush administration credit for much of anything, but if there is one thing they got right, it’s in their approach to passing legislation.  President Bush and his advisers realized, correctly, that the partisan make-up of any given vote matters far less than what Beltway insiders normally think.  It doesn’t particularly matter if X piece of legislation has bipartisan support so much as it matters that X piece of legislation is popular.  The Washington Post’s Eugene Robinson seems to get this, and makes a strong case for passing partisan legislation:

The rule among politicians in Washington used to be that when the provincials become restless, as they are now, the safest thing to do is run to the center. But as this sour and unsettled summer ends, the political center looks like the white line running down the middle of a busy street — a foolish place to stand and an excellent place to get run over. [...]

It is a core belief of Washington’s political culture that policymaking by compromise — “meeting in the middle” — is the way to gain and keep the support of the vast, moderate, essentially reasonable group of voters who constitute a coherent political center. My problem with this analysis is that so many of the big decisions that have to be made are binary: yes or no. The terrain in the middle consists only of “maybe” or “kind of,” and I see no evidence that the country is in a “maybe” or “kind of” mood.

Of course, the obvious response is that Bush’s method of passing legislation resulted in Republicans losing both houses of Congress and the presidency.  But I’m not sure if that’s actually the case; Republican losses last year and in 2006 had far more to do with the party’s failed policies and its obstinate refusal to change course on Iraq than it did with institutional minutiae and partisan composition of floor votes.  One could easily imagine a scenario in which various pieces of conservative legislation were wildly successful, and voters rewarded the Republicans with continued control of Congress, even if that legislation was completely partisan.

Plainly put, the “center” does not lead the political conversation, the “poles” do.  It’s simply a fact that during the past twenty-plus years of conservative dominance, the “center” reflected the strength of the conservative movement.  Accordingly, if Democrats want to gain and keep the support “of the vast, moderate, essentially reasonable group of voters who constitute a coherent political center,” the answer isn’t to propose mealy-mouthed “centrist” policies and hope that voters understand the underlying differences between that and a more liberal proposal, instead, it’s to move full-on with the most effective legislation possible, which in health care at least, happens to be the most liberal form of the legislation.  After all, Democrats won’t be punished for partisanship, they’ll be punished for failure.

As I’m sure most of you have noticed by now, I write (and think!) a fair amount about racial politics.  Indeed, it goes beyond my blogging – a good chunk of my undergraduate education focused on the intersection of race and politics, and my senior thesis expanded on some ideas I have regarding the nexus of race and religion in American politics.  That said, I try not to read racial motivations into every dust-up or controversy.  Nine times out of ten, race has nothing to do with a given incident, and if it does, it usually isn’t immediately obvious or even necessarily pertinent.

This is all by way of saying that I have struggled to give Obama’s more vocal critics something of the benefit of the doubt.  Even the most outlandish attacks are grounded in something approaching a legitimate fear, and dismissing those folks is as simply prejudiced is as unfair as it is incomplete (as far as explanatory value goes).  But, at the risk of sounding a little predictable, I can’t help but reconsider my reticence at using the “prejudiced” card, especially in light of this completely ridiculous “controversy” over President Obama’s address to the nation’s students.  It’s something of an understatement to say that this outrage, over a routine presidential address to children, is absolutely absurd, even granting the fact that the right-wing completely freaks out over the reality of a Democratic president.  And while there are certainly a few possibilities as to why conservatives have latched on to this particular address as a rallying point, I think the simplest explanation – and the one which goes further to explain a good deal of this irrational opposition – is that these folks are (still) terrified and bewildered at the fact that our president doesn’t look like them.  Their sincere ideological opposition is mixed up with a unconscious – or conscious, for that matter – fear of blackness and what they perceive as its “contaminating” effects.

That is, the narrative of white supremacy in this country is a narrative of “purity.”  In this story, America was built white hands, and it’s the job of those hands to keep the country – and her virtues – free of contamination from “mongrel” races.  Hence Jim Crow, and anti-miscegenation laws, and the “one-drop” rule*, as well as the fierce obsession with racial purity in Southern religious traditions.   Of course, this is something of an oversimplification (I’m setting aside a whole lot about economics and power relations), but it gets the basic outline right: an initial prejudice transformed, over the course of American history, into a distinctive narrative of white supremacy and racial purity.  And one that still holds quite a bit of currency; a recent study (and unfortunately, I can’t find the link) suggests that most Americans continue to associate “black” with dirtiness and “white” with cleanliness.  The study doesn’t draw any conclusions about the impact this might have on race relations, but you’d be delusional to think that it doesn’t influence the ways in which Americans – of all races – see each other.

This all said, I don’t think it’s a coincidence that its children and health care which are sending the right-wing into a rabid froth.  After all, both are associated with purity; parents – terrified of a fifteen minute presidential address – are yanking their children out of school in an effort to protect their “innocent” children from contamination by the words of a “socialist” (which, historically, is a charge often thrown at prominent black leaders).  And retirees are denouncing health care reform as an attempt by socialists/communists to, essentially, taint their benefits by “giving them away” to illegal immigrants and other non-white “others.”

I’m not entirely sure where I’m going with this, so I want to end it with this link to a LA Times article on President Obama’s rapidly declining support among white voters.  Read it, and the explanations by various analysts and strategists, and I think you’ll come away with a solid impression that underneath all of the controversy, there is a real and palatable racial anxiety on part of white voters, and that’s driving a good chunk of the opposition to Obama’s presidency.

In light of Max Baucus’ now circulating health care bill, Josh Marshall asks if he is “the only one who thinks that if the Dems pass a bill with mandates and subsidies for poor and moderate income people to purchase it but no public option or competition with the insurers, that it will be pretty much a catastrophe for the Democrats in political terms?”

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David Frum comes out in favor of Wyden-Bennett and against the Club for Growth’s recent attacks on Senator Bennett.  He points out that the very things the Club for Growth are attacking in Wyden-Bennett – namely “job-killing tax increases on employers” – exist in the Republican Coburn-Ryan plan as well.  However: [Read more →]

1.  It is disheartening to watch conservatives take up the mantle of Defenders of Medicare, even going so far as to propose a “Senior Citizens’ Bill of Rights.“  It’s really tremendously frustrating and cynical.  It’s a combination of fear tactics and gross dishonesty.  Yes there are cuts to Medicare planned.   No, conservatives should not oppose them (or at least ideologically that makes absolutely no sense).  Defending one entitlement just to sink another is pretty low, even for Republicans. (see #5)

2.  It is equally disheartening to see the Club for Growth go after Sen. Bennett and by extension, the Wyden-Bennett bill, which is the best piece of health care reform legislation out there.  It would be so nice to stop playing this game for awhile.  The status quo is horribly flawed, people are going without insurance, the costs of the uninsured are driving up the costs for everybody else – now is a good time to work toward reforms, but it’s not going to happen because winning has become more important than governing.  It’s childish, which is the nicest word I can come up with to describe the Republican leadership right now. [Read more →]