Baby and Bathwater

This from 538.com:

From progressives' point of view, they have been waiting many, many years for this moment -- for an ostensibly fairly liberal Democratic president, an ostensibly filibuster-proof majority in the Senate, an ostensibly lock-solid majority in the House, and a discredited opposition party. For a variety of reasons, the situation isn't as good for progressives as it appears on paper and never was. But that doesn't mean that expectations aren't very high. And yet they've seen little progress on climate change, on gay rights, on torture policy, on regulating the banks -- and now they're running into a stiff headwind on health care. It's 1994 all over again. To the progressive mind, it seems to be -- pardon my French -- the same old bullshit re-asserting itself. The moment is on the verge of being lost.

Silver's question, couched in (another) poker metaphor, is this: will progressives will go all-out batshit and absolutely insist on a public option that doesn't have a terribly strong chance of passing? I think that his analysis, which breaks up possibilities into discrete options, misses some of the gray areas that will doubtlessly be hammered out as a final bill is offered to the Senate: first, that there is such a thing as a strong and weak public option, just as there is such a thing as strong and weak reform (I'm speaking here from what he would call the 'progressive' point of view, and what I would call the 'pro-reform' point of view), and second, that these are all on the same spectrum. Enter the spectrum:

This is a simplification, of course, but it's a different one than Silver's -- I can't control Congress, not exactly, but I feel like my support for the public option, even if we end up with no strong public option, pushes the conversation to the right (on the chart, that is). I'll take an end to the way that health insurance companies profit from our fractured state-based insurance system, for example, and I'll support any politician brave enough to enact it -- even though I want more.

That's maybe the difference between now and 1994 -- because we have so many options on the table, there is much greater space for moderates of all kinds, and a much larger chance of getting some reform, even if it's not ideal reform, passed by the fall.

The only problem, really, is the fake reformers like Lieberman -- Democrats and Republicans (or in his case, neither) who accept large amounts of insurance company money and then it's all aww, shucks, do we really have the cash for this sort of thing? Ooo, it seems so complicated -- let's wait until it's impossible to pass reform, and then pass some reform.

Nothing's Over

I took a few days and posted pieces I had saved up so that I could mull over what's happened to the public option in the last week -- after the Obama administration hinted that it was willing to drop a public option as part of a health reform bill and then said that nothing was settled yet. I didn't want to flip the hell out without really thinking about it.

And I'm not flipping out. It's U. S. politics. We didn't suddenly get a better political system once President Obama was elected, and I've never doubted that if he was Imperial Lord, we'd probably already have a health insurance guarantee for every American. I've looked at questions about whether the administration is working hard enough on our behalf, and tried to figure out, but I just don't know.

Here's what I can answer, though. Am I working hard enough to be able to say that I've done everything I can to ensure that all American children have health insurance? That my friends and neighbors don't have to put off doctor visits or lose their homes over medical bills? The answer to that would be no.

One thing that has held me back a great deal was the assumption that what proponents of a public option have been working against is the attitudes and beliefs of other citizens, but this isn't entirely true. This statistical analysis at fivethirtyeight.com makes an argument that should be familiar to most of us: insurance company PAC money and direct donation have had a significant impact on health care reform votes in the Senate. Democrat Mark Warner of Virginia has raised $69,000 in health insurance contributions in the six months since he entered the U. S. Senate -- that's $10,000 a month, and he's not up for reelection for another five years. This article breaks down contributions accepted by the Gang of Six, the bipartisan committee that called for a slowdown of public option legislation in July. Republicans accept health insurance corporate funds across the board -- and that certainly has strengthened their resolve to oppose a public option -- but what is surprising is that Democrats like Joe Lieberman of Connecticut and Ben Nelson of Nebraska have each, over the course of their careers, raised more than two million dollars from donors in the pharmaceutical and health insurance industries. This is more than a debate between people who want a government option for health insurance and those who want an unrestricted free market; all citizens who want what they feel is best for their nation are pitted against corporate interests who are attempting to purchase favorable policies for themselves.

If you aren't convinced that health insurance companies intentionally and aggressively court industry-positive policies in Washington, check out this interview with a former executive for CIGNA who helped end reforms during the first Clinton administration, and is now speaking out about the excesses and cruelties of the current US health system.

So no basic principles, for me, have changed -- I support affordable health care for every American, and a competitive government option for the provision of that health care. I oppose profits earned by encouraging human suffering, and the disproportionate voice that monied interests have in our government.

What has changed is that I no longer trust my elected officials to make good law without the energetic oversight and intervention of people like me and you. So let's get to intervenin'.

Good News or Bad News?

This made a banner headline at the NY Times -- which has apparently started to feel guilty about failing to more aggressively report the truth about the false "death panels" claim, because they slip a rehash in at the bottom. Medium-length story made short, the administration seems like they're willing to drop support for a public option in favor of a network of private, not-for-profit cooperative insurers.

What does that mean? Are health insurance co-ops -- non-profit organizations that provide an alternative to private insurers -- going to serve the US in the same way that the public option will?

Looking into it just a little bit, I can already see a few differences. 1) Negotiation power. The NYT makes this point -- small co-ops, regional or local co-ops, have less muscle to force price cutting by hospitals and pharmaceutical companies. 2) Regional inequity. The co-cops here in Los Angeles will likely be really nice -- there are a lot of motivated people and a lot of resources pressed up together. In Arkansas, though, or Georgia, they'll probably be considerably less nice, because enrollees will have less money with which to support the co-op, more problems, and the talent and dedication needed to run the co-op itself will be spread over larger areas. 3) Secret profit. Lots of 'non-profit' organizations are actually highly motivated by profits in the form of individual and executive salary -- this could provide the same incentives to deny care in order to 'keep the co-op afloat', i.e. maintain the for-profit employment of the not-for profit's employees. Because there will likely be many of these co-ops, government oversight will be a challenge.

These are significant concerns. They can be addressed -- a national purchasing system that unites the co-ops, for example, or some kind of federal sliding scale for funding them. Whether that will happen or not remains to be seen. What I am not interested in, very specifically, is analysis of this nature, from Cenk Uygur. Here's the key spot where he and I part company:

"But that's still not the main reason why the public option is so important. It's because it is a standard bearer. It is a road sign. It tells you what Obama is all about. Is he willing to compromise something he knows is essential to get a deal done so that he can brag in the next election that he got "healthcare reform" passed? Or does he actually give a damn about policy and getting it right? That is the central question."

This is not a standard bearer -- this is a policy. Uygur has here joined the ranks of people who are playing political football with health care reform -- I've become used to calling them "Republicans" -- and who are interested in forging win/lose politics and short-term horse-race headlines out of this very complex issue. A public option has to be for everyone, and that includes the farm family in Iowa who doesn't trust the government, or the 46% of the nation that voted for John McCain. That the far left is willing to sniffle and return to their tents because they lost a legislative battle, and that they can only conceptualize opposition to their chosen reform as an unwillingness by their elected officials to "insist" on a public option, shows a certain lack of civic engagement.

Which is to say that we should all maintain strong support for a policy that will cut costs, insure the uninsured, increase the quality of care, and strengthen competition against and between insurance companies. The reason for that? Comments like this one, from a man who had to fight his insurance company to receive lifesaving and medically necessary treatment. The goal of the public option is identical to the goal of health care reform -- better care for people. Narrow-minded dependence on scorecard politics isn't going to improve our health care.