That Gollum-Like Feeling on Health Care

I find myself gripped in a bitter argument -- with myself -- about the fate of health care reform. It's sort of like watching the schizophrenic Gollum in the Lord Of The Rings saga fight angrily with himself over how to deal with Frodo: "the master is so nice to me, he takes care of me and wants to help me" vs. "I will strangle him, I will crush his head against the rocks, I will feed him to the giant spider." In my case, the raging fight with myself goes more like "But there are so many nice things in this bill, I really like a lot of it, and I've wanted this bill for such a long time" vs. "those evil insurers are screwing us again, I want to kill this bill, crush it against the rocks".

Okay, now that I've officially admitted that the health care fight has driven me crazy, let me take a step back and look a bit more coolly at this whole dynamic, and how we turn this chickenshit into chicken salad. Here are some thoughts as we move forward:

  1. I think everyone in this battle needs to be honest with themselves about the negative consequences of all the paths forward. I hate to make this analogy, but this is feeling a little too much like Afghanistan to me right now, in that all of the choices have big downsides, and we each have to pick the choice we think has the smallest. Passing a bill with no public option will demoralize the Democratic base, tick off millions of Americans forced to buy insurance without the choice of that public option so many wanted, make the 2010 elections very problematic, embolden the big business special interests on the next big issues Democrats face, and create little downward pressure on insurance rates which will probably mean rising health care costs for the next several years. Going to reconciliation means serious delays as we wait for bills to be split apart, parliamentary rulings with a great deal of uncertainty to them, more negotiating over how to remake the bills and get the voters, further delaying tactics by the Republicans, more filibusters of the part of the part of the bill that can't go into reconciliation, less time for climate change and jobs and immigration reform, and the likely loss of important parts of the current legislative package. Killing the bill entirely means we lose all the good regulations and expansions of coverage in this legislation, create a devastating political loss for the President and Democrats in general, lose the chance to finally enshrine in America the idea that health care is a right not a privilege, lose momentum for future legislative fights, and quite possibly the blow the last chance in a generation to get anything big done in terms of health care. Whatever people are saying in public as they position themselves for the final days of battle, I hope they aren't fooling themselves that any of these paths is trouble free.

  • The details still matter enormously. Right now, way too many of the details favor the insurance industry. Assuming this goes to conference committee, we shouldn't just be focusing on the big things that have gotten all the attention, like the public option: progressives in the House should be fighting like tigers for the less visible but incredibly important things like improving the language on community rating, insuring people earlier, and taking more of the burden for paying for Medicaid off of the states. Some of those details may be a lot easier to improve than the high profile items.
  • One of the things progressives should absolutely extract before they even consider voting for this is a promise from Obama, Pelosi, and Reid that health care is revisited again, through reconciliation and in general, to keep improving the legislation as long as the Dems are in control. This should absolutely not be one of those deals where leadership says, "okay that was hard, we'll never go back to that issue again". Progressives should also demand a firm promise from Obama that the primary person doing the implementation of this bill in HHS should be a strong progressive, because the initial regs on this bill will be hugely important.
  • One final thought here: two of the progressive leaders I respect most on our current political scene are Howard Dean and Sherrod Brown, and the fact that they have taken diametrically opposite positions on the legislative tactics regarding whether to move the bill forward doesn't bother or surprise me in the least. This is a hugely complicated issue, and I think the good and the bad in this bill make it a close call, as do the specifics on legislative tactics.
  • Progressives should not be attacking each other over the different calls we are all trying to make.

    This has all become a mess, both policy wise and even more politically. Progressives have become divided among ourselves over how best to navigate the incredibly rocky shoals in front of us, but we should keep talking with each other and pivoting off each other as we try to improve this bill.