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Starting over

Kevin Drum is baffled by the progressive demand to "start over" on health care:

If you don't like the Senate bill, fine. Don't support it. But in what universe will healthcare reform get revived anytime soon if it dies this year? 2010? With the legislative plate already jammed, healthcare reform probably polling in the mid 30s, and midterms coming up? 2011? After Republicans have gained a bunch of seats in both the House and Senate thanks to public disgust with Democratic disarray? 2012? A presidential election year? 2013? 2014?

I usually don't say much about legislative tactics because I figure you need some serious ground level knowledge before you mouth off about what's possible and what's not on Capitol Hill. But the fate of failed major initiatives is so obvious that I can't believe anyone is taking this seriously. When big legislative efforts go down in flames, they almost never spring back onto the calendar anytime soon — and that's especially true when big healthcare bills fail. It didn't happen in 1936, it didn't happen in 1949, it didn't happen in 1974, and it didn't happen in 1995. What makes anyone think it will happen in 2010?

If healthcare reform dies this year, it dies for a good long time. Say what you will about the Democratic leadership, but Harry Reid, Barack Obama, Rahm Emanuel, Nancy Pelosi, and Steny Hoyer all know this perfectly well. So do John Boehner and Mitch McConnell. (Boy do they know it.)

By Ezra Klein  |  December 16, 2009; 7:00 AM ET
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Next: Joe Lieberman, Jay Rockefeller, and Sheldon Whitehouse's bid to save the Medicare Commission


Ezra, instead of just pleading for people to support the latest bill, and saying things like, "this bill is the most important social policy achievement since the Great Society", perhaps you could help provide important details about the new bill and let us make up our own minds based on whether it is a bill that actually accomplishes anything.

The following questions are regarding a bill without a public option or medicare-buy-in:

- Can insurers set arbitrary annual and lifetime maximums?

- Can insurers set arbitrary coinsurance and deductible levels?

- How will this bill reduce costs for the government and individuals? How much in the first two decades? Will premiums instead rise?

- What percentage of Americans will have adequate insurance ten years from now (if this bill remains unchanged in that time)?

- Will insurers be able to reject applicants because of pre-existing conditions? If not, why then the perceived need by Democrats for medicare-buy-in or the public option?

- Will insurers be able to withhold medical payments from the insured sick (recision)?

- Will this bill substantially reduce the number of Americans who go bankrupt because of medically-related expenses and also reduce the number of deaths due to people being uninsured?

Posted by: Lomillialor | December 16, 2009 7:43 AM | Report abuse

The course of true health reform never did run smooth. We had many ups and downs in Massachusetts before passing our landmark legislation in 2006.

Posted by: chipjh | December 16, 2009 7:53 AM | Report abuse

Keep in mind, passing an unpopular bill may actually do more to defeat HCR than putting it on the backburner for 3-5 years. Ezra may not be old enough to remember 1989 when Congress passed the Catastrophic Health Care act to "protect" seniors from being driven into bankruptcy by nursing home expenses. It was actually fairly good policy and initially gained the support of several senior advocacy groups. Unfortunately, a few others, includling an overly influential advice columnist, saw an opportunity to rake in cash and contributions by demogouging the bill and created a firestrom among seniors. The bill was repealed in the next Congress and I guarantee you no one the Hill will touch the subject again for at least another decade, maybe longer. Which is unfortunate because if we had stuck with the policy, many of the long term health costs would already be covered. BTW, this was also one of the last instances of bipartisan cooperation on health care legislation and Republicans who supported the bill were rewarded with Democrat attack ads in 1990 defeating many of them, a not trivial fact remembered by many Reublicans in Congress today.

Posted by: WoodbridgeVa1 | December 16, 2009 8:09 AM | Report abuse

it's beginning to look a lot like christmas,
and howard dean is beginning to sound a lot like ralph nader.

at this point in time, for people to threaten to walk away from the bill, thinking that starting over again, is going to bring them any closer to having everything they hope for, is a fantasy.
it is naderesque.
it does not surprise me that howard dean would advocate kill ing the bill now. i am glad that howard dean went more into politics than health care. if he couldnt immediately heal a patient, would he just throw up his hands and leave him to die on the table?
that is just what ralph nader would do.
if his perception of the ultimate good cant be achieved, then he will take everyone down in flames with him.
we have seen this play out before, with dangerous consequences.
this is the influence of the generation of those of us that grew up in the sixties. it was a generation that lived in an america of plenty, and a generation that was raised, believing that one could seriously have everything that they wanted, and other happy fantasies.
i think that those that would walk away from a very hard-won bill...instead of continuing to work for improvement and this point, are escaping from the reality of what is possible at this moment in time.

Posted by: jkaren | December 16, 2009 8:18 AM | Report abuse

Excellent observations jkaren. Harvard sociologist Theda Skocpol had similar observeations in her text "Boomerang" analyzing the failure of the Clinton intitiative in the early 90's.

Posted by: chipjh | December 16, 2009 8:52 AM | Report abuse

For years, the Republicans have courted the Right Wingers by promising that they would end abortion. Over thirty years later, those promises have not been kept.

The Democrats have played the same game with progressives, promising health care reform. The time has come to put up or shut up. If the Democrats fail to deliver, this can no longer be a credible campaign issue for them. They simply will not be believed when they promise to reform the health care system.

There are those who argue that the choice is between this health care reform bill and the status quo. However, the choice really is between what sort of change we will have, because the status quo is not stable and cannot be maintained.

While supporters of this horrible bill talk about he consquences of failing to pass it, the bill does nothing to alleviate the problems for which it was created, and most likely, it will aggrevate them.

Regardless of whether the bill passes or not, medical costs will continue to skyrocket, more and more employers will drop or reduce health care coverage, medical expenses will remain the leading cause of bankrutptcy and 45,000 plus Americans will continue to die every year because they lack adequate health care. The only difference is that the average American will be forced to purchase overpriced and crappy health insurance. No, thank you.

This awful reality will continue to place pressue on our leaders for meaningful reform. Any politican who believes that he can expected to be reelectd based on this craptastic "reform" is not living in reality. Pretending that the current bill is any sort of fix for our health care system only demonstrates that its supporters are the ones living in a fantasy world.

Posted by: HighPlainsLawyer | December 16, 2009 8:58 AM | Report abuse

...But the bill ain't no good, jkaren, it ain't no good. You can't FORCE me to purchase health insurance without providing me with decent alternatives, for gosh sake! I'm in my early 50's, work for a tiny company that can't afford me health insurance. I can't afford it either, so I have none. All this draconian pile does is force me to purchase what I can't afford. (By "can't afford" I mean that it would take virtually all of my disposable income and I choose not to do that.) I've already suffered some by choosing not to be insured, but it's my choice. By advocating for the bill as it's become, you're essentially making private industry the government and putting me, and us, at their whim, it seems to me. You're just eliminating my remaining choices, poor though they are.

At least if you're going to force me to purchase insurance whether or not I can afford it, provide me with
a) a government provided policy that I at least have a citizen's influence over, or
b) heavily regulate the industry, again, so I at least have a citizen's influence over it.

This turkey's been overcooked. It's ruined.

Posted by: jonboinAR | December 16, 2009 9:38 AM | Report abuse

The catastrophic health care act seems a lot like the exception, rather than the rule. Even so, let's game this out, knowing what we know now, when it comes to the history of health care reform.

The options are:

a) The act passes, and the parts of it that are inadequate get tweaked over time

b) Congress pulls the legislation, and no one touches it for another 20 years

c) The act passes, and it gets repealed in 2 years due to public outrage

d) Congress pulls the legislation, and they come up with something better 3-5 years from now.

a, b, and c have all happened and are consistent with the history of health care reform efforts. (d) isn't very common at all and is a complete pipe dream. The most likely outcomes, consistent with what we know, are (a) and (b). So it seems to be that it is better to risk the small possibility that the legislation will get repealed in 3 years than place hope in the highly unlikely possibility that we could pass new legislation from scratch a few years from now.

Posted by: constans | December 16, 2009 9:52 AM | Report abuse

"This turkey's been overcooked. It's ruined."

you make my point exactly, jonboinAR.
there is a big difference between something being overcooked, and something being ruined.
so it is not cooked to your liking....that means it is ruined?
tell a hungry person that an overcooked turkey is not worth eating, and one should simply "throw it away."

perhaps you should reread some of the posts from yesterday, and you will find more redeeming value in what is being crafted, instead of an "all or nothing" approach.

"is the senate health care reform bill still worth passing"
"the political cost of failure"
"on cost control....."

"do what you can, with what you have, where you are."
~~~~~theodore roosevelt

Posted by: jkaren | December 16, 2009 9:59 AM | Report abuse

"Keep in mind, passing an unpopular bill may actually do more to defeat HCR than putting it on the backburner for 3-5 years."

That's exactly how I feel. This is not reform; it's a poverty program that does some good for a small population while leaving the real problems unaddressed. It reinforces the really bad aspects of our current model and provides no mechanism for getting on a better path.

This bill will not improve the competitive position of US industry. It will not improve the return on the investment we make in healthcare. And it will not change the bankrupting trajectory of escalating costs.

If this is indeed the best we can get, we need to focus on getting better legislators (who actually understand the underlying issues) rather than just being fatalistic about this non-solution.

Posted by: Athena_news | December 16, 2009 10:14 AM | Report abuse

Sorry to go off topic a little here but I'm going to put in here a reaction to Ezra's Charlie Rose comments

I was in general agreement with MUCH of what you were saying about the dysfunctionality of our legislative system BUT you draw a fallacious (word of the day) conclusion from that: that Obama and the Administration are therefore not responsible for the healthcare reform mess (or the extremely weak state of reform if you are viewing this as a step forward). I think you, Schmitt, Yglesias and Fernholz are generating a discourse about the Administration being as aggressive as it can be on reform is simply wrong. You are overlooking the ability, that comes maybe once in a generation, for a leader to reframe the debate. I'm not saying that Obama was coming into office, EXCLUSIVELY looking like another Roosevelt or Reagan, only that he had SOME of the potential. He did not realize that potential.

If Obama had (counterfactual) used the bully pulpit to mobilize people, I'm not saying that Congress would not have resisted in the ways that you see it doing now, only that they would have had a lot more of a reason to fear resisting reform. Obama left people basically cold after the election...there is no way around this.

Furthermore, anger and "populist" discontent was left to the Right, so we saw the Right, small and crazy as it is, having more on the ground juice than the Left.

In your short experience, you have not seen a liberal or left President who is nominally sympathetic to mass movements on the ground that are occurring during his Presidency. And yes, those Great Society reforms occurred during that time.

I have had personal dealings with Mark Schmitt, who as the editor of the Prospect may have some influence in your circle, and he is QUITE short-sighted about this. There is a worship of legislative and inside-the-Beltway technique and a discounting of the broad frame of political life that comes in part outside the Beltway.

Posted by: michaelterra | December 16, 2009 1:33 PM | Report abuse

Crumbs from the table, and Ezra tells us to say Thank You Sir.

Posted by: SqueakyRat | December 16, 2009 2:21 PM | Report abuse

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