With regard to health care reform...
Is the sky falling?
No, but it's stormy. It was entirely predictable that it would get stormy the closer we got. There's a reason why the U.S. doesn't have universal health care and why Obama has gotten farther in his quest to deliver on health care reform than any president in decades.
So my handwringing is justified?
With regards to Congress, yes. I did think that the handwringing over what the White House wanted and jumping on every morsel from a White House staffer or Obama was ridiculous and a waste of time. The WH's stance on health care was never the problem. Said this all in March:
The problem is NOT the Obama White House. It's the Senate. The 'enemy' is, of course, those who are against any reform at all, if they can help it -- health insurance companies.
Yeah, but you neglected to add "health insurance companies, Republicans, and Democratic fools."
Yeah, I didn't spell that out, but I figured that was implied when I said health insurance companies.
Can't we just knock some heads and get this done?
Ha. We all wish this were the case! It's not like LBJ or FDR got universal health care done when they were president, and as I said, Obama's gotten farther than anyone.
But getting big ticket legislation was so easy for previous presidents!
Health care reform on this scale is not comparable to any of George W. Bush's major domestic proposals in his first term (tax cuts, NCLB, Medicare Part D). The most powerful entrenched interests weren't against those pieces of legislation, and the interests that were against those policies had less power than the interests that are fighting us on health care reform. Those were easier fights and less ambitious from a political standpoint. Health care reform is closer to Social Security reform in scale and difficulty, and Bush went down in flames on that in 2005.
It took a year for the Civil Rights Act of 1964 to go from being introduced to passing both chambers. It took Reagan months to get his tax cuts through Congress and he concentrated almost exclusively on that aspect of his domestic agenda from the beginning of his term (which Obama couldn't do by virtue of what he inherited), and Obama is already looking like FDR/LBJ compared to Clinton's first year.
Anyone who tells you that it was easy for other presidents or that there weren't compromises made has a pretty glorified view of exactly what happened.
Is it all Harry Reid's fault?
No. (But UGHHHH)
Is it all Max Baucus's fault?
No. (But Double UGHHHH)
Who's fault is it?
We have a great democracy here in this country, but this nation is slow to change. And the Senate is designed to slow things down.
Yeah, but who specifically?
Well, there are bigger Democratic tools on this issue (in the Senate) than Max Baucus.
So what? We've got reconciliation, don't we?
Reconciliation might be the only way to get the best parts of health care reform but it isn't the best way. To my knowledge, the Dems still want 60 votes for cloture for a comprehensive plan. We do not and likely will not have all 60 Dems. We need some GOP votes. It's pure Senate math. (I know, blech.) It doesn't help that we don't know if Ted Kennedy will ever vote again. His absence (as well as Byrd's) has meant that a major voice in the Senate isn't around. Kennedy actually has good working relationships with GOPers, too.
So, what about the House? We should get a better bill there, right?
Yes, but I do wonder if the House will want to move further ahead on elements that some have deemed more controversial if the likelihood of it making it into the final bill is nilch. Hopefully they will, so in negotiations we don't have to give up any more.
In any case, as we saw with ACES, Pelosi and her team know how to whip a vote.
Shouldn't the public option be a no-brainer?
Yes from a policy standpoint for progressive, moderate and conservative Democrats.
But from a political standpoint?
It was always an uphill battle to get the public option in the final bill, as I said in March.
Personally, I think that the public option is a no-brainer from a political standpoint, because it's unlikely that employment will have rebounded significantly by the 2010 elections. Democrats will need something to campaign on, so that the base comes out. Many of the Democrats that are the toughest arms to twist right now do appear to be those who are either not up for election in 2010 or are fairly secure in their reelection.
But you've got a lot of Democrats (and a traditional media and pundit class) stuck in the 1990s...
So, what's the likelihood that the public option stays in the bill?
Not sure. from the beginning, I personally didn't think that the chance of the public option being a part of the final health care reform was higher than 50-50.
Is it worth it to keep fighting for the public option?
Of course! Contact your member of Congress and make sure you let them know how you feel. Email, call and fax. (Snail mail may not be best because there is a delay in that mail getting to the office.) Not just the D.C. office, but the district office, too. Also, find out when your members of Congress have office hours or town halls, and pay them a visit! Write LTEs and get the word out in your community. Join up for OFA health care events. It's important that if you're a small business owner or a health professional, that you register your support for a public option either directly with your members of Congress or in an LTE or op-ed for your local newspaper. Having the support of small business and health professionals will go a long way in giving reluctant Dems political cover.
Still, didn't Obama say he wanted us to shut up?
No. That statement was misinterpreted. Messaging to members of Congress is important. He wanted people to stop attacking members of Congress and to start ratcheting up the pressure. It's one thing to say that so-and-so is on the take, and another to say that the public option is necessary and waiting will only cost us more money in the long run. It's another to say that thousands lose health insurance every week.
Or to put it another way, there's a right way and a wrong way to go about dealing with the most reluctant of Democrats.
If no public option, is health care reform still worth doing?
Yes. Really tough regulations can make a big difference. (Not as much as a public option, of course, but a difference nonetheless.)
So do you think we'll get health care reform this year?
Yes, health care reform will happen. It just may not include the public option.
So what is the hold up? Lobbyists? Health care industry money? Are these guys just on the take?
Entrenched special interests (and their money) are a big problem. But there's more to it than what you get when you look up donations by industry on OpenSecrets. That so many former staffers are now lobbyists for the health care industry sucks. It doesn't help that Evan Bayh's wife works for an insurance company. Don't limit influential people to just former staffers and family though. Which big donors may be particularly influential? Which in-state stakeholders may be helpful? If someone used to be a state legislator, getting a former colleague who has a good relationship with that member of Congress, to advocate for the public option could be helpful.
But still, what are Democrats afraid of? They've won big the last two election cycles, so what's the deal?
Some of those members who won recently aren't entrenched yet. Some members won by going to the right of most Dems, so it's no surprise that they're going to be that way while in office. Some have also had tough reelections and have irrational fears of what could do them in. Also, a tougher political environment in 2010 for Democrats is likely, so some are scared of looking too liberal. In addition, conservative Dems attract conservative Democratic staffers who sometimes can affect the stance a member of Congress takes. There are a lot of progressives, but even some progressives will moderate their advice if they know the boss is more centrist. Also, pay attention to what political consultants, pollsters (not the media ones but those who work in politics for a living), and in-state commenters are saying. Political consultants talk to their old clients, too. It doesn't help that Marjorie Margolies-Mezvinsky is telling the WSJ that her vote for tax increases cost her her seat in 1994, when some Dems from affluent districts are balking at tax hikes on the uber wealthy. (Marjorie has a skewed view of exactly what caused her loss. Had she voted differently, she probably still would've lost given the makeup of the district back then and her husband's legal woes.) Now, I'm not saying that quotes like that are the biggest f-ing deal ever, but it doesn't help.
Still, doesn't the fact that polls show that three-fourths of the country support the public option count for anything?
Counts for something but the polling on health care reform is more complicated than that. Support drops when you get into the details, and when the other side is messaging against it.
Well, we can message for it, right?
Sure. Urgency is important. Emphasizing the long-term benefits to doing health care reform now is important. Talking about the cost of doing nothing being the most expensive option possible.
But the media sucks
Yeah, their reporting on the AMA's stance and the CBO estimates has been atrocious.
How can we get them to report on the truth?
Well, we can't change the fact that much of the media is stuck in the 1990s and that we've got a lot of idiots in the media. But acting as watchdogs (for local and national media) and donating to Media Matters helps. Work around the media and try and persuade your friends and neighbors.
OK. Back to Congress...members are working on something that affects everyone! They represent me even if I don't live in that district or state! They take out of state donations, don't they?
Yeah, but it's about the people who vote for them. One of the easiest ways to undermine any representative regardless of party and regardless of the lean of a district or state, is to paint a member of Congress as someone who has "gone D.C." or "gone national." Ya know, someone who has stopped paying enough attention to their district/state in the eyes of the broad electorate (not just the activists). This has hurt many politicians like Liddy Dole, Rick Santorum, Phil Crane, and Joe Lieberman. It's said that former VA Gov. Doug Wilder's approval ratings dropped when it looked like he was exploring a presidential run.
Ugh.
I know. I should also add that you have to look closely at each individual member of Congress and each district/state. You can't successfully lobby the most reluctant of Dems unless you understand the district and what would hold sway with that member (and as noted above, you have to go beyond just following the money). A member may have a pet issue, and if you can relate that to health care reform (or whatever issue is at hand), then, you may win support. (For example, Arlen Specter hearts NIH, adding funding for NIH to a bill will likely help ensure Spectr's support.) Reluctant Dems are going to want something to make it look like they didn't succumb to those pinko commies. They are going to want to hear arguments framed in such a way so that they can say that they stood up for their principles. You'll also want to know who among a member's colleagues is he/she close to and who is influential. There's a presumption that Congressional leadership is always where all the blame lies (whether it's Pelosi or Reid) when something goes awry in the legislative process, but there are members of Congress who are respected for their knowledge of policy in certain areas, who hold sway, too. For example, we know that when John Glenn was in the Senate, his colleagues would go to him on all things NASA given his background.
We've got to do a better job of not only getting to know how Congress works from a procedural standpoint but also how the interpersonal relationships affect legislation and the individual concerns that a member of Congress has. (An example of a member/district profile here.) You've also seen splits in the Blue Dog coalition, right? On health care, currently, the split appears to be an urban/suburban/rural divide. Rural Blue Dogs are more likely to oppose the House version of health care reform than those Blue Dogs coming from non-rural districts. Tailor the message based on what you know. If you live on a farm in a rural district represented by a Blue Dog, point out that you live on a farm. Work it into your correspondence with that member's office.
As far as health care reform goes, Thursday, July 23, 2009, sucked.
Yeah, I know. But we shouldn't get too mired in the day to day. All is not lost. So get cracking:
Organizing for America's Health Care Action Week
FDL's Whip Count Tool
Contact House members
Contact Senate members