Paul Krugman says the demands of the Blue Dogs for "fiscal responsibility" in health care reform are contradictory and incoherent:
There has been a lot of publicity about Blue Dog opposition to the public option, and rightly so: a plan without a public option to hold down insurance premiums would cost taxpayers more than a plan with such an option.
But Blue Dogs have also been complaining about the employer mandate, which is even more at odds with their supposed concern about spending... [W]ithout an employer mandate, health care reform would be undermined as many companies dropped their existing insurance plans, forcing workers to seek federal aid — and causing the cost of subsidies to balloon. It makes no sense at all to complain about the cost of subsidies and at the same time oppose an employer mandate.
It's a huge problem that a group like the Blue Dogs, with their financial ties to drug and insurance lobbies, is in a position to decide the fate of health care reform.
But there's another deeper problem here. As Digby says, it's been a mistake to let deficit hawks like the Blue Dogs and their Republican soulmates define the parameters of the health care debate:
[T]he Democrats...spent the last 25 years bowing and scraping to the Republicans over balanced budgets like a bunch of 50s era housewives answering to a domineering husband (and then stood by idly as their husbands blew the family savings on gambling and hookers.) They are also to blame for failing to properly explain that the "savings" from health care reform was going to be seen in the system as a whole, not necessarily the government portion of it, which would likely be realized later.... At the very least they should not have paid obeisance to all these fiscal scolds and deficit hawks the way they did. It's a little self-defeating when you are proposing a new program that was always going to cost money in the early years. I don't know how they ever hoped to finesse this.
How pathetic is it that the current batch of elected Democrats, now holding the Executive, the House, and 60 seats in the Senate are still looking for a pat on the head from the cut-throats on the other side of the aisle? Cut-throats who want nothing more than to kill the Dem agenda, especially real health care reform.
And the Dems will help them do it if they stay with this "saving money" approach to health care reform. The Congressional Budget Office is giving them fair warning that savings won't be substantial, at least if the current for-profit framework is kept substantially in place. The point of real health care reform can't be - shouldn't be - purely to reduce costs.
If Democrats cannot stand up and say that America is worth paying for, that we have an overclass in this country that's had it very good for a long, long time, that rampant inequality threatens economic stability, and that the way to a sustainable future includes paying for the commons that we all share, we'll really never get anywhere...
Conservatives since the Reagan era have determined that America has an innate selfishness that they can exploit, to claim "the other guy" is getting your tax money, and everyone should resist it. As government has provided little of perceived tangible value since the invention of Medicare in the 1960s, they've been able to get away with this. But it's not a path that can hold.
It starts by making the argument that while nobody likes taxes, nobody builds their own roads, or schools, or police and fire departments, or health care infrastructure, and government needs to act as a provider of services. This is basic stuff that has been pushed aside in our national debate for far too long. In the final analysis, we have a selfish and cruel segment of society that has been allowed to rule the roost for decades, promising their constituents endless services and endlessly low taxes forever. Democrats have the choice of accepting that and permanently nibbling around the edges the few times they get into power, or making the argument that we can have a better society.
To say you're pursuing health care reform primarily in order to cut costs is to start off within a Republican/conservative frame of reference, in which public spending is always bad and to be minimized. It leaves out the whole idea that something of tangible value can and should be created by public spending that will improve the lives of the vast majority of the population.
Aside from being a lost opportunity to push a progressive reframing on public spending, it's also a dangerous frame, because health care reform that's going to actually accomplish anything worthwhile for people who don't have decent health coverage is going to cost. It's going to cost the government. It's going to have to be paid for outside of market conditions. The market can't provide what people actually need in this case, at least at a price they can afford.
That's why Obama is getting himself twisted up in nonsense like trying to reform the health-care system without making substantial change to it.
Democrats shouldn't be shying away in terror from the Republican/Blue Dog mania about "tax and spend." Instead, they should be talking about the tangible value that real reform will create, i.e., guaranteed access to needed care and removing fear and insecurity that coverage might evaporate at the very moment it's needed most.
They should be talking about health care as the way a decent society supplies all its citizens with a basic human right - the right to medical care. Republicans and Blue Dogs need to be excoriated for caring only about money and not caring one whit about the lives and well-being of their fellow citizens.
Here's an example of what the actual point of a universal health care policy is supposed to be:
... The primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers...
Continued access to quality health care without financial or other barriers will be critical to maintaining and improving the health and well-being of Canadians...
Wise County, Virginia:
Let the Republicans and the Blue Dogs tell people like these to their faces that they don't need fundamental change, that they already have universal health care, and that in the best health care system in the world that easing their pain and suffering is just not worth the price.