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This is the last part of the series about the economy, health care and the budgetary restrictions of the Obama agenda.
Nobody said that being liberal was easy. If we let the seduction of prejudice and laziness prevent us from doing the hard work necessary to make of the Obama presidency a transformative one, we will have nobody else to blame but ourselves... while Palin is sworn for her first administration.

5. Conclusions about health care reform
(i) Nobody misses what nobody has seen before. It’s necessary to count with health care reform even if it begins with subsidies only for those under 150% of the poverty level. Of course, this would be a weak favor to the real values behind health care reform if we would not consider a phase-in to a 500% of the poverty level. For this not to be an empty promise a future Republican administration could easily reverse, it would be advisable to include a system of triggers attached to other kind of expenses. Thus, an increase in defense spending or any tax cut would be possible only if it is accompanied by a proportional increase that helps close the gap between the 150% and the 500% level. Whether using a flexible taxation, flexible phase-in, flexibility of the benefits package or flexibility in the access to subsidies available, financial sustainability is a must if we want health care reform to be irreversible. Of course, that 500% is subject to periodic evaluation to make sure it doesn’t bring unfair competition with the private sector. Private competition is not an objective in itself and should be justified in their efficiency and not in the public option overpricing its services to conceal private sector’s inefficiencies.

(ii) The public option is absolutely necessary. Even though theoretically health care reform could be achieved without a public option if we apply tight regulation, the profits made by health insurance companies will constitute a permanent temptation to roll back the lines of any reform. Only an entity whose benefits are internalized in the lives of the population, the public option, can have a chance to make the social benefits of health care reform permanent. Even if in the future a Republican administration put that entity in inefficient hands, it will always be possible for the population to compare the current administration with the previous ones as everybody could compare the FEMA of Bill Clinton with the FEMA of George W. Bush. Of course, this implies a minimum of political debate without which there is practically no limit to what the American public could swallow. Examples of this risk are too many to risk another ‘Harry and Louise’ or ‘Willie Horton’ tactic.

(iii) A public option should not provide subsidies those over the 500% of poverty level to compete fairly with private options but those subsidies could begin at the 400% of poverty level while the overhaul of the health care system has time to reduce health care costs that, at the end, affect the costs of the insurance companies. Exceptions to this rule should result only from specifically identified cases. The public option taking many uninsured people from the emergency rooms will help insurance companies reduce costs in the near future. It’s absolutely ridiculous that Republicans depict as something absolutely unavoidable that the public option will push private insurance companies out of the market as it all depends on when what groups are benefit by subsidies but it is even more outrageous that Democrats has not been able to make this point clear in at least one public presentation.

(iv) Regulation, free imports of medicines or co ops could be complementary measures but not substitutes of the public option. In the case of the co ops, they would not count with the leverage necessary to bargain prices and produce results to which the population get used at a level that made health care reform irreversible.

(v) On funding health care reform Obama has to be very conservative. Obviously Republicans has target health care benefits for taxation because they want to weaken or at least scratch unions. Capping both itemized deductions and exempted health care benefits can give Obama a bigger margin of maneuverability and, legitimized now by health care reform and later by a sustainable recovery of the economy, he can always scale back in the future any taxation on health care benefits. Considering taxes on sugary drinks and the extension of the 1.45% Medicare tax to capital gains earned by high-income taxpayers should also be part of a basket guaranteeing resources for health care reform. An underfunded reform would make easy for Republicans to kill health care reform still in his crib, before people has gotten used to it.

(vi) Triggers making the public option wait until private insurance companies had failed to meet certain standards should be considered unacceptable. Otherwise it would be very easy for Republicans to kill a reform nobody would miss because nobody has had a chance to internalize in their lives. Republicans remember Bush waiting too much to launch his project of retirement private accounts and failing as a result. Making Obama wait, they expect to regain their filibuster power or at least erode Obama’s popularity making him repeat Bush’s story. They know that, with a number of moderate Republican Senators reduced to two, if Obama doesn’t get health care reform done this year, he won’t have a chance to pass it even if he is reelected. A ‘pay or play provision’ could be necessary to properly fund health care reform. A weakly funded reform will be a permanent temptation for Republicans to bring the reform down. Republican Senators like Olympia Snow are willing to negotiate on this issue.

(vii) Conservatives, both Republican and Democrats, expect to kill the public option which could represent competition for insurance companies, but expect to increase these companies’ clientele with the 47 million uninsured thanks to governmental subsidies. Thinking that special interests imply only direct contributions to conservative politicians could be fatally naïve. The best way to secure the battlefield for health care reform is selling the idea to their constituents while denouncing cases like Lieberman’s, where his reluctance to a public option doesn’t result from running for conservative constituency. Cool 140-character Twitter messages and Survivor 30" ads will not do the trick.

(viii) Obama has to twist arms (in private of course) with the same toughness Lyndon Johnson did. Failure to pass serious health care reform will weaken his position on 2010 and, if Republicans get back their filibuster power, they will sabotage easily Obama’s expectations of having a transformative presidency. Calls to bipartisanship like Reid’s should be addressed the same way. Having 60 Democrats in the Senate is very useful for Obama as he can put extreme pressure on any Senator even considering joining a Republican filibuster.

(ix) Reconciliation should be the last resource as it seems that laws passed through this process have to pay for themselves in 6 years while this term is 11 years for laws passed though the regular channels. Nevertheless, passing health care reform through reconciliation or through the regular process is a secondary issue as the hopes of a durable health care reform rely on it having enough time for people to internalize it in their lives and being financially sustainable.

(x) Democrats should not expose themselves to the embarrassment of being so grossly corrected by the CBO again. This has gravely damaged the image of Democrats on this issue before important constituencies.

Final thought on health care
I hope to be wrong but what I expect is to see Republicans resurrecting Harry and Louise on steroids, falsely attacking health care reform over and over of bringing socialism, taking over the health of American citizens, increasing taxes, surrendering our freedom to the whims of bureaucrats, destroying jobs and even of selling our children into slavery in Turkey. Unfortunately I expect the Democratic answer to be like this: "The American people are great people. The American people have voted for change because they are wise and generous people. The American people have spoken with optimism because the American people... and the American people... and the American people... America is a great and proud nation". Exaggeration? How many Democratic ads or messages have you seen defending the public option? Amid these encounter between venomous lies and generic sissy statements, the Republican lies will make roots and Obama will lose support for making health care reform on his own terms, what will make of it a laughable band aid financially unsustainable but a good source of windfall profits for insurance companies eager to expand its clientele at the expense of the American taxpayer and by then everybody will have forgotten that our health care system is the most expensive of the world but has Third World indicators on infant mortality or any other relevant number. Instead of us being ridiculing their proposals of solving this problem letting people buy insurance across state lines and increasing tax deductions, it is them who are taking over this debate –Yes, this one too. After some time, people will begin to repeat the idiotic credo of the Right (as has happened with many other issues, from Iraq to taxes to immigration) and health care reform will be postponed or transformed in a caricature of itself.

If you expect that cool, non-confrontational, empty 30" TV ads will make the trick, you probably still believe in unicorns. When I was a volunteer for the Obama campaign I had some clashes with those who saw political campaigning as a choreographic organization of massive cheerleading. Once I propose to launch ‘Obama tents’ (similar to the tents I had proposed to Hispanic leaders to spread light over the many misconceptions sowed by the xenophobic Right, themselves based on the successful experience of the Argentine ‘Carpa docente’). Of course, I was dismissed, getting to the Metro Station on my way back to Maryland I could see a small table with independent volunteers doing something similar to what I was proposing and I was so excited that I joined them that afternoon. I could see how their efforts were much more fruitful than the official results. Whoever wants to think that cool choreographies and 140-character cool Twitter messages will put pressure on Senators like Feinstein and Lieberman on one side or Baucus and Conrad on the other side, is playing to fly planes based only on his experience with videogames and his firm Joystick hand. Life is not fair. It is plagued with examples of some people paying for the mediocrity of others.

So, what I am going to do after finishing this entry is watching Sicko and pretending it is fiction; pretending that the uninsured people abandoned in the streets by hospitals are just actors. And I thought that, after Bush 2000 and 2004 Palin 2012 was laughable!

Appendix
The unread announce the coming of Sarah Palin and some imbeciles celebrate it
I have seen some a couple of critics to this series. It has been those poor attempts to refute my positions in the entry or just suggest any reader that is not worth the pain to read the entry due to the way my name sounds or how they imagine my personal life. As surprising as it could sound to an adult, one is about how funny my name sounds and the other one is summarized in the merciless phrase "get a life". These imbeciles, voluntary or involuntary minions of Michael Steele and his strategy of preferred hats, disapprove of my long argumentation and declare that the correct way to address serious issues that affect thousands of lives is in cool phrases written in 140-character messages; exactly what Michael Steele wants you to do. These imbeciles, without the skills or the courage to engage in an adult debate, hide behind nicknames and, at best, think that they could help the Obama administration by partying and looking naughty.

Steele’s strategy of preferred hats pretends that political affiliation should not be a matter of research, debate and ideas to honor ideals and to move plans and strategies based on those ideals but a matter of arbitrarily chosen styles and preferences, as when you prefer strawberry to chocolate.

No major transformation has been made without a solid intellectual base. I have noticed that the improvisation shown by the Obama administration in their lack of capacity to respond quickly to the CBO objections to their lack of capacity to formulate an alternative counterinsurgency to Bush’s (what we have seen in forward and backward movements on the role of our military in Iraq, Guantanamo and the detainee abuse photos). While the Right has spread the influence of its pseudo think tanks, with Heritage at the lead, the Democratic Party can hardly rely on the Brookings Institution. The next step is the way we can reframe the debate in a different way than the Right has done in the last decades. On health care, just to mention an example, we should be able to communicate what I have mentioned in this series about how unfit are co ops to replace a public option on making health insurance companies more honest. Reducing the political debate to short and cool slogans is the way of communication preferred by the Right because it does not make room for the information what would crash the dishonesty of its message (to begin with, co ops would not be able to have an acceptable participation in the market in less than 40 years). In a short of puerile dichotomies, increasing taxes is bad, decreasing them is good; more government could be bad but government bureaucracy is bad and less taxes is good. Amazingly, some imbeciles inside the Democratic party push for oversimplifying the debate to puerile levels. It should surprise nobody that the level of political education of those preferring Right-wing media is very low. As I have said sometimes, the idea of publishing these entries in Daily Kos for me was to engage in a healthy debate that could enrich us all for the moment we could direct this message to the public, whatever the marketing strategy we use according to the circumstances, without forgetting that we have to prepare the field as the Right has done since the 70 to prepare the way for Ronald Reagan. In general, the ground for honest Democrats, liberal or conservative is not too promissory. It’s this side of this side picture what I am going to address in this appendix, which I have added to the original series.

[UPDATE 09-17-09]
If I had to choose between co-ops and a trigger, I’d go for a trigger because it lets the debate be reignited again in a few years but only if we are willing to grow up over the infantilism that has plagued the liberal activism these last years (http://www.dailykos.com/...). Quoting the case of Social Security, which began excluding many groups which were included later, is naïve. Financial regulation was set in the 30s only to be perforated and disassembled 50 years later. Of course, Social Security is something that people internalize in their lives more than banking leverage or derivatives regulation but beginning with a restrictive or bad bill do not lead to a good bill unless clear the path for that evolution be possible.
On the other hand, the option of regulating insurance companies tightly, like in Switzerland, is a very risky option because insurance companies are already used to the profits resulting from oligopolistic fragmented markets what means that they already know not what they may lose but what they will lose in more competitive conditions. This means that this would constantly try to water down the new regulation. That’s why an institution whose effects people can internalize in their lives, like Medicare or Social Security are today, are a much better option. If liberal activism is ready to grow up to clear the path for this debate in a few years, then a public option limited to the uninsured could be an acceptable provisional compromise. If the alternative is the Max Baucus bill, no bill at all would be the best option.
On the other hand, complacence with the reduction of liberal activism to cheerleading while the Right astroturf civically outraged ‘common folks" or expecting to beat financially with small contributions the funding made by the health insurance industry in order to air 30" TV ads that, if not victim of zapping, cannot compete with the 24/7 preaching of Fox News and the Religious Right is naïve to say the least. Even the most bizarre accusations got around 50% of sympathy in some polls. Furthermore, for Max Baucus or Kent Conrad to fear a challenge and not to laugh to another Lamont, we need to engage into a sustained effort to deal with the people for whom the Right plays his Tea Party and 9/12 shows. To Town Halls I have added some suggestions in previous entries (like Carpas Docentes and personalized e-mails) that I believe can work to generate a "What’s the matter with Kansas" process in reverse. Only if we get that, Baucus and Conrad will fear us. The Freedom Riders of the 60s were not famous because they exchanged cool 140-character messages on their couches. They rode into the entrails of the White Supremacist South and many were sent to the hospital by its goons but that’s precisely why they won.
Finally, in the entry mentioned in this update I have criticized Obama for many things but I don’t think he had faked his support for the public option from the beginning. If he had wanted health care reform to be a shallow reform that ended up widening with subsidies the market for health insurance companies at current prices, he would have begun with single-payer. Single-payer, for a misinformed people (to whom we have made nothing to inform seriously since Organizing for America became a choreographic act) would have sounded as more radical and would have been an easier victim of the Republican labels. In other words, single-payer would have been much more easy to drop than the public option.

  1. Book circulation per US public library per user per year (http://www.galbithink.org/...):

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  1. Mathematical literacy (OECD, 2000) (http://www.nationmaster.com/...): 18/27 (rank 18 out of 27 developed countries)
  1. Adults with at least moderate literacy (most recent) by country (OECD. 1998). The indicator refers to those over 15 who can read and write (http://www.nationmaster.com/...): 11/17
  1. Reading literacy of 15 years old. OECD, 2000 (http://www.nationmaster.com/...): 15/27
  1. Scientific literacy of 15 years old. OECD, 2000 (http://www.nationmaster.com/...): 14/27

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Originally posted to Alfredo Martin Bravo de Rueda Espejo on Wed Jul 29, 2009 at 12:13 AM PDT.

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