This is sort of a grab-bag diary of thoughts about health care, large and small, but generally involving the themes of the need to take the long view and why taking the long view doesn't always mean acting like you're doing it.
I'm essentially collecting thoughts from comments I've been tossing around for the last couple of days that I'd like to see get a little more exposure. Consider this one a sort of health care commentary dim sum.
Here's what my decision on whether to support the health care bill comes down to: does what we pass this year make it more or less likely that we'll have the sort of system we'd like to see by 2017, when Obama's definitely out of office (and a Republican might be in.)
Here are some things that don't bother me that much about the bill because the deficiencies that they will illuminate make it more likely that they will be fixed:
(a) Adverse selection leading to a more expensive program
I think that this is likely, actually. I think that the final bill is likely to be weakened enough that the public option will disproportionately be attractive to sicker, more expensive patients. I don't like this, but it doesn't scare me. That will give us an argument for either the private insurers doing more to take such patients or else the public option may give way to single payer. But I'll tell you, once the poor and sick are covered, it is going to be hard for Republicans to say "yes, we think that this person who is alive today because of this program should have been allowed to die." Those people become our equivalent of what the "snowflake babies" are in the abortion debate.
(b) The public option not covering enough people
Then expand it! "Wyden eligibility" is part of stage 2 of reform -- and it will be introduced (and I think passed) as a way to solve the first problem above.
I think that some states will -- and then they'll either opt back in or be taken over by Democrats as the populace wants what other states are getting. Look for this compromise in the next few years, if opt-out passes: the ten largest cities, as well as any county over 100,000 population, gets to opt-back-in.
(d) Negotiated rates
If they don't work, then we'll see a drive to Medicate + 5 (or maybe first +10) as a deficit-reducing measure.
I could go on, but won't. The point is that it's a lot easier to get what you want in 2017 after something is passed in 2009 then it is to hope that we continue to gain political clout in Congress -- which we probably won't -- to the point where we can pass the bill we'd like to see.
Justice William Brennan -- probably the person I'd choose as my favorite political mentor -- used to say that the most important thing on the Supreme Court was getting to 5. That is: "win the case, write the decision, everything else is secondary."
The same is largely true in politics (which of course is a dirtier game than Supreme Court jockeying): we need to get to 218 and to 50 (and sometimes to 60 -- and when we need to get to 60, we actually do need to get to 60.)
This, and the Democratic votes on a bill where we got to 220, has led me to think about what I really care about in a representative. I care about three things:
(a) Don't be the sort of crook that ruins our brand.
(b) Don't be the sort of shnook -- slagging your party -- that ruins our brand.
(c) If we really need your vote on something critical, you will sacrifice your career for the greater good. You will be a hero and fall on a grenade to save people.
The first two -- don't be William Jefferson and don't be Joe Lieberman -- are self-evident. The last one -- do be Marjorie Margolies-Mezvinsky, aka "M3" -- needs a little explanation.
When Clinton took office in 1993, his greatest accomplishment was the passage of the 1994 Budget Bill, which raised taxes, cut the deficit (more than I would have liked), and laid the stage for eight years of economic growth. That bill passed the House without a single Republican vote. (They should never have been allowed to live that down.)
The last vote to be won over by Clinton was "M3," a first-termer who represented a conservative suburban Philadelphia district. The second-to-last one, a fellow commenter reported, was Athens, GA Congressmen Don Johnson, who also deserves a statue for this. Both M3 and Johnson wanted to vote "no"; as is true of most politicians, they knew their districts better than we visitors from the netroots do. But Clinton worked on them and in the end they agreed to take the shot for the greater good -- and it was for the greater good. Both of them lost in the 1994 Republican wave, effectively ending their political careers.
In 1992 she ran for an open seat in Congress for Pennsylvania's 13th congressional district, a largely suburban district outside Philadelphia which Republicans had held since 1916. After defeating Republican Jon D. Fox in a close contest, she became a member of the 103rd Congress. However, she was not re-elected. Losing in 1994 to her 1992 opponent, she was one of 34 Democratic incumbents who were defeated in the Republican Revolution. Her defeat was blamed on her vote for President Bill Clinton's controversial 1993 budget, for which she was the deciding vote. After the vote, Rep. Robert Walker (R-Pennsylvania) reportedly mocked her, jumping up and down and said "Goodbye, Marjorie" alluding to the fact that her deciding vote would cost her the seat.
But they came through. It makes a tear well in my eye: they came through when we needed them. Heroes.
That's what I want in a politician, and that's why I can't really condemn Scott Murphy or Dennis Kucinich or Harry Teague or all of the others who voted on the bill. I can't condemn them for voting against the bill when we didn't need their votes. I can disagree with them -- see the entry just below -- but I don't consider them evil. I wouldn't consider them evil until and unless we asked them to fall on that grenade and they refused. After that: they're worthless.
(3) Getting Creighmed
Markos and several other diarists, commenters and bloggers made a great point as early as Election Night (or even before) -- there's a reason that I love this website as much as it sometimes frustrates me and I more than sometimes frustrate others -- that the people who are most likely to lose are those who run away from Democratic Party principles. (The argument is often made that while people didn't agree with Reagan, they respected his convictions.) I proposed a term for what happens to people who do this, at least as regards health care: they end up getting Creighmed.
I don't have a lot to add to that other than offering the new phrase for your approval. Note, for those who haven't been following the news and came here looking for the Greek Island named Kos, that "Creigh" is pronounced "Cree" in the name of Creigh Deeds, who distanced himself from Democrats and couldn't turn out the base in the Virginia Governor's race.
(By the way, I thought I was being clever in coming up with the term "Stupe Pack" for Democrats who voted for the Abortion amendment, but it turns out that a stupe pack is actually a real product. So I guess that the real definition is that it's something that should be microwaved until hot and then frozen solid.)
(4) My kidney
I wrote this in three comments yesterday and now I want it in a diary:
[What matters is:] They got the bill to conference
They could have attached an amendment to it requiring that Bill Frist personally remove one of my kidneys and send it to Arnold Schwarzenegger so he could feed it to his cat, if it was necessary to get the bill to conference, and I wouldn't have cared so long as the provision would be surely removed in conference.
"The bill" is what gets out of conference. That's what I care about. Eyes on the prize.
We're not throwing pro-choice supporters -- and I've been an activist on choice issues since the mid-70s -- under the bus here. Look at the probable House conference committee: Pelosi, Waxman, Rangel, George Miller. That's the New York Yankees Murderer's Row of conferees. They're going to chop this provision down to the exact proportions of Hyde -- possibly with language as simple as "nothing in this bill requires any action which violates the Hyde Amendment." Simple and clean.
At some point you have to let our better political representatives do their jobs, huh? Because if you cannot trust the four people above to do their job in conference which is the first and only time that the ultimate wording of the bill truly matters, then you might as well give up on politics.
Let's be loud enough that Pelosi et al know that they have to trim back this provision. But let's not freak out and condemn our good progressive leaders while doing so.
The long view is that the game doesn't really start until the conference committee meets. The last act in this drama is our stomping the guts out of Republicans and recalcitrant Blue Dogs and ConservaDems by getting to, and then winning, that final vote. Before then, the Stupaks and Baucuses and Snowes of the world will claim their little victories. But everyone one of those victories is temporary. We have, if we play it deftly, a winning hand. Not a guarantee, but a huge advantage. I don't care if Boehner wags his oak-colored phallus around claiming that the Republicans are going to beat us. That's brave talk, that's trash talk, and the only reason he can say it is that he knows that no one is going to remember it once this is over.
So: fundamentally, I don't much care what poison nuggets are in the House bill or in the Senate bill, just so long as the two bills get to conference with a great set of conferees. Does the Senate truly need to put in a trigger to get it to conference. I hope not, I'll get apopleptic at whoever made it necessary, but fundamentally, if that's what they need to do to prove that they are independent and stinking conservative enough for their constituents, what the hell. Just gimme my bell and let George Miller and Henry Waxman make it nice.
(5) Knowing that politics is theater doesn't excuse you from playing your role
OK, this is going to be the wildest mental gymnastics you've seen here for a while: I'm going to simultaneously defend the people who voted for the Stupak-Pitts amendment and the people who want to see them skinned alive for doing it.
How can I do this bit of magic? By bearing in mind that Politics is Theater.
Yes, politics is theater: it's playing to the audience -- to several audiences, actually: the one's own constituents, to the national electorate, to the media, to the party leaders, to the interest groups, to the lobbyists, to the bundlers of checks, to the dirty hippie bloggers.
That's another way of saying that politics is symbolic.
As I say above: the people I hate are the ones who damage the party that I see as the vehicle to positive change. They can do so by defaming it with their corruption, by talking it down -- or by refusing to be a hero when necessary.
Everyone else, I don't hate. But I will act like I hate them.
And sometimes I will come to hate them, so it's no longer an act. (Got that, Joe Lieberman?)
So, even though I excuse Scott Murphy for his vote on the overall bill (even though I think -- from my distant vantage point -- that he is misreading his district and risking getting Creighmed), and even more horrifyingly I can excuse David Obey for his vote to harm women, outside of the confines of this website (where I feel some need to counterbalance people who really do think that the theater is real and the end of the world is nigh), I am going to bust their asses for what they've done.
Why? Because in the theater of politics, I too am an actor -- and so are you.
I disagreed with some of the angry diaries over the past few days talking about how Democrats had so badly betrayed -- as opposed to insulted, which I think is hard for anyone with an ounce of feminism in them to deny -- women. They got it to committee. We shouldn't be talking about abandoning the party, never contributing again, etc. We will eventually come to regret it -- like one year and three years from now -- and pretend that we never said it.
However, am I glad to see those diaries? Wink: you betcha!
If you don't burn people when they touch the hot button, they won't learn not to touch it. So I'm fine with people going a bit freaky at what has happened in this vote -- even while agreeing with Obama that the vote is historical and wonderful -- because we have a role to play, and that role is telling politicians to stay away from our hot buttons or we'll rip off their heads and bowl with them.
There's nothing intrinsically wrong with such unseemly behavior. Need I point out that our opponents do it -- and do it worse -- all the time? No, that doesn't make it right. That it works makes it right.
My position is one that should either unite everyone here or piss everyone off, and I'm not sure which. That is: most of the roles we choose in these debates -- defenders of Obama and of pragmatism, or attackers of Blue Doggy apostasy -- are fine. We need both. We need people who can be both on consecutive days. We need to have our feet in both camps, both oars in the water.
We need to be REALLY ANGRY at how screwed up our system is and at how imperfect our ability is to fix it -- and we need to be dedicated, in the final analysis, to maintaining our strongest collective ability to keep on changing things for the better in the long run.
So we take the long view of the long run.
In the long run, some wit said, we're all dead.
Indeed. And when we are dead, we and what we have done belong to history.