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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.

(1) 2017

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.

  (c) Opt-out

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.

(2) 218

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.

Originally posted to Doane Spills on Mon Nov 09, 2009 at 08:28 PM PST.

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Comment Preferences

  •  The long view: (28+ / 0-)

    A journey of a thousand miles begins with a single step.

    Lao-tzu

    Someone's no doubt going to explain to me, as if I don't know, that "people are going to die in the meantime!"  I do know that.  People always die in the meantime.

    A mess of Bush Admin officials have gotten away with serious crimes! Grab a mop!

    by Seneca Doane on Mon Nov 09, 2009 at 08:24:08 PM PST

  •  If they take it out.. (5+ / 0-)
    Recommended by:
    mattman, Nulwee, Seneca Doane, Norbrook, CMYK

    And IF we can change it..

    And If the Senate does ANYTHING..

    Remember, it took quite a few years to fix Social Security & Medicare..

    And, I found something else they have to fix.. Expats who use other countries health care shouldn't pay the (No insurance) penalty..

  •  Of course you are an infidel (6+ / 0-)

    you're talking politics, right? I am royally pissed at Stupak and his little band of merry men. I am even more pissed at how totally the party has FUBARed this bill. From the message to the time frame, FUBAR all the way.

    Still, I'm pulling for it because we have to break this log jam somehow. Everytime someone has a glimmer of the idea of HCR the Rs and their posse saddle up to kill it. It must be very powerful magic, no?

    "Take it back, take it back. Oh no you can't say that. All of my friends are not dead or in jail." John Prine

    by high uintas on Mon Nov 09, 2009 at 08:46:58 PM PST

    •  No FUBAR I hope, just (2+ / 0-)
      Recommended by:
      high uintas, Seneca Doane

      Fucked Up, rather than Fucked up beyond all repair.

      I hope that we get some form of HCR, just because Obama has so much riding on it, and some of the provisions (e.g., no recision) are so commonsensical that not even the Republicans can oppose them.

      Whatever Congress passes will probably be shit - but shit is fertilizer for future growth.

      Note to Blue Dogs: I didn't vote Democratic so you could act like Republicans

      by Permanent Republican Minority on Tue Nov 10, 2009 at 12:43:43 AM PST

      [ Parent ]

  •  One of the things that we need to think (12+ / 0-)

    of this is:  War, not Battle.  We've been fighting for universal healthcare for a long time.  There's a tendency to think of every single action in Congress as the the be-all and end-all of the goal, when it's just one battle in the series.  In this case, we won the battle, but it wasn't as clean and decisive as we'd hoped.  There are more battles ahead - and we need to think in those terms.  

    I pointed out in a different diary that David Brooks had made (inadvertently, I'm sure) a good point:  Once you get a program like healthcare enacted, it becomes "sacred."  That is, the public may have to be dragged kicking and screaming into it, but once they're in, they'll fight any attempt to kill the program.  That's why Republicans are fighting so hard against it, and so many of the vested interests are.  They know that when it gets rolling, there's no way they're going to roll it back.  

    This is why we need to keep pushing now - but also look at the upcoming elections in 2010, 2012, and 2014.  Legislation can be modified.  It can be expanded and refined.  That's another area where we can improve what we have - but only if we have legislators who are willing to do it.

    I think that I have had enough of you telling me how things will be. Today I choose a new way to go ... and it goes through you!

    by Norbrook on Mon Nov 09, 2009 at 08:52:37 PM PST

    •  That's a good point (5+ / 0-)
      Recommended by:
      mattman, Nulwee, Norbrook, Egalitare, CMYK

      which is why you will not be surprised when I tell you that it's not original with Brooks!

      A mess of Bush Admin officials have gotten away with serious crimes! Grab a mop!

      by Seneca Doane on Mon Nov 09, 2009 at 08:58:07 PM PST

      [ Parent ]

    •  That raises another point (3+ / 0-)
      Recommended by:
      Seneca Doane, Norbrook, Egalitare

      HC is going to be tinkered with in both directions. There will be a Republican President someday. He will appoint evil slimes to administer HC, because that's what Republican Presidents do - appoint people who hate Americans to administer any program that might benefit them, and try to ruin it.

      So by the time Obama leaves office the HC program needs to be not only a sacred cow, but have enough of the kinks worked out of it that it is clear to the American people that the GOP is deliberately sabotaging a good, working program.

      In theory, there is no difference between theory and practice; but in practice, there always is a difference. - Yogi Berra

      by blue aardvark on Tue Nov 10, 2009 at 07:44:59 AM PST

      [ Parent ]

      •  That's an insight that we don't hear enough (3+ / 0-)
        Recommended by:
        Norbrook, Egalitare, blue aardvark

        My big fear going into this was that whatever system we create, Republicans will be able to dismantle, privatize, or otherwise pervert.  Knowing a little more about it now, my guess is that when in power they'll try to starve it with global budget cuts that lead to more rejection of expensive therapies, "experimental treatments" and the like.  Things wouldn't be wine and roses even after we passed even single payer, if we ever do.  But we will then be able to compare what is available in the U.S. to, say, that available in France and elsewhere.

        My hope is that eventually we'll see a policy that if it's too expensive to do something in the U.S., the U.S. will send someone to Manila or Mexico City or Mombasa for less expensive but still high-quality care.  But that's a later fight, of which we'll have plenty.

        A mess of Bush Admin officials have gotten away with serious crimes! Grab a mop!

        by Seneca Doane on Tue Nov 10, 2009 at 08:00:17 AM PST

        [ Parent ]

        •  Agreed (2+ / 0-)
          Recommended by:
          Seneca Doane, Egalitare

          It's happened to all of the programs at one time or another.   But at some point in the process, people start to wake up to it.  Privatization of Social Security, one of the things the Right has been trying to do for decades - when they couldn't kill it - almost became "a good idea" until the actual results became quite clear.  There's a reason it was considered the "third rail of American politics."  It's more than a little ironic that many of the teabaggers complaining about "socialized medicine" also state "don't touch my Medicare."  Any wingnut who wants to run on repealing Medicare is likely to get very, very few votes - and if they try it when they're in office, they won't be afterwards.  

          I think that I have had enough of you telling me how things will be. Today I choose a new way to go ... and it goes through you!

          by Norbrook on Tue Nov 10, 2009 at 09:16:19 AM PST

          [ Parent ]

      •  would Eisenhour have appointed "evil slimes"? (0+ / 0-)

        I don't think we are going to have another Repub. President until the moderate wing of the party asserts itself... I don't think the crazies in the party have a chance of winning nationwide!

        There will be a Republican President someday. He will appoint evil slimes to administer HC, because that's what Republican Presidents do - appoint people who hate Americans to administer any program that might benefit them, and try to ruin it.

  •  excellent diary.. (5+ / 0-)

    highly recommended, and now heading back to read it again, at least once, maybe twice!  ;)

    (Sadly, in Kathmandu no longer.)

    by American in Kathmandu on Mon Nov 09, 2009 at 09:18:32 PM PST

    •  Well beyond the call of duty there! (2+ / 0-)
      Recommended by:
      American in Kathmandu, Nulwee

      Thanks, AinK, and I hope that all is well in not-Kathmandu!

      A mess of Bush Admin officials have gotten away with serious crimes! Grab a mop!

      by Seneca Doane on Mon Nov 09, 2009 at 09:19:56 PM PST

      [ Parent ]

      •  politics is more depressing here (2+ / 0-)
        Recommended by:
        Nulwee, Seneca Doane

        than in the US, and, for reasons I couldn't really articulate, even more depressing than it was in Nepal, where things certainly were stuck and no real progress obvious.  But here in my little corner of Africa there's a real lack of political space, and cynicism and apathy on the part of the people, that dwarfs anyhing you'd see in the US, so I suppose yay for perspective, as depressing as it is sometimes, lol.

        (Sadly, in Kathmandu no longer.)

        by American in Kathmandu on Mon Nov 09, 2009 at 09:26:24 PM PST

        [ Parent ]

        •  Italy's Pretty Depressing: (2+ / 0-)

          "I am, and not only in my own opinion, the best prime minister who could be found today," he told a press conference. "I believe there is no one in history to whom I should feel inferior. Quite the opposite."

          The problem, he explained, was that "In absolute terms, I am the most legally persecuted man of all times, in the whole history of mankind, worldwide, because I have been subjected to more than 2,500 court hearings and I have the good luck – having worked well in the past and having accumulated an important wealth – to have been able to spend more than €200m in consultants and judges ... I mean in consultants and lawyers" -- Silvio Berlusconi.

          http://www.guardian.co.uk/...

          These clowns claim to admire him [Cronkite] but do not wish to emulate him - GUGA

          by Nulwee on Tue Nov 10, 2009 at 12:24:41 AM PST

          [ Parent ]

    •  Read first then rec (1+ / 0-)
      Recommended by:
      Nulwee

      Keeps you from having to un-rec.  :-)

  •  I'm with you on Wyden-Bennett and Murderer's Row (2+ / 0-)
    Recommended by:
    Nulwee, Seneca Doane

    But surprised at the least to see 3 Californians out of 4 on the conference committee.  Can't say I disagree with that list, based on the deans and relevant conference chairs, but wow.

  •  Your read of the kabuki is nuanced and (3+ / 0-)

    strategeriffic. Stupak is my line in the sand, yet you're right that it's smart to look at the whole picture and influence context as much as outcomes.

    Great diary. My takeaway is about the hero factor and that it's appropriate to expect Congress members to rise to their higher selves and make decisions for the greater good instead of purely personal gain. Some actors in Congress seem to have no idea what production they're starring in because all their scripts are the same.

    Yeah, well, cue the netroots, stage left. Time for some improv!
     

  •  When I read the bill summaries, I think (2+ / 0-)
    Recommended by:
    Nulwee, Seneca Doane

    too of what it'll look like in the future. There are things in it I dislike but overall I think many things will inevitably be improved and the structure is in place for a far better system than the current one. So, I concur on your ideas on this and appreciate your voice of reason about it.

  •  Just win, baby (1+ / 0-)
    Recommended by:
    Seneca Doane

    Winning is everything; it's the only thing.

    And so on.

    Winning is passing a health care bill (I refuse to use the word 'reform' for anything) that significantly improves the US, that moves us in the right direction.

    The Stupak amendment is going to be gutted. Do you think Harry Reid is going to send anyone to the Senate side of the conference who will fight tooth and nail for Stupak?

    Now, the question is, will Nancy get the conference bill through the House without Stupak-Pitts? Will Joe Lieberman use this as another excuse to play Drama Queen?

    In theory, there is no difference between theory and practice; but in practice, there always is a difference. - Yogi Berra

    by blue aardvark on Tue Nov 10, 2009 at 07:41:06 AM PST

    •  Yes, even Stupak will vote for a Stupak-less bill (1+ / 0-)
      Recommended by:
      blue aardvark

      in the end (at least if we need him.)  He's had his moment and made his point.

      Lieberman is still the obstacle -- but I can't tell how much of one because no one can explain clearly how the entire reconciliation process works, excruciating step by step.

      A mess of Bush Admin officials have gotten away with serious crimes! Grab a mop!

      by Seneca Doane on Tue Nov 10, 2009 at 08:03:27 AM PST

      [ Parent ]

      •  But Harry Reid says he is not worried about Joe (1+ / 0-)
        Recommended by:
        Seneca Doane

        Which makes me think that in the end the fix is in.

        Probably because Harry knows where a body or two is buried.

        In theory, there is no difference between theory and practice; but in practice, there always is a difference. - Yogi Berra

        by blue aardvark on Tue Nov 10, 2009 at 08:11:24 AM PST

        [ Parent ]

        •  I still think that the odds are good (0+ / 0-)

          that we'd get Joe in the end even if the fix isn't in.  Reid can put reform on the shelf and bring it back any time he wants, including when it would be of maximum benefit to rally the Democratic base and when the sole spotlight would be too hot even for Joe.

          A mess of Bush Admin officials have gotten away with serious crimes! Grab a mop!

          by Seneca Doane on Tue Nov 10, 2009 at 08:32:49 AM PST

          [ Parent ]

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