And how they can win.
These are my observations, developed over the course of watching the progressives and liberals1, both in the House and in the Senate lose point after point, make concession after concession, and compromise over and over again just to get health care insurance reform through a Democratic-dominated Congress. I am not a master of 11th dimensional chess; nor am I parliamentary wonk with intimate knowledge of the inner workings of the rules of order. I suffer from the conceit, however, that I am somewhat intelligent, capable of critical analysis and problem solving.
With those caveats in mind, I bear bad news . . . Progressives were always going to be forced into unpalatable compromises in the reform debate.
Why?
Now that is an interesting question, and one that must be answered before moving on to an even better question. Progressives were always going to lose in the reform debate for the simple reason that they care. They care that the current system is unjust and unsupportable economically and morally. They care that the working poor do not receive adequate, or any, health care because they labor at jobs that do not provide such benefits, and they earn too much for the too restrictive and limited opportunities at subsidized health care. They care about those who are uninsurable in the current system, who cannot purchase private insurance because of pre-existing conditions. Because Progressives care, because they want something better, they want to reform the system. In fact, they almost want it too much.
On first encountering this mere assertion, one might reasonably question how caring about crafting an effective solution to an immense problem, how that caring itself could get in the way of reform. While I believe that Progressives care deeply about reaching universal coverage, they do not possess sufficient clout to push such reform through on their own. Progressives care about reform and want reform, but to get it they have to deal with people whose cares and worries are far different.
It is not that moderate and conservative Democrats in Congress do not see the need for some reform. They certainly want to tinker about the edges, doing a few patches to shore up Medicare and Medicaid for a little while longer - hopefully until they are no longer fundraising for the next election cycle. They are willing to entertain the reforming desires of the Progressives so long as to do so does not imperil their own campaign donations. The moderates and conservatives1, however, do not expressly care about the working poor or the uninsured, and because they do not care so much, they do not particularly want to upset the status quo.
To change anything about the status quo in DC things have to happen. Bills must be written and introduced. Committeees must act. Leadership must act. Motions must be made. Votes must be taken. At every point in this process, any idea that will truly reform the status quo will be under assault. That the moderates and conservatives do not care so much about actually reforming health care, aside from performing some fiscal tricks to Medicare and Medicaid, leads to two problems. First, they are inherently suspicious of even the most incremental change, and by nature they will seek to slow down and water down any such effort at every point along the way. Second, and more importantly, because they are not truly invested in reform, because they do not really care about it, moderates and conservatives are willing to see it fail.
This is not to say that the moderate and conservative Democrats are entirely uncaring, even in light of the course of the health care reform debate. Most of them would be perfectly willing to give the Progressives a good bit of what they want to see happen as reform. But the status quo that they defend happens to be one of the most powerful and rich industries in the country, with one of the most thoroughly organized and well financed lobbies. It would be redundant to recount in this diary the platoons of lobbyists deployed to Capital Hill and the millions of dollars spent each day to defeat reform. In the face of such a display of raw power, some of the moderates and conservative Democrats took their cue to adulterate the reform effort to the greatest extent possible and at every fork in the road. Now I don't want to overstate my case, and this diary is not intended to call out any particular actor -- if you've been paying attention then you know who's to blame that has a D after their name -- so I'll say that some moderate and conservative Democrats took it as their mission to keep as much of the status quo as could be preserved and to exact a high price for the rest.
But how?
To review, in brief, in the House the moderates and conservatives worked through the committees, where in concert with the republicans they could affect the shape of the bills that would be reported out, merged, and voted on by the full House. By the time HR3962 came up for a vote, the fix was in, but even so the House version still contained a public option. Compared to what would eventually emerge in the Senate, the House bill was still a relatively progressive bill. It took the anti-democratic rules of the Senate, and the peculiar circumstances of a Democratic caucus with exactly the votes needed to override those rules, to give the conservatives the leverage they needed to seriously undermine reform, again in concert with the republicans. It is the continued threat from Senate conservatives that appears will ultimately lead to a final bill that barely merits the name 'reform'.
So, why the Progressives lost, and were always going to lose, on health care insurance reform is because they had for negotitating partners -- moderate and conservative members of their own party -- some of whom did not truly care if true reform and some of whom actively preferred for it to die. Progressives cared more that some reform pass than their counterparts cared about the consequences of failure, and there were enough of them willing to lie down with the GOP to ensure that health care reform would be a pale shadow of its potential.
Apparently they don't mind the fleas.
Now what?
Although there are hopes that some small remedies will be found in the conference between the House and Senate, it looks like the Senate bill is by and large the measure of the reform that we will get out of this Congress. The Senate bill will not be killed. Obama will sign whatever final legislation comes from the conference. It will happen that way. Nothing will change that.
Nevertheless, progressives can win, in the long run, as long as the Congressional Progressives continue to fight. The first task is make sure that they do. Beyond that, as far as I can tell there are three possible ways forward: (1) reform the Senate rules to relax the filibuster (this is the Fuck You Joe option); (2) use the Senate's reconciliation rules to attach certain elements of reform to future budget legislation (probably a middling strong public option); and/or (3) stop playing defense and go on the offense. As far as reforming the Senate rules first, good luck. I see no reason to believe that can happen in anything approaching a timely fashion. I'd be in favor of it, make no mistake, just like I'd be in favor of Sir Galahad finding the Holy Grail, but more likely this quest will be siderailed by a castle full of nubile 16 to 19 year old virgins. Moreover, using reconciliation rules to attach a public option to future budget legislation, I believe, would require the consent, if not support, of the Senate leadership. To carry on with the terribly strained Monty Python references . . . well, Brave Sir Robin ran away, he bravely ran away. That leaves the third option, the Progressive offensive.
If my thesis is even somewhat correct, that the Progressives lost point after point because they actually cared about health care reform, then the corollary must also be at least somewhat true: that the moderates and conservatives won because they didn't really care. In other words, they had nothing to lose. Turning this dynamic on its head is the basic idea behind going on offense.
The concept, time-honored in politics, is simple. Find something the moderates and conservatives care about and hammer them into the fucking ground with it. My favorite is the annual billion dollar giveaway to farmers. Most Progressives probably come from urban and suburban districts and states. Most moderates and conservatives probably come from more rural districts and states. So they care about the stupid farm bill far more than we do. The thing is, the Progressives need to stop bringing out the comfy chair and make them feel some pain. They want to hand out billions in pork to their constituents? Great. We want a strong public option. So threaten their bill with a filibuster unless we get an amendment establishing the kind of national public option we want. They want to use the tools in the Party of No to gut health care reform? Okay. We'll do the same thing to their priorities.
The point is to shift the balance of power, from the conservadems to the Progressives, by attacking legislation that they want. Of course the Progressives would have to mean it. In fact, they'll have to get downright mean about it. But wouldn't that be something to see, Congressional Progressives fighting for what the country actually wants and needs, wouldn't it? Someone talk me down off the ledge, as Rachel would say, tell me why it wouldn't work. The Progressives wouldn't need the blessings of the White House or of leadership. As long as the Republicans continue their stupid obstruction of anything and everything, why wouldn't it work? A sneak attack, on the floor of the Senate when cloture is moved on the next farm bill. Why not? At least then we would be the ones with nothing to lose.
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1 Throughout the diary I'll refer to progressive and liberal Democratic members of Congress as "Progressives", for the sake of brevity.
2 The Party of No made its position on health care reform quite clear, and its intent to obstruct all Democratic initiatives at all turns and at all costs. It, and its troglodyte members, are irrelevant. This diary, therefore, refers exclusively to moderate and conservative Democrats, and Joe Lieberman for as long as he is suffered to remain in the caucus.