For a long time now, progressives have been looking for lines in the sand. They’ve been trying to get progressive members of Congress to commit to vote no on any health care reform bill that doesn’t include a robust public option, and they’ve also been after the President to clearly state his unwillingness to sign a reform bill without one. Today, in his weekly radio address, and framed by his characteristic eloquence, the President has offered not one but a number of lines in the sand. He said:
”I want to be very clear: I will not sign on to any health plan that adds to our deficits over the next decade. And by helping improve quality and efficiency, the reforms we make will help bring our deficits under control in the long-term. . .
”any plan I sign must include an insurance exchange: a one-stop shopping marketplace where you can compare the benefits, cost and track records of a variety of plans – including a public option to increase competition and keep insurance companies honest – and choose what’s best for your family. And that’s why we’ll put an end to the worst practices of the insurance industry: no more yearly caps or lifetime caps; no more denying people care because of pre-existing conditions; and no more dropping people from a plan when they get too sick. No longer will you be without health insurance, even if you lose your job or change jobs.”
With the first line in the sand, he undercuts the claims of Blue Dogs, ConservaDems, and “moderate Republicans,” including the “six deadly hypocrites” Ben Nelson (D-NE), Joe Lieberman (I-CT), Mary Landrieu (D-LA), Olympia Snowe (R-ME), Susan Collins (R-ME), and Ron Wyden (D-OR) that the health care reform bill will increase deficits, and he makes it much harder for Nelson, Landrieu, Lieberman, and Wyden to vote against the upcoming legislation without exposing themselves as simple tools of the insurance companies.
With the other lines in the sand he provides cover for progressive members of Congress and Senators who have been under pressure to draw their own lines, but who have not been clear on where the White House would come down on the public option, and who have been resisting the efforts of progressive groups including Firedog Lake, to get them to commit to a hard line on it. There’s also some new language here calling for abolishing rescission that we haven’t heard from the President before.
President Obama’s address is part of a more general White House campaign to take ownership of the health care reform legislation. If he repeats his requirements stated in the radio address in upcoming activities this week, including a scheduled press conference, the die will be cast, and progressives will have a green light to fully mobilize against the hypocrites, Blue Dogs, and ConservaDems, who are standing in the way of eliminating all those unnecessary deaths and bankruptcies that are the product of our current health care system.
There remain, of course, important details to be worked out as we go forward. First, even though the President commits to “. . . a public option to increase competition and keep insurance companies honest . . .” the success of any public option in increasing competition will depend on the constraints placed upon it in the details of the legislation. The devil will really be in the details, and that is where the insurance companies and their allies will concentrate their influence as the bill goes forward. They’ll be trying to produce a public option that will introduce as little competitive pressure on the private companies as possible, and they will be doing everything they can to ensure that they can continue to be as dishonest as they want to be in dealing with their customers. They will also be doing everything they can to retain the capacity to commit the legalized fraud on their customers that has been responsible for their excessive profits for many years now. Where will Obama come down on these details? Will he lean toward the insurance companies and support their efforts to make the public option a mockery, or will he really deliver a bill that will set the stage for evolution toward a single payer plan as the years go by?
The second really important thing to watch for in the bill, is when its public option will be effective and available to all. The House Bill now provides for an operative public option in 2013, supposedly to provide time for the market exchange to be set up. Such a lengthy period for initiation of the public option portion of the Bill is a great gift to the insurance companies and will allow them to continue to victimize their customers for a lengthy period. This will be politically unpopular, because it will allow the medically-related deaths and bankruptcies to continue even though taxes will go up immediately, and no benefits of the Bill will be visible. I really can’t believe that this provision of the Bill made it through committee. Some people must have been asleep at the switch, while others were trying to ease the pain for their insurance company donors. It’s very reminiscent of Chris Dodd’s Credit Card Reform Bill which allowed the Credit Card companies a full 9 months to extract revenue from their customers before they had to worry about any of the new regulations in that Bill. Lyndon Johnson’s original Medicare legislation was implemented in 11 months with 20 million people enrolled over a period from 1965-1966. With our far greater Information Technology skills to help us in 2009-2010, I suspect that the Obama Administration could do at least as well as the Johnson Administration did, if Congress is willing to recognize that a vote for 2013 implementation is a vote for many more needless deaths and bankruptcies.
Yet another thing to watch for is the fate of the Amendment introduced by Dennis Kucinich and just added to the House Bill in committee on July 17th. The Amendment doesn’t change the legislation except to allow States to create single payer systems if they want them. While the Amendment sounds good, it would seem to create a situation where citizens of these States would be paying for the national plan in the form of increased taxation and also paying for their state’s single payer plan with increased state taxes. How this sort of situation would be handled is not yet considered in the House Bill. A single payer opt-out for states was already overwhelmingly defeated in the Senate.
President Obama’s lines in the sand, are a long time coming, and they are very, very welcome at this juncture. But I think there will be a need for a few more lines in the sand in the future, centering around the issues of how robust the public option will be, whether it will be fully available in under a year’s time, and whether the states will really have a practical choice to choose a single payer plan if they so desire.
1 response so far ↓
1 Henk Hadders // Jul 19, 2009 at 10:04 am
About the line between self-interest and solidarity.
How to value this line drawn in the sand ? It can be legitimized from an ideological and an economical point of view. In this comment I deal with the ideological point of view. Usually this view starts from the premise that the state has too much a grip on societal processes. It paralysis the private initiative, makes the citizen nonage and doesn’t support personal responsibility. In the background it’s about the question whether societal arrangements, like a system of social security or healthcare may be reduced to the self-interest of the privileged. Cynical people may conclude that the welfare state is an invention of the privileged for the privileged. Whatever way one may look at this, it’s clear that during the last decade self-interest has become a foundation in the theory of “public choice”, where short-term self-interest is central. The starting point of this theory is that individuals act like reasonable selfish people, who strive for their own self-interest in their economical and political life (“utility maximizing”). The economic model is that of the neo-classical market with complete competition, where there is an equilibrium based on the free exchange between individuals who all strive for their self-interest. This ideal typical model is also used by those who follow the “public choice” model for the political domain and political actions. Voters become consumers, political parties become enterprises who market competitive proposals for services and tax cuts in exchange for votes and political propaganda becomes advertisement. Government agencies are in this view public services which are dependent of political support for covering their expenditures. In short, the advocates of “public choice” consider the political system as a market of supply and demand of “public goods”. We had Reagan, Thatcher and Mitterand as champions of this no-nonsense “public choice” model. “Social welfare” has gone, …so let’s restore the incentives for business as a new policy.
But is this theory true ? Based on his research Lewin came to the conclusion that the voting behavior of American voters is not exclusively based on the interest of their own wallet, but also by the faith in the alternative for which they think the nation as a whole is best served. Etzioni introduced a new paradigm: a “responsive society” and “codetermination”. Such a community is constant looking for a balance between two forces: those of the individuals and those of the society in which they live. Society is more than the sum of all individuals. Both need each other. “The I’s need a We to be”, and I remember that even Jung spoke about this a long time ago. In such a “responsive community” (or open, responsive society) individuals are not only guided by a subjective utilitarism, but also by a “moral commitment” regarding to others, which refers to active involvement based on internalized moral values. It is more than passive compassion. “Moral commitment: presupposes the willingness to change (call it solidarity). There is little evidence to me that people are constantly and exclusively busy chasing their own self-interests. The “I and We” paradigm is not in opposition with the public choice theory, but it’s an adjustment. The actions of individuals are influenced simultaneously by two important factors, self-interest and the “moral commitment”. The degree, in which one or the other factor dominates, differs depending on historical, societal or personal circumstances. So for me a system of social security or healthcare is a product of the combination of self-interest and “moral commitment”. But how this product looks like at a specific moment in time depends on the actual combination.
Your healthcare posts made me look at the oration of W.de Gooijer (Dutch professor of Healthcare systems in International Perspective) once again. I used some of his ideas in this post, as he speaks about the convergence of healthcare systems in the world and the split between people in the world who have and those who have no access to health care services. It is his guess that the product mentioned above depends on the actual societal and personal circumstances, for instance that individual prosperity and large employment, will probably lead to an enlarged “moral commitment” in society, accepting the idea of a “caring “state looking after those who do not benefit from these favorable developments. Which also means that the importance of the market mechanism isn’t stresses that much. But we now live in troublesome times. So what will the outcome be? Will the product shift in favor to self-interest ? Will it lead to favoring the market mechanism ? Will it strengthen the tendency of individualism? I stop now commenting on this ideological packaging of policy, and on this line drawn in the American sand. Deep down, for me all this line is about cultural issues.
I guess Europeans and Americans will never understand one other on many issues. There’s also a lot of prejudice in Europe about Americans, Europeans can really become very excited, as they are loud and superficial. Yet we imitate the Americans. We watch their movies, eat their fast food, listen to their music, and slowly become –just like them- far too fad. But what do we really know about Americans? Charles Groenhuijzen who worked for more than 13 years in Washington as our national correspondent asked those same questions. He wrote a beautiful book about this. The cliché is that Americans only think about themselves. But why are there so many American churchyards in Europe. This line in the European sand was no self-interest. And why is there nowhere in the world so much charity as in the US ? Americans are not crazy; they just need a President with a new “Man on the Moon” vision and corresponding statement. Obama really needs to step up, as for me ….Kennedy is still ahead.
That reminds me to watch the Tour the France now; to see what my favorite Lance Armstrong is doing.
Henk