When I was young the United States had some liberals of courage in the Senate. People like Estes Kefauver, Paul Douglas, Hubert H. Humphrey, Herbert Lehman, Wayne Morse, Richard L. Neuberger, Maurine B. Neuberger, Eugene McCarthy, Mike Mansfield, Ernest Gruening, Pat McNamara, Phil Hart, Frank Church, George McGovern, Albert Gore, Sr., Ralph Yarborough, Warren Magnuson, and William Proxmire. These liberals could be counted on to go to the mat for most liberal causes. They said what they meant, and meant what they said. They compromised. But they never pre-compromised, and they never folded. They were never afraid to walk away from negotiations that were producing bad bills. They passed a lot of good bills, a lot of regulatory bills, a lot of consumer protection bills. I could and was proud of them. I looked up to them, and frankly, loved them for what they did for America.
Of course, when Hubert Humphrey left the Senate, he didn’t act as he had before, and appeared to be overwhelmed by Lyndon Johnson. And some might argue that others, such as John, Robert and Teddy Kennedy, J. William Fulbright, and Lyndon Johnson, or even some Republicans like Jack Javits, ought to be part of this group for their championing of certain liberal causes. But I never viewed them as among the most liberal and unequivocally courageous politicians, but more as pragmatists occasionally motivated by principle.
In any case, the point I’m making is that this long list of courageous liberals is not matched by any group we have in the Senate today. We have Bernie Sanders, and sometimes Russ Feingold now to stand on principle, and Al Franken showing some promise, and everyone else seems to be a “caver,” dedicated to the idea that “the perfect is the enemy of the good,” and ignoring that both the timid, and the path of least resistance, are also, and equally, the enemies of the good.
Considering, that almost everyone in the progressive wing of the Democratic Party in the Senate is a “caver,” and that Jay Rockefeller, in particular, had acquired the nickname “Jello Jay,” from Marcy Wheeler, for his behavior in knuckling under to Executive attempts to avoid accountability for its surveillance and torture activities, and failing to provide proper Congressional Oversight of these activities, it was surprising for awhile to see his activities in the Senate Finance Committee resisting attempts to get rid of the public option and prevent an unmitigated giveaway to the insurance companies. In fact, Marcy and the FDL community were so pleased with these activities, that “Jello Jay” became transformed almost overnight into “Jay Rock.”
But, alas, the Jello Man has now returned in his full pliable glory to the Senate. And, in response, to the latest retreats by Harry Reid before the cranky capriciousness of Joe Lieberman, and Howard Dean’s reply calling for killing the Senate bill, and a new approach through reconciliation, Jello Jay has said that Howard is wrong and that “the perfect should not be the enemy of the good,” and without detailing them, has said that many good things remain in this bill, and that since it will cover 30 million people, it must be passed, even though it doesn’t have any kind of PO, and does have the mandated pay-offs to the insurance companies that the Jello Man so strenuously objected to in days gone by.
So, what should we say about this? Well, it would be bad enough if all we were seeing was the return of the Jello Man alone. But, in fact, what we are seeing now, is the spread of the Jello disease among progressives in the Senate. Now all of them are singing the same Jello Song as the estimable Jay. All of a sudden a PO is not necessary for reform. All of a sudden, no real competition is necessary to ensure that insurance costs will be cut. All of a sudden, the elimination of lifetime limits in insurance coverage is not necessary for reform. And, trust me, if Harry Reid knuckles under to the CBO fantasy that a 90% loss ratio for the insurance companies makes the private insurance sector part of the Federal Budget, suddenly these jello progressives will also say that an 85% loss ratio, or whatever level of loss ratio Douglas Elmendorf thinks is consistent with continuing to exclude the insurance companies from the Federal Budget, is enough for reform.
What we can say about this progressive behavior is that it is all nonsense, a manifestation of cowardice, and not pragmatism or concern for the uninsured, at all. The progressives currently eating their previous words with such happy faces, are telling us that the bill ends rescissions and denials due to preconditions, and that it will cover 30,000,000 who will no longer die from lack of insurance. However, apart from the fact that even if this were true, the bill still would leave 17,000,000 uninsured, and roughly 17,000 fatalities per year due to lack of insurance, this claim is almost certainly false.
It is false, because there are no price controls in this bill, and the subsidies, mandates, and exchanges don’t become operative until 2014. So for four long years, the uninsured, or those with preconditions, will have to obtain insurance from an insurance pool where they will pay some multiple, probably as much as 300% of standard insurance rates to get into a private insurance program. Moreover, during the four years “band-aid” period until the exchanges, subsidies, and mandates are operative, standard insurance rates will be rising, and, based on recent experience, will probably be doing so at a rate of between 10% and 20% per year. How many people who don’t have insurance will be able to afford that? Unless they’re rich, almost no one. So, how many of the uninsured will get coverage between now and 2014? An average of five percent? Ten percent? At most 20%. Let’s say ten percent is the figure, a generous estimate, since costs in 2010 will probably be up to 8,000 per individual, and 15,000 per family in the non-group market, and some multiple, perhaps as much as 300% of those figures in the case of insuring people with pre-conditions.
That means that until 2014, when the subsidies are available, an average of only 4,700,000 additional individuals will be insured as a result of this bill. In addition, the number of insured will probably decline with each passing year, since, premium increases will increasingly cause the cost of insurance to exceed the capacity to pay of most people. Also, while this is happening, population increases will lead to corresponding increases in the uninsured. In 4 years, population increases will probably lead to 50 million uninsured, wiping out most of the gains in number of insured made by the program during those years.
What happens in 2014, when the subsidies kick in? Well then, more people will be able to afford insurance. However, assuming the final Senate bill is like the one previously produced by the Senate Finance Committee, the subsidies won’t be indexed to inflation in insurance premiums. This means that by 2014, the subsidies will already be inadequate to pay for the likely rise in premiums. So, people won’t be able to afford the insurance after all. Since getting insurance is mandated, people will simply defy the law, or pay the relatively low penalty for not getting insurance, because they just cannot afford to pay an appreciable portion of their insurance for it. For all these reasons I think that even after 2014, it is very doubtful that anything like 60% of the uninsured, or 30,000,000 people, will get coverage under the program, because they simply won’t be able to afford it.
Most discussions of the various reform bills considered in this legislative cycle have focused on the features of the various reforms, but they have not focused on whether or not the bills would have outcomes that solve or greatly reduce negative outcomes resulting from the present system of insurance. We know that 45,000 deaths, more than a million bankruptcies, and foreclosures in the many hundreds of thousands result from the present system. But no one is addressing the question of how many deaths, bankruptcies, and foreclosures will be prevented if one of the current reform bills is passed. The failure of CBO to estimate this is criminal negligence, because it offers no help in assessing what the key benefits of the bill will be.
So let me be clear (don’t I sound like Jello Jay now?). I am contending that, in the first four years only 4500 out of 45,000 annual fatalities due to lack of insurance will be prevented by this bill. I am also contending that only a small percentage of bankruptcies will be prevented because the high deductibles and co-pays allowed by this bill will not allow people with health problems to escape bankruptcy, and that I estimate that 95% of medical bill-related bankruptcies will still occur, and a like number of foreclosures, as well. After the first four years, increased coverage may decrease the percentage of annual fatalities, bankruptcies and foreclosures, compared to what we have now. However, if the 30,000,000 estimate of number of people who will eventually be covered by this bill is off by as much as 50%, as I suspect, and the cost of premiums keeps increasing by 10-20% per year, it is likely that even after 2014, we will still have 35,000 annual fatalities, and given rising co-pays and deductibles, bankruptcies and foreclosures of a similar order of magnitude compared to what we have now.
In short, this bill does nothing significant for people, but delivers a bonanza to the insurance companies, at an average cost of about $90 Billion per year. No jello progressive who votes for it will be thanked by their constituents, and every progressive who votes against it will be considered courageous and acting in the interests of the people. If that progressive then turns around and insists that Senate and House leadership take up reform again in January, they will be considered even more courageous by their constituents, and they will be in a much better position to actually get a real reform bill in an election year, provided that they keep the issue of health care reform in front of the American people, while advocating for a program such as Medicare for All which will unambiguously help them.
An argument that has been made to the jello progressives at the end of this process is that they must support the current Senate bill, or they will “hurt” their President, Barack Obama. My reply to this, is that President Obama has already hurt himself with his lack of leadership, his behind the scenes manipulation of the progressives and the public, his betrayal of the interests of the American people, his deals with Pharma and other interests, and his failure to live up to his campaign promises, and to keep faith with those who put him in the White House. For the progressives in Congress to keep their faith with the people who put them in office, they have to represent those people, and vote for what their people want and need. if the President gets hurt in the process then I have three things to say. First, that is just too bad. If he had decided to represent the people who put him in office there would no question of his getting hurt right now. Second, he’s no longer their President. Now, he’s Wall Street’s President, Ben Nelson’s President, Joe Lieberman’s President, Max Baucus’s President, the Big Bank President, the health insurance industry President, and the military industrial complex President.
And third, I think that if progressive actions insisting on a good health care reform bill result in a political defeat which hurts the President, then that is all to the good. He needs to be politically hurt right now. He’s acted badly, carelessly, heedlessly, and stupidly. He needs to feel the consequences of his actions, so that he can learn from them. So, don’t protect him from the pain of defeat. Let him learn. He needs the experience to become a better President, if that’s possible.
But apart from whether the President gets hurt politically, and even whether the real interests of the people in the area of HCR are served, there is the larger issue of restoring the Congress and the Senate as institutions. Today, the Senate needs a group of progressives like the liberal Senators of the ’50s and ’60s. It needs people who have the courage of their convictions, and who can negotiate successfully for what they believe in. But the problem is that jello progressives, like Jello Jay can’t do that. The reason is basic to the process of successful negotiation. In any such process, you have to be prepared to walk away from the table to get anything good at all. You have to be able to say “no.” When you lose something in negotiation, you have to be able to deny your negotiating partner something. You have to make that partner pay a price for the concession they denied to you. Jello Jay and his jello progressive colleagues can’t do that. They can’t say no. Until they can, every other party to the negotiations they take part in will roll them. It’s as simple as that. The old liberals were prepared to walk away. But Jello Progressivism says “yes,” no matter how much it loses in negotiation. Jello progressives are so afraid of failure that they always fail, even while they tell themselves they’ve accomplished something. That has to stop, or these progressives have to be replaced, because as things are now they are neither any good to us, nor to themselves.
(Also posted at firedoglake.com and Correntewire.com where there may be more comments)