Let’s begin with a quote from the New York Times:
In the great health care debate of 2009, President Obama has cast himself as a cold-eyed pragmatist, willing to compromise in exchange for votes. Now ideology — an uprising on the Democratic left — is smacking the pragmatic president in the face.
Stung by the intense White House effort to court the votes of moderate holdouts like Senator Joseph I. Lieberman, independent of Connecticut, and Senator Ben Nelson, Democrat of Nebraska, liberals are signaling that they have compromised enough. Grass-roots groups are balking, liberal commentators are becoming more critical of the president, some unions are threatening to withhold support and Howard Dean, the former Democratic Party chief, is urging the Senate to kill its health bill.
This description of the debate over the Senate version of health insurance reform reproduces conventional journalistic wisdom about politics in America. On one side are the moderates, the compromisers, the policy wonks. These are the good guys.
On the other side of the ledger, are the lefty villains: the unreasonable, the unserious, those who are moved more by ideology than understanding.
Meanwhile, Joe Lieberman is never an ideologue; neither is Ben Nelson. They’re moderate centrists resisting the vicious Hard Left. It’s grass-roots groups, unions, and complainers like Howard Dean who are thwarting the pragmatism of the president.
The problem with this narrative is that — if you judge based on the conversations happening in the blogoverse — both groups claim to be wonky, pragmatic, clear-eyed undeceived realists; both sides accuse the other of not seeing the forest for the trees. As Steve Benen argues, this is a serious debate.
Serious is fine, but who’s right?
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For me, the bottom line is this: if you’re an anti-corporate liberal — and I’m probably more in this camp, though I am willing to be convinced to support the Senate version of the bill — who thinks that the system in Washington is oriented toward the interests of large companies, at the expense of the needs of people, then the Senate version of this bill will confirm all your fears about how Washington works.
Those who argue — as most who advocate for the bill do — that yes the technical details of the Senate bill are more or less as bad as everyone is saying but that it will be improved over time have the harder argument to make. Take Ezra Klein, who argues:
In a world with an individual mandate, large premium increases are Congress’ problem. It focuses the mind on cost control. Given a choice between passively letting people become uninsured and taking on providers and insurers, Congress will choose the path of inaction. But given a choice between voting to take people’s insurance away and taking on providers and insurers? That’s a harder decision. Right now, the pressure in the political system comes from organized interests. The mandate levels the playing field.
Advocates of imperfect reform assume what they need to argue for: that when it comes time to reform the inadequate bill, to address its lingering structural problems, there will be no choice but progressive change, or an increased likelihood for improvement. Instead of stripping care from people, serious cost cutting measures will be implemented. But why? What will have changed in Washington? The main difference will be that health care corporations will earn more income — their stocks are rightly soaring now — Democratic politicians will depend more than ever on donations by the insurance and Pharma industries to win reelection, and there will be companies on the exchanges that are now “too big to fail.”
Klein offers the most detailed and persuasive case for supporting the bill that I have found, but I think his claims are based on a lot of supposition and incorrect analysis. After all, wouldn’t a private exchange system packed with high-deductable, low-care “coverage” be cheaper, a very plausible way to control costs? What if this is what universal “coverage” will ultimately look like? Is there anything in the Senate bill that does anything to undermine this outcome?
If I had to put on my speculative hat, I would guess that insurance companies on the exchange will cut costs by technically following the letter of the law, and lobbying to make coverage universal but effectively meaningless for many poor people. If you have insurance but can’t afford to pay your high deductible, aren’t you back to square one in some sense? No, haven’t you been pushed back a few squares, since you’re out of that money you’re being forced to pay for inadequate care?