We Made Him Do It

I agree with most everyone that it's good to have this out there:

Despite months of seeming ambivalence about creating a government health insurance plan, the Obama White House has launched an intensifying behind-the-scenes campaign to get divided Senate Democrats to take up some version of the idea in the weeks just ahead.

President Barack Obama has long advocated a so-called public option, while at the same time repeatedly expressing openness to other ways to offer consumers a potentially more affordable alternative to health plans sold by private insurers.

But now, senior administration officials are holding private meetings almost daily at the Capitol with senior Democratic staff to discuss ways to include a version of the public plan in the health care bill that Senate Majority Leader Harry Reid, D-Nev., plans to bring to the Senate floor later this month, according to senior Democratic congressional aides.

Among those regularly in the meetings are Obama's top health care adviser, Nancy-Ann DeParle, aides to Reid, and Senate finance and health committee staff, both of which developed health care bills.

At the same time, Obama has been reaching out personally to rank-and-file Senate Democrats, telephoning more than a dozen lawmakers in the last week to press the case for action.

If the "left of the left" didn't agitate and activate folks throughout the debate, this story wouldn't exist. And neither would the public option. The White House is now trying to save face by getting something they can call the public option into the bill. They cannot not have it, at this point. The pressure has been ratcheted up too high.

So there will be a public option in there, I'm convinced of that now. The question is what will it look like? Chuck Schumer seems to be saying that Tom Carper's state-based network would maybe be the answer. That's really no worse than Schumer's level-playing field version. None of them will have the scale and scope to really compete with insurance companies. But all of them can be expandable. And that's what's important at this point.

It took several months of banging on these politicians just to get a weak version of a public option in a position to possibly succeed. Meanwhile some conservative can just say the word "ACORN" and get their federal funding revoked. There's a definite imbalance there. But progressive power is at least imaginable, and hopefully when this passes and the world doesn't go up in flames, it will get easier.

MoveOn Joins The Fray

The big progressive groups hadn't yet spoken on the question of escalation in Afghanistan - their silence was pronounced. MoveOn finally broke that silence today, appealing to the President to commit to a clear exit strategy. It's a pretty big step.

U.S. policy in Afghanistan has reached a pivotal moment. President Obama is poised to make a critical decision about the Afghanistan war in the next few weeks. And there’s a big debate happening right now about what to do.

Pro-war advocates both inside and outside the administration—including John McCain and Joe Lieberman—are calling for a big escalation. The general in charge of Afghanistan is expected to request tens of thousands more troops, and that may just be the beginning. They’re cranking up the pressure for an immediate surge.

But other powerful voices are urging caution: Vice President Biden and White House Chief of Staff Rahm Emanuel have raised real concerns about the idea of sending more troops to Afghanistan without a clear strategy, as have Democrats in Congress. And a majority of Americans oppose increasing troop levels.

Can you write to the White House and tell them we need a clear exit strategy—not tens of thousands more US troops stuck in a quagmire? You can send the President a message by clicking below:

http://www.moveon.org/r?r=51843&id=&t=1

Some administration officials are arguing for a smaller, nimbler approach with a narrow focus on the threat from al-Qaeda. But cheerleaders for the war refuse to acknowledge that there could be any viable strategy other than more and more troops. So they’re trotting out the same tired old lines and questioning the motives of those who disagree with them.

They figure they can cut off any debate about our ultimate goals in Afghanistan and the region. But President Obama has consistently shown a willingness to stand up for his more thoughtful approach to foreign policy, and that’s what he needs to do here, too.

The hawks are making their position heard. Now, the majority of Americans—those of us who are for as quick and as responsible an end to the war as possible—need to make our voices heard, too.

With Democrats opposing escalation by more than two to one, MoveOn is just reflecting the opinions of their membership. They're a bit late to the debate, but better than ducking it entirely.

Requiem For A Public Option

The traditional media is certainly trying its best to bury the public option today, whether motivated by their corporate colleagues, the usual bipartisan fetishists or key figures inside the White House itself. Both major newspapers write essentially the same article about it today. The New York Times writes an elegy for the public option beginning with the line "It was just one line in a campaign manifesto, and it hardly seemed the most significant or contentious." The story goes on to claim that the public option's death is basically attributable to its probable success.

Champions of the public plan said it could save money by using Medicare rates and fee schedules to pay hospitals and doctors. In a book last year, one of Mr. Obama’s top advisers, former Senator Tom Daschle, said consumers should have the option of enrolling in “a government-run insurance program modeled after Medicare, a proven and popular program.”

That is exactly what worries health care providers, who say Medicare pays them less than market rates paid by private insurers. And they have pressed their concerns on Capitol Hill with a small army of lobbyists.

Conservatives have another concern. They see the public option as a step toward a single-payer system in which the government would pay most of the nation’s health care bill and could supplant private insurers.

Essentially, health care providers want to maximize their profits, and so they prefer an inefficient, profit-taking private insurance system. They are symbiotic to protect one another's profits.

The Washington Post's article gives yet another voice to White House officials' feigned surprise that the public option has become so outsized in the debate.

White House officials are somewhat baffled by House Democrats continuing to push for legislation that includes a robust public insurance option when it's clear the Senate will not embrace such a provision. In their view, the public option was never debated in the campaign, was never the center of a national debate and appears to lack the votes regardless of what public opinion polls show about its popularity.

In the opposite view, the public option may have not been debated in the campaign, but it's the center of a national debate right now, polls show it popular, and if it's such a minor part of the overall bill, why are Democratic moderates holding the legislation hostage to it? But for some reason, the dynamic never flows that way in Washington.

If there was ever a moment to get through to the White House, it happened yesterday. The President, at a rally in Minnesota, stated his support for a public option, and the crowd went wild. Absolutely nuts. So much so, the President seemed unnerved by it. He kept on with the same rhetoric from his Wendesday speech about how it's not a big deal and it wouldn't cover everybody. But efforts to rein that in just elicited confusion.



Like it or not, the public option has major grassroots support, and it's driving whatever energy exists around the bill. Kill it and you kill any attempt at leveraging that energy. And the prospects for a bill become remote. Maybe Obama figured this out yesterday in Minnesota.

Obama And The Base

Everybody has gotten to this before me, but I did want to say a few words about Obama and the progressive base. You can see in recent polling that the slide in the President's numbers is coming not from the right, who have already lined up against him, but from the left. Liberals and Democrats are not seeing the change they voted for, and are responding by rejecting this President. Liberals tolerated a lot of the slow-walks and aping of Bush policies in the areas of civil liberties, gay rights, the banks, and other realms, but the wobbling over the public option was the last straw, as they say. Digby explains it well.

There have been a series of issues, one on top of the other and each one more distressing, in which the fundamental principles on which Obama ran have been either betrayed or compromised. It's been too much, too many, in too short a time, from civil liberties to secrecy to cozying up with industry behind closed doors. These aren't minor issues --- they go directly to values and principles.

He's losing trust among the base because he appears to believe that those constituents have no serious claim on his agenda. Even the appointment of Sotomayor did not reflect a liberal commitment beyond the breaking of ethnic barriers, which is wonderful, but cannot be seen as a substitute for progressive principle. Bargaining away the one substantial progressive demand in health care reform is seen as simple bad faith.

I'm not one to trust politicians, but I recognize that most people do, even ardent partisans. They are busy, they don't want to have to follow every detail of the political sturm and drang or try to read between the lines of the NY Times every day to try to figure out what's going on. They more or less inform themselves before an election about what their representatives say they believe in, they assess their sincerity and commitment to certain broad principles and values, and then they leave the governing in their hands, trusting them to do what they said they would do to the best of their ability. Obama promised a lot. A whole lot. And he garnered the trust of many millions of liberal minded folks. When that kind of trust is betrayed, it's very hard to get it back.

I certainly hope they are not fighting the last war. Bill Clinton did not suffer a backlash in his base because he was operating in an environment of conservative dominance and a very weak left flank. The base was desperate and demoralized. But it's not 1996 anymore and that strategy just won't work this time. The conservatives are a clownish group of know-nothings whose approval ratings are in the single digits. They should not, in a democratic society, have the power to shape strategy to the extent they are and the president should not be empowering them. Big business and finance is even more discredited and has no trust among the poeple whatsoever. Openly catering to them in this environment is nothing short of defiant (and politically suicidal.)

Glenn Greenwald and Joan Walsh make largely the same points. I want to say a few things about it.

• There is no question that the Obama Administration isn't getting a lot of credit among the public at large from essentially preventing a Great Depression. If the environment was such that the crises happened a year earlier, and Bush's bumbling put us firmly into Depression, Obama would probably have received a lot more credit for digging us out that preventing things from getting to that point. You can argue with his team's methods for preventing such a crisis, namely shoveling all kinds of money to the banks. But EJ Dionne is right - this prevention has led conservatives to go right back to talking up deficits and spending and big government, as if big government didn't just prevent the worst economic calamity in post-war history.

• That said, Obama isn't blameless for the problems with the base. Indeed he has cozied up to industry in unseemly ways - playing golf with the head of UBS, a company his Justice Department is trying to investigate for harboring illegal tax shelters, is just a metaphor. Bungling multiple gay rights issues and the open hostility of the DOMA brief was just stupid.Joe the Nerd was correct when he told the President on Michael Smerconish's radio show that his "knees were buckling" a bit by trying to compromise with people who have no interest in such a compromise. And the civil liberties outrages are truly contemptible, amounting mainly but not totally to covering up the sins of the past, and in turn abetting them.

• The actual tipping point for all of this was not necessarily the weak-kneed language on the public option, but something that happened a little before, when it came out that the backroom deals Obama cut with industry would save them plenty in the health care reform and shield their profits. Bob Herbert wrote about this last week, but it's been rumbling under the surface for a while. In fact, it was my question to the President at that blogger conference call a few weeks back:

I asked the President about this tension between these buyoffs to stakeholders and his goal to "bend the cost curve" and make health care cheaper and more effective in this country, and here's a paraphrased version of his answer.

"I cannot expect the hospital association, for example, to sign up for something they don't think is right for hospitals and exepct them to back reform. So I understand what they're doing to protect their interests. I think we can negotiate and find a good way to go about this. In theory we could cram down additional savings, but to have the American Medical Association, the American Nurses Association, the drugmakers, the insurance companies, all of them on our team, that does help us move the process forward. Theoretically, there should be enormous savings inside the system. We all know that we pay more for health care than we should, and we shouldn't need additional revenue. But that's harder to do in practice, because all these powerful interests block the efforts. What I think is that we can get a framework where reform begins, one with an insurance exchange, and a robust public option, concrete reductions in cost, prevention, health IT, comparative effectiveness research, and it will be possible to achieve greater savings with a more efficient system down the road. And we can revisit the policy 10 years from now and possibly see even more savings than what was scored and anticipated."

He's basically admitting that he allowed industry to cut favorable deals to keep them on the side of reform. This is still reverberating. Today's New York Times has hospital associations crowing about the benefit to their members over the 10-year window in the form of reimbursement payments for the newly insured. Drug companies are seeing a freer hand to deny access to affordable drugs abroad so they'll keep their end of the bargain on health reform. When people started to put two and two together, and realize that the health reform bill looked more like a giveaway to the stakeholders, they got extremely upset. I don't begrudge hospitals and drugmakers the ability to make money if they are healing more people, but there's a real disconnect when the groups who profited from the broken system stand to profit more off of something called reform. THAT was the moment things went off the rails.

• Nevertheless, I think that Obama has a chance to turn this around. It's not just about progressive outreach, however; it's about the actions he will take, or be forced to take. The President late last week started to use forceful, moral language about the need for health care reform, and that's great too.

It has never been easy, moving this nation forward. There are always those who oppose it, and those who use fear to block change. But what has always distinguished America is that when all the arguments have been heard, and all the concerns have been voiced, and the time comes to do what must be done, we rise above our differences, grasp each others’ hands, and march forward as one nation and one people, some of us Democrats, some of us Republicans, all of us Americans.

This is our chance to march forward. I cannot promise you that the reforms we seek will be perfect or make a difference overnight. But I can promise you this: if we pass health insurance reform, we will look back many years from now and say, this was the moment we summoned what’s best in each of us to make life better for all of us. This was the moment when we built a health care system worthy of the nation and the people we love. This was the moment we earned our place alongside the greatest generations. And that is what our generation of Americans is called to do right now.

But actions will now drive the outcomes, because liberals have heard enough talk throughout the campaign and the first seen months of the first term. Whether the White House likes it or not, the public option has become central to most progressive conceptions of the health care debate. Calling it a source of confusion or a sliver or reform simply won't work. And liberals who are needed at the end of this fight will not work for a policy in which they do not believe. The President put himself down this rabbit hole, and only he can bail himself out. Because progressives are going their own way.

For many Obama supporters who supported President Obama's candidacy because they believed he would rally the public to pass a reform agenda, the White House focus on legislative chess in the healthcare debate has resulting in grumbling about whether or not President Obama is the President they voted for. Fairly or unfairly, Obama now faces a rising tide of doubt in his administration from the very supporters who have backed him most steadfastly since the election.

Many of these supporters are now using internet tools and small donations to signal that their support of healthcare reform anchored in a robust public option would be stronger than their support for an Obama administration willing to negotiate away or weaken a public option.

Thus, weeks before any final bill has actually been written, the healthcare debate has already brought about the most significant change in the American political landscape since Obama won the Iowa caucus to become the leading contender for the Democratic nomination.

The idealists who elected the President are siding with their ideals rather than their candidate.

Obama can choose to live up to those ideals, and turn the tide at this stage of his Presidency, or he can play the same games he's been playing, and lose the base - perhaps permanently.

...Arianna has some very good thoughts on this.

Baucus Caucus: Less Health Care For America NOW

The six-headed Presidential hydra, also known as the sub-group in the Senate Finance Committee, has decided to ignore everybody and keep working diligently to do absolutely nothing on the health care bill.

Senate health-care negotiators agreed late Thursday to ignore the increasingly strident rhetoric from Republican and Democratic leaders and to keep working toward a bill that can win broad support from the rank-and-file in both parties, according to sources familiar with the talks.

In a conference call, the three Democratic and three Republican members of the Senate Finance Committee agreed to redouble their efforts to craft a less costly alternative to the trillion-dollar initiatives so far put forward in Congress. They discussed the possibility of also reining in the scope of their package, the sources said.

The senators rejected the idea of imposing a deadline on their negotiations, and they agreed to talk again Sept. 4 -- four days before lawmakers are scheduled to return to Washington from their August break. The consensus, one participant said, was "to take your time to get it right." [...]

Before leaving for the month-long recess, Baucus had pegged the cost of the negotiators' ideas at less than $900 billion over the next decade. Thursday's discussions focused on driving that cost lower, the sources said.

Their draft bill was already woefully short in terms of subsidies for those who can't afford insurance. The Gang of Six wants to drive them even lower.

I'm sure the people most enamored of themselves did reject having a timeline on their circle jerk. But look who is making these decisions. Chuck Grassley has basically said he'd vote against his own bill, even if he gets everything he wants, if he cannot get more than 80 Senators total on board. The #2 ranking Republican in the Senate has already said that votes for reform aren't coming. So Grassley, one of the key negotiators here, has admitted that he won't support anything the Gang of Six does. Mike Enzi is probably stronger in that direction. Olympia Snowe admitted today that the public option was never on the table in this Gang of Six, and that co-ops are worth exploring, even though two months ago she called them worthless. Kent Conrad has been ideologically opposed to the public option for as long as anyone can remember, and came up with co-ops, in all likelihood, as a way to steal seed money for the "non-profit" Blue Cross of North Dakota, which has captured 90% of the market in his home state. Max Baucus admitted as far back as March that the public option was nothing but a bargaining chip. Jeff Bingaman hasn't been getting nearly enough heat for being part of this charade, but he has talked the talk on co-ops as well.

These six Senators, who come from states representing 2-3% of the population, have proposed ideas out of step with 77% of the public, and think they're entitled to hijack the entire process in Congress to serve those ends.

The question is what to do about this. 270,000 people listened to the President's strategy session yesterday, and over 5,600 supporters have contributed almost $350,000 to lawmakers standing up for the public option. These six lawmakers, most of whom probably want no bill at all, know that the longer they hold up the process the harder it becomes to pass anything. Harry Reid needs to use whatever means necessary to force a bill out of the Senate - discharge petitions, going around the committee of jurisdiction, whatever. At that point, we're talking about a conference committee. Which is what Obama has asked for all along. The problem is a matter of trust, as Paul Krugman put it today.

...Chris Bowers is right that this is the worst part about it - the Senate Finance Committee has decided to take two additional weeks off before meeting again. They are so bound and determined to get health care right that they'll do nothing for weeks, presumably in the hopes that health care reform will die on the vine and they won't have to do anything at all.

"Now, I Hate The Left, Believe Me. But..."

I just listened to a good bit of Barack Obama's OFA session, and I think I can now pinpoint what has been irking me lately. He got up there and tried to rebut all the misinformation about what the bill would do. In fact, he said exactly what Matt Yglesias pre-butted this morning:

I think that if someone gets sick in the United States, that person ought to be treated without being subject to a citizenship test. I think that abortion is a legitimate medical procedure. And ultimately I think health insurance should be directly provided by the government. Interestingly, the one thing that doesn’t get a majority is the thing that’s actually a bad idea—killing grandma.

This reminds me of something that’s bothered me throughout the health care debate. The president’s only real allies and advocates are, you know, serious liberals. People who think that people born in Mexico are human beings but fetuses are not. And most of all, people who believe in government-provided health insurance. But when we man the barricades for the president’s plan, we’re in a weird situation. Obama gets accused of wanting a single-payer system. Then I have to say “no! no! he doesn’t! that’s a slander . . . not there’s anything wrong with single-payer.” It’s a damn dirty lie to say that the government will fund abortion services, but really the government should fund abortion services.

This just deflates a lot of people, the same people who could be counted on to rally for a policy they support. We knew all along that the right would fearmonger and scare people and make up whatever lies served their purpose regardless of the reality. Pre-compromising bills to shield oneself from those charges makes absolutely no sense.

There's this inherent, reflexive self-loathing among establishment "liberals" that turns off people who unabashedly call themselves liberal. Take a look at this article by Joe Klein, an article whose subject is that Republicans have become a nihilist party, and how long he takes punching hippies before getting to his point:

Given the heinous dust that's been raised, it seems likely that end-of-life counseling will be dropped from the health-reform legislation. But that's a small point, compared with the larger issue that has clouded this summer: How can you sustain a democracy if one of the two major political parties has been overrun by nihilists? And another question: How can you maintain the illusion of journalistic impartiality when one of the political parties has jumped the shark?

I'm not going to try. I've written countless "Democrats in Disarray" stories over the years and been critical of the left on numerous issues in the past. This year, the liberal insistence on a marginally relevant public option has been a tactical mistake that has enabled the right's "government takeover" disinformation jihad. There have been times when Democrats have run demagogic scare campaigns on issues like Social Security and Medicare. There are more than a few Democrats who believe, in practice, that government should be run for the benefit of government employees' unions. There are Democrats who are so solicitous of civil liberties that they would undermine legitimate covert intelligence collection. There are others who mistrust the use of military power under almost any circumstances. But these are policy differences, matters of substance. The most liberal members of the Democratic caucus — Senator Russ Feingold in the Senate, Representative Dennis Kucinich in the House, to name two — are honorable public servants who make their arguments based on facts. They don't retail outright lies. Hyperbole and distortion certainly exist on the left, but they are a minor chord in the Democratic Party.

It is a very different story among Republicans.

He goes on, of course, but Klein clearly felt he could not get away with a strident article about Republican insanity without saying "Hey, look, I think liberals are the scum of the earth too, don't get me wrong, but..." It's like a facial tic.

I saw the President today call those who believe government should not be involved in anything at all "reasonable people" with whom we could have a principled argument. Unless we're arguing about whether or not they should use roads, police, fire departments, libraries, and the judicial system, then no, that is not a reasonable line of argument. Here's a reasonable line of argument, from Jesse Jackson Jr., and it's so bitterly partisan, I know, but in the absence of this argument you have the President of the United States giving anti-government cranks a legitimacy they simply don't deserve.

Reverend Jackson and I were talking this morning about health insurance reform. He said ‘“Jesse, sum up this public option thing for me.’ I heard the President give an analysis that I think appropriate: Federal Express, UPS, DHL, the private option. The public option: email, the post office. If you want to pay your bill, sending it overnight for $30, choose the private option. But if you want to mail your mail like most of us do, WITH A STAMP (applause and laughter) use the public option…. The post office offers competitive overnight mail options. And those of us who are not interested in overnight mail can go the slow route, 2-3 days. That’s just fine for me. The post office is universal. It reaches the rural areas. It reaches the urban areas. It reaches where DHL, and UPS, and Fedex will not go. And so in the barrios and the ghettos and the trailor parks of our nation, for the uninsured in our nation, in order for us to save our health care system, we need a legitimate, real public option! (Cheering and applause.)

Instead of this message, we have a President talking about working constructively with people who have said out loud they want to deny any health care bill.

Now some would say that the nation as a whole is not all that liberal, and we have to find common ground because legislation is the art of the compromise, etc., etc. ad nauseum. What never gets discussed is the role of long-term messaging. People are falling for right-wing lies about government-run health care because they're been told for decades that government is evil, with no countervailing message from the other side. Those who resist these lies, the most strident supporters of a health care overhaul in the abstract, are being told to accept half a loaf, that doing reasonable things, like allowing a public option to provide the same medical services that 90% of all private insurance companies provide, is a damn dirty lie, are told to compromise and compromise, are actually told that we cannot have a government insurance option because it would be too popular. You really don't have to get very far from that to a statement like "You don't matter, go away, we don't want you." It's happened before.

And don't you dare, ever, add anything like morality into the individual actions of lawmakers.

It would be, for instance, very uncouth to say that a coal-state senator who opposed climate change legislation was literally consigning thousands of people to death in order to protect hometown interests. That's a very mean thing to say. Senator so-and-so doesn't want to kill people, he just wants to be reelected. But that's what he's doing. He has constituents and polls and pressures. Similarly, a lot of the congressmen who are opposing health-care reform are, again, ensuring that tens of thousands of people will die from inadequate access to health care. But you're not supposed to say that [...]

...no one ever has to make those arguments directly because these debates take place at a high level of abstraction. That's how you get weird situations wherein a congressman who has spent two decades enriching industry and voting to cut Medicaid and welfare can be run out of office because he crossed an ethical line and had an affair or took a kickback. The moral dimension is entirely absent in discussions of policy, as if we've all signed some agreement admitting that the cost to civility would be too great if we took the implications of each vote seriously.

Apparently Obama made something of a moral argument yesterday, calling health care "a a core ethical and moral obligation," saying that “These struggles always boil down to a contest between hope and fear,” and likening back to when FDR was called a socialist, and JFK and LBJ the same for trying to pass Medicare. But that's coming a bit late, and little of that was on display today.

The bottom line is that, until progressives rallied behind the public option this week, the air was out of the balloon. The base of supporters are energizing this debate, and they will reward any lawmaker that reflects their values and actually seeks to follow through on their promises. They now represent the last, best hope for real health care reform. And they won't cotton to being kicked around, dragged through the mud, or played as pawns any longer. 2012 lies in the balance.

Lower Your Sights

Paul Starr tells us all to give up on the public option. Paul may be very smart and right on the merits, but he fails to understand the political contours of the debate.

Because the public option has stood no realistic chance of being enacted in the form it was conceived, its main value all along this year has been as a bargaining chip. The proposal will now have served a valuable political purpose if, by sacrificing it, the White House is able to provide enough cover to Democratic senators from red states to get a bill out of the Senate Finance Committee, through the upper chamber, and into conference with the House.

The Republicans have focused their opposition on the bugaboo of "government-run health care." By jettisoning the public plan, swing Democratic senators can tell their constituents that they prevented a government takeover. This argument will not sway die-hard right-wing voters, but it may suffice for many others and thereby help give those senators confidence they can vote for the bill.

Some liberal members of Congress are still insisting the public option must be part of health reform. They should continue to say so -- their protests may make the ultimate concession all the more valuable. But if any of them actually do vote against the final bill and prevent it from passing because it fails to offer a public option, they will help to ruin the best chance in years to put health care on a path toward reform. And they will do severe damage to the presidency of Barack Obama.

Um, it hasn't swung one Republican, who keep talking about "Trojan horses." This is why the leadership has now resorted to talking about splitting the bill.

Furthermore, this idea that liberals are pawns in Paul Starr's Great Game just will not sit will with the only people out there fighting for this bill. As we saw in polling yesterday, support for reform collapses without a public option. That's the reality of the situation, folks, and to try and decouple the public option now will just remove all the energy from the fight, all the support, leaving the White House in the unenviable position of trying to pass something without any public engagement on their side. The legislation is shaky enough as it is, before cutting all the public support off at the knees. That would be suicide for the bill.

Max Baucus has been saying that the public option is a bargaining chip to get insurers to embrace other reforms since March. There's no question that he and the White House saw it that way. But we're now in August, and support is collapsing, and the only thing holding this bill together are progressives, who don't really want to be humiliated anymore. Especially when we know that offering an individual mandate without a viable public insurance option would be political suicide.

Keeping in mind that this anonymously sourced report could be total bunk, it's worth pointing out that axeing the public option and requiring individuals to purchase coverage under a private health insurance plan would be a horrible political miscalculation. If you think we're having problems selling health care reform now, just wait until we try to explain why all adults under 65 will be required to purchase health insurance from the private sector with no public option.

Oh, you're not interested in making that argument? I didn't think so.

When coupled with a public option (or the sort of rigorous regulatory regime which isn't under consideration), a mandate achieves universal coverage and cures the free-rider problem. But without the public option, the private sector will have a monopoly on a product the public is required to buy, and over the long-run you'll almost certainly see premiums skyrocket and quality of care plummet.

Progressives don't support a public option because they're four year-olds and they reflexively support anything conservatives oppose. They support it because they want to see an end to the private insurance monopoly that's put the squeeze on them for decades. And no, the bill as designed currently wouldn't do that to the degree it must to reverse incentives, because it firewalls out those who get coverage from their employers; but these kinds of things have the tendency to evolve over time, and it's crucial that it's put into place now. Without doing so, Democrats are once again putting themselves at risk with losing a generation.

But on a political level, the left has been betrayed over and over again on the things that matter to us the most. The village is pleased, I'm sure. But the Democratic party only needs to look back eight short years to see just how destructive it is to constantly tell their left flank to go fuck themselves.

In 2000, I recall standing in line to see Al Gore speak here in LA and I was inundated by a bunch of young, impressionable lefties, inspired by the globalisation movement and Ralph Nader's message. We sparred for some time, me telling them how third parties don't work, and them having none of it. They had no political experience except what they saw as a betrayal of liberalism and they found Nader's analysis of the two parties as being in bed with corporate interests extremely convincing. And it was very hard to argue that point, although I did try valiently, knowing as I did that while both parties were corporate whores, the Republican Party, being insane, wanted to actually kill large numbers of people in foreign countries, put the church in everyone's bedroom and give everybody's money directly to the wealthiest people in the nation. But I didn't convince any of them. And we know the result.

At the time nobody believed that an incumbent Vice President in a roaring economy would have a race so close that the Republicans could steal it. But we know differently now don't we? And you would think that the Democratic establishment would also know that because of that, it may not be a good idea to alienate the left to the point where they become apathetic or even well... you know. It can happen. It did happen. Why the Democrats persist in believing that it can't happen again is beyond me. Perhaps they internalized all the villager CW about Al Gore being a bad candidate, but the fact remains that if a slice of the left hadn't been so disgusted by the New Democratic, mushy centrism of the Clinton years, he would have won.

Obama mobilized a whole lot of young people who have great expectations and disappointing them could lead to all sorts of unpleasant results. Success is about more than simply buying off some congressional liberals or pleasing the village. It's worth remembering that a third party run from the left is what created the conditions for eight long years of Republican governance that pretty much wrecked this country.

And that's where we're at right now. Obama can pretend Chuck Grassley is acting in good faith and renounce the public option in the name of bipartisanship (that's a really brilliant move by Grassley, by the way, he's playing in the big leagues), or he can support the people who elected him and believed in his message of change. I think those 60-odd million are more important than Sen. Grassley's feelings, but what do I know, I don't live in Washington.

I do know this: alienating your key supporters right when they're needed the most is a recipe for disaster.

What Obama Wants

Robert Gibbs sez Obama "wants" a bipartisan bill. I want a recording session with Styx. (That's right, Styx) It's not going to happen, however. So he can "want" something all he wants, even say it publicly, but if he wants a bill, he's going to have to go it alone. And I think Obama recognizes that.

The President has also said that he "wants" a public option in the bill. It's funny how it's given as Beltway conventional wisdom that reality is intruding on the ability to get a public option, but not on bipartisanship. Especially when you look at the numbers, with no Democrat committing to filibuster health care reform, but 64 Democrats in the House vowing to vote against any bill without a public option. Beltway types aren't really good at math.

Maybe they can read a poll.

Just 34% of voters nationwide support the health care reform plan proposed by President Obama and congressional Democrats if the so-called "public option" is removed. The latest Rasmussen Reports national telephone survey shows that 57% oppose the plan if it doesn't include a government-run health insurance plan to compete with private insurers.

There are multiple positive elements to be gained from a health care reform bill as set out by Congress - Families USA lists ten of them very succinctly right here - but the lack of messaging from the White House created a vacuum, and the public plan slid into that space. It cannot be bargained away at this point, as it's become synonymous with reform. Clamping down on insurers is great (though who, exactly, will do that?), and I want to see Medicaid expanded and subsidies for those who can't afford coverage and real competition through an exchange. And modernizing health care delivery and Medicare spending, cutting waste from the system and securing give-backs from providers is all awesome. But the politics of the situation are such that the public option can no longer be decoupled from the bill. Indeed, the intensity and energy around the public option is the only thing sustaining the bill, as it completely changed the conversation from right-wing tea partiers and gun-toting loonies to policy considerations. Even with supporters outnumbering the opposition, the town hall meetings gambit was a losing bet and it would have threatened reform severely. Obama has a chance to deliver on what he says he "wants" now, which would burnish his credentials among the base and create the energy needed to drag legislation over the finish line.

I guess it all depends on what he wants: bipartisanship, or a public option.

They Should Be Thrilled

Anonymous wankers in the White House expressed surprise in the WaPo this morning about the intensity of feeling about the public option in the health care debate.

President Obama's advisers acknowledged Tuesday that they were unprepared for the intraparty rift that occurred over the fate of a proposed public health insurance program, a firestorm that has left the White House searching for a way to reclaim the initiative on the president's top legislative priority [...]

"I don't understand why the left of the left has decided that this is their Waterloo," said a senior White House adviser, who spoke on the condition of anonymity. "We've gotten to this point where health care on the left is determined by the breadth of the public option. I don't understand how that has become the measure of whether what we achieve is health-care reform."

"It's a mystifying thing," he added. "We're forgetting why we are in this."

If the public option gravitated to the center of the debate and the White House never wanted it there, it's their own damn fault for talking like CPAs about "cost curves" and "risk adjustment" and arguments that could be plotted on a graph for six months without being specific about the moral case of covering millions of people who have no choice and no hope, and beating back the unrivaled greed of the insurance industry. The only element of health care reform as set out by the White House with a beating pulse has been the public option, and humans being emotional creatures as well as rational ones, that's where progressives gathered.

But I want to focus in on this element of "surprise," which is silly, since the public option was the compromise down from the policy with the most intensity on the left in the health care debate, single payer. Beyond this anonymous staffer being clueless for his surprise, he's not even understanding that the revolt on the left is the only thing saving health care reform at this point.

When town hall crazies and conservative misinformation dominated the debate, health care was on a losing trajectory, if not dead in the water. Since Kathleen Sebelius' statement on Sunday on CNN, the nature of the debate has shifted so much away from that and toward actual policy you'd think it was intentional on the part of the White House. Noam Scheiber captures this at TNR.

Around the conference table at TNR, we’ve been saying for weeks that what Obama really needed was a group of equally vocal, equally zealous critics on the left, pulling the debate’s center of gravity in the other direction. And, wouldn’t you know, that’s exactly what’s happened over the last 48 hours. We’ve now got a pole on the left to match the intensity of the pole on the right. (Don’t get me wrong: I’m not suggesting a moral equivalence between the two. As far as I’m concerned, the critics on the left are basically right and the critics on the right are either insane or deeply cynical.) From a sheer tactical perspective, I think the White House and the Democratic leadership in Congress have dramatically improved their position.

You now have 64 House Dems who have raised over $100,000 and counting from over 1,600 Democrats in 24 hours since they took the pledge of not voting for any bill without a public option. You have House Democrats strongly behind the public option in their weekly caucus meeting, with everyone in support of it because their constituents had pressed them on it. You have labor warning Democrats that they'll sit out specific elections if any members oppose a public plan. There's a vital energy to the debate now that was simply missing when Obama was offering vague principles and playing an inside game trying to frame health care reform as entitlement reform. And it's actually doing more to get a health care bill passed than anything the White House has done all year.

Elites who reflexively kick the left will retreat to the familiar ground of the Washington Post editorial page to demand that liberals "give up on the public option". And they can make their case for that on the policy - the currently administered public option on offer, by firewalling those who get insurance through employers, will struggle to survive because it cannot capture enough of the market to force competition on price and quality of care (though historically, governments build on what gets enshrined into law gradually over time, so the policy of the moment matters less than what can be done with it eventually, and having nothing, or weak co-ops that experts have shown cannot work at all, would be disastrous). On the politics, liberal elites are dead wrong. They will lose health care completely if they alienate the base. And the base wants competition against for-profit insurance CEOs with a public option, at the very least. Because they understand that a properly administered version of this competition would save people and the government money, with more savings the more popular it is. That's only something to fear if you want to protect insurance company profits.

As Chris Bowers says:

However, the current fight over the public option is a perfect demonstration of why such left-wing criticism is absolutely essential to any attempts to pass progressive legislation by the Democratic leadership and the Obama administration. If there had been no left-wing revolt to Sebelius's statements on Sunday, it would be far more difficult for the Democratic Congressional leadership and the Obama administration to justify not giving into right-wing demands. Lacking any Progressive Block demanding more progressive legislation, the Democratic leadership and administration would be practically forced to offer up even less progressive legislation than even the compromises they were floating over the weekend [...]

It is understandable that some progressives who worked very hard to elect President Obama get irked by left-wing criticism. Not all Democrats are on the left, not everyone buys into the same strategies as me, and criticism toward someone you personally identify with is irritating [...]

No matter these objections, in order to pass progressive legislation, both prominent left-wing criticism and powerful, Congressional Progressive opposition to a Democratic trifecta is absolutely necessary. In the current health care fight, the lack of such criticism and the lack of such a block would mean that the public option was dead in the water right now. Not everyone is going to like it, and some party higher ups like Rahm Emanuel may call it "f*ckng stupid," but any progressive ecosystem lacking such criticism and left-wing organizing is only a short time away from suffering a mass extinction.

I would go further, and say that without progressive organizing around the public option, there wouldn't be any health care reform legislation. Period. The band of hippies is saving the Democrats from themselves.

Please thank those who have stood up for their efforts. Let's get to $200,000 today.

On Pressure And The Obama Administration

It's faint praise to say that the Obama Justice Department surpassed expectations by not comparing same-sex marriage to pedophilia and incest anymore, but that's basically what John Aravosis is offering with respect to the Administration's latest brief on DOMA. As Aravosis says, in the end, they're still defending discrimination, but they are doing it with a recognition that the President does not support the law and wants it repealed. There's a fair question over whether the DoJ could just not defend the law, but it would conjure up the Bush era, when they simply ignored whatever laws they felt like ignoring.

With respect to the merits, this Administration does not support DOMA as a matter of policy, believes that it is discriminatory, and supports its repeal. Consistent with the rule of law, however, the Department of Justice has long followed the practice of defending federal statutes as long as reasonable arguments can be made in support of their constitutionality, even if the Department disagrees with a particular statute as a policy matter, as it does here.

The larger point here is one about pressure. The Obama DoJ made a huge mistake with their initial, hostile brief on DOMA, and it enraged the LGBT community, who promptly reacted in very strong terms. Since then Obama has been trying at various points to make things better, going further and further each time. At Netroots Nation, Valerie Jarrett said the President is committed to repealing DADT and DOMA, without any weasel words. The Administration made a bad decision, got a huge amount of pushback, and responded in favorable ways. That doesn't mean gay rights advocates will end their pressure, nor should they until the actual repeals are signed and gay rights are advanced. It means that they've learned how pressure works with this Administration. We could all learn from that.

The Guerrilla Meeting Strategy And Counter-Strategy

Some smart people in Washington had better come up with a way to counteract these lobbyist-organized mobs. Lloyd Doggett did decent enough job on Hardball today.

Rep. Lloyd Doggett (D-TX) said his health care town hall this weekend was a "mob scene" filled with people from outside the neighborhood who were brought in by the Republican and Libertarian parties.

Their purpose was not "just to get their own voice heard, but to ensure other people weren't heard," he told Chris Matthews on Hardball. "I think these folks are really desperate to stop health reform." [...]

Doggett also compared the protesters to birthers and secessionists.

"It's the same fanaticism I saw on Saturday," he said. He claimed most of the protesters weren't from the neighborhood, but were brought in by the Republican and Libertarian parties.

The protest was one of several at town halls across the country this weekend and over the past few weeks.

One protester carried a sign with a picture of a marble tombstone engraved with Doggett's name, he said.

Later on in the same show, Matthews marveled at the passion and intensity of the protestors, without mentioning what Doggett told him a half-hour earlier, that rioters were bused in from out of town, and without mentioning the organized lobbying effort to build fake grassroots movements to disrupt meetings by whatever means possible. Likewise, other media weathervanes are claiming that such town hall vigilantism is a Democratic idea (!), although I appreciate Ambinder's admission that "the press will be complicit in telling the story" because the riots make for better visuals.

Congressman Patrick Murphy appeared to handle his town meetings pretty well, and really it isn't about the spectacle, the theater, but how Democrats use them as cover to return to the beliefs they already hold. Any politician who tells you they "listen to their constituents" and then talk about a town hall meeting with 100 or 200 people is engaging in terrible polling, and really selecting to get a preferred result.

Maybe members of Congress have to be aware of what's happening in the room, as we used to say in comedy, and flat-out state that an organized group in the meeting seeks to disrupt the proceedings. Republican supporters on the stump last fall didn't do themselves any favors, revealing an ugly underbelly of extremism and violence. I would highlight it. Make it personal.

Finding The Target

As I said in the last post, astroturf groups are going to be out in force in August, creating mini-Brooks Brothers riots all over the country, harassing members of Congress, doing whatever they can to be the squeakiest wheel in the hopes of drowning out support for health care reform. So how will Democrats respond?

With polls suggesting that public support is sagging for President Obama's push to overhaul health care, House Majority Leader Steny Hoyer said the party will use the August break to make a strong sales pitch to middle-class voters.

"We're going to be on the air. We're going to be in the neighborhoods," said Hoyer, D-Md. "Our members are going to now have the opportunity to go home ... and say to their constituents, 'Look, this is what we're doing. This is why it's good for you and your family.' " [...]

A House Democratic memo obtained by USA TODAY shows the steps the party is taking to coordinate its message over the break. Lawmakers are encouraged to hold town-hall-style meetings, post videos on the Internet and find small-business owners "whose testimony can provide a powerful narrative," the memo states.

And it looks like Democrats have settled on a message, one that I guess works as well as any other - bash the hell out of insurance companies.

"Remove them from between you and your doctor. No discrimination for pre-existing conditions. No dropping your coverage because you get sick. No more job or life decisions made based on loss of coverage. No need to change doctors or plans. No co-pays for preventive care. No excessive out-of-pocket expenses, deductibles, or co-pays. No yearly or lifetime cost caps on what insurance companies cover."

According to the memo, they've coordinated this strategy with the Obama administration and a number of sympathetic groups. "The Leadership is working in close coordination with the White House and outside groups (including but not limited to HCAN, Families USA, AFSCME, SEIU, AARP, etc.) to ensure complementary efforts during August."

Those groups have literally hundreds if not thousands of events planned in August, and they're digging in against opponents of reform, Republican or Democrats. You already hear the fruits of this rhetorical shift, from health care reform to health insurance reform. Nancy Pelosi called insurance companies "the villains" in this debate. The President has also shifted the debate toward insurers versus consumers, a "people versus the powerful" maneuver.

President Obama has framed the health-care debate in Washington as a campaign against insurance companies whose irresponsible actions, he repeatedly says, must be reined in to control costs and improve patient care. In North Carolina this week, he told an audience that the existing system "works well for the insurance industry, but it doesn't always work well for you."

The message is no accident, as the president's chief pollster made clear in a rare public speech last month. Joel Benenson told the Economic Club of Canada that extensive polling revealed to the White House what many there had guessed: People hate insurance companies.

"Take the public plan, for example," Benenson said. "Initial reaction to it wasn't as positive as it is now. . . . But we figured out that people like the idea of competition versus the insurance company, and that's why you get a number like 72 percent supporting it."

Hitting insurance companies must poll off the charts. And it's certainly better than having to discuss the intracacies of the employer deduction or MedPAC. Obama said in his interview with Karen Tumulty that he's struggled with relating the urgency of reform to the public in clear, simple terms. He's decided to go with a battle with the insurance industry, something that appeals to both the base and has resonance for most people. It's probably the right choice, even if it is shorthand. Scaling back and targeting the rhetoric can actually move forward the policy.

Obviously we have to keep this up for the next month.

We're Here, We're Progressive, Get Used To It

House progressives have really tried to throw their weight around on the deal put together between Henry Waxman and the Blue Dogs. They probably should get the full list of co-signers before releasing it, but still, this represents a rare step for the Progressive Caucus in taking a stand against compromise after compromise with the conservative wing of the party. I hear they got 53 members to add their names to this:

We write to voice our opposition to the negotiated health care reform agreement under consideration in the Energy and Commerce Committee.

We regard the agreement reached by Chairman Waxman and several Blue Dog members of the Committee as fundamentally unacceptable. This agreement is not a step forward toward a good health care bill, but a large step backwards. Any bill that does not provide, at a minimum, for a public option with reimbursement rates based on Medicare rates - not negotiated rates - is unacceptable. It would ensure higher costs for the public plan, and would do nothing to achieve the goal of "keeping insurance companies honest," and their rates down.

To offset the increased costs incurred by adopting the provisions advocated by the Blue Dog members of the Committee, the agreement would reduce subsidies to low- and middle-income families, requiring them to pay a larger portion of their income for insurance premiums, and would impose an unfunded mandate on the states to pay for what were to have been Federal costs.

In short, this agreement will result in the public, both as insurance purchasers and as taxpayers, paying ever higher rates to insurance companies.

We simply cannot vote for such a proposal.

At issue seems to be the reimbursement rates for the public option, which seems odd to me, because the Medicare +5% rates in the House Tri-Committee bill only exist for the first three years, and the negotiated rates from the Health and Human Services Secretary will presumably be improved over that of private industry. I agree about the lower coverage subsidies, but again, we're talking about 1% on those between 300 and 400% of the federal poverty level, which is not determinative. Finally, looping back to the public option, I agree that bargaining rates are important, but even if they are restored, the fact that relatively few people can access it because it's firewalled for people who get health insurance from their employers seems to be a MUCH bigger problem.

If you're interested in covering people, the primary questions are the subsidies, the employer mandate and the individual mandate. If you're interested in reforming the system, the primary question is the strength of the Health Insurance Exchanges. And if you're interested in the public plan? It's the Health Insurance Exchanges. Again.

In all the bills we've seen, the public option is on the exchange. It is only available to those who are able to buy into the exchange. But most Americans can't buy into the exchange. They're not allowed. To make this very clear, imagine that the House and the Senate both pass Henry Waxman's proposal tomorrow. Liberals would celebrate. That's got a good, strong public plan. And I can't use it. Not even if I want to pay for it out-of-pocket. I work at a large employer and thus I am not allowed to buy into the exchange.

A strong public plan on a weak exchange will fail because it won't attain sufficient market share. It's as simple as that. Conversely, even a weak public plan on a strong exchange could thrive, because it would have access to a lot of customers. Focusing on the public plan and ignoring the rules of the exchange is like focusing on engine power but ignoring whether people can buy the car.

And the one remedy for this problem, the Free Choice Act, which would give employees the choice to take employer coverage or use that money on the insurance exchange, is being pushed by Ron Wyden but virtually nobody else, certainly not House progressives or the larger progressive activist community.

(Now, I will say that Matt Yglesias' contention that the exchanges aren't the most important part of reform, but the insurance regulations are, when things like rescission and pre-existing conditions don't apply to the employer market either, is a little weird. An exchange that has all of those consumer protections on the insurance industry AND is available to anyone who wants to buy in would be a game-changer, particularly with a public plan providing competition inside the exchange.)

So, if progressives are vowing not to vote for deals that don't even contain the kinds of reforms they'd want, what's going on here? I think Ezra Klein has it right.

House liberals are afraid of the dynamic in which good bills face Blue Dog opposition in the final mile and are aggressively watered down. Senate liberals are afraid of the same. And throwing this final compromise with the Blue Dogs into doubt is a show of strength. After all, House liberals feel they've already compromised plenty: Coming down from single-payer is a compromise. Cordoning the public plan off on the Health Insurance Exchange is a compromise. The whole bill is one big compromise, and every subsequent iteration is a compromise stacked atop a compromise placed upon a compromise. At some point, the compromises have to stop. Or, better yet, they have to go in the other direction.

Yep. This is not about the specifics of the bill as much as it is about changing the general dynamic. It shows me that progressive lawmakers are learning from the mood of the grassroots, who have been demanding this for a while. Furthermore, they can add that, if health care goes down, the people on the front lines will be the ones who wouldn't deliver what the people wanted and are in the kind of districts most likely to flip to Republicans. I'm sure that progressives are mindful that a half a loaf bill will open them up to challenges from the left, too.

The Real Problem With Obama's Poll Numbers

My big takeaway today is supposed to be that Barack Obama is fading in selling his health care plan, as eroding poll numbers, both on health care and his job approval rating, threaten legislation in the coming year. As references to "Obamacare" rise, some blame the President for a poor sales job with health care legislation. I fault the President, but for different reasons.

Right now Obama is simply a captive to Congressional process. That process is messy, it's easy to view it as negative, and people are in general reacting to the ups and downs that wound the possibility of passing a bill. The President has no bill to go out and hawk because the Congress is deep into negotiations, so he's selling nothing, a difficult task for anyone. You could say that Obama should have just stepped in and laid down the law, but not only has that proven to fail in the 1993-94 Clinton health care plan, but I don't necessarily want executive dictates to trump Congressional process. I think there's a lot of unnecessary bottlenecks in Congressional process, like the undemocratic filibuster and the seniority system for Committee chairs (particularly in the Senate) and the anti-majoritarian nature of the Senate itself. But in general, we don't elect emperors, and checks and balances are by and large healthy, and I'm OK with Congress performing their task of coming up with legislation and the President performing his task of executing it. Obviously he has some input, but I don't want an executive dominating the process. The paradox of this is that, since people generally believe that a President can just walk in and magically implement his policies, his personal approval is getting dragged down by the slog of health care bills in Congress.

The other wall that Obama is running into has been described for years as the Two Santa Claus theory. For 30 years and more, the American people have been sold on the idea that they can have unlimited services and endlessly low taxes. Somehow the lower taxes generate enough revenue to cover all the services they desire. This was part of a Republican ideological project begun by Reagan aides to basically force Democrats into wearing the black hats, and it has turned into doctrine from then on.

By 1974, Jude Wanniski had had enough. The Democrats got to play Santa Claus when they passed out Social Security and Unemployment checks – both programs of the New Deal – as well as when their "big government" projects like roads, bridges, and highways were built giving a healthy union paycheck to construction workers. They kept raising taxes on businesses and rich people to pay for things, which didn't seem to have much effect at all on working people (wages were steadily going up, in fact), and that made them seem like a party of Robin Hoods, taking from the rich to fund programs for the poor and the working class. Americans loved it. And every time Republicans railed against these programs, they lost elections [...]

Wanniski decided to turn the classical world of economics – which had operated on this simple demand-driven equation for seven thousand years – on its head. In 1974 he invented a new phrase – "supply side economics" – and suggested that the reason economies grew wasn't because people had money and wanted to buy things with it but, instead, because things were available for sale, thus tantalizing people to part with their money. The more things there were, the faster the economy would grow.

At the same time, Arthur Laffer was taking that equation a step further. Not only was supply-side a rational concept, Laffer suggested, but as taxes went down, revenue to the government would go up!

Neither concept made any sense – and time has proven both to be colossal idiocies – but together they offered the Republican Party a way out of the wilderness [...]

Democrats, (Wanniski) said, had been able to be "Santa Clauses" by giving people things from the largesse of the federal government. Republicans could do that, too – spending could actually increase. Plus, Republicans could be double Santa Clauses by cutting people's taxes! For working people it would only be a small token – a few hundred dollars a year on average – but would be heavily marketed. And for the rich it would amount to hundreds of billions of dollars in tax cuts. The rich, in turn, would use that money to import or build more stuff to market, thus increasing supply and stimulating the economy. And that growth in the economy would mean that the people still paying taxes would pay more because they were earning more.

There was no way, Wanniski said, that the Democrats could ever win again. They'd have to be anti-Santas by raising taxes, or anti-Santas by cutting spending. Either one would lose them elections.

The most important numbers in these collections of polls this week are this. People generally still want health care reform and they believe the system is broken. But they also believe that Congress should cut the deficit without raising taxes or cutting spending. With the caveat that we're talking about aggregate data and cannot make specific conclusions about individual beliefs on the deficit, taxes, and spending, this is not the result of one poll but pretty much the standard poll result over many decades, particularly when Democrats are in power and the deficit-industrial complex ramps up their rhetoric. Simply put, Republican fantasy projections have given the country an out to refuse to accept the normal choices that must be made to deal with reality.

If you don't have the time or inclination to obsessively pay attention to issues, I don't see why you wouldn't decide that we should just pay down the deficit but get good services like comprehensive health care reform but do it without raising taxes. It's very untroubling and simple, and if I'm working two jobs or busy with other things in my life it sure sounds like a good deal to me.

I agree that the President needs to do better in selling his plans to the public. A speech in prime-time, not a press conference but an actual speech, complete with Ross Perot graphs if necessary, as Nate Silver advocates, sounds like a good idea. But his problem is more about American political ideology than the ins and outs of this bill. America elected a Democrat because they didn't like George Bush. But they didn't elect a liberal ideology, even if they may agree with it on many points, because a liberal ideology wasn't on offer. Nobody in the Democratic Party has pushed back against the Two Santa Claus theory, or offered up a competing theory of their own, in the thirty-plus years since it was invented. Obama spent the first few months, when he had a honeymoon and his approval ratings were high, assuring everyone that 95% of Americans will see a tax cut, that he was pragmatic and will only go with "what works," and so on. And so when you get to an issue like health care, which does have moral overtones, which does speak to the fundamental rights of a society to ensure care for their sick and bleeding, there's no ideological foundation to fall back upon, no belief that America is worth paying for and those who use the commons to a disproportionate degree need to give a little bit to maintain the societal fabric. So we have an overhaul of health reform to expand coverage to everyone who needs it couched in the terms of cost curves and long term budget projections and constrained by the obsessive desire of deficit neutrality. This does not inspire activists and partisans to action. It does not force any thinking from those susceptible to attacks on "government-run health care" from the other side. And it does not break the underlying principles of the Two Santa Claus Theory. Nobody has fought the dominant wisdom, inside the Beltway and even in the country, and stated plainly that conservatives have lied to the country about economic issues for 30-plus years. The epic collapse of the economy under the Bush Administration provided an opportunity that nobody took.

Unless and until we start challenging conservative ideology and not conservative candidates, we will always have trouble making major changes because the public has swallowed a notion of government that makes no logical or coherent sense.

Money For Nothing

I think Ezra Klein hits the saddest part of Max Baucus' largesse from the health care industry - the Montana Senator simply doesn't need the money.

Imagine that Baucus is, at best, bemused by the lobbyists and corporate chieftains autographing checks in a futile effort to purchase his affections. Why let them? Baucus is from Montana. It's one of the smallest states in the country. It has a cheap media market. And Baucus -- who faced no serious competition in his last campaign -- isn't up for reelection until 2014.

Baucus could have shut off his fundraising operation and avoided the appearance of any and all impropriety. Instead, on June 10, he held his "annual fly-fishing and golfing weekend in Big Sky, Mont., for a minimum donation of $2,500." Sometime this month he'll preside over "Camp Baucus," a "trip for the whole family" that touts horseback riding and hiking on the list of activities. The problem with this is not that it necessarily influences Baucus's thinking on health-care reform. It's that all this industry money reduces his credibility to make necessary concessions and hard decisions. And there's no reason for it. He doesn't need the money.

I would guess that Baucus takes the money because he's supposed to take it. It makes him a major player in Washington, someone whose boots the lobbyists have to lick. It probably flatters him to have all these rich folks plying him for attention. If he has higher designs - and I'm thinking Majority Leader, not President - that money will come in handy, considering he can pass it around to other Senators to make allies for the next four years. Like any politician, he relishes the power.

The people are trying to turn the tables on that this week.

Progressive groups are launching a new round of advertising against Senate Finance Committee Chairman Max Baucus, (D-Mont.), in an effort to persuade him to support a public option.

The Montana Democrat was the (unfortunate) winner of a contest sponsored by the Progressive Change Campaign Committee and Democracy for America, in which the groups allowed members to choose which senator to target in an ad campaign. Baucus has, at times, indicated he supports a government run plan but it is not certain if the proposal will make it into the final version of his committee's bill.

For this, 15,000 progressive voters determined that he should get an additional bit of political pressure. The ads being run against the senator, which will air in three media markets in Montana -- Billings, Butte-Bozeman, and Helena - are duplicates of an old PCCC spot. Only it is customized for Baucus, pointing to the $3.9 million he has taken from "health and insurance interests."

Baucus is holding up the bill over how to pay for it, and I'd prefer to see some progressive action on that. But putting money into opposing Baucus rather than flattering and fluffing him is certainly something I can get behind.

Misdirected Activism

Am I the only one who didn't really see a line in the sand from the President in yesterday's health care YouTube address?

That’s why 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.

The emphasis of the must is on the insurance exchange, which is actually a very important policy to break regional monopolies in the insurance market. The public option is wedged in there, but mostly Obama demands an insurance exchange so that individuals and small businesses have the ability to choose from a wide variety of plans.

But what this shows to me is that the public option is yesterday's debate. I think we'll get it, if we get a bill. But it's not holding up the process any more. It's too popular to kill the bill over. There are other elements that can sink the bill, most of them to do with cost. The DNC push against recalcitrant House and Senate Democrats just references some horror stories from citizens and states "it's time" for health care reform. No policy is forwarded, certainly not the public option.

The groups pushing back against reform aren't simply opposed to the public option, they're opposed to reform in general. And they see the cost controls and how to pay for the bill as the best way to attack it. Unfortunately, not a lot of people on the progressive side are defending wealth surtaxes or increasing the authority of MedPAC, for example.

Direct Line Between Weakness Of Climate Bill And Weak Public Reaction

The Senate version of the climate and energy bill has been delayed until September, which means a few more months of debates over whether it's worth it to pass at all. The Waxman-Markey climate bill included so many compromises and hedges and backdowns that many, including the respected Dr. James Hansen, find it unworthy of passage.

With a workable climate bill in his pocket, President Obama might have been able to begin building that global consensus in Italy. Instead, it looks as if the delegates from other nations may have done what 219 U.S. House members who voted up Waxman-Markey last month did not: critically read the 1,400-page American Clean Energy and Security Act of 2009 and deduce that it's no more fit to rescue our climate than a V-2 rocket was to land a man on the moon.

I share that conclusion, and have explained why to members of Congress before and will again at a Capitol Hill briefing on July 13. Science has exposed the climate threat and revealed this inconvenient truth: If we burn even half of Earth's remaining fossil fuels we will destroy the planet as humanity knows it. The added emissions of heat-trapping carbon dioxide will set our Earth irreversibly onto a course toward an ice-free state, a course that will initiate a chain reaction of irreversible and catastrophic climate changes.

Some, like Joseph Romm, disagree violently with this.

Hansen claims "For all its 'green' aura, Waxman-Markey locks in fossil fuel business-as-usual and garlands it with a Ponzi-like 'cap-and-trade' scheme." Not so. I have previously explained why W-M takes us sharply off of the BAU emissions path over the next decade, probably reducing coal use more than 25% by 2020 (see "Game changer, Part 2: Why unconventional natural gas makes the 2020 Waxman-Markey target so damn easy and cheap to meet"). And then it requires a 42% emissions reduction by 2030 and an 83% reduction by 2050, which will drive a massive energy transition over the next few decades.

The global economy is indeed a Ponzi scheme, but this is the first piece of legislation by any major country that makes a serious effort to end that Ponzi scheme.

You can read both of these efforts and draw your own conclusions. I would simply say that the environmental community, including people like Hansen, have generally failed to create the urgency necessary to pass the kind of bill he would prefer. All you have to do is look at this recent poll, showing that less than half of all Americans believe that climate change is the result of human activity. This may not even be the fault of Hansen and climate activists - this problem is uniquely ill-suited for the American political system to solve. It's long-term and not entirely tangible. It forces parochial lawmakers to act in the global interest. But the facts are that under the current structure, a straight-up carbon tax cannot pass, and anyway would be completely flawed with numerous loopholes, because it would have to run the exact same gauntlet that the Waxman-Markey bill has. It's dishonest to glorify all the positives of a bill that hasn't been through that ringer, and demonize the negatives of one that has.

Many climate activists have been valiant - Greenpeace draping a banner on Mount Rushmore is fantastic - but they have not broken through in the popular imagination. We have not seen the kind of pressure necessary, and furthermore the mainline enviro groups have been happy to pass whatever they can pass, and signaled that so early in the debate that they nullified any effect they could have on lawmakers, and disappointed progressives who could mount energy on that score. As a result you get politicians happy to take duplicitous stances like this:

I sent several emails to Rep. Glenn Nye urging his support for the ACES climate change bill and more emails expressing my disappointment after he voted against it.

I received two different emails from him in response:

In one email, Nye said I will be pleased to know the bill passed, praising it as "a comprehensive approach that charts a new course toward a clean energy economy" and "will create jobs, help end our dangerous dependence on foreign oil, and combat global warming" (without ever mentioning that he voted against it).

In the other email, Nye said I will be pleased to know that he voted against it "because we do not need another tax on American families during this time of economic hardship."

Oops! Nye can't have it both ways. Thelma Drake was consistently wrong, but at least she was consistent.

The environmental community simply must find other ways to intensify the debate. Otherwise, our political system will not produce what's necessary.

The Role Of Grassroots Action In Policy Debates

I've seen a lot of buzzing about this story from Harold Meyerson, about the faltering of Barack Obama's online army when it comes to health care:

Organizing for America (formerly Obama for America), which maintains that list within the confines of the Democratic National Committee, has asked those 13 million Obamaites to "create a conversation within their communities," in the words of one DNC official. Specifically, the DNC has asked them to collect health insurance horror stories and put them online, to support a set of broad health-care principles, and to go door-to-door among independent voters in their neighborhood and talk to them about those principles. On June 27, some activists participated in what the DNC termed a "day of service," working in blood banks, volunteering at health clinics, raising money for medical research.

All very commendable, and about as likely to affect the outcome of the health-care deliberations as the phases of the moon. "What made the presidential campaign so potent were clear goals and a strategy that made sense to people," says Marshall Ganz, one of liberal America's foremost organizing geniuses (who led training sessions for Obama campaign staffers and volunteers last year). Such goals and strategies are hard to discern today, and the participation of Obama volunteers has declined accordingly.

Even when the battle for health care finally comes down to a single bill, the plans to activate Obama supporters are conceptually modest. "We can't target individual members of Congress," says one DNC official. "To tell people to target certain Democrats puts the party in a weird position." Not even 13 million supporters, apparently, can instill party discipline into a political culture that scarcely knows the meaning of the term.

Meyerson thinks we need a mass movement strategy to win the day on health care. Well, that can never possibly come from inside the party machinery. In a 60-vote environment, Republicans have no part in the debate. It will rise or fall based on the actions of conservative Democrats. And a DNC-based organization, as the official says, won't go after Democrats, at least not in public.

Now, Organizing for America has built a large list of health care horror stories that activists can use. And their architecture of calling and canvassing tools is more than available to anyone to start their own independent push toward particular legislators. In fact, I know that some grassroots groups have already done so, whether OFA likes it or not. And they are really in a capacity-building phase right now, and there's going to be a learning curve. Things are happening that columnists in Washington might not see.

As for the efforts by outside groups to push recalcitrant lawmakers, Meyerson thinks they are pursuing a legislative strategy and not a movement-building strategy. Well, that's not entirely true. There are health care rallies at Congressional offices tomorrow. Health Care for America Now put 10,000 people in Washington for a rally. I don't really know what he wants. Meyerson hints that single-payer advocates are actually building a movement, one I believe will endure no matter what reform bill passes, but it currently lacks critical mass.

Even if we grant Meyerson these points, I'll say this. Health care is a maddeningly complex topic. Everyone's for fixing this broken system but they have about 100 different ways to do so. If Meyerson thinks that ordinary Americans can actually impact that debate at the granular level, I'd love to see his blueprint. When elements of reform - like single-payer, like a public insurance option - have been used to stand in for reform, it has moved a couple legislative mountains. I believe in movement politics, but on health care reform that movement, unlike with "civil rights now" (the 1960s) or "We're in a Depression" (the New Deal era) there's just no bumper sticker for health care reform that's going to turn it into a mass movement. You're seeing the best digital-age equivalent of it - online organizing, grassroots ads, etc. - but it doesn't throw people into the streets.

I don't totally disagree that OFA isn't a great model, it being situated inside a party infrastructure. But I really fail to see a vision of a million people on the Washington Mall shouting "national health insurance exchanges with subsidies up to 400% of the poverty level now!" And, activism circa 2009 is different than activism circa 1963.

Learning To Count

This has been a consequential day in the health care debate, and it all started when Rahm Emanuel opened his trap and tried to turn the public option trigger into the compromise, rather than the public option being the compromise between nothing and single payer. First the White House tried to staunch the bleeding, with the President shifting the emphasis (but not really deviating from what Rahm said all that much). The advocacy groups pounced at the mention of the trigger. Sam Smith reported that Rahm has been looking to cave on this point for months:

It was, White House aides insist, far from a commitment to a trigger option. But a source close to the administration, who has been in contact with the White House on health care matters, said that Emanuel has been "floating" the trigger compromise since January.

"Rahm's problem with this is he is on the more conservative end of the Democratic Party and he is a very political guy," the source added. "He is working for a way out without a bloody fight. The problem is he doesn't mind taking that fight to the left. And what I worry could happen is the left will just quit."

Bernie Sanders confronted Emanuel directly, vowing that he had plenty of votes to scuttle any bill that didn't include a public option, and in fact taking aim at the bill being pushed through the Senate Finance Committee, which doesn't even have so much as a trigger:

"I think that it is fair to say that there are a number of us who would not be voting for anything resembling a Baucus-type plan as we understand it right now," the senator told the Huffington Post, referring to Finance Committee Chairman Max Baucus' effort at constructing a reform bill [...]

"Emanuel is dead wrong," Sanders said. "The triggers are meaningless. The American people have shown in poll after poll their contempt for private health insurance companies. They don't trust them and for good reason.

"Now, where we are right now politically is the HELP Committee, of which I'm a member, is going to bring forth a public plan," Sanders added. "The House of Representatives is supporting a public plan. And President Obama ran for office talking about a strong public plan. Why, with that political reality of the American people wanting it, the House going forward, the Senate HELP Committee going forward, would Rahm Emanuel suggest that we would compromise on this issue?"

More significantly, Harry Reid basically told Baucus that his watering-down efforts will only end in failure, and he will lose too many Democratic votes in the exchange.

Senate Majority Leader Harry Reid (D-Nev.) on Tuesday ordered Finance Chairman Max Baucus (D-Mont.) to drop a proposal to tax health benefits and stop chasing Republican votes on a massive health care reform bill.

Reid, whose leadership is considered crucial if President Barack Obama is to deliver on his promise of enacting health care reform this year, offered the directive to Baucus through an intermediary after consulting with Senate Democratic leaders during Tuesday morning’s regularly scheduled leadership meeting. Baucus was meeting with Finance ranking member Chuck Grassley (R-Iowa) Tuesday afternoon to relay the information.

According to Democratic sources, Reid told Baucus that taxing health benefits and failing to include a strong government-run insurance option of some sort in his bill would cost 10 to 15 Democratic votes; Reid told Baucus it wasn’t worth securing the support of Grassley and at best a few additional Republicans.

I don't think capping the employer deduction (which is not really taxing health-care benefits) is so horrible, but it's clearly a non-starter, to the extent that the House prefers a surtax on the wealthy to get the proper funding. And what's not said here is that all the other sops to the right that Baucus has smashed into his bill don't sit well with Democrats either and would not pass the Senate, including the removal of a public option.

Even more interesting than all that is Raul Grijalva's letter to the White House today on behalf of the Congressional Progressive Caucus, saying flat-out that the caucus will not support any health care reform bill without a "robust public option plan, akin to Medicare." And there's this extremely interesting line:

Public opinion polls show that 76% of Americans want a robust public plan option and I will stand in solidarity with them. Moreover, I consider it unacceptable for any of the cost savings that you are negotiating with hospitals and other sectors of the health care industry to be made contingent upon a robust public plan option not being included in the final legislation.

This is what I was getting at earlier today, that these deals with stakeholders are coming with some strings. Grijalva comes out and says it.

There's a lot of good news here, though of course this isn't over. The White House has learned that they absolutely don't have the votes for a plan without the public option, and hopefully this will carry over to other elements of the debate. I can envision a world with a public option but not enough subsidies, no changes to Medicaid and a health insurance exchange that isn't strong enough to force competition. And there will be other pitfalls: this notion of denying legal abortion funding inside the health insurance exchanges is horrific, for example. And there's the matter of cost, which Republicans are playing up by touting yet another inaccurate CBO score today. But what we see today is the liberals in Congress and the progressive movement standing up to announce that they will not be rolled. Not this time. The centrists threatening the Obama agenda will have to pay a price.

We're a long way from home, with lots of lobbying, both corporate and grassroots (go Mainers!), to follow. But the left is standing up, for now. Let's help them.