“Just in case there’s any confusion”

“I’m not going to walk away from healthcare reform”—Barack Obama, today, to ecstatic applause from DNC members. Some self-styled progressives may approach the health care bill with ambivalence. Partisans can’t, and won’t.

“So just in case there’s any confusion out there, let me be clear: I am not going to walk away from health insurance reform.” —Barack Obama, to the DNC, earlier today.

Per Tom Schaller, this was his “biggest applause line” in front of a DNC audience. Forget “I do not quit.”  From now on, it’s “I do not triangulate.”

Bipartisan rhetoric aside–though activists scorn such rhetoric at our peril, way underestimating how well it plays with most voters–this is now a matter of party, not ideology. As Obama says, “Here’s the thing, Democrats“–one of three times, in a pretty short speech, that he used that word describing his audience.  Nate Silver has pointed out for some time that while those fighting for an ideology can argue over small differences and bridge some of their disagreements through constructive compromises, partisan politics is largely zero-sum: what makes one party looks good, makes the other look bad.  (I can’t find my favorite post from him on this, but this gives an idea.)  So far, this has been an uncannily good way of parsing the health reform debate–except that even Nate overestimated how likely Olympia Snowe was to cooperate.

Some “progressives,” if one can apply the term to people who care more about hurt feelings and sticking it to Washington insiders than about sick and poor people, may be unwilling to whip the health care vote.  (SEIU, and other groups whose members actually lack health coverage, are another matter.)  But anyone concerned with whether the country is run by Democrats or Republicans has only one choice.  Pass the damn bill.

Update: Transcript here.

Second Update: Video here.

Author: Andrew Sabl

I'm a political theorist and Visiting Professor (through 2017) in the Program on Ethics, Politics and Economics at Yale. My interests include the history of political thought, toleration, democratic theory, political ethics, problems of coordination and convention, the realist movement in political theory, and the thought of David Hume. My first book, Ruling Passions: Political Offices and Democratic Ethics (Princeton, 2002) covered many of these topics, with a special focus on the varieties of democratic politics and the disparate qualities of mind and character appropriate to those who practice each of them. My second book Hume's Politics: Coordination and Crisis in the History of England was published in 2012; I am currently finishing a book on toleration, with the working title The Virtues of Hypocrisy, under contract with Harvard University Press. A Los Angeles native, I got my B.A. and Ph.D. from Harvard. Before coming to Yale I taught at Vanderbilt and at UCLA, where I was an Assistant, Associate, and Full Professor; and held visiting positions at Williams, Harvard, and Princeton. I am married to Miriam Laugesen, who teaches health policy and the politics of health care at the Mailman School of public health at Columbia, and we have a twelve-year-old son.

12 thoughts on ““Just in case there’s any confusion””

  1. FERCHISSAKES It wasn't progressives that held up the bill for a year. We should be in the first year of implementation – if that is progressives weren't getting kicked in the teeth every time Rahm lost his chew toy.

    It was more important to play games and make nice to Snowe, Baucus, Lieberman, Grassly – not you'll notice to anyone that actually ever actually cared about health care – than make good policy and now to blame the progressives is at best misreading the sorry history of this debacle.

  2. I do not for one second, think that this bill will lead to further improvements. Instead, the awful taste this leaves in the public's mouth will poison the well for years to come. So, because I do care about poor sick people, I want this bill to fail.

  3. "I am not going to walk away from health insurance reform." You mean, like he walked (ran?) away from health care reform?

  4. @paulo: I'm not blaming progressives for anything having to do with the bill's progress thus far. I'm blaming progressives who refuse to support passing the bill now for the consequences of not passing the bill now: no insurance for sick people. That Rahm insulted progressives, that Joe Lieberman was a back-stabber, that it was a gross misjudgment to hope for anything from Snowe–all true. But it DOESN"T MATTER. The fact that you insist on talking about last year instead of this year only reinforces my point: any progressive who doesn't contribute his or her best effort now, cares more about score-settling than about sick people. I care about score-settling too. We should by all means raise money against Lieberman, demand Rahm Emanuel's resignation, all of that. In addition to passing the damn bill.

    @Finn: It is possible that having the bill fail now, with the biggest Democratic majorities in a generation, will convey the message that the electorate is screaming for a bill more radical than the current one and that a torrent of popular demands for such a bill will lead to its being passed in short order. It is also possible that having the bill fail now will lead, the way it did last time, to a gigantic victory for *Republicans* and to Democrats' being afraid to tackle this for another generation. I would like to see, and have yet to see, actual evidence and analysis–as opposed to wishes and demands–explaining why the former is more likely than the latter. (Again, I don't mean an argument that it's an outrage that the Senate didn't pass a more comprehensive bill last year, but an argument that failure NOW would result in passage of a more far-reaching bill NOW.) In the absence of such evidence, I judge that dividing the first probability by the second yields, coincidentally, Ralph Nader's share of the vote in 2000.

  5. I judge that dividing the first probability by the second yields, coincidentally, Ralph Nader’s share of the vote in 2000.

    I'd judge that ratio (the chance the Dems are inspired by failure to ram through a wonderfully idealized bill divided by the chance that they slink off to lick their wounds for a political generation) as closer to Ralph Nader's share of the vote in 1992 than his share in 2000. And I say that because Ralph didn't run in 1992, so I assume he only got a single vote, his own (the idea being that Ralph could never vote for anyone other than himself for President, even when he wasn't running). Anyone who thinks that the message that the Dems would take from painful failure trying to pass moderate improvements in access to health care is to be more idealistic and hardline and then they'll get the bill through and ensure their political futures — well, any person who thinks that really ought to share their stash.

  6. Ohh, don't get me wrong. I think, no matter what happens, there will be no changes to health care in the US for another 10 years or so. With the exception of near immediate repeal of any good the Senate bill does. But if it does pass people will still be dying from lack of affordable care only now they will be paying premiums or the penalty for not carrying insurance. When I look at the out of pocket caps that still end in bankruptcy, unchanging recission language (I realize that what is a material fact may change – I'm not betting on it), decreasing total salaries and the cutting of programs people do like (Medicare) to force people to buy insurance from companies with skyrocketing rates I can't see anyone saying "Gee, we should vote for them again!"

    Maybe you are right, however, in that the last failed attempt at health care got us this utter piece of trash. Maybe if it fails this time the next attempt at reform will be a few years indentured servitude for the privilege of $100 co-pays and 80% out-of-pocket.

    I will say that my distaste for the current bill skyrocketed when I checked in for surgery on Thursday and the first question I was asked was "Have you paid yet?"

  7. Finn, I don't think you're characterizing the Senate bill fairly. As I understand it, and I'd welcome any corrections, the bill does the following:

    1) Guaranteed-issue and no loopholes in coverage (the insurance firms can no longer reject applicants who aren't well enough, and can no longer say they won't cover things they say are related to the pre-existing conditions). No more rescission, at least in my understanding – although your comment suggests you believe this regulation does not exist or would not be effective.

    2) Community rating on prices (so they can't just charge you the cost of your treatment as your "premiums"; goes hand-in-hand with guaranteed-issue).

    3) Mandates, with a tax penalty if you don't get insurance (this is necessary if you've got guaranteed issue of reliable insurance and community rating, because otherwise people would wait until they were ill to obtain insurance). The tax penalty really isn't all that high (indeed, backers of a strong mandate complain it may not be high enough). Moreover, you perhaps mislead when you complain of its impact on the worse-off among us, because of:

    4) Subsidies to help people who'd otherwise be hit pretty darn hard by the mandates.

    5) Some sort of revenue-raising measure: in the Senate bill, this is a tax on all plans over a certain value (on the total value, not the part over that threshold, as I understand it, which is bad). The threshold is currently fairly high, so relatively few people need be hit hard, but as it doesn't index there's the potential this will matter more in the future; conversely, it may apply downward pressure on health insurance prices.

    Now, what in all that do you not like? What part of that wouldn't you do if you were doing health insurance reform? Or do you like those goals but assert that the bill fails to achieve them? You may desire single-payer, or at least a strong public option, but the latter is former unlikely in terms of the votes needed, and the latter would presumably accompany these measures rather than supplanting them – and if the bill really does those five things, then killing it for lack of a public option is not a position I understand.

    Also, note that I was careful to phrase my question to you in terms of "health insurance reform". Our country desperately needs "Health Care Reform", because we pay twice what some other industrialized countries do for results that are not measurably better, and the rate of health-care inflation threatens to cripple us. And the likely health care bills, including what I understand to be the Senate bill as I outlined it above, do approximately nothing to address this. But does that make what the bill does achieve any less desirable? Don't we need the "insurance reform", for those thirty-to-fifty million Americans who've got no insurance, plus the many more who've got insurance they can't trust, insurance they can't use, or insurance they can't really afford? Won't the bill help these many tens of millions of people who need it?

  8. "latter is former unlikely in" should have been "former is unlikely in". My apologies for sloppy writing and editing.

  9. I second Paulo – if it weren't for the f*cking Blue Traitors, we'd have had it done by September, results clear by now, and be most of the way through financial reform. But Serious People do have to kick a hippy to show their Seriousity.

    Andrew Sabl:

    “So just in case there’s any confusion out there, let me be clear: I am not going to walk away from health insurance reform.” —Barack Obama, to the DNC, earlier today.

    Per Tom Schaller, this was his “biggest applause line” in front of a DNC audience. Forget “I do not quit.” From now on, it’s “I do not triangulate.”"

    IMHO, if Obama and the Senate were actually getting things done, he wouldn't need to say that; he'd have a well-publicized signing photo op. This to me sounds like somebody spinning away defeat.

  10. Warren, thanks for responding to my post:

    1) I think the 'changes' in recission are nebulous at best and misleading at worst. I believe a ban on recission when I see the first court case one or so much stronger language in the bill: 'under no circumstance can an unhealthy person be dropped from coverage' or some such.

    2) I have not seen community rating in the bill. What I have seen is that all rate hikes on the exchange must be approved. Lately that means that rate hikes by 10-20% yearly are ok (that was in Maine). I'm getting my information from here: http://www.nytimes.com/interactive/2009/11/19/us/
    3) The mandate is not very high at all. I think that a lot of people are going to look at the large chunks of money they have to send away for insurance (even with subsidies) and choose to pay the fine instead. Of course, raising the fine is political suicide so I don't think there is anywhere to go on this.

    4) This, I don't object to, I don't think there are enough subsidies.

    5) Part of the revenue measure in the senate bill is to prevent nearly $500 billion in Medicare spending. I don't think that will be popular.

    The CBO scored this bill with two salient points to my mind: first, there would be a revenue increase because employers will pay their employees more with reduced benefits – fat chance. And second, 30 million people will be covered in 2017 (or whatever that date actually becomes). 15 million on medicaid and 15 million on insurance rolls. And I don't buy that many in the second group are going to do the math between paying the fine, eating, and taking insurance and end on paying insurance. Which is smart, because even with subsidies, the out of pocket expenses limit for people at 133% FPL is about 20% of income. How many people making $30,000/year for a family of 4 can afford to spend $6,000 this year on medical costs? This doesn't protect anyone from the financial hardships of becoming sick but it does transfer a hell of a lot of money to a group of companies notorious for denying care and blocking reform efforts. The solution to losing chickens is NOT allowing the foxes to guard the coop.

  11. Finn, I can't speak to the rest of your post (obviously I hope you're wrong), the Medicare "cuts" merely kill the corrupt and absurd Medicare Advantage subsidies. Bad politics, maybe, but good policy.

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