Progress on health care

Yes, they’ve figured out that the only thing to do now is Pass. The. Damned. Bill. and then patch it up.

Apparently the leadership on both sides of the Capitol has figured out that the only thing to do now is Pass. The. Damned. Bill. with an agreed-on set of fixes to some of the problems with the Senate version.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

18 thoughts on “Progress on health care”

  1. Meanwhile, the Chamber Of Commerce spent more on politics last year than the DNC and RNC – combined. Against health care. And before Citizens United. If the D's are gonna act, better be quick.

  2. Democrats should be waking up to the fact that the GOP are going to try to punish them for this bill, whether it is passed or not. Might as well put on a brave face and start to fight for it as a reasonable measure.

  3. On the contrary, most of the public feeling against the bill has come from scaremongering (death panels etc.) and sheer perplexity at the prolonged squabble. Dems (if they have the commnosense, and who can tell about that?) can sell it as a set of positive measures (previous conditions etc.)

    When (if?) the bill is passed, the public ire will turn against those who unreasonably try to flog the issue to death.

  4. I must admit, I never cease to be amused by the liberal conviction that any public opposition to your proposals consists of some kind of false consciousness, and will evaporate like the morning dew the moment you force the proposal down the public's throat anyway.

  5. Meh, I'm against this bill because it doesn't go far enough and it entrenches the interests that will never support single payer or better, you know, actual cost savings. As an added bonus it could lead to the GOP gaining a significant amount of seats in November. Great work guys!

  6. Heh, right after I posted the above message the automatic page refresh generated an add: "Join the fight against Nancy Pelosi" – Dana Walsh for Congress.

  7. Brett,

    Attributing opposition to false consciousness is hardly unique to lefties. It's a signature trait of committed partisanship more generally. One has to be persuaded that disciplined teamwork in pursuit of negotiated team goals in the face of equally disciplined teamwork in opposition is worthwhile. That's much easier if you believe the other side is wrong, and for some it is easier to process the idea that people are fighting for the wrong thing if you think of them as 'misinformed' or 'wrong-headed'.

    The more usual pattern with the Republicans is to simply demonize the opponent (eg Rush or Beck). Librulz are just plain EVIL!!! So maybe what you are amused by in liberals is their unwillingness to consign republicans to outer darkness. So we're back to the old "a liberal is someone who won't take his own side in a fight" joke. I think that may be the most conspicuous way in which Obama currently qualifies as a liberal. Most of the philosophical positions associated with liberalism have already been sacrificed to making nice with the CIA, the Pentagon, the banking industry, the health insurance industry, etc. etc. How's that been working out?

    Still, he's the only president we have, and he is at least occasionally capable of resisting the tide of K-street policymaking. I expect I'll keep trudging along in formation hoping he learns better generaling on the job. The Union eventually beat the Confederacy in a similar rather inelegant way.

  8. With the growths in the last 50 years of TV commercials influencing votes in our democracy, Citizens United likely increase that influence. To counter it we need to invest in better education, including during the period of early childhood when learning has the biggest bang for the buck and TV is used as a daily babysitter. With a new generation of potential critical thinkers, maybe America will get lucky and save its democracy. You can't expect a democracy to survive with congressmen elected by citizens who believe the stuff peddled in tv commercials, including government is taking over health care, rather than simply making it fairly available to all.

  9. Lawrence O’Donnell, the Democratic Senate Finance Committee staff director during the ’93-’94 health care debate:

    Pelosi said that, ‘We don’t have the votes for passing the Senate bill’ and that should have just ended it. Any discussion of another scenario is juvenile,” he said. “It’s ridiculous.”

    Democrats knew they lost reform with the Massachusetts election and some of them like Rep. Barney Frank essentially said so. “The first reaction to the Massachusetts election was the honest reaction”

    But since Election Night, he said, Democrats have moved into “full bluff mode.”

    We’re absolutely in full fake cheerleading mode. I think Nancy Pelosi has absolutely no moves left. I think she knows that now. I think Harry Reid knows that. And that’s why they don’t bring it up. They had a Senate leadership press conference (Thursday) and it was as if (reporters) were asking about World War I [when they asked about reform.]"

    Politico link.

  10. I must admit, I never cease to be amused by the liberal conviction that any public opposition to your proposals consists of some kind of false consciousness…

    This is not what the expression "false consciousness" means. It's not just a fancy, vaguely pink term for error.

    It's a common argument for representative, as opposed to direct, democracy that representatives may be better able than their constituents to predict the constituents' evaluation of outcomes. This is esp. the case where a proposal in complex, constituents report false beliefs about it, & polling is ambiguous (eg where the specific elements of the proposal poll well). And we do know of cases where voters approve of reforms after enactment that were controversial prospectively.

  11. And we know of cases where the voters punished the legislature severely for imposing some unwanted measure. What amuses me is the confidence that public opinion is going to end up loving what it says it hates.

  12. I'd say liberals have generally exhibited at least a reasonable measure of uncertainty on this point; in any case, no more unwarranted certitude than you do. If they were as confident as you imagine, or as the right actually is, their entire agenda would've long since been enacted.

  13. "This is not what the expression “false consciousness” means. It’s not just a fancy, vaguely pink term for error."

    I'm quite aware of that; It's actually a vaguely pink excuse for attributing to somebody the beliefs and motivations you think they ought to hold, in place of the ones they really hold. Makes a really poisonous combination with utilitarianism, too, when you're over-riding people's preferences in favor of preferences you've assigned them, in place of their own.

    I chose the term precisely because I see a lot of liberals who don't just think the public is wrong, but seem to think the public's "real" opinions are somehow being masked.

    I suppose it's possible that, after overturning long-standing legislative rules, and openly buying the votes of key legislators with unconstitutionally special treatment for their particular states, you'll pass a widely unpopular bill. And then when it kicks in, the public will suddenly change their minds. But I don't think that's the way it's going to go down.

    And, honestly, I don't think that's how the Democratic Congressional leadership sees it going down, either. Rather, they figure that putting more of the economy under government control will tilt the electoral playing field in their favor, long term, even if it leaves the public unhappy, and that, having safe seats, they can ride out the storm and reap those long term benefits. The problem for them has always been the members who quite rationally doubt that THEY have any chance of riding out the storm.

    I suspect that all you'll manage to do is keep the pot boiling without accomplishing anything, long enough to make sure the issue is still hot come the fall elections. But that might be MY irrational hopes speaking.

  14. It’s just true that people often prospectively lack the information to fully evaluate a proposal from the point of view of their own interests – their actually expressed interests –, or are confused or misled by other interested parties, or don’t foresee the evident consequences of alternative courses. They also change their minds as more information reaches them. Practical politicians should & do take these facts into account. In doing so, they aren’t generally acting on the basis of some arcane theory of the people’s ‘real’ interests; they’re seeking to produce results that voters, in the event, actually will approve. This is true in the present case.

    Politicians seek to persuade. When voters are open to persuasion, there’s the possibility they may settle on more than one view. Sometimes the alternatives they may settle on are ultimate, incorrigible preferences of the I-like-vanilla-you-like-chocolate, de gustibus non est disputandum sort. But generally they’re instrumental choices among alternative means to some further interest. To this extent, they’re evaluable in terms of reason. Sometimes politicians, w/ a clear view of somebody else’s interest, seek to persuade – bamboozle – voters to make unreasonable choices, given their own further interests. This seems trivially true to me. If you accept it, you subject voters’ preferences to scrutiny relative to those further interests. This doesn't make you peculiarly liberal.

    At the level of theory, the main defenders of the view that policy should be oriented toward (someone else’s idea of) people’s real interests, rather than their actual expressed ones, are not liberals. (I agree that, at least, paternalist claims of this sort should be viewed w/ a cold eye.)

    Sorry to say, but your political analysis seems to me hopelessly wrong. I don’t see how it can possibly be in your interest to be so confused.

  15. Brett remarks on "the confidence that public opinion is going to end up loving what it says it hates."

    I think the confusion here is simply that Brett is asserting something about 'public opinion' which is untrue. Public opinion, honestly measured, favors a lot of the most liberal elements of the HCR bills that have been publicly debated. As those features were eliminated by successive stalling actions and power moves by various "centrist" blackmailers, the popularity of the overall effort gave way to increasing levels of frustration and irritation.

    I am quite willing to accept that Brett personally has a reasonably well-informed negative view of the bill and that there is a substantial segment of the population which will share at least some of those negative views of whatever is passed (knock on wood). But the key point is that this segment of the population is a distinct *minority*. It isn't representative of "public opinion".

    That Massachusetts voters preferred Scott Brown to Martha Coakley by a few percentage points last month doesn't say anything unambiguous about 'public opinion' of HCR policy options. It suggests that people who hate the bill were highly motivated by their minority status to "fight back" while disappointed proponents just didn't feel like showing up for a lackluster Democrat. But the most direct effect of the election was to provide lots of lazy journalists with easy-to-write stories to help them meet deadlines. The narrative took a sharp turn. The reality of our inefficient, value-subtracting health insurance oligopoly didn't change at all.

    K, I think your analysis applies better to folks like the "Tea Party" protesters who said things like "hands off MY medicare …" etc. Once a bill was passed, implemented and life went on with no startling changes in such a person's welfare, yes they might well be happier with the result than they anticipated. And it applies even more to folks who never went to any town hall meetings because they don't really know what to make of it all.

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