What the gang of six negotiations have wrought

As health reform is implemented, there will be other glitches through good-faith bipartisan negotiation. Our currently polarized politics makes it hard to address or even to acknowledge this basic reality. Recent memories of bad-faith negotiations doesn’t make this any easier.

I wrote a column this week for Kaiser Health News on both the necessity and the difficulty of making some changes to the CLASS provisions of health reform. There’s reason to believe that some program provisions must be tightened to ensure the program’s actuarial soundness. There will be other glitches and issues that must be addressed as states and the federal government implement health reform. Unfortunately, our currently polarized politics makes it hard to address or even to acknowledge this basic reality. The fact that Republicans negotiated in bad faith on the path to health reform doesn’t help…

My conclusion reads as follows:

On CLASS, and surely on other matters, there is just too little political space to implement midcourse corrections or enact programmatic improvements. That’s a price Democrats paid by achieving their dream of near-universal coverage on a party-line vote. That was a price Republicans paid, too, through their implacable opposition to just about everything Democrats proposed, including many ideas Republicans traditionally supported.

Each side had plausible strategic and ideological reasons to pay that price. For now, anyway, our politics give us the choice between health reform that is less flexible and less carefully crafted than it really needs to be, and no reform at all. If this is the political choice presented to us, I strongly prefer the first option. I still wish we had a better way.

Bill, a Democratic commenter over at the Incidental Economist, took umbrage. He believes that I am too evenhanded:

These two quotes just don’t make sense….
Democrats didn’t want a party-line vote, they tried desperately to make the bill bipartisan. Pollack’s second quote tells us that he too is aware of this fact. If Democrats hadn’t accepted a partisan vote we wouldn’t have had health care reform at all.

He has a good point. I’m an emphatic partisan Democrat. In fact, I’m on record opposing fetishizing bipartisanship in the negotiations over health care reform. I’m so aware of what Bill is talking about. The fact remains that health reform can’t be implemented properly without midcourse correction, which will require some good-faith bipartisan negotiation.

That will be hard to do. It is an inherent challenge to fix such a massive bill that was passed on a party-line vote. Moreover, Republicans have so poisoned the well that many Democrats are understandably suspicious of any effort that might open vulnerable provisions to revision or repeal.

If you believe Democrats are being paranoid or inflexible, consider what happened during the gang of six negotiations. Republicans made Max Baucus look foolish. As far as I can tell–and as most Democrats will tell you publicly or privately–Republicans made a basic strategic decision to oppose the new law. The gang of six talks merely provided a vehicle to delay and obstruct what Democrats were trying to do. So when Mitch Daniels or others come along with proposed revisions, it’s understandable that many Democrats aren’t so interested in talking.

In my view, Republican governors such as Daniels are more sincere than Republican senators were 18 months ago. It’s important to to talk. Yet once people have been burned in a bad-faith negotiation, it’s asking a lot to recommend that they proceed as if this never occurred.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

15 thoughts on “What the gang of six negotiations have wrought”

  1. if you look in a dictionary for the term “negotiating in bad faith” you’ll find it illustrated with a picture of michael enzi, chuck grassley, and olympia snowe sitting around a table. it would be delusional of the democrats to attempt to reach a bipartisan compromise on health care. so obviously that’s what they’re going to do . . . *head desk*

  2. The mistake, imho, was for Democrats to pass on a party-line vote what was, basically, a Republican plan. Nothing for it now.

  3. “Democrats didn’t want a party-line vote, they tried desperately to make the bill bipartisan.”

    What is this, partisan delusion time? That’s like a (Omit impolite analogy).

    The bottom line was that there was a disconnect between the minimum ‘reform’ Democrats wanted, and the maximum ‘reform’ Republicans would sign onto. So we got a party line vote. Party line votes are GOOD. They let the public, with a minimum of research, hold legislators who did something they despised responsible. They further democratic accountability.

    Why’d you want the bill to be ‘bipartisan’? Simply because you wanted to do something you knew the public wanted no part of, and making the Republicans complicit would have saved you from last November.

  4. Well, I’m largely with Brett, but want a more smooth and emollient formulation: the Dems wanted, really, guaranteed health care for everyone in the country, and no better health care on offer for Rockefellers than for Juan Cruz. It’s an honorable idea, and fits with Dem ideas of equity. Fringy-er parts of the Dem coalition wanted to rearrange the whole system, but what passes for centrists among the Dems had had enough trouble with HillaryCare that they thought the way to do it was through current institutional arrangements, rather than in some new way, and this required pumping even more money into our health care sector than was being spent before. The Reeps thought this was unaffordable, and have an ideological notion that if Rockefellers want to spend more for their care, there is no reason they can’t get more. Fringy-er parts of the Reeps would really like to roll back quite a lot of the public provision we already have.

    “Democrats didn’t want a party-line vote, they tried desperately to make the bill bipartisan.” I haven’t been able to find the passage, but it’s my memory that Robert Caro wrote of Lyndon Johnson that he kept looking for additional votes for something well past when he had his majority, making changes to bring more Senators on board. Bellmore says “making the Republicans complicit would have saved you from last November” – well, I think that’s probably right. Dems should have been looking desperately to bring Reeps on board – once someone has voted for something, it is his, and he is behind it. Passing it on a party-line vote required Pelosi to have been right, that people would like it better and better as they got to know it (how’s that workin’ out for you, Nancy Pelosi? Ben Nelson, is your vote looking better in retrospect?).

    What could the Dems have done? Well, first, I think it was foolish to try and do health care in the middle of a financial hurricane. I doubt the Dems would have had anywhere near the losses they did in the Great Shellacking if they had stuck to the things which the polls were clearly telling them were of concern to voters. A couple of remarks really hurt them desperately, and still resonate: ‘never waste a good crisis’ and ‘you have to pass it to find out what’s in it’. Second, I think they should have started with less. Most every voter has a brother-in-law, or a cousin, or a 24-year-old kid, who needs coverage. A good majority of voters has health care with which they are happy, and is suspicious of attempts to mess with it (remember the Harry and Louise ads which sunk HillaryCare?).

    Propose some mechanism to care for the bro-in-law, cousin, kid, which didn’t threaten the voters’ Cross & Shield, and if it failed to pass, bang the Reeps like a drum for that failure until it did. As it is, the Reeps see obduracy on this as the biggest factor in their success in the Great Shellacking. I think Harold and Brett are quite right that it will be very hard for the Dems to get any backing across the aisle for perfecting changes in this legislation which was rammed down the throats of the Reeps.

  5. To sum up, the Democratic desperation for a bipartisan vote sprang from exactly the same source as the Republican determination to avoid the bill getting any Republican votes: Everybody knew the bill was massively unpopular.

    If Democrats had thought the public would actually like the results, you’d have been happy to have a party line vote, because you’d have gotten all the credit. But you knew going in that you were going to piss off the public, and all that talk about people getting to like it once it had passed was just whistling past the graveyard.

    Now you want Republicans to sign onto fixing the bill, rather than repeal, and, again, this desire for ‘bipartisanship’ has the same sources: You know your law, (And it IS your law, ownership is unambiguous.) is going to have massively unpopular effects going forward, and you’re desperate for a way to make Republicans take some of the blame. And, again, the exact same motive will drive Republicans to stick to efforts to repeal it.

    Unless the Republicans behave very stupidly, (Never safe to bet against.) you’re going to own this mess going into the 2012 elections, too.

  6. @dr_buzzsaw–i don’t know about dave but brett isn’t a troll, he’s a comedian/performance artist. his posts give me a laugh almost every time.

  7. So, I don’t think any conservatives answered this the last time I bothered to ask, but just out of curiosity, if you love the system we have so much, please tell me why so many people *with* insurance go bankrupt, and what are they “doing wrong?” did they fail to correctly psychically predict their future maladies, such that they bought the wrong kind of (faux) insurance?

    And what, if anything, would you have done to fix this?

  8. NCG, I’m pretty sure I *did* answer: They’re going bankrupt because they were already on the verge of bankruptcy, and just about any major, unanticipated expense would push them over the edge. People don’t generally schedule medical expenses, which makes them the leading form of “major, unanticipated’ expenses.

    But we’d be better off asking why so many people are living on the verge of bankruptcy, than taking this as a given.

  9. The bill was “massively unpopular” only because the Republicans and their allies at Fox News demonized it, even before it was written, and encourage–and participated in–a campaign of vilification. Had the Republicans in Congress worked in good faith with Democrats to achieve health care reform–an extremely popular goal–the bill would have been popular; that’s exactly why Republicans decided to oppose and villify.

    The unpularity of the bill in polling is in contradiction to polling which shows that nearly every significant aspect of the bill is, in fact, very popular. But say “death panels”, “government takeover”, “threat to your liberty” often enough and loudly enough and people will believe it.

  10. Who the heck cares WHY the bill was massively unpopular? A bill being massively unpopular because people opposed to it don’t STFU, and public opinion ends up agreeing with opponents, is pretty common. The legislature going ahead and passing the bill anyway? Rather less common, and November demonstrated why.

  11. Brett, the question is why didn’t the insurance protect them, if no reform was needed? Otherwise, why have it?

    Or are you against the need for health insurance, like me?

  12. What I am really trying to find out is, what is it about our system that conservatives like so much? I understand that people who can pay can get terrific care in the US, and that’s fine. But the fact that overall access and health are so much less than they could be if we had a reasonable system for everyone else is, to me, a major flaw. And it seems to me like conservatives just dance around this, whereas it would be so much more honest to just admit that you aren’t willing to subsidize care for poor people. Trust me, it won’t be a surprise. It might bother you in the abstract, but you are not willing to *do* anything.

    For example, this idea that letting insurers sell across state lines would fix anything is absurd. It’s true that simplification would cut some costs, but it’s not like they’d get passed on. Meanwhile, there’d be a race to the bottom in what’s covered. So someone like me would only agree to the minimum being set at something *decent,* which would put the kibosh on the whole thing for conservatives. Therefore, it is no solution at all.

  13. Brett, if you meant you answered last week, I’ll go back and dig it up. Sorry about that — I took a few days off b/c I’ve been getting too attached to this blog!

Comments are closed.