Wednesday, October 02, 2013

Credit where credit's due

The super-charged political atmosphere online has put me in an ornery mood. I don't normally go off on political stuff (unless it involves Rick Perry) but damn, too much crap's been flying around today to put up with it. If you're going to criticize, criticize FACTS not bullshit. Jesus H. Christ on a pogo stick, you don't see George Will running around screaming that Obama and Congress exempted themselves from the Affordable Care Act. That's patently untrue, but it's easier for Teabaggers to cut and past these email forwards than actually, you know, do objective research. Instead of basing their arguments and criticisms on fact (and there's plenty there worth criticism), they choose instead to fixate on the fictitious. I've had several TeaOP folks in recent days confront me aggressively online, demanding I justify (wink wink) and defend any number of easily disproved falsehoods related to President Obama, Obamacare and Democrats in general. When I've pointed out the falsehoods--going so far as to provide multiple links--they dismiss my efforts as propaganda and dance a jig because I "dodged the question."

So yeah, I'm cranky. If they want to point fingers for today's bitter partisan environment, today's government shutdown and the damage done to the U.S. credit rating come Oct. 17 when we default on our debts because of the right wing obstructionists in Congress, okay. I'm game.

I place the blame squarely on the GOP for this mess we're in.

But I place said blame retroactively, dating all the way back to the summer of '09 when health care legislation was still a fluid thing. Single-payer wouldn't fly, that much was clear. The pipe dream of the left, hard-core liberals fixated on single-payer (and still comprise a significant portion of the population polling data shows disapprove of Obamacare). But from a realistic point of view, single-player was never going to pass Congress. Maybe, back in the late 1970s, had Iran not fallen into revolution and the oil crunch not thrown the U.S. economy into recession, a Democratic-controlled Congress with a Carter Presidency might have passed such an animal, and that's a stretch. There has never been a moment in U.S. post-LBJ political history where single payer could've passed. Hell, Nixon couldn't pass his modest health care plan in that era, which is clearly a direct ancestor of Obamacare. There are inherent inefficiencies in the single payer model, and opponents focus on those. Which is legit. But there are other inefficiencies in the individual mandate, cooperatives, and the Clinton's Health Security Act (which adopted an employer mandate, manifesting pretty much as a political trainwreck). Each approach boasts benefits, and each have drawbacks--not necessarily equal in scope, either. And of course, without any health care model in place other than "Them that gots," inefficiency manifests itself as bankruptcy and death for the patient who isn't well off or fortunate enough to work for an employer who provides coverage. So, pick your poison.

But getting back to 2009, President Obama and Democratic leaders in Congress brought the health care industry into the inner circle, to preempt the fierce opposition from those quarters that played a huge role in scuttling the Clinton plan two decades prior. What came out of these meetings was a plan based upon ideas put for by the conservative Heritage Foundation and later implemented fairly effectively by Mitt Romney during his term as governor of Massachusetts, aka "Romneycare." Despite the plan being conceived by a conservative, Republican-allied think tank, and implemented successfully by a Republican governor, the GOP immediately lined up in opposition. The cynic inside me says this was solely for political gain--in 1994, Newt Gingrich's "Contract with American" Republicans swept to control of the House of Representatives based in no small part on the Democratic-controlled Congress' inability to pass any type of health care reform despite working on it for nearly two years. The label of a do-nothing Congress, coupled with a series of (non-Clinton) scandals doomed the Democrats. The idea of repeating this pattern was like catnip to the GOP, which had suffered serious election losses in '08. Plenty of political pundits and strategists from both parties openly identified this strategy early on--delay, oppose and obstruct until the next election, then ride to victory by labeling the Democrats a "do-nothing" party. President Obama, naive and idealistic, never quite believed this strategy was real. But it all fell apart in August. Iowa Republican Senator Chuck Grassley, the GOP's lead negotiator with the White House and Congressional Democrats, made an uncharacteristically honest assessment of the chances of a bipartisan compromise, essentially saying, "Even if Democrats agree to every single Republican demand on the health care bill, we won't guarantee even a single Republican vote for it." Grassley himself said he wouldn't vote for anything to come out of the negotiations--stop and think on that. Even if the other side capitulates entirely, and lets you rewrite the legislation to your heart's desire, you still won't support it because it would count as a "win" for your opponents.

Around this time, there was an opening for a much less painless alternative in health care reform that avoided single payer and individual mandates entirely. Plenty of Blue Dog Democrats didn't like the individual mandate idea. Being of a more conservative bent (which in the olden days was known as "moderate") they had reservations about a major health care intervention at the Federal level. The Blue Dogs didn't wholly support individual mandates, and neither did more liberal Democrats who tenaciously clung to the idea of single payer. But the Blue Dogs were critical to the passage of health care reform. The Blue Dogs realized the GOP's "do-nothing" strategy targeted them specifically, so they were locked into to passing something. So the Blue Dogs got innovative, and floated the idea of state and national health care cooperatives. The Democratic left howled in protest--cooperatives would effectively scuttle any chance at single payer--but if the Blue Dogs could bring in Republican supporters, the support of the Democratic left was superfluous. Cooperatives addressed pretty much every objection the Republicans had about a federal health care plan. That's not to say cooperatives would be a panacea (see what I did there?) but they'd be a solid starting place toward addressing the inequities in U.S. health care. First and foremost, cooperatives are "owned" by the members, and by definition, keep control locally. Of the handful large, non-profit health cooperatives that exist in this country, two interesting facts emerged during the debate that weren't widely reported at the time: 1) cooperatives did little to rein in health care costs (which was a big reason for the whole health care reform initiative in the first place). This, obviously, is a concern. But to be fair, the sample size was limited and the extant cooperatives weren't really established with cost containment as a primary goal, so there was room for experimentation. And cooperatives weren't more costly than average health care, either. Just not less so; 2) Significantly, although costs rose on par with non-cooperative health care, the quality of the health care services rendered--both as measured by outcomes and patient satisfaction surveys--increased significantly. So, worst-case scenario, Americans would've paid the same as ever, but gotten more direct control and voice in their care while at the same time getting much better care overall. Yeah, I'd say that would be a very good starting point.

The biggest knock on cooperatives (the fiercest opposition came, obviously, from the Democratic left) was that they had never been attempted on this scale before. Well, duh. That's where innovation comes from--trying new things.

The idea was to get a truly bipartisan bill passed and put and end to the divisiveness of the endless health care debates in Washington (ha!). Unfortunately, the GOP withheld support for even this, sticking with their "do-nothing" gamble. The GOP did not believe the Democrats had the nerve or stomach or whatever metaphor you choose to go ahead and ram through health care legislation on their own. Following Grassley's inflammatory comments, negotiations broke down. But then, unexpectedly, Democrats made a choice--faced with getting voted out of office for doing nothing, or getting voted out of office for doing something they generally believed in, they chose to do something. They pushed the Affordable Care Act through Congress for the president's signature. It took a while for the GOP to realize this was really a thing that was happening, and suddenly Grassley, Boehner and others started calling for more negotiations, that maybe it'd be better if the whole thing be punted down the road to the next Congress, after the next elections. Remembering Grassley's comments, the Democrats didn't take them up on the offer--a year of bad-faith negotiations apparently taught them that much, at least. The moral of this story: Don't double-dog-dare someone if you're not prepared for them to call your bluff.

The GOP made a political calculation and gambled. The won half of it--the Democrats were indeed weakened for the 2010 election, and the GOP did sweep to historic gains in the House--but lost the other half, in that Obamacare did pass. And the GOP allowed itself to be overtaken from within by Libertarians and ideologues in the Tea Party, who'd rather burn down a house than spend the money to repaint it. The TeaOP is now probably the most dysfunctional political organization in living memory, with John Boenher the weakest Speaker of the House in U.S. history. They at the point where GOP-sponsored legislation does on the floor because too many TeaPublicans oppose it. If the GOP can't even agree internally, how can it work with Democrats to actually run the country? Republicans sold their soul for an easy win in 2010, but the fallout's been long and ugly.

I am not now and never have been a big fan of Obamacare, but you know what? The Republicans gambled and forced the hand of the Democrats. They could've engaged. They could've influenced the legislation in profound ways. They could've taken "half a loaf," which was once an honorable strategy in America. Instead, they took their ball and went home. Because of that, they own Obamacare and all its flaws as much as any Democrat. Stick that in your tea bag and steep it.

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