Bipartisan health care reform: the sound of one hand clapping

As Paul Starr demonstrated back in September and as Obama has repeatedly emphasized recently, the Democrats' health care reform plan has a largely Republican pedigree. Plans depending in large part on subsidized private insurance were proposed by Republicans including Richard Nixon and Jacob Javits in the late 1940s, by Bob Dole and John Chafee in the early Clinton years, and again by the trio of Bob Dole, Howard Baker and Democrat Tom Daschl last year.

Ezra Klein recently documented six more contemporary Republican ideas incorporated into the current Democratic bills: an allowance for interstate compacts; the exchanges themselves, which pool risks for individuals and small businesses; a "waiver for state innovation" that allows states to structure their own plans; encouragement of state innovation on malpractice reform; the excise tax, which is a start on reigning in the employer tax deduction for health care; and the absence of a public option. 

All this conceptual bipartisanship has of course won the Democrats zero votes (okay, one House vote, to be retracted in the next round) from the present-day extremists who have taken over the Republican party. Yet the Democrats are still singing the same tune -- whether to win over the more conservative members of their own party,who largely replaced moderate Republicans, or to demonstrate their moderation to the country at large -- or both, as a centrist cast to the bill makes it easier for blue dog Democrats to justify a yea vote to their relatively conservative constituencies.

Here's Nancy Pelosi, contradicting herself in two sentences, defining the new bipartisanship in the second:

“Bipartisanship is a two-way street,” House Speaker Nancy Pelosi declares in an interview airing Sunday on CNN’s State of the Union.

“But let me say this,” Pelosi continues, “The bill can be bipartisan, even though the votes might not be bipartisan, because they [Republicans] have made their imprint on this.”

Ruth Marcus's false "false false choice" charge

Purporting merely to debunk an irritating and misleading rhetorical device, Ruth Marcus has struck at the heart of Obamaism. Her target is Obama's fondness for what she calls a "false false choice':

The false-choice dodge takes three overlapping forms. The first, a particular Obama specialty, is the false false choice. Set up two unacceptable extremes that no one is seriously advocating and position yourself as the champion of the reasonable middle ground between these unidentified straw men.

I will argue further down that most of the Obama false choice tropes Marcus takes on are valid.  But first I want to spotlight the seriousness of the charge.  The false choice trope is not merely a tool of rhetorical combat. Setting things up this way reflects a core tendency in Obama's personality and approach to problem-solving.

Taxes or trigger!

Nancy Pelosi was not entirely clear when she said that Democrats negotiating (if such a thing is possible) with the GOP on the bipartisan supercommittee charged with putting forward a deficit reduction plan should be "as forceful as possible and as unified as possible," but that they should not rule out reforms to entitlement programs. She raised a lot of Democratic eyebrows by declaring "you won't see me drawing lines in the sand."  But if I understand her right, she's right. 

There is confusion about the kind of line in the sand Democrats on the supercommittee must draw. They will have to resist Republican intransigence, not mirror it. That is, they have to hold the line on taxes, not entitlements.

HHS guidelines for privatized Medicaid expansion

The Department of Health and Human Services issued a FAQ on Friday regarding its receptivity to state proposals, like the one floated by Arkansas, to use the federal funds for Medicaid expansion through the ACA to offer private insurance through the ACA exchanges to Medicaid-eligibles.

HHS points out that outside the ACA expansion, states already can use Medicaid funds to buy private coverage  (mostly through private group health plans) for Medicaid recipients, provided that the plans are deemed "cost effective" -- that is, "that Medicaid’s premium payment to private plans plus the cost of additional services and cost sharing assistance that would be required would be comparable to what it would otherwise pay for the same services."

The new departure would be using federal money to buy qualified health plans on the new ACA exchanges for those covered by the ACA's Medicaid expansion. It's important to note the context in which HHS will consider "demonstration projects" of this sort: it will do so to "inform policy for the State Innovation Waivers that start in 2017."  In 2017, states can apply to "pursue their own innovative strategies to ensure their residents have access to high quality, affordable health insurance" providing the proposed plan

In which Obama publicly negotiates with himself

It's become a cliche that Obama is a poor negotiator because he "negotiates with himself." In his weekly address, he makes it literal. Here's what he says about the budget he's releasing on Wednesday:

This is the compromise I offered the Speaker of the House at the end of last year.  While it’s not my ideal plan to further reduce the deficit, it’s a compromise I’m willing to accept in order to move beyond a cycle of short-term, crisis-driven decision-making, and focus on growing our economy and our middle class for the long run.  It includes ideas many Republicans have said they could accept as well.  It’s a way we can make progress together.

Of course he's willing to accept this compromise, because he proposed it. The Republicans, however, didn't accept it. Putting it on offer now signals that he's willing to accept a new compromise further to the right.

Obama bends over backwards, and does not yield

Obama's post-summit bid for a comprehensive health care bill, unveiled in a letter to the Congressional leadership, extends his paradoxical  approach to Republican intransigence: bend over backwards/do not yield.  That is, keep suggesting -- and trying to showcase -- the meme that Repubicans can be right at the margins but are missing the big picture.

The White House blog stresses that the President is proposing to include "even more Republican ideas" (!) and the revised plan incorporates several proposals voiced by Republicans at the summit. Yet at the same time, Obama's letter insists "that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs." In other words, the damn bill -- a blend of the bills passed by House and Senate Democrats -- will pass. 

Learning to love the individual mandate

A pivotal moment in Boston Globe reporter Brian C. Mooney's in-depth retrospective on Mitt Romney's role in passing healthcare reform in Massachusetts centers on a qualified acceptance of the plan's most politically fraught element:

“I’ve never been one for individual mandates in the past, but I do think that the way this has been proposed, in that everybody will do their part, that’s a compromise...I can buy into that.’’

That's Ted Kennedy speaking.  Romney's commitment to the mandate came earlier (it was Romney's plan that Kennedy responded to above) and was much less guarded when it came.  The mandate was far more in accord with Romney's principles (at that point in his career it still appeared that he had some) and with the interests of his support base than it was with Kennedy's. 

The making of a great President

In his long essay Can America Rise Again? James Fallows sought for a solution to "the American tragedy of the early 21st century: a vital and self-renewing culture that attracts the world’s talent, and a governing system that increasingly looks like a joke."  Our political system has not evolved, Fallows warned, citing the unrepresentative Senate, the distortions in the House wrought by gerrymandering, and the near-impossibility of fundamental Constitutional amendment.  So what to do?  Fallows concluded that we can only "muddle through" -- in effect, trust that our society's civil and economic dynamism will continue to throw up leaders who squeeze far-sighted policies through our creaking political institutions:

America has been strong because, despite its flawed system, people built toward the future in the 1840s, and the 1930s, and the 1950s. During just the time when Frederick Law Olmsted designed Central Park, when Theodore Roosevelt set aside land for the National Parks, when Dwight Eisenhower created the Pentagon research agency that ultimately gave rise to the Internet, the American system seemed broken too. They worked within its flaws and limits, which made all the difference. That is the bravest and best choice for us now.

Tonight is a night to celebrate a muddle-through breakthrough.  One month ago,  Barack Obama framed the struggle to pass comprehensive health care reform this way: "What’s being tested here is not just our ability to solve this one problem, but our ability to solve any problem."

The country passed this test because we have a leader who understands how broken our governmental machinery is and works simultaneously to fix our politics and our policies. We elected a President who appreciates how messy democracy is and understands the manifold constraints as well as the multiple levers of presidential power.  His acknowledged errors notwithstanding, Barack Obama moved this mountain because he knows how to prioritize, strategize, execute and communicate. 

Where Obama's "placation" ended

Garry Wills, summing up David Remnick's portrayal of Obama in The Bridge: The Life and Rise of Barack Obama, is close to right, and yet so very wrong, as he segues to his own judgment:

Obama’s strategy everywhere before entering the White House was one of omnidirectional placation. It had always worked. Why should he abandon, at this point, a method of such proved effectiveness? Yet success at winning acceptance may not be what is called for in a leader moving through a time of peril. To disarm fears of change (the first African-­American presidency is, in itself, a big jolt of change), Obama has stressed continuity. Though he first became known as a critic of the war in Iraq, he has kept aspects or offshoots of Bush’s war on terror — possible future “renditions” (kidnappings on foreign soil), trials of suspected terrorists in military tribunals, no investigations of torture, an expanded Afghan commitment, though he promised to avoid “a dumb war.” He appointed as his vice president and secretary of state people who voted for the Iraq war, and as secretary of defense and presiding generals people who conducted or defended that war.

To cope with the financial crisis, he turned to Messrs. Geithner, Summers and Bernanke, who were involved in fomenting the crisis. To launch reform of medical care, he huddled with the American Medical Association, big pharmaceutical companies and insurance firms, and announced that his effort had their backing (the best position to be in for stabbing purposes, which they did month after month). All these things speak to Obama’s concern with continuity and placation. But continuity easily turns into inertia, as we found when Obama wasted the first year of his term, the optimum time for getting things done. He may have drunk his own Kool-Aid — believing that his election could of itself usher in a post-racial, post-partisan, post-red-state and blue-state era. That is a change no one should ever have believed in. The price of winningness can be losing; and that, in this scary time, is enough to break the heart of hope. 

It is true that Obama sets tremendous stock in his ability to win buy-in from potential adversaries, to disarm them by acknowledging what he regards (or presents) as the legitimate points in their argument, to find common ground and therefore assent. Remnick captures this.  Recounting Obama's reaction to Robert Caro's portrayal of the old hard-core segregationist bull of the Senate Richard Russell, Reminick writes:

Much of Obama's self-confidence resided in his belief that he could walk into any room, with any sort of people, and forge a relationship and even persuade those people of the rightness of his positions. Jim Cauley, Obama's Senate campaign manager, said he thought Obama believed that he could win over a room of skinheads. "All of us are a mixture of noble and ignoble impulses, and I guess that's part of what I mean when I say I don't go into meetings with people presuming bad faith," Obama has said. Now he seemed to think that he would have had a fighting chance with Russell: "Had I been around at all in the early sixties and had the opportunity to meet with Richard Russell, it would have been fascinating to talk to somebody like that.  Even if you understood that this enormous talent would prevent me from ever being sworn in to the Senate"(426).

But placation is only weakness if it has no end point. Obama did persist too long in trying to win Republican cooperation. But his faith in his ability to win assent was not weakness but hubris.  According to George Packer, the title of whose long chronicle Obama's Lost Year gave Wills his keynote above:

Obama's quest for bipartisanship, in the face of exceedingly discouraging facts, has been so relentless that it suggests less a strategy than a core conviction: reasonable people can be civil, exchange ideas, and eventually find points of agreement.

Where Obama's placation ended

In honor of the ACA's end-of-open season rush, a repost. 

Sunday, April 18, 2010

Garry Wills, summing up David Remnick's portrayal of Obama in The Bridge: The Life and Rise of Barack Obama, is close to right, and yet so very wrong, as he segues to his own judgment:

Obama’s strategy everywhere before entering the White House was one of omnidirectional placation. It had always worked. Why should he abandon, at this point, a method of such proved effectiveness? Yet success at winning acceptance may not be what is called for in a leader moving through a time of peril. To disarm fears of change (the first African-­American presidency is, in itself, a big jolt of change), Obama has stressed continuity. Though he first became known as a critic of the war in Iraq, he has kept aspects or offshoots of Bush’s war on terror — possible future “renditions” (kidnappings on foreign soil), trials of suspected terrorists in military tribunals, no investigations of torture, an expanded Afghan commitment, though he promised to avoid “a dumb war.” He appointed as his vice president and secretary of state people who voted for the Iraq war, and as secretary of defense and presiding generals people who conducted or defended that war.