ACA defenders don't need to "learn from" the Tea Party. They beat them in 2009-10

The fight to save the ACA is on, and all across the land, progressive groups large and small are mobilizing the law's supporters to let their senators and reps know the cost of dis-insuring 20 million people -- more, if Republicans block-grant Medicaid and/or collapse the individual market, less if they pass some poorly funded and designed facsimile of the ACA.

In reaction to the 35 "protect our care" rallies staged across the land on Sunday (Jan. 15), I keep seeing sentiments to the effect of  "progressives are learning from the Tea Party."  That's a half-truth at best, in that supporters of the ACA-in-progress fought protestors at least to a draw in 2009-2010 (proponents won in the sense that they got the ACA passed, but they did (briefly) have a 60-vote Senate majority and a large House majority). The ACA would never have got anywhere near the finish line without the most massive grass-roots advocacy ever achieved.

The Tea Party protests against the ACA-in-progress at Town Hall meetings in the long hot summer of 2009 have become part of American political lore. What’s less well known is that progressive groups supporting health reform fought back on the spot, often with equal or superior manpower and local impact. The media preferred the screamers, of course.

There was a massive coordinated effort led by Health Care for American Now (HCAN), an umbrella organization for groups committed to universal healthcare, formed in the runup to the 2008 election. Member groups’ ability to muster supporters provided vital support that kept many representatives and senators committed to passing the bill that became the ACA.

Here comes Bishop Romney

In Mitt Romney, Community Organizer, I noted that Romney, in his capacities as the Mormon equivalent of parish priest and a bishop, actually engaged quite deeply in the lives of his fellow Mormons. I suggested  that he really has to invoke this experience to counter the perception that he's lived his life in a superrich bubble. Yesterday in Ohio, Sara Murray reports, Romney cracked that Mormon kimono a little:

On Wednesday afternoon, though, there were glimpses of a candidate who could connect with voters as he disclosed a more personal side, one that’s rarely seen during his campaign events.

He spoke about counseling the unemployed through his work with the Mormon Church. He said his religion is an “unusual religion in a number of respects,” because of the rotating minister program Mr. Romney participated in as a volunteer for roughly a decade.

I expect to hear more in this vein.

Liberal Reagan redux

E.J. Dionne compares Obama's structural approach to the SOTU to Reagan's while contrasting the two presidents' political philosophies:

Reagan laid out what became the major themes of his campaign, including not only the nation’s recovery from economic turmoil but also his central philosophical purpose: a continuing battle against “the tendency of government to grow.”

Obama’s speech was Reagan’s turned on its head. Like Reagan, Obama previewed his election arguments in a philosophically aggressive way. But Obama’s claim was the opposite of Reagan’s. Obama spoke of government’s essential role in ensuring shared prosperity and in creating an America “built to last” — a slogan drawn, perhaps not accidentally, from truck commercials for General Motors, the company whose rescue Obama engineered.

Dionne seems mildly surprised by the reverse-Reaganism:

It was to be expected that, in the course of his State of the Union address, President Obama would mention the killing of Osama bin Laden, whose death represented the culmination of the battle against terrorism that began on Sept. 11, 2001.

Far less expected was Obama’s use of the bin Laden episode to present a community-minded worldview that contrasts so sharply with the highly individualistic and anti-government message that has been heard over and over from the Republicans seeking to replace him.

The surprise is somewhat warranted by the infuriating year in which Obama directed his indignation at "Congress" and "Washington" as he tried to cut a deal with adversaries openly devoted to destroying him. But that was a detour (that ended last Labor Day). Obama's whole career -- on the national stage, at least -- has been an extended attempt to turn Reaganism on its head.

The more perfect union we love to hate

Just read two 4th of July essays that I can't help juxtaposing, because each has a valid point to make, and yet they're all but contradictory.

First, E. J. Dionne, arguing that the Tea Party fundamentally misunderstands the American experiment:

Decay...decline...yada...we're fine (?)

Taking a cue from E.J. Dionne, Andrew Sullivan asks his readers to weigh in as to moments when they "realized we were late imperial Rome," adding, "Personally, I think it was some moment between the Congress's assent to torture in 2006 and when Sarah Palin was selected as a serious vice-presidential nominee in 2008."  The results are (by definition) impressionist:

The Clinton impeachment, hands down.  The long list of ridiculous investigations leading up to it were bad enough, but taking a step designed to remove an elected President over a personal affair showed that the view of politics over country now ruled the day.  The proceedings were political Kabuki Theater at its basest.

Well, maybe -- though I also must admit, net admirer of Clinton though I am, that I feel the force of Sandy Levinson's assertion that Clinton's "cold-blooded lying" (ultimately admitted) to constituents and Cabinet set an perhaps equally troubling precedent.


I am wary, though, of the decline narrative. It's hard to take the measure of an era, or put bounds around a given set of years as an "era," and harder yet to peg that era within a longer narrative. "You are too shallow, Hastings, much too shallow,/To sound the bottom of the after-times" (Henry IV, Part 2, IV ii). That's true for all of us.

I do fear that the U.S. has lost political functionality in two waves, one coming in with the Gingrich Congress in 1994 and the second with the Bush torture crew. The first destroyed norms that enabled the parties to work together, however adversarially; the second severely weakened our civil liberties and abused the powers of the executive branch.  Still, U.S. politics has probably been in dysfunctional mode more often than not since founding; the one virtue of our democracy is self-correction, and I'm hopeful for another round of that under Obama's stewardship. (I admit though that there too my faith goes wobbly; I am susceptible to the Krugman view of the Obama administration, damned repeatedly by half measures and failure to strongly rebuff GOP lunacy. See, for example, Joe Nocera's frustration today with Obama's failure thus to take a stand for Elizabeth Warren to head the fledgling Consumer Financial Protection Bureau.)

The battle for a national health insurance exchange

Good news (or good rumor) from E.J. Dionne on a likely outcome of Senate-House negotiations on health care reform:

Over the last week, I've been talking with key figures in the House, Senate and White House, and the outlines of a deal are becoming reasonably clear. The public option is, alas, dead. But the idea of setting up a national insurance exchange -- alongside state exchanges -- where the uninsured can purchase coverage is very much alive. The House is demanding this as the price for giving up on the public plan, and a national exchange would provide for much more consumer-friendly regulation of health insurance policies.

David Herszenhorn also reports that "House Democrats are pushing hard for a national insurance exchange, or marketplace, rather than the state exchanges proposed by the Senate."

Attention, Clive Crook: "uncertainty" is an antidote to "unintended consequences"

Clive Crook objects to the "uncertainty" that the public option injects into the health care reform debate. He also warns against unintended consequences. What he fails to recognize is that an element of uncertainty -- an "option" that may evolve in more than one direction -- is a way of coping with unintended consequences.

Below, Crook gets his "if...then" exactly backwards:

Democrats have been debating whether a "strong" public option should pay Medicare reimbursement rates, something an ordinary competitor could not do. If it did, this would drive down costs and have many other (not necessarily intended) consequences. It would be a big step towards Medicare for all. As I have argued before, there are worse things than Medicare for all, including in my view the present system. But this outcome is one of the things that the administration is saying it does not want. If you want Medicare for all, do what some Democrats do and make the case. If you don't, stop proposing a public option that would push the system towards it.

Politically, the problem with the public option is that it has added to the uncertainty, and hence the anxiety, that surrounds this reform. People want to know where all this is heading. The public option might be nothing, or it might be everything, depending on how it is done. But when advocates like Dionne say that it can be both everything and nothing at the same time, according to your preferences, then centrist voters are right to say, "No thanks."

Possible outcomes to creating a public option might be sorted into three categories: a) it has no great effect, becoming one health care 'option' for a limited percentage of the population; 2) it coexists in robust competition with private health care plans, as (to cite Obama's analogy) public universities do with private ones; or c) it proves a superior choice and causes private insurance to wither on the vine.

None of these outcomes is undesirable, unless a) transpires because the public option is neutered from the start and hence is never a viable option. Instituting a public option should either make private insurance better or prove it to be parasitical. It's a way of creating competition, not a prejudgment of the competitive outcome. "Uncertainty" is good. It's a condition of competition.

As for those lawmakers who would prefer "Medicare for all," i.e. a Canadian system, the public option is a rational -- not disingenuous -- way to get there. There's no virtue in ignoring political reality by pushing for a single payer system in the U.S. now. If the public option gets us there, it will do so in a prudent, incremental way, by earning its stripes as the best service offered. If the public option is a Trojan Horse, it's got to be one that runs, i.e., defeats the competition. If paying Medicare rates hurts quality, private plans ought to be able to differentiate themselves by paying higher rates, thereby presumably attracting better doctors.

Obama likes mechanisms that set the conditions for incremental, adjust-as-you-go change. That's how he's cast "MedPAC on steroids." A robust public option should be in that category.