How Democrats might lose the ACA insta-repeal battle and win the war

In the interview I posted last week with Chris Condeluci, who was counsel to Republicans on the Senate Finance Committee when the ACA was being drafted,  I foregrounded the most urgent point at present: ACA proponents have a very short window to deter lightning passage of a repeal-and-delay bill, and at least a handful of Republican senators may be responsive to pressure and balk at repeal with no replacement. Three defections would kill insta-repeal, if Democrats hold together.

I think this possibility has been underplayed. 21 Republican senators are in states that have enacted the Medicaid expansion, and many of those states have slashed their uninsurance rates by 40% or more.

Still, odds are probably that Republicans will go through with a repeal-and-delay, in which they preserve the ACA Medicaid expansion and marketplace subsidies for at least 2-3 years while they allegedly craft a replacement plan.

If that's the case, there's still a high-stakes battle to be fought. Its outline can be discerned in the detailed options menu Condeluci laid out for Republicans (or their aides) racing to draft a repeal bill. Since that interesting material was buried rather deep in the prior post, I've reposted it below.

The sticking point (to my mind) is whether repeal of the taxes that largely fund ACA benefits is delayed along with repeal of the benefits. If not, the Medicaid expansion is probably dead, along with marketplace subsidies that make coverage affordable for lower-income buyers. The negotiations with Democrats over a replacement bill that Condeluci envisions are really only possible if substantial tax revenue is still coming in.

Shock treatment or catastrophe?

During one of the GOP's exercises in debt ceiling terrorism, I think in 2013, Jonathan Chait wrote (in a piece I can't locate) that Republican extremism would lead to catastrophe eventually (here is a variant).

That forecast played in my mind whenever I looked ahead at elections -- not just to 2016, but beyond. My thought was, it's a two-party system, and Republicans have to win the presidency sooner or later. Would we win a breathing space in which Democratic reforms could be cemented and the GOP would finally begin to moderate? Which would happen first, Republican victory or moderation?

Now we have our answer. In 2012, Obama told donors that if he won reelection, 'the fever would break." He won, and it went to 106 degrees, and spread to half the electorate.

Sometimes catastrophe is the route to progress -- as in the Great Depression, which ushered in FDR's huge and long-lasting majorities in Congress and ultimately led to enduring acceptance of the pillars of the welfare state: social security, unemployment insurance, labor protections, bank regulation.

Why Americans spend so much on health care: The big picture

Stimulated, like a lot of people, by Bernie Sanders' single-payer healthcare plan, I spent some effort this week speculating about how the U.S. might attain affordable healthcare for all. Government efforts focus mainly on how to strain out wasteful care, how to coordinate care, how to pay for performance. To my mind, a possibly more important question is: how to gradually squeeze down payment rates for hospitals, doctors, and pharmaceuticals?  How to move toward all-payer if not single payer -- that is, phase out or reduce healthcare providers' divide-and-conquer leverage?

3 a.m. this morning,* looking for something else on my Kindle, I stumbled on a book I'd bought and forgotten about that offers a very different answer as to why the U.S. spends so much more on healthcare than comparably wealthy countries. The authors made quite a splash with their central hypothesis four years ago**, and their insight is no secret, but it had faded into the background for me.

The book is The American Health Care Paradox: Why Spending More is Getting us Less, by Elizabeth H. Bradley and Lauren A. Taylor.  Their answer: we spend more because we're sicker, and we're sicker because we spend less than peer countries on social services that have a bigger impact on health than medical care does: housing, nutrition, education, the environment and unemployment support. Here's the core argument:

Last laugh for Republicans in the SCOTUS session that was

Democrats were still in their happy dance over Supreme Court decisions preserving ACA subsidies and legalizing gay marriage throughout the U.S. when, in its final orders of the year, the Court agreed to hear cases poised to gut pubic unions and affirmative action.

In Friedrichs v. California Teachers Association, ten California teachers are challenging a requirement that they pay fees to the teachers union for nonpolitical services, chiefly collective bargaining. That's the type of provision that Scott Walker killed in Wisconsin; without it, pubic sector unions wither. As Mark Joseph Stern at Slate points out, "there is virtually no chance" that the Supreme Court will rule against the teachers:

Racism in service of plutocracy: Beutler's response to Chait

Jonathan Chait's two-front argument that 1) the Republican policy platform has deep roots in slavery and racism, but 2) Democrats are too quick to ascribe racism to individual conservatives, their policy positions and utterances, angered a lot of progressives, who see false equivalence as well as neglect of the real effects of conservative policies on African Americans and other minorities.

On the false equivalence front, Brian Beutler argues that Chait has mischaracterized progressives' case that the Republican gestalt is racist:

Why the South doth prevail (and why to some extent it didn't)

A 1957 essay by William F. Buckley, Why the South Must Prevail, was making the rounds on Twitter last night (thanks to Erik Kleefeld). In it, Buckley pretends to some regard for the ultimate welfare of Southern "negroes" but asserts that Southern whites have the right to preserve their cultural superiority by denying their black neighbors the right to vote --because  "the claims of civilization supersede those of universal suffrage."

That is, southern whites don't want to integrate and so pollute their...culture, so they have the right to keep "negroes" from voting to force them to do.  How can a minority claim to speak for "civilization"? "[T]he White community is so entitled because, for the time being, it is the advanced race."

People well-versed in Buckley's oeuvre and career, and in the legislative civil rights battles of the of the late 50s, will doubtless weigh in with appropriate context and analysis. Lacking more than passing familiarity with the latter and interest in the former, I still think it's worthwhile to note a couple of points that struck me, coming to this cold.

Chait channels Obama

When I read Jonathan Chait's extended argument that a) many Republican policies have deep roots in slavery and racism, but b) for liberals to assume that advocacy of core conservative policies is itself a marker of racism is illegitimate, my immediate thought was that Chait was echoing Obama:

@xpostfactoid1  Apr 7@jonathanchait Hey, didn't Obama say that in March 2008? http://www.huffingtonpost.com/2008/03/18/obama-race-speech-read-th_n_92077.html …

In a followup post, Chait himself notes that Obama had more recently stolen his fire -- in an interview with David Remnick published this past January:

“There is a historic connection between some of the arguments that we have politically and the history of race in our country, and sometimes it’s hard to disentangle those issues,” he went on. “You can be somebody who, for very legitimate reasons, worries about the power of the federal government — that it’s distant, that it’s bureaucratic, that it’s not accountable — and as a consequence you think that more power should reside in the hands of state governments. But what’s also true, obviously, is that philosophy is wrapped up in the history of states’ rights in the context of the civil-rights movement and the Civil War and Calhoun. There’s a pretty long history there. And so I think it’s important for progressives not to dismiss out of hand arguments against my Presidency or the Democratic Party or Bill Clinton or anybody just because there’s some overlap between those criticisms and the criticisms that traditionally were directed against those who were trying to bring about greater equality for African-Americans. The flip side is I think it’s important for conservatives to recognize and answer some of the problems that are posed by that history ...”

That is in fact a pretty exact match with Chait's thesis, as Chait asserts. But like almost everything Obama says -- in fact like almost everything most of us say -- it was close kin to prior pronouncements.  Here's what I had flashed back to, from Obama's great speech on race in the immediate wake of the Jeremiah Wright controversy. After recounting the roots of African American anger, Obama pivoted, in his on-the-one-hand-on-the-other manner:

"How politics makes us stupid": Ezra Klein's hypothesis, Chait's case study

Serendipity. On one sunny Sunday, Jonathan Chair purported to explain the controlling dynamic in U.S. politics. And Ezra Klein purported to explain the controlling dynamic in politics, period. Their hypotheses are congruent.

Klein deployed social science research from a team led by Yale law professor Dan Kahan demonstrating that all of us actively resist evidence that challenges our assumptions. In matters of passion and identity, we almost literally can't see contrary evidence. Exhibit A is an experiment in which people who had already demonstrated their ability to use math to arrive at a counterintuitive conclusion disabled that capacity when it threatened to undermine a political conviction.

In Kahan's experiment, people who had previously parsed data about the effectiveness of a skin cream were shown similarly presented data about the effectiveness of gun control. And, lo:

Democrats should shut down the government

Not really. But they should let Republicans shut down the government rather than agreeing to a two-month continuing resolution that will bring on debt ceiling apocalypse.

When word was that Boehner would postpone a budget showdown until the debt ceiling is reached in November and try to force a defunding of Obamacare then, I suspected that he and his party would shift gears and seek to extract more attainable budget concessions. That has now happened, as Chait summarizes:

The Republican leadership is perfectly aware that a debt default could have explosive implications and that the Obama administration is not willing to negotiate over it. It’s already formulating a line of retreat to back out of this threat. As Politico reports, they want to tie together negotiations over the debt ceiling with negotiations over budget sequestration. Then they can extract concessions from Obama on the budget and sell them to their base as a ransom for lifting the debt ceiling, rather than admit they just gave in on the debt ceiling.

"Gave in" is a relative term. Extracting further budget cuts beyond sequestration would be a major GOP victory by my lights, if not by the GOP base's. And they may get it. As Chait warns here and has warned before, a debt default (stemming from failure to raise the debt ceiling) is a " vastly more dangerous threat" than a government shutdown. Yet Chait, like Greg Sargent and Brian Beutler, seems to have more faith than I do about what Obama will not yield to if faced with a debt default:

Will we hear Obama in retrospect?

Greg Sargent very sensibly notes that Obama, in his speech at Georgetown today announcing executive actions to reduce greenhouse gas emissions, "recast the call for climate action as the centrist, common-sense solution." Further developing that idea, he cites Chait:

As Jonathan Chait noted recently, the untold story of the Obama era is his vision of achieving liberal goals as a means for also achieving long-term economic growth:

Fashioning a long-term growth strategy is, and has always been, Obama’s deepest passion. He’s been caught up in an economic crisis and a culture war over the role of government that he wants badly to escape.

I must add that if Obama's vision of enacting liberal policies as a means for achieving long-term growth has been left untold by certain parties, those parties don't include Obama. He has never stopped telling that story: it is the very heart and soul of his pitch to America and always has been. That goes for casting those policies as "common-sense centrism," too. Throughout the 2008 campaign, tracking his speeches, I referred repeatedly to Obama's bid to move the center left. The argument has (and had) these components:

Chait all wet on high-stakes testing

Jonathan Chait has been a critic of the perverse incentives that distort our healthcare delivery system.  But he is willfully oblivious to the perverse incentives created by overemphasis on high-stakes testing in public school systems. 

Here's his reaction to the Atlanta cheating scandal, in which former Superintendent Beverly Hall and 34 other 34 teachers, principals and administrators were indicted on allegations that they “conspired to either cheat, conceal cheating or retaliate against whistle-blowers in an effort to bolster C.R.C.T. scores for the benefit of financial rewards associated with high test scores”:

[Eugene Robinson's] factual premise — that connecting teacher and principal incentives to student achievement leads to more cheating — is probably true. Is this a reason to get rid of incentives? No, it isn’t.

The real budget battle: voucherize Medicare, or IPABize it?

Noting that the emerging Republican budget strategy seems to be stalemate -- refuse to approve any new taxes, consequently give up on entitlement reform, and blame Obama, Jonathan Chait notes that this strategy makes a kind of sense. That is, it locates the long-term budget battle where it belongs, on the means of controlling healthcare costs:

This may sound like a cynical strategy. And it is. But it’s not a purely cynical strategy. It reflects an important intellectual development on the right. Capretta is advocating not just the classic no-taxes-ever approach that has defined the party for years, but also its newer (or newly fervent) belief in privatizing health-care services.

The main driver here is Paul Ryan, whom Capretta advises. (Yuval Levin, another Ryan favorite, makes a similar, though less openly cynical, no-deal argument for the Weekly Standard.) Ryan has accepted the argument, traditionally pushed by Democrats, that the main driver of long-term budget deficits is not the aging population but skyrocketing health-care costs. Ryan has decided that the only possible answer to the problem is to turn Medicare into a system of subsidized private insurance, and that the wonders of competition between insurance firms will dramatically suppress cost inflation (“the way it always works when the consumer is in charge,” he says).

What's truly cynical is not Ryan's ideological faith in the competition fairy, but his demonization, in the illustrious McCaughey-Bachmann-Palin tradition that is now general GOP dogma, of other more proven means of controlling healthcare costs. Chait continues:

As in December 2010, trading tax cuts

The pending debt ceiling deal is shaping up as quite a Rorschach test. On the left, Michael Cohen crows that the GOP caved, while Noam Scheiber is convinced that Obama has finally and definitively destroyed his negotiating cred.  Reception on the left was shaped this morning, as the deal came gradually into focus, by an uncharacteristic freakout from Jonathan Chait. Just returned from vacation, Chait seemed to be reacting more to Obama's offer several weeks ago to start income tax hikes at the $400k level than to overnight developments (though the overnight news did move that higher threshold to the realm of the more limited deal).  Me, I wavered between "poles of hope and fear... Dec 2010 tax deal vs.crappy Jul 2011 deal Boehner did O favor of pulling out of. ' My hope:  "Perhaps cliff deal postmortem will look like 12/2010 - jaw-dropping headline concession offset by lower profile plusses."

My sense at this point is that the pending deal does look something like the 2010 agreement: a steep headline price paid to preserve core Obama priorities, with judgment yet again to be deferred until another round of deficit reduction is negotiated in 2013. On that second point, Obama laid down a key marker in his press statement this afternoon: that all subsequent spending cuts would have to be offset by tax hikes of equal value.  It's unclear how he would enforce that: his ability to do so depends both on how the sequester is handled and how he plans to make good his proclaimed refusal to negotiate under threat of a debt ceiling default. If he can make his own ground rules stick, then this is indeed a good deal.

The deal resembles the December 2010 agreement insofar as in both cases, the two sides found it easier to trade favored tax cuts than to either cut spending or raise revenue (surprise...).  In exchange for holding households earning $250k--$450k nearly harmless (though they are subject to some deduction limitations), the Democrats will have secured (if the deal goes through) 5-year extensions of Obama's tax credits for low- and middle-income Americans (expansions of the Earned Income Tax Credit, the Child Tax Credit, and the credit for college tuition), alternative energy, and business investment, along with a one year unemployment benefit extension. Thus Obama continues to forego hardball to maximize future revenue in favor of easing financial pressure on the needy and nonwealthy, stimulating the economy, and advancing his energy policy.  Long-term, I suspect he thinks that revenue can be squeezed out of the GOP in stages, but that the economy and Americans with stagnant incomes need help now.  Those who insist that our chief challenge is to stimulate the economy rather than reduce the deficit ought to be pleased.

Obama can't quite keep it simple

[11/15: several updates at bottom]

In response to the first 'fiscal cliff' question in his press conference today, Obama seemed to shut the door on any alternative to letting the Bush tax cuts for the wealthiest 2% expire -- that is, to raising the top marginal income tax rate. But there was a little sliver of light along the doorjamb, and when Chuck Todd pushed on it, Obama swung the door open.

First, this seemed all but definitive:

QUESTION: You’ve said that the wealthiest must pay more. Would closing loopholes instead of raising rates for them satisfy you?

OBAMA: I think that there are loopholes that can be closed, and we should look at how we can make the process of deductions, the filing process easier, simpler. But when it comes to the top 2 percent, what I’m not going to do is to extend further a tax cut for folks who don’t need it, which would cost close to a trillion dollars.

Annus mirabilis

If I may repeat a thought from September 8, mentally converting the conditional into the indicative as I reread:

With breath held as the billion-dollar Romney air assault kicks into post-convention gear, I am also prepared to be proud.  Step back and contemplate that in the face of 8-plus percent unemployment, and a united opposition that has sabotaged and demonized his every initiative for 44 months, Obama remains at least a slight favorite for reelection.  Renewing our vows would be even more awe-inspiring than electing Obama in the first place.

In the euphoria of 2008, it was possible to think that racism was losing its potency, was not a major factor in our politics. After we lost that innocence, after four years of more and less racially coded attacks, from birtherism to Gingrich's food stamp president to Romney's subtler charge that Obama doesn't understand what makes America unique; after the death panel screams and the debt ceiling debacle; Obama's support has never fully cratered, and is looking more likely than not to carry him over the finish line. His basic competence, and intelligence, and dignity, and concern for the mass of the people, and integrity are manifest enough that a large plurality has always stuck with him.

Pundits moan no end about the stupidity of the electorate. Progressives worry, with reason, about the effects of unprecedented and unaccountable billions flowing into campaign coffers, and an equally unprecedented willingness to base a campaign entirely on lies. And yet, in the face of all, it appears more likely than not that the race-baiting, compromise-ditching, economy-sabotaging, government-gutting, corporate-controlled GOP is going to fail to fool most of the people enough of the time to unseat Obama.

If he prevails again, it will be America's finest hour since the Voting Rights Act.

----

So he has prevailed. And let's pause for a moment to remember -- and, in his triumph, savor -- the rings of fire he has passed through: economic freefall. Implacable disloyal opposition from the day he was elected; sabotage and smear, to the point where the real effects of his economy-saving and built-to-last stimulus bill were erased from the public perception. The heaviest legislative lift since the Voting Rights Act, resulting in the most important addition to the safety net since Medicare. The midterm shellacking, followed by the debt ceiling debacle, out of which he salvaged a debt ceiling-free run to the present and massive leverage at the edge of the fiscal cliff, and after which he learned to hammer an opposition incapable of compromise. Whitewater rafting past the rocks of Supreme Court ruling on the ACA, Israeli threats to set the world afire, and European meltdown.  Hard-won backdoor stimulus in the form of payroll tax cuts and unemployment extensions.

Obama knows how to be president now.  He knows what his opposition is an dhow to deal with it.  He is free to cement the pillars of his legacy, the long-term investments in the future: universal healthcare with evolving cost controls, a new banking regime dependent on rule-writing by an administration serious about curbing the industry's excesses, ongoing investment in alternative energy, moderating the Supreme Court, completing the gay rights revolution, a peaceful resolution to Iran's nuclear development, continued patient, subtle leadership in the continued development of multilateral institutions...the list goes on.

Jonathan Chait recently argued convincingly that Obama has been a great president. Second terms are notorious for setbacks and dissipated energy. More than most presidents, though, Obama has a full plate simply in the hard, essential work of implementing and building on his towering legislative accomplishments. I am confident that he will be a good steward of those works in progress.

Capitulate, Chait! Succumb, Drum! Obama's rhetoric is a force for change

Two of the admirers of Obama I'm most attuned to claim a tough-minded immunity to the alleged intoxications of the president's rhetoric. Jonathan Chait, in a truly moving and incisive tribute to Obama's radical pragmatism, protests at the outset, "I never felt his election would change everything about American politics or government...Nothing Obama did or said ever made me well up with tears." Kevin Drum goes him one better:

I simply never took seriously any of Obama's high-flown rhetoric—Hope and change, Yes we can! You are the solution, etc.—dismissing it as nothing more than typical campaign windiness.

To which I must respond: Gentlemen! Tune in, turn on, don't cop out. Listen to what the man has been saying these five-plus years.

The tribute Obama deserves

has been delivered by Jonathan Chait:

What can be said without equivocation is that Obama has proven himself morally, intellectually, temperamentally, and strategically. In my lifetime, or my parents’, he is easily the best president. On his own terms, and not merely as a contrast to an unacceptable alternative, he overwhelmingly deserves reelection.

Chait understands that true pragmatism is the rarest and most powerful lever of leadership:

Obama’s résumé of accomplishments is broad and deep, running the gamut from economic to social to foreign policy. The general thrust of his reforms, especially in economic policy, has been a combination of politically radical and ideologically moderate. The combination has confused liberals into thinking of Obamaism as a series of sad half-measures, and conservatives to deem it socialism, but the truth is neither. Obama’s agenda has generally hewed to the consensus of mainstream economists and policy experts. What makes the agenda radical is that, historically, vast realms of policy had been shaped by special interests for their own benefit. Plans to rationalize those things, to write laws that make sense, molder on think-tank shelves for years, even generations. They are often boring. But then Obama, in a frenetic burst of activity, made many of them happen all at once.

Did Romney "panic"? Or revert to form?

Ezra Klein and Jonathan Chait each offer insightful views of the thinking, such as it was, behind Romney's disgustingly opportunistic attack on the Obama administration's response to the assaults on U.S. missions in Egypt and Libya, the latter of which left four Americans dead. But the two explanations are actually somewhat at odds with each other.

Klein takes the verbal assault as evidence that the Romney campaign is panicking.  It has been determined to keep the focus relentlessly on the economy:

We may be on the brink of a democratic miracle

Jonathan Chait recently framed a conundrum facing Democrats who are convinced that the Romney campaign is playing the race card: you don't have to be racist to subscribe to conservative positions on spending for the poor, but such positions are attractive to those who envision the "undeserving poor" primarily as minorities. His conclusion: while Romney attack ads alleging that Obama is gutting the work requirements for welfare might not be racist if the charge had any basis in truth, the fact that it was concocted out of thin air points conclusively to a race-based appeal. 

Chait is wary of Democrats overplaying the race card, and so asserts at the end that "the best counterattack against Romney’s welfare gambit is simply to point out that Romney is shamelessly lying." But he's threading a needle here, much like people who acknowledge that while a given hurricane can't be chalked up to global warming, an overall increase in hurricane intensity probably can. His personal conviction is delivered in the conditional:

A boring white guy will (counter)balance Romney's ticket

Jonathan Chait points out today that Romney's veep pick will tell us whether he's decided his campaign needs a game-changer (ethnic! female! ideologue!) or whether he remains confident that hammering Obama for a limping economy will be enough, in which case the pick will be the "boring white guy" the campaign hinted at in May.

I am of the James Fallows school of Romney campaign advisers.  Romney, Fallows suggests, should stick to one message:

• The economy is broken;
• Obama can't fix it;
• I can.

Of course, Romney's formula has also required hiding the fixin' prescription. And that's where the veep choice will represent a crossroads. "Boring white guy" would not mean a neutral, neither-help-nor-hinder placemarker. He (not she) would help Romney continue to hide the ball.