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.”

Obama's meta mea culpa, cont.

Taking questions at a town-hall meeting in Indiana today, Obama reiterated his oddly elusive confession of error in connection with the Daschle appointment:

The woman asked how Americans could trust him if “those you have appointed to your cabinet are not trustworthy,” referring to his nomination of several officials who did not pay all of their taxes until the prospect of working in his administration. ...

“I think these were honest mistakes,” Mr. Obama responded. “If you’re not going to appoint anybody who’s not made a mistake in their life, then you’re not going to have anybody take a job.” But he agreed that he erred by not seeing that it would look like a double standard. “I made a mistake because I don’t want to send the signal that there are two sets of rules,” he said.

As it did when Obama delivered his initial, riveting "I screwed up," the mea culpa seems peculiarly meta, admitting to a failure to recognize how his defense of Daschle would be perceived rather than to an error in judging Daschle himself. Obama didn't want to look like he was setting a double standard by defending Daschle after Daschle admitted to a failure to report use of a car and driver as income. But was he setting one? If Obama were the only person who knew of Daschle's tax error, would he have been wrong to stick with him?

Assuming not, was Obama wrong to bow to the perception of a double standard? Would it have been impossible to credibly elaborate the defense of Daschle above - these were honest mistakes...If you’re not going to appoint anybody who’s not made a mistake in their life, then you’re not going to have anybody take a job? Is it fair for Obama to confess that the whole gestalt of three nominees' tax reporting failures plus Daschle's lucrative quasi-lobbying interregnum trumped his personal conviction that Daschle was the best person for the job? And does the confession suggest that Obama should have pushed Daschle before he jumped?

Depends what your definition of "screwed up" is

The country has been ga-ga over Obama declaring "I screwed up" in connection with the Daschle nomination. So refreshing, such a break with the prior administration. But what exactly did Obama mean?

Did he mean that Daschle was the wrong pick to head HHS and the effort to reform healthcare? No....

Tom, I think, is an outstanding individual. I am absolutely convinced that he would've been the best person to help shepherd through what's going to be a very difficult process to get health care for American families.

Did he mean that his vetting process was somehow wanting? No...

Well, I, you know, don't think there's something wrong with the vetting process.

Did he mean that Daschle's tax error, once revealed, should have disqualified him? Or that, once the error (and Daschle's quasi-lobbying activities) came to light, Obama should have asked him to resign immediately? Maybe, kinda:

I think that what happened, certainly, let's just take Tom as an example. I made a judgment that he was the best person possible for the job. I was very eager to make sure that we can deliver on a commitment that I have to deliver healthcare for the American people. I think I messed up. I screwed up in not recognizing the perception that even though this is an honest mistake, I believe, on Tom's part, that, you know, ordinary people are out there paying taxes every day and whether it's an intentional mistake or not, it was sending the wrong signal. So again, this was something that was my fault. I continue to consider Tom Daschle an outstanding public servant, uh, and what we're going to do now is make sure we get somebody confirmed and start moving forward.

I screwed up in not recognizing the perception. Was the perception wrong or right? Did Daschle violate an ethical standard to an extent that made him unfit for the office? If not, was the perception wrong? If wrong, should Obama have tried to change it?

I think Obama "screwed up" in setting the ethical bar too high. He's absolutely right that lobbyists' grip on U.S. politics needs to be weakened. But the focus should be on rules in effect going forward, not on selecting only people who are simon-pure by a new standard. And while it's true that "ordinary people are out there paying taxes," it's not true that "ordinary people" with any discretionary items routinely pay all taxes they could be construed to owe. How many of those condemning Daschle, or Killefer, or Geithner for their tax misdemeanors hold themselves to a higher standard? Ask their accountants, if they're reasonably affluent, or the people who paint their houses, if they're middle class, or the people whom they serve privately, in unsalaried positions, if they're poor.

Yes, public officials should be held to a higher standard. But perhaps we've arrived at the point, to paraphrase AIG's Hank Greenberg, where footfaults are treated as a murder charge.

Frank Rich is probably right that populist rage at the excesses of Wall Street and Washington are going to be a formidable political force in the years ahead, and that Obama needs to "get in front of the mounting public anger." But Obama also demonstrated a rare ability through the endless campaign to explain nuance, and to articulate two sides of a matter in dispute. Sometimes he may need to stand between his subordinates and the public rage.

Was losing Daschle a 'catastrophic' cost?

Assenting to the sacrifice of Tom Daschle on the altar of political reform, Joe Klein, it seems to me, views that sacrifice from the wrong end of the telescope:

The excesses of wealth, throughout the country, have become an American problem. The extremely rich have detached themselves from the rest of society, which was the point of Obama's story about private jets. In Washington, it is a bipartisan phenomenon. Democrats have their special interests too, and their lobbyists are terrific at what they do. A guy like Daschle, who knows the system cold, who could talk to both the insurance companies and the liberal advocates, would have been invaluable to Obama in bringing health insurance to everyone who needs it. But, as the man said, we're all going to have to sacrifice, and it now seems clear that Obama's sacrifice, if he wants to reattach Washington to a nation sick with cynicism about its government, will be to detach himself from the lobbyist élites who might have helped grease the skids for his policy goals.

The key phrase here is would have been invaluable to Obama in bringing health insurance to everyone who needs it. This country cannot restructure its economy and get a grip on future spending without reforming healthcare effectively. We can't roll back the great risk shift without shielding Americans from catastrophic medical costs and ending the risk of exposure every time a person loses or changes jobs. Daschle's understanding of healthcare policy is of the highest order, and his political skills and knowledge of the legislative process are matchless. Losing him could prove catastrophic to the most important policy initiative of Obama's first term.

It's true that Obama based his campaign on the premise that we can't reform our policies effectively until we reform our politics. It's also true that he has a unique opportunity now to break the lobbyist culture that Klein outlines. But Obama may have miscalibrated his ethics message and policies to a degree. In limiting lobbying and lobby-like entanglements, it's impractical to start from scratch. To rule out anyone who didn't now meet the kind of standards that make sense going forward is as constraining as trying to pick a cabinet that "looks like America."

The tax issues are tougher. You'd think that by this point anyone with ambition for high office would regard a "when in doubt, report and pay" principle as indispensable career protection if
nothing else. These "screw it, I'll keep it" tax reflexes are hard to excuse, particularly in the current climate, as the country reacts to decades of ever-increasing self-licensing excess from elites of all stripes. But they're also near-universal. What percentage of Americans with non-salaried income really chose to pay taxes on all income that would not readily show up if they didn't declare it?

As Ezra Klein points out, "The endlessly long vetting forms forcing deep tax and income transparency... in turn uncovered embarrassments that would never have emerged under past regimes." He also provides important perspective on the mode of Daschle's cashing in:

In recent days, there's been an effort to paint Daschle as one of Washington's most corrupt creatures. Jack Abramoff with an electoral history. But so far as sell-outs go, Daschle's sins were almost modest. His path frequently diverged from money. He never registered as a lobbyist or did any lobbying, even though you get paid more to ensure access than offer advice. He spent huge chunks of time working with the Center for American Progress and writing a technical book on health reform. None of that proved lucrative (his book advance was $22,000; poor for a political pundit, much less a former Senate majority leader). He endorsed Obama in February of 2007, when Clinton was far ahead in the polls. If she'd won -- and most thought she would -- his access to the White House would be close to nonexistent, and his value to clients would be greatly diminished.

Ultimately, though, Klein (Ezra) too embraces the Daschle withdrawal as the price of reform:

But it turns out that Obama's words, well, mattered. They made it harder to ignore scandal, as the Bush administration had done. The endlessly long vetting forms forcing deep tax and income transparency, which in turn uncovered embarrassments that would never have emerged under past regimes. This has made for a more troubled transition, but will probably also result in a cleaner administration. For all the embarrassments, this, in a concrete sense, is what change looks like. It's not an administration that decides to be clean so much as one that has little choice in the matter.

Cleanliness is never absolute, however, and it never lasts. The cycle of reform and corruption and new reform is eternal -- or rather, it's only broken when corruption becomes so endemic that reform is impossible, at which point democratic choice becomes an illusion. Our politicians will never be monks, and we shouldn't want them to be (in fact, monkish orders endure their own cycles of corruption and reform). Perhaps those vetting forms shouldn't have cut so deep; perhaps the lobbying guidelines should have been more forward-looking, more forgiving of past conduct. Obama should not have lost the people he's lost.