Friday, December 18, 2009

If Paul Krugman says we're better off with the best HCR bill we can get now, then . . . well, I guess that's what he believes


by Ken

I would love to believe that health care reform hasn't passed the point of all possible hope.

Last night we had Doug Kahn arguing in favor of Senate passage of a health care bill, any bill, on the ground that once the thing gets into House-Senate conference, serious people will take over the negotiating and produce a decent bill. Could happen, I say. Hey, it could also happen that I take off the weight I've put on over the last year or two.

Howie and I have both been pretty rough on the bill now taking misshape in the Senate, and I for one am eager -- just this side of desperate, actually -- to be shown that there really is a realistically hopeful outcome. And since I'm always willing to listen to Paul Krugman, and since pretty much nobody else on the planet is willing to talk to progressives, as Paul does unashamedly in today's NYT column, I'm listening.

Pass the Bill

Published: December 17, 2009

A message to progressives: By all means, hang Senator Joe Lieberman in effigy. Declare that you're disappointed in and/or disgusted with President Obama. Demand a change in Senate rules that, combined with the Republican strategy of total obstructionism, are in the process of making America ungovernable.

But meanwhile, pass the health care bill.

Yes, the filibuster-imposed need to get votes from "centrist" senators has led to a bill that falls a long way short of ideal. Worse, some of those senators seem motivated largely by a desire to protect the interests of insurance companies -- with the possible exception of Mr. Lieberman, who seems motivated by sheer spite.

But let's all take a deep breath, and consider just how much good this bill would do, if passed -- and how much better it would be than anything that seemed possible just a few years ago. With all its flaws, the Senate health bill would be the biggest expansion of the social safety net since Medicare, greatly improving the lives of millions. Getting this bill would be much, much better than watching health care reform fail.

At its core, the bill would do two things. First, it would prohibit discrimination by insurance companies on the basis of medical condition or history: Americans could no longer be denied health insurance because of a pre-existing condition, or have their insurance canceled when they get sick. Second, the bill would provide substantial financial aid to those who don't get insurance through their employers, as well as tax breaks for small employers that do provide insurance.

All of this would be paid for in large part with the first serious effort ever to rein in rising health care costs.

The result would be a huge increase in the availability and affordability of health insurance, with more than 30 million Americans gaining coverage, and premiums for lower-income and lower-middle-income Americans falling dramatically. That's an immense change from where we were just a few years ago: remember, not long ago the Bush administration and its allies in Congress successfully blocked even a modest expansion of health care for children.

Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage -- and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it's now the bedrock of retirement stability for the vast majority of Americans.

Look, I understand the anger here: supporting this weakened bill feels like giving in to blackmail -- because it is. Or to use an even more accurate metaphor suggested by Ezra Klein of The Washington Post, we're paying a ransom to hostage-takers. Some of us, including a majority of senators, really, really want to cover the uninsured; but to make that happen we need the votes of a handful of senators who see failure of reform as an acceptable outcome, and demand a steep price for their support.

The question, then, is whether to pay the ransom by giving in to the demands of those senators, accepting a flawed bill, or hang tough and let the hostage -- that is, health reform -- die.

Again, history suggests the answer. Whereas flawed social insurance programs have tended to get better over time, the story of health reform suggests that rejecting an imperfect deal in the hope of eventually getting something better is a recipe for getting nothing at all. Not to put too fine a point on it, America would be in much better shape today if Democrats had cut a deal on health care with Richard Nixon, or if Bill Clinton had cut a deal with moderate Republicans back when they still existed.

But won't paying the ransom now encourage more hostage-taking in the future? Maybe. But the next big fight, over the future of the financial system, will be very different. If the usual suspects try to water down financial reform, I say call their bluff: there's not much to lose, since a merely cosmetic reform, by creating a false sense of security, could well end up being worse than nothing.

Beyond that, we need to take on the way the Senate works. The filibuster, and the need for 60 votes to end debate, aren't in the Constitution. They're a Senate tradition, and that same tradition said that the threat of filibusters should be used sparingly. Well, Republicans have already trashed the second part of the tradition: look at a list of cloture motions over time, and you'll see that since the G.O.P. lost control of Congress it has pursued obstructionism on a literally unprecedented scale. So it's time to revise the rules.

But that's for later. Right now, let's pass the bill that's on the table.

Me, I'm not persuaded:

* that a better bill is going to come out of conference than goes in. If by chance a seriously better bill does emerge, enough better to piss off the people who've already said they won't vote for such a thing, I have no difficulty believing it'll be filibustered by people who are perfectly happy to see "no bill" as an outcome, especially since there's no evidence at the moment that there's any political price to pay for obstructionism.

* that a bill that's enacted now stands much of a chance of being seriously improved at any time in the near future. In the present political climate, where is the will (i.e., the votes) going to come from?

Still, that could just be me.

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At 8:48 PM, Blogger Cirze said...

Thanks for your comments.

I like Paul too, and value his input, but it seems to me that any bill that emerges from this bloodbath will be so lacking in what we had hoped for that it will take many years to rectify it and thus will do no one any good for an awfully long time.

And wasn't this the plan?

Preserve a very bad system in order to continue to enrich the worst actors.

And benefit none of the best.


At 12:30 AM, Blogger Doug Kahn said...

Hard to believe you could misinterpret this at the top of my post: "the bill that gets Lieberman's vote . . . will necessarily be a totally useless kiss-up to the insurance industry". Does that sound as though I'm in favor? I just think that's what's going to happen.

I'd like to see a direct challenge to the insurance industry and Lieberman come out of conference, then see if we can't, as I said at the end, "bring the heat" to break a filibuster.

I agree with you Ken, if you're saying the Senate bill is worse than nothing. People who compare 2009 to 1994 and the Clinton health care debacle are wrong. We are much, much stronger now, and the insurance industry has lost any shred of credibility they might have once possessed. Am I the only person who remembers the Clinton plan as a completely horseshit capitulation to the insurance industry?

As I said, "I still wish they'd do reconciliation . . ." That means ramming through a bill on a majority vote.

You agree, I'm sure, that the present system is "unsustainable", as our fearless leader says. That word means what it means; the insurance companies have to go. We're involved in a death struggle with a very powerful but imminently dead industry. We have our hands on its neck. Compromise is wrong.

At 8:26 AM, Anonymous Balakirev said...

Could happen, I say. Hey, it could also happen that I take off the weight I've put on over the last year or two.

No, Ken, it's less likely to happen than your weight loss. Because the likes of Nelson, Landrieu, and especially Lieberman, have made it clear exactly where they stand. A Senate bill can go into conference with the House and end up looking and sounding like a compromise, but they won't accept it. In other words, the bottom line on the health care bill as it currently exists is exactly what comes out of the Senate, or less. Nothing stronger.

I have a great deal of respect for Krugman's economic insights and expertise, but in this instance he's not looking at what's on the table with clear eyes. He's seeing A Health Care Bill as though it will solve a lot, when instead it solves very little and gives the insurance industry so very, very much, instead. This is not a case of the good being the enemy of the perfect, but of the truly awful being the enemy of something good. And far from propping up the Dems' chances in coming years, the hollowness of the Senate's legislative effort will become a rallying cry for disaffection with the party and its leadership if it passes.


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