Wednesday, July 22, 2009

Three Sides of a Healthcare Reform Debacle
In offering some praise for the Obama administration's American Graduation Initiative proposal earlier today, I noted in passing that this had been largely obscured in the media's fixation on the health care debate. As the president gets ready to go on TV in a couple hours to defend his proposal, I'm not optimistic about its prospects--and not even sure that it should pass.

The problem might simply be that this issue is too big, too complicated, and too dysfunctional to address in the incrementalist, consensus way that Obama obviously would prefer (and which makes sense in a myriad of other policy areas). What I think happened is that the administration overlearned the lesson of the Clintons' failure to reform health care 15 years ago. As Robert Reich noted last week, they've put so much emphasis on co-opting potential opposition from industry groups (the AMA, Big Pharma, even the insurance lobby) that the concessions they made rendered cost control impossible. In a political moment when legislators and the public are really worried that our financial house is structurally unsound, and the administration itself had pledged not to add to the debt with its plan, this won't fly, and shouldn't.

A related point that's particularly painful for those of us who invested so time, money and hope into putting Obama in office is that in its efforts to win this political fight--which is exactly how it's been framed--the president and his team have embraced some of the most loathsome Bush-Cheney tactics in terms of rejecting accountability and transparency. I'm not even sure what it is they think they gain by not making public whom they've been talking with.

But maybe the real problem is that in our growing decadence as a people, we refuse to accept that we can't get something for nothing--and we refuse to give anything. Consider:
One of the bigger, but more under-reported, sea changes in American politics is how any kind of tax increase -- whether in war or peace, good economic times or bad ones -- has become absolutely unacceptable. After all, Ronald Reagan raised taxes. So did every modern American president involved in war, until George W. Bush. But not anymore. Indeed, as one of us pointed out on Nightly News last night, only 29% (or 157) of the 535 and House members and senators serving in Congress were around the last time -- 1993! -- the federal government raised taxes, and that was on gasoline. Think about that for a moment: Congress hasn't really had a TOUGH vote in 16 years, if one defines a "TOUGH" vote as the government asking for a financial sacrifice from the American people. This is the political climate that President Obama faces in trying to pay for health reform. Republicans and some Democrats are opposed to a tax on the wealthy, and unions and Obama's political strategists are against taxing health benefits.
But at some point, if you're fighting two wars, trying to pay for health care, promising to reduce the deficit, and trying NOT to "starve the beast," you've got to raise taxes, right? When they were in charge, Republicans punted because they could NEVER go back to their base and defend a tax increase of any kind (and look where that got them). But is Barack Obama, who called for a “new era of responsibility” in his inaugural address, willing to use his influence to truly change how Washington works? So far, he's supported borrowing -- for the stimulus and for part 2 of the bank bailout.

In today's Times, David Leonhardt has a typically excellent analysis of the politics around health care reform. He points out that the average voter--who is almost certainly insured--is asking "What's in it for me?" There's an answer to this question--the waste in our piecemeal, irrational system costs every American household thousands of dollars--but the specifics are not easily explained in a soundbite. As Obama prepares for one of the most important appearances of his presidency tonight, he'd better find a way to communicate that answer.

Edit: As Obama mentioned during tonight's (I thought just so-so) press conference, the administration has indeed released the names of health care industry figures they've met with. Yeah, it was in response to a threatened lawsuit (and the group that threatened the suit isn't satisfied with the action), but the same threat didn't come close to getting Cheney to give up information. So that's not a bad thing.

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