Stop Celebrating

Be careful what you wish for, little dems. You wanted any old piece of shit bill you could try to sell to the rubes as "health care reform," and boy did you get it.

Digby is in favor of passing the senate bill, if only to get it into conference, but here she explains why it's nothing to celebrate, and indeed condemns Democrats to far more work, far more difficult work, over far more time, than if they had negotiated from strength from the start.

In my view these mandates make this bill something quite different from "entitlements" as people know them. And it's a psychological/philosophical difference as much as a practical one which I believe it makes these reforms much more vulnerable to repeal.

I'll let Robert Kuttner make the point much more artfully, as he did on Bill Moyers last night:

ROBERT KUTTNER: Think about it, the difference between social insurance and an individual mandate is this. Social insurance everybody pays for it through their taxes, so you don't think of Social Security as a compulsory individual mandate. You think of it as a benefit, as a protection that your government provides. But an individual mandate is an order to you to go out and buy some product from some private profit-making company, that in the case of a lot of moderate income people, you can't afford to buy. And the shell game here is that the affordable policies are either very high deductibles and co-pays, so you can afford the monthly premiums but then when you get sick, you have to pay a small fortune out of pocket before the coverage kicks in. Or if the coverage is decent, the premiums are unaffordable. And so here's the government doing the bidding of the private industry coercing people to buy profit-making products that maybe they can't afford and they call it health reform.

You should watch the whole thing if you missed it. Shrill bloggers aren't the only ones who have this point of view.

One thing those of the old political hands may not realize is that in this era of 24/7 cable and the internet this is the first time most people have watched a big piece of legislation enacted in such close-up detail. And what they are seeing is shocking and disturbing --- the obvious corruption of the process by wealthy corporate interests. There's a lot of populist resentment out here and it's coming down on the heads of the Democrats who are now ironically seen to be funneling taxpayer dollars to rapacious corporations which have been making people's lives miserable, insurance companies being among the worst of them. This health care debate has reinforced that perception. (And sadly, that perception isn't exactly wrong.) It makes health care reform a very different animal than our other social welfare programs.

On the practical political level, I think that rather than being thrilled they are "getting health care" many uninsured people are going to be very disappointed to find that the "benefit" is that they are going to be required to buy something --- especially from companies they don't like or trust. And even if they get subsidies, it's still going to be expensive by the standards of people who make between 30 and 60k a year. Suddenly requiring healthy people to come up with a few hundred dollars a month to pay Aetna isn't really mitigated by the argument that it would have been more before the reforms. I realize that's how mandates work but I don't think people are being adequately prepared for that reality.

SNIP

There has been no public education about responsibility to buy insurance in all this or any strategy to manage expectations of what people will get with Health Care Reform. And because of that the right is going to have a field day telling everyone that the nanny state liberals are forcing them to give to money to insurance companies and then spending their tax money on poor (brown/black) people. So, again, running around saying "Mission Accomplished" is bad politics.

As for the promise to fix all the problems once the bill is in place, I think people are vastly underestimating the forces that are going to be brought to bear to prevent that from happening. Republicans aren't so disorganized that they forgot that they must stop Democrats from giving people reason to believe in government. In addition to deploying their formidable communications apparatus to present health care reform as a massive failure to the majority who are currently covered by employers and will only see the effects from afar, they are going to strangle improvements in the cradle by any means necessary including leveraging their most valuable new voting demographic in the age of Obama --- the elderly. On top of that, we are entering an era of deficit fetishism and have an industry that has shown it will do everything in its power to protect its interests. It's not impossible, but watching the Democrats operate at the zenith of their institutional power over the past year does not give me any confidence that they want to, much less can, battle all that back.

SNIP

I don't know how this bill will play out politically. It's not what I thought health care reform would be, but perhaps it is better than nothing. Your mileage may vary. I think it definitely is better for the working poor if we can hang on to the funding, which I think is dicey. As for the rest, we'll see.

But I think the first thing Democrats need to do is dial down the end-zone dance and start talking about this bill for what it is. Indeed, if I were them, I'd work hard to lower expectations. I do not believe this legislation will be exempt from repeal or serious whittling away as time goes on nor do I think that the political system will allow the quick fixes that will be necessary to keep people on board while they get the reforms in place, regardless of whether the Republicans come back into power during the implementation period, which they very well could. This just isn't a big New Deal style social insurance program and selling it in those terms is setting the stage for a backlash.

Read the whole thing.