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Let's Argue Policy

Ed Kilgore, who I am friendly with, writes a very good post that I want to riff off of in a post tomorrow (about the different conceptions of effective reform for health care). But I want to highlight now a key point he makes:

[I]deology, however muddled, is part of what makes most politically active people tick. And if we don't talk about it--and about differences in strategic thinking as well, which should be the subject of future discussions--then all we are left with to explain our differences on this issue or that is questions of character. And anyone paying attention must recognize there's far too much of that going on.

Ed's right. And I am as guilty as anyone. For now, I will stop it and will instead stick to the policy and the politics. More . .

Ed continues:

"Progressive pragmatists"--the camp with which I most often personally identify, as it happens--often treat "the Left" condescendingly as immature and impractical people who don't understand how things get done. Meanwhile, people on "the Left" often treat "pragmatists" as either politically gutless or personally corrupt. This is what happens when you don't take seriously other people's ideological and strategic underpinnings; whatever you gain in ignoring or minimizing differences in perspective or point of view is lost in mutual respect. Sure, the character attacks on both sides are sometimes accurate, but nobody should assume that in any particular case without further examination of each others' ideological and strategic views. That examination is long past due.

All true. Ed and I used to have good discussions about these things back in the day. I hope that discussion can be recommenced throughout the progressive side.

Speaking for me only

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    I read that earlier (5.00 / 3) (#1)
    by andgarden on Wed Dec 16, 2009 at 11:11:37 PM EST
    And you know, I'm about as much of a "new Democrat" as you'll find on this side of the political blogosphere. And considering the world I live in, I have to be (there are all sorts of social, cultural, racial, and class issues built into that that we're basically not allowed to touch in most cases).

    But as a policy matter, I agree with the left-wing single payer advocates. That's not because I'm a socialist (though my mother sometimes accuses me of that). It's because I don't believe that the private model envisioned will even begin to achieve the ends its proponents insist it's designed for. Fundamentally, I have been convinced by Paul Krugman that private market solutions  can't cure healthcare. (For reasons he has not yet explained, he supports this monstrosity).

    Congress must use alternate means, just as it did in creating the FDIC in the 1930s. (BTW, as a history lesson, FDR supposedly opposed the FDIC in the first instance).

    Just to play devil's advocate here (5.00 / 3) (#6)
    by gyrfalcon on Wed Dec 16, 2009 at 11:27:55 PM EST
    the folks who sincerely oppose single-payer (or even a "public option") don't believe that the government model can ever be able to achieve the ends its proponents insist it's designed for.

    There are abundant examples to "prove" either side.

    Where you come down on it really does come down to your underlying ideology, or world view.  If you see government as an institution as essentially benign, if certainly imperfect, you prefer the government handle stuff like health care.  If you see government as inherently, ineluctably corrupt and institutionally driven to greater and greater intrusiveness, then you're going to want to avoid a government role at all costs.

    Etc.

    I was raised from infancy with the firm belief that government, however flawed, is the bulwark against the rapaciousness of capitalism.  It's almost literally part of my DNA.  I freely admit I'm simpley not capable of ditching that world view.  It seems to me so obvious as to be unarguable.

    Parent

    I disagree (5.00 / 2) (#7)
    by Big Tent Democrat on Wed Dec 16, 2009 at 11:30:50 PM EST
    My conclusions are drawn from the American experience regarding health insurance and health care.

    It is an undisputed fact that the program that has been most effective at covering people decently at the lowest cost is Medicare.

    It is an undisputed fact that private insurance is terrible at holding down the cost of insurance and costs of care. Regulation has utterly failed.

    I support public insurance not because I want the government to do it, but because the government has proven itself the most effective vehicle for this market.

    Parent

    You're both right (5.00 / 1) (#14)
    by andgarden on Wed Dec 16, 2009 at 11:40:44 PM EST
    And the other side (none / 0) (#20)
    by gyrfalcon on Thu Dec 17, 2009 at 12:49:04 AM EST
    points to government monopolies like Amtrak, the Post Office, the DMV, etc.

    Hey, I'm utterly on your side on this, but just acknowledging my prejudices can't help but affect my judgment.  The "other side" would say the reason private health insurance hasn't been as efficient as, say, Medicare is because it's handicapped by regulations, etc.  Everybody's got an excuse, including us, for why our preferred approach hasn't worked perfectly in the past.

    We would do well, too, btw, to contemplate the consequences of that efficient Medicare model.  It's not just the removal of profit, it's also the low fees paid to providers.  What that means is that in areas where there isn't a lot of provider competition, like the rural area I live in, providers who will take Medicare are few and far between.  Policy makers really need to think long and hard about that, and I see no sign that they are.

    Parent

    Amtrak* gets a bad rap (5.00 / 2) (#22)
    by andgarden on Thu Dec 17, 2009 at 12:58:23 AM EST
    and so does the post office. As for the DMV, you should ask people who live in New Jersey how much they liked it when Christie Todd Whitman privatized it.

    The problem is that unlike some other countries, we expect unrealistic things and have mutually exclusive goals from our government monopolies, and often move to defund them when they predictably disappoint us.

    *Between Biden, Specter, and Schumer, I will be seriously pissed if we don't get half a billion dollars invested in Amtrak over the next few years.

    Parent

    Agree (none / 0) (#26)
    by cal1942 on Thu Dec 17, 2009 at 01:16:31 AM EST
    So, what happened when Whitman privatized the DMV?

    I'm guessing that it was a disaster. That's what usually happens when government services are privatized.  Seen it here as well.  Did work well though for the Republican Governor who was the force behind privatization.  His campaign coffers were bulging with loot from grateful contractors.

    Parent

    Your guess is correct (though I don't know (5.00 / 1) (#28)
    by andgarden on Thu Dec 17, 2009 at 01:27:07 AM EST
    about the fundraising). Jim McGreevey switched it back. Arguably that was his lasting accomplishment as Governor.

    Parent
    Well (none / 0) (#31)
    by cal1942 on Thu Dec 17, 2009 at 02:29:03 AM EST
    McGreevey's accomplishment could be viewed as relatively monumental given the destruction of the past decade.

    An act of good government.

    Parent

    The post office has been and is the backbone (5.00 / 2) (#38)
    by esmense on Thu Dec 17, 2009 at 07:57:31 AM EST
    of US commerce. The volume of service provided by the US postal service -- it processes about 60% of the entire world's mail -- is immense and unmatched. Both UPS, and to an even greater extent Fedex, rely on the US Postal Service to help them do business. (As in so many other things, private shipping's profitability is greatly enhanced by turning the less profitable bits over to the Feds to handle.) Fedex's "independent agent" business model is especially ill-suited to meeting the needs of consumers in low population, rural areas (like the West). They depend on the Post Office for processing and delivery to those areas.  

    The average person depends on the postal service routinely but uses private carriers only occasionally. In terms of quality of service, this does not in anyway provide an adequate basis for comparison.

    I use both the post office and private carriers in my mail order business. Both offer relative advantages and disadvantages depending on the circumstances. All are hugely complex human enterprises in which things sometimes go wrong and bad actors sometimes participate. But I have to say, in my personal experience, they have tended to go wrong a little more often with the private carriers. No postal employee, for instance, has ever left one of our shipments in some random car parked on the customer's street, or, without any notice to the receiver or shipper, randomly dumped a package at a 7/11 five miles from its rural destination because it was late and he didn't want to drive any further.  

    People who use the post office as a kneejerk example of government inefficiency can't be taken seriously. They are speaking without real thought or from ignorance.

    All those cranks who rage over standing in line while some postal employee patiently helps Grandma re-wrap her package or serves non-English-speaking customers, have no one to blame but themselves. If they had half an ounce of sense they'd go online and arrange for a free pick up -- and, while they are at it, have the post office deliver free shipping boxes too.

    Anyone who can't recognize good value in that can't recognize it in anything.


    Parent

    Agreed ... (5.00 / 1) (#39)
    by Robot Porter on Thu Dec 17, 2009 at 08:28:34 AM EST
    not that long again I ended up sending two packages to the same location (on the other side of the country) on the same day.  One second day, by a private carrier, the other via regular mail.

    They both arrived the same day.  

    Needless to say, the regular mail package was sent at a fraction of the cost of the private carrier package.

    And we cannot forget one of the biggest business success stories of the last decade, Netflix, who's business model has depending hugely on the P.O. for its success.

    The P.O. gets a very bad rap.  It's one of the best value-for-money enterprises we have in this country.

    Parent

    Regional reputations (5.00 / 1) (#47)
    by Inspector Gadget on Thu Dec 17, 2009 at 09:53:27 AM EST
    The Puget Sound area gets incredibly fast and accurate service from really nice postal people.

    Can't say the same about counter workers inside the PO's, though.


    Parent

    Last I checked, Amtrak didn't deliver health care (none / 0) (#55)
    by lambert on Thu Dec 17, 2009 at 09:26:49 PM EST
    Nor did the Post Office. If you confine the comparison to government health care solutions, you find that government wins hands down, whether in the US (Medicare) or internationally, and that's whether you look at a centrist solution like single payer or a more left-wing solution like the UK's National Health Service.

    It could be, as is pointed out about, that the market for health care is different from the market for train travel or stamps.

    Parent

    Are you guys disagreeing? (5.00 / 1) (#8)
    by Steve M on Wed Dec 16, 2009 at 11:31:16 PM EST
    I thought the point was that everyone's viewpoints are sincerely held even if we completely disagree.

    Of course, it ought to be relatively easy to draw that conclusion when it's just us liberals in the room, at least in theory.  The hard part is grasping that the bad guys are sincere a lot more of the time than we think.  Rick Perlstein is always talking about that.

    Parent

    Rereading her comment (5.00 / 1) (#11)
    by Big Tent Democrat on Wed Dec 16, 2009 at 11:35:57 PM EST
    Less disagreement than I first thought.

    Parent
    Or, you could entertain the idea that governments (5.00 / 1) (#32)
    by esmense on Thu Dec 17, 2009 at 02:51:43 AM EST
    can be either.  In a democracy it is the citizens responsibility to determine which it will be.

    My preference for government involvement in some areas has nothing to do with notions of government's inherent good or evil.

    As a practical rule of thumb, those activities that provide much greater social value than profit (if any) when made most broadly available are best undertaken by government.  Education and health care are both examples of services that provide the greatest value for society as a whole when they are most universally available. But, because of the inherently high cost of providing such services (a highly educated, high wage work force, unusually high overhead in terms of plant and equipment costs, etc., etc.) the number of individuals who could afford to pay the true cost of such services in a genuinely, entirely for profit private system that was not subsidized in some way by taxpayers would be limited.  Which is why government, charity and other community resources have ALWAYS played a large role in both education and health care.

    I am not a lefty. I'm a business person and a pragmatist. People who claim that the private sector or "the market" can do anything and  everything better or more "efficiently" than the public sector commonly make two mistakes.

    First, they fail to recognize the difference between creating profit and creating social value. The primary and only goal in the market is profit, although social value may accompany that profit (as may social harm). If your primary goal is creating social value, the market is simply not the right instrument.

    Second, they fail to understand that "efficiency" in providing services for profit is likely to mean limiting who is served or what services are offered, or both.  

    Parent

    In theory, government should (none / 0) (#37)
    by inclusiveheart on Thu Dec 17, 2009 at 07:56:50 AM EST
    create dividends where profits are impossible if you're doing something right and corporations should go for the profit.

    The problem is that too many people have bought into the idea that government's arena can be profitable and create dividends which is simply not true.  Further, without the dividends of good government, business is at a disadvantage.  The healthcare situation is a great example given the fact that the crisis is literally crushing businesses, individuals and innovation.  You can't actually profit if you are delivering good health insurance coverage.  You can, however, generate dividends that positively affect all aspects of society.

    I think ideology has played a huge role in shaping this HCR bill.  The ideological side that believes that business can do everything better than government has won in the Senate bill.  It is disappointing that all of these "smart" people could not overcome their ideology in the face of facts that show that government does this particular job better than private industry.

    We can debate the merits and demerits of the privatization of food service in the military until the cows come home - that's more of an ideological debate - more shades of gray under our current volunteer system - but with healthcare people's lives are literally at stake and we can demonstrate how the for profit model is destructive to the objective of the exercise.  Every additional dollar that goes to pay a huge CEO salary or a shareholder is one that doesn't go to healthcare.  I think CEOs should get paid and I believe in paying shareholders, but I don't think that they play a positive role in this particular aspect of our society.  They can't.  Their need for profit undermines their ability to deliver the services required.  I think that's pretty straight forward.

    I believe that government has a place in society - probably moreso than some people - but HCR is different in my mind.  It just so happens that the data tends to support my ideology in this case - but the data is a stronger driver in my view than my ideology is - because it has to be - because people's lives are at stake.

    Parent

    I don't disagree (none / 0) (#15)
    by andgarden on Wed Dec 16, 2009 at 11:44:15 PM EST
    In my experience, there are more than a few otherwise reasonable people who equate any form government-run healthcare with Dr. Mengele. If I felt that way, I would probably be making common cause with the teabaggers.

    Parent
    The Teabaggers (5.00 / 1) (#17)
    by cal1942 on Thu Dec 17, 2009 at 12:45:07 AM EST
    The rank and file anyway have been told that government involvement in health care equates with Dr. Mengele.

    Granted that it's a sincerely held belief but they've been fed a lot of dishonest propaganda by people who have either an ideological or a vested interest in keeping government away from providing health insurance.

    If it were possible to get honest answers, I'd wager that the people with a vested interest in preventing publicly funded insurance know very well that government run insurance is, from the standpoint of the common good, superior.

    How does that stack up with an honestly held sincere belief?

    Parent

    Ignoring the common good (5.00 / 3) (#18)
    by andgarden on Thu Dec 17, 2009 at 12:48:07 AM EST
    is in the job description of health insurance executives. But the Republicans are worse, because there's no earthly reason for them to work against the common good.

    Parent
    What? "No earthly reason?" (none / 0) (#30)
    by oldpro on Thu Dec 17, 2009 at 02:11:28 AM EST
    I'd say campaign contributions and stock/bond investments are about as 'earthly' as they come.

    Parent
    You just reminded me of something (5.00 / 3) (#34)
    by andgarden on Thu Dec 17, 2009 at 03:08:44 AM EST
    100 years ago the government of this country, and of many states, was under the effective control of a handful of industries. It took 40 years, a great depression, two world wars, and two Roosevelts to come close to doing anything about that. And it didn't take long to trade the old industries for new ones.

    Parent
    Additionally (none / 0) (#51)
    by cal1942 on Thu Dec 17, 2009 at 02:49:07 PM EST
    It took two significant movements, the Populists and Progressives to battle for good government.

    Parent
    Nice while it lasted, hmmm? (none / 0) (#62)
    by oldpro on Fri Dec 18, 2009 at 02:14:12 AM EST
    ...or was that a movie, a dream, a story in a book I read as a child?

    Good government?  Good policy is the best you can hope for.  Work for it.

    Parent

    People don't object to genuinely liberal (5.00 / 3) (#46)
    by esmense on Thu Dec 17, 2009 at 09:36:42 AM EST
    policies as much as they do to half-assed, compromised ones. For instance, Medicare and Social Security are genuinely liberal entitlements in which everyone can eventually participate by right. No one except extreme ideologues objects to Medicare and Social Security. In fact, quite the opposite, they are very popular with the general public.

    But subsidies and income qualified programs, like Medicaid, foodstamps, Title 8 and those now proposed for health insurance, which require income and asset reporting and government intrusion into one's personal affairs, and, of course, government enforced mandates, are another matter altogether. People accept, and are even grateful for, such aid or "welfare" when they are in crisis, desperate, dealing with emergencies and without other options, but there is a certain amount of humiliation involved in doing so. And along with that humiliation comes resentment. That fact makes them totally inappropriate as a on-going, universal solution to a universal need like affordable health insurance. And, it will inevitably make them unpopular. Nothing is likely to kill "government health reform" faster, and damage taste for "government solutions" in the long term, than offering the humiliations of Medicaid and welfare -- programs from which people generally try to escape as quickly as possible -- as the major government approach to a broadly experienced and on-going problem.

    Those on the so-called "pragmatic left" who prefer, along with some of the Republican "middle" (who aim to discourage "dependency" on government), these kind of policies aren't being pragmatic at all -- they are being extremely dense and dismissive of genuine concerns about too intrusive government.

    And, everytime they insist that the only reason people might object to this kind of government intrusiveness and coersion is ignorance, prejudice or bad faith, they are digging the hole for real reform deeper, and reinforcing the Right's argument about "clueless liberal elites."

    Parent

    Good comment G... (none / 0) (#42)
    by kdog on Thu Dec 17, 2009 at 09:00:28 AM EST
    I can relate from the flipside...ingrained in me someway somoehow through life experience and upbringing is the firm belief that our government in practice, despite some good work done towards the common good, is an overall detriment to individual liberty, prosperity, and self determination.  I too find this worldview hard to shake and realize my prejudice towards this view shapes my take on any number of issues, including healthcare.

    The trick is, and its no easy task, is to remain mindful of your ideological prejudices, admit them, and try like hell to keep an open mind.  Unfortunately truly open minds are hard to come by.

    Like sarc's tagline goes..."Convictions are a greater foe to truth than lies".


    Parent

    A description of non-government (none / 0) (#52)
    by cal1942 on Thu Dec 17, 2009 at 03:11:28 PM EST
    government in practice, despite some good work done towards the common good, is an overall detriment to individual liberty, prosperity, and self determination.

    Really the last of that statement is about 'no government' anarchy.

    What we have today is a government unwilling to protect its own people.  Selling their support to the highest bidder, failure to enact meaningful regulations, etc. produces a type of anarchy where the great majority of citizens are subject to an unchecked marauding elite.  Bankers are allowed to jack interest rates without cause.  Health insurance companies are free to breach contracts, businesses are free to move jobs overseas, reimport their products without penalty and destroy whole communities.

    These are the results of non-government allowing unchained liberty for a small number of wealthy, connected elites and in effect denying liberty, prosperity and self-determination to the overwhelming majority of its own citizens.

    Only government can really protect the great majority from a rapacious, rampaging elite.

    A government that allows unencumbered 'liberty' to those elites is no government at all.

    Government itself is not the enemy here it's the failure of individuals in government to govern.

    Parent

    No argument on a lot of that cal... (none / 0) (#53)
    by kdog on Thu Dec 17, 2009 at 06:21:22 PM EST
    we don't have a government right now, we've got a protection racket for the marauding elite.  

    I just think the government you envision is so unlikely to ever exist (I've never seen anything close), I'm more inclined to be given the same freedoms the marauding elite enjoy, maybe we got a fighting chance.

    Parent

    I know what (none / 0) (#61)
    by cal1942 on Thu Dec 17, 2009 at 11:27:37 PM EST
    you're saying kdog, but frankly, the majority of people don't stand a chance when powerful private interests are allowed to rape and pillage at will.

    Lambert says kleptocracy.  Good description.  Aiding and abetting.

    Parent

    And even less chance... (none / 0) (#63)
    by kdog on Fri Dec 18, 2009 at 07:43:38 AM EST
    when powerful private interests have the government, and its color of authority, bought and paid for.

    Parent
    That's not a government (none / 0) (#56)
    by lambert on Thu Dec 17, 2009 at 09:33:00 PM EST
    It's a klepotracy.

    And I really don't know what other word there is for a government that forces people to buy a defective product so that the companies that sell it can remain profitable.

    Parent

    Some of the opposition stems (none / 0) (#50)
    by me only on Thu Dec 17, 2009 at 12:14:14 PM EST
    from the fact that no current proposal for single payer is predicated on the people who use the care to pay for it in any way.  All the proposals are for taking high wage earners.

    All of this looks like politicians fixing the problem by taking something from one group and giving it to another group.

    I was raised from infancy with the firm belief that capitalism, however flawed, is the bulwark against the rapaciousness of government socialism.

    Parent

    I would consider myself as (5.00 / 5) (#13)
    by MO Blue on Wed Dec 16, 2009 at 11:40:23 PM EST
    a pragmatist although I'm sure Kilgore would not.

    To me the first requirement is will the legislation work. IOW will it meet it's stated objectives or fix the problem.

    The current proposal does not IMO provide affordable health care nor does it do anything to stop the  acceleration of costs that are unsustainable. In fact, many of the things that would actually reduce costs have been eliminated or voted down by a Democratic congress. Case in point, negotiating drug prices or reimporting drugs from Canada.

    On one hand, Obama states that we must "fix" entitlement programs such as Social Security and Medicare or they will bankrupt the country and on the other hand he is creating a true entitlement program where the medical industry, insurance and pharma can continue to increase prices without limit and the government will pick up the tab in subsidies.

    Rather than "fix" the problem they are enabling it IMO.

     

    Parent

    Funny thing (none / 0) (#3)
    by Big Tent Democrat on Wed Dec 16, 2009 at 11:16:35 PM EST
    Last year I refused to delve into the health care issue. Just did not interest me. And to be honest, it still is not that interesting. But it is vital.

    and I looked and read and thought about it all, first from the politics perspective and then extensively in the policy.

    And yes, Krugman convinced me too, the market does not work for health insurance. It may work in Switzerland or the Netherlands, where regulations really actually work, but not here.

    It just doesn't.

    More on this tomorrow.

    Parent

    Massachusetts would have created (none / 0) (#5)
    by andgarden on Wed Dec 16, 2009 at 11:22:36 PM EST
    a model for the country if it had been allowed to run a budget deficit.

    (As a side point on that topic, I think one of Krugman's biggest predictions from a year ago is coming true: the little Hoovers in the states are causing immense pain.)

    Parent

    In those (none / 0) (#19)
    by cal1942 on Thu Dec 17, 2009 at 12:48:54 AM EST
    European examples aren't the insurers non-profits?

    Parent
    Sort of (none / 0) (#36)
    by Radix on Thu Dec 17, 2009 at 07:02:14 AM EST
    In those systems the Government has set forth a minimum level of coverage that insurance companies must offer. The amount the insurers can charge may not exceed the actual cost of treatment. There is a bit of an overcharge beyond the basics of treatment, this covers the administration of the policies. These admin fees are heavily scrutinized to ensure no gouging. This doesn't preclude these same companies from offer additional coverage, if desired, by the individual. This additional coverage often includes private rooms and non-essential type procedures.

    Parent
    It's all about the fees! (none / 0) (#57)
    by lambert on Thu Dec 17, 2009 at 09:39:11 PM EST
    Or, to use the term of art, (economic) "rent".

    What's so damaging about the "pragmatic" approach is that by guaranteeeing the insurance companies a steady stream of rents, they further entrench profit into the health care system. And since the insurance companies will divert a stream of their "rents" to further lobbying, there's really no telling what we'll get when 2014 rolls around.

    Parent

    Jon Walker on FDL (none / 0) (#60)
    by MO Blue on Thu Dec 17, 2009 at 10:49:40 PM EST
    has a great post comparing the Netherlands private insurance based system to what the Senate is planning.

    Senate Plan Nothing Like The Netherlands; Poor Regulation Makes Individual Mandate Unacceptable

    Parent

    Very grateful (none / 0) (#21)
    by gyrfalcon on Thu Dec 17, 2009 at 12:56:04 AM EST
    you did decide to dig into health care reform.  I may not agree with your every last thought, but by God, you are the only clear-headed and honest voice I've found on this subject, and many others.

    Parent
    A good post by Kilgore (5.00 / 2) (#2)
    by TheRealFrank on Wed Dec 16, 2009 at 11:15:52 PM EST
    I agree completely.


    Thought you liked it (none / 0) (#4)
    by Big Tent Democrat on Wed Dec 16, 2009 at 11:17:12 PM EST
    You may remember Ed and I discussed the South a lot back in the day.

    Parent
    I do remember that (none / 0) (#9)
    by TheRealFrank on Wed Dec 16, 2009 at 11:31:42 PM EST
    Although not the details, I must admit.

    I especially liked his post, because there have been two divisive issues recently: the troop buildup in Afghanistan, and whether it's worth passing a bill without the PO or not. Both times I came down on the side of "let's do it", but without much enthusiasm, and I could see arguments for or against.

    Both times I learned on the "progressive" blogs that this made me some a warmonger, and an immoral sellout. That gets old quickly.


    Parent

    Heh (none / 0) (#10)
    by Big Tent Democrat on Wed Dec 16, 2009 at 11:35:02 PM EST
    At least not here.

    Hell, I may end up saying vote for the bill. Probably not as I expect it to get worse.

    On Afghanistan, my support for Obama has been of the full throated variety.

    Parent

    Very nice (5.00 / 1) (#12)
    by s5 on Wed Dec 16, 2009 at 11:38:11 PM EST
    I would like to think that I agree with him. My litmus test for the final bill will be: (1) does it help people or make matters worse? and (2) does it open or close the door to real reform within the next election cycle or two?

    Ideologically, my gut feeling is to say "public option or nothing, because I already gave up on single payer". But an incremental success is still success as long as future increments become more likely, rather than less likely. I will be judging the bill on that basis (even though my opinion means essentially squat at this point, given that my name is neither Joe Lieberman or Rahm Emanuel).

    If what is politically possible is not a solution (5.00 / 4) (#23)
    by esmense on Thu Dec 17, 2009 at 01:07:26 AM EST
    to the problem voters have asked lawmakers to address, how is it "pragmatic"? And how can anyone be considered "politically pragmatic" in supporting it?

    I consider myself a pragmatist first and foremost. But I've always thought the test of whether a political proposal is pragmatic or not is whether it is likely to work (effectively addresses the issue it is intended to address) -- whether it meets practical objectives and not just ideological ones -- not how many senate votes it can muster at any given time.

    If some senators vote for a bill because it will hold them in good stead with well-heeled contributors, others agree to vote for it once it meets some ideological demand that has no real or direct bearing on the problem at hand (for deficit neutrality or increased limits on access to abortion services for instance)  and others sign on because some specific provision is inserted to provide a boon to a powerful constituent, etc., enough votes may be gathered for passage -- without the bill in fact addressing the issue it claims to address in any genuinely effective and pragmatic way.

    If pragmatism means striving mostly or only for those things that a majority of politicians find it easy to vote for then massive tax cuts that, as a pragmatic matter, do not, have not and can not provide the benefits their ideological supporters claim, and massive  military spending,  are clearly the most pragmatic policies of all.  

    It's exactly because I'm a pragmatist... (none / 0) (#58)
    by lambert on Thu Dec 17, 2009 at 09:45:59 PM EST
    .... that I view involvement with either legacy party as having unacceptable opportunity costs. That, to me, is the lesson of the health insurance debacle.

    I mean, compared to a big problem, like financial reform, or a bigger problem, like the empire, or an even bigger problem, like global warming, the health care problem should be easy. There are clear examples of success to look to and study (which seems a more rational path toward success than looking to what has already failed or never been tried).

    So, if our political system can't cope with a relatively small and tractable problem like health care, how can we expect it to cope with anything else? I don't know what the path forward is, but whatever it is, it's not through the legacy parties, since, although they are in power alternately, they both seem to be owned by the same owners. The pragmatic approach is to stop doing what doesn't work, and look for something that will.

    Parent

    Can I make an off topic comment? (5.00 / 1) (#24)
    by andgarden on Thu Dec 17, 2009 at 01:08:11 AM EST
    I love Gail Collins sometimes:

    It's certainly easier to leap from one position to its total opposite if you never understood your original stance in the first place, and I am thinking Chait's theory could get some traction. "When I sat next to him in the State Senate, he always surprised me by how little he'd learned about the bill at the time of the vote," said Bill Curry, a former Connecticut comptroller and Democratic gubernatorial nominee.

    I really like the not-that-bright theory, in part because it's as good an explanation as any, and in part because it will definitely drive Lieberman nuts.



    What frustrates me to no end is this: (5.00 / 2) (#25)
    by phat on Thu Dec 17, 2009 at 01:12:36 AM EST
    If costs of health care is what is bankrupting this country than we should be attempting to solve that problem. Not coincidentally, solving the cost problem is likely to save lives. It's both a practical and a moral issue.

    So we are in a position to make a decision.

    That decision is based on whether or not we believe that public policy can actually solve the problem or problems. This is where, I think, the divergence in governmental philosophy lies. The evidence does not show that people like say, Mike Johanns, have the answer. But ultimately, the village decides that Mike Johanns's opinion is just as valuable as any other opinion, despite the fact that he is wrong, given the evidence.

    I'm of the opinion that the people who have decided to stop any real reform don't much believe in the value of public policy as any sort of valuable way to mitigate problems that a society might run across. If they did believe in the value of public policy, philosophically, deeply, than pragmatism and morality would become the same thing.

    That's not happening right now. This is why so many people think the people in the Senate are useless and most people think they're acting like 4 year-olds.

    The posturing is so obvious to even the least politically engaged.

    The reasonable belief, considering the evidence, is that the people who have control over the process aren't pragmatists and aren't even motivated by moral or ethical considerations.

    They are, it seems, just doing what they do, for no good reason.

    Furthermore (5.00 / 1) (#27)
    by phat on Thu Dec 17, 2009 at 01:21:22 AM EST
    If OFA were truly thinking about getting good policy passed they would be pushing the next big policy initiative instead of sending out e-mails asking for money and phone calls to Ben Nelson about health care reform. The time for them to have made that push was in February, before the opposition started buying radio ads in marginal districts across the country.

    Sending Nebraskans emails asking them to call Ben Nelson about health care reform now is almost comical.

    Parent

    OFA more interested in the $$$$ (none / 0) (#29)
    by MO Blue on Thu Dec 17, 2009 at 01:47:48 AM EST
    Oh, "public policy" is effective (none / 0) (#59)
    by lambert on Thu Dec 17, 2009 at 09:50:06 PM EST
    Just not effective for the public.

    It's an effective means of siphoning off the public's money. I mean, what else is a guaranteed market for the insurance companies which is what the mandate is, than a bailout? As Ian Welsh writes:

    A mandate by itself is not sufficient to control costs, all it does is set up a company shop.  Absent hard regulation of the sort of the US has proven very bad at enforcing (see Crisis, Financial) a mandate is just a looting license.


    Parent
    Oh holy hell (5.00 / 3) (#33)
    by The Last Whimzy on Thu Dec 17, 2009 at 02:58:28 AM EST
    Everyone knows that progressive politics is boiled down to two well intentioned individuals calling each other "lying cowards."

    and before you disagree, just stop right there.  i know every single one of you is smart enough to know I'm right, but you all just lack the guts and honesty to admit it.  

    D'UH!!!!!!

    jesus.  is this what therapy is like?  what's the hourly rate?

    An excellent post (5.00 / 1) (#40)
    by Militarytracy on Thu Dec 17, 2009 at 08:28:42 AM EST
    And I don't mean to resort to character attacks but we have people in this country really suffering and many pragmatists shamelessly refuse to notice or consider what a total failure of humanity it is.  How can I not question their humanity?  When my daughter was a baby I worked in a hospital business office in Wyoming.  I worked the money side of things because I've always been attracted to money over mucus even though we have many nurses in my family :)  It was calm, stable employment too...exactly what a single mom needs.  Walmart was just starting up and I remember the copays for their insurance then being small and the coverage was good (not anymore though).  I remember looking at the policy and being impressed that they took care of their employees better than any other retail business in town.  The coal mines of course had first rate insurance coverage (unions and the threat of unions).  Most babies born to young people in the area were medicaid babies.  Things were beginning to strain then though because the insurance companies began to use techniques to avoid payment.  We hired more coding clerks, they had to be on their toes constantly and tenacious in their work.  The war was obviously on.  Nothing has gotten better since then, and everything is much much worse.  Medicaid coverage does not cover those falling through the cracks now and is broke in most states.  People are in serious trouble, some not going in for care in order to avoid charges.....this is a stress that destroys the fabric of our healthy peaceful society and we need to fix this!!  There is a quote from a Brit in Michael Moore's movie 'Sicko' about how Americans in general have been demoralized because of the health-care industry.  What is  sad is that we have been so for so long we think it is a normal condition to be in 24/7.  It makes us angry, bitter, reactive, fear ridden people.

    In a way (5.00 / 1) (#43)
    by CST on Thu Dec 17, 2009 at 09:01:06 AM EST
    I would say the pragmatists absolutely acknowledge the suffering, and are willing to accept any bill that they think will ease that suffering.

    I do not doubt that they believe this bill will save lives.

    We were talking about the MA mandate a lot yesterday.  One of the things lost in that conversation is that the MA health plan was VERY effective at one thing - getting people to sign up for health insurance.  Something like 98% of people here are now covered.  And there are fairly strict definitions of "covered" under the plan as well, so we are not talking about junk insurance here.

    The federal plan is not the MA plan, but that doesn't mean it's supporters don't think it will help people.

    Personally, I am undecided, but then, we are talking about a bill that doesn't exist yet.

    Parent

    We don't know everything that will be in this (5.00 / 1) (#44)
    by Militarytracy on Thu Dec 17, 2009 at 09:14:29 AM EST
    bill or could be in this bill but we know that Joe Lieberman does not have my interests at heart, and the idea is to give Joe what he wants.  People are so fatigued and just want something.....anything passed.....and here we are.  We may get something that makes things worse, not better.  People are fighting now and not just going with the flow.  I think this is necessary because our legislators need to get it.....if this isn't reform and if this gives more to insurance companies while draining the rest of us - there will be hell to pay!  To be fair though, I think we all need to remember that this administration didn't really care what got to the desk to be signed, they just wanted something to sign.  So if this was going to be a war we had already halfway lost it when we started.

    Parent
    And Obama secret deals cut with insurance (5.00 / 1) (#45)
    by Militarytracy on Thu Dec 17, 2009 at 09:17:42 AM EST
    companies and big pharma....you know what? Many of the so called pragmatists never had the suffering of the people foremost in their mind. But they had better now!

    Parent
    I don't really know (none / 0) (#48)
    by CST on Thu Dec 17, 2009 at 10:08:18 AM EST
    if this bill will make us better or worse off.  There are a few problematic aspects to it (the excise tax and possibly Stupak if it's included -although it is currently out of the senate bill).  But at the end of the day, I have a hard time seeing how spending hundreds of millions of dollars on subsidizing insurance for the poor will make us worse off.

    I agree that it's not the best way to do it, and that it is essencially a hand-out of tax payer dollars to the private insurance companies, which is wrong in principle.  I just don't agree that we will be worse off because of it.  I think the people who really need help will probably be better off.  Then again, like I said before, I don't know, because we haven't seen the bill, so I'm not sure what will survive.

    Whatever interests Joe Lieberman has at heart is irrelevant to me.  I don't think Mitt Romney had our best interests at heart either (although he was less effective at gutting the bill than Joe appears to be).  The important thing is what ultimately gets passed.  And I'm okay with passing a "health insurance assistance bill" (not reform), if that's what we're actually going to get.

    Parent

    Although frankly (none / 0) (#49)
    by CST on Thu Dec 17, 2009 at 10:17:30 AM EST
    the "pragmatist" in me still doesn't see a Lieberman gutted bill passing the house.  And I really hope they give the senator hell in conference.

    This should be so much better than it is.

    Parent

    Well (5.00 / 2) (#41)
    by lilburro on Thu Dec 17, 2009 at 08:35:49 AM EST
    first of all, one of the reason "character issues" keep emerging is that the most rabid Obama fans, who suffered from CDS, are now wholly behind this:

    To put it simply, and perhaps over-simply, on a variety of fronts (most notably financial restructuring and health care reform, but arguably on climate change as well), the Obama administration has chosen the strategy of deploying regulated and subsidized private sector entities to achieve progressive policy results. This approach was a hallmark of the so-called Clintonian, "New Democrat" movement, and the broader international movement sometimes referred to as "the Third Way," which often defended the use of private means for public ends.

    Now imagine so-called progressives fiercely arguing for the Third Way.  That's just dumb.  But they are.

    And for a lot of these supporters of the Obama bill the 2008 election was supposed to be about the defeat of Clintonism.


    The pragmatist in me says (none / 0) (#16)
    by Radiowalla on Thu Dec 17, 2009 at 12:04:37 AM EST
    AMEN!!!!

    character drives ideology (none / 0) (#35)
    by pluege on Thu Dec 17, 2009 at 04:43:46 AM EST
    the two are inseparable.

    Understanding who you are dealing with is essential to effectively dealing with them. obama's refusal to recognize the insidious personality of republicans, that they will block what he does regardless of the merits or ideology is a great failure of (or counted on by) team obama. Has no one noticed that the public option blockers claim to be worried about HCR costs? Obviously this is all personality, not policy where they counter their own professed ideology.

    The focus on policy and not personality is the constant failure of progressive and democrats when they blindly insist that they are dealing with honest opposition. reid and obama's failure to understand the petty personality of LIEberman has led us to garbage HCR bill in the Senate.  

    We would have LOVED to talk about policy (none / 0) (#54)
    by lambert on Thu Dec 17, 2009 at 09:22:43 PM EST
    And in fact, that's exactly what single payer advocates did.

    Unfortunately, the collective decision by the administration, the Dems, the press, and the access bloggers to exclude, demean, and censor the "little single payer advocates" WAS corrupt. So why listen to the perps?

    Certainly, the decision was intellectually and morally corrupt -- particularly from a White House that promised an open and transparent process, on C-SPAN!

    Now, I'm not saying that the decision involved personal corruption, or any sort of quid pro quo... Though it is odd that the head of the Democratic Rules and Bylaws Committee in 2008, James Roosevelt, is also the CEO of Tufts Health Care...