Avdat

Health care reform and abortion

I've always been a bit wobbly on abortion rights, so it should come as no surprise that I'm not terribly bothered by either the Stupak amendment or the Nelson amendment, both of which would limit federal funding for abortion in the new health care regime. In 2005 the average cost of an outpatient abortion was $413. Honestly, this is not a lot of money, even for poor women. You'd be amazed at the money even very poor people can come up with if they are sufficiently motivated.

Of course taxpayer dollars go to a whole range of programs that I think are either practically unwise or morally dubious, but I pay my taxes anyway. On balance, the bureaucracy is a net benefit to human flourishing. If these restrictions didn't make it into the final bill then that won't change my support for it; I'm so over the politics of purity (see below). At the same time, if you're really into "justice," then aren't there bigger hills to die on than getting in and out of an abortion clinic for a copay and some change?

Making the perfect the enemy of the good

Fire Dog Lake asked me to sign an online petition calling for the death of the Senate health care reform bill. Instead I filled out their unsubscribe form. I'd just as soon the Tea Bagging Right hold a monopoly on political purity. I myself am a recovering purist. Back in the day, I thought that a vote for Nader was worth it, even if it meant handing the White House to the Republicans. I was tired of compromise.

We see how well that worked out. 

Yes, it is infuriating that you need 60 votes to do routine business in the Senate. Yes, Joe Lieberman is insufferable. And Yes, maybe a bill more to liberals' liking would have emerged from the Senate had pieces of the bill been shoved through using the budget reconciliation process.

Nevertheless, the Senate bill would cover an additional 30 million people; end the denial of coverage for pre-existing conditions; end the equally pernicious practice of capping benefits; and most importantly, begin to compensate health care providers for good outcomes, not sheer number of procedures, thus reigning in skyrocketing medical inflation.

What's not to like?

I did get a useful email from MoveOn contrasting the House and Senate bills. The former does have a public option, and pays for the plan with a tax increase on wealthy Americans rather than taxing so-called Cadillac plans, which is how the Senate pays for the bill. I have no idea which is the better policy. The House plan is probably the better politics for Democrats,given that rich people don't vote for Democrats anyway, unless they're movie stars, and given that a lot of these Cadillac plans were negotiated by labor unions. If the conference committee opts for the House tax rather than the Senate tax, that's fine with me.

But I'm not into tilting at the public option windmill. It's dead. There aren't the votes in the Senate for it. I hate it that Democrats would filibuster their own party's signature piece of domestic legislation over the public option, but unless Fire Dog Lake can cast an Imperius Curse on Lieberman, Lincoln, Landrieu and Nelson, going to the wall on this point means no health care reform at all. I don't want to be in the position of saying to uninsured Americans, You'll have to wait until we take Joe Lieberman to the woodshed.

Instead of cutting off your nose to spite your face, why don't liberals take what they can get today, and work like the devil to elect liberal Senators and minimize losses in the House next year, so that progressive legislation doesn't need smokin' Joe's vote?

Turns out Obama's not the messiah after all

I understand that people on the left are deeply disappointed in the Obama administration, especially on the eve of this Afghan troop surge announcement, but they have only themselves to blame. Barack Obama campaigned on shifting the war focus from Iraq to Afghanistan, and that is what he is doing. You didn't really think that you'd elected a peacenik, did you?

Even if Obama were a true peacenik, I'm not sure that he could stop an escalation in Afghanistan if he wanted to. The military wants this. Between Republicans and moderate Democrats, there's probably a majority in Congress who want this. The elite journalists think that peace is an unserious proposition. Can one man, even if he is President of the United States, withstand the sustained pressure of the federal bureaucracy and its allies in the fourth estate?

We're talking about principalities and powers here. We're talking about the whole being greater than the sum of its parts. Obama, and any President, has a tiger by the tail. They all wind up getting eaten eventually.

Ditto on domestic issues. Liberals are furious with the excruciatingly slow pace of health care reform, and frustrated that Obama hasn't brought the hammer down on recalcitrant members of his own caucus, but Obama didn't campaign as the Dick Cheney of the left. He pledged to be a post-partisan President. And post-partisanship means tolerating a meandering legislative process and a certain amount of showboating by people who aren't where you are politically.

I get frustrated too, but I don't really think I'd want my own man stifling dissent the way that the Bush administration stuffed a sock in John Dilulio, assassinated the character of Richard Clarke and won a spurious criminal conviction against Don Siegelman. Do you? Do you want to move along health care reform by having friendly state attorneys general opening campaign finance investigations against Blanche Lincoln, Ben Nelson and Joe Lieberman? 

To paraphrase Dennis Green, the Obama administration is who we thought they were. Moderate by temperment and constrained by forces they aren't fully in control of, Obama is doing about as well as I thought he could.

Much better than the alternative.

Sexy and not-so-sexy health care reform

Ron Brownstein has written a long and somewhat wonkish assessment of the health care reform bill currently being debated in the Senate. Long story short, the bill's chief purpose is to cut skyrocketing health care costs by moving the system away from a fee-for-service template and toward a fee-for-outcomes template.

Republicans outside elected office like the bill, but wish it had as many sticks as carrots to encourage better coordination of care among providers. And malpractice reform. But since Republicans have decided to not play ball with the White House and the Democratic majority, there's no one at the table lobbying for the latter.

Like a lot of liberals, I've tended to view the success or failure of the bill almost solely in terms of the survival of the public option, but the article points out that a state-sponsored insurance plan "would affect who writes the checks in the medical system, but not what the checks are written to pay for." It raises the question of the relationship between universal coverage and cost containment, and the priorities of the two.

Apparently, President Obama is rather smitten with the article, and Rahm Emanuel has made it required reading for the White House staff. 

Campaigning for universal coverage is sexy in that social justice kind of way. But the HCR bill detailed by Brownstein's article isn't a bit sexy. It's the government using its regulatory and reimbursement power to encourage a set of best practices that are designed to make health care less expensive and the nation's citizens healthier.

And that's OK. In fact, that's probably the best we can expect from people at the pinnacle of power in 21st century America.

It's the difference between Amos's passion and Joseph's prudence. So long as the prudent are seeking to achieve the aims of the passionate, we ought not denigrate reform just for lacking sex appeal.

Getting to yes on health care reform

Even though health care reform leaped yet another hurdle yesterday, I'm less buoyed than before. With Blanche Lincoln joining Joe Lieberman in threatening to filibuster a final bill that contains a public option, it seems like the prospects for a public option are now rather dim. And without a public option, will Congress wind up passing a bill that forces people to buy health insurance they can't afford? That's neither a policy nor an electoral winner.

Lincoln's is a frustrating case. One might hope that she's posturing, but apparently she spoke in such categorical terms that there's no way she could walk away from her threat without a loss of face. Even stranger, Lincoln's web page still shows her supporting a public option. I definitely expected more party discipline than this.

Then again, it may be that the last two elections are masking the real ideological balance of power in Congress. The Democrats built large majorities in Congress running against the Bush administration's manifold incompetence, but that doesn't necessarily mean that Congress or the nation as a whole has moved as far to the left as those numbers indicate. Under more normal circumstances, we might have watched Democrats negotiating with moderate Republicans to overhaul the health care system this year, but since there are no moderate Republicans left, Democrats are negotiating with Democrats. The result is starting to look like a centrist compromise, rather than the more progressive bill that 60 Democratic Senators could theoretically enact.

Then again, as Yglesias is so fond of pointing out, we wouldn't being having this discussion if the Senate ran according to majority rule, or, even better, if we didn't have a legislative body in which Wyoming, population 532,688, has the same representation as California, population 37,756,666. So we have the Founding Fathers to thank. Even now they are saving the Republic from the mob rule of the uninsured and the price gouged.

UPDATE: Here's Robert Reich on the slow withering of the public option.

Don't tread on me and all that yada yada

I watched some history made last night. No, not the Bama-LSU game, the House vote on health care reform. I did catch some of the football game too, but for sheer entertainment purposes, watching the House debate won hands down. My nine-year-old would watched a bit with me, and he could always identify the Republican members of Congress because they sounded so angry. In a sense I can't begrudge them anger. Having preached for 14 years I know what it's like to be condemned to making arguments that you are sure will fall on deaf ears.

What I can begrudge them are the sheer incoherence of their arguments:

"This is a government takeover of our health care system!"

• Um, no, it's not. If you have private insurance and you like it, you get to keep it.

"This plan cuts Medicare!"

• Well now, Medicare IS a takeover of the health care system, at least for Senior Citizens. If you're against "gubmunt run health care," then you shouldn't be fighting Medicare cuts. You should be fighting to kill Medicare.

"This plans FORCES you to buy health insurance whether you want it or not!"

• Pardon me if I don't pick up my pitchfork and march on Washington about this one. The government already forces me to buy auto insurance if I want to drive. My seminary forces me to buy health insurance as a condition of my enrollment. People should carry health insurance instead of parachuting into an ER when they get sick and letting me pick up the tab with higher premiums on my policy. It's a matter of personal responsibility. And if you can't afford it, you'll be subsidized, which is more efficient than the current system.

"This plan fosters government dependency. Why, I used to be a judge and I had to send away too many boys born to welfare queens who got paid by the gubmunt to have babies."

• Not a direct quote, but pretty close. Some Congressman from Texas. Please see the above comments about personal responsibility.

"We're going broke!"

• Ahem, the Congressional Budget Office estimates that the House bill will reduce the deficit over the next ten years.

"Pelosi bill, Pelosi bill, Pelosi bill!"

• Yes, some people don't like strong women from the Left Coast, but really, can't we do better than ad hominem attacks? Besides, the House-approved bill is a bi-partisan bill. That's right. One GOP lawmaker voted for it. Only one, but it counts.

I think that when all is said and done, the Republicans were opposed to this bill, not because it might fail, but because it might succeed. Tactically, they want to deny the President a legislative victory. Strategically, even if the government can solve problems, they don't want it to. You see this dynamic in spades with global warming. That kind of ideological rigidity gives birth to the kind of angry, non-sensical ranting we saw on the House floor yesterday. I have no use for it, nor do most people. It's taking longer than we thought, but the reform movement continues to jump every legislative hurdle. I remain confident that it'll happen, and years from now, everybody will wonder what all the pitchfork-brandishing was about.

Can kissing this bone clear my blocked duct, or should I try the sage again?

We kicked off our Medieval Christianity class with Peter Brown's The Cult of the Saints. A classmate who moonlights as a humanities teacher at a parochial high school said he appreciated the book because Brown rather forcefully pushes back against the CWthat the transition from Patristic to Medieval Christianity basically amounts to a re-paganization of the Church. That's the point of view he sees articulated in a lot of western civ textbooks.

Brown's argument, in short, is that both Jews and pagans regarded cemeteries as places of cultic pollution, and viewed with askance the Christian move to build churches over the graves of the martyrs. When Christianity moved into the Roman and post-Roman countryside, they erected shrines as monuments to the saints out there too. It wasn't so much the Church shrewdly co-opting the pagan pantheon--the goddess Brigit morphing into the nun who founded the Church at Kildaire, for example. It was instead the triumph of a Christianized urban patronage system over a rural healthcare system based on herbal remedies and magic. The sick in the countryside were convinced/compelled to seek healing from the martyred saint's relics at the shrine in the way that pagan urban Romans once sought relief from their patrons at the Forum. (The bishop here acts as the saint's authorized representative).

So, yea! No pagan-Christian syncretism! And Boo on all those Protestant historiographies that say as much about everything that happened between 325 and 1519.

But the problem with what did happen-assuming Brown's argument is correct--is that Christians engaged in an act of gross cultural imperialism as they evangelized the rural West. In terms of healing, it was probably a wash. The placebo effect from seeking a cure from an especially efficacious relic was probably as good as the trial by error herbal remedies rural Celts and Gallo-Romans had arrived at. But why not investigate whether or not the roots and herbs had any healing power apart from the incantations said over them, and run with it? Alas, it was an age of scientific and technological stasis.

Long story short: Christianity obviously changed a whole lot between, say, Irenaeus (3rd century) and Gregory the Great (7th century), and there's a bit fight in the scholarly community as to whether the Church conceded too much (see Russell's The Germanization of Early Medieval Christianity) or too little (see any neo-pagan revisionist European history or any of the laments that Celtic Christianity got squashed by the Roman bureacracy) as it ensconced itself among the barbarians invaders and the rural populace.

It's a fun period to study because Christianity always has to sail between Scylla of syncretism and the Charybdis of imperialism in its missionary journey, and you get these issues in spades in the late antique-early medieval period.

You can do lots of stuff with a rope

Time will tell if Barack Obama's health care speech is a game-changer, but it sure felt like one. Obama explained a very complicated piece of legislation in terms everyone can understand, powerfully refuted the lies circulating about the proposal, and closed by effectively showing how health care reform is the embodiment of the nation's highest ideals. It didn't hurt that GOP Representative Joe Wilson "showed his butt" as we say down here. Once again, Obama looks thoughtful and sober not only because he is, but because the opposition by contrast can't help but present as stark raving mad.

Obama's been on the national stage for a while now. It's safe to say a pattern's emerging. It's almost as if he hands over the mic to his opponents--yields the floor entirely--only to return more powerful than ever.

There was that time in the primaries where, between Jeremiah Wright and Hillary Clinton dominating the airwaves, no one could get a good word in edgewise about Obama. Then he gave that masterful speech on race which sympathetically outlined but ultimately refuted Wright's brand of racial politics--and Obama was back on top.

Same thing last fall. Sarah Palin's slutty stewardess look and red meat speech had the GOP convention as excited as the Gentleman's Club at last call. Obama's numbers were down, and Democrats were wondering when he was going to knock this nonsense down. But come October, and the debates, Obama was looking much smarter than Palin and much steadier than the erratic and angry John McCain.

Ditto the GOP hissy fit about the stimulus. Obama got the bill he largely wanted.

And now, after a month of GOP sound and fury, the President has recaptured the momentum on health care reform. There's a long way to go, but I think that Obama and his congressional allies took an essential step forward last night. 

You could call this rope-a-dope. Obama lets the opposition wear themselves out taking their best shots at him. When there's no gas left in their tank, Obama gets off the rope and goes to work. That's the political strategy of a man who's supremely confident in his own abilities.

You could also call this giving the opposition enough rope to hang themselves. That's the strategy of a man who's taken the measure of the other side, and knows them better than they know themselves.

Decline and fall II

Cantor cites other reasons why Rome "fell." In a time of economic decline, localism reigned, and Romans everywhere resented the central government's increasing demands and increasing inability to deliver basic services. "Rome" was not an entity that many Romans were wholly committed to, and some hard-pressed aristocrats welcomed the Germans because they thought they'd cut their taxes!

But they deserved to be hard-pressed. Drawing a comparison to high Mandarin Chinese culture in the first millenium A.D., Cantor speculates that Roman aristocrats had become so culturally ossified, that they couldn't and wouldn't look for technological or economic solutions to a changing world. All they knew was how to live off slave labor and read Cicero--because reading Cicero helped you win lawsuits!

Failing to effectively manage the inevitable migration of people from south to north certainly poses problems. The greater danger, however, is a refusal to adapt to a changing world. The world is getting hotter. New diseases are constantly appearing. The population is growing and aging. The global flight of a deadly new flu, or the forced evacuation of tens of millions of people from low-lying coastal areas make our current illegal immigration problem look like small beer indeed. These problems need to recognized as such, as real problems, and we need new technology, new forms of community, and ways of defining and generating economic development to deal with these problems.

We also need a new commitment to the common good. The culture of cars, cul-de-sacs, and starving the beast is ill-equipped to deal with pandemics or a changing climate. And the public sector needs to demonstrate an ability to provide a good return on what the public invests with it

Git-r-done

Since the Senate has stripped public funding for end-of-life consultations in the health care reform bill, I must admit that I was a bit over-optimistic when I wrote this last week. Don't know if I was overly optimistic about our Senators' political courage or the capacity of the general American public not to be bamboozled, but there it is.

Nevertheless...

I remain optimistic that we will pass genuine health care reform this year, owing to Obama being squeezed by both the left and the right. His poll numbers have dropped, but especially among Democrats, who, like me, must be confused and frustrated that we keep getting emails from the White House saying, "Call your Senator and tell them how much love you have for public insurance," only to be cut off at the knees by the HHS Secretary who told the press that a public option wasn't an essential part of the plan.

On the other side, Republican intransigence is proving that Democrats, to paraphrase the Israeli right, "don't have a partner for peace" on the other side of the aisle. Paul Krugman reminds us here that Obama's public option is itself a compromise for liberals, who'd rather see Medicare for all than a public/private mix of insurance plans. But that was going nowhere with Republicans. So Senator Conrad proposed co-ops instead of a public option to get a few Republicans on board. It's not as efficient a way to achieve universal coverage, although it might get us there eventually, just as co-ops electrified the countryside in the 1950s, but now GOP Senators are saying that co-ops are a public plan by another name.

See? You take a step toward them, and they just as quick step away from you.

I'm reminded of a conflict management seminar I did years ago in which the facilitator, drawing on the somewhat famous Cottonburger video, argued that there's two kinds of people: cooperative and aggressive. The former believe in win-win situations, while the latter don't. When a cooperative person comes up against aggression, he/she usually tries to overcome it with more cooperation. The aggressive person interprets this olive branch as weakness and adopts an even more hostile position, and on it goes until the cooperative person is vanquished, or negotiations break down. Cooperative people, said the facilitator, need to learn to gently yet firmly push back at the first sign of aggression if they want to get anything accomplished.

It's become clear that there's no possibility of bi-partisan health care reform because the Republicans have no interest or inclination in seeing any bill pass this year. So rather than continue down the path of fruitless concessions to the opposition, concessions which also alienate his base, Obama just needs to tell the truth and move ahead: Republicans don't want to work with us; they have lied about this bill's intentions, so we will pass our own bill, which will kill two birds with one stone: control costs and increase coverage.

Long story short: co-ops turn off Republicans and Democrats. A public option is the only option left.

Another long story short: Democrats control the House, Senate and the White House. They can reform health care if they want to. If they fail, it's a leadership failure. Obama won the Democratic nomination by the skin of his teeth. If he can't deliver the goods with these numbers and this pent up level of interest, he ought to look over his shoulder. A primary challenge wouldn't be out of the question.