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December 15, 2009

Health Insurance Reform

So, there's been quite a bit of drama with Health Insurance Reform this week. This was the week where Reid thought he had a breakthrough with Medicare Reform, but today was the day when Lieberman insisted he'd filibuster it. In return, it appears that Rahm told Reid to give Lieberman whatever he wanted, which means we are probably going to have the Senate pass a bill that doesn't have a public option or a medicare expansion.

It's worth reviewing what has happened up to this point, and who the big winners and losers are, if things go forward from this point.

Winner: Sick people. We've still got a huge expansion of Medicaid going on here. This is huge addition of people to public insurance - bigger than the public option or the medicare expansion ever would have been by itself. We've got the end of rescission, and the end of pre-existing condition exclusions. We've got improved out-of-pocket maximum rules. And the mandates don't matter to them, because the sick people are going to be glad they have insurance.

Winner: Health Insurance companies. They don't have to risk being put out of business by a public plan marketed towards people with money. And, the mandates mean more people will get on their plans.

Winner: Congressional moderates. They've expressed their power and have really split the difference between Progressives and Republicans.

Loser: Republicans. Progressives might howl that Republicans are winning here, but really - they have to deal with a massive expansion of health care that people will feel they have a right to, given to them by the Democrats. And them getting an expansion will be contagious, and they'll feel like they can get more.

Winner: Pragmatic Progressives. See Republicans, above.

Loser: Harry Reid. Maybe there's something I don't know, but we have the spectacle here of Reid getting embarrassed by both Lieberman on one side, and the White House on the other, in agreement and ganging up on him. Meanwhile, progressives are blaming him for not getting the job done, probably unfairly. What Reid seems most guilty of is getting too clever for his own good. By putting the public option and then Medicare in the bill, a lot of his own decisions get gutted and pulled out, embarrassing him and making him look ineffectual. And now, if the bill ends up better than what is in the Senate bill, it is likely it will seem to be in spite of him rather than because of him. I still may not be seeing this clearly, though - his role has done more to expose Lieberman's cynicism than anything else, and there may be advantages in that.

Loser: Daily Kos and the netroots. What a bunch of idiots the daily kos community has become. My own political attitudes have remained largely static over the last few years, but my reading habits have changed a lot. The only places I can go to get any of those "yes, finally someone said it!" relief feelings are Paul Krugman, Ezra Klein, Matt Yglesias, Brad DeLong, and others. I used to get that with Daily Kos - particularly back in the days when several smart Daily Kos columnists were explaining the ins and outs of GWB's Social Security cons - but no longer.

Even Markos - a more pragmatic citizen - is getting sucked in to the mentality. He's off on his twitter feed railing against the bill, saying it's a "bloody abortion" that should be pulled entirely. Ezra Klein makes the point that even as is, the bill will still save over 150,000 lives over ten years. End 150,000 lives because you're not getting what you want politically? What have these progressives become? What is really the bottom line here? What is really more important than saving lives?

Daily Kos and other parts of the netroots have been off on the wrong foot here since the beginning of the Health Care debate. The netroots are great for passion, and mobilizing for things like elections. Causes that require energy, but not a whole lot of logic and deep policy knowledge. But the netroots suck eggs at this kind of thing. What happens is that you get a collection of people with their own petty collection of non-negotiables, people with a talent for rabble-rousing that has no relationship with their ability to deeply understand policy, and they set the terms of war. What follows is a long pattern - large groups of people reinforce to each other that they have power, power they really don't have. They then fail, and then there is a lot of anger, bargaining, and finally a greater sense of bitterness, disengagement, and cynicism. They don't leave the community, they just dial up the snark and tear each other down. I think it's possible that as powerful a platform as the internet was for an out-of-power progressive netroots, it may be just as powerful at creating cynicism and bitterness while the Democrats are in power. At least, unless a major platform change occurs.

What the netroots need to accept is that just because we may have the power to affect elections, it doesn't mean that we have a proportional ability to affect policy. It's not our skill set. Our skill set is in numbers, and in money. Not in our ability to come up with stunning insights about policy, not yet. Any congressional staff can run circles around us. All we can hope to do is positively affect an election cycle, and then see how the results turn out legislatively. If they're not ideal, then all we can do is positively affect the next election cycle, and so on. Maybe someday an open netroots community will pop up that will be able to analyze bills correctly, and lobby, and even write new bills, but we're not even close to that point yet - and it'll take longer if people start sitting out elections just because they didn't get everything they wanted after one year.

You'll notice there's one small player in this drama that I haven't judged: Obama. The man is so far above the fray that it's impossible to judge him until the bill is on his desk. Will he get the credit for a massive positive change in health insurance reform? Or, on balance, will he look weak for not being able to offer a public plan to more segments of the population? I think this will basically come down to messaging and posturing in the late stages, and that is still to be played out.

Posted by tunesmith at December 15, 2009 01:20 AM

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