This is my first post to the C&L community. Since my book on the future of the American labor movement (A New New Deal: How Regional Activism Will Reshape the American Labor Movement) came out a few months ago, an important new case study developed that is worth examining. I wanted to use this as an opportunity to share my perspective on political lessons that we can take away from the health care debate. I arrive at the following conclusion: unless progressives change how we do politics, we will never get what we want from Washington.

As Congress prepares to pass health care reform (now that the Senate passed its bill today), most talk among progressives centers on whether we should be satisfied with a piece of legislation that has been diminished and compromised. But regardless of what we make of the final agreement, the real lesson from the health care debate is a political one: Unless we change how we do politics, we will never get what we want from Washington.

It is not insignificant that 35 million Americans will be receiving something more than they had before in terms of health care. Yet even with a progressive president and a supermajority in the Senate’s Democratic caucus, we are left to quibble over piecemeal legislative victories, passed only with huge concessions to corporate interests.

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I've been writing for weeks that the House needs to step up and improve the Senate health care bill in conference. They are co-equal branches and when a bill is to be merged, there are usually compromises made. Sen. Conrad screamed out on FNS and said that if the House tinkers with their precious bill, it won't pass.

CONRAD: It is very clear that the bill, the final bill, to pass in the United States Senate is going to be -- have to be very close to the bill that has been negotiated here. Otherwise you will not get 60 votes in the United States Senate.

My sources on the Hill have told me that Nancy Pelosi doesn't have the votes from progressives to pass the Senate bill as it stands. I know the White House doesn't want to play hardball now, but we do. What will Lieberman say if they do make changes to strengthen the bill? Will he be the man that killed health care reform to Americans?

mcjoan had an article posted yesterday that said the progressives appeared to be caving.

It's beginning to look like the House is going to cave into Lieberman and Nelson, too. TPMDC And co-chair of the Progressive Caucus Raul Grijalva seals it.

In the interview, Grijalva confirmed that House Dems were beginning to discuss the idea of revising the Senate bill in conference to move up the implementation date for insurance coverage and make it more in line with the earlier date in the House bill. I asked Grijalva if he could support the bill if such a change were made, even if it lacked a public option or other similar concessions sought by liberals. "It would sweeten it somewhat," Grijalva said, "if they speed up the coverage mechanism."

He added: "That would be something I’d have to look at very closely."

Asked if he was suggesting that he’s open to supporting such an outcome, Grijalva answered in the affirmative, but insisted that he would have to evaluate the changes in conference before making any decision. He said House liberals would continue to push for a public component and a repeal of the anti-trust exemption for insurance companies. And he demanded that conference negotiations not merely "rubber stamp" the Senate Bill.

Moving up implementation dates would help, and that appears to be a House leadership might use as a "key arguing point" in the upcoming conference.

But today a new Politico piece paints somewhat different picture: House Dems: We won't roll over

House Democrats insisted Tuesday they have no plans to roll over for the Senate in upcoming negotiations on a health reform bill, even as they acknowledged it would be all but impossible to reinsert a public insurance option or force the so-called millionaire's tax on the Senate.

Either move would disrupt Senate Majority Leader Harry Reid’s no-margin-for-error 60-vote majority. But House Speaker Nancy Pelosi and her leadership team seem to have their sights set on lower-profile - but no-less important differences, like boosting affordability credits in the final bill and starting the insurance exchange a year earlier, which they did in the House.

Members will return the next week, and aides said they would still like to pass a bill by the State of the Union at the end of January or the beginning of February. But leadership staff in the House said that that doesn't mean they're prepared to just accept the Senate bill. {..}

"We want to move a bill by the State of the Union, but we want to do it because we're ready, not because we have to," an aide said.
Here are a few key points that can be fixed in conference, but please add your own...read on

Again, I've been writing that the House needs to stand up and be counted and they seem to be listening to our calls not to roll over for the Senate. I've contacted several members of the House for comment and will get back to you soon on that.

There's plenty of info on-line that explains what's wrong with the Senate bill, but here's a few key points. Add to the list in the comments.

* National exchange (rather than state exchanges)
* Public option
* Repeal anti-trust exemption
* Wealthy surtax, rather than middle-class insurance tax
* Better affordability provisions in House bill, including level of subsidies and Medicaid to 150% poverty.
* Repeal Stupak language.

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Glenn Beck hosted one of his hourlong sessions before a studio audience talking about the role of heroes in American life. The consensus, both by Beck and his panelists, was that Americans no longer look up to their historic heroes the way they should. Instead, as Beck suggested, we have "Mao Tse Tung hanging in our White House."

Say again? Oh yeah -- the Obama administration is riddled with radical Marxist revolutionaries. Right. Tell that to progressives right now. Moron.

Anyway, Beck apparently draws the line when it comes to the possibility, heaven forfend, Obama might be regarded as a hero:

Beck: I'm a big visual guy. And if you look at the way Barack Obama was imaged -- he was, as a savior. He was, as a -- you look at it now, anybody notice -- you watch the newspaper, and you watch the photos of him coming out of the White House, almost always, they'll have a shot of him with the seal of the President -- you notice that? And it almost looks like a halo. They'll take a shot from the side, and he's standing there, and it looks like a Russian icon!

He's talking about the photos of the president that have been shot for some time now whenever there's a press appearance at the White House. And it didn't start with Obama:

Indeed, if we're suddenly all worried about presidents being made out to be heroes, you have to wonder where Beck was when W. strutted out to his "Mission Accomplished" photo-op:

Now that's what I call an action hero.

Fortunately, Obama has spared us any codpiece appearances.

The progressive  "journo/blogospere" is sharply split over the Senate health bill.  Some, like Jane Hamsher and Matt Taibbi, are saying "kill it."  Others, like Paul Krugman, Ezra Klein, and Jonathan Cohn, are saying "pass it" - as is.  Steve Benen says " it's worth appreciating the vibrancy, energy, and seriousness with which progressives are engaging in the debate." 

I say maybe - but there's been a lot of condescension and hostility, too.  And what bothers me even more is the tendency of some bloggers - good people, people who are seen not only as advocates but as as information gatherers on health policy- to ignore data that undercuts their position while pushing a false political choice.  I'm not saying their decisions are deliberate,  and I assume they're not.  But it's disappointing, and it's worth discussing. 

It's difficult for me to name names, since I respect their work a lot, but I'm talking about people like Jonathan Cohn, David Leonhardt of the New York Times, and Ezra Klein (who has been very friendly and helpful to me since the beginning.)  Since I know they're people of good will, I can't help wondering if the polarized nature of this debate has something to do with what's been going on.

I've been working on a campaign to resist the excise tax, which I have long thought was based on flawed logic and would turn out to be counterproductive both as politics and policy.  (Let the first part of that statement - "I've been working on a campaign" - serve as a disclaimer and full disclosure regarding what follows.)  Both Klein and Leonhardt have written admiringly about the tax's ability to "bend the cost curve," but a broad range of studies have been released that challenge that assumption, whole polls have shown that its likely to be highly unpopular politically. 

These are not unscientific, flaky studies.  Two papers were published in the highly respected journal Health Affairs.  These are studies from respected firms that seem to overturn the conventional economic wisdom behind the excise tax.  Citizens for Tax Justice has reviewed data from the Joint Committee on Taxation (pdf) and drawn negative conclusions about the tax. Other studies by top benefits consulting firms like Martin E. Segal, Watson Wyatt, Mercer, Towers-Perrin, and Hewitt (whose livelihood depends on a corporate clientele)  challenge the arguments made in support of the tax, while polling from a well-regarded firm suggested the tax would have a devastating political impact in front-line states.  So how much have Klein, Leonhardt, or Cohn written about all of this new and revelatory information?

As far as I can tell, not a word.

The silence bothers me more than disagreement ever could.  These guys are viewed as experts in health policy and as gateways and interpreters of the latest research.  Sure, they've come out foursquare for accepting the Senate bill, but does that really excuse the silence?  Maybe they're too busy to write about these reports.  Maybe they haven't seen them (although I sent a few links to one of them.)  Maybe - and I hope this isn't true - they're so concerned about ensuring that a bill passes that they'd rather not muddy the waters with new data that undercuts that position.

Or maybe I'm out of line.  Maybe people don't see them as reliable sources for all the new health policy info.  Perhaps they're perceived as strong advocates for a certain position, with no newsgathering brief.  If so, I apologize - sincerely.  But, if I'm right, they really need to address these studies.  They can argue that they're methodologically flawed , or that they're inconclusive, or that it's too late to change anything now.  But ignore them?  That's disturbing.

"Gah," writes Paul Krugman, who also presses for passing the Senate bill.  "I see that some people are still using the Rasmussen polling on MA’s health care reform. You shouldn’t do that ..."  I'm one of those who has used those polls - but I've written about and linked to his critique, which includes another poll he likes better.  That's what we should all be doing if we want to have a serious debate.  (Now, as it turns out, I don't interpret the poll data the same way he does - but I'm acknowledging its existence, responding, and letting people decide for themselves.)

I identify with Prof. Krugman's frustration, though.  Gah, why are people still saying the excise tax "bends the curve"?

There's a basic structural flaw in the Klein/Cohn/Krugman position, too:  that it's either this health bill or nothing.  I believe that's a false choice.  Opponents of the Senate draft don't all believe that no reform is better than this bill.  But they should act as if they do.  Once you say the Senate bill is good enough, the negotiations with the left are over.  

The Senate health bill has been improved in some areas, including strengthening the Medicare cost containment commission and - most critically - once again lifting lifetime caps on coverage.  Like McJoan, I believe that's a direct result of the outcry on the left.  Fear of a progressive backlash has already improved this bill, and it may continue to do so - if we don't back down too soon.  In a very practical sense the Deans, Hamshers, and Taibbis are accomplishing more than any other progressives to get a better bill.

There are many people who disagree vehemently with that statement.  By all means, let's keep talking about it.  But let's do so openly, with all the information at our disposal, and without either hostility or manipulation.  I'm not out to antagonize anyone here.  I'd really like to see debate that's based on data and grounded in strategy - and not in false choices.

The news in the last few days has continued the drumbeat of demoralizing events which started in the Bush administration, and with only a few hiccups has continued through the Obama administration. It is clear that Obama is, fundamentally, Bush's 3rd term.

First we have the health care "reform" debacle, where it has been confirmed that the White House pushed Harry Reid to accept Lieberman's ultimatum, not go to reconciliation. There will be no public option in the Senate bill. There will be no Medicare expansion. There will be no cap on yearly limits. What there will be is a mandate forcing people to buy insurance, some subsidies which can still leave people spending money they can't afford, and guaranteed issue of lousy plans (Plans where only 70% of the premiums have to be spent on care, for example.) Unless progressive Senators are willing to filibuster, or House progressives are willing to vote against en-masse, something very close to the Senate plan is what will pass, because as I noted some time ago, the White House's bottom line is that something, anything must pass, and conservative Dems are willing to kill the bill to make sure it doesn't actually threaten health industry profits in any way, shape, or form. (Thus why drug importation, which would cost Pharma money, will be made illegal.)

All of this was completely predictable. Furthermore the weakness of progressive and liberal legislators, is largely to blame:

Obama and the Democratic leadership's bottom line is they must pass some bill called "health care reform". Unless you threaten to take away their bottom line, they will take away anything that isn't progressives bottom line

This is Negotiation 101, and progressive legislators either don't understand it, or are spineless. As a result they, and Americans, have been rolled yet again. What is depressing about this is that it should be a surprise to no one, but apparently has surprised many.

It is also noteworthy that spending billions on turning brown people into a fine red mist (a.k.a. the Afghan war) is acceptable, but health care (a.k.a. saving actual American lives) is something which can't cost money. What an interesting--and clearly evil--set of priorities that reveals. I guarantee that real healthcare reform would save more American lives than the entire war on terror—assuming said "war" hasn't cost more American lives than it's saved, which is almost certainly the case.

Next we have what Glenn Greenwald is calling the creation of Gitmo North, in which people whom the government judges there is not enough evidence to convict, will be held indefinitely without trial. This is the very definition of tyranny. Any nation which does this is a nation of men, not laws. America has forsaken its fundamental premise and proved its degradation. Yes, this started under Bush, but as Obama embraces this, it because a bipartisan project and the new elite consensus. This is now something which has been confirmed as US policy which is extremely unlikely to change no matter who is in power.

Then we have bankers are giving themselves bonuses larger than the entire economy's GDP growth this year.

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Nate Silver has written a piece called "Why Progressives Are Batshit Crazy To Oppose the Senate Bill."  He says we need to stop being "polite" (who's polite these days?) and start being "real."  In the spirit of impoliteness and reality (realness?), he offers some numbers in order to argue that the Left is nuts not to embrace the Senate health reform bill.

In that same "no-politeness" spirit, here's my response:  Garbage in, garbage out.  Is that "real" enough for ya?   Progressives - and everyone else, for that matter - should keep fighting.

Silver's heart may be in the right place, and his math is right, but many of his assumptions are flat-out wrong.  More importantly, he fails to place his work in the proper human and political context.  It's like this:  You can build the best model in the world for predicting the outcome of hockey games.  But if you knew that sometime during the third period Rahm Emanuel was going to drive out on the ice in a Zamboni and flatten your team's entire defense, wouldn't that change your model a little?  And if you knew half the hockey players would wind up bleeding and broken ... (Oh, wait - they do. Bad example.)

Progressives would be insane to do as Silver suggests.  He tells us that "a picture's worth a thousand words"  (and then gives us 1,795 words - but who's counting).  Let's review both his analysis and his conclusions.   

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Raw Story: 135,000 uninsured Americans will die before health reform takes effect, analysis finds. Some useless Dems will declare ‘victory’ but Dean says “kill it.”

Consortiumblog:: How banks fleece the unemployed

The Agonist: Hoyer: Bring back Glass-Steagall

Balloon Juice: Somebody hose off Vitter

Climate Progress: Gore derangement syndrome

James Wolcott is deadly...

That is the number of times suspected terrorists, those on actual watch lists, successfully bought guns or explosives in the good ole US of A over the past five years. Why? Because of the Terror Gap. That is the space in our law created by right wingers with celery-stalks-for-brain-stems, bed-wetting Blue Dogs, and neglectful progressives that allows those on watch lists to pass background checks when purchasing weaponry that kills. You can't get on a plane--but you can buy a freakin' explosive.

Even Rahm agrees! (or at least he did):

Remember, conservatives are in a corner shivering over the prospect of KSM being tried in New York, but if a member of Al Qaeda buys a cache of guns the FBI won't know about it and the any background information given when purchasing said weapons is destroyed faster than you can say Nidal Malik Hasan or Eric Rudolph. Now that seems just downright crafty!

Learn more about how you can close the Terror Gap, so that our laws to protect the homeland make just a modicum of sense.

Full Disclosure: I happily advise Mayors Against Illegal Guns

Nate Silver on why we shouldn't celebrate just yet:

Needless to say, it would have been very, very bad news for the Democrats if the motion to proceed to debate on their health care plan had failed tonight. But I'm not sure how newsworthy this really is. The potential hold-outs, like Lincoln and Ben Nelson, are going to have much greater leverage later on, when the bill nears its second major procedural hurdle: the cloture motion to proceed to the final vote.

And there's some bad news for Democrats too: Lincoln has joined Senators Ben Nelson and Joe Lieberman in making a fairly explicit threat to filibuster a bill that contains a public option. Mary Landrieu, on the other hand, sounds a little bit more open to compromise. But this impromptu Gang of 3 -- Lincoln, Nelson, Lieberman -- could be a tough one for progressives to penetrate.

Yeah, it's going to be ugly by the time they get done dealing away any real hope of competition for the insurance companies. I'm not optimistic about the short-term results here and I have to keep muttering to myself that this will be good for our children and grandchildren - probably.

Media Matters points out how conservative commentators such as Rush Limbaugh, Glenn Beck, and Michael Savage like to use rape metaphors when discussing progressives or progressive policies.

Right-wing media are very quick to claim progressives are "raping" Americans:

Beck: "People in New York, you're being raped by your government -- raped." On his November 19 radio show, Beck stated:

BECK: When the people lead, the leaders will follow. And we're building life boats, because, right now, you know it to be true -- and I'm hearing it in New York. People in New York, you're being raped by your government -- raped. California, how are you doing it, man? They just took an extra 10 percent withholdings from you, as a forced noninterest loan. Get the hell off my land. My gosh, how are you doing it?

Well, I'm seeing it in New York. People are just starting to see now what has been done to them in the last six months here in New York. And they're starting to look at it and say, "Whoa, whoa, whoa, wait a minute. What the hell -- look at how all of this is adding up?" Well, that's what's going to happen as a collective in this country. I don't how long it's gonna take. It may take three months, six months, a year -- I can't imagine.

Beck: "We're the young girl saying 'No, no, help me,' and the government is Roman Polanski." Discussing health care reform on the November 16 edition of his Fox News program, Beck stated:

BECK: America has spoken clearly, consistently. We don't want this. And for the first time in history, we don't think it's the government's place to give it to us. ... We are -- excuse this analogy, but I feel like it's true -- we're the young girl saying "No, no, help me," and the government is Roman Polanski. In the end, I think we're all going to be cowering in France.

Beck: Health care reform is "good old socialism ... raping the pocketbooks of the rich to give to the poor." On his July 21 Fox News program, Beck stated:

BECK: President Obama has his massive $1.5 trillion health care plan. It's hogging up the news cycle. The Republicans and, you know, a lot of people are starting to say, "Isn't this socialist, here? I mea, this is pretty crazy." The answer to me on that one is really easy: Yep, it's good old socialism -- you know, pretty much raping the pocketbooks of the rich to give to the poor. I think that's socialism.

Limbaugh: Obama ordered his "pay czar" to "rape" bailed out executives. On his October 22 broadcast, talking about Kenneth Feinberg, who was appointed to oversee executive compensation at financial firms that were still holding funds authorized under the Troubled Asset Relief Program, Limbaugh stated:

LIMBAUGH: I think everything about this story, this "pay czar," is blockbuster. It is -- I mean, it's late-night comedy gold. Everything about the story is a lie. ... Every detail about this story has to be a lie. I refuse to believe that Obama didn't know what Feinberg was doing. In fact, the truth probably is Feinberg's following orders. Feinberg is following orders and I guaran-damn-tee you Obama said: "You get up there and you rape 'em. And you make 'em poor. And you make 'em pay. And you let 'em know. Just don't tell 'em that I knew anything about it."

Limbaugh: "Get ready to get gang-raped again, folks." Discussing health care reform on his June 29 broadcast, Limbaugh stated:

LIMBAUGH: Well, isn't this good? Get ready to get gang-raped again, folks. House Speaker Nancy Pelosi says she will not give the public a week to review the final text of a health care reform bill before it's voted on later this year. And Harry Reid has also declined to commit to giving the public a week to read and consider the final health care bill, despite Obama promising that all legislation would be up for five days on one of his stupid websites where everybody could read it.

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Darcy Burner, the leader of the Progressive Caucus Policy Foundation says that if the Stupak amendment passes, progressives should vote down the health care bill in the House.

Burner: It means that women who find they have cancer while they are pregnant won't get the choice of how to proceed, but those choices will instead be made by politicians in Washington, DC whose lives aren't the ones who are being destroyed. The idea that we would throw women under the bus in the process of doing health care reform is completely unacceptable.

Now the word I'm hearing is that the Senate is more progressive than the House on this issue and the belief is that it will come back from the conference committee without the Stupak amendment included.

If the bill that comes back from conference does have the Stupak amendment, then organizing will be huge.

I'm always happy to see the progressives step up and demand what they want - you know, instead of falling into the fetal position. Greg Sargent from The Plumline:

At a private meeting at the White House yesterday, top House liberals urged President Obama to more aggressively throw his weight into a public campaign on behalf of the public option, a leading House progressive said in an interview.

Dem Rep. Raul Grijalva, the co-chair of the Congressional Progressive Caucus, says that this point was made “emphatically” to the president in the meeting yesterday with House liberals, and that his help was urgently needed in bringing centrist Dems on board.

“We need the full engagement of everybody in this discussion — that includes the White House,” Grijalva said in characterizing the message that was delivered to the president. Grijalva described the meeting in an interview with Democracy Now.

Dems have largely refrained from making such a blunt case publicly, not wanting to appear critical of the president. But Grijalva appears to have no qualms about making it.

“We really do feel that engagement from the leader of this nation is vital if we’re going to end up with anything that approaches a robust public option,” Grijalva said.

Strong stuff. I’ve asked Grijalva’s office what the president’s response was, and will update you if I learn more.

Ah, the audacity of playing it safe! Obama clearly doesn't understand how positively this will affect people's lives, or he wouldn't be so lukewarm. The public option is polling well everywhere - including those conservative districts.

In fact, just about the only group not strongly supportive are the big contributors:

President Barack Obama is actively discouraging Senate Democrats in their effort to include a public insurance option with a state opt-out clause as part of health care reform. In its place, say multiple Democratic sources, Obama has indicated a preference for an alternative policy, favored by the insurance industry, which would see a public plan "triggered" into effect in the future by a failure of the industry to meet certain benchmarks.

The administration retreat runs counter to the letter and the spirit of Obama's presidential campaign. The man who ran on the "Audacity of Hope" has now taken a more conservative stand than Senate Majority Leader Harry Reid (D-Nev.), leaving progressives with a mix of confusion and outrage. Democratic leaders on Capitol Hill have battled conservatives in their own party in an effort to get the 60 votes needed to overcome a filibuster. Now tantalizingly close, they are calling for Obama to step up.

"The leadership understands that pushing for a public option is a somewhat risky strategy, but we may be within striking distance. A signal from the president could be enough to put us over the top," said one Senate Democratic leadership aide. Such pleading is exceedingly rare on Capitol Hill and comes only after Senate leaders exhausted every effort to encourage Obama to engage.

"Everybody knows we're close enough that these guys could be rolled. They just don't want to do it because it makes the politics harder," said a senior Democratic source, saying that Obama is worried about the political fate of Blue Dogs and conservative Senate Democrats if the bill isn't seen as bipartisan. "These last couple folks, they could get them if Obama leaned on them."

But with fundamental reform of the health care system in plain sight for the first time in half a century, the president appears to be siding with those who see the Senate and its entrenched culture as too resistant to change. Administration officials say that Obama's preference for the trigger, which is backed by Maine Republican Sen. Olympia Snowe, is founded in a fear that Reid's public option couldn't get the 60 votes needed to overcome a GOP filibuster. More specifically, aides fear that a handful of conservative Democrats will not support a bill unless it has at least one Republican member's support.

Getting the public option in the Senate bill makes it that much more likely that we'll be able to get it through conference, and not through the reconciliation process.

TPM reports that Reid is close to pulling off senatorial support for the public option - and the White House wants Olympia Snowe's trigger option instead.

In other words, the White House wants the plan that won't work, so they can claim it's a bipartisan plan. Or is it that the administration wants a plan that won't really work, and they're using bipartisanship as a cover? Just asking the obvious question, here:

Multiple sources tell TPMDC that Senate Majority Leader Harry Reid is very close to rounding up 60 members in support of a public option with an opt out clause, and are continuing to push skeptical members. But they also say that the White House is pushing back against the idea, in a bid to retain the support of Sen. Olympia Snowe (R-ME).

"They're skeptical of opt out and are generally deferential to the Snowe strategy that involves the trigger," said one source close to negotiations between the Senate and the White House. "They're certainly not calming moderate's concerns on opt-out."

This new development, which casts the White House as an opponent of all but the most watered down form of public option, is likely to yield backlash from progressives, especially those in the House who have been pushing for a more maximal version of reform.

It also suggests for perhaps the first time that the White House's supposed hands off approach that ostensibly allowed the two chambers in Congress to craft their own bill has been discarded.

High level White House officials have floated the trigger idea a number of times, and it seems they continue to do so, even at this, crucial stage of the health care reform process, when their involvement is greatest. That has senators who support the public option concerned.

UPDATE: Big Tent Democrat has another take. So does Nate Silver.

C&L is honored to have proud progressives Congressman Joe Sestak of Pennsylvania, and 2006 Democratic nominee for US Senate from Connecticut Ned Lamont, joining us for a live chat at 3 pm Pacific / 6 pm Eastern. The conversation will be wide-ranging, from health care and the economy to the upcoming 2010 mid-term elections. Ned Lamont endorsed Joe Sestak in the Pennsylvania Senate race earlier today.

Everyone is invited; if you haven't registered as a commenter here you will need to do that at this link in order to participate.