The Left's Fatal Abstraction Critics Of Health Reform On Obama's Left
Have Largely Focused On Symbolic Issuesby Ronald Brownstein
National Journal Magazine - Thursday, Dec. 24, 2009
"But the idea that Democrats should just press restart
after the grueling struggle to reach this point carries
an air of fatal abstraction: If health reform fails now,
the next chance for big change probably wouldn't come
for years, if not decades."
With the Senate's passage Thursday morning of sweeping health
care reform, President Obama took another giant step toward the biggest
legislative achievement for any Democratic president since Lyndon
Johnson muscled Medicare into law in 1965.
Comprehensive health care reform has defeated every president who has
pursued it, from Franklin Roosevelt to Bill Clinton. But, even with some
hurdles remaining, Obama is now on track to sign legislation early next
year moving the U.S. toward universal coverage.
Though the bill bears all the scars and imperfections of its arduous
advance, it's likely to stand as the signal domestic accomplishment of
his presidency, even if he serves two terms.
And so, naturally, the reaction of the most visible component of the
Democratic base has been to link arms with congressional Republicans and
the conservative grassroots to insist that the bill be killed.
Even as conservatives denounce the bill as an ominous extension of
government's reach, leading lights of the Internet-based digital left
like Howard Dean, MoveOn.org, Markos Moulitsas and Arianna Huffington
are portraying it as a Christmas gift to special interests.
One side sees a socialist taking America on a sleigh ride toward Sweden;
the other a sell-out surrendering to big business and reactionary
"ConservaDems."
Who says no good deed goes unpunished?
The new Internet-based left, because it is so heavily reliant on
college-educated whites generally less exposed to the economy's storms,
has a blind spot on kitchen table issues.
The right's fury is easy to understand. It has opposed universal
coverage for generations both on policy (excessive federal intrusion
into the marketplace) and political grounds. Though conservatives are
now confidently predicting a short-term backlash against the
legislation, the right's shrewdest strategists have long worried that if
government-guaranteed health care ever takes root, Americans would
become more inclined to look to Washington for economic security, which
would weaken conservative anti-government arguments.
The left's outrage is more puzzling.
The bill has been wrenched by many compromises. But it imposes on the
insurance industry tough rules long sought by liberals, including a ban
on the denial of coverage for pre-existing conditions. Once fully phased
in, it would spend nearly $200 billion annually to help more than 30
million uninsured Americans obtain coverage.
Yet it squeezes enough savings from inefficiencies in current health
spending that the Congressional Budget Office projects it will reduce
the federal deficit in the near- and long-term, and the independent
Medicare Actuary calculates that it will vastly extend coverage while
increasing total national health care spending (by business, government
and individuals) by less than a penny on the dollar through 2019.
And it advances almost all the ideas that cutting-edge reformers
consider essential to slowing long-term cost growth by nudging the
medical system away from fee-for-service medicine toward approaches that
more closely tie provider compensation to results for patients.
Against all that, the aggrieved left has mostly focused on two
concessions made to centrist Senate Democrats: restrictions on abortion
coverage and the abandonment of a public competitor to private insurers.
But each is a largely symbolic dispute: There's little evidence the
legislation would seriously constrain access to abortion, and the CBO
has estimated that only about 6 million people would choose a public
option. (It was equally irresponsible for the Senate centrists to
threaten to sink the bill over such tangential provisions.)
Even political scientist Jacob Hacker, widely considered the father of
the public option, wrote this week that it "would be wrong" to derail
the bill because it still contains "vital reforms."
In some respects, the left's discontent may be unavoidable. Perpetual
dissatisfaction is the nature, and arguably the role, of activists.
It's easy to forget that not only did liberals issue similar complaints
about Clinton, but conservatives like Newt Gingrich groused that Ronald
Reagan cut too many deals with Democrats.
The new Internet-based left, because it is so heavily reliant on
college-educated whites generally less exposed to the economy's storms,
also has a blind spot on kitchen table issues.
According to the Census Bureau, just 6 percent of college-educated
whites lack health insurance, for instance, compared to 19 percent of
African-Americans and 31 percent of Hispanics.
But the idea that Democrats should just press restart after the grueling
struggle to reach this point carries an air of fatal abstraction: If
health reform fails now, the next chance for big change probably
wouldn't come for years, if not decades. "The universal rule of health
care -- there are no exceptions -- is you get what you can," says Brown
University political scientist James Morone, co-author of The Heart of
Power, a recent history of health care politics.
Still, the left is raising one legitimate concern: the risk that
Republicans will seize on the deals the White House cut to secure
support from individual senators or key constituencies like drug
manufacturers "to rebrand Obama and the Democrats as the party beholden
to special interests," as Huffington wrote.
The left's prescription for that problem -- junk the health care bill --
is batty, but that doesn't mean its diagnosis is wrong. With a populist
wave building against all large institutions, Obama could find himself
deluged if he doesn't learn to surf.
The president's strategy of enveloping potential opponents has brought
him to the brink of an historic health care victory. But if Obama is to
keep his head above water next year as he moves to issues like financial
regulation and climate change, he may need to tilt his dial from
conciliation toward greater confrontation with the powerful interests
blocking his way.
http://www.nationaljournal.com/njmagazine/nj_20091224_5120.php
