I've had the privilege of learning about politics from some pretty amazing people throughout my academic career, including a Nobel Prize winner, a man who redefined the way we understand ideology and public opinion, and an intellectual successor to Murray Edelman. Despite all that I think I have learned more about politics from my dad.

The HCR legislation passed this weekend is, in any reasonable analysis, watered down. Weak. A shadow of a real reform bill. For this reason I was staunchly opposed to it for months. I argued that passing no bill would be a better outcome than passing reform in name only. What we got is marginally better than that.

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But it is a good thing that it passed. It took me a while to understand why. More accurately, I needed to have it explained to me.

This bill is a beachhead – a way for the idea of universal health care to establish a foothold in this country.
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It packaged a number of the most lukewarm, least controversial ideas in health care reform and was enacted over strenuous opposition, opposition based mostly on ignorance (or misinformation). It is not a good bill, but it is the first step in a long process. And no matter what the wingnuts say this week, it isn't going anywhere. As one of the dumbest up-and-coming conservative superstars said:

I never thought I would say this, but Patrick Ruffini is exactly right. "They" are well and truly fucked. This thing is not going anywhere.

First of all, it would require a Republican president.

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That won't happen for at least 3 years, possibly 7. By that time the changes will be well entrenched both bureaucratically and politically. The wheels of government move slowly but they are difficult to stop once they start rolling.

Second and more importantly, David Frum is right. (What is wrong with me today?) A campaign to repeal these reforms would amount to the longest suicide note in the history of American politics. Here are just a few examples of changes made that future Congresses will not touch with ten-foot poles.

  • Dependent children can be covered by parental policies up to age 27
  • People can no longer be dropped for pre-existing conditions
  • The Medicare D gap ("donut hole") is closed with subsidies
  • Tax breaks to cover 50% of costs for small businesses to offer coverage to employees
  • Lifetime and annual caps are banned
  • No-copay preventive care and annual screenings
  • What kind of delusional sociopath is going to base a campaign around repealing that? Don't get me wrong, the GOP's commitment to nihilism is strong enough that they'll make the argument anyway. But politically that will go over about as well as the flat tax, flag burning, or mandatory HIV infection for children under six. If they want to campaign to kick Junior off your insurance, jack up the price of Granny's pills, and give insurers the right to drop people for pre-existing conditions, I am happy to see them do it. "We demand to pay copays!" is a mighty strange campaign slogan to say the least.

    So is Frum right? Is this Waterloo for the GOP? If they were smart it wouldn't be. There's plenty for which they can claim credit. They kept many things they disliked out of the legislation. But the fact remains that they failed to stop it. This is the first real victory for Obama and it's hard to avoid the fact that he looks like a more competent President today than he has at any point in the last six months. Most people understand politics like a football game – who won, who lost, and the final score. And the bottom line is that after six months of histrionics, threats, and blood-curdling rage from the Teabag crowd and talk radio, in the end they couldn't go a goddamn thing to stop it. They altered the final product but could do little more than throw tantrums like children on Sunday as the final vote was tallied.

    I'd love to say I figured that out on my own, but sometimes we all need a good talking-to from someone older and wiser.


    • I'd love to say I figured that out on my own, but sometimes we all need a good talking-to from someone older and wiser.

      Well, that's why some of us count on you, youngster.

    • Hey,
      I've always thought simple was better on this one. Right after all the accusations of earmarks, deception and a 2000 page monstrosity the Democrats should have given in… and bitch slapped the Republicans with a two page bill with just a handful of the most popular reforms designed to do two things: stick it to republicans by passing with ease and show the public that the private system is unfuckingbelieveably broken if it's really going to go insolvent without the ability to drop those with cancer diagnoses, not take those with pre-existing conditions and generally bend people over. Imagine that… you pass a bill everyone understands, then when and if the industry breaks as a result of that bill, the public understands very clearly that it had nothing to do with some crackpot plan of the Democrats and everything to do with the private system just not being cut out for providing actual health care.

      It's a strategy that paves the way for single payer and would have been significantly more difficult for the Republicans to stop.

      Now if the healthcare system stumbles the bill is so unintelligible that it's easy to whip out the smoke and mirrors and point the fingers at the Democrats.

    • You know, I've heard a lot of conservatives raging about how the bill is "unconstitutional," but I have yet to see any of them actually explain why. Seems to me that the only powers necessary for this bill are taxing and spending and interstate commerce, both of which are explicitly granted by the Constitution to Congress. If anyone's seen an actual argument as to why this bill "shreds the Constitution," as one blogger I read put it, I'd love to see it. Otherwise I'll be forced to conclude that "unconstitutional" has become, like "judicial activism," just another term that means "something I don't agree with," which would be depressing but not surprising.

    • Funny that a reform that will be impossible to repeal once in place can be so unpopular before it is in place.

    • Ed, we differ about 180 degrees philosophically, but I agree with you that this is just a beachhead, and that's precisely why the fight was so intense.

      We all know exactly where this is meant to go — the final destination is either much, much better than where we are now or much, much worse, depending on your perspective.

      You're also right that an entitlement, once created and sampled, gets locked in as an iron-clad right. It's human nature, and another reason that entitlements are historically a one-way expanding ratchet. Again, good or bad depending on your perspective.

    • I too would have preferred a public option from the start but like Dennis Kucinich I'll support a 'beach head'.

    • displaced Captalist says:

      The claims that it is unconstitutional all seem to be based around the 10th amendment which basically says that the state can do anything that isn't reserved for the federal gov't in the constitution. Of course this doesn't mean that the states can usurp the fed's role as some are suggesting. Here, the fed gov't is regulating interstates commerce which is constitutional, and the fed gov't is taxing which is also constitutional. Even the Roberts court wouldn't try overturning these two principles.

      I still am waiting for some states to secede from the union. I'll be happy when they're gone and this time I say we shouldn't even bother fighting to get them back.

    • I will be far beyond floored if any of these legal challenges from the states go anywhere. It makes about as much sense as tax protester legal arguments.

    • Straight up question: aside from the tax and commerce challenges, do you think that it's constitutional to require everyone to purchase insurance?

      I think it's a step beyond anything we've ever done before and I'm not sure it fits into the taxation or commerce clause arguments. I'd expect lots of individuals to challenge it as a direct violation of their individual rights — property rights, the right to be left alone, etc.

    • I don't know that requiring everyone to purchase insurance is a big step beyond. We've been doing it for auto insurance for years. An obvious difference is that you can choose not to own a car to avoid buying insurance, but I don't think the concept is too far removed from healthcare.

    • The concept is identical.

      You can be required to buy auto insurance because without it, your actions can impose substantial financial cost on other people and on society as a whole.

      Without health insurance, you can impose the same costs. On individuals and on society. Those freedom-loving patriots who choose to be uninsured are as likely to run up a five-figure hospital bill as anyone else.

    • They don't have to repeal it at once; rather, they can undermine it piece by piece. Once they get their Romney in the WH, they can start the war with Iran they've been itching for. And that will cal for some "budgetary balance," which they could use to justify eliminating some part of this weak bill. Then they can start again banging the drums of "economic freedom" to justify de-regulation, such as the requirement that insurers cover everybody, irrespective of pre-existing condition.

      Never underestimate the potent combination of right-wing disdain for the masses, the electorate's gullibility, and the ease of collective forgetfulness. As soon as they get their first president or regain majority again, they'll start hacking at this bill.

    • Good post. I think this was a learning experience for a lot of us.

      The Sirota/Hamsher faction make a lot of sense, but as Markos pointed out, the time for negotiation was a long time ago.

      The only proof we need this bill was worth passing is the complete meltdown of the right-wing. They are defeated and they know it.

      The 'beachhead' thesis is a good one. But I also like the notion that this is the victory over the right-wing and the punditry class that we need to allow more progressive/liberal ships to begin landing on the beachhead.

      D-Day indeed.

    • Our use of the insurance model to deliver health care is primarily why our system, even with this new law, will remain terribly inefficient. We buy insurance to protect us from loss or injury, which may be ok if we suffer an accident, but does it make sense if we need a mammogram, a physical, or heart operation? The for-profit insurance system puts the incentives in the wrong place. Single payer would be a huge improvement, of course, as would simply nationalizing health care in the way we've nationalized our highway system.

    • Crazy for Urban Planning says:

      Here are my two cents: The things the right wing is saying is just a continuation of a mantra that the government can't do anything. Therefore, it doesn't really matter what the hell is proposed or talked about, at this point the dittoheads and right wing voters have become Pavlov's dog – they just need to say the magic word and people respond in the conditioned manner. For example, Rush says: "government healthcare," they say: rationing! deathpanels! socialism!

      Lets not forget that they can use strategy for any issue and expect the same response. The Senate remains pretty dysfunctional and useless so (I don't think) we know what will come up on the agenda next, but transportation (which will be less dedicated to highway money), cap and trade (which is already labeled the "cap and tax" bill), bank/financial reform, and a number of other progressivish bills have been waiting in the wings of the Senate since last year and the masses are simply waiting for Pavlon to ring his bell. My point here is that people have been conditioned to turn every issue into the end of mankind and the end of the world!

    • While the external costs aspect of car vs. health insurance is the same, there is still a significant difference presented by the fact that you can opt out of buying a car easier than opting out of being human. Because of my objection to a mandate that everyone buy private health insurance – something that would be a giveaway to a morally-bankrupt system – I supported a public option. However, I do agree in that this bill starts the process toward a better system.

      About the mandate: as I understand it, the "mandate" operates in the form of a tax penalty for those who do not buy insurance. Essentially, one could "buy" the right to opt out of insurance by paying an "uninsured tax." This acts as the stick to get people to buy insurance as well as helping fund the hospital visits of those opting out. That said, I have no idea the amount of money involved in the tax, so have nothing to say about its fairness or reasonableness.

    • there is still a significant difference presented by the fact that you can opt out of buying a car easier than opting out of being human.

      Yes, and because of that, you can't opt out of the costs you impose on others by not having health insurance.

    • You can't opt out of imposing costs on others??? Why not???

      As a start, how about if we let the wealthy demonstrate their ability to pay for their own care and opt out of the mandatory insurance? Seems fair since they won't impose costs on anyone else (your argument). I'd support this for auto insurance too.

      Please come up with a better argument to justify forcing someone to buy something they don't want and may be able to prove that they don't need.

    • The concept is identical.

      You can be required to buy auto insurance because without it, your actions can impose substantial financial cost on other people and on society as a whole.

      Without health insurance, you can impose the same costs. On individuals and on society. Those freedom-loving patriots who choose to be uninsured are as likely to run up a five-figure hospital bill as anyone else.

      With auto insurance, there are those who opt not to have a car, or cannot afford one, and so don't carry insurance. This law is akin to forcing everyone to buy auto-liability insurance, whether they can afford to drive or not. Now if people were robots that could turn into cars, that's make sense, but here on boring earth, not so much.

      More worrisome is the argument put forward for the mandate:

      You are in effect saying that, just by being alive, people are a drag on the system and must be forced to pony up money for junk-insurance as a way to pay for that imbalance.

      That's what the fucking Heritage Institute thinks. It doesn't enshrine healthcare as a right, it codifies the idea that people should have to pay money to some large corporation just for fucking living.

    • Ed, I think you're forgetting how effective the GOP can be at poisoning a good thing. If I wanted to get rid of this thing under my watch what I would do is underfund the crap out of it and a couple years later say "see, this thing is a complete failure. Let's kill it once and for all". I think it would pretty easy to accomplish under the banner of "saving your tax dollars by taking money away from greedy sick people". Not trying to give any ideas here but I get the feeling it's not as immovable as many would like.

    • Skyskier, I'm with you that the GOP has a long history of debilitating government agencies by defunding them, and then pointing to the resulting quality drop as an excuse to defund or privatize them further. It's a real threat, in general, but what in this bill would they defund? They couldn't defund the subsidies until they'd already repealed the individual mandate. And even if they did, the subsidies are effectively a tax break, so it would play as a tax hike. Medicare and medicaid? That never goes over well. I guess they could try and monkey up insurance regulatory boards (kneecapping regulatory boards is a Republican Olympic sport, after all), but I'm not sure that stopping new & improved oversight would bring things to a worse state than they're in now. I could definitely be forgetting something, but for all the money that's tied up in this bill, I'm not seeing much room to cut funding at let it fail.

    • Michigan had a buyout when they were transitioning to compulsory car insurance. Either you showed proof of insurance or you paid a fee to the Uninsured Motorist Fund. If you got in an accident the fund paid for the damages. You couldn't register a vehicle again until you paid back the fund all the money it put out for the accident.

      The question I have about the states suing over this HCR bill is how can they sue if no one has suffered any damages yet???

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