Showing posts with label health care reform. Show all posts
Showing posts with label health care reform. Show all posts

Tuesday, July 3, 2012

FDR Got Things Done. So Has Obama.


Sunday was a bad day for FDR in the New York Times Sunday Review section.

Ross Douthat, showing a level of understanding of the New Deal that I would find deficient in an undergraduate, used FDR to bash President Obama's decision to pursue health care reform. Bill Scher used FDR's allegedly cozy relationship with corporate heads to praise Obama. Both showed how little they understand about the politics of the 1930s.

Douthat's argument is that, despite the Supreme Court ruling upholding the constitutionality of the Affordable Care Act, Obama was foolish to pursue it early in his first term--that choice, he says, was "disastrous." His evidence for that is that the legislation is "deeply unpopular." (Douthat never deigns to evaluate the actual merits of the legislation. Evidently that is not important--timing is all.)

Douthat says the law is unpopular not because people don't understand it (the usual Democratic argument) but because of the timing. See, people are just mad that Obama pushed this legislation before the economy improved enough. "By turning from economic crisis management to sweeping social legislation before the crisis had actually abated, Obama made himself look more ideological than practical and more liberal than pragmatic." Evidently Obama did this by pursuing a goal he had explicitly campaigned on (the nerve!) and by embracing Republican ideas (eschewing a public option and accepting the individual mandate instituted by Mitt Romney in Massachusetts).

Douthat's points are self-evidently wrong on the surface, but he deepens his errors by claiming the authority of history. "This was not a mistake the icons of the liberal past made," he intones. "Franklin Roosevelt spent two years defining himself as a Depression fighter before he set out to establish Social Security."

To call this point simplistic would be an understatement.

FDR announced his intention to implement Social Security in June 1934, 15 months into his presidency. He signed it into law in August 1935, 29 months into his presidency.

Obama signed the Affordable Care Act in March 2010, 14 months into his presidency. According to Douthat, 15 months is the difference between political success and political disaster. This is not an argument. It is an assertion without evidence or logic.

More to the point, Douthat's praise of FDR ignores the rather significant fact that FDR had hardly ended the Great Depression when he pushed for Social Security. In fact, he pushed it because the first New Deal had failed, recovery was sluggish, and he was under political pressure to do something, anything, so he could point to successes going into the 1936 election. FDR didn't push for Social Security because the "economic crisis" had passed, as Douthat implies, but because it hadn't.

Scher's argument is a little better. His point is that Obama is to be commended, not criticized, for working with corporate interests on health care. Obama has been unfairly criticized by liberals, Scher says, who neglect how much their heroes FDR and LBJ did the same thing.

It is true that, as Scher says, FDR "was quite adept at bargaining with corporations" in the First 100 Days. What he neglects to note is that the major policy he negotiated with business, the National Recovery Act, is almost universally considered an abject failure.

FDR's most notable successes came after he stopped trying to appease big business. He learned that his attempts to do so were futile, since they excoriated him anyway. By August 1934, they had formed the anti-FDR Liberty League and dedicated their efforts to defeating him in 1936. So much for "bargaining."

After business turned on him, FDR not only passed Social Security, but the Wagner Act (which established union rights) and the WPA (which created jobs for the unemployed). These liberal policies were passed over the objections of businessmen, not by compromise with them.

Scher's point, however, is still a reasonable one: "most of the time politics is exasperating and irritating, not euphoric and cathartic." That's true, and it is also true (though Scher doesn't note it) that FDR returned to a detente with business when American involvement in World War II loomed.

I have no idea whether FDR would have, in Obama's shoes, pushed for health care in his first year in office, or if he would have sought to appease drug companies and the Chamber of Commerce whenever he did it. What I do think I know is that he would be proud of Obama for having gotten it done.

FDR's commission on Social Security recommended including health insurance as part of that program, but FDR feared (probably correctly) that it would be too much for Congress to swallow.

But he did not give up on the idea. In January 1944, when he proposed his postwar political agenda, the "Economic Bill of Rights," he included the following: "The right to adequate medical care and the opportunity to achieve and enjoy good health."

In short, we owe the very idea of health care as a right to FDR. Given that fact, and his own rather flexible approach to politics, I rather doubt he would care very much how--or when--Obama got it done. FDR got things done. So has Obama.

Monday, March 26, 2012

The Supreme Court and the Health Care Law Decision: Judicial Victory, Political Defeat?

The Supreme Court takes up the constitutionality of the health care law today. I'm not a constitutional historian, so I can't speak definitively about its constitutionality (though the law strikes me as a reasonable use of the commerce clause, and to find otherwise would seem to me like a reactionary reversal of 80 years of constitutional history).

The politics of the decision seem likely to be interesting, no matter what the Court decides. Ever since it was signed into law by President Obama two years ago, Republican candidates have denounced it as unconstitutional and have pledged to work to repeal it. The presidential candidates know that calling for repeal of "Obamacare" is a sure-fire applause line every time.

Politically, that won't be easy. Not only would the Republicans need to win the presidential election, they'd need to hold onto the majority in the House of Representatives and not only win the Senate, but get 60 votes to overcome a likely Democratic filibuster to thwart repeal.

In theory, then, the GOP should welcome the prospect of the Supreme Court doing its work for it. But as the old saying goes: "Be careful what you wish for. You might get it."

There is an inherent danger in trying to settle political disagreements by court decision. It is appealing, no question. If one can get the Court to declare the other side's view unconstitutional, one not only wins the immediate battle, but the war. No mere democratic majority can undo what the Court has done. Unless the Court reverses itself, that view stands. What could be better?

Well, the politics can get tricky.

No case better demonstrates that than the infamous Dred Scott decision of 1857. Technically, the matter was a fairly simple one: Was Dred Scott, who had been a slave, now a free man due to having been taken to free territory?

The question could have been answered simply, by looking at that narrow question. But the Court, looking to issue a more comprehensive decision that some people hoped would put an end to the political controversies surrounding slavery--especially slavery in the territories--decided to go big. As James McPherson puts it in Battle Cry of Freedom, many Americans were "yearning for settlement of this question."

Not only did the Court rule that Scott was still a slave, it also ruled that no black person could be a citizen of the United States (despite the fact that many had been treated as such for decades) and that the 1820 Missouri Compromise, which had banned slavery in the northern territories, was unconstitutional.

The majority opinion, written by Chief Justice Roger B. Taney (an Andrew Jackson appointment), is widely considered to be one of the worst, if not the worst, in the history of the Court. Taney was a southern partisan, who privately said that northerners were trying to destroy the south: "the knife of the assassin is at their throats." According to one of the foremost historians of the case, the Dred Scott decision was "essentially visceral in origin ... a work of unmitigated partisanship."

Southerners and Democrats were thrilled, thinking the decision had destroyed the Republican Party, whose position on slavery was that it should be banned in the territories--precisely what the Court had now said could not be done. The decision was called "the funeral sermon of Black Republicanism." Southerners were convinced that they had won the final victory over anti-slavery forces: "Southern opinion on the subject of Southern slavery ... is now the supreme law of the land."

But the politics turned out differently. Republicans like Abraham Lincoln seized upon the Court's opinion as a rallying cry. Far from destroying the Republican Party, it breathed life into it. It now became more important than ever for Republicans to control Congress and the Presidency, so they could nominate new members to the Supreme Court and undo that awful decision.

Perhaps more importantly, Taney and the Court, with their overreaching decision, reversed the political dynamic of the moment. For many years. Southerners had been portraying themselves as victims of northern (political) aggression. Abolitionists and other anti-slavery agitators had been attacking their "peculiar institution" for years. They could plausibly claim that the political discord in the land came from their northern enemies.

Then came Dred Scott. It had undone the 1820 sectional compromise, and in the process, wrecked what remained of the spirit of political compromise. Using the undemocratic institution of the Supreme Court, they had thwarted the political process, which Republicans could claim was stumbling in its typically awkward American way toward some resolution.

The decision, Republicans could say, showed that southerners and Democrats had no respect for or faith in the democratic process. They were simply determined to protect slavery any way they could--even if it meant hopelessly perverting the historical record, even if it meant twisting themselves into knots to justify their illogical opinion.

The Dred Scott decision was a pyrrhic victory for southerners. Three years later, the Republicans proved the "funeral sermon" was premature--they won control of the Presidency and both Houses of Congress. The case produced not an end to the debate, but rather a political backlash that ended with the destruction of the very institution of slavery that southerners were trying so desperately to save.

It would be foolhardy to predict the possible outcomes of all of the potential Supreme Court decisions in the health care case. The temptation for some members of the Court to issue a sweeping decision will be strong, but a more temperate majority may emerge. The safest thing to predict is that a decision that initially appears to be a clear-cut judicial victory could end up being a political defeat.

Monday, January 10, 2011

Assassination is the Real Tyranny


Back in early April, in the disturbing aftermath of the passage of the healthcare bill, which included acts and threats of violence against members of Congress, I wrote two posts about the dangers of the violent rhetoric permeating the political culture (here and here).

And now a member of Congress has been shot.

As news personnel compulsively remind us, we don’t know the exact motives of this shooter.  We do know that he seems to be deranged.

But that doesn’t mean that this is merely a random act with no political significance.

We take it for granted that political leaders can inspire good with their words.  Many thousands, maybe millions, of baby-boomers cite JFK’s inaugural challenge (“Ask not what your country can do for you, ask what you can do for your country”) as the reason they went into the Peace Corps, or the military, or some other form of public service.

No one claims that Kennedy “created” idealistic people.  But we do accept that his challenge helped channel their existing idealism into particular forms of service—because leadership matters.

Yet, when something awful happens, we suddenly resist the idea that the rhetoric leaders use can take the evil that exists in human hearts and channel it in a particular direction.  Over and over we are told that this troubled person was going to do something awful and there was nothing anyone could do about it.

Perhaps.  But we do know that this particular troubled person chose a political leader to whom he had access as his target.  We know his rantings, however incoherent, had political overtones.  To pretend that the toxic political atmosphere of the last two years had nothing to do with how his derangement was channeled is the worst (and most dangerous) kind of denial.

Some people seem to get this.  Contrast the words of new House Speaker John Boehner now with his words then.  In the wake of the incidents back in March (including an attack on the offices of Rep. Giffords), Boehner appropriately said "violence and threats are unacceptable."  But he also added: "many Americans are angry over this health care bill, and angry at Democrats here in Washington for not listening."  In other words, he could not limit himself to condemning the violence; he also blamed the victims.  (Rep. Giffords was one of those Democrats who voted for the health care bill and who, in Boehner’s words, did not listen.)

Saturday, he rightly said: “An attack on one who serves is an attack on all who serve.  Acts and threats of violence against public officials have no place in our society.”  There was no “but you have to understand the anger” qualifier this time.  He should have had the same clarity back then that he belated has now.  It should not take a shooting to show “leaders” that you should never, in any way, excuse violent rhetoric and political violence in a representative democracy.

An assassination is the utter abnegation of democracy.  It is one person thwarting the will of the electorate.  It is, in that sense, the ultimate tyranny. We can only hope and pray that the demagogues and opportunists who have recklessly thrown around the word “tyranny” to describe the workings of a duly elected government for the last two years will now have the decency to keep their paranoid rantings to themselves.

Friday, October 8, 2010

Burning Down the House



The Cranick family didn't pay a $75 fire surcharge required by their community in Tennessee. Last week, their house caught fire. The fire department came, but since the owner hadn't paid the fee, they allowed the house to burn. They did so despite the owner's pleas, even as he told them he would write them a check for any amount if they would just save his house. The house burned to the ground. Fortunately no people died, but family pets, three dogs and a cat, were killed in the fire.

Here is what Glenn Beck had to say about this event: "If you don't pay your $75, then that hurts the fire department. They can't use those resources, and you would be sponging off of your neighbor's $75 dollars." He called what happened "equal justice." It was a lesson, he seems to think.

This may be the only time I ever say this, but Beck has a point. When some people pay into a system that supplies a public service and others don't, it is unfair to those who pay in if everyone who does not also receives those services.

The problem is that, as usual, he fails to see the all the ramifications of that point of view. This awful event is, in fact, the logical consequence of a vision of government that turns what should be basic public services into a pay-for-service function. If you make the services of firefighters into a privilege one must pay for, then Beck is right—you logically have to let the house burn down, with the animals inside (and, one supposes, any people too).

The morally correct conclusion to reach, however, is that something that can be literally a life-and-death matter therefore should never be relegated to pay-for-service status.  Fire protection should be a public service, available to all, and supported by taxes. As the owner's son has said, "To stand and watch a man's house burn is morally and ethically wrong." One might expect Beck to come to that conclusion too (after all, he claims that Americans must, as says he has, "turn back to God"). But he hasn't. Why not?

This is probably giving Beck too much credit, but perhaps somewhere deep down he realizes that the system of fire prevention that resulted in the Cranick home burning down is essentially the same system we have until recently had for health care, the same system that conservatives campaigning this fall are pledging to restore, the same system that Beck defends.

Before the new health insurance law was passed last spring, our ad hoc health care system was basically a pay-for-service system. There was no legal requirement to have health insurance. Those who had insurance, when they got sick, could go to the doctor. But the uninsured individual in need of emergency medical care was in the same position as the Cranicks. The difference, of course, is that a civilized society does not turn away a sick person in the emergency room because the person has no health insurance (of course, up until this week, I thought the same was true of every fire department).

Such people, in Beck's words, have been "sponging off" their neighbor's health insurance premiums. That essential problem with the old system is why the new health care law includes the requirement that people buy health insurance (government subsidized, if necessary), precisely the element of the law that Republican attorneys general all across the country are challenging in court.

Without that requirement, the logic that Beck applied to the Cranicks would kick in. When the uninsured person showed up in the emergency room, the doctors and nurses should do what those firefighters did: stand by and let nature take its course. If Beck thinks it is acceptable for government to require people to pay a fire protection surcharge or face the consequences, why not apply that same logic to the individual mandate? Given the Republican contempt for those who "sponge off" the system, you would think that they would be all for the individual mandate. Instead, they denounce it as unconstitutional socialist tyranny. So much for consistency.

One final note: obviously oblivious to the tremendous irony of it, when Beck spoke those callous words, there was a poster of Benjamin Franklin hanging on the wall behind him, and beneath Ben's face, the word "Charity." Part of Beck's schtick is that he presumes to be teaching the rest of us about American history, especially restoring to the American people the "real" founders. But if he really knew the first thing about Franklin, Beck would know that fire prevention was one of his favorite causes.

In 1734, Franklin recommended a system composed of a "Club or Society of active Men belonging to each Fire Engine; whose Business is to attend to all Fires with it whenever they happen." All fires, not some. And their compensation was "an Abatement or Exemption in the taxes." In other words, they were paid from public funds. Supplying the firefighters with "Buckets and Ladders" Franklin considered "a Duty incumbent upon all who can afford it." Putting out fires, he believed, was a public good, one that all should contribute to in some fashion, and one that those with greater means should support economically for the greater good.

If only Beck would take to heart this piece of advice offered by Franklin: "But such as can neither advise nor labour, should not stand in the Way of those who can, and are willing."

Sunday, April 4, 2010

Newt's Kids, Continued


I wrote my last post on Friday, and then on Sunday, like a basket of chocolates from the Easter Bunny, arrived further evidence of my point in the morning paper.

Cal Thomas turned his column over this week to Newt Gingrich, who said the following when asked if overheated rhetoric might lead to violence: "For the mugger to complain that people are objecting to being mugged ... is an act of chutzpah on a grand scale." To be clear, the muggers he's talking about are the Democrats, the party that won the congressional elections in 2006 and 2008, as well as the presidency in 2008. The mugging is that they then had the gall to pass the health care bill, which they campaigned on in the last election.

How does Newt justify calling the predictable outcome of free, fair and democratic elections a "mugging"? "For any of these people who have deliberately bullied, bribed and abused the system to impose their will against the country to now be shocked that the country is unhappy with the machine, I think, is a further act of arrogance." And there you have it: an outcome Newt doesn't like is, by definition, illegitimate and "an act of arrogance." Lest you think that the "mugging" metaphor was a mistake or just a passing comment, Gingrich drove it home. The Democrats, he said, "would like to mug you routinely while you quiescently thank them for the privilege of being mugged." He knew exactly what he was saying--the Democrats are like violent criminals. And, well, you do what you have to do to defend yourself against violent criminals.

To hear Newt tell it, the health care outcome was not truly democratic. The other side got its way because it "deliberately bullied, bribed and abused the system," not because the Democrats were the majority party. Gingrich cannot accept that duly elected majorities in both houses voted for the health care bill. Somehow that becomes "abuse," because, you see, in Newt's world, the Democrats are not the real majority. He believes the U.S. is a "center-right" country, and that what we have now is "70 percent of the country being misgoverned by a militant minority."

Where does he get this number? As best I can tell, it is from the most recent Gallup poll on party affiliation, which shows 30% of Americans identify themselves as Democrats. What he fails to note is that 29% identify as Republicans and 39% as independents. So what Gingrich does is simply claim all of the independents as part of his "center-right" coalition.

This is intellectually dishonest. This same poll shows that when "including 'leaners'" the numbers are 45% Democrats and 44% Republicans. The country is split right down the middle. But Gingrich glibly ignores that fact in trying to paint the Democrats as a "militant minority" that is "mugging" the country. Well, what do we call it when a militant minority mugs the country? Newt knows--that's tyranny. And we know what happens to tyrants, don't we?

The former speaker is once again playing a cynical, dishonest and dangerous game. And it needs to stop.

Saturday, March 13, 2010

Time to Act


My friend and colleague John Lane referred me (in exasperation) to this piece by Jon Meacham in Newsweek. In it, Meacham argues the value of gradualism. He quotes with favor Robert Penn Warren, who said: "Gradualism is all you'll get. History, like nature, knows no jumps." At first I thought, "well, that's hard to argue with," and I wondered what had gotten John so worked up.

But as I read on, that became clear. Meacham is not merely arguing that change takes place gradually. He is arguing that the American political system's current and frequent paralysis is a virtue because it reflects this gradualism. And that's where he goes wrong.

There's a world of difference between the way any society gradually changes and the inability of a political system to reflect changes that have already taken place, or to lead in changes that need to take place. Meacham never mentions it, but it seems likely that what he has in mind when he says "Better to govern creakily than to be victim of passions moving too quickly" is the current impasse over health insurance reform.

You can say many things about the history of this issue, but "moving too quickly" is not anywhere on the list. As President Obama has taken to noting, the idea was first proposed by a Republican president, Theodore Roosevelt, over 100 years ago. FDR's commission on social security proposed including it in that plan in 1935, but the president thought that would be a little too much for Congress to bite off at one time, and was better left for another day. When Harry Truman saw the abysmal state of public health as revealed by the physicals of men who were drafted during World War II, he decided the time was right. Demagogues cried "socialized medicine" and, at the height of the cold war, that was all it took to defeat the idea. LBJ scaled back the ambition, and proposed covering only the elderly and the poor. Exercising his formidable political skills, he got that bill through Congress and signed it in the presence of Harry Truman.

That was 1965. Until last year, only Bill Clinton had dared to attempt significant reform, and he failed. For the last year, the topic has been under active consideration by Congress, and for at least a year before that, it was one of the most prominent topics in the 2008 presidential primaries and general election. To pass a bill now is not moving too quickly. You can object if you will on the merits of the bill, but don't try to couch it in some grand theory of how history moves slowly.

As a nation, we have moved slowly. Too slowly, I'd say. Not just on this issue, but on most issues of great import. It took the bloodiest war in American history to end the moral outrage of slavery. It took the Triangle Shirtwaist fire to get safety regulations in the workplace. It took the worst of economic calamities to start building a social safety net. It took the deaths of countless citizens lynched and one of the greatest grassroots protest movements in history to end segregation.

That last example brings to mind a story that encapsulates Meacham's basic misreading of the past. Addressing what ails us, he says, "is at best a gradual undertaking." When the civil rights movement was building in the mid-1950s, President Eisenhower responded to a church sermon on the need for civil rights legislation by saying "You can't legislate morality." Morality only changes gradually. Martin Luther King responded that while Eisenhower was correct in one sense, he was missing something else: "A law may not make a man love me, but it can stop him from lynching me." Law can never make a society perfect, but it can make its rules a little more just. The law can't change hearts, but the law can lead.

Years later, Dr. King wrote in his marvelous "Letter from a Birmingham Jail" of the cost of waiting. "For years now I have heard the word 'Wait!' ... This 'Wait" has almost always meant 'Never.'" Today, calls to "wait," to "start with a clean sheet of paper," mean the same thing: never. Our creaky political system needs to act. If this bill turns out to be flawed, then let it be fixed. If it turns out to be unworkable, then let it be repealed and replaced with something better. But let's be done with pretending that we need to take more time because history knows no jumps. We need to act.





Monday, February 8, 2010

It's All About Discipline


Watching the depressing spectacle of the Democrats stumbling to pass comprehensive health care reform got me wondering how the Republicans were able to pass the Medicare drug benefit in 2003 with a mere 51 Republican senators—nowhere near the 60-vote majority Democrats enjoyed up until last week. The contrast between the stories of the two bills is enlightening.

The difference isn’t ideological—both bills called for an expansion of the role of government in providing health care benefits. It isn’t a matter of fiscal conservatism—the Medicare bill was originally estimated to cost over $400 billion in its first 10 years (though after its passage that number quickly ballooned to $1.2 trillion, and there was a minor dust-up when it was revealed that the Bush administration’s own numbers during the debate estimated its cost at closer to $600 billion). If anything, the current bill is more fiscally responsible, in that it contains means to pay for it, which the Medicare bill did not. In fact, Republicans pushed to waive the normal rules in place that said any new program needed to contain a mechanism to pay for it. No, the difference is quite simple: party discipline. The Republicans have it, the Democrats don’t.

Today’s Democrats have focused, understandably so, on the problem of the Senate filibuster rule. The need to overcome a potential filibuster means that, in the face of a united Republican front in opposition to any bill, the Democrats have to get every single Democrat (plus ostensible independents Joe Lieberman and Bernie Sanders) to vote to end debate in order to pass a bill.

But that same procedural impediment faced the Republican Senate in 2003. So how did they do it? One obvious answer is that they were able to get some Democrats to break party ranks and support the bill. Ultimately, 11 Democrats voted for the bill. Had the Democrats shown the same devotion to party as today’s Republicans have, they could have killed that bill.

But there is another interesting subplot to the 2003 story. The final bill passed the Senate by a 54-44 vote. How did they manage this, if today Democrats need 60 votes to get health care reform passed? The answer once again is party discipline, but of a different kind.

There was an attempted filibuster against the 2003 bill. But the cloture vote passed, 61-39, because seven Republicans senators (Chafee, Ensign, Graham, Gregg, Lott, Nickels and Sununu) who voted against the bill voted for cloture. In other words, unlike today’s strutting prima donnas (i.e., Joe Lieberman and Ben Nelson), the Republicans who opposed the Medicare bill did not try to use their votes to kill the bill if it did not conform exactly to their liking. They agreed to vote for cloture and then against the bill, ostensibly (or maybe even actually) in the name of democracy and the value of an up-or-down vote--but more likely in the name of not denying their party and its president a legislative victory. Had Lieberman and Nelson done the same, instead of holding up the bill while they continually demanded more concessions, they could have voted against the bill, but still allowed an up-or-down vote, and health care reform could have passed in the fall.

Yes, if even one Republican had been willing to break ranks, the bill could have passed (and still could). But Democrats should have known early on that, as Jim DeMint too honestly put it, Republicans wanted to hobble the entire Obama presidency by turning this issue into his “Waterloo.” Given that reality, the blame also falls on a Democratic leadership that allowed itself to be blackmailed by two senators who put their own selfish interests ahead of the party’s and the nation’s.

One final note—among the Democrats voting for this unfunded Medicare benefit in 2003 were Max Baucus, Mary Landrieu, Blanche Lincoln and Ben Nelson—all of whom worked to curtail the size and cost of the current bill, allegedly in the name of “fiscal conservatism.”