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Post-Political Critiques of “Post-Political Politics”

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A tweep asked me to comment on Alex Gourevitch’s brief essay on health care politics. Not surprisingly, it’s much better on the policy than on the politics.

To start with the points of agreement, Gourevitch (and Bob Kuttner, in the piece Gourevitch discusses) are certainly correct about the Obama administration’s failures on the rollout of the ACA. Whether these initial failures will affect the politics of the ACA going forward — I think that if the website and other administrative issues are fixed the initial disaster will be as forgotten as the disastrous rollout of the prescription drug addition to Medicare — but it was a major failure of what is supposed to be a strength of technocratic liberalism, so no argument there. And, certainly, Gourevitch and Kuttner are correct that Medicare for all would be much more efficient than the ACA’s ungainly public-private hybrid.

The political analysis…that’s another story. Before we get to the core argument, let’s deal with this, a very bad sign for an analyst of contemporary American politics:

Other liberals began to join in. William Galston, a political philosopher who worked in the Clinton administration and now at the Brookings Institute, recently wrote in the Wall Street Journal that “Every experienced manager knows that, left to its own devices, the system will not always behave this way… So the president must lean against these perverse tendencies… [but] it has become clear that President Obama failed to institute such arrangements.”

Eventheliberal Bill Galston engaging in rare criticisms of Barack Obama!

That aside, the bigger issue is with the increasingly familiar form of political analysis. It takes the tone of a tough-minded left-structuralist critique of Obama, but the content is an echo of the middlebrow liberalism it purports to detest, a combination of naive black-box pluralism and the great man history found in bestselling presidential biographies and Aaron Sorkin scripts. There’s essentially nothing in this political universe but the will of the president:

The health care law was not just Obama’s signature initiative — it was also the single best representative of his general post-political approach to politics. Obama thought he could rise above partisanship by taking an essentially Republican plan and then leaving it up to Congress to manage the details of compromise. He thought he could avoid all semblance of ‘class warfare’ by taking single-payer off the table and by eliminating any talk of redistribution. He thought he could find a consensus plan by working with, rather than taking on, the insurance companies.

In other words, the belief was that he could get something done without taking any sides or even acknowledging that there were significant conflicts of interest and principle. The result was a public-private partnership that yielded a measure of agreement not so much because everyone could see their interests represented in the final result as because nobody could understand that result. It was legislation by stupefication.

I’m not even sure where to begin. Well, first, the ACA is not a “Republican plan” in any meaningful sense. The idea that Obama thought that health care politics would somehow transcend partisan divisions and didn’t involve questions of principle is trivially easy to disprove. Leaving the initial stages of the process to Congress doesn’t reflect a belief that politics no longer exists but rather is just presidenting 101 — Obama, unlike too many of his critics from the left, learned from the failures of Bill Clinton’s strategy of developing a health care plan and then trying to get Congress to pass it by “going public.” The idea that Congress would have rolled over for whatever Obama wanted if only Obama had the will to do so is simply an alternate universe with no relationship to American politics. FDR, for all intents and purposes, didn’t get any major legislation passed that wasn’t favored ex ante by Southern Democrats, and the moral compromises this necessitated makes the handouts to various rentiers associated with health care look like nothing. The fact that Medicare for all would be superior policy to the ACA is completely irrelevant to the politics of 2012.

Now, it may be true that Obama overestimated the possibility of getting some token Republican support for the ACA in the Senate. But, as we’ve been through before, Gourevitch fails to think the implications of this through. The presence of liberal Republicans was a major source of leverage for a deal-cutter like LBJ. Once we concede that zero Republican votes was the maximum for the ACA, then every single conservative Democratic senator has a veto. Joe Lieberman would have blown up the ACA over lowering the buy-in age for Medicare, but we’re supposed to believe that he — and Ben Nelson and Evan Bayh and every other greasy conservative Democrat in the Senate — would have been perfectly OK with eliminating the private health insurance industry altogether had Obama just been more…political? Gourevitch doesn’t specify how Lieberman could have been made the extension of Obama’s will, which is probably for the best.

But what’s missing Gourevitch’s analysis above all else is any sense that American political institutions place any constraints on health care policy at all. The power of Congress over domestic policy and the fact that American social programs get passed by buying off vested interests are not things that Barack Obama created because he disdains politics. They’re permanent features of American politics that have affected every element of the federal welfare state even in the rare periods in which major progressive reform is possible. Any good analysis of health care politics in the United States has to start at this structural level, rather seeing legislative enactments as essentially unfettered presidential choices.

..one additional point. The failure to do any kind of institutional analysis is also a problem for Gourevitch’s subsequent argument that the problems with the ACA have their roots in Obama’s alleged hostility to state as opposed to private power. But if we compare the ACA to the relevant baseline — the status quo ante — it obviously increases the federal role in health care substantially. And in particular, I don’t see how Gourevitch can account for the huge expansion of Medicaid, and it seems to me that the Supreme Court inventing new doctrine to make the part of the law that gave the most direct benefits to the poor less effective should be the kind of institutional feature that any tough-minded critique of American politics really should take into account.

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  • This bears repeating in bold face:

    The power of Congress over domestic policy and the fact that American social programs get passed by buying off vested interests are not things that Barack Obama created because he disdains politics. They’re permanent features of American politics that have affected every element of the federal welfare state even in the rare periods in which major progressive reform is possible. Any good analysis of health care politics in the United States has to start at this structural level, rather seeing legislative enactments as essentially unfettered presidential choices.

    I had a bout of insomnia last night after reading the essay about Adam Lanza, the new information about how the Republicans in California are directing people to a false web site for fake health care disinformation, the story about how the Republicans have spent 9.4 million anti ACA dollars primarily in states where there are 10 to 30 percent uninsured, and then reading a round up of “Obama is incompetent” stories from the right side of the aisle. The Republican mantra is ABCBBS: Always Be Closing By Bullshitting. There is no Democratic Health Care plan that could have passed without a war to the knife during and after and the Republicans are not going to stop trying to destroy Obamacare, ever. Why “liberals” have to join in with critiquing the PResident using right wing memes and themes is beyond me.

    • rea

      American social programs get passed by buying off vested interests

      “Vested interests,” yeah, but also there are a couple of million people working in the health insurance industry and related jobs. Can’t go to single payor without some program for a soft landing for those people.

      • Absolutely. Ditto for the army. There might be better and worse ways to do it but those jobs need to be preserved in a down economy.

        • ericblair

          There might be better and worse ways to do it but those jobs need to be preserved in a down economy.

          You can say the same for coal mining, defense manufacturing, and on and on. In most places where this is an issue, the state policy towards a social safety net is “Fuck You You Loser Getta Job”, and the industrial policy is “Do What We’ve Always Done and If Not Walmart is Hiring (Maybe)”. So hell yes the local population is going to fight back against the equivalent of dropping a neutron bomb on their entire world.

          Until we both put together some sort of sane forward-looking industrial policy and get the safety net to a level where you can tolerate not working for years at a time, this will continue to happen. I’m not holding my breath.

          • Van

            My thoughts exactly. Defense spending is jobs. If you don’t have a plan to replace them with something equivalent, then you are just hurting the economy.

            • guthrie

              You mean like the massive infrastructure rebuild that the USA, or the various renewables programs which are on the drawing board? THere isn’t so much of a problem of lack of work to be done, there’s a lack of political ability and will to pony up the cash by taking it from the owning class.

      • Bill Murray

        and without the vested interests on their side those 2 million jobs would end up out there with all the outsourced jobs that were in the way of the vested interests

      • pseudonymous in nc

        The clipboard-wielding billingbots of the medical-industrial complex come way down my list of those whose redundancy I’d regret.

        That’s terrible of me, because I’m mindful that it’s skilled employment, and a sector that provides decent work for women, and that they’re not responsible for the cruelty of the system. But still, I want them gone.

        • rea

          Well, of course, we want their jobs to go away, long run–but abolishing an industry with a stroke of a pen is not a good idea. There has to be some kind of transition . . .

        • LeeEsq

          We want it gone to but you can’t get rid of two million jobs in depressed economy or even a good economy without creating a lot of angry voters or causing a lot of misery to people who don’t deserve. Those two million people have dependents to care for and bills to pay. Getting rid of their jobs would increase the already existing hardship faced by people.

          Its like with the auto-industry bailout or the Federal government rushing into save the banks during the financial crisis. We don’t want to necessarily save CEOs from their own screw-ups but letting the auto-industry fail would have affecting too many people to be a plausible solution. Nearly the direct employees of the auto industry would loose their jobs. Thats probably millions of people right there. Dependent industries would also shut down in the wake of the failure of the auto industry and that would cause millions of others to loose their jobs in a depression. Not a good thing.

        • pseudalicious

          My best friend is one of those billingbots. I temped at her office a while back. And yeah, the place is about 95% women, especially women of color. The insurance they get through work isn’t shit, but isn’t great. My friend’s been there a decade now. She works overtime “voluntarily” in that way that isn’t really voluntary and is probably illegal. No raise in a decade, no promotion. Save your ire for the CEOs, dude. And I say this as someone who really, really wants single payer, and realizes that every time I say that I want it, I’m also asking for the destruction of my best friend’s livelihood. But yeah. A soft landing is pretty goddamn necessary.

      • JoyfulA

        Health insurance companies administer Medicare. I assume all or nearly all the clerks, computer operators, and other “little people” would still have jobs under Medicare for All.

        • LeeEsq

          Not necessarily. A properly designed Medicare for All would be less bureaucratic and require fewer people to administrate it. I’m not sure but federal hiring guidlines would probably also prevent directly hiring from the staff of the former health insurance companies for reasons concerning fairness. The federal contracting process is one reason why the Obama administration could not simply turn to the best programmers to design healthcare.gov.

          • JoyfulA

            No, I mean health insurance companies administer Medicare. They bid on contracts. In 1998, Blue Shield of PA officers were convicted of cheating on contracting. The non-for-profit was paid $510 million from 1990 to 1994 to process $19.3 billion in Medicare claims for residents of Pennsylvania, New Jersey, Delaware, Maryland and the District of Columbia. See http://articles.philly.com/1998-09-04/news/25756438_1_highmark-pennsylvania-blue-shield-whistle-blowers

            I assume Medicare for All would operate the same way.

            • mpowell

              A substantial portion of the benefit of medicare for all would be that healthcare billing would be greatly simplified. One way or another, this effectively means less jobs for people whose only job it is to fight over who pays the bills.

              • JoyfulA

                Long ago, a friend worked for a health insurance company. It had two or three claims reps and a pile of lawyers. If it wasn’t Tuesday and no elephant was involved, the claim was denied. If the claim was appealed, a lawyer took over.

                Before she quit, my friend noted that claims reps were a lot cheaper than lawyers and suggested claims should be properly evaluated, more reps hired, and one best lawyer retained. Her boss didn’t seem to grasp the point.

                I hope that company isn’t still in business.

        • JKTHs

          Plus there would still be supplemental insurance plans to administer. It’s not like the private sector evaporates into thin air even with a single payer system.

  • Pat

    These critiques also completely fail to address questions about health care delivery. I’ll be the first to agree that Medicare for all is a much simpler proposition…. and since Medicare pays much lower rates for services than any health insurance group, it would have made a massive hole in the health care budget of many hospitals. And while I’ll be the first to argue that health insurance executives are paid way too much money, it’s a fallacy to think that cutting their salaries could somehow make up for that difference. Regulating their profits and overhead is a better solution.

    However, with the promise that every patient will be covered by insurance, hospitals can alter emergency medicine protocols to be faster and more efficient. That saves buckets of money.

  • Lisa S. no L. Simpson

    Missing the end of your simile?

    FDR, for all intents and purposes, didn’t get any major legislation passed that wasn’t favored ex ante by Southern Democrats, and the moral compromises this necessitated makes the handouts to various rentiers associated with health care look like.

    what?

    • Ooh, ooh, let me try:

      “makes the handouts to various rentiers associated with health care look like”

      . . . peanuts? Chump change? The National Review’s famous support for desegregation?

    • Like nothing?

      • Scott Lemieux

        Yes.

    • njorl

      Blue-footed boobies!

      I’m not sure how, exactly, but I really like blue-footed boobies.

      • DrS

        Ugh. Liberal pervert.

        This seems worse than penguin lust.

  • Ronan

    I’m not going to talk to the specifics (obviously, b/c I dont know them)but I think this is a misreading of the article

    This is the main point:

    “Despite their many limitations, the original American progressives at least thought there were political tasks that could be best achieved through collective political agency. Neo-progressives like Obama, and Clinton before him, have raised what began as Reagan’s attack on Washington to the level of a concept. Not only have they tended to accept the view that public ownership and administration is, in itself, inefficient when compared to “market solutions,” but they have turned this into a kind of principle. The operating assumption is that any government program would be better run as a public-private partnership operating in an artificially created market. The truth is much the opposite.”

    He’s arguing against the method by which elite democrats have approached piolitics (through expert design and implementation of policy) rather than through politics (organising l/t political constituencies, interest groups..pushing back against market centric solutions) which is also a topic raised around here, *a lot*

    So you can both be right, and both agree (in general)

    • brewmn

      This critique fails becuase it relies heavily on an assumption that both”neoliberals” like Obama, Clinton, et al. prefer public-private, quasi-free market solutions to direct government intervention and management. Obama is even on record saying that a single-payer system for healthcare would be preferable to Obamacare if we were starting from scratch.

      A more charitable explanation for this advocacy of neoliberal solutions would be that these politicians are trying to solve problems by any means necessary, and the imposition of large-scale, exclusively government-administered programs are politically impossible in the current political climate.

      Combined with the fact that this piece focuses exclusively on the failure of the website as a proxy for the shortcomings of the ACA as a whole make this piece worthles as political analysis. A “true progressive” would acknowledge that the ACA has already massively contributed to two political goals the left presumably supports: huge increases in the numbers of working poor eligible for Medicaid, and an significant decrease in the inflation rate for health care. That people like Gourevitch can’t even give Obama a tip of the cap for the good the law is doing should consign this tripe to the Firebag whingeing bin.

      • Ronan

        I agree that this piece might fail on its merits (that Obama doesnt *favour* the solutions that G-vitch assigns to him) but to do that the article has to be critiqued on what it’s actually saying.

        Health care reform was a lead in, a contemporary example of what G-Vitch see’s as the problem with the Democrat leadership, that they are tied with (and believe in) bi partisan technocratic solutions over mass politics

    • Kurzleg

      From the outside, it’s pretty hard to separate the motivations for policy choices from the political forces constraining policy choices. At the time, I thought it was politically shrewd to use a plan that had been offered by Republicans as an alternative to Clinton’s healthcare plan. It was entirely predictable that the current GOPers in Congress would reject it, which made them look pretty silly. It also very well could be the case that Obama preferred the ACA as superior policy to single-payer, and the fact that it made sense politically was just a happy accident. But it’s hard to prove the latter point beyond all doubt short of a post-presidency biography that explicitly documents it.

      • Lee Rudolph

        which made them look pretty silly

        except to 90% of the pundit class and some large percentage of the voters. Alas.

        • Kurzleg

          But enough so that Obama could be re-elected. May not have been the determining factor, but it played a role. Certainly put Romney in a difficult position.

          • djw

            There’s no particularly good empirical or theoretical reason to think this had a discernable impact on the actual election outcome–certainly not enough to think without it the outcome would have gone the other way.

            • Kurzleg

              I should have worded both points differently and said that using a GOP plan gave Obama the rhetorical and factual high ground, which was helpful tool to one degree or another in his re-election campaign. It certainly limited the credibility of Romney’s attacks. Maybe this is just me viewing things through my partisan rose-colored glasses.

      • But you know what, it didn’t “make them look silly” in any realistic way. As far as I know neither the media nor their own voters took the slightest note of the hypocritical rejection by the Republican party of its own plan. They went seamlessly from the punitive, pro capitalist “mandate” to attacking the mandate as an attack on freedom and took that attack all the way to the supreme court and no one said boo.

        • Kurzleg

          I don’t agree that “no one” said boo. The point may not have been made as prominently as we’d like by pundits, but it was made, and was certainly made in the 2012 campaign.

          • mpowell

            I agree with Kurzleg. Did it swing the election 5 points? No. But 0.2 or 0.3 pts? It really is true that if the Republicans were not so crazy more people would vote for them. And this is part of their being crazy. These things add up. I’m not sure where this ranks in the pile.

      • Ronan

        “But it’s hard to prove the latter point beyond all doubt short of a post-presidency biography that explicitly documents it.”

        Yeah, I agree. But I think it’s more general than that, he’s saying Obama is another in a long line of elite Dems who have bought into this narrative (so the problem is amongst a branch of progressivism, rather than one individual)

        • Kurzleg

          There’s some truth to notion that “moderate Dems” tend to favor “market-based” solutions, and Obama may be amongst them. However, I don’t think the ACA alone is the best example to use. If he’d included Arne Duncan’s appointment to the Dept of Ed – an implicit endorsement of charters/vouchers/”teacher accountability” – then he’d have a stronger argument.

      • Sharon

        Or you could read Brad DeLong and what he has to say about the reasoning behind a lot of domestic proposals in the Clinton and the Obama administrations.

        • joe from Lowell

          What particular knowledge would Brad DeLong have of the internal thinking of the Obama administration?

          Seems more likely he’s taking his insight into the Clinton administration and assuming the Obama administration is the same.

      • Davis X. Machina

        But it’s hard to prove the latter point beyond all doubt short of a post-presidency biography that explicitly documents it.

        We don’t need to wait for the biography, because we’ve got DailyKos today.

    • Scott Lemieux

      My update addresses the point. If Obama just inherently hates government solutions the ACA is inexplicable, particularly since it’s the most statist viable policy.

      • gmack

        A couple of notes, however:

        (1) For reasons you would likely appreciate, Scott, I find this particular sub-thread a bit misguided. The question most of the commenters are discussing has to do with whether Obama or the “neo-progressives” (better or worse than “neoliberal”? I’ll let the reader decide!) really want “statist” solutions or whether such solutions are imposed upon them by current political realities. My answer is: who cares? The critique of the contemporary Democratic party ought not to be (although it surely is, too often) that they are a bunch of immoral sell-outs who have some sort of idiotic ideological commitment to public-private partnerships. Such a critique is ultimately too moralistic–too focused on what is in Obama’s heart, or what his personal ideological beliefs are. It is (or perhaps rather, ought to be) that the discourse has, for whatever reason, shifted so that now these sorts of market-based solutions are the only ones that are taken seriously by current elite political actors. If so, then what is needed is not just the Steinmo-esque new institutionalism* but also a broader critical analysis of how the current range of “thinkable” solutions has been constituted.

        (2) If I’m right, then I think Ronan’s point still stands. Gourevitch simply has a different target of analysis. While it’s true that his critique tends to move in the “moralistic” direction I mentioned in my first point, I think it’s possible (and generally a good idea) simply to glide past that to ponder what I take to be his main question, namely, why is it that there is so much tendency among certain political elites to disdain politics and what effects this effort to “rise above” politics produces. Again, I’ll emphasize that I’m not sure whether it makes sense to link Obama’s behavior in producing the ACA to that tendency, but I think his approach can help see things that institutional analysis might not.

        *For non Political Scientists, Scott is adopting a fairly standard approach to the explanation of political outcomes, new institutionalism, which holds that the design of institutions–for instance, whether one has a parliamentary or presidential system–does most of the explanatory work in helping us understand the laws produced. My suggestion is that this approach be linked to an analysis of the rise of new strategies of governing and the discursive shifts that have attended it. One example of this (not that I endorse it fully) would be Nikolas Rose and Peter Miller’s Foucault-inspired investigations of how the idea of “society” (and the notion of “social solutions” to its problems) has given way to the concept of “community,” etc.

  • I wasn’t able to find confirmation quickly, but I believe that the NHS also involved compromises with entrenched interests (e.g., the GPs).

    Politics? How does it work!

    • sibusisodan

      Nye Bevan, the man, the legend, said of GPs on the formation of the NHS that he had ‘stuffed their mouths with gold’.

      • The Jewish People

        Bevan was in a much better position to implement radical change in the healthcare system than Obama was. His party had an extraordinarily large majority, were more ideological unified, faced no procedural hurdles like the filibuster, and the UK was basically in tatters after WWII, which meant that starting from scratch was an option. There was no health insurance industry that was rich and providing employment for millions of people. Even with all of these advantages, the British equivalent of the AMA was enough of a threat to almost destroy NHS before it was born.

        • LeeEsq

          That was me.

          • Hogan

            Aw. I thought for once I was going to agree with the Jewish people.

          • Malaclypse

            I was wondering how long your secondary nym was going to last. Not that I’d ever make that sort of mistake myself, of course.

            • LeeEsq

              I just used it because it made for a good joke durign the latest truther thread.

  • Josh G.

    Once we concede that zero Republican votes was the maximum for the ACA, then every single conservative Democratic senator has a veto.

    Of course, this assumes no filibuster reform. In retrospect, getting rid of the filibuster was and is one of the most important prerequisites to any meaningful progressive change.

    • Manny Kant

      But there weren’t 50 votes for filibuster reform, either. There *still* aren’t 50 votes for getting rid of the filibuster for legislation.

      • panda

        There is a circularity to this argument: filibuster reform in 2008 required the votes of the 10 most conservative Democratic senators, the same 10 senators a filibuster reform would have defanged.

        • Malaclypse

          Not quite. With 60 Democratic senators (in 2009, which I’m assuming you mean), filibuster reform could have ignored 10 Democratic senators, as long as they had the 11th-worst plus Biden on board.

          Of course, they would not have gotten the 11th-worst.

          • panda

            Theoretically speaking, that’s true. However, I seriously doubt any senate majority leader would use a VP vote to change Senate rules. Separation of powers and institutional coherence tend to matter to people who spent enough time in Senate to get to that kid of a position.

      • NonyNony

        There *still* aren’t 50 votes for getting rid of the filibuster for legislation.

        This bears repeating. In bold face type. I’d stick a blink tag around it if I thought it would help.

        After 5 years we’ve reached the point where the Democrats in the Senate have conceded that Republicans can’t be trusted with the filibuster for executive appointments. If the Democrats could manage to hang onto the Senate and the White House, it would probably take another 5 before they finally concede that Republicans can’t be trusted with the filibuster on legislation either.

    • djw

      Agreed. Obama should have pushed the red “end filibuster” button located under his desk in the oval office in January 2009.

      • Hogan

        Or just gotten Reid and McConnell into his office and told them to cut the bullshit.

        • Pat

          Cause all it takes is the exercise of Presidential Will to make bullshit disappear…..

      • Davis X. Machina

        Staples still makes those?

        • Hogan

          They’re great stocking stuffers!

    • Scott Lemieux

      Of course, this assumes no filibuster reform.

      A most reasonable assumption, given the fact the filibuster existed at the time, and there was nothing Obama could do to get rid of it. And as another commenter notes, there still aren’t 50 votes to eliminate it for legislation.

    • joe from Lowell

      “Once we concede that zero Republican votes was the maximum for the ACA, then every single conservative Democratic senator has a veto.”

      Of course, this assumes no filibuster reform.

      Problem is, that’s something else every single conservative Democratic senator had a veto over.

  • JC

    This is my response to the people who argue that we should have gone with a single-payer system in 2010.

    • Davis X. Machina

      It’s good to see you bring the principle of charity this debate — you’re a better man than I am, JC-Din. I’d have used another word, or words, entirely.

  • Anonymous

    Economists and political scientists seem to use models of politics that are so simplistic I sometimes believe their shoes must be all Velcro.

  • The Jewish People

    I can’t link to it right now but the New Republic had a good article on why Medicare for All would be much easier for the Republicans to beat than the ACA. For the reasons that REA pointed out and above, Medicare for All would require some very radical changes that would effect millions of people involved in the healthcare industry, costs lots of money to implement and change federal-state legislations.

    Single-payer advocates never wrote a model bill to show us how to implement it.

    • Davis X. Machina

      There is actually a bill — but none of the other problems are addressed by anything beyond hand-waving of industrial strength.

  • DAS

    I understand that there are limits to the bully pulpit and that Obama operated within political constraints and learned from Clinton’s mistakes with health care reform. Certainly Obama was correct to push the general policy of health care reform and let Congress do its job and actually draft the legislation.

    That being said, there were a few things Obama should have done differently:

    (1) Of course, pragmatic democrats promising technocratic leadership should get the technology right!

    (2) Obama has a distressing tendency to want “deals” and to “get things done” rather than being concerned about the actual results. The most atrocious example was with one or other of the debt ceiling/budget negotiations where you heard someone from the admin (usually Geithner) on the radio every day emphasizing the importance of making a deal without every really indicating what the admin wanted that deal to look like. But with health care, while Obama was correct to not get into the details, he should have indicated clearly (and publicly) a strong “opening offer”. For all his love of making deals, Obama clearly does not know how to negotiate nor does he surround himself with people who do.

    (3) When all was said and done, Obama did very little to publicize what the ACA would mean concretely to people in various situations. Some of the calculators associated with the “infamous” website should have been made available even while the details were being worked out so people would have a rough idea of how the law would affect them. If people were not so nervous about what would happen to their health care, they would be more willing to accept the ACA. I remember one particular reform involving the doughnut hole being publicized when it would first have an effect — during open enrollment season in 2012. AFTER THE 2012 election! Why wasn’t this concrete benefit publicized BEFORE the election?

    (4) Obama’s team should have been ready for insurance companies’ using the law as an excuse to jerk around their customers. Heck, insurance companies did this with Clinton’s health care reform efforts (“we need to deny your claim, because … HillaryCare”), and HillaryCare wasn’t even passed into law. Why wasn’t Obama’s team prepared for insurance companies’ canceling plans and changing networks while they still had a chance to do so in advance of the ACA’s reforms coming into effect?

    As my wife put it: Obama has spinach in his teeth in re the ACA (policies being canceled, the website problems), and shouldn’t a president have someone to tell him that he has spinach in his teeth?

    • panda

      1) Is absolutely true. Obama’s management failure on this one is inexcusable.
      2) Is problematic, a) Obama did lay out the general parameters of what he wanted (for example in the public option fight, he declared he supports it, while clearly signalling he can live without it.) Those parameters might not be what you wanted, but when push came to shove, he insisted on not retreating from the legislation. Additionally, while it’s true that Obama uses the rhetoric of compromise incessantly, which bad deals (with the possible exception of the 2011 debt ceiling one), did he sign?
      3) The marketing associated with the law could have been better, but I think you are being way to appreciative of the ability of the American people to be appreciative of benefits that don’t exist yet. When it comes to the donut hole, my guess is that the people who did the polling for the Obama campaign decided that the elderly were more or less a lost cause in the short term, hoping they will come around when the death panels fail to materialize. Given that the elderly are very marginal to the success of the law itself I think it was, on the balance, a defensible omission.
      4. As for the changed plans, I strongly suspect that the Obama administration viewed the cancelled plans as a good things, part of a streamlining of the individual insurance market. The big assumption they made is that the people on those plans will have a smooth transition to exchange plans. Thus, when the technology failed, the administration was left with a bag of dog poo in its hands.

      • panda

        What I am trying to say, in short, is that point 1 is the crux of the matter. Had the technology been working in October, point 2-4 would be academic.

      • Brien Jackson

        I’d go further than that on number (2) and say that it’s just a flat out ridiculous way to think of Senatorial ego. There were at least 5-10 Senate Democrats, including conservative ones like Max Baucus, who had been seriously working on healthcare reform for years before anyone outsiide of Chicago had even heard the name Barack Obama. What’s more, a decent number of those Senators felt (probably not unfairly) that Obama owed them for endorsing him over Clinton in the 2008 primaries. The idea that Obama was just going to walk in and start making demands of these people in 2009 and they were going to roll over and do whatever he asked is absurd.

        • djw

          Indeed. For pretty much every version of “Obama screwed this up, he could have done X and it would have worked out much better,” X involves deep ignorance or denial about the state of the Senate.

          • panda

            “Our job is not to read about how the Senate works. Our job is to write about how the Senate should work.”

          • ericblair

            This goes for the website as well. The sort of process-free hiring and firing of contractors without congressional approval that gets tossed around as Monday morning quarterbacking is exactly the kind of thing the Federal Acquisition Regulations is intended to prevent. Usually in the project of this magnitude you could use Congress for course correction, by reallocating money, tweaking the law, and the like. Here that was politically impossible.

            • panda

              On that one, I wouldn’t be so easy on Obama. If he could appoint an administration point man and the point man could appoint a general contractor after the failure in October, why didn’t this happen earlier? How much did Obama know about the development process, if he didn’t know enough, whose fault was it? There really was a major managerial failure here.

              • Pat

                And if Congress had actually authorized any real money for the website instead of trying to throttle it in its cradle, there might have been people around to do this sort of thing.

                • panda

                  Maybe, but the fact is that the money/organizational wherewithal to fix the website was found in October-November without any Congressional action. Now, the point could be made that the Republican jihad against the law made officials wary of highlighting any problems at all, but that hardly explains the entirety of the rollout issue.

                • Hogan

                  So they were able to move money around at the very beginning of the fiscal year? But not at the end? What a surprise.

    • Scott Lemieux

      (1) Of course, pragmatic democrats promising technocratic leadership should get the technology right!

      As I said, we agree.

      (2) But with health care, while Obama was correct to not get into the details, he should have indicated clearly (and publicly) a strong “opening offer”. For all his love of making deals, Obama clearly does not know how to negotiate nor does he surround himself with people who do.

      He opened with a more progressive offer than what passed. People who think that a completely empty threat to enact single payer would have been better strategy really shouldn’t be lecturing others about negotiating strategy. Empty threats don’t provide leverage.

    • joe from Lowell

      But with health care, while Obama was correct to not get into the details, he should have indicated clearly (and publicly) a strong “opening offer”. For all his love of making deals, Obama clearly does not know how to negotiate nor does he surround himself with people who do.

      Odd, then, that he got health care reform passed, while every single person who tried it the way you suggest failed.

      • Scott Lemieux

        Odd, then, that he got health care reform passed, while every single person who tried it the way you suggest failed.

        Again, Clinton following the brilliant negotiating strategy that Obama allegedly should have used and crashing and burning always goes straight down the memory hole, even when people are aware of it.

  • Bloix

    Obama handed over control of his signature bill to Max Baucus, who wasted over a year in Finance Committee negotiations in a failed effort to obtain the support of Grassley, Enzi, and Snowe. During that time, he took no personal responsibility at all for the bill. The effort to get the Republican votes was not an attempt to get “token support” – it was an effort to present a bi-partisan plan, and it was a mistake. During that time, he allowed Baucus to give away the public option and got nothing in return.

    Here’s how Ezra Klein reported it in July 2009:

    “This is who is in the room helping Baucus put together his bill. Olympia Snowe, Mike Enzi, Chuck Grassley, Jeff Bingaman and Kent Conrad. In a Senate of 60 Democrats and 40 Republicans, the health-care reform bill is being written by three centrist Democrats, one centrist Republican, and two conservative Republicans… And there’s not a liberal — or even a Democrat traditionally associated with health-care policy — working on it. Jay Rockefeller, chairman of Finance’s health subcommittee, is not included in the negotiations. Nor is Ron Wyden, who has written the Healthy Americans Act. Chuck Schumer isn’t in the room, nor is John Kerry, Debbie Stabenow or Maria Cantwell.”
    http://voices.washingtonpost.com/ezra-klein/2009/07/the_max_baucus_committee.html

    And here’s what the NYT had to say:

    “Already, the group of six has tossed aside the idea of a government-run insurance plan that would compete with private insurers, which the president supports but Republicans said was a deal-breaker.”
    http://www.nytimes.com/2009/07/28/us/politics/28baucus.html?_r=0

    A deal-breaker. How clever to give it up in exchange for all that Republican support.

    So yes, it’s a Republican plan – devised by the Heritage Foundation, implemented by Romney in Massachusetts, and then adapted for the country as a whole by a group of conservative Dems whose main goal was to please a group of moderate Republicans, who then voted against it.

    It’s failures are not failures of technocratic liberalism. Social Security is technocratic liberalism and that works. This thing is a kludge that is better than what came before but is not liberal in any sense of the word.

    Not to mention that the major problems with it stem from a unified effort by Republican governors to make it fail. Oh, but that couldn’t have been foreseen either, because everyone expected that the Republicans would act in a responsible, bio-partisan way for the good of the country.

    • NonyNony

      The effort to get the Republican votes was not an attempt to get “token support” – it was an effort to present a bi-partisan plan, and it was a mistake. During that time, he allowed Baucus to give away the public option and got nothing in return.

      He got Baucus to support the bill. That was the entire point of leaving it up to the Democratic majority in the Senate – to get the Democrats to support the goddamn bill.

      If Obama had done what you propose, it would have been tanked by the conservative wing of his own goddamn party. That time was needed to convince Baucus and his cohorts to get on the train. Letting Baucus tilt at the GOP windmill was for Baucus’s benefit. (though when it all started it was still not obvious that Snowe, for example, couldn’t be persuaded.)

      • Brien Jackson

        This is giving him too much credit. Obama didn’t “hand over” control of anything to Baucus, Baucus chaired the Finance committee, which gave his jurisdiction over huge parts of the process if he wanted it.

        • LeeEsq

          This. Even if Obama’s cabinent still drafted a model bill for Congress to pass, our system of government gives Congress a tremendous amount of power to alter the proposed bill and the only think Obama can do if he doesn’t like the changes is veto the finished product. Once a bill is in Congress, the President basically has no control on how Congress goes about passing it.

          • Bloix

            I understand that. But Obama let Baucus play out the string long after it was obvious to any impartial observer that there wasn’t going to be any Republican support. He put no pressure on Baucus to report a bill out because he trusted Baucus to obtain bi-partisan support on Baucus’s say-so, even when it was clear that Baucus could not be trusted to see what was going on.

            What you’re arguing is that something much deeper was going on: that the Times, Klein, etc misunderstood what was happening and that Baucus tanked the public option because Baucus himself didn’t want it, but he used the Republicans for cover, and that Obama let him do it in order to obtain a passable bill. Well, perhaps that was the 11-dimension chess game that was going on. But you don’t quote anyone who thought so at the time and it’s not how I remember it.

            Baucus himself said he supported the public option, http://www.huffingtonpost.com/2009/08/24/baucus-declares-that-he-w_n_267307.html.

            In contrast, Obama walked away from the public option. He never put any pressure on anyone to vote for it, going so far as to deny that he ever campaigned for it (a lie, see http://thinkprogress.org/politics/2009/12/22/74682/obama-repeatedly-touted-public/)

            So your argument is that everything that appeared to be happening wasn’t really happening, and that no one except you really understands what happened.

            • Brien Jackson

              I think you have this backwards. I’m arguing that the guy who chaired the most powerful committee in the Senate and who has jurisdiction over both revenue generating measures and Medicare exercised his legislative authority as he saw fit. You’re arguing, it would appear, that Obama was manipulating this very powerful Senator behind the scenes. *You* would seem to be the one arguing that everyone else can’t see what was *reallly* going on.

            • brewmn

              I understand that.

              No, you don’t.

            • Scott Lemieux

              I understand that. But Obama let Baucus play out the string long after it was obvious to any impartial observer that there wasn’t going to be any Republican support.

              Of course he did. Letting Baucus play out the string was crucial to getting the votes of conservative Democrats.


              Baucus himself said he supported the public option

              Sadly, I think you really are taking this at face value.

              In contrast, Obama walked away from the public option. He never put any pressure on anyone to vote for it…

              Which is entirely sensible, given that the chances of it getting 60 votes were 0%. Presidents who know what they’re doing don’t pick fights with legislators for nothing.

              • Bloix

                “Letting Baucus play out the string was crucial to getting the votes of conservative Democrats.”

                Yes, that’s the 11-dimension chess argument. Liberals at the time, including Tom Harkin, didn’t see it that way.

                http://thehill.com/homenews/house/80315-congressional-dems-point-finger-at-rahm

                Nancy Pelosi and Chris Van Hollen, who were absolutely key in the parliamentary maneuvering that got the ACA passed after the administration had allowed the bill to drift until Scott Brown took away the veto-proof majority in the Senate, didn’t see it that way:

                “Nancy Pelosi kept pressing the White House to stop dealing with the Republicans. “It’s never going to happen,” a Democratic official quoted her as saying. “Grassley’s just going to wait you out and then pull the rug out from under you.” Representative Chris Van Hollen [said], “Some of us concluded much earlier than the White House that Senator Grassley and the two other Republicans had clearly made a decision that they were not going to participate in a meaningful way at the end.””

                http://www.nytimes.com/2010/03/14/magazine/14emanuel-t.html?pagewanted=all

                So maybe you’re right. Maybe Obama was playing a deep game in which he pretended to want a bi-partisan bill in order to keep the conservative Dems in line. Maybe he was so deep that pikers like Pelosi and Van Hollen and Harkin couldn’t understand what was happening. But it would be nice to see some evidence.

                • Bloix

                  Excuse me, not ‘veto-proof’ – filibuster-proof, obviously.

                • Scott Lemieux

                  Um, you’re not actually contradicting my point. I agree that if the point of letting Baucus go on was to win Republican votes, it was futile. But that wasn’t the point.

            • Murc

              But Obama let Baucus play out the string long after it was obvious to any impartial observer that there wasn’t going to be any Republican support.

              How could he have stopped Baucus from doing that? Please be specific.

              He put no pressure on Baucus to report a bill out

              Max Baucus has a shitload of seniority, many allies in the caucus, his own powerful political machine and completely independent funding streams in his home state of Montana, a state which Barack Obama lost by quite a large margin. And he was already at the time probably considering retirement. Neither Barack Obama nor Harry Reid can make Max Baucus do shit.

              How, precisely, could Obama have put effective pressure on Baucus that would have worked? Or, hell, I’ll spot you that one; how could Obama have put even ineffective pressure on Baucus that he was sure wouldn’t cost him Baucus’ essential vote?

              Please be specific.

              • Bloix

                He could have gone to Baucus and said, Max, face it, this isn’t working. We need you to report a bill out of committee by X date. Pelosi needs it, the party needs it, I need it.

                Obama never did that. He never showed a moment’s doubt in Baucus. He had Baucus’s back for the whole year.

                Now, if the President had said, it’s time, Max, Baucus could have said, fuck you, Mr. President, fuck you and Pelosi and Harkin too, I’m the boss and I’m going to keep working to get Republican support for this bill whether you want it or not. But why would he have done that? Are you arguing that Baucus was in on Obama’s deep game? What’s your reason for thinking that Baucus wouldn’t have worked with the President to move the bill?

                You may not remember that after Coakley managed to lose Ted Kennedy’s seat in Massachusetts, Obama was willing to walk away from health care. It was Pelosi would managed to get it through without the need for another Senate vote. The only reason she was put in the position of having to rescue Obama’s “signature bill” was that Baucus was not pressured to move more quickly. Obama was unlucky in the incompetence of Coakley as a candidate, but Kennedy’s death was long foreseen and the possibility of a bad result in Massachusetts was always clear. He was extraordinarily lucky that the ACA did not fail in the spring of 2010.

                • djw

                  He could have gone to Baucus and said, Max, face it, this isn’t working. We need you to report a bill out of committee by X date. Pelosi needs it, the party needs it, I need it.

                  Let’s say you’re Obama in this hypothetical conversation. Baucus says “Look, you can do this my way, or you can try and do it without my support. Up to you.” What’s your next move?

                  Now, if the President had said, it’s time, Max, Baucus could have said, fuck you, Mr. President, fuck you and Pelosi and Harkin too, I’m the boss and I’m going to keep working to get Republican support for this bill whether you want it or not. But why would he have done that? Are you arguing that Baucus was in on Obama’s deep game? What’s your reason for thinking that Baucus wouldn’t have worked with the President to move the bill?

                  If he really wanted to do that, why did he need to wait for Obama to ask him?

                • Scott Lemieux

                  He could have gone to Baucus and said, Max, face it, this isn’t working. We need you to report a bill out of committee by X date. Pelosi needs it, the party needs it, I need it.

                  1)Why would you think that would work, and 2)even if it did, how would it have changed the content of the bill? You still need Lieberman and Nelson and Bayh and there’s still no way in hell they’re voting for a public option.

                • Scott Lemieux


                  If he really wanted to do that, why did he need to wait for Obama to ask him?

                  For the same reason that his Deep Commitment to a public option managed to never find its way into any of his legislative proposals.

                  I’m always amazed at the number of people who think that being a real tough-minded lefty means being willing to buy Montana oceanfront property from greasy conservative Democrats.

                • Scott Lemieux

                  Obama was willing to walk away from health care.

                  Cites, please? Emmanuel was, but Obama disagreed with him. And according to the PBS doc, at that stage Obama was pushing Pelosi more than the opposite.

                • Murc

                  He could have gone to Baucus and said, Max, face it, this isn’t working. We need you to report a bill out of committee by X date. Pelosi needs it, the party needs it, I need it.

                  Obama never did that.

                  You don’t know that.

                  Now, if the President had said, it’s time, Max, Baucus could have said, fuck you, Mr. President, fuck you and Pelosi and Harkin too, I’m the boss and I’m going to keep working to get Republican support for this bill whether you want it or not. But why would he have done that? Are you arguing that Baucus was in on Obama’s deep game? What’s your reason for thinking that Baucus wouldn’t have worked with the President to move the bill?

                  Isn’t it more likely that Max says, “With all due respect, Mr. President, I disagree with you. This plan needs bipartisan support in order to have any kind of legitimacy, and you haven’t given me enough time with the Republicans. If I pull the plug now, my credibility is shot and you get zero Republican votes. You may not even get my vote; this hydra-headed monstrosity we’re cobbling together ain’t real popular with the folks back home. Frankly, I’m not that sure about it myself, but I recognize the need for reform and it isn’t like you went with some sort of commie option like single payer.”

                  Max Baucus is a conservative Democrat. He has certain ideological preferences beyond just political ones. He wouldn’t have worked with Barack Obama to move the bill if Obama hadn’t given him his head because it would have offended his sense of propriety and his policymaking preferences.

            • joe from Lowell

              But Obama let Baucus…

              No. Baucus did not require Obama to “let” him do anything.

        • Scott Lemieux

          This is giving him too much credit. Obama didn’t “hand over” control of anything to Baucus, Baucus chaired the Finance committee, which gave his jurisdiction over huge parts of the process if he wanted it.

          Right. The “handed over” formulation is silly.

    • joe from Lowell

      Obama handed over control of his signature bill to Max Baucus,

      Actually, he handed it over to Harry Reid and Nancy Pelosi. Reid handed it over to Baucus.

      who wasted over a year in Finance Committee negotiations in a failed effort to obtain the support of Grassley, Enzi, and Snowe.

      Yes. And letting Baucus do this was the cost of getting Baucus’ vote.

      The effort to get the Republican votes was not an attempt to get “token support” – it was an effort to present a bi-partisan plan, and it was a mistake.

      Yes: Baucus’ mistake.

      During that time, he allowed Baucus to give away the public option and got nothing in return.

      Neither the President, nor the Senate Majority Leader, “allows” the Chairman of a major Senate committee to do, or not to do, squat. The Senate isn’t the House. The Chairs get to do that if they want to.

    • Malaclypse

      So yes, it’s a Republican plan – devised by the Heritage Foundation, implemented by Romney in Massachusetts

      If anybody thinks Romney would have done this without Robert Travaglini’s veto-proof majority, I’d like to play poker with them.

      • joe from Lowell

        I think it’s touching the way Bliox takes the Republicans at their word.

        Hey, the Heritage Foundation cooked this up during the Hillary Care fight, and some Republicans said they wanted it instead of Hillary Care, but then they never adopted it when they had the chance, and opposed it when it came up.

        So, you know, Republican Plan.

        • Bloix

          It was devised by Republicans and passed by a Republican administration in Massachusetts. It only became anathema to Republicans when it was adopted by a Democratic administration.

          Look, you’re playing games here. Of course the Republicans oppose it now. Nobody is arguing to the contrary. They oppose it because Obama is for it, not because they have any problems with it ideologically.

          Why did Obama adopt it? It wasn’t what he campaigned on.
          http://equitablegrowth.org/2013/12/02/1011/why-did-obama-deviate-from-his-primary-campaigns-david-cutler-hundred-flowers-no-mandates-health-care-reform-plan-anyway

          He adopted it because he thought, touchingly, that it would attract enough Republican support that he could get it through. You may also remember that his big selling point was not universal care – it was cost control – bending the curve, something that would appeal to Republicans. That’s what he said, anyway.

          http://www.whitehouse.gov/the-press-office/remarks-president-barack-obama-address-joint-session-congress

          http://www.whitehouse.gov/the-press-office/remarks-president-after-meeting-with-senate-democrats

          Obviously politicians lie. But what you have to believe, in order to conclude that Obama was on top of the process all along, is that everyone was not only lying but clueless, and that only Obama (not even Rahm Emanuel!) understood what was really going on. This is magical thinking.

          • joe from Lowell

            It was devised by Republicans and passed by a Republican administration in Massachusetts.

            Actually, it was passed by a ridiculously lop-sided Democratic legislature in Massachusetts, with the support of Ted Kennedy. You really don’t know anything about Massachusetts politics, do you?

            Of course the Republicans oppose it now. Nobody is arguing to the contrary. They oppose it because Obama is for it, not because they have any problems with it ideologically.

            The Republicans opposed it every single day they controlled Congress, from their election in 1994 through 2006.

            He adopted it because he thought, touchingly, that it would attract enough Republican support that he could get it through.

            Fixed that for you. He needed Lieberman, he needed Baucus, he needed Specter.

            Obviously politicians lie.

            But not Republicans! When they say they support a health care plan, we should take them at their word. Just not those terrible Democrats.

            everyone was not only lying but clueless

            The only clueless one here is the fellow who doesn’t realize that Obama needed to get conservadems, not Republicans, to pass a bill when the Senate had (nominally) 60 Democrats.

            • Hogan

              You really don’t know anything about Massachusetts politics, do you?

              Or Massachusetts government. Or, really, government.

          • Scott Lemieux

            He adopted it because he thought, touchingly, that it would attract enough Republican support that he could get it through.

            No, he adopted it because the scheme wouldn’t work without the mandate and when he said otherwise during the primaries he was pandering.

      • Scott Lemieux

        Oh, Christ, I missed that piece of gullibility. It’s amazing that Republicans only favor the “Republican health care plan” when a veto-proof majority of liberal Democrats puts it on their desk!

        The Heritage Foundation guy I debated about the ACA sure seemed confused about the Heritage Foundation’s actual preferences on health care policy….

        • Bloix

          Look, a Republican governor actually enacted the plan into law. The Heritage Foundation really did devise the priniciples of the law. Massachusetts is a real place and Romney was a real Republican. There’s nothing gullible about pointing out the reality of Romneycare. Obviously it was a Republican plan in opposition to a Democratic plan. But it was a Republican plan.

          The Heritage Foundation today, of course, is not the Heritage Foundation of the early 1990’s. It, and the entire Republican party, have moved far to the right since then.

          So what you’re arguing is that to be a Democrat today means to be about where the Heritage Foundation was in the 1990’s. That’s pretty sad, but you may be right.

          • Scott Lemieux

            Look, a Republican governor actually enacted the plan into law.

            It would have been enacted into law whether he signed it or not, making the Republican governor the lead actor rather problematic. Where has a unified Republican government passed the “Republican health care plan” into law? Why isn’t this much better described as a “liberal Massachusetts Democratic” plan?

            The Heritage Foundation really did devise the priniciples of the law.

            Yes, but as anyone with the slightest sophistication about American politics understands, that’s meaningless in context because it was a decoy. Republicans controlled the government for most of the 2000s — did the HF ever advocate that Republicans pass it? Did they offer it to Clinton as a counter? If not, it’s not a “Heritage Foundation” plan in any meaningful sense.

            So what you’re arguing is that to be a Democrat today means to be about where the Heritage Foundation was in the 1990′s.

            This is plausible, if you’re also naive enough to think that Max Baucus was a big fan of the public option. By the way, when has the Republican Party favored massively expanding Medicaid? Cites please!

          • Malaclypse

            Massachusetts is a real place and Romney was a real Republican.

            And the MA Senate really was 35-5 Democratic, and the MA House really was 139-21, and Romney really did veto parts of the law, and most of those vetoes really were overridden.

            You could, as they say, look it up.

          • djw

            Look, a Republican governor actually enacted the plan into law.

            In a context in which he had virtually no power to stop it, and there was considerable momentum for universal health care in the veto-proof Democratic majority legislature, and in a movement to put an expanded coverage plan on the ballot. Romney vetoed 8 parts of the bill to make it more corporate-friendly, they were all overridden. What happened in Massachusetts was primarily the product of public pressure, the sheer size of Democratic majorities, and the priorities of Democratic leadership. Associating Mass HCR in 2006 primarily with Romney is ‘cult of the executive’ nonsense.

  • Manta

    Doesn’t your analysis treat the filibuster as something impossible to repeal?
    If I’m not mistaken (correct me otherwise), getting rid of the filibuster would not have required the vote of Joe Lieberman.

    Keeping the filibuster was the way to ensure that “medicare for all” would be out of the possibilities: but keeping the filibuster was a political choice too, not some law of nature.
    In other words: a Democratic party that wanted medicare for all would have got rid of the filibuster; a Democratic party that wanted Obamacare instead would have kept it.

    • LeeEsq

      Even without the filibuster, there were not enough votes for Medicare for All in the Senate or even possibly the House. I also think that you are really underestimating how complicated it would be to extend medicare for to all Americans. It would be a lot harder than simply writing a short bill saying that Medicare is now available to all Americans.

      As Rea pointed out, the health insurance companies provide employment for millions of people. Medicare for All would have led to a lot of unemployment and since the economy was weak, there would be little chance of them getting new employment. The expanded Medicare could not provide employment for all those displaced. When you get rid of health insurance companies, you are causing pain to more people than there CEOs and directors. Its why the auto industry needed to be bailed out or the big banks, too many people would suffer otherwise.

      Expanding Medicare to cover every American would require a lot of new funding and this would require new taxes or increased taxes. It would require a complete restructurig of the existing program to cover hundreds of millions of people and procedures that never had to be covered before.

      • panda

        All this, and the cuts a Medicare for all would impose on the healthcare system (clerical staff cuts in doctor’s offices, lower reimbursement rates across the system, etc), while beneficial in the short run, would be HUGELY disruptive in the short term. That is not to say that a limited extension of Medicare, say for people over 55 with preexisting conditions, would not have been a great idea. Unfortunately, Joe Lieberman took care of that.

      • witless chum

        I think that was the concept for the public option. A way to ease more and more people gradually from private insurance to publicly-funded insurance. People would realized slowly that it was obviously a better, more efficient deal and switch over slowly, letting the health insurance and related industries contract slowly and naturally.

        • panda

          I don’t know. The public option would be part of the individual market, operate under the same general principles insurance companies work under, and be sold on the same exchanges the insurance products are sold under. I am not very convinced it would be perceived as a anything different than another insurance company, for better or worse.

          • joe from Lowell

            It would be perceived as better if it was, in some substantive way, better.

            I think it would be. Lower premiums, better service.

            • panda

              Possibly, but the public option would still be using the actuarial principles, reimbursement strategies, and IT infrastructure of the insurance corporations. Besides being non profit, and thus, in theory,having less overhead, I don’t see how a public option would be radically different from a strongly regulated insurance corporation in a blue state in a post-ACA world.

          • Pat

            And this is why it is still viable. I think that the “death of the public option” is pretty silly when liberal Northeast states can get waivers to implement a version on their health care markets. Get the ACA running, and put your public option in on a state-by-state level.

    • Incontinentia Buttocks

      There are also weren’t enough votes to get rid of the filibuster.

    • joe from Lowell

      Keeping the filibuster was the way to ensure that “medicare for all” would be out of the possibilities: but keeping the filibuster was a political choice too, not some law of nature.

      Right, “keeping the filibuster” and “eliminating the filibuster” are just two forks in the road, and the Democrats had both choices available in 2009. Sure they did.

    • Scott Lemieux

      Doesn’t your analysis treat the filibuster as something impossible to repeal?

      Well, it treats it as impossible to repeal in 2009 because it obviously was.

      If I’m not mistaken (correct me otherwise), getting rid of the filibuster would not have required the vote of Joe Lieberman

      Well, no, but there aren’t even 50 votes for it now.

      Keeping the filibuster was the way to ensure that “medicare for all” would be out of the possibilities:

      The filibuster wasn’t necessary to make single-payer impossible. Please enlighten me: who are the 50 senators who were plausible votes for single-payer in 2009?

  • Ronan

    My impression of the ‘presidential rhetoric’ narrative is that it’s more complicated than ‘the bully pulpit is not effetive’.

    This is what Amnon Cavari (apparently) finds:

    “Presidents move public opinion by “going public.” Challenging the scholarly consensus that presidents benefit little by speaking to the public, I show that presidential communications have a strong effect on Americans’ policy preferences—once we recognize that presidents may be seeking to shape the opinions of fellow partisans more than the general public. Presidential communications also play an important role in shaping public assessments of which party can best handle various policy challenges. Reversing the causal arrow common in the parties literature, I show that party reputations for competence determine long-term partisan attachments, rather than party identification driving assessments of competence. My data include responses to Gallup’s most important problem question from 1956 to 1999, content analysis of every major presidential address from President Eisenhower to President Clinton, and survey data of policy preferences on major policy initiatives of Presidents Reagan through Obama. Employing regression and time-series analyses, I reveal that actions of the presidents are not detached from the party system but instead drive the evolution of that system in important ways. ”

    http://cavari.wordpress.com/research/

    So by this argument, rhetoric can be effective within the Dems, which leaves room for the sort of politics G-Vitch is pushing (partisan, conflictual, with the Dems adopting a specific ideologial position)

    How would this work in this senario? “The flaws in the program are the result of compromise with Republians. The program would have worked as single payer” or some version thereof..

    • Davis X. Machina

      My data include responses to Gallup’s most important problem question from 1956 to 1999, content analysis of every major presidential address from President Eisenhower to President Clinton, and survey data of policy preferences on major policy initiatives of Presidents Reagan through Obama.

      George C Edwards looks at essentially the same data, and reaches the opposite conclusion.

      • Ronan

        Well two people disagree, in good faith !!

        • joe from Lowell

          Actually, many many many people – virtually the entirety of the relevant research community – disagrees with Cavari in good faith.

          • Ronan

            Once again Joe, it’s specifically on the effect that political rhetoric can have on partisans, so perhaps theres some nuance there.

            Now, i havent read his work and dont know the literature on this *at all*, i simply found it when looking for info on US attitudes towards Israel..so Im not standing over it. But what a non partisan response would say is ” oh, this looks interesting. Is it empirically supported? Does it deal sufficently with the counterarguments? Let me email Mr Cavari and see if I should update my priors”

            What the ideologue would say is, well..

            • joe from Lowell

              What the ideologue would say is, “I found a single study that backs up what my gut already told me, so I’ll link to that one and ignore everything else.”

              Psst. That’s you, Ronan.

              • joe from Lowell

                Well, you, and the global warming deniers.

              • Ronan

                No, b/c I couldnt care less about Presidential rhetoric. I have no investment in it. In fact, as far as it goes, I’d support the consensus, b/c thats what (knowledgable) people tell me is the case.

                But, I just didnt find your definitive, well it cant be true b/c *all* the (unspecified, unsourced) literature says X, convincing. Thats all.

        • djw

          In the published piece of that dissertation, he concedes Edwards is right about long-term effects of rhetoric being non-existent. His hypothesis is that presidential rhetoric might move opinion toward the president in the short term only, and pretty much only among those who directly observed the speech. His primary data for this is six speeches in the last 20 years that had polls immediately before and after the speech of the same respondents.

          It’s an interesting, if limited, finding, and certainly deserves continued attention. Maybe the unpublished portions of the dissertation contain much more. But it’s hardly enough to nullify the scholarly consensus that has emerged in the last 20 years, which is what you seem to want to do here.

          • Ronan

            I certainly dont want to nullify the consensus, that seems a hyperbolic interpretation.

            All I was saying is as per the G Vitch article , if there is space for presidential rhetoric to influence *partisans* could that help change the priorities *within* the Dem party. As I said throughout, I dont know the literature and havent read the dissertation, I was looking for clarification rather than making any definitive claims myself

      • Ronan

        does he look at how rhetoric effects ‘partisans’ rather than ‘the public’ as a whole?

        • Davis X. Machina

          Not in anything I have to hand, but I’m guessing Edwards’ “Barack Obama and the Strategic Presidency.” in Issues in American Politics: Polarized Politics in the Age of Obama, John Dumbrell, ed.. New York: Routledge (2013) does….

  • Crunchy Frog

    There is a difference between asking “In retrospect, how could the Obama’s team have done better on ACA?” and saying “Knowing what they did at the time Obama’s team screwed up ACA.”

    Certainly there are a ton of really good lessons to be learned from the passage and roll-out of ACA. Throw in the question of how the economic crisis was addressed and the causes of the 2010 election debacle and you have several books worth of lessons on how to do things better next time.

    But not every lesson-to-be-learned is something that a reasonable person would have known at the time. I do think some criticisms are valid. By mid-summer 2009 it was obvious that the GOP was engaging in delay tactics and that getting a GOP Senate vote was a lost cause. It was foreseeable that getting ACA passed sooner and off the table would be better for many reasons. By end-summer 2009 it was obvious that the stimulus was effective but insufficient, and that failure to put additional economic steps in place would risk bad economic conditions heading into the 2010 elections. Could anything have been passed at that point with the most conservative Senators? We don’t know because nothing was tried.

    But not every lesson-learned is valid criticism of what Obama’s team did at the time. Single Payer? Off the table. Public Option? The only way that had any chance at all would have been to try Rovian scorch-the-Earth arm-twisting tactics with the most conservative Senators and perhaps even a few House blue dogs. We can’t know if they would have worked, but once tried they would have made it difficult to work with those same congresscritters

  • joe from Lowell

    Every time health care reform has been tried Gourevitch’s way, the result has been catastrophic political failure and the delay of reform for a generation.

    The one time it was tried Barack Obama’s way, the bill passed both houses of Congress and was signed into law.

    So, clearly, what the first black person to win a Presidential election needs is a lecture from hugely successful political prodigy Alex Gourevitch about how politics and the legislative process work.

    • sibusisodan

      Well put.

      Trying and failing has consequences. The failure of Clinton’s healthcare bill took it off the legislative agenda for over a decade. That should be factored into claims that so and so didn’t even try…

    • Ronan

      “So, clearly, what the first black person to win a Presidential election needs is a lecture from hugely successful political prodigy Alex Gourevitch about how politics and the legislative process work.”

      Well, political scientist voices opinion on politics is pretty much built into the job description and professional norms

      • joe from Lowell

        …for certain definitions of “voices opinion on politics.”

        The bit about quoting Bill Galston and holding forth on a sweeping theory about why the Democratic Party is ideologically unreliable is not actually part of the practice of political science.

  • deadweasel

    Hi. I am one of the 50% of Americans disconnected from the political process, and I am thinking of rejoining it. I need some advice in which political party I should place my trust.

    My choices are the Evil Party, which knows exactly what it wants and will do anything to get it, and the Do Nothing Party, which doesn’t know what it wants, compromises endlessly with the Evil Party, gets nothing for its efforts, and then makes structural excuses for why failure was inevitable.

    Which one should I trust?

    I don’t like the Evil Party, but on the other hand, life is short, and I have no time to waste on failure.

    • Malaclypse

      Agreed. If only the Do Nothing Party could point to any actual substantive achievement, this would be a lot easier. Best to just complain, and advertize ignorance at the same time.

      • Rob in Buffalo

        +1

      • deadweasel

        You’re right. I forgot the monumental achievements of the Do Nothing Party. I must have been distracted by Jim Crow in 1898-1912, its spread to the Federal government under Wilson in 1916-20, the establishment of the Southern Bourbon oligarchy under FDR from 1932-40, the Cold War under Truman in 1948-52, the Kennedy’s subversion of the Civil Rights movement from 1960-63, LBJ’s War on Vietnam to split the Civil Rights movement from 1965-68, the total abandonment of the modern reform movement under the Reagan Democrats from 1980-88, welfare reform under Clinton, and the Wall Street bailout under Obama.

        I apologize for my neglect but in fairness, I should be able to blame structural obstacles.

        • Malaclypse

          Yes, I also am blissfully unaware that political alignments change over time. That’s why I hold Obambi and the Democrats of today responsible for the Trail of Tears. And I always, always, always agree with Manju.

    • tonycpsu

      Tell the millions of people who are getting insurance right now that they got “nothing” for the Democrats’ efforts. Better yet, try to take it away from them, since it’s “nothing.”

      • deadweasel

        It won’t be me, doing it.

        • Malaclypse

          We know. You are far too pure to vote for the dirty compromisers who actually accomplished something. And too lazy to vote against the party of active fucking Evil.

    • Murc

      I need some advice in which political party I should place my trust.

      On the off chance you’re at all serious, this is your problem right here.

      You shouldn’t trust any political party. Ever. With anything. I’ve given more money than I could afford to the Democratic Party, and I wouldn’t trust them to organize a bake sale. It’s a matter of constant, unending vigilance. It’s like needing to keep one eye on a child who will do its chores when under a watchful eye, but will scarper the second you quit paying attention.

      I don’t like the Evil Party, but on the other hand, life is short, and I have no time to waste on failure.

      Then I would advise you to remain disconnected from the political process.

      Progress in America happens by people using the pile of corpses of those who came before them as a way to climb up and plant the flag. This fact is, indeed, outrageous and horrifying, but the cruel irony is that changing that fact in any way will require a lot of failures before success comes.

      I’m pretty angry every day that I will probably be at retirement age before the damage done by the conservative ascendancy that started around the time I was born is undone. The conservatives essentially stole my life from me. I’m going to have to go be part of that pile of corpses so that people who come after me can climb up.

      That’s just how it works.

      • deadweasel

        I am sorry to hear that conservatives stole your life from you. Go to them and ask for it back. Be nice, be polite, be compromising. Let me know how that works out.

        • Scott Lemieux

          Deliberately throwing elections to them in exchange for nothing, conversely, is pure gold!

          • Malaclypse

            Let’s be fair. There’s a distinction to be made between “deliberately” and “willfully stupidly.”

          • deadweasel

            By throwing elections, you mean Mondale ’84, Gore ’00 and Kerry ’04, right?

        • Murc

          I am sorry to hear that conservatives stole your life from you. Go to them and ask for it back. Be nice, be polite, be compromising. Let me know how that works out.

          If my choices are to accept crumbs from the table or get nothing, I will take the crumbs.

          Ideally, I would of course like to upend the table and send a few people to the guillotines. If that option isn’t available, I will avail myself of whatever I can get.

          • Murc –

            You reminded me of something my father told me about 50 years ago: “Every once in a while, when a crumb fall off the plate, the democrats will let you keep it. The republicans won’t even do that.”

            I didn’t get it at the time, but it is indelibly etched in my memory. And I sure as hell get it now.

            So here’s your answer, deadweasel. You vote for the god damned democrats for every office from dog-catcher to god’s right hand man, because the fucking republicans will find a way to take every fucking penny away from you and hand it over to a billionaire, if you give them the chance.

            Unless you like feudalism. Then, by all means, vote republican, because that is where they will take you.

    • Hogan

      I am thinking of rejoining it.

      No, you’re looking for excuses not to, and you already have them lined up.

    • Ronan

      This is beautiful troll post. Simple, unsophisticated, perhaps even idioitic, yet pushing all the right buttons and so garnering multiple responses.
      I salute youmy good (wo)man

      • deadweasel

        I think the word you’re looking for is, “elegant.”

        • Ronan

          youre like a breathe of fresh air, imho

          • deadweasel

            You, sir/ma’am, are truly civilized.

    • Davis X. Machina

      This is why I’m a Whig. National bank, internal improvements, protective tariff — the whole megillah.

      • Malaclypse

        Back in the Naderite days of my youth, there actually was a Whig that ran for some local office in Watertown, MA. So I really did vote for a Whig once.

        It was every bit as effective as my vote for Nader. Even more so, since it makes a marginally good story.

    • joe from Lowell

      If you think Evil is an option to be chosen, you definitely belong with the Republican Party, and any pretense that you might select the Democratic Party is the purest grade of bullshit.

      • deadweasel

        I remember watching an interview with a German socialist who joined Hitler’s SS. He explained that, with Hitler’s triumph over the Social Democrats, the SS was the only organization History had selected to, as he put it, “carry the flag of Socialism.”

        I wonder how many in the Tea Party made the same evaluation.

        • Malaclypse

          Put down the bong, son.

          • T. Paine

            Harrumph.

            • deadweasel

              I have a confession to make. I did not really come to this site to engage in a discussion of the issues. Frankly, I came here hoping that, if I am Evil enough, the Do Nothings would compromise with me, and give me money and power.

              I have seen for myself how the Do-Nothings compromise with Evildoers: Bourbon racists, Cold War paranoics, pro-life sidewalk-humpers, Wall Street Too-Big-to-Fails, and thought to myself, “Huh. Maybe if I show up all Snidely Whiplash, twirling my mustache, I can get in on some of that sweet, yummy compromise.”

              But I must confess failure. No one compromised with me at all! I examined the structural obstacles to my success, and concluded that I’m just not Evil enough to get me some compromise!

              So I must leave, and seek to be truly Evil before I can be compromised with. I should build a proton reactor to implode the Earth’s core, or try to replace the poor with robots, or howl for war with Luxembourg. Only then will I be truly Evil enough to be compromised with!

              • Malaclypse

                pro-life sidewalk-humpers

                I linked to that already
                . But your precious mind is too pure to “know” “facts.”

                • deadweasel

                  Part of the process for achieving true Evil is total disregard for the facts. They only get in the way of ambition.

                  Do you think that the Evil Party achieved their dominance of the courts, the media narrative, the federal bureaucracy, by paying attention to mere facts? They did not; they set out to destroy them, as obstacles to their will.

                  To triumph in this world, you must destroy the facts!

                  There. I think, for the first time in my life I said something truly Evil. Ready to compromise with me now?

  • Van

    I still don’t see why ‘The Left’ didn’t just have a big Washington protest for single payer. Then Obama and the Republicrats would have seen the light and we’d be living in a socialist paradise :) Oh,and thank you Scott for continuing to hammer this point. There are too many people who have unrealistic expectations of politicians. I think it’s one of the biggest obstacles to Progressive reform.

    • Hogan

      I still don’t see why ‘The Left’ didn’t just have a big Washington protest for single payer.

      Because Obama didn’t tell them to.

      • Scott Lemieux

        HE DIDN’T EVEN TRY!

        • Ron Fournier

          Obama can’t lead!

          • Tyto

            With LEADERSHIP!

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  • Anonymous

    These critiques (the linked and the posted) are the exact type of depressing water-blooded muddles we on the left spew at each other endlessly. What’s wrong with them:

    Any plan he signs must include a public option? What was the penetration of this public option in any of the hearings? Is its relative absence another symptom of that powerless office, the presidency? Any critique without analyzing this bizarre broken promise is incomplete.

    What of the shameful secret deal with Tauzin, shutting out Congress until its conclusion? Why surrender for cheap ransom the most potent cost-saving weapons in the arsenal, Rx drug price negotiation and re-importation? I recall an ad in the campaign relying entirely on Tauzin as the epitome of what was to suffer a righteous Change from the candidate. This deserves some notice.

    As for the Clinton debacle, we’re like the poker novice who sees a strong hand cracked and endeavors to discover a pat answer of how it was played incorrectly. We want a pat answer when none may exist (see “Gore’s loss” and “Nader” for a similar event and pat cause to “Hillarycare” and “shoulda hands-offed it”). It’s not that we can’t identify strong candidates for the decisive factor, but when only get to run these mass political events to conclusion once, and many factors are plausibly decisive as to the result, a lack of pat-ness would be nice.

    Finally, if we were to draw a historical analogy, forgetting the epochal changes between periods that make such analogies an unmatched breeding for blundering errors, FDR is surely less happy than LBJ as a point of comparison. How does Obama stack up to LBJ on massive health care legislation?

    • Scott Lemieux

      How does Obama stack up to LBJ on massive health care legislation?

      Very, very well, since in more favorable circumstances LBJ wasn’t able to get comprehensive reform and had to settle for a program that cherry-picked the most unprofitable customers from the health insurance industry.

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