osewalrus (osewalrus) wrote,
osewalrus
osewalrus

Why Healthcare Reform Is Different

Normally, as folks who follow me here and on professional blog know, I'm an incrimentalist when it comes to reform. It's a long-term game. You grind out your victories inch by inch, take what you can in each go-round, and compose oneself with patience.

But a few things are different. One of them is health care reform.



There are several reasons why health care represents an exception to this general rule. First and foremost, it requires tremendous political pressure to reform at all. The amount of money and the number of people invested in the outcomes guarantee that only massive political push back can create change. Now add that the three times in the last 50 years we have had major change -- Johnson's introduction of federal health insurance for the elderly and the poor in the form of Medicare and Medicaid, Clinton's attempt at Universal coverage, and Obama's attempt -- have all provoked the outcry of "socialized medicine" and the opposition of significant components of the medical profession.

To have the issue on the table at all is the consequence of enormous unhappiness creating a political climate ripe for reform. An incremental reform that relieves the pressure is therefore not a step toward ultimate reform, but an end to reform.

Which is why it is imperative for progressives to resist any change without a public plan option. If the effort collapses entirely, it is possible to try again after the 2010 election -- depending on whether pro-reform or anti-reform elements of the electorate can better mobilize. But a reform without a public option means another 20 or so years before things are again so out of whack as to create another chance at something more rational than what is proposed.

It is also imperative to send a warning to the Dems for 2010. Mind, the Dems seem permanently tone deaf on what actually makes a winning coalition. Paul Rosenberg has this excellent piece on the problem of the Dems political dynamic. Whereas I often take my fellow progressives to task for despairing too soon and failing to grasp that policy is generally a long-term war of maneuver, centrist Democrats have developed a genius for pissing off everybody who would support them. They are also utter geniuses for learning precisely the wrong message from their defeats.

Which is why "centrist" Dems and the Dems who follow them keep playing to a crowd that isn't there and are rapidly bleeding their base away. the foot soldiers commonly referred to as "Obama's Army" are fundamentally different from the foot soldiers of the conservative movement in that they are not dedicated to the dominance of a particular political party or ideology, or even a charismatic individual. The folks who turned out in droves want solutions that make sense and the promise that someone will stand up for them. Caving on key points on what Obama chose to make his signature policy initiative (he could have chosen financial reform instead, for example) erodes the morale and willingness of these foot soldiers to come out again in 2010 and 2012. The fact that people like Rahm Emmanuel are openly contemptuous of these activists does not help.

Again, if this were a different issue, the matter would be otherwise. Few folks are going to care about broadband policy, or transportation, and even clean energy has time on its side. Ditto gay rights and even labor rights. Each had segments of the base excited, but could ultimately yield to a greater common goal -- such as health care reform. But after everything has yielded, it turns out there is no center for health care.

At some point, the whole coalition collapses. Unless the Administration rediscovers its courage on this one, I fear they are going to lose their support without understanding why.
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