Obama’s approach: the drawbacks
Krugman spells out the difficulties of trying to take a middle path in the current political context:
I’ve been alerted to an interesting Boston Globe article about Barack Obama’s role, when he was in the Illinois legislature, in the attempt to get the state committed to universal health care. It turns out that the story very much prefigures the debates we’re having right now.
Obama later watered down the bill after hearing from insurers and after a legal precedent surfaced during the debate indicating that it would be unconstitutional for one legislative assembly to pass a law requiring a future legislative assembly to craft a healthcare plan.
During debate on the bill on May 19, 2004, Obama portrayed himself as a conciliatory figure. He acknowledged that he had “worked diligently with the insurance industry,” as well as Republicans, to limit the legislation’s reach and noted that the bill had undergone a “complete restructuring” after industry representatives “legitimately” raised fears that it would result in a single-payer system.
“The original presentation of the bill was the House version that we radically changed – we radically changed – and we changed in response to concerns that were raised by the insurance industry,” Obama said, according to the session transcript.
To be fair, the piece also says this:
During debate over the Health Care Justice Act, Obama also attacked the insurers, accusing the industry of “fear-mongering” by claiming, even after he made changes they wanted, that the bill would lead to a government takeover.
This story gives a lot of context to the debate over health reform now. Obama clearly sees himself playing the same role as president that he did as a state legislator — as a broker among groups, including the insurance industry, as someone who can find a compromise solution that’s acceptable to a wide range of opinion.
My thoughts: being president isn’t at all like being a state legislator, Illinois Republicans aren’t like the national Republican party, 2009 won’t be 2003, and the insurance industry’s opposition to national health reform — which must, if it is to mean anything, strike deep at the industry’s fundamental business — will be much harsher than its opposition to a basically quite mild state-level reform effort.
The point is that if national health reform is going to happen, it will be as the result of a no-holds-barred fight of an entirely different order from what Obama saw in Illinois. The president’s role will have to be far more confrontational, involve far more twisting of arms and rallying of the public against the special interests, than Obama’s role as a state legislator in the Illinois case. And it will take place against a backdrop of fierce attacks not just from the industry but from Republicans who fear, rightly, that any kind of reform will move the country in a more liberal direction.
My worries about Obama are that he doesn’t seem to understand this — that he thinks that in 2009, as president, he can broker a national health care reform the same way that as a state legislator, in 2003, he brokered a deal that mollified the insurance industry. That’s a recipe for getting nowhere.
I have to agree: getting a good national health insurance plan is going to be a fight every step of the way, and Big Pharma and the insurance companies are not going to give an inch. The only way it will happen is with a strong and combative president and a solid Democratic majority in Congress.
I disagree. The only way a national health care system is going to happen is if the pharmaceutical and insurance companies mysteriously go completely bankrupt a few weeks before the vote occurs.
Ben Overmyer
19 December 2007 at 10:46 am
Mike, couldn’t agree more. Several weeks ago on jim lehrer newshour, I heard the conservative pundit, David Brooks, make the claim that William Kristol, editor of the “weekly standard”, a murdoch publication, worked mightily behind the scenes to prevent Hillary’s 1992 single payer plan from taking effect. The reason: kristol knew that if this plan were implemented, the right’s claim that all government is bad, would, if effect, basically collapse.
Big pharm spends over $1 million per congressman, annually, lobbying, including against anything that resembles legislation toward a single payer plan.
The other irony is that it’s time for a health insurance program. The major candidates on the Dem side are all promoting a health insurance plan of one form or another, while the dwarfs on the Repub side are demonizing such plans with the label, “socialized” medicine, and “mandates don’t work” etc., but the cachet of these terms has been lost, largely because health insurance is a increasing drain on many pocketbooks, not just the reputed 49 million americans without insurance.
Assuming that we get a Dem president, what we end up with as a health insurance program will, of course will be entirely different than what they are currently proposing.
To get any results, the logjam in the senate will have to be overcome, ie, a larger Dem majority.
Raymond McInnis
19 December 2007 at 11:40 am
Praytell, Raymond, how do you plan on achieving that larger Democratic majority?
I see lots of discussion on the Web about how bad things are or what would help, but rarely do I see organized action. Talking is all well and good, but it is nothing without action.
Ben Overmyer
19 December 2007 at 11:58 am
Ben, reluctantly i agree.
A majority is needed, and no telling about that until november 2008.
maybe i’m guilty of wishful thinking.
there are some signs however. one of the most potent is the ongoing discussion — if you can call it that — between the campaigns about the merits.demerits of of the respective plans.
in addition, i have a google alert on “universal health insurance”, with a pace of “hits” coming in at such a great quantity that I don’t have time to read them all.
in end, however, only time will tell us whether the inevitability of health insurance is here. i am not betting on the guarantee of inevitability, but the signs are good
Raymond McInnis
19 December 2007 at 1:20 pm
Though I’m generally libertarian in my political leanings, I definitely would support universal health insurance if it were properly implemented.
What can we do to further that process?
Ben Overmyer
19 December 2007 at 1:59 pm
What can we do to further that process?
Most important, i’d say “vote”.
you yourself are a telling indication of winds of change. Check out lew rockwell’s libertarian blog, and see how many of his corespondent’s approve of health care for all.
i’ve been thinking, ben, though, of your earlier question: a Dem majority? It’s not as strange as you may think. check out the polls, on the daily kaiser blog.
also, if say someone like either obama or edwards is nominated, either will be running with a platform that includes a strong universal healthcare component. Now, if the winds seem to be blowing in that direction — ie, public opinion, the coat-tails effect kicks in, right?
to insure he/she gets elected, congresspersons will embrace healthcare too. again, this may be too simplistic to fly (in reality) but the signs are better than they ever have been.
our city is scattered with lawn signs that say something like “we’re are single payer family”
Raymond McInnis
19 December 2007 at 2:41 pm
I live in a deeply red state with relatively low literacy. People here are passionate about politics and rarely objective; as such, I don’t see a Democratic majority ever having hold here. South Dakota replaced its only powerful Democrat, Tom Daschle, with a weak sycophant. I doubt Dakotans will be supporting a Democratic candidate in ’08.
Ben Overmyer
20 December 2007 at 7:09 am
yeah, Ben I know the feeling.
My home state is not a state, it’s a province, Saskatchewan, where premier Tommy Douglas in 1947 introduced universal healthcare. Shortly after the legislation, a doctor’s strike occurred, but the doctors lost out to public opinion in favor of the program, and went back to work.
I grew up with the program, and never noticed that I was missing any care, especially from my doctor.
(At age 11, also in 1947, I got a brain concussion when I fell off a galloping horse and hit my head on stout fence post. Under any system, I was lucky to survive.)
Yes, universal healthcare has its problems, but at least ALL have care. To tell canadians that their health service would be removed would be tantamount to a declaration of war.
I notice that the Repubs are demomizing universal healthcare as a term because they think it is a code word for a single-payer system, an anathema to them.
Raymond McInnis
20 December 2007 at 7:28 am