Friction On The Left Over Health Care Getting More Personal

The battle over health care reform on the left is getting more personal. Ronald Brownstein attacked Howard Dean for his criticism of the bill:

Maybe one reason former Vermont Gov. Howard Dean and so much of the digital Left can so casually dismiss the Senate health care reform bill is that they operate in an environment where so few people need to worry about access to insurance.

The 2004 presidential campaign that propelled Dean to national prominence was fueled predominantly by “wine track” Democratic activists-generally college-educated white liberals. (In the virtually all-white 2004 Iowa caucus, for instance, exit polls showed that two-thirds of Dean’s votes came from voters with a college degree.) Those are the same folks, all evidence suggests, who provide the core support for online activist groups like or Dean’s Democracy for America and congregate most enthusiastically on liberal websites. (According to studies by the Pew Internet & American Life Project, college graduates are more than twice as likely as those with only a high-school degree to communicate about politics online.) Along with Dean, those digital Democratic activists are generating the loudest demands to derail the Senate bill.

Some individuals in these overlapping political networks undoubtedly face challenges with access to health care, but as a group college-educated whites are much less likely than any other segment of the population to lack health insurance

This may or may not be what is influencing Dean, but he does have some valid points which deserve an answer, along with some points which have been countered. Considering how similar the current plan is to his 2004 plan which also lacked a public option, it is also possible that the bad blood between Dean and the White House is influencing him on this.  This was most evident when Dean was not offered a spot in the Obama administration. (This would not be the first time that Howard Dean has created political waves by attacking someone with a similar viewpoint. During the 2003 fights for the 2004 nomination, Dean repeatedly distorted and attacked John Kerry’s position on Iraq despite the fact that the views of the two were virtually identical.)Regardless of Dean’s motivations, there are some real issues here and I would prefer to see actual discussion of the issues rather than dwelling on speculation over his motivation.

If we must attack Democrats (including Lieberman who still caucuses with the Democrats), it should be the Democrats who are really standing in the way of meaningful health care reform. Ezra Klein points out that Joe Lieberman is responsible for much of the mess we are now in:

Joe Lieberman’s reckless decision to blow up last week’s compromise has had exactly the impact many of us predicted. Much of the left has flipped into vicious, angry opposition to the bill. Is that because the Medicare buy-in, a good but limited policy, has disappeared from the bill? Ostensibly. But not really. If you don’t believe the bill has cost controls, Medicare buy-in was not an answer to your concerns. If you believe the mandate is bad policy, letting the small slice of exchange-users between 55 and 64 choose public insurance did not answer your fears.

But progressives had compromised plenty already. Single payer became a strong public option, a strong public option became a weak public option, a weak public option became Medicare buy-in, and Medicare buy-in became Joe Lieberman’s revenge. Progressive ends are submitting to conservative means, and industry is laughing all the way to the bank. All this amid the first year of a president they elected, a Democratic majority they built…

Lieberman has tossed the process into chaos. But the short-term satisfactions won’t overwhelm the long-term judgments. Lieberman is “point person” because he has appointed himself the 60th senator. Every other member of the Democratic caucus could have done the same, but most all have judged the underlying bill more important than their disagreements with it. Lieberman did the opposite, and there’s little evidence that he actually had disagreements with the bill so much as dislike for some of its supporters.

And Lieberman, let’s remember, is not a lefty blogger. He isn’t a pundit or an op-ed columnist. He is the “point man,” and by choice. He bears a special responsibility. Atop the shoulders of another man, it would make for a heavy load. But not his. His recklessness has endangered the bill, and through it, many, many lives. He may not be ashamed. But he should be.

I agree with Klein’s assessment of Lieberman but disagree with his push to maintain the mandate. Dropping the mandate would appease many on the left (as well as center and right) who now oppose the plan. Previously it appeared that the mandate at least made health care reform simpler. Now, instead of simplifying the legislation, among the many other problems with the idea, mandates to purchase private insurance are causing the greatest degree of friction on the left.

There are many other ways that the legislation could be written to provide assistance to those who desire to purchase private insurance while simultaneously providing disincentives to trying to game the system by holding off on purchasing insurance until one becomes ill. Currently the Medicare D program for prescription drugs is voluntary and, while few turn it down, even Medicare B which covers physician services is voluntary.  The bill could provide greater advantages for those who sign up by 2014 which are phased out if people do not enter the system and/or exclusions on pre-existing conditions could be reserved for those who fail to obtain coverage. Obama also should have stuck to his first instincts and maintained the position he held during the primary campaign.

As bad as Lieberman has been during this debate, we must not forget Ben Nelson. Jed Lewison sums up his objections to the plan:

In sum: unless Ben Nelson is bluffing, the only way he will vote for cloture is if abortion is restricted, the subsidies are whacked, the revenue provisions are nuked, and its Medicaid expansion is gutted. Oh, and he doesn’t think there’s any chance of it happening by Christmas.

Compared to this, Dean’s attack on the Senate bill  doesn’t look anywhere near as bad. Even David Axelrod has backed away from calling Dean’s criticism “insane.”

White House Responds To Concerns of Bloggers Over Health Care Plan

With the debate over health care reform getting more heated on the left, Crooks & Liars reports on a White House conference call which answered some of the objections from liberal bloggers:

I started by asking about the recent maneuver to block imported drugs. I said it was “shameless,” not only because Candidate Obama ran on the issue of allowing Americans to buy cheaper drugs from Canada, but because the FDA already does site inspections in those same plants they were calling unsafe. (Basically, in order to sell any drugs in America, your manufacturing facility must meet the same standards as an American plant.)

I was pleasantly surprised to hear that they would be submitting an HHS bill in the near future – they’d “just this week” gotten funding to address any safety concerns, but more importantly, to start putting an infrastructure in place to import drugs.

My other question (as a former reporter who frequently covered insurance corruption) was about using state insurance commissioners to enforce new insurance regulations.

I said that in many states, insurance commissioners were pretty much owned by the local insurance companies, and I was skeptical as to whether making them the enforcers would actually work.

DeParle said HHS Sec. Kathleen Sebelius, a former state insurance commissioner, was not one of “those” commissioners, and she would be overseeing state departments. Sebelius already met with state insurance commissioners, she said, and having found a wide discrepancy in authority from state to state, got language inserted in the bill that would give them additional powers. (DeParle noted that the West Virginia commissioner didn’t even have the authority to see if insurance companies were solvent.)

DeParle said this was the widest expansion of insurance regulation in 20 years.

David Axelrod also chimed in, noting these changes were part of the reason why the insurance industry has opposed the bills so stringently. If this was a giveaway, he said, they wouldn’t be lobbying so hard to defeat the bill.

I have to give it to Axelrod on this: Without even a little exaggeration, I’d say that standardizing state oversight is probably the insurance industry’s worst nightmare. They’ve always taken advantage of a hodgepodge of weak state regulations, sprinkling generous political contributions along the way to buy off state legislators. So this bill is really what you want from federal regulation: Overriding weak state laws that trample consumers.

Other points:

Joan McCarter from Daily Kos wanted to know if the annual cap on expenses was left in the Senate bill. DeParle said they were working with CBO and Senate on improvements, and said a lot of what people thought was happening was due to “misinformation.” She said CBO said to put the qualifier “no unreasonable limits” in the bill language so they could score it, and said they’re working with the American Cancer Society in an attempt to make an enhancement to the system. She said at the very least, it will ban annual limits.

Open Left’s Chris Bowers wanted to know if the White House wanted the bill to go to the conference committee – or did they support “ping-ponging,” which would essentially mean the House would accept the Senate bill without changes. (DeParle said no, they want to get it to the conference committee.)

In response to a question from MyDD’s Jonathan Singer, Axelrod talked about having a daughter with a chronic illness while he was a reporter in an HMO plan. “I spent tens of thousands of dollars out of pocket that I didn’t have. The stress was extraordinary. This bill attempts to fix the system on the basis of the human costs on patients and their families.” He called it “wrongheaded to suggest these bills aren’t infinitely better than anything we have today. This is an extraordinary moment on which we can win.”

The Advantages Of Being Chosen By God

The Booman Tribune asks “Why doesn’t Ben Nelson just come out and say that he hates Democrats and cannot remember why he is one?”

Because he is a member of The Family. Members of The Family were chosen by God and are always right. They don’t have to explain themselves.

Sarah Cuts Short Vacation From Early Retirement


My immediate reaction to reading the headline  Sarah Palin cuts vacation short was “vacation from what?” She already left her day job. It seems that she was receiving too much publicity, so she had to talk to the media about it and receive more publicity:

Sarah Palin announced Thursday night that she ended a Hawaii vacation early because of the ruckus raised after she blacked out “McCain” on her sun visor in an effort to elude paparazzi.

After the former Alaska governor was photographed on the beach earlier this week, portrayed the visor marking as a slight of Sen. John McCain (R-Ariz.), her running mate last year.

Palin, in the midst of a book tour for her million-selling “Going Rogue,” released this statement:

“In an attempt to ‘go incognito,’ I Sharpied the logo out on my sun visor so photographers would be less likely to recognize me and bother my kids or other vacationers.

“I am so sorry if people took this silly incident the wrong way. I adore John McCain, support him 100 percent and will do everything I can to support his reelection. As everyone knows, I was honored and proud to run with him. And Todd and I were with him in D.C. just a week ago.

“Todd and I have since cut our vacation short because the incognito attempts didn’t work and fellow vacationers were bothered for the two days we spent in the sun. So much for trying to go incognito.”

Maybe it would have worked better if she bought a sun visor rather than blacking out “McCain” with sharpies.

Paul Krugman Supports Passage of Senate Bill

Paul Krugman wants the Senate to pass the bill. He notes the problems caused by the need to appease conservative Democrats:

But let’s all take a deep breath, and consider just how much good this bill would do, if passed — and how much better it would be than anything that seemed possible just a few years ago. With all its flaws, the Senate health bill would be the biggest expansion of the social safety net since Medicare, greatly improving the lives of millions. Getting this bill would be much, much better than watching health care reform fail.

At its core, the bill would do two things. First, it would prohibit discrimination by insurance companies on the basis of medical condition or history: Americans could no longer be denied health insurance because of a pre-existing condition, or have their insurance canceled when they get sick. Second, the bill would provide substantial financial aid to those who don’t get insurance through their employers, as well as tax breaks for small employers that do provide insurance.

All of this would be paid for in large part with the first serious effort ever to rein in rising health care costs.

The result would be a huge increase in the availability and affordability of health insurance, with more than 30 million Americans gaining coverage, and premiums for lower-income and lower-middle-income Americans falling dramatically. That’s an immense change from where we were just a few years ago: remember, not long ago the Bush administration and its allies in Congress successfully blocked even a modest expansion of health care for children.

Bear in mind also the lessons of history: social insurance programs tend to start out highly imperfect and incomplete, but get better and more comprehensive as the years go by. Thus Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans.