I'm a terrible poker player. There are a lot of reasons for this: I can never remember whether a full house beats a flush (it does) and I don't do the mental arithmetic to calculate whether I should draw one more and hope it completes my hand or not. So, I suck at poker for a lot of reasons. But those reasons don't really matter when I'm playing against other amateurs, but I still lose. I think it's because I'm not skilled at getting the best outcome out of a given hand. I fold early, or bet big on a weak hand, or accept a small pot on a very strong hand. I'm a guy you are happy to see at the table when you're playing for real money.
So, just to be clear, I'm not the guy Obama should be taking advice from when it comes to negotiating strategy in the health reform debate.
Like many other progressives, I've become concerned about the prospects for the health insurance reform currently before Congress. It was going to be a tall order even before the August recess, and the angry backlash and waning public sentiment may well erode the support of the centrists, who were none-too-enthusiastic to begin with. Are we going to lose this? Might it be a better strategy to "take our money and run"?
By which, I mean that, despite the hard-core conservative opposition to the reforms, there really is agreement over about 85% of the reform package. The public option is the irreducible sticking point, with some technocratic disagreements over funding mechanisms and threshold for subsidies. The take-away from interviews like this, is that if progressives dropped the public plan, or even accepted a triggered public plan (which might be the same thing as no public plan), there would be quite a few moderate republicans who would sign on and the bill could easily pass the Senate*.
There's a potentially compelling reason to cut this deal before the final cards are played: if health care reform goes down to defeat in the Senate, it's not a given that the Democrats will be able to revive it in any form, save perhaps some trivial incremental reforms. If heath reform dies, it would be catastrophic from a policy perspective, and somewhat worse from a political point of view. It would kill the hopes for meaningful reform, and possibly deal a near-lethal blow to the nascent Obama presidency. Given the downsides of a clear loss, the opportunity to cut a deal and walk away with a win, albeit more modest than we would like, seems like a preferable alternative.
Should we? What would reform look like, absent a public option?
As much as I really believe in a public option, it's important to note that the other elements of the proposed reform packages are very good indeed. If you had offered me these bills eighteen months ago, I'd have jumped at it. We have, at least in HR 3200:
- Universal coverage (or nearly so)
- Individual mandates
- Employer mandates
- Community rating
- Guaranteed issue
- No recissions
- Subsidies for middle-income individuals
- Elimination of the SGR
This is where we're at: do we accept an imperfect and incomplete health care reform bill, or do we go for broke and try for the big win? Robert Reich put it colorfully: This is it, folks. The concrete is being mixed and about to be poured. And after it's poured and hardens, universal health care will be with us for years to come in whatever form it now takes. But Paul Begala sees the cup as half-full: No self-respecting liberal today would support Franklin Roosevelt's original Social Security Act. It excluded [long list of stuff.] If that version of Social Security were introduced today, progressives like me would call it cramped, parsimonious, mean-spirited and even racist. Perhaps it was all those things. But it was also a start.
I don't know where we should go from here, but as I disclaimed earlier, I'm a terrible poker player. If we take the modest reforms we have on the table, it's a more-or-less sure win, but are we walking away from so much more? On the other hand, if we walk away with the proverbial bird in the hand, the failure to impose cost controls guarantees that we will need to revisit this issue in a few more years, and perhaps incrementalism is in order here.
We are not yet at the point that we have to show our cards. It's possible that the tides will turn and the pro-reform sentiment will be back on the rise come September. And Obama has nerves of steel, and an uncanny tendency to get exactly what he wants in the end. I'm glad he's on our side. And I'm equally glad that I don't have the responsibility for making the call on this one.
* It's possible that all the Senate GOP are working in bad faith and, as so many times before, Lucy will pull the football away from Charlie Brown once again. I don't think so in this case: I think Snowe, Collins, Graham, Voinovich and Grassley are possibly "gettable" if the right deal is offered.