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The Sound Of One Hand, Patting It's Own Back

Part of the problem, too, over the weekend was the monumental sense of self-congratulation: as much as there's a significant milestone in having a close vote to pass such an enormous element of the ultimate reform package, too much of the lauding of Nancy Pelosi and Democrats celebrated what hasn't happened. And, to my chagrin, people who've held out admirably against the Obama-era vogue for celebrating in the future tense succumbed to it.

Missing from most laudatory comments was any sense of perspective, and almost any sense of balancing the problematic with the historic. As I said earlier, too many posts (usually men) did a "yes, but" with the Stupak Amendment... but that was simply one aspect. Just as often, few mentioned that the House vote suggested more bad news than good, given that Pelosi struggled, more than anyone expected, to find a bare majority of her members, losing 39 of the 40 votes she had to cushion victory. And not just, as many noted, losing "Blue Dog" conservatives: Dennis Kucinich voted against the bill, noting that if you are truly a progressive who favors single payer... there was nothing to like in the utimate compromise.

Kucinich made a good, sensible point that underlined how much liberals and progressives have given over to the politics of the process in DC and abandoned the very goals that "healthcare reform" was meant to accomplish. As I've said all along, fetishizing a "public plan" which was always a modest adjunct to other, far more crucial, aspects of change, made a hash of the whole bill. And as a result, people got swept up in the MSM presentation of  "historic moment" journalism over good sense, I'm convinced.

Since his election, there's been a sense of artificially set pressure by the Obama folks to accomplish major change in a short time frame. And that pressure has served, too often, as an easy out to make bad compromises and weak hash. Too few progressive activists have asked the questions that matter about how this process has unfolded - why was it being done in secret, behind closed doors? Why wasn't more effort expended, earlier, to better explain the need for certain reforms and lay out  responsible proposals for public debate? Why are we just accepting that every bad development is a necessary, if regrettable, watering down of a previously bad choice?

Nancy Pelosi and the - largely male - leadership team she's assembled did not, miraculously, go from the middling, not altogether effective legislators they've been all year to geniuses on Saturday; Pelosi has, all along, been able to deliver most of her majority to pass almost anything she wants. What she has been less good at, and always has been, is in rising above political gain to defend important principles. Everything, ultimately, is in service to winning and maintaining political control of the House. And if that means watering down a public option, or turning back years of progress on women's reproductive health... oh well. Maybe later, we can fix that. Look... it's history!

Sober reflection, I think, would have tried, harder, to put what happened over the weekend into perspective. Yes, it's exciting to see the potential for modestly positive developments in some reforms in healt insurance make some siginificant progress. But we are nowhere near the final result of an actual bill, agreed to by both houses, that makes sense and ought to be signed into law. And just as importantly, many of the bad compromises that have been made to achieve that result - including a cynical expansion of Medicaid eligibility without addressing the embarrasingly low reimbursement rates of the program, the failure to truly recognize or cover the costs of the reforms proposed, and the vague, poorly thought through notions of "improving" Medicare without making hard choices - all of these are reasons for serious, continued concern about just what it is "reform" is actually amounting to in the end.

Rather than get swept up in trying to write historical progress before it has actually happened, and to play the contorting game of patting one's own back too hard, I'd feel better if progressives didn't exhale and let up just when the pressure is needed most. Ask yourself... is this really the reform we said we favored? Are these the goals that progressives set for reform at any point in the process? Does this bill really offer the necessary pieces of progress to improve health care access, make it more affordable, and ultimately improve quality of care? Too much of what we're getting doesn't remotely meet these goals. And if that's case... why is that hand of yours still reaching over your shoulder?

Aw Hell No

Stunned into relative silence, it took a day or so to let the anger find its way to the surface. Now I'm just furious. The idea that Democrats in the House just eliminated access to reproductive health services for millions, and possibly all, women is just stupefying.

I think incomprehension has been the main force behind the slow rolling reaction - only late last evening did it seem clear that the full horror had begun to sink in widely - an incomprehension that itself seems cheerfully naive.   The signs that healthcare reform had become a political exercise fully ignorant of larger implications was clear months ago, the sense that women's heath concerns were being dismissed was clear weeks ago, and the national madness around abortion policy is just part of my entire lifetime. Yet, still... it's hard to imagine something quite this unbelievable taking place.  Even as I watched it unfold on Saturday afternoon... and then went to see Precious.

For years, I have tried to be one of those voices of "it's not their fault" when it comes to Democratic missteps. I've been one of those "gee I hope they get their act together one day" type of Dems who, since the seventies, has figured I just happen to be in the hapless party that can't quite pull it together. Sometimes we do... but usually, wecave, or we get scared, or we fold too soon.  If only we could get our act together... well, I have to admit, this one's got me realizing... this is their act. And it is together... and that's the scary part.

As others say so often, the Stupak amendment is "a feature, not a bug;" These things don't "just happen" and Nancy Pelosi doesn't just get to say some group or other made her do this, against her will. The woman who could claim to be prochoice and let this happen can't claim to be buffeted by circumstance. This is a choice that can be made, comfortably, by people who lead a party no longer attuned to the needs of poor people, working people, people in need. It's a cavalier, uncaring assessment that somehow, people can make do... or they'll just have to deal with it. Or the kind of bald political calculus that says, somehow, magically, this will all just go away.

There's plenty of reasons to be unhappy about the healthcare "reform" still going full steam ahead, racing pell mell to a foregone conclusion that looks less and less appealing each day. But there's unhappy... and then there's this, a situation which cannot be acceptable, cannot be excused, cannot just be called okay, if we just make a few changes. This is a "hell no... and what the hell were you thinking?" moment. Say it... shout it. And dammit, let's do something about it.

The Part About Nidal Hasan Being Muslim

It was, depending on your perspective, bound to happen or incredibly insensitive and prejudiced. Once Nidal Malik Hasan's name was out there as the shooter at Fort Hood, somebody was bound to note the name... and leap to a conclusion. And clearly, some did.

As it turns out, Dr. Hasan was apparently an observant Muslim who followed religious traditions. He prayed every day. He wore traditional clothing. He was aware, and resentful, of anti-Muslim prejudices that became apparent after 9/11.

... And none of that makes him an example of "home grown terrorism."

Time and investigation will tell if there's any connection to be made, or other indication to consider, but for the moment, nothing about Nidal Malik Hasan suggests a connection to terrorist organizations, or that his act had a terrorist component. And I doubt it will - his family, who seem to have no need to hide or not talk about the man they knew, describe a sad, lonely person who they can't imagine resorting to violence.  Which speaks volumes, I think, more about what we see, and don't see, when we describe another's mental health.

In our quest to make mass shootings about something, anything but the mental health of the person doing the shooting, we all pick distractions. In the case of Seung Hui Cho, many liberals honed in on the ability to acquire guns easily in Virginia, while conservatives resisted any talk of gun controls... both sides ignoring more obvious solutions like improving campus mental health services, or identifying the steps the University could have takemn to separate Cho from the school.

With Nidal Hasan, we get the distraction of knowing that it was a Muslim soldier who resorted to violence, despite the fact that we know that all sorts of soldiers with mental health issues are doing the same thing. Ironically, the military aspect may have robbed liberals of their usual fallback of blaming the gun; we can do lots of things to rein in some gun sales... but military soldiers and weapons are likely to be together no matter what we do.

And so liberals have had to counter the "ohmygodmuslimradicalislamterror" moment with admitting the obvious - that Hasan probably acted alone, and that some sort of mental health issue was probably involved. Which leads, uncomfortably, to the discussion of soldiers and mental health issues and treatment problems we've been trying to avoid for a long, long time. Which may be why, despite little else happening in the news, the Fort Hood shooting is quietly sinking to the bottom of the news coverage pile, now the place of tributes, memorias, and video montages to sad music.

For all the rejection of snap judgments about Islam=Terrorism, we shouldn't, and we can't, just ignore that Hasan was Muslim, and that his life in a religious minority was somehow not a part of him or what happened. We need to talk about this in order to make, at least, a couple of obvious points: that if we plan to class Hasan as "Muslim terrorist" we've just made the "War on Terror" impossible to fight or win, and that, if we plan to hold these kinds of views of Muslims, we should be asking ourselves far more thoroughly just what it is we're still doing in Iraq and Afghanistan and elsewhere in the Middle East. Because if we can't ratchet down or deal with these prejudices and false assumptions, we're nowhere in figuring out how we plan to coexist with the Islamic world. And no matter what crazy conservative war types suggest... we're not going to defeat the whole idea of Islam with our Army - an Army that contains Americans who are themselves Muslim.

It's easy to call the revelations about Hasan's religious beliefs a distraction, even the unnecessary invitation to expression of unwarranted fears and prejudice. But the liberal inclination to tamp down any discussion of a difficult topic for the potential of some extreme to offend doesn't help us deconstruct, demystify or figure out the relevant aspects of the story. We have to find a way to deal with the part about Nidal Hasan being Muslim so that we can put his actions into a context, sort out what matters, and what doesn't. And than, I keep hoping, figure out how all of this context helps us to better understand the mental health issues that really need to be explored.

The Post I Keep Writing After A Mass Shooting

...but first: so much for that "Republican Revival" after Tuesday's election. If your "incredible momentum" can be stalled simply by a major news event sweeping you off the front page... perhaps tales of a Republican Renaissance are a bit premature.

I don't mean to minimize the horrific events in Fort Hood or trivialize them into a political discussion... but yesterday's mass shooting, as these things do, made a quick reordering of priorities possible, and made clear that much of the noise in politics lately has been irrelevant to the real struggles in our real lives. Watching Representative Joe Carter - whose district includes Fort Hood - or Kay Bailey Hutchinson deal, calmly and soberly, with an unfolding event underscored how rarely, these days, we get a news event where the last relevant detail is who's right, or left.

Like many, I was stunned into relative silence as events unfolded yesterday afternoon; for hours, there was so little information, so little clarity around what had happened that it was impossible to know what to say... and yet, it was clear, there'd be something. And by the end of the night, I was struck by the fact that what's clear about yesterday's tragedy is what's been clear in precious ones, and someone needs to say it, yet again: the shootings at Fort Hood are going to be about a man who was mentally ill. And until we do something much more extensive, and more honestly, about identifying and treating mental illnesses, we're dancing around the edges of disaster.

Do Nothing Til You Hear From Me

Day after day, the steady drumbeat of news and blogging insists that we are "almost there" on passage of "healthcare reform>" And day after day, I debate writing something, usually annoyed and slightly sarcastic, pointing out that, in fact, nothing much has happened, still, and the real prospects for reform are still as unlikely as ever.

And then I say... why bother?

Still, last week's passage of a bill out of the Finance Committee suggested that too much naysaying would be premature; it's certainly possible, on a momentum basis, that there will be... something... passed by the end of the year for the President to sign. It's probably some sort of hare brained "compromise" of ideas that have been bouncing around, which pretends that major elements of "reform" - like addressing Medicare reimbursements - if done in other bills won't be added to this one to determine an overall cost of reform.

I'd love to say I find any of this heartening or useful or even merely progress for the sake of progress (or as Olympis Snowe does, let's just repeat things twice - "when history calls, history calls." Ooooh. Now I get it. History is... calling). But I don't find much of what's happening at all helpful, and I think it's incumbent on those who know something about healthcare to point out, again, just what's not happening, and why it matters.

So here, a few points about why we may not be anywhere near the bill people think we're getting:

• How to pay for the thing is still a big mess. One of the remarkable simmering issues that's never been resolved is a mechanism to cover the cost of expanding coverage as proposed in all of the bills. Proposals have lurched from "luxury taxes" on the highest earners to a tax on "Cadillac Plans" of health coverage over a certain amount... which turns out to be some of the very nice plans unions have negotiated for members in various fields. Most prudent observers continue to point out that perhaps we should use tax revenue to cover the trillions of dollars of deficit spending already in place, and many other reasonable people also point out that tax increases in a precarious economy can't solve all your problems. It remains entirely likely that this issue, alone, could derail the whole thing.
• Do reform that doesn't really reform anything. The Finance Committee bill is the best indication yet that what's really happening is what was predicted by many - me included - months ago: that, as the idea of a Giant Reform of Everything fell apart, we'd get a scaled back proposal that does a few things, but is nowhere near the full attempt to reform major parts of our healthcare systems. That appears to be the result: we may get some insurance reforms ending preexisting conditions and lifetime caps (or at least, words to suggest both), we may get some subsidies to allow more people to purchase insurance... and that may be about it.
• Is there Medicaid reform... or not? Totally undiscussed is the most costly, and necessary, element to any real reform effort: federalizing Medicaid, and expanding it to cover everyone in poverty. The Finance Committee appears to have stuck to some sort of formula that approximates this... but it may be, as many Governors fear, a temporary fix that doesn't address the long term, structural problem of dumping the question of how to pay for halthcare for the poor on the states. This too is a major, undiscussed issue that could derail the whole effort.
• And then there's Medicare.  Medicare is the elephant in the room that at least everyone admits is there; pretty much every reform plan passed tinkers with some marginal questions, but nothing, really, is being done about fundamental problems in Medicare's structures that drive problems across the system. This is especially true of a looming problem around Medicare reimbursement rates, which have been a huge issue for doctors and hospitals. Then there's the generally expected move to significantly reduce Medicare Advantage, the HMO plans aadministered by private insurers which receive extra funds - essentially bribes - on top of normal Medicare rates. The cuts proposed will likely eviscerate the plans, and leave many seniors - especially in rural areas - with few or no options. That too is a disaster waiting to happen.
• "Public Options" are the least of it. Meanwhile, of course, progressives have made the presence of a Public Option - some sort of government subsidized insurance option - the be-all, end-all of reform. As always, it bears repeating that a "Public Option" onlyu solves a small subset of the overall problems with reform - you can't get to full coverage without one, but "full coverage" may itself be an unrealistic goal, and an incremental approach would make this a goal to get eventually... but not right away. What "public option" really stands in for is "move to single payer", which is even further unlikely than ever. Getting a public option, and especially winding up with a bad, poorly constructed one is no slution at all. But that's probably where we're headed, and by making that the only goal, progressives are giving away the other reforms that are far more key.

Will there be a bill? Right now, I'd guess there will be something... but what it looks like, I think, may be far different - and much less - than where we seem to be now. I think as a number of issues turn out to be too hard or the compromises too absurd, things will get dropped until very little is left and the real change will be modest, a few insurance reforms, some increased access, and not much else. But you can't count out the pressures to "do something" and that the Administration has made this a major goal. Failure will be disastrous.

But failure takes many forms - one of which I'd say is concoocting, as the Finance Committee did, a bill in which the main reforms are years away, and are strikingly modest and weak, all designed to hit a budget number, rather than ask the more pertinent question of what reforms are most important, and which ones can wait. Doing nothing remains a recipe for disaster, but "thie reform or nothing" does make the compelling case that doing nothing, just now, and starting over with a new, smarter proposal... would make more snese. But good sense, I suppose, is soething that's never been in the mix. And doing nothing til we have it... means we never will.

I Am Seriously Getting Too Old For This...

As I wander around the intertubes, looking for something, anything to distract me and change my mood, I find this - and when I find myself nodding in vague agreement with Kathryn Jean Lopez at NRO, and find myself shaking my head at the "Ask Professor Foxy" segment at Feministing... I'm either getting too old... or too conservative. But seriously... is it just me?

Update: In addition to confirming it's not just me (Thanks, Mom!), I also found that Lopez posted the link to Feministing as a follow up to this post, which is more in line with K-Lo's usual embrace of macho nonsense and traditional male/female gendered expectations (she was one of those "9/11 reminded us that manly men are firefighters and policemen" types, which even she now admits pretty much didn't take)... all of which makes rejecting her gendered expectations pretty easy; I'm all for revising the notion of being a man to include the actual expression of emotion and uncertainty. It's called being human, K-Lo, which seems like something to value, not ridicule... even in bisexual boy hustlers with queers cis girlfriends.

Does Olympia Snowe Want To Expand Medicaid?

As my good friends, and a few loyal readers know, I've been contributing pieces over at Change.org, specifically related to the subject of poverty, since Red has been editing the "Poverty in America" blog over there. Thanks to some recent changes in their organization,and my own feelings about being overstretched, I've decided to refocus my energies here, rather than contributing extensively elsewhere, at least for now. This piece was originally intended for the Poverty blog yesterday. I've decided to put it up here, instead.

Since I haven't made mention of my work over there for a while, I thought I'd preface this by mentioning that my own focus on achievable healthcare reform has changed: I am now especially concerned with making sure that any reform plan addresses the needs of people in poverty most, and thus have turned my focus onto Medicaid, the federal program designed to provide health insurance to people in poverty. For some understanding of how Medicaid does (and doesn't) work, you can check out this post I did a while back. For some discussion of the Medcaid proposal currently under consideration, I put this post together last month. To take action, please consider joining this drive I started over at Change.org to contact Congress.

In the context of the process already under way, in addition to hearing Obama speak tonight, we are waiting for the final bill to come out of the Senate Finance Committee, the 5th of 5 bills related to reform that have been considered by committees in the House and the Senate. The other 4 have already been passed out of their committees, and await further action. This piece is a discussion of the role of a key member of the Finance Committee, Senator Olympia Snowe of Maine.

As Tim Foley noted last week over at Change’s Healthcare blog, all eyes have fallen onto Olympia Snowe when it comes to the reform bills in Congress. Snowe, a Maine Republican, is seen as the last, best hope of finding any sort of “bipartisan” compromise on health reform… even if the only two Republicans to vote for it would be Snowe and her colleague Susan Collins.

There is nothing new to Snowe being in this position – as the Republican numbers have dwindled, and as the Northeast has turned into a Democratic stronghold, Snowe (and Collins) are about the only remaining examples of New England style moderate Republican approaches to government. Snowe walks a fairly fine line between staying true to her Republican caucus and crossing over to support major pieces of legislation, often providing crucial votes for passage, as she did with the Stimulus package at the start of Obama’s term.

Snowe’s centrist tendencies have made her a key player even as her moderate positions have proved endlessly frustrating. In the healthcare process she is part of the “Gang of Six” of the Senate Finance Committee, along with Republicans Mike Enzi and Charles Grassley, led by Committee Chairman Max Baucus, looking for a compromise that can pass the Finance Committee, and may well serve as the model for what will ultimately pass the full Senate. Unlike many of her colleagues, Snowe does not negotiate via press release, making her positions sometimes hard to discern, until the actual compromise appears.

As you might guess… there’s not much to tell us where she stands on healthcare and poverty.  But we do have some clues, and they’re not all bad.

After Talking... Now What?

Health care reform needs more than a speech.

I'm sure, when the President speaks tonight that it will be a very good speech, very well delivered, and certainly well intentioned. By staying off the public stage until yesterday, President Obama may have left room for opponents to charge in and make loud, often foolish, countercharges, and made his own re-entrance more of an event than it would be, say, if he'd done it two or three weeks ago. He can clear much of the misinformation in a few sentences. And he can go a long way to clarifying his own positions on various aspects of reform under consideration, all while reminding us, generally, that this what he's really, really, good at doing.

But still, that shouldn't be construed as doing what needs to be done to get reform passed.

Too often, even in this short time frame, the Obama Administration has mistaken the first step for the follow-through, a kind of "The Great Oz has spoken" notion of governing. He gives a speech, his aides point out all the brilliant aspects of the speech, and then... they seem to wait. Often, until they feel the need to give another speech.

While the previous Administration seemed to fear telling the public anything at all and preferred to take executive action in secret, The Obama folks seem to be all about getting everyone on board... and then not quite knowing where to go from there. That's the real hallmark of the reliance on legislators to do the heavy lifting of turning vague notions into practical proposals, and its been the root of frustration with Obama, both from those who believe in him, and those who don't. There's a distance between the vague exhortations he generally offers and the actual work of making them happen. And it's fine if he's not the one to make the leap from one to the other... what concerns me is that no one else around him seems especially good at it, either.

What I was trying to say in my previous post about Obama and illusions - and I'm not sure I did clearly enough - is that I don't think he's doing a terrible job, or that he's a failure. I do think that the more clearly we face the strengths and limitations of him and his team, though, the better off we'll be understanding what's doable and what isn't, what's working and what's not. Giving a speech, exhorting others to stand up, work for change, do things (which, really, was always going to be his message to students)... these things are second nature to President Obama. And from his campaign, to the Stimulus package in February and March to healthcare reform ever since... over and over, its' been shown that his fine speeches, alone, are not the answer; and, over and over, the people closest to him seem to have no idea how to move beyond that.

Healthcare reform doesn't need an exhortation (though it does, even now, need a better explanation than anyone's offered, one that Obama is unlikely to provide tonight), it needs practical proposals, hard work at finding workable compromises and the follow through of fighting for what's important and letting go what's not (a reality that no one seems to want to face when discussing, say, a "public option"). Tonight's speech will be fine; that was never the issue... and it's not the last step. My only concern is... I'm not sure the Obama folks know what the next step is... or how to do it.

The Labor of Preserving Illusions Or Letting Them Go

More than most Labor Days, I suspect that this year's official "end of summer" (yes, yes, autumnal equinox is 2 weeks away... but you know what I mean) is meant to be a real "restart" for many people and many issues. Summer in America is all about escape, and our escapist tendencies, I think, have kicked in a little more than ever in this post economic apocalypse year. Take the vacation while you can... or don't worry about the job search until later... I've just seen a lot of "I'll think about it tomorrow" or more like next month, especially all through August.

Tomorrow, a lot of that putting off will come due, especially in terms of our national politics. In two days, President Obama is giving two major speeches, one to "reset" the health care debate, the other to indoctrinate children into his unholy schemes to... oh, sorry. Just kidding.

The serious side is that President Obama will return to the national stage - and let's give credit to him actually taking "vacation" seriously enough to not make a lot of public appearances, except for the most necessary one (Kennedy's funeral) - to a nation that is not what it was, even a few months ago. The distinct sense that there's more bad than good right now, that people are growing disillusioned with the President, Congress, and government generally, can't really be ignored. Whether anyone, even the President, can fix that, remains to be seen.

But in some ways, contrarian that I am, I think "disillusion" is the wrong word - perhaps the more useful way to think about what's changed, especially over August, is that illusions, dreams, and fantasies have come hard up against some necessary realities. The limits of Presidential power, of the potential for massive progressive change, of stopping real change solely through fear, anger and desperation... these things needed to sink in. And maybe, when President Obama returns to the national stage, we can see him in a more realistic, human way... and begin to make progress - however slowly - on the real problems we face.

The Blame Game... Blame Canada, Blame Grandma...

As we move into the hopefully final unproductive week of summer, the question of where things go on healthcare reform is both wide open... and pretty well wrecked. It's hard to see how progress can be made on the current mish-mash of bills (especially the painfully nonexistent bill yet to be produced by Senate Finance), but any sense of the alternatives, or a negotiated deal or giving up all together... is entirely unclear.

Already, the Washington, mass media conversation is moving away from specific reforms to "horse race" questions of who's up, who's down, and what went wrong... along with mournful sobs of "if only Teddy were here" which continue to overstate what Kennedys actually do. It would be helpful to have a Ted Kennedy just now for two rather basic reasons: he knew stuff, and he did the work to get it done. Beyond that, progressive dreams that Teddy would have ended private health insurance when no one else could... are pretty much fantasy.

Without agreeing to the rules of the blame game, I think it is probably time to asses what's not working, figure out some sense of why, and figure out if anything can be done. Ever the optimist, I think we will, ultimately, see some sort of healthcare reform. My bet, though, is that it will be modest, fairly incremental, and please probably no one... a result that will hurt Democrats and the President more than Republicans.