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.
First, I think the left has no one to blame but themselves - blaming conservative scare rhetoric, Palin and her "death panels", Betsy McCaughey and her "well read" idiocy... doesn't really amount to much. Conservatives came to the healthcare reform debate with nothing, and they've provided... well, nothing. And instead of firmly challenging the right to come up with something before we would take anything they said seriously, we let them say anything... and pretended it was serious.
Perhaps the most foolish errand was the "Blame Canada, Blame the NHS" line many conservative pundits took. Complaints about the Canadian and British healthcare systems - rarely were any other foreign countries mentioned - were a dead end that few should have bothered to fight so vehemently; while their single payer systems are interesting, stories of individual issues, queues, and poor care are the worst kind of "evidence": anecdotal, occasionally accurate, ignorant of the full picture. But the larger point that was lost - primarily because many thoughtful progressives favor single payer so admantly - was that in no way were we ever likely to wind up with either a "Canadian model" or the NHS. Yet, instead of taking on this fallacy, and using it as a way to inform many people about the realities of what we have here in America, we were instead diverted into arguing wehther Canadians wait for back surgery or not. Who knows... who cares... why bother.
One blogger I should be reading more - Anglachel - sums all of this up very nicely, referring to articles by others, especialy Bob Somersby, pointing out that Democrats have a fundamental messaging problem that's hard to shake, and that the semi-unity around Barack Obama really only papered over. The failure to focus on a message, and communicate it well, is a real political liability. I think it is, as Angachel suggests, a key demographic problem: we are letting academic elites and wealthy lefties, for whom "helping the less fortunate" is a nice idea, but not a direct need, drive the terms of debate. And in our educated well off way, we enjoy a good debate, we think knowledge will trump everything, and often, we view practical needs as a negotiation, rather than a dire urgency.
I think we're well past the point of admitting that this sense of his Presidency is what Barack Obama will either overcome or fail for. All the disheartened hand-wringing of the past few weeks, urging Obama to "lead the way" and "take a stand" are symptoms of the larger dilemma. And in many ways I think our expectations that he can change this are unrealistic - the academic, distanced way of discussing issues, the lack of practical, hands-on solutions... these were issues many of us pointed out going in; healthcare has only made them more p[ronounced (and really, you could use the banking, financial and economic crises as a perfectly fine substitute example as well).
Can we salvage healthcare reform? In its current form, I suspect not; after 4 weeks of drumbeats and consolidation of opposing points of view, there's just too little to salvage, and few ways to sell it successfully. No one - certianly not Obama - has the political cachet, just now, to try and bulldoze over the right wing anger and fear moachine, push through a seemingly unpopular, but vital reform, and look good after doing it. Without that... there's probably little will to get this done, when Congress reconvenes.
Already, we've moved into absurdity - mainstream media pundits and bloggers have started decrying the "Horserace Journalism of the MSM" as if they, somehow, were writing about healthcare as something other than just that. Few, if any, serious bloggers have used their platforms to look at healthcare in a deep, substantive way... and no, harping on "a public plan" does not make you deep. If the right has shown itself, yet again, to have little more than anger, fear and "no" to offer, the left has not risen to the occasion to improve the discourse nearly as much as we need: too much of the left has been caught up in figuring out when and how political advantage can be deployed and ignored the more basic issue - are getting good reforms to health insurance that make snese? Are we actually solving for key issues and constituencies?
By thinking "sales job" first, and "substance" second, if at all, progressives have set themselves - ourselves - up for failure. Helathcare reform isn't a sales job, and trying to make it a sales job guarantees failure. As we move into "Blame the old people" mode - the familiar trope that Seniors, scared about Medicare, will turn from pro-reform to anti-reform whenever they feel threatened - a more basic reality is that too many progressives fail to start the healthcare debate with an honest assessment of Medicare at all. It's popular, it works (sort of)... but it's very expensive, it's approach to healthcare financing is driving a lot of the bad things we need to change, and very soon, we won't be able to afford doing it as we have been. By taking Medicare off the table too soon... we set up a dynamic that makes it worthwhile for seniors, and their advocates, to take a hardline against doing anything at all.
Perhaps the real challenge here is to stop thinking in terms of fault and blame; I admit, in some ways it's too soon to suggest that "healthcare reform is over"... but unreality has plagued our "healthcare moment" from the get-go: unrealistic expectations, unrealistic notions of what Americans can and will accept, and unrealistic plans to "ram through" unpopular changes atb all costs. The failure of healthcare reform to make it through the heat of August didn't happen, suddenly, as the recess loomed; it was a series of missteps, over time, which need to be faced if anything can be done to fix them. And that's why it doesn't matter, ultimately, who's to blame... what matters is what we're going to do now... and we have no one to blame but ourselves if we can't figure that one out.
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