Like a number of people, nothing's bugged me quite so much about the rush to dignify the process of passing healthcare reform than assertions that this legislation was pursued for noble reasons. The insistence on ennobling the bill (excuse me, law, as of this afternoon) with qualities it does not possess, beating back objections with cries of "pipe down, this is important and historic" tends to ignore what really drove the entire process of this bill, and will probably define its aftermath as well: political calculations meant to influence future elections.
What we're witnessing, I think, is the ultimate result of a series of steps towards setting up Washington, and service in government, as little more than a way station to permanent campaigning for office.
This may seem obvious - I can see a number of people saying "weboy, you naive sod, it's always been thus" - but such assertions, I think, tend to underline how this endless campaign mode has taken hold of our collective discussion of politics. It's not just winning for winning's sake - notice that the loudest, most intemperate, and often most misplaced cheers after Sunday night's vote amounted to "nyah, nyah, suck it, losers" aimed at the GOP - it's the sense that our policies and processes are now in service to the needs of elections, rather than the other way around.
There are a number of reasons for this shift, but I think the most obvious observation is that this is not a sudden, wholesale event, but a series of gradual shifts, which is why undoing them is far harder than it appears rhetorically (there's a lot of muttering about the problems of excessive fundraising, the need for campaign finance reform, etc); more to the point, the will just isn't there - for each side, the prospect of winning under whatever scenario is in play is far more attractive than the hard work of making unpopular, controversial choices that might give the other side some sort, really any sort, of advantage.
But the excessive money swilling through the economy, the rise of highly partisan media, the development of the twenty-four hour news cycle via cable - and now the internet and all that has followed - have distorted our politics and our government. It's only possible, I think, to suggest that the most local governments (where the basics of delivery of government service to communities remains fairly intact) have avoided some of this. At state and certainly national levels, the weight of campaigning has taken over the weight of good government. Just to a New Yorker, I think, this is beyond apparent: we've thrown up our hands at getting anything like a decent government out of Albany... now we just hope that, maybe, the next election can fix what the last one broke.
This week, I think, the reality of a health insurance reform bill designed for campaigning became all too apparent, especially by today, when the White House held, in essence, a Democratic Party rally and called it a bill signing. That's why the reform efforts of the past year don't really compare to 1965 and Medicare or 1993 and the Clinton failure; this bill, really, was drawn with both eyes on voting trends, rather than on identifying the best policies and processes to make healthcare more rational, with improved care, and less cost.
The bill just signed, in fact, exists far better as campaign talking points than it ever has as a completely thought-through exercise in governance. Too many questions remain; too much of the bill's changes are kicked into a far-off, yet proximate future, full of possibilities for undoing changes long before they take effect. The bills biggest proponents - on the blogs (Ezra, Jons Cohn and Chait), in the papers (Krugman and Kristof), and on TV (Maddow and Olbermann) - have been far more comfortable in the language of campaigns and talking point rhetoric than on hardcore policy (especially contradictory in Ezra, who dances uncomfortably between admitting that the bill is weak in many respects, while insisting it represents just the sort of historic change a weak bill can't provide). To look beyond the talking points, into the specifics, is to realize that there's far less going on than meets the eye.
It's tempting, in this, to blame the permanent campaign on the campaigners: in particular, I remain convinced that we are here, in no small measure because of Nancy Pelosi's leadership. With her roles as former fundraiser and local party Chair, I'm convinced that she reflects a partisan sense of policy held in service to party goals. She has made the narrow party-line vote into a necessity because the idea of comity and compromise across party lines serves no purpose in election results. And she can force members into line, essentially, by providing the resources needed for future elections. The circular elements feed themselves.
All of this, ultimately, is why I think so many progressives are aiming their energies in the wrong directions: passionate healthcare advocates miss the reality that radical, thoughtful proposals on broad change don't fit electoral goals; supporters of a Democratic majority miss the reality that "change" - the thematic glue of the Obama campaign - can't happen when the Party relies on legislative incumbency and status quo for success. And most of us in the general electorate, I think, try not to face the realities created by the needs of a permanent campaign: just who gives money, who gets access, what that access gives the people who want it.
Like I said, I'm not convinced, knowing any of this, that the permanent campaign mentality can be undone; it would take a lot of bravery and risk to get either Party's establishment to try and shift the focus of elected officials away from future job security, without upside. But I suspect it's why progressives who want more substantial change - whether on healthcare or a host of other issues - might be better served advocating a "lose to win" approach when talking about Democratic incumbents. It's unlikely that a real shift by the leadership can happen... until there's different leaders in charge of the Democratic caucuses in both houses (or one can hope, given that Nancy Pelosi is now 70, that age alone will force a transition; I wouldn't).
In any case, though, I think it's valuable to realize that healthcare reform exists and succeeded, primarily, to fulfill the needs of legislators in upcoming elections. And it may help to deliver future election success. But if it doesn't... I think we may have just lost a year to "healthcare reform" that might never actually come to pass, and somehow, it will be our fault, and not our leaders. If we let them get away with it.
I've seen a few comparisons of this bill to an earlier one (from the Clinton years, perhaps?) proposed by Republicans, and my question becomes would the reactions ("historic")be the same if this bill had passed under GW?
Posted by: jinb | March 23, 2010 at 10:19 PM
Intriguing post. Interesting and well written. One quibble:
"As a former fundraiser and local party Chair, I'm convinced that she reflects a partisan sense of policy held in service to party goals."
Are you the former fundraiser or is Pelosi? ;) (I ask in semi-seriousness, given your past NYC work.)
I don't know what to make of all the celebrating; I feel a bit excited myself, by the occasion of it all, I confess. Today at the MD I had to sign a form about some testing that some pp opt to pay out-of-pocket, we could only surmise from the form language, because they worried it would trigger suspicion of a pre-existing condition down the line. But this was several hours after apparently we have this new law that no longer allows that. So that seems like a good thing.
And I think it's a good thing that we have compulsory insurance here in MA. Affording it and getting in to see the doc, well...ok, we're working on that... ;)
Anyway, I do think the bill is probably underwhelming compared to the fanfare Obama is and forever will receive for it. And here's David Axelrod on Charlie Rose as I head to bed - the permanent campaign indeed.
Posted by: Leigh | March 23, 2010 at 11:52 PM
Thanks for the catch (and where is J when there's bad subject/object agreement?); I fixed the referencing, since the alternative was to start a career in local politics. :)
To your points about specific improvements: I think we can all, generally agree that the most popular and common sense provision of the bill (preexisting conditions) is a fine achievement; and yes, many other elements of the bill (mandates, subsidies and such) do flow from that step. And you make the point that insurance does not equal care and insurance reform is not cost control. But as I said, I think the key here is that the policy choices were guided by what will get future votes, and not by, say "let's get the best policy together... and even if it's unpopular, we'll know we did the next right step." For many people, there will be some helpful outcomes (I have seen, clearly, the joy of many under 25 slacker kids thrilled to get insurance via their parents). But I think the bigger question is, in the long run, are we getting the truly substantial reforms that will transform healthcare, and clearly, that's a no. Popular, feelgood fixes that extend deeper problems are the real hallmark of this bill.
That said, I love your observation about David Axelrod - I wasn't even thinking about the role he (or say David Plouffe) play in the current White House, an extension of putting Karl Rove into the last Administration. Permanent Campaign, indeed.
Also, to J's point about this being a "moderate Republican" bill: I think Republicans, in the past, envisioned some sort of insurance mandate, and probably some fixes meant to address the risk pool issues insurers have covering everyone. But Republicans, of any stripe, wouldn't have crafted an expansion of Medicaid (they hate it, like most poverty programs), and they wouldn't eviscerate Medicare Advantage as the Dems have done - it's been a long Republican dream to turn Medicare into a more private sector enterprise. Remember to that George Bush's "health proposal" was what became John McCain's: push people out of employer insurance into the individual market, by ending the tax break on employer benefits. While a similar result may, theoretically, be a result of this bill (on the notion that people get pushed wholesale into the exchanges), I'd argue that this is exactly the way Republicans never wanted it to happen, with government subsidizing premiums and defining the insurance product. And, if anything, I think the last election was a referendum on McCain's proposal, which soundly lost.
Posted by: weboy | March 24, 2010 at 06:41 AM
check out this diary; I think it relates to this post quite well
http://seminal.firedoglake.com/diary/37191
Posted by: jinb | March 25, 2010 at 10:30 PM