Tuesday, December 15, 2009

Why I Probably Won't Be Voting for Obama Again

It would seem that meaningful health care reform has been killed in the Senate. Really and utterly destroyed. Joe Lieberman, Bill Nelson, and a few other conservative "Democrats" have said that they will not vote for the bill as it stands. Let us take a brief detour through the history of this process.

Medicare was created in the U.S. in 1965 under Lyndon B. Johnson. It is offered to those who are U.S. citizens or have been living as legal permanent residents for 5 years or more, who are 65 and older, and have been paying taxes for Medicare for at least 10 years. Medicare is a single-payer system, and in fact is the largest single-payer system in the world, covering 43 million Americans in 2007. The program has been under constant scrutiny since its inception, and indeed has a lot of problems - one of the largest being huge fraud issues. Medicare has been updated several times since its creation, and largely has gotten better by most measures of such things. Conservative opposition has always been the strongest, and typically fall along two pillars - 1) It's too expensive; and 2) It leads to socialism.

As to expense...yes, I'll give them that. The Medicare system needs significant overhaul to cut costs and perform audits on treatments. Clean up the program, and you will probably see significant savings. Al Franken has made this a huge talking point - the guy is very much in favor of Medicare, but recognizes it needs significant work.

As for the second pillar, that of fear-of-socialism...well, I offer this to the conservatives. If you really and strongly are opposed to all "socialized medicine," and are so concerned about principles and values as you claim, then propose an amendment to eliminate Medicare. Get rid of it. Tell all your constituents that Medicare is "evil" and "socialized" and is ruining American freedom and that you're going to eliminate it and allow the elderly to exercise their freedom of choice and buy their own health insurance out of their own savings (because subsidizing them would be exactly the same problem). You'll be saving money and protecting American values. I don't understand why you haven't already done this when you controlled Congress and the Presidency.

More below the fold...

Let's jump ahead to the Clinton administration. A bit arbitrary and skipping over some things, definitely, but this is a blog post, not a history of health care in America. Clinton made it an important part of his presidency (in some parts spearheaded by the First Lady) to introduce health care reform. Part of the problem was that it wasn't sold very well, and conservatives and the health care industry made their case loudly and well (whether or not it was a valid case is an entirely different point, but here is the problem inherent in humans - we don't often, if ever, make choices based purely on logic). Clinton tried and got little done - it was all basically shot down by Congress. We had no meaningful reform, despite the fact that so many conservative members of Congress claimed that they were quite happy to legislate reform, so long as it was the right reform.

Let's skip to the Obama administration. This is not as arbitrary. For more than a decade very little was done with health care, despite conservative control of government. That silence may, in fact, be the most damning evidence against them of all.

Obama campaigned primarily on promises of health care reform, on significant reform in foreign policy, on constitutional adherence and on transparency in government. In foreign policy...well, he's done a pretty good job. He has restored a large part of foreign nation's relations with the U.S., and has taken a tough but measured stance on specific groups. While I don't fully agree with the idea of sending 30,000 more troops to Afghanistan if your only purpose is hunting down the reported 100 or so people left, I'll give it to him, it's a strong political message, and at least he's showing he is attentive to the situation there.

However, Obama has made little moves to eliminate or reduce Bush's foreign or economic policies. I see this as a significant failure. The Patriot Act, tax cuts, even the TARP bailout. Let me be the first to state that I do agree that some sort of bailout was necessary to prevent a deeper depression - whether or not we should have had a bailout may not be the right question. How the bailout was carried out...that is entirely a different question. The bailout should not have been, I think, at a $1:$1 ratio, nor do I think that it should have come without any oversight or regulations. Basically, nothing has been done to fix the basic system. Obama's speech in the past few days about the bankers' responsibility? Please. A glorified publicity stunt - a public slap on the wrist, nothing more. He's asking them to self-regulate. The media complains that the White House doesn't have much leverage in this situation. Please. My ass the White House doesn't have leverage. Let's look at it this way - the only reason most of these banks are still afloat is because the American tax-payers bailed them out. Obama, as the representative of the American taxpayers, should be able to tell the banks a few things, as that we own a rather large stake in them now. And what should he tell them? Well, first of all, that they're going to open up lending again. And if they need a little assistance in that, well, we could just eliminate the whole credit default swap mess that got us into trouble to begin with. Executive decision - regulatory power, hell, use whatever agency you want to decide that they're fraudulent and just effing ban them. That's a big stick right there.

But Obama consistently makes deals with the bankers and continues to open loophole after loophole for them. I believe that he is smart enough to realize that he does have the ability to push for regulation, (certainly Britain and France have recognized it). I believe that if he had the will to do it, he could accomplish it relatively easily. Which leads me to believe that he simply doesn't want to do it.

So now let's look into health care. If we go with the most progressive/liberal option, Obama could have pushed for a single-payer system. This would essentially be like expanding Medicare to everyone. The basic pros would be everyone would be covered with health insurance, and assured coverage. The basic cons would be costs and likely tax levies. But, instead of pushing for this, they compromised to a strong public option - a government run insurance plan that most anyone could buy into. This would also have come with significant regulation reforms to bring down costs in other areas such as Medicare. I was in support of this plan to begin with, but again and again the Democrats compromised, and the White House stood basically silent or encouraged such compromising. Now the public option, if it happens at all, seems likely to be a completely toothless measure that would cover very few people, be vastly more expensive than it would have been to begin with, and chock-full of loopholes. I am not in support of this type of public option.

Now, granted, the House passed a proposal with a public option. It's not everything that we would want, but...maybe it's a bit of a step forward. But let's look at the Senate. Here we have the utter breakdown. The Obama administration has again and again called for "bipartisan support" for this bill, and has signaled his willingness to compromise again and again to get even one Republican vote. But that's exactly the problem - they have given you the laundry list for what it will cost to get even a single vote from their side of the aisle. We'll have to eliminate the possibility of a public option, we'll have to eliminate the expansion of Medicare, we'll have to mandate that everyone gets private insurance coverage, we'll have to reduce regulation. Essentially, if we take out all meaningful reform and fill the coffers of the private insurance companies, then we might get a Republican vote or two...but probably not.

So here are the basics - the Senate's bill does not include a public option. That got eliminated due to "conservative Democrats" like Joe Lieberman and Bill Nelson. Then someone proposed that we could expand Medicare to people 55 and older in special cases. But Joe Lieberman didn't like that, so, of course, we have to bow our heads to him. The Obama administration has made a deal with him and has basically told Harry Reid to accept whatever Lieberman says. Lieberman says that not only will he not vote for any bill that has a public option or Medicare expansion, but that he will join a Republican filibuster.

Let's look at the situation. If the Democrats had any spine at all, this would be a very easy fix. There is a special option for budget resolutions in Congress called reconciliation - it's a fairly drastic measure, but let's be honest...the Republicans used it all the time when they were in power, including to get the Bush tax cuts passed. Back when they were in control, reconciliation was just another means of doing business, while filibustering (the Democrat's option at that time) was a horrible and obstructionist policy. Now that the Democratic Party controls Congress, reconciliation is a means of railroading policies and destroying American freedoms, while filibustering is a noble venture to protect the people. Hmm...politics as normal.

Anyway, the point is, you could have a Senator, one of the ones already locked in to vote for a reform bill, go on any of the programs that Lieberman and Nelson are touring and say something like the following:

"Oh, hi Mr. Lieberman, Mr. Nelson. I'm sorry to see that you've been wasting your time on these talk shows. You see, we've decided to split the bill. Yeah, it's going to be a headache, but, here's the thing. We're going to put in a public option, or an expansion of Medicare, or whatever the American people want, and make it a budget matter. Then we're going to push it through in reconciliation. I'm sorry, but you are effectively irrelevant now. Oh, what's that you say? It's going to cost too much? Well, it's up-front costs, maybe; but the Budget Office has already returned estimates that show that these measures would save us a helluva lot of money over the next decade. So, at the very least, it's budget-neutral. What about that war that's going on? I notice the conservative senators across the aisle never had any budget problems when Bush was in office. How odd it is that they and you are complaining about the budget now. Oh, and we're going to push private insurance out of business? Look, I really don't think that's going to happen - FedEx, UPS, and the USPS all coexist quite happily. And if they have to trim their belts a bit and offer better services, well, that's capitalism for you. Socialism? To begin with, that's ridiculous, and on the other side of it, a majority of Americans want significant health care reform and are in favor of a public option. So, you tell me, if the American people want it, why are you standing in their way? Even if it does smack of socialism to you?

"You see, (interviewer's name), the problem is that most of us in America believe that when you have two opposing views, the truth must be somewhere in the middle. Our issue is that here we have one side, the conservatives and people like Mr. Lieberman, who are so far off into non-reality, that even when you take the middle ground between them and the facts, you're still wrong. It's like when you split the differences between American progressives and the "pure" Republican party, you're still pretty conservative. We need a fact-based approach to this, and here are some basic facts - private insurance premiums have continued to rise unchecked in the past years; health insurance is covering fewer and fewer people for fewer and fewer conditions, and thus excluding more people for more conditions; the majority of American tax-payers, who people like myself and Mr. Lieberman are ultimately accountable to, want strong health care reform like a public option; the people elected Obama, who ran on a platform of strong health care reform; and no significant reform has happened in quite a long time. Beyond these basic facts, there are the numbers of comparing different health care systems around the world. On any standard measures, ours ranks fairly low. Conservative congressmen are wont to say "Our health care system is the best in the world." I can only assume that they include the V.A. and Medicare in that, as they often tout our treatment of veterans and the elderly. If that is so, why are they so opposed to a government-run plan for the rest of us?

Could it be that these senators and representatives are not truly representing the will of the people? Could it be that they have been bought off by private insurance companies? We know they receive significant amounts of money through that lobby, and it seems that opposition to health care reform is directly correlated with the amount of money being received from them. Which brings us back to Mr. Lieberman, senator from Connecticut. You stand to gain a lot from revenue increases for private insurance companies, Mr. Lieberman, and have proven time and time again that you have no real interest in actual reform. Thus, we have decided to cut you out of this process. We are going to reconciliation, and we will spend every nickel we can to run an actual progressive against you in Connecticut in the next election. Don't pretend to be surprised or angry. You can pack your things and move to the other side of the aisle if you want, but for now, you've effectively been cut out of the debate."

You want to tell me that the Democrats don't have leverage to spare right now? Fuck, it's like everyone's taken a stupid pill. I think the issue here is that, with a few notable exceptions, no one, including Obama, is really interested in creating real reform in this area. Maybe the lobby is too big and there's too much money in it for them; maybe they were never interested in reform to begin with but just wanted to garner some of the progressive vote - I don't know. What I do know is that Obama has completely given up on a lot of his campaign promises. While I think that's normal for politicians, it's also disappointing to have allowed the process to go this far and then have the guy who proposed it in the first place stomp it down.

I know that Rahm Emmanuel has his strategy - gather whatever support you can from conservatives by compromising, because progressives will never vote for the other guy. They're expendable. Well, maybe that's true. We're not so crazy as to vote for ass-hats who have been coming to the forefront of the conservative movement recently. But, maybe we're not so stupid as to keep voting for people who are going to turn out to be conservative-lite in the end.

So, for now, I'm probably not going to be voting for Obama again. Don't caution me about voting against whatever crazy-person the Republicans offer up...at this point, I'd almost relish knowing again that the person in power has no intent to do anything but selfishly promoting their own power and control. I'm not sure that it's less dangerous than having someone who promises so much and not only fails to delivers, but purposefully does the opposite. Obama can win me back, but it's going to be a hard, hard fight.


Max Reddick said...

I agree with you. I did a blog post on the president's mis-handling of HCR stating much the same thing: http://soulbrotherv2.blogspot.com/2009/12/president-obama-you-can-be-remembered.html

Ragoth said...

Hey Max,

A really good post, and it looks like you've got some good comments as well.

One of my biggest worries about the whole thing is that we've spent decades trying to get real reform in health care, and while the situation continues to get worse, every time we "get back" to talking about reform, the proposals are weaker and weaker.

We need a strong progressive voice in the country, and I don't think that necessarily means radically left, but I'm starting to wonder if at this point the only way to fight the right's rhetoric is fire with fire.


tom sheepandgoats said...

If what I read is correct, those who oppose the health care bills also do it on the
basis that said bills do nothing to control costs. Is there anything to discourage the
sue-happy culture that prevails in this country? In medicine, huge financial verdicts,
consequent sky-high malpractice premiums, plus endless tests ordered in the course of
defensive medicine all drive costs excessively. It's a Democrat issue. Too, it is nothing
for several hundreds of thousands of dollars to be spent at end of life, with little or
no result, by a culture that somehow imagines it a worthy goal to forestall death a few
days or weeks. This tends to be a Republican issue. Alas, there is a sense that, while
other countries have long ago figured out tolerable, if not ideal, health coverage,
Americans are too unreasonable and contentious for it to happen here. Time will tell.

On financial issues, I think bankers long ago seized control of our affairs, and not
politicians. Probably a parallel situation with the military and international relations.
I suspect many politicians who are accused of lying in reality step into situations which they
ill understand. Once they manage to get their heads around it, they realize they don't
have the power or the options they thought they did. Obama, say what one may about his intentions or integrity, can hardly be said to be seasoned.

(btw, you are mentioned by name in a post I wrote a few weeks ago about our folks and the
WWII Germany)

Good to hear from you, as always, Ragoth.

Ragoth said...

Hey Tom,

I will partially agree with your first point - indeed, there are no real restrictions on costs, but that's more a problem with the watered-down Senate version. The Budget Committee had already shown that the stronger public-option version of the bill would have reduced the deficit over ten years, and would drive down costs, as well as imposing efficiency standards. The Senate version...not so much. But this is where the hypocrisy really comes in - conservatives oppose every measure that could control costs or reduce premiums, and then complain that the bill is too expensive to the government and does nothing to control costs.

Likewise, I understand the issue of end-of-life expenses. By the same token, I am rather opposed to the idea of telling someone that they've reached the end of their useful life and so we should stop providing some measure of care for them. This is a bit of a thorny issue, especially considering quality of life, but, I don't think that means that we should simply give up on it. There needs to be debate on this issue, but a large part of the problem is that we never even get the point of a debate before the argument derails into emotional appeals and falsifications. Unfortunately, America, especially at this point, does appear to be too unreasonable to get anything useful passed.

As to banker-control, I'm again somewhat sympathetic, but I think the problem runs deeper. With corporation laws being what they are, at this point we've basically guaranteed any sufficiently wealthy lobby control over their own industry. I do think that corporations deserve some representation for their interests, but not this much. We get to vote with our ballots, but they get to vote with their dollars...and in the end, the dollars tend to win out. Especially when they can spend their money on campaigns to convince people of their moral righteousness and how they're really helping the "little person." And most people buy it.

As for Obama...I think he has run into the realities of Washington, but on top of that, I think he's a born and bred politician. That isn't necessarily a bad thing, but his natural instinct is to always move to the perceived middle of any situation. Democratic nominee Obama was quite progressive. Presidential candidate Obama was fairly moderate, and now President Obama is moderately conservative. Each move has brought him into a situation that is more conservative, and so in each situation he has moved more and more to the right, toward a perceived middle ground. I think that it's possible that if enough people on the left spoke up and made noise, he might realize that he's not really in the "middle" anymore, nor is he representing the people who elected him.

Anyway, that's my analysis, for what it's worth.


tom sheepandgoats said...

I don't understand why you haven't already done this [repeal Medicare] when you controlled Congress and the Presidency.

I believe these fellows would respond by observing that an entire society has been built on this decades-old program. It has become ingrained into two or three generations that it represents and American entitement, if not a right. It may be a house of cards (its bankrupsy suggests it is) but it is still a house, and the only one Americans have. One is naturally reluctant to pull the lynchpin of a house of cards when they have nothing with which to replace it.

I believe the program wasfought tooth and nail when it was first proposed, but conservatives did not have sufficient clout until Reagan's election 16 years later. Once you take a turn in the road, you can't necessarily go back and untake it. People quickly build plans around the program and look forward to drawing upon it. I'm of the age where I start to do so myself, though with the caveat that it may be much reduced by the time I get there.

Ragoth said...


I agree that it was fought tooth and nail when it was first proposed, but the argument here is more about logical consistency. While the budget problems are obvious for Medicare, it's mostly based on how the program was set up - put only the people who would be using it the most out of the population in the program. For an insurance program to work, traditionally speaking, you need some people who use it not at all and some heavy users.

If Medicare were expanded to say, the entire population, you would have such a system where a large percentage are either light or never-users, and then have the heavier-users. This would be more helpful from a financial standpoint.

I'll fully admit, at the moment, the system is set up for failure. So, yes, there does need to be significant reform.


tom sheepandgoats said...

I think you've put your finger on why it was fought tooth and nail. Medicare was set up to be a self-sustaining fund. Everyone would pay in; everyone would draw upon it in old age. The separate medicare and social security 15.3% allotment in payroll tax still suggests that this is true.

Conservatives, thinking they knew human nature, felt sure in their heart of hearts that what in fact has happened would happen - that politicians would spend the monies on various pet projects, and that the project would amount to just a massive tax increase, with its actual purpose ultimately undermined.

Hard-hearted and self-serving though some of these folks may be, I suspect opposition would have been far less had they the confidence that the monies collected would be used as intended.

Somewhere there is a quotation - I wish I could recall where, do you know of it? - to the effect that democracy is doomed to fail over time, because the people realize in time that they have power over the pursestrings, and eventually spend themselves into insolvency.

Ragoth said...

@ Tom

I will agree that a lot of the funding has gone to...well, not where it should have been going. This is in addition to the widely different standards and uses found in different hospitals, where some are charging more than twice as much from Medicare for the same treatments. Efficiency standards would help, a buy-in would probably help as well.

As to the quote, there is one from Alexander Hamilton that goes along the lines of "That power that holds the purse-strings absolutely must rule." I don't think that's quite along the lines of what you're intending, but it's the closest one I know, and one that I don't particularly agree with (though I understand the sentiment, the same from Plato's Republic).