Thursday, July 10, 2003

The Medicare Trap

Lambert's done yeoman work posting particulars of this new Medicare bill. Now, I'd like to apply a narrative perspective to the issue of what Democrats are and ought to be doing.

What's the story here; what do we want the story to be?

As the President's men and women will be telling you at nauseous length, the addition of a prescription drug benefit to Medicare would be the largest expansion of this vital social insurance program for decades. If you have the feeling that there is a whirlwind quality to this Republican enthrallment with the benefit itself, rather than with their decades' long efforts to reform, privatize, modernize (they all really mean privatize, i.e., destroy) Medicare, you're right.

What seems to have happened, Karl Rove decided the President was vulnerable to charges of being less compassionate than advertised, and as with the Homeland Security Bill, met the challenge by quietly shifting the White House position on what had been a make or break issue, tying the benefit to some form of privatizing.

The shift worked in the Senate, where Republicans can't pass anything like this without Democrats. Ted Kennedy was the key figure here. But please understand, this is not a bash Kennedy, or a bash the Democrats piece. First, because they don't deserve it on this one; second, because that gets us nowhere fast.

Once the Pres gave up the either or choice of HMO with drug benefit, traditional fee for service, no drug benefit, Kennedy decided a compromise was in the long-range interests of us citizens.

Here's how Molly set it up in a June column:

Kennedy is supporting the Senate version because (A) it's marginally better than what we have now, and (B) in one of the hoariest cliches of political debate, this gets the head of the camel into the tent. In other words, it's a start, and a better program can be built later -- in fact, it pretty much will have to be.

The White House's logic is (A) Republicans promised a prescription drug benefit, and (B) they can pass this in time for the 2004 election and take credit for it, but it doesn't go into effect until 2006 (a clever ploy), so no one will have time to figure out it's a fraud.

That might make you think Molly was agin it. She wasn't.

Bottom line, Kennedy's right: The Senate version is incrementally better, and in politics, you should always take half a loaf, or even 22 percent of a loaf, if you can get it.

And here's the message Max was speaking in late June.

There's a lot of argument whether to support either of these bills. Some don't want to give the President credit for a crappy, misleading drug benefit.


Others, including the estimable Senator Ted Kennedy, argue that the first step is getting the new program. It can be expanded more easily later than starting from scratch.

As a devotee of salami tactics in legislation, I tend to agree with Teddy. The contrary argument tends to put Democrats' electoral fortunes ahead of their constituents. So I conclude, this benefit sucks; let's take it. Give people a taste of it, and on the strength of the arbitrary benefit schedule, they will oblige Congress to fill in the blank spots.

Luckily, Tom DeLay and Bill Thomas are such arrogant turds, they stiffed the White House and produced a bill that is the beginning of the end of Medicare as we've come to know and love it. Jim McDermott, Frank Palone, Marcy Kaptur and other Dems have been spelling out just how outrageous is this bill in "Special Orders" colloquies. That's pretty much all they can do. The House is a majoritarian institution; life for the minority is meant to be lived in purgatory, if not the actual hell the Republicans have carefully fashioned, since they took over.

A lively Democratic discussion of all this was going on last night on C-Span. Marcy Kaptur had the charts to prove that the only decent prescription drug bill was the Democratic House alternate. The knock against The Dems bill was that it's too expensive; a possible 600 billion cost, according to Repubs, as opposed to their 400 billion. But that higher estimated cost does not factor in the potential savings from a key provision of the Democratic bill, which would give Tommy Thompson's Democratic successor the power to engage in that fundamental free enterprise practice of negotiating the best competitive price from those who make and market prescription drugs.

Remarkably, or perhaps one should say, insanely, both the House and Senate bill prohibit the government from doing that. Count on the Republicans to protect large corporate interests from the unfair power of the government to do what the majority of its citizens want it to do. There are so many awful provisions in the House bill, one doesn't know where to begin, so I won't; this is already a long post that may be telling you what you already know. Patience please. There's an important point to all this.

Who's right about what progressive's should be doing? Would Democrats holding firm to a defense of Medicare against any inroad of privatization be putting their electoral interests against constituent well-being?

Here's the best argument I've seen that they should, all the more interesting because it's by a self-described liberal centrist. .

Bush and Karl Rove are counting on two "achievements" to sell the compassion hoax. The first was the No Child Left Behind Act, passed with Democratic support in 2001. No honest observer can say this law did anything serious for America's most troubled schools. But it has given Bush the credibility on education he shrewdly craves.

If Bush can go to voters in 2004 and also say he's the one who added prescription drugs to Medicare, this seals the deal on "compassion." You only need these two "talking points" in a stump speech (not to mention a record-breaking $200 million advertising campaign) to convince independents you're a caring kind of guy, and trump Democratic complaints to the contrary.


Thinking this way isn't pretty, I know. But in a world in which power matters, there's no avoiding it. Republicans know this and play for keeps.

Matt gives an example from the William Kristol led opposition to Hillary's health reform initiative and suggests it's a model for Democrats.

Stopping Bush's Medicare plan without being successfully blamed by Bush for obstructionism would call for a political dexterity that (to put it mildly) Democrats haven't shown in recent years.

But Democrats have a reservoir of public goodwill on health care that Republicans don't. And that means this political feat should be possible, though the line of attack would have to be chosen and demagogued -- I mean, communicated -- very carefully.

When it comes to morality and public policy, it's now common to ask "what Jesus would do." Before Democrats hand Bush his prescription drug victory, they ought to at least debate what Bill Kristol would do.

Why Matt is so hard on Democrats when his own ambivalence is on such conspicuous display, political strategy equated with demagoguery, is a discussion for another day. And a lot's changed since Matt wrote his piece in early June. You can tell from Dean Broder's piece that Lambert links you to.

Notice that Broder isn't selling the usual CW, which would have been an exclusive warning to Democrats not to play politics and get something done for a change. Instead, you get the Dean's own ambivalent caution that it's not a done deal, and that maybe that's not such a bad idea, sorta, maybe, doyathink, huh? For all of it's fuzziness, the Broder column is good news for our side.

Democrats are rethinking their commitment to any compromise that tilts the bill towards the House version. Here's what I think their position should be, spelled out loudly and clearly, starting yesterday.

No compromise, except in their direction. None of the privatizing features of the House bill are acceptable, no legislative protection for big pharm against the risks of free market economics is acceptable. The Democrats aren't going to pass a bill that is essentially a Corporate Welfare Protection Act.

If the President wants to get a subscription drug benefit to Seniors, let him compromise; let him show real leadership and get Tom DeLay to follow him.

Molly, being the darling, funny, genuis that she is, had it right back in June:

But if the Senate version is even slightly weakened by the repulsive House version, fuhgeddaboutit.

Too many of those who belong to what was once referred to as the power elite think of citizenship as being a member of an audience; we get to express our approval or our disapproval, and we can decide to buy or not to buy a ticket to the show, but what the choice of repertory is going to be? Forgetaboutit.

Naturally, the Dems could use our help, in a variety of ways. That's the ultimate point of this post. No, I'm not sending you off into the wilderness with not so much as a telephone number to copy or a link to click. I've been in touch with several congressional offices who are aiding me in preparing another post that will facilitate some grassroots input into all of us.

Before I do, though, I want to know what you think? About the issue. About what we should do. About what I can do to make it easier for you to do it