Re: They Like Us! They Really Like Us!

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Most things seem popular, until you have to discuss the trade-offs.


Posted by: ogged | Link to this comment | 11-10-06 11:58 AM
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What about the media? They're pretty much in the tank for the GOP right now, and have been for a long time. And they're very influential.


Posted by: teofilo | Link to this comment | 11-10-06 12:00 PM
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Can you really envision the Democrats putting the health insurance industry out of business? The time to enact universal health care was during the New Deal -- now it's going to require massive upheaval. I'm all for putting those criminals out of business, of course -- but do you think the Democrats really want to do that?


Posted by: Adam Kotsko | Link to this comment | 11-10-06 12:02 PM
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I'm sort of torn. It's probably wise to firm up the center first, as I do think this election was an indictment of the idiocy of this administration.

On the other hand, it's probably wise to act as though we have a mandate. "We're the party of the center, you're the party of the man-raping dog afficionados" has to be the Dems' refrain, because no one is going to want UHC if they think it's a liberal hippie cause, but they'll all want it if they think it's just what it means to be a normal red-blooded American.


Posted by: Cala | Link to this comment | 11-10-06 12:03 PM
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The American people elected a bunch of liberals to Congress on Tuesday.

Heath Shuler? Bob Case Jr.? Jim Webb?


Posted by: mike d | Link to this comment | 11-10-06 12:07 PM
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Exactly. And it's really kind of true.

The tradeoff bit, on the other hand... do tradeoffs every get properly valued? The war was popular when it started, but certainly wouldn't have been with the real pricetag on it.


Posted by: LizardBreath | Link to this comment | 11-10-06 12:08 PM
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6 to 4.

To 5, aren't you exaggerating the degree to which this is a conservative class? Our pickups in red state conservative areas were conservative for Democrats, but there are a hell of a lot of real liberals in Congress after Tuesday.


Posted by: LizardBreath | Link to this comment | 11-10-06 12:10 PM
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4: Isn't the point of this post that "firming up the center" would, in fact, involve pursuing things like universal health care, and that it's just the DLC that wants you to think otherwise?


Posted by: redfoxtailshrub | Link to this comment | 11-10-06 12:10 PM
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You know, UHC was pretty popular in 1992...


Posted by: teofilo | Link to this comment | 11-10-06 12:12 PM
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I like this post, I think it's right. But even with both houses, the Dems are going to have to play a little defense, because the executive is still crazy, and still doesn't believe in the constitution.

The defensive efforts against the executive's craziness will be popular with the masses, so maybe it allows the Dems to go out on a limb with other things we want. But we can't ignore it--we've got to deal with the NSA spying on Americans, the torture, the scary stuff.


Posted by: text | Link to this comment | 11-10-06 12:14 PM
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I don't know what the DLC thinks, but I think UHC needs to wait until we can get it signed, not just passed. Iraq & corruption fixed, first, while we lay the groundwork for whatever we want to get passed in 08 that we can't get through now.


Posted by: Cala | Link to this comment | 11-10-06 12:16 PM
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no one is going to want UHC if they think it's a liberal hippie cause, but they'll all want it if they think it's just what it means to be a normal red-blooded American.

And guess how every major medium will portray it? "UHC" … isn't that pretty similar to THC?


Posted by: ben w-lfs-n | Link to this comment | 11-10-06 12:16 PM
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but there are a hell of a lot of real liberals in Congress after Tuesday.

Sure, but weren't those by and large the same set of Liberals that were in the Congress before Tuesday? I mean, none of the pick-ups were in liberal areas - they were in centrist (and conservative ones). I just don't see the liberal wave.


Posted by: mike d | Link to this comment | 11-10-06 12:16 PM
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I mean, none of the pick-ups were in liberal areas - they were in centrist (and conservative ones). I just don't see the liberal wave.

Not so at all. I'd have to go look, but we cleared a whole bunch of Republicans out of the Northeast -- the race I'm thinking of offhand is John Hall taking out Sue Kelly in NY-19, but there are a lot more.

And check my update -- Eric Rauchway reminded me that he just did a post on something very very similar.


Posted by: LizardBreath | Link to this comment | 11-10-06 12:19 PM
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The main thing I'm concerned about (and there's no evidence that the Democrats will actually do this, it just seems like the logical consequence of LB's arguments) is that if the Dems say "You may not think you're liberals, but you actually are. That's why you voted for us. So sit back while we give you the UHC you love so much" the GOP will spin it in terms of the "liberals are obnoxious know-it-alls" meme and it'll take hold because business has deep pockets and the media's in the tank. Then the Republicans take back everything in '08.

Not that this is likely to happen, but what's the harm in going slow and focusing on issues like Iraq, corruption and civil liberties before going for the big liberal goals?


Posted by: teofilo | Link to this comment | 11-10-06 12:21 PM
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I guess this is what you get in a two party system consisting of a right wing party with a centerist element, and a centerist party with a right wing element.


Posted by: | Link to this comment | 11-10-06 12:21 PM
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12 -- "Ultra-Hydro Cannabinol"


Posted by: Clownæsthesiologist | Link to this comment | 11-10-06 12:22 PM
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11: Sure, fair enough.


Posted by: redfoxtailshrub | Link to this comment | 11-10-06 12:23 PM
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1, 9 : Yeah

Also, this, by Kevin Drum.


Posted by: | Link to this comment | 11-10-06 12:23 PM
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I think organized corporate interests are the biggest obstacle, and what the energy of blogs, to return to the question of the week, ought to focus on now. With the collapse of the K street project, they're off-balance, over-committed to Republicans, and we've got a small window of opportunity. I think Pelosi is right to focus on the mechanics of corruption to start with, though.


Posted by: I don't pay | Link to this comment | 11-10-06 12:24 PM
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16: This is the second unsigned comment in a couple of days. I find non-accidental unsigned comments irrationally irritating, and will start deleting them if there are more.

If it's accidental, and you've commented before, pipe up with an ID. If you're new and you'd like to participate, pick an ID.


Posted by: LizardBreath | Link to this comment | 11-10-06 12:24 PM
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15: what if the dems were to spin it as: `the insurance industry and HMO's have been giving it to you up the ass for a long while now, and we're going to help make that stop'. Since it is basically true, a focussed message could cut through the corporate spin, deep pockets or no.


Posted by: soubzriquet | Link to this comment | 11-10-06 12:25 PM
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You may not think you're liberals, but you actually are. That's why you voted for us. So sit back while we give you the UHC you love so much"

But it's "the UHC you say you want". Which makes it centrist.


Posted by: LizardBreath | Link to this comment | 11-10-06 12:25 PM
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Since it is basically true, a focussed message could cut through the corporate spin, deep pockets or no.

How? Can you really see Wolf Blitzer saying this?


Posted by: teofilo | Link to this comment | 11-10-06 12:28 PM
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21: LB: whups, that was me. my browser remembers my name, except when it doesn't. For some reason this happens (blanks the field) occasionally, but not enough that I always remember to look. Anyone else get this from firefox?


Posted by: soubzriquet | Link to this comment | 11-10-06 12:28 PM
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But it's "the UHC you say you want". Which makes it centrist.

Maybe in a couple of years. I'm just saying, we just had a huge victory, let's not blow it right away by overreaching.

(And again, I don't see this as likely. I'm just worried about it when I hear this kind of rhetoric.)


Posted by: teofilo | Link to this comment | 11-10-06 12:29 PM
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Why would we have to say 'you're actually liberals'? Screw the labels. They're not helping. You want X, Y, and Z. We're the party that can give it to you. They're the party of stupid wars and fringe obsessions with sex. Even Limbaugh's given up on them.


Posted by: Cala | Link to this comment | 11-10-06 12:29 PM
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No problem at all, accidents happen. It just annoys me no end when I think someone's being deliberately unidentifiable. (I went off at someone a while back on a contentious thread, and had to apologize abjectly for being such a jerk about an accident.)


Posted by: LizardBreath | Link to this comment | 11-10-06 12:30 PM
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13: The following not-especially-conservative districts have switched from Republican to Democratic:

- One of the Connecticut ones
- Maybe another Connecticut one, which is now tied
- the Louisville, Kentucky district (went for Kerry 51-49)
- Two in the Philadelphia suburbs (Weldon and Fitzpatrick)
- Both New Hampshire districts
- The NY district where sane, moderate Republican scientist Sherwood Boehlert retired
- The Iowa district where sane, moderate Republican Jim Leach unexpectedly lost
- John Sweeney replaced in NY
- Two Arizona districts where the race was basically "Angry anti-immigrant Republican vs. some other guy"

We also picked up the Tom Delay district, the Bob Ney district, the Mark Foley district, and the Duke Cunningham district; those may be areas where Republicans are still the majority, but it's a good sign that the Democrats picked up those districts by capitalizing on disgust with the Republicans rather than by running as Republican Lite.


Posted by: Cryptic Ned | Link to this comment | 11-10-06 12:31 PM
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24: teo, I mean that because a lot of people are really pissed about the state of health care. And a lot more aren't at all happy with it, they're just unclear about workable alternative. If you can keep the first group remembering why they are pissed off, and give the second group a clear uncomplicated message about how a new system would actually work, I think you'd be ok.


Posted by: soubzriquet | Link to this comment | 11-10-06 12:31 PM
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28: Sure, no worries. I just wish I had to either always enter it, or never enter it, not occasionally enter it. That makes mistakes easy.


Posted by: soubzriquet | Link to this comment | 11-10-06 12:32 PM
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Peals before lizards...


Posted by: SomeCallMeTim | Link to this comment | 11-10-06 12:32 PM
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Fuck. "Pearls," but really, what's the point. Me an Kerry.


Posted by: SomeCallMeTim | Link to this comment | 11-10-06 12:33 PM
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My impression is that people were a lot more pissed off about healthcare back in the early nineties, when the economy was a lot worse. And we all know how that turned out.


Posted by: teofilo | Link to this comment | 11-10-06 12:33 PM
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28: Is there any way to make the "Name" field required in order to post a comment?


Posted by: My Alter Ego | Link to this comment | 11-10-06 12:33 PM
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34: hmmm. could be; I may have sampling bias on my impressions.

On the other hand, the economy is going to get a lot worse so that might help.


Posted by: soubzriquet | Link to this comment | 11-10-06 12:35 PM
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I don't know what the DLC thinks, but I think UHC needs to wait until we can get it signed, not just passed.

Cala, you're thinking like a Democrat, and that kind of thinking is one reason why Democrats lose so much. Gingrich's road to power was marked by a series of losing votes where he succeeded in putting the Democrats on the spot. "The Democrats voted to raise your taxes -- again!"

The minimum wage increase, for example, is a no-brainer and will have a massive political impact on a fair-sized bloc of potential voters. For a lot of people it will be about a 30% wage increase. SO we pass the bill, it's vetoed, and in 2008 we can say "Candidate X will sign the minimum wage bill!"

There are quite a few liberal issues that are popular. The moderation people are talking about is on the wedge issues: primarily gun control, gay marriage, abortion, and probably affirmative action. Not every new moderate is moderate on every one of these.

Replacing a moderate Republican with a moderate Democrat is a big move to the left. By and large both parties in Congress are more polarized than they used to be; moderate Republicans and conservative Democrats are almost extinct.

Kos has something up about Tester. He's no conservative.

A big change is just the new willingness to confront Republicans head-to-head on the issues, rather than just trying to weasel in. Even if the Democrat fighting on the issues is fairly moderate, the fact that he's not playing me-too is a move to the left.

In Minnesota one Dem House challenger (Walz) won and another (Wetterling) lost. wetterling was the one who had the benefit of Rahm Emmanuel's advice, and she ran a sneaky losing campaign. Walz only got DCCC support very late, and it was mostly cash rather than advice. He went head-to-head and he won. (I think that Duckworth's case is the same as Wetterling's: she was Rahm's baby, and she lost. Both Wetterling and Duckworth were excellent candidates. It's too bad that Rahm got ahold of them.)


Posted by: John Emerson | Link to this comment | 11-10-06 12:36 PM
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Is there any way to make the "Name" field required in order to post a comment?

In Wordpress, at least, you can't do this without also requiring e-mail address. Blogger has something similar, where it's either totally open or Blogger account required. Dunno about MT.


Posted by: teofilo | Link to this comment | 11-10-06 12:37 PM
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36: I was a little kid at the time, of course. But it's what I've heard.


Posted by: teofilo | Link to this comment | 11-10-06 12:38 PM
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28: Is there any way to make the "Name" field required in order to post a comment?

Yes. For a price.


Posted by: ben w-lfs-n | Link to this comment | 11-10-06 12:39 PM
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Add a few moderates to a liberal delegation and you still have a liberal delegation, but it's a liberal delegation which is on the majority. This is the winner-take-all problem. The new people are a minority, but they changed the status of the party.


Posted by: John Emerson | Link to this comment | 11-10-06 12:39 PM
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34: I don't think so. While the economy was worse then, people weren't as worried about their insurance status. I don't know if things have really gotten much worse, or if we've just become more aware of it, but I think it's a more salient issue to the electorate now than when I was graduating from college.


Posted by: LizardBreath | Link to this comment | 11-10-06 12:39 PM
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Cala, you're thinking like a Democrat, and that kind of thinking is one reason why Democrats lose so much.

The last time we failed to get universal health care through it was an untouchable subject for another decade. How well did saying 'Oh, but I voted for the health care plan in '92' play in the '94 midterms?


Posted by: Cala | Link to this comment | 11-10-06 12:41 PM
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39: One difference between now and '92 is that the baby boomers are now nearing retirement & pricey prescriptions brought about by late middle-age.


Posted by: Cala | Link to this comment | 11-10-06 12:43 PM
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Right, but that health care really was a mess, and it was a mess out of caution. A huge selling point of UHC is simplicity -- cutting out the parasitic middleman -- but the 1993 health care plan didn't have that. And seriously, I think it's more popular now than it was then.


Posted by: LizardBreath | Link to this comment | 11-10-06 12:44 PM
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Cala, it was untouchable because the Republicans took control of the House in 1994.

One of the reasons why I don't like Hillary is that I think she really fumbled the health-care issue. She came off as a bureaucratic insider wonk, and her plan was a mess.


Posted by: John Emerson | Link to this comment | 11-10-06 12:45 PM
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Cala, it was untouchable because the Republicans took control of the House in 1994.

I'm unconvinced that the Republicans taking the House in '94 wasn't enabled by the universal health care debacle.

Like I said, don't do it if it's not going to work. Forcing Bush to veto it? Good plan, maybe. Can we get it passed? We have a majority in the Senate only if you count Lieberman. Hence why I said laying groundwork for making the case to the public, not punting.


Posted by: Cala | Link to this comment | 11-10-06 12:52 PM
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Right, but that health care really was a mess, and it was a mess out of caution.

It was a mess because (a) Hillary was a jackass, (b) Magaziner was (and probably still is) more of a jackass, and (c) it's a really, really hard problem that involves something like (at the time) 15% of our economy.

IIRC, the 1992 recession was interesting because it hammered the white collar world as well. Which means more "elite" people predisposed to want a healthcare plan. The only way we get to UHC is piecemeal.


Posted by: SomeCallMeTim | Link to this comment | 11-10-06 12:56 PM
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I think that everything should be stage managed, but not in a timid way, and putting Republicans on the spot should be a goal.

And Hillary should be locked in a closet while the Democratic plan is being put together. She was so proud of her work, and it was so awful.


Posted by: John Emerson | Link to this comment | 11-10-06 12:56 PM
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Seriously. One of the things that makes me most hesitant about the idea of persuing health care is that Hillary will be around to fuck it up.


Posted by: redfoxtailshrub | Link to this comment | 11-10-06 1:01 PM
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FWIW, I think there are two crises that need solving, and whose neglect under the GOP has become widely apparent and unacceptable: healthcare and global warming. I think it will be not only acceptable, but expected of a Congressional majority that they address these issues. The manner in which the Democrats address them will of course be important -- i.e., avoid some of the errors committed in the Clinton healthcare initiative.

Where were the pickups, and what does that say about the ideological shift? See Schaller's table; within those numbers it looks to me like the biggest "flips," percentage-wise, happened in New England and in the West North Central part of the Midwest -- which were pickups in Minnesota, Kansas, and Iowa.


Posted by: Eric Rauchway | Link to this comment | 11-10-06 1:02 PM
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Discussion has moved on, but to follow up on Ned's point, here's a list from mydd.com (which I'm not fond of but which has the occasional useful discussion). This is based on the Cook Political Report's partisan voter index, which is based on voting records and registration and some sort of magic fairy dust:

Connecticut 2* (D+8): Joe Courtney; Iowa 2 (D+7): Dave Loebsack; Iowa 1 (D+5): Bruce Braley; Connecticut 5 (D+4): Chris Murphy; Florida 22 (D+4): Ron Klein; Pennsylvania 7 (D+4): Joe Sestak; New Hampshire 2 (D+3): Paul Hodes; Pennsylvania 8 (D+3): Patrick Murphy; Colorado 7 (D+2): Ed Perlmutter; Kentucky 3 (D+2): John Yarmuth; New Hampshire 1 (R+0): Carol Shea-Porter; Arizona 8 (R+1): Gabrielle Gibbords; Minnesota 1 (R+1): Tim Walz; New York 19 (R+1): John Hall; New York 24 (R+1): Mike Arcuri; Florida 16 (R+2): Tim Mahoney

There's a bunch that don't fit this idea of moderate districts coming home to Dems (Brad Ellsworth, who should totally get a Deadwood outfit; Heath Schuler, back in DC to torment 'skins fans; etc), but I think it's fair to say that this is the flipside of the partisan realignment of the South. Rockefeller Republicans are now defunct in the northeast, leaving it more strongly partisan than the South is. Assuming the Connelly election holds up, there's now a single Republican congressman from all of New England.

When combined with a solidly Democratic West Coast, you're left with the Rust Belt, the plains states, the Rockies, and the Southwest as "swing areas" of the country. In all of those places, I think a socially libertarian and economically populist position plays at least as well as what the Republicans are stuck with.

37 - I don't think it's Rahm Emmanuel's fault that Patty Wetterling lost. She's a pretty awful campaigner and, honestly, doesn't seem too bright (and I say this as someone who sent her money in 2004).


Posted by: Steve | Link to this comment | 11-10-06 1:11 PM
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Pwned by 51, damn it.


Posted by: Steve | Link to this comment | 11-10-06 1:12 PM
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Ok, people. Can I just point to some polls?

The most recent ones I can find are from '03, but that's recent enough to be relevant for our purposes.

"Which of these do you think is more important: providing health care coverage for all Americans, even if it means raising taxes, OR, holding down taxes, even if it means some Americans do not have health care coverage?" Options rotated
Coverage For All : 79%
Holding Down Taxes: 17%
Unsure: 4 %

"Which would you prefer: the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance, OR, a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers?" Options rotated

Current System: 33%
Universal Program: 62%
Unsure: 6%


Posted by: Joe Drymala | Link to this comment | 11-10-06 1:19 PM
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From what I saw, Wetterling would have been better off without Rahm's advice as long as she got his money. The TV ad was apparently a disaster. I didn't follow her campaign but people say that she didn't even try to nail Bachman on her loony-tune positions, but took a cautious approach and even tried to outflank her. To me that has DCCC fingerprints on it.

One of the unique things about Minnesota is that there really is a hard left/hard right swing vote here. On the net Minnesota is fairly moderate, but it's a moderation you get by averaging Ellison (black Muslim) and Bachman (Krazy Kristian). At the statewide level it's hard to elect a real rightwinger, but Grams and Durenberger were much more conservative Chafee. (Coleman is scum.)

Grams and wellstone


Posted by: John Emerson | Link to this comment | 11-10-06 1:21 PM
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I think Pelosi is right, as per the conference call that's been reported, to start with changes to the political and executive process. (public financial of campaigns, extensive disclosure laws, end to earmarking) If successful, those kinds of changes will make it easier to pursue substantive legislative agendas of this kind in the future.


Posted by: Timothy Burke | Link to this comment | 11-10-06 1:25 PM
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Pattern holds here in Chicago area. Melissa Bean held on to what was long Phil Crane's seat, and Tammy Duckworth came pretty close to succeeding Henry Hyde. But moderate Mark Kirk, our local liberal Republican, was given a surprisingly close challenge in a campaign that only gained steam in the last month. I'd love to think this is what the future will look like.


Posted by: I don't pay | Link to this comment | 11-10-06 1:31 PM
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Except Wetterling ran a crap campaign in 2004, as well (admittedly against the much slicker Kennedy). She might have had a chance if the election had occured a week after the Foley story broke, but I think her loss is because of her. (I'll agree that it seems like Duckworth seemed to get pretty bad advice from the DCCC despite them handing her a ton of money.)

Re your 37, I'll say that one of the nicest things about taking the Senate is that it provides a chance to squeeze McCain's balls until he hurts; he's either going to have to ruin his oh-so-moderate image* by voting against a ton of legislation making it out of committee or kill himself with the Republican base by being statesmanlike and moderate.

* Except that this message seems to have been etched into Tim Russert's brain with a laser, so I have no doubt that he could stab Jim Webb in the eye while screaming that he's a North Korean mole and still get invited onto the Sunday talk shows.


Posted by: Steve | Link to this comment | 11-10-06 1:31 PM
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Lizardbreath:

"And I really think this does explain it. We're living in a world where the conventional wisdom is created by people who simply don't agree with me about liberal policy goals; while they may be Democrats, they're as far to the right as you can be and stay Democrats. Given that disagreement, I don't see any reason to accept their judgment as to what's electorally possible. The American people elected a bunch of liberals to Congress on Tuesday. The polls show that liberal policies are popular. I don't see any reason for exaggerated caution to hold us back."

But without the DINOs you don't have majorities in Congress and can't pass anything.


Posted by: James B. Shearer | Link to this comment | 11-10-06 1:32 PM
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Ok, people. Can I just point to some polls?

As Yglesias (or someone else) notes today, there are a lot of polls that suggest that Americans want a significantly smaller government. But Americans' support for specific applications of the "smaller government" philosophy is thin.


Posted by: SomeCallMeTim | Link to this comment | 11-10-06 1:33 PM
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Duds, 54! 54!

That's the kind of polling that should really embolden UHC-supporters. "More than three-quarters of the American people say they want some kind of government sponsored health care for all. Why are the Republicans preventing it?"


Posted by: mrh | Link to this comment | 11-10-06 1:38 PM
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Tim, I think those poll questions I pointed to are pretty damn specific. The first one even mentions raising taxes, and still gets 78%.


Posted by: Joe Drymala | Link to this comment | 11-10-06 1:38 PM
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Duckworth really connected with the Cook County suburbs where I was campaigning. It might have been a more effective campaign but she was a hit. The Tribune ran a follow-up story on her this morning. I'd like the next campaign to start now.


Posted by: I don't pay | Link to this comment | 11-10-06 1:38 PM
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And if someone can find more recent numbers refuting those numbers above, by all means pwn me.


Posted by: Joe Drymala | Link to this comment | 11-10-06 1:39 PM
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60, 62: Right. "Smaller government" is a buzzword. UHC is a policy.


Posted by: LizardBreath | Link to this comment | 11-10-06 1:41 PM
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59: Were the Republican majorities constrained by needing to get Chris Shays and Olympia Snowe to go along with their lunacy? Not so much. We have DINOs, they have RINOs, and I think we can learn something from how they handled theirs.


Posted by: LizardBreath | Link to this comment | 11-10-06 1:42 PM
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It's not a view I actually hold, so I'm not going to do it, but shouldn't we have someone randomly screaming, "No enemies on the left! No enemies on the left!"


Posted by: washerdreyer | Link to this comment | 11-10-06 1:45 PM
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McCain has never been moderate. In the present Republican caucus, even a small degree of rationality counts as rationality. Certainly discrediting McCain should be a goal. "Turning" him shouldn't, because he's really hopeless because of his natural conservativism and his Presidential ambitions.


Posted by: John Emerson | Link to this comment | 11-10-06 1:46 PM
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"In the present Republican caucus, even a small degree of rationality counts as rmoderation".


Posted by: John Emerson | Link to this comment | 11-10-06 1:48 PM
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60, 62: Right. "Smaller government" is a buzzword. UHC is a policy.

They're both buzzwords. I haven't found it on the lazy web, but my recollection is that the poll numbers were pretty good for UHC in 1991 and and 1992. Hillarycare still got killed, and lots of people at the time thought it (and the gay military) helped turn Congress over in 1994. If people wanted enough, they would have punished the Republicans for their opposition (though some significant part of the opposition came from other Democrats).

I think UHC would--depending on the implementation--be a really, really good end result. But I also think that it's easy to tar as "tax and spend" just as we're getting out from under that label, and claiming the mantel of "fiscal responsibility" from the Republicans. Rightly or wrongly, I think a lot of Dems now think of themselves as "fiscally responsible, socially liberal."


Posted by: SomeCallMeTim | Link to this comment | 11-10-06 1:48 PM
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Democratic "fiscal responsibility" amounts to continually cleaning up Republican messes. Clinton did it for Reagan and Bush I, and a Democratic President will be expected to do it for Bush II. What this amounts to is anulling Democratic programs while fostering Republican programs (wars and tax cuts).

I don't know how to beat that dynamic, but Democrats should stay away from the "fiscal responsibility" slogan. "We're going to have to clean up their mess" would be a better slogan.

Really high, punitive taxes on the most pro-Republican industries should be part of the fiscal plan.


Posted by: John Emerson | Link to this comment | 11-10-06 1:54 PM
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The last thing the Democratic party needs is to cower in fear of losing its legislative majority. "Oh, no. What will the Republicans say?" That timidity will lead to loss. We might lose after not being timid. Far better to try and lose than not to try at all and still lose. Those merciless elephants can smell bleeding donkeys from miles away.


Posted by: md 20/400 | Link to this comment | 11-10-06 1:56 PM
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This Ezra Klein-hosted piece on who killed Hillarycare may be relevant.

68 - Right, no, I'm all about beating him up before the '08 Presidential contest that he's been demeaning himself in preparation for for the last six years.


Posted by: Steve | Link to this comment | 11-10-06 2:00 PM
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Seriously, Tim, at what point would it be worth trying to expand health care coverage? When the polls are at 90%? 99%?


Posted by: Joe Drymala | Link to this comment | 11-10-06 2:09 PM
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70: I think the image the "tax and spend" charge conjures up is "They want to take UR MON$Y for unclear-therefore-nefarious purposes." But most of the New Deal is still popular when push comes to shove. When it's going to go to something as understandable and clearly beneficial as UHC, "tax and spend" will be a meaningless charge -- or it can be made so with aggressive argument.

Frameworks out of The Economist, like holding down government spending as percentage of GDP or refraining from "unnecessary" market interference, don't have to enter into the political equation.


Posted by: Minivet | Link to this comment | 11-10-06 2:10 PM
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Now that we're talking about Minnesota...how does this affect the chances of Al Franken running against Howdy Doody in 2008?


Posted by: Cryptic Ned | Link to this comment | 11-10-06 2:12 PM
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I'd forgotten the TNR role in the healthcare plan defeat. I didn't really need another reason to hate Peretz and Andy Sullivan, but thanks anyway. (Clinton was a New Dem -- Peretz kills everything he touches, no?)

I'm not really a Hillary-hater, but she sure did screw this one up.


Posted by: John Emerson | Link to this comment | 11-10-06 2:13 PM
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4: On the other hand, it's probably wise to act as though we have a mandate.

Damn right. We all chant in unison "we have political capital; we're uniters, not dividers; it's time to end the partisan bickering; we're going to pursue a humbler foriegn policy; no more nation building"

Then we push a few moderate policy initiatives:

- a 200% marginal tax rate for incomes above $500k/yr
- allow discharge of corporate pension obligations in bankruptcy, but only when 200% of all compensation paid to management over the previous decade is recaptured
- make accounting fraud that causes more than $1MM in damages a capital offense
- raise the CAFE standards to 50mpg
- no cap on income taxed for social security


Posted by: Michael H Schneider | Link to this comment | 11-10-06 2:21 PM
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I endorse Schneider's proposals.


Posted by: John Emerson | Link to this comment | 11-10-06 2:25 PM
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This is a time to aim big, because anything the Dems pass will get vetoed by Bush. There's no need to make a perfect UHC bill that will avoid all possible problems. Make the bastard use his veto pen.

Probably the ideal bill would be a big middle-class tax break tied to a card-check bill with other pro-union provisions. Put Bush in a position where he has to simultaneously turn down a tax cut and blatantly screw workers.
Heighten the contradictions, as they say.


Posted by: Brian | Link to this comment | 11-10-06 2:33 PM
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No, but seriously -- the Democrats are going to put the insurance companies out of business? Some discussion of the role of corporate power needs to be involved here, beyond campaign-finance reform. It's not as if some tighter rules on lobbying are going to make the modern state stop being the representative of the interests of the capitalist class.


Posted by: Adam Kotsko | Link to this comment | 11-10-06 2:46 PM
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Seriously, Tim, at what point would it be worth trying to expand health care coverage? When the polls are at 90%? 99%?

I think, in part, it's about how you go about it. And, basically because I trust Dean, I think it has to be done incrementally. Cover all the kids first. Then we'll have the old and the very young, and we close the circle afterwards.

However, I think Schmitt might agree with you, and I'm basically willing to follow him wherever he wants to go. So, if he comes out for a massive attempt upfront, I'm on board.


Posted by: SomeCallMeTim | Link to this comment | 11-10-06 2:51 PM
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81: Why not? The industry has made a mess of health care, and ought to pay for it. Ok, perhaps not completely out of business, or at least not all of them. A major shakeup wouldn't be out of line though.


Posted by: soubzriquet | Link to this comment | 11-10-06 3:05 PM
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>No, but seriously -- the Democrats are going to put the insurance companies out of business? Some discussion of the role of corporate power needs to be involved here, beyond campaign-finance reform. It's not as if some tighter rules on lobbying are going to make the modern state stop being the representative of the interests of the capitalist class.

Corporate power didn't stop UHC in every other first world country; there is no reason it should stop it in the US. And there are plenty of companies like auto companies with big pension based healthcare obligations and companies like wall-mart who just don't want pay for any healthcare benefits who really wouldn't mind UHC.


Posted by: joeo | Link to this comment | 11-10-06 3:11 PM
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82 - I should clarify. I'm not necessarily for a massive attempt. I think you're right; we should do it in pieces. But neither should we be afraid of it. We should identify ourselves with the issue.

And Kotsko's idea of talking about the insurance companies screwing us is good.

A card-check bill needs to happen. And I think it will.


Posted by: Joe Drymala | Link to this comment | 11-10-06 3:20 PM
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a 200% marginal tax rate

To be paid in seven-dollar bills on the 30th of February.


Posted by: standpipe b | Link to this comment | 11-10-06 3:20 PM
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A marginal rate over 100% would be possible, wouldn't it?


Posted by: teofilo | Link to this comment | 11-10-06 3:27 PM
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Yes, it's functionally equivalent to a maximum income.


Posted by: washerdreyer | Link to this comment | 11-10-06 3:29 PM
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A 100% marginal rate is equivalent to a maximum income. Greater than 100%, and your after-tax income shrinks as your pre-tax income grows.


Posted by: standpipe b | Link to this comment | 11-10-06 3:31 PM
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Which is to say, it's no longer marginal.


Posted by: standpipe b | Link to this comment | 11-10-06 3:32 PM
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But that's still a possible (albeit unlikely) policy to implement.


Posted by: teofilo | Link to this comment | 11-10-06 3:32 PM
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91: Oh, sure. I was just piqued by the contradiction in terms.


Posted by: standpipe b | Link to this comment | 11-10-06 3:34 PM
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right. I want something truly confiscatory to discourage high salaries. I'm happy with someone who makes $600k paying $200k in taxes on the income above $500k. Hell, Michael Eisner could end up paying like $400 million in taxes on his $200 million salary each year. Fine by me.


Posted by: Michael H Schneider | Link to this comment | 11-10-06 3:36 PM
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89, I'm not sure we're disagreeing, but just in case: Setting a marginal rate of 100% at $X and setting a marginal rate of 100+n (where n is positive)% at $X should have the same effect on observable behavior: everyone makes sure they don't earn more than $X/year, unless they're interested in making extra donations to funding the governemnt.


Posted by: washerdreyer | Link to this comment | 11-10-06 3:36 PM
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and, of course, we call it the Tax Simplification and Reduction Act of 2007.

It still seems like a marginal rate to me, because it only applies at the margin.


Posted by: Michael H Schneider | Link to this comment | 11-10-06 3:38 PM
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94: no, different effect. At 100% marginal rate there's no penalty above losing the additional money. It doesn't cost you anything to earn max+1 than to earn max.

At 200% marginal rate you earn *less* at max+1 than at max.


Posted by: Michael H Schneider | Link to this comment | 11-10-06 3:40 PM
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should have the same effect on observable behavior

Ah, so it should. This is what I overlooked.


Posted by: standpipe b | Link to this comment | 11-10-06 3:41 PM
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In light of 96, I am retreating to one-liners and wordplay.


Posted by: standpipe b | Link to this comment | 11-10-06 3:43 PM
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sorry. Didn't mean to be discourteous. I'm just a slow typist and a slower thimker.


Posted by: Michael H Schneider | Link to this comment | 11-10-06 3:46 PM
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I'm no supply-sider, and I realize you're all probably joking, but you do realize a 200% marginal tax rate would spend all day every day sucking donkey balls, right?


Posted by: Brock Landers | Link to this comment | 11-10-06 4:05 PM
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Hell, Michael Eisner could end up paying like $400 million in taxes on his $200 million salary each year. Fine by me.

MHS, I don't want to be discourteous, but you understand this simply won't happen for the reasons I outline in 94. You might think it a good idea to institute a maximum income and I might disagree, but surely we can agree that (with the caveat that they might want to donate money to the government) that both a 100% and a 100+n% marginal tax rate do impose a maximum income at whatever number they phase in.


Posted by: washerdreyer | Link to this comment | 11-10-06 4:05 PM
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At 200% marginal rate you earn *less* at max+1 than at max.

That sounds like an absurd policy to implement, unless you're a lawyer trying to make money loopholing people down to max from max+n.


Posted by: Cala | Link to this comment | 11-10-06 4:06 PM
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AMTF, the lot of you. Is hyperbole a foreign concept? ("Well, yes. It's Greek." "Oh, shut up, you.")


Posted by: LizardBreath | Link to this comment | 11-10-06 4:09 PM
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66, well the Republican effort to "reform" social security went nowhere so it is not enough to just have majorities in Congress. And the general lack of influence for RINOs just led to a lot of them getting defeated and the Republicans losing control of Congress not necessarily an example to be emulated.


Posted by: James B. Shearer | Link to this comment | 11-10-06 4:09 PM
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- a 200% marginal tax rate for incomes above $500k/yr

Well that's one way of getting rid of state lotteries.


Posted by: James B. Shearer | Link to this comment | 11-10-06 4:14 PM
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103- What I found most funny is that Michael's last suggestion isn't hyperbole at all. Or shouldn't be; it's sound policy.


Posted by: Brock Landers | Link to this comment | 11-10-06 4:38 PM
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Besides confiscatory taxes, I'm in favor of dressing up the children of the middle class as Circassians and selling them. (Maybe not your kids, LB).


Posted by: John Emerson | Link to this comment | 11-10-06 4:45 PM
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106: I'd make an argument for the last two being good policy as they stand.

107: They'd fetch a good price, and the odds are the purchasers would bring them back. Has anyone read The Ransom Of Little Red Chief?


Posted by: LizardBreath | Link to this comment | 11-10-06 4:50 PM
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Yes!


Posted by: Cala | Link to this comment | 11-10-06 4:59 PM
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Why not just nationalize Blue Cross Blue Shield? It's already a non-profit, and as of last summer, a freelance market researcher discovered that state BCBS's currently handles 37% of insurance policies anyway.


Posted by: Adam Kotsko | Link to this comment | 11-10-06 5:05 PM
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Is this pwned?

UHC = screwing insurance companies, at least some
Lieberman = Senator for insurance
Senate = 51-49

You really wamt to try this...now?


Posted by: bob mcmanus | Link to this comment | 11-10-06 5:35 PM
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I also endorse the Schneider Plan


Posted by: bob mcmanus | Link to this comment | 11-10-06 5:49 PM
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mcmanus is right on there. fucking Lieberman.


Posted by: text | Link to this comment | 11-10-06 5:50 PM
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oh well, we'll have to start with the high speed trains.


Posted by: text | Link to this comment | 11-10-06 5:52 PM
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Coming in at the end here, I'll say that sure the electorate probably likes all those things...they just don't like paying for those things.

(Let's see how many times I pwned myself by not reading the thread first...)


Posted by: Pooh | Link to this comment | 11-10-06 5:55 PM
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83: 81: Why not? The industry has made a mess of health care, and ought to pay for it. Ok, perhaps not completely out of business, or at least not all of them. A major shakeup wouldn't be out of line though.

And a pony, per 111


Posted by: Pooh | Link to this comment | 11-10-06 6:11 PM
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How does anyone pass UHC withough 60 senators?


Posted by: yoyo | Link to this comment | 11-10-06 6:13 PM
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Lieberman also had a lot to do with the way the Enron case had no political significance.


Posted by: John Emerson | Link to this comment | 11-10-06 6:14 PM
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117: We don't. But we have fun making Bush explain why he doesn't want you to be able to go to the doctor when you're out of work.


Posted by: LizardBreath | Link to this comment | 11-10-06 6:15 PM
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Here's the thing: 75% is fucking huge. If those numbers are robust and not flukes, I'm not sure we couldn't get 60 senators. Even Republicans have to face reelection. 75% is not the sort of number with which one wants to toy.


Posted by: Brock Landers | Link to this comment | 11-10-06 6:19 PM
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Sure one does. One wants to toy with a number like that lightly and affectionately, getting the number all excited before driving it home to a legislative climax.


Posted by: LizardBreath | Link to this comment | 11-10-06 6:23 PM
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>How does anyone pass UHC withough 60 senators?

It gets vetoed in '07, democrats run on it in '08, then president Edwards signs the bill in '09.


Posted by: joeo | Link to this comment | 11-10-06 6:36 PM
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103 pwns everything on this site, this mineshaft if you will.


Posted by: Clownæsthesiologist | Link to this comment | 11-10-06 6:37 PM
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116: sort of. Ok, I was being facaetious a bit, but unless UHC was badly screwed up in implementation, it would be cheaper than what we are paying today. So the `they want it but they don't want to pay for it argument' is a matter of perception, not reality.


Posted by: soubzriquet | Link to this comment | 11-10-06 6:39 PM
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From a PBS timeline:
"August 25, 1994 - Democratic leaders of both congressional chambers give up on health care and announce they are letting their members go home for their much-postponed vacation. Neither the Senate (where Democrats outnumber Republicans fifty-six to forty-four) nor the House (with a Democratic majority of 257 to 176) has come close to passing, or even voting on, any health bill. "

This is with a Democratic President and bigger majorities in both houses. Public support is not so strong for any specific plan. Btw what specific plan do you all want to pass?


Posted by: James B. Shearer | Link to this comment | 11-10-06 6:54 PM
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124. Ok, sure. I still want my pony too, though.

122 misses that it doesn't even get voted on to get vetoed if we don't have 60 senators. I'm not convinced that the "obstructionist" label really hurts that much, so what is the downside for the GOP from playing parliamentary games. I mean aside from it being the right thing to do, but this is still politics, so fuck that, right?


Posted by: Pooh | Link to this comment | 11-10-06 6:56 PM
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French style single payer universal health insurance, with the possibility of supplementary private insurance for additional levels of care.

And if you actually look at the poll question Drymala quoted, it describes the plan as Medicare for everyone, which is a pretty darn specific description, given that Medicare is an actually existing program that people are generally familiar with.


Posted by: LizardBreath | Link to this comment | 11-10-06 6:57 PM
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122 misses that it doesn't even get voted on to get vetoed if we don't have 60 senators.

I am a dimwit -- I was focusing on vetoes and wasn't thinking of the filibuster. But obstructionist works, I think, when it's a popular plan. "Sen X voted to keep health care for you and your family from coming up for a vote. He knows that if the Senate had been able to vote on it, it would have passed. Ask Sen X why he's afraid of democracy."


Posted by: LizardBreath | Link to this comment | 11-10-06 7:00 PM
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Yeah I somehow can't see a UHC type bill being filibustered, when once it had been brought to the floor by the party in control of admitting bills to be voted upon.


Posted by: Clownæsthesiologist | Link to this comment | 11-10-06 7:04 PM
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128 and 129, really? Which looks worse for the GOP, filibustering or vetoing? Yeah Bush isn't running again, but there may still be enough stink on him in '08 to hurt if he is forced to whip out the pen often enough.

I mean we all know the difference, but joe taxpayer doesn't know a filibuster from Adam, while a veto is bright and shiny.

And specific to 128, there is no way to avoid it being wonky enough so that there won't be strong public support for a specific plan. I'll retract if someone comes up with something digestable and passable, but I'm skeptical. In that regard, I'm with SCMT that it is far more likely to happen piecemeal.


Posted by: Pooh | Link to this comment | 11-10-06 7:11 PM
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I just think the filibuster has such a lousy PR value to its name (not to mention the whole thing about there being a "nuclear option" previously discussed, bruited about and set aside) that I would be a little bit surprised to hear it come up (ATM) this term. But I guess anything is possible and I have notoriously inadequate imaginative faculties when it comes to the game of "what is going to come next from the Republican party?"


Posted by: Clownæsthesiologist | Link to this comment | 11-10-06 7:21 PM
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(is "Becks-style" specific to alcohol or can non-alcohol substances also be understood as leading one to that named state?)


Posted by: Clownæsthesiologist | Link to this comment | 11-10-06 7:23 PM
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127 the poll first asks about coverage for all vrs low taxes - 79% support.

Then about universal program like medicare vrs current system - 62% support.

Then of the 62% supporters will they still support if choice of doctors is limited - 57% will so combined support 35%.

Also of the 62% supporters, will they still support if wait lists for non-emergency ops - 62% will so combined support 38%.

I think this supports my contention that support drops off rapidly for any specific plan. Note there will always be a sticking with the devil you know effect that makes big changes difficult to sell.


Posted by: James B. Shearer | Link to this comment | 11-10-06 7:35 PM
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as for the "make bush veto it, get it done in '09" - i was just rereading http://ezraklein.typepad.com/blog/2005/07/this_is_matthew.html which seems to say "get it done in the dead of nite so the insurance companies can't organize against it"
Like how Clinton's plan became less and less popular the longer it was out there, and at the same time people became more and more disinformed about it.


Posted by: yoyo | Link to this comment | 11-10-06 9:23 PM
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I will not be rushed. I am not afraid. I want 250+ Dems in the house, 60+ Dems in Senate, and 2 terms of President. Some time in the next decade. I think it is doable, and once done, will be sustainable. Dems owned this country for fifty years, the opposition is crazy.

Nothing matters much except reaching that goal. I really think the stakes are the survival of the human race. I think the opposition is that crazy.

Too early for UHC. We will probably have to accept something like O'Connor on the bench, and lose Roe.


Posted by: bob mcmanus | Link to this comment | 11-10-06 9:49 PM
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Give up Roe? That's the one issue that is both solidly associated with the Dems and that a majority of Americans are on the same side for. Tossing that aside for perceived political expediency would be suicidal.


Posted by: Magpie | Link to this comment | 11-10-06 10:05 PM
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That's the one issue that is both solidly associated with the Dems and that a majority of Americans are on the same side for.

Uh, Social Security? But I don't think Bob is advocating giving up Roe, just saying that he thinks it's inevitable. Of course, before the election he was saying violent revolution was inevitable. Take that as you will.


Posted by: teofilo | Link to this comment | 11-10-06 10:33 PM
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134:Bush will put up an Alito, followed by an O'Connor. I will almost guarantee that. He will not put up a Roe protector. Timing makes a difference, bu Dems won't block for two years.
...
Still early, teo. And I don't think the loss has sunk in yet on the right.


Posted by: bob mcmanus | Link to this comment | 11-10-06 11:33 PM
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I've felt the same as John on the underlying point: I believe that the DLC crowd is actually most comfortable being perennial losers. They can nibble at stuff on the not-entirely-reactionary wings of Republican effort, rack up campaign money and lobbyist donations, and never have to deal with the burdens of governance. They aren't the biggest threat in Congress to sane and effective government, but that's only in the sense that one house burning down isn't as bad as a whole block burning down. Nothing suggests that they wish to know what the public thinks or to deal with the consequences of their own in-group's preferences.

So, fuck 'em. Or rather, treat them with the respect due to one's partymates, but no more. They should be welcomed when they cooperate and marginalized when they insist on the policies that have failed all through the last couple decades.


Posted by: Bruce Baugh | Link to this comment | 11-10-06 11:41 PM
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text--Yeah, the pro-corporate-management accounting policies and his ties to the insurance industry (I think the "I" after his name really does satnd for Insurance) are a big part of why I hate Lieberman. Maybe he'll have less power in the caucus now that he's abandoned the party.

Okay, fine. Let's go with incrementalism.

1.) Cover everyone age 19-25 under Medicare NOW. Younf people will like it. More of them will vote, and it will build Demcorats for a generation. After a while a bunch of them will demand that the program be extended.

2.) Let anyone who wants to buy into Medicare. Individuals definitely. Maybe businesses too. At first only sick people will do this. After a while everyone will decide that the risk pool needs to be expanded and we'll pull everyone else in too.

3.) Open up the Federal Employee Health Benefits program to anyone who wants to join. (Maybe. This has pluses and minuses.)

I've said 1 before, but we Democrats need to learn to just keep repeating ourselves until our ideas stick.


Posted by: Bostoniangirl | Link to this comment | 11-10-06 11:45 PM
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4.) In Massachusetts, Medicare should be an option for people who will receive state subsidies to buy insurance.


Posted by: Bostoniangirl | Link to this comment | 11-10-06 11:54 PM
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Timing makes a difference, bu Dems won't block for two years.

No one knows how long Stevens'll hold out, though.


Posted by: teofilo | Link to this comment | 11-10-06 11:56 PM
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I'd like to see some competence demonstrated in fixing the stuff that's obviously broken and visible to me before I'd support major overhauls in the big programs.

How about getting the TSA screening and searching rational so flying isn't a detour through hell? How about some serious FEMA exercises demonstrating that another Katrina wouldn't result in the same results? How about writing some laws with built-in metrics to show that law is working as intended or not?

Grandiose plans toi save the universe based on a particular ideology or the other are a dime-a-dozen, I'm not supporting any of those before I have some idea they might actually work.


Posted by: Biohazard | Link to this comment | 11-11-06 10:12 AM
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2.) Let anyone who wants to buy into Medicare. Individuals definitely. Maybe businesses too. At first only sick people will do this. After a while everyone will decide that the risk pool needs to be expanded and we'll pull everyone else in too.

Businesses, maybe. Individuals kills insurance, though. Young people in their mid-twenties in excellent health are the pool you need, and they're the class least likely to purchase insurance, even if they can afford it. So what you have is people who are sick, or people who are worried about getting sick, or people who are too high-risk for regular insurance.

Your #1 is spot-on. But I really think that any program has to be mandatory if it's going to succeed.


Posted by: Cala | Link to this comment | 11-11-06 10:25 AM
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This Drum post says a lot I agree with.


Posted by: FL | Link to this comment | 11-11-06 10:27 AM
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"nuclear option" previously discussed, bruited about and set aside

The percentage of the country who understands and remembers this, or even could be made to care about it with a concerted effort, strikes as both low and highly partisan identified.


Posted by: washerdreyer | Link to this comment | 11-11-06 11:36 AM
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145: Yeah, I was thinking of linking to the Steven Teles post Drum links as an expression of what I'm disagreeing with, but it's not as square a disagreement as I like. I don't have a problem with tactical caution, depending on the specifics. What I want to get away from is the strategic caution -- unless we recognize and publicize the fact that the left-wing policies we support are, in at least some important cases, fantastically popular, we're going to get the tactics wrong.


Posted by: LizardBreath | Link to this comment | 11-11-06 12:02 PM
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147: There are a series of fights and reconciliations within the Democratic Party that have to happen before we can have a useful sense of our strategic goals. For example, I believe that the DLC wants something like the managed competition plan promised by Hillarycare, Ezra wants single-payer, and (IIRC) Schmitt wants something in the middle. Those are pretty different ends for which to aim, and there are already intra-party fights along parallel lines already shaping up.

NB: I'm not sure how this fits in, but Yglesias made an interesting claim about blogs on bloggingheads: the blogosphere functions as the civic organization, like union locals, that organizes the increasing number of Democratic professionals and rationalizes their desires. I think this is connected to some of the fights that need to occur. One explanation for the virulence of the language surrounding the "netroots" vs. the DLC split is that each organization represents, in some way, the same base in the Democratic Party. Fratricide and all that.


Posted by: SomeCallMeTim | Link to this comment | 11-11-06 12:15 PM
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147: LB true that, but if this administration has taught us anything is that it's important to know what you can and can't accomplish before you start. UHC simply isn't happening in the next two years, and bringing it up at the Congressional level, I think, is unwise for at least 2 reasons: 1) It can distract us from the stuff we can do that are also good politics; and 2) if we put it out there, those opposed to it have a lot more opportunity to take shots at it, and frame the debate in ways that are bad for both UHC and Dems generally.


Posted by: Pooh | Link to this comment | 11-11-06 12:20 PM
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Point of order, or something, LB:

AMTF = ?

All I can find is "Average Modulation Transfer Function".


Posted by: no fortunate son | Link to this comment | 11-11-06 4:00 PM
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AMTF.


Posted by: teofilo | Link to this comment | 11-11-06 6:41 PM
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Grazie, teofilo.

What I get for not reading every comment thread.


Posted by: no fortunate son | Link to this comment | 11-11-06 8:32 PM
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Also, Hilzoy.


Posted by: FL | Link to this comment | 11-11-06 8:36 PM
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Cala in 144:

(1.) I get that letting anyone into Medicare without making it mandatory is unsound from an actuarial point of view, but I think that it could be a bridge to a universal system. Medicare, as it is now, is pretty stupid, because it only covers the sickest people: the old and the disabled. We'd realize that we were only covering sick people and then force everyone to join.

(2.) I would make the 19-25 year-old enrollment mandatory or automatic. They're mostly pretty cheap anyway, so you wouldn't need much in the way of taxes to cover them.


Posted by: Bostoniangirl | Link to this comment | 11-11-06 8:44 PM
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A thing that's increasingly irritated me over the past several years is the tendency of people writing "whither Democrats" essays to search for some unpopular issue--or some unpopular constituency--that Democrats can jettison in order to make people suddenly like them. If we just throw the gays overboard, if we just go anti-abortion or pro-school-prayer, if we abandon gun control (already tried) or affirmative action or whatever it is this week, normal salt-of-the-earth Americans will then stop hating us so much.

I'd assumed it was all a product of losing a whole lot, and I'd hoped that winning huge in a national election would dispel this kind of talk for a little while. But no: the aftermath of the midterm has has been filled with analyses saying that Dems won not because Republicans manifestly screwed up everything but because the Democrats (usually extrapolating from some specific candidate) moved right on X or Y or Z. There is no end to the insanity.


Posted by: Matt McIrvin | Link to this comment | 11-11-06 9:55 PM
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The actual purported example of AMTF in the (classic) linked thread is just ogged being very confused.


Posted by: washerdreyer | Link to this comment | 11-11-06 11:16 PM
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On the specifics of UHC, I really worry about incrementalism. It's a two part worry. First, a big part of the efficiency of UHC is eliminating the "who's covered?" beauracracy; no one needs to get too stressed about who you are or what your status is, because if you're breathing, you're covered. There's no enrollment process, no checking to see if you're no longer eligible and your coverage needs to be cancelled; a whole category of beauracracy is eliminated. (I do not have wonkish data establishing the size of this efficiency gain, but it makes sense that it would be to me.) So an incremental process leaves that source of efficiency on the table to the last minute.

And then, the problem is that if you enroll people in the order of how sympathetic they are, what you're left with at the end, if you ever want to achieve the efficiencies of true universality, is the least sympathetic group. This can't make the final steps easy.


Posted by: LizardBreath | Link to this comment | 11-12-06 8:34 AM
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LB, do you think that having various states try different approaches is likely to be useful or not? Will being able to point to, e.g., Massachussets or Wisconsin and say, "Here's what works and what doesn't!" help or hurt national efforts?

155 - Scott and friends at Lawyers Guns and Money have been all over this particular pundit tendency. (I'll say, though, that the guns thing really, really did turn off a lot of soft supporters with very little gain in actual policy benefits. I'm glad to see the Dems jettison it, even if it's been years since I so much as plinked a can with a .22.)


Posted by: Steve | Link to this comment | 11-12-06 8:53 AM
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I don't think it does help. For one thing, any state-by-state solution is going to have to be punitively restrictive about immigrants for generous states to avoid being overwhelmed by sick people from stingy states. For another, I don't know if anyone's noticed, but there's a certain amount of regional antagonism in the US -- I just picture a successful NY program, and can't see that its success would be a selling point in Mississippi.

I don't see that extraordinary creativity is necessary to set this up. There have been universal coverage programs in other countries for over half a century. Lots of things have been tried, and we can see how they've turned out -- this is a solvable problem, without any need for the "federalism is necessary as the laboratory of democracy" routine.


Posted by: LizardBreath | Link to this comment | 11-12-06 9:18 AM
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First, a big part of the efficiency of UHC is eliminating the "who's covered?" bureaucracy.

I'm not sure I buy that as an objection. At a minimum, it's hard for me to believe that the proportional gain in efficiency scales ever upward with the size of the population; for a large enough number, we'll see, as a percentage, the savings we should expect. If it's more efficient, we'll see it, and we'll pick up the money we left on the table by extending coverage. Furthermore, bureaucracy worries should include worries about the responsiveness of a single bureaucracy responsible for all healthcare. I'm glad we killed Ma Bell.

the problem is that if you enroll people in the order of how sympathetic they are, what you're left with at the end, if you ever want to achieve the efficiencies of true universality, is the least sympathetic group.

Maybe. But the "least sympathetic group" here is us. Poor people have coverage (of a sort), old people have coverage, and kids would have coverage. If there are clear gains, we would only have to be willing to accept the benefits for ourselves. If we can't be convinced that it's good enough for us, we're not going to get UHC in any case.


Posted by: SomeCallMeTim | Link to this comment | 11-12-06 9:56 AM
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I think Tim's right about the "least sympathetic" bit. While it's true that the last people to be covered wouldn't have much in the way of pity for them to pull the heartstrings of the electorate, it's also true that those are the very people who most need to be convinced to accept UHC. When it becomes "everyone else has universal coverage, why not you?" I think a lot of people will be swayed.


Posted by: teofilo | Link to this comment | 11-12-06 10:02 AM
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160: Either I'm being silly, or I'm being unclear. My point was that there's an arm of beauracracy devoted to distinguishing between the covered and the uncovered: signing people up, cancelling their coverage, checking their status when they show up for care. The size of that arm doesn't track linearly with the percentage of the population that's covered -- it's going to have more to do with flux in and out of coverage. Once everyone is covered, though, it goes away completely. That seems like it should be a real savings in overhead, but we only get it when we go all the way, not when we approach universality incrementally.

If there are clear gains, we would only have to be willing to accept the benefits for ourselves. If we can't be convinced that it's good enough for us, we're not going to get UHC in any case.

I'm not sure what work 'us' is doing in this sentence; 'we' the whole electorate isn't 'we' the middle-life employed isn't 'we' Unfogged readers. Can you say this again, louder and slower, because I missed it?


Posted by: LizardBreath | Link to this comment | 11-12-06 10:16 AM
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162: If you extend universal coverage to children under the age of X, the entire bureaucracy will amount to someone verifying the kid's age. That doesn't seem like it will generate a sizable, or even any, new bureaucracy. At most, it strikes me as marginal.

"'we' the whole electorate isn't 'we' the middle-life employed isn't 'we' Unfogged readers.

I'm not sure I understand this objection. At the moment, and as I understand it, we are supposed to have universal coverage for (a) the very poor, and (b) the old. It might suck, but the coverage is supposed to be there. If we extend coverage to children, we'll have left a population that isn't (a) very poor, (b) old, or (c) underage. That seems like more or less "us" (L, Cala, w-lfs-n, teo, MattF, and Becks accepted).


Posted by: SomeCallMeTim | Link to this comment | 11-12-06 10:27 AM
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163: Doing an age check on tens of millions of people requires a lot of people. Determining if anyone is really very poor requires a lot of people. I don't think it's insignificant in terms of overhead.

And what I worry about by leaving the non-old-young-or-poor out is the 'too stinking proud' problem. I don't want to make people having hard times prove that they're completely destitute before they can go to the doctor. But if they aren't willing or able to prove that, then they remain part of the unsympathetic 'us', and not an argument for UHC.


Posted by: LizardBreath | Link to this comment | 11-12-06 10:47 AM
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Doing an age check on tens of millions of people requires a lot of people.

Why? You do a point of service check by the receptionist, just as you would at an R-rated movie. There might be an initial pain in making sure people bring appropriate documents, but after that, it seems pretty easy. Furthermore, I suspect it's easier to gauge someone's age than to gauge someone's income.

But if they aren't willing or able to prove that, then they remain part of the unsympathetic 'us', and not an argument for UHC.

There are enough of the rest of us that I think they'll be lost in the masses. Basically, we'd be going after people who already have health care coverage, and simply worry about losing it.


Posted by: SomeCallMeTim | Link to this comment | 11-12-06 10:59 AM
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165: And then after you do the point of service check, in order to get reimbursed, you transmit your proof of the patient's age to the claims processing department of the UHC bureaucracy, who checks them, and decides if you've provided sufficient proof for reimbursement. It takes people to process claims.


Posted by: LizardBreath | Link to this comment | 11-12-06 11:09 AM
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Ah. You're thinking single-payer, I'm thinking single-provider. (Which is strange, as I think single-payer is better.) But if you have single-payer, you're going to need claims processing units to make sure, at a minimum, that (a) the people exist, and (b) needed the treatment. I'm not sure how much trouble an age requirement adds. And there's always going to be fraud at the margins (or not-so-margins, according to some estimates, IIRC).


Posted by: SomeCallMeTim | Link to this comment | 11-12-06 11:14 AM
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Oh, you want to expand the VA system, or something similar. Yeah, that might be easier bureacracy-wise, but I don't see it happening.


Posted by: LizardBreath | Link to this comment | 11-12-06 12:14 PM
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L, Cala, w-lfs-n, teo, MattF, and Becks accepted

It's nice to have that sense of approval.

In regards to single-payer vs. single-provider, it seems like most of the talk has been about single-payer. Is this because it's actually the superior approach, or is it a compromise that just realistically has a better shot of coming to pass?


Posted by: Matt F | Link to this comment | 11-12-06 4:25 PM
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The phenomenon of the too-stinking proud is a real problem. I've avoided really important care in the past because of this problem.

There's also its corollary,"the bureaucracy is so damn confusing."

I know someone at work who makes around $25,000, maybe $28K max. She's a single mom. She gets insurance through work which has a high deductible. Her premium is fully covered. Her kid's costs something. She'd probably be eligible for partial free care if she got her care at a clinic or in a hospital-based practice, but she doesn't want to fill out the paperwork, and the hoops you have to jump through are very confusing. As it is her credit is pretty bad because she get sbehind on her medical bills. I'm trying to get her to sign up for a healthcare reimbursement account. She doesn't want more money taken out of her check, sicne her busget's tight. I told her that she knows that they're goign to spend at least $500 annually above the amount that they put into her personal wellness accoutn annually, and she can spare $10/ week.

The paperwork and the existence of overlapping programs make it really confusing. I gather that those of you who think that it's not a big deal haven't had significant contact with the system as a patient. All of this stuff is that much harder to deal with when you're sick and not feeling well.


Posted by: Bostoniangirl | Link to this comment | 11-12-06 9:00 PM
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