Did progressives win anything in the health reform negotiation process?

by: Chris Bowers

Thu Mar 18, 2010 at 15:48


The entire reconciliation bill now posted on House Rules Committee website. Did progressives win anything?

Changes from the Senate bill
Politico has a long summary of how it differs from the Senate bill.  The very existence of the reconciliation bill comes from a refusal of House members, most of them Progressives, to just pass the Senate bill as is.  Every single change Politico lists is thus a concession to House Progressives, and supplements the other ways that the bill became more progressive progressives.

Number of people on public insurance
Compared to current, 16 million people are projected to receive public health insurance as a result of the reconciliation bill (PDF, page 7). This compares to 21 million projected in the House Ways and Means bill, and 14 million people in the Senate Finance Committee bill (page 14).  That is closer to Baucus, but it isn't nothing.

While it is true that there is a substantive difference between Medicaid and a public health insurance option tied to Medicare rates in the exchange, it is also true that the bill strengthens Medicaid in important ways.  By moving most of the funding to the federal level--a $99 billion addition to the Senate Finance Committee bill--Medicaid recipients in red states are now in little or no danger of having their public health insurance taken away by local right-wing governments.  Cutting Medicaid now becomes nearly as politically difficult as cutting Medicare.

Number of people receiving public primary care
Additionally, there is $11 billion extra for Community Health Centers in the reconciliation bill over five years.  At current rates of patients receiving care (20.27 million annually) to federal funding for Community Health Centers ($2.5 billion annually), that projects to an additional 17.8 million patients receiving public primary care from the bill.  This compares to zero extra patients in the Senate finance committee bill, and 22.7 million extra in the House bill in November.

Since this concession was directly made to win progressive votes, again I guess it means Progs got nothing.

****

It is factually untrue that progressives won no concessions in this bill.  People are free to debate over whether the concessions are enough either to support the bill or to demonstrate increased influence, but it is simply untrue that they won nothing in return for their support.

Chris Bowers :: Did progressives win anything in the health reform negotiation process?

Tags: , , (All Tags)
Print Friendly View Send As Email
Did progressives win anything in the health reform negotiation process? | 40 comments
Thanks for the reminder (4.00 / 2)
Chris,

Thanks for that important reminder. As frustrating as this process has been, and as much crap as we have been getting from our friends (and they really are our friends) at places like Firedoglake for supporting this very imperfect bill, it is important for us to remember just how much we did achieve together, and how much this bill will improve things for so many people, despite its many flaws and inadequacies.
-- Joel

"In a mountain half-way between Reno and Rome/ We have a machine in a plexiglass dome/ That listens and looks into everyone's home." -- Theodore Seuss Geissel

Trying to wrap my head around this (4.00 / 3)
From what I'm reading, the federal government is going to guarantee at least 70% and up to 100% of the cost of Medicaid to the states going until at least 2020?  Is that right?

If that's the case, this is a major accomplishment.  Not only does it place Medicaid on the same level as Medicare in terms of the funding stream but it also takes a significant burden off of states and gives us the budget flexibility at the state level to implement progressive programs state-by-state.

If I have this understood correctly, this is a major victory.

"Never be afraid to stand with the minority when the minority is right, for the minority which is right will one day be the majority." -William Jennings Bryan

When Does The Funding Start Exactly? (4.00 / 1)
I know it started in with The Recovery and Reinvestment Act, and will get pushed along some more with the new jobs bills, but when does Federal funding start?

I thought it said 2012--wrong?  Just looking for an answer?  Anyone?

PS  A major factor would be increasing the reimbursement rates.  Because, as it stands now, depending on the state, rates are very low, and a lot of doctors don't want to take Medicaid.  Though, my understanding states that bill will make  states change their practices, because of the federal funding.   Is there a Federal law in this bill mandating states to follow certain Medicaid enrollment levels?

[ Parent ]
I Agree--This Would Be Huge (0.00 / 0)

[ Parent ]
Don't lose what's making this site so special at the moment... (4.00 / 2)
I guess it means Progs got nothing

Dude, your tone on this has been refreshing, and I say that as someone who thinks the bill still does more harm than good and should not be enacted. You've been respectful to folks like me who disagree with your final analysis and, as such, its been about the only place where a reasoned disagreement can occur.

Don't descend into defensive sarcastic stuff now. C'mon. We need you.... the pro and the con crowd.

undercaffeinated

Sarcasm has been applied as needed for a long time. (0.00 / 0)
Please re-read past posts.

I hope that soon SNL's "Really?" will be available for use as well. Its part of the site upgrade that a coder has been hired for.

I dont think sarcasm is so difficult to understand.  

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

[ Parent ]
missed the part (0.00 / 0)
where anybody said it was difficult to understand.

undercaffeinated
[ Parent ]
Got health care? (0.00 / 0)
Yet?
[ Parent ]
no natl exch? (0.00 / 0)
looks like no natl exch. i dont want rick perry running the ins exch here!
Art3 my typing is so bad its a joke, so please take this with a grain of salt (4.00 / 1)
But if you could use a few more letters your posts would be more useful, and in some cases, useful. I have read, and this will make many laugh out loud at my irony, a few of your posts that were unintelligible.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky
[ Parent ]
Do you consider these to be major concessions? (4.00 / 1)

I don't see how (4.00 / 1)
and, really, the reason there's a reconciliation bill is not because of progressive balking or making demands, it's because of unions.  The unions stiffened the progressives spines and insisted they balk at the excise tax in the Senate bill.  If the unions hadn't done that, the progressives would've rolled again and voted for the Senate bill with no reconciliation.  Not that the unions have been all that great at bargaining, but they do get credit for the reconciliation fix (as lame as it is).  
[ Parent ]
I wanted Chris to answer because every time someone brings up the lack (4.00 / 4)
of bargaining ability by progressives, he brings out this list. My thoughts are that the list is okay, and in fact, it will help some of my family members, but its not just about me or my extended family (several of them are near but not below the poverty line), and more about whether or not these are major concessions that will change the trajectory of health care in this country for everyone. Many of these issues are very personal to me. So when I see someone trying to convince me that given the potential that these are concessions that matter, then I got to ask them do they really believe these are major concessions given the potential? To me, they are not. The bill is an okay right of center bill and as I said my family members will be helped in the short term. The question is what do all of us face in the long term? I can't in good faith claim that minor concessions are major concessions. I can not pretend a right of center bill is not a right of center bill just because my family is helped. So, I don't get how other progressives can do it. I would like to understand their thinking.  
[ Parent ]
i think it boils down to how much risk for how much reward you are interested in (4.00 / 2)
i think people respond differently, partly depending on their circumstances, and partly depending on their temperaments (small c conservative --> small r radical).

maybe an obvious point, but it is nice, at least for me, to take a moment to remember the obvious :D

[ Parent ]
What did progressives concede just to get the Senate bill? (2.67 / 3)
which appears to be the basis of your analysis.

How do these claw-backs,won in reconciliation, measure up to those made to the conservoDems in the Senate?


"It sounds wrong...
     ...but its right."

Is this bill better than the senate version? Yes (4.00 / 4)
Is it better enough to be worth passing? That's for everyone to decide for themselves. I think it is, not only for the bill itself, but to avoid the political disaster that woukld ensue if no bill is passed (and at this point I think thatg holding out for a much better bill would either kill any chance at passing any bill, or else make Dems look totally inept and seriously risk losing both houses next year).

To me, though, the real question is whether this bill is more or less the best bill that Dems could have gotten. And I say no, not even close. We could have gotten a much better bill, with a meaningful PO, Medicare buy-in, employer mandates, rate controls, etc., had Dems held out for it, using the sort of tough and smart hardball tactics that historically gets one substantive concessions. They did not, or at least not enough of them did, and as a result we have this better than the senate version but not nearly good enough or as good as we could have gotten bill to look forward to. Yes, politics is about compromise, but there are compromises here that need not have been made.

The issue isn't that this bill is better than the senate version, which it is, or is better than the status quo, which it appears to be, but that it's not nearly as good as it should and I believe could have been--in a real-world way. And Dems--especially progressive Dems--are the reason for why it isn't.

FISA redux. Like Ole' Man River, they keep on rolling...

"Those who stand for nothing fall for anything...Mankind are forever destined to be the dupes of bold & cunning imposture" -- Alexander Hamilton

Actually, There Were A Lot Of Factors That Weakened The Bill (4.00 / 2)
that did not include the ineptness of Progressive Democrats.

1. No one expected the degree of the corruption of the financial industry.
2. Not to many people would have predicted throughout the "bailouts" that the bailouts would have been handled so horribly the Obama and his advisors.
3. This in turn, allowed movement conservatives to pounce on the anti-spending, anti-gov't, anti-tax nostrums that created The Tea Party.  Sorry, no one--save a few--would have predicted that conservatives and Republicans would have helped  turned Health-Care Reform into all the spurious claims.
4. So with Main St. hurting, and everyone in a panic--rightfully--the focus on health care reform took a back seat.

   This does not include their ineptness at negotiating stronger, but with all things considered, I think Chris and others makes a good case for supporting the bill.
 

[ Parent ]
Let's see (4.00 / 2)
1. Lots of people new how corrupt the financial industry was, and were yelling their heads off for Obama to get tough with the perpetrators of the financial implosion.

2. The fist round of bailouts was handled by Bush, Obama made no effort to blame Bush for the bad state of the economy that made the bailouts "necessary", so he gets no credit for how he handled his half of them.

3 no one--save a few--would have predicted that conservatives and Republicans would have helped  turned Health-Care Reform into all the spurious claims.

How shall I put this? Where the hell have you been for the last decade? The GOP thugs do this same tactic on everything. WTF planet have you been living on?

4.  More importantly, what does any of this have to do with Obama making backroom deals with corrupt industry leaders to scuttle real healthcare reform?

[ Parent ]
Listen You Insensitive Jerk-Off (1.33 / 3)
1. Hello, everyone knew how corrupt financial industry was, but no knew the extent of how many "toxic assets" were on their books.  And, as Dean Baker points out in his latest book  the biggest perpetrators were:  Greenspan, Ben, Paulson, and the Republican Party.

2. According to many of the liberal economists, a bail-out was needed.  The problem was that the proposal to the bail-out was poorly designed by Bush--and Obama later. "No strings attached." Did I want receivership? Of course.  And, Obama's boys just made it worse.  (I agree that Obama did not--and does attack Bush--like Reagan attacked Carter for over 2 years.)

3. Regarding cherry-picking #3, yes the Republican and conservatives were going to attack and make spurious claims, but no one could have imagined town-hall meeting w/ raving lunatics--under a faux populist movement--especially after liberal and progressive groups felt pretty confident of passage.

4. If you knew, after the GOP and the conservatives were tarnished, then you should sounded the alarm, and started a counter-movement to block their power.

5. We are talking about the Progressive Bloc's capacity to negotiate and win stronger concessions. So, with all the bullshit that always occurs with legislation--especially of this magnitude--where the Hell have you been living!?--there are always back door deals; and if you didn't notice a good portion of our Congress is owned by Big Hospitals, BigPharma, and AHIP, etc--not to add Obama.  Or did you not notice this? The question was did the Progressive Bloc win any concessions?  I say yes; though, they still need to work  on their strategy and they need our help.

[ Parent ]
The question was did the Progressive Bloc win any concessions? (4.00 / 1)
Mmmmmmm, crumbs.

Yummy yummy crumbs.

Are you gonna eat that whole crumb now? I like to save some for later, when I'll be hungry.

Hey, wow, is that... an ort!? Holy crap it's an ort. Man, we're living high on the hog, now.

Yessir, progressivism! A crumb in every pot. And Friday is ort day!

3. Regarding cherry-picking #3, yes the Republican and conservatives were going to attack and make spurious claims, but no one could have imagined town-hall meeting w/ raving lunatics--under a faux populist movement--especially after liberal and progressive groups felt pretty confident of passage.

Right, because conservatives have never been intransigent dickheads, and democrats have never been overconfident, and say, gone on vacation for a month.

How long have you been following politics, now?

4. If you knew, after the GOP and the conservatives were tarnished, then you should sounded the alarm, and started a counter-movement to block their power.

Yep, it's all my fault.

[ Parent ]
No one could have predicted (0.00 / 0)
that you'd be so thin-skinned after having your assertions refuted (well, maybe Paul Krugman wrote a blog piece on it). Clearly, we've been outplayed here in the comments section. Probably Rahm's doing.

"Those who stand for nothing fall for anything...Mankind are forever destined to be the dupes of bold & cunning imposture" -- Alexander Hamilton
[ Parent ]
Sorry but I have to disagree with all these points (4.00 / 1)
This was all completely predictable to anyone who's been paying attention to politics these past 20 years, ever since "Third Way" pseudo-progressive "New Democrats" took over the party. They are effectively as corrupt as the GOP, just in a slicker way. Industry influence was predictable, tea parties were predictable, public anger over the mishandled bailout was predictable, progressive ineptness was predictable, and so on.

This was all one big Kabuki drama with all the players playing their predetermined roles. The fact that it resulted in the economy not totally imploding and a health care bill that doesn't totally blow is I think the result of a democratic system that tends to have a moderating effect on outcomes, leading to ones that might be far from ideal, but which are usually not totally sucky, either. But none of this was unpredictable or unpredicted. I don't know where you got that from.

"Those who stand for nothing fall for anything...Mankind are forever destined to be the dupes of bold & cunning imposture" -- Alexander Hamilton

[ Parent ]
Kovie, I agree with a lot of what you said in the paragraph (0.00 / 0)
And, I have understand the "Third Way" has exerted major influence in the Democratic Party.
Though, I believed that this year a lot of lobbyists and PACS that were behind health care reform were just as emboldened--and they were.
Mike Lux, who has been in the trenches in DC for a long time, felt pretty confident that we would get a stronger bill.  And so, did a  lot of other people.  Yet, all these groups were all in "veal pen", I suppose.
Also, I think a lot of net-root progressives felt pretty good after the elections of 2008.
If public anger over the bailouts were predictable--which I will cede--why didn't progressive play hardball or do anything  to form capture that anger and funnel it on the progressive side? A New Way Forward was one of the few groups that came out it from the left--albeit unions.  
It's amazing what liberal and progressive got accomplished against a pretty corporatist Democratic Party, a more conservative media, wealthier and more entrenched conservative groups, not all the lobbyists fighting to weaken or kill this bill, etc. As Chris notes, there were definite Progressive concessions that improved the overall bill.

Yes, the bill on the whole is not what anyone in liberal and progressive circles hoped for.  I prefer single-payer. That said, progressives need to form a stronger infrastructure to compete with the conservative hegemonic instutions that weakened this bill.  

Bottom line:  We need public financing for our elections, or more fair way as Lessing has shown with CongressMatter.org to get the money more out of elective representatives in Babylon.


[ Parent ]
1st Paragraph (0.00 / 0)

[ Parent ]
I will take issue with Bowers framing of this question. (4.00 / 3)
I see things overall very differently than Bowers does. Let's go through this slowly. Bowers' thesis is that the bill is better than it would be otherwise because progressives applied pressure. The key point for me is just how very trite this thesis is. It is not exactly wrong, but it is trite. Progressives are not some part of the populace insulated from the vast majority. We reflect views and politics that are much more broadly accepted and tolerated and supported than our numbers in themselves.There is a reason "populism" has the same etymological stem that "popular" does. Our beliefs and the policies deriving from them represent policies to broadly aid and improve the general population...not all of course, but the vast majority. In addition we are articulate, passionate and often intellectually and morally compelling. These are great strengths. Our weaknesses are legion and legendary.  It is not an indication of our optimally applying our leverage, that "we" have an influence on a  much needed, but clearly deficient and damaged,  health care reform bill; that in a sense goes without saying. More than our influence as an accepted part  of a ruling coalition, it was the votes of disgruntled electorate in Massachusetts (together with our full-throated voicing of and amplifying  the weaknesses as well as wrong-headedness of the Obama-Emanuel approach) that forced a slightly changed attitude and the slight improvements that the administration made, always in my mind continuing the marginalization and exclusion of the left. The question is not whether they can ignore what we stand for; they cannot...at least not entirely. But how do we force them to acknowledge the centrality of the policy needs we support. (Not to make us feel good, but because these policies are needed by the country and satisfying them is the only long term prospect of success at the polls. One can count on Republican ineptness only so long. As Massachusetts proved the Democratic ineptness is a very part of the party's allegiance to the ruling elite with the superficial cover of populist rhetoric).
Agree (4.00 / 1)
Proper question is:

Did We, the People, win anything in the health reform negotiation process?

[ Parent ]
Answer: (4.00 / 4)
Not enough to make it worth the cost.
[ Parent ]
At what point (4.00 / 4)
do we begin to think about the next step, which is the implementation process, especially at the state level. I suspect that the right, which has been mobilized throughout this entire process, will be ready to go at the state level. They are already making noise about nullification and lawsuits.  And no doubt the business community is already strategizing and lobbying.

In order for this reform to do what it claims it will do, states will have to implement it. And obviously there will be room (how much is still unclear) for states to enact elements of reform that didn't make it through the sausage fest or that were jettisoned before we started as unserious, whether that is single payer or the kinds of cost controls that were stripped out the other day.

I realize for some that will have to wait until after the final votes.  But it can't wait one second longer.  

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

At what point do we begin to think about the next step? (0.00 / 0)
Can we wait until the first weekend of the NCAAs are over at least? :)
[ Parent ]
That comes after the chip in your head (0.00 / 0)
You didn't notice the addition of the chip in your head on page 1842, paragraph 12, footnote #3b?

[ Parent ]
Definitely Not (0.00 / 0)
Considering that the Right was mobilized more fervently on the ground.  We thought--or a lot of people--that the electoral Democratic victories to carry the day. Obviously, this was a major mistake.  

Not to add: the MSM, Versailles, and the rest of the conservative hegemonic structures that are in place will do everything to aid the enemy.  It seems, that we need have a mass movement coordinated with all the pro-health care groups, unions, the weakened and centralized DNC to fight back asap.
Coffee Party anyone?

[ Parent ]
Medicaid expansion (4.00 / 6)
would be required even under the most conservative proposal. These people don't have any money. You can't force them to buy insurance. And it's not as great as you say. There are at least 5 million people walking around right now who are Medicaid-eligible but haven't enrolled. Then there's the reimbursement issue. It's a good thing we are expanding community clinics (though not by as much as you say) because otherwise there would be no one to see these patients. They will still have trouble getting specialty care. Finally you have to look at the overall context--was it worth entrenching private insurance? was it worth protecting the industry from meaningful cost control? was it worth give pharma unprecedented protections from competition?
These Expansion Will Still Improve Health and Save Lives. . . (0.00 / 0)
The goal of Medicaire-for-All might be easier, because the federal govt is going be funding a higher and higher percentage of Medicaid.  That can help rolling both of these programs together in the future for better reform.
    This will take the power more out of the states--no?
[ Parent ]
I would rather log in to Red State (4.00 / 3)
and see them listing the conservative crumbs they were thrown in a heavily liberal bill than read what crumbs progressives got here (with 59 Dem senators, a full house majority, and a commie liberal muslim president.)  You are supposed to win largely symbolic victories when you are in the minority, in the majority it should be concrete.  This bill is amorphous at the very kindest reading.

I don't blame Chris, we just have a difference of opinion.  He doesn't see things my way, I don't see things his way on HCR.  I think passing this is a massive mistake, the mandate (without a counter anchor) is an 800 lb gorilla that dwarfs almost everything else in importance.  No counter ballancing 800 lb gorilla of cost controls = a bad bill.

I hope and pray that I am wrong and Chris is right, I would so love to be wrong on this issue.  But it just sounds bad, reads bad, portends bad things in the future IMHO.

Someone tried handing me a $20 bill (4.00 / 1)
wrapped in a wad of dogshit. They said "Yeah, I know it's dogshit, but there's still SOME good in it."

I'm not going to accept a pile of dogshit. Period.

For the desperately poor, they might take it. (0.00 / 0)
So, I think your analogy needs a little work.  First off, you have to take it if you have at least $1 to your name, but you don't get it at all if you have less than $1.  Second, if you have to take it, you have to pay for getting it.  (The amount will be determined when you go to use it.  Sorry.  Can't be more specific, but the rates just keep going up.  You'll just have to hope it's not more than you can afford when you go to use it.)

Oh yeah.  And you have to eat the shit.

Have a nice day!

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
based on what you say, Chris (4.00 / 1)
There are some concessions to really really poor people and absolutely zilch for the middle class. In other words, the vast majority of people who earn over, say, 25-30 K for single person are no less screwed by this bill than they are without it. The gains from the senate bill are minimal and the mandates are truly regressive as well as punitive. The one possible progressive concession is by Kucinich who may have gotten something on Erisa (is yet to be known and is deliberately kept quiet now). Oh yes, there is also the concession to labor because they were as good as their vote. Proving that it pays to be firm - something that progressives have yet to master.

hate to tell you that but Rahm was right in the sense that progressives can be blown over with a feather. I just can't forget how hard you and others here worked for those signatures by house progressives to vote no without public option. The truth is what it is. They'll vote yes in the end because their bluff was called just like we knew it would be.

Question is - why did you and others on Openleft bother and what will happen to the money donated to the wimps?

What really angers me are those shapeshifters like Moulistas - here they say "kill the bill". There they say "kill kucinich' (or close to that). Unfortunately jane hamsher and FDL and Dean - and, to some extent Dennis, look like the only real men to come out of this fight. The rest are - well.....politicians?

As for myself - I did not support the senate bill and will not support the new bill which has more bad news than good for most of us. The main reason I differ with people here seems that that there are still way too many progressives with head in the sand who think this bill will ever be improved. That's not going to happen because the votes will never be there. The insurance companies bill makes progressives look like a cross between good corporate citizens and pie-in-the-sky fairy dust. I am sure that Rahm is having a long good laugh as you keep whipping the cream-puff of a bill.

Oops --- do I sound angry or something?

medicaid is a public program? (4.00 / 3)
i know that's how it started out, but it's ~2/3 privatized now. that's a bigger win for the insurance companies than for the people, i'm thinking.

and why is it a progressive victory to make people of very modest means first spend whatever money they might have saved up for retirement, or sending their kids to college, or maybe even buying a house, or a dependable car before we allow them access to medical care?

Important point (4.00 / 1)
I really would like to see more discussion about Medicaid.
[ Parent ]
medicaid was an ok stopgap at the time (0.00 / 0)
but johnson's original plan was medicare for all, amd his plan b was medicare for the old and medicaid for the poor, and then later expanding medicare -- not medicaid -- to the rest of us.

too bad progressives fell down on the job on this one.

[ Parent ]
Did progressives win anything in the health reform negotiation process? | 40 comments
USER MENU

Open Left Campaigns

SEARCH

   

Advanced Search

QUICK HITS
STATE BLOGS

Home | RSS/XML Feed | Register | Contact

  © OpenLeft 2007-2010, Powered by SoapBlox

Powered by: SoapBlox