Let me see if I’ve got everything:
“Once-in-a-generation” healthcare bill is proposed to transform a failing healthcare system. Liberals shout with joy and conservatives shout with outrage. First draft of plan leaked in late spring shows concessions to conservative arguments before conservatives can argue against it. New draft comes out of finance committee chaired by Congressman Max Baucus to outrage by Left because it eliminates the biggest cost-saving principles (competition) and its instrument of fundraising may reduce the quality of care (tax on “Cadillac plans”) as well as by the Right on principle. The House cleans up this now weaker proposal, but soundly passes it with an eleventh hour draconian anti-abortion amendment by Rep. Bart Stupak (who I once voted for). Sarah Palin posts on her Facebook page that this bill transforms the country into the Soviet Union by creating imaginary “death panels” and rationing. August is spent watching confused Americans scream “take your government hands off my Medicare” and other nonsensical things. The Senate reconvenes and takes up the debate, starting with Majority Leader Harry Reid courting the two Republicans that they got to cross over last time as well as members of his own party that are apprehensive. They believe that something should be done, but not for another 5 years or so and not anything that would actually change anything or cost anything or actually do anything after all. Sen. Joe Lieberman says that he’s in favor of Medicare expansion, lowering the retirement age—a suggestion bouncing around Washington since Gov. Howard Dean’s proposal on the campaign trail in 2004. As Republicans continue to stonewall and talk about those imaginary “death panels” and communism and socialism and the state taking away your guns and wanting to kill grandma, the two Republicans signal that all of those bipartisan discussions were for nothing since they won’t break ranks. Sen. Lieberman now opposes Medicare expansion. Now Reid and Pres. Obama have a bill in which they are forced to compromise with their own party—or more specifically, the four holdouts in Nebraska, Louisiana, and Connecticut. The compromise brokered this weekend brought back the original complaints in the Baucus bill and seems even more compromised than Liberals feared and many are now talking about rejecting the current compromise bill.
Did I get it all?
There are several storylines in this mess that are worth noting, especially the basic political eventuality of many of the issues within it, but I’ll hold to this one thing: what the self-described moderates have managed to create is a bill that changes very little.
I’ve blogged before about the problems with moderates (including my first one on the myth of the political center, this one on the myth of the U.S. as "center-right," this one on the scandal of centrism, and this rant), but mostly that in their practical application as a subgroup (and not “liberal” or “conservative”, but as a third option) they have a truly and classically conservative impact on the discussion by minimizing the change to the status quo. Where conservatives act to maintain the status quo (or revert back to a previous status quo), the moderates serve to avoid significant alterations to the status quo in either direction. In many ways, this is a much deeper form of conservatism because it avoids transformative change, while conservatives are willing to transform the culture to better embody an idyllic past.
Chris Hayes of The Nation recently pointed out that the healthcare bill is not a transformation of a bad system into a better system, but the patching up of a bad system. I’ll bite at the obvious analogy. It’s like treating cancer with orange juice or a broken leg with a Band-aid: yes, it is helpful, but doesn’t combat the underlying problem. It’s the medical equivalent of treating the symptoms without attacking the presenting illness.
In some ways, the most masochistic part of the president’s demand for bipartisan support is that, in doing so, he gets no true transformation. To transform the system, the president would be better served reaching out to Conservatives, not Moderates, as they would be more willing to see dramatic change to the system. This may seem counterintuitive, especially in light of the two Republican Senators from Maine (Collins and Snow) who, in their willingness to even have a conversation, were treated as a revelation. Moderates, however, look to minimize the impact and drive unyieldingly after compromise, when better solutions may be negotiated without compromise—or perhaps come through compromise, not in compromise.
I’m not suggesting that the President miscalculated anything or that what the current bills offer isn’t significant change. They are. But it isn’t transformation. It isn’t a radical change in the behavior of Americans toward their healthcare system. Some of the symptoms will look better: fewer medical bankruptcies, expansion of care opportunities, and perhaps more standard expectations of care. But the presenting illness will remain unchanged: it protects the profit-making of insurance companies, corporate hospitals, and entrepreneurial physicians while limiting the recourse of those citizens seeking medical treatment, which means that today corporate CEOs get to decide whether Granny lives and dies (to use Sen. Chuck Grassley’s obsession with Grandmothers).
Perhaps before the story ends on healthcare reform, the leadership will be able to tell the difference between Re-Form and touching up.
