Sunday, November 01, 2009

A Slippery Slope To Irrelevance

Health care. New cars. What’s the difference? Not much.

You’re looking to buy a new vehicle, perhaps a small SUV. Perhaps one built by an American manufacturer. You drive to a Ford dealership and ask about ordering a new Edge, whose MSRP (base model, or, before sexual inhibitions set in, “stripped”) is $26,920. Wisely, you say that you do not want to pay more than $25,190, and want it with the cargo accessory package, list price $290.

The salesman says that he (still a male-dominated profession) can give the vehicle to you for $25,975, but without the cargo accessory package- although he’ll throw in the all weather floor mats, listed at $75. After all, he urges, you’re still getting the car for (almost)$1000 off the sticker price, and is there really much difference from your original offer? You agree, at which point the salesman says it’s a “go”- as long as his manager agrees.

You know the rest. Returning, your salesman says the manager won’t approve the sale for under $26,200- but you still can get the floor mats. You recognize that you’re not getting exactly what you walked into the dealership expecting to get and are becoming concerned.

When you hesitate to agree to the deal, the salesman gently coaxes you. You came in for a new black Ford Edge, he notes, and here you’ll be getting one. And for several hundred dollars less than the car is worth. And wasn’t the point that you would leave the dealership as the owner of a new vehicle? Surely, you won’t walk away with nothing, all because of $225! Think of all that is at stake- the advantage of owning a new Ford for many years, something far superior to the heap you’re now driving.

There are credits, rebates, loan conditions, and other factors. So it’s an imperfect analogy. But in its broad outlines, this is what we progressives/liberals are being asked to accept.

We came in to the process hoping for a single payer system (unrealistic, but did you really expect to get the Edge at your original asking price?) However, instead of a single payer, we would get a government option in the health care exchange, even if it would cover less than 10% of the population. Then salesman Rahm Emanuel tells us this “robust” public option isn’t popular; the manager conservative Democrats just won’t accept it. So we’ll just have to accept an opt-in. It’s still a public option, we’re reminded- and if we can’t get exactly what we wanted, are we going to throw away the entire transaction effort merely because we can’t get everything? Won’t we still be better off than with our old vehicle current health care system?

But wait! Maybe this auto price public option isn’t available, either. Michael O’Brien of The Hill reports (10/30/09)

The Senate health bill is drifting toward ending up with an "opt-in" provision versus an "opt-out," one Democratic senator said Friday.

Sen. Sheldon Whitehouse (D-R.I.) predicted that healthcare reform in the upper chamber would shift from its current construction, which allows states to opt out of a public option, to a version that forces states to opt into such a plan.

"I think it's falling into an opt-in, versus opt-out," Whitehouse said during an appearance on MSNBC. "You have a public option, but it's up to a state to take an affirmative act to take advantage of it."

Whitehouse suggested the opt-in as a potential compromise on the public option to win enough Democratic votes in the Senate, where Sen. Joe Lieberman (I-Conn.) has said he will vote against a bill containing a public option, and several other centrist Democrats have been reluctant to support the current proposal.

Forgetting the first rule of purchasing a car, you encountered a problem because you fell in love with the Ford Edge before even entering the dealership. Liberal Democrats, justifiably, fell in love with the idea of health care reform. Legitimately, we fell in love with the idea of a health care reform bill. But, dangerously, we fell in love also with the idea of enacting a health care reform bill in the first year of the Obama presidency.

Now, if Whitehouse is typical, liberals/progressives are trapped in a web of their own making. Even someone as insightful as economist and New York Times columnist Paul Krugman appears to have defined health care reform down as a major admirer his, Paul Somerby, noted the other day:

But hasn’t this also become the moment for defining health reform down? We refer to something that seems to have changed as Krugman starts his column:

KRUGMAN (10/30/09): O.K., folks, this is it. It's the defining moment for health care reform.

Past efforts to give Americans what citizens of every other advanced nation already have—guaranteed access to essential care—have ended not with a bang, but with a whimper, usually dying in committee without ever making it to a vote.

But this time, broadly similar health-care bills have made it through multiple committees in both houses of Congress. And on Thursday, Nancy Pelosi, the speaker of the House, unveiled the legislation that she will send to the House floor, where it will almost surely pass. It's not a perfect bill, by a long shot, but it's a much stronger bill than almost anyone expected to emerge even a few weeks ago. And it would lead to near-universal coverage.

Let’s assume that the House bill would in fact “lead to near-universal coverage.” In the past, didn’t we also speak about giving people “access to affordable care?” In this column, “affordable” has largely made way for “essential” (see highlighted statement above)—except when the House bill “includes more generous subsidies than expected, making it easier for lower-income families to afford coverage.”

Alas! Presumably, those generous subsidies are necessary because the bill will do next to nothing about the astonishing cost of insurance premiums. And guess what? Employers and those persons who don’t qualify for subsidies will still have to grapple with those daunting costs. For the vast majority of consumers, Krugman’s column says little or nothing about the discarded matter of affordable costs.

And they have given no indication of seriously contemplating walking away from a bill which is developing into something radically different (and that’s not even considering the Administration’s deal with Pharma) than what was expected, let alone hoped for. (Even Somerby, counter-intuitively, still supports the bill/bills.)

President Obama has his own motive(s). But others of the left have been left in the lurch, stuck with a mere shell of health care reform. Apparently, they will vote for the eventual bill, whether because it’s better than nothing, a “foot in the door” with the possibility of leading to something much better, a chance to be part of “history in the making,” or simple reluctance to allow Obama to suffer his Waterloo.

For the left, this has been a process of compromising, then compromising some more, and then compromising some more until....?

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