I've been as upset as most of my other progressive friends about the changes that have been imposed on the health care reform bill in the senate, and over how the most important measures seem to keep getting stripped out in order to please "moderates", insurance & pharmaceutical industry shills, abortion opponents and, of course, Joe "Look-At-Me-I'm-A-Pompous-Little-Man-Wit
1) The Civil Rights Act of 1957:
- When Lyndon Johnson (as senate majority leader) passed the Civil Rights Act of 1957, he faced all the same shamelessly hypocritical opposition that health care reform faces today, including hysterical claims that civil rights represented a takeover of states rights by the federal government, etc. This was the legislation that Strom "I Love Black Women" Thurmond filibustered for 24 hours straight, setting a record that sill stands. LBJ had to make so many compromises to win the support of southern dixiecrats, including stripping out anti-lynching provisions, that the final bill was almost completely ineffective. In fact, fewer african americans were registered to vote in 1960 than had been registered in 1956. But, the logjam had been broken, and "It did however open the door to later legislation that was effective in securing voting rights as well as ending legal segregation and providing housing rights. In particular, it established both the Commission on Civil Rights and the office of Assistant Attorney General for Civil Rights. Subsequently, on December 9, 1957, the Civil Rights Division was established within the Justice Department by order of Attorney General William P. Rogers, giving the Assistant Attorney General for Civil Rights a distinct division to command." (wikipedia). By passing an imperfect bill, LBJ established the framework for later improvements and expansions that provided true civil rights.
2) Social Security:
- When Franklin Roosevelt passed Social Security, it had to be watered down so severely in order for him to get it passed that at first it didn't even cover african-americans. Republicans screamed that social security was socialism and that it would cause the loss of millions of jobs. In the version that was finally passed, women and minorities were excluded from unemployment insurance and old age pensions. Jobs that employed mostly women and minorities were also excluded, including workers in agricultural labor, domestic service, government employees, and many teachers, nurses, hospital employees, librarians, and social workers. "Nearly two-thirds of all African Americans in the labor force, 70 to 80% in some areas in the South, and just over half of all women employed were not [initially] covered by Social Security" (Wikipedia). But, as Paul Krugman wrote in yesterday's New York Times "Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans."
3) The Emancipation Proclamation:
- Finally, when Abraham Lincoln enacted the Emancipation Proclamation, it was also a very circumscribed piece of legislation that disappointed many abolitionists of the day. Josh Marshall discussed this yesterday in Talking Points Memo (www.tpm.com) and is worth quoting at length:
"Like President Obama, President Lincoln was seen by many of his supporters as something of a disappointment once in office. This was largely due to the number and types of compromises he needed to make, most notably with the institution of slavery. In his first inaugural address, Lincoln came out and said that he was not bound and determined to end slavery, that the President does not in any case have the power to unilaterally change the law of the land, and that his first priority was the preservation of the Union, even if the price of that preservation was to accept the continuation of slavery. During the war, when pressed by a group of ministers about why he had not more forcefully worked to end slavery, he reiterated that his overriding priority was to preserve the Union, and added that there were four slave states which had stayed loyal and which were currently contributing 50,000 soldiers to the war effort; these, he pointed out, were states and soldiers which he could not afford to lose in a dispute over slavery.
"When Lincoln finally issed the Emancipation Proclamation, its scope was remarkably circumscribed: it did not call for the emancipation of slaves in loyal states (for this, Lincoln would need the participation of Congress, and in any event, as described above, he did not seek such an act for fear of worsening the Union's position in the war); it did not call for the emancipation of slaves in those areas under military control by the Union; it limited emancipation to those areas which would be brought under military control subsequent to January 1, 1863, which was about 3 months after the Proclamation itself was issued. As one historian noted, this meant the Proclamation carefully excused all of the slaves which the United States actually had any authority over at the time of issuance! As another historian noted, the Proclamation was in essence the offer of a bribe: any state then in rebellion which would lay down its arms and return to the Union would not be compelled to give up its slaves; any state conquered by force of arms after January 1, 1863 would be so compelled.
"Needless to say, the Proclamation was seen by anti-slavery partisans of the time as wholly unacceptable, a compromise too far, and yet more evidence of the unfitness of their elected standard-bearer in the White House. And yet, as Foote points out, Lincoln is today hailed as the preserver of the Union, which he was, but as The Great Emancipator, which he was not. This is because the Proclamation, while useless in a practical sense at the moment of issuance, was the crucial starting point for the abolition of slavery, a project which was completed just a few years later." (http://www.talkingpointsmemo.com/archi
Final thoughts:
So - my view, and the view of many people who I respect, is that many, if not all, social insurance programs tend to start out highly compromised, imperfect and incomplete. But, one the precedent has been set, and a framework is in place, then the programs can get better and more comprehensive with subsequent revisions and expansions.
- Obama knows this, he takes a long-term view to these issues, which is why he can maintain such calm and equanimity throughout the process.
- The republicans know this, and they know that social programs tend to be quite popular once they are enacted (you don't see many of the older tea-baggers volunteering to give up medicare, do you?), so they are fighting tooth and nail to deny Obama and the democrats a victory.
- The insurance and pharmaceutical companies know this too - even if there is a short term benefit to them, the longer term trend will be to reduce costs and improve coverage, which will ultimately force change to their industries.
By passing the bill, universal coverage will be established as a goal and the process of cost containment will begin. The internet and 24 hour news coverage allow us unprecedented views of the nitty-gritty of the legislative sausage-making process, and it's ugly up close, but if health reform passes, and I pray with every cell in my resolutely atheist heart that it does, Obama will be on track to be the greatest president since FDR.
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1) The Civil Rights Act of 1957:
- When Lyndon Johnson (as senate majority leader) passed the Civil Rights Act of 1957, he faced all the same shamelessly hypocritical opposition that health care reform faces today, including hysterical claims that civil rights represented a takeover of states rights by the federal government, etc. This was the legislation that Strom "I Love Black Women" Thurmond filibustered for 24 hours straight, setting a record that sill stands. LBJ had to make so many compromises to win the support of southern dixiecrats, including stripping out anti-lynching provisions, that the final bill was almost completely ineffective. In fact, fewer african americans were registered to vote in 1960 than had been registered in 1956. But, the logjam had been broken, and "It did however open the door to later legislation that was effective in securing voting rights as well as ending legal segregation and providing housing rights. In particular, it established both the Commission on Civil Rights and the office of Assistant Attorney General for Civil Rights. Subsequently, on December 9, 1957, the Civil Rights Division was established within the Justice Department by order of Attorney General William P. Rogers, giving the Assistant Attorney General for Civil Rights a distinct division to command." (wikipedia). By passing an imperfect bill, LBJ established the framework for later improvements and expansions that provided true civil rights.
2) Social Security:
- When Franklin Roosevelt passed Social Security, it had to be watered down so severely in order for him to get it passed that at first it didn't even cover african-americans. Republicans screamed that social security was socialism and that it would cause the loss of millions of jobs. In the version that was finally passed, women and minorities were excluded from unemployment insurance and old age pensions. Jobs that employed mostly women and minorities were also excluded, including workers in agricultural labor, domestic service, government employees, and many teachers, nurses, hospital employees, librarians, and social workers. "Nearly two-thirds of all African Americans in the labor force, 70 to 80% in some areas in the South, and just over half of all women employed were not [initially] covered by Social Security" (Wikipedia). But, as Paul Krugman wrote in yesterday's New York Times "Social Security originally had huge gaps in coverage — and a majority of African-Americans, in particular, fell through those gaps. But it was improved over time, and it’s now the bedrock of retirement stability for the vast majority of Americans."
3) The Emancipation Proclamation:
- Finally, when Abraham Lincoln enacted the Emancipation Proclamation, it was also a very circumscribed piece of legislation that disappointed many abolitionists of the day. Josh Marshall discussed this yesterday in Talking Points Memo (www.tpm.com) and is worth quoting at length:
"Like President Obama, President Lincoln was seen by many of his supporters as something of a disappointment once in office. This was largely due to the number and types of compromises he needed to make, most notably with the institution of slavery. In his first inaugural address, Lincoln came out and said that he was not bound and determined to end slavery, that the President does not in any case have the power to unilaterally change the law of the land, and that his first priority was the preservation of the Union, even if the price of that preservation was to accept the continuation of slavery. During the war, when pressed by a group of ministers about why he had not more forcefully worked to end slavery, he reiterated that his overriding priority was to preserve the Union, and added that there were four slave states which had stayed loyal and which were currently contributing 50,000 soldiers to the war effort; these, he pointed out, were states and soldiers which he could not afford to lose in a dispute over slavery.
"When Lincoln finally issed the Emancipation Proclamation, its scope was remarkably circumscribed: it did not call for the emancipation of slaves in loyal states (for this, Lincoln would need the participation of Congress, and in any event, as described above, he did not seek such an act for fear of worsening the Union's position in the war); it did not call for the emancipation of slaves in those areas under military control by the Union; it limited emancipation to those areas which would be brought under military control subsequent to January 1, 1863, which was about 3 months after the Proclamation itself was issued. As one historian noted, this meant the Proclamation carefully excused all of the slaves which the United States actually had any authority over at the time of issuance! As another historian noted, the Proclamation was in essence the offer of a bribe: any state then in rebellion which would lay down its arms and return to the Union would not be compelled to give up its slaves; any state conquered by force of arms after January 1, 1863 would be so compelled.
"Needless to say, the Proclamation was seen by anti-slavery partisans of the time as wholly unacceptable, a compromise too far, and yet more evidence of the unfitness of their elected standard-bearer in the White House. And yet, as Foote points out, Lincoln is today hailed as the preserver of the Union, which he was, but as The Great Emancipator, which he was not. This is because the Proclamation, while useless in a practical sense at the moment of issuance, was the crucial starting point for the abolition of slavery, a project which was completed just a few years later." (http://www.talkingpointsmemo.com/archi
Final thoughts:
So - my view, and the view of many people who I respect, is that many, if not all, social insurance programs tend to start out highly compromised, imperfect and incomplete. But, one the precedent has been set, and a framework is in place, then the programs can get better and more comprehensive with subsequent revisions and expansions.
- Obama knows this, he takes a long-term view to these issues, which is why he can maintain such calm and equanimity throughout the process.
- The republicans know this, and they know that social programs tend to be quite popular once they are enacted (you don't see many of the older tea-baggers volunteering to give up medicare, do you?), so they are fighting tooth and nail to deny Obama and the democrats a victory.
- The insurance and pharmaceutical companies know this too - even if there is a short term benefit to them, the longer term trend will be to reduce costs and improve coverage, which will ultimately force change to their industries.
By passing the bill, universal coverage will be established as a goal and the process of cost containment will begin. The internet and 24 hour news coverage allow us unprecedented views of the nitty-gritty of the legislative sausage-making process, and it's ugly up close, but if health reform passes, and I pray with every cell in my resolutely atheist heart that it does, Obama will be on track to be the greatest president since FDR.
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If you want to read an interesting account of a similarly smart man, read Gore Vidal's novel 'Lincoln'.
Another interesting read is also this account of how LBJ worked behind the scenes to accomplish Medicare:
http://content.nejm.org/cgi/content/ful
I'm going to look over the current version of HR 3590 and see what's in it and what's not, and post a summary.
The introduction of universal health care in Canada was similarly staged, as it were, but more in a geographical than a legislative way. (One province did it, the world didn't come to an end, and then the guy who got that province started with it became a federal politician and helped get it going on a national level.)
(For the record, California passed single-payer twice -- and vetoed by the governor twice.)
http://www.healthcareforall.org/index.p
He's good for a Republican but still a Republican.
Arnold will take some work, what with being still alive and all.
Social security, by its very nature, was an evolutionary pension plan in which the first benefits were paid five years after its enactment. It was wonderful and it had the time to change, lacking the urgency to our economy and the general welfare of universal healthcare, as it exists in nearly every civilized country but ours.
Speaking of healthcare, one could argue that Medicare was more progressive when first enacted than it is now. When it was passed by LBJ in 65 there was only Medicare Parts A and B -- hospital and outpatient medical insurance. Then in 97 Part C was passed, the so-called "Medicare Advantage" plan, which opened it up to private insurance. Remember when Newt Gingrich said at the time that Medicare should "wither on the vine" and argued for its complete privatization? Well, IMO this was their way of trying to get there through the back door. Why is it that the Republicans are demagoguing the Medicare savings in this bill so hysterically? Because they know it may put the brakes on an expansion of private insurance for Medicare. Then there's Part D, passed again in 2006 by Republicans, which is nothing but a huge windfall for Big Pharma.
One of the few good things this bill does is begin to reverse the privatization of Medicare -- perhaps.
My own view is that social legislation works best when its purpose is clear and its foundation solid, e.g. Medicare and the Civil Rights Act 0f 1964, and also that its necessary implementation is an important consideration regarding timelines that extend for generations (Social Security). We can't wait that long for universal healthcare, and we've got a lot of it wrong (no cost containment, no competition, and a complete capitulation to the insurance lobby). The only bright light is the idea Traitor Joe killed: expanding Medicare to 50-somethings, then 40-somethings, and so on. That's what Democrats need to concentrate on. But I don't think history shows that bad, or flawed social legislation will necessarily evolve into something better. Not so with Medicare, unless one has the view that Big Pharma and private insurers should keep their sticky little fingers in it.
But the private insurance companies will be stronger and more influential than ever, thanks to President Obama. His chances at greatness dwindle with each successive corporate sellout. Maybe, as some commentators (Frank Rich, NYT) have argued, he is a corporatist at heart.
So insurance companies cannot drop people with pre-existing conditions. Well, big deal. There's nothing to stop them from jacking up the premiums, deductibles and co-pays, for people they consider "too expensive." If you can't afford the policy, what's the use of a law that says it's got to be made available to you? It's like a law that says I can live in the Hamptons if I want...realistically, I have to have the money to buy a place there. Anyone can be elected president in theory too, according to the Constitution. Getting there without tons of money and Influential Friends is the tricky part.
Medicare coverage has been eroded over at least the past fifteen years. If this bill reverses any of that, I will be very surprised. It's more likely to speed up the degradation of coverage and the need for "Medicare supplemental insurance" that's reared its head recently.
I think the gamble that has been made is to offer the insurance companies a short-term bribe to take something that is actually not necessarily in their long-term interest. That's the cold realism that Obama has that pisses off so many of his supporters. But, as I said before, I could very well be wrong.