Health Care Reform Redux

Health Care Reform Redux


Now that the House has left for summer recess, with the Senate leaving in a week, it’s a perfect time to look back and see what may have gone wrong in the Democrats’ plan to pass a major health care reform package before this week had passed. Most people tend to focus on the policy and the intrigue of ‘the fight’, but I think the failure to pass this bill is more a tactical one rather than mistaken policy or lack of potential votes.

Polling on the issue has been fairly  consistent. A majority do want health care reform this year, but while a majority is willing to pay more in taxes for better coverage, they care more about lowering costs than expanding coverage. A large majority support a public option that competes with private insurance, but an even larger majority are actually satisfied with their current coverage. This creates a situation where people are wary that government coverage may lead to rationing and will lose the relatively free choice they currently enjoy in their health care options now.

Much of the debate has circled around how to try and pay for this health care reform, so it doesn’t lead to more debt. I suggested one way to help pay for some of it, but I am not aware of the idea of taxing the consumption of unhealthy things as a source of funding being discussed as an option (although polling shows the public supports the idea). The idea of taxing the wealthy is still popular and will probably be included in the final bill to pay for part of it. A big wrench was tossed in the gears when the CBO announced that the cost savings touted by Democratic leaders really didn’t exist.

Perhaps as much attention has been given to a coalition of conservative and moderate (or centrist if you prefer) democrats who hold the swing votes to push this piece of legislation over the hump into passage. They’ve been leveraging this situation to push for modifications that lowered costs and squeezed more savings from the system itself before adding taxes on the wealthy or taxing more high cost benefits. The latter idea has hit a brick wall, since some labor unions have extremely good benefit packages that they have negotiated for over the years that would fall into the category of taxable benefits in some of the proposals.

The tipping point for this legislation stands here, at the junction between the more liberal Democratic Party leadership, the so called Blue Dog Democrats and the independent and moderate Republican constituents they need to get reelected. If I had to point out one thing that has had the most detrimental effect on the march towards passage, it would be the misplaced attempted strong-arm tactics against these Democratic swing votes.

When confronted with a powerful enemy, do not fight them head on but try to find their weakest spot to initiate their collapse. This is the weak overcoming the strong.

-Sun Tzu, from The Thirty-Six Strategems

An illustrative example of this fell into our lap yesterday, with moderate Democrat Ben Nelson, of Nebraska (where I live), lambasting ads leveled at him by Howard Dean’s Democracy for America (DFA). I was pretty surprised at how poorly executed the ads are, but the same tired attacks are being leveled at Nelson, that are being leveled against other swing votes across the country, are what make the ads so ridiculous.

We begin with the perennial attack you can level at any politician regarding who donates to their campaigns. Pretending that you know that he’s doing what he’s doing because of who his donors are, rather than the distinct possibility that he’s doing it because many of his constituents (including myself) asking him to slow down passage of the bill, look for more cost savings and make sure we don’t rush this, is plain idiocy. Nobody can read his mind, and I’ve yet to see any evidence that the guy is any more corrupt than any other politician. I would be pushing for many of the same modifications if I was in the senate, and I (unfortunately) don’t get millions of dollars given to me each year by anyone.

Then there is the time pressure argument, that we need to pass this legislation now. I can’t disagree with this sentiment more. If anything we should slow down further still, with more and more coming out as to mistaken estimates of cost savings and details of proposals being made more clear. There is no artificial timetable you can set on something like this, it needs to take however long it takes to be reviewed in great detail.

Regardless of what you believe, this sort of push only works when you have a majority of the public with you. It would work if he was in a weak position, but he’s not. This is Sun Tzu 101 stuff here… you don’t mount a full frontal attack on an enemy in a fortified position unless you have vastly superior forces. Like it or not, the Blue Dogs have the high ground right now.

The groups that are pushing for this with these tactics need to look in the mirror to lay blame when they look back and wonder why they weren’t able to get some of the things they wanted when this finally moves to passage. A public plan pegged on Medicare, with that panel slowing the rate of cost growth, would have saved us an amazing amount of money over the years, and I think the Blue Dogs and Moderates would have been convinced to support that with more work on cost savings and less political pressure. The pressure from liberal groups force them to fight back very publicly, so they don’t look like they are towing the liberal line to the independent and moderate republican supporters they need to get reelected.

Sun Tzu would have advised these groups to use the same tactic that PHARMA used once they saw that a health care bill of some kind was going to pass whether they wanted it to or not. The choice was to go in early, get a seat at the table and get a better deal by offering concessions from the start, or fight a losing battle later on and get stuck with a much worse deal. These groups demonizing Blue Dogs and moderates are doing precisely opposite what they should have done. They should have realized the situation early and negotiated a way for them to show their constituents that they fought for cost savings, like the Medicare panel, which instead took months of fighting to accomplish.

Sun Tzu would have told these groups that they should ‘remove the firewood from under the pot’. Instead of fighting the Blue Dogs head on, they could have weakened their resistance by working with them from the start, rather than turning a soft ally into a potential enemy with these tactics.

Previous articleOne less thing to fight about
Next articlePLO PR
  • http://sidewaysmencken.blogspot michael reynolds

    Once the GOP lost any real power there were only two plays for an ambitious Dem: Team Player, or Blue Dog.

    Team Players would get the better treatment, but Blue Dogs would wield the power. Surprisingly, many politicians enjoy wielding power.

    But I suspect this is all a dance. If the Blue Dogs actually defeated health reform they’d lose power. They would have hurt their own president and party severely, still have no love from the GOP, and find themselves marginalized, pushed out of chairmanships, facing harassment by primary, and isolated.

    On the other hand, if they scream and yell and draw attention themselves, but ultimately back a compromise (ever so reluctantly) they retain their positions in the party and remain on track to leadership roles. And they can point to the improvements they made and tout their courage in standing up to Obama.

    They want power, they want to be important, they want to be all mavericky for their hillbilly constituencies. Once that’s accomplished they’ll vote with their party. Think of them as Democratic Specters if you will.

  • Jim S

    It’s simple, Michael. The plan is simply to kill health care reform while passing some kind of bill that can be called reform without really doing anything for most people who really need health care.

    Make private plans “available” to everyone. Don’t mention that the insurance companies will still jack up rates so that it’s really not available. Hide as best as you can that the insurance companies will continue to practice recission. Make certain that whatever bill you pass will funnel any government funds to the insurance companies. Do nothing about people who have insurance still being driven into bankruptcy by medical bills. The list of things that will be mentioned but not much improved is long.

  • http://sidewaysmencken.blogspot michael reynolds

    Jim S:

    Yeah, I think that’s the idea. I’m not so sure they’ll manage it, though. Don’t forget that Obama hasn’t really been deployed full force yet. He has not said, “Here’s the bill, it’s what we need, it’s what I want, and we’re going to do it.” We’re still in the sausage making phase, not in the sausage selling phase.

  • Solomon Kleinsmith

    Please DO read the sarcasm into this next statement…

    Yeah… because liberal Democratic ‘Team Players’ don’t do this dance you refer to.

    All politicians do this dance. Pointing this out about the Blue Dogs means nothing, and pretending you know WHY they are doing any particular thing is just ridiculous. As I said above, I largely agree with the provisions they have gotten into the legislation so far (not for them taking out the public option that is pegged to Medicare though… still hoping that makes it into the final bill) and I haven’t gotten any money from anyone to hold that belief and throw my support behind Senator Nelson’s effort to slow the process down, cut costs and whatnot.

    And to Jim S… you don’t get to define what is meant by health care reform. Some people think it should be totally single payer, others think it should be just insurance reform with more subsidies and mandates. In between those are a whole range of possible reforms and if you really don’t think that the current package will pass “without really doing anything for most people who really need health care” Then I think you should go out there and read what the bill currently looks like. There are plenty of reforms in there, they may not be enough for you, but to say they aren’t much of anything is absurd.

  • http://sidewaysmencken.blogspot michael reynolds


    Obviously your ear for sarcasm isn’t as sharp as you think. When I said the Dems had a choice between being team players or Blue Dogs I did not intend “team player” to be read as “good guys.” They are simply two paths. That’s why I said there were two “plays” and pointed out that each yielded benefits.

    So it’s not a slam on Blue Dogs or an endorsement of team players. Generally speaking politicians (and humans in general) are motivated by a desire for wealth, for significance, for power in varying degrees. So yes, I think I do know the “why.” That may mark me as cynical, but I don’t think that’s where you were going in your odd attack on me.

    Maybe you know a lot of people motivated by altruism, I don’t. And I’m straining to come up with a single politician so-motivated. Maybe Paul Wellstone? I don’t know. The names aren’t coming easy.

  • Solomon Kleinsmith

    Sorry, I misread your comment there.

    Although any assumed stance is just as flimsy as any other assumed stance on their part. You have no idea why they do it. Even if you assume selfishness you cannot know whether they’re doing it for the donors, or the moderate and independent voters they need to get reelected. Picking the donors is just a knee jerk cheap shot.

    I have met a ton of people motivated by altruism… most of the people I know in politics actually, but sadly the higher you go up the food chain the lower the ratio gets. Regardless, assuming I know people’s motivations for any particular act would be silly. A pattern of behavior can be seen that would heavily suggest something along the lines of what you think overall, but as to a particular act, you can never know.

  • http://sidewaysmencken.blogspot michael reynolds

    This is Sun Tzu 101 stuff here… you don’t mount a full frontal attack on an enemy in a fortified position unless you have vastly superior forces.

    Taking nothing away from Sun Tzu who was a brilliant writer (if he existed, but that’s another story), there are any number of reasons to launch an attack on a well-entrenched enemy despite not having the forces to carry it.

    First, it might just work. See battle of Chattanooga. The entrenched enemy may not have the position they think they do.

    Second, a frontal assault can be a useful if your goal is attrition of a numerically inferior enemy, even if you can’t carry the day. See Grant’s end game at Petersburg.

    Third the obvious: to pin an opposing force.

    Finally, sometimes you just want to show the crazy. Not necessarily even to the party you’re fighting, but to another potential foe.

  • mw

    Nice summary of the debate Sol. I’ve bookmarked it for reference.

    Interesting theory but at variance with much of the punditry on the left, who seem to put the blame on poor salesmanship, rather than lack of trying.

    Kevin Drumm
    Steve Benen

  • Solomon Kleinsmith

    MR- None of your examples fit this situation…

    1- This entrenched enemy does have the swing votes. This isn’t perception here, this is fact.

    2- In this case the numbers you refer to would equate to support for a particular action, which also doesn’t fit because of the conservatives and independents in Nebraska Nelson needs to get reelected aren’t changing their minds on the issue because of these silly ads.

    3- And these actions are pinning anyone.

    All they’re doing is pissing off someone who doesn’t have to be an enemy and forcing them to act in a way that is specifically against what these people want them to do. Its just faulty tactics.

    And I don’t see how the ‘show the crazy’ fits here either. The ads are crazy, they’re just misplaced.

  • http://sidewaysmencken.blogspot michael reynolds


    I was just making military history chit chat. Your comment started me thinking about that question because it’s a point I’ve cited in other contexts. I was re-examining my own presuppositions out loud. Admittedly going off topic. Sorry.

  • Solomon Kleinsmith

    Oh, thats fine :)

    I’m not so good on military strategy, but Sun Tzu is useful in just about everything :)

    I’ve been reading the book ‘Hide a Dagger Behind a Smile’ by Kaihan Krippendorf, so this has been on my mind lately. It puts political strategy into context really well, even though it was written for business strategy.

  • Nick Benjamin

    The Blue Dogs are not on the defensive. The bill was written with the objections they’d raise in mind. So most of the changes they demand contradict with their principles.

    For example they are supposed to be fiscal Conservatives, and oppose wasting government money. But they also want the public option to pay more than MediCare does. Using MediCare rates means paying a lot less than everyone else because MediCare is run by cheapskates who figure exactly what each procedure would cost in a well-run health system, and then refuse to pay a penny more.

    So while in theory if all of them agreed on a plan they could force it down everyone’s throat, it’s highly unlikely that all of them will oppose this plan. Given that there are 204 non-Blue Dogs in the House, Pelosi only needs 14 Blue Dogs to vote with her. That’s 27% of the Blue Dog caucus.

    They’ve got quite a bit more clout in the Senate. Ben Nelson alone could force a filibuster. The trouble with individual Senators doing that is that they know they’d face a primary challenge. They’d risk being the next Lieberman.

    BTW, they don’t really care about offending Nelson. He was never gonna vote to pass it. He’s agreed not to filibuster it already. By “showing the crazy” in NE they’re trying to convince Landriex et al. to join Nelson as non-Filibusterers.

  • Jim S


    I do not expect the bill in its current form to pass. I also expect that it will get worse, not better, as time goes by and those who do not want to lose their profits from the existing system have more time to do it more harm. That was the basis of my comment, not the bill as it currently exists.

  • Paul

    I am a Blue Dog Democrat who favors health care reform, but don’t try to rush it ! After all it’s been in slow motion for years. At least let the elected Congressmen and Senators get the gist of it in order to make an intelligent decision on how to vote ! President Obama made a mistake in trying to ramrod it through in quick time.

  • Solomon Kleinsmith


    I didn’t say the Blue Dogs are on the defensive, they clearly have the upper hand. This is why I think its foolish for these groups to attack them so publicly.

    As for the rest of your comment… this post isn’t about the details of what some of the Blue Dogs have tried to insert into the bill. I also think the pricing of the public plan should be pegged at Medicare levels and I think it would have had a better chance of making it into the final bill had these groups not went after the Blue Dogs like they have. If we’re lucky they’ll be able to get it back in there when the Senate and House bills are brought together.

    BTW, they don’t really care about offending Nelson. He was never gonna vote to pass it. He’s agreed not to filibuster it already. By “showing the crazy” in NE they’re trying to convince Landriex et al. to join Nelson as non-Filibusterers.

    I’m not sure if that’s true or not, but it appears that way… and my point is that its STUPID. You don’t know how he would eventually vote. He’s one of the most conservative Dems, but he still votes with them the vast majority of the time. If they are trying to convince some other Senator by attacking Nelson, thats an even worse strategy. If you attack one that is in a state where it might actually hurt them, that has some logic to it, but if you attack the whole group then you again give them a reason to ‘circle the wagons’ and fight back… which is what it looks like they’re doing.

    Yeah, really smart.

  • Ann

    Although the health reform may be great news for those who could never receive health coverage, I’m wondering how it will affect the economy in its current state.

    Not sure how Obama will manage…

  • JoelS

    Just wanted to let everyone know that Bill Moyers is covering a cool documentary on his PBS show tonight called, “Money Driven Medicine”. It should be really interesting!