Sunday, July 26, 2009

Relocation

This blog hasn't been updated a while, due to the fact that I've been blogging elsewhere and likely will be for the foreseeable future. However, this blog will stay up, both as an archive and for personal blogging.

Future political/academic blogging will be at The Realignment Project.

Saturday, May 30, 2009

Kennedy's 12-Page Proposal: Why the Devil Is In the Details

Note: This is a cross-post from my group blog The Realignment Project and DailyKos.

So, if you've been following the day-to-day drama over the health care bill - Baucus says he'll fight for public option! Ben Nelson backs off opposition! Schumer tries for some weird single-payer/trigger double play! - then you've probably heard about Senator Kennedy's attempt to push the emerging bill to the lift by getting his HELP Committee's version of the bill out first and pushing Baucus to the left.

Well people have been asking about the details of what this 12 page proposal that's been circulating are.

Well, look no further!

Background:

So for people who haven't maybe been following the back and forth over the health care bill, the basic elements of the legislation being covered are these:

  • Insurance Reforms - guaranteed issue, community rating, and banning pre-existing conditions exclusions have been mentioned here, along with some sort of minimum standards as to coverage and services.
  • Mandates - both individual and employer (so-called "pay or play") mandates have been central elements of the deal, in order to achieve universal coverage, and in the case of employers, additional funding.
  • Health Exchanges - state-level purchasing pools where insurance plans would have to compete for clients, overseen by some kind of board that would set minimum standards, and the like.
  • Sliding Subsidies - probably using some sort of refundable credit, the idea is to construct a subsidy to pay for premiums that "slides" up or down depending on income, to deal with the "affordability" question.
  • A Public Plan - details unknown as to how Medicare like this would be, but some form of public plan available for individual and group purchase has been a central part of the debate.

The Kennedy Memo:

The key purpose of the Kennedy memo (which you can find here) seems to be an effort to shift the terms of the debate, and the eventual legislation left-wards. Not quite in the same way that single-payer advocates are hoping to do, but in a more traditionally moderate liberal fashion, focusing on the expansion of public programs.

Kennedy accomplishes his aims in a number of ways.

Private Insurance Reforms:

  1. Guaranteed Issue and renewal - this is quite clever, because not only does it include the basic concession that insurance firms have made in return for individual mandates, but it also closes a potential loophole by making sure that you couldn't later get dropped.
  1. Banning Pre-Existing Conditions Denial and Underwriting - this is also quite clever, because it tackles both the denial of care, but also the increasing of premiums due to an existing medical conditions, which often creates cost-related uninsurability.
  1. Community Rating - "Premiums charged by health insurers should vary only by family composition, geography, and age, within clear and reasonable limits," a little bit vague here, but it seems to be pointing to allowing some regional variation.
  1. Mandatory % Spent On Care - called rather sneakily "ensuring value in health insurance purchasing," this would require a certain percentage of every premium dollar to go to care as opposed to administration.

Sliding-Scale Subsidy:

Here's the big one, and it's snuck in via a short paragraph. The Baucus bill being drafted assumes some kind of sliding-scale subsidy to help pay for premiums, but a rather limited one. Kennedy's memo calls for "sliding scale premium assistance for individuals and families with income up to four times the federal poverty level to help them purchase quality health insurance policies."

This is crucial, both in the policy and the politics. Policy-wise, this means that the money involved is likely to be substantial, bringing people's medical costs down substantially (which would have beneficial ripple effects on living standards and consumer spending), and ensuring that people lower down on the income scale really can afford the premiums. However, politically, it's very important that a family of 4 making $88,000 a year would be eligible for subsidies. That means that the subsidy provision would be a relatively universal benefit that the middle class would enjoy. This builds a huge potential coalition for this benefit, which is crucial for turning it into the future equivalent of Social Security or Medicare, rather than the future equivalent of AFDC. It also makes the overall bill more of a political winner for politicians - who doesn't want to pass a bill giving millions of middle-class voters unsubstantial checks?

Health Exchange:

Nothing particularly new here, although it's very explicit that "To ensure that fiscal discipline and full accountability are built into this new structure, one health insurance option available to participants will be a publicly sponsored and guaranteed plan." I think the guaranteed is quite important - it means that the public plan in question could not be a spun-off Amtrak like affair, but something that had the financial support of the U.S government, and thus would be as sound as the rock of Gibraltar.

Individual Mandate:

Boilerplate here, although the phrasing "national health reform requires that everyone who can afford to must sign up for coverage," is important, putting emphasis on ensuring affordability front-and-center.

Not Included in the Memo:

Although this was in a separate email, according to Politico, two important key elements of the Kennedy plan should be included in this discussion: "in an e-mail summary that began circulating this week, Kennedy was described as considering a public insurance option that would pay providers slightly more than Medicare rates...He would also expand the Children’s Health Insurance Program to cover individuals up to 26-years old – up from 18."

These two details are crucially important. First, the payment rates - this is important for several reasons. It means that doctors and the AMA will have more of an incentive to back Kennedy's version than Baucus' version; it also means that the resulting public insurance plan would actually be widely accepted and usable, and hence worth purchasing, as opposed to something like Medicaid where it's very hard to find doctors who accept it; it also means that costs should be closer to the Medicare model than the private insurance model. Second, the CHIP expansion - if, as I suspect, this is paired with an expansion of Medicare down to 60 or maybe 55, this is an important step in gradually moving us in the direction of single-payer. People like Medicare a lot, they like CHIP a lot as well, and moving people away from insurance-based-on-employment to insurance-based-on-citizenship is a crucial intermediary step.

So there you have it. Now, Baucus' plan is significantly to the right of this, and Schumer's weird thing is to the right of that. However, by putting this plan out there as the HELP committee's bill and the bill that's on the table, it changes the terms of the debate by establishing a positional bargaining point that's significantly in the direction of more leftward alternatives, which in turn shifts the middle ground away from industry's preferences.


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Tuesday, May 26, 2009

Why the Law Matters: Santa Clara County v. Southern Pacific Railroad


In light of Obama’s recent Supreme Court nomination and the likely fight over the liberal vs. conservative direction of the Supreme Court, I’d like to reflect on how recent and unusual it is that the major political conflicts around the Court have revolved around questions of abortion and the rights of the accused, as well as other so-called “personal freedoms.” Don’t get me wrong, however – I’m not arguing that there has been a recent politicization of an otherwise neutral Court. I find that to be a ridiculous assertion. In a democracy, law and its interpretation is inherently political, an expression of our most deeply-held beliefs about the extent and expression of our rights, the meaning and reality of justice, the nature and scope of the state and the market, our very definition of what freedom, equality, democracy, privacy, independence, speech, mean.

Historically, however, the conflicts over the Court have gone through phases: before the post-1973 struggle over abortion, Court politics largely revolved around questions of civil rights (especially questions around affirmative action and de-segregation) which exploded onto the national consciousness in 1954, but had obviously been brewing for at least ten years before that. However, the longest-lasting political fight over the Court has been the fight over the nature of the state and the economy, and the competing claims of democracy and property rights, that arguably lasted from the end of the Civil War (many of the Civil Rights Cases that emasculated Reconstruction and its 13th, 14th, and 15th Amendments revolved around questions of economic regulation) through to the 1940s.

I’d like to consider this particular political struggle, because I think it illuminates the critical importance of the law and the Supreme Court in shaping the most fundamental political decisions in our country’s history (which raises the question of how democratic our decision-making process really is), and because it shows that the true fight being carried on is not actually a fight over the law (because neither side has even been consistent regarding separation of powers, judicial independence or activism, strict constructionism versus more expansive legal philosophies, etc.), but rather a broader fight over the direction of national policy. In that sense, both sides believe that the court “is where policy is made” in our peculiar system of checks and balances, but not everyone’s honest about it.

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Saturday, May 23, 2009

Like Water Dripping on a Stone: Rethinking the Politics of Single-Payer

In the run-up to the universal health-care bill being debated in Congress, one of the more contentious issues on the political left has been the question of single-payer and its’ inclusion or exclusion from the debate. Recently, we’ve seen single-payer advocates getting themselves arrested to draw media attention, a huge amount of back-and-forth within the progressive blogosphere (of which the links here are just a small sampling), and a good deal of fear about the public option getting watered down or eliminated.

I feel somewhat ambivalent in this debate, in part because I agree with the policy of single-payer advocates, but I find myself turned off by their political style. And I think a lot of it has to do with a particular theory of activism and an ahistorical understanding of how social policy happens that I really disagree with.

Especially as we draw closer to the crucial mark-up and voting phases, and ever closer to passage of the Baucus/Kennedy/Dingell/Obama health care legislation, it’s imperative that the progressive movement think very carefully about what we want to accomplish.

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Thursday, May 21, 2009

Strange Fruits of Victory: A Vision of the Democratic Party in 2040

Note: This is a cross-post from my new group blog, The Realignment Project.

One of the side-effects (collateral damage if you want to be ironic) of the 2008 election, and the broader public reaction against the Bush Administration, has been a massive shift in partisan identification away from the Republican Party and toward the Democratic Party.

One example of this trend is the most recent Pew Poll on partisan identification that shows a shift from a tie of 43% to 43% in 2002 to a 53% Democratic and 36% Republican split. This follows several other polls that suggest a massive decline in Republican identification and a smaller, but still significant increase in Democratic identification.

All of which has caused a bit of speculation over whether the Republican Party will survive as an institution, and what this will mean for the future of American politics. Will the Republican Party collapse, and what will fill its place? Will there be a new second party, and what will it look like? Will the Democratic Party become the lone major party, and how long would their sole dominance last?

For the purposes of a thought experiment, I’d like follow one particular line of speculation in order to tease out some major questions about the current nature and future direction of the Democratic Party.

  • A New Second Party – in this model, the fall of one of the two major political parties results in its place being taken by a new second party that assembles a new coalition, often borrowing from elements of the fallen political party’s coalition and adding new groups in order to forge a new and more durable coalition. The best example of this from American history is the rise of the Republican Party from the wreckage of the Whig Party. The Whig Party’s Northern and Southern coalition, previously formed on the basis of economic policy, was destabilized by the introduction of a new issue – slavery – into the political debate. The new Republican Party brought Northern Whigs, anti-slavery Democrats, Free Soilers, Nativists, and abolitionists into a new anti-slavery coalition. It’s interesting to note, however, that the Republican Party’s economic policy largely followed Whig lines: support for a national banking policy, a protective tariff for industrial goods, internal improvements (public works, usually in the field of transportation infrastructure), and nationalism over regionalism.
  • The Dominant Party Breaks Into Two New Parties – in this model, the fall of one of the two major parties results in the remaining period experiencing a long period of dominance. Ultimately, underlying tensions within the ruling party’s coalition built to the point of fracture, resulting in two new parties. Here, the best example is the emergence of the Whig Party in 1828-1832 out of the National Republicans (who themselves had emerged from the ex-Federalist New England wing of the Democratic-Republican Party). The divisions between the Whigs and Jacksonian Democrats had many causes, including personality conflicts and divisions over separation of powers issues, but chief among them were the expression of economic policy divisions that had persisted for some time, with Whigs following the more Federalist lines of John Quincy Adams and Andrew Gallatin, and Jacksonian Democrats cleaving more towards the Jeffersonian economic philosophy.
  • The Second Party Gets Its Act Together, But Changes Dramatically – in this model, one of the two parties comes close to political oblivion and spends some time in “the wilderness,” before adapting itself to suit a new coalition, new ideological position, and/or geographic or demographic changes. In some ways, this is the most frequent case – one can look to the transformation of the Democratic Party in 1932 into the New Deal Coalition after spending 10 years in the minority, the re-emergence of the Republican Party as the party o anti-communism in the 1950s following nearly 20 years of political isolation, the Cold War Liberal dominance of the Democratic Party in the 1960s, the re-constitution of the Republican Party into the party of the New Right from 1964 to the 1980s, the emergence of New Democrats in the 1980s and 1990s, and so forth. In each case, the party takes on new constituents (urban workers and African Americans in the New Deal coalition, Southern Whites in the Reagan coalition, and so forth) or new issues (anti-Communism in the 1950s, civil rights int he 1960s).
Ultimately, I’m persuaded by polling data that shows a continuing trend of declining Republican identification, which suggests that the failures of the Bush Administration have not merely damaged the reputation of George W. Bush, but have also damaged the long-term reputation of the Republican Party as well. In addition to the partisan damage, I think economic conservatism has been badly damaged by the Bush recessions, and it will take some time before the public is willing to support more pro-market policies. Furthermore, I think that surveys of political ideology – as can be found here and here - suggest that the political environment is likely to shift leftwards for some time to come, making it more difficult to establish a new second party. This evidence is especially persuasive on social issues, suggesting that cultural conservatism may be in for a more long-lasting decline, as younger generations turn against cultural conservative issues across the political spectrum.

What I think will happen, therefore, is a period of Democratic Party dominance for the next 10 to 20 years. However, I think tensions will gradually emerge between its left and right flanks over economic and social policy that may very well lead to the establishment of two new parties. What we may have in 2040 is one party that is socially liberal and economically liberal – a genuine Progressive party, although probably partaking less of the class politics of a Social Democratic Party than the “social organism” politics of Progressivism – and another party that is socially liberal and economically laissez-faire – what Europeans would recognize as a Liberal Party. The reason for this is that as moderate and liberal Republicans desert the Republican Party for the Democrats, there will be a wider base for this kind of politics – at least after expansions of the welfare state (especially in the area of universal health care) and the return of economic prosperity have given middle class and affluent Democrats the sense of economic security necessary for the return to a more New Democratic attitude towards markets, especially given the availability of corporate financing for such a political shift.

However, it’s hard to tell what will happen. It may well be that the Republican Party will jettison cultural conservatism and become a European-style Liberal Party – if that does happen, I don’t think it will happen any time soon. At the very least I would think it would take a period of sustained losses in 2010, 2012, and probably 2014 and 2016 to really produce enough of a scare to make that happen. It would also be wrong to suggest that any of this could happen on its own – any political shifts we might see over the next 10 or 20 years will require huge amounts of political work. At the very least, we will need to see key policy victories in the Obama administration – with universal health care being the most important among them – in order to create the political climate for an enduring left shift.

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Wednesday, May 20, 2009

Re-Post Number 11: "Stimulus Is Not Enough: Job Creation Now!" (Jan 09, 2009)

Note: and that's the last of the re-posts. The context for this post was the political fight over the Obama stimulus package.
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In the last few months, the U.S economy has seen one of the fastest slides into one of the most terrifying employment declines in American history - we are now losing jobs at the rate of 500,000 a month.

Given this reality, the current stimulus proposal is no longer sufficient. We must move beyond a debate that tries to balance a couple hundred billion in tax cuts with four hundred billion in public works, aid to the states, and traditional stabilizers (UI, food stamps, etc).

In the last few months, the U.S economy has seen one of the fastest slides into one of the most terrifying employment declines in American history - we are now losing jobs at the rate of 500,000 a month. Given this reality, the current stimulus proposal is no longer sufficient. We must move beyond a debate that tries to balance a couple hundred billion in tax cuts with four hundred billion in public works, aid to the states, and traditional stabilizers (UI, food stamps, etc).

What we need are jobs, and jobs now.

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Tuesday, May 19, 2009

California Budget: Where Do Progressives Go From Here?

Given that the current ballot propositions have gone down in flames, then the state of California faces a brand-new budget crisis of some $21.3 billion. While obviously the Democratic leadership has focused their attention on trying to pass the ballot measures they thought represented the best possible compromise, I do hope that some thought has been given to what the new strategy will be on 5/20. Granted, the imperatives of political strategy mean that it's more than likely that there is a Plan B that's being kept under wraps at the Legislature, At the same time, however, it is vital that California Progressives come together to construct a stronger coalition and a winning strategy for the future of our state.

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