The Health Care Mess: Who’s To Blame?

August has been a frustrating month for progressives who seek quality, affordable health care for every American. Why does the Administration vacillate? Why does the media legitimize the opinions of right-wing liars and kooks? Why can’t congressional leaders get their act together? Most of all, who’s to blame?

Not President Obama. Sure, the White House has made its share of mistakes, but they have been minor. The Obama strategy has been consistent and firmly based on political realities. One reality is that Obama cannot dictate the details of legislation to members of Congress, even to loyal Democrats. The Administration’s job is to help, guide, and cajole lawmakers to craft the most effective plan that can possibly be enacted into law—and the measure that has taken shape in the U.S. House fits that description. As a former Senator, Barack Obama knows that no one, not even the President, can order around U.S. Senators. Each Senator has his or her own political kingdom, and insists on being treated as royalty. It is not Obama’s fault that a handful of Democratic Senators are not, and never were, progressives. More about that in a moment.

Not “the Democrats.” Let’s be reasonable. No one controls the whole Democratic Party. But Speaker Pelosi and her leadership team have done a pretty impressive job of getting House Democrats to support the stimulus, the FY2010 budget, and a strong health care bill. The “Blue Dog” caucus of Democrats remains a stumbling block. But Pelosi and her whips have already shown their power and determination—when push comes to shove they will succeed in passing a pretty strong health care plan. Sadly, the Senate is a different matter. Senator Reid has perhaps been too patient while Senator Baucus fiddles around with phony bipartisanship. In any case, the majority of Senate Democrats have, so far, worked faithfully for a real health care solution.

Not the progressives. You never thought we progressives were to blame, of course. But the media have recently suggested that the proponents of a public health care option are holding up legislative progress. The Washington Post [1]even found some unnamed source in the White House to say:

I don't understand why the left of the left has decided that this is their Waterloo… We’ve gotten to this point where health care on the left is determined by the breadth of the public option. I don’t understand how that has become the measure of whether what we achieve is health-care reform. It’s a mystifying thing…

Okay, maybe some blame is appropriate here. During the past year, what planet was this spokesperson on? Progressives have made it entirely clear why the public health care option is essential—and Barack Obama agreed during the campaign! The President is now going around the country arguing for the public option. In poll after poll, Americans overwhelmingly support a public option—we are fighting for the will of the people. What’s so mysterious about that?

Not the Republicans. Well yes, of course they're at fault for opposing health care reform. But really, who’s surprised? If there was any hope of Republicans working in a bipartisan fashion this year, that hope was shattered by their irresponsible obstructionism during the stimulus debate. As Campaign for America’s Future co-director Robert Borosage [2]made very clear, the vision of bipartisan health care legislation has been proven a fantasy:

The effort to gain bipartisan support was torpedoed by the leading Republican negotiator, Senator Charles Grassley, when he revealed his true colors by embracing the vicious inanity about “death panels.” He aligned himself with the wingnuts, and there is simply no reason or way to negotiate with lunacy…. More to the point, the Republican National Committee scorns [any reform] as a “government take over of health care.”

The point is, except for a very few reasonable GOP Senators like Olympia Snowe, we never were going to get Republican cooperation. The Republicans never were the solution.

Not the right-wing crazies. A frantic fringe of militants are being mobilized and used by the likes of Dick Armey and Newt Gingrich—who themselves are acting on behalf of wealthy GOP interests—to shout down Democrats, progressives, moderates, and even well-intentioned conservatives. We know that these people do not represent the silent majority. They are merely the same old John Birch Society-types who continually shriek absurdities (e.g. “Get us out of the U.N.!), but who are—for good reason—almost always ignored. Except to the extent that any wavering Democrats take them seriously, the tea-baggers are irrelevant. We need to answer their lies and de-legitimize their hate speech. But they are not our focus.

A very small group of so-called moderate Democrats are to blame.

This legislation, or at least much of it, requires a 60 vote majority to pass the Senate. At best, we might hope to persuade two or three Senate Republicans to support it. Sadly, we cannot count on our long-time health care leader, Senator Edward Kennedy, to be available for the vote (and an unusual provision in Massachusetts law makes it impossible for him to be quickly replaced).

So we need the vote of nearly every Senate Democrat and a handful currently stand in the way, including the likes of Max Baucus (MT), Evan Bayh (IN), Ben Nelson (NE), Mary Landrieu (LA), and Blanche Lincoln (AR). None of these Democrats ever professed to be a liberal or progressive. Their voters elected them as moderates or conservatives. We think the right thing to do is obvious. But it’s not obvious to them.

We progressives need to persuade them (and a few House Blue Dogs as well) that real health care reform is not liberal or conservative, it is neither too expensive nor too radical, and it is no danger to the market system—rather, it will help businesses both large and small. The President, congressional leaders, and grassroots activists need to focus on these few target Democrats and make them understand that the progressive vision for health care reform is essential—it is the only way—to provide for the security of all Americans, our children and their children.

The challenge is clear. Go get ‘em.