Gerontocracy and its discontents: Back to your ovaltine!

One of the things I like best about the news are the old people. They’re rather cute, in their puttering little way. They’re constantly on about something, like the absurd price of Ovaltine or the yellow peril. It’s presh.

No topic exercises old people quite so much as us. By us I mean, to put it perhaps indelicately, not-old people. Call us young, relevant. Sane. Whatever you like. We aren’t them and so it’s very important that they teach us everything they know, so we avoid their mistakes, like appeasing Hitler. (By the way, my ancient and venerable friends: check.)

Today RealClearMarkets has an article by a man called Bill Frezza, who would probably qualify as “old” even if he didn’t begin his articles with a reference to “my 26 year-old son.” Props to your fecundity, sir. My mother would probably describe it as a mixed blessing, but different strokes, right? Anyway. Bill – Mr. Frezza – sir is very concerned about Social Security. It’s “eat[ing] the young alive.” I know this because his article’s entitled “Watching Social Security Eat the Young Alive.”

His son got this letter – why do all old people’s stories begin with something that happened to their children? Things must happen to them too. Like when Mavis played a perfect game of shuffleboard until she slipped on Sidney’s umbrella and knocked away her last puck. Man, good times. I’m off-topic. Now I know how it feels.

His son got this letter from the Social Security Administration. Sinister, as all communications from the government are. The letter talked about his social security, and informed him that payments go into a “Trust Fund” which pays the people already in it. Mr. Frezza is shocked: “Paying off early investors with funds taken from later investors is precisely how Wikipedia defines a Ponzi scheme.” My word! Do you see how hip he is? He’s on the interwebs! Sadly he’s clearly not attended college in the last thirty years, as professors are a bit wary about accepting internet sources as credible. He missed that.

But I’ll humor him – so much of dealing with the elderly is – and look it up. The first line of the Wikipedia article as it now is reads:

A Ponzi scheme is a fraudulent investment operation that pays returns to separate investors from their own money or money paid by subsequent investors, rather than from any actual profit earned.

Since he used the term first, for comparison:

In common law legal systems, a trust is an arrangement whereby property (including real, tangible and intangible) is managed by one person (or persons, or organizations) for the benefit of another.

Wow. The definition of “trust fund” is pretty similar to that of Ponzi scheme. I think he’s on to something. That government, with its tricks and its Jell-O and the whoopdee wootchow.

Except. Ol’ Hickory here overlooks a word. That word is fradulent. A Ponzi scheme is fradulent. It is built on a fraud. A trust fund, on the other hand, requires that I – to put it in my hippest terms that Bill could understand, let’s call me Dude A – know that I am putting the money forward to the benefit of somebody else. Dude B. (What a loser Dude B is. Yeah, dude. I mean you.)

So, for instance, if I were running a Ponzi scheme I would probably not send out a letter which reads

Dear Sir

You are paying a great deal of money that is going directly to beneficiaries who are not you. You are doing so in a manner which will not allow you to recoup these monies but, if you’re lucky, will create a situation where other people pay for you to get money back. But probably not, despite the impression I earlier gave you on the phone.

Yours

Peter

This would be silly, and against the spirit of the Ponzi scheme. It would also expose the recipient to their own stupidity in a way that buying into a business strategy constructed by Underpants Gnomes had not already, which is foolhardy.

(I provided the link for you, Bill, in case you got confused.)

After taking a sideswipe at the health care bill – which he’s also concerned about as everyone knows all young people are born with perfect health so why should they pay for insurance? – he gets to the root of the question. (Not before time, as Matlock is coming on.)

“An entire generation is being systematically robbed by their parents with nary a peep. Why aren’t they marching in the streets like we did? […] There only conclusion I can come to is that we Baby Boomers have infantilized our children into idiocy.”

Or your generation’s comprehensive failure to create either lasting prosperity or a durable welfare state means we don’t have the luxury of spending our twenties engaged in nakedly-frivolous acts of rebellion against generations past. Or perhaps we’ve been robbed of all our collective wealth by the inscrutable machinations of venture capital firms – like the one you work for, Bill! – so that the deregulation you pushed for has resulted in the funds we built up being liquidated in favor of bailouts subsidized by my tax dollars to save the money I put in the bank in the first place. I don’t know though, I’m kind of shooting in the dark. Us kids! No spirit.

This is not the first such article I’ve lately come across. As if the constant hand-wringing about our children (of which I was lately one) by anyone with a stake in politics is not enough, we have to suffer the constant attacks of old people who, having fucked comprehensively the society and indeed the planet they so callously inherited, are now intent on foisting upon us their jerryrigged fixes in an effort to preserve their aged social fiefs under the guise of altruism. Hence the Bush-era hundred-billion-dollar giveaway to AARP, and the stunning duplicity involved in simultaneous whining over cuts to Medicare in the light of the possibility of the introduction of general health insurance.

Who’s behind this? The old people lobby. You laugh, but the average age of a Congressman is presently 56; of a Senator, 62. There is one congressman in his twenties and only a handful in their thirties. Hardly surprising, when the “decentralized,” “local” and “bipartisan” nature of our politics means the most important thing is a lot of money (or friends with it) and no political background, if it can be avoided. No inconvenient principles to get in the way of caring for our children. We – the not-old – could always influence the process, of course, but there’s not much room for us because none of us have any money to donate. Which is why we’re so busy working, because our parents… You get the idea.

Now, you’re going to think that, on the reverse side of the coin, I blame old people for all of our problems. Considering they have all of the power, money and well-tailored lobbyists, yes, I do. But this is beside the point. I am looking instead for that rarest of qualities which my generation apparently lacks: responsibility.

You see, I’m tired of being hid behind. I’m tired of old people justifying their policies – or tragically more often, their rejection of policies – as a necessity for our children’s future. Or not passing the buck to future generations. Or whatever. Because the very ironic thing is that in so doing that is exactly what you accomplish. You’re saying, implicitly, that we should wait until future generations have their say – that they, or we, will make the decision when we’re ready. And you can say the same during the next one. And the next. There’s always a future generation that needs to be given its say, that can be used a shield to perpetuate the status quo in the name of generational justice. There is always an excuse not to choose now, because it is unfair, because it does violence to some as-yet unheard group.

I am aware of this difficulty. There’s even a term for it. It’s called governing. And by blaming your inaction and worse, your bad, self-serving ideas on the need to protect future generations – to protect me – you’re not only failing to govern and paternalizing us in the same way your parents did you, you’re guilty of those cardinal sins you accuse us of: Irresponsibility. Bad grammar. And cowardice. Moral, and political and practical cowardice.

So I say stop worrying about me, Bill. Look to your own defenses. I do not need to be protected, thank you. All the “coddling” you and people like you whine about isn’t helped by the prospect of the failure that is your ruling class taking it upon itself to engage in decades of hand-wringing – or worse, a radical rollback of the “failed” benefits system – based on your idea about what I need and how I need it. I can’t help notice, Bill, that the one thing your article doesn’t include is the part where you ask your son what he thinks. Maybe he agrees with you. But I don’t.

Because you’re right about one thing. There is a problem with how this country is run, with the people who run it and with the worldview you represent. It’s old and stale; it’s dying. And the solution lies not with the people who brought us to this pass. It is to let a new generation fuck it up all in its own unique way. When you finally get out of the way, Bill, I look forward to the opportunity. It probably won’t be the America you know anymore, but I don’t mind. I no longer care for yours. And generational justice is not about your fear and trembling over my future – it is letting me live my present.

That might not be a bad thing. Anyway, I’m pretty sure we can’t do as badly as you did. We think too much. Just not like you.

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The poetry of Harry Reid

From Politico:

“Remember, a public option is a relative term,” Reid said. “There’s a public option, there’s a public option, and there’s a public option. And we’re going to look at each of them.”

Uh… no.  There’s a public option, there’s a public option, and there’s a public option.  And they’re all the public option.  But thanks for that.

Though I suppose he’s right in the sense that no matter what a public option looks like he’s perfectly incapable of preventing any of these children from being devoured by Cronus, especially when there’s a half-billion dollar effort afoot to defeat the public option (and keep the bill, now that includes a mandate to buy health insurance at perhaps the worst possible time since World War II).

Of course this appeared in a British, not American, paper.  I don’t think it’s a cover up.  I think we’re just deadened to the influence of this money in the legislative process.  Given the expense of electoral politics these days, why not?

Perhaps processes like these would be a mite easier, if not more civil if we asked the question “Why not?” – and forbade mention of Hitler, or Stalin, or anybody wanting anyone else dead, in the answers.

Marked for life?

One of the more curious features of the 24-hour news cycle seems to be that it contributes to this weird Lazarus phenomenon amongst disgraced public figures.  It’s inevitable that there should be a flip side to the intense, hysterical, vitriolic heat that falls upon a politician or celebrity accused of the most passing and insignificant of failings.  It appears to be that attention is so focused that just a year or two later we no longer remember who the person is.  Frankly I can’t help but acquiesce to that; if your life must be utterly destroyed it’s best that society at least grants you the opening to rebuild it.  Being all to human myself – to my occasional disbelief – I think that perhaps it’s better than the long, low-level shunning we used to dole out to reprobates in public life.

The newest member of this club since Eliot Spitzer‘s semi-resurgence is Mark Foley, formerly a Republican-Florida-Central Southeast and Everglades and inadvertent architect of the Democrats’ 2006 sweep. He’s apparently got a new radio show out called “Inside the Mind of Mark Foley” (if only it really were) to debut on “Adult Standards” AM Radio in the Palm Beach-Miami area.  He’s apparently being billed most for his health care savvy, as he was member responsible for the subject on the Ways and Means Committee.  This is one of like twelve committees dealing with public expenditure, all of which are apparently very powerful.  Let’s hope he’s been taught a little humility and doesn’t make the meal of it that everybody else in the media has.

Press release here.  Hats to the almost inevitable Politico Scorecard blog.

Want health care? Nuke the Senate

I’ve temporarily run out of steam on soccer, so I guess it’s back to politics.  At least until I can afford to buy an album to review or something.

It seems like I’m not the only one running out of steam.  The fracas festering over the long hot weeks of August has put the health insurance initiative onto the back foot in a serious way.  That culminated over the past weekend with a serious trial balloon put up by senior Obama officials, including Health Secretary Kathleen Sebelius, that seemed to accept the likelihood of the loss of the “public option.”  Their reward for this suggestion was a few warm words from ex-Democratic Senator Richard Shelby (R – Alabama) and the rekindling of a newer, stronger liberal uprising than even the one I sensed coming in July.  (You can read that slightly-updated post here.)

There is no longer any mincing of words: House Democrats are openly talking about scuttling the ship if it doesn’t carry some kind of government extension of health insurance, and it appears possibly that it’s abandonment could touch off a wave of protests that would make the town halls look like insignificant skirmishes.  This is what I meant about Obama’s potential failure being worse than 1994.  In 94 Democrats blamed Republicans.  If Obama removes the public option, Democrats will blame him.  His people have backed off the notion of dropping a public plan in a real hurry, but even suggesting it openly has been almost as damaging as allowing the bill to wither on the vine in the first place.

The flurry of activity of Obama’s first several months was designed to embolden the party, whose electoral success has left it inexperienced and fractured, while demoralizing Republicans. Before they could finish getting over the election you get the stimulus.  Before you can get a grip on that you get the environment bill.  Before you can finish chewing on that you get health care.  Fast and furious.  This has not been a wasted effort – part of the vitriol you see at town halls is likely pent-up anger amongst hardcore conservatives (and make no mistake that it is hardcore conservatives, not any Nixonian Great Silent Majority, though they ought not be disregarded because of it). But the failure of the town halls, and the failure of the first stage of this battle, is that enough time was left for such anger to coalesce and express.

The reason Obama and his people kept going on about this August deadline was to keep the pressure on and prevent Republicans from getting a grip on the battle.  Up until now the Republicans have been like the French in 1940: getting the shit kicked out of them so badly that they can’t imagine a situation other than having the shit kicked out of them.  This pause is vital time they need to regroup, and they are using it.  In retrospect it was a gift from Obama.  The idea that you can push for Congress to do something-anything, so long as it’s quick, and not actually hand them a bill is a bit ridiculous.  The chaos that followed was eminently predictable, though Nancy Pelosi was swift in marshaling her forces and getting something passed.  Of course as soon as progress looks likely there lies the Senate.

To whit:

House Democrats also are growing increasingly agitated at what they see as the Senate’s outsized role in the health care debate. Liberals are especially wary of the Finance Committee, the only congressional panel that has yet to pass health care legislation and where support for a public plan is weakest.

“The Senate needs to understand that they are one-half of the process, not the entire process,” said Engel. “This is not a matter of [Senate Finance Committee Chairman Max] Baucus or anybody else negotiating a bill, than coming to the House and saying, ‘Take it or leave it.’ That’s not how it works.”

So petrified is the White House of the now automatic Senate filibuster that they’re ready to throw in the towel without anyone actually having voted against it – and despite sixty Democratic votes in the Senate.  This is hardly the first time the once-rare filibuster has conspired to destroy legislation which has clear majority support in both houses.  It ought to be the last.

You may remember that in 2005 there was a big fracas about the so-called “nuclear option.”  Democrats in the Senate had successfully blocked several conservative federal court appointees, and Republican frustration has reached a boiling point.  They proposed a striking (and not-so-unprecedented) manuever: to change the rules of the Senate to forbid a filibuster.  The idea was rather ingenious: matters under filibuster require 60 votes to clear, and a change to the rules of the Senate requires 67, but an opinion of the chair on a point of order under parliamentary procedure may be overruled by a simple majority – 51.  Such a move would create a precedent effectively overturning the cloture rule.

It would have worked like this: a senator makes a point of order asking for an immediate vote to end debate (cloture) by simple majority. The chair – the Vice President or temporary President of the Senate – rules on this point of order;  for this process to work properly they would have to uphold it. A filibusterer (perhaps filibustero) would move to appeal the decision of the chair.  This is a debatable motion. To overcome it an opponent moves to table the appeal, which is not debatable and is voted on via a simple majority.  If the appeal is tabled, the chair’s decision stands and a precedent against the filibuster is created. That precedent would be binding.

Why all this complicated crap?  Because it’s the way the Senate works.  And herein lies the problem.

It’s time to use the nuclear option.  Many Democrats opposed it in 2005 – I can’t remember, but I probably did too – but we’re not talking about a couple of judges on the DC Court of Appeals.  We’re talking about the provision of health care for millions of people.  We’re talking about what Woodrow Wilson called “a little group of willful men” when the first rule against filibustering came about in 1917.  We are talking about a body that, to quote an Australian, most closely resembles a “tinselled abortion of the House of Lords.”  And make no mistake that this is precisely what the Senate has always been and remains today: an attack on popular sovereignty and a frustration to the will of the people, regardless of who is in power.

Senators would resist, you say.  Undoubtedly.  The plans in 2005 were scuppered by a “Gang of 14,” a group of senators who pledged to support a number of appointments, accept opposition to others and vote against the nuclear option, denying it a majority.  But that was four years ago, when Republicans had a 55-45 majority.  A whopping third of the Senate is different than it was then and there are 14 more Democrats.  Of the Gang of 14, four are gone – one to the Obama Administration, one retired and two lost re-election in 2006.  All of those seats are now Democrats.  Even if you include the remaining Democrats from the 14 in opposition to such a move, that’s only 46 votes against a nuclear option – not enough to stop it.  Perhaps some others would buckle; but when you consider the stakes – not a few judges but the centerpiece of the Democratic agenda, on which they were elected with an overwhelming legislative mandate, and which has been a dream of Democrats at every level for 50 years – there is only one right option.

It’s time for a majority to count for something.  Americans do not cast votes for their officials to do nothing, and yet too often that’s exactly what they get.  The Democratic Party said it would be different; it’s time to show it.  And should Republicans take back the Senate, a year from now or three or five?  They will be elected to lead and to govern.  They have the right, and should have the ability, to do so.  This is the democratic principle: that your opponents have as much right to rule as you should they secure a popular mandate.  Sixty votes is nobody’s mandate, which nobody foresaw and which was never writ in any Constitution or charter.  By clinging to it the Senate has become not merely anti-democratic – it always was – but ossified and corrupted by purely negative power.

No more.

Hawking British health care

Nobel laureate and Lucasian Professor Stephen Hawking hit back against the more comically shrill attacks against the British NHS in The Guardian today, especially an article in Investor’s Business Daily that suggests that were he faced with the quality of medical care in the United Kingdom Professor Hawking would not be alive today.  (Neglecting, of course, that as a British subject and British resident he’s never had anything else.)  The original article has been “corrected” – redacted – but reference to the original is here among many other places.  Suffice to say I’ll never read IBD again… though I’m not sure I or anyone else ever did.

Now I wrote about this, in part detailing why I didn’t like this so-called “public option” and why single-payer was a superior system for the country and for taxpayers.  It’s just one man’s opinion and unlikely to influence others but I can safely say that at least it wasn’t the frothing comedy being produced by some (though hardly all) conservative outlets in this country.

The fact is that expenditure on health care as a percentage of GDP in this country is the highest in the world if you exclude the Pacific islands; America’s health care system is 37th in the world, way behind France, Italy, Germany, the UK and most of the industrialized world (indeed the US is one of the highest, if not the highest, only among those nations lacking public healthcare); and the US’ health performance rank – that is the efficiency, fairness and cost effectiveness of the entire system – is a whopping 72nd, far behind first and third world alike.  (We are below China.)  Overall life expectancy is better – 24th.  But still behind the UK.  (All numbers from the WHO in 2000.  They’re questioned and questionable, of course, but far better founded than a lot of the information major papers will run; I defy you to find a study of equal comprehensiveness and trustworthiness that speaks better of the US.)

The fact is that health care is a moral issue.  When Congress starts harping about money I stop listening.  Frankly I don’t care how much it costs.  40 million uninsured and 27 million underinsured in this country equals early deaths from preventable disease; equals higher total expense because of the lack of wellness care, which means people aren’t treated until they’re already sick; equals lower life expectancy.  It equals crime, as people are impoverished forcing to make difficult choices and scrabble together whatever they can get to care for themselves and their family.

It even equals impaired national security.  America’s strength in the world is heavily dependent on the ability of our businesses and our government to attract the most brilliant minds anywhere, and we do so with our prosperity, our security, our liberty and the amenities life in the United States offers.  The lack of a guaranteed, quality national health insurance is going to be a great and increasing disincentive to jumping through the hoops necessary to live and work in the United States.  This erodes America’s attractiveness and erodes that competitive ability.  (Imagine it – a single national health system improves competitiveness!)

This is an issue of life and death today and it will only become more so.  That – not money – is the heart of the matter.

Obama’s Bangkok Dilemma: or, why health care is doomed again

[I have been promising this post for a week to as many as five different people.  As it happens it was rather prescient when I first started to compose it.  It will be less impressive as circumstances have overtaken things.  But regardless, Mom, here you go.]

Like most of the three or four cronies and political obsessives I’ve conned into reading this blog, I watched Barack Obama’s press conference on health care a few nights ago and read some of the initial reaction to it.  I suppose we’ll have to wait until new polling numbers come out to get a feel for the whole thing, assuming they say anything useful at all.  (My limited experience is that polls are mostly interested people talking to themselves through the public about their favorite topic while the rest of the country looks on with consternation.)

First a digression.  I have a history of making bad predictions.  I also have a history of making surprising, odd and wildly-successful predictions.  These two phenomena are connected intimately: I’m not afraid to be stupid, which means I can constantly make statements that others will dismiss out of hand but that can occasionally come true in a spectacular way.   All of the dozens of dumb predictions I make are quickly forgotten.  The ones that pan out, for which my batting average is far below randomly choosing from a given set of options, I sing about for months or years.

Not this one.  I’m going to make a bad prediction today: Obama’s health care initiative will fail.  I hope earnestly it’s wrong.  My moral conviction as well as my personal interest agitates against it.  And the systemic factors don’t support it.  Sixty votes in the Senate, two-hundred-and-a-lot in the House, a Republican Party focused principally on Obama’s birth certificate – the variables are good in a way that doesn’t remotely compare to 1994.  That’s part of the reason I think it will fail hard.  This thud will be resounding: forget 1994.

But first, a trip down memory lane

A very intelligent Australian psephologist called Dr Adam Carr coined a phrase about the 2007 election there.  He called it “the Bangkok dilemma“: a situation in which a governing party suffers a loss of credibility to both the electorate at large and its own core supporters.  (Or, in his words, gets screwed at both ends.)  In the service of his core demographic John Howard, the Prime Minister at the time, pursued a deeply unpopular labor relations policy (you remember kids… unions?  No?).  The possibility of it, and his fervor, alienated him from the majority of voters who didn’t much care about unions.  Its ham-handed failure alienated him from his own base.

Dr. Carr diagnosed such a failure properly – it wasn’t that Howard lacked the strength to carry his policy.  It’s that he was strong enough to do it.  Like Obama and the Democrats Howard got a working majority in the Senate for the first time in decades, in part because the opposition was so clumsy that they lost too big.  Like the Democrats, Howard’s legislation was something that was nursed within the party’s deepest darkest heart.  And despite that perfect storm he bungled it such that nobody was willing to trust him anymore.  From then it was only a matter of time.

The not-so-great debate

Fast forward a few months to the middle of 2008.  Barack Obama and Hillary Clinton were embarking on a slugfest for the nomination.  I didn’t have a dog in the race until New Hampshire, a situation I find astonishing eighteen months later.  I eventually picked Clinton for two reasons.  The big one was health care.

Clinton was seasoned on this issue: she’d been as tied up with the 1994 failure as anybody.  To me that meant she learned a valuable lesson about how to see it through next time; was hungry for it; and best of all still wanted a single-payer system.  To me this just made sense.

The idea behind this is that there is a single source for health care expenditure – the goverment. (Technically this is not a monopoly but a monopsony – when a market has only a single buyer.)  You go to doctors, get your medication, etc. etc. and the doctors receive payment from the government.  All the payment comes from one source so the desperate effort by doctors to keep up with most major insurers is rendered unnecessary, and the fact that the government becomes the single purchaser of prescription drugs essentially “captures” the pharmaceutical industry: Latisse is all well and good (and to Wikipedia’s credit it makes this gem look less stupid than it appears on TV) but if the government won’t pay for the drugs there’s a lot smaller market for them.  It incentivizes pressing medical research.

This is a question of what’s wrong with the health care industry.  It’s a failed market.  There are two really egregious types of market failures.  The first is when something of value is not valued.  (For instance, the environment – it’s very important but largely “free,” so pollution etc. goes unchecked.)  The second is when something is dramatically overvalued.  This is what’s up in healthcare.  The traditional supply and demand system doesn’t work in the healthcare industry: practically the only ceiling on peoples’ expenditure is actual ability to pay.  Normally, as the price of a thing increases demand should decrease.  Health care demand is far less elastic – people want it regardless of the cost.  They’ll abstain from buying it only when they absolutely can’t afford it.

This is based on information asymmetry.  My health is very important to me, but I don’t know precisely what I need to maintain it.  (Diet and exercise come to mind, but I’m one to talk.)  In many countries, their reply to this is a combination of strict advertising laws and a government-run health insurance (or health care) system that heavily disincentivizes frivolous and minor medications.  They won’t pay for Latisse, so doctors won’t prescribe it, whether or not I see Brooke Shields pleasantly cascading through a meadow with thick, full lashes. In the United States we lack this guarantee.  There are lots of ads and lots of insurers who’ll pay, because they don’t really pay – we do, in the form of an employer-paid system that comes back to us in the form of a draw on my wages.  Their failure to supply a designer drug to me, who is not well-equipped to determine whether I would ever need Latisse, risks that I’ll take my business elsewhere.  All we have left is the good offices of an agent in the form of a doctor, and then only in the case of prescription drugs, and then only insofar as the doctor is noble.  Many are.  Not all.

This, to the best of my meager understanding, is the problem we face.

Enter hope

Now Barack Obama did not before and continues not to believe in a single payer system.  (He sent mixed messages, because we campaign in poetry, but his positions especially early on were fairly clear on his opposition to a “mandate.”)  This could be and likely was for a number of reasons.  Conviction that the government shouldn’t bully insurers and their employees out of their own market.  Fear of a replay of 1994 on the same terms.  Concern about the cost of fully insuring the entire country.  Question whether it’s necessary to give insurance to those without through getting rid of everybody else’s.  Whatever.

Now I get that.  Totally redoing the entire American health insurance system is not something you snap your fingers and order.  It’s a massive technical, legal and logistical effort, even if you make no change to the physical provision of health care.  (This fascinating article by a former Amazon.com technology manager makes clear the difficulty of solving issues far less fraught.)  But then this is why I elect representatives in our form of a democratic system: complexity is not my problem.  My concern is what gets done, especially since it’s my responsibility to help him see it through. (And I thought I was just a nutcase posting on a dingy little corner of the internet.)

Tinfinger?

But the initial hearings lacked even a single advocate for a single-payer option.  The responsibility of this falls to Senator Baucus, chair of the Senate Finance Committee, who is explicitly and vociferously opposed to a single-payer solution. In the House single-payer did get a hearing, if not in front of Appropriations, which makes the Senate’s omission all the more glaring.  It’s the Senate, not the House, in which this bill is really going to have trouble.  You’d think that more “deliberative” body would be more careful in its deliberations.

The fallback to single-payer has become the “public option.”  This is essentially a mandate that everybody be covered combined with the ability to sign up for Medicare or some new government-created system as part of a constellation of the usual choices.  (Blue Cross et al.)  The rationale is that those who already have their insurance and like it, which hype would have it is a significant percentage of people, can keep them.  Those who don’t can sign up for the government brand.  There are a number of variations involved, partly because a number of different committees are working on several different bills.  (They have a term for this in the Army.)

This “public option” itself is what is under heavy contention right now.  Though it’s quite vague, there’s not much question of taking anything away from anybody: no rationing boards or British doctors with bad teeth and breath coming to tell you that your four-month old son can’t have a lung transplant because he ought to buck up and be more manful about the whole thing.  These are right-wing phantasms which are to the best of my knowledge unfounded.  However, that does not mean criticism of the public option is unfounded.  The Bush-era chair of the Council of Economic Advisers (and familiar face from introductory college textbooks), N. Gregory Mankiw, posted the following on his blog.  It is as incisive as it is brief.

Would the public plan have access to taxpayer funds unavailable to private plans?

If the answer is yes, then the public plan would not offer honest competition to private plans. The taxpayer subsidies would tilt the playing field in favor of the public plan. In this case, the whole idea of a public option seems to be a disingenuous route toward a single-payer system, which many on the left favor but recognize is a political nonstarter.

If the answer is no, then the public plan would need to stand on its own financially and, in essence, would be a private nonprofit plan. But then what’s the point? If advocates of a public plan want to start a nonprofit company offering health insurance on better terms than existing insurance companies, nothing is stopping them from doing so right now. There is free entry into the market for health insurance. If a public plan without taxpayer support would succeed, so would a nonprofit insurance company. The fundamental viability of the enterprise does not depend on whether the employees are called “nonprofit administrators” or “civil servants.”

The bottom line: If the goal is honest competition in the provision of health insurance, the public option cannot do much good but can potentially do much harm. (emphasis mine)

Half of the reason I’ve always favored the single-payer option is that I don’t think a free market is the best way of regulating health care, especially in terms of breadth of coverage.  The other half is basic politeness: you stab someone in the front.  In this case the target is an entire industry, that of the health insurance, and I think it only sporting to fax them a death warrant first.

But Mankiw hits it right on the head.  Either the government will open just another insurance company, and let it go its merry way (sound familiar?) or it will create a super company that will drive the rest of the industry to the rocks.  What’s to prevent the insurance industry using its clout to secure delicious sweetheart buyouts from the government, or bailouts to prop up their service (competition is our watchword in the public option, after all)?  Worse still – what’s to prevent it simply being a gift to the private insurance companies through the ability to shuck off all the sickest and most vulnerable clients, passing them to the government at public expense?  It will be much like the “toxic assets” bank created in the bailout – only what will be toxic are people.

In short, the public option would likely mean either that we’d kill insurance or insurance would kill us.  At worst it’s dishonest; at best it’s bringing a knife to a gunfight.  When we own a tank.

Change – need we?

At least the public option would do something.  Now it looks like that, too, has run aground.

The Obama Administration’s tactic when confronted with opposition has been, thus far, the primetime press conference.  Why they prefer this to an Oval Office address is rather beyond me: but in every case until this one it worked.  Measures were passed, ranks massed, and the Congress stable, if hardly peaceful.  His latest press conference manifestly failed on that score.  His performance was widely panned and about ten minutes into watching it I found myself more interested in his choice of tie (and that of the reporters) than what he was saying.  It’s not that he was saying something too complicated.  It’s that he wasn’t saying anything.  (Except about the Gates arrest, in which he got the only good line of the night before promptly putting his foot in it.  This may have helped him, in a weird way – but not enough.)

And now comes the other half of our dilemma.  Leaving health care to the relatively conservative Baucus in an effort to ensure conservatives were suitably placated was bad enough, but now powerful House Democrats under the leadership of Mr. Waxman (D – California-Hollywood and Beverly Hills), who have generally enjoyed the support of the Obama Administration, appearready to abandon even the “public option.”  The result?

A left-wing uprising.  Which I was going to have predicted last week.  And to think I could have sounded so smart.

General Gordon at Khartoum

Even Barney Frank (D – Massachusetts-Brookline and Southwest Massachusetts), no particular legislative rabblerouser he, has declared that he is perfectly willing to do to the Administration and Waxman what the so-called “Blue Dogs” have: stall it.  Perhaps even kill it, from the sound of things.  And why shouldn’t they?  Why should liberals and left-wingers, who make up the bulk of the party, allow themselves to be run roughshod over by Southern and Western conservatives – many of whom the majority can afford to lose?  If they can look past party to their convictions – and I do not mean to suggest that the Blue Dogs do anything but this – there is no reason liberals shouldn’t either.  Many of them barely swallowed the abandonment of single payer in the name of progress.  This is too much.

At the end of the Politico article already quoted, one congressman remarked that at least “The progressives are in the room now.”  Why weren’t they before?  There are almost half-again as many members of the Congressional Progressive Caucus as there are of the Blue Dog Coalition.  The answer is that they were treated as a foregone conclusion, despite having one of their own in the Speaker’s chair.  If you had to ask me what the terminal mistake of this process so far has been, it is that.  The Blue Dogs may yet get their way – but at immense public cost and possibly at the risk of the Democratic majority.  And should an electoral drubbing follow, they will pay with their offices.  Perhaps then they will wish the march to socialism had lived up to its brutally effective reputation.

Alas, Babylon

At this point I have little reason to believe things will get this far.  Delay is inevitable.  That isn’t in itself bad – but the fact that the price of the Blue Dogs have been the entirety of the House liberals, as evidenced by the collective outrage of very senior Democrats there, puts paid to the idea that the recess will allow time for a new consensus to emerge.  This was a compromise worthy of King Solomon.  Sadly.

If such difficulty exists in organizing the House to pass health care (and given the similar activities of Senator Baucus in the other place), what chance is there of mustering the votes necessary in the Senate, where the bar is higher, the margin of error lower and the leader there, as I have heard it put, “gun shy”?  They have little reason to act if the House merely scrapes together a bill, and certainly none if they don’t.

Meanwhile the Republicans in both chambers, small in number though they may be, have the negative at their backs: the opposition doesn’t need to provide an alternative.  They just have to dislike the plan.  Sometimes being the “party of No” is all you can, and should, do.  As Napoleon remarked: “Never interrupt your enemy while he’s making a mistake.”

So here we are.  And here lies my terrible prediction: that health care will fail.  Except perhaps it’s not so terrible.  Perhaps this has turned into such boondoggle that failure is the best we can hope for now.  For any good liberal this is a “die in the ditch” moment.  A health care bill that fails to provide health care to people that can’t get it, in a way the private sector can’t give it, is not worth having.  I say this as someone who is without.  I say this as someone whose family is without.  Not that it really matters.

The lesson of the Clinton failure was to avoid completely centralizing a major legislative effort.  The lesson of the Obama failure will be not to pretend you can split the difference when the extreme, however unpalatable, has the benefit of being decisive; and not to trust Congress with your major legislative effort.  That’s a shame, but it is also a fact.  Here’s another: opposition means never having to say you’re sorry.  Government means never being able to.

Then again, I make lots of bad predictions.  I can only hope this is one of those.

I guess.

[UPDATE: Apparently initial efforts to delay the crucial votes and convince the Progressives have been unsuccessful.  Shockingly.]