Now for the Ugly Part...

The assembly line in the Congressional sausage factory is ready to roll, to stuff what Max Baucus' butchers have hacked up into a casing with scraps from four other committees in the Senate and House.

Harry Reid, Nancy Pelosi and the "Bill Blenders" start work today in a process that will make the past few months look like the Lincoln-Douglas debates as lobbying groups across the spectrum flood Washington with "a torrent of spending and grassroots activity" to influence what gets into the final product.

Underlying all the din will be the central question: How much control over American health care will remain in the hands of the profiteers who have made it the most expensive and one of the worst systems in the world?

The White House, after months of trying placate the implacable, is finally framing the issue openly as Obama's deputy communications director puts it: "The insurance industry has decided to lead the charge against health reform, and everyone recognizes their motives: profits, We are going to make sure they can't sink this effort at the last minute."

The saddest part of the spectacle in the coming weeks will be the near-impossibility of a rational public conversation about the issue in a time when TV ads will make "Harry and Louise" look like "The Waltons" and the staged public outrage will make the Tea Parties look like tea parties.

The Wall Street Journal fires its first salvo at "ObamaCare" with a scare editorial about cost controls in Massachusetts and a promise to explain what the Senate Finance Committee did yesterday that its members fail to understand. "You know," it warns, "who wins when the interests of government conflict with those of patients to choose a doctor or treatment."

The only consolation for all this bilge is that it has finally reached the stage where individual voices can be heard with letters, phone calls and emails to Senators and Representatives, urging them to stand up for the public interest, and some form of the public option, against the privateers who have held American health care hostage for more than half a century.

The Last Republican

Olympia Snowe may not be out of a Frank Capra movie but, as an independent-minded Republican in an era of hard-line party politics, she is certainly an anachronism.

When Time Magazine picked her as one of "America's 10 Best Senators" in 2006, it noted: "Because of her centrist views and eagerness to get beyond partisan point scoring, Maine Republican Olympia Snowe is in the center of every policy debate in Washington."

As the Senate Finance Committee votes today on health care, Snowe is in the spotlight, wooed by Democrats including the President and being blackmailed by GOP colleagues threatening to deny her chairmanship of a powerful committee to which her seniority entitles her.

But as a Republican who supports legalized abortion and gay rights, voted against the impeachment of Bill Clinton and supported Obama's economic stimulus, Olympia Snowe, whichever way she goes today, is a throwback to the last century when party label did not require a member of Congress to go brain-dead.

In those days, there were Senators like Republican Jacob Javits of New York and Democrat Henry "Scoop" Jackson of Washington, universally respected for independence and bipartisan on issues where their views did not conform to the party line.

Snowe's life story, which has suddenly become media fodder, suggests what shaped her. Orphaned early in life (her mother died of breast cancer when she was eight, her father of heart disease a year later), Olympia Jean Bouchles spent her childhood with working-class relatives and at boarding schools, studied political science at the University of Maine and never looked back in a career that started with marriage to a state legislator and working for Republican Congressman William Cohen, who later became Bill Clinton's Secretary of Defense.

Widowed by an auto accident, she ran for her husband's seat, then was elected to the US House of Representatives and eventually remarried. Her new husband, whom she had met in Washington, was elected Governor of Maine, making her the First Lady of a state while serving in Congress--a 24/7 life in politics.

With her overwhelming approval by voters over more than three decades, Olympia Snowe has little to fear from the Republican Far Right, which makes her a rarity on today's political scene and a reminder of the way it used to be before Washington became an arena for blood sport.

Update: At mid-day, Sen. Snowe indicates she will vote yes but with reservations about what she may do on the final version: “Is this bill all that I would want? Far from it. Is it all that it can be? No. But when history calls, history calls. And I happen to think that the consequences of inaction dictate the urgency of Congress to demonstrate its capacity to solve the monumental issues of our time.”

Well--and independently--said.

"Yes We Can," "Maybe We Shouldn't"

Is Barack Obama trying to hide some innate shyness? After being on 60 Minutes almost as often as Andy Rooney and rivaling Oprah on weekday TV, the President will go for overexposure records with five Sunday talk shows tomorrow to be followed by Letterman Monday night.

The All Obama All the Time blitz is meant to explain and sell health care reform to confused Americans, but it calls up that ancient resistance to argument, "Don't bother me with facts, I've made up my mind."

Can one more rational explanation, or a dozen, undo the visceral resistance stirred up by lies and half-truths about government control crafted from thousands of pages about taxing, mandates, rationing, deficits et al?

Can any rewording of "If you like your current insurance, you can keep it" calm rampant fears about bureaucrats deciding who gets what treatment?

Can any appeal to American decency to care for "the least of these" erase suspicions that coverage for millions of uninsured will deprive current premium payers of medical attention they have been buying for years?

In the eight months of his presidency, Barack Obama has been piloting the ship of state through perilous waters, repeatedly being forced to unload billions on stimulus bills, bank bailouts and carmaker rescues to keep predators from swamping us all.

So far, his exertions have kept most Americans on board, as worried as they may be, and there are some early signs of success, but the swelling wave of ideological opposition to his health care legislation--whatever it finally turns out to be--is threatening his presidency.

The President has made his case over and over again. This weekend he risks jumping the shark with too many installments of a show that has run its course.

It seems past time for the White House to stop trying to persuade the unpersuadable and concentrate on working behind the Congressional scenes to salvage some semblance of true reform and, in Paul Krugman's words, "make some hard choices about the degree of disappointment they’re willing to live with."

Good Speech, Wrong Listeners

The President is telling an audience to work hard, develop problem-solving skills and learn how to get along with others. "Whatever you resolve to do," he will say, "I want you to commit to it. I want you to really work at it."

That advice will come today in a nationwide address to schoolchildren, but the message is needed much more in the one he will deliver to a joint session of Congress tomorrow night.

The Hard Right has been howling over the prospect of Barack Obama promoting socialism in education and in the health care system, with about as much truth in one charge as the other.

His back-to-school message urges the young to learn from the successful: "JK Rowling’s first Harry Potter book was rejected twelve times before it was finally published. Michael Jordan was cut from his high school basketball team, and he lost hundreds of games and missed thousands of shots during his career. But he once said, 'I have failed over and over and over again in my life. And that is why I succeed.'"

He may be delivering essentially the same message to Max Baucus, Nancy Pelosi, Harry Reid et al about health care tomorrow night, but there are no JK Rowlings or Michael Jordans in Congress, just a collection of goofoffs brawling during recess and trying to ace an A from voters in their next test.

But the President will keep trying in the hope that there is some truth in the bromide that no one is ever too old to learn.

Yes We Can...What?

Team Obama is in full campaign mode, firing off e-mails and organizing events to push ahead for health care reform, but nobody knows exactly where the goal line is.

According to the Washington Post, "President Obama's supporters hope to recapture the energy of last year's triumphant election campaign in a bid to regain control of the health-care debate, planning more than 2,000 house parties, rallies and town hall meetings across the country over the next two weeks."

The trouble with such exertion is that the object is not pulling the lever in a presidential election or urging a simple affirmative Congressional vote but influencing thousands of pages of still-shifting legislation in both Houses.

Yes, we can...what?

In the morass of issues involved, only the public option has come into focus to be distorted by lobbyists and loons into a future of government control and death panels, Big Lies that have to be answered with long and convoluted explanations

The demagoguery level is so high that Paul Krugman today resorts to nostalgia for the Unindicted Co-Conspirator, arguing that "Nixon’s proposal for health care reform looks a lot like Democratic proposals today. In fact, in some ways it was stronger."

On the other side of the ideological divide, George Will asserts, with some justice, that on health care reform "our ubiquitous president became the nation's elevator music, always out and about, heard but not really listened to, like audible wallpaper."

All this puts Obama supporters in the position of rushing around in all directions, trying to contain the flames of opposition in the equivalent of a Chinese fire drill.

As the Right revels in its newfound voice and the Left indicts the President for losing his nerve, health care reform is evolving beyond a crucial political and economic issue.

In many ways, it is becoming a test of how well American democracy can let rational voices be heard in a 21st century Tower of Babel--of whether Obama's new politics has enough power to revive and revitalize the best of the old.

Obama's Benign Betrayal

Inevitable as it was, news of the President's caving in on the public option brings sad confirmation that the sellout of true health care reform was inevitable.

"The White House," reports the New York Times today, "facing increasing skepticism over President Obama’s call for a public insurance plan to compete with the private sector, signaled Sunday that it was willing to compromise and would consider a proposal for a nonprofit health cooperative being developed in the Senate."

Only yesterday, the President was OpEding on the same pages, "We have broad agreement in Congress on about 80 percent of what we’re trying to do," but the ground he is ceding to the Congressional Establishment and lobbyists is the difference between repair to a bad system and real reform.

After months of insisting that a government plan was needed to "keep the insurance companies honest," the President is backing off by telling a Colorado town hall yesterday, "The public option, whether we have it or we don't have it, is not the entirety of healthcare reform. This is just one sliver of it, one aspect of it. And by the way, it's both the right and the left that have become so fixated on this that they forget everything else."

Not so. This rhetorical sleight-of-hand may reflect the President's conviction that half a loaf or three quarters is better than none, but it's Bill Clinton-slippery of him to label it a right-and-left issue, sidestepping the fact that Max Baucus, recipient of $3 million from the industry over five years with a platoon of former staff members working as lobbyists for them, is prevailing in the Senate Finance Committee, to gut the legislation of its crucial elements.

In the face of the ideological madness that has been stirred up on the subject, Obama's backing off is understandable for the pragmatists in the White House but bitterly disappointing for an Administration that promised to overcome politics as usual and fight for real Change.

The patchwork legislation to emerge will leave Democrats claiming victory and Republicans denouncing a government takeover of health care, but both will be trading politically on what will be a betrayal of the long-term public interest on a critical issue.

"Honey, We Shrunk the President"

After months of a bigger-than-life presidency, Barack Obama is being cut down to size--by the enormity of an economic crisis, by orchestrated fear of Change as a reality rather than an idea and by exhaustion of the hope and idealism he stirred up during two years of campaigning. But behind the falling poll numbers and raucous town halls, something else may be going on.

"Health Debate Fails to Ignite Obama’s Web," says a New York Times headline for a report from Iowa: "As the health care debate intensifies, the president is turning to his grass-roots network--the 13 million members of Organizing for America--for support.

"Mr. Obama engendered such passion last year that his allies believed they were on the verge of creating a movement that could be mobilized again. But if a week’s worth of events are any measure here in Iowa, it may not be so easy to reignite the machine that overwhelmed Republicans a year ago."

Sensing a potential Obama Waterloo, the previously overwhelmed are suddenly energized. "The Obama White House has done the near impossible," Peggy Noonan claims. "It has united the Republican Party. Social conservatives, economic conservatives, libertarians—they're all against the health-care schemes as presented so far. They're shoulder-to-shoulder at the barricade again."

Maybe so, but there are also signs that Obama is morphing, not into Jimmy Carter as Noonan suggests, but more of an embattled Harry Truman who found his presidential voice by taking on a "good-for-nothing" Congress in 1948.

In his less combative way, Obama is now directly confronting the proprietors of America's failed " health care system that works better for the insurance industry than it does for the American people."

In today's weekly address, he says: "If you’re worried about rationed care, higher costs, denied coverage, or bureaucrats getting between you and your doctor, then you should know that’s what’s happening right now. In the past three years, over 12 million Americans were discriminated against by insurance companies due to a preexisting condition, or saw their coverage denied or dropped just when they got sick and needed it most.

"Americans whose jobs and health care are secure today just don’t know if they’ll be next to join the 14,000 who lose their health insurance every single day. And if we don’t act, average family premiums will keep rising to more than $22,000 within a decade."

In Montana yesterday, the President was confronted by an insurance salesman who asked him to explain why he was "vilifying" insurance companies. Obama told him and, in the coming weeks, will undoubtedly be telling Americans everywhere who the enemy is.

In what looks like the wreckage of his hopes for health care reform, Barack Obama, like John Paul Jones when asked to surrender, may be saying, "I have not yet begun to fight."

Stupidity as a Pre-Existing Condition

The rowdiness will no doubt subside, but could civility save the "debate" over health care? The signs are not encouraging.

Today the President devotes part of his weekly address to "dispelling the outlandish rumors that reform will promote euthanasia, cut Medicaid, or bring about a government takeover of health care.

"That’s simply not true. This isn’t about putting government in charge of your health insurance; it’s about putting you in charge of your health insurance."

A Republican rebuttal comes from the newly liberated Sarah Palin on her Facebook page:

"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s 'death panel' so his bureaucrats can decide, based on a subjective judgment of 'their level of productivity in society,' whether they are worthy of health care. Such a system is downright evil."

As Obama and Democratic Congress members spend time and energy treating such stupidity as a pre-existing condition, the real issues in health care reform may be quietly being bartered away behind the usual closed doors.

A perfect example surfaces with news that the Administration had assured lobbyists that "any health care overhaul would not include allowing direct government negotiation of drug prices or require certain additional price rebates."

Now that this deal has gone public, the Obama White House is backpedaling away from it, but it raises questions about what else is being aborted there as well as in the Baucus-Grassley operating room on Capitol Hill in the name of bipartisanship.

When the hecklers are gone from TV screens next month, what will remain of real health care reform?

Unhealthy Debate About Health Care

Left and right, anxiety over the ugly turn of American politics this month is provoking conflict about the conflict.

Paul Krugman decries "recent town halls, where angry protesters--some of them, with no apparent sense of irony, shouting “This is America!”--have been drowning out, and in some cases threatening, members of Congress trying to talk about health reform."

Across the ideological divide, Peggy Noonan finds, "What the protesters are saying is, 'You are terrifying us,'" expressing "a feeling of rebellion, an uprising against change they do not believe in."

Both sides agree that some of the outrage is trumped up--by "well-heeled interest groups...crass as they come" (Krugman) or the White House itself (Noonan), compiling an "enemies list" with an "email address to which citizens are asked to report instances of 'disinformation' in the health-care debate."

According to The Hill, "The showdowns between lawmakers and constituents have not only fueled the high-stakes battle over healthcare reform but also started a debate over the authenticity of the interruptions.

"With websites like EmbarrassYourCongressman.com encouraging activists to upload video and pictures from the heated meetings, Democratic members are asking Speaker Nancy Pelosi whether they should continue holding town hall meetings with large numbers of people...

"The Speaker has advised her rank and file to do what they deem appropriate. She said scheduled town hall meetings should go ahead as planned. There are other ways to get the message out, including tele-town halls, interviews, one-on-one meetings with constituents and news conferences, leadership aides said."

We are a long way, as Krugman notes, from the Norman Rockwell painting illustrating FDR’s "Four Freedoms" that "shows an ordinary citizen expressing an unpopular opinion. His neighbors obviously don’t like what he’s saying, but they’re letting him speak his mind."

For an historical parallel, we have to go back even more to William Butler Yeat's post-World War I poem, "The Second Coming":

"Things fall apart; the center cannot hold;/Mere anarchy is loosed upon the world.../The best lack all conviction, while the worst/Are full of passionate intensity."

The Crooked-Doctor Component

While the nation suffers a political migraine over health care reform, today's news spotlights an overlooked aspect of the mess--that the current system is turning doctors into thieves.

Federal authorities yesterday arrested 30 physicians and other medical providers for $16 million of fraud as part of a series of crackdowns in what the FBI estimates to be between $60 and $100 billion a year of health care crime.

The healers this time are accused, among other neat tricks, of billing Medicare for liquid food provided to dead patients and $4000 "arthritis kits" consisting of braces and heating pads.

Such a financial and moral breakdown was dramatized in a New Yorker article last month that President Obama has made required reading in the Oval Office.

Written by a New England surgeon, Atul Gawande, it reports on the small town of McAllen, Texas, which has the second-highest per-capita Medicare costs in the country (after Miami) and twice those of neighboring El Paso with no discernible health benefits as a result of doctor-owned hospitals, surgery centers and diagnostic-test facilities.

This kind of borderline thievery transcends the question of public or private health insurance, calling into question the fees-for-service nature of American health care.

"Providing health care is like building a house," Dr. Gawande writes. "The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later?"

He points to alternatives such as the Mayo Clinic and other "accountable-care" systems in which doctors and hospitals "adopted measures to blunt harmful financial incentives and...took collective responsibility for improving the sum total of patient care."

In overhauling the system, he concludes, "the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.

"There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous."

Meanwhile, the fraud and waste go on. The President should send copies of the New Yorker article to Congress. Reading it first will give them some perspective on the thousands of pages of the new bills they will be studying during their summer break.

The Upside of Inertia

Six months and counting, Obama's Era of Change has reached a crucial point where the push against "politics as usual" has found a test case in health care reform

At his press conference last night, the President observed that "if you don't set deadlines in this town, things don't happen. The default position is inertia, because doing something always creates some people who are unhappy. There's always going to be some interest out there that decides: You know what? The status quo is working for me a little bit better."

In his struggles against deadlines in the stimulus bill, bank bailout, imminent downfall of Detroit et al, Barack Obama has been governing on a crisis high, where the dangers of doing nothing far outweigh the pitfalls of not getting it exactly right.

Now he is tilting against a health care dragon that has fed on half a century of greed, neglect and, yes, inertia, and his assault is being slowed not only by Republican reflexes as the Party of No but doubting Democrats and the slow erosion of public support for multiple proposals that have failed to cohere into a clear alternative to the current mess.

As the momentum for Change slows, the President may want to consider that inertia in American life has always worked both ways, as a deterrent to progress but also as a brake to driving off a cliff in the passions of the moment.

Nancy Pelosi may or may not "have the votes" to push a bill through the House, but the President--and the country--would be well served by stepping back from a half-year of a crisis high and taking a deep breath to sort out the various aspects of reform--the costs, the savings, the clear need for a public option--and put them together for a consensus that would appeal to all but the extremes of the political spectrum.

In the Senate, Dick Durbin doubts there will be a vote before the start of a month's recess on August 7th to get a bill to the President by his goal of mid-October, since differing House and Senate versions would take weeks, if not months, to reconcile.

On a subject that literally affects people with life-or-death consequences, it's painful to counsel patience, but as the effort of the early Clinton years showed, real chances to get better health care are few and far between. Inertia may be maddening, as reflected in the President's sense of urgency last night, but it also has its uses.

The Politics of Attention Deficit Disorder

Six months of scrambling on all fronts--bank bailouts, economic stimulus, climate change--have brought the President lower approval ratings from a public suffering from crisis overload and left him needing a Hail Mary pass to score on his key issue.

"With skepticism about the president's health-care reform effort mounting on Capitol Hill--even within his own party," the Washington Post reports, "the White House has launched a new phase of its strategy designed to dramatically increase public pressure on Congress: all Obama, all the time.

"Senior White House aides promise 'an aggressive public and private schedule' for Obama as he presses his case for reform, including a prime-time news conference on Wednesday, a trip to Cleveland, and heavy use of Internet video to broadcast his message beyond the reach of the traditional media."

This test of presidential clout, coming up on a complex issue against the background of other trillion-dollar commitments that have still to bear fruit, leaves him exposed not only to Republicans with their simple-minded message of tax phobia and deficit fear but increasing anxiety among 2010-vulnerable Democrats who now sense a potential lack of visible progress on all fronts by next fall to keep them in office.

In this kind of ADD political climate, health care legislation lends itself to demagogues' cover on all sides, with providers "promising" non-binding new efforts to cut costs as Republicans line up with Senate Finance Chairman Max Baucus to "back" a future public option for health insurance with trigger mechanisms that will never be pulled off.

This leaves the President having to resist the temptation to settle for small gains that can be claimed as victory but will leave the failed health-care system fundamentally unchanged.

As he embarks on this week's campaign, to get him into "Win one for the Gipper" mode, he may want to take to heart Ted Kennedy's valedictory in Newsweek, "The Cause of My Life," which retells the medical consequences from generations of the "Kennedy curse" and makes a passionate plea for universal health care now.

Democracy of the Deaf

In Washington's two debates this week, health care reform and the Sotomayor nomination, you could turn off the TV sound and miss little of substance--the D or R on the chest of the talking head will tell you that the subject is universal coverage or government control and deficits, judicial qualifications or activism.

The election of a president who prides himself on reaching across political divides has resulted in the irony of more partisanship than ever as remnants of the Republican party that rode roughshod over opposition in the Bush years are reduced to mouthing the slogans that brought them to power back then.

On health care, it's the Blue-Dog Democrats who are discussing the substance of proposals as the GOP repeats scare mantras about socialized medicine and keeps voting a straight party line in committees.

In the Sotomayor hearings, Republicans are obsessing over the Wise Latina remark and other speeches, while majority members are asking the judge about specific cases and legal principles in the course of her career on the bench.

As the Obama Administration closes in on its first six months in office, the reality of possible bipartisanship keeps receding, leaving it as only more slogan in a dialogue of the deaf.

Health Care as a Right

The House proposal to raise taxes on the very rich to help cover health insurance for all brings into focus what has been a hidden issue in the debate until now: Should medical care be a right guaranteed to all by all, as education, safety in the streets and freedom from foreign invasion now are as part of life, liberty and the pursuit of happiness?

If government pays for the schooling of Americans and their safety in the streets, is it any less logical to consider protection from life-threatening disease as a basic right rather than an individual choice?

"Tax is a four-letter word" with voters, says conservative Democratic Sen. Ben Nelson, pointing out that even families not in the top 1 percent "hope they're going to be there someday. So they don't necessarily think it's fair."

Even the Rightmost legislators and their constituents wouldn't propose privatizing the armed forces (pace Blackwater) and the nation's school systems but will argue that even partial public responsibility for saving lives in doctors' offices and hospital waiting rooms is unfair.

As the final showdown on health care reform comes closer, the President and his supporters are going to have to make that case against those who are still living with the Dickensian attitude that public responsibility for the poor ends with workhouses and prisons.

With Ted Kennedy's Senate committee now offering its own version of 21st century health care, that time is at hand.

Health Care Fallbacks

The Obama White House is waffling on the public option and making piecemeal deals with providers, as hospitals now agree to sacrifice $155 billion over 10 years toward the cost of insuring 47 million Americans without coverage.

With the Administration conceding it "won't draw a line in the sand" and citing the Bush prescription-drug benefit in 2003 as a precedent, real health care reform is receding into a politics-as-usual charade to give the illusion of Change while making marginal improvements.

Now, the catch phrase is "trigger mechanism" that would let a public plan come into play when "competition was judged to be lacking," an evasion of breathtaking vagueness.

With Ted Kennedy on the sidelines, the Senate Health, Education, Labor and Pensions Committee is weakened in its efforts to push for an immediate public plan, but rhetoric is still strong.

Sen. Chuck Schumer is emoting: "If it's not there on day one, those of us who support a public option have a real problem with it."

Not exactly "We have just begun to fight," but with true reform approaching critical condition, the vital signs are growing weaker. Those who want to rage against the dying of the light had better make their voices heard soon.

Health Care Horror Show

After eight years in a Bush coma, Congress is busy "working" again and proving it doesn't work. The health care debate is a classic of evasions, non-sequiturs, empty rhetoric and lobbyist lies to patch together reform that will look like a Frankenstein monster with a Dr. Strangelove deception at the heart.

Despite public support for a government insurance plan, House and Senate members are going through contortions to craft something to look like one but guaranteed to fail.

Even Tom Daschle, the President's derailed first choice for health czar, has had an opinion transplant. Last year, he wrote a book arguing that a single-payer health care system would be fair, effective and save billions of dollars. Now he has joined has-been Republicans Bob Dole and Howard Baker to oppose a federal insurance plan.

"We've come too far and gained too much momentum for our efforts to fail over disagreement on one single issue," Daschle now says.

This recalls the classic response of a general in "Dr. Strangelove" who, being asked how a system designed to avoid nuclear devastation has allowed a failure that is about to blow up the world, "Well, I don't think it's quite fair to condemn a whole program because of a single slip-up, sir."

The military metaphor seems apt in the circumstances. As a nation, we don't outsource wartime safety of citizens to private contractors (with the exception of Blackwater, which proves the point). Why then has saving lives in peacetime become a for-profit enterprise that clearly isn't working for individuals and is endangering the whole economy to boot?

Is socialized medicine any more of a threat to the American way of life than a socialized Armed Forces?