When it’s a close-run thing just one person can make a difference and change everything – like in a football game tied in overtime when the hopelessly obscure fellow subbing for an injured substitute linebacker, who had himself been subbing for the injured superstar, makes that key interception and runs the ball back for the winning touchdown. No one expected that. The guys with the ball ran the play his way because he was clearly not that good – they could burn him. Oops. But you just never know. On the other hand, that actually seldom happens. The new guy usually gets called for dumb rookie pass interference near the goal line and the other team walks into the end zone on the next play, and that’s that.
But either way, one seemingly minor person can change everything – all the coordinated teamwork, all the scouting and strategy, and all that business of choosing the prefect offensive play or defensive scheme, ends up counting for little. One guy can change it all. One guy usually does.
Of course one thinks of Joe Lieberman, the Independent senator from Connecticut, who caucuses with the Democrats, as he used to be one, and almost never votes with them, and as things have worked out is the one man who can stop any sort of healthcare reform in America and make sure it won’t be considered again for another sixty years. It has all come down to him.
Yes, the idea of having a national healthcare system, where all citizens are assured that when they fall sick or have an accident, or need some sort of medical attention, that there’s a system in place, so no one dies in the street and that sort of thing, has been kicking around since the days of FDR and all the rethinking of the idea that the government should look out for the well-being of its citizens. That would be good for everyone, and probably even good for business. In hard times, like the Great Depression, such things were bound to come up. People were dying in the streets. Others were, in fact, starving. Nothing much was working. And we had a government, purportedly representing the people, and supposedly established by the people, that could print money and assume debt and still do things. Why not use it? We did get Social Security, and a whole lot of make-work WPA jobs – so there were new roads, new bridges, the Hoover Dam, new schools and municipal buildings, the TVA bringing electricity to a big swath of rural America and all sorts of things. That was fine. The number of elderly who died in poverty dropped dramatically – everyone chipped in with Social Security taxes so they now got enough to get by. And people were working. The economy was no longer frozen. We just never got around to a healthcare system. It remained an interesting idea – something that was what a government might do for the good of all its citizens, and to assure a healthy population of workers for the fields and factories. Well, you can’t do everything all at once.
Harry Truman proposed finishing the job – a national healthcare system where everyone was assured basic care. But that got shot down – the AMA said it would ruin everything, doctors were independent businessmen and would have the business, their livelihood, taken from them. They successfully labeled it socialism. Everyone hates socialism, so we only got pieces of a national healthcare system, for specific populations, the VA for veterans, then Medicare for those over sixty-five and others in special circumstances. No one opposed the government taking care of veterans – that would be political suicide – but Ronald Reagan led the charge against Medicare. In 1961 as part of Operation Coffee Cup, he recorded a long playing record as a paid spokesperson for the American Medical Association called “Ronald Reagan speaks Socialism” – listen to it here. Medicare would be the end of America as we know it. But it wasn’t. Now people seem to like it. But it was limited in scope.
The Clinton Administration gave it a go, but when Bill handed the task of proposing a national healthcare system to Hillary, things went south, fast. You got the same argument about socialism, to enrage the public, and she managed to design a system pretty much in secret, with mysterious consultants, and then spring it on Congress as the way things should be. That was seen as arrogant, and she hadn’t been elected to anything. She was the First Lady, America’s perfect housewife. Who did she think she was? What was Bill trying to pull? The whole thing was a disaster.
And now the Obama administration, leaning from all this, seems poised to enact some sort of healthcare reform – having let Congress hash out the design under very general guidelines, and having headed off those wetting their pants over any whiff of socialism by making sure the insurance cartel and major pharmaceutical conglomerates and big hospitals chains knew they would still be able to make money hand over fist. The idea was not to get rid of them, just give them forty or fifty million new customers, with the government picking up the tab for whatever they wished to charge, no questions asked. All they had to do was agree to not arbitrarily cut people off, and to insure those with preexisting conditions. It was a trade-off. They would get a ton of new business, but some of those will be what the insurance companies call dogs – those who cost them too much money. But of course the government would cover their losses there. What was not to like?
That things have gotten this far is amazing. But think of that football game. All the coordinated teamwork, all the scouting and strategy, and all that business of choosing the prefect offensive play or defensive scheme, ends up counting for little when one guy can change everything. And that guy is Lieberman, and there are two factors that made this so.
The first is structural. The rules of the Senate didn’t change, but how they are used has changed. As always, debate can go on forever, and often seems to. Some senator will eventually say enough of this, we’ve heard it all, people are repeating themselves, this is going nowhere, so let’s just vote on this damned thing and be done with it. They call for an end to debate and an up-or-down vote on the floor – they call for cloture. But the rule is that cloture requires sixty votes. If you cannot assemble sixty votes the issue remains open. And the Democrats don’t have sixty votes – they have fifty-eight, and the Independent senator from Vermont, Barry Sanders, and the Independent senator from Connecticut, Liebermann, who loves to stick it to the Democrats and seldom votes with them. They’re almost always one vote shy of cloture. And the Republicans, who are famous for their party discipline, know this. They stick together and defeat any cloture vote, on any matter before the Senate. What had previously been quite rare, a vote to stop all the talking and just vote being opposed, is now the norm. The minority of forty can stop all Senate action, and they do, on everything. And it is great politics – you can say the president cannot get anything through Congress, that he’s an incompetent ninny. And you can say the Democrats in Congress are useless – they can’t get anything done, so throw the bums out. You can run on that. The upshot is that for anything to pass in the Senate, anything at all, you need sixty votes, always. Things used to be a matter of majority rule. Now they are not. Thus Joe Lieberman has the final say on every issue before the Senate. He is the one man who decides what happens in America, as most everything has to be approved by the Senate – funding for everything, appointments to the Supreme Court and key government positions, treaties that need ratification and all the rest. Things just fell out that way when the Republicans adopted this new virtual filibuster tactic for all Senate business. Lieberman is like that third-string linebacker when the game is on the line. It’s all on him.
But of course he loves it, and that’s the other factor. Lieberman is a bitter, angry, sanctimonious man who loves to stick it to the Democrats. And there’s a history to that. He was, early on, Holy Joe, with his holier-than-thou speeches about the world going to hell in hurry. He was the first to publically condemn Bill Clinton over the Lewinsky matter, from the floor of the Senate, saying Clinton pretty much wasn’t much fit to live. And he kept it up. Al Gore put him on the ticket in the 2000 race, perhaps because Gore needed to distance himself from Clinton with the Value Voters on the right. But it didn’t help. Gore got himself a smug scold, boring some and offending others, who was also an ostentatiously Orthodox Jew, turning his piety into political theater. It quickly got absurd. And when the right started calling the ticket Bore-Loserman, well, you could see Gore shrug but Liebermann stiffen in anger and defensiveness. And then they lost. Lieberman was not a happy camper. He was better than everyone else, morally. Why didn’t people see that?
And then Bush’s war in Iraq came up, and Lieberman was all for it. Part of that was that the war was the only thing that could save Israel, which meant much to him, and part of that was moral too – they were the bad guys, we were the good guys, and that was that. And when there were no WMD and then no ties to al-Qaeda, he dug in his heels. He couldn’t have been wrong. We had to take care of these people, with all-out war – Afghanistan then Iraq and then Iran. He was the total hawk, actually to the right of most of the Republicans. And then he lost the Democratic nomination for re-election the last time he ran for Senate, in 2006, to an anti-war guy, Ned Lamont, who said it was time to step back and rethink all this. The Democrats in his own state told him to go away. But he was better than everyone else, morally. Why didn’t people see that? He had to run as an Independent, and barely made it back to the Senate. And he made it back to the Senate with a chip on his shoulder, carrying the mother of all grudges. So it was little wonder he broke with the Democrats and not only supported John McCain, but campaigned with him, covering up the old man’s errors and confusion by whispering in his ear when McCain got the basic facts wrong.
But the Democrats need that sixtieth vote, so they still need Joe. They let him caucus with them, and he still retains his chairmanship of the Homeland Security and Government Affairs Committee, a post he holds at the pleasure of the Democratic-controlled Senate. But they dare not strip him of that. He’d go ballistic. All work in the Senate would freeze – a stalemate on everything.
And that brings us back to healthcare reform:
Risking the wrath of Democrats, Sen. Joseph Lieberman, I-Conn., threatened Sunday to join Republicans in opposing health care legislation if it permits uninsured individuals as young to 55 to purchase Medicare coverage.
Lieberman, whose vote is critical to the bill’s prospects, expressed his opposition twice during the day: first in an interview with CBS, and more strongly later, according to Democratic officials, in a private meeting with Senate Majority Leader Harry Reid.
Democratic aides, speaking on condition of anonymity, said Lieberman later told Reid he would support a Republican-led filibuster against the bill if it contained the Medicare provision or permitted the government to sell insurance in competition with private companies.
It’s 1961 and Operation Coffee Cup all over again, with Lieberman playing the part of Reagan. There will be no Medicare provision, and in no way will he allow the government to sell insurance in competition with private companies. He alone can stop this, and he alone will. He is the one who will determine what happens in America – he’s no longer Al Gore’s calculated afterthought, and Ned Lemont and his like can rot in hell. And he’s far more powerful than Obama, damn it.
But if you go on to read this AP item you’ll see he softens that by saying that really, that Medicare provision, expanding it, is unnecessary – the exact word he uses – as is messing with private companies selling insurance, without competition from government. Hell, if there were a US Postal Service, FedEx and UPS would go under tomorrow – or something like that.
But think about that. We have a system where you pay private companies for access to doctors and hospitals and clinics. You pay your money, or your employer does, and the private for-profit companies let you use the providers they have under contract. Otherwise, there will be no healthcare for you. The providers have these contracts – they don’t take random patients with cash in hand. So you have to pay for access to the system. And get in trouble and find yourself having to use a doctor or hospital out of network, as they say, and you’re on your own. And these private for-profit companies reserve the right to limit or rescind your access to what they have, for any reason they choose, at any time. They may approve some treatment, then, after you’ve been serviced, if you will, refuse to pay the provider, so you’re stuck with the bill – they have to contain costs to stay solvent, after all. You choose a doctor from their roster, only, who has privileges at only the hospitals with which they’ve contracted, and they will then also ration your care, to contain costs. Some panel may determine that – that you don’t see this specialist or that, or you don’t get this treatment or that – but at least it’s not a government Death Panel. And it’s not socialism. It’s free-market capitalism at its best. What’s not to like? Why would you think anything else is necessary?
Joe is fine with this, so you’d better be fine with it too. But the big game always comes down to one player in the end, doesn’t it? How it turned out to be Holy Joe is a curious tale, but that’s how things worked out. Consider it his revenge for not being elected nine years ago. He got to where he wanted to be anyway. He seems to find it sweet.
And to complicate matters there’s the cave-in that healthcare reform advocates feared – the Senate healthcare reform bill permits insurers to place annual caps on a given policyholder’s coverage.
As Andrew Sprung notes here, this allows for “illusory” insurance – “the kind that switches off when costs become ruinous.”
And he cites Stephen Finan, a policy expert with the American Cancer Society Cancer Action Network, saying this – “The primary purpose of insurance is to protect people against catastrophic loss… If you put a limit on benefits, by definition it’s going to affect people who are dealing with catastrophic loss.”
But this is not exactly a corporate giveaway. Sprung says it is just the result of “political pressure generated by the misleading sloganeering that passes for political debate in this country.”
Ezra Klein explains:
The tradeoff here is slightly higher premiums for everyone versus total financial ruin for the people who absolutely need help the most. Politically, choosing “everyone” rather than “people with cancer” makes sense, because the first group has more votes than the second. But on a policy level, it is nuts. Health-care insurance literally exists to protect us from the worst-case scenarios. This provision says that the Senate bill will protect everyone but the truly worst-case scenarios. If you assume that people support the basic concept of health-care insurance, then they don’t, or shouldn’t, support this.
But the American people are much more likely to hear that premiums are going up than they are to get a detailed explanation of what they’re getting in return for higher premiums, and so the Senate bill is watching its back. In a more sensible political system, however, the two parties would agree to institute a reinsurance program, as Reihan Salam has suggested. Chuck Grassley has broached reinsurance in the past, but he seems more interested in opposing this bill than improving it, so I don’t see much chance of him resuscitating the idea.
Wait – reinsurance? You’d buy insurance to cover what your insurance doesn’t cover? And the insurer and reinsurer would both make a ton of money? Actually, Holy Joe might like that.
But Andrew Sprung is not impressed:
The pressure to gut coverage rules to meet cost control targets highlights what a long road the U.S. has to travel before we manage genuine universal health insurance. In France, Germany, Japan, Canada, the U.K., and every other wealthy country in the world, a citizen’s risk of being bankrupted by health care costs or denied access to a level of treatment available to any fellow citizen is zero. In the United States, the best we can hope for within 5-10 years (and it will be an enormous improvement) is to cover 94% of the population, with premiums that in many cases will cause significant financial hardship, under coverage rules riddled with fewer holes than are now allowed but with as-yet-undetermined (and under-reported) gaps remaining. With those limitations, we’ll still spend 50-100+% more per capita than the wealthy countries that provide true universal care under a variety of payment systems – that is, every wealthy country but the U.S. …
The House bill bans annual coverage caps. Protecting that ban is worth going to the mat for.
Yeah, but Joe will win. It’s his country now. You will pay for not taking him seriously.