There are a number of people on the left wing of the Democratic Party who are dismayed at the recent turn of events in Washington. The election of a Republican to Teddy Kennedy’s seat in Massachusetts, the Supreme Court’s 5-4 decision re-instating corporate and union campaign spending, and a reinvigorated Republican Party portend a rough road ahead for the liberal agenda.
If a charismatic and popular Democratic president can’t pass health care reform with a solid majority in the U.S. House and 60 of the 100 seats in the Senate, the lament goes, how much change can any president bring? The answer, I’m afraid, is not much.
Sure, there are always things a president can do on his own. On his first day in office, President Obama signed executive orders to close down Guantanamo, ban prisoner torture, and end the revolving door between White House staff positions and offices on K Street. He gave a well-received speech to the Islamic world in Cairo and re-drafted the marching orders for Iraq and Afghanistan (for better or worse). Through the cabinet departments, he has affected thousands of small matters with a thousand regulatory changes, and made big changes on Wall Street, in the auto industry and global markets using emergency measures approved during the Bush administration, including juggling money in the TARP accounts.
But major changes in public policy invariably must pass through Congress, and, as the last eight months has demonstrated, Congress is the lowland swamp of politics, placid on the surface, murky below, infested by disease-carrying lobbyists and dominated by snakes and crocodiles with no other interest than their own self-preservation.
The irony is that it took a debate over health care to bring all this to the surface. Health care was not Obama’s strong suit in the campaign. Other candidates had far more detailed and more strongly-held positions. But in “the fierce urgency of now” Obama convinced himself health care reform would never have a better chance than when the winds of change were strong, and blowing at his back.
The Devil in the Details
He sent his package up to the Hill on a bed of olive branches. In Obama’s formulation of reform, he would outline the parameters, then he would leave it to the legislative process to work out the details. Republicans and Democrats, consumer advocates and industry lobbyists, patient caregivers and patient advocates all would have their say. There would be hearings and compromises, debate and discussion, but he promised, “We’re going to get it done!”
Alas, health care reform is very much undone today because the devil is in the details. Every step of the rocky path toward passage has proven perilous, and idealism has taken its knocks at every turn. The first sign of danger came when Republicans in the U.S. House sat on their hands and refused to participate. This left House Democrats an open field to lard up their bill with favors for the special interests. That in turn set the stage for even more horse-trading in the Senate, where the infamous Senate rule 22 governing filibusters meant Democrats would need every one of their 60 vote majority to get anything passed.
Over the summer and early fall, the issue that dominated health care reform was whether there should or should not be a public option. The vigorous debate Obama envisioned on Capitol Hill played out with far more fervor in the blogosphere. Liberal bloggers defiantly pressed for a government health plan as a way to rein in greedy health insurance companies; conservatives debated whether it was the first or last step on a slippery slope to socialized medicine.
In their own separate but identical way, the cable newsers flogged the health care debate like it was a rerun of the 2008 campaign, a second chance as it were for the demagogues on Fox and MSNBC to get in their licks at the other side. It had the same viewer appeal as an election (and almost as many TV advocacy spots): passionate spokesmen, heartrending personal stories, villainous opponents, and a deep, fundamental philosophical division over whether the government should or should not be in the health care business. (That train, of course, left the station years ago. Medicare and Medicaid alone, not to mention hospital subsidies, research grants, insurance re-imbursements, drug patents, veterans’ care and disease control, constitute 23 percent of federal spending every year.)
Show Me The Money
Meanwhile, the actual bills that were working their way through Congress were so much more than an up-down vote on a public option that the halls of Congress swarmed with lobbyists. Some 338 health care entities registered to lobby on the issue and over the last two years they have spent $635 million doing it. According to a study by the Center for Responsive Politics and Northwestern’s Medill News Service, the health care lobbyists included 13 former lawmakers and 166 former aides to committees and party leaders who were shaping the bills. At least 14 of them had worked for House majority leader Steny Hoyer and 13 were former aides to Montana Democratic Sen. Max Baucus, whose Finance Committee version passed in the Senate two days before Christmas on a 60-39 vote.
By then, Baucus’s bill had become a 2,074 page Christmas tree of special interest favors (many added with no public debate). To win over the vote of Louisiana Sen. Mary Landrieu, Baucus inserted $300 million in added Medicaid for parishes struck by Hurricane Katrina. For Nebraska Sen. Ben Nelson, there was a clause to reimburse his state for any added Medicaid costs in the bill. For Oregon Sen. Jeff Merkley, a last-minute exemption from the Cadillac health tax for longshoremen in his state. Connecticut Sen. Chris Dodd won authorization of federal funds to construct a university hospital that can only be built in Connecticut. Florida Sen. Bill Nelson got $3.5 billion to allow seniors in his state to keep their Medicare Advantage policies while seniors in other states were losing theirs. In handing out favors to other states, Baucus didn’t forget his own. The final bill assures that the 2,800 residents of Libby, Montana, who were exposed to asbestos in a local vermiculite mine will be eligible for enhanced Medicare assistance.
Many of us grew up on history class lessons of senators who, on momentous occasions when great issues were at stake, stood out as exemplars of courage. This was not one of those occasions. The examples of senators acting in venal and petty pursuit of their own self-interest were far more numerous, and Senate Majority Leader Harry Reid made it seem like that was a good thing. “I don’t know if there is a senator that doesn’t have something in this bill that was important to them,” he said. “And if they don’t have something in it important to them, then it doesn’t speak well of them.”
A Winking White House
Up until the Massachusetts special election last week, President Obama wasn’t particularly concerned with how Reid “got it done.” Whatever got the Senate to 60 votes was good by him. Now that Scott Brown’s election has dropped that to 59, however, the rhetoric coming out of the White House has gone from “the fierce urgency of now” to the less inspiring “watching sausage-making is never pretty.”
In the State of the Union address, Obama tried to climb back onto the moral high ground. He admitted health care has become enmeshed in too much horse-trading and vaguely offered to “take my share of the blame for not explaining it better to the American people.” In an earlier interview with ABC’s Diane Sawyer, he called the health care debate “a big mush,” adding “I didn’t make a bunch of deals. There is a legislative process that is taking place in Congress and I am happy to own up to the fact that I have not changed Congress and how it operates the way I would have liked.”
The president did a good job in his speech identifying the public’s “deficit of trust” in the way Washington works. “What frustrates the American people is a Washington where every day is Election Day. . . . Washington may think that saying anything about the other side, no matter how false, is just part of the game. But it is precisely such politics that has stopped either party from helping the American people. Worse yet, it is sowing further division among our citizens and further distrust in our government.”
But Obama’s first year in office has given the public more than speeches to go by. You don’t name Rahm Emanuel your chief of staff unless you intend to make deals with Congress, and putting him in charge of the health care negotiations was like asking Evil Knievel to write the highway safety regulations. Nothing is out of bounds –– unless you crash. As Mark Halperin and John Heilemann point out in their new book “Game Change”, even as a freshman senator, Obama was skeptical about what could be accomplished in the Senate. “The glacial pace, the endless procedural wrangling, the witless posturing and pettifoggery, the geriatric cast of characters doddering around the place: all of it drove him nuts.”
In his first year of engagement with the process, after all the past promises of change, there is little evidence that Obama played the game any differently; or if he did, that it was a winning strategy.
The lesson of the last eight months has been the hard to swallow reality the legislative process, as it is euphemistically called, is agonizingly slow, petty and pernicious – largely by design – and it’s not going to get any better in the coming years. The new free flow of corporate cash into politics all but assures that entrenched interests will become more entrenched; and special interests that have no champion will––for the right price––find one. Until Congress can come up with a way to change that, any sausage coming out of the factory will look very much like tainted meat.