By Suzanne Gordon
Salt Lake Tribune
Progressive Media Project
01/15/2010

I’ve had enough of the derisive talk about “Cadillac” health insurance plans. They’re not all that they are cracked up to be, and they are not what is driving health-care costs skyward.

My husband has been a union member and staffer for many years, and his employer provided my family (as a hard-won benefit of union negotiating) with what is now considered an unnecessarily “luxurious,” “wasteful” insurance vehicle.

So let me tell you how we’ve used our insurance plan over the past few years and how, in turn, it has misused us.

Three and a half years ago, I had an emergency appendectomy. During the surgery, I suffered several preventable complications, one that has proved to be quite serious. As a result, I needed extra visits to multiple doctors and physical therapists, as well as MRIs, ultrasounds and a variety of painkillers and other medications.

My husband was bitten by a feral dog in El Salvador and had to get 10 rabies shots when he got home.

Our daughter needed a variety of pills and shots before going to Rwanda to work for a group that helps women who were raped and infected with HIV/AIDS.

How have we fared when we’ve taken the Cadillac for a ride? Not well.

For more than 25 years, I was on the rolls as Suzanne Gordon, but then the insurer suddenly renamed me Suzanne Early (giving me my husband’s last name) when I submitted bills for my emergency appendectomy. Since there is no Suzanne Early (at least
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not one who’s actually me), it was no surprise that they couldn’t identify me as an enrollee. Claim denied. That took months to sort out.

When my husband got his rabies shots, the insurer denied the $1,000 claim because somehow the services weren’t coded as “medically necessary.” In his lengthy conversations with the insurer, he reminded them that since rabies is invariably fatal, dying of the disease would cost the company a heck of a lot more than $1,000.

No matter. To get the bill paid, it took a year of haggling, including receipt of many threatening letters from not just one but three bill collectors. And for months after the problem was resolved and the bill paid, we still were receiving dunning notices from one bill collector.

When my daughter needed more than the formulary-allotted supply of malaria pills (you can’t easily get them in Rwanda), it took dozens of calls to pharmacists, doctors’ offices and the union’s human relations department to get them and renew them.

Driving a Cadillac, it turns out, is almost a full-time job.

Like so much else in our health care debate — “death panels,” “socialized medicine” — the depiction of the so-called Cadillac option is a scare tactic meant to deceive and derail.

The tragedy is that in this instance, the scaremongers and derailers include President Obama, some of his party and too many of the progressive policy commentators.

Instead of blaming unions for bargaining for better (but still insufficient) health benefits for their members, we should be clear on who is really to blame for the real cost escalators in health care: a for-profit private insurance and a pharmaceutical industry that puts us all at risk.

Suzanne Gordon is the co-editor of the “Culture and Politics of Health Care Work” series at Cornell University Press. She wrote this for Progressive Media Project, a source of liberal commentary on domestic and international issues; it is affiliated with The Progressive magazine. Readers may write to the author at: Progressive Media Project, 409 East Main Street, Madison, Wis. 53703; e-mail: pmprojprogressive.org.

http://www.sltrib.com/opinion/ci_14202903

By James Thindwa
In These Times
January 19, 2010

The voters who made Barack Obama’s historic election possible rightly expected far-reaching policy change. Yet what they have gotten is the same old corporate-driven politics.

Frustrated Obama supporters are told that the “machinery of Congress” grinds slowly; that only incremental change is possible; and that folks on “the left” are demanding too much and letting “the perfect be the enemy of the good.” Thus, we get a healthcare bill that rewards a predatory insurance system with millions of new customers—at taxpayer expense.

Apparently, it is paranoid to suspect that undue corporate influence might account for the rejection of demonstrably reliable governmental underwriting of healthcare. We are told the gradual degrading and then jettisoning of the public option and the proposed Medicare expansion—not to mention exclusion of single-payer from debate—is just a part of legislative deal-making.

But, delivering billions of taxpayer dollars to a monopolistic industry by forcing millions of people to purchase its product—with no option to join a public plan—is not inevitable. Nor is it good politics. How will Democrats defend forcing people to buy such tainted goods?

In recent weeks, some Democratic pundits have sought to silence the left. Instead of encouraging progressives to heed the example Obama himself once set as a community organizer, they countenance the sacrifice of core liberal principles such as reproductive rights, corporate accountability and inclusion of immigrants.

Writing in The New Republic, editor Jonathan Chait grumbled that progressives have an “irrational attachment to the public plan” and that criticism of Obama reflects the “bizarre convergence of left-wing and right-wing paranoia.”

Obama, in his September 9 address to Congress, also propagated this false parallel between left and right opponents when he decried the “unyielding ideological camps that offer no hope of compromise.” He even assigned motive to critics, saying they have “used this as an opportunity to score short-term political points.”

In other words, the President represents the “sensible center.” The left—those who demand a healthcare program that does not further enrich greedy insurance companies—are the extremists. The center is occupied by the likes of Sens Joe Lieberman (I-Conn.) and Ben Nelson (D-Neb.), who would hold hostage millions of uninsured in order to protect corporate profits. The center belongs to conservatives such as Rep. Bart Stupak (D-Mich.), whose obsession with abortion trumps any concern for the 45,000 people who die every year for lack of health insurance.

By reducing left-right differences on healthcare to merely “unyielding ideological camps,” the president and his defenders ignore the deep moral divide between progressives and conservatives. The left’s push for universal healthcare is grounded in the long-held principle of social justice, the same one that produced the New Deal, gave us Medicare in 1965 and ushered in a new era in civil rights.

Instead of dismissing progressives and apologizing for the President, Beltway liberals could have led the charge to dismantle the structurally conservative elements of our political system, from the undemocratic filibuster to the undue influence of corporate money in elections. Further, since progressives, liberals, the left—whatever we are calling ourselves—support universal healthcare, let us from now on, together, create a national echo chamber around “Medicare For All.” If this had been our collective mantra for the last 15 years, we would be in a better place today, and perhaps more unified.

James Thindwa is a member of In These Times’ Board of Directors and a labor and community activist.

http://inthesetimes.com/article/5430/who_really_won_in_2008/

By Vicente Navarro, M.D.
American Journal of Public Health, Jan. 14, 2010 

The current state of health care reform in the United States reveals the enormous limitations of democracy in this country, unparalleled in the western world. Why is there such a large gap between what people want from their representatives in Congress – including universal access to health care as a matter of right – and what they get? 

To answer this question, we first need to look at what is happening in the U.S. medical care sector. I think it’s fair to say that what we see there is also unparalleled in the western world. Forty-seven million people are without any form of health insurance coverage (and a million more are added each year) and 102 million have insufficient coverage (and many aren’t aware of how limited their coverage is until they find out that an illness or needed test is not covered).1 The clearest indicator of the inhumane system of funding and organizing medical care in the United States is that 40 percent of people in the terminal stages of illness say they are worrying about how to pay their medical bills.2 No other major country comes even close to this level of inhumanity. 

The root of the problem is the privatization of the funding and organization of medical care. Most of the funds are collected and services administered by private insurance companies. This system is rooted in the Taft-Hartley Act (the same act that forbade the working class to act as a class, by forbidding sympathy strikes that would allow workers from different employment sectors to strike to defend their class interests). Taft-Hartley shifted the responsibility for working people’s health benefits coverage to highly decentralized collective bargaining agreements, which explains the great variability in coverage. One consequence is that when American workers lose their jobs, they lose not just income but health benefits for themselves and their families. It is not surprising that the United States has the fewest working days lost to strikes. Workers are afraid to make trouble in the workplace, because getting fired could mean losing medical care for their families.3 

It has been a traditional demand of the labor movement to get rid of the consequences of the Taft-Hartley Act. The demand for universality of health care, with every American having the right to access care, has been a constant in the labor and progressive movements. The majority of Americans agree with this demand, but they are unlikely to get it.4 

The reason for this gap between what people want and what people get is, again, privatization – a privatized electoral process, in which most campaign funding of candidates for political office comes from private sources. That private money does not mainly come (as myth would have it) from multitudes of average Americans sending in $50. The great majority comes from huge economic interests (components of the “Corporate Class”), including the insurance, pharmaceutical, and medical equipment companies; the professional associations; and other components of the medical-industrial complex. The six key members of the Senate Finance Committee, chaired by Sen. Max Baucus (D-Mont.), have received support from these interests. They received a million dollars each.5 

To further compound the problem created by a privatized electoral process, U.S. democracy is a nonproportional type of democracy— that is, the population is not represented in Congress in proportion to the size of the electorate. Each state is represented by two senators, regardless of its size, which gives enormous power (as the country’s founders intended) to rural, conservative states. The six key senators on the Finance Committee represent rural states that, in sum, include only about 3 percent of the U.S. population, and these senators have the future of health care reform in their hands. 

Democracy in the United States is indeed extremely limited. The opening of the nation’s founding document, the U.S. Constitution, suggests that it is “We the People . . .” who make decisions, but it should include a footnote saying “or Corporate America.” Furthermore, those who do decide are not fully representative of the population. Still, the United States is not a dictatorship, but a democracy so tilted in favor of corporate and conservative interests that an enormous effort is required to create change. The election of President Obama seemed to be such a change and a sign of hope, because this was the trademark of his campaign. But since coming into office, he seems to have been poorly advised on his strategy for implementing the promised change. He has made several big mistakes. 

OBAMA’S MISTAKES 

1. An emphasis on the issue of economic viability of the system, stressing that medical expenditures (private and public) are increasing too rapidly and enlarging the federal deficit. This message has been repeated in many different ways, emphasizing that a primary goal of health care reform is to reduce the federal deficit. Most of the reforms the administration is calling for (which will, undoubtedly, cost money) will be funded by increasing the efficiency of the current public and private programs. People’s well-founded skepticism about Congress explains why so many (including Medicare beneficiaries) have expressed their concern about the meaning of “increasing the efficiency,” which they interpret to mean reducing their benefits. It is not surprising that the major opposition to the Obama reform proposal comes from the beneficiaries of these public programs, especially Medicare. 

2. The concern about costs and the need to improve efficiency expressed together with an emphasis on covering the uncovered as a moral problem that needs to be resolved. This is indeed a moral issue. But, when Obama adds that he plans to pay for this expansion of coverage by increasing the efficiency of current programs, he is calling on people’s compassion, with the possibility of most people (who do have coverage) seeing their benefits reduced to take care of the uncovered. We have plenty of experience (with antipoverty and other means-tested programs) to show that compassion is not a good motivator. Solidarity (I take care of you on the condition that you take care of me) is a much better motivator. 

What Obama should have done is expand and improve the Medicare Program to all Americans. This would resolve the problems of the uncovered and of everyone else. The call for a universalism mandated by government (not a mandate that individuals must buy their own health insurance, just as they have to buy car insurance) is far more ambitious (and more realistic) than a gradual path to universalism, which is likely to fail. 

3. Antagonizing the left. Achieving a universal right to health care requires a huge mobilization, comparable to that which got Obama elected. For this the president needs the left. Obama could not win only by mobilizing the left, but he could not win without it. He has antagonized the left by excluding single-payer health care from the negotiating table. I can understand why he changed his mind and decided not to support the single-payer option, but I cannot understand (because it was a tactical error) why, after saying that all options would be included, he excluded the single-payer option – the alternative preferred by the trade unions, the major social movements (such as the civil rights, feminist, and green movements), and others who were the core of his support and are the grassroots of the Democratic Party. To make things worse, he is ready to eliminate even the public option, which is seen as a way of introducing the single-payer option through the backdoor. So, it is not surprising that the left is feeling frustrated, angry, and
demoralized (and did not show up at the town hall meetings). 

All of this reminds me of what I saw during and after my time on the Clinton White House health care reform task force (as the “token single-payer expert”). Clinton had won the election of 1992 with a commitment to provide universal coverage. But once in office, he gave priority to reducing the federal deficit (not even in his campaign program), under pressure from Wall Street through Treasury Secretary Robert Rubin, and to approving the North American Free Trade Agreement, which was opposed by the trade unions and the majority of the Democratic Party. This antagonized the left of the party, and large numbers of Democratic voters stayed home in the 1994 congressional elections. The “Gingrich Revolution” was a consequence of this abstention of the Democratic grassroots. The Republicans received about the same number of votes in 1994 as in 1990 (the preceding nonpresidential election year). There was no increase in the Republican vote, but rather a decline in the Democratic vote. I am afraid that the same could happen in 2010. 

Vicente Navarro is with Johns Hopkins University, Baltimore, Md. Correspondence should be sent to Vicente Navarro, M.D., Ph.D., Professor of Health Policy, The Johns Hopkins University, 624 N. Broadway, Rm 448, Baltimore, MD 21205 (e-mail: vnavarro@jhsph.edu). 

This article was accepted November 11, 2009. doi: 10.2105/AJPH.2009.187633 

References

1. Hellander I. The deepening crisis in U.S. health care: a review of data, Spring 2008. Int J Health Serv. 2008;38(4): 607–623. 

2. Ann Intern Med. 2000; :132– 145. 

3. Navarro V. Dangerous to Your Health. Capitalism in Health Care. New York, NY: Monthly Review Press; 1993. 

4. Washington Post/ABC News. 2008. 

5. Kaiser RG. So Damn Much Money: The Triumph of Lobbying and the Corrosion of American Government. New York, NY: A Knopf; 2009. 

http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2009.187641v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=waitzkin&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

By Brad Jacobson
The Raw Story
Wednesday, January 20th, 2010

Though Senate bill cuts ‘pre-existing conditions,’ it still allows insurance companies to create ‘pre-existing’ categories to raise rates

The Democrats’ healthcare overhaul, billed as a monumental game-changer for Americans’ health insurance coverage, provides numerous loopholes for health insurance companies which will allow them to raise rates to protect profit margins, a health insurance whistleblower says.

Wendell Potter, a twenty-year veteran of the insurance industry and former vice president of communications for Cigna, warns that current healthcare legislation does nothing to prevent the insurance industry from continuing its ongoing practice of increasingly shifting healthcare costs to consumers.

A form of bait-and-switch, such practices often set up individuals, families and small businesses for inadequate or unaffordable access and a continued looming threat of financial ruin. The overlooked element, Potter says, is that insurance companies will be able to claim they are reducing premiums by forcing more Americans to pay higher deductibles and offering less coverage.

“We talk a lot about affordability, and we talk about affordability of insurance premiums,” Potter told Raw Story in a nearly hour-long interview. “But when you talk about affordability, you need to talk about affordability of premiums plus out-of-pocket expenses.”

He said that there’s been a lot of discussion on how the Congressional Budget Office scored this legislation and what it says this legislation will cost the country in the long run, but little to no focus on how the legislation will directly impact individual Americans.

Potter pointed out, for example, that many plans — even after consumers received proposed government subsidies to help pay for them — would come with high deductibles that prohibit people from using their insurance or cause them the kind of financial hardships that healthcare reform was purported to prevent.

“What worries me,” he said, “is people who are forced to buy coverage and all they can afford to buy is a high deductible. And if they get really sick then they have to pay so much out of their own pockets that they’re going to be filing for bankruptcy and losing their homes.”

In the Senate bill, in particular, Potter noted, some people will be buying insurance that will only cover roughly 60 percent of their medical costs if they get sick.

“There are a lot of people who don’t have insurance now because they can’t afford premiums,” he said. “They certainly couldn’t afford premiums plus the out-of-pocket expenses in today’s market.”

Potter asserted that the current legislation will, in large part, simply move millions of people from being uninsured to underinsured, or from insured to underinsured. Citing a 2007 study by the Commonwealth Fund, he said there are already over 25 million Americans who fall into the category of the underinsured.

Potter also noted the deleterious effect of cost shifting on small businesses. Many small business owners will earn just enough to be denied subsidies.

“After a certain income level, there are no subsidies,” Potter explained. “But you still have to buy coverage. And I’m concerned that after you get above the median level of income, you’ll find that a lot of people who don’t get subsidies will probably be forced to buy coverage. But the only coverage they’ll be able to buy will make them underinsured.”

There’s also no prohibition in the legislation against insurance companies moving more and more people into high-deductible plans. Such plans, Potter argued, will help insurers’ bottom lines because fewer policyholders will actually avail themselves of their insurance.

“When you have a benefit plan that requires people to pay a lot out of their own pocket, a lot of these people will never get to the point of using their insurance because they won’t go to the doctor or pick up their medicines to satisfy the deductible,” Potter told Raw Story.

“I see nothing in this legislation that essentially would protect people from losing their homes or filing for bankruptcy,” he added.

How insurance companies can still game the system

While prohibitions on such practices as denying healthcare to people with pre-existing conditions remain in the legislation, Potter noted that the Senate bill, in particular, provides the insurance companies with “all the flexibility they need” to more than make up for any profits lost due to new reform measures and to prevent people from accessing coverage.

He pointed out, for example, that “health factors” such as chronic diseases and age would continue to play into how much individuals can be charged in premiums and how many of them may be forced into high deductible plans.

“What they will be doing, what they can in the Senate bill, is charge people significantly more if they have certain health factors,” Potter said. “And it would be pretty much up to the industry to decide what those health factors are. You could have high blood pressure, high cholesterol, diabetes. You could be overweight, have a history of tobacco use. There definitely would be a wide range of things that the insurance industry would be able to look at and determine whether or not to charge you more.”

He also noted that the Senate bill would allow insurance companies to charge people who are older up to three times as much as those who are younger and, in the House bill, two times more than a younger person.

“And of course when people get older they develop more health factors,” Potter said. “So that is another way to get around the loss of revenue. Plus, of course, they would be able to get new revenue coming in from people who are younger and don’t have health factors that they charge more for.”

Moreover, he said, “They still would be getting a new revenue stream from people who are younger. So they’ll be getting significantly more in revenue. And those people are quite profitable too because they don’t file many claims.”

To justify this practice, Potter explained, insurers would claim that they’re providing lowered or discounted premiums to healthier people. But, in reality, premiums across the board are set so high that healthier people wouldn’t actually be receiving anything that could be considered a discount.

“Healthier people would be paying pretty much a standard rate at the end of the day,” said Potter, while the chronically ill and the aged would be paying exceptionally more on top of the already pricey standard rate.

Medical-loss ratio

The former insurance executive also says another element of the healthcare overhaul is receiving too little attention: the medical-loss ratio, which determines what percentage of health insurance premiums are spent on actual medical costs. The difference of just a few percentage points can mean billions of dollars to the insurance industry.

“We’re talking about big-time money here,” said Potter. “The insurance industry doesn’t want to have any restrictions on the medical-loss ratio. So they’ll be doing all they can to keep it from being enacted if possible.”

Some members of Congress, led by Sen. Al Franken (D-MN), proposed an amendment to require that 90 percent of consumer premiums go to medical costs, but Potter doesn’t think that’s likely to happen and said insurers will fight tooth-and-nail to set any minimum as low as possible. The Congressional Budget Office said that the 90 percent figure was too high and would basically drive insurers out of business, recommending 80-85 percent instead. Democrats are expected to embrace the
lower figures in their final bill.

Potter cautioned that legislators need to keep an eye on how insurance companies define medical and administrative expenses. And he said that legislation should require companies to explain what they’re spending money on and what percentage in dollar amounts they’re spending.

“You can set the medical-loss ratio, but you need to make sure that it’s clearly understood what the components of the administrative expenses are,” Potter explained. “Because they can shift stuff around from one bucket to another and claim that what they’re actually spending is beneficial to the patient when it may not be.”

For example, he said they can easily meet an 85% standard if the definition enables them to categorize such items as disease management programs as paying for medical care. Currently, money spent on disease management programs is counted toward administrative costs.

Potter also noted that insurance companies have kept the issue of the medical-loss ratio — something little understood by the American public — “pretty much just a conversation between them, their shareholders and the analysts who cover them. They don’t talk about it anywhere else.”

Potter raised this complex but critical issue during his Senate testimony in June.

“Every decimal point makes a big difference,” he added. “We’re talking in the billions.”

http://rawstory.com/2010/01/whisteblower-reveals-health-insurers-game-insurance-bill/

By Robert Scheer
TruthDig, Jan 20, 2010

The president got creamed in Massachusetts. No amount of blaming this disastrous outcome on the weaknesses of the local Democratic candidate or her Republican opponent’s strengths can gainsay that fact. Obama’s opportunistic search for win-win solutions to our health care concerns and our larger economic problems is leading to a lose-lose outcome for the president and the country.

The two issues that mattered on Election Day were the economy, which Obama has sold out to Wall Street—as quite a few disgruntled voters pointed out—and his plea to save health care reform, which the voters who had backed him for the presidency with a huge majority now spurned. It is significant that it was the voters of Massachusetts who have now derailed the Democrats’ efforts to revamp the country’s health care system by denying them the necessary 60th vote in the Senate, for these voters know the subject well.

The federal proposal is based on their own state’s model requiring people to obtain health insurance without the state doing anything to effectively control costs through an alternative to the private insurance corporations. Lacking a public option, the cost of health care in Massachusetts, already the highest in the nation at the time of the plan’s implementation, has spiraled upward. Services have been curtailed, and many, particularly younger people, feel they are being forced to sacrifice to pay for a system that doesn’t work.

Instead of blindly following the failed Massachusetts model, Obama should have insisted on an extension of the Medicare program to all who are willing to pay for it. He squandered the opportunity to bring about meaningful health care change that the public would have supported had it been kept simple and just. Instead, Obama gave away the store to medical profiteers. They, in turn, hopelessly muddied the waters with well-funded scare advertising tactics that principled leadership on Obama’s part could have thwarted.

A mere seven months ago, The New York Times/CBS poll found that 72% of Americans “supported a government-administered insurance plan—something like Medicare for those under 65—that would compete for customers with private insurers.” Even half of those identified as Republican said they would back such a public plan, as would three out of four independents and 90% of Democrats. Instead of heeding that call by endorsing a serious extension of Medicare, along with increased subsidies for those who could not afford it, Obama played to the conservatives in Congress—and they rolled him.

If he wasn’t prepared to make a breakthrough in health care, and that meant a reform program that would begin sooner rather than later, he should have put it on a back burner. The furor over a very unsatisfactory plan drew attention from the far bigger crisis concerning the meltdown of the nation’s economy. By accepting and indeed expanding the Bush administration’s strategy of throwing money at Wall Street, Obama ceded the populist label to the Tea Party Republicans who now pretend that a banking mess brought about by their radical deregulatory philosophy is not of their making.

It is the economy, stupid, and the sooner Obama grasps that, the better for his and the nation’s prospects. A new Wall Street Journal/NBC poll finds that “Americans ranked job creation and economic growth as their clear top priority for the federal government, well above national security and deficit reduction. Health care, Mr. Obama’s top domestic priority in 2009, now ranks fourth, closely trailing the deficit and government spending.”

Of course, the public is right. In the midst of the worst economic crisis in 70 years, why waste enormous political capital battling to pass a health care plan that is modeled on a proven failure in Massachusetts, as voters there clearly registered? Meanwhile, the president has dropped the ball in the effort to make bankers act responsibly by forcing them to forego outrageous bonuses and help homeowners stay in their homes.

Again quoting the message of that Wall Street Journal/NBC poll: “The president’s focus on health care amid heightened job concerns could be hurting his ratings. At the one-year mark of his presidency, 35% of Americans said they were ‘quite’ or extremely’ confident he had the right priorities to improve the economy, down from 46% at midyear.” The Journal noted that a majority disapproved of the government’s response to the financial crisis, adding, “The related problem for Mr. Obama is the public’s lingering anger about the bailouts of 2008 and 2009, which helped boost bank profits even as unemployment grew—a toxic political problem.”

To salvage his presidency, Obama must reverse course and make solving the “toxic political problem” of Wall Street greed that’s bankrupting the country his highest priority. 

http://www.truthdig.com/report/item/what_massachusetts_got_right_20100120/

By William Greider
The Nation, January 20, 2010

Barack Obama went to Boston to rally voters and got a pie in the face. He lost his innocence as the valiant young president and also lost his sixty-vote majority in the Senate. Now we will find out what the man is made of–either a true political leader or just another show horse. Dozens of explanations are being offered for why the Dems were humiliated in Massachusetts. Democrats incline to grab easy answers. The president, if he is tough enough, will instead face the hard message of this political fiasco.

The special election displayed monumental miscalculations by which Obama has governed, both in priorities and political-legislative strategies. It may seem perverse and unfair, but the president’s various actions for reform generated a vaguely poisonous identity. Amid the general suffering, Obama is widely seen as collaborating with two popular villains–the me-first bankers and over-educated policy technocrats of the permanent governing elite. Obama made nice with the bankers and loaded up his administration with Harvard policy wonks who really don’t know the country. These malignant associations gain traction because people see there are grains of truth in observable reality.

On Sunday, I listened on the radio to Obama’s soaring speech at Northeastern University and remembered again why his oratory first took the nation to the mountaintop. His attack lines lashing bankers and insurance companies were fluid and tough, shouted repetitively over the rising cheers. His diction was loosely colloquial. He dropped the hard g’s to get down with the folks. Too little, too late, I figured. He is still masterful, but this is performance, not substance. People grasp the difference between the two. This gulf will imprison Obama as a stereotype for weakness, a joke on late-night TV, if he doesn’t change.

The humiliation, I decided, could become a good thing for this presidency if it forces Obama to rethink his political strategy and rearrange his governing order. For all his brains and talent, for all the brainy people around him, the Obama White House seems tone-deaf and blind on many aspects of the popular reality. Too full of itself to listen closely. Too condescending to recognize the rage and fear are about more than right-wing frothers.

On healthcare, Obama played coy while his White House aides cut private deals with the drug industry and other sectors. The legislative process was drawn out month after month in an addled bargaining marathon with hostile Republicans (who stiffed him in return) and industry-leaning Democrats (who got whatever they demanded). The liberal base was conned, ignored and bullied, as its vital issues were one by one discarded. Labor unions were stroked and intimidated by the White House, then double-crossed as Obama’s reform extracted greater costs from union members than it demanded from the drug makers. People at large were confused, then frightened. They could not understand what reform would do for them, and some of their doubts were well-founded. The longer it went on, the more people wondered why Democrats weren’t talking about their problem–jobs and incomes.

Obama’s mild-mannered faith in bipartisan deal-making seemed strangely out of touch. Didn’t he realize Republicans were going to maul him at every turn?

The bankers, meanwhile, did their own tap dance on the new president, putting a paw on his shoulder while gobbling up public resources. Obama kept holding meetings with them, urging them to do the “right thing.” They practically laughed in his face.

People were meanwhile agitated by the swelling budget deficits and easy prey for right-wing propaganda. Instead of explaining the economic necessity of deficit spending in a straightforward way, Obama adopted these worries as his own. He has promised to reduce spending, but he cannot deliver on this if he truly expects recovery.

Obama’s style became an inadvertent formula for sapping the life out of the political majority that elected him, deflating the reach of reform and turning off the electoral base that came together in 2008. Democrats are being told (and telling themselves) that they over-reached, but what became clear as the months dragged on is the Democratic party under-achieved, and so did its president.

Obama’s most disturbing quality is that he evidently intended this from the start. Soaring rhetoric notwithstanding, he managed the presidency as a pragmatist in search of the possible. The real goals for change were minimalist, not visionary. This has to change and soon, if he is to revive his presidency.

Obama, in other words, has to change himself. That may sound too wishful and maybe it is. But we know he is a brilliant politician, astute in his political vision. The great politicians, when faced with new circumstances, revise themselves. We will see if Obama can.

First, he has to clear out the cobwebs of his hopeful aspirations and take on the fight. To do so, he also has to clear away a lot of the people around him. If Rahm Emmauel was the chief strategist, the guy who made the private deals and told the senators what they could accept, he failed big-time and should be replaced. Find a new manager whose thinking was not shaped by cynical triangulation in the Clinton era.

The president chose Larry Summer and Timothy Geithner to speak for the administration on the economy. Can you imagine finding anyone less convincing? Both are active advocates of the Wall Street status quo, neither has any feel for what’s happening in the country. The bean counters led the president into the trap he now faces. Permissive bailouts created flush financial giants that sit on their profits and ignore the public need for lending. Dump the bean counters now.

Obama’s turn-around speech would declare–honestly–that he misjudged the situation. The damage is far worse than he originally realized. Some deeper structural changes are required. The political opposition is more than ever blindly resistant than he had hoped. But now Obama can promise to govern nose-to-nose against the political forces blocking everything he attempts. He may not prevail, he concedes. But he is going to throw himself at them and he asks the people to join him in the fight.

If comprehensive healthcare reform is out of the question, Obama Democrats can break it down into smaller pieces and try to pass worthy measures one by one. A bill to prohibit insurance companies from banning people with pre-existing ailments? Pass it the House and try to pass it in the Senate. If Republicans want to filibuster, make them filibuster. A measure to allow cheaper drug imports from Canada? Let Republicans vote against that. Repealing the antitrust exemption for insurance companies–Democrats support it. Democrats need to start a fight on taxes too. Do Republicans want to tax Wall Street banks or not? Obama has proposed it, let’s have a roll call. The attack strategy will focus on all the reforms people want and need and create a new political dynamic.

At the same time, Obama has to change the subject by refocusing reform actions on jobs and the structure of the faltering economy. Do something concrete and visible. If it doesn’t work, try something else. If it’s real, people will respond. If it doesn’t succeed, people will understand. A governing agenda that creates a sense of action and shared commitment does not require cerebral policy wonks. Go anywhere in America and you will hear fresh thinking about how to get the country out of the ditch.

Obama needs to locate some seasoned politicians and bring them into the White House–people with a less cynical view of the Democratic party and deep experience in how to mobilize substantive political support. That includes the active citizens who do not mess with elections because they consider them a waste of energy. People who want big change are
all over this country, nurturing new ideas and waiting to be asked.

Barack Obama is a cool character, not given to impulsiveness. But he needs to accept that the political assumptions with which he began his presidency are malfunctioning. I can’t be sure he will be brave enough to change things. I do say he cannot wait for his second term.

http://www.thenation.com/doc/20100201/greider

By William Greider
The Nation, January 20, 2010

Barack Obama went to Boston to rally voters and got a pie in the face. He lost his innocence as the valiant young president and also lost his sixty-vote majority in the Senate. Now we will find out what the man is made of–either a true political leader or just another show horse. Dozens of explanations are being offered for why the Dems were humiliated in Massachusetts. Democrats incline to grab easy answers. The president, if he is tough enough, will instead face the hard message of this political fiasco.

The special election displayed monumental miscalculations by which Obama has governed, both in priorities and political-legislative strategies. It may seem perverse and unfair, but the president’s various actions for reform generated a vaguely poisonous identity. Amid the general suffering, Obama is widely seen as collaborating with two popular villains–the me-first bankers and over-educated policy technocrats of the permanent governing elite. Obama made nice with the bankers and loaded up his administration with Harvard policy wonks who really don’t know the country. These malignant associations gain traction because people see there are grains of truth in observable reality.

On Sunday, I listened on the radio to Obama’s soaring speech at Northeastern University and remembered again why his oratory first took the nation to the mountaintop. His attack lines lashing bankers and insurance companies were fluid and tough, shouted repetitively over the rising cheers. His diction was loosely colloquial. He dropped the hard g’s to get down with the folks. Too little, too late, I figured. He is still masterful, but this is performance, not substance. People grasp the difference between the two. This gulf will imprison Obama as a stereotype for weakness, a joke on late-night TV, if he doesn’t change.

The humiliation, I decided, could become a good thing for this presidency if it forces Obama to rethink his political strategy and rearrange his governing order. For all his brains and talent, for all the brainy people around him, the Obama White House seems tone-deaf and blind on many aspects of the popular reality. Too full of itself to listen closely. Too condescending to recognize the rage and fear are about more than right-wing frothers.

On healthcare, Obama played coy while his White House aides cut private deals with the drug industry and other sectors. The legislative process was drawn out month after month in an addled bargaining marathon with hostile Republicans (who stiffed him in return) and industry-leaning Democrats (who got whatever they demanded). The liberal base was conned, ignored and bullied, as its vital issues were one by one discarded. Labor unions were stroked and intimidated by the White House, then double-crossed as Obama’s reform extracted greater costs from union members than it demanded from the drug makers. People at large were confused, then frightened. They could not understand what reform would do for them, and some of their doubts were well-founded. The longer it went on, the more people wondered why Democrats weren’t talking about their problem–jobs and incomes.

Obama’s mild-mannered faith in bipartisan deal-making seemed strangely out of touch. Didn’t he realize Republicans were going to maul him at every turn?

The bankers, meanwhile, did their own tap dance on the new president, putting a paw on his shoulder while gobbling up public resources. Obama kept holding meetings with them, urging them to do the “right thing.” They practically laughed in his face.

People were meanwhile agitated by the swelling budget deficits and easy prey for right-wing propaganda. Instead of explaining the economic necessity of deficit spending in a straightforward way, Obama adopted these worries as his own. He has promised to reduce spending, but he cannot deliver on this if he truly expects recovery.

Obama’s style became an inadvertent formula for sapping the life out of the political majority that elected him, deflating the reach of reform and turning off the electoral base that came together in 2008. Democrats are being told (and telling themselves) that they over-reached, but what became clear as the months dragged on is the Democratic party under-achieved, and so did its president.

Obama’s most disturbing quality is that he evidently intended this from the start. Soaring rhetoric notwithstanding, he managed the presidency as a pragmatist in search of the possible. The real goals for change were minimalist, not visionary. This has to change and soon, if he is to revive his presidency.

Obama, in other words, has to change himself. That may sound too wishful and maybe it is. But we know he is a brilliant politician, astute in his political vision. The great politicians, when faced with new circumstances, revise themselves. We will see if Obama can.

First, he has to clear out the cobwebs of his hopeful aspirations and take on the fight. To do so, he also has to clear away a lot of the people around him. If Rahm Emmauel was the chief strategist, the guy who made the private deals and told the senators what they could accept, he failed big-time and should be replaced. Find a new manager whose thinking was not shaped by cynical triangulation in the Clinton era.

The president chose Larry Summer and Timothy Geithner to speak for the administration on the economy. Can you imagine finding anyone less convincing? Both are active advocates of the Wall Street status quo, neither has any feel for what’s happening in the country. The bean counters led the president into the trap he now faces. Permissive bailouts created flush financial giants that sit on their profits and ignore the public need for lending. Dump the bean counters now.

Obama’s turn-around speech would declare–honestly–that he misjudged the situation. The damage is far worse than he originally realized. Some deeper structural changes are required. The political opposition is more than ever blindly resistant than he had hoped. But now Obama can promise to govern nose-to-nose against the political forces blocking everything he attempts. He may not prevail, he concedes. But he is going to throw himself at them and he asks the people to join him in the fight.

If comprehensive healthcare reform is out of the question, Obama Democrats can break it down into smaller pieces and try to pass worthy measures one by one. A bill to prohibit insurance companies from banning people with pre-existing ailments? Pass it the House and try to pass it in the Senate. If Republicans want to filibuster, make them filibuster. A measure to allow cheaper drug imports from Canada? Let Republicans vote against that. Repealing the antitrust exemption for insurance companies–Democrats support it. Democrats need to start a fight on taxes too. Do Republicans want to tax Wall Street banks or not? Obama has proposed it, let’s have a roll call. The attack strategy will focus on all the reforms people want and need and create a new political dynamic.

At the same time, Obama has to change the subject by refocusing reform actions on jobs and the structure of the faltering economy. Do something concrete and visible. If it doesn’t work, try something else. If it’s real, people will respond. If it doesn’t succeed, people will understand. A governing agenda that creates a sense of action and shared commitment does not require cerebral policy wonks. Go anywhere in America and you will hear fresh thinking about how to get the country out of the ditch.

Obama needs to locate some seasoned politicians and bring them into the White House–people with a less cynical view of the Democratic party and deep experience in how to mobilize substantive political support. That includes the active citizens who do not mess with elections because they consider them a waste of energy. People who want big change are all over this country, nurturing new ideas and waiting to be asked.

Barack Obama is a cool character, not given to impulsiveness. But he needs to accept that the political assumptions with which he began his presidency are malfunctioning. I can’t be sure he will be brave enough to change things. I do say he cannot wait for his second term.

http://www.thenation.com/doc/20100201/greider