But it is a liberal bill in another regard: it should make a real dent in income inequality. David Leonhardt addresses one of the most important, yet underappreciated, aspects of the Affordable Care Act (as we're now calling it):
For all the political and economic uncertainties about health reform, at least one thing seems clear: The bill that President Obama signed on Tuesday is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.
Over most of that period, government policy and market forces have been moving in the same direction, both increasing inequality. The pretax incomes of the wealthy have soared since the late 1970s, while their tax rates have fallen more than rates for the middle class and poor.
Nearly every major aspect of the health bill pushes in the other direction. This fact helps explain why Mr. Obama was willing to spend so much political capital on the issue, even though it did not appear to be his top priority as a presidential candidate. Beyond the health reform’s effect on the medical system, it is the centerpiece of his deliberate effort to end what historians have called the age of Reagan.
Speaking to an ebullient audience of Democratic legislators and White House aides at the bill-signing ceremony on Tuesday, Mr. Obama claimed that health reform would “mark a new season in America.” He added, “We have now just enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their health care.”
The bill is the most sweeping piece of federal legislation since Medicare was passed in 1965. It aims to smooth out one of the roughest edges in American society — the inability of many people to afford medical care after they lose a job or get sick. And it would do so in large measure by taxing the rich.
A big chunk of the money to pay for the bill comes from lifting payroll taxes on households making more than $250,000. On average, the annual tax bill for households making more than $1 million a year will rise by $46,000 in 2013, according to the Tax Policy Center, a Washington research group. Another major piece of financing would cut Medicare subsidies for private insurers, ultimately affecting their executives and shareholders.
The benefits, meanwhile, flow mostly to households making less than four times the poverty level — $88,200 for a family of four people. Those without insurance in this group will become eligible to receive subsidies or to join Medicaid. (Many of the poor are already covered by Medicaid.) Insurance costs are also likely to drop for higher-income workers at small companies.
Finally, the bill will also reduce a different kind of inequality. In the broadest sense, insurance is meant to spread the costs of an individual’s misfortune — illness, death, fire, flood — across society. Since the late 1970s, though, the share of Americans with health insurance has shrunk. As a result, the gap between the economic well-being of the sick and the healthy has been growing, at virtually every level of the income distribution.
The health reform bill will reverse that trend. By 2019, 95 percent of people are projected to be covered, up from 85 percent today (and about 90 percent in the late 1970s). Even affluent families ineligible for subsidies will benefit if they lose their insurance, by being able to buy a plan that can no longer charge more for pre-existing conditions. In effect, healthy families will be picking up most of the bill — and their insurance will be somewhat more expensive than it otherwise would have been.
Much about health reform remains unknown. Maybe it will deliver Congress to the Republicans this fall, or maybe it will help the Democrats keep power. Maybe the bill’s attempts to hold down the recent growth of medical costs will prove a big success, or maybe the results will be modest and inadequate. But the ways in which the bill attacks the inequality of the Reagan era — whether you love them or hate them — will probably be around for a long time.
The reason the liberal age (1932-1968) lasted so long and accomplished so much was in large part due to FDR's success at addressing income inequality and getting us all more or less on the same page. It's also good for the economy because when average people have extra cash they tend to spend it. If Obama and the Democrats could narrow the gap between the rich and everyone else they would be doing a great service for the country. (This, by the way, is not Communism. We're talking about finding pragmatic ways of using government to temper the inevitable excesses of the free market... not having the government take over the economy.)
But as Ronald Brownstein points out, there's a disconnect in terms of public perception, especially among whites:
On the long climb to health care reform that ended with this week's momentous signing ceremony, President Obama aimed many of his arguments at a different audience from the one targeted by predecessors who faltered on the same steep hill.
Compared with earlier presidents, Obama focused his case less on helping the uninsured and more on providing those with coverage greater leverage against their insurers. That shift was especially evident in his final drive toward passage.
And yet, polling just before the bill's approval showed that most white Americans believed that the legislation would primarily benefit the uninsured and the poor, not people like them. In a mid-March Gallup survey, 57 percent of white respondents said that the bill would make things better for the uninsured, and 52 percent said that it would improve conditions for low-income families. But only one-third of whites said that it would benefit the country overall -- and just one-fifth said that it would help their own family.
In both that Gallup Poll and the latest monthly survey by the nonpartisan Kaiser Family Foundation, nonwhite respondents were much more likely than whites to say that the bill would help the country and their own families. Those responses reflect not only experience (African-Americans and Hispanics are more likely than whites to lack insurance) but also minorities' greater receptivity to government activism. By meeting a tangible need in these communities, health reform is likely to solidify the Democratic hold on the one-quarter (and growing) minority share of the electorate, especially if Republicans define themselves around demanding repeal.
But whites still cast about three-quarters of votes. And if most remain convinced that health reform primarily benefits the poor and uninsured, Democrats could find themselves caught in an unusual populist crossfire during this fall's elections.
The ACA (aka HCR) will in fact help middle class people (of all ethnicities)... in some ways immediately, but in other ways not for several years. So its still important for Democrats to sell this. I think the job will be easier now that it's passed, but they really can't rest on their laurels.
Meanwhile it seems that Republicans plan to continue their strategy of playing to the Tea Party crowd, doing everything in their power to obstruct Democratic governance, rather than engage with Democrats in an effort to secure compromises and move legislation to the right. Such engagement would certainly succeed in making future legislative more conservative, but it would also be a boon the Obama Admin., who would have succeeded in making Washington work. So we can't have that!
These dynamics were on clear display in the case of David Frum's recent criticisms of Republican strategy (linked to in my previous post), which quickly got him expelled from the American Enterprise Institute (one of the preeminent Conservative think tanks).
Frum has an excellent conservative pedigree. He was a speechwriter for George W. Bush, among other things, and he remains extremely conservative today. However, over the last year or so he has been making a name for himself as a reasonable conservative, one willing to call out the Republican Party when he thinks it's making a mistake. And that, apparently, is the problem. The last straw for AEI was apparently this post on Frum's blog, where he said, "Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s," and went on to lay the blame at the all-or-nothing strategy employed by the GOP leadership.
Frum's crime was not an ideological one but a partisan one. Apparently, not only is it forbidden to question GOP strategy when it's still being executed, it's even forbidden to question it after it has already failed.
As Frum saw clearly, if you were interested in a conservative health-care system, there was room for compromise in this bill. If Republicans had cut a deal on revenue, we could've capped the tax break for employer-sponsored insurance and there would've been no increase in Medicare payroll taxes. Health savings accounts and tort reform could've been much larger parts of the bill. A system of reinsurance for catastrophic costs, as Sen. Chuck Grassley once proposed, was certainly on the table. If Republicans had offered 40 real votes for Wyden-Bennett, I would've been on their side in this debate.
But whatever interest there was in making the outcome of this legislative process more conservative, it was swamped by the interest in making the outcome more Republican. I'm not saying that there's no reason conservatives could've found to oppose this bill. But there's no way to look at Medicare Part D and RomneyCare and conservative think tanks in the 1990s and 2000s and believe that all conservatives should've opposed this bill. There's definitely no way to square their past preferences and the rhetoric they abetted this time around. And in the final analysis, the bill is worse -- both from their perspective and mine -- for that opposition. You can pass bills on a party-line vote, but you can do more with bipartisan cover.
Which is not to say there was nothing to recommend the right's electoral strategy here. But pure obstructionism failed. You might think they'd go through a period of soul-searching now where they considered whether people like Frum might've had a point about the benefits of well-timed, principled compromise. Instead, they're excommunicating him.
Frum's wife even felt compelled to jump in:
We have both been part of the conservative movement for, as mentioned, the better part of half of our lives. And I can categorically state I’ve never seen such a hostile environment towards free thought and debate–the hallmarks of Reaganism, the politics with which we grew up–prevail in our movement as it does today. The thuggish demagoguery of the Limbaughs and Becks is a trait we once derided in the old socialist Left. Well boys, take a look in the mirror. It is us now.
It's hard to believe that this revelation came like a bolt out of the blue. The Republican arguments on health care, the economic stimulus and financial regulation have become so convoluted and degraded that they only make sense from the perspective of raw political strategy and Tea Party pandering.
What holds the Republican Party together isn't anything remotely like a coherent philosophy or set of values. The only things holding it together are group-think based on a cold calculation of how best to block the Democrats and rile the base. It's an intellectual circling of the wagons. Small wonder that it becomes oppressive.
I am tempted to think that the revulsion expressed Crittenden is part of a bigger ferment among Republicans. I'd like to think that there is a group of young Turks or moderates who agree with Frum that the GOP health-care rejectionism will turn out to be the party's Waterloo. I'd like to think that there is a new generation GOP that is ready to take a chance on constructive engagement.
But my good friend Bruce Bartlett is skeptical. Republican leaders think their strategy since the 2008 election has been a great success. If they win back House and Senate seats this fall -- as they almost certainly will -- they'll argue that their strategy has been vindicated. And the truth is, the Young Turks are among the most fervent of the hard-liners -- the Jeb Hensarlings, Paul Ryans. The moderates are disappearing faster than ever, and the ones who stay are disdained.
Matthew Yglesias adds:
I think that to understand what’s wrong with the conservative movement today, you need to think about Barry Goldwater’s 1964 Presidential campaign. In ‘64, the GOP establishment felt that Goldwater was too radical. They said that nominating a hard-rightist like Goldwater would be counterproductive. But conservative activists worked hard, and they did it. Goldwater got the nod. And, just as the establishment predicted, Goldwater got crushed. And just as the established predicted, it proved to be counterproductive. The 1964 landslide led directly to Medicare, Medicaid, Title I education spending, and the “war on poverty.” In the 45 years since that fateful campaign, the conservative movement managed to gain total control over the Republican Party and to sporadically govern the country. But it’s only very partially rolled back one aspect of the Johnson administration’s domestic policy.
Which is just to say that the conservative movement from 1964-2009 was a giant failure. By nominating Goldwater, it invited a massive progressive win that all the subsequent conservative wins were unable to undue. But the orthodox conservative tradition of ‘64 is that it was a great success that laid the groundwork for the triumphs to come.
Which is to say that it’s not just a movement incapable of thinking seriously about the interests of the country, it can’t think rigorously about its own goals. 2009-2010 has already seen the greatest flowering of progressive policy since 1965-66. No matter how well Republicans do in the 2010 midterms, the right will never fully roll back what the 111th Congress has done. And yet, as Andrews suggests, if they win seats in 2010, conservatives will consider their behavior during 2009-10 to have been very successful.
So maybe Republican insanity is a good thing! But in the big scheme of things it really isn't. The reality is that power tends to shift back and forth between the two parties, so having one party dominated by lunatics doesn't bode well.
I admit it: I had fun watching right-wingers go wild as health reform finally became law. But a few days later, it doesn’t seem quite as entertaining — and not just because of the wave of vandalism and threats aimed at Democratic lawmakers. For if you care about America’s future, you can’t be happy as extremists take full control of one of our two great political parties.
To be sure, it was enjoyable watching Representative Devin Nunes, a Republican of California, warn that by passing health reform, Democrats “will finally lay the cornerstone of their socialist utopia on the backs of the American people.” Gosh, that sounds uncomfortable. And it’s been a hoot watching Mitt Romney squirm as he tries to distance himself from a plan that, as he knows full well, is nearly identical to the reform he himself pushed through as governor of Massachusetts. His best shot was declaring that enacting reform was an “unconscionable abuse of power,” a “historic usurpation of the legislative process” — presumably because the legislative process isn’t supposed to include things like “votes” in which the majority prevails.
What has been really striking has been the eliminationist rhetoric of the G.O.P., coming not from some radical fringe but from the party’s leaders. John Boehner, the House minority leader, declared that the passage of health reform was “Armageddon.” The Republican National Committee put out a fund-raising appeal that included a picture of Nancy Pelosi, the speaker of the House, surrounded by flames, while the committee’s chairman declared that it was time to put Ms. Pelosi on “the firing line.” And Sarah Palin put out a map literally putting Democratic lawmakers in the cross hairs of a rifle sight.
In the short run, Republican extremism may be good for Democrats, to the extent that it prompts a voter backlash. But in the long run, it’s a very bad thing for America. We need to have two reasonable, rational parties in this country. And right now we don’t.
Well, yesterday was Pelosi's 70th birthday, so at risk of overdoing it, here's a little more love for our Speaker...
AT THE end of January, when all of Washington was wailing that Scott Brown’s election to the US Senate meant a stake in the heart of health care reform, House Speaker Nancy Pelosi held a press conference and outlined her plan for the bill. “You go through the gate,’’ she said. “If the gate’s closed you go over the fence. If the fence is too high, we’ll pole-vault in. If that doesn’t work, we’ll parachute in. But we are going to get health care reform passed for the American people.’’
You have to admire the grit and persistence of Pelosi, whose persuasive powers were at their height in the days leading up to the vote. Buffeted by doubts even from within the White House, she held her seat, and managed to cajole both the pro-life conservative Bart Stupak and the single-payer liberal Dennis Kucinich into supporting the bill. That’s some savvy legislating.
“She’s no-nonsense,’’ said Boston congressman Michael Capuano, who is close to the speaker. “She’s a liberal at heart but she knows when to give and when to take.’’
In forcefully arguing for major reform, and in successfully lining up the votes for it, Pelosi was reflecting the two distinct strands of her political heritage. Along with her fellow Californians Howard L. Berman, George Miller and Henry A. Waxman, she is one of the four members of the House Democratic caucus who were proteges of the late Phil Burton -- the militantly liberal, legislatively brilliant San Francisco congressman who dominated the House during the 1970s.
Pelosi is also the daughter of Thomas D'Alesandro Jr., a New Deal-era congressman who became mayor of Baltimore. D'Alesandro was an old-style ethnic machine pol with liberal values, and Pelosi's own rise through the ranks of the House Democratic caucus was greatly aided by support from similarly old-style, tough, deal-making Democrats such as David R. Obey and the late John P. Murtha, who found in her a deal-making ability to equal their own.
San Francisco and Baltimore, West Coast liberal and New Deal boss -- you can see all these in Pelosi's passion, her charm, her toughness, her smarts. You can see them in the battle she waged: Waxman and Miller were the key authors of the House bill, and she put tough-as-nails Obey in the chair Sunday night to guard against Republican obstruction as the House finally voted on the contentious legislation.
On Friday -- though she surely doesn't look it -- Nancy Pelosi turns 70. Not a bad couple of weeks' work, Madame Speaker. Happy birthday.
Even now she's urging her colleagues to go on offense... go Nancy!