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May 10, 2006
The DLC and Medicare Part D
Folks interested in the TNR-DLC-blog wars should check out Ed Kilgore's rundown of where the DLC differs from the list of policies Atrios thinks the blogosphere basically supports. Mostly, things stack up as you'd expect, with the DLC and the blogosphere concurring on near everything -- domestically speaking, the organization has pretty good policies, if pretty poor spokespeople. The divisions, however, are surprising.
Where Atrios thinks bloggers agree that Medicare should run the Medicare drug program, Kilgore dissents that the DLC "opposed the current plan, but [we] think the problem is cost and complexity, not the basic idea of offering choice and competition, a la the federal employees' plan." Of course, cost and complexity are absolutely intrinsic to the primacy of private insurers, so it's near impossible to separate their preservation from Medicare Part D's structure (and I'm sorry to see Kilgore buying into the GOP spin that terms privatization and insurance industry participations as "choice and competition" rather than inefficiency and profit-seeking). So far as I know, none seriously dispute that Medicare pays more for drugs than the VA, Canada, Britain, France, or any other socialized system because Medicare, unlike the others, is barred from using its market power to negotiate. The current king of the free market, Wal-Mart, dominates on cost and crushes the competition by throwing their size around. It's schizophrenic to value the free market but bar Medicare from adapting the tactics most successful within the market's rules.
This is, of course, what frustrates liberals about the DLC. There's no coherent policy reason to support a "choice and competition" structure. Even if they oppose the current arrangement (and it's not clear how they really can), holding those two values inviolable confines them to very similar programs. That makes for bad policy. It also relies on a willful decision to ignore all evidence from all examples of contrary systems that achieve better results. Whether you're looking at the tiny Veteran's Administration or the majority of developed countries, denying the superiority of centralized bargaining for pharmaceuticals requires slapping your hands across your ears and "la-la-la"ing till the other discussants put away the uncomfortable facts. Indeed, while I'd be interested to see a policy defense on this count from Kilgore, my sneaking suspicion is that it's an example of the DLC's fetish for opposing anything that smacks of old-school liberalism. And, in the end, no matter how many points of agreement we all have, it's hard for progressives to be safely allied with a group so totally committed to visibly distancing themselves, and thus discrediting, traditional progressives.
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Comments
Ezra, Great picking apart the DLC on this issue - you're absolutely right.
I studied health care in-depth ten years ago and have followed it with interest ever since. What's amazing about the issue is that there is clear break between reality and free market ideologues in health care. All the evidence says that free market systems don't work in health care. Everyone in the industrialized world has socialized medicine, except for the US - and almost everyone of them has better health stats for less money.
And the reason is pretty obvious when you stop and think about it: almost all the basic assumptions of micro-economics don't apply in health. There is no perfect information, nor informed consumers - heck most consumers can't understand the choices they're given. Plus there are enormous economies of scale, huge time lags in investment for preventive medicine and medical training, massive certification and veritifcation requirements, etc.
And on a related note, if you ever wonder why some of of us former TNR readers have turned into TNRO haters, take a look at this sentence of yours - and see whether it also applies if you switch the subject from DLC to TNR:
"my sneaking suspicion is that it's an example of the DLC's (TNR's) fetish for opposing anything that smacks of traditional liberalism. And, in the end, no matter how many points of agreement we all have, it's hard to be allied with a group deeply committed to discrediting the proposals of mainline progressives."
Which in turns reminds me of that cheap shot, false article that TNR ran in 1994 which helped sink the Clinton health plan. I forgave the magazine and subscribed for a bit longer, but... etc.
Posted by: Samuel Knight | May 10, 2006 4:07:58 PM
Eh, I get the DLC's "position" (I suspect) on this, and I probably share it. I think it's probably something closer to an aesthetic preference than a position. I suspect the DLC worries about massive government bureaucracies because they remember how crappy those bureaucracies were in the past. But, in the last fifteen years, such bureaucracies have rendered much better experiences for the taxpayer/consumer. So this disconnect may be age related. The Dept. of Motor Vehicles experience today is leagues better than it was in the past. I always wonder if TV jokes about the experience make sense to anyone younger than thirty.
Anyway, that's all guess work.
Posted by: SomeCallMeTim | May 10, 2006 4:18:42 PM
Sam: The magazine, under current editor Foer, apologized for their role in 1994. Since the staff is new and the editor has signaled institutional repentance, I don't hold that against them any longer.
Posted by: Ezra | May 10, 2006 4:32:03 PM
Kick them again, harder, Ezra. And then do it some more. But, as Samuel points out, save the other leg and foot for the TNR.
Tim (SomeCallHim): But in this case we have the example of Medicare Part A which is nearly universally loved, awesomely efficient, and run solely by the government. It takes effort for the DLC to ignore what is directly in front of your face. This isn't some abstract issue of what to do about a new issue, but a logical extension of what already really works.
The DLC (and the Rethugs), for ideological reasons - not for evidence of poor results) aren't satisfied with the excellent or superior, they want to pursue private insurance alternatives that have already been shown to be at best acceptable but more often fair or poor.
Posted by: JimPortlandOR | May 10, 2006 4:34:13 PM
SCMT:I can understand what you're saying, and I think you might be right. We can put it down to this...
"Beauacracy sucks"
The problem is that people don't realize that the modern HMO/insurance agency has much more beauacracy than a governement run system...
And that the modern progressive movement is actually interested in shrinking the amount of beauacracy as much as it can, while maintaining and increasing the quality of service. We just don't see a difference between public and private beauacracy.
Either A. Kilgore and the rest of the DLC don't realize this, or B. Realize it and are upset that our third-way movement is stealing their third-way thunder.
Posted by: Karmakin | May 10, 2006 4:45:25 PM
As far as the DNC goes, it's simply about who makes campaign contributions and pays the lobbyists. Medicare doesn't really have a paying constituancy lobbying for its expansion. Private insurance on the other hand...
Under the current system you can't get elected without the big bucks. Until that's fixed forget about substantive reform, it ain't gonna happen. Too many deep pocketed interests will lose money. Good public policy, health poilcy, common sense and fiscal restraint be damned.
Posted by: Sonny | May 10, 2006 4:56:02 PM
Good point that Foer apologized, but:
1) Despite the fact the staff is new, Peretz is still around - and he owns the darn thing.
2) It wasn't just the 1994 article, there was Michael Kelly, Chait's hate fest with Dean, the Bell Curve stuff, continuing to print Sullivan after he accused all of us on the coasts of being traitors, publishing the same idiots as National Review, etc. I grant you that there were some good articles (well mainly because you wrote some of them...) but it was just too much.
3) And the tone. That snotty Economist-like tone that the editorials started using after Sullivan took over. And the scathing contempt for anyone who questioned first the "War on Terror" and then Iraq.
You're absolutely right that many of the old left had that same scathing tone. The fellow travelers of the 1930s were useful idiots. But now I'd venture the "useful idiots" are more commonly found all over the capitol.
Posted by: Samuel Knight | May 10, 2006 4:58:08 PM
"Medicare doesn't really have a paying constituancy lobbying for its expansion."
AARP and the seniors do this job quite nicely.
Posted by: Ezra | May 10, 2006 4:58:16 PM
AARP was one of the biggest backers of the drug bill, because, coincidentally enough, they were poised to offer their own Part D insurance. There's nobody putting money into expanding public insurance.
Posted by: spike | May 10, 2006 5:21:46 PM
"There's no coherent policy reason to support a "choice and competition" structure."
The way I'd interpret the DLC's thinking here is that there is a very good politics reason to support a "choice and competition" structure. And that reason, of course, is money.
(And not money for the DLC, but money for Democratic Congressional candidates.)
In the generic case, that's probably a good thing. Democrats can't get outraised 100% to 0% in the corporate community and still run competitive campaigns.
But in this specific case, I part company from Kilgore.
The trick here is understanding the importance of picking some non-trivial enemies in politics. Think about the Republicans frontally taking on trial lawyers. It creates a motivated group aligned with the Democrats and costs the Republicans a non-trivial amount of campaign dough.
But creating that enemy also gives the Republicans significant advantages. It solidifies their financial ties with the business community and gives them a rhetorical point that they can use to create false reform solutions to problems that undercut real Democratic reform.
If the Democratic coalition made a decision to demonize the health insurance industry and, to a somewhat lesser degree, the pharmaceutical industry, it would lose our candidates some money and create a motivated Republican ally. But it would gain the coalition some significant advantages in strategic politics, and of course would be greatly advantageous in terms of policy.
Democrats need to pick few, but strategic, fights in the business community. This is one to take on.
Posted by: Petey | May 10, 2006 6:27:58 PM
I think Somecallmetim raises a point, is it possible that the state & state bureacracies have become more effective in the years since the anti-government backlash began? Could the DLC, who originated as a Democratic response to what they saw as forever prevailing anti-government hegemony? Perhaps they just need to abandon some facets of "Backlash liberalism" and give government a chance.
At the very least, I think you come down a bit harsh Ezra, you seem to preclude the possibility that the DLC arrived at it's position in good faith, rather than out of a distaste for "traditional liberalism" Anyways, Kilgore & Marshall aren't the guys to talk to about this anyway, they are just in charge of the talking points & the platitudes. You need to talk to their in house health wonks & tell them how wrong they are.
Posted by: Dustin | May 10, 2006 8:49:02 PM
""my sneaking suspicion is that it's an example of the DLC's (TNR's) fetish for opposing anything that smacks of traditional liberalism."
Care to put that thesis to a test? What traditionally liberal issues does TNR routinely oppose day in & day out?
Posted by: Dustin | May 10, 2006 8:52:02 PM
This is fantastic news. The fact that Kilgore thinks it necessary to defend the DLC against the attacks from the blogosphere shows its increasing relevance and power within the Democratic party. Obviously they fear that increased activism and decentralized policy-making will hurt their ability to maintain their precious access and power.
The DLC is worthless - no, they're worse than that, because they actively seek to marginalize and weaken large parts of the Democratic party in order to advance themselves.
I'm sick of having 'Democrats' repeat GOP talking points about me and people who believe as I do. I'm sick of those who would sacrifice core progressive principles for the sake of winning elections - not that they're really doing all that great of a job of it.
I hope that Ezra is well-known enough that some DLC-type reads this comment thread so that I can say directly:
You have done as much, if not more, damage to the Democratic party with your absurd Republican-lite "triangulation" than all of the so-called crazy hippy liberals put together. You are the reason people think we don't stand for anything, because you try your damnedest to make that the truth. You are the reason that people think both parties are out to screw average Americans, because you are.
The best outcome for not only the Democratic party but for the country at large would be for your offices to burn down, your electronic files erased, your articles stricken from Lexis-Nexis and all of you to suffer from group amnesia so that your stupid, stupid, stupid ideas can finally disappear from the earth.
Posted by: Stephen | May 10, 2006 9:22:51 PM
It's ok to tell us how you really feel.
Posted by: Dustin | May 10, 2006 10:09:50 PM
Dustin: "Care to put that thesis to a test? What traditionally liberal issues does TNR routinely oppose day in & day out?"
That's easy: Iraq. Corporate Trade Agreements. Labor Laws. And I think that Bankruptcy bill.
But the main thing that I wanted to suggest to Ezra is that I'm starting to think that the massive anger at the DLC and TNR is in part displaced anger of many progressives at their Washington "leadership". This morning in the Post there was yet another article about how Schumer and Rahm Emmanuel met with Dean and started yelling at Dean for not signing on for yet another last minute ad blitz Congressional strategy. Yup, they felt free to yell at the elected Chair of the DNC for explicitly following the 50 state strategy that Dean ran on.
And this is going to be a huge problem for the Democrats - a lot of the base just don't like high profile democrats. They don't like Biden, Lieberman, Schumer, Kerry, Hillary Clinton, Steny Hoyer. And they don't like them on 3 levels. They dislike the strategy they keep proposing, they don't like their attacks on progressive Democrats, and they generally don't like how arrogant they appear to be.
Now, I know that they aren't the elected Democratic leaders (who are Reid, Pelosi, and Dean). But Schumer and Emmanuel are elected to lead the campaigns - and consistenly ticking off your own base doesn't appear to me to be a good idea this round.
And I definitely am one who would not want to give a red cent to either Schumer and Emmanuel to play with - and in fact am reluctant to give to the DNC until they make perfectly clear that they're going to stick to the strategy they promised. My guess is that this visceral reaction isn't that uncommon.
Lastly, are staff at the DNC really that stupid to chat about an internal fight to the Post? Or did the Post reporter just make it up?
Posted by: Samuel Knight | May 11, 2006 9:39:46 AM
"And this is going to be a huge problem for the Democrats - a lot of the base just don't like high profile democrats."
"a lot of the base" = one tenth to one fifth of the party.
God, I wish the enthusiastic but nescient progressives learned how to count...
"Lastly, are staff at the DNC really that stupid to chat about an internal fight to the Post? Or did the Post reporter just make it up? "
The Post just made it all up. Nobody in the party thinks the good doctor is doing anything wrong. Good catch.
Posted by: Petey | May 11, 2006 11:10:54 AM
The trick here is understanding the importance of picking some non-trivial enemies in politics. Think about the Republicans frontally taking on trial lawyers. It creates a motivated group aligned with the Democrats and costs the Republicans a non-trivial amount of campaign dough.
Damn, Petey, that is one of the most incisive comments I've read anywhere about the difference between the D and R approach as it has evolved.
Need to expore it a bit, but a couple of initial thoughts. One, it's not a problem of not ever having had such an "enemies" strategy. The New Deal was built on a whole culture of animosity toward those cigar chomping capitalists That character who became the logo for Monopoly. But the minute you say that, you see that the GOP strategy has been not just to identify enemies of their own, but to deligitimize our traditional ones. "Class warfare!" they cry at any move in this direction. And if the DLC has internalized any GOP memes, it is that one. Not without reason, to be sure. But it's a political problem, as you point out, and they aren't offering an alternative that provides the same leverage or footing to push back at the GOP. So they--and we--get rolled every time.
I think your point also clarifies why the Dems have this Foreign Policy/Toughness, "If they won't fight for themselves they won't fight for me," and "I don't know what they stand for" perception problem. According to your theory, they've completely misconceptualized the issue. They think--and their consultants keep telling them--that it's a matter of having the right market basket of affirmative policies. Consultants say this because that's what their polling tells them, and their polling tells them that because those are the kinds of questions they ask, and because people generally think in affirmative terms when they're thinking about what defines a person or a thing. But the GOP seems to have learned what Derrida kept insisting on way better than the Left in this regard--that definition is as much or more a matter of negation than affirmation. Or in less hifalutin terms...
Whatever people say, what they really mean by "I don't know what they stand for" is "I don't know what they stand AGAINST."
It is this above all that the GOP has mastered, and that the Dems seem utterly unaware of. Defining themselves by what they are proud and confidently against. Even if people don't agree, they vote for them because this makes the GOP feel like a known-quantity, and the Dems lack of such a position makes them seem amorphous no matter what position statements and policy papers they release.
If the party could finally get a grip on this aspect of their perception problem we'd see some real progress. But framing the problem correctly is a key part of the battle, and I think your insight goes a long way toward doing that. So thanks.
Posted by: DrBB | May 11, 2006 11:13:51 AM
"It is this above all that the GOP has mastered, and that the Dems seem utterly unaware of. Defining themselves by what they are proud and confidently against."
I will offer the caveat that this strategy of intentionally making enemies is best practiced in moderation.
Democrats can't stand in opposition to all perceived enemies in the corporate community without returning to the 43% party we were before the DLC rose to prominence almost 20 years ago.
I'm in favor of making an enemy out of the healthcare insurance industry, and to a lesser degree, the pharmaceutical industry because I think it offers the Democratic party a significant strategic benefit.
But one should be wary of generalizing that tactic toward all circumstances.
Posted by: Petey | May 11, 2006 11:55:38 AM
Instead of making enemies, perhaps Democrats could just realize that there are certain groups that have declared the core constituencies of the Democratic party their enemies.
It is not necessary to declare war upon the pharmaceutical or insurance industries, or upon wealthy, bible-beating whites. They are the ones who have initiated aggression, they are the ones who have decided that the poor, women and ethnic minorities are worthy only of exploitation and restriction.
All the Democrats need to do is stand up for what we say we believe in. We need to fight back against those who have targeted the weakest of us in order to fatten their wallets.
Posted by: Stephen | May 11, 2006 2:40:10 PM
I will offer the caveat that this strategy of intentionally making enemies is best practiced in moderation.
Absolutely. The GOP has become, shall we say, slightly over-focused on enemies and hit lists and us-vs-them issue framing. But I think you've put your finger on the gut-level reasoning that has been drawing voters into their camp and away from ours despite most people disagreeing with their policies and priorities. "I don't like their policies but I know what they stand for," where "stand for" really means "stand against."
Not an "enemy" strategy exacly, but Russ Feingold's censure motion was the right move IMO because it was a decisive action against an intolerable policy. Being thoughtful and calling for more study and so on doesn't get you credit for statesmanlike wisdom and temperance, it makes you look like you don't have any real principles you're willing to fight for. And to fight for means to fight against.
Posted by: DrBB | May 11, 2006 3:24:18 PM
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