July 12, 2007
It's Finally Happened
Question: Do you think Sirota actually formulates his DC-bashing ("only the Beltway's Wise Old Men, Serious Policy Experts, Self-Described Political Gurus and Universe-Rescuing Pundit Superheroes," etc) anew with each and every post he writes? Or has he created some sort of awesome Sirotabot program that does the work automatically? I'm sort of leaning towards the latter. After all, Sirota is a fairly smart guy, and clearly a helluva computer programmer, and I'm sure if he'd actually written this post, then somewhere between "only inside I-495 where theses Gods of Mt. Olympus frolick (sic)" and "folks are either too obsessed with the the pseudo-celebrity fanfare of being able to meet a U.S. Senator" he'd have managed to actually deal with one, or even half of one, of the article's points. Hopefully, a "substantive response" option will be included in Sirotabot 2.0.
For a somewhat more interesting reply, Nathan Newman takes on my arguments here. Well, sort of. Nathan argues that universal health care is more politically possible at the state level, which I fully agree with, and the article grants. His conclusion that "any reasonable analyst has to admit that serious health care reform is far closer in the states than at the federal level" sounds a lot like my article's basis, which is that states have repeatedly passed universal health care plans even as the federal government repeatedly failed.
It just doesn't take the next step, which is to admit that the states have, over and over again, proven incapable of sustaining these plans. I'd love to hear Nathan, or David, or someone explain how this next crop of reform attempts will avoid the fate of every other attempt, which was to fall apart because the economy entered a downturn, the state couldn't deficit spend (most can't), and revenues dropped even as the costs of the program increased. But then, I do live in Washington, DC, and am thus not as credible on these matters as employees and board members of an organization meant to push legislative reform through the states.
July 12, 2007 | Permalink
I read your article the other day and thought it was a perfectly good critique of the situation. I think Sirota took it personal because of his work with the Progressive States Action Network, and that is sad because he failed to address your point, and I would figure that if the states have failed to sustain their universal health care programs Sirota would like to know why and maybe use his groups reach to maybe fix the problem.
Knee jerk reactions do not help anyone.
Posted by: jbou | Jul 12, 2007 3:35:16 PM
Sirota's just now losing his mind? I could have sworn it happened earlier...
Posted by: Cain | Jul 12, 2007 3:44:59 PM
What is it with these guys? Sirota is consistently on the right side of actual issues, but he's terrible at understanding other people's arguments and giving useful responses. In the past, Newman has seemed better at that, but he completely blows it here. This, which you mention above, seemed to me the key point of your article:
recessions rob government of the revenue it needs to cover the uninsured at precisely the moment that the most people need subsidies to get them through the lean times. And states are incapable of responding, since they, unlike the federal government, are constitutionally barred from running deficits.
That's an important and interesting point, and we don't see any response from either Newman or Sirota. Instead they get totally confused and attack you on issues where you actually agree with them (States are closer to passing things, MA has a good system.) Frustrating.
Posted by: Neil the Ethical Werewolf | Jul 12, 2007 3:46:46 PM
I didn't find that initial piece that compelling given that
-- European countries of smaller size than many states in the US have relatively successful UHC
-- only real limitation then provided in the piece was lack of deficit spending, which given current cost growth doesn't seem like such a bad thing
Posted by: wisewon | Jul 12, 2007 3:47:04 PM
Oh it's right in the response - you should re-read. We point out that no one is claiming there shouldn't be a federal role - namely, to write checks. That's right in Nathan's piece, and right in my piece.
The problem with Ezra's piece is that he portrays it as either/or, when it has to be both. Both state efforts and federal efforts have to occur simultaneously. And, as Nathan argues, the real solution might be a partially federally FINANCED program, administered and run by the states (a la Medicaid).
But to say that neither Nathan or I addressed that is untrue. We believe both federal and state efforts are key - we are not conceited enough to claim that one set of efforts is a waste, as is the central premise of Ezra's article.
Posted by: David Sirota | Jul 12, 2007 3:52:21 PM
As a resident of Colorado who is self-employed and, frankly, pretty poor, I'm eligible for a state financed health plan. It's pretty good--comparable to most plans offered by my friends' employers, and far better than anything I could get on my own. It's an example of the states doing something right.
It's also an example of the state's generosity being unstable. Every six months the benefits and fees change, sometimes dramatically. As Colorado's perpetually in a budget crunch (thanks, Taxpayer Bill of Rights!), I'm always worried the program will be curtailed substantially if not axed outright. It's also not a very prominent program, so there isn't much of a lobby that would defend it.
On the other hand, should a national program be created I have a hard time imagining it would ever be dismantled, mostly because of the reasons Bill Kristol cited in his infamous memo.
Posted by: boatshoes | Jul 12, 2007 3:56:19 PM
The Washington Monthly's office has a gilded roof? Or did he mean the Prospect. Either way, you guys are are doing better than I thought.
Posted by: Matt F | Jul 12, 2007 4:02:18 PM
What is it with these guys? Sirota is consistently on the right side of actual issues, but he's terrible at understanding other people's arguments and giving useful responses.
That's a really good way to put it. Sirota is on the right side, and yet he's annoying as hell because he just doesn't listen (figuratively speaking).
So in this case, I think he reads 'letting states continue to take the lead' as allowing states to experiment with health care, when what Ezra actually means (correct me if I'm wrong) is the Federal government abdicating its responsibility to reform healthcare (i.e., 'letting states...take the lead' instead of the Federal government leading).
Posted by: Tom Hilton | Jul 12, 2007 4:08:04 PM
Ezra, you skirt a number of Nathan's solid arguments, too. You admit that federal reform is politically tough, but seem to indicate that we should put all of our eggs in that basket. What is your plan to overcome the filibuster?
Ultimately, as you yourself note, Nathan's got history on his side. Health care reform in foreign countries got started in state-based reforms. And most prominent progressive American reforms were also based on state programs, including things like Social Security and the minimum wage.
You say that we might not want Romney's plan at the federal level. I concur. So shouldn't part of the effort be to bolster credible alternatives at the state level, like Wisconsin's plan?
Posted by: Matt Singer | Jul 12, 2007 4:10:10 PM
What we've done is ratcheted down Nathan's argument till he and I are saying the same thing. My piece argues that :
"The history of state health reform initiatives (and there’s quite a history) is a tale of false hopes and great disappointments. The deck is stacked from the start, and the house—in this case the insurers, the providers, and other agents of the status quo—always wins. The new raft of reforms may prove different, but they probably won’t. Universal care advocates must be realistic about that, and think hard about how to convert the energy in the states into a national solution before the current crop of novel experiments fail—because fail they almost certainly will."
You say Nathan wants to use the plans coming out of the states as the basis for a national solution, as they have in other countries. We're all on the same page. I'm just saying that the states themselves cannot, and never have been able to, sustain a UHC plan on their own. Ever. And we need to be cognizant of that.
Posted by: Ezra | Jul 12, 2007 4:17:42 PM
Sirota claims the best way forward is for federally financed, state run healthcare programs. I fail to see how this is more politically viable than the alternatives (political viability being the reason he dismisses a fully federal system).
The states as testing grounds makes a lot of sense, if you think policy is actually going to be made via a process like "this worked best, let's expand it". Policy in the modern American political climate just does not work that way, as demagogues are adept are picking out supporting data points and ignoring bad ones no matter what the outcomes. Hell, we have a TON of data points simply by looking at other liberal democracies, and state programs to date. No one (on the right or center) seems very intent on analyzing those results.
Delaying what you think would be the appropriate national program for 10 years or so, just so you can add one more argument to why we should have national healthcare in the future, an argument that will probably be ignored by some witty bumper-sticker insult of California (or whomever has the successful program), seems pretty bad policy wise.
Posted by: Tony V | Jul 12, 2007 4:20:54 PM
Is this what you're talking about, David? From Newman:
"progressives at the federal level should concentrate on expanding funding going to the states to support these programs."
And from you:
"While no one argues that the federal government has played a role in these successes, that role has been primarily financial - not administrative. That is, the feds have cut some checks"
I didn't notice initially that this was supposed to be a response to Ezra's central point, because it doesn't seem adequate. Suppose we're under GOP control nationally when the hard times come. How are non-swing blue states going to maintain their funding? It's a lot easier for the GOP to punish a few strategically unimportant states by withholding federal funds than to make cuts in a national, universal program. We can slaughter them if they try to go after Medicare or Social Security, but they can sometimes cut less broad-based programs.
And how are funding levels for each state going to be determined, anyway? None of the big entitlement programs we love -- Social Security, Medicare -- have a state-by-state funding structure. We don't want to distribute the cash by running a 50-state political food fight in which states running 50 different systems with different funding levels compete for federal money.
Those are all policy objections, but here's a political strategy objection: If you don't think we'll be able to raise taxes on the federal level to fund national health care, why do you think we'll succeed in raising taxes on the federal level to fund big checks to all 50 states? (Personally, I'm an optimist about getting national health care passed in the next couple years, given that the Senate calendar favors our having a big majority in 2011. But if you're a pessimist, you have to explain why it's any different for the big checks than for an actual national program.)
If you have more to say about how this would work, I'd be interested in hearing it. But on first glance, this seems like a really weird way of funding health care for everyone in America.
Posted by: Neil the Ethical Werewolf | Jul 12, 2007 4:21:39 PM
Wow what a non-post that was as we went from David Sirota is a crazy robot to we're all on the same page.
Posted by: jerry | Jul 12, 2007 4:24:15 PM
Says Matt Singer: "Health care reform in foreign countries got started in state-based reforms."
My brief Googling suggests that provinces in Canada are allowed to run deficits. This is crucial to Ezra's argument. I don't know about other countries, but it seems that the Canadian path will be hard to follow in America where states can't do this.
Posted by: Neil the Ethical Werewolf | Jul 12, 2007 4:34:33 PM
Hey, if people want to say they're making my argument, I'm happy to say we're in agreement. Nathan and David, I'm getting the feeling, don't even disagree with my central points. They just don't think I should have written them. But Nathan's reply is at least quasi-relevant. Sirota's is a mash of reverse-elitism and insinuations of bad faith.
Posted by: Ezra | Jul 12, 2007 4:36:32 PM
No, my response was that your article used progressive resources to take a dump on the work of the progressive movement, and potentially imperil major progressive advances on health care (though I wouldn't dare to grant your article that much importance). Really, what was the point of the article other than to tell people that state efforts at health care aren't important? I'm sorry, but if you expect people to just applaud you and tell you how awesome you are because you did that - in the face of the fact that 20 million more Americans now have health care EXPLICITLY because of state efforts - well, think again.
Posted by: David Sirota | Jul 12, 2007 4:45:53 PM
Of course Klein attacks Sirota without addressing the issue. Classic Klein. All bluster, no substance.
Posted by: Bill | Jul 12, 2007 4:48:22 PM
We point out that no one is claiming there shouldn't be a federal role - namely, to write checks.
That's not enough to overcome the problems Ezra's piece actually describes, unless the states are off the hook financially to a much greater extent than is likely to ever happen in a joint state/federal program. You need to address the particulars of what he said.
You admit that federal reform is politically tough, but seem to indicate that we should put all of our eggs in that basket.
I must have overlooked that. What I read was an explanation of why we can't rely on states to be the leaders here, that we need to act on the federal level. That doesn't rule out state programs, which Ezra has spoken favorably of. It only shows why they aren't likely to work in the long run.
Really, what was the point of the article other than to tell people that state efforts at health care aren't important?
More that they probably won't work in the long term. They'll work while they work, but are likely to founder on hard times. You haven't addressed that.
Posted by: Sanpete | Jul 12, 2007 4:55:06 PM
I think, Ezra, that you miss two of the key reasons that state-based reforms fail.
1) There's no possibility of re-distribution of existing government money. It's pure added spending, and keeps the current screwed-up incentives in place; there's no way of taking the employer-provision subsidy, and Medicare, and covering based on $/QALY across the population.
2) Mobility is a bitch, because of the 90/10 rule. It only takes a few thousand diabetes/MS/sickle-cell patients moving to your state and the costs go up a lot.
Posted by: SamChevre | Jul 12, 2007 4:56:36 PM
David, the point of Ezra's article was that the end goal of our efforts for universal health care can't be a bunch of state systems, because systems that can't deficit-spend are unstable in the face of recession while a national one is stable.
This is a really important point for progressives, because if we sit tight after building a bunch of state systems, we'll be in for an unpleasant surprise when recession hits and the waves wash them away. (Except in MA and maybe CA, for state-specific reasons that Ezra goes through.) Maybe you have some neat funding system to solve this problem, but as I said above, I don't see how it's going to work.
If we can't make points like this in our national publications, the progressive movement is going to be flying blind.
Posted by: Neil the Ethical Werewolf | Jul 12, 2007 5:06:19 PM
Ezra - thank you so much. Sirota is insufferable. I stopped reading his blog a year and a half ago. Unfortunately he has recently moved to Denver (my hometown) and has literall taken over the local blogs with his 1,500 word screeds. He is undoubtedly a smart guy but he is also undoubtedly arrogant to the extreme and so rigid in his ideology that honest debate is impossible.
As for Stoller, I find it amusing that someone who moved to the Mountain West about 15 minutes ago is going to tell those of us who have been here on the ground working to turn our states blue how we can do it better. Who asked you?
Posted by: TRM | Jul 12, 2007 5:10:37 PM
wrote "Stoller", meant "Singer" my bad
regardless I think Neil is spot on, David is on the right side of many issues but he comes off, as someone said, as a "reverse elitist". It's nauseating.
Posted by: TRM | Jul 12, 2007 5:16:08 PM
No, my response was that your article used progressive resources to take a dump on the work of the progressive movement, and potentially imperil major progressive advances on health care (though I wouldn't dare to grant your article that much importance).
It's ironic that Sirota bashes Ezra like this, considering Sirota's entire schtick is to bash people from his own side of the aisle who aren't deemed sufficiently pure.
Did anyone see his rant when the Employee Free Choice Act failed? Was it about the evil Republicans who filibustered this important worker's rights legislation? Of course not! It was about how the Dems, because they brought the thing to the floor for a vote rather than trying to sneak it into some other bill in the dead of night, must have wanted to lose on purpose so they could keep the unions fighting for them in 2008.
But Ezra is undermining the progressive movement, apparently. God.
Posted by: Steve | Jul 12, 2007 5:45:50 PM
I expect there are other states like Colorado where Sirota's apprach doesn't have the snowball's chance in Hades. States tinkering with Colorado's TABOR amendment would have an equally hard time. Ezra's observation, recessions rob government of the revenue it needs to cover the uninsured at precisely the moment that the most people need subsidies to get them through the lean times. And states are incapable of responding, since they, unlike the federal government, are constitutionally barred from running deficits ought to be repeated until the listener can recite it by heart.
Posted by: mk | Jul 12, 2007 5:47:06 PM
Um, Matt Singer is a life-long Montanan.
Posted by: David Sirota | Jul 12, 2007 6:09:53 PM
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