Bend It Like Obama?

As I write, the Senate Finance Committee has yet to release its version
of healthcare reform legislation, and Harry Reid has announced that the
Senate won't vote on any healthcare bill until after the August recess.
This is worrisome. The future of progressive politics and the nature of
the American social contract, not to mention the lives and health of
millions of our fellow citizens, is up for grabs.

Strangely, though, you wouldn't really know it from listening to the
pronouncements emanating from the White House. Instead, they're focused
with laserlike precision on "bending the curve." Testifying before
Congress in June, Council of Economic Advisors chair Christina Romer
said she wants "to focus on slowing the growth rate of costs...the
so-called curve-bending that can last for decades." Office of Management
and Budget director Peter Orszag emphasized in a recent interview that
"the legislation that emerges from this process has to contain key
provisions that will bend the curve over the long term." And even before
he took office, President Obama said that "the key is going to be
medium-term and long-term, how do we bend the curve so that we start
getting these deficits down to a manageable level?"

In this case the "curve" is the projected increase of healthcare
expenses over the next several decades. Healthcare currently accounts
for 17 percent of GDP (more than in any other industrialized nation),
and its share is growing. This predicted inflation in healthcare costs
will drive up the cost of Medicare and Medicaid, which if allowed to
grow at the current rate will eventually bankrupt the government.
Therefore, reforming healthcare is crucial to keeping America solvent.
This is true and right and compelling enough, so far as it goes.

But in politics there are two kinds of issues: those that make your
cheeks flush and inspire passion, and everything else. The integrity of
our bodies, the care loved ones will or will not receive when they fall
ill, the fear and misery that beset millions of people who are cruelly
left to a prison of nagging illness because they don't have routine
care--those are in the first category. Long-term fiscal deficit
projections are decidedly in the latter.

In its healthcare messaging, the White House has taken an issue more
intimate and immediate than perhaps any other in a voter's life and
transformed it into an abstract, technical argument about long-term
actuarial projections. It's a peculiar kind of reverse political
alchemy: transforming gold into lead.

Of course, there's a certain logic to the White House approach: despite
widespread public support for reforming the healthcare system, a desire
for more choices and pervasive insecurity about the stability of
coverage, a majority of people think that their health insurance is just
fine. The trick then is to promise two contradictory things: that
healthcare reform will change the system while leaving your healthcare
intact. In what at first appeared a deft bit of jujitsu, the White House
settled on the long-run-cost argument as the way to pull this off.

But now we're seeing the problems with this approach. For one,
converting a moral and political argument into a technical and
accounting one ends up ceding veto power to the accountants at the
Congressional Budget Office. In a Beltway version of Revenge of the
Nerds, every time a Democratic bill comes out of committee it's sent
to the CBO to be "scored"--that is, to evaluate how much it will cost
and how much it will "bend the curve" on future costs. So far, the
results have been mixed. CBO head Doug Elmendorf has been skeptical
about the gains to be had from measures like health IT and wellness
programs, and both the House and Senate bills have been scored as
revenue neutral over the next ten years. In another context that would
be great news, but since healthcare is being sold as a way to reduce the
deficit, revenue neutral doesn't quite cut it.

The other problem is broader than just these pieces of legislation.
Obama has inherited a shared political vocabulary in Washington (with
phrases like "fiscal discipline," which he himself employs) that shapes
the contours of the possible and semantically militates against
progressive politics at every invocation. If "fiscal discipline" meant
that politicians support tax increases on the wealthy or cuts to the
military budget to pay for programs, it would be a useful concept. But
what "fiscal discipline" means in Washington is cutting government. It
means no taxing and no spending. It means "pain" and "sacrifice" and
gutting the welfare state. When politicians say they're "fiscally
conservative," what it actually means is they're conservative. Full
stop.

Even with his mandate and the broad social forces moving America toward
a progressive majority, Obama doesn't have the time (and may not have
the inclination) to undo three decades of accumulated right-wing,
antigovernment rhetoric. So in order to strike while the iron is hot,
he's attempting to use the language of fiscal conservatism to pull off a
marginally progressive shift in the social contract.

But the rhetoric of "fiscal conservatism" also empowers the enemies of
reform. When "moderate" Democratic senators on the Finance Committee,
Max Baucus and Kent Conrad, finally unveil their secretly crafted
version of healthcare reform, which reports indicate will include
neither an employer mandate nor a public option, they can claim it
fulfills the president's goal of "bending the curve." By cutting
subsidies and reducing the number of Americans covered, their plan could
still manage to come in under the magical $1 trillion mark. Since the
CBO's Elmendorf has been intimately involved in crafting the bill, that
seems assured. What Congress could end up with, then, is a bill that
costs less than others but doesn't, you know, provide universal
healthcare.

The policy argument the president is making is sound: more government
intervention, a public option and broader coverage will reduce costs in
the long run. But this causes so much cognitive dissonance that
mainstream media figures are incredulous. And that skepticism, along
with industry propaganda claiming that a public option will limit
choices, is, not surprisingly, showing up in public opinion. A recent
Washington Post/ABC News poll found support for Obama's
healthcare agenda at 49 percent, down from 57 percent in April.

So what to do? If there's a silver lining to the fact that Congress will
enter its August recess without a bill, it's that the White House and
advocates of real reform will have a chance to modify their pitch. If
there was ever a time for Obama's vaunted and much-anticipated
grassroots army Organizing for America (OFA) to do its thing, it's now.
Since it's closer to the actual lived experience of voters, OFA may have
superior instincts about what kinds of messages resonate. Recently it
undertook an effort to compile stories from people about their
experiences with a broken healthcare system, like this one:

I am 36 years old and have Blue Shield HMO health insurance coverage
through my employer. In January 2009, I was diagnosed with metastatic
(stage 4) breast cancer.... My doctors prescribed a medication that
targets and removes the cancer throughout the body like a "smart bomb";
however Blue Shield of California denied coverage of my doctors'
recommended treatment. Blue Shield also denied a radiation procedure
that would target and remove the two lesions in my brain. In both cases,
Blue Shield denied the original requests and subsequent appeals I filed
on the grounds that the treatments are not a medical necessity. I have
learned that insurance companies will use "medical necessity" as an
excuse to not cover treatment when it appears that the patient is "too
sick" (read: not worth it).

Stories like this strike me as a whole lot more potent than talk about
"bending the curve."