[Full disclosure: My firm built Ron Wyden's and Jeff Merkley's websites, but I speak only for myself.]

Enough with these DSCC negative ads. It is now hurting Jeff. I am being told by a lot of people, including committed Democrats that they will not vote for either Jeff or Gordon becasue they hate the way this race has turned. Jeff's ads are OK. What works in NY doesn't necessarily work in Oregon.

If you like frozen peas you should check out these:

Rosebud Frozen Peas

July over the Snow

I have been told that Wyden was able to close the deal for his senate race against Smith when he stopped negative campaign ads.

Of course, Jeff Merkley hasn't run any negative personal attack ads in this general election campaign. You can watch all his ads here.

I wonder if the DailyKos age demographics...

One thing I'll note, before anybody goes there: This poll was paid for by DailyKos, but conducted by Research 2000 - a nonpartisan for-profit polling firm.

They also use a likely voter screen that's based on answers to questions. If it skews young, it's entirely possible that the likely-voter population skews young. Hard to believe, but OK.

Also, as TJ noted over at Kos, it seems to have a moderate oversampling of Republicans -- so maybe it leans Smith.

Hard to know. I consume all my polls in aggregate.

Chris, single-payer isn't politically viable right now. Right, wrong or indifferent that's just how it is.

It seems to me that any support by Smith for Wyden's plan is premised on political advantage for Smith.

It seems to me that any support by Merkley for Wyden's plan is premised on it being the most viable improvement away from what we've had and towards something along the lines of single-payer that is available right now.

Reading inbetween the lines it seems to me that given his druthers Smith would NOT be backing the Wyden plan. Whereas it seems to me that Merkley (and Wyden) would prefer to treat the Wyden plan as an opening gambit rather than as the final destination.

So, from where I sit there is miles of light between Smith and Merkley with respect to the Wyden plan.

Smith likes to say he is for something, but then he votes against it when it comes up, does nothing to actually get it passed, etc.

Merkley won't just say he's for it - he'll work actively to see it passed. I saw that when I worked alongside him to get payday loan reform passed in the state. Merkley could have just said he was for it and that was it. Instead, he testified at hearings, talked with people around the state, and did everything he could to ensure it's passed.

But in terms of their publicly stated positions, there is no difference in terms of health care?

You're taking Smith's publicly stated positions at face value?

Kari:

Exactly. Kind of like how he's against drilling in the Arctic National Wildlife Refuge, how he's against the war, etc.

I have looked around, but can't find how Merkley distinguishes himself from Smith on health care. It seems like both support the Wyden plan and neither supports single payer. I assume Merkley is better on this and hope someone can point me in the right direction.

Chris #12--

First, Smith only backed the Wyden plan after Merkley did. It's political cover at its worst.

Second, Merkley has commented on single-payer. He has said that he will vote for single-payer if it makes it to the Senate floor. He has said, however, that he thinks we can't wait for single-payer -- that we need a plan that will create universal coverage now, even if it's imperfect. (I'm paraphrasing here.)

He's talked about that in many places at many times. The one I remember that is online is on OPB's Think Out Loud program, during the primary. You can listen to it here.

Anybody who has actually worked with Merkley or his office on an issue that both sides know he believes is not key to his election chances, also knows he's a hollow politician through and through who conditions his support solely on what is going to be best for him.

That must be why Merkley has been so overwhelmingly popular in his House District--cuz he is just so damn shallow that he'll only work on stuff that gets him elected. He never does any actual real work...that MUST be it.

Gosh..everything is so clear now....

And so we should all just switch our allegiance to Gordon Smith..because he doesn't do work that helps him get reelected. In fact, he doesn't do much of anything AT ALL.

And even if he did--there's no way his constituents could actually talk with him about it because none of us are allowed to see him. Unless we're willing to write a campaign check, that is.

Kevin:

Chris, single-payer isn't politically viable right now. Right, wrong or indifferent that's just how it is.

Kari:

Merkley has commented on single-payer. He has said that he will vote for single-payer if it makes it to the Senate floor.

Of course single-payer isn't "politically viable" right now. Just like opposing the Iraq war wasn't considered politically viable in 2002. That's why most of the Democratic party leadership helped hornswoggle the public into our multi-trillion debacle in the sand.

Without leaders in Congress who are willing to stand up for The Health Care That Dare Not Speak Its Name, it's never going to be politically viable.

"If it makes it to the Senate floor?" Is Merkley waiting for a white knight to ride in on a horse with a health care bill? He's supposed to be keyed into health issues because his wife's a nurse who's ministered to the poor around the world, isn't she? I've got to expect something more solid from someone vying for what is arguably one of the most powerful positions in the world.

Any attempt to provide single-payer health care -- or even affordable basic health care to everyone -- in this country is going to be a massive undertaking. It's a task that requires leadership and probably years of work in the Senate, not someone who's going to speak up only to cheer while someone else pushes the rock up the hill. Merkley didn't even give the amount of support to single-payer that Kari mentions in last fall's online chat (from his web site at 2:15 PM).

Wyden's proposal is as anemic as it was when it was first proposed. And as I quoted from The Hill in April:

Congressional Democrats [i.e. Sens. Schumer and Clinton] are backing away from healthcare reform promises made by their two presidential candidates, saying that even if their party controls the White House and Congress, sweeping change will be difficult.

And they aren't even on board with Wyden. Wyden's 17 listed co-sponsors are pretty much the same as they have been: mostly conservative Democrats, plus Lamar Alexander (R-TN), Bob Bennett (R-UT), Norm Coleman (R-MN), Bob Corker (R-TN), Mike Crapo (R-ID), Chuck Grassley (R-IA), Joe Lieberman (I-CT), Arlen Specter (R-PA), and Trent Lott who's not even in the Senate any more. Oh, and Gordon Smith.

Maybe Merkley can join onto single-payer advocate Bernie Sanders' Access for All America Act to expand community health care centers and National Health Service Corps programs (S.3412 and S.3413). Both Obama and Clinton signed onto those when they were introduced in late July. No Wyden, though.

As to the alleged non-viability of single payer, this has to be broken out into four issues.

1) What is the underlying economic viability and health viability of different systems? In the long run, single payer will provide the best, broadest and deepest health care access (including prevention and maintenance prior to more expensive degeneration) leading to better health outcomes, and will be most effective at reducing current costs, and also be most coherently systematic. In terms of substantive viability, single payer wins hands down.

2) The comment was on political viability, however. Yet as made, it elides two imporant distinctions

General poll data show that single payer certainly is politically viable among the general public. N.b. viable doesn't mean certain, and as it increasingly comes forward in the public debates (as it has been), attacks against it will shift public opinion back and forth, and its fate will depend considerably on the skill of advocates in advocating and gathering the resources to get skillful advocacy where it needs to go. Those are uncertain issues, as the problems with the Oregon single-payer initiative a number of years ago now illustrate -- it had problems in addressing issues of alliances, and resource problems. But in general the public is much more willing to entertain the idea than elected officials, political "professionals"/"experts" and media pundits.

3) The alleged lack of viability of single payer rests predominantly with "elites" (actually, people with their handles on the levers of power who are not "elite" in the sense of being "the best" at all) acting in an elitist manner. They include elected officials beholden to insurance, certain health industry and pharmaceutical interests, or ideologically committed against public provision; media pundits who are either ideologically committed against public provision or excessively deferential to officials who are beholden or committed as mentioned, and like to assert their alleged superiority with claims about "realism" and "viability'; and "political professionals" who overlap with and act in much the same way as the public media pundits.

If these forces all agree to agree that single payer "is not viable," they can exercise as substantial degree of censorship over the debate, and have done so for decades. It is a short-circuit of full, honest intellectual debate that is as self-fulfilling as it is self-serving.

Against this runs the underlying substantive non-viability of the current increasingly failing non-system. The allegedly "viable" alternatives ultimately don't get at the dynamics that are driving the problems.

4) Within the political stasis between items 2 & 3 above, there is the question of whether various actors are acting in ways to increase the viability of single payer. a.) The most direct and forceful way to do so of course is to act as a direct and open advocate, like John Conyers, Dennis Kucinich and other elected officials, like Physicians for National Health Program, like Healthcare NOW!, like the California Nurses Association/National Nurses Organizing Committee etc.

b.) Less forceful and less direct ways to break the stasis, also exist, that can be taken up by people who honestly believe both that it will take single payer ultimately to deal with the health system crises (or create an actually systematic health "system") but also that there is palliative action that can has a greater chance of being passed quickly and should be in terms of meeting some immediate needs. This could take the form of supporting something like the Wyden plan or Obama plan while stating clearly that it is not enough and that single payer should be the ultimate goal and also working toward that end; it could take the form of something like John Edwards' proposal which included a provision for a public system that in the first instance would compete with private plans as a kind of demonstration or persuasion by doing.

It appears that Jeff Merkley has taken up only the most tepid and perfunctory version of #4 b above. This is disappointing, but also is something that gives at least a toehold to single-payer advocates, and we ought to be thinking about how to persuade Merkley to take a stronger stance if he's elected. Smith does not offer even that toehold.

There is all the difference in the world between saying "single payer isn't politically viable now" full stop, and saying "single payer isn't politicvally viable now and I am going to work to change that." Progressives whose sense of "realism" focuses only on the political and not on the underlying unrealism of the private health non-system, and take the "not politically viable" line, should at least commit themselves to doing what it takes to make it viable, and not being part of a self-fulfilling ideological blockade of full and honest debate.

In particular, in this context, that would include persuading Jeff Merkley (and others) to take a stronger stance.

That said, miaf substantially misrepresents the Wyden plan, in itself and by saying it is the same as McCain's.

McCain in fact would not require everyone to use his tax credit, so what he proposes is more like Obama's plan in not containing either "consumer" or "employer" mandates. (Obama does have a mandate to cover children).

Wyden's plan would not "get rid of employer sponsored health care insurance" or "make it illegal for employers to provide insurance" across the board -- employer plans provided under collective bargaining agreements would be exempted. Wyden's system would be substantially employer provided in the sense that employers would be required (on a sliding scale relating to number of employees and enterprise income) to contribute funds to pay for the limited number of "HAPI" (stupid cutesy acronym - "Healthy Americans Private Insurance") plans offered in each state.

Morever the implication that Wyden's plan would throw individuals willy-nilly upon the tender mercies of a largely unregulated health insurance market in the way McCain's would is simply false. In fact, while still "private" and having many cost disadvantages related to that, the number of plans available would be small, two per state and maybe a third under some circumstances I think, and the coverages wide with exclusions for pre-existing conditions and other abuses of the current system (from a health-efficiency point of view) forbidden.

Thus individuals would be part of large risk pools, and provider prices regarding services, facilities and pharmaceuticals would be negotiated by large entities with strong bargaining power, drastically decreasing or eliminating current unfair systems of differential provider pricing based on who's doing the negotiating. From the individual point of view this would reduce dependence on your employer's whims about how much of offered plans should be paid by whom, which companies and plans to sign up for (affecting what's covered and provider & pharmaceutical pricing) and so on. It also, while continuing to have employers paying substantially for the system, would detach health insurance from any particular employer, so that employer benefits would cease to function as a quasi-indenture keeping you tied to a particular job lest you lose coverage or be thrown into "pre-existing condition" trouble during a transitional period.

The plan would also offer substantial subsidies up to some multiples of poverty levels.

miaf says that Wyden's plan that current health benefits would be converted to wages/salaries is not to be believed. However, that is the same provision as is in HR 676 (the Conyers plan co-sponsored by Kucinich, supported by PHNP, Healthcare NOW!, CNA/NNOC etc.), and if it is a problem with one, it is a problem with the other.

The Wyden plan is in a number of respects similar to the German health insurance system, which is neither directly state provided nor single-payer. The German system costs considerably less per capita with better results than the U.S. system, though considerably more per capita than Canadian, French, British or Scandinavian systems (which all differ from one another). The Dutch recently moved from something very close to the German system to something like the French or Canadian systems (which are not the same, however, just generically more similar to one another than the German system).

As PHNP and others have correctly pointed out, state level private "individual mandate" plans such as in Massachusetts, the OHP here, the Schwarznegger plan in California etc. have repeatedly failed because they end up costing more than promised, and state legislatures prove unwilling to fund them fully. (See Healthcare for All -- Massachusetts, and organization that supports this general kind of approach and is the basis of a wider national alliance promoting it, on current cuts in Massachusetts proposed by Democratic governor Deval Patrick.

Such a plan on a national level, like Wyden's or Obama's, would face somewhat similar pressures, although they would not be constrained by state balanced-budget requirements.

However, it should be recognized that the same thing also applies to single-payer systems. While general satisfaction with the Canadian Medicare system ("single payer") remains substantially above satisfaction with the U.S. system (as is true of Germany, the U.K., France, Scandinavia, Japan etc. as well -- U.S. has lowest overall satisfaction of any industrialized country), satisfaction in Canada has been falling. The reason for this is that the system was initially built at the provincial level, became federalized in the 1970s, and in recent years has seen federal level cuts by conservative governments that have thrown the burden back on the provinces.

So, any kind of single payer system will also depend for its success on the willingness and commitment of the government to fund it adequately, as with "Massachusetts model" type systems. It is just more likely to receive such adequate funding because of cutting various kinds of administrative and overhead costs.

Just what about the (political) whore path to popularity do you think is in contradiction to what I wrote?

I found nothing particularly substantive or moving about what you wrote. Hence the smart-alek response it deserved. If you'd care to actually write something of substance--perhaps you'll find the comments more to your liking.

Frankly, I don't care if Jeff has sucked up to whoever he had to to get elected, I care about the emptiness of his character and his positions and how that hurts us all. Too bad you apparently don't.

You may toss invective and nasty BS all you like--but you provide no substance or evidence for your drivel. But do feel free to carry on. It gives me that much more incentive to work for Merkley's victory.

And although you obviously are far too dishonest to admit it, there is a big difference between repudiating Merkley because he represents the failure of our party this election season to nominate someone (probably other than Novick too) who actually stands for solid values, and voting for Smith. Just what about a "no vote" and the meaning of it doesn't register in your adolescent and self-centered brain?

Again..nasty invective with no substance. While consistent with your other posts, it certainly doesn't give you much in the way of real meaning, much less credibility.

You may think you are boosting your stock by being such an empty partisan hack. A few years from now, and maybe even a few months from now, if you have the capability of becoming wiser as you get older, the real question you may wish you had asked yourself at this time is if you really should have wanted to boost your stock with the kind of people such idiocy helps to boost your stock.

You seem to have a lot more concern about my "stock" than I do. While I find your concern touching, please don't worry for me. I'm sure I'll somehow muddle through without your approval or the benefit of the wisdom you seem so eager to impart. And while you may find my "idiocy" at supporting Merkley a source of contention, I somehow think you'll get over it when he wins the Senate job. And if you don't, I can't imagine losing sleep over it.

So what your readers might want to know from you, you petulant blowhard, is if you call on Merkley here to within 24 hours publicly demand that Wyden and the DSCC knock off their ads by, shall we say, midnite PDT Monday?

Why? Because the "petulant blowhard" remark is just bullying and assinine enough to sweet talk me (and everyone else) into your way of thinking? Or perhaps I'll just take you for the jackass you purport to be--and do what I generally do with jackasses: mock them. :)

Remember even as Wyden is pandering and lying through his teeth about how tired he is of political ads in his juvenile, whoring ad, he in fact gave the DSCC who is running them a lot of money to help pay for them.

Charming to the last, eh?

To other readers, please ignore the second of my two posts above, and/or pay attention to miaf's response. Despite some relatively minor continuing disagreements, on the essentials miaf is more right and I am wrong.

miaf,

I cited PNHP as critical Wyden-Bennett. They also are critical of Obama, on essentially the same grounds, I believe. The fundamental points they make about the "individual mandate" systems as I understand it is that their purported universality proves spurious in the face of legislative responses to costs, while they fail to gain the cost advantages of single payer. The resulting incompleteness (e.g. in the OHP, or as has been deepening in Massachusetts) make these systems like Obama's in terms of not really being universal, while Obama's also fails in terms of the failure to gain cost advantages.

You certainly are right the requirement to buy lemon insurance or face a tax or other financial penalty on persons who don't buy insurance under present circumstances will be onerous and unfair to many people. PHNP is of course concerned about that too.

You are right and I erred about H.R. 676 with respect to existing employer-provided benefits. To what extent the loss of such benefits as a form of income for those who get them might prove a political obstacle I'm not sure. I suppose the removal of the burden of providing such benefits for many employers might offset this (apparently relatively minor) component of the proposed funding mechanisms: "(C) Instituting a modest and progressive excise tax on payroll and self-employment income." The self-employment income part seems likely to make the proposal weaker with self-employed contract workers and small business owners, which is too bad politically IMO.

On Wyden-Bennett, I may have been dealing with an earlier version of the bill, since in 2006 PHNP quoted a Lewin group study without demurral that I can see to this effect: "Employers would be required to “cash-out” their health plans by terminating their existing health coverage and paying the amount saved to their workers in the form of increased wages," which is how I recall understanding the relevant section of the bill when I read it last. But maybe my memory is faulty and I was just remembering the Lewin gloss, and maybe it was wrong.

In any case, you are right that the current version of the bill does not do that. Rather it offers a two-year transition period in which employer contributions to the funds that would be used to provide subsidies in varying degrees for individual premiums would be equal to their current contributions to insurance plans they currently offer as benefits, less any wage and salary increases they gave workers in lieu of their benefit contributions. So it is an incentive -- they can pay workers more, which presumably would be more popular with the workers in question, or they can pay the whole amount to the government. However, after two years the only reason to continue with such new pay levels would be unhappiness at pay cuts, there is no requirement to continue any new pay levels nor any subsidy of the new required employer contributions. On balance it seems likely that the best outcome for workers would be employers calculating some increased wage forming only part of the current benefits that would be less than the difference between their projected costs under current high insurance inflation minus the required contributions under the Wyden-Bennett plan. As you say, none of that would be required.

It also appears that I either misread, misunderstood or misremembered the Wyden bill before, or that it has changed on another point, with respect to the number of insurers. My memory was that it would have restricted the number of insurers allowed to offer "HAPI" plans in a way that would have drastically changed the structure of the insurance market such that it would not really be accurate to say simply that workers with employer benefits were simply being put directly into the current market. However, the current bill specifies a minimum number of plans in each state but does not restrict it, as far as I can see, and leaves the setting of premiums to the insurance companies, so your characterization is much closer to correct than mine. Likewise my (false?) memory was that the bill would have required all plans to be HAPI plans or "actuarily equivalent" ones with the same minimum benefits (a distinction still in the bill that I don't understand), whereas on my current reading that seems at best much less clear, and if all plans are not forced to operate within the same constraints, actuarily non-equivalent plans and cherry picking get opened up again.

Thank you for pointing out my errors. I will shut up now about Wyden-Bennett until I actually understand it (the subsidy formula is quite opaque to me, and I am not sure where the employer contributions go, if only into the direct subsidies of premiums, or into lowering the premiums required of individuals, but either way it does look as if most people with current employer insurance would end up paying higher premiums).

And more to the point, I suppose, I will turn my energies more fully to advocating for single payer, because whether I misunderstood it before, or Wyden has compromised and changed what I read before, the current version looks lousy to me.

Miaf wrote... Kari, I'm genuinely wondering how you square your venal pandering for the corrupt "machine" core of our Party that Jeff represents with your game-playing position on M65 where you are siding with proponents whose specific reason for putting forth M65 is to fight "machine" Democrats like Merkley?

Maybe because I don't see my position on Merkley as "venal pandering" nor do I see my position on M65 as "game-playing".

And for the record, I'm undecided on M65.

Miaf, of course, is brand-new around here - and has done nothing on this lovely Saturday but launch invective at any number of people. While there may be some interesting discussion to be had with Miaf, he/she is all ad-hominem all the time.

I, for one, won't dignify those comments.

Ok, I finally just picked myself up off the floor after a good laugh and can respond.

I worked alongside Merkley, State Rep. Schaufler, Rob Brading, and others to get payday loan reform passed in this state. And I can tell you there was nothing about working on that reform that wasn't an honest effort to help people who were being taken advantage of with 500-800% interest loans. At the time we were working on it Dems were still in the minority - Merkley wasn't even Speaker of the House yet.

The districts Merkley and Schaufler represent had some of the highest concentrations of payday loan shops around. It was obvious that of course this would be an issue that Merkley would spend his time on - it directly affected a huge number of his constituents. And like any good representative, he tackled issues that were of importance to his constituents.

Back when this issue first came up and we began working on it, Merkley had no idea he'd be running for the U.S. Senate this year. Heck, he wasn't even Speaker of the House yet. So it definitely wasn't something he did to get elected to the U.S. Senate.

Merkley and I may disagree on some issues, but he will still make one heck of a U.S. Senator who will fight for working class families like my own. Not voting, voting for Smith, etc. just means another term of having a U.S. Senator who won't even listen to, meet with, or respond to his constituents. We deserve more.

I hope you'll consider allowing Chris to report on the reform process if that is his interest.

Of course. Was that even in question?

maif: "The real question is, if Merkley loses, what responsibility by virtue of your attitude and behavior are you going to take for that loss? Or are you going to arrogantly and stupidly blame everybody who you think is not as wise or civil as you as being responsible?"

Nice job of projecting your own characteristics to others. So much so that it very much reminds me of someone who also doesn't go by his actual name on Blue Oregon and elsewhere.

Be that as it may... A question: How many years would you deem it acceptable to continue under the current broken health care system until single-payer can be enacted? 1? 10?

As a follow up question: What happens to the working poor in the period between what exists now and the institution of a single-payer system?

Be that as it may... A question: How many years would you deem it acceptable to continue under the current broken health care system until single-payer can be enacted? 1? 10?

Well, it's never going to happen so long as single-payer is The Health Care That Democrats Dare Not Speak Of. If you can't even get the words out of your mouth, or you say you'll only be willing to cheer as someone else pushes the rock up the hill, then it's never going to happen.

Other developed countries have had various forms of universal care for forty years, and they still have to inker with the system to keep it running. The US is already decades behind. We don't need some sort of haphazard system to limp along and hope that someone gets their act together on health care. What's needed is a long-term plan with the explicit goal of a universal care system, with a well-thought-out transition of how to handle the various economic and infrastructure ramifications. It would still probably take a decade or more. But unless you know where you're going, you're probably not going to get there.

So... is your answer another 40 years, Darrel?

Keep in mind that it's not a hypothetical question. Right here, right now single-payer isn't politically viable. Assigning blame doesn't change that reality one iota. Nor does it bring even minimal coverage to those who currently don't have any.

Now, how 'bout the follow up question? What happens to the working poor, who are increasingly being squeezed out of any health care coverage, between now and when single-payer is up and running?

Here's the point of both questions. It's awefully easy for folks who HAVE health care coverage and figure to securely continue to have access to it for the foreseeable future to demand that society jump to the end game.

But are those who DON'T HAVE health care coverage or are very likely to lose it in the near future willing to risk incurring the life-long massive debt that a single serious health challenge could cause while waiting for single-payer?

I have a really, really hard time believing that anything close to a plurality of them are willing to take the same hardened long-view given the risk.

miaf,

Thanks for the gracious response, though it's plain enough who's truly humbled :->, but that's all to the good, nothing to be proud of in being wrong.

Kari has influence at BlueOregon in various ways, most extensively just because he writes a lot I think, but controlling what columnists write truly isn't one of them. I am actually pretty sure that he'd be pleased to see me add more substantive writing about health issues and policy to my fairly erratic & shallow repertoire since becoming columnist (fact of the matter is it's easier to have thoughts provoked by others, for me anyway).

Your comments on Obama are very interesting and I hope you are right. Edwards did actually have a publicly offered alternative in his outline of a plan, and when it came to down to Hillary vs. Barack there were people saying Clinton had moved a bit more clearly in that direction, but if so it was less prominent.

If Obama really is open to including such an option (or room for such options within the geographical variations of his plan outline) that might raise interesting possibilities, though some of the advantages of a full public system would be lost I think (universal risk pool/ no cherry-picking and a good deal of the administrative savings, since the public plan would presumably get drawn into all the b.s. differential price negotiations & cost shifting on the provider esp. hospital side, and from a provider point of view they'd still be having to cope with the multiple insurers & coverages & the public plan would just be another one). Still the lack of a profit imperative at the high rates of return demanded by big capital in recent times would count for something I suppose -- also inevitably leading to a lot of squealing about "unfair competition" and "apples and oranges" from the market ideologues and industry, but that's just the point, isn't it? But by the same token, because it wouldn't be a universal risk pool, there might be some tricky stuff about becoming an insurer of last resort that couldn't compete by excluding people. It seemed like at least part of Edwards' point was to try to lay to rest media and lobbyist and lobbyist-influenced legislator shibboleths about how the public doesn't like anything that's publicly provided, and that in itself could be worthwhile.

I'd like to learn more about the reform efforts relating to the Oregon legislative session that you mention. I've been in sort of intermittent touch with some of the Health Fund Board through the Archimedes Movement/We Can Do Better link, and the reports on their website by Mallen Kear, a retired nurse who's very engaged with them, on meetings of the Board's sub-groups as well as the main group might be worth your while if you're interested in what they've been doing up to now. Personally though I've found AM/WCDB quite murky and rather frustrating as a process, and, like the OHFB itself, likely to be hamstrung by the "include all stakeholders" approach. It sounds like you're talking about different reform efforts; if so I haven't been involved with them and am ignorant, to my discredit. A lot of my energy has been going into anti-war work. Pointers definitely welcome, either here or if you wanted to send e-mail to clowe187 (A) gmail [] com.

On the Health Fund Board, I was sort of surprised by the modest character of their initial proposals, in comparison to the report that the Oregon Health Policy Commission issued last spring that appeared to hope to provide the OHFB a blueprint for a full-blown Massachusetts/ Schwarznegger type plan and seemed to have some of the hallmarks of a done deal. It may be that the OHFB's current "start with the kids" emphasis reflects a combination of the failure of M50 and the looming budget crunch. But I suppose that also leaves more room open for other kinds of advocacy.

Kevin,

There's a large, maybe gigantic undistributed middle in your response to Darrel. It has to do with the attitude with which immediate steps are taken, and how it shapes the forms of those steps. (From another angle, it also involves false assumptions that Darrel's position involves doing nothing, and that currently received types of reform are likely to produce deeper and longer lasting and more effective types of change than is likely realistically to be the case.)

Let me suggest three possible attitudes: a) make immediate reforms with a view to forestalling and preventing development of a universal public system; b) make immediate reforms in a way that is agnostic about a universal public system but creates potential pathways to move that way and grounds for honest public debate that takes the possibility seriously; and c) make immediate reforms explicitly intended to be transitional.

It seems to me that all of these are potentially "politically realistic." In fact a) pretty much seems to be political reality, when it comes to most proposals for "individual mandate" private insurance system plans. Even before my recent rethink documented above, one thing I've always hated about the Wyden plan is how it fetishized the idea of "private." The problem dogs other related plans, and also coalitions like the SEIU-backed Health Care Now at the national level, or Archimedes/ We Can Do Better & looser networks relating to the OHFB process, insofar as they involve a combination of people who would be open to or even favor a universal national public system, and people who would not and who would object so much as to be willing to play dog-in-the-manger with other people's healthcare access, health-related bankruptcies, high cost wrong use of emergency departments etc. etc.

As I wrote in my first comment above, I think this variety of "political realism" at the end of the day runs into underlying "health realism" and "economic realism." But the end of the day can be endlessly put off if you let your definition of "political realism" give irreconcilable obstructionists veto power over both policy and what's admitted on an extensive basis, examined both on its own terms and comparatively with other approaches, into public debates. And what putting off "the end of the day" means in practice is that in fact the problems don't get solved & improvements are temporary at best.

The political realism of agnosticism & opening pathways to possible public provision and doorways to honest full debate is well within reach. Jeff Merkley's position that started this whole discussion & is the connection of it to the nominal thread topic is in a sense the weakest, most passive form of such agnosticism. Until reading miaf's interesting comments about Obama, I thought that also was essentially where he had retreated to, from a more active leaderly position. But if in fact Obama has opened up his position again in the ways suggested, perhaps related to convention platform negotiations (?) it would illustrate a current, live political realism of a more active kind of agnosticism that recognizes the underlying health and economic realities and sees the problems as big enough and deepening enough that faux-realist obstructionism is not acceptable any more.

I would argue that while tougher, attitude c) also is politically realistic, at least in some situations and places / regions. In a sense it would be a dynamic force in relationship to b), pushing for taking up opened pathways, getting in there and advocating for the public universal path if the debates became more honest, if attitude b) spreads, and meanwhile pressing to open up the debates and arguing why the obstructionism of faux-realist political arguments inevitably will shipwreck on the reefs of health reality and the rocks of economic reality.

In other words, to take your question seriously and treat it as not simply rhetorical obstructionism, which I hope is the case, the question of getting from here to there is one, politically, of pulling more and more people out of defensively hopeless "realism" that willy-nilly allies with irreconcilable obstructionism, into backing full and genuine debate and reforms that are not designed to block potential public provision. Simultaneously it will take pulling more and more people from that greater openness into active support for policies positively designed for transition to public provision.

I am actually pretty sure that he'd be pleased to see me add more substantive writing about health issues and policy

Yes, please! Especially after the election, when I believe this nation will turn its eyes to health care - and the various reform proposals emanating from Oregon will be front and center.

In other words, to take your question seriously and treat it as not simply rhetorical obstructionism, which I hope is the case, the question of getting from here to there is one, politically, of pulling more and more people out of defensively hopeless "realism" that willy-nilly allies with irreconcilable obstructionism, into backing full and genuine debate and reforms that are not designed to block potential public provision.

Chris, it seems to me that LGBT rights is a corollary. As we both witnessed during the contentious Primary and the whole "leveling up/down" cannard, some saw Merkley's fight for nonmarriage LGBT rights as some sort of sell-out while others saw it as consumate pragmatism fighting for the maximum intermediate legal recognition. Ultimately, the near universial support, via endorsements, for Merkley by LGBT groups seems to indicate that the latter view dominated.

I believe that the same dynamics apply to your three possible attitudes. a) assumes motive, which makes it inherently subjective. And c) artificially (IMHO) restricts the attitude to "explicitly" rather than the also possible implicitly "intended to be transitional". Although I suppose that too is subjective depending on one's assumptions of the candidate's motives.

Meanwhile... millions either don't have health care coverage today or won't have it in the very near future. What are they supposed to do while we parse motives?

I will add that this is near and dear to me because the fact of the matter is that, like many millions of my fellow Americans, I'm a couple paychecks or a serious health crisis away from being one of those uninsured folks who are the ones who are truly fucked while we fiddle away over how best to reach the end game.

What happens to the working poor, who are increasingly being squeezed out of any health care coverage, between now and when single-payer is up and running?

What part of "long-term plan with the explicit goal of a universal care system, with a well-thought-out transition of how to handle the various economic and infrastructure ramifications" do you not understand, Kevin?

I'm a couple paychecks or a serious health crisis away from being one of those uninsured folks who are the ones who are truly fucked while we fiddle away over how best to reach the end game.

Why do you assume you're the only person in that position? It's like Gordon Smith becoming a great advocate of mental health funding only after his kid commits suicide. They only have empathy for others who have faced the same issues and they become the only champion of the cause once they've finally realized their "calling."

Single-payer is the only way we're going to get a sustainable universal coverage program that will insure the uninsured. It's just not economically feasible in the long-term if plans can opt out of covering people who either can't pay or have large expenses. That's why it has to be the long term goal of any universal coverage legislation. Universal coverage tomorrow, for sure, but then you've got to find some way to keep it from collapsing, or you're worse off than you were before.

In the interim, there has to be some sort of phase-out of the current insurance system in order to deal with the hundreds of thousands (or millions) of people working in the health insurance industry. That's not going to be shut down overnight. Some of the administrative tasks could be absorbed into administration of a government health care system, medical personnel won't be a problem, but there's a lot of potential for economic disruption.

Not that I think Kevin cares. He's more interested in being the Joe the Plumber of Blue Oregon and freaking out than having a rational conversation.

Why do you assume you're the only person in that position?

Obviously I don't. Which is why you had to cherry-pick the phrase from the middle of a sentence. That's most commonly understood to be a classic Strawman Fallacy set-up.

In the interim, there has to be some sort of phase-out of the current insurance system in order to deal with the hundreds of thousands (or millions) of people working in the health insurance industry.

In order for that interim phase to ever become relevant, there has to be a majority who agree upon the point of the exercise. Please correct me if I'm wrong about this, but I don't believe there is any credible evidence which indicates that a majority are ready to go to single-payer.

I'm going to go out on a limb here and suggest that the reason that the PDA is working the grassroots to drum up support for single-payer rather than spending their time on blogs castigating politicians who otherwise give every indication of being progressive enough to back a viable single-payer plan is because they've correctly got the horse in front of the cart - where it belongs. Ditto, by the way, with LGBT organizations who openly want "marriage" but are enthusiastically backing progressive politicians who have pushed for "civil unions".

Slaughtering the horse won't move the cart forward one inch.

Kevin,

Of course my categories are subjective. So are the claims about what is "politically realistic" advanced in the cause of doing nothing about the disgraceful exclusion of serious full discussion of single payer in public policy debate, (i.e. public debates on policy, not academic seminars and fora on public policy).

Please read what I've written about Jeff Merkley carefully. I have not criticized one thing that he has done. I disagreed with his approach to certain issues in M50, voted for it anyway, it lost.

Also please look at where I placed him in my spectrum -- not among the obstructionists, just among the weakest of those who might tend to open up a more honest debate. I am evaluating him from the point of view of someone who wants and honest debate, and wants single-payer as soon as we can get it. I don't think he's acting in ways that he could that are not at all in conflict with pursuing immediate transitional goals that also would expand the prospects and shorten the timeline to single payer.

I have hopes that he might change that, especially if what has been reported by miaf about Obama is true.

Actually I think the LGBT rights example supports my argument more than yours. Jeff not only pushed for domestic partnerships but pushed for strong content within those, there are plenty of weaker versions in other states. He did not say that supporting domestic partnerships was incompatible with supporting equal marriage rights. On the contrary, he backed marriage rights, as you correctly argued during debates here during the primary. Moreover, he worked closely with the advocacy groups seeking the fullest equality who also supported immediate steps now.

You, however, are unrealistically defining "political realism" on health care coverage to mean that any mention of "single payer" = opposition to shorter term action. The equivalent position on LGBT marriage equality and substantive related rights would be someone who favored domestic partnerships achievable now and insisted that any discussion of marriage equality was somehow opposed to domestic partnerships in the short term. That wasn't Jeff's position, nor your own as I recall. I wish you'd have the same flexibility about healthcare coverage debates.

All I'm saying is that political realism, including looking for measures that can pass in short order that will improve the situation for some people, is not at all incompatible with advocacy for single payer, and the "not politically realistic" argument for not even talking about single payer is spurious obstructionism.

Of course, if you're not for single payer in a more direct way, that's your prerogative. But if so, say so, and still work for honest debate on the merits. And if so, don't make the LGBT rights comparison with Merkley's position, because the equivalent position would opposition to full same-sex marriage equality with domestic partnerships as an alternative, different end point.

It looks like the Oregon Health Fund Board is going to bring the legislature some sort of proposal to fully fund making sure all kids have health insurance -- another version of the goals of M50. That on a national scale is a key element of Barack Obama's plan and it may be that he will bring it forward first, rather than as part of a bigger package, I am not sure. I'll support that goal at either level, but that is not in any way incompatible with supporting a national single payer system and working actively for one.

I want Jeff Merkley to become more activist in support of such a reform. I want him to become and active force in the process of making it increasingly politically realistic and eventually making it a reality. He's shown that he has the capacity to work on two levels of an issue like that in the past, an admirable skill. He should apply it to health care access reform.

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I personally am no more secure than you in my health insurance situation and quite likely less so.

If I end up in an uninsured situation, I am not at all sure that Massachusetts style lemon insurance really would meet my needs or be worth the (required) money -- at best it resembles the kind of increasingly watered down insurance more and more employers are offering to control their costs, and forms part of the creeping crisis of underinsurance that parallels complete loss of insurance.

Which is why you had to cherry-pick the phrase from the middle of a sentence.

I didn't have to cherry-pick anything. Your whole comment was based on the premise that people at risk of losing their health care would have to wait "forty years" for universal covereage while people who didn't care about them (and presumably had more secure health care) pushed for single payer and danced on their graves.

You also seem to be confusing universal coverage and single payer. They aren't the same thing.

<h2>It's just too damn bad if you don't like anyone criticizing politicians. If I vote for people I get to criticize them. It's the American Way.</h2>