Obama’s job: to explain away a quagmire

            Tomorrow, President Obama will hopefully explain to American what, precisely, we’re fighting for.  At a time when the public is deeply split on whether the Afghanistan fight is worth the effort and whether Obama is personally handling the operation well, this is the president’s best shot to sell a continuation of an eight-year-long battle against an amorphous enemy with no end in sight.

            It’s tricky to phrase Obama’s dilemma in that way.  Is this war worth it?  Many people would say, of course it’s worth the fight.  We were attacked on 9/11.  We still have to capture Osama bin Laden.  We may get attacked again if the Taliban and al Qaeda resurge in Afghanistan and Pakistan.  The whole region could be destabilized, and the rest of the world could follow. 

            Yes, that’s always possible.  But then again, that was a widespread concern during the Vietnam War: that if Vietnam fell to communism, a domino effect across the region would destabilize all Southeast Asian countries.  Not only did that prophecy fail to come true, but communism itself soon collapsed entirely—not because of our willingness to put boots on the ground, but largely due to its own shortcomings and the right combination of charismatic leaders.

P100709PS-0353, originally uploaded by The White House.

            As it stands, though, Obama is poised to initiate a military escalation in the range of 30,000 to 40,000 troops.  But to ask that commitment from those men and women, from Congress, and from the public, he owes us an explanation of his goals.  Obviously, if he could stabilize the country with a one-time infusion of force and be absolutely certain that no further commitment of troops would ever be needed, the decision would be fairly easy.  But no one knows whether this new strategy will work, hence Obama’s search for the least-awful course.

            Are we sending troops over to train the Afghan army?  Are we going to track and kill members of the Taliban and al Qaeda?  Are we trying to stabilize the Karzai government while forcing him to get a handle on corruption?  Are we trying to keep quasi-democratic institutions from collapsing?  Are we continuing to destroy poppy crops to deny terrorists a major source of funding?  Are we building schools and creating jobs to get the Afghan people on our side?  Is this a watershed moment—a modern day Tet Offensive—which, if it fails, will signal the impossibility of restoring order in key parts of the country?

            No one should be accusing the president of only “half-heartedly” fighting the war.  He, like many members of Congress from both parties, wants to complete the struggle as soon as possible and end the United States’ costly overreach.  The continuing need to monitor corruption reports and casualty counts in the Middle East detracts from Obama’s attention on the economy, healthcare, energy, and countless other policies.  Furthermore, an inability to deliver on promises in one policy area may have a ripple effect across the legislative spectrum: hostility toward his Afghanistan policy by Congress may portend a failure on healthcare, or vice versa.

            This is not a lesson in victory and defeat.  It is a question of how to cut our losses without removing all semblance of stability from the region.  We will not “win” this conflict in the sense of creating full, functioning democracies in Iraq and Afghanistan.  What we must settle for is stability abroad—even if it is authoritarian—and peace of mind at home.

            I hope that Obama will support (if not propose himself) a source of funding to continue this war.  Any tax burden should not fall on only the rich, since every American has the responsibility to support our troops and will benefit from a secure Middle East.  It is unfair to prevent radical and necessary reforms in our healthcare, education, and energy generation systems from taking place because they will add to our debt and burden our children.  These issues are just as vital to our national security as the fight overseas and it is time for the country to pay the real cost of interventions in the Middle East—a responsibility that has, so far, only been shared by the men and women in uniform.

Healthcare passes—at the expense of women

            Healthcare reform is inching along and if the close vote in the House is any indication of the deep split between liberals, moderates, and conservatives, then the Senate—with a higher concentration of the latter two groups—will have to dilute the bill even more to surmount a filibuster.  Still, the House’s bill is not a resounding victory.  It takes two steps forward and one step backward—in that for all of the great features that will expand health coverage and crack down on insurance companies, this comes at the expense of women’s reproductive rights.

            While abortion coverage (along with illegal immigrant coverage) was always a contentious point of reform, the settlement over the weekend on the Stupak Amendment is not only against women’s rights, but is against working-class women’s rights.  The language of the amendment denies federal funding for abortion services (an already-established provision of the law), but also denies women who are receiving subsidies from the government to purchase public or private insurance in the new Exchange from getting an abortion even if they pay out-of-pocket into their monthly premiums.  A far more sensible amendment was offered by Rep. Lois Capps (D-Calif.) in which federal funds and private funds would be segregated in premium payments, and only the non-subsidized money would be used for the operation.  However, detractors called it an accounting gimmick that could not be enforced.

            The glaring irony is that small-government conservatives of both parties voted in favor of this amendment, even though it expands the reach of federal prerogative right into a woman’s physician’s office.  What’s more, the vast majority of those voting for the amendment would not have voted for the final bill even if the language was not approved.  But alas, the art of politics requires that a tiny fraction of lawmakers be appeased for the country as a whole to progress.

            While the language makes an exception for women whose life is endangered, or who have been the victims of rape and incest, that is little consolation.  A pregnancy is more than a medical condition.  It is an obligation to the woman, the child’s father, and the families of both parents.  But the weight of obligation is sometimes too much for women to bear.  The child might be unwanted or the woman might be physically, mentally, or financially unprepared to bear such a burden.  No one wants any abortion to happen, but when a woman needs more time before  entering into motherhood or when she must weigh the costs of rearing a child to whom she cannot dedicate herself or her material resources, it is unfair for a group of (primarily) men to stipulate that a woman must be dying or traumatized for her to have any choice in the matter.

            It makes little sense to me that this bill will bring opportunity for treatment to millions of working-class and young women—both of whom are most subject to false information and interest group tug-of-wars on the family planning front—so that if they accidentally get injured, they will be fine—but if they accidentally get pregnant, they are out of luck.  Would it not be more practical to simply regulate abortion providers to ensure that women who seek the procedure are not put in jeopardy by back-alley, unlicensed abortionists?  The last time I checked, the Constitution charged our government with promoting the “general welfare” of all its citizens, not simply the welfare of those who are wealthy and already have access to employer-based private coverage and who have an unbiased accounting of their options regarding reproductive rights.

            While the bill should not be sunk on the basis of this one anti-woman provision, it just goes to show that sex discrimination is still acceptable by the majority of elected representatives, even if it takes away a long-established legal right.

Let’s opt out of the “opt-out” idea

            Senate Majority Leader Harry Reid’s (D-Nev.) announcement that the healthcare bill for his chamber will include a government-run option is a double-edged sword.  On the one hand, it is a relief to liberals who consider the public option to be the next-best (and only) alternative to a single-payer system but at the same time it puts moderates of both parties (well, Democratic moderates plus Sens. Collins and Snowe) in an enormous position of power.  Every senator who could potentially vote for this bill is needed and must be accommodated in the search for sixty votes.  It’s an undemocratic system that gives disproportionate advantage to rural states, but that is the way our Constitution works, for better or worse.

            The small state senators have a legitimate point with a public plan which is linked to Medicare, in that doctors already receive lower per-patient reimbursement by the government than by private insurers in their states or by Medicare payments to other states.  In part, this is due to the different costs of living throughout the country, but also it is attributable to formulas which have historically penalized efficient, rural providers such that they cannot afford to take on a good number of Medicare patients and still meet operating costs.  So, from their perspective, private insurers would better compensate doctors.

            Still, the formula can be altered.  What’s more, the people who do not have insurance currently are treated either at neighborhood clinics or in emergency rooms, so all that this legislation is doing is shifting the costs around.  The goal of healthcare reform is to bring down the cost of providing care overall, so the combination of new customers, reduced premiums, lower drug prices, and patient-centered care will, in theory, increase the number of patients that doctors see while decreasing the amount of billable-hours treatment people receive for their illness.

            I am concerned about this new “opt-out” aspect of the public option.  If states are allowed to forgo participation, how will the people currently uninsured find an affordable plan, especially if there is a mandate on individuals to purchase insurance?  Plus, the greater the number of people that participates in the public option, the more the costs of treatment will be spread between healthy and ill people, lowering premiums not just for people in the government plan, but for its competitors.  If half of the states choose not to make the public option available, what will that do to cost estimates which base premium prices on a certain level of participation?

            Lastly, there is a civil rights question here: if states are presented with a means of insuring those who are sick but choose not to make that path available to citizens, is the state liable for every ensuing preventable death?  Will public plan-based insurance be valid if a person seeks medical treatment in a state that has opted out?  And if states opt out, should they have to find another way to ensure that at least 95 percent of their legal residents have insurance or face some penalty, such as being denied funding for highways?

            The top map in this graphic is from Gallup, and I colored in the bottom section with the electoral results from last year’s election.

There seems to be a slight correlation between the percentage of insured adults per capita and the political leanings of the state.  Of course, this map does not indicate which party is in charge of the state legislature or the governor’s mansion.  For instance, even though Virginia voted Democratic in 2008, we will very likely have a Republican governor and legislature when the healthcare bill takes effect.  So, we can say that generally, state governments controlled by Republicans (who will be most likely to opt out) tend to have higher rates of uninsured adults.

            What it comes down to is this: I am worried that the ability to opt-out of the public option will fail to help people in states that most need an alternative method of procuring affordable insurance.  The senators from states such as Arkansas, Nebraska, and Louisiana should look at the 19 to 27 percent of constituents who lack insurance and explain why they were loathe to support a plan that will ensure their wellbeing.

Congress’s woman crisis?

            When watching President Obama’s address to the joint session of Congress, it was hard not to notice all of the brightly-colored suits and dresses of the 90 women in the House and Senate—representing seventeen percent of Congress and highly visible for the cameras.  In the 2008 election, more women won congressional races and consequently more women are now serving in Congress than at any point in history.

OBAMA-Joint Session, originally uploaded by lauren victoria burke.

            But that could potentially change in 2010.  In midterm election years, the president’s party typically loses seats in Congress.  Right now there is a huge disparity in the numbers: 70 women are Democrats; only 20 are Republicans.  Even during the 1994 election in which a net gain of seats held by Republican women occurred, more Democratic women were candidates than were GOP women.  In fact, while the number of GOP women running for House seats each year has more or less held steady around 40-45, the number of Democratic women has increased from 72 in 1994 to 96 in 2008.

            In the Senate the math is stark and simplified: of the 17 women, Democrats outnumber Republicans by more than 3:1.

            Last year, eight new Democratic women were elected to the House and, as freshmen, at least four of them from more conservative-learning districts are being targeted for defeat; it’s more than likely that their challengers will be men.  Why is it that more Democratic women run for Congress than Republican women?  Perhaps it is simply because more women are Democrats.  Or, as U.S. News and World Report’s Bonnie Erbe writes, Republican women view their role as being more of a traditional homemaker than an officeholder.

            I have no definite answer.  But it has been well-publicized that the GOP is not only having problems with recruiting women: blacks, Latinos, Asians, and other ethnic groups are either underrepresented or not represented at all on the Republican side of the aisle.  Many non-white women, though, represent majority-minority districts, so their seats are pretty safe.  But still, there remains a problem: if the U.S. Congress is intended to represent the American people, comprise many points of view, and achieve gender equality, then many more women must fill the ranks.  That is something most people can agree upon.

            While Republicans tend to be more suspicious of affirmative action, even in the broad sense, I would hope that they are actively recruiting female candidates in order to combat their image as the party of old, white men.  It would be a missed opportunity if, one year after a historic presidential race for women, the appointment of Sonia Sotomayor, and the passage of the Lilly Ledbetter Fair Pay Act, the number of women in the national legislature actually deceased because of the dynamics of the political cycle.

From Obama, emotion and understanding

            With tonight’s speech to Congress, the president told legislators that the ball is in their court now.  He answered the calls to draw lines in the sand and show some leadership on his signature issue.  And just as he explained his hopes and expectations to nervous and excited schoolchildren back from summer vacation yesterday, he tried to calm the nerves of jittery members of Congress and refocus their attention.

         As usual, Obama tried to negotiate positions that would satisfy all constituencies: he laid down his support for a public option to appease liberals.  He pointed to a need for malpractice reform to get Republicans on his side.  He repeated his insistence on a deficit-neutral bill to bring fiscal conservatives of both parties to their feet.  And importantly, he talked about the human side of healthcare—the suffering that goes on each moment of every day—to remind people everywhere why he is staking his presidency on this issue.

            Unfortunately, the media will probably seize on the congressman who yelled “You lie” during the speech, or the fact that Minority Whip Eric Cantor was busy texting or that Republicans were waving their own proposals for a reform bill.  What I hope doesn’t get lost is the obvious emotion that Obama felt when singling out all of the Republicans who had worked with Ted Kennedy to provide health insurance to children, among other things.  Kennedy did not pursue the cause of expanding healthcare because he was a large-hearted liberal, but because his family had been through medical trauma many times.  Ted Kennedy simply could not comprehend why someone should be denied care or receive inferior care simply because of insufficient wealth or because of perverse corporate incentives to limit treatment.

            I would hope that Republicans and skeptical Americans would realize that Obama would surely never sincerely intend to approve a bill that dictates immigration or abortion policy.  Nor should liberals interpret his belief on the necessity of a public option will be a centerpiece of healthcare reform.  This president has repeatedly shown himself to be open to multiple ideas from both parties as long as they fall under his general conception of injecting competition into the marketplace to decrease costs to consumers, increase choice between plans, and provide near-universal coverage instead of the 85 percent that is the status quo.

            I can’t help but wonder if people in other industrialized nations overseas are looking curiously at what’s happening in this country.  I suppose they are asking, what is it about Americans that they can’t decide on a way to ensure that everyone gets the care they need from the doctors they want?  As the president said, we’re the only wealthy nation where people are left to die out of a desire to serve corporate welfare and a lack of collective determinism to take responsibility for the least-well off in society.

            Of course, all of the healthcare sob stories and reasoned explanations of the plan’s framework won’t mean a thing unless reasonable men and women in both houses can agree on the details.  As it stands, Democrats have 59 senators, but they may not have 59 votes.  Some conservative and vulnerable Democrats—who may or may not happen to have taken large campaign contributions from the healthcare industries—are concerned about the size and scope of reform efforts.  The number of Republicans who are willing to cross the aisle can probably be counted on one hand.

            Or, make that one finger: Olympia Snowe of Maine, the only Finance Committee member not to sign a letter to the president vowing never to vote for a public option.  Unfortunately, today she has asked the president to drop this feature—not because of a personal objection, but on the realistic grounds that “all Senate Republicans as well as some Democrats do not support” it. 

         However, that does not change the fact that Snowe is the only Republican who is still providing constructive input—such as suggesting a “trigger” mechanism in lieu of an immediate public plan.  If that’s what it takes, I’m sure the president would give his blessing.  The fact is that the bill cannot be passed without her.

         Obama did a good job tonight of combating lies and explaining the truth behind this bill.  Let’s hope that some good will was generated on both sides of the aisle toward action on this issue.