It's becoming more and more apparent that if you are not armed with a ball of gold thread, you will never find your way out of what has now become the labyrinth of healthcare reform. A sense of multiple dead ends and irreconcilable disparities--of dots that will never connect and inscrutables gone feral--has been well captured and embodied in this text that arrived on my email yesterday from Marc Ambinder, a blogger on the Atlantic. Feel free to snigger while you read it, but don't be surprised if you end up with a bitter vertigo by the time you're done. And whatever else you do, do not fail to bring along that ball of gold thread.
Health Care: Choose Your Own Adventure
By Marc Ambinder
Posted: 17 Aug 2009 01:07 PM PDT
With apologies to Edward Packard and Bantam Books...
The White House is always accusing the media of treating health reform like a game. So..
Step 1. The health care system is broken and needs reform.
If you agree with this statement, please go to Step 50.
If you disagree with this statement, please go to Step 50.
Step 2: If you're afraid that ObamaCare will spell the end of private insurance and be a total disaster, Go to Step 54. If you support -- in general -- the consensus insurance reforms in the House and Senate bill, go to Step 3. If you support a single payer system and are worried that the White House has conceded way too much, go to step 33.
Step 3: If you believe that, even with insurance reforms, health care isn't worth the effort unless it includes a "public option," go to step 5.
If you believe that "consumer protections," combined with some cost-cutting measures, higher taxes on the rich, structural reforms and inducements TBD are good enough, Go to step 4.
Step 4: Congratulations. I've identified you, at heart, as a health care policy wonk with center-left tendencies. Or, you work in the White House. Go to step 6.
Step 5: You're outraged that the White House thinks the public plan is negotiable. Go to step 6.
Step 6: House Democrats say that a conference bill without a public option won't pass their chamber. If you believe their threat, Go to step 8. If you think they're bluffing, go to step 7.
Step 7. All your focus is on getting to 60 votes in the Senate. If you think Sen. Ted Kennedy will be able to return to the Senate and cast the 60th vote, go to Step 8. If you don't think Kennedy will return to cast the deciding vote, go to Step 9.
Step 8: You're focusing on a handful of Democrats and a few Republicans. If you think you should play hardball, go to step 10. If you think you should let the finance committee, messy as it is, reach a consensus, go to step 11.
Step 9: If you think 61 votes is undoable, you decide to take a gamble on the reconcilliation process. Go to step 35. Else, proceed to step 8.
Step 10: The White House fills in the details: reform is a must. It's a clarifying issue. When the American people watch the final, final vote, they're going to view the pro-reform side as being "right," and senators need to get on the right side of history. If you think this is sufficient enough, go to step 14. If you think this is an insufficient threat, go to step 13.
Step 11: Your base approval rating drops another 10 points. If you think this is temporary, go to step 12. If you're worried, to back to step 6.
Step 12: Wait a while. Then go to step 16.
Step 13: You have your chief of staff threaten to cut the balls off of any Democrat who KOs his president's signature item. If you think this will work, go to step 16. If not, go to step 15:
Step 14: You bargain that the polarization of the health care debate will diminish over time, and that appeals to logic and reason are sufficient, and that things will sort themselves out in the end. If you're confident, go step 16. If not, go back to step 8.
Step 15: You resort to bribery and trickery, are arrested, and thrown into jail. Game over.
Step 16: The Senate falls in line, and passes a health care bill that includes a government-funded co-op and no public option. The House passes a bill with a public option. A conference begins.
If you think this is plausible, go to step 17. If you think the Senate won't fall in line and won't pass a bill, go to step 20.
Step 17. Stalemate in conference. If you think the conference bill is reported out WITH a public option, go to step 24. If you think the conference bill is reported out without a public option, go to step 25.
Step 20: Health care is scrapped for the year. If you agree with James Carville that the Democrats should punish the Republicans for killing it, go to step 21. If you think the Democrats should punish the Democrats for killing it, go to step 22. If you think the Democrats ought to remain mute, go to step 22.
Step 21: This works. Go to step 40. This doesn't work. Go to step 23.
Step 22: In January of 2010, The Democrats try again. If it works this time, go to Step 16. If it does not, go to step 23
Step 23: Democrats are wiped out in the election of 2010,. having no accomplishment to show for it. If you think this is a likely scenario, go to Charlie Cook's symposiums. If you don't, turn on MSNBC. Game over. Go to Step 61.
Step 24: The House and Senate pass a bill with a public option. Obama has won. Go to Step 61.
Step 25: If you think House liberals will cave, having been sufficiently, ah, induced, by the White House, go to step 26. If you think they will hold, go to step 27. If you think the Senate Democrats won't support the conference report with a public option, go to step 27.
Step 26. Go to step 24.
Step 27: If you think that a permanent stalemate arises, go to step 20. If you think that a third way compromise can be reached, go to step 28.
Step 28: A third way compromise is reached. If you think that the House and Senate manage to pass a bill and that Obama will get credit by the American people and his base for health care reform, go to step 29. If you think that Obama's "win" will be seen as a loss, go to step 30.
Step 29: Obama, brimming with confidence, ends the year with high approval ratings again. Democrats, sensing the popularity of the president and his bill, have something to run on in 2010. Go to step 40.
Step 30. You convene a conference to figure out what Obama should do in 2010 in order to cast his first year and a half as a success. Public opinion gradually softens over time, and Obama's approval rating creeps up. If you think it will creep up, go to step 40. If not, go to step 32.
Step 32: 2010 opens with Republicans and Democrats on an even footing, but President Obama has lost much of his luster, and struggles to regain the magic. His experiment at political reform -- the Obama project -- has failed. Obama decides to govern as an unreconstructed liberal. If you think this is a plausible scenario, e-mail me. If not, you recruit Joe Lockhart and Joel Johnson to take over the White House. Go to Step 61.
Step 33: If you believe that reform ain't worth the paper it's printed on unless it changes the health care system to single papyer, go to step 34. If you agree that the consumer protections are worth having, even if the rest of the bill totally sucks, go to step 4.
Step 34. The bus to Canada has plenty of open seats. Game over. Go to Step 61.
Step 35. If the Senate parliamentarian is skeptical, go to step 8. If the Senate parliamentarian lets you wind up with a pretty good bill, many provisions sunset within five years, and you're consistently fighting an implementation battle with Republicans. Go to Step 61.
Step 40: Democrats lose, at most, a few seats in the House and one or two in the Senate. It's possible that they pick up seats in both chambers.
Step 50: You have private health insurance. You develop pancreatic cancer. Your health insurer won't pay for experimental treatments. Go to Step 51.
You have Medicare. You develop pancreatic cancer. Treatment is available, but you won't get it for several months. Go to Step 51.
Step 51: You decide that the health care system is broken and needs reform. Go to step 2.
Step 54: You are probably a Republican, or a conservative independent, or a libertarian.
Step 61: Turns out that the White House underestimated costs. Congress approves emergency supplemental of $500-billion and raises Debt Ceiling to $14.5-trillion.