Tag: politics

Why Not Just Mail Out Checks?

A friend writes:

Let’s suppose that the United States could get a Universal Basic Income, but it had to trade a bunch of stuff for it. What would be important to keep after a UBI?

Obviously, various income support could right out the door (food stamps, unemployment insurance). But would we be willing to trade labor regulations (minimum wage, union laws)? Public schools? Medicare? Curious as to your thoughts.

This sort of choice comes up all the time these days. Of course in practice it’s a false choice: They take our parks and public insurance, and never send out those UBI checks. Or occasionally, as in New York, they give us our universal pre-K and parks and bike lanes, and we don’t have to give up our meager income-support checks to get them.

Still, it’s an interesting question. How should we answer it?

1. At least for an important current on the left, the goal isn’t to distribute commodities more equally, but to liberate human life from the logic of the market. Or, a society that maximizes positive freedom and the development of people’s capacities, as opposed to one that maximizes consumption of goods. From that point of view, diminishing the scope of the market — incremental decommodification, as Naomi Klein used to say — is the important thing, so we’d always reject this kind of trade. (Assuming it’s on more or less “even” terms.)

2. Setting that aside. Shouldn’t we have a presumption that the goods that are currently publicly supplied are subject to some kind of market failure? Presumably there’s some reason why many governments provide insurance against old age and health costs, housing, education, police and fire services, and very few governments provide clothing or restaurant meals. Of course one wouldn’t want to say the current mix of public-private provision is ideal. But one wouldn’t want to say it carries no information, either.

3. There’s a genuine value in institutions that pursue a public purpose, rather than profit. We can debate whether hospitals should be public, nonprofit or even private at the level of management, but presumably in the operating room we want our doctor thinking about what’s most likely to make this surgery successful and not what’s most likely to make him money. (And we don’t think reputation costs are enough to guarantee those motives coincide — so back to market failures as above.) In the same category, and close to many of our hearts, are professors and other teachers, who teach better when they’re focused on just that, and not worrying about their paycheck.

4. Related to (3), how do we manage a system in which the public sector is disappearing? Seems to me the logical outcome of the UBI-and-let-markets-do-the-rest approach is stuff like this. Either you agree that intrinsic motivation is important, in which case you have to honestly ask in each particular case whether self-interest adds more than it detracts. Or you deny it, but then you’re left with the problem of how to you assure the honesty of the people sending out the checks. (Not to mention all the zillion commercial transactions that happen every day.) DeLong somewhere calls neoliberalism a counsel of despair, which makes sense only once you’ve given up on the capacity of the state. But without minimal state capacity even neoliberalism doesn’t work. If the nightwatchman won’t do what’s right because it is right, you can’t have markets either. Better pledge yourself to a feudal lord. And if the nightwatchman will, then why not the doctor, teacher, etc.?

5. How confident are we that unfettered markets plus UBI is politically sustainable? Being a worker expecting a certain wage gives you some social power. Being a participant in a public institution gives you, arguably, some social power, an identity, it helps solve the collective action problem of the poor. (Which is the big problem in all of this.) But receiving your UBI check doesn’t give you any power, any capacity to disrupt, it doesn’t give you a sense of collective identity, it doesn’t form a basis of collective action. My hypothesis is that the parents at the local public school are more able to act together — they have the PTA, to begin with — than the same number of voucher recipients are.

Bring Back Butlerism

From Eric Foner’s A Short History of Reconstruction:

Even more outrageous than Tweed … was Massachusetts Congressman Benjamin F. Butler, who flamboyantly supported causes that appalled reformers such as the eight-hour day, inflation, and payment of the national debt in greenbacks. He further horrified respectable opinion by embracing women’s suffrage, Irish nationalism, and the Paris Commune.

Or, as a horrified Nation put it, Butlerism was

the embodiment in political organization of a desire for the transfer of power to the ignorant and poor, and the use of government to carry out the poor and ignorant man’s view of the nature of society.

Labor law, inflation, women’s rights, anti-imperialism, and small-c communism, not to mention government by the poor? We could use a little more of that 1870s spirit today. People on the left who want to central banks to do more, in particular, could talk more about loose money’s radical pedigree.

So who was this guy? The internet is mainly interested in his Civil War career. Made a general on the basis of his pro-union, anti-slavery politics, he was, not surprisingly, pretty crap at it; but it does appear that he was the first Union officer to refuse to return fugitive slaves to their masters, and the first to successfully enlist black troops in the South. That was enough for Jefferson Davis to order that if he were captured, he should be executed on the spot. So he didn’t know how to lead a cavalry charge; sounds like a war hero to me.

In the current Jacobin (which everyone should be reading), Seth Ackerman offers emancipation and Reconstruction as a usable past for the Occupy left, unfavorably contrasting “the heavily prefigurative and antipolitical style of activism practiced by William Lloyd Garrison” with the pragmatic abolitionists who

saw that a strategic approach to abolition was required, one in which the “cause of the slave” would be harnessed to a wider set of appeals. At each stage of their project, from the Liberty Party to the Free Soil Party and finally the Republican Party, progressively broader coalitions were formed around an emerging ideology of free labor that merged antislavery principles with the economic interests of ordinary northern whites.

Today’s left, he suggests, could learn from this marriage of radical commitments and practical politics. Absolutely right.

There is, though, a problem: Reconstruction wasn’t just defeated in the South, it was abandoned by the North, largely by these same practical politicians, whose liberalism was transposed in just a few years from the key of anti-slavery to the key of “free trade, the law of supply and demand, the gold standard and limited government” (that’s Foner again), and who turned out to be less frightened by the restoration of white supremacy in the South than by “schemes for interference with property.”

If we must, as we must, “conjure up the spirits of the past …, borrowing from them names, battle slogans, and costumes in order to present this new scene in world history in time-honored disguise and borrowed language,” then certainly, we could do worse than the Civil-War era Republicans who successfully yoked liberalism to the cause of emancipation (though I’m not sure why Seth name-checks Salmon P. Chase, an early opponent of Reconstruction). But personally, I’d prefer to dress up as a populist who continued to support the rights of working people even after liberalism had decisively gone its own way, and who ended up representing “all that the liberals considered unwholesome in American politics.” Anybody for a revival of Butlerism?

This Is What Democracy Looks Like

I haven’t Occupied Wall Street, have you?

The protests are great — more anger, please! — but I don’t have any particular insight into them. And those of us without first-hand knowledge should probably defer to those who do. Except, I want to think critically about one common criticism of the protests: that they lack a clear statement of what they’re about.

It’s not clear how much this is really true. But still, one can say, isn’t there something circular about the idea of “Occupy Wall Street”? It’s not identified as a movement against bank bailouts or foreclosures, or for jobs or free elections or socialism. It’s a movement to, well, occupy Wall Street — a protest to hold a protest.

I think there’s an important sense in which this is true. And in which it’s always true — in which, indeed, it’s the whole point.

If you’ve ever been to one of these things, you know that the most successful chants are the self-referential ones, like “Whose streets/Our streets!” and “This is what democracy look like.” (Or “We’re here, we’re queer” and “We shall not be moved.”) Whatever the ostensible reason for the protest, the real content is always simply We Are Here.

This is most obvious, and most powerful, when the participants are people who are not supposed to be political agents or be seen in public at all: The early civil rights and gay rights protests, undocumented immigrants today. The message is, We exist. Think of the Memphis sanitation workers strike, with its signs reading, “I AM A MAN.” But it also works if the “here” is a setting that is not supposed to be political. The flipside, as everyone knows, is that a protest of recognized citizens at a place and time designated by the authorities is politically meaningless.

Most of us very seldom experience ourselves as political agents, in the sense of being active participants in the collective decision-making of our community. For better or worse, most of the time we delegate collective decision-making to specialists who represent us more or less faithfully, as the case may be. The only reason for protest — for any kind of mass politics — is that this system has broken down. The message of any protest is: There is a political subject, a We, that is not being represented. This, in the broadest possible way, is what the “99%” rhetoric is saying, and why it resonates. At some point, if a when movements like this are successful, some new more legitimate form of representation will be established, as people form new collective identities and new norms of collective action. But it’s foolish to criticize an assertion of the failure of representation for not itself being an effective representative, with a specific set of demands and a strategy to carry them out.

It’s a long time since I read any Habermas, but he has a passage somewhere about how politics is necessarily an open-ended discussion, a process for deciding a question that could in principle be resolved in many ways. So anything that becomes routine, that becomes part of the regular process of social reproduction, is no longer political. You can find a similar argument in Hannah Arendt, and Luciano Canfora makes it very powerfully. Democracy, he says, isn’t a form of government, like in civics class and Civilization. It’s something that happens, occasionally and intermittently. Any mechanism can be captured; you can’t institutionalize rule by the non-rich, as long as there are rich. To assert ourselves we have to heckle from the sidelines, or once in a while storm the field.

With a legitimate system of political representation, the question is what we should do and how to do it. Without one, we first have to establish that “we” exist.

UPDATE: Once you start looking for this stuff, it’s amazing how consistent it is. Pull up a photo of the protests at random, and there’s at least even odds you’ll see a sign with some self-referential message: “I am a human being, not a commodity,” “We are the 99%“, etc. Here’s a particularly nice example:

“We” are made up of the people here with signs. Exactly.

UPDATE 2: Matt Stoller, who’s actually spent time there, says the same thing: 

What do the people at #OccupyWallStreet actually want? What are their demands? For many people, this is THE question. So let me answer it. What they want, is to do exactly what they are doing. They want to occupy Wall Street. They have built a campsite full of life, where power is exercised according to their voices. It’s a small space, it’s a relatively modest group of people at any one time, and the resources they command are few. But they are practicing the politics of place, the politics of building a truly public space. They are explicitly rejecting the politics of narrow media, the politics of the shopping mall. To understand #OccupyWallStreet, you have to get that it is not a media object or a march. It is first and foremost, a church of dissent, a space made sacred by a community. … There’s no way to agree or disagree with a church or a carnival.

Don’t Let Nobody Walk All Over You

Here’s a heartening story from the old neighborhood:

An 82-year-old great-grandmother cried tears of joy Friday as nearly 200 neighbors rallied in her support on the day she was to be evicted. Mary Lee Ward was granted a reprieve when the owner of the Brooklyn house where she lives agreed to continue meeting with her lawyers next week. “You have to stick with it when you know your right,” Ward told the cheering crowd. “Don’t let nobody walk all over you.” 

Ward, who fell victim in 1995 to a predatory subprime mortgage lender that went under in 2007, has been battling to stay in the Tompkins Avenue home for more than a decade. A city marshal was supposed to boot Ward from the one-family frame house Friday, but didn’t show as her lawyers sat down with an assemblywoman and the home’s owner. … “I hope they realize that they can never really win,” Ward said. “I will not compromise.”

Why don’t we see more of this kind of thing? There are millions of families with homes in foreclosure, and millions more heading that way. Being forcibly evicted from your home has got to be one of the most wrenching experiences there is. And yet as long as you’re in the house, you have some real power. And the moral and emotional claims of someone like Ward to her home are clear, regardless of who holds the title. Someone just has to organize it. Here, I think, is where we are really suffering from the loss of ACORN — these situations are tailor-made for them.

Still, there is some good work going on. I was at a meeting recently of No One Leaves, a bank tenant organization in Springfield, MA. Modeled on Boston’s City Life/Vida Urbana, this is a project to mobilize people whose homes have been foreclosed but are still living in them. Homeowners who still have title have a lot to lose and are understandably anxious to meet whatever conditions the lender or servicer sets. But once the foreclosure has happened, the homeowner, paradoxically, is in a stronger negotiating position; if they’re going to have to leave anyway, they have nothing to lose by dragging the process out, while for the bank, delay and bad publicity can be costly. So the idea is to help people in this situation organize to put pressure — both in court and through protest or civil disobedience — on the banks to agree to let them stay on as tenants more or less permanently, at a market rent. In the longer run, this will discourage foreclosures too.

It’s a great campaign, exactly what we need more of.

But there’s another important thing about No One Leaves: They’re angry. The focus isn’t just on the legal rights of people facing foreclosure, or their real chance to stay in their homes if they organize and stick together, it’s on fighting the banks. There’s a very clear sense that this is not just a problem to be solved, but that the banks are the enemy. I was especially struck by one middle-aged guy who’d lost the home he’d lived in for some 20 years to foreclosure. “At this point, I don’t even care if I get to stay,” he said. “Look, I know I’m probably going to have to leave eventually. I just want to make this as slow, and expensive, and painful, for Bank of America as I can.” Everyone in the room cheered.

Liberals hate this sort of thing. But it seems to be central to successful organizing. Back when I was at the Working Families Party, one of the things the professional organizers always talked about was the importance of polarizing — getting people to articulate who was responsible for their problems, who’s the other side. It was a central step in any house visit, any meeting. And from what I could tell, it worked. I mean, it’s foolish of someone like Mary Lee Ward to say, “I will not compromise,” isn’t it? Objectively, compromise is how most problems get solved. But if she didn’t have a clear sense of being on the side of right against wrong, how would she have the energy to keep up what, objectively, was very likely to be a losing fight, or convince her neighbors to join her? Somebody or other said there are always three questions in politics. You have to know what is to be done — the favorite topic of intellectuals. But that’s not enough. You also have to know which side you are on, but that’s not enough either. Before you devote your time and energy to a political cause, you have to know who is to blame.

A while back I had a conversation with a friend who’s worked for the labor movement for many years, one campaign after another. If you know anyone like that, or have been part of an organizing drive yourself, you know that in the period before a union representation vote, an American workplace is a little totalitarian state. (Well, even more than usual.) Spies reporting on private conversations, mandatory mass meetings, veiled and open threats, punishment on the mere suspicion of holding the wrong views, no due process. And yet people do still vote for unions and support unionization campaigns, even when being fired would be a a personal catastrophe. Why, I asked my friend. I mean, union jobs do have better pay, benefits, job security —  but are they that much better, that people think they’re worth the risk? “Oh, it’s not about that,” he said. “It’s about the one chance to say Fuck You to your boss.”

Hardt and Negri have a line somewhere in Empire about how, until we can overcome our fear of death, it will be “carried like a weapon against the hope of liberation.” When I first read the book, I thought that was pretty strange. But now I think there’s something important there. Self interest, even enlightened, only takes you so far, because when you’re weak, your self-interest is very often going to be in accomodation to power. I’m not sure I’d go as far as Hardt and Negri, that we have to lose our fear of death to be free moral agents. But it is true that we can’t organize collectively to assert our rights in our homes and our jobs as long as we’re dominated individually by our fear of losing them. Some other motivation — dignity,  pride, anger or even hatred — is needed to say, instead, that nobody is going to walk all over you.

Some Thoughts on Negotiation

I don’t claim to be any expert on the negotiating table. But I was, about ten years ago, the lead negotiator for my graduate employee union (~3,000 members.) I’ve spent plenty of time around unions, before and since. And in my years at the Working Families Party, where I was the designated wonk, I inevitably had some involvement with negotiations over the terms of bills. From which I derive an observation that’s perhaps relevant to the debt-ceiling talks.

The principals are never at the table.

Maybe because they’re busy; very likely because they’re diffuse; or maybe they’re only constituted through the negotiating process. In any case, there are not one but three negotiations going on: between the two agents at the table, and between each of those agents and their respective principals.

So for instance, the question for me as Local 2322 representative was not just what I think of this deal, but whether I can sell it to the membership. Even worse when you’re trying to nail down health care legislation; the union at least has a defined membership roll but the coalition exists only insofar as there’s a chance of passing something. In either case, your problem as a negotiator is the same: When you go back to your constituents, you have to convince them that the deal (1) is good enough and (2) is the best you could have got. What I’m talking about here is the tension between 1 and 2.

Let’s say you’ve got some big demand — a 20 percent pay raise, let’s say. And let’s say, miraculously, the employer agrees to this the first day of negotiations. This tells you two things: First, the deal you have now is better than you expected; but also, that the payoff to continued negotiations might be better than expected too. If they gave you this for just sitting down, they must be desperate; who knows what they would give if you could really hold their feet to the fire. So it’s not actually easier for you to convince your principals to ink a deal at this point. You’ve got an easier time selling them on (1), but a harder time selling them on (2).

Now you might say this is irrational, unfortunate, people should know how to say, Yes. But I don’t agree. The principal is not negotiating not just this once. So knowing which agents, or which kinds of agents, are reliable may be every bit as important as getting the best possible deal in this round. So they’re observing, Did the negotiators keep pushing until the other side was ready to walk away, as much or more as, Is the outcome acceptable. From the principals’ point of view, an early concession from the other side is a signal that this side’s agents need to ask for more to prove they are doing their jobs.

In this sense, even if you (the agent now, like Obama) are happy to agree with everything the other agents have proposed to you, it’s in your shared interest (yours and theirs) to only concede it at the last moment, and in return for the most costly concessions, to help them sell it to their principals.

Bottom line: Even if you intend to concede X, it’s in everyone’s best interest – including the negotiators on the other side — that you don’t give up X until the last possible minute. Conceding it early actually makes it harder for the other side to accept. This sounds like a paradox but I think it’s really a perfectly logical and inevitable implication of the negotiating situation.

It’s a broadly-applicable problem in economics, that a change in price has opposite effects if it’s considered once and for all vs if it’s considered as a proxy for future changes. Whatever the model says, one has to think a change in prices might continue. This is how bubbles get started. Just so, politically, current concessions makes the current deal look better — statically. But the relevant question is, do they make the current deal look better, with respect to some future deal? To the extent that conceding now makes both look better, that effect is indeterminate.

So, Obama’s a bad negotiator, then? Maybe. I have to admit, there;s something appealing, in a poetic-justice sense, to the idea that the decline of the labor base of the Democratic Party has led to a fatal loss of practical negotiating skills. The other, more obvious possibility, is that he is not trying to get the best outcome for the Democrats in the sense that most people understand it — that he shares the Republicans’ essential goals. But I might put it a little differently — Obama’s bargaining position is weak precisely because of his independence, the fact that he doesn’t answer to anyone. Digby asks, quite reasonably, if we have any idea at this point what the President’s principles are. I might put it a little differently: it’s who are his principals.

Some Should Do One, Others the Other

A friend writes:

In August 1968 I was on an SDS trip to Cuba, one of about 30 student activists from around the US. One day we went to the mission of the Provisional Revolutionary Government of South Vietnam in Havana (it had been called the National Liberation Front but had recently taken on a new name). We decided to see if the NLF, as we called them, could settle some debates in the US antiwar movement. After exchanging pleasantries with the representative of the PRG/NLF, we had the following exchange.

SDS students: We have a debate in the antiwar movement. Some of us think we should organize militant, obstructive demonstrations that are openly in support of victory for the NLF. Others argue we should organize much larger, peaceful, legal demonstrations around the demand of immediate US withdrawal from Vietnam. Which should we do?

PRG/NLF rep: Some of you should do one, and others should do the other.

SDS students: We have another debate in the antiwar movement. When a male antiwar activist gets a draft induction notice, some of us think he should refuse to serve, either going to jail or going to Canada. Others of us argue that he should quietly go into the military to organize among the soldiers for an end to the war. Which should we do?

PRG/NLF rep: Some of you should do one, and others should do the other. And when an antiwar activist goes into the military and ends up in Vietnam, there are ways to arrange contact between the activist and the local NLF fighters.

After that exchange, I began to see why the NLF was so successful in their struggle to force the US out of Vietnam.

Here is a parable for the Left! How many pointless debates about tactics could be avoided if someone just said, “Some of you should do one, and others should do the other.” Except in the case of a specific, finite resource, and a decision-making body able to allocate it, the merits of one approach aren’t an argument against another.

Peaceful demonstrations, or direct action? Challenge foreclosures in court, or block them in the street? Work within the Democrats, or build a third party? Support organizing and contract fights by AFL-CIO unions, or help build rank-and-file insurgencies? Try to shift the Obama administration from the inside, or pressure it from the outside? Debate the economics mainstream, or build a heterodox alternative? Nationalize the banks, or shoot the bankers? Fight for women’s access to male-dominated professions, or for greater social recognition of traditionally female activities? Well-funded public universities, or an end to credentialism? Green capitalism, or cooperatives? Theory, or practice? Recycle, reuse, or reduce? Some of us should do one. And others should do the other.

Is Liberalism Done Yet?

I don’t have much to add to Mike Konczal’s respectful but thorough rebuttal of the idea that the passage of health care reform marks the end of the liberal project; Yglesias is so clearly wrong, for so many reasons. Most immediately, the health care bill as passed will leave 8 percent of the population uninsured, so even if universal health insurance is the finish line, we haven’t crossed it yet. More generally, there are clear areas where expansion of public provision and regulation is almost inevitable, whenever the political climate turns favorable. Most obvious is childraising (and caring labor more generally), where our current system of uncompensated household labor is being steadily eroded by the acid of the market, even while the demands on it increase. In a few years, universal childcare will be seen by liberals as essential to a civilized society, just as universal health coverage is now.

More broadly, I’m reminded of Stephen Resnick’s story of his fellow MIT grad student Stephen Hymer going in to Robert Paul Samuelson’s office (this would be the early ‘60s) and asking him if there was anything important in Marxism that you couldn’t talk about using conventional economics. Samuelson’s answer: “Class struggle.”

Liberals and radicals do disagree over ultimate ends – more stuff, more equitably distributed, for them; the full and free development of human capacities, for us. But the more salient disagreement, at least in the current conjuncture, is over means. Liberals believe that the political process is ultimately a form of rational debate, in which the objectively best ideas win out and are then executed by a neutral administrative mechanism. Political engagement means situating yourself within shouting distance of the seat of power, and then making the case that your preferred policy is in the best interests of everyone. Who you are doesn’t matter, just the merits of your views. Carl Schmitt, interestingly enough, gives one of the clearest statements of this conception of politics:

All specifically parliamentary arrangements and norms receive their meaning first through discussion and openness. This is especially true of the fundamental principle that the representative is independent of his constituents and party… The characteristic of all representative constitutions … is that laws arise out of a conflict of opinions, not out of a struggle of interests. … Conduct that is not concerned with discovering what is rationally correct, but with calculating particular interests and the chances of winning and with carrying these through according to one’s own interests is … not discussion in the specific sense.

Schmitt, the anti-liberal, saw better than liberals that this mode of politics is specific to the particular institutional context of parliamentarianism. A context that remains very important, of course, outside of the formal political domain as well as within it. [1] But it’s not universal, and in particular it can’t be the last word in a society that is divided by fundamentally conflicting interests.

Radicals, by contrast, see the conflict of interests as fundamental. Or rather, we see it as inescapable in politics as long as it exists in economic life and society generally. From this point of view, arguments are won in parliament only thanks to the rioters, literal or figurative, in the streets outside. And liberalism as a concrete political project is a compromise between opposing interests, one that’s always open to renegotiation when the balance of forces changes. So unlike in science (liberalism’s implicit ideal), progress is always reversible, so no political struggle is ever definitely finished. Any given compromise is only sustainable to the extent that there are social forces striving for a horizon beyond it.

[1] For example, I’m current serving on a university hiring committee, and the norm that discussions must be conducted only in terms of differing opinions, never opposing interests, is very strongly felt.

The atrophy of the liberal imagination, a continuing series

My buddy Mark Engler wrote an interesting piece for the Dissent blog on why the left should oppose the Kagan nomination. Interesting, but not convincing, at least not to me. It’s not that I like her, altho I’ve been more or less convinced by people who know the academic-law world from the inside that her publication record is perfectly adequate. On substantive political issues there’s not much to say for her, and that’s on Obama, not the “process”.

What I don’t see, tho, are what are the principled demands being made here. “Liberal justice” is almost an empty signifier; I suspect that beyond the important, but fairly narrow, areas of civil liberties and executive power, most of us on the labor or socialist left will find a wide range of legal issues on which our views and Glenn Greenwald’s sharply diverge. Just as importantly, what is the public debate that this is clarifying or polarizing? Will this fight help develop a left opposition in Congress? Does it mobilize people? Could we win? Looks like no on all counts, to me.

Being on the left can’t just mean bitching about everything, it’s got to mean staking out clear, principled positions, organizing people around them, and having concrete victories to show for it. Opposing Kagan does not seem to meet this test.

Anyway — the reason for this post, or at least its title — I was going to say all this in a comment to Mark’s Dissent post. But it turns out the Dissent blog has no comments section. Yes, Dissent does not allow comments. Doesn’t that say it all?

Health bill thoughts

Short version: It’s an expansion of Medicaid, with some doodles in the margin.

Longer version:

Today, the US has the world’s highest medical spending and poor-to-mediocre health outcomes. It’s the only rich country where health coverage is provided by private insurers; where most people’s coverage is linked to their jobs; with a large number of people without health insurance; where millions of people lack any health coverage; and where medical problems often mean financial catastrophe. When this legislation is fully phased in, by 2016 or so … it still will be.

We know what the bill won’t do: fundamentally change the structure of health coverage and finance. But what will it do? My own bottom line is, Enough to be worth passing.

The bill’s provisions break down into half a dozen major categories: (1) new insurance regulations; (2) health insurance exchanges; (3) individual and employer mandates; (4) Medicaid expansion; (5) Medicare (and Medicaid) spending cuts; (6) tax on high-cost insurance policies, plus a bunch of other smaller taxes; and (7) a grab bag of experimental measures to improve the efficiency and quality of health care. And then there’s the provision that’s not there, (8), the public option. There are serious questions about the logic and impact of most of these provisions, many of which I have not seen analyzed seriously. As time and inclination permits, I’ll dig more into the most glaring ones. The bottom line, per the CBO, is that the uninsured would fall from 19 percent of the population today to 8 percent after 2015. [1]

I was thinking of walking through the major provisions of the bill one by one. But you can find that elsewhere. (Start here.) I might come back and write up a full summary, but in the meantime, I want to flag a half dozen important issues and questions that I haven’t seen discussed much elsewhere.

1. The individual mandate — is it really necessary to make community rating and related regulations work?
2. the distribution of new Medicaid spending, which is highly unequal between states.
3. The cuts in DSH payments, which could be catastrophic for some urban hospitals.
4. The crazy-quilt employer mandate.
5. Why the public option mattered.
6. How meaningful in practice are the limits on out-of-pocket costs, premiums, and medical loss ratios?
7. How much do insurance companies gain?

There are a couple other issues that have gotten a bit more discussion, where I don’t think I have anything much to add.

First, what is the role of insurance companies under this system? It seems they no longer have access to the two main choice variables on which they maximize profits currently: the terms on which they offer coverage, and the mix of benefits they will pay for. If they must offer policies on publicly-fixed terms with a publicly-set package of benefits, there’s no margin left for them to operate on. (Which doesn’t mean they won’t be profitable, just that their profit will depend on federal policy, not on factors under their direct control.) Two possibilities here: First, they will find ways to continue selecting healthier populations and limiting payments; the medical loss ratio restrictions won’t bind; in short, the status quo. Second, the insurance companies become essentially vestigial, simply taking a cut off the top of what is basically a public system. Purely parasitic insurance isn’t something anyone would propose, but it does have to be admitted it’s an improvement on insurance companies that take their cut and try to increase it by denying people health coverage.

Anyway, this is looking at the bill through the lens of universal reform — what is the logic of the system it creates? Whereas it plainly isn’t fundamental reform, and it doesn’t create a system with any particular logic, just tweaks the system that’s formed itself willy-nilly.

Second, the abortion restrictions. It’s clear that for some women, the bill will actually make things worse — it will restrict abortion coverage compared with the status quo. How much, for how many? I don’t know. But I did want to flag this lovely quote from The New Republic: “Poor people pay surprising amounts for cell phones and cable TV. They can be surprisingly resourceful in paying for abortions, too.”

[1] Also, at The New Republic, Jonathan Cohn writes, “For nearly a hundred years, the political system has been debating whether access to basic medical care should be a right all citizens enjoy. When reform passes, the political system will finally render its verdict: ‘yes.'” But 92% — or even 94%, if you don’t count undocumented immigrants — is not “all”. This kind of dishonest rhetoric has been all too common among those defending the bill.