Archive for category Health Care

President Obama: One of the Greats?

This image is taken from the Washington Monthly which has a story The Incomplete Greatness of Barack Obama.   I’ve been puzzling my liberal friends and annoying/shocking my conservative buddies by repeating my prediction that President Barack Obama will likely be remembered as one of the great Presidents in US history.

Liberals believe that Obama has somehow not been strong enough, some claim he’s been “GOP Lite.”  He caved on the debt ceiling, extended the Bush tax cuts and hasn’t stood up to the GOP.   They see his efforts to make deals with Speaker Boehner as having been weak and foolish.  To many on the left Obama is a militarist who has continued US policies in Iraq and Afghanistan, doing what he needs to to curry favor with the Pentagon.   Moreover, he’s too close to Wall Street, having used advisors like Summers, Geithner and other “insiders” instead of embracing radical reform.   Instead of pushing change, he’s trying to be liked by Republicans who want only to destroy him.

Republicans think Obama has been dangerously radical, weak on defense, and unfriendly to business.   They see the modest compromise ridden health care reform the Democrats see as sometimes worse than doing nothing as some kind of radical dangerous burst of socialism.  Sometimes the criticism is bizarre.   Newt Gingrich warns that Obama has been “pretending” to be reasonable for four years in order to slam his agenda down our throats after his re-election.

The often bizarre beliefs his opponents hold about him is indicative of Obama being a transforming President - when the country is in transition, many people don't like it!

In short, the extremes of each party have tended towards seeing anything not in line with their perspective as bad.  They are in two parallel universes, showing the depth of the partisan division over Obama’s Presidency.

Given tea party noise, continuing unease about the economy and the partisan divide it’s easy to miss all that the President has accomplished.  That list of fifty accomplishments is pretty substantive, and beyond what most Presidents do in their first four years.  Now some on the right might think some of these accomplishments are mistakes — policies we shouldn’t have engaged in.   But that’s a different issue.   In terms of getting things done, Obama has been an effective activist President.

Rather than put together an argument about why he may be destined for greatness, I’ll channel an historian from the year 2050…hold on, turning out the lights, starting the seance…OK….

“Why do we consider President Obama to have been one of America’s great Presidents?  Well, in 2008 the United States slipped into a severe recession caused by thirty years of deficit spending and current account deficits as the country binged on cheap consumer goods produced elsewhere and bought with borrowed money.  Many said the US was in collapse, and predictions ranged from complete breakdown in authority to a weakened state groveling to the Chinese to keep them from dumping dollars and treasury notes.   Two dubious wars had divided the country, harmed the economy, tarnished America’s image and seemed to symbolize US decline.

President Obama came into this horrible situation and arguably prevented the Great Recession from becoming a depression.  Forging a compromise heavy on tax cuts to help please Republicans, the stimulus package of 2009 helped save the US and arguably the globe from a spiraling depression.   Obama also continued President Bush’s policy of rescuing the credit markets with the Troubled Asset Relief program, which also staved off depression and prevented a banking collapse.

His first years were rough, even as he engineered major changes like a health care reform program that over time has cut US health care costs and which now enjoys immense support.  He supported the civil rights movement of that era by ending “Don’t Ask, Don’t Tell,” carefully bringing the Pentagon on board to undercut opposition.  In foreign policy he not only patched up relations with the rest of the world (being more popular abroad than at home during his first term), famously getting along with leaders of diverse views, but he also took a stance for freedom, helping push out dictators in the Arab Spring.

When the global economy turned around his second term, his popularity grew, and many now credit President Obama with saving the US from decline as a superpower.  He recast US policy as one of working with like minded states to pragmatically solve problems, beginning the alternative energy cooperative that has allowed a smooth shift from fossil fuels to alternatives in a way that did not bring about a feared oil catastrophe.   As one biographer put it, ‘President Obama is a major reason why ‘peak oil’ became simply a transition, not a disaster.’

His shift of emphasis from hard power to soft power, as well as limited American involvement won support at home from a public weary of middle east wars, and caused other countries to recognize the need for cooperation – America isn’t going to do it alone. It paid dividends when diplomatic pressure forced Iran to give up its nuclear program and gave room to Iran’s dissidents who ultimately forced the clerics to move towards a truly democratic and modern Iran.  Obama’s shift also turned the US into a kind of hero to the Islamic world, credited with helping end the regimes of Mubarak, Gaddafi and Assad.   Without a mix of US pressure and support the Saudi Royal Family would have never ceded power without a fight.

Historical causality is often hard to label.   Things had gotten so bad by 2008 that perhaps any leader would have become great, the times can make the man.   But President Obama’s pragmatism, willingness to compromise, and recognition that the US could no longer say “we lead, you follow” helped guide the US from its unipolar moment to its position of multipolar cooperative shared leadership.   It was in his second term that the initial plans were created to recast the power grid, restructure the American tax code (which had become byzantine in its complexity by 2008) and ultimately put the US on a path of sustainable success…”

Bringing about "change you can believe in" doesn't happen overnight.

The reality is that President Obama took charge at a time when the country was in transition, and at this point, if you see above the noise and uncertainty, there are real signs that we’re making progress.   We’re not only starting to restructure the economy but recast our role in the world and set up policies with an eye on a very different future than the world of the 20th Century.

Yes, his foes will never accept that — many still hate FDR, and no one denies his greatness.  But President Obama is in the midst of a transformative Presidency, starting the country on a new direction.   That is a recipe for greatness.

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Let Them Eat Cake

Mitt Romney repeated one of the most malicious and misguided political lies of recent years: that people who criticize Wall Street and inequity in America are driven by “envy.”

Besides the fact that one has to wonder who Warren Buffett envies — he’s one of the richest men in America and he’s been a critique of inequity, as has George Soros, a wealthy international capitalist tycoon — the claim is not only absurd, but fundamentally dishonest.

Rather than look at real issues of power, wealth and opportunity, those who question whether it is good for society to have extreme wealth alongside extreme poverty are dismissed via insult — it’s “envy.”    Occupy Wall Street, nothing but envy.   President Obama’s effort to curb Wall Street excesses – just envy.   Any criticism of the wealth gap and lack of opportunity gets brushed aside as “envy.”

This is a point that President Obama and the Democrats need to turn around on Romney.    It’s best to do it with real stories.  A family who lost health care and couldn’t afford an operation for a child, thereby leaving the child crippled or handicapped, for instance.   Is their problem simply that they envy the rich?   It’s not wrong that the wealthy have excellent insurance as a matter of course and the poor often see their children suffer.   They’re just envious of the health care the rich take for granted.

A worker that lost his job and has nowhere to turn as they can’t afford college for their children or to keep their house thanks to the recession.   They shouldn’t be upset about the shenanigans on Wall Street or how the wealthy have gained nearly 300% in the last thirty years while the poorest have barely stayed ahead of  inflation.   No, it’s just envy.

The message should be clear:  It’s not envy to want real opportunity for Americans.  It’s patriotism.  It’s the values of our constitution, it’s the key to the future of the country.   If we allow these inequities to continue in the false belief that somehow wealth and opportunity will trickle down and the wealthy are all “job creators,” then our country will continue to decline and we’ll find that America’s day in the sun is over.   We need to fight for real opportunity and against a new aristocracy, because that’s a fight for America’s values and future.   That’s got to be the message that the President runs on this year.

And soundbites of Romney muttering “it’s envy” should be ubiquitous on Obama commercials.   An elitist Wall Street insider who has lived of life of privilege sneers down his nose and says the poor unemployed and struggling are just envious of people like him.

“Let them eat cake,” he may as well add.

Don’t get me wrong.   I actually think Mitt Romney isn’t a bad candidate and would probably do well as President.   But as you can probably tell, this claim that “it’s envy” to be concerned about poverty, equal opportunity and wealth disparity has gotten under my skin.

Moreover, if I compare my household income with the rest of the country’s, I’m not in the 1%, but I’m not that far away.   My wife and I work very hard, make good money and are living the American dream.    We’ll be able to provide the best for our kids, help them if they ever have difficulties in school, and get them a good education.    But if I were to say “well, we’re smart and got ahead, those poor blokes down the road who are having a rough go are just envious,” well — what kind of arrogant slime ball would I be?

The second fallacy is the dodge, “oh we should be concerned and help, but government shouldn’t do it, it should be done by individuals.”   Sure.   We should all be concerned about murder, rape and arson, but government shouldn’t handle those protections, let individuals do it.    The fact of the matter is that the collective action problem is real, well documented, and undeniable.   If you leave it to the private sector problems get worse.   You need government to do so because nobody else can do it.   You might get food shelves to keep the poor from starving, but you won’t get real opportunity.

And that is where Obama has the rhetorical upper hand.   He can say “the American dream is that every American has access to the education and opportunity to go into the market, work hard, innovate and be rewarded for the fruits of his or her labor.   We reject socialism and efforts to equalize all outcomes because that makes everyone worse off and undercuts innovation and ambition.  If you doubt that, look at the former Communist world.   But to work capitalism needs to make sure that the elites aren’t rigging the game in a way that denies liberty, opportunity a fair shot to the middle class and poor.

“If we unleash America’s potential of ingenious experimentation, a willingness to work hard and take risks, and freedom to break with the past and try new things, we can achieve anything, we can maintain the American dream for generations.   When a small group of elites rig the game with insider trading, schemes to rob pension funds and retirement accounts, predatory lending practices aimed at the poor and a tax system that gives them advantages that most people don’t have, it’s undercutting the American dream.  It’s contrary to American values.   It’s risking our future.

“It’s not envy to want a fair chance for everyone.   Let those who work hard and innovate well succeed and become wealthy.   Let those who choose to do the minimum and refuse to take the opportunities that exist suffer the consequences.   Let it be the actions of the individual that determines the outcome, not the structure of a rigged game.   It’s not envy to want fair play, it’s a sense of justice.”

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The Political Pendulum

After the 2008 election Democrats were on a high.    President Barack Obama had been elected as the first black President, the Democrats controlled both the Senate and the House, and demographics seemed to indicate that if anything, their future  was brighter than ever.   President Bush left office as one of the least popular Presidents in history, being blamed for a dubious war in Iraq and an economic crisis that hurled the US into recession.

Yet the pendulum swung.   The depth and severity of the recession proved greater than the Obama White House had anticipated, and with the Democrats in control of government they were blamed for anything that went wrong.   After health care reform was pushed through just barely, yielding a compromise that angered conservatives and many liberals alike, President Obama found the honey moon over.   The tea party movement achieved amazing success at shaping the political discourse, and a new narrative took hold.

This narrative said that President Obama’s policies were hindering the recovery, that the stimulus was a waste of money and a failure, and that the raw politicking of the health care deal showed the shady side of Democratic politics.    Republicans said the real solution to the problems the country faces is smaller government and fiscal conservatism.   The hope and change promised by the Democrats was just more tax and spend — more government programs.

In 2010 the GOP achieved dramatic success, something unexpected after two election cycles dominated by the Democrats.   Without the drag of the Iraq war and with President Obama “owning” the economy (even though neither he nor Bush ever could control it) the public swung right.   Some of it was fear that change was going too fast; others thought the Democrats simply moved farther and faster than the public wanted.  President Obama’s approval ratings dropped down below 50%.

Yet even as the Republicans start to lick their chops over electoral prospects in 2012, the pendulum may be swinging again.   The President’s approval ratings are still bad, but they are picking up slightly.   Don’t forget, President Clinton had 40% approval in early 1995, and Reagan dropped to 38% for awhile in 1983.   President Obama is now at about 43%.

The mood seems to be changing.  E J Dionne notes this “narrative change,” citing Paul Ryan’s somewhat bitter speech to the Heritage Foundation as evidence that Republicans recognize that the argument is slipping away from them.   Occupy Wall Street has shown itself more popular and resilient than anyone expected, and the efforts to paint them as a bunch of spoiled hippies and malcontents has failed.     President Obama’s “new populism” is hitting a chord.   Americans don’t want massive redistribution and high taxes, but the idea that the system is unbalanced in favor of the wealthy is gaining traction.

Moreover, the Republican party doesn’t seem to have a clear leader, and their primaries have been dominated by sometimes extreme rhetoric that scares independents.   Herman Cain wants an abortion ban with no exceptions, not even for rape and incest.   That kind of talk scares people.   Michelle Bachmann’s call to bring taxes back to the level they were under Ronald Reagan is illustrative.    Taxes were much higher under Reagan than they are now; as she had to retreat from that statement it reinforced the idea that Reagan would be far too liberal for today’s GOP.    The narrative of an extremist Republican party is building.   Rick Perry’s assault on social security addsto that as the GOP Presidential field tries to capture the tea party electorate that vote in early primaries.

Mitt Romney should be a strong candidate.  He is clearly a moderate who shouldn’t scare anyone, but his Mormonism and moderation might actually decrease conservative enthusiasm in 2012.   He’s benefited from the turmoil in the GOP field, but the Republican party has lost control of the conversation.   Instead of Reaganesque optimism the tune from the right is increasingly antagonistic.

Meanwhile, Democrats in the House start whispering that there are a lot of vulnerable Republicans, especially first termers, who are having trouble raising money and whose ideological voting records don’t play well at home.    All Democrats expect gains in 2012; the idea of winning back the House is not as far fetched as it used to be.

Right now the conventional wisdom remains that President Obama is, if not the underdog, in a difficult position heading into the re-election fight.   But at this point in 2009, when Obama was still above 50% in approval, few people realized that the pendulum had already started a decisive swing away from the Democrats and towards the Republicans.

It’s still too early to know for sure if the pendulum is swinging back in the Democrat’s direction.   Obama is getting kudos for success in Libya, he announced the end of the Iraq war, and there may be an end in Afghanistan sooner than people expect.   The economic news has become slightly more optimistic.    Occupy Wall Street has stolen the attention that the tea party used to enjoy and has spread across the country, gaining a lot of support from Iraq veterans.    In states like Ohio, Wisconsin and even here in Maine conservative causes have led to dissatisfaction — ballot initiatives in both Ohio and Maine might be very telling about the way the mood is changing (Ohio’s involves public labor unions, Maine’s is an effort to undo Republican legislation removing same day voting registration).

It feels like the pendulum has switched directions.   It feels like 2012 could be for the Democrats what 2010 was for the Republicans.   It feels like Obama may join Presidents Clinton and Reagan in the catagory of having their political obituaries written too soon.   Time will tell — there is still a lot that could go right or wrong for both parties.     The good news about the political pendulum is that if you’re on the losing side of an election, it won’t be that way forever.   The bad news is that if you’re on the winning side the same applies.

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Lessons from the Wisconsin Recall

The recall elections in Wisconsin are almost finished — the final two Democrats up for recall are not considered in serious trouble — and overall it looks like the Democrats managed to recall two of six Republican Senators, not enough to put the State Senate in the hands of the Democrats.

Republicans are happy with the result.  They kept control of the Senate and can claim a victory despite losing two members.    Democrats can take solace in the fact that they were going against Republicans who had won their districts in 2008, a year when Obama took Wisconsin and the public was in a far more Democratic mood.   The fact that the Democrats could bat .333 in such districts — and come within two percentage points of taking a district that hasn’t gone Democrat since 1896 — should give them pause.   They didn’t get a victory so much as dodge a bullet.

Democrats privately had admitted they were only likely to win two — though they hoped for the third (and got close).  But many on the more liberal wing of the party had convinced themselves that public rage against Governor Walker and the GOP, along with voter enthusiasm on the left, would give them more — some thought a sweep possible.   For them this is disappointing, their chance to send a message failed.

The other day I had a post critical of a group Norbrook named the “Frustrati,” — progressives convinced that the only thing Democrats lack are leaders willing to take strong liberal stances and refuse to compromise.  They believe the public will reward strength and principle, and that Obama and Reid have been too willing to work with the GOP.    This election should give them pause.   Even with a very energized and hard working base fervently trying to win at least three elections voters didn’t vote that much different than they did before.   Republicans can also argue that the two who lost were in trouble for personal reasons, that stronger candidates would have won.

Put bluntly: people on both sides of the political spectrum over-estimate how much the voting public agrees with their side.    Each will cherry pick issue polls, look at particular races (e.g., the Democratic victory in a Republican district in New York earlier this year) and read into them a national mood or trend.  The fact is that the country voted overwhelmingly Democratic in 2006 and 2008, willing to elected an untested Barack Hussein Obama who was accused of being far left and somehow not truly American.   Then in 2010 an admittedly smaller electorate turned around and voted a stunning number of Democrats out of office in the House to take control.    The only reason the Democrats held the Senate was that they had few seats up for re-election.   If the 20+ seats up in 2012 had been on the line in 2010, Mitch McConnell would again be Majority leader.

There’s only one way to read that.   The voting public is neither liberal nor conservative.   People do not equate political ideology with principle.   Principles are what guide every day personal choices and ethical perspectives.   Politics is about making deals, compromising, and solving problems.   Pragmatism is the quintessential American philosophy.    People will vote one year for someone whose principles are informed by liberal or even Social Democratic values, then turn around the next time and vote for someone who embraces very conservative views.

Any party that over-estimates the appeal of its own ideology risks overreaching and causing the public to correct the situation in the next election.   Any party that refuses to compromise or show an understanding of different perspectives will be seen as intransigent and unable to govern.   And, though parties must keep their bases in line, giving their base too much power can doom them in the next election.

Right now the Republicans believe Obama is vulnerable in 2012 and the GOP can gain control of the Senate.   They see the potential of repealing the health care reform, dramatically cutting spending, and steeply downsizing government.   Many think that’s the only way to deal with the economic crisis.    If they hang around right wing blog sites and talk with like minded folk, they’ll bolster each others opinions and start to believe their view is self-evidently correct, and that compromise is therefore weakness and wrong.     But so far the more Social Democratic countries of Scandinavia are in less economic trouble than we are, their way is one way to respond, but not the only way.

Obama is vulnerable (though not dead in the water as some believe), but it’s not because Americans have done an ideological flip flop.   Rather, Americans are frustrated about the economy and if they see Obama as ineffective they’ll consider trying something else.    If the Republicans over-reach or show too much ideological stridency, they could lose the House (many tea party Congressfolk are in clear danger) or even cause people willing to vote against Obama to see him as a safer bet.

Democrats have to take from this that the energy of their base is not enough to win the hearts and minds of  voters.   President Obama isn’t having trouble because he’s weak or a bad President, anyone would be having trouble with this economy.  Moreover, you can’t just give beautiful speeches and stand firm and expect the other party to crumble.  The Republicans control the House — some on the left fall victim to groupthink and under estimate the ability of the GOP leaders in the House to play a high stakes game.   Obama can’t force them to vote for what he wants.

Rather, they have to recognize that given the current economic conditions the ideological appeal of big government is probably at a low ebb.  The public wants someone who will talk seriously about reducing debt, solving problems and making compromises.   Despite the problems Obama’s had with the economy, his approval isn’t any worse than Ronald Reagan’s was in the third year of his Presidency.   Obama’s obvious pragmatism and patience is one reason he is still favored by many to win re-election — people may be upset he hasn’t been able to fix the economy, but the 2010 image of Obama as an over-reaching liberal has given way to Obama as a conciliator.     The Democrats best bet in 2012 is to grab the center and hold it as firmly as they can, allowing the tea party rhetoric sure to be flying furiously in the primary season define the GOP.   That doesn’t guarantee victory (though if it were combined with a rebounding economy in 2012 it could come close), but it assures a competitive election.

The Republicans dodged a bullet but risk not learning their lesson.  The bravado of John Boehner saying he got 98% of what he wanted may mollify the base, but risks turning off a public not keen on ideology.    Did 98% of what he wanted guarantee a downgrade?   They have every reason to believe that 2012 will be the second part of the kind of two election cycle the Democrats enjoyoed in ’06 and ’08.   But it’s not guaranteed — and too much red meat for the base may come back to haunt them, they could be their own biggest obstacle to a successful 2012 election.

Both sides should take Wisconsin seriously.   Democrats have to realize the country isn’t mad at the GOP and willing to march boldly to the left.   Republicans shouldn’t think the US embraced tea party ideals and is swinging to the right.   Whoever occupies the center in 2012 is most likely to win.   For the Republicans that would be the safest strategy.   For the Democrats it’s essential.

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Mood Shift?

President Obama’s handling of the debt ceiling crisis may ultimately turn out to be seen as political mastery, a symbolic point where the country shifted from a dissatisfaction with the Democrats to frustration with the way the tea party prevents the Republicans from pursuing the rational policies voters thought they’d get.

Right now Obama isn’t getting a lot of credit for how he handled this.  Many Democrats compare Obama to past leaders and say he could have pushed the GOP harder.   I do not share that assessment.  Too much was on line, especially the nascent recovery that Obama will rely on to bolster his chances at re-election.   A default, a shut down of much of the government to avoid default would do tremendous damage to the economy.   Misuse of the 14th amendment would have started a constitutional crisis, severely damaging the economy and leading many to believe Obama was abusing power.  Any of those scenarios would have destroyed the Obama Presidency.

If Obama were to have played this differently, he would have had to have done it starting last year.   Perhaps even as late as May he could have framed the issue differently and forced an earlier decision.  Even that might not have worked.      Still, criticism of Obama has been rather muted compared to the anger at the tea party.   That is the narrative coming out of this drama, not one of a weak Obama.

When the public and especially independents shifted to the right to vote in a Republican House, they did it for one reason: to force the two sides to compromise and work out solutions together.   The country is moderate and pragmatic, even if the political activists are ideological and partisan.   They thought the 111th Congress pushed too hard to secure the Democratic agenda, over reaching their mandate.    But as the President said, people wanted divided government, not dysfunctional government.

President Obama comes out of this looking Presidential.   He called for a balanced compromise on national TV.  He then stayed aloof from the final negotiations once it was clear the “grand deal” of a $4 trillion mix of cuts and new revenues — a deal that would have been good for the economy — was rejected because the tea party cannot abide ANY tax increase.

He let Reid, Pelosi, McConnell and Boehner do most of the dirty work.   He was criticized for not leading when he spent four days outside the public view making phone calls and having private meetings.    Those saying he wasn’t leading have fallen victim to the idea that media presence = leadership.     It appeared at one point Reid and Boehner were close to a deal that would have been worse for the Democrats, and a private meeting with Obama stiffened Reid’s spine.   Boehner complained, but it was clear that Obama had set down markers that the Republicans could not pass.    As blame grew on the GOP for turning down an historic compromise, Boehner realized he’d gotten all he could get.

The result — a compromise that does nothing, and doesn’t even start making cuts until 2013 — simply pushes the debate down the road.   That is a victory for Obama.   Moreover, it does not harm the economy going into 2012.   The year the cuts could damage the recovery is 2013 — setting up a huge debate for the election.   Not agreeing to any cuts would have assured bond downgrades and loss of investor confidence in the dollar, doing considerably more harm to the economy than spending cuts or tax increases would.

Congress is getting approval ratings lower than any time in history.   Those on the right who were pointing to low approvals of the Pelosi House have gone silent; the GOP is no more popular.   GOP candidates walk gingerly among the tea party brigades.   Some like Mitt Romney and Jon Huntsman realize they’ll never win over the far right, they have to neutralize their strength.  I suspect this fight has improved their chances.   Moderate Republicans don’t oppose tax increases as part of the mix for debt reduction, and they certainly don’t approve of risking default over a principle.   Many have been horrified by this spectacle and worry about the direction their party has taken.

I’m not predicting certain re-election for Obama, but the chance that it will be either Obama or a moderate Republican like Romney or Huntsman is greater than before.    People like Bachmann will still rile up the party faithful.   The Democrats may not take back the House, but strident tea partiers in unsafe districts face a good chance of losing — even Michelle Bachmann could lose.

In short, public disgust at this whole spectacle — not so much the result but the way in which it played itself out — is going to have political ramifications.   The tea party has, as the saying goes, “jumped the shark.”   They’ve peaked and over reached.    In essence, Americans are becoming sick of the ‘politics of emotion.’    People are tired of angry rants, demonization, refusal to compromise, and mistaking rigidity for principle.    We’ve got real problems, they want people to solve them.   We’ve got real disagreements, they want people to compromise.

Whichever party can appear more adult, level with the American people, and show a capacity to compromise and reach out to the middle, will have the upper hand in 2012.   President Obama played that role in this last crisis, making him the only one of the principles who could truly condemn the ‘manufactured crisis’ with credibility.   John Boehner’s image was tarnished by both outbursts and bravado — bragging the Senate will “fold like cheap suit” while the country is heading to catastrophe doesn’t make him look very dignified.

Democrats may hope that this continues, and that the tea party divides and exerts undue control over the GOP.   That would help the Democrats in 2012.   But that would not be good for the country.   Best for the country would be if the majority of Republicans who do not agree with the tea party stand up and reassert their power.    I’d much rather the face of the GOP be Senator Olympia Snowe than Representative Michelle Bachmann!   This country needs real debate and engagement of diverse ideas, not partisan war.  With the public no longer as entertained by or fooled by the emotion-laden spectacle of Glenn Beck’s rants and tea party calls for revolution, it’s time to settle down and take a pragmatic approach to the problems facing the country.

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The Historic 111th Congress

They lost their majority in the House and suffered significant loses in the Senate, but one has to look back to the 1960s to find a more active and legislatively successful Congress.   They started with a bang, passing a major stimulus bill, and ended with a flurry of lame duck activity, repealing DADT, ratifying the new START treaty and passing a major tax and spending compromise bill.   In between they passed health care reform, overhauled reform of the financial sector, expanded the powers of the FDA to regulate tobacco products, expanded hate crime laws to protect sexual orientation, increased protection of equal pay laws for women, and increased/reformed financial aid for college students.

To be sure, thanks to the filibuster the Republicans could stop them from tackling immigration reform, institute a CAP and trade system to put the US in line with other industrialized states in fighting global warming, or close Guantanamo Bay.   Even in victory, the reforms of health care and the financial industry required major compromises, though in each case Democrats joined Republicans to make these compromises necessary.   But like the laws or hate them, few will deny that the 111th Congress was the most active in a generation, often because of the personal leadership of President Obama, especially during the lame duck session.

The Democrats paid a price.   Nancy Pelosi went from Speaker of the House to House Minority leader as Republicans gained more seats than any party has since the 1930s.   In general, Americans don’t like their Congress too active, and in undertaking major reforms at a time of economic recession many thought the Administration and the Congress had misplaced priorities.   To be sure, the amount of public spending and investment increased dramatically, designed to stimulate the economy, but the depth of the crisis caused Americans to doubt the wisdom of all these reforms.  Ironically the left wing of the Democratic party, apparently unable to accept and enjoy success, often pouted over what they didn’t get, angry at “blue dogs” and others who forced often painful compromises on the majority.   But politics is the art of the possible, and the Democrats did in two years probably all that they could have hoped to accomplish.   Some acts were historic — repeal of DADT is a major civil rights landmark, while health care reform has been on the agenda since before WWII.    Simply, the last two years may have been critical to shaping the future direction of the country over the next generation.

For President Obama, the goal now has to be to try to digest the changes, and integrate them into the federal bureaucracy and the political culture.  To do that he must win re-election in 2012, regardless of what happens in the House and Senate.   For Republicans opposed to the changes, they need to win the Presidency in 2012 if they want to have any hope of turning back the tide.   Even then, they likely will find it hard to undo what has been done, but they’ll have a chance.   Otherwise, by 2016 the changes will be so integrated into both the government and the public mindset that undoing them will be politically costly and will likely be supported by only the staunchest conservatives.

Republicans are crowing about their 2010 victories, but as Obama showed last month, political winds can shift on a dime.  After all, Obama and the Democrats looked all but invincible in 2008.    Moreover, the 2010 election found a very different electorate than voted in 2008 — more white, more conservative, and older.   If Obama rejuvenates a good chunk of the “less frequent” voters who came out in 2008, that will go a long ways to turning around the electoral fortunes of the Democrats.   By blocking the DREAM act — a path to citizenship to children born to illegals who want to go on to college or join the military — the Republicans also make it hard to make inroads in the group with the biggest demographic shift, Latinos.

Although the census made headlines by showing so-called “red” states gaining representation (though likely not enough to significantly alter electoral math), most of the growth was via immigration.  If you include children of immigrants, it accounts for 60% of our growth.    At this point, that’s actually good news for the Democrats who tend to do very well amongst Latinos.   Republicans thought they’d have a shot at this group, actively courted by President George W. Bush in his campaign.  They are often socially conservative and have world views that align reasonably well with the Republican party.   However, immigration issues have pushed them to the Democrats in recent years, and if the Republicans don’t turn that around, this will be a major force helping President Obama win re-election in 2012.

The economy matters as well.  As noted before, both Presidents Clinton and Reagan were less popular at this point in their Presidency than Obama is now.  Both recovered as the economy recovered.   If there is any good news on the economic front, that could make Obama’s re-election seem like an inevitability by mid-2012.

For the left of the Democratic party, the good news is that the Republicans are unlikely to turn back what President Obama with a Democratic Congress accomplished the last two years.   The bad news is that most of the legislative work of even an eight year Obama Presidency has been achieved.     The next six years will be tweaking programs, and creating an under-gird of regulations and bureaucratic procedures to make the reforms more effective.   There may be qualitative improvements in areas like health care or financial reform, but almost certainly within the framework of what’s been passed.

Two issues that may still see significant progress are immigration and the federal budget.   Assuming economic growth returns in some form, President Obama is likely to become a deficit hawk, and depending on the scope of the problem, this could yield significant changes to how government operates.  On immigration if the Republicans do find that the Latino vote threatens to thwart their ability to win Presidential elections, or hold on to Congressional seats, they may return to the kind of ideas that John McCain and President Bush pushed back in 2007.   In the tea party furor even McCain ran from his past position, but that could turn around and bi-partisan comprehensive immigration reform may become possible.

If the Republicans do win the Presidency in 2012, they’ll find that there isn’t a magic “reset’ button they can push to simply undo what the 111th Congress accomplished.   They’ll be able to make major changes in the health care reform (their headline issue), and may try to undo some of the financial reforms (though that would be politically risky).   DADT will almost certainly stay repealed, the START treaty will remain in effect, and most of the more minor changes noted above will remain.    Once something is passed it’s hard to repeal, though easier to revise.    This means that, for better or worse, the actions of the 111th Congress will have effects that will linger for generations.   While that may motivate Republicans, it also should cause Democrats to take heart, even as they get used to the phrase “Speaker Boehner.”

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Inside Out

I took a 20 minute survey today from the Maine State division of Health and Human Services, designed to measure what the health of Mainers is like.   They asked about almost every possible sort of illness or condition, and the only reason it took 20 minutes is that my answers were mostly quick and easy.  I’m healthy, have had no major illnesses or injuries, and probably the only “bad” answer I gave was that I often don’t wear sun screen when outside in the summer sun.

There was a mental health portion of the survey, asking questions about how satisfied you are with your life, have you felt depressed in the last thirty days, felt down, out of control, anxious, etc.  Again, my answers were quick: very satsified, and no I haven’t felt depressed, stressed, anxious, or anything.   I wondered how common those answers are.  Are most people really happy with their lives, or am I just one of the lucky ones?   What would life be like if I had all those problems they asked about, even for a portion of the time?  What would it be like to feel depressed, or like life was too much?   How many people live that way?

I can identify at least a bit with anxiety.  Back in 1993 when I was running seven miles a day, I had a TIA, which mimics stroke symptoms.   One side of my body became paralyzed, and I couldn’t talk.   It lasted only about an hour or so, and I was completely aware and alert during the whole time.  I still remember everyone in the computer lab at the University of Minnesota scurrying about, calling the hospital to send an ambulance.   I recall Dr. John Sullivan getting angry as he watched the ambulance not be able to figure out how to approach the Social Science tower (we were on the 12th floor), and then when they arrived I recall a warm feeling as I laid down (I had been sitting) — I felt I was starting to get some movement back.   When leaving the department AA was there and looked at me.  I tried to acknowledge her but all that came out of my mouth was an ugly grunt.   The look of horror and sadness on her face touched me — wow, these people are concerned about me!

The ride across the Mississippi to the U. of Minnesota hospital was quick.  They did every test imaginable on me, from putting something down my throat to look at my heart, a Catscan, MRI, and something inserted in my groin area and directed to my brain to break up any blood clots in case it was a stroke.   They found nothing.   My case even led to an article in a medical journal — a healthy 33 year old fit runner suddenly had stroke like symptoms!   They asked if I’d been taking drugs (only caffeine — though I had a lot of  beer at the German Stammtisch the night before), and a team of five doctors took over the case.

The head doctor, who I saw little of, had his own theory — migraines.  I have low pain migraines with intense auras.  They are rare now, but back then they were more frequent, especially if I was tired and had been drinking the night before.   The aura is a contracting of blood vessel, and it’s possible it cut off blood to a section of my brain.  They found no clots or anything because once it opened, blood flowed back.  Within an hour I could sing songs I already knew (my first was “I’m so dizzy my head is spinning”) but I couldn’t make up my own lyrics.   Within two hours, speech came back slowly, it was a day or so before I was talking normally.

The doctors gave me three options:  1) Open heart surgery.  They said my heart had a small hole, and though 20-30% of the public has this, a clot could have traveled through there; 2) six months of coumadin, a blood thinner, or 3) an aspirin a day.   I choose the latter.   When I informed the doctor of my choice she told me to think it over.    She gave me a stern lecture on the risks, and it was clear she thought it was foolish for me not to at least take the blood thinner for a few months.    When I asked, she said the vote amongst doctors was three for coumadin, one for heart surgery and one for aspirin.   I wanted out of the hospital, and only the aspirin option could get me out quick; plus, I found the migraine diagnosis persuasive.  They gave me books to read about the drug, the condition, etc.   I finally said I was ready to choose.   Unfortunately, it was the same doctor who came (I’d been hoping it would be another one).

She then made sure I understood the choice, and finally told me she’d actually been the one who had voted for aspirin.  She just wanted to make sure I understood the issues.   And anxiety?  For six months every time I felt funny, I’d fear my body was doing it again.  I’d lay down, and have a classic anxiety attack.   I traveled with a German friend to New Orleans two months later, and had to stop the car often and lay down.   It took awhile for me to trust my body again.  I got over it, but it was the first time I ever felt like I wasn’t in control, and it made me more sensitive to the problems others have.   Sometimes you can’t will yourself to overcome emotions or fear.

Getting back to the broader issue, I imagine a lot of people have similar reactions to other things in life, and some people may have it as part of their “wiring.”  So I just genetically content, luckily born with a “happy gene.”   One of my sons seems to have a similar personality, smiling a lot and generally not too bothered by things.

Or perhaps it’s because I’ve taught myself to live “inside out” – projecting my internal ideas and mood on to the world, rather than expecting the world to provide me with happiness or meaning.   I decided long ago to rely only on myself for my happiness, and not let it depend on the actions of others, and especially not on circumstances over which I have no control.    It’s not always easy — when things go wrong, I sometimes have to talk myself through it — “OK, have perspective, its not that big a deal, in a few days it’ll be forgotten, don’t let circumstances or actions of others bother me, I can’t control them…”  But usually it passes quickly, and my day and overall mood isn’t ruined by external circumstances.

Living inside out may be impossible in some circumstances — the death of a child or loss of job may overwhelm anyone.   My lesson from my anxiety after the TIA is to know that circumstances can get overwhelming at times, and depending on the situation, perspective may be harder to internalize.    No one is completely immune.

Moreover, living inside out is hard if you spend your mental life either planning for the future or reminiscing or regretting the past.   It’s easiest in the present because you can focus on now, and bring perspective to the moment.

So maybe my effort to live as much as possible in the present or “now,” and live as much as I can “inside out” help me remain content.   Maybe that’s even related to genetics.  Or maybe I’ll experience a life event similar to the TIA and learn quickly the limits of my contentment.  But for now that’s my mantra — to try to live now, and live inside-out.

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Poisoning our Children?

In the middle of the 20th century psychiatrists thought they may have found a solution to deviant and psychotic behavior: the lobotomy.   Easy to perform, patients often went from being violently insane into becoming docile and quiet.   However, the procedure left people a shell of what they used to be, or as the Soviet Union put it in abandoning the procedure in 1950 “people go from being insane to being idiots.”

Even more people are affected by a new psychiatric effort to take the anti-psychotic drugs that replaced the lobotomy and prescribe them to children who have behavioral problems.   Children often end up on a mix of medications, all designed to alter behavior in some way, usually to counter act side effects of other drugs being taken.  The result can be seen by considering this story in the New York Times, or watching this episode of Frontline.   Quite literally children are being treated with drugs whose efficacy has not been tested, and which can alter the children so much that they cannot live normal lives.   Since they were diagnosed as mentally ill in the first place, parents (and Doctors) often see mental illness as the reason for their difficulties, when in many  (perhaps most?)  severe cases it’s the “medications” that cause the problem

In some ways, this is a result of the inhumane way health care has been provided in the US.   Insurance companies, loathe to pay more than have to, have determined that a child psychiatrist usually needs at most 15 minutes to evaluate and assess a child.  That’s all they’ll pay.   Hospitals and clinics push doctors to see as many patients as possible so that they can pay their costs (including, of course, doctors’ salaries).   This is also a result of our culture.  We’ve been conditioned to think that medicines can cure anything.  Any ache, pain, or abnormality needs to be treated — and the pharmaceutical companies promise they can give us a “better life.”

Doctors, of course, complain that parents come in at wits end about their child’s behavior, often demanding something be given to make the child ‘normal.’   Therapy takes too long to work, after all.  Moreover, children develop at such different rates and in different ways that behaviors exhibited can be interpreted as being mental illness.   A hyperactive child or one with attention deficit disorder — conditions that often need no treatment or can be treated with non-psychotic drugs — can show behaviors that might be labeled bipolar disorder, autism, or some other malady thought to benefit from anti-psychotic medication.

So doctors under pressure from parents and insurance companies dash off a prescription, and the parent leaves hoping they now have the magic potion to make their child “normal.”   If it works, but the child has trouble sleeping, then the doctor prescribes something for that.   Soon there is weight gain, so medications are changed again.  The child then may seem anxious, so a new medication might be added.    Children might be on a regimen of ten drugs or so for their entire childhood, usually making them different from the rest, often thinking they have some deep down problem that would consume them should they go off their medication.  And, of course such powerful drugs can’t be dropped cold turkey, children need to be weaned off of them, and as they are the side effects of ending a medication may make it seem like it actually was needed.   For some, a diagnosis at 2 years old may mean a lifetime of possibly dangerous and unnecessary drugs.

Because studies are so rare and vague, we have no way of knowing how many children have their lives altered or even destroyed by such practices, nor do we know in how many cases the medications do some good.   We’re experimenting on our children, and we don’t know the impact of these powerful drugs on the long term psychological and physical development of the child.   But because smart doctors prescribe, and our culture sees medication as the cure to any problem, people go along with it.

Two things need to be accepted:  first, children need to learn to live with themselves as themselves.   If a child has a temper, is wired to react quickly and perhaps be anxious, that might just be who he or she is.    Young and unable to really understand or control behaviors, a child of this sort might violently misbehave, or have times of uncontrollable rage.   Now, in some cases mild medications may be necessary to help the child through this, but ultimately the child has to learn to control his or her temper, and deal with the fact that he or she has this kind of personality.  If a child is overly medicated so that his or her true self isn’t experienced, then medications may continue for life — the person will never discover who he or she really is.  Or, if the medications end when the child becomes an adult it’ll be much harder for the individual to handle his or her own personality — the lessons weren’t learned gradually while growing up, but would need to be learned all at once, with expectations higher.

Second, it takes all kinds to make up a world.   Normalcy is simply an average.    Each person brings a unique perspective to life, and contributes in his or her own way to a community.  Most importantly, though, children need to be shown patience.   The uncertainties of human and psychological development make it dangerous to see ‘abnormal’ behavior as an illness so early in life.   It could just be a quirk of that person’s development.

Yet, there are children who have serious chemical imbalances and really benefit from even strong anti-psychotic drugs.  How do you know when to make that call?   Well, last year my son, then age 6, had a series of difficult episodes at school.   We took him to a doctor to assess what the problem is.    She came in on a day she’d otherwise have partially off, and spent almost two hours talking with us and our son.   She listened.   She made a diagnosis (Tourettes, with ADHD symptoms), and recognized that we were very skeptical of medications.   She not only respected that, but praised our concern.   Ultimately we did choose a mild medication – Intuniv (guanfacine), which is usually used to fight high blood pressure.

We researched this decision intently (I check now and then for anything new — it seems a very safe drug, with few side effects and is neither an anti-psychotic nor a stimulant), have kept the dosage low.    He did show improvement, and most importantly our son’s personality has not changed.  He’ll still get angry, he’ll still be intense — he is definitely himself.  But problem behavior has become rare, he’s learned to control his actions most of the time, and he remains active, creative, inquisitive and academically well ahead of the second grade average.

So I’m not completely anti-medication, I don’t mean this as an extremist tirade.  But with children it’s really important parents and doctors take TIME to assess, and do what we can to cope with behaviors that are difficult.  Children do grow and learn, and sometimes maturity is what it takes for an especially intense child to learn how to operate effectively with his or her personality.  Also, from what I’ve read, I think parents should be VERY skeptical of anti-psychotics for children, or a regimen of any more than one drug at a time.     Children should be given every opportunity to be themselves, even if it’s sometimes hard on the adults.

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Health and Wealth

Last night here at the university we attended part of a film festival on social justice (take that, Glenn Beck!) put together by members of our Economics and Sociology departments (Dr. John Messier and Dr. Kristina Wolff).   This is the third year of the film/lecture series, and though they choose the topic of health care awhile back, the timing of the series couldn’t have been better.   Yet the films make clear to me that passing health care reform is not in and of itself an answer to our problems.

The first film was In Sickness and Wealth, and the second a Frontline episode Sick Around the World. The Frontline show surprised students as they learned that what gets decried as “socialized medicine” here is common around the world, and works.   In most countries there are no waiting lists (or very short ones for elective surgery), private insurance companies competing for customers, and very satisfied citizens.   There are problems — in the British single payer system elective surgeries do have rather long waits (six months or so), in Germany and Japan doctors complain about being underpaid, and in Taiwan the government is scared to raise prices enough to cover costs.   In Switzerland a US like system was transformed to universal care about a decade ago, and it’s popular and working well.  Clearly the doom and gloom statements from the right are non-sensical if you actually go out and get real world examples to compare.

Yet the US is larger, more diverse, and culturally different from the rest of the world.   Health care reform will be a work in progress.   That also brings up the first film, In Sickness and in Wealth.   That film presented very compelling statistics that health in terms of life expectancy, diabetes, cancer, and heart disease gets worse as wealth declines.   The wealthiest live longer and are healthier than those who are poorer.   Moreover, this is a continuum, it’s not just a stark difference between rich and poor.   Finally, this difference exists even if you control for life style choices. Wealthy smokers live longer than smokers who are not so wealthy.   There is something about wealth that in and of itself contributes to health.

Part of it, the film argued, is the every day stress levels on people who do not feel empowered and in control of their lives.   Stress releases hormones into the blood stream, and studies show that there is a positive correlation between poverty and high stress hormone levels.  This can cause immune system weakness, early aging, weakened internal organs, and even cancer.   Moreover, this affects children.   Children whose parents were home owners have stronger immune systems than children whose parents did not, regardless of their life experiences today. The stress of a poorer childhood impacts health for all ones’ life.

To be sure, lifestyle, genetics, and other factors all play a role in an individual’s health.  But one cannot just say that poorer people are less healthy than wealthy because they made worse choices, nor can one say that giving them all health insurance and access to health care will significantly improve their health or life expectancy.   It’s class rather than access to health care that creates these problems, and the problems cost all of us in society.

They cost us first in Medicare and Medicaid, as well as in paying for those who get care but can’t pay for it.   Over 60% of bankruptcies in the US come from medical bills, in the rest of the industrialized world bankruptcy caused by medical expenses would be scandalous.  It also costs us in productivity.   Instead of being active, producing members of the economy, many of the poor battle chronic conditions due to stress and other problems.   That cost is hard to quantify, but if we had a society where class differences caused less stress and difficulty in life, the whole society would benefit.   It was interesting that in the second film a German said, “we know that unemployment increases the chances someone would get sick.  It would be irrational to take away insurance when someone gets unemployed, that’s when they need it the most.”  But in the US we do that, adding to the stress level.

No one suggests that hierarchy and class can be eliminated.   However, in Europe a mix of having health care as a right like education and police protection, along with better social programs to reduce the stress of living below the poverty line, probably explain why our health care statistics are so bad compared to the rest of the world.  We pay the most — 16% of GDP (the next highest is Switzerland with about 12%, then most others are 6-8%), but have sub optimal results.

Those results are not because of people like me.   My health care is very much like it would be if I lived in Germany, where private insurance brought through an employer covers you (and you can by supplemental insurance).   I get as good as care as I’d get anywhere.   But those who are not covered, or whose coverage gets denied, bring down the statistics.   The culture of the country also harms us.   Listen to the rhetoric by those who are angry about health care reform.   Any government effort to try to help minimize the negative effects of being poor is criticized as ‘socialism,’ as people cling to a myth that anyone can pull themselves up by their bootstraps, and it’s the poor’s fault that they are poor.

That myth is increasingly false.   Between 1900 and 1976 the gap between the rich and poorest was decreasing, and people in that era had an easier time getting the education and opportunities to control their lives.  Since the 80s there has been a tremendous shift of wealth to the elite — the upper 2% have 90% of the wealth, a statistic that has more in common with third world countries than other industrialized ones.    If this trend isn’t stopped, we may start to look more like a third world country.  It also is the underlying issue that really drives up health care costs, and which, if not addressed, will assure that health care reform can at best be a band aid, not a solution.

Somehow, Americans have to abandon the “myth of the market,” and recognize that left on its own, markets have winners, and those winners know how to subvert the game to make sure they keep winning and secure benefits for their families.  Markets are neither just nor humane, and in the realm of health care, they can be deadly.   In some areas, we need a strong government presence.  And second, we have to develop some sense of social solidarity, that we’re in this together, that it matters if many fellow citizens have severe problems.    Yes, charity is one way of showing that, but history shows that relying on charity alone just can’t work in a mass industrialized society.   We need to figure out how to use government to address these problems without giving too much authority to the bureaucrats.   There is no perfect way to do that, no pat and simple ideological solution.   But at the very least we can look to other industrialized states and learn from them a bit about what works and doesn’t work, and then adapt it to our circumstances.

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Why Republicans Should Worry

The conventional wisdom now is that the Democrats need to watch out for a drubbing this November, akin to 1994.   There is a slim possibility they could lose their House majority, and many believe that by ramming partisan health care reform through, they are setting themselves up for a fall.   But Andrew Gelman at “Politics Done Right” points out that the predictions of a massive GOP win started last September, and it’s not clear that passing reform changed the dynamic.   In fact, I think there are a number of reasons why Republicans need to be worried this November.   Not that they’ll lose seats — I cannot conceive of them not gaining seats — but they may find November not to be the spectacular victory of which they dream.   Here’s 8 reasons why:

1.  Obama’s PR machine.   Up through November you’ll see the Obama machine in campaign mode, pushing the positives of health care reform, and filling the public agenda with other popular items.   They didn’t fight the PR fight last year in part because they feared peaking too soon.   The Republicans thus dominated the news with tea parties, talk radio and scary rhetoric.   For the next seven plus months, they’ll have a formidable opponent.

2.  Rhetorical extremism.   Last night the Republicans attacked the Democratic plan less on practical grounds then with red meat rhetoric that is sure to energize their base — comparisons to the Soviet Union, claims America is being “destroyed,” and attacks on the Democrats as arrogant, dishonest, extremists wanting to impose their elitist vision of the country on the average hard working folk.   That rhetoric does appeal to party ideologues.   They despise government regulation, see the world in cold war ideological terms, and have an intense hatred for Pelosi and company.  To them, the Democrats have declared war on “real” America.

However, most Americans are as distant from that ideological extreme as they are from the far left.  If they go into November sounding like angry extremists, they’ll see their appeal fade as quickly as it grew, especially if the Democrats offer a reasonable counter-narrative.  The country is not going to “rise up in anger” and start the electoral equivalent of a revolution.   The Republicans have to put forth a more positive vision.

3.   Issue salience fades.   Right now Republicans claim they are ready for the fight, and the activists and bloggers are certainly in this for the duration.   I remember how in 1983 Helmut Kohl was seen by Germans as a weak Chancellor because he was a “patsy” for the US by modernizing NATO missiles, even though there massive protests (we’re talking 400,000 and 500,000 strong — far more than the wildest ‘tea party’ fantasy) and 70% of Kohl’s own conservatives opposed it.   If he went against the country, he’d lose the next election!  But once modernization was a reality, the anger went away and Kohl easily glided to victory.    Most who went along for the ride simply moved on after they lost the fight.   Most people aren’t really all that active in politics, most people don’t stay engaged, and they especially don’t stay angry.

4.  An energized Democratic base.   Yesterday gave Democrats a dose of what they felt when Obama won the election and then took office: a historic sense that something consequential has happened.   That’s been missing in the ho-hum politics of the last year, as Obama’s aura faded and his agenda stalled.   Now the mid terms may matter more, fund raisers will ask donors to “save those who put their jobs on the line for health care,” and a bit of the magic may return.  Add some more “big issues” (immigration, climate change, jobs) and the atmosphere in November could swing towards the Democrats.

5.  Bad Republican Strategy.   David Frumm  has it right when he said that health care, predicted by Senator DeMint to become Obama’s Waterloo, turned out to be the Republican’s.  Frumm, a former Bush speechwriter, notes that the Republicans could have decided to work with the Democrats and create what to many in the GOP would have been a better health care bill.   If they had done so from the start, they’d have gotten the chance to “go back and start over” as Paul Ryan pleaded during the debate.   But by March 2010 it was too late for that.  The Republicans bet on a strategy to hold out and block reform, believing that it would fatally wound Obama and make it impossible for him to move his agenda forward.  It almost worked.   However, by failing, the Republicans get the worst of  both worlds.  They had virtually no impact on policy, as Pelosi was forced to make sure the left wing of her party was satisfied with the bill in order to pass it, and they ended up giving Obama an opportunity to rejuvenate his Presidency.

6.   The bad strategy is likely to continue.   Similar to number “2” above, the rhetoric from the GOP suggests that they want to make this an all out war against the Democrats come November.   But to succeed, they have to essentially gain majorities in both Houses of Congress and take the Presidency in 2012.    That is very unlikely.    A better strategy would be to show they can bring good ideas forward and work with the Democrats.   They look unwilling to do that and risk become seen as the “Tourettes” party that simply hurls epithets like “Liar” and “Babykiller” in the halls of Congress.  If anger over this bill causes them to spend the next seventh months trying to obstruct all progress, they could turn the public against them quickly.

7.   Public opinion on health care reform is fluid.   Polls that dig deeper find that so many people really need to know more before they can be sure of an opinion.  It’s wrong for the Republicans to say that the country has “spoken clearly” against this bill.   Many are still in the “easily persuadable” range, meaning that this bill could be far more popular come November.

8.  The economy might show signs of real life by late summer.   If the country starts feeling like we’re moving in the right direction, a lot of what people see as negative moves by Obama now might appear in a more positive light.   The economy is, after all, the real force determining election results.   Campaigns and other factors can have a significant impact, but ultimately the Democrats best hope is for a sense that the “worst is over” in the recession, and Obama’s policies may be working (something the campaign machine will trumpet loudly).

Should the Democrats also be worried?  Of course.   If the economy seems to stumble even more, then perhaps the Republicans can indeed build a sense of rage or frustration.    Anything can happen, and even in the best of all worlds for the Democrats it would be very difficult not to lose a significant number of seats this year.   Many seats won in 2006 and 2008 are in conservative districts; the GOP will win a lot of those back.    Comparisons to 1994 abound, but 1994 came as something of a surprise to the Democrats.   Now they are bracing for disaster, and that’s good — they should be worried, and building a campaign on that premise.

Still, the Republicans need to guard against delusion, the false belief that the country is thinking like them, and that their rhetoric about “losing liberty” and “Democrats destroying America” reflects the country’s mood.    The biggest threat facing them is to under estimate the ability of the Democrats to put forth a strong, effective campaign.   The Democrats know the threat to them is real, and understand that ‘Obama mania’ is gone.   That understanding may be what saves them.

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