That subtitle can be taken two different ways. To be absolutely clear, I meant it in both interpretations. In fact, it is so exasperating that I feel a rather longish rant coming on (relatively speaking -- which makes "longish" even more intimidating, coming as it is from me). Just to warn everyone, up front.

But back to the subtitle. The first way it can be taken is, of course: "Where are the Democrats on healthcare reform?"

And the second is: "Where are the Democrats on healthcare reform?"

To put it another way (that is less dependent upon how readers personally interpret italics), the first point is: "Where the heck are the Democrats in the public debate about healthcare reform? I haven't been hearing much from them on the news, or the talk shows. Who is leading the effort? Who is supporting the effort? WHERE are all the Democrats out there talking about it in public?"

And the second could be translated as: "What, exactly, are the Democrats ready to label a 'deal-breaker'? Where are the lines drawn in this battle? What is the basic, core Democratic position on how to effectively reform the healthcare industry?"

Neither question, in my mind, has been answered adequately. Because of this dereliction of duty, the Republicans are dangerously close to dominating the entire debate -- even though they don't have any real plans or suggestions as to what to do. Or any power to do it with, even if they did have a clue in the first place!

This is pathetic. And it has to end. Soon. Or the promise of real healthcare reform will be yet another lost opportunity in a long history of such which stretches back over seventy years in American history.

What's really pathetic is that the public is solidly on the Democrats' side in this debate. They just need a champion to remind them of this, in the midst of the debate.

So far, I have to say, we have not seen such a champion. And if we don't see one real soon now, the window of opportunity for change will have again slammed shut, perhaps for another generation.

And that, truly, would be pathetic.

President Obama seems to be leading this brigade of wussiness, I am sorry to say. Either that, or David Broder is misquoting his sources (which, knowing him, is always a possibility). In his most recent column, Broder reports: "The goal of the Obama White House is to come up with a health-care plan that can attract bipartisan support. The president has told visitors that he would rather have 70 votes in the Senate for a bill that gives him 85 percent of what he wants rather than a 100 percent satisfactory bill that passes 52 to 48."

Excuse me, but that is a stinking pile of manure. Here's a quick quiz: what the Hell is the purpose of healthcare reform? Answer: To improve things for the American healthcare consumer. So why is the president willing to sacrifice 15 percent of his goals just so he can look good politically while doing so? What the Hell is that all about? How many Republicans voted for Social Security when F.D.R. was pushing for it? Does anyone remember? Can you quote Roosevelt's vote count in the Senate today? How many Republicans voted for Medicare when it passed Congress? How many Republicans voted for Medicaid? You know why you don't know the answers to those questions? Because nobody cares! Social Security and Medicare and Medicaid are all highly successful programs which stand on their own merits -- LONG after everyone has forgotten the political battles which took place when they were passed. So what, exactly, is the benefit to passing something that throws 15 percent of your ideals under a bus, just so you can look better politically? Will "History" record this fact? Or will it be buried in the mists of time? So what, exactly, is the point of the statements Broder reported from White House officials?

Let's get this straight from the beginning of this battle royale -- the end result is what is important here. Helping Americans is the goal. And most decidedly not how many votes you get in the Senate while doing so. I've even helpfully written about what the core Democratic framing on the issue should be, which can be easily summed up as: "Democrats want to change the system so that nobody ever faces a bankruptcy judge from a hospital bed." You can read the whole column for more details, but that's it in a nutshell.

Why oh why do Democrats always prepare for every legislative battle by tying one of their own hands (the left one) behind their back? It reminds me of the scene in Monty Python's Life Of Brian where Brian is taught how to haggle by a shopkeeper. "You've got to haggle!" the scandalized proprietor keeps insisting, while Brain keeps immediately agreeing to the outrages prices quoted. Read the whole scene in the original script, and then apply it to the Democratic healthcare battle:

Republicans: "Well, how about we reform healthcare by doing absolutely nothing, by passing a bill with lots of flowery language that doesn't change anything?"

Democrats: "OK, that sounds good to us, let's pass that!"

Republicans: "No, no, no -- that's not the way to have a legislative battle. you've got to haggle!"

Democrats: "But we just want to say we passed something. Do we really have to?"

Republicans: "'Do we really have to?' -- you've got to be kidding. Let's try it again. Republicans are offering a window-dressing bill that does absolutely nothing to truly reform healthcare."

Democrats: "Um, how about a regional co-op plan instead, with 'level playing field' provisions, and a trigger written by the insurance companies that will never be triggered?"

Republicans: "No, no, you've got to do it properly. See, you're supposed to say 'We demand single-payer healthcare, and anything else is a deal breaker!'"

Democrats: "OK, we demand single-payer!"

Republicans: "What, and turn America into some socialism? You're crazy!"

Democrats: "Yeah, you're right. Let's just do it your way."

Republicans: "You almost had it there, but you've got to keep it up. See, now you go to: 'We are reluctantly giving up single-payer, for now, but our line in the sand is a strong public option where people -- if they choose -- can buy into Medicare if they want."

Democrats: "Well, I don't know if all of us will keep to that line in the sand, maybe we better just let you guys write the whole thing, OK?"

Republicans: [slap forehead in disgust]

Is it just me, or does anyone else see this Pythonesque quality to the Democrats these days?

Here is how this campaign could have gone: the farthest left members of Congress get first swing at the bat. They come out strongly for single-payer healthcare, and make their argument for a week in the news. They get beat up by a few Republicans, but they get people talking about the idea. Then more senior members of the congressional Democrats weigh in, offering a grand compromise of a public plan in addition to (rather than "instead of") the private market. They warn Republicans, respectfully, that they can pass a bill with only 50 (plus Biden) votes in the Senate, and tell the GOP that unless they want to see single-payer become a reality before Thanksgiving, that they better get on board this compromise, which will keep the private insurance market alive instead of making the whole industry irrelevant. They would calmly explain that, since every person got to choose, and since Republicans have believed for decades that nothing government does can ever be better or cheaper than what the free market does, that their philosophy will probably ultimately prevail; but that we've got to have this public plan option (which, according to them, will fail miserably in the marketplace, of course)... just to appease the left wing of the party. In a wink-wink-nudge-nudge sort of way (I seem to be in a Monty Python mood today), "serious" Democrats could have sold Republicans on the idea as a sop to the left which will, of course, fail in the end. In other words, no problem -- the marketplace will crush the government-run plan because everyone knows the government can't do anything right.

How hard would this have been to arrange?

Part of the problem is we're lacking the strong voices from the Democratic side so far. This has already led to an initial defeat. A few weeks ago, when I first tackled this subject, the term everyone (even Republicans) were using was "public plan" or "public option." Now (check a newspaper if you don't believe me) it is "government-run healthcare" or something similar with the word "government" in it. This is like throwing away your best weapon before the battle even begins.

This is because Democrats have been so silent in the debate so far. There are a few reasons for this, I believe. The first is what happened to the Clinton healthcare plan. It was released too early (many think), and was picked to death before it had a chance in Congress. Because of this, Democrats now believe it is to their advantage to play their cards close to the vest and hammer something out between them before they start the big public push for it. This is wrong, in my opinion, because it is not what we were promised. We were promised a full discussion of the situation, with everyone getting a seat at the table. We are getting neither. Single-payer advocates actually were arrested trying to get heard in a hearing -- because they were denied a place at the table. The debate, so far, has been going on in the Democratic backrooms in Congress, and not in public. This has to change.

Another reason, closely related to the first, is that Democrats do not want to appear divided on the issue, preferring instead to present a united front behind a single bill. This is a mistake, because squabbling is going to happen anyway -- it's inevitable. Better to start the squabbles now and get them over with, and be united at the end of the process.

Part of the problem, too, is that Teddy Kennedy is supposed to be the point man on healthcare reform. And Teddy's not as young or healthy as the job may demand. To solve this, Democrats everywhere should use Kennedy's name liberally (pun intended), while Teddy himself anoints a surrogate champion to speak for him on the airwaves. There are plenty of media-savvy Democrats who could handle this job, and if Kennedy gave a news conference and announced his heir apparent on the issue, the spotlight would shift to the new spokesperson immediately.

And lastly, part of the problem is President Obama. Obama has always been reluctant to be seen as championing this detail or that in his preferred legislation, because he knows it is much easier politically to let congressional Democrats fight it out, and then swoop in at the end and bless whatever they've come up with. That isn't going to be good enough on healthcare, though (see: the past few weeks).

To Obama's credit, he has kicked off his personal advocacy tour for healthcare reform. He is saying nice things about the public plan. And he can perform at a town hall like nobody else can, at this point. All to the good.

But it's not going to be enough. Obama, at some point, is going to have to draw those lines in the sand. He's going to have to say "I will veto a bill that does not have X in it," and mean it. This will give Democrats in Congress the political cover they crave to actually vote for something real. And this will shift the fight to a personal one -- Obama versus Republicans. Frank Luntz, a highly-paid GOP consultant, wrote in a leaked briefing book on healthcare for the Republicans the following (emphasis in original):

If the dynamic becomes "President Obama is on the side of reform and Republicans are against it," then the battle is lost and every word in this document is useless.

. . .

The status quo is no longer acceptable. The overwhelming majority of Americans believe significant reform is needed – and they see Republicans (and the insurance companies) as the roadblock. If the dynamic becomes "President Obama and Congressional Democrats are on the side of reform and Republicans are against it," -- which is exactly what Obama has already started to promote -- the public will side with the Democrats and you will lose both the communication and the policy.

. . .

Your political opponents are the Democrats in Congress and the bureaucrats in Washington, not President Obama. Every time we test language that criticized the President by name, the response was negative – even among Republicans. Americans want solutions, not politics.

. . .

If you make this debate about Republicans vs. Obama, you lose. But if you make it about Americans vs. politicians, you win.

That's clear enough, right? But if Obama doesn't start drawing lines in the sand, it won't work -- it'll just punt the ball back to "Congressional Democrats versus Republicans," which is nowhere near as good.

And finally, before we get to this week's awards and the talking points, Democrats need to tap some populist rage. This is NOT hard to do. You don't have to look very far to find someone with a heart-breaking healthcare story that is tragic, crushing, and totally avoidable. Democrats need to get some of these people in front of some television cameras. Obama did a good job of this at his town hall yesterday, but how about some hearings from Congress? How about a parade of stories of people who had been screwed over by their health insurance company? Like I said, they are not hard to find. Hearing these stories is crucially important to this debate, because it refocuses everyone on the problem we are trying to solve. A few poster-patients on the issue is just what the doctor ordered. OK, I apologize for that last sentence, but I think you get my drift. Picture a Democratic politician saying "After hearing Mrs. Eileen Smith's tragic story, I vow that any piece of legislation which does not specifically address the inhumane situation she was faced with will not pass Congress and will not be signed by the president. Passing healthcare reform without fixing the problem Mr. Joe Shlabotnik faced is not real reform and is a waste of time. We will not allow any window-dressing bill to move forward unless it addresses these problems."

How hard is that to do? So why haven't Democrats started doing it yet?

Barack Obama can be Democrats' champion on healthcare reform. But he needs some other Democrats backing him up. Where (and who) is Teddy Kennedy's surrogate? Who will be the "designated lefty" in the public battle? Democrats can ignore Republicans legislatively (since all they need is a bare majority of votes in the Senate), but they cannot ignore them (or their arguments) publicly, or they will wind up losing the battle for public opinion. Speaking of public opinion, where is the public's face in all of this? Where are the endless horror stories of dealing with insurance companies? As Senator Jeff Merkley recently pointed out, Republicans are already using Frank Luntz' talking points on the floor of the Senate, so why are Democrats seemingly incapable of making their own snappy soundbite arguments to counter this?

The clock is ticking, people. Time's a-wastin'.

Barack Obama came very close to winning the Most Impressive Democrat Of The Week award this week, for two reasons (one important, one maudlin). President Obama realized that nobody else was leading the battle for the Democrats on healthcare reform, and so he did what he does so well -- he started taking his message to the people. He's out beyond the Beltway holding town hall meetings on healthcare, and showcasing the reality of how this affects average American lives. More than that, he is also pushing a lot more strongly than other Democrats for the public option. Since that is exactly what is needed right now, he almost won the MIDOTW for the week -- for stepping into the spokesman role everyone else was abdicating.

The second reason was why Obama fans like him so much. In a town hall meeting on healthcare reform in Green Bay, Wisconsin, Obama got a question from a man in the audience who, jokingly, said that his fourth-grade daughter Kennedy was with him, and that he hoped she wouldn't get into trouble for missing school for the event. So what did our president do? He immediately responded: "Do you need me to write a note?" and then (after the laughter had died down) actually wrote her a note and personally passed it to her. The note read: "To Kennedy's teacher: Please excuse Kennedy's absence. She's with me. Barack Obama."

How cool is that?

For both reasons, Obama gets an Honorable Mention this week.

But for playing the game the way it is supposed to be played (i.e., with a hardball), this week's Most Impressive Democrat Of The Week award goes to the Change Congress organization. While it's bending the rules a bit (they're not exactly a Democratic officeholder), we do so to take note of their fine work on the public plan's behalf. They took on Democratic Senator Ben Nelson of Nebraska over his opposition to a public plan, and they have apparently persuaded him to change his ways and be a little more open-minded. And it only took $10,000 in ads to do it (which, on the political scale of things, is mere pennies). For using advocacy dollars this effectively, and for using the finger of public shame to do so, they are hereby awarded this week's MIDOTW award.

Lawrence Lessig, co-founder of Change Congress, writes his account of their victory in the Huffington Post, which is well worth reading as a blueprint for using this type of leverage on other Democrats who appear to be standing in the way of real healthcare reform. Well done, Mr. Lessig, and well done to Change Congress. You have earned your Most Impressive Democrat Of The Week award in stellar fashion.

[Congratulate Change Congress on their web site, and, if you should feel so inclined, you can also give them a donation.]

Democratic Senator Max Baucus seems to be the largest obstacle toward getting any meaningful reforms enacted on healthcare. Baucus chairs one of the two Senate committees the bills have to make it through, so he is a powerful obstacle indeed.

While Baucus is, in general, a large obstacle in this fight, I am awarding him the Most Disappointing Democrat Of The Week not for any specific thing he's done this week, but rather for something that happened last month. Baucus called a hearing of healthcare reform experts, and pointedly forgot to invite anyone who was for either single-payer or a strong Medicare-like public option. This is not what Obama promised us. This is not giving "everyone a seat at the table." This is barring certain voices from being heard in the debate. When some protesters showed up at the hearing, demanding to be heard, Baucus had them arrested. His response was reportedly "We need more police." DailyKos has the full story.

Senator Baucus deserved the MDDOTW award back in May, but was somehow overlooked at the time. So I am awarding a special retroactive Most Disappointing Democrat Of The Week to Baucus this week, because it is so on-topic. For showing exactly the opposite of "change we can believe in," Baucus certainly earned the public shame which comes with this award. Unfortunately, as I said, he chairs one of the committees healthcare bills need to make it through. Perhaps Change Congress needs a new target for some ads? It seems there is no better candidate for this treatment than Baucus right now.

[Contact Senator Max Baucus on his Senate contact page to let him know what you think of his actions.]

Volume 81 (6/12/09)

OK, this is way too long already, so I'll try to keep the talking points short. As they should be. Short, and to the point -- this is what Democrats really should be saying about healthcare reform, to anyone in the media who will listen.

   PUBLIC OPTION

I'm "shouting" with all capitals there for a reason. It's not that I think the public option is the main battleground (which I do, but that's beside this particular point). It's the language. A few weeks ago, I wrote:

[T]he Democrats have actually been given an enormous gift. For once, the media has picked up on their framing of the issue. Everyone now talks about the "public option," and not "government-run healthcare" (which Republicans obviously favor). This doesn't normally happen, but it is a rare and fragile flower. It could easily be crushed once the Republicans crank up their message steamroller.

Which is exactly where we find ourselves now. Democrats need to take this ground back. by using the term over and over and over again, until it becomes the default term, once again. This may not be possible, but it is definitely worth trying.

"Why do you keep calling it 'government-run' healthcare, as if that's some sort of boogeyman? The public option is just that -- an option. People can choose the public option, or not. Does the media use the term 'government-run' whenever they run a story on Social Security? Do you use the term 'government-run Medicare' every single time, or do you just say 'Medicare' instead? Do you call the Veteran's Administration 'government-run healthcare' or 'socialized medicine' for our veterans? Or not? You are using scare tactics straight out of Frank Luntz' Republican playbook by insisting on calling the public option 'government-run healthcare,' and it is nothing short of demagoguery on the media's part. Ask a veteran what he thinks of his 'government-run' healthcare. Ask a retiree what they think of their 'government-run' Medicare. The answers might just surprise you. Or you could even ask Republican members of Congress how they like their 'government-run' healthcare plans. We call it the public option because that's exactly what it is -- an option offered to the public. If they don't like it, they will reject it. So how is that a government takeover of healthcare?"

   Can the government do anything cheaper and better than private industry, or not?

This is where the Republicans' argument just completely falls apart. And they need their noses rubbed in this every chance Democrats get. In a one-on-one matchup, imagine a Democrat turning to his Republican co-interviewee, and saying:

"Can I just ask you a question? Yes or no, do you think the government can do anything cheaper and better than private industry? Please, I'd like an answer to that question right now. Yes or no. No? Is that your answer? Government can never do anything better and/or cheaper than private industry? That's what Republicans have been telling the American people for decades now, right? So why are you so scared about a public option on healthcare? According to you, government-run programs are always a giant failure and cost way too much. And yet you sit there absolutely terrified that a public option is going to out-compete private industry and deliver equal or better service for less money. You can't have it both ways. Either everything the government touches costs too much and is worse than private industry, or else a possibility exists that the public plan will be cheaper and better for the American consumer than private health insurance. Either one of the core Republican beliefs is just flat-out wrong, or else the plan will ultimately fail. So, assuming you still hew to that core belief, what exactly is it you're afraid of?"

   What ideas do Republicans have?

This is a gigantic gaping hole in the Republicans' position. The big secret that the media has yet to uncover is that the Republicans have nothing. They have no plan, they have no argument "for" anything. They are defining themselves by trying to stop Democrats from changing the healthcare system. Which means they are defending the status quo. This needs to be forcefully pointed out.

"So what, exactly, do the Republicans suggest we do about healthcare? Where is your plan to fix the system? You don't have one? Oh. So you're saying that the system is just fine, and nothing should change, is that it? Is that why, when Republicans held both houses of Congress and the White House, you never even tried to fix healthcare? Because you just didn't see any problem with the system as it stands today? Well, that is exactly what Democrats are fighting against. We know that we don't even have to educate the public on the need for change. We know the public already 'gets it' that the system's broken. And for all the Republican scary talk about Democrats wanting government to 'force' this or 'take over' that, under our proposal if you are happy with your health insurance as it is then you don't have to change it at all. Well, that's not true -- there will be one change for people who like their health insurance as it is -- we will lower the premiums you have to pay. But we think 'forcing' people to pay less is a something everyone can live with. The problem with Republicans is that they only seem to be speaking to Americans who like the health insurance they already have. For everyone else, Republicans have nothing to say. Democrats, on the other hand, are talking to everyone. Because there are millions out there who can't afford health insurance, and millions more who are very unhappy with the way they are treated by insurance companies. Democrats want to fix these problems. Republicans can't even see that there is a problem. That's the difference between us."

   Make "medical bankruptcy" as obsolete as leeches in medicine

This, as I keep saying, is the core "values" argument the Democrats really need to be making. Why they haven't jumped on board this train is a mystery to me.

"You know why Democrats are trying to change America's healthcare system? Because we want the term 'medical bankruptcy' to be wiped from the dictionary. We want the concept of losing your life's savings because you fall ill to become as obsolete in the practice of medicine as bleeding people with leeches. Actually, that's a fair analogy. A couple hundred years ago, lots of illnesses were 'treated' by bleeding you dry with leeches. Today, many illnesses result in a similar bleeding by less literal leeches, when people are forced into bankruptcy -- even though they thought they were insured. A recent study found that 62 percent of personal bankruptcies happen for medical reasons. And, astoundingly enough, that three-fourths of them were people with insurance. This is wrong. It is morally wrong. It is a national disgrace. We are trying to end it. We never again want to hear someone went broke because some health insurance bean-counter decided that they had to spend their retirement money on an operation to save their life. Democrats want this to go the way of the horse and buggy. Leeches have no place in our medical system -- whether they are slimy bloodsucking slugs or... well, I'll just leave it at that."

   Freedom to choose

These next two talking points are repeats from my earlier Luntz column, because I simply could not improve upon them. They do tend to repeat arguments I've already made, but I still had to paste them in to this debate anyway.

"Excuse me, did you say a 'government takeover' of healthcare? How, exactly, is the government 'taking over' anything, when every single American will have the choice -- note that word: choice -- of a public option as opposed to private health insurance. How will the government 'take over' healthcare, when all Democrats are for is giving the American public a choice? If people don't want the government plan, they simply will not choose it. We are not going to force anyone to make that choice, we just want the option available in the healthcare marketplace alongside what already exists. How is that a government takeover? If people find that the public option is what they want, they will freely choose it. That is what Democrats are for -- the freedom to choose your own healthcare. How can Republicans be against freedom? Do they think the American people are too stupid to make choices for themselves on healthcare? We don't, which is why we favor giving them the choice."

   The public option is doomed, so what's your problem?

Again, a repeat from Friday Talking Points, Volume 76.

"How can the Republicans say at the same time that the public option is going to 'take over' American healthcare, and that the public option will be absolute Hell on Earth? If even one-tenth of the Republican fear-mongering about the public option were true, then you know what? Nobody would sign up for it. So how is something that is going to be so horrendous going to take over healthcare? Do the Republicans just think all Americans are stupid, or what? If we give the public the option to buy into a system like Medicare -- which most seniors are pretty happy with, by the way -- and they wind up hating it, they will opt for a different plan from private insurers. Word will quickly get around that the public option is bad, and it will fail on its own merits. Republican politicians would rather make that choice for you -- instead of giving the American people that choice. Talk about politicians limiting healthcare from Washington! My question to Republicans is, if you are convinced the public option is so bad, then what are you afraid of, exactly? If the public option is as bad, or even a fraction as bad, as you say, then it will fail in the marketplace -- remember the free market Republicans are usually for? We Democrats don't think the public option is perfect for everybody, which is why we give people a choice instead of forcing them to accept something they don't like. So either the Republicans are lying when they say the public option is so bad, or they are lying when they say it'll take over the American healthcare system. You can't have it both ways. If the public option is a good one, a lot of people may sign up for it. But if it's not a good one, nobody will sign up for it. So what's the problem?"

   If the free market is so great, why don't Republicans support it?

This is one of the strongest arguments Democrats have to tap into the populist anger the public feels about the entire debate. And, once again, it's a mystery why Democrats are too timid to use this line of attack.

"I defy -- absolutely defy -- any Republican member of Congress to voluntarily reject the health insurance which is provided for them by taxpayer dollars. In fact, I would even suggest giving Republican officeholders the same amount of taxpayer money to purchase health insurance out on the open market. Republicans love to say how wonderful this free market is -- but none of them know what they're talking about. So I offer this challenge -- Republicans, take the same amount of money from the taxpayers, and go find out what that 'free market' is really like for an American trying to purchase health insurance. If it's so wonderful for your constituents, why do none of you use it? Why do you condemn any attempts to change the system, when you are afraid to use that system yourself? This, to me, exposes the rancid hypocrisy of the Republicans. They are happy to fight against the right of their constituents to even have the choice of what they've got. They are happy to extol the supposed virtues of the free market because they do not have to use it. And they want to limit everyone's choices, while their elite health insurance is paid for by the very people they are denying other choices to. So I say to all Republicans who speak so glowingly of the free market for health insurance: 'Put up, or shut up.' Either go find out what that market is really like for your own health insurance, or else please stop telling us it is some sort of utopia of freedom."

Cross-posted at: Democratic Underground

Cross-posted at: The Huffington Post

-- Chris Weigant