Health Care Reform passes

The Democrats finally did it, passing health care reform. Props to Nancy Pelosi for bringing it through the House. Props to all the Dems in the House who voted the right way, which was most of them, and enough of them. There are some other procedural votes in the Senate, and then Obama has to sign it. But it's done.

The details of what this bill covers have been examined in excruciating detail in many, many places. Andrew Sullivan rounds up the usual suspects and their reactions. I'm just thrilled that we finally have something - anything - different from the status quo. I don't know whether or not this bill will solve the problems we hope it will. I hope it will. I have a certain amount of faith. For various reasons, I haven't followed the ins and outs of this debate as closely as I could have. I understand the basic outline, the amount of detail has been mind-numbing. I started following politics seriously when all you had to do was read The New York Times and a couple of other sources, and you knew all you had to know. I still haven't learned how to drink from the firehose that is the Internet.

What I do know, or at least what I feel comfortable theorizing about, is that this isn't just about healthcare, as broad as that topic may be. This may be the last great victory in the culture wars that started almost 50 years ago. Liberals have won on almost every issue in those wars: they have won on feminism, civil rights, the environment, abortion, and separation of church and state. They're winning on gay rights. They've essentially lost on gun control, but they're starting to win on crime, after losing for decades. Some would argue that they lost on the very broad issue of capitalism, but I don't think that was really up for debate. As frustrated as liberals are by corporations, only the wackiest have really seriously contemplated any kind of alternative to capitalism.

This is not just a political, legislative, or even cultural victory. This is a philosophical victory, an ideological one. What won tonight was the idea that government can improve the lives of its citizens. That's an idea that has been around for a long time, and there have been many victories on that front along the way. But this may be the ultimate victory for that idea. Which may be one reason Republicans fought this legislation so hard: they knew what was at stake, and they knew how badly they were losing. And now they have lost. Take it away, Mr. President:

Health Care Passes In The House

The House of Representatives passed its version of health care reform today. TPMDC has a great analysis of the issues here.

The bill passed the House 220-215, just a couple of votes more than needed. Abortion, a long-simmering issue, exploded in the debate in the last couple of days, as some conservative Democrats decided that they couldn't vote for Federal funding for abortions. They got their way. I'm not thrilled with that, and lots of feminists and liberals are going to be disappointed, but I'm not surprised this happened. Abortion is one of the last battles of the culture wars that is still open, and conservative Democrats need to feel like they won something in this debate. As a percentage of the actual money involved, I'm sure funding for abortion is miniscule. But it's a very high-profile issue, and Democrats from culturally conservative districts can use this vote to demonstrate their independence from "Washington elites."

Obama, as I expected, used some of his political capital at the end, showing up on Capitol Hill to bang some heads and twist some arms. Just a few days after the votes in Virginia and New Jersey that were allegedly so bad for him, he achieves a major victory.

Momentum breeds momentum. As Democrats have come together, they have, collectively, ever more reason to vote together, to make something happen. They must all hang together. They don't all have to vote for the bill to get it to pass, and I'm sure Nancy Pelosi, Steny Hoyer, and James Clyburn have a very good sense of who they can bring on board under what conditions. As they get closer to passing the final bill, they get closer to defining the political reality. And conservatives and Republicans get closer and closer to losing a major battle. That's one reason that they are fighting so hard, and using such absurd rhetoric - if they lose this one, they don't just lose on the issue - they lose their ability to be obstructionist. Some members of the base will be ever-more frustrated and vitriolic. But a fair number of Republicans are going to be deflated and demoralized. And a fair number are going to be disgusted at the tactics of this highly vocal minority. There are still many, many moderate, tolerant, decent, open-minded conservatives and Republicans who still believe that respecting your opponent is a key quality for being successful in a democracy. Those Republicans, by definition, are not rabble rousers. They are not the ones raising signs on the steps of the Capitol. Which means that they aren't the ones being noticed in this debate. But there are millions of them, and they are paying attention.

Reading the article in TPMDC, I finally started to pick up a good understanding of what is at the core of the debate. I finally get the basic issue. We have lots of uninsured people in this country. Taking care of them costs the rest of us a lot of money. We have to get those people insured. There are a couple of ways to do that: abolish all private insurance, and enroll everyone in the same government program, or encourage/force everyone to buy insurance on their own, or encourage/force all employers to offer insurance. The problem with encouraging/forcing all people to buy insurance on their own is that many of them will not be able to afford it, and many will resent having to buy insurance when they haven't had to before. So, to make it possible, and to ease the pain, the government will do two things: 1) offer subsidies so people can afford to buy insurance, and 2) set up a government-run insurance program for people to buy into. To level the playing field, and to make insurance work better, the government will also be imposing new restrictions on insurance companies.

I finally get it. It's great not to have to worry about the constant battle over fine details of political gossip - which Senator said what about what obscure part of the bill, and how did the White House react, and how did the Senate leadership react, etc. I found the news coverage - particularly on the liberal blogs, TPM, DailyKos, and HuffPost - getting bogged down in that kind of detail. That's a subject for a post-mortem.

But the bill passed the House. On to the Senate.

Health Care Reform Passes Senate Finance

The Senate Finance Committee passed its version of health care reform today. Woo hoo! That's a big one, the last committee vote. One Republican voted for it: Olympia Snowe, of Maine. Personally, I'm glad I can finally rest easy and not worry about whether or not she is going to vote for this committee bill.

Except that, of course, I now have to worry about whether or not she is going to vote for the final bill, and whether or not that will include a public option. Brian Beutler at TPM provides a good analysis of Snowe's role in the end game. If she supports the final bill, does that give moderate Democrats political cover? The problem with this analysis is that ignores the fact that the Democrats have a 60-vote majority. At some point, Obama is going to start twisting arms, and make supporting this legislation a key test of party loyalty. "Supporting the President" has a lot of pull in DC. At the end of the day, they are Democrats.

There is no question that some bill will pass. The only question is what will be in it. Republicans want to water down the public option. Snowe will score points with Republicans if she can claim that she used her leverage to make it a better bill, as Republicans define it. Of course, there's also the issue that she will look the odd woman out if she is the only Republican to vote for it. Critics on the right will be able to make her a convenient target, and they can easily accuse her of selling out.

But there is one thing that has to be keeping Republican leaders up at night: it is entirely possible that the Democrats know what they are doing. What if this bill really does bring a lot of resolution to the health care crisis? What is a public option turns out to be a good thing?

What if Barack Obama is right?

That possibility has to have people like Mitch McConnell just terrified. That is one of the basic rules of politics: you have to keep in mind that sometimes (hopefully rarely), your opponent will be right, and you will be wrong. The tricky part is knowing when to admit that. The trickier part is knowing when to recognize it.

The fact that one Republican might vote for this bill means that Republicans are hedging their bets. Democrats, to their great credit, have been very open to Republican suggestions during this debate. It was extremely frustrating for the Kossacks to watch Max Baucus negotiating with the Republicans on his committee for what seemed like forever, but there is no way that Republicans can say that Democrats rammed this down their throats.

So Republicans have to keep in mind that the Democrats might be right. If they are right, the fact that one Republican voted for it, and several Republicans on this committee negotiated with Baucus in good faith, would mean that the Republicans could claim that they had some influence on the bill, and it was their contributions that made it a better bill. Of course, the fact that almost all of them voted against it would be a rather effective counter argument.

The Republicans beat Clinton on health care. Newt Gingrich took that victory and ran with it, winning the House in 1994, much to the Democrats' surprise. But Clinton won reelection in 1996, and Gingrich was eventually forced out of office.

Obama's bill will probably be much better than Clinton's would have been. So Republicans won the battle back in 1993, but with this bill, they will have lost the war.

No more cupcakes for you!

New York City has decided that there shall be no more bake sales, or at least a lot fewer, because selling junk food to kids makes them fat.

But it also makes them rich. Or at least rich enough to be able to go on field trips and buy sports equipment, which is what they do with bake sale money.

I want to go on record as saying that I think this is a terrible idea. Yes, I understand the imperative to stop feeding kids lots of bad food, and I could lose a few pounds myself. But this is also a great example of why conservatives criticize liberals: because liberals believe in the nanny state, i.e. the idea that those in power know what is good for you, and have the right to dictate how you should live your life.

Liberals are forgetting a key lesson of history, and that would be the political correctness of the 1980's. I survived that era, but barely; I still have bad memories of the PC police. There is an element of puritanism in both liberal and conservative viewpoints; conservatives have their versions of enforcing morality. Someone (H.L. Mencken?) once said that puritanism is the idea that someone, somewhere, is having fun, and that they must be stopped. Telling students that they cannot have bake sales is a version of that.

How about this: if a group has a bake sale, they also have to have a fundraiser that somehow promotes healthy living, like a walkathon. Or maybe the football team (although I suspect there aren't a lot of high school football teams in NYC) asks people to pledge a certain amount of money for each point they score. Or bake sales have to incorporate some educational element, like coming up with new recipes, or working with professional chefs. What about forming some kind of organization, and encouraging the students to treat it as a real corporation? There could be a group that hosts bake sales, and the other school groups outsource it to them. Or maybe limit the amount of sugar and/or fat that can be used, which would force students to be really creative with their ingredients. It's entirely possible to make really good snacks and desserts without lots of calories, but you have to focused on doing just that. That might require more work on the part of the school administration. But it would also be much more rewarding than a straight ban. And there wouldn't be risk of a backlash. Remember, these students are all future voters.

Kyl v. Stabenow

Jon Kyl, Republican senator from Arizona made a bit of a mistake today. Michael Kinsley famously said that a gaffe is what happens when a politician tells the truth. Kyl, in this case, said something that is undeniably true. Speaking of health care and requiring insurance companies to cover certain conditions, he mentioned that he does not need maternity care. So forcing him to pay for it will make his policy more expensive. Good thing he has health insurance - I think he's going to need surgery to extract his foot from his mouth. I'd love to be a fly on the wall when he has to meet with his female staffers. To say nothing of his wife or daughters.

Debbie Stabenow, Democrat senator from Michigan, came right back with the perfect response: "I think your Mom probably did." Wow. She's going to be a feminist hero for the next election cycle. At least. I'd love to be a fly on the wall in the next conversation she has with her campaign treasurer. I think she probably got a few clicks of the PayPal button for that line.

But other than a moment of good political theater, this illustrates a couple of things. First, it illustrates that Jon Kyl does not understand the basic principle of insurance: the point is to spread the risk. Of course he can't get pregnant. Of course, he can GET someone pregnant, and if he doesn't believe in paying for maternity care, I think we need to ask him some questions about how he feels about men being responsible fathers. But there's also almost no chance that he will get breast cancer, and there are other diseases that he can't get. There are, however, diseases that he can get that women can't - does that mean that women shouldn't pay for prostate cancer coverage? We do make adjustments for insurance coverage based on things like smoking, but that is a personal choice, not a result of genetics.

Second, it also illustrates a fundamental difference between liberals and conservatives. The classic liberal criticism of conservatives is that conservatives are not compassionate. I'm not sure that's the case; I've known some conservatives - notably my grandparents - who cared very deeply for their loved ones. The difference seems to me to be a matter not of compassion, but of imagination. Conservatives do not seem very good at empathizing with someone with a different point of view. This explains why conservatives are very compassionate towards people who are like them, but not so much towards people who are not like them. This is why conservatives are willing to use torture. They feel the pain of people who died on 9/11 - mostly Americans, like themselves - but they do not feel the pain of the people being tortured.

This is also why Jon Kyl doesn't want to pay for maternity care - he doesn't empathize with women who might have to go through childbirth. I have a feeling, however, that he is going to be empathizing with women on this score in short order. There are many, many women who are not going to let him forget this comment. It has to be one of the most sexist things I have heard in a long time.

It feels almost trivial to be pointing this out, but it does seem to highlight a basic difference: liberal brains are wired to empathize with people who different than they are, and conservative brains are wired to empathize with people are similar to them. This applies to "liberal" and "conservative" as we currently understand them in American political discourse; there are philosophical definitions of each that do not necessarily mesh with this distinction.

There are strengths and weaknesses of each; conservatives are more self-reliant, and forge tight bonds with each other, while liberals appreciate differences and are better at forming political allegiances across all kinds of differences. Conservatives don't deal well with people unlike themselves, but liberals can overcompensate and become hypersensitive to differences.

Fortunately for liberals, the ability to understand and empathize with people with different perspectives confers a substantial advantage in politics. Particularly when there are more and more people like that, both in this country and around the world, who are demanding to be treated as equals.

Back on the grid

Well that was a great vacation. I spent a few days ignoring politics as much as I could; I didn't read a newspaper item about politics, despite subscribing to the LA Times and the Financial Times; didn't check a blog or news Website of any kind.

It lasted about three days. Maybe four. Then I started feeling the urge again.

But it was a wonderful three or four days. Really cleared my head. It was particularly useful to take a step back from the partisanship on both sides. Much as I agree with the progressive/liberal side, I also very clearly remember the political correctness of the 1980's, and sort of still have some scars from that. So I am very sensitive to liberals enforcing ideological purity, particularly with invective and sarcasm aimed at people on their side with different approaches or ideas for reaching a similar goal. Not a big fan of that.

So what did I miss? Some guy named Joe Wilson embarrassed himself and his party by heckling Obama during his speech to Congress. I still haven't watched that, but plan to. I think the House did the right thing by voting formal disapproval. I am a big fan of respecting your ideological opponents, but self-respect also demands that you stand up for yourself occasionally, and I think that's what the Democrats did. I would like to think that I would have the same position if the situation were reversed. I would like to go on record as advocating the same penalty for a Democrat if he/she heckles a Republican president.

The healthcare debate is crystallizing. Is Max Baucus a fool or a hero? Right now, it depends on the time of day, and where you stand on the public option. At the very least, Republicans cannot say that they were not given an opportunity to have their voices heard - Baucus gave them every chance to contribute. If they don't like the final product, that's fine, but they can't claim that Democrats shoved it down their throats.

But if the bill passes without some kind of public option, liberals, particularly the Kossacks, are going to crucify Baucus for giving away the store and not getting anything back. That does look like a questionable strategy.

Obama imposed tariffs on Chinese tires. My question is: was this justified by treaty and/or international law? I haven't been able to find out. I'm assuming it's a bump in the road - I have seen many other trade disputes flare up and then dissipate. My guess is that that will happen here.

Healthcare Reform: The End Game Begins

The healthcare reform debate has been going for a long time. Months in this Congress, years in the country at large. Negotiations are ongoing in the Senate Finance Committee, among the so-called "Gang of Six." President Obama is starting to get frustrated, and may go it alone, i.e. pass a bill without Republican support. That might be difficult, but it's possible.

Some liberals, progressives, and Democrats are nervous. Some aren't. I'm in the "not that worried" camp.

What we are watching now is equal parts flash and substance. There are strong, profound philosophical difference motivating the parties, and those differences are particularly pronounced in this debate. Government vs. free market; communal concern vs. individual rights; profit motive vs. co-ops and the "public option." Some of these are simply irreconcilable differences that come down to contrary worldviews. People like Max Baucus and Charles Grassley are trying to bridge those differences, but that is hard work.

But we are also watching a great deal of the politics, and the politics is far more interesting and obvious than the policy. For some of us, it's a game, and it's fun. Who's up, who's down, who has the better strategy, who made what mistakes?

But the politics are also far less inspiring, and far more discouraging. We are seeing compromise and gamesmanship. Most importantly, we are watching a few very powerful people bluffing.

Obama holds most of the cards, and the Republicans know it. He can pass some kind of health care reform without them; he can also pass some kind of healthcare reform with them. They, of course, want to force Obama to pass a healthcare reform with them. They want to do that because it will weaken him politically, partially by pissing off his base, but also because they honestly want some things in this bill.

What the Republicans don't know, and what terrifies them, is how Obama is going to play the end game. He is still a popular president. He is still an incredible and inspiring speaker. He is still a very charismatic leader. He has a great organization out there in the country drumming up support, gathering signatures. He still has many allies in Congress with their own organizations and teams out there fighting for their versions of the bill.

What really and truly terrifies the Republicans, so much so that many of them don't even realize it, is that they don't know which of their political weapons is going to work against Obama. They've dropped their biggest bombs, they've thrown as much mud as they can. The "death panel" claim is easily their most serious charge - the government is not only not going to help you, it's going to kill you? Some people believe that. But Democrats are not giving up fighting against it, and eventually they will win on that issue. Eventually the idea that the government is sponsoring "death panels" will be ridiculed as an absurd, extremist idea, because that's what it is.

Democrats did not take the "birther" mania seriously for a long time, but now they have spent some time and energy fighting it, and Orly Taitz was exposed as a flake and a crank.

Through all of this, Obama has looked calm and cool and collected, like he always does. Some people mistake that for lack of strategy, or aloofness, or lack of fighting spirit. But that's only in contrast to the previous administration, which worked by conniving, bullying, and subterfuge. Obama is playing it somewhat straight, because that's the way he is. He is making the strongest argument he can for the best bill he thinks he can get through Congress. Obama's problem, of course, is that he doesn't know what the best bill is that he can get through Congress.

I think Obama is going to surprise - and terrify even more - the Republicans in Congress by playing hardball at the end. He will rally the troops, like only he can. He will claim that he has been patient with Republicans, that he has listened to their concerns, that he has tried very hard to work with them, but that now is the time for decisions to be made. "Now is the time!" Imagine Obama leading a crowd with that rallying cry.

One of Obama's greatest weapons is the GOP failure to solve this problem for so many years. The absolutely last thing any Republicans want is to be reminded of is the squandered opportunities of the Bush years. Republicans do not want to be held accountable for the failures of Bush, but Obama is in a position to do exactly that. All he has to do is call the Republicans obstructionists who never offer solutions, even when they have the opportunity and the power. Obama's reputation for bipartisanship will come in very handy, because he will come across as a reluctant partisan warrior. He would much rather prefer to work with Republicans, but if he has to go it alone, so be it.

Obama is very different from the Republicans in one key respect: Obama is not afraid of his base. Obama may not agree with the Kossacks on everything, but he is perfectly comfortable using their energy and their talents. When the time comes, he will rally those troops. And he will not have to worry about whether or not rallying the base will alienate middle America. The Republicans, on the other hand, have to be scared to death of rallying their base, because they cannot control their base, and the followers of Rush Limbaugh and Sarah Palin have the potential to seriously alienate independents and the few moderate Republicans left.

So the end game begins. It's not quite a rope-a-dope; Obama is not feigning weakness. But neither is he telegraphing his strategy. Nor has he started deploying all of the weapons in his arsenal. He is keeping extraordinary strengths in reserve.

He can keep those strengths and those weapons in reserve because he is not afraid to use them. He is patient because he knows that he will know when to start the fight. He will know when to move. And then he will move very, very decisively, and very quickly. And that has the Republicans very, very afraid.

Finally, Some Substance on Health Care

It has taken a while, but we finally have some substantive discussions going on about health care. A real, honest-to-goodness Canadian writes in The Denver Post about the differences between the US and Canadian health care systems (thanks to my Uncle Lenny for forwarding it to me). Bottom line: Canada spends less money for better health. She takes apart all of the myths about the Canadian system. My response is simple: ADT (About Damn Time). Most of the stories and myths about Canadian health care that I've heard are strictly anecdotal, the "I heard about this one guy who came to America because he couldn't get the surgery that he needed in Canada" variety. So it's nice to see some myths debunked.

Of course, many conservatives will dismiss this out of hand, but it will also give liberals more ammunition, make them more confident, and maybe even convince a few independents. Probably the strongest point in the piece is the one about doctors not needing any kind of pre-authorization to practice the medicine that they think is appropriate.

I have a question for conservatives about health care in Canada. Supposedly lots of Canadians are unhappy about health care in Canada, and they are coming to the United States. Where exactly are all these Canadian? Presumably they're coming across the border to Seattle, Detroit, Buffalo, and other border cities. Can we please get some statistics from conservatives proving that Canadians are coming to the US en masse for health care? Because if we can't get those statistics, I'm going to call it a myth.

Next, Patrick Appel, who is performing quite ably in the absence of his boss, Andrew Sullivan, writes a superb post about malpractice insurance and tort reform. This is another bogeyman of the right, largely derived from anecdotal evidence: there are too many frivolous lawsuits from ambulance-chasing lawyers, and the result of all those lawsuits is that malpractice insurance rates are going through the roof, which drives up health care costs. Maybe not so much.

Malpractice payments account for less than 1% of the nation's health care costs each year. Since 1987 medical malpractice insurance costs have risen just 52% despite the fact that medical costs have increased 113%. The size of malpractice damage awards has remained steady since 1991. Adjusted for inflation, the average malpractice payment has actually decreased since then. The number of payments for malpractice judgments of $1 million or more has never exceeded one-half of one percent of the annual total number of malpractice payments dating back to 1991.

The specific subject of the post is tort reform in Texas, which was supposed to solve the problem by limiting the size of malpractice awards. It hasn't, and there hasn't been the promised reduction in health care costs. The basic idea, which we also have in California, is that certain awards for damages in these suits are limited. The idea is that if the insurance company only pays out $250,000, instead of $5 million, malpractice premiums will decline. It hasn't worked out that way. The unintended consequence is that it is now more difficult for some patients to sue, because it's not worth it for the lawyers to sue, since there is a cap on how much money they can make.

I've always thot that the solution to absurdly high malpractice awards is to implement a better solution for disciplining doctors. Appel quotes a reader who wrote in with stats about how many doctors are disciplined. It's not much. Physician, heal thyself.

We owe Sarah Palin and the other wackjobs on the right a big thank you, because their ranting and raving have finally brought these arguments out of the woodwork. Rationality will eventually prevail, but it takes longer to deploy calmly constructed arguments than it does to throw out insane lies and bizarre innuendo. Palin, Glenn Beck, et al. have a slight advantage in this debate in terms of timing, because it takes them no time whatsoever to make something up and throw it out into the public discourse. Liberals, on the other hand, have to take the time to actually think and research and write. Fortunately, liberal arguments end up being much more persuasive, at least to people willing to listen to them.

That's How It's Done

Barney Frank is my hero of the day. I've always admired the fact that he is perfectly willing to use his superior intellect and encyclopedic knowledge of politics, process, and policy to just dismantle his opponents. He understands that sometimes politics is about listening, engaging your opponents, and compromise, and sometimes it is just about beating them. I'm a big fan of respectfully participating in civil dialogue, and I have been disappointed on countless occasions by my fellow liberals' refusal or inability to thoughtfully consider conservative or Republican arguments.

But there are limits to how long you can keep turning the other cheek when the other side insists on slapping you in the face. There is a time to disagree without being disagreeable. Conservatives doe not consider this to be one of those moments. So liberals are starting to recognize that there is a moment to be dismissive and argumentative, and this is one of those moments. There is a time to listen, and there is a time for flat-out ridicule. This is a time to be harsh, and call idiots what they are.

Obama himself is, as always, calm, cool, collected, and rational. I still think there are lots of Republicans and conservatives who are worth listening to, and who are capable of responding with intelligence and grace. But the inmates have taken over the asylum, and demagogues are framing the debate on the other side.

This is how it's done:

Health Care: Who Will Take Care Of You?

One basic divide in the health care reform debate is a simple question: who will take care of you? Will it be the government, your company, your family, you, your doctor, your insurance company, or something else? How you answer that question defines where you stand on this issue. If you think government is or will be more capable of taking care of you, you're probably in favor of the "public option," and you're probably a liberal Democrat. If you think the government will completely botch your health care, and let you rot and waste away, but you trust your company or your insurance company, you're probably opposed to Obama's plan, and in favor of the status quo.

This is one thing I haven't heard from Obama, and that I wish I did: his plan is about giving you the option to choose who will take care of you. If you think your insurance company will take care of you, great, stick with them. If you think the government can do a better job of it, then we want to give you that option. Obama and his minions, like Kathleen Sebelius, do keep on repeating the line about "choice and competition," but it's starting to sound like a cliche. Here's how I would sell it: we believe in giving Americans the greatest possible freedom to choose who will take care of them. Liberals deserve their choice, conservatives deserve their choice.

The hard part of the sales job, but one of the most rewarding, would be reminding people that the reason they have any freedom in the first place is because of their government. Freedom is not something that you just wake up to every morning; it has to be fought for and won, and it has been. By the government of the United States of America. This is the same government that gives its citizens freedom of speech, of assembly, and of religion.

Conservatives like to think of freedom these days in terms of how far they can distance themselves from government; freedom means being free of regulation, of "Big Brother," etc. This would be a good time to remind them that it is government that gives them their freedom in the first place, and that doing so requires a great deal of hard work, and an equal amount of deep and difficult thinking.

Healthcare Reform: Latest Battle Of The Culture Wars

I haven't been blogging much about healthcare reform because it has felt overwhelming. It's an all-or-nothing proposition. Part of my feeling has been that this healthcare reform bill will set the stage for other reform efforts. This establishes the framework, but there will be lots of opportunities for changes later on.

Now that we are in the final stages, it feels like a good time to step up to the plate. The policy details are out there and are being hashed out in Congress, mostly the Senate Finance Committee at this point.

Outside of Washington, the debate is getting nasty, with some very loud protesters from the right shouting down their opponents. The right is arguing that these people are just upset. Andrew Sullivan noted the lack of attention to detail in these protests:

Look: if these people were yelling: "End the employer tax break!" or "More Cost-Controls!" or "Malpractice Reform!" I'd be more sympathetic. But this is blind panic and rage.

The protesters don't care about the policy details of healthcare reform because for them, this is not about healthcare reform. This is the latest battle of the culture wars.

Conservatives have lost just about every battle of the culture wars since the 1960's. They lost the battle over civil rights; a black man is now president. They lost the battle over feminism; a woman was a major-party candidate for president. They are losing the battle over immigration and assimilation; a Hispanic woman was just confirmed for the Supreme Court. They have lost the battle over abortion. They have lost the battle over separation of church and state, particularly in the classroom. They have lost the battle over gay rights, and, although they have won most of the battles over gay marriage, they will lose that battle over the long term. They have lost the battle over traditional family structure and sex in general. They have lost the battle over basic cultural norms. They have lost the battle over environmentalism.

About the only battles conservatives have won have been over gun control, crime, capitalism vs. socialism/communism, taxes, and lower regulation. But Democrats have largely given up trying to win the gun control debate, crime is down, and no one has cared about the capitalism/communism divide for years. Conservatives are still winning the battle over taxes, but it's turning out to be a Pyrrhic victory, as deficits are soaring and states can't balance their budgets. Lower regulation led to a loosening of standards, which allowed financial predators to take advantage of too many consumers, and wreaked havoc with financial institutions. Conservatives lost the foreign policy culture wars - diplomacy vs. "peace through strength" when Bush & Co. completely botched Iraq. There's still free trade, but that's not popular with anyone right now.

This is why the healthcare debate is so heated. This is not about healthcare. When conservatives scream about "government," they are screaming about liberals and what they feel is liberal control of government. Of course, since liberals actually believe in making government work properly, conservatives are justified in feeling that liberals have more influence over government. Funny how that works - people who take something seriously and want to improve it tend to have more faith in it.

Conservatives feel besieged because they have lost the culture wars on so many fronts. William F. Buckley famously said that the purpose of conservatism was to stand athwart history and yell "Stop!" But of course history doesn't stop, and to pretend otherwise is to set yourself up for constant disappointment.

Several commentators have pointed out the irony of older people, who are presumably on Medicare, a successful government medical program, protesting "government takeover of healthcare." They are not protesting government takeover of healthcare. They are protesting government, period. They are channeling years of frustration at losing so much ground to liberals in so many aspects of life in general. Years and years of built-up vitriol is spewing out over this one issue.

It doesn't help that conservatives haven't had a successful president since Reagan. They're frustrated that W. was such a failure, but they can't take their frustration out on him or the GOP, so they take it out on Obama.

It also doesn't help that so many conservative policies have failed. Cutting taxes is supposed to lead to higher economic growth, which therefore makes up for the taxes lost when they are cut. That's the original justification of supply-side economics, and it has been a miserable failure. Nation-building in Iraq? Uh, no.

The one thing that might make a difference for conservatives, that might make it easier for them to be civil when engaging in the debate about healthcare, would be if they had any good alternatives. But they don't. This just adds to the feeling of helplessness. It's impossible to deny that healthcare costs are spiraling out of control, particularly when the victims are so many business owners. But who are conservatives going to use as the target for their anger? Drug companies? Insurance companies? Those are supposed to be examples of the free market at work. They can vent at lawyers, a key Democrat constituency, and their penchant for suing for malpractice, but even taking on that won't solve every part of the problem with rising healthcare costs.

So they invent reasons to be angry. Sarah Palin makes the incredibly bizarre - even for her - claim that Obama's plan will result in government bureaucrats euthanizing her Down's syndrome baby. This is beyond ludicrous, but she apparently believes it. This has no relation whatsoever to reality. None. But this debate is no longer about reality for Sarah Palin and other conservatives. It's about trying to retain some shred of dignity as liberals win yet another victory.

The solution, and I'm sure Obama knows this, is to stay calm and cool. Let them freak out. Let them make fools of themselves. At some point a healthcare reform bill will pass. It won't be perfect. Lots of liberals will bemoan the lack of some feature or other. But it will pass, it will start to change how we deal with healthcare in this country, and then we will start to debate about how to change it.

Obama on Stem Cells

President Obama has issued an executive order changing the Bush administration's position on stem cell research. Check off another idiotic decision consigned to the dustbin of history. The folks at Daily Kos are, of course, thrilled, and offer some good background.

This should drive a nice fat wedge between three Republican constituents: the pro-life crowd, on the one hand, and, on the other hand, people who have been affected by diseases like Parkinson's and Alzheimer's, and businesspeople who stand to benefit from the research that will now be allowed.

Conservative opposition to science has always confused me. I can understand opposition to stem-cell research, based on opposition to abortion. But these people are also supposed to be capitalists. Don't they know that advances in science are an absolutely essential part of increasing productivity, and therefore driving economic growth? Pick any company on the planet - there's about a 99.999% chance that its success is based on science. The internal combustion engine. Microprocessors. Radios. Televsions. Heck, electricity, without which our modern economy would not be possible, required scientific discovery.

So Obama has just given capitalists another reason to believe that Democrats are more in tune with their needs than Republicans. Works for me!

Obama signs children's health insurance bill

And the crowd goes wild. It's a great short speech by Obama. It's a solid step forward on health care reform. And it's yet another stupid move by Bush - letting Obama take all the glory for helping American parents take care of their kids. In a month or two or six, no one will remember Tom Daschle's tax problems. But millions of parents will be eternally grateful that they have health insurance for their kids.

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