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Lines In the Sand

For a long time now, progressives have been looking for lines in the sand. They’ve been trying to get progressive members of Congress to commit to vote no on any health care reform bill that doesn’t include a robust public option, and they’ve also been after the President to clearly state his unwillingness to sign a reform bill without one. Today, in his weekly radio address, and framed by his characteristic eloquence, the President has offered not one but a number of lines in the sand. He said:

”I want to be very clear: I will not sign on to any health plan that adds to our deficits over the next decade. And by helping improve quality and efficiency, the reforms we make will help bring our deficits under control in the long-term. . .

”any plan I sign must include an insurance exchange: a one-stop shopping marketplace where you can compare the benefits, cost and track records of a variety of plans – including a public option to increase competition and keep insurance companies honest – and choose what’s best for your family. And that’s why we’ll put an end to the worst practices of the insurance industry: no more yearly caps or lifetime caps; no more denying people care because of pre-existing conditions; and no more dropping people from a plan when they get too sick. No longer will you be without health insurance, even if you lose your job or change jobs.”

With the first line in the sand, he undercuts the claims of Blue Dogs, ConservaDems, and “moderate Republicans,” including the “six deadly hypocrites” Ben Nelson (D-NE), Joe Lieberman (I-CT), Mary Landrieu (D-LA), Olympia Snowe (R-ME), Susan Collins (R-ME), and Ron Wyden (D-OR) that the health care reform bill will increase deficits, and he makes it much harder for Nelson, Landrieu, Lieberman, and Wyden to vote against the upcoming legislation without exposing themselves as simple tools of the insurance companies.

With the other lines in the sand he provides cover for progressive members of Congress and Senators who have been under pressure to draw their own lines, but who have not been clear on where the White House would come down on the public option, and who have been resisting the efforts of progressive groups including Firedog Lake, to get them to commit to a hard line on it. There’s also some new language here calling for abolishing rescission that we haven’t heard from the President before.

President Obama’s address is part of a more general White House campaign to take ownership of the health care reform legislation. If he repeats his requirements stated in the radio address in upcoming activities this week, including a scheduled press conference, the die will be cast, and progressives will have a green light to fully mobilize against the hypocrites, Blue Dogs, and ConservaDems, who are standing in the way of eliminating all those unnecessary deaths and bankruptcies that are the product of our current health care system.

There remain, of course, important details to be worked out as we go forward. First, even though the President commits to “. . . a public option to increase competition and keep insurance companies honest . . .” the success of any public option in increasing competition will depend on the constraints placed upon it in the details of the legislation. The devil will really be in the details, and that is where the insurance companies and their allies will concentrate their influence as the bill goes forward. They’ll be trying to produce a public option that will introduce as little competitive pressure on the private companies as possible, and they will be doing everything they can to ensure that they can continue to be as dishonest as they want to be in dealing with their customers. They will also be doing everything they can to retain the capacity to commit the legalized fraud on their customers that has been responsible for their excessive profits for many years now. Where will Obama come down on these details? Will he lean toward the insurance companies and support their efforts to make the public option a mockery, or will he really deliver a bill that will set the stage for evolution toward a single payer plan as the years go by?

The second really important thing to watch for in the bill, is when its public option will be effective and available to all. The House Bill now provides for an operative public option in 2013, supposedly to provide time for the market exchange to be set up. Such a lengthy period for initiation of the public option portion of the Bill is a great gift to the insurance companies and will allow them to continue to victimize their customers for a lengthy period. This will be politically unpopular, because it will allow the medically-related deaths and bankruptcies to continue even though taxes will go up immediately, and no benefits of the Bill will be visible. I really can’t believe that this provision of the Bill made it through committee. Some people must have been asleep at the switch, while others were trying to ease the pain for their insurance company donors. It’s very reminiscent of Chris Dodd’s Credit Card Reform Bill which allowed the Credit Card companies a full 9 months to extract revenue from their customers before they had to worry about any of the new regulations in that Bill. Lyndon Johnson’s original Medicare legislation was implemented in 11 months with 20 million people enrolled over a period from 1965-1966. With our far greater Information Technology skills to help us in 2009-2010, I suspect that the Obama Administration could do at least as well as the Johnson Administration did, if Congress is willing to recognize that a vote for 2013 implementation is a vote for many more needless deaths and bankruptcies.

Yet another thing to watch for is the fate of the Amendment introduced by Dennis Kucinich and just added to the House Bill in committee on July 17th. The Amendment doesn’t change the legislation except to allow States to create single payer systems if they want them. While the Amendment sounds good, it would seem to create a situation where citizens of these States would be paying for the national plan in the form of increased taxation and also paying for their state’s single payer plan with increased state taxes. How this sort of situation would be handled is not yet considered in the House Bill. A single payer opt-out for states was already overwhelmingly defeated in the Senate.

President Obama’s lines in the sand, are a long time coming, and they are very, very welcome at this juncture. But I think there will be a need for a few more lines in the sand in the future, centering around the issues of how robust the public option will be, whether it will be fully available in under a year’s time, and whether the states will really have a practical choice to choose a single payer plan if they so desire.

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Joseph M. Firestone, Ph.D. is Managing Director, CEO of the Knowledge Management Consortium International (KMCI), and Director and co-Instructor of KMCI’s CKIM Certificate program, as well as Director of KMCI’s synchronous, real-time Distance Learning Program. He is also CKO of Executive Information Systems, Inc. a Knowledge and Information Management Consultancy.

Joe is author or co-author of more than 150 articles, white papers, and reports, as well as the following book-length publications: Knowledge Management and Risk Management; A Business Fable, UK: Ark Group, 2008, Risk Intelligence Metrics: An Adaptive Metrics Center Industry Report, Wilmington, DE: KMCI Online Press, 2006, “Has Knowledge management been Done,” Special Issue of The Learning Organization: An International Journal, 12, no. 2, April, 2005, Enterprise Information Portals and Knowledge Management, Burlington, MA: KMCI Press/Butterworth-Heinemann, 2003; Key Issues in The New Knowledge Management, Burlington, MA: KMCI Press/Butterworth-Heinemann, 2003, and Excerpt # 1 from The Open Enterprise, Wilmington, DE: KMCI Online Press, 2003.

Joe is also developer of the web sites,,, and the blog “All Life is Problem Solving” at, and He has taught Political Science at the Graduate and Undergraduate Levels, and has a BA from Cornell University in Government, and MA and Ph.D. degrees in Comparative Politics and International Relations from Michigan State University.