In all likelihood, Barack Obama will be the Democratic Party's nominee for president this fall. As Hillary Clinton has repeatedly said, we will have a unified Democratic Party going into the November elections. There is no question of that. We all want to win the White House and enlarge our majorities in Congress. But beyond that, the question remains--for what purpose?

I've made no secret of my apprehension about Barack Obama on this site. Much of my consternation on issues has to do with what I think are his excessively timid proposals on the hugely important issues of health care and the housing crisis, and the unfortunate conservative-minded rhetoric that he often uses to defend them. However, these also tie into a larger more fundamental skepticism about Obama--that his campaign is more of a case for himself than a case for the Democratic Party, and more of a call for post-partisan unity than a declaration that the Democratic Party is the right party to lead America back to its ideals.

Now there are plenty of people here who argue in good faith that Obama will do more to establish a Democratic majority than Clinton. Most of these arguments are based on Obama's higher appeal among independents and Republicans, contrasted with the higher negative ratings that Clinton has accumulated over sixteen years in the national spotlight. I see this differently, however. There are two ways to grow the Democratic Party. The easier way is to dilute our party's message, to soften our ambitions and to seek compromise for its own sake--namely, to move our party towards new voters. The harder, but much more rewarding, way is to convince independents and Republicans that our ideas are better, that the policies and ideals that we support are the right ones--in other words, to move new voters into our party.

My fear is that Obama, despite the rhetorical brilliance first demonstrated at the 2004 convention, has chosen to commit the party to the wrong way. A look through his speeches tends to find very few mentions of the Democratic Party. When he uses the word "Democrats", it is likely to be contained in a phrase about bringing them together with Republicans, or blaming both of them for our nation's problems, as in this excerpt from his victory speech after the Potomac primaries:

It's a game where Democrats and Republicans fail to come together year after year after year, while another mother goes without health care for her sick child. That's why we have to put an end to the division and distraction in Washington, so that we can unite this nation around a common purpose, a higher purpose.

While listening to one of his speeches, you might indeed experience an epiphany and realize that you have to vote for Barack Obama, but he is not trying to spark a companion epiphany that you should also vote for other Democratic candidates. It is true that he appeals to conservative-minded pundits such as Andrew Sullivan, David Brooks, George Will, and the New Hampshire Union Leader, but it is not because they've suddenly become liberal--rather, it is because they perceive that Obama himself is not, or at any rate, is not particularly committed to liberal values. They are not now Democrats; at the most they are that other creature of Obama's creation--the Democrats-for-a-day.

In contrast, the right way is exemplified by another barn-burning, roof-raising convention speech, that of Mario Cuomo at the 1984 convention in San Francisco. This was truly a speech for the ages--a bold, unapologetic, emphatic affirmation of the Democratic Party and its values. It is worth watching in its entirety (a long excerpt and full transcript is available at http://www.americanrhetoric.com/speeches /mariocuomo1984dnc.htm), but here is a clip and a few key excerpts:

What's the difference between the Democratic and Republican parties?

It's an old story. It's as old as our history. The difference between Democrats and Republicans has always been measured in courage and confidence. The Republicans -- The Republicans believe that the wagon train will not make it to the frontier unless some of the old, some of the young, some of the weak are left behind by the side of the trail. "The strong" -- "The strong," they tell us, "will inherit the land."

We Democrats believe in something else. We democrats believe that we can make it all the way with the whole family intact, and we have more than once. Ever since Franklin Roosevelt lifted himself from his wheelchair to lift this nation from its knees -- wagon train after wagon train -- to new frontiers of education, housing, peace; the whole family aboard, constantly reaching out to extend and enlarge that family; lifting them up into the wagon on the way; blacks and Hispanics, and people of every ethnic group, and native Americans -- all those struggling to build their families and claim some small share of America. For nearly 50 years we carried them all to new levels of comfort, and security, and dignity, even affluence. And remember this, some of us in this room today are here only because this nation had that kind of confidence. And it would be wrong to forget that.

So, here we are at this convention to remind ourselves where we come from and to claim the future for ourselves and for our children. Today our great Democratic Party, which has saved this nation from depression, from fascism, from racism, from corruption, is called upon to do it again -- this time to save the nation from confusion and division, from the threat of eventual fiscal disaster, and most of all from the fear of a nuclear holocaust.

What about the president, Ronald Reagan?

Because the truth is, ladies and gentlemen, that this is how we were warned it would be. President Reagan told us from the very beginning that he believed in a kind of social Darwinism. Survival of the fittest. "Government can't do everything," we were told, so it should settle for taking care of the strong and hope that economic ambition and charity will do the rest. Make the rich richer, and what falls from the table will be enough for the middle class and those who are trying desperately to work their way into the middle class.

And, ladies and gentlemen, please think of this -- the nation must think of this: What kind of Supreme Court will we have?

Please. [beckons audience to settle down]

We -- We must ask ourselves what kind of court and country will be fashioned by the man who believes in having government mandate people's religion and morality; the man who believes that trees pollute the environment; the man that believes that -- that the laws against discrimination against people go too far; a man who threatens Social Security and Medicaid and help for the disabled. How high will we pile the missiles? How much deeper will the gulf be between us and our enemies? And, ladies and gentlemen, will four years more make meaner the spirit of the American people? This election will measure the record of the past four years. But more than that, it will answer the question of what kind of people we want to be.

What have the Democrats ever done?

Now for 50 years -- for 50 years we Democrats created a better future for our children, using traditional Democratic principles as a fixed beacon, giving us direction and purpose, but constantly innovating, adapting to new realities: Roosevelt's alphabet programs; Truman's NATO and the GI Bill of Rights; Kennedy's intelligent tax incentives and the Alliance for Progress; Johnson's civil rights; Carter's human rights and the nearly miraculous Camp David Peace Accord.

Democrats did it -- Democrats did it and Democrats can do it again. We can build a future that deals with our deficit. Remember this, that 50 years of progress under our principles never cost us what the last four years of stagnation have. And we can deal with the deficit intelligently, by shared sacrifice, with all parts of the nation's family contributing, building partnerships with the private sector, providing a sound defense without depriving ourselves of what we need to feed our children and care for our people. We can have a future that provides for all the young of the present, by marrying common sense and compassion.

We know we can, because we did it for nearly 50 years before 1980. And we can do it again, if we do not forget -- if we do not forget that this entire nation has profited by these progressive principles; that they helped lift up generations to the middle class and higher; that they gave us a chance to work, to go to college, to raise a family, to own a house, to be secure in our old age and, before that, to reach heights that our own parents would not have dared dream of.

Mario Cuomo would never say that Reagan helped curbed the excesses of the 1960s and 1970s, or that he brought the nation a return to clarity, dynamism, and entrepreneurship. He would not ever buy into the Republican meme that government had grown and grown without accountability. He would not portray universal health care as the government forcing you to buy something you can't afford. He would not say that the GOP has been the party of ideas. He wouldn't say that Democrats and Republicans are equally to blame for the lack of progress in Washington. He would understand that to truly build the Democratic Party and to truly get the kind of liberal progress we so badly want and need, we can't just tell people to elect us to work with Republicans--we have to convince them that the Democratic Party is the party of progress, the party of better ideas, and the party whose vision for our country is the one that they share. That's the kind of candidate I want leading my party--our great Democratic Party.

In his very moving diary of two months ago, markjay gave four reasons he was supporting Hillary Clinton, one for each of his four children.

http://www.mydd.com/story/2007/12/18/192 841/33

I'll let his words do the speaking for his oldest son:

Our first son was born in 2002, after several years of infertility.  It was the happiest time of our life.  But everything came crashing down in August 2003 when, at the age of 10 months, he died in my car in circumstances I can't even bear to recount.  I swore to myself that I would do whatever I could to prevent other families from facing this kind of tragedy.

I got involved in a group called Kids and Cars, which works to prevent children dying from non-traffic automobile incidents, such as kids being backed over by vehicles, trapped in power windows, or inadvertently left in cars.  Hundreds of children a year die from these incidents, and most of them could be prevented by simple, inexpensive safety technologies.  However, like many safety devices used today, such as seat belts or air bags, the car manufacturers are resisting them.  And the National Transportation Safety Association (NTSA) doesn't even monitor these types of non-traffic incidents, let alone work to prevent them.  Kids and Cars has been working for years to get national legislation past mandating that the NTSA monitor these incidents and investigate safety devices that could prevent them.

It's been tough going, but there has been one Senator (out of 100) who has sponsored this legislation year after year, and worked tirelessly with her staff to try to get it through.  Yes, that's Hillary Clinton.  We came close last year, and we are in excellent position this year.  There are now 36 co-sponsors (including 7 Republicans, and including presidential candidates Chris Dodd, Barack Obama, and John McCain, for the Senate Bill Hillary has sponsored, S. 694, the Cameron Gulbransen Kids and Cars Safety Act of 2007, and its companion bill, H.R. 1216 is also making progress.  (The Consumers Union has set up a site where you can easily send a message to your House and Senate members asking them to support this legislation.)

So, in memory of our first son, I am proud to support the Senate who quietly and without fanfare has worked so that other children like him will not needlessly die.

Well, that bill has now passed both the House and Senate, and is on its way to be signed into law by President Bush. Best wishes to markjay for seeing this legislation finally make it through Congress, and thanks to Hillary Clinton for getting it done.

In the end, this is what politics is supposed to be about. Thank you for making a difference, Senator Clinton.

There have been a number of rather substance-free diaries hitting Obama of late, including even a rehash of the infamous Muslim email. I'm therefore a little reluctant to post this one, since I feel like he deserves a bit of a break. But I came across something that helped me clarify some of the concerns I have about his campaign.

Via Taylor Marsh comes this comparison of the very similar campaign speeches of Deval Patrick and Barack Obama. (I know Marsh proudly calls herself a Clinton partisan, so I understand that Obama supporters will take the following with a helping of salt.)

Marsh's point is that the similarity brings into question the authenticity of Obama's speech and sentiments, but that's not the point of this diary. For what it's worth, Obama's campaign has relayed a statement from Patrick in which Patrick praises Obama for the language in his speech. I'd like to focus more on what Obama said:

"Don't tell me words don't matter. 'I have a dream.' Just words. 'We hold these truths to be self evident. That all men are created equal.' Just words. 'We have nothing to fear but fear itself.' Just words. Just speeches."

Obama is trying to rebut Hillary Clinton's claim that he offers only words and speeches, not action and solutions. That's perfectly understandable and reasonable. But the way he's doing so crystallizes one of the nagging doubts I have about him, and one reason I come up short when I try to be more enthusiastic about him--namely, I'm afraid that his campaign is too much about him, and how essential and indispensable Obama himself is, as opposed to his ideas or policies.

Let's look at the examples Obama uses: There's Martin Luther King's "I Have A Dream" speech, Thomas Jefferson's words from the Declaration of Independence, and the famous line from FDR's first inaugural. All of these are taken from hugely momentous times in history, as rhetorical impetus to great causes--the civil rights movement, the American Revolution, and restoring a nation during the Depression. (FDR's line is also often associated with World War II, and Obama may mean it in this way, but FDR said it long beforehand.)

Let's leave aside now that all of these great causes reached success through the very hard work and sacrifices of thousands or millions of people. (My own guess is that only Jefferson's words were critically important, because they were written into a nation's founding document. The eloquence of King's speech has almost overshadowed how much sacrifice and suffering he went through as a leader of the movement. Had he not led by actions, his words would have had much less credibility.)

I don't mind Obama implicitly comparing his own words and oratory to these. It sounds to me as if he's offering respect and admiration to the others. What bothers me is the implicit comparison between the cause and purpose of his rhetoric and those of the others. Obama makes his speeches so that people will vote for him. There's nothing wrong with that. But that's simply not in the same universe as the grave purposes in the minds of King, Jefferson, and Roosevelt. King and Jefferson were giving the moral case for freedom, whether in the segregated South or in the American colonies; Roosevelt was trying to encourage a suffering nation. It's unsettling to hear these goals put on the same level as someone trying to win an election.

I suppose one could argue that the purpose behind Obama's speeches isn't just getting him elected, but what he plans to do after he becomes president. Perhaps Obama means that as King's words urged Americans to examine their consciences and fight for equality and freedom, Obama's words are not merely urging people to vote for Obama, but to help realize Obama's goals as president. Even so, the implication that the way to achieve this is to vote for Obama is bothersome. It casts Obama as the indispensable tool of his "movement", not merely a messenger. This echoes the often expressed concerns about a perceived messianic tone from the Obama campaign.

To be fair, Obama does say the right thing a lot of the time, about how change comes from the bottom up, not the top down. I'm much more comfortable when he talks like that. Given that it's now more likely than not that he'll be our party's nominee, I hope he tries to do that more often.

What can we learn from the Massachusetts universal health care experiment?

Second in a series of long-winded diaries on health care policy by a non-expert. The first diary, on how well a plan without mandates might work, is here.

As everyone knows, Massachusetts is currently trying to implement a statewide universal health care plan that works partly by requiring state residents to buy health insurance (or obtain an exemption). Since there is fundamental disagreement between Barack Obama and Hillary Clinton over whether mandates are necessary to achieve universal health care, the Massachusetts example is often cited in policy arguments, usually by Obama supporters who claim that it is failing, and that mandates are therefore a bad policy idea.

Is that really the case? I wasn't well-informed about this, so I went to do some research about how the Massachusetts plan works, what its results are, and whether this has implications on how well a Clinton/Edwards style plan might fare in the real world.

What the Massachusetts plan does and does not do.

The Massachusetts health care plan was passed in April 2006 with overwhelming bipartisan support and the approval of then-Gov. Mitt Romney. Among other things, it provided for the following:

• An individual mandate. Massachusetts residents must show that they had health coverage as of Dec. 31, 2007, or lose a $219 exemption on their state tax returns.


• Subsidies for low-income residents. The state created Commonwealth Care to provide subsidized no-deductible insurance for those earning less that 300% of the poverty level who do not have access to health care through their employer or through MassHealth, the state's Medicaid program. Premiums are based on a sliding scale that reaches zero at 150% of the poverty level. This was accompanied by an expansion of MassHealth as well.


• Employer requirements.Employers with more than 11 employees must either offer health plans or pay the state a fee of up to $295 per employee per year.


• An insurance connector.The law established a Commonwealth Health Insurance Connector that connects individuals and small businesses with state-approved private insurance plans. This helps combine the buying power of the purchasers, and also allows people to keep their insurance even if their employment changes.

Thus, while the Massachusetts plan shares an individual mandate with the Clinton plan, it is more limited in several significant ways, most likely as a result of the huge disparity of power between federal and state governments. Among other things, the Massachusetts plan does not have the following items in the Clinton plan:

• A new public plan based on Medicare. Clinton's proposal would establish a new public health insurance program that would compete directly with private insurers.


• Strong new requirements for insurance companies. Insurance companies must accept any applicant who is able to pay their premiums, regardless of risk, and must renew coverage automatically for any patient. Premiums could vary based on age, gender, and occupation, but the amount of this variation will be regulated.
  
• Subsidies for low-income citizens. Through the use of a refundable tax credit, no person will have to spend more than a certain fraction of income on insurance.
  

The Clinton proposal also includes a wide range of other initiatives to reduce the cost of providing health care, such as the use of electronic medical records, that are not as directly relevant to this discussion.

To summarize, the Massachusetts plan combines an individual mandate with subsidies for the poor. It does not, however, create a generally available public insurance plan, nor does it do much to reform the insurance industry by requiring insurers to accept all new patients at fairly regulated premium prices, both of which are key components of the Clinton plan. More simplistically, the Massachusetts plan combined a stick with a few carrots. Clinton's plan adds more carrots.

How is the Massachusetts plan working?

Perhaps out of awareness of the size and complexity of its mission, the Massachusetts plan has a long ramp-up period and measured goals: the stated intention was to cover 95% of the uninsured within three years.

Despite being enacted in April 2006, it was not until Dec. 31, 2007 that state residents faced any penalty for not having insurance. Prior to enactment, it was estimated that Massachusetts had roughly 500,000 uninsured residents. Of these, 100,000 were eligible for MassHealth, but had not signed up. (To me, this is a good argument that not having a mandate is problematic--we have 100,000 people who could have had insurance who simply didn't.) Another 200,000 did not qualify for MassHealth, but were too poor to buy insurance. The Massachusetts plan covers them with subsidies; the Clinton plan would as well. This group of people is believed to make up most of the uninsured nationally. Finally, there were 200,000 people who could afford to buy insurance, but simply chose not to. These are the targets of the mandate. Under Clinton's program, they could but into either the public plan or any private plan.

As of this writing, it has been less than two months since the original deadline for buying health insurance in Massachusetts. The Commonwealth Connector estimates that some 300,000 people have become newly ensured since the passage of the law. A third of these acquired private insurance, while the remainder obtained subsidized coverage through MassHealth or Commonwealth Care. By most accounts, this appears to be a reasonable first step--already Massachusetts has halved the number of uninsured.

Criticism of the program has come for several reasons. From those opposed to mandates, there is the mention that some 60,000 people earning over 300% of the federal poverty level were exempted from buying insurance, since they couldn't find any affordable policies. I'm not clear on why this is--perhaps these people have pre-existing conditions that make their premiums too high? If this is the case, then Clinton's new insurance regulations will make plans affordable. In any case, this appears to be more of a problem with not having enough subsidies rather than the concept of mandates. Certainly removing the mandates would not help these people get insurance. There is also the criticism that the costs of the Massachusetts program have grown more than expected. As far as I can tell, this is because the program has been almost too successful in signing up residents for subsidized care.

Conclusions

The Massachusetts experiment is still in its infancy, and in any case is sufficiently different from the Clinton plan that it is hard to draw any firm conclusions from its experience. While apparently generally successful, there are some cautionary notes on applying this nationally. Massachusetts is a fairly wealthy state that began with a relatively small uninsured population (about 10% of the population, compared with 16% nationally). On the other hand, of the problems that Massachusetts is facing, I'm not certain that any of them are being caused by having mandates. The worst that one can say is that mandates have not completely solved the problem in their first few months of existence. It is also very possible that Clinton's proposal, with its strong new insurance regulations and the creation of a private plan, would go a long way towards reducing the number of people who have to be exempted from coverage.

Overall, then, my tentative conclusion is that the Massachusetts results in fact bode well for the idea of an Edwards/Clinton style shared responsibility program.

Sources
Springfield Republican: Report: New health care law is working
Hillary Clinton's health care plan
Business Week: In Massachusetts, Health Care for All?
NYT: Massachusetts Universal Care Plan Faces Hurdles
Massachusetts Health Connector
NPR: Romney's Mission: Massachusetts Health Care
Kaiser Family Foundation: Massachusetts Health Care Reform Plan - An Update

How well will a no-mandates plan work?

Those of you who have spent too much time on MyDD know that my main issue in this election is health care. I think substantially improving our health care system (ideally by implementing universal health care) is the most important thing we can do, from both a policy and political viewpoint.

There have been a lot of heated arguments about whether a plan involving individual mandates (such as that offered by Clinton, Edwards, Richardson, and Dodd) would end up covering everyone. That's not the point of this diary.

Here, I want to discuss how well a plan without individual mandates, such as Obama's, might work if passed. Given that he's the odds-on nominee at this point, it is more than idle speculation.

Hillary Clinton's campaign, citing work by several independent experts, says that without a mandate, Obama's plan will leave 15 million people uninsured. In fact, without mandates, the models say that 23 million people would be uninsured, but Obama's mandate for children reduces this to the widely quoted 15 million. To put this in perspective, right now about 84% of Americans have insurance; using these numbers, that would climb to 95%. In other words, the number of uninsured will still be 1/3 the current number, which seems unacceptably large to me, especially as a starting point for negotiations.

Obama himself repeatedly claims that he would cover "everyone", arguing that once health care is affordable, everyone will sign up. David Cutler, one of his top health care advisers, says that Obama's plan could result in coverage as high as 98-99% of the population. This seems to be more of an intuition than a calculation, at least based on the source I saw for this (after following the link, scroll to the bottom, where this figure is an "internal calculation." This seems to mean that around 90% of the currently uninsured will buy insurance once it becomes more affordable.

Is this plausible?

I can see two arguments against this. The first argument, which I wish to leave aside, is the frequently mentioned problem of adverse selection and free riders. Under Obama's plan, insurance companies will be required to provide coverage to all comers regardless of risk or pre-existing conditions. Thus healthy people who are already insured will have an incentive to drop their coverage, saving themselves the premiums until they become sick, at which point they can sign up without penalty. This could drive down the number of insured, though I haven't seen any estimates for how much, possibly because no insurance company could survive this kind of market in the real world.

The second argument is what I want to discuss. Let's even suppose that Obama's plan passes Congress intact. Will there still be people who can afford insurance and not get it, simply out of poor planning, lack of awareness, or procrastination? These people are not actively trying to game the system, but they might do so passively, since they'll only get around to getting insurance after they get sick.

This may sound unrealistic--why would people not get insurance even if it were affordable? The answer is simply that people just aren't good at doing what's best for themselves, even when the choice is much more obvious than it would be for buying health insurance. As the centerpiece of my argument, let's take a look at employee 401(k) plans.

People leave free money on the table at work. Why should we expect them to do better with health insurance?

Many companies that have 401(k) plans offer a company match--typically, for every dollar put into the plan by an employee (up to 6% of salary), the company will contribute 50 cents. This is as close to free money as it gets--you can give yourself a 3% bonus every year by investing at least 6% of your pay in your 401(k). If people were rational, 401(k) participation rates would be nearly universal. Are they? Um, no. Not even close. Studies show that 401(k) participation is surprisingly low--one study showed that 39% of employees did not contribute anything at all, and 40% of those who did left money on the table by not maxing out the company match.

One explanation is that some people had other things to do with their pay than to contribute to their retirement, even at an instant 50% return. After all, you can't withdraw that money without penalty until much later, and perhaps you have to pay down debt right now. I'm not sure that this explains it, but even if it does, a strong case can be made that people willing to make this tradeoff would do the same thing with the money they might use to buy health insurance. If they're consciously choosing to pass up a huge rate of return, it would seem that they'd also pass up the idea of buying insurance, especially if they can do so later without penalty when they actually need it.

Strong evidence that low participation is a result of ignorance or laziness comes when you examine employees who are at least 59 1/2 years old, for whom there would be no penalty for withdrawal. These folks can put money in, almost immediately get a 50% return on it, and then withdraw it for free. The only easier way of getting money for nothing would be for your boss to drop a sack of cash on your desk. And yet 40% of even these people did not take maximum advantage of their 401(k) plans.

What's the conclusion? I'm not a trained economist, but it seems to me that if nearly 40% of employees who have access to a 401(k) plan are not accepting free money from their companies, it's hard to believe that 90% of the currently uninsured would get around to actually paying out of pocket for insurance, especially since they can always get it later when they really need it. Keep in mind that 1) people who have company 401(k) plans are probably better-informed on average than the general population, 2) the currently uninsured are likely to be poorer than average and presumably less inclined to spend money, and 3) it's often easier to sign up for a 401(k) plan than to figure out how and where to buy health insurance.

So there's my argument. My fear is that under Obama's plan, the number of uninsured will decrease somewhat, but remain stubbornly high--perhaps at the 15 million people range. Without a mandate, people simply will not sign up, even if it's obviously in their best interest (which it may not be, since free riding is an attractive option). Will a mandate solve things? That's another debate, though I think they'll be more effective than skeptics think, since by and large Americans tend to follow the law, even when it's not strictly enforced (you don't litter, do you?).

So if you disagree, feel free to tell me why I'm wrong, and why a voluntary plan without mandates will be more effective than I think.

To me, health care is the single most important issue in this election. Implementing a universal health care plan is the one thing we can do to vastly improve the lives of millions of Americans. So I thought I'd share the following rather stirring case for universal health care, which I happened to stumble across while researching the topic. It's been excerpted, and in some parts, lightly edited for length:

In the 2008 campaign, affordable, universal health care for every single American must not be a question of whether, it must be a question of how. We have the ideas, we have the resources, and we will have universal health care in this country by the end of the next president's first term.

I know there's a cynicism out there about whether this can happen, and there's reason for it. Every four years, health care plans are offered up in campaigns with great fanfare and promise. But once those campaigns end, the plans collapse under the weight of Washington politics, leaving the rest of America to struggle with skyrocketing costs.

For too long, this debate has been stunted by what I call the smallness of our politics - the idea that there isn't much we can agree on or do about the major challenges facing our country. And when some try to propose something bold, the interests groups and the partisans treat it like a sporting event, using fear and divisiveness and other cheap tricks to win their argument, even if we lose our solution in the process.

...

And yet, in recent years, what's caught the attention of those who haven't always been in favor of reform is the realization that this crisis isn't just morally offensive, it's economically untenable. For years, the can't-do crowd has scared the American people into believing that universal health care would mean socialized medicine and burdensome taxes - that we should just stay out of the way and tinker at the margins.

[R]egardless of what combination of policies and proposals get us to this goal, we must reach it. We must act. And we must act boldly. As one health care advocate recently said, "The most expensive course is to do nothing." But it wasn't a liberal Democrat or union leader who said this.

It was the president of the very health industry association that funded the "Harry and Louise" ads designed to kill the Clinton health care plan in the early nineties.

The debate in this country over health care has shifted... And so Washington no longer has an excuse for caution. Leaders no longer have a reason to be timid. And America can no longer afford inaction. That's not who we are - and that's not the story of our nation's improbable progress.

Never forget that we have it within our power to shape history in this country. It is not in our character to sit idly by as victims of fate or circumstance, for we are a people of action and innovation, forever pushing the boundaries of what's possible.

Universal health care as a core Democratic value. No more caution. No more timidity. No more caution. We must propose something bold, and fight back against those who would try to oppose it using fear tactics and Harry and Louise-style ads. An appeal to our national spirit of accomplishment. Exactly what I want to hear.

Now is the time to push those boundaries once more. We have come so far in the debate on health care in this country, but now we must finally answer the call first issued by Truman, advanced by Johnson, and fought for by so many leaders and Americans throughout the last century. The time has come for universal health care in America.

--Senator Barack Obama, January 25, 2007.

Whatever happened to the person who said all this? Somewhere between then and now, that person turned into the one who is now sending out misleading mailers based on Harry and Louise, denying that he was ever in favor of single-payer, raising the specter of government intrusion and burdensome payments, and promoting a plan that is in some ways less ambitious than those of Mitt Romney and Arnold Schwarzenegger.

As Paul Krugman wrote in his blog the other day, a dream is dying. And for some terribly cruel reason, this time it is dying not at the hands of an implacable Congress--it is dying in the Democratic primary.

Just like that, it's January 7 again. On that Monday night, reporters and pundits were gleefully predicting a humiliating defeat for Hillary Clinton in the New Hampshire primary, after which the media momentum would gravely wound her campaign. Rumors flew about campaign shakeups, or even a withdrawal. But then something shocking happened--the voters of New Hampshire made up their own minds. Taking control of the primary process from the media, they gave Hillary Clinton one of the biggest upsets in recent primary history. Much to the media's chagrin, she lived to fight for another month.

Now Monday, February 4 is the new eve of reckoning. Once again, the media is writing the story of Hillary Clinton's imminent demise. Tomorrow, they say, the voters will go to the polls and deliver an ambiguous result. Barack Obama, having survived Clinton's best chance of finishing him, will ride a wave of momentum into the remaining contests and sew up the nomination. Once again, unless the voters take control of the primary process again, the media will crown its desired winner.

The extent of the media's cheerleading for Obama has been startling to watch. Even to someone who watched their demolition of Al Gore (wooden, lies, exaggerates, etc.) and their complicity in the swiftboating of John Kerry, their behavior this time is surprising.

In a previous diary (link here), I listed numerous instances in which independent media critics noticed that reporters simply hate the Clinton campaign. These included Craig Crawford saying that the media's bias against Hillary Clinton "borders on mental illness", quotes from Time's Mark Halperin saying that reporters are cheering for Obama, E.J. Dionne acknowledging an "old, irrational Clinton hatred" in the media, and one reporter unabashedly noting that they were "giddy/relieved" that they wouldn't have to cover Hillary Clinton in a general election.

I wish that those instances were comprehensive. But indeed, a whole batch of new examples has emerged in just the last few days.

For example, Howard Kurtz pretty much flatly states that the media's adoration of Obama caused them to completely overplay the Ted Kennedy endorsement:

When Ted Kennedy backed John Kerry for president in 2003, no major newspaper outside Massachusetts bothered to cover it, and even the Associated Press kissed off the event with a 200-word item.

When Ted and Caroline Kennedy gave Barack Obama their political blessing last week, it was treated as the second coming of Camelot: live cable coverage, lead story on all the newscasts, anchors intoning the old JFK line that "the torch has been passed."

Why the difference? The liberal lion's embrace of the rookie senator seemed to wave away objections about Obama's inexperience... But it would be hard to overstate the excitement of many journalists too young to have covered the Kennedy presidency, who see Obama as a charismatic champion of another New Frontier...

"The endorsement included two things that media people like: Barack Obama, and the memory and glamour of the JFK years," says Slate writer John Dickerson.

Roger Simon, a Politico columnist, says "It was a huge, emotive outburst for the candidate who's won a lot of hearts in the press corps already."

If Kennedy had backed Clinton instead, it's hard to imagine he would have drawn the same blowout coverage as did his appearance with Obama at American University... Indeed, Clinton's endorsement by Robert Kennedy Jr. and Kathleen Kennedy Townsend was relegated to a mere footnote.

You know things are bad when even conservatives are feeling that Hillary Clinton is getting a raw deal. Quoting from Kurtz's article, Rich Lowry of the National Review says:

"[T]he press hates Hillary. There's real glee over the prospect of being done with the Clintons."

You don't have to look much farther than today's New York Times for the double standard applied to the two candidates. First, in describing Hillary Clinton's speaking style, the reporter actually criticizes her for talking too much about policy:

When Hillary Rodham Clinton speaks to large audiences, be it a rally with several thousand students or a fund-raiser with well-heeled donors, she often sounds more like a senator than a presidential candidate -- delivering wonky recitations of her policy positions instead of a raise-the-roof stemwinder.

[At an event in San Francisco, she] delivered what sounded like a university lecture, analyzing domestic and foreign policy issues and laying out her plans for tax credits, health care and education reform.

"Hillary Clinton can dismiss soaring oratory all she wants, but it works and there is a time and a place for it, such as Friday night in San Francisco," said Ruth Sherman, a political communications consultant who has been tracking Mrs. Clinton's speeches. "When she cannot drop her prepared remarks in favor of what the moment dictates, it bespeaks a tin ear, a lack of flexibility and certainly a missed opportunity."

In other words, her affinity for policy details is actually a negative. She should deliver soaring oratory and raise the roof.

What about Barack Obama? In a rapturous article about his speaking style, we find this nugget:

The cerebral, soft-spoken speeches that sustained him for months -- shaped to prove Mr. Obama's seriousness -- have given way to energetic words of motivation that are typically interrupted every few sentences by applause.

So when Obama talks policy, he is cerebral and serious. For Clinton, it's a character flaw that reveals her tin ear and inflexibility.

Actually, a side-by-side reading of the two articles--run in the same paper on the same day--shows exactly what Hillary Clinton faces in her campaign.

The media first killed off Chris Dodd, Joe Biden, Bill Richardson, and finally John Edwards with benign neglect. They failed to knock off Hillary with malicious intent earlier, and are now one day away from succeeding in their second try, having labeled Hillary as a race-baiting liar while lavishing plaudits and praise on Obama. Can the voters again fight through the relentless media drive? I hope they can, but fear that's it's too much this time. New Hampshire voters are famously independent and wary of the press, but nobody can successfully fight the press for that long.

Does this fawning press coverage guarantee an Obama win in November? Let's just say that those whom the press wish to destroy they first give good coverage.

A very discouraging thought came to me recently. Is it possible that deep in its heart, the Democratic Party doesn't want to push for universal health care?

We all know that Republicans have certain issues that they pretend to care deeply about in order to get votes. The viciously anti-gay Federal Marriage Amendment, for example, had no chance of passing Congress, but it was useful politically. I doubt that the big GOP honchos were the slightest bit disappointed when it failed. The same is true with their draconian ideas on mass deportations of illegal immigrants, or their attempts to implement a flat tax, or possibly even to ban abortion. These issues have great value to the Republicans as campaign tools, but they either don't genuinely care about the issue or care so little that they're not willing to take the risk of pushing them.

Now the question is if the Democratic Party really cares about universal health care? Is it in fact a core Democratic principle, as Hillary Clinton says, or is it only something to be used as a talking point while we play it safe politically?

What brought this up to me was the reaction of our party elders to this year's presidential primary. Among our presidential candidates this year, Chris Dodd, John Edwards, Hillary Clinton, Bill Richardson, and Dennis Kucinich each proposed some version of universal health care (Kucinich advocates a single-payer system while the rest favor individual mandates). In contrast, Barack Obama not only leaves mandates out of his proposal, but is now actively campaigning against them, using conservative framing about government "forcing" people to buy insurance they can't afford. He's created a highly unpleasant situation in which President Barack Obama will be politically unable to ask for universal health care, and in which Senator Barack Obama's words will be used to attack President Hillary Clinton's universal health care plan.

And yet the Democratic elders are rallying to him in the days leading up to Super Tuesday. Not only have Ted Kennedy and John Kerry endorsed him, they are out campaigning for him. Two of Nancy Pelosi's confidants in the House, Reps. George Miller and Anna Eshoo, both of the San Francisco area, have endorsed him as well. No doubt they all have their reasons, and possibly good ones. But it's hard to escape the conclusion that if their candidate prevails, universal health care will be delayed again, likely for President Obama's entire administration. All of these establishment figures must know that this may be our only chance for a long while--if all goes well, this year will be the first time in 14 years that the planets will align with a Democratic Congress and president. Given the cyclical nature of American politics, it may be another lengthy wait for the next opportunity.

Is it possible, then, that the Democratic establishment would prefer not to try to pass universal health care in the foreseeable future? I don't have much doubt that if we could wave a wand and have universal health care magically appear, we would do so. But it appears that after the failed effort of 1994 and subsequent loss of Congress, many of our party leaders prefer to avoid trying again. It's not important enough to run the political risk. Like banning abortion for the Republicans, passing universal health care is for Democrats a holy grail that we deliberately keep out of reach.