My post from a couple days ago, about how my instincts about Howard Dean from 2004 have been vindicated, made me think of something: Just how awful was the 2004 Democratic primary field? Go through the list, and try to imagine any of these men as a presidential nominee, let alone (shudder) a president:

One way to judge the health of our political system is to divide the president’s agenda into three categories. First are the items that seem like they’d be hard to accomplish and actually are hard—health care reform and cap-and-trade come to mind. Then come the items that sound easy to the uninitiated but turn out to be pretty hard—like eliminating wasteful farm subsidies or obsolete weapons systems. Lots of presidents have taken on these programs only to find that they have powerful, well-organized defenders. Finally, there are some legislative goals that sound easy to accomplish, and normally are easy, until some unique brand of dysfunction intervenes—say, some senator takes a special interest in an obscure appointment.

Trenchant political analysis, from Senator Evan Bayh:

If you lose Massachusetts and that’s not a wake-up call, there’s no hope of waking up. ... It’s why moderates and independents even in a state as Democratic as Massachusetts just aren’t buying our message. They just don’t believe the answers we are currently proposing are solving their problems.  That’s something that has to be corrected. ... The only we are able to govern successfully in this country is by liberals and progressives making common cause with independents and moderates. Whenever you have just the furthest left elements of the Dem party attempting to impose their will on the rest of the country -- that’s not going to work too well.

I'm sure we'll hear versions of this argument many more times in the coming hours and days. But is it right?

Last time I checked, the "furthest left elements of the Democratic Party" wanted a much bigger stimulus, more aggressive treatment of the financial industry, and a draw-down of troops abroad. Instead, they got a stripped-down stimulus, soft treatment of the banks, and more troops in Afghanistan.

American liberals have a habit of withdrawing into cynicism and ennui at the most inopportune moments. The 2000 presidential election, and subsequent recount, was one such moment.

On "Meet the Press" just now, Howard Dean took a few steps back from the ledge. He said that Harry Reid's manager's amendment improved the bill, by requiring insurance companies to spend more money on patient care and by restoring a little power to the independent Medicare commission.* And while he's still not happy with the Senate health care bill, he focused his remarks on the need to improve it conference committee, even opening the door (ever so slightly) to the possibility of supporting a bill with no public option.

Jacob S. Hacker is the Stanley B. Resor Professor of Political Science at Yale University. An expert on the politics of U.S. health and social policy, he is author, coauthor, or editor of numerous books and articles, both scholarly and popular, including The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream (2006; paperback, January 2008) and Health At Risk: America’s Ailing Health System and How to Heal It (2008).

Now that the core demand of progressives has been removed from the Senate health care bill--namely, the public health insurance option--should progressives continue to support the effort?

For me, the question is particularly difficult. I have been the thinker most associated with the public option, which I’ve long argued is essential to ensuring accountability from private insurers and long-term cost control. I was devastated when it was killed at the hands of Senator Joe Lieberman, not least because of what it said about our democracy -- that a policy consistently supported by a strong majority of Americans could be brought down by a recalcitrant Senate minority.

It would therefore be tempting for me to side with Howard Dean and other progressive critics who say that health care reform should now be killed.

It would be tempting, but it would be wrong.

From a smart, provocative column about Governor Howard Dean and those who think it'd be better to scrap the Senate bill and start over:

For Dean to insist that Senate Democrats start over after that grueling struggle is a little like suggesting that American troops on the outskirts of Berlin in 1945 should have retreated back to France because D-Day wasn't choreographed just right.

Andy Stern, president of the Service Employees International Union, just put out a statement on health care reform. There are few players in the health care debate whose judgment I respect more than his. And he is not happy with what's transpired in the last week.

I wonder if the White House understands the very serious problem emerging on its left. Keep in mind that insiders won't be able to dismiss Stern the way they do Howard Dean. Stern is seasoned. He is shrewd. And he has serious clout.

I'll have more to say soon. Meantime, here is the letter:

When the history of the Obama administration is written, this week may well be regarded as the moment when Democrats’ anxieties crystallized into genuine alarm. Factional fights within the party exploded into public view.

If you are among those who want to "kill the bill," as Howard Dean has proposed, Nate Silver has some questions for you. Here are the first five:

1. Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people?

2. Would a bill that contained $50 billion in additional subsidies for people making less than 250% of poverty be acceptable?

 In a dramatic vote of confidence, Howard Dean—who as recently as last week said a bill without the public option “should be defeated”—helped broker and Continue reading "Dean Joins the Pragmatists"

Created by Ben Bernstein, Noah Kristula-Green, Julie Sobel, and Barron YoungSmith

(Click here to see a full-sized version of the matrix.)

When Joe Lieberman declared on yesterday's “Face the Nation” that no health care reform bill at all would be preferable to one with the public option, he reminded me less of a wannabe John Boehner than a bombast on the other end of the political spectrum: Howard Dean. Like his former opponent, Dean is no stranger to grandstanding for attention.

Organizing for America is a complicated beast, and my story yesterday couldn’t quite contain some of the interesting things about it. For all the activism geeks out there, here are some outtakes.

Time's Karen Tumulty and Michael Scherer have a thoroughly enlightening, and thoroughly depressing, article in the new Time about how the drug industry got its way in health care reform. The industry spends more than $600,000 a day in lobbying, they note. And, from the looks of things, it's money well spent.

The focus of the article is the debate over "exclusivity" for biological drugs--that is, the period during which the maker of a drug can manufacture and sell it without threat of generic competition. Reformers, like Representative Henry Waxman, had been pushing to cut the exclusivity period down to five years. The industry wanted twelve. Guess who won?

The power of special interests is an old story, of course. But the reach of pharma's influence is still something to behold, as it goes well beyond the usual game of campaign contributions and revolving door connections:

When the world last left Wesley Clark in early 2004, he was a streaking meteor of a presidential candidate. Still fresh from leading NATO in the Kosovo war, he arrived as a savior for the left, who saw a bulletproof patriot that the rest of America could believe in; hero of the netroots, beloved by Michael Moore and Madonna; hope of the Clintonites, delighted by such a clean ideological slate.

"You can’t really have reform without a public option," former governor Howard Dean, a prominent public-option advocate, said recently. "If you really want to fix the health care system, you’ve got to give the public the choice of having such an option." Promising as this sounds, it seems increasingly likely that the public option will be a liberal dream deferred. Republicans and conservative Democrats, panicked that the government plan will squash competition and the medical industry as we know it, are slowly killing the idea.

Democracy for America, Howard Dean's group, has (via TPM) launched a campaign to pass health care reform through the reconciliation process. The idea is that while there may not be 60 votes in the Senate to support a public option, there may be 50. And, in the reconciliation process, legislation can pass with just 50 votes, with no worries about rounding up the 60 it takes to break a filibuster.

As discussed here and elsewhere, many times, it's an intriguing idea--and not just because it might make a public option possible. Fifty votes instead of 60 means fewer interests to accommodate. Democratic leaders in the Senate could stop watering down reform in order to appease centrists and Republican Olympia Snowe. With reconciliation, in theory, it'd be possible to get something that looks less like what Senate Finance will take up this week and more like what the House and Senate HELP committees passed over the summer--that is, a bill with better funding, more generous subsidies and financial protection, along with (perhaps) more far-reaching reforms of the medical delivery system. All very good things.

But, within the administration and on Capitol Hill, there seems to be very little interest in trying reconciliation. Over the past week, I've put the question to everybody I know. With a handful of exceptions, even those officials and staff who support more liberal versions of reform told me they didn't think reconciliation was a good idea.

Sheer unpredictability seems to be the main reason.

Suzy Khimm's post at The Treatment about Howard Dean's latest remarks on health care reform strategy shows the perils of the obsession with the public option on both sides of the barricades.  After a fiery demand that progressives refuse to relent on the public option, the good Doctor allowed as how if we can't get that, he'd be fine with legislation that just regulated health insurance abuses. 

Ironically enough, Dean seems to be embracing the same fallback position as his old adversary Joe Lieberman, who's said regulate-only legislation is all he'd be willing to support if a public option is included in a comprehensive reform bill.   The problem, of course, is that absent an individual mandate to bring healthier people into the risk pool, or significant subsidies to lure them in, imposing a national system of community rating or guaranteed access to insurance on behalf of less robust Americans will likely boost private insurance premiums for everybody--not exactly an ideal outcome.

Speaking Tuesday night at Busboys and Poets--homebase for lefties in Obama’s Washington--Howard Dean laid out his health reform game plan for liberal activists. “What we’re going to pass is a bill that includes a public option--the Democrats just don’t know it yet!” he boomed out to rousing cheers and applause.

I'm a bit late getting to this, but over the holiday weekend famous Iraq war opponent Howard Dean visited Fox News Sunday and weighed in on Afghanistan:

CHRIS WALLACE: Governor Dean, the president will reportedly decide in the next few weeks whether or not to send more troops to Afghanistan. As a leader of the anti-war movement when it came to Iraq, will the liberal wing of the Democratic Party will you support the president if he deepens our commitment in that war?

Speaking on Thursday before thousands of activists gathered on Capitol Hill, former Governor Howard Dean made clear his litmus test for health reform: “We expect change,” he told the crowd, “We want a public health insurance option now.”