Is it possible for something to be historic and yet not terribly surprising at the same time? That’s how I feel about yesterday’s healthcare reform vote in the U.S. House. 

Democrats got their shit together — OK, I guess it was a bit surprising — and passed the thing. Predictably, this was met with handwringing by the likes of Republican Tim Murphy, who lamented that, “A long time ago people stopped communicating and doors closed … [W]e have to make sure this is not a moment that divides America.”

(Note to Rep. Murphy: If you’re worried about divisivenes, you might want to talk to the Tea Partiers. A Philly-based chapter of the movement sent out a blast e-mail observing that a pollster “has called the partisan vote ‘a political Jonestown.’  We think that’s an understatement.” An understatement? How is alluding to the mass suicide of more than 900 people an understatement?)

Anyway, Democrat Mike Doyle voted for the measure, predictably. And Jason Altmire, predictably, voted against it.

I say “predictably,” though a lot of folks were upset by Altmire’s decision. But the conventional wisdom is that party leaders gave Altmire a quiet go-ahead to vote “no” on the measure. After all, as Nate Silver notes, the most useful factor for predicting how a Dem would vote on this issue was how Obama did in his or her district back in 2008.

In every district where Obama got less than 40 percent of the vote, the Democrat voted against healthcare reform. In districts where Obama got between 40 and 49 percent of the vote, the odds of a Dem voting against the bill were two-in-five. 

In Altmire’s district, Obama took 45 percent of the vote, so he was right on the bubble.

Even if you regard Altmire’s vote as cowardly, though, you have to admire the guy’s finesse. His statement in opposition to the bill is a masterpiece. It begins with Altmire fretting over costs:

I ran for Congress in large part because I believe we need to find a way to bring down the cost of health care … [While] the cost of inaction on health care is great, … it would be an even bigger mistake to pass a bill that could compound the problem of skyrocketing health care costs.

Such bottom-line concerns are utterly consistent with what Altmire has been saying since last summer. Say what you want, the guy didn’t flip-flop. (Of course, that’s partly because you can’t flip-flop unless you first take a position one way or the other.) 

Altmire follows with some blather about how the reform creates “winners and losers” — as if the current system doesn’t do the same thing — but then hits his stride again. 

It has become clear that the vast majority of my constituents want me to oppose this bill. Particularly hard hit would be western Pennsylvania’s Medicare beneficiaries, which many experts believe would experience dramatic premium increases with enactment of this bill.

That bit about Medicare is a bit of a poser: Medicare recipients could see some improvements in the prescription-drug plan, for one thing, and the American Association of Retired People has been a consistent champion of the measure. But hey, it never hurts to play to the fears of cranky seniors. And truth to tell many of the cost-saving proposals meant to protect Medicare — like reining in fraud and abuse — are easier said than done. 

But my favorite part of Altmire’s statement is this one:

I am acutely aware that my decision to vote against the health care bill will disappoint some of my constituents and alienate supporters of the bill. The politically easy vote would have been to vote with my party.

So just above, Altmire observed that “the vast majority of my constituents want me to oppose this bill.” But taking an overwhelmingly popular position is an act of courage? Not sure that follows. 

Altmire’s probably right that there’s only lukewarm support for this measure in his district. And he’s also consistently said that he couldn’t support a measure that his constituents were strongly opposed to. Give him points for consistency, sure. But courage? Ehhhhh …

This article appears in Mar 18-24, 2010.

E-mail Chris Potter about this post.

8 replies on “Healthcare reform passes, political headaches begin”

  1. I’m glad Jason Altmire went to bat on behalf of Pennsylvania’s insurance companies. It’s about time someone stood up to the working poor.

  3. No offense intended; I just meant that IS a widely accepted explanation. Just ’cause it’s conventional doesn’t make it wrong (says the paper that brings you “Savage Love” every week).

  4. I can see Altmire’s dilemma. He had to play the percentages. Are there more conservative Democrats than liberal Democrats in his district? Are there more conservatives in his district than liberals? The first question addresses the primary, the second the general. My suspicion is that Altmire faces something similar to what Arlen Spector faces, but on a smaller scale. I also suspect that Altmire got it right, that there *are* more conservative Democrats in his district than liberals.

    I also suspect that Altmire is as liberal a Democrat as that district can tolerate right now. So the choice is not between Altmire and someone more liberal, rather it is between Altmire and which ever Republican wins *their* primary. Maybe in ten or twenty years things will be different, but for now, Altmire might be it.

  5. Perhaps your observation was more accurate than some prefer to acknowledge. The Post-Gazette today installed a link to Infinonymous at Early Returns (after an extended period in which several defunct blogs were listed while Infinonymous was not). Are the Infinonyvant-garde days over, and we among the last to know?

  6. @ Ed Heath —

    Yeah, that’s the big question. Polling data and my own encounters in the 4th district have suggested that Altmire may be about as far to the left as a Democrat can afford to be in district 4. Which would mean he isn’t lying when he says his constituents don’t back it. (I’m not sure I agree with Jason Togyer below that this is just carrying water for the insurance companies … though clearly it ain’t a profile of leadership either way.) But it may be I’m letting him off the hook, and in any case I’ve been VERY glad to see union folks holding his feet to the fire. Power concedes nothing without a demand.

    @ Infi, as I’ve told some others in private conversation, you’re my leading choice to pick up the torch the Pittsburgh Comet laid down. Which sort of makes you a quasi-member of the establishment, like the DC representative to Congress or something. Prepare to see your name in “Cutting Edge” on a regular basis.

  7. You wrote: “Such bottom-line concerns are utterly consistent with what Altmire has been saying since last summer. Say what you want, the guy didn’t flip-flop. (Of course, that’s partly because you can’t flip-flop unless you first take a position one way or the other.)”

    How is supporting the payment adjustments to Medicare Advantage plans last summer, thus saving the Medicare program $170 billion over the next decade — talk about “bringing down the cost of health care” ! – and then NOT supporting the payment adjustments to Medicare Advantage, anything but flip-flopping?

    Remember, one of the deciding factors on his NO vote was the “cuts” to Medicare beneficiaries in the district. He’s talking about Medicare Advantage there, conveniently leaving out the donut hole relief they’ll receive very soon.

    Another way of saying Medicare Advantage cuts is “reductions in the over-payments to the likes of the Highmark and UPMC’s Medicare Advantage insurance products,” both of which will now have a business decision to make about how to adjust to getting only 100% of the average fee-for-service beneficiary, instead of 14% more. I don’t know if you or anyone else reading this has access to the New Republic, but back when it was still a fairly important outlet in the mid-90s Matthew Miller wrote an interesting piece on the Medicare managed care model from a business perspective (what later became Medicare Advantage). Called the whole thing an arbitrage opportunity. Dig it up!

    I could put all kinds of academic references in here, but it might get even more tedious (did I mention I wrote my dissertation on this stuff at USC in ’98?). Here’s a more recent (August ’09) LA Times article on the topic that covers a lot: http://articles.latimes.com/2009/aug/19/nation/na-medicare19?pg=2

    But the issue you’re missing here is Altmire claiming to be a health policy expert while flip-flopping on the issue where there is almost uniform agreement regarding the necessary policy adjustment. It would be comical, if it wasn’t so sad. He’s making the baby health policy geeks weep.

    So, you read “finesse” in that statement. Okay. But please report on how most of his grassroots has evaporated in the mean old PA-04.

    I wouldn’t buy the conventional wisdom that he got a pass from leadership on this one. You really think Obama the Organizer in Chief’s three conversations with him ended with letting him off the hook? You think they believe it’s a good idea to have their favorite in-house “expert” going off the reservation to some epistemological wilderness and scaring the old folks in the ‘Burgh? No way Jose.

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