Paul Begala has said hard things to Presidents that needed to be said.  I have a lot of respect for him and think he's very sharp.

That said, I want to quibble with what Josh reported him to have said yesterday: that if there is no health care reform there will be no Democratic majority after November.

I've written at the cafe about my ambivalence about the health care bill.  I think the essential approach taken is one that should leave us unsurprised at the unease about it on the part of many citizens.  I realize that some polls show fairly good support for it.  I suspect that misses the point, however.

My intuition now is that it may not so much be what proportion of those polled who are favorable that is the most significant dynamic right now.  It's who--which demographics--is unhappy with it, in some cases really unhappy with it. This, at any rate, is an empirical question which a further breakdown of polling numbers might be able to resolve.

The mandate to purchase insurance out of pocket is radically different from the social insurance model the designers of Social Security came up with.  With Social Security the idea was that a) you, the worker paid into the fund and were thereby entitled to receive a pension backed by the US government (the latter very tangibly reinforcing a concept of citizenship meaningful to many people), and b) you got it the old-fashioned way, by earning it in the workplace. 

It was (and is) not quite a social citizenship model.  It did not say to participants "You are a citizen of this country and you are therefore entitled to a pension."  You had to participate in the workforce.  But most men at that time assumed that was what they were going to spend their days doing--or at least hoped that would be the case once we got out of the Depression.

It did not have all the features of a universal program. But it felt "pretty universal" in its approach, with the huge exception of those concentrated in the seasonal agricultural worker and domestic worker sectors, by no means a coincidence or an accident. 

My sense--not having checked survey data--is that more Americans today would say that health insurance should be a right of citizenship than would say that a pension should be a right of citizenship.  A right of citizenship would be a step beyond a right accruing to those with an employment history. 

But that's not the approach the mandate to purchase health insurance takes.  The mandate is experienced by those who have difficulty coming up with the out of pocket money as a nosy, intrusive government telling them what to do.

The alternative is to treat health insurance as a right of citizenship, not even requiring an employment history.  And actually talk about it that way.  It comes to you as a result of a) being a citizen and b) being a taxpayer.  That way, you don't experience it as being a burden imposed upon you by your government (a justifiable one or not) but as one of your rights as a taxpaying citizen.  

Call me crazy, but to me, if I'm thinking about a lot of middle-class, working class, and working-poor folks who should be voting Democratic with enthusiasm, the difference between my government telling me I have to come up with money out of pocket I don't have for something it, not not necessarily I, considers a social necessity, versus me receiving, as part of what I get for paying my taxes, health insurance that can never be taken away, is the difference between an offputting message versus the message I would want to hear from a government I trust and believe cares about me.

When it comes to how to design and sell a major social program, I don't fully understand why the current group of politicians has not assimilated this basic lesson from the history of the Social Security program.  The idea for today should be "health insurance that can never be taken away." 

There are a lot of citizens out there who think about things in this way.  An awful lot of them are voters whose votes a peoples' Democratic party, FDR's party, should get.  There are very legitimate reasons for the anxiety about the mandates approach to the health care bill in a country many of whose citizens are disposed to think the worst of government.  The conclusion I draw is that whether or not this approach to health care passes this year is not the most critical factor affecting Democrats' fortunes going forward.

The most critical factor affecting Democrats' fortunes in November is whether we get a major green infrastructure jobs bill (this has to happen asap because it takes time to get the money out and people to work) and action to clean up Wall Street and recoup the deeply offensive bonuses many people on Wall Street arranged for themselves.  Do those two things--or be perceived as having gone down fighting for them and desiring a referendum on them in November if they can't be passed this year--and I think Dems have a fighting chance of getting back the mojo coming out of the 2008 elections.

Retreat back into the shell, fail to push aggressively these measures, and I think Dems' chances in November are dismal.  When it comes to a jobs bill and financial reform, those who self-identify as "left" and those who self-identify as "center" should be pushing all-out for the same measures.  Both types of measures do, or will, command widespread public support.  If the Republicans want to block those, great, we should be elated to run on those issues.  The arguments just about make themselves and they are ones we win.

On HC going forward it seems to me there are broadly two options:

Option A: Pass the Senate bill before Brown is sworn in.  Defend it aggressively and unapologetically, and defend the Democratic party aggressively and unapologetically from the charges that this is Chicago-style politics.  This tactic can only work if there is something close to unanimity among Democratic elected officials to go this route.  If there isn't, it won't work.  Any defense of such actions which appears remotely halfhearted will not work.  The Republicans will smell blood in the voter.  Voters will sense the lack of conviction, the hemming and hawing, the vacillation many are prone to associate with Democrats, and react with disgust.

Option B: This one is well outside the CW and, I admit, not fully baked on important specifics of what a revised proposal would look like.  Some will think it crazy.  I think of it as unconventional.  But we live in times when unconventional actions may need to be taken.  In several steps:

1. The Democratic leadership in Congress strips out the individual mandate to buy and calls to a vote, right after Brown gets sworn in, a bill with as much of the uncontroversially good stuff in the current bill as possible--particularly the very worthwhile and important restrictions on private insurance company practices.   

2. Cast that step as the first step of several necessary for real cost control that will be pushed aggressively this year and next.  The removal of the mandate from the current proposal is cast as Obama and the Dems hearing voters' concerns on that issue while insisting that measures that command overwhelming support be passed now. 

3. Come back, even as soon as late this year, or first thing next year--but after the jobs bill and financial reform votes are taken before November--with the second installment.  This is a revamped health care proposal that starts from a very different premise--that most citizens believe health care that cannot be taken away should be a right of citizenship, something citizens get as part of what we pay for with our taxes.  Finance the expansion of coverage to the currently uninsured with the taxes on upper income brackets of the sort now in the House bill and perhaps the Medicare savings in the current bill as well.  Cast a robust public option as the way we ensure that health care that cannot be taken away is a right of citizenship and not something we let the private insurance lobby have the last word on.  We don't elect insurance company executives to run our country--those who want that can vote Republican or for Senator Lieberman.  Recognize that there may not be enough votes for such a proposal to pass before November, even if the political climate changes for the better for the Dems as a result of the jobs and financial reform bills.  If this can be done through the reconciliation process this year, consider going that route. 

4. If the votes aren't there now, well, this is what we have elections for, to have a debate about what we should do and let the voters decide whether we want to elect people who represent the private insurance lobby, or who represent all of the people of a Congressional district, a state, and our country.  If by November the Republicans have blocked the jobs bill, financial reform, or both, the case will be that much easier to make for re-electing and electing people of whatever party who go on public record in support of the people on these necessary measures.  Those who see it differently can vote for a continuation of a politics as usual that looks out for the fatcats and irresponsible corporations at the expense of all the upstanding and hard-working ordinary Americans who expect nothing more than a government that... 

Something like that.