"If you can't tell me how you'll get to 60 in the Senate"

I can tell you how to get to 60:

Elect a President running on a legislatable UHC plan such as the Edwards/Clinton plan.

We're about 12 months away from universal healthcare, as long as we can win the nomination.

I love Petey's commitment... but I tend to agree with Ezra - the first thing we need to do is get people - more people - to understand the dimensions of the problem (problems, really), and figure out how to get a substantial majority on the same page about a solution. The exact shape of a solution, I'm happy to be flexibile about. But getting there is the challenge. And we're not nearly there yet.

Good stuff, Ezra. Sorry I can't be there to see it. Or hear the discussion.

How is that an argument, Petey? Which Republicans are voting for the Clinton Plan? (And what's the Senate partisan balance likely to look like with Clinton as the nominee?)

Is this where we all ignore what you said and tell you what "the only way" is?

Start by covering all preventative care for everyone. Then add things to the universal coverage bit by bit, rather then cover all and try to figure out later how to control costs by selective coverage. Preventative care is a clear argument, it's in the public good to invest in PC and imporve the health of all and avoid some of the more costly visits later.

"So this is the point: On the left, there's too much policy dogmatism and too much political agnosticism. Too much conviction about what we'll do and not enough thought as to how we'll do it. A smarter strategy would be the reverse: A qualified policy agnosticism mixed with political dogmatism. Before supporting any plan, in other words, you should demand a viable political strategy for its passage. And that means Republican votes, it means interest group buy-in, it means 60 in the Senate. Now, maybe you can get some Republicans on your side because they like your idea, or maybe you're going to make them afraid to oppose it. But either way, you're going to need a couple of them to hit that magic 60."

I agree on the larger point, but I don't think that Republican votes, interest-group buy-in, and 60 Senate votes are the same thing as a viable political strategy.

Taking them in reverse order, I would argue that 60 votes represents the opposite of good strategy on this issue - it allows 41 Republicans to set the terms of the debate, and it sets the bar for unity so high that the most conservative members of our coalition can dictate terms to the rest. Rather, a viable political strategy should revolve around getting 51 votes to push through universal health care through a budget reconciliation bill that's not subject to filibuster, or barring that, 51 votes to abolish the filibuster.

In regards to interest-group buy-in, I think we need to be very careful about not trying to get every interest group, which often leads us spinning in circles. Different interest groups can have opposing interests on health care - small business v. big business, insurers v. providers, etc. Trying to get everyone in together gives you a muddled bill and weak support, such as we had with the Clinton plan. I would suggest, rather, that we divide and conquer - establish a bill that our caucus feels good on, and then go out and grab some interest groups that will support it. Certainly, get the docs and the nurses and the hospitals. But don't expect too much from business, and don't expect too much from the insurers or the pharmas.

Finally, on the Republicans. I don't really see this as the critical issue. Rather, the issue is uniting our own caucus. Let's face it, the Democratic caucus can get REALLY fractious on health care - the single payers especially are hard to keep in the fold, but there will be a lot of Blue Dogs and soft moderates who'll be wobbly. Most important is getting a plan that has strong buy-in from the Democratic caucus, making sure we have tactical unity on pushing it through, getting just enough of the interest groups on our side, then daring the Republicans to stand in the way of the steamroller or get out the way.

Dude, it's HR 676. We expect better from you.

This is not a very good or sensible political strategy. Getting to 60 will only happen at the ballot box. It will never, ever happen unless the numbers of Republicans in the US Senate are reduced below 40, otherwise the things they will demand in exchange for passage of a plan will be poison pills that will make a health care reform useless.

I would think that Ezra would have understood by now the folly of a 50%+1 strategy, whether it's employed in campaigns or on the Senate floor. The only way we will procure the votes for health care reform is to run campaigns that promise good health care plans, and put those people in the Senate with the mandate to produce change.

A truly realistic strategy would involve doing this in the 2008 cycle, then proposing a solid plan - probably single-payer - in the 111th Congress, and going to the voters in 2010 if Senate Republicans block it.

Ezra is right that it's not enough to demand single-payer, but he is wrong in discounting the ability to produce a politics that can make single-payer a reality. Single-payer advocates need to be thinking both strategically and tactically, and it would be wonderful if Ezra could join us in such an effort.

Unless you actually were referring to the /To establish the Kentucky Artisan Heritage Trails National Heritage Area Act in the Commonwealth of Kentucky, and for other purposes. bill, but I don't know what that has to do with health care.

StevenAttewell makes a good point about the divided Democratic caucus. That suggests to me the solution here is the same solution used on fractious House Democrats regarding FISA - get some single-payer advocates to win primaries and run ads against incumbents who oppose it. Pressure from below, properly organized and applied, particularly at the ballot box, is the solution. If we think we can win meaningful reforms with the current composition of the US Senate, we have not been paying attention.

Ultimately, all that I'm seeing discussed here reinforces for us single-payer folks the value of refusing to compromise. Nobody has yet proposed an intermediate step that actually would work in practice. And nobody has yet proposed a political solution that does not involve going to the voters and getting them to change the composition and/or behavior of the US Senate.

Since only major reform - like single-payer - is going to produce that voter action (because you need clear and bright lines and contrasts; note the failure of the presidential candidates' mandate plans to arouse activism), that simply suggests to us single-payer folks that there's no need to compromise a thing on principle or policy, and that instead what is needed is an organizational plan.

Pesto's Political Plan for Passing UHC:

1) Large, restless mobs at the Capitol.
2) Tar.
3) Feathers.
4) Frightened legislators.

"Pesto's Political Plan for Passing UHC:

1) Large, restless mobs at the Capitol.
2) Tar.
3) Feathers.
4) Frightened legislators."

Hmmm ... someone watched John Adams last night on HBO.

Or maybe just extrapolating from the behavior of the supposed progressive blogoshere during election season?

Good points - I hope the talk went well!

The real irony is that the more panelists at these conferences debate different ways of getting to universal health care, the more they distract us from discussing the political realities of getting a policy passed.

At the Roosevelt Rx conference last week, Claudia Deane presented some powerful statistics about how disagreement over plans is the real political enemy - over 80% of Americans support the government doing some sort of major health reform, but when American's are asked which plan they support, not plan gets support of 20%.

Good luck getting people to focus on the real issues at stake!

Robert, I think the problem with your political plan is that you would effectively have to replace a very significant chunk of the Democratic caucus, especially the more wobbly purple state Democrats. If your primary challenges didn't get the necessary votes, you'd still be the same situation of needing to unify a divided caucus.

If anything, what the current situation indicates is two things: first, that the perfect should not be the enemy of the good. The Democratic Party screwed itself on two separate occasions - in the early 1970s and in the 1990s - by failing to pass health care bills, in no small part because many liberals in our caucus voted no hoping for a better result. Needless to say, they didn't get one.

The other is that you shouldn't try to be all things for all people - this is something of a contradiction to the above point, which would seem to counsel endless moderation to try to get everyone on board. Rather, I would advocate Democrats sitting down at a Health Care summit between the election and the inauguration and not leaving until they had a simple, concrete plan that the entire caucus agreed on. Don't try to do what the Clintons did and try to get everyone on board by bending in a thousand different directions.

What keeps this being a total contradiction is that we do have to aim to accomplish. Ultimately, as the case of Social Security versus the Wagner-Murray-Dingell bill has shown, it's a lot easier to get a decent-but-flawed system established and then improve it gradually over time than it is to create the perfect plan and push it through.