The ritual is becoming familiar. Health care reform passes a major political hurdle. And progressives don’t know whether to laugh or cry.
Last time, the occasion was a vote in the House of Representatives. Health care reform passed by the slimmest of margins, but not before conservative Democrats had extracted a major concession on abortion rights.
This time, it was a vote in the Senate--not on whether to pass a bill, but whether to begin debating one. This measure, too, passed by the slimmest of margins, but not before conservative Democrats and one notorious independent made clear they were prepared to shut things down later if legislation includes a public insurance option.
It’s no fun to watch this unfold. And yet this is the exactly the sort of drama you should expect for the next few weeks, as the Senate deliberations play out.
The bill Majority Leader Harry Reid introduced last week is not everything it could be--not by a long shot. And progressives will try their best to improve it. But the real battle will be an ongoing rearguard action, to fend off changes from the right--amendments that, in many cases, Republicans will support even though they have no intention of voting for the final bill. Abortion. Immigration. The mandates, for individuals and employers. You name it.
For progressives, victories are more likely to come in the form of ground not conceded than ground gained. Every day that legislation doesn’t get worse is a day to cherish.
That may not sound like much to celebrate. But to get a bit of perspective, glance over to the other ideological corner--where the right, and many of its kindred special interests, are going absolutely crazy. To some extent, they are reacting merely to the possibility that President Obama and his allies will get a political victory. But they are also reacting to the fact that health care reform, even in this highly compromised form, will have an impact.
Reform will mean government meddling with health care in a way it never has before, to discipline the insurance industry and reorient the incentives that make our care so expensive in the first place. It will mean offering financial support to millions--no, tens of millions--of poor and middle-class Americans struggling to keep up with their medical costs. And on and on and on.
That doesn’t mean the blows don’t hurt. Blanche Lincoln’s speech on the Senate floor Saturday was like a gut punch. Her condemnation of the public insurance option was not particularly persuasive, at least not if you believe--as I do--that reform with a public option would mean better, more affordable insurance than reform without one. But her stance seemed unambiguous--and unyielding. Joe Lieberman and Ben Nelson seemed equally obstinate.
Maybe somebody (Charles Schumer?) will find yet another twist on the idea, one that all three would find acceptable. It might even involve a trigger--which, truth be told, may not be as awful as its reputation. The left treats the idea like poison, perhaps because it’s so closely associated with Olympia Snowe and the frustratingly futile hunt for bipartisanship that soaked up so much of the summer. But, at least on paper, you could make the case that a well-designed trigger--emphasis on “well-designed”--could be as, if not more, effective than a poorly designed public plan, which seems to be the only kind of public plan that might possibly get by with conservative Democrats in support.
To be sure, Liberals can flex their muscle, too. Bernie Sanders made very clear, in his own statements over the weekend, that he wasn’t guaranteeing to give his vote--particularly if conservative Democrats (and former Democrats) extract even more concessions.
Sanders is right to play hardball like this, but, at the end of the day, it’s hard to imagine he’d cast the vote to kill health care reform. He simply cares too much about the people even a weakened bill would help. The same goes for Sherrod Brown, who’s emerging as a leading voice for progressives. Their interest in helping their fellow man is, in strategic terms, a great weakness.**
But the public option fight--however it turns out--could also help progressives in other ways. Whether out of pique, politics, or principle, Lieberman, Lincoln, and Nelson (and maybe one or two others) want to scream about something--and to have a concession they can claim as their own. If they end up demanding the public option as the price of their support--and I’m not saying I want that to happen--perhaps the rest of the bill can go through relatively unscathed. Or, to put it more starkly, if they didn’t have the public option to attack then it’d be the subsidies, or the price tag, or the insurance regulations. Merely by including the public option in his bill, Reid has increased the chances that the final bill is a good one--even if the public option is gone by the time deliberations are done.
And don’t forget that the debate doesn’t end with the Senate. There’s always conference committee. Jay Rockefeller, among the Senate’s most reliably liberal voices on coverage issues, has said he’ll be one of the negotiators. (Senate leadership won’t comment.) The House will be there, too, including--I’m sure--Henry Waxman, who strikes fear into the heart of adversaries, whether they be fellow members of Congress or special interests trying to get their way. Who knows, maybe liberals can still make some improvements, in return for what they're bound to give up. (One good starting place would be Paul Starr's new proposal, making federal funding available to states ready and willing to set up their own insurance exchanges before the reforms fully kick in.)*
Am I confident things will work out well in the end--that the strategic decisions made so far, and the ones to be made soon, will be the right ones? Not at all. There’s plenty of room to second-guess everybody, from the president on down, and I’m sure we’ll all be doing lots of that. But however frustrating this process may seem, keep in mind that it’s hard--really hard--to hold sixty votes in line. When it happens, like it did this weekend, that’s usually a reason to feel good.
Update: I've clarified the specifics of Starr's idea.
Late Update: Reading this over again, I think I implied that anybody who opposes health care reform does not care for his/her common man. This is obviously not the case. It's entirely possible to oppose health care reform because you believe, honestly, it will do more harm than good. My point, rather, was that supporters of health care reform are at a strategic disadvantage when they bargain with relative skeptics like Lieberman or Nelson.
.jpg)
Print
COMMENTS (10)
Since the public option is probably going to cover only a few million and likely cost more than for-profit insurance, how about we trade that for the kucinich amendment to allow for some states to develop single payer systems. While there are some important changes in the proposed bills, we need to keep in mind that we're making a system that's already too complex and expensive even more so. It's not sustainable. We don't want the message a few years down the road to be that more unwieldy expense is what happens when government steps further in. That could put off the day when we move to a single, not-for-profit system. That's the only way we'll afford to cover us all well.
Since the public option is probably going to cover only a few million and likely cost more than for-profit insurance, how about we trade that for the kucinich amendment to allow for some states to develop single payer systems. While there are some important changes in the proposed bills, we need to keep in mind that we're making a system that's already too complex and expensive even more so. It's not sustainable. We don't want the message a few years down the road to be that more unwieldy expense is what happens when government steps further in. That could put off the day when we move to a single, not-for-profit system. That's the only way we'll afford to cover us all well.
I agree that focus on the public option advances reform, although at the outset I thought the process was set up for the focus to be on the mandate. But with the focus on the public option, don't be surprised to see some strange bedfellows over the final weeks of deliberation. In particular, if passage of health insurance reform becomes certain (which today it is not), don't be surprised if the insurers switch sides and make the case for a public option.
I agree that focus on the public option advances reform, although at the outset I thought the process was set up for the focus to be on the mandate. But with the focus on the public option, don't be surprised to see some strange bedfellows over the final weeks of deliberation. In particular, if passage of health insurance reform becomes certain (which today it is not), don't be surprised if the insurers switch sides and make the case for a public option.
Actually Jon, I think it's great fun to watch this unfold. This is public education at its best.
All those who imagine that a "public option" wouldn't be just as ineptly managed as our current on-the-verge-of-bankruptcy version that already handles over 60% of our healthcare costs as Medicaid and Medicare; and those who think making people who want an abortion pay for it with their own money rather than using the power of the Federal government to force people with profound moral objections to it to do so amounts to a reduction of "abortion rights"--this is called DEMOCRACY.
The fact that so many on the left have trouble with the concept is what makes reference to their party as Democrat rathe ... view full comment
Actually Jon, I think it's great fun to watch this unfold. This is public education at its best.
All those who imagine that a "public option" wouldn't be just as ineptly managed as our current on-the-verge-of-bankruptcy version that already handles over 60% of our healthcare costs as Medicaid and Medicare; and those who think making people who want an abortion pay for it with their own money rather than using the power of the Federal government to force people with profound moral objections to it to do so amounts to a reduction of "abortion rights"--this is called DEMOCRACY.
The fact that so many on the left have trouble with the concept is what makes reference to their party as Democrat rather than Democratic better English.
RP - you're misrepresenting the facts in the Senate bill. There are going to be distinct options - (AKA choice - you know DEMOCRACY) for supporters of abortion rights and those that do not support those rights. This is exactly how it should be. Rationalityin fact reigns. Look up the frigging facts.
You throw around "the left" this and "the left" that alot, always unflatteringly. Do you call yourself a Democrat or what? Anyone who thinks Joe Liebermanism is admirable on this fundamental issue should just leave the party. You clearly hate it and see boogey that don't exist in it constantly, always impugning motives and exaggerating the evils of government. Pro-choice groups have as much ... view full comment
RP - you're misrepresenting the facts in the Senate bill. There are going to be distinct options - (AKA choice - you know DEMOCRACY) for supporters of abortion rights and those that do not support those rights. This is exactly how it should be. Rationalityin fact reigns. Look up the frigging facts.
You throw around "the left" this and "the left" that alot, always unflatteringly. Do you call yourself a Democrat or what? Anyone who thinks Joe Liebermanism is admirable on this fundamental issue should just leave the party. You clearly hate it and see boogey that don't exist in it constantly, always impugning motives and exaggerating the evils of government. Pro-choice groups have as much right to advocate for their beliefs as anyone.
The country desperately needs this and has screamed louder for every year since 1950. Honestly, if you don't support radical reform to the health care industry, I think you should leave the party. Go ahead: man up for those insurance companies who in no way represent capitalism, blindly fetishize commerce to the point where you don't see what's right in front of you.
If the goddamn health insurance industry worked, the feds wouldn't HAVE to come up with this bill. "Work" meaning covering our citizens and shutting down commerce killling monopolies, which may not be your thing either. Doesn't sound like it.
So many low- and moderate-income folks are counting on real help from a robust public option --little realizing how it was diluted by the House, and may be erased entirely by the Senate.
On NPR the other day, listeners were reminded of the meaning of the term "enervate" --to deprive of strength, force, vigor; to weaken physically, mentally or morally; devitalize (Webster's New world). That about sums up what has happened to the public option--it's been enervated, and the electorate has been punked.
See also Robert Reich's piece in Salon.com (Nov. 19): "The Public Option ain't what it used to be."
Progressives should be standing up for Medicare for all. Single payer is a proven model, woul ... view full comment
So many low- and moderate-income folks are counting on real help from a robust public option --little realizing how it was diluted by the House, and may be erased entirely by the Senate.
On NPR the other day, listeners were reminded of the meaning of the term "enervate" --to deprive of strength, force, vigor; to weaken physically, mentally or morally; devitalize (Webster's New world). That about sums up what has happened to the public option--it's been enervated, and the electorate has been punked.
See also Robert Reich's piece in Salon.com (Nov. 19): "The Public Option ain't what it used to be."
Progressives should be standing up for Medicare for all. Single payer is a proven model, would save trillions while covering everyone. But Nancy Pelosi convinced the House that single payer wasn't politically feasible. Well, how politically viable is the Reid proposal? What kind of a devil's bargain will the White House and Harry Reid have to make with Landrieu, Lincoln,and Leiberman who seem to care little for their constituents.
You are laughing now, but a year from now will be crying looking at the new makeup of the Congress. The Senate bill is joke. Hope that Rick Foster can produce a CMS actuarial memorandum on the Senate bill similar to what he did for the House bill. First of all, the Senate bill is basically a huge Medicaid expansion for at least 16 million people. Medicaid is universally acknowledge as the least innovative and lowest quality delivery system in the country. It pays providers about 60 cents on the dollar if you can find doctors who will even accept Medicaid. So liberals are locking in a two tier health care system with the poor locked into one of the worst welfare medical delivery systems ... view full comment
You are laughing now, but a year from now will be crying looking at the new makeup of the Congress. The Senate bill is joke. Hope that Rick Foster can produce a CMS actuarial memorandum on the Senate bill similar to what he did for the House bill. First of all, the Senate bill is basically a huge Medicaid expansion for at least 16 million people. Medicaid is universally acknowledge as the least innovative and lowest quality delivery system in the country. It pays providers about 60 cents on the dollar if you can find doctors who will even accept Medicaid. So liberals are locking in a two tier health care system with the poor locked into one of the worst welfare medical delivery systems. You should cry about that. Then the bill creates state connectors with a 3 to 1 age rating band without an effective individual mandate ($95 in 2014 -- that will sure get alot of young people to join). Every actuary (as opposed to pundits) have shown that this will lead to sky high premiums because of adverse selection. The employer element is still the free rider provision which is an open invitation for employers not to hire low income people (read the multiple critiques from Center for Budget Priorities). The bill is loaded with taxes on high end plans, Medicare HI tax, and taxes on insurers, phrma, and device industry which will generally be passed on to the insured. AND TO BE FISCALLY RESPONSIBLE THE ENTITLEMENT NOW STARTS IN in 2014. Why not started in 2019 which will bring the score way down. The true ten year number (2014 to 2024) IS 1.8 TRILLION. Again, the bill is joke if you actually read it.
WandreyCer--
I am an Independent, and reserve the right to criticize, and vote for, both "major" parties as I deem appropriate. Personally I think both are full of crap, just in different ways.
On healthcare, please read above post by lawphd. Or even better, the truly comprehensive and well-written article on Atlantic.com entitled "How the American Healhcare System Killed My Father". The healthcare problem requires a root-and-branch overhaul, which is not currently on offer.
On abortion, the "choice" you cite is available as a direct result of the Stupak Amendment, which is described in Jon's piece and elsewhere as an attack on abortion rights. Let me just say that under current law women ... view full comment
WandreyCer--
I am an Independent, and reserve the right to criticize, and vote for, both "major" parties as I deem appropriate. Personally I think both are full of crap, just in different ways.
On healthcare, please read above post by lawphd. Or even better, the truly comprehensive and well-written article on Atlantic.com entitled "How the American Healhcare System Killed My Father". The healthcare problem requires a root-and-branch overhaul, which is not currently on offer.
On abortion, the "choice" you cite is available as a direct result of the Stupak Amendment, which is described in Jon's piece and elsewhere as an attack on abortion rights. Let me just say that under current law women have a right to an abortion. They don't have a right to make me pay for it.
http://www.theatlantic.com/doc/200909/health-care
http://www.theatlantic.com/doc/200909/health-care
"The healthcare problem requires a root-and-branch overhaul, which is not currently on offer."
So how do you propose we do this Mr. Powell? Any attempt to do this is destroyed by monied interests that might get touched by any overhaul.
"The healthcare problem requires a root-and-branch overhaul, which is not currently on offer."
So how do you propose we do this Mr. Powell? Any attempt to do this is destroyed by monied interests that might get touched by any overhaul.
The Atlantic article I linked above has some excellent ideas on the subject, but you are right about the chances of actually getting anything accomplished in the face of the giant vested interests in the current system. We'd probably need a full-scale economic collapse first.
The Atlantic article I linked above has some excellent ideas on the subject, but you are right about the chances of actually getting anything accomplished in the face of the giant vested interests in the current system. We'd probably need a full-scale economic collapse first.