Our friend Chris Kromm has an excellent analyis up on Facing South, entitled “Why the reformers are losing the health care debate — and how to win it back.” It’s especially strong on the “why losing” side — reform is getting Swift Boated, plain and simple, as Kromm says. On the “how to win” side, though, it’s less persuasive. Out-organize the opponents is Kromm’s prescription, with which I’d agree except for one thing: So far, reformers have nothing to out-organize them with.
The problem boils down to this: Two versions of reform are on the table in Congress, and they’re not the same. They are, to put it in simple terms, half a loaf and the whole loaf.
The half-loaf version would regulate the health insurance industry, require most folks to have health insurance, and subsidize people who can’t afford to buy it; but it would do little to control costs — thus, taxes would increase, and for those with insurance, there’s no promise of a let-up in the relentless rise in our insurance premiums.
Not surprisingly, this version would probably pass in Congress today, since everybody in the health care industry — the doctors, hospitals, pharmaceutical companies and especially the private insurance companies — would stand to make at least as much money under “reform” as they do now, and probably more. Out of all of our pockets, unfortunately.
But such abuses as insurers dropping coverage on the sick and refusing to cover people with pre-existing conditions would cease — a half-loaf, perhaps, but a very important half.
The whole-loaf version would do everything that the half-loaf does plus one more thing: It would put a “public option” in play, a government-run insurance plan (like Medicare) that would compete with the private insurers for business and almost certainly undercut them year after year on price. Initially, the public option would be very limited — most of us wouldn’t be allowed to buy it. But some of us would — the uninsured, the self-employed and employees of very small companies — and the rest would quickly notice that they’re getting ripped off for insurance of the same or lesser quality.
This second version thus offers something of enormous benefit to everyone, which is the prospect that reform might begin to shrink the incredibly expensive health care colossus now crushing the American economy. But, not surprisingly, this version cannot pass the Congress, it seems, precisely because it would peal back the amount of money going into the industry’s pockets.
Or can it pass? From everything I read, it can pass the House, and it can get 51 votes in the Senate, or 57, but it can’t get all 60 Democrats, because Sens. Ben Nelson, Kent Conrad and Max Baucus, representing the great unpopulated states of Nebraska, North Dakota and Montana, respectively, won’t support the public option — won’t go against the industry, in other words.
And in the Senate, quite possibly the least democratic body in the world outside of a tinpot dictatorship, you need 60 votes out of 100, not 51, to pass any bill other than a budget bill. (What about any of the 40 Republicans? Yeah, right.)
Meanwhile President Obama, while he campaigns hard for reform, hasn’t brought himself to make the hard call. Will he fight for a bill with the public option, pressuring Nelson, Conrad and Baucus to be with him and promising to go down in flames if they aren’t? Or is he really (as it seems to me) paving the way for the first version, without the public option, and preparing us for that day when he goes on TV to say: We can’t get the whole reform package, and I’m calling on my supporters to swallow hard and take what we can get.
(Or a third alternative would be the so-called “nuclear option”: Call the reform legislation a budget bill and enact it with a 51-vote majority, blowing off the threat of a filibuster. But in the Senate, where the members jealously guard a whole panoply of ridiculously anti-democratic rules that might start to fall if the filibuster rule was tampered with, this seems even less achievable than getting 60 votes.)
Until Obama makes that call, reform’s supporters are stymied. They’d fight hard for second version if the President, whom they love, turned them loose to do it. They’d probably fight almost as hard for the first version if he told them it’s the best he can get. But for now, Obama keeps dancing around the issue, letting Baucus tie up the Senate Finance Committee, the Senate itself and the entire reform effort in hopes that — what? Baucus, Conrad and Nelson will come around on their own? Or some Republicans will?
Kromm is exactly right that the Republicans have zero interest in debating this legislation and every incentive to change the subject, make stuff up and rail against socialism. And just to be fair — even though they make no attempt to do so — the Republicans do have a point that the federal government’s record of cutting the costs of anything, from defense spending to banking to any other industry where campaign contributions are to be had, including the health care industry, just simply sucks. It’s not socialism, though. The right word for is fascism — government that lines the pockets of special interests instead of regulating them.
But Chris, you’re letting Obama and the Democrats off the hook. They’ve had all year to figure out a bill that their supporters can rally around, and they haven’t done it. So guess what? Supporters ain’t rallying. And they won’t until Obama issues a marching order.