We’ve now reached the stage of maximum negotiation. Congressional Democrats who have every intention of voting for health care reform (or who would never dare to be the one who kills it) are fighting like hell to defend certain narrow interests. Some want to limit fees on medical device manufacturers, while others want to protect labor health plans from taxes, or prevent a surtax on millionaires in their districts, or decouple a public option’s reimbursement rate from Medicare, or lower the fines on people who ignore the mandate, or kill the mandate altogether, or kill the public option altogether. Some Dems are going to win in these fights and some are going to lose. But, at the end of the day, there is going to be a giant piece of legislation on the table that represents the president’s top domestic priority item. Who will dare cast the deciding vote that defeats it?
This is why it is so important to keep the ball moving even if it occasionally bounces sideways, or even backwards. HillaryCare died when the Finance Committee, under the chairmanship of Sen. Daniel Patrick Moynihan of New York, couldn’t report out a bill. It now looks certain that ObamaCare will pass that mile-marker sometime this week when Max Baucus’s Finance Committee reports out its bill. That will put us in new uncharted territory, but it will also make it all that much harder for any member of the Democratic caucus to step in and kill off the effort. The closer we get, the less likely it is that even a Ben Nelson or a Evan Bayh or a Joe Lieberman or a Blanche Lincoln will be the one vote that kills health care reform.
And, the less likely they are to pull that trigger, the less likely it is that we will need to cede to their demands. I have been working on a basic assumption. My assumption is that Obama wants to pass a bill that is as close as possible to the bill that he campaigned on. I have very little reason to believe that he wants to cave on his stated goals for any other reason than he is compelled to by political reality. When the fight comes right down to the the end-game nitty-gritty, I assume Obama will be fighting for what he said he would be fighting for.
He’s within reach of accomplishing that goal now. He needs two things to happen. He needs the House to pass a bill with a robust public option and he needs Harry Reid to make the HELP bill the cornerstone of the Senate bill, and not the Finance bill. Then he must rely on sheer momentum, and the reticence of skeptical Democratic senators to kill reform at the very end of the process, to carry the day.
You can help by lobbying Congress to meet those two criteria.
As this mess has unfolded, I’ve been wondering how much truth there is to the argument that getting a halfway decent healthcare bill passed now sets up the possibility that in the coming years it can be tweaked and pushed in a more progressive direction. I have so little faith in our democracy at the moment that I can’t manage to invest much hope in the notion. But it might have some merit….
Well, I will say this.
If the problem with the bill is primarily that it doesn’t do enough to bend the cost curve, I wouldn’t worry too much. They will have to live with the reality of the budget, not some fantasy. The cost aspect will get fixed.
Just how can ‘fixing’ the cost of health care happen when all the versions of reform rolling through the two houses fail to meaningfully address the underlying causes of those costs? Senator Rockefeller’s amendment, the so called “strong public option” which would have significantly reduced costs, was decisively voted down. I’m afraid we’re going to discover that the cost of this supposed ‘reform’ still has a major role to play in further diluting any real change in the present health care system.
If you read what I wrote again, you’ll see that I said if the health care bill doesn’t have a robust enough public option to bend the cost curve, they will have to come back and fix the cost curve later. It isn’t going away.
Oh I read and understood what you were saying. I simply disagree with you that the problem of controlling costs is distinct from the need to radically change the way health care is delivered today. I feel the two are inextricably intertwined. Eventually, when American society collapses under the weight of all the horribly corrupt decisions made this decade real health reform will come into being. I just wish that it could be done now rather than later and skip all that misery.
I didn’t say that the need was distinct. What I said was that it is worth it to vote for a bill that doesn’t bend the cost curve enough because that problem will get fixed later. There are other parts of a potential bill that would be deal-breakers because they would not get fixed. But if the biggest problem with the bill is that it doesn’t allow for negotiated Medicare Part D prescription drugs or have its reimbursement rates tied to Medicare, then I think we should pass it anyway. The insurance reform aspects of the bill are what are going to impact most voters’ lives and decision making process. They will be very popular.
Imagine not having to stay in your shitty job just so you have have affordable health care? Imagine being able to start a small business even though you have a pre-existing condition?
Yeah, the bill will have shortcomings, but it will be worth supporting.
You need to go make that case on Conservative web sites. That’s a good angle no one is talking about.
I appreciate and admire your sane commentary about the state of health reform and Obama’s role in it. Thanks.
Still, I have to disagree with you here. The bill as written doesn’t take full effect until 2013, when health costs will be higher than they are now. After 2013, the bill continues to ramp up for a few years before coming into full effect.
By 2016, there’s a good chance the country is going to be ready to hand power back to the GOP; it’s rare for one party to stay in the White House longer than 8 years. If the cost curve hasn’t changed by then, the GOP will take charge of limiting the impact on the federal budget, and I don’t think we’ll like how they go about it.
I don’t disagree with you. We might not like how the cost curve gets addressed if it is put off now. But it will get addressed.
The question was whether it is okay to support a less than ideal health care bill. My answer was it was okay if the only real shortcoming was cost-containment. If it were going to enshrine a horrible health care system that cannot be easily fixed, then no bill would be better. But if it provides universal access with subsidies, portability, and gets rids of recissions, then it is worth supporting even if it doesn’t do enough to contain costs.
I’m with you there. The country is so broken we can only address crises. Medical coverage is the current crisis, and cost isn’t a crisis yet. If Congress creates a cost crisis, then maybe they’ll get around to fixing it.
Sorry if that sounds cynical. 🙂
Also, the people getting left out of this bill – at least the Baucus version – are working people who make too much for subsidies but have no plan available for under 8% of their income. Those are going to be wholesome, marketable families capable of screaming very loudly. They’ll get coverage somehow, eventually.
Well written, BooMan, well written, indeed. I will get on the horn tomorrow to the two senators from New York and pitch the need for the public option and the overwhelming need for health care reform.
right on the money – Boo. just a suggestion- why not create a box in which you place the liks to both the house and senate lists of e- mail addresses and phone numbers and keep the box active until this insanity ends!!!
People can at least visit:
http://www.senate.gov
http://www.house.gov
If they don’t know who their Senators are or who their Representative is, they can find that info at those sites. All their contact info is there.
Btw – I STRONGLY recommend faxing. In a phone call, the person will only take down one word in 10 of what you say. In a fax, you can say exactly what you want and they’ll be able to read it. If you send regular mail or email, they may not get to it for weeks or months.
I am not even overly worried about what the Senate bill looks like after the two committees smash their bills together. The strongest bills are in the House, anyways.
One of the best things we can do, aside from pushing for the strongest bill we can get from these bought-n-owned- bobbleheads-in-a-D.C.-bubble, is to keep pushing for legislation guaranteeing states’ rights to be able start a single payer program if they want to.
Via Think Progress:
I really ain’t too worried about what the Senate does at all… Not until we get to the conference part of it.
I think they need the public option in the Senate bill. But they don’t need it to be as strong as the House version. It can be triggered or it can be decoupled from Medicare. But it should be there precisely so we don’t have Dems joining Republicans in taking a stand against it in the Conference Report.
There will be no republicans in conference. There is already a public option from the senate HELP committee. The House bills, while not all that great, are far and away better than anything in the Senate. Having it in the Finance committee’s final bill means nothing, IMHO.
And what O’donnel talks about there, essentially reducing the right wing to a bunch of talking points that only the far right wingnuts and teabaggrrrs can appreciate, really does make sense. What could be better for the left than uniting what remains of the GOP in opposition of the least contentious parts of the bill? Which Dem will be stupid enough to stand with the crazies and against reform after that no matter what comes out of conference?
But that is inside baseball stuff more than sound policy. All the senate has to do now is pass anything. The more liberal House will provide the meat of the Bill. Just my two cents worth.
Actually, there will be Republicans on the conference committee. If enough Dems side with them, the public option will not come out of the committee. That is why it is very important that Harry Reid choose the conferees carefully. If Baucus and Conrad are both in the conference, they will be able to kill anything we want to do.
So far the only names out there are Baucus and Dodd. I had expected Harken and maybe one other from the Senate Finance committee but no republicans. I have my doubts that they will even let Snowe or Collins in on these conferences (Senate and then all committees from Senate and House) like they did for the stimulus. It would be counter productive to the goals in this case, since the other side, including their supposed moderates, are hellbent on killing the PO.
Unless one of those “moderates” comes out publicly in support of the PO sometime soon, expect them to be completely shut out this time, IMHO.
The onus remains on President Obama to pass a bill with the public option. He campaigned on it. he has stated that is what he wants since taking the office.
I am a skeptic. He failed to revamp the bankruptcy bill to allow primary mortgage holders to have their mortgages written/crammed down in bankruptcy. It is the only debt that cannot be changed in the bankruptcy court. Thus the average american homeowner is paying to support bankrupt financial organizations and their managements that have given up nothing while at the same time watching their only real asset depreciate in value.
The Financial Institutions could have been completely reorganized and their leadership drawn and quartered when the bonus scandal emerged in Feb/Mar of 09. Nothing has happened.
The onus remains on the President.