Meaningful healthcare reforms are closer than ever - Macleans.ca
 

Meaningful healthcare reforms are closer than ever


 

The Senate Finance Committee, chaired by Montana Senator Max Baucus, a Blue Dog or conservative Democrat, recently voted 14 to nine in favour of a healthcare bill that got the support of only one Republican Senator, Olympia Snowe of Maine. Barack Obama praised the efforts of the Baucus committee, though he indicated that there was still much work ahead, especially if he is to sign a bill before the holiday season. There are now five bills out of committee. Working from these, each House of Congress will produce one of their own that will end up either in a conference (resulting in a compromise bill worked out between the two Houses) or in reconciliation (resulting in a bill considered without the possibility of a filibuster even if it adds to the deficit). Either way, it seems likely Obama will have a health care bill to sign within his first year in office.

The bill which just passed the Finance Committee is noteworthy because it is the only one without a public option and the only one the non-partisan Congressional Budget Office expects will reduce costs over a 10 year period. The bill is also expected to feature near-universal coverage, with every American mandated to have health insurance, as well as eliminate some unsavoury practices by private insurers with respect to pre-existing conditions and other arbitrary insurance industry policies.

Expect the more left wing members of the Democratic party to object strongly to this bill. They will say it is too conservative, too weak to be called real reform, and too focused on attracting bipartisan support. The fact that only one Republican senator voted for it will reinforce the opposition from the progressive base of the Democratic party. Already, Democratic politicians like Florida representative Alan Grayson have chastised the Baucus committee for watering down the bill just to obtain a single Republican vote. A significant number of Democrats in the House of Representatives clearly want a public option and seem to have the votes. Senate Democrats, on the other hand, may appear to have 60 votes locked up, but in reality, as few as 52 senators could be willing to back a public option, meaning they will not be able to lean on a filibuster-proof majority to push the bill through. In short, Obama will have to rely on persuasion and good old arm twisting to produce a bill with a public option that can clear both Houses. This will not be easy, as Obama has yet to display a penchant for this kind of LBJ-style politicking.

Those wanting a public option have made a compelling case for it. Recent polls show that a significant majority of Americans want a public option similar to Medicare and the Veteran Affairs healthcare program. The problem is that Americans get spooked if it is attacked as adding to the deficit or resulting in a tax increase. Polls also indicate that the economy is by far a greater preoccupation than healthcare reform. After all, 85% do have healthcare and most seem happy with their current plans. While I still believe that the public option is the best guarantee for lowering costs because it would compete in an insurance exchange mechanism with private insurance, it appears likely that the final bill will fall short of the hopes of the progressive base of the Democratic party.

Still, reform is probably inevitable after today’s vote. All Democrats, including West Virginia Senator Jay Rockefeller, a supporter of the public option, voted for the Baucus bill. The call of history is acting as a greater unifier of the Democratic party. Sure, there will be attempts to cobble together a public option in the weeks ahead and a compromise proposal may emerge. But no matter what is included in the bill that finally clears both houses of Congress, it is safe to assume that the 2009 version of the Democratic party is not going to self-destruct like the 1994 Clinton Democrats did in time for next year’s mid term elections.

Many supporters of Obama’s “change we can believe in” will be disappointed and disillusioned by the outcome. But if universal and affordable healthcare is achieved without sacrificing quality and accessibility, unacceptable practices by private insurers are eliminated, and health care costs as a percentage of GDP are reduced, the Democrats will be able to argue that this reform package is historic and transformational. It will certainly be on the level of Medicare and Medicaid, which were landmark, although both programs covered only a portion of the population. This reform will have a far greater reach and, especially if it includes a public option, the Democrats will have grounds to celebrate.

Traditional Republicans like Bob Dole and Bill Frist have urged Republicans to support reforms and pressed upon them the historical implications of such an effort. After all, the Republicans did not dismantle New Deal programs and many supported Medicare, Medicaid and civil rights in the 1960’s. Coupled with the support of doctors, nurses, hospital administrators and the pharmaceuticals, all of whom were opponents in 1994, the prospect of Republican backing makes healthcare reforms closer than ever to becoming reality.


 

Meaningful healthcare reforms are closer than ever

  1. After all, the Republicans did not dismantle New Deal programs and many supported Medicare, Medicaid and civil rights in the 1960's.

    Even Parisella has to realize he's reaching, here.

    But: the end result here will please nobody, and put an awful lot of Democrats in electoral danger in the near future, so that's probably good enough.

  2. After all, the Republicans did not dismantle New Deal programs and many supported Medicare, Medicaid and civil rights in the 1960's.

    Even Parisella has to realize he's reaching, here. What happened to the slobbering triumphalism, hmm?

    But: the end result here will please nobody, and put an awful lot of Democrats in electoral danger in the near future, so that's probably good enough.

    • "slobbering triumphalism"?

      What are you talking about?

    • I think avr is reaching himself. I see this post as nearly a done deal for reform . The only uncertain aspect is the public option but 4 of 5 bills have it . It is IMPOSSIBLE to have a final bill without a variation of a public option . So I think it is a done deal if I read this blog correctly . avr is still on Obama can`t do anything right and will lose after one term . NOT !

    • Anyone who thinks that there is a political upside during an election campaign for a nay-saying Republican understimates the Democrats ability to campaign. Not too many Americans want nothing to happen on healthcare.

  3. I am at a loss to understand the second to last paragraph where the writer assumes a great success, similar to Medicare?? Medicare has a long term federal liability of over forty (40) trillion (40,000,000,000,000) dollars. How can such a program be labeled a success for the country when, over the long term, it will be a disaster??

  4. The most significant aspect of this "reform" is that it is wholeheartedly endorsed by the big Pharma and Health insurance interests. Based on that alone, I consider this a disaster.

    I am also baffled by the ability of commentators to hold these two ideas in their heads:

    1. That it is huge problem that there are millions uninsured Americans
    2. That currently uninsured Americans must be coerced into buying insurance

    • I don't agree with approach either.

      But presumably we had the same problem with auto insurance here in Canada which is now sold by the private sector but mandated and regulated by the government. The two statements taken together are not as confounding they at first appear.

      • A significant difference between health and auto insurance is that you are only required to have 3rd party liability insurance. If you don't want to insure against your own damages, you don't need to.

        What started out as being an argument on how to provide insurance to those that couldn't afford it has turned into an argument on how to make people buy insurance when they don't chose to.

        This strikes me as instructive on the motives and goals of the reformers.

        What seems to be emerging is a nasty little deal with the private insurers: if they commit to accepting all applicants regardless of existing health status, the government will force everyone to buy health coverage from them (and ditch the public insurance plan as well).

        What they are moving towards is a nationwide scheme whereby every American adult will be forced to buy health insurance (just like our taxed system) but which will be operated by private insurance companies and HMO's.

        This seems like the worst possible outcome.

  5. It's really weird to me that Obama could lose the public option fight (I mean, not "weird" exactly, I get how it works, but it's still a bit, I don't know, confusing?).

    A majority of the American people want a public option. A majority of Representatives in the House of Representatives want a public option. A majority of Senators in the Senate want a public option. The White House wants a public option. The bill most likely to pass has no public option.

    Again, I get how all that can be true, but it's still a bit weird. It's a bit sad (read: pathetic) that the Democrats might not win this fight, given the above.

    Of course, this is a debate that has featured protesters yelling at members of Congress at the top of their lungs to keep the Government's hands off Medicare, so there's that.

  6. If I were Obama I'd give this another month and then allow state-by-state referendum on a public option – states as a whole could directly opt in our out. It's time this went directly to the people. It's politically safe because then Texas would be able defend not having a public option and New York would be happy to get one.

  7. If I were Obama I'd give this another month and then allow state-by-state referendum on a public option – states as a whole could directly opt in our out. It's time this went directly to the people. It's politically safe because then Texas would be able defend not having a public option and New York would be happy to get one.

    Yes there is some complicated math and tax formulation that nees to be done – but so what? Part of life!

  8. the study by the Health Insurance industry makes the point against the Baucus bill . So there will be no public option .