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.