Ever since Al Franken parked his rear end in the Democratsâ€™ 60th U.S. Senate seat, the conventional wisdom has held that no matter how much of a fuss the Republicans kicked up this summer and fall, some form of healthcare legislation was bound to reach President Obamaâ€™s desk. Taking the midterm election of 1994 as a template for what happens when Democrats spend a year on healthcare and donâ€™t pass anything, party leaders have insisted that such a fiasco must not be repeated, no matter how mediocre a bill eventually emerges. So now that the House has wrapped up its business â€“ taking what was already a warm bucket of piss and vomiting all over it with the Stupak amendment â€“ a nation that not-so-narrowly voted for this agenda turns its lonely eyes to the Senate and screams, â€œCould you people please just get on with it?â€
And the self-proclaimed â€œworldâ€™s greatest deliberative bodyâ€ responds, â€œNot so fast.â€ The House bill is â€œdead on arrival,â€ says Lindsay Graham. â€œI wonâ€™t let the public option come to a vote,â€ says Joe Lieberman. â€œWeâ€™re ready to take the whole Democratic Party down, rather than vote for a package that might cost us a small percentage of voters in our backwater states,â€ say Ben Nelson and Blanche Lincoln. (Or, at least, they may as well be saying it.) No one at this moment has a clue how the Senate will proceed, or when â€“ not even its majority leader, Harry Reid, who was against the public option before he was for it, and may soon be against it again.
But you know what? Thatâ€™s all OK, because I canâ€™t imagine thereâ€™s anybody out there who is actually happy with the House bill. Truth be told, there may be a grand total of 43 such folks â€“ those being the Democrats who voted for the bill after also voting for the Stupak amendment, which bars the inclusion of abortion coverage in any health-insurance plan that participates in the new purchasing exchanges. Already weâ€™ve seen a similar number of progressive Dems insist they wonâ€™t vote for final passage of the bill if the abortion measure isnâ€™t stripped out in conference. But even if both chambers eventually agree on a bill, it will undoubtedly cost too much, cover too few (and make some pay too much to buy in), start too late (the new exchanges are delayed til 2013, simply to keep the billâ€™s 10-year cost projections down), and be positively loathed by far too many.
In other words, Obama and Congress have screwed the pooch completely on this bill. They should pass it anyway.
Stupak is a perfect representation of the depths to which the Democrats have sunk. Dreamed up by an anti-choice Dem for whom the good olâ€™ Hyde Amendment wasnâ€™t good enough, it passed (with 64 Democrats on board) despite the fact that nobody could agree on its effects. (Sound familiar?) I have to admit that Iâ€™m of two minds about all this. On the one hand, expanding the Hyde Amendment â€“ and using a government-created exchange mechanism to limit abortion rights for a subset of the female population â€“ is an onerous, distasteful and inappropriate outcome for a â€œreformâ€ effort whose intentions are otherwise progressive. On the other hand, I never knew so many private insurance plans included abortion coverage in the first place — at least 13 percent of U.S. abortions, and probably many more, are paid for with help from insurance policies — and Iâ€™m frankly surprised itâ€™s such an under-argued part of the larger abortion debate. (A few states do restrict such policies to the usual rape-incest-life of the mother triumvirate, though they allow women to purchase â€œridersâ€ for broader coverage. And a few more states have implemented even harsher restrictions on the plans of public employees.)
Even setting aside the bizarre concept of a woman purchasing an â€œabortion rider,â€ Iâ€™m not sure how I feel â€“ and Iâ€™m strongly pro-choice â€“ about paying into an employer-based insurance pool that enables a woman to cough up just a small co-payment to obtain an abortion for non-medical reasons. Imagine, then, how a strongly anti-choice person must feel when she discovers that her premiums are helping to facilitate low-cost abortions! With that in mind, itâ€™s not difficult to understand conservativesâ€™ abhorrence for the notion of using the new exchanges to make abortions easier to get.
The abortion quandary is far from the only issue that has turned this reform into a dogâ€™s breakfast. The most important, of course, is how weâ€™re going to pay for all the new subsidies â€“ the Houseâ€™s surtax on the wealthy, the Senateâ€™s tax on â€œCadillacâ€ plans, or some other idea we havenâ€™t heard yet. Then thereâ€™s the continuing argument over the public option, which Democrats now view as a â€œsilver bulletâ€ to cut costs while Republicans view opposing it as a line in the sand against creeping Socialism. So far, Obama has refused to demand it; hopefully, his commitment phobia is grounded in the kind of best-practices research that has been sorely lacking elsewhere. The fact is, among the many nations that do a better job at providing healthcare than we do, only a few follow the single-payer model that is so envied on the left and so vilified on the right. Most of the rest feature some hybrid of government support (via subsidies, price controls and/or stiff regulation) and private provision of insurance and treatment. None is perfect â€“ Englandâ€™s waits for elective procedures are too long, Japanâ€™s system is woefully underfunded, and Swiss doctors resent their comparatively low salaries â€“ but theyâ€™re all far, far preferable to both our current system and anything thatâ€™s likely to emerge from this fallâ€™s legislative morass.
As should be apparent by now, Iâ€™m no longer a fan of the Democratsâ€™ work to date on this issue. In fact, I think HR 3962 positively sucks, and thereâ€™s no question that the final Senate bill (assuming there is one) will be even worse. Why, then, am I still in favor of seeing it through, in the face of Republican demands to scrap the whole thing and take a mulligan?
The easiest answer, though not the best one, is that I donâ€™t want to see the teabaggers win, because even one victory would be profoundly dangerous to this nation â€“ and Democrats, too long deficient in intestinal fortitude, need to show that the publicâ€™s chosen agenda canâ€™t be sacrificed to quiet a small factionâ€™s infantile name-calling and Hitler/Stalin demagoguery. Republicans may be begging now for renewed bipartisanship, but theyâ€™re the ones who abandoned any traditional effort at compromise â€“ i.e., the minority party attempting to extract whatever concessions they can in exchange for support of the majorityâ€™s basic agenda. So now theyâ€™re going to have to sit and watch while moderate Dems continue to do their job for them.
But thatâ€™s not the real reason I want this shitty version of healthcare reform to pass. The real reason is that a huge chunk of it â€“ the part that practically all Americans agree on â€“ is not shitty, and if that stuff doesnâ€™t get done now, it probably never will. The stuff like banning insurers from denying coverage based on pre-existing conditions, or from dropping clients when they get sick. The stuff like making it easier for uninsured individuals to join a pool to buy insurance at better prices. Having seen the variety of ways other countries get to universal coverage, I no longer believe the public option is necessary; in fact, if itâ€™s not a strongly positioned harbinger for a single-payer system, it may do more harm than good. Better that we create a private, nonprofit insurance system that proves so popular that it destroys the greedy for-profit sector. That, alone, would provide a measure of cost containment the current reform can’t even approach.
As for the rest of it â€“ well, no bad (or even just imperfect) law is forever. If the nonprofit collectives donâ€™t work, the public option can be revived later. If the current revenue schemes donâ€™t pan out, Congress can find another way to scrape together enough dough, or else tweak the benefits to fit the money weâ€™ve got. Whatever system is put in place by this legislation no doubt will need to be massaged and manipulated and overhauled to make it work more effectively â€“ but you canâ€™t overhaul something that doesnâ€™t exist. And in case you hadnâ€™t noticed, Republicans controlled at least one branch of the government from 1994 to 2008, and during that time universal healthcare was never even on the table. If legislation now requires 60 votes in the Senate, Democrats had damn well better get this done before next November.
I firmly believe that Americans can achieve a high-functioning, lower-cost health system that reflects our values as a people. I also believe that the roots of that system are somewhere in the colossal mess thatâ€™s been dumped on the Senateâ€™s doorstep. So come on, boys and girls â€“ break out the shovels, and letâ€™s start the process of turning this shit into shinola.