In the Wake of the Mass Massacre—Bipartisan Reform or the Senate Bill?

In the Wake of the Mass Massacre—Bipartisan Reform or the Senate Bill?
by Maggie Mahar
Crossposted with Health Beat Blog

Let’s begin by addressing some of the myths:

First, the Massachusetts vote was not a “Massacre”: Brown won 51 percent of the vote.

Secondly, this was not a referendum which shows that the public opposes health care reform. Among Massachusetts’ voters who said health care was their top issue, 53 percent voted for Democrat Martha Coakley reports JoAnne Kenen, over at the “The MA Message? Not So Fast” New America Foundation Kenen understands politics better than most health care commentators: for more than a decade, she covered Congress for Reuters. Ignoring what the pundits are saying about “the Massachusetts message”, Kenen looked at the data:  “Jill Lawrence at Politics Daily crunched some Massachusetts numbers and discovered that ‘a solid majority—56 percent—said health care was their top issue.’ And 53 percent of them voted for  . . . Coakley.” “Majority of MA Healthcare Voters wanted to Save Reform” Politics Daily

Third, health care reform is not dead.  Democrats are not going to walk away from the issue. If they did, they would give the conservatives everything they need to re-take Washington. “President Obama is incapable of governing,” the opposition would argue. “He is another Jimmy Carter.”  Obama would be left a dead man walking. Democrats who had voted for reform would then have to try to explain to voters that either a) they were right but just weren’t able to pass legislation that so many Americans sorely need –even though they had a majority or b) it wasn’t that important after all. Yes, your insurance premiums are likely to rise by 25%–or more—over the next four years . . . and if you lose your job, you’re in big trouble.  But, well . . . we had other priorities. .

Fourth, I very much doubt that Republicans will step up to help forge a bipartisan bill.

Granted, Sam Stein reports Progressive Democrats are now worrying a pared down package — stripping it to its unobjectionable core (insurance regulation, money to help people buy care, etc.) – could lead to Republicans claiming they saved Healthcare reform. “New Dem Worry: GOP Taking Credit for Healthcare Reform,” Huffington Post

“Senate Minority Leader Mitch McConnell ‘will have his whole caucus vote for it and make it a political win for the Republicans,’ one well-connected Democratic health care strategist said. ‘They’ll say, “This was the Republican plan from the beginning. We’re glad the Democrats joined us.” And take all the credit for passing reform.’” Indeed, “On Thursday, former House Speaker Newt Gingrich suggested that the Republican Party do just that Stein Observes, quoting Glen Thrush Politico. Gingrich argued that it would be “clever” for the GOP to pass non-controversial reform measures with “huge bipartisan majorities.” But consider the rest of what Newt said: “he thinks many Republicans disdain Pelosi so much they simply won’t go along with anything with the speaker’s name on it, even if it serves the party’s larger interests.”

“If you are a House member in the [GOP] caucus, I suspect we are about to have a huge argument. We could get clever and work with her…And I think people should work with her… But at that point it becomes a huge problem because nobody trusts her; they distrust her ideology, and distrust her because she has run over them so hard.

A lot of Republicans would work with House Majority Leader Steny Hoyer, but they won’t work with her,” added Gingrich.

As I reported yesterday, I agree with Bob Laszewski. “The problem with bipartisanship now is that the Republican base is not about to let any of their own Senators do anything to take the Dems off the political meat hook from which they are now dangling. A Smaller Bipartisan Bill, What It Could Look Like” HealthCare Policy and Market Review.

The anger is visceral, and it’s not just directed at Pelosi. 

Liberals and conservatives disagree on very basic values. Try to imagine what a “bipartisan” bill would look like. Please read Naomi’s post, outlining the Republican health care proposal below Can We Really Have a Bipartisan Heath Care Plan HealthBeat

There is no individual mandate—because there is no requirement that insurers offer you an affordable plan if you suffer from “a pre-existing condition.”  In other words, many of the sick remain uninsured. Most of the middle-class and lower-middle class who don’t have employer-based insurance also would be left out in the cold. Subsidies would be available only to those earning up to 200% of the Federal poverty level (not 400% as in the Senate bill). And the subsidies would be too small; at best, families would be able to buy a skimpy policy that shouldn’t even be called “insurance.” 

Meanwhile, employers would be allowed to charge employees premiums that are 50 percent higher than the premiums their colleagues pay if they are overweight and can’t lose weight –or if they don’t want to take cholesterol-lowering drugs because of side effects that include deep muscle pain and memory loss. You might be exempted if you bring a note from your doctor: can you imagine explaining to your employer that you’ve been suffering too many “senior moments” and have a hard time remembering what you are doing? Or that everyone in your family is overweight and that your doctor says it’s genetic? (Many employers adamantly refuse to believe that this is true.)

I could go on. There is no way to reconcile these differences. Conservatives do not believe that health care is a right, or that a civilized society has a responsibility to provide care for all.

What Those Who Understand Our Health Care System Say

Finally, a group of 45 health-care experts have sent a letter to Nancy Pelosi, Charlie Rangel, Henry Waxman and George Miller calling on progressive reformers to stay the course. “Tap Dump” Washington Post (Thanks to Ezra Klein for pointing to this document)

“We have come further than we have ever come before,” they write.  “Only two steps remain.  The House must adopt the Senate bill, and the President must sign it.”

“While the House and Senate bills differ on specific points, they are built on the same framework and common elements—eliminating health status underwriting and insurance abuses, creating functioning insurance markets, offering affordability credits to those who cannot afford health insurance, requiring that all Americans act responsibly and purchase health insurance if they are able to do so, expanding Medicaid to cover all poor Americans, reforming Medicare payment to encourage quality and control costs, strengthening the primary care workforce, and encouraging prevention and wellness.”

“Some differences between the bills, such as the scope of the tax on high-cost plans and the allocation of premium subsidies, should be repaired through the reconciliation process. Key elements of this repair enjoy broad support in both houses. Other limitations of the Senate bill can be addressed through other means.”

“The Senate bill accomplishes most of what both houses of Congress set out to do; it would largely realize the goals many Americans across the political spectrum espouse in achieving near universal coverage and real delivery reform.”

“With the loss of Edward Kennedy’s Senate seat, Democrats no longer enjoy a filibuster-proof Senate majority, though they still enjoy the largest Senate majority any party has achieved in the past generation.  The loss of this one vote does not require Congress or the President to abandon Senator Kennedy’s life work of health care reform. A year of political infighting, misleading debates about death panels and socialized medicine, and sheer inaction has left Americans exhausted, confused, and disgruntled.  Americans are also bearing the severe consequences of deep recession and unemployment. Still, a majority of Americans support the elements of the Senate bill.” 

“The House of Representatives faces a stark choice. It can enact the Senate bill, and realize the century-old dream of health care reform. By doing so, it can achieve a historic milestone while freeing itself to address other national problems such as joblessness and mortgage foreclosure that affect millions of Americans.  Differences between the House and Senate bill can be negotiated through the reconciliation process.” 

“Alternatively, Congress can abandon this effort at this critical moment, leaving millions more Americans to become uninsured in the coming years as health care becomes ever less affordable.  Abandoning health care reform—the signature political issue of this administration—would send a message that Democrats are incapable of governing and lead to massive losses in the 2010 election, possibly even in 2012.  Such a retreat would also abandon the chance to achieve reforms that millions of Americans across the political spectrum desperately need in these difficult times. Now is the moment for calm and resolute leadership, pressing on toward the goal now within sight.”

“Some have proposed dividing the bill or starting anew with negotiations to produce a less comprehensive bill. From the perspective of both politics and policy, we do not believe this is a feasible option. We doubt that the American public would welcome more months of partisan wrangling and debate. We doubt that the final product would match what has already been achieved. Indeed we doubt that any bill would reach the President’s desk should congressional leaders pursue this misguided course.”

This letter is signed by people who truly understand what’s wrong with our health care system—and what needs to be done.

Henry J. Aaron, Brookings Institution
Gerard Anderson, Johns Hopkins University
Ronald Anderson, UCLA
Dean Baker, Center for Economic and Policy Research
Ronald Bayer, Columbia University
Anna Burger, Secretary-Treasurer, SEIU
David Cutler, Harvard University
Linda C. Degutis, Yale University
Eric Feldman, University of Pennsylvania
Thomas Fisher, University of Chicago
Brian R. Flay, Oregon State University
David Grande, University of Pennsylvania
Thomas Greaney, St. Louis University
Colleen Grogan, University of Chicago
Jon Gruber, MIT
Mark A. Hall, Wake Forest University
Jacob S. Hacker, Yale University
Jill Horwitz, University of Michigan
James S. House, University of Michigan
Peter Jacobson, University of Michigan
Timothy Jost, Washington and Lee University (organizer)
Theodore Joyce, CUNY
George A. Kaplan, University of Michigan
Jerome Karabel, University of California at Berkeley
Mark A.R.. Kleiman, UCLA
Paula M. Lantz, University of Michigan
Simon Lazarus, NSCLC
Arleen A. Leibowitz, UCLA
Theodore Marmor, Yale University
Lynda Martin-McCormick, NSCLC
Michael L. Millenson, Northwestern University.
James A. Morone, Brown University
Jonathan Oberlander, University of North Carolina at Chapel Hill
Karen Pollitz, Georgetown University
Harold Pollack, University of Chicago (organizer)
Daniel Polsky, University of Pennsylvania
Sara Rosenbaum, George Washington University
Meredith Rosenthal, Harvard University
Lainie Friedman Ross, University of Chicago
William Sage, University of Texas
Theda Skocpol, Harvard University
Paul Starr, Princeton University
William Terry, Brigham and Women’s Hospital
James A. Tulsky, Duke University
Alexander C. Wagenaar, University of Florida
Joseph White, Case Western Reserve University
Celia Wcislo, 1199-United Healthcare Workers East, SEIU
(Institutional affiliations listed for identification only).

I know many of them. I respect them. I have quoted some of them in my book and on this blog.  And I wholeheartedly agree with them.

Forget the personal politics. Forget who disappointed you. This is about people who need health care—and the fact that we must make that care affordable. Spiraling health care costs are the greatest threat to the U.S. economy. Cost control cannot be spelled out in the legislation; we don’t want politicians deciding where to make cuts. Healthcare professionals will have to make those decisions, based on medical evidence that tells us where our health care dollars can best be spent to benefit patient