Wednesday, January 20, 2010

Health Care Options

One of the prevailing stories coming from Tuesday's special election in Massachusetts -- in which Republican Scott Brown took the Senate seat that once belonged to the late Ted Kennedy -- was that Brown gives Republicans the 41 votes necessary in the Senate to potentially kill health care reform. Democrats would need 60 votes (the so-called "super majority") to avoid a filibuster, and unless someone within the Republican party breaks rank, the GOP now has enough votes to filibuster.

But all's not completely lost when it comes to health care reform; Democrats have a few options to make sure Brown's stunning election to the Senate doesn't derail President Obama's first major domestic initiative.


***Democrats could bypass merging the House and Senate bills, forcing the House to vote on the Senate bill as-is before sending it to the president. This isn't the most attractive option, since the Senate bill practically amounts to an insurance industry bailout -- no public option, no Medicare buy-in, no revocation of the industry's antitrust exemption, an individual mandate -- but the option is there ... assuming progressives in the House decide to cooperate. Which is no given, considering their collective ire.

***Reconciliation, which Democratic leadership in the Senate has been reluctant to consider, could return to the forefront. Only items relating to the budget -- such as the public option -- can be passed via reconciliation -- leaving pre-existing condition bans and other such facets of reform to be passed in their own bill the old-fashioned way. What's more, anything passed via reconciliation would have to be voted upon again in five years. Still, reconciliation could be exactly what progressives are looking for, as it could bring the public option back on the table; there may not be 60 votes in the Senate for the public option, but there are certainly 51.

***If the Senate goes the reconciliation route, they could have an easier time passing a separate bill that would ban pre-existing conditions, ban policy recission, ban lifetime coverage limits and revoke the industry's antitrust exemption status. In theory, these factes of reform are less toxic in terms of the public discourse; Republicans and Democrats alike agree these are good ideas that would likelt benefit the American people. Pass these ideas in the usual manner, and ram through the public option (or, hell, single-payer) through reconciliation.

***This most recent reform effort could die entirely, much like it did under President Richard Nixon in the 1970s and under President Bill Clinton in 1994. If that happens, we might not see Congress try again for another 15 or 20 years; don't believe members of Congress who say wqe could scrap the whole thing and start over; considering the consternation regarding this issue (Washington has made this whole thing needlessly complicated), do you really see Democrats trying again in an election year?

Of the above options, I prefer the reconciliation idea. Letting reform die would be the most disastrous development possible with regards to this issue, and passing the Senate bill in its current form wouldn't be much better. I disagree with the White House's assertion that any health care reform bill is a good bill; the Senate bill has serious flaws in it -- as does the House bill, even though that bill is stronger and more liberal.

My guess is, Democrats didn't threaten to use reconciliation because they wanted to appear as bipartisan as possible -- and to a degree, wanting to be bipartisan is admirable. But in today's toxic political climate, bipartisanship equals political weakness; instead of working together with Republicans, Democrats were bowing down to a group of politicians who were never going to support the legislation anyway.

Don't even get me started on "centrist" Democrats.

When George W. Bush was in the White House, he and the rest of his party never hesitated to use reconciliation -- particularly when it came to those tax cuts early in his first term. If President Obama and Democrats in Congress had half the conviction Bush did, we would not only have true health care reform by now, but we'd be a lot farther along in terms of other initiatives -- such as climate change or jobs.

Besides, let's say -- for the sake of argument -- that Democrats do pass a strong public option through reconciliation. Like Medicare back in the 1960s, who's to say the public option wouldn't become so popular upon passage that it would be political suicide to try and do away with it?

Democrats have been governing scared for the past year, and that played a big role in Brown's upset win in Massachusetts. I don't see it necessarily as a Republican-Democrat issue, but more as a frustrated and angry public looking to take it out on all incumbents. The reason that's bad news for Democrats is that there are so many of them in Congress.

If they don't shape up, there won't be nearly as many in November.

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