The health care reform debate has taken up a lot of the country's attention over the last six months or so, and while it feels like every little step has been "momentous" (the votes of the individual committees such as Finance and the HELP committee in the Senate, the passing of the House health care reform bill a couple weekends ago) it is now, truly, game time.
The House of Representatives passed a bill that includes a bevy of essential health insurance reforms including requiring all who do not already have health insurance through either Medicare, Medicaid, employer-based health insurance, or individual private plans to purchase insurance. This is called an individual mandate, and it is a key element of reform, in that it is a central tenet of economics that in order to get people to do anything in large numbers, you must either offer negative incentives (the stick) or positive incentives (the carrot). So if all of those who are uninsured are going to be required to buy health insurance, how can we ensure that health insurance is affordable? Here is where the political/ideological sticking point that has held up reform for so long is located. One initial plan pushed by the progressive Democrats in Congress was for a single-payer plan, which is defined by Physicians for a National Health Program as "a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private." This maximizes the government's leverage in negotiating reimbursement rates with insurers so that efficiency is given priority and administrative costs are kept low (with executive compensation hopefully kept low too). Needless to say, the single-payer option was given a quick shove out the door by the Democratic leadership and those who receive large amounts of campaign contributions from the health care and health insurance industry.
So the compromise option for Democrats became what is called the "public option," perhaps you've heard of it? While there are many variations on what the public option would be, the main elements of the public option is to create a government-administered competitor to the health insurers, many of whom operate with virtual monopolies in many states. The public option would create a government-run insurance exchange where those who are currently uninsured (i.e. those who earn too much to qualify for Medicaid, those who are unable to purchase insurance currently due to "pre-existing conditions," or young people who are healthy) could purchase their newly-mandated insurance coverage. the most robust version (i.e. most cost-cutting version) would have what's called "Medicare plus 5," where reimbursement rates to health care providers would be set at Medicare rates plus 5% on top of that. The advantage of the public option compared to our current system is that it pools people together to have stronger leverage in negotiating rates with providers, as well as having lower administrative and executive compensation costs (compensation costs are significant, truly.) Without the Medicare plus-5 option, the public plan would be forced to negotiate its reimbursement rates separately from the much-larger Medicare pool, and therefore would not be able to save as much money, resulting in higher premiums for those under the program and more government subsidies to help people buy insurance, thus costing the taxpayers more money.
Sadly, yet predictably, the weaker public option passed the House, due to the entirely inconsistent arguments of "fiscally conservative" Democrats that the most robust public option would cost taxpayers too much money. To add insult to injury, a last-minute legislative offensive by anti-abortion Democrats inserted an abhorrent amendment adding major restrictions on abortion provisions to the health care bill, but that's a whole other topic. Suffice it to say that the amendment authored by Rep. Bart Stupak (D-MI) will hurt poor women the most, as if they don't have enough on their plates already.
So now it comes to the Senate, led by Harry Reid of Nevada, to debate health care reform. While the majority of Senate Democrats support the public option, there is a bloc of 4 who are holding things up by hemming an hawing about filibustering the health care bill if a public option is included. The filibuster (for those who haven't taken civics classes in a while) is a parliamentary tactic used by Senators to hold up votes on a bill, and indeed, all work in the Senate, indefinitely. The filibuster is a major obstacle to getting bills passed generally, and the way to end debate in the Senate is by 60 senators voting to invoke cloture of the debate. Despite the Democrats having 60 votes in the Senate (in truth it's 58 plus Joe Lieberman of Connecticut and Bernie Sanders of Vermont who normally caucus with the Democrats) the 4 holdouts mentioned before may not vote to pass healthcare unless the bill is heavily watered-down and/or the public option stripped out entirely. To prevent the from filibuster from killing the bill, Sen. Reid can use another parliamentary tactic to combat the filibuster called reconciliation, which is essentially to vote only on the parts of the bill that directly involve the federal budget. Reconciliation limits debate (i.e. filibustering is not allowed) and requires only 51 votes to pass, versus the 60 to end a filibuster. Using reconciliation would allow a much stronger bill to pass the Senate, as Sen. Reid can round up a group of strong Democrats to pass a robust public option without having to kowtow to the wishes of those senators who are bought and paid for by the insurance industry. The downside to reconciliation is that those parts of the bill that do not directly affect the budget could not be included in the health care bill and would need to be voted on separately, and that it would create an open war with the Republicans, who would accuse the Democrats and President Obama of violating their pledge of seeking greater bipartisanship.
That being said, we're at a major point of decision here; we've never been this close to comprehensive health care reform for all, and for the good of the country and our nation's future, if it takes reconciliation to pass the best bill possible, then I'm all for it. The Republicans have offered no serious reform bill of their own and have made it clear that they will stand united against anything that alters the status quo and/or is one of President Obama's legislative priorities. If the Democrats don't pass this bill, they're going to take massive losses in the 2010 elections, as former Gov. Howard Dean of Vermont predicted recently, and they will absolutely deserve those losses, as there is major support for health care reform in this country right now, with recent polls showing 72% of Americans supporting the public option. If we can't do it now, then when? Why must our health and well-being be subject to the profits of insurance companies? What is the price of inaction? With over 45 million uninsured in this country, it is huge.
Firedoglake, a premier progressive blog, has a petition set up urging Sen. Reid to pursue reconciliation to achieve the strongest bill possible for the good of us all. While my posting here elides over many of the nuances and difficulties inherent in trying to achieve major reform, and there's no guarantee that everything will get better once health care reform is passed, it's better to try and fail than wake up in the future and wonder what could have been. Please sign the petition, for the good of our country's fiscal future and future generations.
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