THE PLANK NOVEMBER 23, 2009
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As has been the case all year, progressives are giving mixed reviews to the latest legislative step health care reform legislation, the 60-40 Senate vote-to-proceed, which is basically a preliminary cloture vote. While everyone's happy that the vote wasn't lost, there's a fair amount of angst over the threats of some Democrats to vote against the final bill, or against cloture on the final bill, unless actions unacceptable to most progressives are taken to change the bill.
And again, as has been the case all year, nearly all the focus among progressive worriers is over the public option, which Senators Lieberman and Nelson seem to be ruling out categorically.
Let's look at these two issues separately.
If, indeed, wavering Democrats who voted for the motion to proceed nonetheless conclude that they have no obligation to vote for cloture on passage of the bill unless their substantive demands are met, then we might as well start rediscussing the reconciliation strategy, because there is no version of health reform, now or at any point in recent history, that could command 60 votes in the Senate. To get to 60 on cloture (even granting that a Republican or two might still be lured across the line), it will be necessary to convert those who basically said "I hate this bill but I don't want to prevent the debate" to a position of "I hate this bill but I don't want to prevent a vote." And that will require not just moral suasion but pressure and maybe serious threats of reprisals from the Senate leadership, supplemented by a robust public campaign over the next few weeks to demonize the de facto 60-vote requirement, which much of the public knows nothing about. Keep in mind that health reform isn't the only progressive initiative that's doomed if it takes 60 Senate votes to enact anything serious on any subject, and also keep in mind that an increase in Democratic votes in the Senate in the immediate future is exceptionally unlikely.
On the second issue, the public option focus, it's as good a time as any for progressives to finally begin looking at this legislation as a whole, and as compared to what will happen if no legislation is enacted before the 2010 elections. It is entirely possible (particularly if you are a single-payer advocate) to conclude that a reasonably strong public option is more important than covering most of the uninsured, more important than the level of subsidies to make coverage practically affordable, more important than regulation to end highly discriminatory insurance practices, and more important than how and when health reform is phased in, just to mention four competing priorities. But it's equally possible--and more to the point, legitimately progressive--to consider one or more of these factors to be as important as a conventionally constructed public option--again, if you major concern is the practical effects of reform rather than setting the stage for a future single payer system. In any event, an intra-progressive debate on priorities that goes beyond the public option issue needs to happen right away.
Ed Kilgore is Managing Editor of The Democratic Strategist and a senior fellow at the Progressive Policy Institute.
11 comments
It is entirely possible (particularly if you are a single-payer advocate) to conclude that a reasonably strong public option is more important than covering most of the uninsured (that is only true if you are an asshole, anyone who is willing to sacrifice people's lives over such ideology is generally called a Republican, and never a progressive)
- blackton
November 23, 2009 at 7:47pm
Yes, I also blanched at the notion that a single-payer advocate would subordinate the interest in covering most of the uninsured to the goal of a strong public option. It has been my understanding that the purpose of a single-payer system would be to effect universal (or near-universal coverage). So how could a single-payer advocate take a principled position that it's public option or nothing?
- dhurtado
November 23, 2009 at 9:13pm
It's important for leftists to recognize that objections to the "public option" are not entirely the province of die-hard conservatives. Most voters are familiar on some level with the fact that the 60% of our national healthcare that's covered publically as Medicare and Medicaid is on the verge of bankruptcy, hideously inefficient, and a major culprit in enabling bad practices by the other big players like Big Pharma, Big Insurance, and giant hospital/doctor conglomerates. It is verrry hard to make the case that the currently-proposed public option wouldn't make a bad situation worse. Our system needs root-and-branch reform, which is not currently on offer. The most concise and insightful analysis and proposal I've seen in this whole debate is available for free on "Atlantic.com" under the title "How the American Healthcare System Killed My Father". Highly recommended...
- Robert Powell
November 24, 2009 at 4:10am
http://www.theatlantic.com/doc/200909/health-care
- Robert Powell
November 24, 2009 at 5:02am
eff you and your leftists RP. Leave the party.
- WandreyCer
November 24, 2009 at 6:57am
Robert Powell, the author of the article in the Atlantic makes a very good point, but not the point intended. The author offers several valid criticisms of the current health care system, mostly about inefficiency, and how (in his opinion) the proposed reform would not correct them. But his prescription, placing everybody (including older Americans) in the individual insurance market, would make matters worse not better (that's the assessment of most experts). Though most likely not intended, his prescription points out the difficulty of effective reform, namely, that as long as we have different health care systems for different groups (group insurance, individual insurance, Medicare, Medicaid, etc.), it is impossible for everybody to come together to improve the overall efficiency and effectiveness of the system as each group tries to maintain or advance whatever advantage that group perceives it to have under the existing tiered system. I would argue that, if efficiency is the goal, putting everybody under one, single payer system is best, as opposed to the opposite of putting everybody on his or her own in the indivdual insurance market as proposed by the author of the article in the Atlantic.
- raylward
November 24, 2009 at 9:02am
I have some of the best medical insurance coverage in the country, thanks to my employer (a biotech firm), I live in a region overflowing with medical research facilities and other hospitals (the Bay Area), and my health care, in a word, sucks. So does that of my wife, who as I write this lies in pain waiting for an operation that she's needed for a few weeks. And my best friend, who at dinner last Friday lamented that he will now have to travel 25 miles to see his current primary care physician because it's virtually impossible to find doctors who are taking new patients where he lives (one of the country's wealthiest counties). Speaking of my wife, the primary reason she and I got married when we did was to avail ourselves of my company's health plan. As someone who was at the time enjoying the only "public option" available to her (Medicaid), she discovered, among other cheery facts, that Medicaid dentists are virtually nonexistent and that the ones who do exist--here's that word again--suck. So much so that, on multiple occasions, she called me at night weeping in pain because of abscesses in her mouth that went untreated. Robert Powell is right to question the conventional wisdom that covering everyone is some kind of panacea. Covering everyone is, in my view, a moral necessity, but it's a Pyrrhic victory unless its unintended consequences, especially greater rationing of already dwindling care, are dealt with honestly and swiftly. We all need to realize that doing the right thing begets not some sunny Hollywood ending but, quite often, consequences that are materially unpleasant for the perpetrators.
- williamyard
November 24, 2009 at 1:08pm
Good points by Yard. But here is a fundamental moral question: What if it were true that universal coverage, in order to be fiscally viable, necessarily implied rationing of health care? Which would be morally prefereable? A system with universal coverage in which health care is rationed? Or a system in which a majority has access to unrationed health care, but a substantial minority does not have access at all?
- dhurtado
November 24, 2009 at 2:22pm
Our system currently is almost your second option, hurtado, but everyone here has access to an ER at least. In any case, I think I'd prefer the latter to the former, but it would depend on whether I could buy more health care with my own money, even if it is rationed. In Canada, for example, private insurance is outlawed. Americans will have a real hard time with that concept, I think.
- butchie b
November 24, 2009 at 3:42pm
Butchie, I recognize that our current system is at least roughly like the second option. (Though some would say that there is rationing even under our current system.) I think it is a bit of an overstatement, though, to say that "everyone here has access to an ER." Can you imagine what would happen if all the uninsured went to ERs for the kinds of things that most of us who are insured go to the doctor for? The ERs could not possibly handle it. And those who do go to ERs still get billed for it, and we all subsidize those who can't pay for it. But I am trying to pose a hypothetical by which to test our moral compass. Would those of us who have good insurance coverage and good access to medical care be willing to give up some of that access if that were required in order to provide universal access?
- dhurtado
November 24, 2009 at 5:34pm
dhurtado, I'd rather ration some care to all than deny most care to some. I can't claim that to be the more moral stance because I don't trust myself enough to consider myself a good judge of morality. But that's my story and I'm sticking to it. If ever there's an example of the Devil being in the details, however, it's this one. Having gone through watching the egregious waste of resources when it was Mom's turn to shuffle off, I can attest to the fact that the Devil and I are on a first-name basis, and that he is an astute negotiator. Watching her spend the last couple years of her life ever so slowly drowning in her own mucus brings the issue front and center, which is of course the last place any of us want it to be. Pretty soon the Medicare statements listing all those $700 three-mile ambulance trips to the ER so somebody could suck the snot out of her lungs and send her home elicited little more than a yawn. (Having somebody else pay the bill is like that, no?)
- williamyard
November 24, 2009 at 7:11pm