The Health Care Debacle


Dave Mann

I survived the Bush years by employing a simple mantra: “It’s best not to think about it.”

I would mutter this to myself whenever events of the day became too maddeningly nonsensical: Weapons of mass destruction, Abu Ghraib, Katrina, U.S. attorneys scandal, NSA wiretapping….It’s best not to think about it.

This week, for the first time in the Obama presidency, I’ve had to dust off the phrase and put it back to work.

Since the special election in Massachusetts last week — as I’ve watched the Democrats flop about trying to pass health care reform and do a good impression of dying fish on a boat deck — it seems once again that the people running the country have lost all common sense and perspective.

This time it’s liberal Democrats, who are stubbornly destroying an historic opportunity to pass major health care reform.

I’m not going claim that I like the reform bills. Like most everyone else, I can find a lot to dislike in the legislation.

But, as I wrote last week, we have to look at the big picture: 30 million Americans would receive health insurance. And the reform would represent a huge wealth transfer from rich to middle- and low-income Americans. The bill would save many lives.

There’s still a straight-forward way to salvage the bill and provide better health care for 30 million people. The U.S. House simply has to pass the Senate version.

No problem, right? After all, Democrats have a 78-seat majority in the House.

But apparently it is a problem. Speaker Nancy Pelosi claims she can’t muster enough support in the lower chamber for the Senate bill.

The Washington Post reports:

Pelosi described her members as vehemently opposed to a provision that benefits only Nebraska’s Medicaid system, language added to win the vote of Sen. Ben Nelson (D-Neb.). Also problematic are the federal subsidies the Senate would offer to uninsured individuals, which some House liberals view as insufficient, and the excise tax it would impose on high-value policies, which could hit union households.

So, let’s recap. Liberal Democrats in the House are willing to kill a once-in-a-generation reform that would provide health care to 30 million people for years to come because — drum roll, please — they don’t like the deal Nebraska Sen. Ben Nelson struck, and the unions aren’t happy. Could they possibly have a smaller vision?

Is the Nebraska compromise fair? Of course not. But who really cares in the long run? If anyone thinks the Nebraska compromise is more important than the health of 30 million people (a population bigger than Texas’), they shouldn’t be serving in government. Besides, they can always come back and fix the problems later. Few large reforms are perfect from the start—just look up the history of Social Security.

A couple more points to consider. First, the House passing the Senate bill is the only sensible way forward. The other options seem ludicrous:

1. Start over. This has no chance. If you think this Congress can write and pass major health care legislation in an election year when they couldn’t do it in 2009, I’d like to buy you lunch.

2. Break apart the reform bill and pass it in chunks. This approach won’t work either. Major parts of the bill are unlikely to pass the Senate because of the filibuster. Doing it piecemeal makes no sense anyway. If you want to know why, read this Steven Pearlstein column from the Post.

3. The Senate could make its bill more palatable to the House. This is a bad idea. With a filibuster in place, the only way the Senate can change the current bill is through the budget “reconciliation” process. I won’t go into the details of what that is, but it’s essentially a strong-arm tactic that removes the GOP filibuster from play. First, it’s never good for the majority to trample the rights of the minority (when the GOP talked about doing the same thing several years ago, Democrats preached all holy holy about the sanctity of the filibuster). Second, it would be bad politics, and Senate Democrats clearly have no stomach for it.

4. Wait till after 2010 midterm elections and start again. Good luck with that. Republicans will be in a much stronger position in 2011. If they wait till 2011, Democrats better get used to the idea of health savings accounts again.

So if Democrats want to pass meaningful health care reform right now, moving the Senate bill through the House is the only option.

The question liberals have to ask themselves is not “do we like the Senate bill?” They clearly don’t. Rather, the question is, “do they like the Senate bill better than the status quo?” Because, right now, those are the options. Insure 30 million Americans or do nothing.

If they do nothing, realize that they will have passed up an historic, once-in-a-generation opportunity. (Have these people forgotten how out-of-power they were just four years ago?) It has been four decades since Democrats controlled the White House, U.S. House and 60 seats in the Senate.  It could easily be another 40 years (or longer) before this kind of moment comes around again.

So: is it really worth forgoing the best chance for progressive health care reform in decades because liberals don’t like the Nebraska deal and because the unions are nervous?

That thinking makes no sense to me.

If Democrats go that route and don’t pass a major health care bill, they will get slaughtered in the 2010 elections. And they’ll deserve what they get.

OK, deep breath now and repeat after me: It’s best not to think about it.

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