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Health Care Reform Commentary
March 15, 2010 at 10:03 am #95049
From Clive Crook’s blog on Financial Times
A needed reform descends into farce
By Clive Crook
Published: March 14 2010
Are the defenders of the Democratic party’s approach to healthcare reform irrepressible optimists, or self-deluding fantasists? I declare a personal stake in the issue, as one such defender myself. In that capacity, I only wish I could be more confident of the answer.
As the search for votes to pass a bill continues, the line taken by defenders of comprehensive healthcare reform goes like this. Yes, the public opposes the Democrats’ proposals, but it is the process more than the product that voters question. And though nobody would say the product was perfect, it is basically good.
According to this argument, pieces of the reform – rules to force insurers to ignore pre-existing conditions, subsidies to help the less well-off, and so on – are popular. But the past year’s wrangling has sown confusion. Voters are bored and bewildered. Once a bill is passed, they will come around to liking it.
And the bill is a big advance, defenders insist. Broadening healthcare coverage and making it more secure are ethical imperatives. The measure takes tentative but useful steps towards better control of costs: not enough, but better than nothing. If the effort stalls, the likely result is no reform at all. Just as in the 1990s, a grand attempt at healthcare reform will have been crushed. It might be 20 years before anybody tries again.
These arguments are correct, but there is a problem. The process, not the product, has indeed caused the failure. The trouble is, the process just keeps getting worse.
Unlikely as this seems, confusion continues to deepen. Specialists – let alone ordinary voters – struggle to remember the differences between the Senate bill, the House bill, and the president’s unfinished merged proposal. In the last big push to get reform through, using whatever deals, scams, ruses and parliamentary evasions fall to hand, the public and their concerns are pushed ever more to the periphery of Washington’s vision.
The White House is supporting reconciliation – a procedure that allows the Senate to accept revisions to its bill by simple majority. This defeats the Republican filibuster. It also complicates the parliamentary process, since not all provisions are allowed under reconciliation.
Already beyond abstruse, now in the realm of surreal farce, the debate is thus becoming yet more inward-looking and unintelligible. Can language on abortion be included in a reconciliation measure? (Probably not.) Can the Senate parliamentarian be overruled? (What is the Senate parliamentarian?) All that is missing is a speech in favour of the plan by Groucho Marx. Recovering voters’ respect for the outcome, even assuming the outcome is good, looks an ever more distant prospect.
Under reconciliation, first the House must pass the Senate bill; then both chambers pass the reconciliation measure. Despite their big majority, House Democrats have not mustered the votes. They worry that if they pass the Senate bill, Senate Democrats will renege on their yet-to-be-obtained promise to pass the measure that modifies it.
So this plan, solidly opposed by Republicans, is struggling to command sufficient support even in the president’s own party, whose two Congressional branches do not trust each other to co-operate. This is the same plan, you recall, that the public will come around to in due course. Democrats facing tight elections are right to worry that “in due course” might be a long time. It is hard to see how the public will forget this mess between now and November.
What the Obama administration lacks in clarity of message it makes up for in sheer nerve. Mr Obama has doubled down on his healthcare gamble. He has delayed a planned trip to Asia this week, so that he can exert more influence as the House Democratic leaders try to corral the vote. If the effort fails, he will be fully implicated in the failure.
At the moment, the chances of passing the measure look less than 50-50 – an extraordinary fact, when you consider that House Democrats could pass reform without further ado simply by voting for the unamended Senate bill. (Why will they not do that? Hard to say, since the bills are not very different.)
Suppose that Mr Obama’s gamble pays off, however. Suppose Nancy Pelosi, leader of the House Democrats, assembles her majority and sets the reconciliation wheels in motion. Suppose all then goes smoothly, and the reform is enacted. Under this best possible scenario, what then? The White House and most Democrats say they would be rewarded in November’s mid-term elections for at least getting something done. This is doubtful.
Conceivably, the economy could rescue them. Nothing would improve the Democrats’ prospects more than falling unemployment and a vigorous expansion. But passing an unpopular bill by questionable means is unlikely to prove an electoral tonic.
Last week two respected Democratic pollsters said that the administration’s drive for comprehensive healthcare reform was a “march of folly”. The battle for public opinion had been lost, they said, and if the Democrats insisted on passing this bill regardless, the country will kick them in the teeth in November.
Unfortunately, that sounds right. The US needs this effort to succeed. Even if it does, Democrats will be the losers.
Copyright The Financial Times Ltd 2010
March 15, 2010 at 5:06 pm #95053
Philip L. HoffmanParticipant
I reject the “teeth kicking” analogy. We need to get SMOETHING done, and it needs to be economic. helathcare is one such BIG THING, and if we actually do it, we may well get better polling, so long as it gets sold as leadership – and Democrats control that selling.
March 24, 2010 at 4:29 pm #95051
I for one am very proud of President Obama. He delivered on his promise of Health Care Reform. It isn’t perfect, but what so many people miss is just how huge ANY health care reform bill is. Democratic Presidents since FDR have been championing this effort, and Obama staked his legacy on it. It wasn’t pure politics. It was the right thing to do. When the first Civil Rights legislation was passed, it wasn’t perfect, but it opened the door for the Civil Rights Act. I think Obama was smart enough to get a bill passed that could be passed. We can make improvements to it as we go.
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