The decibel level concerning whether health care reform should include a government-run health plan got a lot louder this week when President Barack Obama reiterated his strong support for the concept. Partisans on both sides of the issue ratcheted up their rhetoric several notches, drew pretty lines in the sand and retreated to reading doomsday passages from their partisan play books. Amid the clamor there were even reasonable, constructive policy discussions to be heard. All of this is to be expected. And while it can generate great anxiety among those who care about the issue, it’s important to keep things in perspective.
First, there’s no health care reform bill yet. Key House and Senate Committees are drafting them right now, but nothing “official” is on paper yet. For now everything we’re hearing comes from option papers, outlines and letters. The legislative process involves numerous steps. What people expect it legislation to look like doesn’t really matter all that much. In fact, what legislation looks like when it’s first introduced doesn’t mean all that much. It’s what the bill contains when it winds up on the President’s desk that matter. Until that version of the bill emerges, it’s all just part of the debate.
Second, no one should be surprised that President Obama considers a government-run health plan to be important. He made his position clear during the campaign. Often. His position on the issue seems to be one of principle, not politics. He sincerely believes that, as he wrote in his letter to Senator Max Baucus and Senator Edward Kennedy, a public plan “… will give [consumers] a better range of choices, make the health care market more competitive, and keep insurance companies honest.” You may disagree with his conclusion, but he has been consistent and specific about his intent.
Third, what President Obama wants from health care reform is critical. He’s a popular president advocating popular positions. The need for comprehensive health care reform is widely accepted. The President is an extremely skillful politician (just as Secretary of State Clinton and Senator John McCain). And ultimately, he’s the one who signs the bill or vetoes it. However, the White House is only one piece of the health care reform puzzle — a big piece, but still only one piece. Congress will write the health care reform legislation. And Congress, by design, does it’s job messily. There are three House Committees (Energy &Commerce, Ways &Means, and Education & Labor) and two Senate Committees (Finance and Health, Education, Labor & Pensions) with jurisdiction. Within each chamber, the committee chairs have all pledged to cooperate and present a unified bill. That doesn’t mean they agree on everything, however. Getting to a common bill in either the House or Senate will require tremendous work and substantial give-and-take. And any unified bill within a Chamber is only the beginning. The House and Senate bills will need to be reconciled.
Fourth, in the end, it all comes down to votes. Democrats have sizeable majorities in both chambers of Congress. That’s a blessing and a curse. It’s a blessing because the majority, eventually, tends to rule — or at least get most of what it wants. It’s a curse because getting to a large majority means creating a big tent. The Democratic political strategy for the past several years have been to recruit and strongly support candidates who fit their districts, not who meet some test of ideological purity. Which means there are liberals, moderates and conservatives on the Democratic side of the aisle in both the House and the Senate. This, in turn, means the White House and the Congressional Leadership must negotiate with members of their own party at the same time they are negotiating with the GOP.
What all this means is that what’s being said today about a government-run health insurance plan is significant, but not determinative of what will become law. President Obamamay want a public health plan. Leaders in Congress may wanta public health plan. But in the end, they want comprehensive health care reform more. And that means bringing along the moderate and conservative members of their caucus and, if possible, Republicans, too.
Some of those moderates have made clear they have problems with a government-run plan. Consider this report from Bloomberg entitled “Health ‘Public Option’ Hits Bipartisan Resistance: “A group of House Democrats from Republican-leaning states said any “public option” must be tightly restricted so it doesn’t undermine private industry. We cannot create a public option that stacks the deck — through rate-setting and forced participation — against a system that currently provides coverage to 160 million Americans,” said Representative Mike Ross of Arkansas, chairman of the health-care task force of conservative “Blue Dog” House Democrats.”
Senator Bill Nelson, a conservative Democrat, said this weekend that, while he is open to a public health insurance plan under some circumstance, “‘It’s a deal-breaker for me if there’s a government-run plan to replace existing insurance plans,” according to the Lincoln Journal Star. Other moderate and conservative Democratic Senators have expressed similar reservations or, like Senator Evan Bayh are, at this stage of the debate, “agnostic” about the value of a public plan. He w3nt on to say that a public plan might be limited to serving as “a backstop, as a last resort, if the private sector has just failed to meet the challenge.”
Politics, it is often said, is the art of compromise. But it’s also a lot like poker and as the song goes, in that game you’ve got to know when to hold ’em, know when to fold ’em. The key word in that lyric is “when.” When it comes to a government-run health insurance plan, then is not now. It’s too early for partisans on either side of the debate to compromise. That time will come soon enough. Who does the compromising will be determined the way it always has been: by whose vote is needed. Passage of comprehensive health care reform will require votes from members of the Blue Dog Coalition (House Democrats) and the Senate’s Moderate Dems Working Group. When it comes to fashioning a compromise, it’s the positions of these lawmakers that need to be closely watched.