Why Liberals Won’t Kill Health Care Reform

For those opposed to the current versions of health care reform moving through Congress it might be enjoyable to see the Democrat versus Democrat circus currently underway in Washington. Both parties are susceptible to the joys of circular firing squads, but the Democrats are embracing the concept with exceptional glee of late as liberals and moderates in the Democratic caucus brawl over the shape of health care reform legislation. But at the end of the day there’s several reasons why it’s highly likely all 60 members of the Democratic caucus will vote to move the bill forward.

  1. The Senate is not voting on a final health care bill. Yes, passage of health care reform by the U.S. Senate would be a historic milestone, but just a milestone. What emerges from the Senate will go to a conference committee where the final health care reform bill will be drafted. This makes it easier for Senate Majority Leader Harry Reid to muster the necessary votes. For example, Senator Ben Nelson who is threatening to vote against allowing a vote on the legislation unless it’s abortion language is modified, can make it clear he’ll vote “aye” now to keep the health care bill alive, but he’ll vote against it if the conference committee doesn’t address his concerns. The liberals who are claiming the legislation is a bail-out of the insurance industry can make the same claim: “I’ll vote for it now, but it needs to get better in conference.”
  2. Liberals opposing the bill don’t vote. With the exception of Senator Bernie Sanders, an Independent who caucuses with the Democrats, most of the complaints have come from liberals outside of the Senate. Former Governor Howard Dean was the first well-known liberal to call for defeating the Senate health care reform bill. he was soon joined by Keith Olbermann of MSNBC and folks at the Daily Kos blog. The AFL-CIO and SEIU are also making noises about killing the bill and starting over. But killing the bill would require liberals to tell millions of Americans that preventing health insurance companies from denying them coverage isn’t adequately progressive. Or that preventing carriers from dropping insureds when they get sick isn’t sufficiently liberal. Or that eliminating annual and lifetime caps on insurance coverage is unimportant to liberals. Or that making health insurance accessible and affordable (through subsidies) for millions of the currently uninsured fails to meet the definition of “good enough.” Liberals will complain. They’ll whine and threaten. At the end of the day, however, it’s unlikely any liberal wants to go down in history as the vote that postponed health care reform for a generation (see reason #4, below). Mr. Olbermann gets paid to talk so the commercials on his Countdown show don’t run together. He doesn’t have vote in Congress. Neither does Governor Dean. What they say matters only within the bubble known as cable news. Having a vote in Congress is a responsibility the pundits lack, but lawmakers take very seriously – seriously enough to keep health care reform legislation moving forward.
  3. Liberals are upset over more than just the public option. While dropping a “robust” public option from the Senate health care bill is generating the most recent complaints from the left, threats to defeat the bill result from several disappointments. Many liberals support a single payer system and see a government-run health plan as a compromise. They look at the requirement for everyone to purchase health insurance and ask a reasonable question: what is to stop carriers from gouging the public? (Hence proposals for requiring high medical loss ratios). Then there’s efforts by anti-abortion groups to use health care reform to insert language that goes beyond the current status quo embodied by the Hyde amendment. Some progressives also are upset pure community rating is absent from the bill and the fact Health Savings Accounts will survive the reform effort. As the end game approaches, it’s not surprising that passions rise and frustration bubbles over. Especially for liberals about to vote for what they consider disappointing legislation, venting their displeasure is to be expected. Venting displeasure, however, is not the same as blocking health care reform.
  4. Liberals won’t get a better bill any time soon. Progressives were understandably delighted by the 2008 election results. President Barack Obama had a demonstrably liberal voting record and still won in what can legitimately be called a landslide. Democrats had substantial majorities in both houses of Congress. What was overlooked is that the Democratic Party (and the president) is more centrist than true liberals like to believe. In fact, nearly one-third of the Democratic Caucus are also members of the Senate Moderate Dems Working Group. Anyone not trying to sell Viagra and auto insurance (which leaves out Mr. Olbermann) has known for months that health care reform would be shaped by these moderate Democrats Senators. And if liberals think they’ll be replacing these moderates with more liberal Democrats they’re spending too much time in a different space-time continuum than the rest of us. The chances of liberals taking the seats of Senators Blanche Lincoln and Mark Pryor (Arkansas), Evan Bayh (Indiana), Ben Nelson (Nebraska), Mary Landrieu (Louisiana), Kay Hagan (North Carolina), or Clare McCaskill (Missouri) any time soon are extremely slight. The reality is that Republicans are likely to pick up several seats in the Senate and House in 2010. Historically, the mid-term elections go poorly for the party in the White House. What this means is that for liberals, the current Congress is as good as it gets. Starting over would likely result in reforms even more moderate than what’s being considered today. That’s why Republicans are doing everything they can to slow down the health care reform process. They know the longer the process takes the more likely health care reform is likely to fail and that future attempts will be more to their liking. Liberals in the Senate know this. The Governor Deans of the world can ignore this fact, but lawmakers have to deal with reality, not the fantasies of ideologues.
  5. There’s always tomorrow. To think that whatever health care reform legislation President Barack signs into law health care reform legislation early next year will end debate on the issue for the rest of his Administration is naive. As Republicans gain strength they’ll seek to modify whatever is enacted. Democrats will attempt to expand reforms through more targeted legislation. Whatever health care reform bill emerges from Congress this session should be viewed as a foundation for future political fights, not the end of them.

Could health care reform fail because of attacks from both the left and the right? Yes. Is it likely to fail because liberals join Republicans in torpedoing health care reform? Not really. I don’t envy Senate Majority Leader Reid his task, but my guess is he’ll soon have the 60 votes needed to bring health care reform legislation to the floor of the Senate. Then if some of the liberals want to make a symbolic vote against the reform package they can go right ahead. Once the bill is brought before the Senate It only take 51 votes to move the legislation forward to the conference committee.

Of course, whether whatever health care reform legislation the conference committee can draft will secure enough votes is still very uncertain. But we will have the chance to find out.

CBO Bolsters Baucus Health Care Reform Plan

The Congressional Budget Office has given a boost to the Chairman’s Mark of America’s Healthy Future Act 0f 2009. In a preliminary analysis of  the health care reform proposal put forward by Senator Max Baucus, the chair of the Senate Finance Committee. the CBO estimates the plan would reduce federal budget deficits by $49 billion between 2010-and-2019.

The Congressional Budget Office is highly regarded by both parties for its independent analysis. Their findings can cripple a bill or enhance its stature. In this case, even though the report is preliminary, the CBO adds substantial credence to Senator Baucus’ reform effort. A good thing considering the attacks on the proposal from both wings of the political spectrum.

The CBO presented its findings in a letter to Senator Baucus on September 16, 2009. (The analysis is summarized on the blog of CBO director Douglas Elmendorf). In addition to the positive effect on the federal deficit the analysis projects the health care reform legislation would increase federal revenues by $139 billion over the 10 year period. To be sure, the CBO, working with the staff of the Joint Committee on Taxation notes these estimates “are all subject to substantial uncertainty.” Further, the analysis was based on a description of the Chairman’s Mark of the America’s Healthy Future Act provided by Senate Finance Committee staff, not the document itself let alone actual legislative language.

What the CBO reports is that Senator Baucus’ health care reform bill would reduce the number of uninsured Americans by 29 million by 2019 according to the analysis. This would increase the percentage of Americans legally in the country and under the age of 65 to approximately 94 percent in 10 years from its current level of roughly 83 percent. This would leave “25 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants).”

Where these newly insured consumers obtain coverage is kind of interesting. As you read these numbers, keep in mind that the size of the individual health insurance market nationally is estimated to be approximately 18 million people. The CBO estimates roughly “25 million people would purchase coverage through the new insurance exchanges, and there would be roughly 11 million more enrollees in Medicaid than is projected under current law.”  These numbers are significant. They will change the dynamics of the market, but they hardly represent a government takeover, especially considering that the Senate Finance Committee proposal does not create a government-run health plan.

The health care reform plan put forward by Senator Baucus has been subjected a great deal of criticism by Democrats and Republicans, but the attacks by liberals have been especially vicious. Which means the real debate has begun. During August it was conservatives dominating the attack on Congressional health care reform proposals. Now liberals are joining the rant party. Here’s another example from Countdown with Keith Olbermann who, like the Glenn Becks on the right, seems unable to disagree with someone on public policy without calling them names or attributing venal motives to anyone on the other side. It’s politics by outrage that demeans the debate, but pleases the partisans.

Are there flaws in Senator Baucus’ health care reform plan? Yes. Hopefully the debate starting next week in Senate Finance will fix many of them. Is his plan better than the status quo?It certainly would be for the 29 million Americans gaining coverage under the proposal. Reducing the deficit seems like a step in the right direction. And, as I’ve noted before, to the dismay of Mr. Olbermann, health care reform will be decided by moderates. And moderates aren’t attacking the America’s Healthy Future Act.