By Harold Meyerson
Wednesday, July 29, 2009
Congress, it's now clear, is crafting two quite different kinds of health-care reform. And the day that President Obama has to choose between them grows near.
Three committees have reported out bills plainly to Obama's liking. These committees -- two in the House, one in the Senate, and all controlled by progressive Democrats who support the president's objectives -- have backed mandates on individuals to get insurance and created generous subsidies to make that insurance affordable. They have backed mandates on employers (all but the smallest) to provide insurance or pay into a pool to fund those subsidies. And they have created a public plan, both to compete with private plans and to bring down the cost of health care more generally.
But the Republicans on the Senate Finance Committee and the right-wing Democratic Blue Dogs on the House Energy and Commerce Committee want to go in different directions. The Blue Dogs want to reduce payments to doctors except in the rural areas they disproportionately represent, where they want to increase them. They oppose, so far, the public option, though it would be the most effective way to bring down costs in their districts. They oppose partly funding the subsidies by taxing the wealthiest Americans. And they are waiting to see what the Senate Finance Committee turns out before they subject themselves to the ordeal of actually voting on a bill (oh, the horror).
Over at Senate Finance, judging by the reports coming of the committee, a solonic gang of six -- three Democrats, including chairman Max Baucus of Montana, and three Republicans, including ranking member Charles Grassley of Iowa -- are turning out a bill whose resemblance to anything the president has championed is accidental and incidental. To secure Republican support, they oppose a public plan. To secure Republican support, they oppose employer mandates, even on the largest corporations. (And many of America's biggest employers are retailers with a proven record of not providing coverage to their workers: Wal-Mart, our largest, employs 1.4 million Americans, 48 percent of whom it does not cover.) The solonic six may end up requiring employers to fund subsidies for employees who need them, but that could create the bureaucratic nightmare to end all bureaucratic nightmares -- 700,000 Wal-Mart employees, say, bringing their tax returns to work so management can investigate ("You sure you reported all your income?") and stall ("Doesn't your spouse work at Home Depot? Why don't they pay the subsidy?") and investigate and stall.
Sounds like a plan to secure universal coverage by the middle of the next century.
The solonic six, in other words, seem on track to produce a plan that falls short of universal coverage, omits the savings that a competitive public plan would create, and might actually make health care harder to get. The only justification for such a bill is that it might win some Republican support. Why that is a goal worth pursuing at the expense of decent reform, however, is not at all apparent.
Problem is, bipartisanship ain't what it used to be, and for one fundamental reason: Republicans ain't what they used to be. It's true that there was considerable Republican congressional support, back in the day, for Social Security and Medicare. But in the '30s, there were progressive Republicans who stood to the left of the Democrats. Nebraska Republican George Norris, who for decades called for establishing public power companies to compete with price-gouging private companies, was the father of the Tennessee Valley Authority. In the '60s, Rockefeller Republicans supported civil rights legislation and Medicare.
Today, no such Republicans exist. In New England and New York, historically the home of GOP moderates, Republicans occupy just two of 51 House seats. Nationally, the party is dominated by Southern neo-Dixiecrats. In their book "Off Center," political scientists Jacob Hacker and Paul Pierson compared congressional Republicans of different eras and concluded that a Republican House member in 2003 with a voting record that placed him at the median of his party was 73 percent more conservative than the median GOP member of the early '70s.
Max Baucus, then, isn't negotiating universal coverage with the party of Everett Dirksen, in which many members supported Medicare. He's negotiating it with the party of Barry Goldwater, who was dead set against Medicare. It's a fool's errand that is creating a plan that's a marvel of ineffectuality and self-negation -- a latter-day Missouri Compromise that reconciles opposites at the cost of good policy. Obama should thank the solonic six for their work, and, as much as is politically practicable, ignore it.