On health care: If not now, when?
Unless the sun rises in the West tomorrow, Thursday's health-care reform summit will yield no bipartisan concord. Congressional Republicans remain unalterably opposed to health reform; the ideas they've advanced -- which the nonpartisan Congressional Budget Office says would insure no more than 3 million of America's more than 45 million uninsured -- barely reach the level of piddling.
But unto themselves, the Democrats have the votes to enact comprehensive reform. And -- what is new -- they finally have a plan on which the president has put his stamp.
The plan that the White House released Monday strongly resembles the compromise proposal that House and Senate Democrats have been negotiating. It is a more politically sustainable synthesis than the Senate's original offering; the Achilles heels and banana peels in the earlier bill have been scrapped. The subsidies that the president's plan offers low- and-middle-income shoppers on the new health insurance exchanges are more generous. It raises the threshold for the excise tax on high-cost insurance policies so that only a relative few policyholders will be nicked. It restores the progressivity of the House bill by extending the Medicare payroll tax to the interest, capital gains and dividend income of the wealthy. Instead of the federal government picking up only Nebraska's new Medicaid expenses -- Ben Nelson's stinkeroo of a deal -- it will now pick up the new Medicaid expenses for all states, easing the plight of America's chronically beleaguered state governments.
The Obama plan also creates a federal authority to regulate the rates that private insurers charge their customers. To hard-right purists, this constitutes government intrusion into the marketplace, but if that's what they believe, they should also demand that the 25 states (a number of them conservative and Southern) that currently vest that authority in their insurance commissioners should forswear this power as well.
So why are some Democrats still hanging back? There's anger in the land, no question, but a recent poll from the Kaiser Family Foundation makes clear that that anger is directed more at congressional dithering than at the actual elements of the Democrats' plan. More than 70 percent of Americans support the establishment of the exchanges, the extension of coverage, and the elimination of lifetime limits on overall coverage and of the "doughnut hole" in Medicare drug coverage. Fifty-eight percent say they'd be angry or disappointed if Congress threw in the towel on health reform.
Still, a number of congressional Democrats -- a small number, but enough to imperil the bill's passage, particularly in the House -- believe that giving up the fight may be politically prudent. They couldn't be more wrong. House Democrats who voted for the bill last year but are now having second thoughts, says California Democrat Henry Waxman, one of the bill's authors and a keen reader of electoral tea leaves for the past 40 years, "are asking for the worst of all possible worlds if they don't vote for it again. The Republicans will attack them for their first vote; some of their Democratic supporters will blame them for their second, if they vote no."
Some House Democrats are also balking at the process required for passing the bill, which is for them to pass the Senate bill and then trust their Democratic Senate colleagues to make the agreed-upon changes in a subsequent reconciliation vote. I bow to no one in my lack of admiration for the Senate -- its abolition as a body would be a boon to humankind -- but for health reform to perish on the altar of bicameral mistrust would compel all future historians of this process to conclude, "These guys were jerks."
Finally, for Democrats who question whether now is the time, I suggest they go back and read Harry Truman's November 1945 message to Congress calling for national health care. "The principal reason why people do not receive the care they need is that they cannot afford to pay for it," Truman said. At the time, the cost of health care accounted for 4 percent of the nation's income.
Truman didn't get his plan enacted, of course; no plan for universal care has been enacted since. The principal reason people don't receive care remains its unaffordability, but the aggregate cost of health care has since risen to 16 percent of the nation's income. Absent a universal plan, it will continue to rise.
Truman sent his message to Congress 65 years ago. The debate over national health care is old enough to collect Social Security. The question for timorous Democrats is: "If not now, when?"