Pearlstein: Congress's antics are holding up health-care reform

Steven Pearlstein
Washington Post Columnist
Wednesday, November 11, 2009; 11:00 AM

Washington Post business columnist Steven Pearlstein was online Wednesday, November 11 at 11:00 a.m. ET to discuss Congress's handling of the health-care reform bill.

Pearlstein won a Pulitzer Prize in 2008 and is co-moderator of the On Leadership discussion site.

Read today's column: Want real reform? Let's start with Congress..

A transcript follows.


Dallas, Tex.: I am unclear about the public option. Will it be one plan for all states? Or will each state have its own management? It seems that Republicans are on to something with the inter-state insurance, if the federal option is ubiquitous and the private insurance is not, what would be the impact? Do I have it wrong?

Steven Pearlstein: Well, you've got it half right, anyway.

Yes, if it is included, the public option would be a national plan. But there could, and probably would, also be competing national plans sold through the same exchanges that offer the public plan. The Senate bill is much more oriented toward maintaining the current setup of state regulation, the House less so, and the White House is pushing in the direction of a national exchange mechanism so that the market is nationalized to the greatest degree possible. That creates the most competition and generates the most efficiencies. The irony, of course, is that this is what Republicans (and the health insurance industry) have long been pushing for, only they can't seem to admit it in public now that it has been incorporated into the Democratic plan.


Ashland, Mo.: One premise for requiring everyone to have insurance is that it avoids freeloaders; yes, younger people pay more now, but they will need health care later and will "get it back." Is there any evidence that the amount they will be asked to pay bears any relationship to the amount they will eventually need? And couldn't it be that the premiums will actually exceed what they will need since a small number of people have extraordinary expenses? Essentially you are saying you have a right to compel me to be a good Samaritan. Isn't that a more honest assertion that saying I will get back in care what I pay in premiums?

Steven Pearlstein: I've written quite a bit about this. What you are talking about is the nature of insurance, in which most of the premium money goes to a relatively small number of policy holders who are unlucky enough to get in a serious car accident, or have their house burn down, or get cancer. If you don't like the economics of that -- the fact that you might pay in more over a lifetime than someone who is unlucky--then you don't like the idea of insurance, and might want to "self-insure" by putting aside your own money in an account to handle your own rainy day.

The problem with health insurance, however, is that if you get real sick and don't have enough put away, then the rest of us wind up paying for some of that through "free" hospital care. That's the result of a societal decision not to let people die on the street. So the fix for that is to require everyone to have at least a high-deductible policy, including the young and invicibles who now go without insurance until their motorcycle hits a brick wall. I'm not sure whether, over a lifetime, someone with a high deductible policy who never gets really sick would come out even but I doubt it. The reality in medical care is that a relatively small percent of "incidents" represent a very large percent of the spending.


Laurel, Md.: The Congressional realities you explained today, I think, are a big part of the reason the tone of the health-care debate has appeared so extremist. Because of all the machinations available to stop a bill from being passed, it's nearly impossible to repeal any large program once any significant part of society has gotten used to it. One conservative columnist (not at the Post) likened the health care debate to Batman fighting the Joker. Batman can win week after week and the Joker will be back for next episode; but if the Joker wins once, it's game over permanently.

I think most Americans realize that federal spending needs to be cut. But as long as there's a political consensus that it's someone else's money that needs cutting, Congress has too many procedures to prevent it. Other than military reductions when hot and cold wars ended, I think Reagan is the only president in living memory who ever made any significant cuts in the federal budget.

Steven Pearlstein: Thanks.


Alexandria, Va.: I read with great interest your article regarding the Rules of Procedure of the Senate, and the use of the filibuster in particular.

I have worked for a US Senator for more than 20 years. During that time, the majority has shifted from the Democrats to the Republicans and back again. I have marveled at the wisdom of the Founding Fathers to establish a bicameral legislative branch of government.

You are correct -- the Senate is designed to protect the rights of the minority. That is an essential component to the framework of our Constitution and it must not be abandoned.

The filibuster has gone from a rarely-used procedure to a common occurrence. This calls for reform, not repeal.

My suggestion is similar to yours, but would be considered anathema by Senators. The Senate Rules of Procedure should preclude the use of the filibuster on a Motion to Proceed, or to bring a bill before the Senate for unlimited debate. This would also require elimination of the parliamentary tactic of "filling the amendment tree," thereby blocking additional amendments to be offered. This would ensure all ideas could be offered, debated, and voted upon.

Only after a full and fair debate and amendment process should the filibuster be permitted, and then only to end debate. Doing so would ensure that legislation is, at a minimum, considered by the full Senate. It could have the effect of forcing compromise during the amendment process to achieve consensus.

And, most importantly, these changes would retain the extremely important principle of protecting the rights of the minority to block a bill if a 60-vote majority is not achieved.

Steven Pearlstein: Yes, we do agree. when no other business is on the floor, a motion to proceed to an item on the Senate calendar should be considered a non-debatable motion. If someone wants to filibuster, let them filabuster the entire bill.


Branson, Mo.: Do you not harbor even an iota of concern that passing a trillion dollar optional health-care plan during the worst recession since the Depression is maybe just even a tiny bit risky? I am astonished that the whole year has been wasted debating health-care legislation ignoring the reality of our failing economy. I just find it astonishing that some believe the argument that the health care plan will save money. Never before has a government program not exceeded its budgeted allowance. Why should this one be different?

Steven Pearlstein: First of all, the most recent addition to Medicare, the prescription drug benefit, has come in below its projected cost. So it does sometime happen.

Second, why do you insist on focusing on the things about the bill that add to cost without subtracting the things that reduce the government's costs going forward? That's where you get your trillion dollar figure, which by the year is a 10-year figure. Why 10 years? Why not pick 20 years and call it $3 trillion? Or 50 years and call it $200 trillion? Why not use the scariest possible number to get us not to take risks, which of course is what any fundamental reform of the health-care system would be. Why take the risk of sending troops to Afghanistan? Or putting in Social Security in the middle of the Great Depression? Or fighting a war to end slavery?

This is as good a time to do this as any time. It will take years to get it up and running and, in the meantime, giving businesses some hope of controlling the growth in health expenditures would be a good sign for investment in the United States. Ditto the impact on federal interest rates if investors know that there will be a serious effort to bend the cost growth curve. Yes, by all means, insist on provisions in the bill that accomplish those savings. But you're ignoring them tells me you are taking a hard ideological position that would not really change if the economy was roaring ahead and the federal government were runnning a surplus. Am I wrong about that?


Boston: Fellow Trinity Bantam (poli sci) guy here. So, in your view, is health-care reform doomed in the Senate or just likely to be tragically flawed?

Steven Pearlstein: No, my view is that it can be done in the Senate and that an extended open debate on the bill and a reasonable number of well-meaning amendments will make the bill better.

But I'm not sure what Professor Clyde McKee would agree with me.


Great Falls, Va.: Added bonus to the Pearlstein floor-debate plan: it would increase the chances that our elected officials have actually read the bill before they vote on it.

It was disgraceful (though surely not uncommon) that the thousand page cap-and-trade bill was brought for a vote just hours after its inception.

Steven Pearlstein: You know, that's a good point and a not so good point. It would be helpful if they read a section-by-section description of the bill. But the actual bill language can sometimes be impenetrable, particularly if it is changing or repealing something in existing law. The Senate Finance Committee puts out good English language versions of bills, which solves this problem.


Cherry Hill, N.J.: I agree 100% with your article. One thing that was not mentioned, but I think is a huge factor is the influence of special interests. Not only lobbyists and corporations, but well-funded organizations like on the left and Citizens for Growth, and the other Tea Party sponsors on the right.

Steven Pearlstein: Some special interests, like the commercial ones, prefer that things be done in back rooms. Others, like Moveon and Tea Party, actually prefer things are done out in the open because they think they can mobilize the grass roots to their cause.


Tampa, Fla.: Yes, the Senate could call the obstructionists' bluff and bring in the sleeping cots onto the Senate floor, just like when the Southerners were trying to filibuster the civil rights laws. Or the Dems could use the reconciliation process to get to an up-or-down vote.

But the House blew it. The House leadership knew this was coming. They've seen this all too often. The House should have held hostage the annual farm welfare, I mean agricultural appropriations, bill as the last bill the send over to the Senate, after heath-care reform was done.

Had Pelosi had the guts to hold the farm welfare, there I go again, I mean agriculture appropriations, bill hostage, she could have threatened farm-state Senators like Bill Nelson of Nebraska with having to allow an up-or-down vote accept a real public option for health insurance as the price for a vote on the public option for crop insurance.

Pelosi would not have had the threaten the Senate to pass a bill, just allow an up-or-down vote.

The House also could have gotten the attention of every Gulf state Senator by holding hostage the renewal of the public option flood insurance program. No vote on public option health insurance, no vote on public option flood insurance.

I guarantee you that both Senators from Florida would cave on this. Private flood insurance simply is not available in Florida. The Florida real estate industry cannot exist without public option flood insurance.

Which brings up a question: How many members who oppose a public option health insurance plan also oppose public crop insurance, public flood insurance, and public export insurance?

Steven Pearlstein: I think you want to be careful not to set up a situation where every bill is dependent, politically, on every other bill, or you'll get nothing.

Look, if members don't like something about a bill, let them propose an amendment and see if they can get a majority to change it. If not, then tough -- welcome to democracy. Kow towing to every member who claims to have a swing vote through backroom deals is not the best way to divine the public will.


Rome, Italy: Bravo, Mr. Pearlstein, on today's article. You wrote what I have been thinking on and off for the past year. Since when did 60% rather than 50% + 1 become the new normal in the Senate? And if it is, let them work for it by holding a real filibuster; talking til their hoarse, sleeping on cots, etc.

How likely are things to change within the near future do you think?

Steven Pearlstein: Don't know. Harry Reid has not been particularly impressive on this front up to now.


Princeton, N.J.: You know, this business about "competing across state lines" is yet another example of Republicans calling black white, and the media letting them get away with it.

Right now any insurance company can compete in any state it wants to. And they do. The big companies offer polices in many states. What the Republicans really want to do is take away from states the ability to regulate polices sold in that state. Then we will have a credit card situation where all the insurance companies will go to a small state whose legislature is cheap to buy.

Right now we have 700,000 bankruptcies each year with a medical component. 70% of these had bad policies. If this passes, we will get a lot more.

And the Republicans say they are for states' rights. Ha!

Steven Pearlstein: Thanks, Len.


Ashburn, Va.: Great article, Steven. You nailed it. My question to you is, why aren't the Democrats yanking the Homeland Security Chair from Joe The Closet Republican?

Steven Pearlstein: I think Lieberman understand that if he's the vote that kills health reform, he loses his chairmanship. There are a lot of things that can happen between now and then, so let's not jump the gun on that.


Reston, Va.: Comment on your article.... yes, you nailed it!

Steven Pearlstein: Thanks.


Arlington, Va.: The dysfunction is due to money in politics and corruption. The rules are the rules in terms of parliamentary procedure and votes etc. Has anyone noticed what it took to buy some of the last crucial votes in the House?

By the time something is debated on the floor the votes are counted already anyway. And does calling your representative matter? Some of the Dems know this bill is unpopular but are willing to sacrifice themselves to increase dependence on government in the future.

Anyway, the more dysfunction the better with this health-care bill. The country can't afford it. Nobody is talking about how much the bill(s) will cost after the first 10 years.

Steven Pearlstein: Actually, members are very responsive to input from constituents if they feel it is well-informed and genuinely felt. You underestimate their deep-seeded desire to please all the people all the time and win the next election.


Laurel, Md.: Nancy Pelosi reacted incredulously when a reporter from a conservative publication asked where the Constitution allows the federal government to require everyone be covered. (The auto insurance analogy is false: everyone has the option not to drive.)

But, everyone is guaranteed some minimal level of care through the mandated emergency room requirement. Since everyone is protected from bleeding to death on the street or giving birth under unsafe conditions, isn't there a basis for requiring that everyone bear SOME cost?

Steven Pearlstein: Where it is in the Constitution is in the power of Congress to impose taxes and their first cousin, fees. The way the thing is structured is that anyone who doesn't have a minimal health insurance plan is subject to a tax. That would be Article One of the U.S. Constitution. Look it up.


D.C.: I'm glad you wrote about the problems in the Senate, and I hope you do it again. I see two main obstacles preventing reform in the Senate.

One is lack of internal motivation. You're asking Senators, especially the minority party and Snowe-Lieberman types, to give up some of their individual power, and for what? To help advance the Democrats' agenda, which most of them disagree with?

The second is lack of external pressure. I'd say 90% of Americans, even the politically aware types, don't realize how dysfunctional the Senate has become, nor have thought much about how to reform it. No one in public office raises the issue. Almost no pundits do either. And while I appreciate the column you wrote, what you propose is only a quarter- step for what needs to be done.

Let me toss this out for thought. The founding fathers didn't intend for us to treat the Constitution as the Bible, a document never to be changed. The country today is totally different from when it was founded, but we haven't updated our institutions to reflect this.

Today, California has roughly 70x the population of Wyoming. If New York had 70x the population of Georgia in 1787, do you think the founders would have still given every state two Senators?

One idea is to give 3 Senators to the top 25% populated states, leave the middle 50% alone, and give 1 Senator to the bottom 25%. It would make the Senate more representative of the people while still giving small states more power than they have in the House.

The idea of changing the Constitution or the way things work makes people uncomfortable. I understand that. But I think we at least need to raise the issue if we ever want true reform to come.

Steven Pearlstein: The Founding Fathers, I think, had no idea of how disproportionate the Senate representation would be. You've got a situation now where Republicans who represent about a third of the voting population (I think I have that right) can now block the votes of Democratic senators representing two-thirds. That's more than a little tilt. That's a wholesale power grab that mocks the principles of democracy and majority rule.

That said, it would be a lot easier to try to change the rules, written and informal, in the Senate, rather than change the constitution, and that could solve a lot of this problem.


The Constitution: The Constitution requires the government to provide for the general welfare (Section 8). If health care is not the general welfare, what is?

Steven Pearlstein: Thank you, Mr. Madison.


Boston: I enjoyed your column today, but isn't the main problem simply that our Congress critters aren't really bright/knowledgeable enough to have a well-reasoned debate about all the issues that they would need to know about? I am not impressed with the Senate, but the House absolutely horrifies me - even during committee hearings where one would assume the members would be brushed up on the issues.

Steven Pearlstein: Yeah, you don't want to spend too much time listening to the debate or you can get very depressed. But, hey, it is a representative democracy.


Chicago: What method of financing the bill do you think will prevail, the House's or the Senate's? Don't they use a value added tax in most of Europe?

Steven Pearlstein: That's an easy one. The Senate version.


Boston: Great column today Steve, reminds me of the disaster California created for itself when it decided on "Minority Rules."

Anyways, I want to focus on a point you made, the complacency of insiders. Here on these chats, Post Congressional reporters regularly bemoan and demean commenters who are upset at the prevalence of the "60 Vote" Senate, the faux Filibuster, and the use of "Secret Holds." When the folks covering the Congress for the capitol's newspaper are active supporters of the status quo and all the things that makes politics so distasteful for 75 percent of the public, what hope is there for real change in Congressional rules?

Steven Pearlstein: It is a fair point, and that is why I used the word "insiders" in the column, to take in not only the members but the press that covers them. The problem is that when you spend so much time watching something close up, you lose perspective on how crazy it is. Even if you know its crazy, and maybe have written how crazy it is, you can't keep writing the same thing every day. And after a while, everyone takes it for granted that its okay that 60 is the new majority threshhold.


Concord, N.H.: Why do the Senate Democrats still maintain the farce that Joe Lieberman is a Democrat? I don't get the quid pro quo. Lieberman gets his committees and the Democratic caucus gets spit in the face. The illusion of 60 actually hurts them by raising expectations and taking away the oppositional scapegoat.

Steven Pearlstein: As I say, I don't think he'll be able to spit in their faces much longer. That said, the fact that he is working hard on global warming is worth noting.


Washington, D.C.: Great article today, Mr. Pearlstein. I loved your suggestion.

However, do you have any even miniscule hope, that the Senate would actually get up there a really debate the bill piece by piece? I believe they are too risk-averse, and too dependent on lobbyists to walk them through legislation to attempt the process you suggest because it would expose their shortcomings.

Was your suggestion more rhetorical in nature, or do you really think it would work?

Steven Pearlstein: Its not a question of the lobbyists. It is a question of the ideological zealots that control the Republican Party and members of the Senate itself who don't want to give up their ability to block other things that they care about. The Senate at its worst is a mutual political protection society, to the detriment of the public interest.


Anonymous: Congratulations on a column that most would not dare to write, much less publish. I was on the Hill, Senate-side, as a committee staffer for 14 years (1975 - 1989), when there indeed was civility and cooperation between the majority and minority. What I see and read today about the Senate makes me cringe and want to cry! Thank you for writing what we all should come to appreciate--no matter how painful.

Steven Pearlstein: I guess we former Senate staffers all have the same reaction -- disappointment and anger at what has happened to an institution we came to love, admire and respect. It is nobody's fault but their own, the members, but they just can't help themselves. They are caught in a trap of their own making that they believe, incorrectly, they can't get out of without caving in to the "other side." In game theory terms, they've played repeated rounds and have now settled into a stalemate that is suboptimal for everyone.


Boston: Just as an interesting factoid - Thomas Jefferson thought the Constitution should simply expire every 20 years or so and a new one written.

However, people he discussed the idea with who were actually present at the writing of the Constitution (Jefferson was in France) told him it was a miracle it got written once - they wouldn't put any bets on ever getting it done again, much less every 20 generation.

Steven Pearlstein: I think Jefferson's friends were right. I'd cringe at what a constitutional convention would be like today.


Arlington, Va.: I don't understand this desire to pass legislation that would put the country in some dire fiscal situation.

It does not cost $1 trillion to insure 5 million uninsured. There is no 40 million uninsured. 10 million or so are not legal residents. Others just haven't signed up or don't want it. Let's just expand Medicaid to insure 5 million and call it a day.

You cannot tax the rich to pay for the poor's health care. People are against income redistribution. The House wants to tax dividends at 45%. Where does it end? If I wanted to pay 50% federal taxes for someone else's health care, I'd be living in Europe.

Does anyone see the voting block that is created when 50% of the population doesn't pay taxes and gets health care at a highly subsidized rate? Can people see where this is going? Seems unfair to me.

Steven Pearlstein: I suppose that depends on what side of the 50 percent line you're on. It's also true that pre-tax income is being distributed more and more unequally by the free markets. Where is it written that markets are always right and any effort by society to restribute the bounty is always wrong?


Sterling, Va.: Just to be clear from your article, you're not advocating for the removal of the filibuster, which both the GOP and Democrats have thought about (until they realize someday they'll be the minority and be hoisted on their own petard). You're advocating for a return to the true filibuster, the "stand and talk until you can't, then vote to end debate" type, rather than where you seem to need 60 votes to pass anything anymore. Correct?

Steven Pearlstein: Exactly. That's not to say the Senate should do away with cloture. But if there aren't 60 votes now for cloture, then let the games begin. Eventually someone will blink.


Woodbridge, Va.: As you probably know, your proposal to have a "real" filibuster is not new. Many conservatives wanted Senator Frist to do just exactly that on a number of issues. The old guard in the Senate (on both sides) continually oppose the idea as ineffective. From a procedural standpoint, they are correct. You need to be a real Senate rules wonk to understand why; but suffice it to say that an organized filibuster with the support of 40 members could take up to 3 months to break procedurally and NO other Senate business could be conducted in the interim. Nevertheless, I think the media optics would work against the minority much more rapidly. Frank Capra and Jimmy Stewart not withstanding, a parade of Senators droning on for days and weeks in a delaying effort would quickly become a CSPAN/YouTube joke. The participants would go from being percieved as a curiosity to maybe courageous to "Ok point made - time to move on" to "are they still at it" to "shut up already" in about a 3-5 week time span. This may be a lot of time to carve out of the Senate schedule but it could be worth it for the right issue, and it is highly unlikely the Senate would have to go through the excercise twice.

Meanwhile, over in the House - what would you think of a committee of 15 evenly divided former members serving staggered non-renewable 8 year terms to set and enforce House rules and ethics including floor decorum, debate times and amendments made in order? To limit partisanship it might even be a good idea for each party to choose the opposite party's members of the committee from a list approved by both.

Steven Pearlstein: You have it exactly right on the theater and political dynamics. I didn't have space to say what you did, but you took the words right out of my typewriter. The public wouldn't stand, in the end, for obstructionists who blocked the government from operating and won't let the majority rule. People's sense of fairness wouldn't allow it.

As for how the Rules Committee might be changed over in the house, that's a harder question. There ought to be a higher bar for a closed rule to be adopted, but if there were simply more comity between the parties, you could still have the efficiency that goes with the House procedure without shutting out votes on key issues. The problem now is that the leadership likes the current setup because it gives the leaders more power. So it is up to the members to take some of it back.


50% of the population doesn't pay taxes : This is a lie. It only looks at income tax. Actually if you count all taxes, the bottom quintile pays a higher rate than the top quintile.

Steven Pearlstein: Yes, the payroll taxes.


Steven Pearlstein: That's it for today folks. Good discussion. "See" you next week.


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