Health Care Without Republicans

Ken AshfordHealth CareLeave a Comment

It's becoming clear that trying to work out health care reform in a bi-partisan fashion ain't gonna happen.

The "public option" itself was a compromise.  Obama and most left-leaning people would prefer a "single payer" universal health care system like most advanced nations.  The single payer system would, effectively, do away with insurance companies and treat health care like we do our military – a single government program, rather than competing corporate programs.  Medicare is essentially a "single payer" health care system — except it is not available to everybody.

But "single payer" was clearly not going to pass muster with conservatives, so it was taken off the table right from the start.  So the "public option" became the administration's position.  The "public option" is analagous to the university education system — you have a public university run by the state (e.g., UNC) competing with private universities (e.g., Duke).  Just as people get to choose their own university, the "public option" provides a low-cost alternative (because, unlike the insurance companies, it is not trying to make a profit… and because, being the government, it can negotiate good deals — like cheaper drugs — from pharmaceuticals).

But no, Republicans didn't like the "public option" either.  Even THAT was too socialist.

And this past weekend, the Obama Administration floated the possibility of co-ops, which is where, instead of the "public option", you have a bunch of not-for-profit insurance companies (the "co-ops") compete with the for-profit mega-insurance companies, again to ostensibly keep down the price of health care.

But no, even that was met with GOP opposition.

So finally finally finally, the Obama Administration is realizing what some of us have already figured out: despite thei lip service to the need for health care, the Republican Party is in the pockets of the insurance companies and it doesn't want to see any kind of health care reform at all.

So why try to work with them?

Fortunately, the Democrats have a new plan.  Split the bill.

The White House and Senate Democratic leaders, seeing little chance of bipartisan support for their health-care overhaul, are considering a strategy shift that would break the legislation into two parts and pass the most expensive provisions solely with Democratic votes.

The idea is the latest effort by Democrats to escape the morass caused by delays in Congress, as well as voter discontent crystallized in angry town-hall meetings. Polls suggest the overhaul plans are losing public support, giving Republicans less incentive to go along.

Jonathan Cohn fleshed this out in more detail.

[The first bill] would include changes to Medicare and Medicaid, new taxes on individuals or employers, subsidies for people buying insurance, and (maybe) even a public plan. Because all of these affect federal outlays, positively or negatively, this bill could go through the reconciliation process, passing with just 50 votes.

The second bill would include the other elements — the insurance regulations, the requirement that everybody get coverage, and so on. These are the pieces of reform the parliamentarian likely wouldn't allow to go through reconciliation. As a result, it would still need 60 votes. But that's not so farfetched, since these happen to be the parts of reform on which there is the most wide-ranging consensus. Plenty of Republicans support these ideas, at least in principle.

All of this is theoretical, of course. Republicans might not support that second bill if it meant handing the Democrats a victory. At the very least, they'd fight Democrats on the details. Nor is it clear Democrats themselves have enough unity to get fifty votes for the controversial elements of reform. And all of that is assuming the parliamentarian lets those controversial elements go through reconciliation in the first place That's hardly a sure thing; it will really come down to his interpretation of the rules. But even the theoretical possibility of Democrats passing reform on their own would change the dynamics in Congress, by giving Republicans new incentives to negotiate in good faith — and giving Democrats a way to enact legislation in case the GOP remains as obstructionist as it is now.

Sounds like a plan.

I guess the main point is that Democrats aren't waiving the white flag yet.  And that's something to be thankful for.