The idea of jamming major legislation through Congress usually crops up whenever there's serious popular desire for change, and equally serious Congressional resistance. In the past, reconciliation has typically only ever made it to the table when one factor of Congress -- at the behest of special interests -- has set themselves squarely in the path of popular legislation, threatening its passage with delays, obfuscation, and parliamentary maneuvers.
This has been true of just about every major fight I can recall, from gun safety measures to mandatory gas mileage requirements. In every case, the public debate had generated majority support, but Congress was blocking it because of special interests groups -- and, every time, the president won a solid victory by overcoming the gridlock.
But, for better or worse, this is not the dynamic in health care today. The litmus test of solid public support remains unmet, making this new strategy a potentially dangerous political Molotov cocktail.
Reconciliation has been used before to pass major legislation. Proponents of this approach are fond of pointing to the passage of welfare reform, COBRA, and Bush's '01 and '03 tax cuts as evidence that the Democrats are fully inside the lines. For the administration, the most crucial difference between those bills and this is not their urgency, partisan nature, or even particularly their impact on the deficit; for Obama and his team, the most critical variant is that those bills were popular with the public. In 1996, 68% of Americans favored welfare reform. In 2000, before Bush's $1.3 trillion tax cut was introduced (by the notably bipartisan duo of Senators Phil Gramm and Zell Miller,) 63% of Americans thought they were paying too much income tax; by the spring of 2001, after a month of legislative wrangling, 56% favored Bush's proposed cuts. In 2003, with the Iraq war railing in the background and a post-9/11 economy flailing at home, 52% supported the second round of cuts. Not a huge margin, perhaps, but still a majority.
A February CNN poll puts voter support for the current bill (or a similar variant thereof) at just 25%. An equal percentage thinks Congress should forget health care reform altogether, while 48% think they should start work on an entirely new bill. Of more concern to any Democrat with an eye on reelection, Independents remain unmoved by the arguments in reform's favor, with only 18% supporting it and 52% calling for an entirely new bill.
I went back to look at some of the big Democratic fights of the past -- Medicare and Civil Rights -- both of which had long, multi-year histories and were eventually fostered amid the kind of bare-knuckle wrangling we're seeing today. The AMA opposed Medicare but a Gallup poll from January of '65 shows it had 63% support when passed. And while most opposed Civil Rights legislation when Kennedy proposed it, polling from the period shows 60% of the public favored the legislation once Johnson got it passed.
In every one of these contentious national debates, public support was solidified as a pre-condition to final passage. There simply is no shortcut or parliamentary maneuver around that process. The public is uncomfortable with the current bill and this is likely to be a Dirty Harry moment for the Republican party as they dare Democrats to "make their day."
It may be that after the bill's passage public anxiety subsides. But history suggests Chief of Staff Rahm Emmanuel had it right calling for more gradual progress. The public's voice has been loud, clear and consistent. They say, fix the economy first. More than half (52%) name jobs or the economy as their top issue in a recent New York Times poll compared to 13% that name health care.
And there is a step-by-step approach that would make sense. Going one round at a time in health care reform, hand in hand with economic recovery, would be a strategic win for the administration. After Massachusetts, it would have made sense to pick out and pass those measures that help control costs and strengthen coverage while building up to the major expansion of coverage as the fiscal situation improved. There are lots of changes that have garnered support through this process. The polls show Americans would embrace a bill banning discrimination based on pre-existing conditions, overwhelmingly support a move to standardized electronic medical records and 66% favor some kind of caps on malpractice awards. Reduce costs, improve the system, and then expand coverage -- that is the way to run this out strategically and bring along full public support.
A lot has happened in the year since health care reform was introduced. Trying to pass it through reconciliation may work to generate a temporary victory, but it seems to dismiss the economic and political events of this year.
someone get this dude some sushi to stuff in his mouth so he'll shut up.
you can change Medicare coverage to encourage out patient care and decrease hospitalization and ER visits and expensive tests by having a copay for Cat Scans of 50.00 and 10.00 for Doctors visits and 100.00 for ER visit ,
We already have a good public option called Medicare , we just need to expand it , we might be able also to dismantle the VA System and put the money in Medicare and cover veterans by Medicare as they are now ,
A better argument, ignoring reconciliation, would be that it should not be passed because it has little support, period.
The best argument would be that it should not be passed because it is simply not a good solution or even any kind of solution to our current collapsing health care system. Rather it will make things worse, and therefore should not be passed.
Private health insurance by for profit companies is simply an idea that has not worked. Given the extreme complexity of the product being offered - how many different treatments are there for all the things that can ail us or happen to us? - the huge costs of certain treatments - and the need for the very large public financial companies which are health insurers to payout huge multi-millions to their top officers as other US financial companies do - PRIVATE HEALTH INSURANCE HAS AND WILL CONTINUE TO FAIL US.
Therefore, let us start over again, expand coverage by expanding Medicare, and tackle only other elements to GET THE UNFAIRNESS OUT of the system. Get rid of the unfairness, and costs will follow.
What do Medicare and Private for profit health care insurance companies have in common.
It is necessary to have personnel and systems that can navigate through DRGs (diagnosis related groups) and CPTs (current procedure terminology), billing codes, etc. Overhead for Medicare is about 2% and private insurance companies have an overhead of 20-25%. The difference between the two is the function in private insurance companies of NOT providing funds for healthcare for the purpose of generating profit for CEOs, top management and stockholders. We can continue to have free enterprise as defined by those who are pimping off of health care professionals or we can have health care in the USA as inexpensively and as good as 36 or so other industrialized nations. BUT WE CANNOT HAVE BOTH WE NEED TO NATIONALIZE THE HEALTHCARE INSURANCE COMPANIES OR MAKE THEM NOT FOR PROFIT”””””””
We can continue pussyfooting around with the private for profit health care insurance companies for the next 100 years and things will be no better.. It is like talking to Osama Bin Laden. They need to be either made to be not for profit or they need to be nationalized and run like Medicare. That might sound like socialized Medicine (which works very well in Scandanavia and on the European continent BTW) What we have here in the USA is more like fascist medicine. From an economics point of view, as far as free enterprise producing a better product, private,for profit health insurance companies are the exception that proves the rule. Health care demand is inelastic. The law of supply and demand does not work its magic. Start with that. From a moral point of view health care insurance companies are pimping off of health care professionals. From an ethical point of view, the insurance lobby and campaign contributions have brought out the worst in our elected officials. In short, private,for profit health insurance companies should not exist for ethical, moral and basic economics reasons
Just as surely as Al Qaeda is a threat to our national security, private for profit health care insurance companies are a threat to health care reform.” .””””””
But I think that you are mischaracterizing the current Health Care reform state that the Democratic Congress and the Administration are in - by stressing some problems to the point of Exploiting them!!
For example, your wording “idea of jamming major legislation through Congress” – and the reference to the “Cnn Poll” In fact, people are in favor of SPECIFICS to change the health care system and you notice that people are dead even, for and against creating a government-administered public health insurance option to compete with private plans
http://www.newsweek.com/media/84/1001_ftop_v2.pdf
I see this Administration trying to invest its Intellectual Capital on Problem Solving, not Solution Making, and that is probably why they are having some divergences with Progessives and the squeaky wheels in the Party.
The ones that want a “Strong Public Option” are looking only at solutions.
And what they are doing is "architecting" solutions in search of a problem.
You are doing the exact opposite, you are architecting more problems, by exploiting them, in search of solutions. Let’s concentrate on problem solving.
"The New England Journal of Medicine" and lectures at Harvard. She is a physician in internal medicine and pathology and knows far more on this subject than most. Watching and reading this discussion confirms to me that Dr. Howard Dean is correct and without the Public Option there isn't real healthcare reform and despite the fact that we need it, THIS BILL IS NOT THE WAY TO GO!
http://www.pbs.org/moyers/journal/03052010/watch3.html
If you really care, watch or read this discussion, you owe it to yourself and everyone you care about. The columnist is right 'The litmus test of solid public support remains unmet, making this new strategy a potentially dangerous political Molotov cocktail.'
http://www.guardian.co.uk/world/2008/apr/07/hillaryclinton.uselections20082
"Penn's lobbying firm, Burson-Marsteller, had a $300,000 contract with Bogota to help win the US Congress' approval of the trade deal. Businesses are eager to lower tariffs on exported goods to Colombia, particularly in the midst of a recession, but working-class voters – the core of the Democratic party – are strongly opposed to the trade deal.
Clinton is promising workers in Pennsylvania, where the next make-or-break primary occurs in two weeks, that she will help them recover from the demoralising job losses wrought by past free trade pacts."
Mark Penn's firm received stimulus money:
http://thehill.com/homenews/administration/71353-mark-penn-got-6-million-from-stimulus
"Federal records show that a contract worth $5.97 million, part of the $787 billion stimulus Congress passed this year, helped preserve three jobs at Burson-Marsteller, the global public-relations and communications firm headed by Penn."
Based on those examples can Mark Penn truly be interested in helping others?
I' waiting.
http://www.pbs.org/moyers/journal/03052010/watch3.html
We need real reform. This bill is no good.
But hey, why would the Dems and BO care about the majority in the US?
Proven systems for Free Public Option care and a 2nd alternative for continuing Private Systems could serve the entire country by year end 2010.
All 300 million people in the US could receive Free Public Option health care, delivered from government VA system styled hospitals, paid for with sales tax revenues instead of insurance premiums, and it would save $1trillion dollars every year from the $2.6trillion spent last year.
Sales tax funded care woud be free to everyone choosing to use the Public Option with no restrictions primary, inpatient, outpatient, long-term, mental, ophthalmology and dentistry including medications.
Americas Veterans Administration is now the largest, lowest cost, best outcome producing at any cost, health care delivery system in the US it uses the world’s best medical software, and it has been controlling the problems with access, cost, quality, and malpractice for years.
Veterans Government Health Care is producing better health outcomes for Vets than civilian patients are receiving anywhere else in the country, at any price, including Mayo, Cleveland Clinic, Medicare, anywhere and VA’s costs are a fraction of private care’s.
Between 1995 and 2004, the cumulative increase in the VA’s cost per enrollee was just 0.8 percent, while Medicare was a whopping 40.4 percent.
The VA’s successes could be used to create a Public Option government health care system that could deliver high quality care at drastically lower costs.
http://www.washingtonmonthly.com/features/2005/0501.longman.html