Prelims Finished, the Big Battle Is Joined

The preliminaries are finally over in the battle to finally, finally, finally -- 97 years after Teddy Roosevelt first proposed it -- pass comprehensive health care reform. I think the right sports analogy to use is the extended, exhausting, NBA playoffs: after 82 regular season games, 16 playoff teams play in a best-of-7 series to get to the second round, and then the remaining eight teams play best-of-seven to get into the conference finals for another exhausting best-of-7 series. I think that's about where we're at, the conference finals, where the coming days will seem like a long tiring 7-game series that is only the preparation for the even more intense final championship round.

I am excited, though, because this is a whole lot further than we got to when I was in the White House health care war room in 1994. We got the bill out of some of the committees, but never out of Senate Finance, and never had a realistic chance to have a floor fight.

So now come the machinations and maneuvering to figure out how to merge the two bills in the Senate and three in the House. The strategy now looks to be to get through on the Senate side with the 60 Democrats and maybe Snowe, but to continue to hold reconciliation (where you only need 51 votes) out as an option if needed once the conference committee comes back.

As I had predicted awhile back, Baucus' initial bill in Senate Finance was an ugly mutt of compromises and decisions, but it got a little better in the committee process, as he gave the progressives on the committee a few solid improvements here and there. Reid will now merge the two bills, and I am convinced that he will work to create a better bill in the process, and then we have the floor fight and finally conference committee. At every stage, I think progressives have the ability, if they stick together and negotiate well, to make progress.

On the highest profile and incredibly important public option issue, I believe we are now well-positioned to have a public option in the final bill. We have come a long way since those summer months where all the conventional wisdom repeatedly said the public option was dead, but I think we are now at a position where the biggest question is more likely to be how good the public option is, not whether we will have one.

There will continue to be conservative Democrats who want to placate insurers and Olympia Snowe by dropping the public option, but I think progressives can stop that from happening. The key, as it has always been from the first day of this fight, is for progressives, especially in the House, to stay together and stay strong in the negotiations. In fact, I will go so far as to say this: progressives should not panic if the Senate bill isn't great on the public option issue, and Democrats in general shouldn't panic if the conference committee is a long drawn-out affair with lots of fussing and fighting. We have come too far not to get a bill, and as long as House progressives stay strong and stay together, that bill will have to include a public option.

The conference finals are about to begin, but I'm not going to tell you to pull up a seat, because we need every progressive to stay in the game (yes, I will torture this metaphor to the end). It is only because of the progressive movement that health care has been on the agenda, and only because of that movement that the debate has not drifted inexorably to the right. We have a shot at passing a strong bill that will actually cover all Americans and create competition and a check on the power of the insurance industry. We have a shot at making history. Let's stay on the court until the victory is won.

Comments

[Solja]

Hi,

After months of delay, the full Senate is about to debate and vote
on landmark health care legislation. But first, Senator Harry Reid and
Democratic leaders have a big decision to make:

Will the Senate consider real health care reform with a public health
insurance option, or a watered-down compromise full of giveaways to Big
Insurance?

I just signed a petition asking Sen. Reid to include a strong public
health insurance option in the Senate's health care bill. Will you join me
at the link below?

http://pol.moveon.org/harryreid/?r_by=17539-10101106-ahdaK0x&rc=comment_mailto

Thanks!

[DONFANUCCI]

The government is a predator not a competitor.....a public option will simply force insurance companies out of business, there is no competition. The CBO has already stated they have no idea if the plan will save americans even a dime....if you want to reform healthcare, start with tort reform...this bill will never pass, but if it does, get ready for 3 month waiting periods as the number of doctors vanish, and costs drive through the roof as private insurance falls victim to big government.....in the end we will get worse health care service with higher prices...buy hey! who cares if you break what most are generally happy with so you can insure a few more illegals.

[Ben6768]

Insurance companies should not even exist in the health care world.
We need health care, not insurance.

Only in the U.S. is a whole population exploited and ripped off. This is not a free market at all - the U.S. has the worst vices of socialism, without any of the benefits.

[JFD8]

Healthcare debating has shifted,
Veils of agreement are lifted;
The sides are now rigid,
The atmosphere's frigid
Judged by the way Snowe has drifted.

News Short n' Sweet by JFD8
http://twitter.com/JFD8

[Ben6768]

Well said, Mike - lets keep up the fight. Sorry to sound like a scratched record, but here are some numbers that hopefully will make the case for a very strong public option.

I live in a southern European country and I am self-employed. My monthly fee for unlimited public health care, excluding dental, is about 260 dollars a month. My mother used to have two employees in her house, and the monthly fee we had to pay for unlimited health care, excluding dental, was about 185 dollars each.

As for medications, we all have a health card that when presented at the pharmacy, will access a computerised database. My medicines cost a very small nominal amount. I have lived in the U.S.,and upon returning to Europe, found out that the same medicine wich is sold in my European country as a generic, was costing in the U.S. 10 TIMES MORE !!!! yes, 10 times more !!!

As a result of the strong universal public system, the optional private health insurance here is very reasonably priced, as it should be, as a result of the workings of a free market with laws of supply and demand.

I find it astonishing that in the U.S. there is not an armed revolution demanding a strong public option.

The strong public option is not about ideology, it is just common sense and a manifestation of a minimum of love for our fellow human beings.

[PlaceboStudman]

I know this sounds flippant and sarcastic and snarky, but I really am curious about how people are going to react when death and suffering statistics don't change, only the income numbers of those who are suffering and die increase

Because that is the end result of insurance reform, that everyone is calling Health Care, but really has nothing to do with Health Care

[Biffmeister]

Strong public option or no go.

[RichieB]

Mike, I hope you are right about your assessment. At least you have made me feel a little better about the process. There has to be a robust public option to get true HC reform. I'll try to hold off on my criticism of Harry Reid and give him a chance to work this out.

[Carl Caroli]

A bill without a strong public option is a backslapping, we passed something, BS bill. Now is not the time for compromise. The insurance companies are applying great pressure and with or without Snowe, Collins and the republicrat bluedogs, it's time for the progressives to say enough! Every ground breaking piece of legislation in the past 200 years has been opposed by the status quo and we need to put an end to their tactics of protecting those with the power and money over the interests of the majority of the people.

[RichieB]

Agreed. That's it pure and simple.

[wyot]

Mike, you have helped me keep my sanity during this process with your positive yet realistic outlook and your personal experiences with history. This article continues that work. Thank you.

And @DA12 - agreed.

[basementfrog]

Yesterday (10/13/2009)my mother received a letter from General Motors. GM sent out a letter to retired/former employees and announced they will no longer provide medical coverage to people who worked over 20 years of their lives at GM.

My mother and her husband no longer have insurance.

My mother and her husband are extremely worried. He put in 38 years at GM and now sees a major part of his retirement package gone. My brother-in-law faces the same fate, and retired from the same factory.

My mother has had 3 cancer operations (lost both breasts) and 2 major strokes; he just had a rectal cancer operation a few months ago; the brother-in-law had a major heart attack on the shop floor 3 years ago and my sister has had 5 hip operations over the coarse of her life.

Where are these people going to get health insurance?

Mom is in a panic. Just one medication they bought yesterday and had to pay out of pocket cost $155 for a month supply (they each take about 10 pills a day). He came home and told her they need to speak to the doctor about all the meds they need and how to reduce the cost.

These are hardworking Americans who spent their lives working for a company they trusted and saving to enjoy retirement in their paid for home. They are freaking out.

[pearlx2]

I'm so sorry this is happening to your family, and to millions of families around the country. Continue to hold out hope that something will change soon to make a positive difference in their situations. I heard on MSNBC yesterday that one possibility might be that once the health reform bill is passed later this year, a certain number of people might be made eligible for Medicare right away, even though they're not yet 65. I think it was Howard Dean proposing this, as a means of getting help to some people immediately, rather than having everybody wait til 2013 for the reform to take place.

So, we should all keep praying. There are some options out there; things might turn around sooner than the media allows us to think.

[JohnTy]

This more than anything I have read anywhere has brought home to me the dire state of health care in the US. The US system was just about defensible in an era of full employment when wages were high and trade unions were able to negotiate working conditions which were the envy of the world - but that has not been the case for about forty years. In Europe we have problems enough, but we would not treat our citizens like this.

[DA12]

If the merged bill does not have a public option, it will be 100% Harry Reid's doing and will be the end of his political career.

[Solja]

You can't blame the entire bill on Reid. If anybody, the blame is solely Baucus'.